int. j. lang. comm. dis., 2002, vol. 37, no.

4, 367–379

Article
Contemporary issues in audiology:
a hearing scientist’s perspective

David. J Parker
Human Communication & Deafness Group, University of Manchester,
Manchester, UK

(Received December 2001; accepted April 2002)

Abstract
Audiology has developed signiŽ cantly over the last 30 years leading to better
identiŽ cation and assessment of hearing loss and better habilitation services for
both children and adults with congenital or acquired deafness. Advancement in
the profession and its services has been largely dependent on the technological
development of key methodologies such as the auditory brainstem response
and otoacoustic emissions. These methodologies have been used for the identi-
Ž cation and assessment of the severity of hearing loss. As a result, these
methodologies have underpinned the emergence of service development initiat-
ives such as hearing screening and provision of hearing aids, particularly for
newborn babies and young children. This review identiŽ es, describes and
evaluates the key methodologies and services involved and presents a hearing
scientist’s perspective on the developments to date. The aim is to provide
state-of-the-art information to those working with children and adults with
communication disorders, particularly speech and language therapists.

Keywords: ABR, OAE, SSEP, deafness, newborn hearing screening, digital

hearing aids.

Introduction
Audiology has come a long way in the last 30 years. Much of the impetus for that
movement has come from our developing understanding of the auditory system,
largely through the eVorts of auditory scientists. Not solely though. Recent events
in the UK, such as the national initiatives in newborn hearing screening and
modernization of hearing-aid services, while soundly based in evidential frameworks,
have been made possible only by political lobbying and eventual government action.
Together, scientiŽ cally and politically energized advances in audiology have created
the possibility of better audiological services, and the climate within the profession
for reappraisal of career and training structures for audiologists.

International Journal of Language & Communication Disorders

ISSN 1368-282 2 print/ISSN 1460-6984 online © 2002 Royal College of Speech & Language Therapists
http://www.tandf.co.uk/journals
DOI: 10.1080/136828202100000772 1
368 David J. Parker

This paper reviews, from the perspective of a hearing scientist, some of the
important elements contributing to the current status of audiology in the UK. In
this way, speech and language therapists and other clinicians in related professions
can have a clearer picture of what is at present available with respect to identifying
hearing diYculties in children and adults.

Tried and tested techniques

Two audiological methodologies, used extensively over the years, have been respons-
ible for the shape of audiology today: Ž rst, discovery of the auditory brainstem
response (ABR) and, second, the discovery (a decade later) of otoacoustic emissions
(OAE). Both had profound implications for otoneurological and audiological prac-
tice. The ABR informed the neurologist and audiologist on the status of auditory
function, particularly at the level of brainstem, while OAEs were responsible for a
revolution in hearing science, as well as informing the audiologist about the status
of peripheral auditory function, particularly at the level of the cochlea.
Both methodologies are still used today, but ABR perhaps less so. It is used
mainly in the prediction of hearing thresholds, while OAEs are used to conŽ rm
the functional status of outer hair cells. Both are used in newborn hearing screening
programmes throughout the world.

Auditory brainstem response

The ABR was born in the mid-1960s. According to the Preface of one text on the
topic (Moore 1983), labour was long and delivery problematic. In that Preface,
Don L. Jewett describes how the then putative scalp-recorded activity of subcortical
auditory brainstem structures was eventually detected, despite the best eVorts of
his research students at that time. Actually, the earliest reference to scalp-recorded
subcortical auditory evoked activity at around 5 ms (eventually be labelled ‘ABR’)
was made by Geisler several years before (1960), but this was just a passing
comment. Unfortunately, publication of Jewett’s work was slowed by the inability
of anonymous referees to concede that these responses did in fact exist. As a result,
Jewett was beaten to press by others (Sohmer and Feinmesser 1967). Nevertheless,
the ABR peaks are popularly (and fairly) described as ‘Jewett’s bumps’, the Ž rst full
description of their properties being given in the early 1970s ( Jewett 1970, Jewett
et al. 1970, Jewett and Williston 1971). A typical ABR waveform is shown in Ž gure 1.
Frenetic global research activity on this topic then ensued throughout the 1970s
and 1980s. As a result of this research activity, ABR was found to be of considerable
importance to audiologists and otoneurologists in a number of separate areas, e.g.
lesion location, threshold estimation and screening. Additionally, ABR was found
useful for: intraoperative monitoring of auditory function, testing for brain death,
detecting auditory neuropathy (with OAEs) and predicting uncomfortable loudness
levels. Some of these issues are discussed below (see the section on Newborn
hearing screening below for further discussion on ABR screening).

Lesion location using the ABR

One early focus of ABR interest was with identiŽ cation and location of lesions and
tumours aVecting the auditory pathway. These include lesions of the cochlear nerve,
Contemporary issues in audiology: a hearing scientist’s perspective 369

Õ
Figure 1. Typical ABR waveform evoked by clicks presented at 70 dBnHL and at a rate of 20 s 1
to the right ear of a normally hearing subject. Responses to 2048 stimulus repetitions were
averaged. Peaks labelled I–VII are the ‘Jewett bumps’, the most prominent and robust being
wave V, whose threshold is used to predict hearing thresholds.

lower brainstem and upper brainstem. The approach is predicated on there being
a correlation between speciŽ c features of the ABR and activity generated in speciŽ c
locations of the auditory pathway. While this may be true in a general sense, a
speciŽ c one-to-one relation of ABR peak to brainstem location is probably not the
case (as pointed out by Jewett 1970). Nevertheless, the ABR was found to be of
considerable value for its high detection rate of cochlear nerve and lower brainstem
lesions (e.g. Musiek et al. 1983).
This notwithstanding, lesion location using the ABR has now been superseded
by the brain-scanning techniques (e.g. MRI) available in modern hospitals today.
As a result, ABR is now rarely used to localize lesions of the auditory pathway.

Estimation of hearing thresholds using the ABR

Another early focus of ABR interest was with ‘objective’ estimation of hearing
thresholds, particularly in people for whom conventional ‘subjective’ audiological
techniques were not appropriate. Individuals in this category typically included:
newborn babies, infants and toddlers, handicapped children and adults, and uncoop-
erative children and adults. In these cases, it is possible to estimate hearing thresholds
based on the threshold of the most prominent peak of the ABR, wave V (Ž gure 1).
Such threshold information has been used to inform audiological management and
the Ž tting of hearing aids.
Where clicks are used to evoke the ABR, wave V thresholds re ect hearing
sensitivity in the 2–4 kHz range (Coats and Martin 1977), despite the broad-band
nature of the click frequency spectrum. Tone pip stimuli are used to provide greater
frequency speciŽ city at standard audiometric frequencies of 0.5, 1, 2, 4 and 8 kHz.
However, ABR waveforms to tone pip stimuli are not as clear and reliable as those
370 David J. Parker

elicited by click stimuli, primarily because of the need for a high degree of neuronal
synchrony to produce a classical ABR waveform (Ž gure 1). Clicks provide excellent
neuronal synchrony, but are not frequency speciŽ c. On the other hand, tone pips
are more frequency speciŽ c, but provide less neuronal synchrony (particularly for
frequencies below about 2 kHz). As a consequence, tone pip ABR waveforms are
poorly deŽ ned, making them less detectable and more problematic in clinical use.
Additional problems emerge as a result of cochlear properties that involve the
spread of excitation to a larger area of the cochlear partition as the intensity of the
stimulus is increased (e.g. Elberling 1974). Because of this phenomenon, a distinc-
tion must be made between frequency speciŽ city of the stimulus and place speciŽ city
of the ABR, since the nominal frequency of the tone pip used, and the actual place
of maximum excitation along the cochlear partition may not be the same. Under
such circumstances, a 500-Hz tone pip, for example, may excite the 500-Hz place
at low intensities (i.e. near normal threshold level) but may cause excitation of the
cochlear partition over an extended area (mostly basalward, towards the higher
frequencies) at the higher intensities needed to initiate aVerent output from less
sensitive cochlear areas. In other words, the higher intensity thresholds obtained
may not re ect the true sensitivity of the cochlea at the nominal frequency of the
stimulus used. To cancel this spread of excitation, ipsilateral masking procedures
can be used.
Nevertheless, despite these considerations, some authors have found threshold
estimation using tone pip ABR audiometry to be suYciently accurate and useful
(e.g. Mason 1992). According to Stapells et al. (1995), 80% of thresholds obtained
using tone pip ABR (with ipsilateral masking) can be estimated to within 15 dB of
the behavioural value.

Estimation of uncomfortable loudness levels using ABR

While threshold information is vital for informing the procedures involved in
hearing-aid Ž tting, information on uncomfortable loudness level (ULL) is, arguably,
just as important since it deŽ nes the upper limit below which the hearing aid must
operate. ULLs are conventionally measured using subjective techniques. However,
as with thresholds, objective procedures are more appropriate in certain individuals.
Attempts have been made to predict ULL from: (1) behavioural thresholds (Kamm
et al. 1978, Cox 1985), (2) the acoustic re ex thresholds (ART) (Kiessling 1980)
and (3) the ABR latency-intensity function (Thornton et al. 1987, 1989). Most
promising was the work of Thornton and colleagues who found that the slope of
the click evoked ABR latency-intensity function tended to zero as the intensity
approached ULL. They used this relationship to predict ULL to within 6 dB of the
subjective value for 90% of subjects, with a maximum error of 11 dB. This level of
accuracy is rather good, though, to the author’s knowledge, the technique has not
yet been exploited in the audiology clinic.

Limitations to the clinical utility of the ABR

There are some limitations to the clinical utility of both click ABR and tone pip ABR.
First, the ABR is an onset response being dependent on synchronous Ž ring of
auditory neurones. Higher-frequency transient stimulation (i.e. clicks) favours such
Contemporary issues in audiology: a hearing scientist’s perspective 371

synchrony. The click stimulus has a wide frequency bandwidth and is not frequency-
speciŽ c, but while the click excites a large part of the cochlear partition, the resulting
ABR is high frequency biased due to the synchrony eVects. In addition, click ABR
place speciŽ city (i.e. region of basilar membrane activity represented in the response)
is variable, depending on both the cochlear sensitivity proŽ le of the subject and
the stimulus presentation level used. Thus, clinical utility may be compromised.
Second, while tone pips are more frequency speciŽ c than clicks, place speciŽ city
remains variable, again, depending on the cochlear sensitivity proŽ le and the level
of the stimulus. In addition, tone pip ABR waveforms are poorly deŽ ned (especially
below about 1.5 kHz) needing increased averaged sweeps to overcome poor syn-
chrony and low s/n ratio. Improved tester skill is needed to identify the poorly
deŽ ned waveform (although objective response detection [ORD] may help here).
Place speciŽ city is improved by techniques involving high-pass or notched noise
ipsilateral masking (e.g. Parker and Thornton 1978, Stapells et al. 1995), but clinical
utility can be compromised by the extended time needed to obtain reliable responses.
Such limitations to clinical utility of the ABR have provided the impetus for
research into new objective techniques for audiological assessment. One such
technique, the auditory steady-state evoked potential (SSEP) to sinusoidally modu-
lated tones, has attracted much research attention in the last decade or so. The
SSEP is a new development discussed below.

Otoacoustic emissions
The mid-1970s saw the emergence of one of the most important discoveries in
hearing science: otoacoustic emissions (OAE). OAE are sounds recorded in the
ear canal, but generated by the physiological processes operating within the cochlea.
They have assumed major importance, both as a clinical index of cochlear function
and as a phenomenon that has forced the hearing science community to reassess
the nature of the physiological mechanisms operating within the cochlea. As with
the discovery of the ABR, the initial discovery of OAE by David Kemp at UCL
(1978) was not readily accepted by the scientiŽ c community. The problem was that
the then current passive model of cochlear physiology based on the Ž ndings of von
Békèsy (1960) could not explain the phenomenon of OAE. In fact, theories of a
possible active mechanism of cochlear physiology able to support the generation
of OAE had been proposed much earlier (Gold 1948), but had been discounted in
favour of the Békèsy model. These theories, involving cochlear non-linearity (and
distortion), have been revived and honed to account for OAE and, as a consequence,
our understanding of cochlear mechanisms has been revolutionized (Sininger and
Abdala 1998).

Types of OAE
There are two basic types of OAE, those that occur spontaneously and those
evoked by auditory stimulation. Spontaneous OAEs, while interesting in their own
right, have attracted little clinical interest. On the other hand, stimulated OAEs
have become very commonly used in contemporary audiology. Stimulated OAEs
can be evoked by transients (clicks or tone pips) or continuous tones.
A transient evoked OAE is shown in Ž gure 2. OAEs occur as delayed responses
to transient stimuli such as clicks and tone pips (Kemp 1978). The delay re ects
372 David J. Parker

Figure 2. Typical TEOAE waveform in response to click stimuli presented at 70 dB peSPL and at
Õ
a rate of 20 s 1 and recorded in the ear canal of a normally hearing subject. Responses to
256 stimulus repetitions were averaged. The initial portion of the waveform (marked ‘stim’)
includes the evoking stimulus and has been blanked out for clarity.

the return travel time for the stimulus journey from the external ear canal, through
the middle ear, into the cochlea and back again (including cochlear travelling wave
delay). The signal re-emerges in the ear canal as an OAE, where it is detected using
a very sensitive microphone. High-frequency OAEs have short delays since they
return from the base of the cochlea. Lower-frequency OAEs have longer delays,
since they return from the more distant apical cochlear locations.
Continuous tones can be used to elicit continuous OAEs (Kemp 1978). After
the round trip delay, however, both stimulus and response are present in the ear
canal simultaneously, making it problematic (though not impossible) to extract the
OAE signal alone. However, if two continuous stimulus tones (f1, f2) are presented
simultaneously, intermodulation distortion product OAEs at cubic diVerence fre-
quencies (e.g. 2f1 – f2) can be detected in the ear canal (Kemp 1979) and are easily
distinguished from the stimuli. Distortion product OAEs (DPOAEs) (Ž gure 3)
have now become very popular in contemporary audiology since they allow the
audiologist to tap into the distortion producing non-linear processes operating in
the cochlea, known to be vital for its Ž ne tuning and sensitivity (Geisler 1998,
Pickles 1988).

Clinical applications of OAEs

Since the outer hair cells of the cochlea have been shown to be responsible for
cochlear non-linearity, Ž ne tuning and sensitivity (Geisler 1998, Pickles 1988),
OAEs are now regarded as a sensitive indicator of cochlear outer hair cell func-
tionality. Clinical applications of all OAE types rely on this property to establish
the normal or abnormal functioning of the cochlea rather than for predicting
Contemporary issues in audiology: a hearing scientist’s perspective 373

Figure 3. Typical DP-gram recorded in the ear canal of a normally hearing subject. Two stimulating
tones (f1, f2) were presented at 70 dBSPL and with a frequency separation ratio of 1.22
(i.e. for f1 5 1 kHz, f2 5 1.22 kHz; f1 5 2 kHz, f2 5 2.44 kHz, etc.). Filled circles indicate the
DPOAE intensity at 2f1–f2 frequencies plotted as a function of f2. The grey areas indicate
the noise levels at frequencies adjacent to 2f1–f2.

hearing thresholds (cf. ABR ). Indeed, any hearing loss greater than about 30 dBHL
will likely result in diminution if not the absence of OAEs, even when stimuli are
presented at suprathreshold levels. DiVerential diagnosis of auditory disorders, by
establishing cochlear status, is, therefore, one of the major contributions of OAEs
to clinical assessment, particularly with regard to auditory neuropathy (Sininger
et al. 1995). The other major application of OAEs is in newborn hearing screening
(see the section on Newborn hearing screening below for further discussion).
However, whatever the application of the OAE technique, any pathology
aVecting the input of the stimulus or the output of the OAE (i.e. external and/or
middle ear pathology) will also have an eVect on the OAE, even in the absence of
any cochlear pathology. Clinical interpretation of abnormal OAEs must, therefore,
take this into account.

New developments in auditory evoked potentials

In addition to the development ABR and OAE technology described above, two
further major developments have occurred in the last 20 years or so and have
impinged signiŽ cantly on auditory evoked potential methodology.
First, in 1984, Rickards and Clark described a new evoked potential to amplitude-
modulated pure-tone stimuli. Subsequently, the response has been variously termed:
the SSEP, the modulation-following response (MFR) and the auditory steady-state
response (ASSR). MFRs have the potential to give fast, reliable frequency-speciŽ c
threshold information in children and adults.
374 David J. Parker

Second, during this period, a number of researchers developed and reŽ ned the
concept of ORD. ORD can now be implemented online by using statistical
procedures to identify, within known probability criteria, the presence or absence
of an auditory-evoked potential (e.g. Dobie et al. 1993). ORD is a signiŽ cant advance
since it removes the element of expert opinion (and its concomitant bias) in
the interpretation of evoked potential waveforms (particularly problematic with
standard ABR techniques).
In combination, these developments oVer the possibility of highly eVective
methodologies for fully objective threshold estimation in, for example, newborn
babies.

Auditory steady-state evoked potentials

SSEPs are a category of sustained electrical responses to continuous periodic visual
or auditory stimulation. Auditory responses are elicited typically by pure or modu-
lated tones. The continuous nature of the stimulus imparts a high degree of
frequency speciŽ city, unlike the transient stimuli used for recording the ABR. The
response, therefore, is attractive to audiologists who want to assess the functioning
of the auditory system at speciŽ c frequencies.
Scalp-recorded evoked potential responses to amplitude-modulated tones with
carriers at audiometric frequencies were Ž rst described in man by Rickards and
Clark (1984). They were subsequently studied by a number of research groups and
have been shown to be highly frequency speciŽ c (Kuwada et al. 1986) and eVective
at estimating hearing thresholds throughout the standard audiometric frequency
range. As demonstrated by Cohen et al. (1991), modulation frequencies around
40 Hz are the most eVective in alert adults. Modulation at higher frequencies around
70–100 Hz produce smaller responses, which are less aVected by sleep, but which
may be more suited to recording from sleeping infants (Levi et al. 1993, 1995).
Stimuli with combined modulation of amplitude and frequency produce enhanced
responses (Cohen et al. 1991). A typical MFR is shown in Ž gure 4.
Recent reports (e.g. Herdman and Stapells 2001) indicate that behavioural
thresholds can be predicted at audiometric frequencies to within 7–14 dB on average
(max. SD 5 13 dB). This is as good as, if not better than, tone pip ABR. In addition,
one highly signiŽ cant feature of the MFR not possible with ABR is that it can be
recorded simultaneously to multifrequency and multimodal stimulation (e.g. Lins
and Picton 1995). Thus, for example, if stimuli for 1 and 2 kHz are modulated at
diVerent frequencies (say 70 and 80 Hz, respectively) and presented simultaneously,
since the response follows the modulation of the stimulus (Ž gure 4), responses to
each individual frequency can be identiŽ ed and analysed based on the modulation
frequency used to evoke it (i.e. 70 Hz for 1 kHz, 80 Hz for 2 kHz). In other words,
several frequencies per ear and both ears can be tested at the same time, resulting
in enormous enhancement of clinical utility over, for example, tone pip ABR.
Given the emergence of commercial systems capable of recording SSEPs and
implementing ORD (e.g. John et al. 1998), the response is likely to be the future
evoked potential of choice for estimating thresholds for babies identiŽ ed by univer-
sal newborn hearing screening (see below) and referred for detailed audiological
assessment.
Contemporary issues in audiology: a hearing scientist’s perspective 375

Figure 4. Waveforms and spectra of an SSEP and its evoking stimulus. (A, B) The electrical waveform
and acoustical spectrum, respectively, of a carrier tone (800 Hz) modulated (in amplitude and
frequency) at 80 Hz. This stimulus was used to evoke the modulation-following response
(MFR ) depicted in (C ). Note how the MFR in (C) follows the envelope pattern of the
stimulus modulation (albeit with some phase delay). The frequency spectrum of the MFR
(D) shows that energy peaks appear around 80 Hz.

Current initiatives in audiology

The UK audiology profession is currently undergoing radical development within
its professional bodies, career and training structures, and services. Negotiations to
merge existing professional associations to form a unitary professional body are
well advanced, as are plans to rationalize career and training structures. One
signiŽ cant development in this regard is the establishment of undergraduate degree-
level entry to the profession. BSc degree programmes in audiology are now being
prepared for their Ž rst intake of students in September 2002. These programmes
have attracted substantial government-funding support to cover student tuition fees,
training-grade placement salaries and means-tested bursaries. These developments
are crucial to the future success of expanding audiological services and their need
for a highly qualiŽ ed work force.
Future expansion of audiological service provision is inevitable given that
audiological services are experiencing unprecedented development as a result of
recent government-backed initiatives: (1) modernization of hearing-aid services and
(2) a pilot and subsequent implementation programme of universal newborn hearing
screening. Considerable Department of Health funding has been provided to support
these initiatives, as described in more detail below.
376 David J. Parker

Universal newborn hearing screening

National UK screening of hearing at 7–8 months of age, using the Infant Distraction
Test (IDT), has been in operation since the 1960s, based on the pioneering work
of the Ewings at Manchester (Ewing and Ewing 1944). Despite some concern
about its eVectiveness over the years, the IDT has continued to operate with
qualiŽ ed support, until recently. In parallel to this, evidence has emerged that
periods of developmental activity, crucial for development of normal communica-
tion skills in babies, occur before any likely resultant intervention following a
positive IDT screen outcome. Thus, it is considered that identiŽ cation of permanent
childhood hearing impairment (PCHI) needs to occur earlier than 7–8 months of
age for eVective intervention and habilitation to be achieved (e.g. Markides 1986,
Yoshinaga-Itano et al. 1996).
This realization provided the impetus for development of earlier behavioural
tests of hearing, such as the auditory response cradle (Bennett 1979). In addition,
over the last 35 years, development of new technologies such as automated ABR
(AABR ) and OAE have made it possible for the audiologist to assess the status of
the auditory system, even in newborn babies. Such development begs the question:
given the need to initiate early intervention in cases of PCHI, should we use the
available technology to screen all newborn babies? The answer (a resounding yes)
is provided by Davis et al. (1997) in an in uential critical review of the role of
neonatal hearing screening in the detection of congenital hearing impairment.
Screening based on AABR and OAE technology has been the subject of world-
wide research since the mid-1980s (e.g. Mason et al. 1984, Kemp and Ryan 1993)
and this technology is now used routinely in a number of countries for universal
newborn hearing screening (UNHS).
In England, a national pilot implementation of UNHS has recently (2001/2)
started in 20 pilot health-service areas. The screen consists of a two-tier system
where newborn babies are tested at a moderate level in each ear, using TEOAEs
Ž rst. If this screen is positive (failed) in any ear, then the baby is retested using
AABR (click evoked). If the AABR screen is positive in any ear, the baby is referred
for detailed audiological assessment (usually including ABR ) with the aim of estab-
lishing threshold and ULL information for the early Ž tting of hearing aids. Babies
with bilateral positive AABR screens are given priority for detailed audiological
assessment.

Modernization of hearing-aid services

Much work done in audiology is associated with assessment of hearing loss and
Ž tting of hearing aids, in both children and adults. Successful Ž tting of hearing
aids depends on establishing, through detailed audiological assessment, the elec-
troacoustic, ergonomic and cosmetic hearing aid needs of the client. In the National
Health Service (NHS), conventional analogue hearing aids have, for many years,
been supplied, Ž tted and managed free of charge to the user. However, the most
up-to-date technology (the digital hearing aid) oVers the prospect of better provision
as a result of, for example, (1) more accurate electroacoustic matching to the hearing
loss, (2) noise control with directional microphones and noise suppression circuitry
and (3) better acoustic feedback control. Until recently, the digital hearing aid has
not been available on the NHS largely due to the high cost of such devices. In
Contemporary issues in audiology: a hearing scientist’s perspective 377

addition, other factors, such as the need for extra training of audiology staV and
the need for additional IT facilities, have impeded the uptake of digital hearing-aid
technology in the NHS. Therefore, in order for NHS hearing-aid provision to take
advantage of the digital technology, now increasingly available privately, services
would need to be modernized.
In 2000, a government-backed initiative to initiate the modernization of hearing-
aid services (MHAS) was introduced with the aim of bringing modern digital
hearing-aid technology to the NHS client. The programme is funded by the
Department of Health, managed by the Royal National Institute for Deaf People,
and is evaluated by the MRC Institute of Hearing Research. It has three main
objectives: (1) to develop a modern and eVective NHS service for hearing-impaired
people, (2) to evaluate the beneŽ ts and costs of providing digital signal processing
(DSP ) hearing aids within the new service and (3) to establish eYcient and eVective
supply mechanisms. Twenty ‘Ž rst-wave’ audiology departments are now (2002)
involved in this pilot modernization process. A further substantial investment
has been provided by the Department of Health, with the aim of rolling out
modernization to more NHS hearing-aid services.

Concluding remarks
As suggested in the Introduction, this review has looked, from the perspective of
a hearing scientist, at some of the important elements contributing to the current
status of audiology in the UK. Given that the role of audiological services is to
identify, assess and manage the eVects of hearing loss in people, then the elements
described above have impinged signiŽ cantly on all three of these areas.
In terms of identiŽ cation and assessment, the profession has seen two major
advances: (1) the development of technologies appropriate for use in establishing
hearing status in children and adults, and (2) introduction of universal newborn
hearing screening. ABR and OAE technologies have become crucial in identiŽ cation
and assessment, particularly in newborn babies and young children. Nevertheless,
the assessment of hearing thresholds in newborn babies may be improved further
by use of the SSEP, which appears to have many advantages over tone pip ABR.
In terms of management of the eVects of hearing loss in people, the profession
has seen a signiŽ cant investment in updating hearing-aid services so that manage-
ment strategies can take full advantage of digital technology. These advances should
be very good news for the hearing-impaired person: adults with acquired hearing
loss will beneŽ t from modern hearing-aid services and newborn babies with congen-
ital hearing loss will beneŽ t from the enhanced communication prospects resulting
from early identiŽ cation, better assessment and Ž tting of better hearing aids.
Furthermore, knowledge of these advances is important to other professionals who
work with children with communication disorders. It is clear that in future, speech
and language therapists and other related professionals can expect much more
accurate and consistent information about the hearing status of children referred
to them.
Finally, these are interesting times for professional interactions between speech
and language therapists and audiologists. The possibility of closer professional
interaction is enhanced given the context of audiology becoming a graduate-based
profession with a unitary professional body, a status already long established in
speech and language therapy.
378 David J. Parker

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