Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program.

BACKGROUND: Guidelines and protocols for pediatric hearing aid fitting are necessary to meet the goals of Early Hearing Detection and Intervention (EHDI) programs. The American Academy of Audiology published an update to their Pediatric Amplification Guideline in 2013. Ontario's Infant Hearing Program (IHP) offers specific protocols that aim to fulfill recommended guidelines. It has recently been updated to align with the American Academy of Audiology Guideline and other evidence. PURPOSE: A summary of the updates to the Ontario IHP's Amplification Protocol is described. In addition, data illustrating hearing-related outcomes of the program are offered. RESEARCH DESIGN: The updated Ontario protocol is based on evidence, wherever possible. Where research is not yet available, clinical decision support has been described in a systematic way. Outcomes of the Ontario IHP were obtained through a longitudinal clinical observation study. STUDY SAMPLE: One hundred and fifteen children with hearing loss, who wore hearing aids, were included in the outcome analyses (mean = 28.6 mo; range = 1.3-115.3 mo). Hearing losses ranged from mild to profound, unilateral or bilateral sensorineural (pure-tone average = 52.3 dB HL). They were recruited from four IHP clinics within Ontario. Children with complexities in addition to hearing loss were included. INTERVENTION: The children were fitted with hearing aids following Ontario's Amplification Protocol. DATA COLLECTION AND ANALYSES: During routine clinical appointments, IHP Audiologists administered questionnaires to the parents of their pediatric patients using a systematic outcome measurement protocol (University of Western Ontario Pediatric Audiological Monitoring Protocol). Hearing aid fitting details (e.g., speech intelligibility index) were also gathered to describe the quality of the hearing aid fittings in relation to the functional outcomes. Regression analyses were conducted to characterize scores on the questionnaires and the impact of important variables. Children with complexities were analyzed separately from those who were typically developing. RESULTS: Important updates to Ontario's Amplification Protocol offer new details about candidacy considerations as well as technical updates. Outcomes from the IHP reveal protocol elements can be executed clinically and when they are, typically developing children who wear hearing aids are meeting auditory development and performance milestones. CONCLUSIONS: Updates to Ontario's Amplification Protocol are necessary to support the evolution of EHDI programs and the evidence which sustains them. With advances in technology and additional research, pediatric hearing aid fitting will continue to progress and support systematic measurement of outcomes for children who wear hearing aids. The application of state-of-the-art hearing aid fitting practices to the pediatric population within EHDI programs supports good outcomes for infants and children with hearing loss.

Stimuli and normative data for detection of Ling-6 sounds in hearing level.

PURPOSE: The purpose of this work was to develop and evaluate a calibrated version of the Ling-6 sounds for evaluation of aided detection thresholds. Stimuli were recorded, and data from calibration values in dB HL were developed. Aided performance was characterized in adults and children. METHOD: Stimuli were recorded, prepared, and transferred to a CD for testing. Initial testing was completed on 29 normally hearing young adults to determine typical responses in dB SPL and reliability. Corrections to dB HL were determined for each stimulus. Twenty-seven adults and 5 children with hearing losses were tested. RESULTS: Average normal sound field thresholds were 1 dB HL. Aided thresholds for adults varied with unaided hearing level and were better for low-frequency sounds. Adults and children performed differently, possibly because of greater hearing aid gain for children. CONCLUSIONS: Stimulus preparation and shaping resulted in a recorded, calibrated set of Ling-6 stimuli that provide flat normal thresholds in hearing level for normally hearing listeners. Typical performance ranges may vary with hearing level and prescription. More data are required to fully characterize this trend in the pediatric population.

The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP).

This study proposed and evaluated a guideline for outcome evaluation for infants and children with hearing loss who wear hearing aids. The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP) was developed following a critical review of pediatric outcome evaluation tools and was systematically examined by the Network of Pediatric Audiologists of Canada. It consists of tools to gather clinical process outcomes as well as functional caregiver reports. The UWO PedAMP was administered to a clinical population of infants and children with hearing aids. Sixty-eight children were administered the functional outcome evaluation tools (i.e., caregiver reports) a total of 133 times. Clinical process outcomes of hearing aid verification (e.g., real-ear-to-coupler difference) revealed typical aided audibility (e.g., Speech Intelligibility Index). Results for the LittlEARS(®) questionnaire revealed that typically developing children with hearing loss who wear hearing aids are meeting auditory development milestones. Children with mild to moderate comorbidities displayed typical auditory development during the 1st year of life after which development began to decline. Children with complex factors related to hearing aid use had lower scores on the LittlEARS, but auditory development was in parallel to norms. Parents' Evaluation of Aural/Oral Performance (PEACH) results indicated no age effect on scoring for children above 2 years of age; however, the effect of degree of hearing loss was significant. This work provides clinicians with a systematic, evidence-based outcome evaluation protocol to implement as part of a complete pediatric hearing aid fitting.