Jodi H 2

Jodi Haberstock, a doctor of audiology, discusses the current state of audiology services in Saskatchewan. Since the closure of the public hearing aid plan in 2017, parents must now seek private audiology clinics for their children's hearing tests, which can come with a fee. Hearing aids are also not covered for children unless they are covered through non-insured health benefits or other specific programs. This lack of coverage creates barriers for families. Haberstock emphasizes the importance of early identification and intervention for children with hearing loss, as it can greatly impact their academic, speech, language, and social development. She also discusses the need for universal hearing screenings in schools and the use of objective testing methods like OAEs and tympanometry. Overall, Haberstock highlights the challenges and shortcomings of the current audiology services in Saskatchewan. Hello and welcome to Let's Talk Talking. I'm Cheryl and I'm Sherry and we're here today with our very first guest and we're so excited. We have Jodi Haberstock who has her doctorate in audiology and she runs her own clinic here in Prince Albert called Carleton Trail. Carleton Trail Hearing Clinic and it's wonderful and I've had the opportunity to work with Jodi over the years and so we're so excited that she can be our first guest. So Jodi, I'm wondering what got you interested in audiology in the first place. I understand that one of the reasons might have been because you had a family member who suffered a hearing loss as an adult. I saw her struggle where we would go and visit with her and she wasn't able to communicate and I just saw her become more and more isolated. And then when I was in high school, she got a cochlear implant and all of a sudden she went from being really isolated and not really contributing to the conversation to being part of the conversation traveling, becoming really active again and it just changed her and I was like wow that's amazing. So I decided that I wanted to go into audiology and I went and had my, I thought, debated a little bit about becoming a speech-language pathologist but then I got down and I started doing it and I just I just fell in love with audiology. And then I started out doing with working with cochlear implants and I loved it but I kind of felt that that wasn't my passion and so then I ended up kind of moving towards private practice. Awesome. Yeah. And when Cheryl and I were thinking of who to have for a guest and again it came up right away because we both have had opportunities to interact with you and work with you. And so hearing is such a sister profession and you know when we talk about communication skills we know that hearing is just a foundational skill. Without hearing there's drastic consequences for communicating. So we wanted you to give us some insights into what was happening in audiology. Both Cheryl and I worked in the school system but we're out long enough and there's been a lot of changes in the services within the province. And we were kind of flabbergasted that after this length of time that we honestly didn't know anymore what was happening with hearing services. And so we thought you would be the best person to enlighten us. Okay well I'll do my best. So after the closure of the hearing aid plan across the province and that was in 2017. I think some of them closed a little bit sooner than that but 2017 was the final. And for those of listeners it was a public system and funded publicly up until 2017 when the government made a drastic unbeknownst change to us all. Yes I actually worked for the hearing aid plan in Saskatoon for years and so they closed the program. And so now if you want services for your child if you want to have your child's hearing tested you can still go to either Saskatoon or Regina for services for some services. However my understanding and I checked today is that the waitlist is for some services through the health authority it's close to a year for a waitlist. So if you're not able to go to the health authority then you can go to a private practice audiology clinic that sees children. Now not every clinic private practice clinic will go and see children. Some just deal with adults some deal with children four and up some deal with children seven and up. So you know you definitely when you if you want to have your child tested you definitely want to ask a few questions when you call. There are some clinics like myself and several other ones in the province that will actually see newborns and up too. So you just have to ask but there is there is a fee for the service so it is not is not covered to have your child's hearing tested if you go to a private clinic. Which can put up a lot of barriers. Massive barriers. We'll talk about that too. And then once they get their hearing tested is there a cost if they need a hearing aid or or how does that work? Yeah so unless the child is covered through non-insured health benefits or covered through a treaty number or if they're covered through supplemental health they're covered for the cost of their hearing aids. Otherwise there is a cost which again is a massive barrier for for parents because hearing aids are expensive and hearing aids also last about an average of five years. So that's a big commitment for a family to have to cover the cost of those hearing aids. Other provinces have coverage for Alberta, Manitoba, that I know for sure BC up to a certain age also has coverage. So it's really disappointing that Saskatchewan doesn't have coverage for children for hearing aids. And my thoughts on that is I don't think again the leadership in Saskatchewan necessarily knows how much of a barrier this is to children who are really having academic communication and social struggles because of hearing loss and the impact of it. Yes and you know we know that if we identify a child and fit them with appropriate technology so with their hearing aid, cochlear implant, bone anchor device before the age of six months we know that that child can reach the same developmental milestones as a child that doesn't have hearing loss. So if we don't catch these kids and we don't get them appropriately amplified then what or services in place and just the identification then we're going to see that trickle down into all kinds of things. They're academic, speech, language, social development, you know it all carries from that. So it's really important that we get these kids identified and fit. It's really sad when we have a family that a child is identified as having a hearing loss but they can't afford the cost of hearing aids. Now there are some excellent organizations like the Elks and Tell a Miracle that have stepped up to try to help but you know sometimes working families don't always qualify for that funding and therefore it becomes a huge burden on them to try to come up with a cost. My first round when I googled and tried to get onto the internet and get onto the Saskatchewan network or whatever to see if through education or health or whatever what hearing services there were, it wasn't an easy find. Is there a go-to spot where parents could find out where to get an assessment for their child? So the CSASC organization has a private practice membership and they will they have it separated into speech-language pathologists and audiologists and audiologists will have listed in there if they see children and the ages that they do see and that would probably be your best resource to start off with and then I would call that clinic and say you know what is the cost of the hearing test because there will be a cost associated with it and I would ask them you know what age of children that they do see too because not every clinic will see say a one-year-old. And would you be able to give advice on who a funder might be if they can't afford like who is there a spot that they could go to to find a funder or who helps them find a funder? Well the ALCS are an excellent resource. They have really kind of taken children with hearing loss under their wing and I also think tele-miracle is also another one and if that doesn't help they should talk to the clinic and see if there's other so there's sometimes some of the manufacturers have some funding for those that qualify so I would I would maybe even talk to the audiologist that they're seeing to see if they know of any other. Do you have any sense of the numbers of children in Saskatchewan who might be having hearing problems? Well we know anywhere between one to three children are born with hearing loss out of a thousand births and then we know that 15% of children school-aged children have some type of hearing loss. Now that might be a temporary hearing loss or that might be a permanent hearing loss but we know that 15% of children school-aged children have a hearing loss. Wow that is very high that's one of our highest stats for for any of the disorders that we've spoken of previously. So you had mentioned the importance of getting to kids early so I know previously when I worked with you we didn't have a provincial newborn hearing screening but I think we do thanks to you and probably some other audiologists who made the efforts to to get that started. So is that available all over the place or how how do parents make sure that their child's hearing is screened as a newborn? So if a child is born in any of the major hospitals in Saskatchewan they will have a newborn hearing screening unless something happens and they're discharged before the screening could happen and that does happen so follow-up becomes really important too. So the parents should be given a form that says you know your child wasn't able to have their hearing screening and here then their choice then is to go to either Saskatoon or to Regina to complete that hearing screening and if that and that's free to them and that's free to them if they go through the health region or the health authority. However if that's a barrier to them to get to Saskatoon or to get to Regina they can go to a private practice clinic that does see newborns so we see children we see newborns here but you know there's a cost now that's involved that they have to cut they have to pay that which is unfortunate. Which is again another barrier for them. It is a barrier for people too. And when we're talking about newborn screening it doesn't mean that that screening is done and then they'll never they'll never have a hearing problem right? Yeah. I mean that that is one type of hearing loss. Is it? We will often see other types of hearing loss that will develop afterwards. Now our hope with the universal newborn hearing screening is that we catch those kids so that we can get them amplified or we can get them the services they need right away. But there's lots of hearing loss that develops after birth so you know if you've got concerns about speech and language development or you're seeing some delays it's really important that you have your child's hearing tested to see if there's something else going on. When we're talking about hearing screening and what would your opinion be about what best practice would be? I know the American Speech and Hearing Association has some guidelines but I'm sure you've discussed with your colleagues what would you like to see in Saskatchewan for hearing screening? In terms of ages? Yes or what that universal screening would be? The newborn screening would be the start? And then I would think I would also like to see somewhere between the two and three year unless there's a risk factor. You know if there's a risk factor we want to see that child on a fairly regular basis say every six months. If say maybe they test a positive for CMV. What would CMV mean? The cytomegalovirus. Okay yeah. I'm not sure our listeners would know that necessarily. We're so used to using our jargon. So you know if a child has a screen positive for that then we would want to make sure their hearing is tested on a more regular basis every six months is usually how we'll follow them. Or if they have any other concerns maybe family history of hearing loss or if they have any other genetic factors going on or some other risk factors that makes it maybe there's some vision issues sometimes too. Those go hand-in-hand with hearing so we want to have their hearing checked more frequently. And then after two or three again when they get into schools if we had we had sort of discussed a speech path when we were yeah that it would be annually up to grade three and then after that it was every two years. That would be fantastic if it was happening but we know that it's not. There are some you know speech-language pathologists that have taken that on in addition to their up rolls in schools but that's not always possible. And gone are the days you know when I went to school we had our hearing tested. We had our eyes tested. You know we had dental work done on a fairly regular basis but that's a lot of that is gone. And so it would be fantastic if the school hearing screenings were back and done for every every school. Now I know a lot of speech-language pathologists have taken on the role of okay if I have a child that's now on my caseload I'm going to do a hearing screening but we're going to miss a lot of other kids that maybe aren't that are that aren't on a caseload that which is too bad. Like I know here in Prince Albert we have the speech-language pathologists here have identified I did my facts before you guys came eight children that we've identified in 13 years that have some type of permanent hearing loss which you know those kids would not have been caught and I without having that school hearing screening. So you know that's fantastic that the speech-language pathologists here have taken that on but that's not getting done in every school. And it would seem to me that that stat is definitely low. It was great to identify them but only eight in 13 years is that what you said? We're talking about permanent hearing loss. Now the other thing that they've also identified of those children that have middle ear infections. Now there are a lot of children that get identified with middle ear issues and you know we have this idea that when somebody has an ear infection which is a middle ear issue that they're going to pull at their ears, they're going to scream, they're going to have you know all the other symptoms that go along with pain and any other type of infection but there is a lot of children that are asymptomatic that you don't have that pulling at their ears and you know those are the kids that often get missed and then what happens is that fluid builds up and it builds up and you get something that's called glue ear where then sound can't get past that and then they end up with a whopper of a hearing loss that affects their speech that affects their language because you can imagine if a child is still trying to learn speech and language and one day they hear it nice and clear like this and the next day it's like this, that's really hard for them to be able to develop in speech and language if they're not getting a consistent signal and that's what happens. Talk about that gray mapping of speech sounds in the brain. Yeah, most definitely. So those are the kids that it's just we need to identify those children also so that they can get the proper treatment for the middle ear issues. And part of that process when children have ear infection it can also burst their eardrums and cause a perforation there that then either scars or stays so that the little left eardrum doesn't vibrate properly and that sort of thing too. And we can also have repeated ear infections will also runs the risk of causing permanent hearing loss too so we have to identify that and we know that 75% of children will experience at least one episode of otitis media which is the medical term for an ear infection by their third birthday. So and like I said lots of these kids they're not pulling at their ears that you know they don't have a red you know outside of their ears so a lot of these kids this the ear infection is going unidentified. It was years ago and again this could be something that that some of our listeners or we could look into it a little bit further but the guidelines we were given by one of the ENTs in Saskatoon when we were setting up our hearing screening program was if a child had experienced otitis media twice in a year they were someone that the ENT would like to have referred to them. So I don't know what what have you got other standards? I'm not sure I don't I don't want to speak for an ear nose and throat specialist but I know we're we treat ear infections a lot differently than we used to. We know that we used to treat them with antibiotics and then if it's we continue to see that we didn't see improvement with the antibiotics and they would be referred on to the ear nose and throat but we're no we know that ear infections can be caused they can be viral or they can be bacterial and not all of those will be successful and be treating them with antibiotics. So gone are the days where that's the first line of care is to treat them with antibiotics. What I think is really important is even if they're not getting treated by antibiotics because that might not be successful is that we identify them so then when you do you can then ask to be sent on to see the ear nose and throat and then you have that documentation that says listen you know my child had you know three ear infections in the last six months and so that you have that documentation for that for when you do see the ear nose and throat. One of the things that has changed over the years, not to say Cheryl and I have our gray hair to support this but it was audiometry that was used like portable audiometry that was used initially for screening and you know we had our screening frequencies and we would but it was subsequent to that we've got other technologies that are really so objective and children don't have to put their hand up to signal or I think I heard it or yeah not sure. So now we have both OAEs and tympanometry maybe you want to speak to that. Yeah we can actually test a child's newborns hearing after 13 hours so how fantastic to leave that hospital and know that at the time of birth that child has you know hearing within normal limits. Now you know if you have a eight month old child or you have a child that's one and a half and you've got concerns you know we can still test their hearing we can do something called otoacoustic emissions and what that is we put a little probe in their ear and they hear some clicking noises and it sends a sound all the way into the inner ear and then it measures how well it comes back. So the child just sits there for that test and then we can say that their cochlea or their inner ear is you know functioning within normal limits. Now if we can't do that we can also do something called I should say in addition to that we can also do something called tympanometry and tympanometry is when we look at the middle ear and that's telling us if there's a hole in the eardrum or if there's fluid and you know I have a lot of families that bring their child in for a hearing test and I'll ask them do you have it does your child have a history of ear infections and they'll say no you know we've been lucky we haven't had any ear infections and the first thing that we do is tympanometry that shows that there's actually fluid there you know and then there's a lot of oh no there can't be and you know that's the thing we don't always know that a child has fluid and my son's a great example I had a I have a son that had nothing but one ear infection after the other ended up having several sets of tubes never pulled out his ear never exactly has any of that didn't have a lot of sore throats didn't have any of those other things that we kind of have this idea that's what happens when you have didn't have a cough doesn't have a stuffy nose and he was that a cement asymptomatic child that always had these ear infections and I was just constantly testing him and I was always shocked when I found out there was fluid so tympanometry is a fantastic tool we can also do some testing where we have some speakers and we have some puppets so as the child gets older two or three we can put them in the sound booth and we can pair the sound to the puppet and then we we watch the child's behavioral response to sound so that's a good tool and there's also a test that we attach electrodes and we can measure the child's brain activity when they hear sound so we can do a lot of things and it's not your you know raise your hand when you hear the beep sound although that's part of it still as they get older but we don't have to have that in order to be able to decide if there's hearing loss there or not well I can listen to you talk about middle ear infections all day you know when you and I worked together Jody you were just critical in helping to get system set up in classrooms for kids who are having difficulty hearing and so they might be an individual FM system or some classroom wide system and I'm just wondering to me I didn't know how to do that that was not my area of expertise is that something that you feel like audiologists should be doing is that a role that they should have in schools because it sure would help to me and I know it would help the kids that you saw classroom acoustics are so critical for a child's learning and not even just the child also for teachers for their vocal health too is classroom acoustics so yeah audiologists can definitely work side-by-side with SLT's in the school divisions to help give some recommendations for classrooms but if you want my tangent to go on and on I'll talk you know it's to talk to you about sound field systems and why they're critical and why I wish if you took one thing away from this podcast it would be that if you were a teacher to please use your sound field system because that is something I'm very passionate about. For this example you just said all these little people that are sitting there that nobody is aware that they have fluid in their ears or they're they're struggling to to hear. Most definitely and not even you know children that have you know permanent or temporary hearing loss it also helps with those children that have learning disabilities or have attention issues to sound field systems are fantastic and you know nowadays with today's classroom you know it's fast-paced instruction there's a use of multimedia and we're using group activities and so it can be really challenging for children to be able to try to hear and they have to put in so much effort in order to be able to process the speech and to separate that from the noise in the classroom. To give you an example the average classroom has background noise levels around 50 decibels and I'm average speech is about 50 decibels so that's like an unoccupied classroom I think I might have said that wrong an unoccupied classroom already has a noise level of 50 decibels so now as a teacher if I want to be heard I have to raise my voice at least 15 decibels above that in order to be able to be heard and that's probably just in the first couple of rows. And 50 decibels what what would that be equal to like so that listeners could understand? Well 50 decibels average speech is about 45 or 50 you know so we're just talking about average speech you know in a regular conversation and quiet that's what an unoccupied classroom is because of HVAC system fans the fan noise from the smart boards and just all the other surrounding noise that happens you know in a classroom. Echoing. Exactly so then we're going to put if we're going to put kids in the classroom then the noise level goes all the way up till around 60 decibels for your average classroom so last summer I went and did an assessment for a class here in Prince Albert and we measured that class the noise level in that class there was no instruction going on it was a young it was a kindergarten class they had 75% of the students there that day so not a full class and it was we were getting measurements about 78 decibels. Now you're supposed to be wearing hearing protection if it's over 85 and just there's not even instruction going on yet this was just classroom activity so if you know if you're a teacher and you're trying to compete with that you know that is very hard and it's not just in our elementary schools but it's also in our middle year schools and also in our high schools too. That is incredible information to have that is enlightening for me. The benefits of a sound field system so you've got the noise level that we've kind of talked about we've also got reverberation because there's a lot of you know hard surfaces and gone are the days where we have carpets anymore in our classrooms so there's lots of reverberation so that's causing lots of echoing in the classroom and then there's distance you know that 60 decibels that's for a child that's in the first couple of rows while the student that's in the back especially if the teacher is using the smart board or they've got their back towards the rest of the class they're not they're not hearing that so it's even more difficult for them to be able to to project to be able to hear in the classroom. With these systems do teachers need to do anything like is it is it technologically difficult for them or how would a teacher use the system? A lot of the systems they just go around it's like a lapel mic or it's something that goes around their neck it's very easy to use and it's very simple and it's set up so that there's multiple speakers in the classroom and the fantastic thing about that is that no matter where the teacher is in the classroom their voice is getting equally distributed across that classroom so it makes it much easier for them therefore they don't have to raise their voice and oftentimes I'll get some teachers that are they don't feel they need a sound field system or maybe they don't need to use the child's remote microphone because they have a loud voice they'll say oh you know I I don't we don't need to use that in my class because I speak loud the problem is is when you raise your voice to project your voice the sounds that come across are the vowel sounds and then the consonant sounds get distorted so when you raise your voice those high frequencies get distorted in those consonant sounds so then the student isn't getting even though you're talking loud the student isn't catching everything that's being said and so by wearing a sound field system the teacher wearing a sound field system or using the students remote microphone when they need it that allows the student to be able to hear all of the sounds as they should be able to can hear the vowel sounds and the consonants equally loud which is what they need. So I would just add in from the speech pass vantage point that some of those consonant sounds are just friction sounds so they're like they're just little crispy blowing sounds right and so for a teacher to be able to project that to the back of the class when you're saying it says 60 decibels or higher you know you can see that children who have any issues may be missing all those sounds when they're trying to process. The other thing I would add in here is there is a total link between auditory processing and reading. Yeah. And I know again that the school systems have been so very focused on reading and that is a measure of sort of school success but if we go if we backtrack again that auditory component is foundational and we need to absolutely know and understand about that dynamic. Oh for sure it definitely goes hand in hand. One of the more popular sound field systems out there did a study and they showed that if the teacher wore their sound field system microphone for just one period of the day that also improved the teachers vocal quality vocal fatigue and the vocal strain that they had too. So we're not talking just about the benefits for children or for students in the classroom we're talking about for the teachers themselves too because you know vocal is something that we don't talk a lot about but vocal quality vocal fry dry throat vocal fatigue that's something that a lot of teachers deal with but they don't even realize because it's you know it's something that happens. Yeah it's hidden stress that they're carrying. So when you were we were talking about screening a little while ago and you were talking about some of the kids who have some middle ear difficulties or that you had actually found some kids with actual hearing problems where they would need to get a hearing aid what about we hear a lot about kids well it's just it's just a small loss yeah I hear that sometimes it's just a little loss I'm not sure we need to do anything about it. Yeah yeah okay so what would you have to say about that? So we know that probably there's one to three students in your class right now that have some type of mild or minimal hearing loss and we know that the problem with that type of hearing loss is is that again you're getting those inconsistent speech and language so one day they're hearing it one way and other way they hear it differently and we know that a child with a minimal hearing loss reports that they have more stress more self-esteem issues and energy issues or lack of energy than children that don't have a hearing loss. So those kids with that minimal hearing loss are having to put that much they're having put that much more effort in order to be able to hear and we talk a lot about auditory fatigue and it's that we see that those kids they come home even children with a minimal or a mild hearing loss and they are exhausted at the end of the day because they're having to work so hard. Okay well we were talking about trees today but I didn't hear anything about trees I heard something about free well that can't be about trees it must it must have been this so they're having to do all those substitution and try to take that information and make it make sense well they're having to put that much more effort in and then what happens is they usually end up fatiguing and so a lot of these kids they'll it would be reported that oh they have you know attention issues or they're not paying attention and they have behavioral behavior yeah which go into behavioral issues. So we know that children with minimal hearing loss will exhibit poor abilities than children without hearing loss in both reading spelling and in sciences and we also know that children with mild hearing loss often do worse than children with moderate hearing loss or even severe hearing loss because they they don't know what to do with that minimal hearing loss and they they haven't developed the coping strategies that a child with a severe hearing loss so a child that has a moderate or severe hearing loss they know I need to tell my teacher you know I need to look I need to be able to read your lips I need that face-to-face communication I need to move myself somewhere in the classroom. They've developed those method skills. Exactly, but children with minimal or mild hearing loss they haven't developed those and they're so exhausted at the end of the day so anything we can do to help make their lives easier you know that's you're going to see better attention you're going to see less behavioral issues and we're going to see you know their academics improve because they're not having to put all that extra effort in. So so we're putting the compensatory strategies on ourselves to deal with the fact that there's there needs to be a different signal noise to signal ratio so that the child can really hear in the classroom for sure more clearly. They have they have found out that children with a mild hearing loss can miss up to 15% of what's being said 50% like that that's huge you imagine if you were you know taking a new topic in class or you're doing spelling or you're you're learning about something and you're missing 50%. And Cheryl and I've used the analogy about that auditory processing part about it's like you're sitting in a classroom and it's in German and you don't know German or you know very little German and so yeah how long can you sustain yourself to keep concentrating and for sure yeah most definitely. So we've covered a lot of topics in a very short amount of time today and we've talked about screening, we've talked about a newborn screening, we've talked about mild losses, we've talked about classroom FM systems and personal FM systems and we've talked about the cost of hearing assessments and screenings and and all these kinds of things. If you could choose and I you probably can't but if you could choose one one issue that we could you know remedy in Saskatchewan in the next say three to five years could you pick one? Oh that would be tough I guess if I if I had a magic wand and I could address issues in health I would be that hearing tests would be covered by by SaskHealth so that it wouldn't be a barrier for families so that anybody could have any child could have their hearing tested and my and then and then be able to get hearing aids covered through SaskHealth that would be amazing and I would be so happy. My other magic wand if because the children really are not getting them if they can't afford them there's all these people and families and children struggling right yeah yeah exactly like needing needing insulin but you can't afford it yeah but you get diabetic but what can you do about it and the trickle-down health effects that happen because of that that untreated that untreated hearing loss. Yes I think you had mentioned before that if audiologists in private practice who see children could bill for the service then parents could take their children anywhere in the province to have an assessment. And then I guess if I had another magic wand and I could address issues in the schools it would be to have the classroom acoustics and sound field. A lot of these schools have sound field systems and they've paid a lot of money for these sound field systems and if we could just get you know teachers using them on a more regular basis I think we would see a lot of decreased behavioral issues and I think it would be so much easier for these kids that are trying to learn in these difficult listening environments. So that would be I had to have to have two one for each one for health one for education. What it reminds me of is our very first podcast that we ever had was on standards within the province and if you don't have standards and you don't decide who is eligible like we talked about our children eligible for speech and language intervention to what degree are they do they get five sessions and then they're done or do they get kindergarten and then they're done or are we going to try to give services what are they eligible for and it's the same thing with hearing is really what I'm hearing is we need to make sure that there's equity yeah in every child no child left behind that that thing saying yeah we need to make sure there's equity across the province for accessing hearing yes and that only comes with again knowing your needs assessment what are we looking at in terms of the numbers children and then having policy having a task force or whatever you're getting some action going about it yeah well we can't thank you enough Jody and I'm sure we'll have you back on because I think there were things that we didn't cover and some of the things we covered brought up more issues and so I think we'll probably be having you back soon sooner rather than later and we just so appreciate having you as our very first guest and we thank you so much so for let's talk talking I'm Cheryl and I'm Sherry