DR LAURIE UPFOLD, one of the founding fathers of audiology in Australia, received an OAM in the 2024 King’s Birthday Honours. A living industry treasure, his memory is as sharp as ever at age 90 as he recalls helping to build the profession in Australia.
As one of the nation’s first audiologists, and a founding member of Audiology Australia, Dr Laurie Upfold has lived through decades of hearing advances, was instrumental in developing Australia’s first behind-the-ear hearing aid, trained many audiologists and fitted thousands of people with hearing aids.
But his greatest achievement was during Queensland’s 1963 rubella outbreak when he helped show that babies could be tested for hearing loss and fitted with hearing aids.
Fast forward 61 years and Dr Upfold is walking to the mailbox at his Narrabeen home in NSW. “I found a letter from the Governor General’s office saying I was receiving the Medal of the Order of Australia for service to people who are deaf or hard of hearing. I didn’t believe it! Why should I get such a thing? I was amazed but very proud indeed,” he says.
After graduating from Sydney University’s New England University College in Armidale with a BA majoring in psychology and a history minor, he was employed in 1960 as a psychologist at the government’s Commonwealth Acoustic Laboratories (CAL), now the National Acoustic Laboratories, where he spent the next 30 years.
CAL provided hearing aids for children and deafened war veterans. Dr Upfold knew and understood what the veterans were talking about as he had the same high frequency hearing loss from his shooting history in national service. He saw a variety of deafness problems in veterans including acoustic trauma and middle ear disturbances because the world wars occurred before effective antibiotics and stapedectomy.
“I was fascinated, it was useful work and I enjoyed it immensely,” he says.
As there were no audiologists in Australia, CAL employed psychologists and trained them in audiology. Lead psychologists Dr Brian Harold and Dr Roland Farrant studied audiology overseas and returned to Australia to train him and others.
“There were 12 people doing audiology in Australia in the 1960s, all at the acoustic laboratories, spread over six states,” Dr Upfold recalls.
“I was told training would be ‘on the job’ because there was no university course on the field in Australia, and chief psychologist Dr Farrant was in America doing a PhD in the field, which was called ‘audiology.’ Dr Harold, my supervisor, had completed a PhD at Manchester under Sir Alexander and Lady Irene Ewing, best known for their work testing the hearing of babies.
“I was given a manual, in which was written all that was known about and how to perform hearing tests for adults and children over three, and two texts, Davis and Silverman’s classic Hearing and Deafness and Ira Hirsh’s Hearing and Hearing Tests. I had an office with a sound-reduced test booth large enough to accommodate a tester, client, parent, desk and equipment.”
After one month’s training he was put to work with repatriation patients and after six months was introduced to school age children then later learnt the Ewing ‘meaningful sounds’ technique for testing babies.
The hearing aid was the Calaid T (for “transistor”), a body level hearing aid in a stainless-steel case in five power levels, with a volume control and induction switch but no tone controls. For every 10 decibels of average hearing loss over 40dB, the aid would move up a step in power which made selection easy, particularly as there was no earmould venting or frequency control variation, he recalls. He also ran lip reading classes to overcome poor speech recognition for people with hearing loss who did not respond well to the Calaid T.
Rubella epidemic
After two years Dr Upfold was promoted to a position in the Queensland laboratory in 1962.
“The rubella outbreak in Queensland in 1963 was Australia’s second biggest epidemic,” he recalls. “We fitted 131 hearing impaired children with maternal rubella histories – one a day for a long time – and there were maybe another 100 with unknown aetiology. It’s no fun to sit and talk to a parent and say your child is never going to speak properly or be in normal education but we were able to help many and provide them with some hope.”
CAL was the state’s only centre for testing babies and young children. “This opened avenues of communication with ENT specialists, deaf schools, paediatricians, speech pathologists and handicapped children’s facilities and led us to begin advocating for early detection of deafness in babies because our work with the rubella children showed it was possible to test babies and fit them with hearing aids,” he says.
“Thus began a career-long interest in rubella, on which I have published several papers, the first in 1970 in the Medical Journal Of Australia, the last in 2004 in the Australian and New Zealand Journal of Audiology.”
An ENT surgeon suggested Dr Upfold compile rubella data and publish it in the MJA to urge GPs to refer affected children more quickly for hearing tests. “Some were saying you couldn’t do anything, you can’t test these kids, they’re too young. These deterrents to early diagnosis were problems and that was the point of the articles, to attract the attention of GPs to the problem of German measles in pregnancy,” he recalls.
The strategy worked and more children came forward. It also put the young audiologist on the international map and helped spread the message overseas.
“We were able to make a difference to these kids, particularly those who weren’t totally deaf,” he recalls. “There was a lot of interest in rubella at this time and by the time the Australian babies were one, the Northern Hemisphere epidemic of 1964 was raging and people were looking at what we were saying and doing. A lot of my information was available to them and it was a great help and gave me many overseas contacts.”
Dr Upfold recorded numbers of rubella cases annually and put this information out in various forms including papers on German measles and pregnancy and letters to medical journals in the hope doctors would read them, especially when vaccination was introduced. He remembers one mother of a deaf rubella child who refused to let her other child be vaccinated.
“But vaccination worked, and we never see a rubella deaf child anymore,” he says. “My most important research was on rubella. It was there to support vaccination, attitudes to rubella and its likely sequelae.
“We showed it was possible to diagnose and fit babies and after that, it became standard that babies were fitted with hearing aids, more research occurred in the field and eventually we had a very effective way of testing day old babies. Now every newborn in Australia has a hearing test which is great as we can find them early enough to give them the best possible opportunity in life.”
In 1947, when CAL was established, it fitted veterans and deaf children with hearing aids.
“No-where in the world had anything like the problem Australia had because in 1940 the worst rubella epidemic recorded happened here. No-one believed (Sydney ophthalmologist) Sir Norman Gregg when he started saying German measles caused blind babies after hearing two mothers talking in the corridor saying they both had rubella in pregnancy. The world laughed at him but he eventually proved maternal rubella in early pregnancy caused birth defects,” Dr Upfold recalls.
“In the 1940s people believed what happened in pregnancy would not get through to babies and this was the first time anyone recognised that conditions in utero could affect the baby.”
Another advance he was involved with included diagnosing acoustic neuromas. This occurred after publication of a monograph on diagnosis in 1964 and a new surgical treatment of the neuromas involved otologists for the first time, using procedures adapted from the middle ear surgical technique via microscope.
“This was very exciting to otologists, who developed increased awareness of the need for diagnosis,” Dr Upfold says. “A major diagnostic tool was audiometry, particularly the Bekesy audiometer, and CAL had Queensland’s only one, so we saw every acoustic neuroma case from 1962 to 1970 – and I was now a confirmed audiologist.”
Hearing aid revolution
In the mid 1960s a revolution in CAL’s hearing aid work occurred as until then the only hearing aid available was the body-worn Calaid T.
“Suddenly, a new type of aid appeared, an all in-the-ear model called Calaid E,” Dr Upfold says. “By today’s standards, it was awful but back then it really was extraordinary as most hearing aids worldwide were behind-the-ear types, and it was not until about 1972 that Starkey’s marketing brilliance began to make the US market adopt in-the-ear types.
“The E was the leading hearing aid in a government program supplying free hearing aids, not in a commercially dominated market. There was nothing like this anywhere in the world. Calaid E began my love affair with hearing aids which lasted the rest of my career.”
In the 1970s, CAL provided the training course for audiologists in Australia, recruiting 40 or 50 students a year with a psychology background and training them in audiology for a year, but the cost was enormous and some would finish training then quit.
“We had to do something, so we went to the universities and said why don’t you start post-graduate courses in audiology? It’s big-time in America. They saw the point and we guaranteed them jobs against what we knew would be increasing demand; we were sure we could provide jobs if they’d provide graduates,” Dr Upfold says.
Queensland University was the first to take up the offer with a Diploma of Speech Therapy followed by the University of Melbourne’s audiology course instigated by cochlear implant pioneer Professor Graeme Clark who saw the need.
Dr Upfold began working with the universities to develop audiology courses and they were soon under way in all states except Tasmania.
“The profession has grown and grown, and we now have more than 3,600 qualified audiologists as members of Audiology Australia, about 98% of the total practising. I’m very proud of having played a part in doing all this,” he says.
Dr Upfold, a fellow and the first life member of Audiology Australia (AudA), attended all AudA conferences until recently and sponsors the Laurie Upfold prize at AudA conferences for the best paper from a first-year presenter. His ties to the peak body date back to its formation in 1968 as the Audiological Society of Australia, established with 10 founding members, including himself, the councillor for Queensland.
“By this time about 20 people were practising audiology in Australia.
The Victorian group was meeting once a month talking about the latest papers and got in touch with everyone and said, ‘why don’t we have a society of audiologists?” he recalls.
Soon after the federal government introduced a scheme for free hearing aids for pensioners to be supplied by the CAL.
“We had the time between the government announcement in 1967 and 1 April 1968 to get ready for the scheme, to get all the hearing aids and staff we needed and train them at CAL in Sydney. It was a big rush job but we trained about 40 people – the equivalent of a two-years Masters course in six months – and it worked well.”
Dr Upfold believes the government was waiting for the Calaid E as such a scheme depended on having a modern on-the-head type hearing aid.
“I was immediately drafted into a position where I worked up many of the administrative details necessary to implement this policy. I’d previously been part of a Health Department team determining the cost of providing hearing aids to CAL’s clients,” he says.
“I became CAL chief psychologist in 1971 and I like to think I gave two significant things to the Australian audiologist: the hearing aid as a significant professional tool, for research and controllable clinical application; and a professional name and definition of the audiologist’s role and work outlook.
“It was apparent to me the future of CAL, and hence Australian audiology, was in the hearing aid but there was little knowledge or research supporting hearing aid activities.”
In the 1960s, there had been only one research innovation, the CROS aid. The CAL course devoted 6% of its time to hearing aids or 8% including ear impression technique, but nothing on acoustics of the hearing aid, Dr Upfold recalls.
Developed behind-the-ear hearing aid
The CROS did not use an earmould, which meant its low frequency amplification was reduced, a big advantage, giving the opportunity to make hearing aids more appropriate for not-so-deaf people. Dr Upfold wrote a paper on CROS aids for the Australian Journal of Otolaryngology, pointing out the control it offered to low frequency amplification was its major advantage and this could be tailored using earmoulds with different diameter vents.
He told CAL director, physicist Mr Raymond Piesse, that “we now know something about varying the output conditions of a hearing aid”.
“I recommended we quickly develop a behind-the-ear model hearing aid to take advantage of the venting possibilities and to enable us to use more power in an on-the-head aid. This was the conception of the Calaid H, CAL’s first behind-the-ear aid,” Dr Upfold says.
Colleagues Mr Denis Byrne and Mr Bill Tonisson came up with a selection procedure based on audiometric measurements, not speech, which could be applied to children. It was based on audiometric thresholds and is still the basis of all aid selection procedures. “My task was to implement its use in CAL’s work, and to sell the procedure nationally and internationally. This was a very successful time in my life,” Dr Upfold says.
After three decades with CAL, as administrative tasks grew, he missed practising so quit government work for private practice. He was then a widower, and worked for audiologist Ms Beth McLeod, a widow, in her practice MAC Audiology, now part of the Connect Hearing group, in Sydney. The pair became a couple and the practice is still going, now run by Dr Upfold’s son Greg, Australia’s first second-generation audiologist.
In 2008, Dr Upfold wrote A history of Australian audiology, for which he received a PhD from Macquarie University. While practising part time, he wrote the book, a legacy of being a ‘frustrated historian’ from university days. Phonak sponsored it and after the print run finished, leftover copies were given to Australian universities and audiology students.
“I got my PhD 23 years after I got my Masters Honours, a thesis on deaf children and causes, granted in 1985. I enjoyed writing the book and travelling around the country talking to people; it was a good ‘end of professional life’ opportunity. It had to be written and I was probably the best person to do it, especiallly -considering I’d been there while most of it was happening.”
When he looks back on his career Dr Upfold says: “I’m most proud of the fact I’ve been part of a maturing, thriving profession which is now recognised around the world for its independent research and its service delivery. And I’m also proud that my son Greg is the first second-generation audiologist in Australia.”
