Pediatric audiologist + CAPD expert
Jane Auriemmo, AuD, CCC-A
Multi-talented Senior Audiologist, Jane Auriemmo, has been an integral member of CHC’s team since 2011. Her expertise in pediatric audiology and central auditory processing disorders (CAPD) have made her an invaluable resource in the New York area for parents with children affected by hearing loss, deafness or listening challenges. Additionally, she works with adult clients, teaches audiology doctoral students at CUNY and somehow manages to find time to hone her skills at darts.
We’re pleased that Dr. Auriemmo could participate in a Q&A that showcases her incredible clinical expertise as well as the passion with which she embraces her work.
What is your role at CHC?
Jane Auriemmo: I see babies, children and adults for comprehensive hearing assessment, hearing aid fittings and follow up. This includes infants who do not pass their newborn hearing screening and require follow-up testing to rule out a permanent hearing loss. When there is a permanent hearing loss, as an Early Intervention audiology service provider, I fit the baby with hearing aids as soon as it is feasible and perform regular hearing and hearing aid testing. I work to ensure excellent audibility through the hearing aid programming parameters so the child has the opportunity to learn speech and language and achieve social and academic success on par with their typical-hearing peers. I also perform central auditory processing disorders (CAPD) testing on children and adults.
What do you find most rewarding as an audiologist?
JA: I’m so moved by the families and their journeys. In some cases, I first meet them for their baby’s ABR test. This is the test we use to assess hearing in newborns and infants. The diagnosis of a permanent hearing loss is devastating, for most parents, even if it is suspected because it is their second or third ABR. Parents feel better as they see their baby progress well and grow into a happy child. They recognize it’s a result of the hard work they themselves have put in, ensuring consistency of hearing aid (or cochlear implant) use, following up with audiology appointments, taking the child to individual and group speech therapy sessions, and enhancing their child’s communication opportunities inside and outside the home. Parents become empowered to help their children achieve their potential and learn alongside typical-hearing peers. The children come in for frequent retesting and fine-tuning, and I witness the parents relax because they trust the process. The progress of the children is the result of a lot of hard work on everyone’s part but always seems so miraculous. The other day a 2 ½ year old that I fit with hearing aids at age 2-months old excitedly said, “Hi, Jane, it’s snowing!” It was a goose-bump moment.
When adults with acquired hearing loss have hearing success, it is also incredibly rewarding. For example, I might see an adult who is a good candidate for hearing aids audiologically but is just not ready to take that action, perhaps because of the stigma we still see today. We talk about the benefits and limitations of amplification. I always try to find out what is important to them in their daily lives to help them decide if they should try a hearing aid and if so, what kind. Hearing aids are actually quite amazing now, allowing users to listen to phone calls through them, wirelessly stream music, podcasts, television, etc. But not every individual needs every feature. I give my clients research to do online. I encourage them to come for a hearing aid evaluation just to see what it’s like. They have to be motivated to be successful with hearing aids. This approach usually works, and when they come back (and they almost always do) they are ready to ask questions, express their goals and talk about how we can meet them. Together we decide on what kind of hearing aids they will try, but I explain why I’m recommending what I do. Hearing aids have a lot of special features now, and it’s our job to match the patient’s goals with the correct product. I love seeing a person who never wore hearing aids before quickly become reliant on their hearing aids. One of my younger, adult clients wanted the most “invisible” fitting. We chose very small receiver-in-the-ear (RITE) instruments, and I explained why custom-fitted earmolds were really important for him to ensure audibility as opposed to a prefabricated option. He agreed to try but was leaning towards the prefabricated ear tips because he was worried earmolds would be more visible. We managed to get very discrete earmolds and after a trial of both options he recognized the benefit of the earmolds. He said, “I don’t want all that good technology leaking out of my ears, I want to hear everything.”
What sparked your interest in central auditory processing disorder (CAPD)?
JA: As audiologists, we spend a lot of time making measurements of hearing and the “peripheral” system, which is the outer, middle and inner ear. These are generally sites involved in hearing loss. However, hearing doesn’t stop at the inner ear. The signals must be propagated up the hearing nerve through the brainstem all the way to the cortical areas of the brain and the frequency, intensity and timing cues of the sound must be efficiently transmitted. These auditory pathways can be neurodevelopmentally delayed or atypical in some children. While their peripheral hearing is normal, they may behave as though they have a hearing loss. They may have difficulty hearing in noise, mishear words or require frequent repetitions. As audiologists, we can’t ignore this part of the auditory system, the central auditory nervous system.
What should parents do if they think their child might have CAPD?
JA: The first step is to determine whether the child is a candidate for testing. The symptoms of CAPD often overlap with those of other issues such as ADHD, Autism Spectrum Disorder and speech and language disorder. If a child has other diagnoses and is already receiving appropriate services to optimize social and academic success, then there may not be a need for CAPD testing. Sometimes the diagnosis is necessary to help a child obtain the services they need, and sometimes it just is helpful for parents and teachers to know the source of a child’s challenges. In most instances, CAPD is not an isolated issue. This is because the auditory brain pathways are shared ones. In these cases, we look at the multidisciplinary findings (results of speech and language testing, psychological testing, academic testing, etc.) and determine whether CAPD testing is appropriate. Some other things we consider are the age of the child and their ability to participate in a lengthy test session.
What is the outlook for children with CAPD?
JA: If specific auditory weaknesses are identified, we can recommend environmental modifications, deficit specific therapy activities and management strategies. The recommendations vary depending upon the pattern of test performance seen. Some of these children may benefit from the use of an FM system in the classroom. This ensures they hear the teacher above the background noise. We may also suggest strategies to help compensate for the child’s difficulties and/or training activities to strengthen the auditory pathways.
For some children, we recommend visual supplements in the classroom to help them keep up with the material. For example, note-taking is very difficult for individuals with listening problems. However, other children do not do well when they are required to use more than one modality at a time and a visual aid would not be helpful. There is no “one size fits all.”
Was teaching always a part of your career plan?
JA: Not at all! For many years I’ve supervised student externs and later trained audiologists in hearing aid feature and programming nuances. I also began sharing results of research studies I was involved in at professional meetings and authored several articles. I’ve been a clinical mentor to students from several doctoral programs while here at CHC. I’ve been teaching audiology doctoral students at CUNY for the past 6 years. I’m a clinical educator there (I supervise the students as they learn to test patients) and teach their Pediatric Audiology and Auditory Processing Disorders courses. I’ve had the good fortune to be mentored by leaders in our field, experts in diagnostic pediatric audiology, electrophysiology, amplification and rehabilitation. I stored away all the pearls of wisdom they shared. I explain this to my students and joke that “I’m opening up the vault for you. Take as much as you can.”
What pursuits do you enjoy outside the classroom and testing booth?
JA: Outside work you can find me in my other office – Central Park! In all kinds of weather and seasons, I’m outside. Or searching every bakery in NYC for the perfect scone. Ideally, a place with the perfect scone and perfect cappuccino! Any suggestions? I’m also an awesome darts player. If I’m not in the city you can find me hiking upstate, an hour drive north and I’m in the woods. Location, location, location!
Is there anything else you’d like to share?
JA: Happy hearing, everyone!