Pediatric Fitting: Verification and Validation Flashcards
What is the sequence in the pediatric amplification process?
Assessment
Selection
Verification
Orientation
Outcome evaluation
When should amplification be provided?
By 6 months (JCIH, 2007)
By 3 months (JCIH, 2019)
Delay that will compromise that objective must be avoided wherever possible
What are some challenges and considerations in pediatric hearing aid fittings?
Anatomical differences (ear canal size is different)
Growth
Environment change (spend most of their lives in quiet environments prior to preschool)
Not well-defined hearing deficit
What are the three major reasons why special considerations apply to fitting hearing aids to children?
Rapidly changing ear canal acoustics
Limited ability to provide reliable behavioral and verbal responses
Need for better SNR and sound access for speech and learning
What are the main goals of amplifying children?
To provide an amplified speech signal that is consistently audible across levels
To avoid distortion of varying inputs at prescribed settings for the user
To ensure the signal is amplifying sounds in a broad frequency range
To include sufficient electroacoustic flexibility ear growth or changes in the auditory characteristics of the infant
When should the fitting our due to JCIH 2007?
One month after diagnosis
Should permanent hearing loss fittings be delayed if there is ongoing ME effusion treatment?
No
When possible, what should be included in the amplification process?
Audiometric thresholds for both ears
Consultation by an otolaryngologist
RECD, if fitting an air conduction hearing aid
Accurate ear impression(s)
Assessment of non-electroacoustic needs
DSL m[i/o] v5 target ear canal sound pressure levels (SPL)
Parent/caregiver Instruction and counseling sessions
Hearing aid verification
Evaluation of the outcome of the intervention
Appropriate follow-up schedule
What happens next for children who fail the newborn hearing screening?
Infants who fail a newborn hearing screening are referred for full diagnostic assessment that includes otoscopy, tympanometry, OAEs, and ABR tests
The information from the diagnostic ABR evaluation will be used for the purpose of fitting hearing aids
Infants have limited ability to provide reliable behavioral and verbal responses to stimuli
What are the assessment methods for infants and young children?
Behavioral thresholds (can be limited)
ASSR
ABR (frequency and ear specific)
BOA
What is a challenge about testing infants?
Electrophysiological tests
May need sedation
What is a challenge about testing toddlers?
Transition to behavioral testing
How do you test infants with stenosis or atresia?
Test using bone conduction at 500, 2000, and 4000 Hz for the affected ear(s)
Threshold estimates at other frequencies (e.g., 1000 Hz) are recommended, but not required for the initial provision of amplification
Are responses for ASSR in infants lower in amplitude than for adults?
Yes
What are some ASSR advantages?
Multiple frequencies can be tested simultaneously
Simultaneous testing of both ears
Faster than ABR
Objective response analysis
Stimuli are easier to calibrate
Potential applications for objective hearing aid evaluation
What are some ASSR disadvantages?
Lack of longitudinal data compared to behavioral thresholds for hearing-impaired kids
Artifact responses at high intensity levels
Lack of data on infants
What is the ABR assessment protocol in infants?
AC ABR toneburst thresholds at 500, 2000, and 4000 Hz; also, at 1000 Hz when indicated
BC ABR toneburst thresholds at 500 and 2000 Hz; when indicated
Click ABR to assess cochleo-neural status (as needed)
Diagnostic DPOAE for cross check and ANSD
Tympanometry at 1000 Hz
Ipsilateral reflexes at 1000 Hz with a 1000 Hz probe
How are ABR thresholds reported?
Results will initially be reported in dB nHL
dB nHL ≠ dB HL; dB nHL < dB HL
Both dB nHL and dB HL are defined with reference to adult norms
Do the electrophysiological thresholds need to be converted into the predicted behavioral thresholds?
Yes
By the use of appropriate correction factor
This conversion may be done by the audiologist manually, within the test equipment, or within the hearing fitting software
How does DSL implement ABR data?
By allowing threshold entry in normalized HL (nHL)
By allowing a behaviorally equivalent measure (eHL)
Do the ABR thresholds tend to be higher than the actual thresholds?
Yes
if you enter the data in nHL without converting it, you will end up overamplifying the child
What is the importance of verification?
Essential to avoid over-amplification during periods of rapid growth (regular evaluations)
Objective measurement is essential to ensure amplification supports effectively supports the acquisition of acoustic cues necessary for stimulating neural connections within the auditory system
RECD measurements conducted at regular intervals serve as an objective tool to confirm that amplification is achieving its intended purpose
Why do we use RECD?
Small ears; calibration issues
Hearing aid output will be higher in an infant ear canal than in an adult ear canal
RECD measures the difference between a child’s ear canal and an acoustic coupler to estimate accurate amplification levels in the child’s ear canal
Children cannot stay quiet and sit still long enough for REM
What is the purpose of RECD?
To correct and convert HL thresholds to the SPL format used by many fitting methods and real ear approaches
To fit the hearing aid in the test box
