Becoming a Pediatric Vestibular Audiologist: Melissa Caine, AuD

“Becoming a _____ Audiologist” is a continuation of the “So You Want to Be a _____ Audiologist” Interview series, and is dedicated to informing students of the vastness of audiology and how they can become the audiologist they never knew they wanted to be.

Dr. Melissa Caine is a clinical specialist and audiologist who works in the Center for Childhood Communication and the Balance and Vestibular Program at Children’s Hospital of Philadelphia (CHOP). Dr. Caine will be presenting on Pediatric Vestibular Testing at the SAA Conference 2021 Virtual on Wednesday, April 14, along with Dr. Violette Lavender. 

Q: Where did you receive your bachelor’s and doctoral degrees? 

A: I received my Bachelor of Arts in Communication Disorders as well as English Literature from Loyola University Maryland and my Doctorate of Audiology from Salus University.                                                                                                                 

Q: What made you want to become an audiologist in general? 

A: Honestly, I stumbled into audiology by chance. I knew very early on that I wanted to work with children in healthcare but wasn’t sure what field. I found myself in my second semester of sophomore year in college and a bit lost on the career path. I wasn’t enjoying the pre-med coursework and disheartened at a future of so many years of schooling ahead before I could specialize. Like many young adults do, I complained to my mother about it and she suggested that I check out Loyola’s career development office for some guidance. That led to taking a career aptitude test, which revealed a 95% match with audiology. I had no idea what an audiologist did and neither did my career counselor. After a very cursory internet search, I changed majors for the following year. I liked that after four years of graduate studies I would enter a profession that made a difference in the everyday lives of children. Reflecting back now, I just had a gut feeling that it would be a good fit and it has all worked out for the best! 

Q: More specifically, what made you interested in becoming a pediatric vestibular audiologist?   

A: It’s a specialty that combines my two main clinical interests: pediatrics and diagnostic care. I’m truly a diagnostician at heart. I enjoy analyzing clinical data to formulate results and apply them to develop individualized patient recommendations. It’s also a great match with my personality and how my overall thought process works. I simply love a good puzzle that needs solving! It’s very fulfilling to determine the cause for a patient’s particular symptoms and assist them towards an improvement in their quality of life. But to science geek out for a moment… the vestibular system is just so fascinating to me. It’s beautifully complex both in anatomical design and function. It’s fragile, yet able to adapt and compensate – especially for children. And it’s responsible for so much that we do beyond dynamic movement. 

Q: What opportunities or classes do you remember from your under/graduate career that really helped you solidify your interest in pediatric vestibular audiology?    

A: I received an excellent education at Salus and was fortunate to have two wonderful teachers that solidified my interest in both pediatrics and vestibular assessment. Dr. Eileen Rall brought such energy and passion to the classroom every week and obviously loved being a pediatric audiologist. Dr. Terri Ives presented the complex anatomy of the vestibular system and the diagnostics of testing in such a fantastic and approachable manner. Everything in that class clicked for me; it was like my brain was pre-set to process it. Centers with pediatric vestibular programs were even more rare when I was obtaining my doctorate, so I was limited to adult testing during my clinical placements. I had to merge and apply knowledge and skills from the classroom and placements to get an idea of what pediatric vestibular testing would look like. After graduation, I chose to pursue a pediatric audiology position at CHOP with a long-term career goal to integrate pediatric vestibular testing to their diagnostic services.

Q: What do you do as a pediatric vestibular audiologist? In what ways is vestibular evaluation and rehabilitation for kids different than it is for adults?  

A: Pediatric and adult vestibular evaluations are the same in that you use the identical set of diagnostic tools to assess the vestibular system. After that, it becomes very different. Let me focus on what it’s like instead of describing testing procedures.

Pediatric vestibular audiologists are highly skilled clinical chameleons. We adapt and shape ourselves to the individual patient’s interests in order to achieve our testing goals. We take the standard vestibular testing battery and determine which of those tests are appropriate to use for each patient given their age, developmental level, medical history, and reported symptoms. Once we determine the individualized testing battery, we deploy every skill possible to determine if the patient’s vestibular system is normal or abnormal. Every single appointment will be different. Assessing a twenty-month-old with bilateral profound sensorineural hearing loss, autism spectrum disorder, and who loves singing “The Wheels on the Bus” will look very different than a three-year-old Paw Patrol expert experiencing benign paroxysmal vertigo of childhood (BPVC). 

Even older children that can complete a full testing battery require a different set of skills based on the symptoms bringing them in for testing. Evaluating a thirteen-year-old with chronic, unmanaged anxiety and motion intolerance needs a different clinical touch than a fifteen-year-old athlete recovering from a case of neuritis, who wants to be back running cross country yesterday. 

We have an abundance of patience, but also know when to challenge a patient to press on with testing. We find ourselves unofficial experts in the art of verbal distraction. It’s amazing the amount of testing you can accomplish simply by talking with your patient constantly. It keeps the younger children engaged and less likely to fatigue, and it provides a mental shift for stressed or bored older children. In one day, we’ll go from singing popular baby songs, to discussing the latest TikTok trends, to guessing when the next Taylor Swift album will drop before we hit lunch time. It’s challenging and exhausting, but so much fun.

Q: What kind of placements would you suggest to a student wanting to go into pediatric vestibular audiology?  

A: While the number of centers offering pediatric vestibular testing is growing, it’s still difficult to find placements. But there are certainly ways to work around this barrier. Given the low prevalence of pediatric vestibular disorders in the general population, I would suggest that you first determine if you are an adult vestibular audiologist that also wants to evaluate children or if you are a pediatric audiologist that wants to provide the full spectrum of hearing and balance care. That decision should guide you in how to split your placements between pediatrics and adult vestibular. Since placements alone may not provide the hands-on experience you are looking for, I would take advantage of educational opportunities outside your program. There are online resources through the Academy’s eAudiology and Audiology Online. The AAA Conference always has educational modules dedicated to pediatric vestibular topics. Other pediatric organizations and institutions frequently host conferences/meetings, which will include pediatric vestibular related lectures. I also recommend reaching out and networking with clinicians in the pediatric vestibular circles. We’re a friendly and fun group! Plus, we love what we do and enjoy talking about it. The best piece of advice I can give is to stay up to date on the education, so you have the foundational knowledge ready to be put into action with further training. 

Q: You are also an inpatient audiologist and a general pediatric audiologist. Can you describe what it is like to be both, and what kind of responsibilities each entail?                                                                                                                    

A: My position at CHOP allows for me to provide a full range of diagnostic and rehabilitative care. About 50% of the time, I’m in one of our outpatient clinics conducting audiological evaluations, hearing aid evaluations/checks, sedated and natural sleep auditory brainstem response (ABR) testing, or supporting an otolaryngology clinic. The other 50% of my time is split between the Balance & Vestibular Program and inpatient care. When assigned to inpatient care, I mainly perform newborn hearing screenings and diagnostic ABRs in our neonatal intensive care unit and cardiac intensive care unit. These babies often have complex medical histories requiring surgical intervention or ongoing advanced medical care shortly after birth. These inpatient care units are the most challenging environments to conduct testing; it is equally rewarding to be part of the medical team for this population. Aside from strong diagnostic skills, you benefit by having a broad range of medical knowledge, which you acquire over time. Also, well-developed communication and interpersonal skills are a necessity given the high-stress and fast-paced nature of inpatient care.

Q: How do you manage to juggle so many different specialties?  

A: I enjoy having a diverse and challenging schedule. It keeps the job exciting to have a mix of appointment types that utilize my various skills in different ways day-to-day. I go into each day with a flexible mindset and adaptable attitude. You never know what the day may bring so be prepared for any possibility! Strong organizational and time management skills are also important assets to have when pivoting between specialties. But most of all, my work-life balance plan is what keeps me at my professional peak week-to-week. Work-life balance is crucial to keeping your mind and body healthy for yourself and your patients. 

Q: What do you know now that you wish you knew when you pursued a career in either pediatric audiology, pediatric vestibular audiology, and/or inpatient audiology?

A:

1. You will make clinical errors and mistakes just like everyone else. What matters most is that you are accountable and that you learn from them. 
2. You never stop being a student. There is something new to learn every day from your patients, their families, and your colleagues. 
3. The smartest people you’ll meet in the profession are the first to admit that they don’t have all the answers for every clinical situation. But they will know where to go and who else to talk to find it. They are also the people who make the best teachers so learn all you can from them.

Q: Is there anything else you want to say or suggest to students considering this field broadly and/or this specialty specifically? 

A: I’m sure there’s loads more I could say, but instead I’ll suggest that anyone considering a career in pediatrics or pediatric vestibular assessment reach out to me or another leader in the field to discuss their interest further. 

Finally, thank you to SAA for inviting me to take part in this series. I hope the student members find it helpful while determining their professional career path.

This interview was completed by Adam Sulaiman, a second-year AuD student at the CUNY Graduate Center in Manhattan, NY. Adam is a member of the Communications Committee and his interests in audiology include diagnostics and vestibular audiology.