American Speech-Language-Hearing Association

Easing Parental Worries

Pediatric Audiologist Brian Fligor Champions Early Intervention

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 years delayed."

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 had."

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 him."

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 program.

"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 emotional development.

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 information."

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 result.

"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 capabilities."

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 love."

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