Opinion Editorial by Frank Bialostozky
Say the word: hot dog. Yes…SAY THE WORD: HOT DOG. In an age of blue-tooth connectivity, nanotechnology, deep-brain stimulation and robotic surgery, audiologists are asking their patients to say a word describing a food developed over a hundred years ago that is potentially composed of meat by-products. Regardless of how many vegans are in the waiting area, requesting the repetition of hot dog (or airplane or ice cream, for that matter) may not be an appropriate way for audiologists to introduce themselves to a new generation of patients. What message does “hot dog” send about professional knowledge and skills in what should be viewed as a highly technical field. Audiology is facing a spondee crisis. It can be averted if action is taken quickly, but responsibly.
The W-2 spondee list is a treasure dating from the early 1950s. Gratitude should be given to both the Harvard Psychoacoustics Lab and the Central Institute for the Deaf for developing the list and ensuring more than a half-century of usefulness. But that was over 60 years ago. Hard-wired rotary telephones, black and white television, and propeller aircraft were the norm. Hearing aids were mostly body-worn, and audiologists did not dispense them. The spondee list of the 1950s worked well for “The Greatest Generation” and will probably do as well for baby boomers, but gen-xers and certainly millennials are going to expect much more.
Spondee word lists and test methodology have been analyzed, studied, discussed, modified, debated and re-named (Asha, 1988). Throughout these many years, it has always been stipulated that a critical characteristic of the spondee list was its familiarity to the general public. Also, it was (and still is) recommended that the list is read to patients before testing to reinforce that familiarity (Tillman and Jerger, 1959). Regrettably, that part of the protocol is often omitted given time constraints in most clinical settings. Although the W-2 list remains familiar to most patients, when did you last hear a 20-something use the words inkwell, padlock, or drawbridge in complete sentences? The familiarity of the W-2 list can no longer be assured. And, perhaps more importantly, the W-2 spondees date audiologists as relics of the past when they so desperately want to portray themselves as vibrant, current and technically competent professionals. Simply put, are the W-2 spondees familiar enough to today’s patients and do they create the respect audiologists want?
Millennials continue to represent an ever-increasing percentage of the population. The Census Bureau predicts that the 75.3 million millennials (ages 18-34) will soon surpass baby boomers as the largest age-group in the U.S. (Kunkle, 2015). Boomers (ages 51-69) held that position for many years, but sadly it is inevitable that their numbers will decline. Are audiologists ready for millennials to elbow the boomers out of their waiting rooms and OCCUPY their test booths? Millennials may not represent audiology’s largest population now, but they will. Can audiologists afford to use word lists that are neither familiar nor impressive to an increasingly important segment of the population?
What follows is a modest proposal for a new “TWENTY-FIRST CENTURY SPONDEE LIST.” The TFCSL-1 solves the problem of familiarity for millennials and will certainly impress (if not amuse) those new to an audiologist’s office.
Potential Alternate Words
The proposed list solves the issue of familiarity but undoubtedly will require some further analysis. Those with the requisite skills will need to evaluate the list for both phonetic dissimilarity and homogeneity of audibility (Olsen and Matkin, 1979). Even a well-constructed list could meet resistance when displacing something as sacred as the W-2. But modifications of test protocols to accommodate special populations are not unprecedented. Toddlers are asked to point to body parts, and limited set picture-cards are employed with those under five. The millennials may also need to be viewed as a particular population for whom accommodations must be made. At first, something as radical as the Twenty-First Century Spondee List may not be readily accepted by all. Why not just implement the list with millennials and as their numbers increase so will the use of the list. By the year 2065, the W-2 will be completely phased out (along with the boomers) and millennials, along with the TFCSL-1, will be firmly entrenched.
Adopting new test materials will not completely resolve all of the issues when measuring spondee thresholds of millennials. Although they will certainly be impressed with words like BITCOIN and RINGTONE, they still may not offer appropriate responses. Based on history-taking and conversations before testing, the audiologist may be concerned when complete silence follows a request to SAY THE WORD: HASHTAG (or any other word from the TFSCL-1.) What could be the motivation for not responding when it is evident the millennial should be able to hear the presentation? Could it be pseudohypacusis? Perhaps. But there is no need to panic. Reconnecting equipment for galvanic skin response testing or dusting off “Swinging-Story Test” materials should not be necessary. Although most boomers are perfectly willing to talk into microphones, millennials can appear non-verbal. Even with those in the same room, their preferred method of communication is often texting. As audiologists, flexibility is paramount. When “say the word” does not get a response at any presentation level, the millennial should be given the audiologist’s cell number, and the test procedure should be modified. TEXT THE WORD: YOUTUBE should be substituted for SAY THE WORD: YOUTUBE. The phone will ring and texting along with testing will proceed without difficulty. Problem solved. This new procedure will require a new name and acronym: “Texting to Elicit Spondee Thresholds”, or more easily remembered as the “TEST” test.
Most would agree that even if the TFCSL-1 and the TEST test could be adopted, a change in spondee threshold measurement would not be a transformational event in the history of audiology. However, the TFSCL-1 should remind us that nothing should or can last forever, not even W-2’s. All industries and professions are subject to disruption if they cannot adapt. That is especially true when there is a tendency to dwell on the minutiae of everyday activities and lose sight of the bigger picture. One could argue that W-2s fall into the minutiae category.
If evolution does not come from within a field, then erosion may easily come from external forces. If the larger issues facing audiology are not addressed, other professions, as well as product manufacturers, will continue to influence the future direction of the field, and not always in a favorable way. Licensing and AuD battles may have been won, but too many other “practitioners” infringe upon or overlap with audiology. Although decades of Audiology Awareness Months and Better Hearing and Speech Months may have improved recognition of the audiologist’s role, that role is not completely understood by the public. And, unfortunately, when there is money to be made, others will take note and attempt to provide what the public wants in other ways.
The TFCSL-1 and the TEST test may just be marginally amusing reactions to testing habits that need some modification. Indeed, any new spondee list reflecting current vocabulary would become obsolete in ten years or less as common vocabulary evolves. Limited longevity is part of the issue. Many procedures and products in the twentieth century had life-cycles much longer than we experience today. Audiology will need to adjust more quickly and continue to question methods and policies much more substantive than the measurement of spondee thresholds.
Although change just for the sake of change would be inappropriate, the field cannot engage in routine practices just because they feel comfortable and have been used for many years. The profession should always be questioning common practices. Are there more efficient ways to obtain the information generated by a standard audiological evaluation? How should the merits of new hearing aid technologies be assessed promptly (independent of manufacturers) to determine if they should be used in daily fittings? What are the practical and ethical dilemmas of continuing to use advertising methods that were discredited years ago when used by others in the hearing healthcare arena?
Patient populations, technology, the insurance landscape and competing delivery systems are all evolving and so should audiology. Whether there is a spondee crisis is debatable, but audiology in the age of the millennial will have to subject itself to ongoing evaluation. Change will have to be embraced more quickly. If audiologists do not initiate that change, there is a greater risk that others will impose it.
Full disclosure: To the best of his knowledge the author has no financial interest in any corporation or organization involved in the production or distribution of spondees.
Frank Bialostozky, MA, is semi-retired. He was private practice audiologist in the Baltimore and Washington areas of Maryland for over 30 years. The opinions, ideas, and thoughts expressed in this article are those of the author and not those of the American Academy of Audiology.
Kunkle F. (2015) Millennials will soon surpass Baby Boomers as largest living generation. Washington Post (1)16.
American Speech-Language-Hearing Association. (1988) Determining threshold level for speech [Guidelines]. Available from www.asha.org/policy.
Tillman T, Jerger J. (1959) Some factors affecting the spondee threshold in normal-hearing subjects. J Speech Hear Res 2:141-146.
Olsen W, Matkin N. (1979) Speech Audiometry. In: Hearing Assessment. Baltimore, University Park Press, 133-206.
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