October 21, 2003 Feature

Pediatric Audiology at a Not-for-Profit Hospital

Two years ago, an online job search brought me to The Hospital for Sick Children in Washington, DC. From the name of the hospital, I didn't know what to expect. The words "sick" and "children" aroused my compassion, yet I was unsure if I was clinically suited for this population. I knew that the children at the hospital would be sick and have special needs, but could I make a difference in their lives? I was new to the field and had limited pediatric experience. I had my Clinical Fellowship in 1999–2000 and started my career working for a private practice audiologist, who based his small business in otolaryngology offices. In that setting, I primarily worked with middle-aged adults and the elderly.

But I always had a love of children. I was born with a special need and felt that it was time to give back and help other children. Diagnosed with scoliosis at 12 years of age, I spent sixth grade to 11th grade traveling with my dad to Kernan Hospital in Baltimore, MD, for spinal X-rays and back brace fittings and adjustments. As I entered audiology practice, I wanted to make a positive difference in other children's lives. The hospital position described online was a perfect opportunity to do that.

The Hospital for Sick Children is a 120-year-old, three-story hospital with a welcoming appearance nestled in a quiet, residential community of Washington, DC. It serves the needs of infants, children, and teens with disabilities and other complex medical conditions. It is the only exclusively pediatric rehabilitation facility in the Washington metropolitan area, and it provides care for both in- and outpatients from birth to 21 years of age.

As the only pediatric audiologist on staff, I work very independently and am also part of an interdisciplinary team of medical professionals. These include physicians; nurses; speech-language pathologists; child life specialists; occupational, recreational, and physical therapists; teachers; psychologists; interpreters; and pediatric case managers.

On any given day, I may treat children with the following medical conditions: accidental or nonaccidental head trauma (closed head injury), cancer, mental retardation, cerebral palsy, AIDS/HIV, tracheostomy/ ventilation dependency, developmental delays, cleft lip and palate repair, short attention span, chronic lung disease, gastroesophageal reflux disease, bacterial meningitis, scoliosis, drug withdrawal, autism, osteogenesis imperfecta (brittle bone disease), prune belly syndrome (absence of abdominal muscles along with expanded bladders), or Trisomy 21 (Down syndrome).

There are many challenges in treating medically fragile children. It is difficult to tell a family who has an already "sick" child that their child has a hearing loss on top of the other diagnoses. Usually the family does not want to believe it. That is when I focus on listening and try my best to be sensitive and supportive.

But the rewards are significant. I really love what I do every day and seeing children's eyes light up when they are fitted with their new hearing aids. When I place their hearing aids, they say, "I can hear, Miss Perry! I can hear!" and give me big hugs. With hearing aids, these children will be able to hear the birds in the morning, friends calling their name, and parents and teachers instructing them.

These children are usually 5–15 years old and have unilateral or mild-to-moderate hearing losses that have been overlooked for years because of their other medical problems. The families often are elated to see the improvement. They have had longstanding concerns that their child's grades are poor or started slipping recently, that television and radio volumes have to be turned up too loud, and their child does not respond when called. It is satisfying to see a family appreciate the value of audiologic treatment.

The Road to Audiology

My road to audiology was a long one. In high school I loved writing, so I studied journalism with a focus on the sciences for a career in pediatric medicine. As an undergraduate I was a broadcasting/pre-med major, but after graduation I decided against medicine because of the years of commitment. Still, I wanted a health care career related to children and communications.

After much research, I finally decided on speech-language pathology, which would keep me in the communications field and take only three years to complete. My plan was to work in medical speech-language pathology at a pediatric hospital. After a year I realized that speech-language pathology was not a good fit for me, and at the same time, ironically, I discovered audiology. I quickly switched my major and never looked back. Having studied speech-language pathology, though, has made me appreciate the work of SLPs.

In my first year at The Hospital for Sick Children, I decided to work on my Doctorate of Audiology (AuD) degree through the University of Florida's distance learning program. I plan to continue my role as a pediatric audiologist at the hospital after I receive my degree. At the same time, I want to help recruit future audiologists. Unless we, as audiologists in the field, get out to the high schools, colleges, and universities to promote the profession, students will not enter the field of audiology, simply because of their lack of awareness. I know that firsthand. It was not until I started my master's program in speech-language pathology that I realized the profession of audiology even existed.

Medical technological advances will continue to improve the survival rates of premature infants needing audiological assessment and intervention. There will be an increased understanding of early intervention, diagnosis, and treatment of hearing loss, and more audiologists will be needed to handle those cases.

Recruiting new audiologists will help with the increasing demand for our services in the future due to aging baby boomers, the emergence of newborn universal hearing screening programs, and simple supply and demand—as people retire or leave the profession, audiologists will be needed to replace them.

I also would emphasize to students that the future of audiology is bright. There are many opportunities for advancement. I will graduate with my AuD degree in May 2004. I cannot wait for graduation day! In addition to becoming a Doctor of Audiology, I hope to study to be a pediatric acupuncturist, so that I can help children like the ones I see at our facility, who often suffer from headaches, pain, and nausea.

In conclusion, I love what I do as a pediatric audiologist and hope to continue to do it for a very long time.  

Tanyka Perry, directs the Pediatric Audiology and Hearing Aid Clinic at The Hospital for Sick Children in Washington, DC. Contact her by e-mail at tperry@hospsc.org. 

cite as: Perry, T. (2003, October 21). Pediatric Audiology at a Not-for-Profit Hospital. The ASHA Leader.

Pediatric Audiology: Tips from Tanyka

Some skills and abilities are particularly useful in working with special needs children in a rehabilitative hospital. It helps to know how—and be willing—to:

  • Stay calm when a child pulls everything off during a test.
  • Change to another test procedure quickly if you are losing a child's attention.
  • Get on the floor to test a child.
  • Play games to make the testing procedure fun.
  • Be flexible—work around the schedules of the patient and other therapists who treat that patient.
  • Manage wheelchairs, IV units, and feeding machines in the soundproof booth.
  • Perform hearing evaluations at bedside—sometimes with excessive room noise.
  • Replace or suction secretions out of a tracheotomy tube.
  • Manage aggressive behavior.
  • Accept that babies may throw up on you.
  • Move quickly when toys get thrown at you.
  • Keep tape and extra electrodes available when electrodes are snatched off in the middle of a brainstem auditory evoked response evaluation.
  • Know when to back off when a child is too fussy or tired.
  • Keep a child from pulling tympanometry probes and insert phones out of their ears, while trying to keep them from sliding off the chair.
  • Handle questions from adolescents who ask, "Why do I need a hearing test?" and from families who ask, "What are you doing with my baby?"
  • And last—but certainly not least—be sensitive and informative, especially when you tell a family that their child has a hearing loss.



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