Marion Downs was “born in a state of euphoria and never left.” So said the woman widely recognized as “the mother of pediatric audiology” as she pondered the introduction to an autobiography she's not sure she'll ever get around to writing.
At 94 years of age, Dr. Downs, who holds an honorary doctor of science from the University of Northern Colorado, certainly has a wealth of life experiences to share: overcoming the skeptics to revolutionize hearing care for infants; writing more than 100 books and articles during a half century in academia; being mother, grandmother, or great-grandmother of 24; surviving a plane crash and two bouts with cancer; and letting nothing stop her from continuing to play tennis, ski, and take the occasional skydive.
But maybe she feels it's too soon to look back at her life's story, since she's still adding to it. Now professor emerita at the University of Colorado Health Sciences Center, she remains deeply involved in her signature cause: identifying and treating hearing loss in children at the earliest age possible. It was for that, among other achievements, that last November she received the Secretary's Highest Recognition Award from the U.S. Department of Health and Human Services.
AN ACCIDENTAL AUDIOLOGIST
Ironically, her entry into audiology was a matter of chance. In 1948 Marion Downs was a young wife with three small children. A Minnesota native with a bachelor's degree from the University of Minnesota, she had recently moved with her family to Colorado. Now, she decided, the time had come to prepare for a career, and so she headed to the University of Denver to enroll in graduate school. Seeing the long lines at many registration tables and with no clear idea what she wanted to study, she decided to choose the shortest line—which happened to be for the speech-pathology and audiology program.
“I had never heard of audiology,” Dr. Downs said, “but it was a short line, and the people were nice there, so I registered for it and fell in love with it.”
She immediately gravitated toward children, who, she observed, were often neglected by male audiologists. She said, “Most men at that time didn't do anything with children; they never took care of them, and they didn't really understand children well, particularly babies.”
After earning her MA from the University of Denver in 1951, she joined its faculty and soon began fitting hearing aids on young children. This was a time when many believed there was no point in providing very young children with amplification. However, she discovered that the earlier a child received help for a hearing impairment, the better the child did in developing speech and language skills.
“I started way back in the ′50s and ′60s to spout ‘let's get them young and put hearing aids on them,’ and people were astounded,” Dr. Downs recalled.
In 1959, the University of Colorado Medical Center in Denver invited Marion Downs to join its newly established otolaryngology department. She gladly accepted the offer, realizing the importance of practicing audiology in a medical setting, she said.
THE ROAD TO NEWBORN HEARING SCREENING
Physicians at the hospital encouraged her to experiment on testing newborns in the nursery for hearing loss, and she developed ways of doing so, largely by using hand-held, battery-operated noisemakers she invented that would emit a blast of very loud noise. Dr. Downs also asked the Junior League of Denver to assist her, and she trained volunteers to screen the babies that were born each day.
Even newborns were very responsive to sound, Dr. Downs found. They turned their heads toward sound, and noise could arouse them from sleep, which, she realized, meant that it should be possible to determine if even the youngest infant could hear.
Marion Downs and the Junior League volunteers screened nearly 17,000 newborns a year, working in several hospitals in Denver, said Jerry Northern, PhD, who at the time was working right across the street at the Denver VA Hospital. Of those 17,000, about 17 were found to be profoundly deaf.
“The techniques we used had a lot of false positives and false negatives,” said Dr. Northern, who later worked alongside Marion Downs as director of the otolaryngology department at the Colorado Medical Center from 1970 to 1996. He added, “People were concerned that if it wasn't 100% accurate, then maybe it wasn't a good screening test, that it would miss babies who were deaf and falsely identify babies who could hear.”
Identifying infants at risk
Realizing that the test's unreliability did subject it to criticism, Dr. Downs reached out to the American Hearing Association for permission to form a national Joint Committee on Infant Hearing (JCIH). In 1969, the committee held its first meeting. Audiologists, otolaryngologists, pediatricians, psychologists, nurses, and members of the National Organization of the Deaf all agreed on the need for a high-risk register that hospitals could use to determine which newborns should be screened for hearing loss. By its second meeting, the JCIH had decided the criteria for inclusion on the high-risk register.
For many years, the high-risk register was the standard for identifying which babies to test for congenital hearing loss, Dr. Downs said. She recalled, “We would test these babies in the sound room and give them all the tests we knew at this time, and we found a lot of babies. But a national study found that we were still missing 50%,” she said.
Everything came together
In 1972, Downs and Northern, whom she still regards as her mentor, co-authored Hearing in Children, the first pediatric audiology book. Published by Lippincott Williams and Wilkins, Hearing in Children is now in its fifth edition and still widely used.
“It was different because it brought in a lot of aspects of the medical field that audiologists at that time didn't [learn about] in their graduate programs,” said Dr. Northern. “As the first pediatric book, it was a pretty important addition to the literature of our field.”
In the late 1970s, the advent of computerized EEG enabled anyone with a little training, not just healthcare professionals, to screen newborns. As a result, use of this “foolproof instrument,” as Dr. Downs calls it, became standard practice.
The discovery of otoacoustic emissions (OAE) followed in the next decade, and the National Institutes of Health suggested the use of OAE measurement in its recommendation that all babies, not just those on the high-risk register, be screened for hearing loss.
Although the concept of newborn screening was slowly gaining acceptance, many physicians were still uncomfortable with the idea of placing hearing aids on babies, believing that they would destroy the newborn's neurons before they had matured.
Fortunately, studies performed in the 1980s showed the benefit of stimulating the brain early in life, particularly the sensory cells. Neurologists reported that the billions of neurons in the auditory cortex of the brain at birth cannot connect until they are exposed to auditory stimulation, (i.e., until babies hear sound).
Meanwhile, Christine Yoshinaga-Itano, PhD, head audiologist on the faculty of the University of Colorado at Boulder, was conducting research to find out how the speech and language skills of children whose hearing losses had been identified in infancy and treated very early compared with those of children whose hearing losses were not treated until they were older. When Dr. Yoshinaga-Itano, who is now vice-provost of diversity and equity at the University of Colorado, published her findings, they showed that those children who had been fitted with hearing aids as babies fared far better in speech and language than children whose hearing losses were discovered and treated later.
“That was really wonderful research and I think it was the thing that impressed the professional community enough to realize it [universal newborn screening] had to be done,” Dr. Downs said. “You know how things can all come together at one time? That was such a time.”
Dr. Yoshinaga-Itano then received a grant to teach people in other states how to screen newborns, and the hub for this effort, located in Boulder, was named the Marion Downs Hearing Center.
A CONTINUING INSPIRATION
After nearly 40 years of advocacy, universal newborn screening had become standard practice in every state by the end of the 1990s.
“Many of us now take it for granted that newborns should be tested. But it was quite a struggle for many years, starting when Marion first went to our nursery in the early 1960s trying to convince everybody that it was a good idea,” said Sandy Gabbard, PhD, director of audiology at the Colorado Medical Center and co-director of the Downs Center. She met Dr. Downs in 1980 when she came to the University of Colorado Medical Center as a graduate student to work with her and Dr. Northern.
She added, “Marion's inspiration continues to drive us in our search for better answers and better ways of providing services. Her philosophy has always been to empower families with information to make good choices.”
Dr. Downs has continued to inspire others even in semi-retirement, lending her advice and counsel wherever needed, particularly in the efforts of the Marion Downs Hearing Center Foundation. The foundation is working to build a center that will house all audiology services from birth to old age.
“Currently, I just support good causes. It's all one does at 94, believe me,” she said. But in her case, that's far from the truth. In 2005 she published Shut Up and Live!, subtitled A 92-year-old's guide to getting there.
She explained, “I was reading all these things that young people were writing [about how to get to 90] and I thought, ‘Oh, those guys have no idea.′ There they were, 50 years old, 60 years old, speaking with great confidence about how to get to 90 and feel good and so forth,” Dr. Downs said.
“Some people, I think, when things happen just sit down and say, ‘Oh, I'm old′ and give up. I wanted them to know, you don't have to give up when bad things happen to you, as they will. You have to fight every way.”
“Old age ain't for sissies,” she added, quoting the actress Bette Davis. And certainly her life is a testament to that notion.
STILL FEARLESS, AFTER ALL THESE YEARS
Just as she overcame the conventional wisdom that infants couldn't be tested for hearing loss or fitted with hearing aids, Marion Downs is just as determined in fighting physical battles these days. Despite having had her share of ailments and conditions (which she prefers not to dwell on), she is still playing tennis regularly (and winning tournaments in her age group), skiing, and trying to get in a good walk every day. For her 90th birthday, she treated herself to her first skydive, something her family wouldn't allow her to do before.
“Finally at 90 I decided no one is going to tell me not to do it this time, so I just went out and did it,” she said. “I've never been afraid of anything; it's just not my nature.”
It's that fearlessness that allowed Dr. Downs to make the contributions to the field of pediatric audiology that inspired the Department of Health and Human Services to give her its most prestigious award.
“It was an outstanding honor, and she was most deserving of it. We're all very proud to have worked with her,” Jerry Northern said.
He continued, “She was always looking ahead and thinking about the next challenge. She was an innovative thinker. She didn't just build on other people's ideas—she literally came up with her own questions.” He added, “She was very tenacious. She would stay on those topics until she could get an answer.”
Marion Downs is still on top of things, said Sandy Gabbard, who noted that even today it's hard to keep up with her either personally or professionally. “She continues to challenge us with new program ideas and new things she'd like to see happen. It's almost a full-time job trying to implement her ideas.”
Even Dr. Downs has to admit that she has never really slowed down. “Sometimes I'll think, ‘Tomorrow I'll sit down and just do nothing and enjoy myself.′ But then something happens and all hell breaks loose,” she said laughing.
It's her mornings, she said, that keep her sane and connected. “My mornings, I just love them. I'll go and have my coffee and have my breakfast, and read the paper and watch TV, find out what's going on in the world and then get on with it.”© 2008 Lippincott Williams & Wilkins, Inc.