Early Amplification for Children : Implementing Change

comments as an endnote to this impressive conference on early amplification for infants and young children. Throughout this meeting, I found myself looking back to an earlier time—to a time when I first entered the profession of audiology as a young graduate student at Vanderbilt University. The year was 1962. From this perspective, the past two and a half days have served as a stunning reminder of the monumental progress we have made in pediatric audiology, especially in the area of early amplification for young children.When I entered graduate school at Vanderbilt University, there were less than 300 certified audiologists in the United States, and the vast majority of these audiologists were employed by VA hospitals and universities. Ken Johnson, an audiologist, had recently been named the first executive director of the American Speech and Hearing Association (ASHA), and the ASHA headquarters had just moved from Detroit to Washington, D.C. (Harford 1993). The giants of pediatric audiology were Sir Alexander and Lady Irene Ewing, Ruth Bender, Marion Downs, William Hardy, Freeman McConnell, Richard Silverman, and Eric Wedenburg. These were men and women of great vision who led pediatric audiology with passion, integrity, and a professional commitment to improve the life quality of young children with hearing impairment. These were men and women who helped to transform our profession—they were change agents, difference makers. For example, thanks to the Ewings, the concepts of early identification, parent management, and early amplification became accepted strategies in the United States for managing young children with hearing impairment. It was reasoned by the Ewings that early amplification allowed an infant to maximize the use of auditory data to trigger an innate propensity for language learning. The goal was to capitalize on that period when speech and language naturally develop. Parent-infant training programs, which emphasized early identification, early amplification, and parental involvement, were developed in numerous cities throughout the United States. The average age of identification for hearing impairment in children was 3 to 4 years, and often there were significant delays following identification before the hearing aid fitting was completed. The hearing aids at that time were very large, unattractive, provided a limited bandwidth, an irregular response, and produced high levels of harmonic distortion (Killion 1997; Ross 1996). Receiver buttons were used to modify the response. Mark Ross reminds us that hearing aids during this period were designed for adults, not for children, and although the hearing aids may have been adequate to provide amplification to an adult with known language, it did not mean that they were capable of providing appropriate amplification for a child with severe-to-profound congenital hearing loss (Ross 1996). The upper end of the bandwidth was only about 3 kHz and of course we know that considerable linguistic information is carried by acoustic energy above this point. Because the hearing aids were so large, Y-cords were often used to provide binaural amplification. In those instances where two body aids were recommended, the instruments were placed high up on the shoulder area in an attempt to place the microphones as close to each ear as possible. Predictably, the fitting of a hearing aid was much different from today’s recommended fitting process. Because it was difficult for us to obtain precise thresholds, the hearing aid fitting was an ongoing process that sometimes took as long as six months to one year to finalize—thus the reason for delays in providing amplification to a child following confirmation of hearing loss. Throughout the fitting process, a Y-cord was often used