Easing Parental Worries
Pediatric Audiologist Brian Fligor Champions Early
For pediatric audiologist Dr. Brian Fligor, one of his
earliest experiences in the profession also proved to be one of
the most meaningful. Four-and-a-half year old Joe Ward who had
been displaying worrisome speech-language delays and behavioral
problems, was one of the first patients Brian ever saw.
"Joe was a wild kid," Brian recalls. "His
hearing had been tested before, so at first we considered this
round of tests as a 'rule out hearing loss' exercise,
which are pretty common in pediatrics."
According to Brian, an ear infection is often the culprit when
a young child has a speech-hearing delay. "It is unusual to
find any permanent hearing loss in the children we test, and
it's extremely rare to find these kinds of problems in
children over four."
Joe had a history of ear infections, and two years earlier had
PE (pressure-equalization) tubes placed in his ears. Although his
hearing seemed to improve after that procedure, his language
learning problems and behavioral outbursts continued.
Brian and his team resorted to some creative testing methods.
"I started the evaluation by trying to teach Joe
conditioned-play audiometry on a portable audiometer," says
Brian. "He did not seem to grasp the listening task, so
another audiologist joined me for team-testing."
Contrary to expectations, Brian discovered that Joe had a
moderate to severe case of sensorineural hearing loss, impacting
speech sounds above 1000 hertz (Hz).
"It was no wonder that Joe could hear his name being
called and responded appropriately to environmental sound. He
could hear those things just fine," Brian explains. "He
just couldn't make out any meaningful differences above 1000
Hz. It made sense that his language skills were two-and-a-half
Because Joe had been born just before the universal newborn
hearing screening law went into effect, he had never had a
newborn hearing screening.
An Explanation-and an Unexpected Reaction
Typically, the moment of reporting hearing loss to a parent is
very dramatic. Because it is difficult psychologically, it takes
finesse to communicate the news clearly and effectively to
families, who may be in shock.
"Some parents find it extraordinarily hard," Brian
explains. "It has even been likened to losing a child,
because it represents the death of the child they thought they
But Joe's mother, Ellen Ward, had an unexpected reaction.
"There was none of the typical tears or anger. She actually
seemed relieved," Brian remembers. He says that she was
happy because, after years of worrying and testing and unanswered
questions, she finally had an explanation as to why her son's
behavior and language were so atypical.
"I took the news well because Dr. Fligor's approach
was so kind, his explanation was so clear, and he gave us very
specific advice about what we should do next," Ellen says.
"From that point on, Dr. Fligor became a hero to our family,
helping us with piles of paperwork, getting Joe placed into an
appropriate school, and being an all around advocate for
Joe was fitted with hearing aids. After considerable
back-and-forth with the school district, the Wards placed him at
a local school for the deaf in a sign language-supported
"Joe had to learn to sign after the age of five, which is
very difficult," Brian says. "Although he still has a
ways to go, he adapted well."
Five years after his diagnosis, Joe has made marked academic
improvement. Yet he continues to struggle with behavioral
problems and ADHD.
"Joe's undetected hearing loss exacerbated the
trouble he was having, and had a profound impact on his
development," Brian says. "He has come far compared to
where he was, but it will take years of intervention for him to
get to an optimal condition."
Matthew Ward: The Power of Early Intervention
Brian's relationship with the family did not stop there.
About a year after Joe's diagnosis, baby brother Matthew was
born. A newborn hearing screening and follow-up diagnostic that
Brian conducted revealed a similar diagnosis to Joe's:
bilateral, mild-to-moderate sensorineural hearing loss.
Matthew was fitted for hearing aids when he was just 3 months
old. Because he had the benefit of early identification and
intervention, his language skills (in both sign language and
spoken English) are age-appropriate, and his behavior is
considered typical of a healthy, rambunctious child.
Matthew and his mother attended a parent-infant program at the
same place where Joe attends elementary school. Today, Matthew is
thriving in a pre-school program there.
The brothers serve as an example of the importance of early
identification and intervention. Left undetected, hearing
impairments in infants can negatively impact speech and language
acquisition, academic achievement, as well as social and
All Roads Led to Audiology
There are ample reasons why for Brian, his work is more than
just a job. Originally from "the cornfields of Ohio,"
from an early age Brian had many people influencing his interest
in medicine, and in hearing loss specifically. His father, a Navy
veteran, suffered hearing loss as a result of his exposure to
non-combat anti-aircraft noise. In addition, Brian was taken
under the wing of his family physician, which sparked his
interest in becoming a doctor.
Along the way, he has experienced quite a professional
journey. He is currently the Director of the Diagnostic Audiology
Program at Children's Hospital Boston, overseeing a staff of
25, and an Instructor at the Harvard School of Medicine. With his
research, he has established a national reputation as a leading
authority on hearing loss related to the use of small, in-ear
style headphones typically seen with MP-3 (iPod) devices.
"The Toughest Job You'll Ever Love"
According to Brian, the story of the Ward brothers in many
ways sums up why he finds his work as a pediatric audiologist so
challenging-and so deeply important.
First, he explains, there's the difficulty of
communicating with young children and understanding their
responses. "It takes creativity to check the threshold of
children's hearing. It's hard to get that
Even more importantly, there's the challenge to
intervening as early as possible in a child's life. The later
the intervention, he says, the poorer the chance for a positive
"If nothing is done with these kids, they often finish
school with a third-grade reading level. When it comes to
pediatric sensorineural hearing loss, there can be potentially
dire circumstances," he says. "A child's hearing
loss impairs communication, and communication skills are how one
becomes successful in life. Kids must acquire language, because
nearly everything we do as humans depends on language
Brian's biggest challenge today is his role as a director,
anticipating the needs of his staff and giving them the precise
support they need. But he finds the work of mentoring newer
audiologists one of the most rewarding things he does.
"As audiologists, we have to be able to make informed
clinical decisions quickly, and be able to incorporate the
information we've gathered into a workable plan. We also have
to alleviate the worries of concerned parents and help motivate
them into action."
"I love this work and I feel incredibly lucky that I
stumbled onto this profession," Brian says. He likens his
feelings about being an audiologist to the classic motto from the
Peace Corp: "It's the toughest job you'll ever
Return to Top