Helping the deaf to hear again

Whether they're curing tinnitus or fitting children with the right hearing aids, audiologists can perform miracles. Nick Jackson hears how working with ears can change lives

That garrulous old lecher Voltaire called ears the avenues to the heart. And the job of retuning them when they become faulty, whether to pick up the softest of sweet nothings or, more prosaically, to help you keep your balance, has never been more complex or more interesting.

Paul Jones always knew he wanted to be an audiologist. His interest in ears came less from the heart than the hearth.

Jones had a deaf grandmother. "She was like a second mum to me," he says. "Through her, I got used to working with deaf people, and that's what got me into the job."

As a recently qualified audiologist, Jones works with everyone from newborn babies to 90-year-olds at the Great Western Hospital in Swindon. His job is to test hearing and diagnose levels and degrees of deafness, provide advice and support for patients, and fit hearing aids. Most people do not simply have impaired hearing across the spectrum, but rather bands of impairment at higher or lower frequencies. To give the best treatment, you need to gauge the frequency involved and adjust the hearing aid to that level.

Like all new audiologists, Jones started off as a generalist, but is now moving into paediatric audiology. "Paediatrics is more complex and more interesting," he says. This is largely because young children cannot tell you whether or not they are deaf, and certainly not at what frequency.

This means that an objective analysis of the physiology of a child's ear is needed, for example, by analysing oto-acoustic emissions, the echo you get from an ear. Most people see the ear as a passive receiver, like a microphone, but by generating a clicking sound and listening to what sound comes back, audiologists can tell what's wrong with it.

The appeal of paediatrics is not only technical. "It comes down to how you are with kids," Jones says. "That's why I enjoy my job so much." And working with children, you can make the greatest impact. "You can diagnose problems so early now, you can make a real difference to a child's life," he says. "If you can get a hearing aid on to a child before they're six months old, you're helping them learn, because they learn so much in those first six months."

More children than ever before are being given access to hearing aids before they are six months old, thanks to a government strategy to screen all newborn babies for deafness within their first few weeks of life.

It is just one policy in which audiology specialists such as Karen Gaudoin are involved. As well as helping to implement newborn screening, Gaudoin works for the Royal National Institute for the Deaf. She joined the RNID two years ago to coordinate the introduction of digital hearing aids, which are easier to tune to the frequency of a patient's deafness and cut out background noise.

In April, that project came to an end, but there are always new policies to be lobbied for and current ones to be coordinated, and this autumn she will be going to her first party conferences to raise the profile of audiology.

It's not something she could have imagined herself doing 20 years ago. While Jones knew he wanted to be an audiologist when he left school, as a science undergraduate, Gaudoin only knew what she didn't want to do: be a doctor or a teacher. "I'd never thought about audiology at the time," she says. "I'd never heard of it."

When she did find out about it, it was the job security guaranteed by a national shortage of audiologists, as much as the job itself, that appealed.

Twenty years in the job have shown her there's much more to it than that. "It's a really exciting area to work in," she says. "There are always new things on the horizon, new initiatives, tests, treatments. And it's a good mixture of science and patient contact."

If the science of testing, diagnosis and fitting hearing aids seems too technical and you're more interested in the patients, there is also the option of becoming a hearing therapist.

"I'm interested in what makes people tick," says Lucy Handscomb, 34, a hearing therapist for St Mary's NHS Trust, in Paddington, central London. "I wanted to do a job helping people but wasn't interested in medicine."

Handscomb's job is to help people deal with the psychological strain of hearing loss and reduce the impact of tinnitus, or ringing in the ears. It's the tinnitus work that interests her most. The noise level of tinnitus varies massively, from a whispering 20 decibels to a rattling 70 decibels, roughly equivalent to the sound of a lawnmower. There's no cure and it rarely disappears on its own.

But there is no correlation between how loud the tinnitus is and how much it bothers the patient, so, through relaxation techniques, patients can learn to limit the impact of the condition, and even become so used to it that they barely notice it.

"I can help people move from being completely distressed by their tinnitus to not finding it a problem," she says. "And it doesn't involve doing anything to them. You're just helping them understand it better."

It was just such an interest in psychological solutions to physiological problems that attracted Joanna Beyts to working as a clinical scientist working in audiology. Trained as a psychophysiologist, Beyts is now a vestibular scientist at the Royal National Throat, Nose and Ear Hospital, in London's King's Cross, with 15 years' experience of treating people with balance problems - there are, she says, more than 90 causes of dizziness.

Beyts treats patients using relaxation, and breathing and eye exercises. "Simple information and exercises can make such a difference," she says. "Dizziness can be easily treated, and it seems awful that people can become housebound because of it."

That empathy and concern for patients is central to a career in audiology, where - as any loquacious lover will tell you - it's not just the ears that count, but the person who is attached to them.

The lowdown

How do I qualify?

In the past few years, the various routes into audiology formerly available have come together in a new four-year BSc in audiology, and a one-year MSc for science graduates. For the BSc, three of the four years are spent at university, with another year on placement. NHS-sponsored students have their fees paid and get a means-tested bursary. You may be paid a trainee salary during your placement year.

Will I get a job?

Yes! There is a national shortage of audiologists.

How much will I earn?

BSc graduates start on just over £10,000, MSc graduates on just over £17,000. Most audiologists earn between £20,000 and £40,000. Top dogs earn up to £68,000.

Where will I work?

Most audiologists are employed by the NHS, working either in hospitals or clinics, but there are also jobs available with charities, at universities and with social services and education authorities.

Useful contacts

www.nhscareers.nhs.uk

Exploring the relationship between audiology and education

'You can see the children's progress and achievement'

John Elwood, 58, is an educational audiologist for Cumbria education authority

I became interested in deaf children when I was working as a teacher in New Zealand in the 1970s. There was a rubella epidemic and the incidence of deafness increased dramatically. Deafness is a hidden handicap, so the epidemic really brought it to the fore.

Now I work in a floating role, covering the whole of Cumbria county, visiting schools, clinics and homes. As an educational audiologist, I'm trained as both a teacher and an audiologist, and my role is to bring together education and audiology and look at the relationship between them.

I oversee the use of hearing aids at home and in school, supplying and monitoring radio hearing aids where the teacher uses a transmitter to overcome background noise. I provide support for specialist teachers, whether that's with equipment or the acoustic environment, and make sure they're doing their job from an audiological aspect. In addition, I establish policies and protocols in schools and do acoustic surveys of classrooms. And I liaise with the health side on hearing reviews, linking the clinic to the education setting.

The rubella epidemic got me interested in deaf children, but I continued working with them because the work you're doing is more obvious in terms of the difference that you're making. You can actually see the children's progress and achievement.

One example is when you fit a hearing aid to a child and see the response a child gives to using the little hearing they have left through amplification. You usually get some kind of reaction. That may be crying or ripping it off, but generally it's positive.