Hearing care and management priority among parents of children with Down syndrome: a grounded theory.

OBJECTIVE: This study qualitatively explored the factors that influence how parents of children who are Deaf or hard-of-hearing with Down syndrome prioritise hearing care and management and developed an associated theory to explain that priority. DESIGN: Grounded theory was used for the purposes of this qualitative study. Data were collected using in-depth interviews which were analysed using a three-tiered qualitative coding process. STUDY SAMPLE: Eighteen mothers of children who are Deaf or hard-of-hearing with Down syndrome participated in this study. RESULTS: The higher the extent of engaged professional support, perception of benefit for child, parent activation, and family engagement, the higher the priority for hearing care and management will likely be among parents of children who are Deaf or hard-of-hearing with Down syndrome. CONCLUSIONS: Understanding how parents of children who are Deaf or hard-of-hearing with Down syndrome decide to prioritise hearing care and management has implications for how hearing health providers and others provide care to parents to enhance priority for hearing-related needs.

Classroom Listening Experiences of Students Who Are Deaf or Hard of Hearing Using Listening Inventory For Education-Revised.

Purpose This study examined classroom listening experiences reported by students who are deaf or hard of hearing using the Listening Inventory For Education-Revised (LIFE-R). Method Retrospective electronic survey responses from 3,584 school-age participants were analyzed using descriptive statistics to report student perceptions of listening difficulty in various classroom scenarios, including the strategies students used when they did not hear or understand. Stratified data were used to explore potential differences between grades and across degree of hearing loss or type of hearing technology. Results Average student listening appraisal ratings for 15 classroom, school, and social scenarios was 5.7 based on a 10-point Likert scale (0 = difficult, 10 = easy), highlighting listening difficulties encountered during the school day. This finding can be considered in context with the average rating of 7.2 reported from a previous study of students with typical hearing using the LIFE-R. The greatest difficulties were reported when trying to listen when other students in the class were making noise and in hearing the comments of other classmates. Average listening difficulty was greater for respondents in Grades 3-6 than those in Grades 7-12. Listening difficulty also generally increased relative to degree of hearing loss. When unable to hear, some students took proactive steps to improve their listening access; some reported they did nothing. Conclusions Students who are deaf or hard of hearing can face challenges in hearing and understanding throughout the school day. A functional tool to evaluate and monitor student experiences, such as the LIFE-R, can provide information to make necessary and effective adjustments to classroom instruction and the listening environment.

Parent challenges, perspectives and experiences caring for children who are deaf or hard-of-hearing with other disabilities: a comprehensive review.

OBJECTIVE: The purpose of this literature review was to explore parent challenges in caring for children who are deaf or hard of hearing with other disabilities and discuss implications for audiologists related to supporting families. DESIGN: A comprehensive literature review was conducted, and through qualitative analysis, emergent themes were identified, and a narrative summary generated. STUDY SAMPLE: Nine research studies were included in this review. Combined, these studies reflect a sample of 111 children, 23 families and 41 parents. RESULTS: Three broad themes were identified, and include parent-reported challenges related to family, professional and child variables. Sub-themes were identified within each broad theme to further describe parent experiences, such as challenges related to decision-making and planning, interprofessional collaboration, and child communication and behaviours. CONCLUSIONS: Parents of children with hearing loss and additional disabilities face unique challenges related to family, professional and child variables that could impact how they manage their child's hearing care.

Counseling in Pediatric Audiology: Audiologists' Perceptions, Confidence, and Training.

BACKGROUND: Pediatric audiologists are an important source of support for parents when a child is identified with hearing loss. As parents learn how to manage their child's hearing loss they often need help navigating challenges that arise; however, audiologists may experience a variety of barriers implementing effective counseling strategies. Many internal and external barriers experienced by parents can be appropriately supported and navigated within audiology services. PURPOSE: To investigate audiologists' perceptions, training, and confidence related to counseling and to explore the influence of years practicing audiology and taking a counseling course on perceptions and confidence. RESEARCH DESIGN: A cross-sectional, population-based survey. STUDY SAMPLE: Three hundred and fifty surveys were analyzed from pediatric audiologists across the U.S. Responses were received from 26 states and one U.S. territory. DATA COLLECTION AND ANALYSIS: Data were collected through the mail and online. Descriptive and comparative statistics were used to analyze the information. Content analysis was performed to identify emergent themes from the responses to open-ended questions. RESULTS: Pediatric audiologists reported their perceptions about importance of counseling skills, challenges they encounter, their confidence in counseling, and how often they use the skills when needed in practice. Most audiologists (≥75%) felt it was very or extremely important to talk with parents about nine of the ten items (e.g., their [parents'] expectations). Three-fourth of the audiologists reported experiencing a moderate challenge or greater in knowing how to assess the presence of psychosocial challenges and in having enough time to address emotional needs. Many of the audiologists felt very or extremely confident in guiding parents in the development of an action plan (62%) and determining if parents have external barriers (60%). Approximately one-third or less of the participants reported performing any of the skills (e.g., determining if parent has external or internal barriers) ≥75% of the time, and a statistically significant difference was found with participants practicing ≤10 yr using the skills more frequently than participants practicing for ≥11 yr. In addition, there was a statistically significant difference between participants who had taken an audiology-specific counseling course and those who had not; those who had reported being more confident and using counseling skills more often than audiologists did not have a counseling course. CONCLUSIONS: This study found strong support for audiologist perceived importance of counseling; however, fewer audiologists reported confidence in their counseling skills and in using counseling skills. Counseling training was variable; audiologists would benefit from a more systematic approach to counseling instruction within graduate training.

Opportunities for Audiologists to Use Patient-Centered Communication during Hearing Device Monitoring Encounters.

Patient-centered care incorporates patient's priorities, values, and goals. Audiologists can increase patient engagement when they use patient-centered principles during communication. Recent research, however, has revealed counseling gaps in audiology that could be detrimental to the intervention process. The present study sought to understand the extent patient-centered communication strategies were used during hearing device monitoring visits by analyzing audio recordings. Counseling portions of the appointments were transcribed using conversation analysis. Missed opportunities were observed, including not validating patients' emotional concerns, providing technical responses to emotional concerns, providing information without determining patient desire for the information, and not engaging the patient in a shared planning process. Training opportunities to enhance audiological services will be discussed.

Performance Feedback to Increase Use of Counseling Skills.

Counseling is a critical component of audiological care and when implemented purposefully can yield multiple benefits for patients. Professional guidelines indicate that counseling is within the scope of practice for audiologists, yet research has shown that audiologists feel unprepared and are not comfortable providing adjustment counseling. This may be due to inadequate counseling training in audiology graduate programs. To identify ways to address this counseling training gap, this study examined the use of performance feedback to increase counseling skills among audiology graduate students. In this study, participants ( n = 5) were recorded during clinical session encounters, and recordings were coded for time spent counseling. A licensed clinical psychologist reviewed the recordings and provided individual performance feedback to participants over the course of the study. Time spent counseling increased by the end of the study, although improvement varied across participants. Results suggest that performance feedback can be used as a method to increase counseling skills in audiology students. However, factors, such as participant motivation, feedback timing, and prerequisite counseling skills, may influence response to feedback. More research is needed on ways to maximize gains from feedback, as well as other methods to improve counseling skills in audiology students.

Pediatric Hearing Aid Management: Challenges among Hispanic Families.

BACKGROUND: Hearing aid fitting in infancy has become more common in the United States as a result of earlier identification of hearing loss. Consistency of hearing aid use is an area of concern for young children, as well as other hearing aid management challenges parents encounter that may contribute to less-than-optimal speech and language outcomes. Research that describes parent hearing aid management experiences of Spanish-speaking Hispanic families, or the extent of their needs, is not available. To effectively support parent learning, in a culturally sensitive manner, providers may benefit from having a better understanding of the needs and challenges Hispanic families experience with hearing aid management. PURPOSE: The purpose of the current study was to describe challenges with hearing aid management and use for children from birth to 5 yr of age, as reported by Spanish-speaking parents in the United States, and factors that may influence hearing aid use. RESEARCH DESIGN: This study used a cross-sectional survey design. STUDY SAMPLE: Forty-two Spanish-speaking parents of children up to 5 yr of age who had been fitted with hearing aids. DATA COLLECTION AND ANALYSIS: Responses were obtained from surveys mailed to parents through early intervention programs and audiology clinics. Descriptive statistics were used to describe frequencies and variance in responses. RESULTS: Forty-seven percent of the parents reported the need for help from an interpreter during audiology appointments. Even though parents received information and were taught skills by their audiologist, many wanted to receive more information. For example, 59% wanted to know how to meet other parents of children who have hearing loss, although 88% had previously received this information; 56% wanted to know how to do basic hearing aid maintenance, although 71% had previously received instruction. The two most frequently reported hearing aid use challenges were fear of losing the hearing aids, and not seeing benefit from the hearing aids. Hearing aid use during all waking hours was reported by more parents (66%) when their child had a good day than when their child had a bad day (37%); during the previous two weeks, 35% of the parents indicated their child had all good days. CONCLUSIONS: Hispanic parents wanted more comprehensive information, concrete resources, and emotional support from the audiologist to overcome hearing aid management challenges. Understanding parents' perspectives, experiences, and challenges is critical for audiologists to provide appropriate support in a culturally sensitive manner and to effectively address families' needs.

Audiologists' communication behaviour during hearing device management appointments.

OBJECTIVE: The aim of this exploratory study was to describe audiologist communication behaviours during appointments for hearing device monitoring and management before and after participation in counselling skills training. DESIGN: The study used a longitudinal design with three assessment points over 6 months. STUDY SAMPLE: The sample included 10 audiologists and audiology graduate students interacting in a professional setting with their clients. RESULTS: Audiologists reported improvement in their counselling skills from pre-training to follow-up, which was consistent with objective findings that audiologist relative speaking time decreased from pre-training to post-training as well as from pre-training to follow-up. Observer-rated scores of participants' counselling skills; however, yielded no significant differences across time. CONCLUSIONS: Some improvement was noted in audiologists' counselling behaviour following a 1-day communication skills workshop and continued learning support. It is evident; however, that further training, such as increased training and performance feedback, is needed to maintain and enhance audiologist progress in the various aspects of counselling.

Paediatric hearing aid management: a demonstration project for using virtual visits to enhance parent support.

OBJECTIVE: The purpose of this study was to explore the use of virtual visits to monitor hearing aid use with data logging measurements and provide parent support for hearing aid management. DESIGN: A 6-month longitudinal case study design was used. STUDY SAMPLE: Four families and two providers participated. RESULTS: Average hours of daily hearing aid use increased 3.5 h from the beginning to the end of the study period. Prior to receiving virtual visits, the parents and the clinicians generally indicated they were hopeful about the benefits of virtual visits including the frequency and convenience of the appointments but had some concerns about technical difficulties. These concerns diminished at the conclusion of the study. CONCLUSION: Virtual visits provided benefits to families including flexibility and timely access to support. The ability to collect data logging information more frequently was important for effective problem-solving to increase hearing aid use. Both parents and clinicians were accepting of tele-support. Parents and professionals would benefit from technology that allows them to access data logging information more easily and frequently.

Parent perceptions of their child's communication and academic experiences with cochlear implants.

OBJECTIVE: To explore parent perceptions of communication and academic experiences of cochlear implant (CI) recipients under the age of 18. DESIGN: Cross-sectional survey design. Two surveys (K-12, birth-5) queried parent perceptions of the impact of CI on communication, listening in various environments and academic achievement. Surveys contained 16-23 multiple choice and/or Likert ratings, plus four open-ended questions to assess reasons for obtaining a CI, satisfaction with CI and suggestions for professionals. STUDY SAMPLE: Surveys were sent to 156 parents of CI recipients; 81 surveys returned; response rate 52%. RESULTS: According to parent report, 95% of K-12 children and 100% of preschool children used spoken language as their primary mode of communication; majority of K-12 children performed same as or better than peers across academic subjects; 99% of respondents were pleased with their decision to obtain a CI. The most important reasons reported for choosing CIs were for their child to use the same language as their families and to effectively communicate in hearing society. Satisfaction with CI was better in quiet than in noise. Respondents stressed the importance of audiologists having excellent skills in CI management and programming. CONCLUSIONS: Respondents were positive about the benefits of obtaining CI for their child.

The effectiveness of commercial desiccants and uncooked rice in removing moisture from hearing aids.

OBJECTIVE: In many low- and middle-income countries, the availability of hearing technology is limited, with few options for hearing aid repairs. Minimising moisture damage to hearing aid electronics improves function and longevity; however, desiccants that absorb moisture from hearing aid components are unavailable in many regions. This study compared the effectiveness of uncooked white rice and seven commercial silica gel desiccants in removing moisture from hearing aids. DESIGN: Relative humidity measurements in a test chamber were obtained from a water-saturated BTE hearing aid prior to and after placement in uncooked white rice and seven different silica gel desiccants. STUDY SAMPLE: Two BTE hearing aids, seven silica gel desiccants and white rice comprised the study sample. RESULTS: All desiccants and the white rice were effective in removing moisture from hearing aids, with Hal Hen Super Dri Aid showing the largest mean reduction in relative humidity. Based on analysis of covariance results, white rice was statistically similar to several of the commercial desiccants. CONCLUSIONS: White rice shows promise as an effective alternative to commercial desiccants in reducing moisture in hearing aids when silica gel products are unavailable. As this study was conducted in a relatively dry region, additional research may be needed.

Pediatric Hearing Aid Management: Parent-Reported Needs for Learning Support.

OBJECTIVES: The aim of this study was to investigate parent learning and support needs related to hearing aid management for young children, and factors that influence parent-reported hours of hearing aid use. DESIGN: A cross-sectional survey design was used to collect survey data in seven states. The child's primary caregiver completed a demographic form, a questionnaire to explore parent learning and support needs as well as their challenges with hearing aid use, and the patient health questionnaire to identify symptoms of depression. Three hundred and eighteen parents completed the questionnaires. RESULTS: Responses were analyzed for 318 parents of children (M = 23.15 months; SD = 10.43; range: 3 to 51) who had been wearing hearing aids (M = 15.52; SD = 10.11; range: <1 to 50 months). Even though the majority of parents reported receiving the educational support queried, approximately one-third wanted more information on a variety of topics such as loaner hearing aids, what their child can/cannot hear, financial assistance, how to meet other parents, how to do basic hearing aid maintenance, and how to keep the hearing aids on their child. The most frequently reported challenges that interfered with hearing aid use (rated often or always) were child activities, child not wanting to wear the hearing aids, and fear of losing or damaging the hearing aids. Forty-two percent of parents reported that, on good days, their child used hearing aids all waking hours. Multiple regression was used to compare the effect on parent-reported typical hours of hearing aid use based on good days for the variables of (1) presence of depressive symptoms for the parent, (2) child age, (3) family income, (4) primary caregiver education level, (5) presence of additional disabilities for the child, (6) degree of hearing loss, and (7) length of time since the child was fitted with hearing aids. There were statistically significantly fewer hours of reported hearing aid use when parents reported mild to severe symptoms of depression, lower income, less education level, and when children had mild hearing loss or additional disabilities. CONCLUSION: Although parents reported overall that their needs for hearing aid education and support had generally been met, there were important suggestions for how audiologists and other service providers could better meet parent needs. Hearing aid use for young children was variable and influenced by a variety of factors. Understanding parent experiences and challenges can help audiologists more effectively focus support. Audiologists are more likely to meet the needs of families if they take care to provide access to thorough and comprehensive education and ongoing support that is tailored to address the unique needs of individual families.

Improving support for parents of children with hearing loss: provider training on use of targeted communication strategies.

BACKGROUND: When proper protocols are followed, children who are identified with a permanent hearing loss early in life have opportunities to develop language on par with their typical hearing peers. Young children with hearing loss are dependent on their parents to manage intervention during early years critical to their development, and parents' ability to effectively integrate recommendations in daily life is foundational for intervention success. Audiologists and early intervention professionals not only need to provide current evidence-based services, but also must address parents' emotional and learning needs related to their child's hearing loss. PURPOSE: This study explored practice patterns related to education and support provided to parents of children with hearing loss and the influence of an in-service training on provider attitudes. RESEARCH DESIGN: This study used a prepost design with a self-report questionnaire to identify practice patterns related to communication skills and support used by providers when working with parents of children with hearing loss. STUDY SAMPLE: A total of 45 participants (21 professionals and 24 graduate students) currently working with children completed the pretraining questionnaire, and 29 participants (13 professionals and 16 graduate students) completed the postquestionnaire. DATA COLLECTION AND ANALYSIS: Data were collected using an online questionnaire before the training and 1 mo after training. Descriptive analyses were done to identify trends, and paired-samples t-tests were used to determine changes pretraining to posttraining. RESULTS: Findings revealed that professionals most frequently teach skills to mothers (91%) and infrequently teach skills to fathers (19%) and other caregivers (10%). Professionals reported frequently collaborating with other intervention providers (76%) and infrequently collaborating with primary care physicians (19%). One-third of the professionals reported addressing symptoms of depression and anxiety as an interfering factor with the ability to implement management recommendations. For providers who completed both the prequestionnaires and postquestionnaires, an increase in confidence was reported for several areas of communication; however, as expected, practices remained similar, and all of the practicing professionals and 94% of the graduate students indicated a desire for more training on how to be effective in supporting parents with implementing intervention recommendations. CONCLUSIONS: Providers do not necessarily use effective methods of communication, needed to adequately help parents, requiring additional focused training to change how providers interact with parents and how support is provided.

Ambient noise impact on accuracy of automated hearing assessment.

OBJECTIVE: The aim of this study was to determine the effect of ambient noise on the accuracy of thresholds obtained using the KUDUwave portable clinical audiometer as compared to those obtained using a GSI-61 clinical audiometer in a sound booth. DESIGN: Pure-tone air conduction thresholds were obtained in three conditions: (1) with a clinical audiometer in a quiet sound booth, (2) with the KUDUwave in a quiet sound booth, and (3) with the KUDUwave with 40 dBA of background noise. STUDY SAMPLE: A total of 31 individuals ranging in age from 15 to 80 years participated in the study, 21 with normal hearing and ten with hearing loss. RESULTS: Eighty-nine percent of thresholds obtained with the KUDUwave in quiet, and 92% of thresholds obtained with the KUDUwave in background noise were within 5 dB of those obtained with the clinical audiometer. Accuracy was poorer at 250 Hz and 8000 Hz. CONCLUSION: Ambient noise typical of that found in a non-sound-treated room, did not affect the accuracy of air conduction hearing thresholds obtained with the KUDUwave. The KUDUwave may be a viable method of testing when a clinical audiometer and sound booth are not available.

Preschool teachers' perception and use of hearing assistive technology in educational settings.

PURPOSE: This study explored how often sound-field amplification and personal frequency-modulated (FM) systems are used in preschool classrooms, teacher perceptions of advantages and disadvantages of using hearing assistive technology, and teacher recommendations for hearing assistive technology use. METHOD: The study used a cross-sectional survey design. Participants were professionals who provided services to preschool-age children who are deaf or hard of hearing in public or private schools. A total of 306 surveys were sent to 162 deaf education programs throughout the United States; 99 surveys were returned (32%). Simple statistics were used to describe the quantitative survey results; content analysis was completed on open-ended survey comments. RESULTS: Surveys were received from teachers working at listening and spoken language preschool programs (65%) and at bilingual-bicultural and total communication preschool programs (35%). Most respondents perceived that hearing assistive technology improved students' academic performance, speech and language development, behavior, and attention in the classroom. The majority of respondents also reported that they definitely would or probably would recommend a sound-field system (77%) or personal FM system (71%) to other educators. CONCLUSION: Hearing assistive technology is frequently used in preschool classrooms of children who are deaf or hard of hearing, with generally positive teacher perceptions of the benefits of using such technology.

Early hearing detection and intervention: parent experiences with the diagnostic hearing assessment.

PURPOSE: The aim of this study was to investigate parent experiences with the infant diagnostic hearing evaluation process. METHOD: This study used a cross-sectional survey design. Surveys were distributed via parent support organizations in December 2009 to parents of children with hearing loss. A total of 416 completed surveys were received from 43 states. RESULTS: The median age of diagnosis of hearing loss has decreased over time from 11 months of age to 2 months. For babies born between 2006 and 2009, the most frequently reported challenge to obtaining a diagnostic hearing evaluation by 3 months of age was a delay in appointment availability (36%). Just >¼ (27%) of parents reported that they did not feel comfortable in knowing what they needed to do next after talking with the audiologist at the time their child was diagnosed with hearing loss. CONCLUSION: Significant progress has been made over the past 2 decades in reducing the age of hearing loss identification. However, many parents in this study experienced challenges that resulted in delays that exceeded Joint Committee on Infant Hearing (2007) recommendations of diagnosis by 3 months of age. The parent-reported experiences provide valuable information about areas that need further investigation to improve the early hearing detection and intervention process for children with hearing loss.

Early hearing detection and intervention: diagnostic hearing assessment practices.

PURPOSE: To gain an understanding of practice patterns for infant diagnostic hearing services at pediatric audiology facilities. METHOD: The authors used a cross-sectional survey design. From August to November of 2009, surveys were mailed to 1,091 facilities in 28 states and the District of Columbia. One survey was completed per facility, and responses were anonymous. RESULTS: The return rate was 33% (356 surveys). The results revealed that the comprehensiveness of the test batteries used varied among facilities. Over half of the respondents, 146 (55%), reported using a limited test battery, 94 facilities reported using a comprehensive test battery but lacked at least 1 component recommended by the Joint Committee on Infant Hearing, and 25 facilities reported using a test battery that met Joint Committee on Infant Hearing recommendations. The wait time for an appointment varied between facilities (range = 3 days-5 months) and was affected by the test condition (i.e., natural sleep, sedation, or operating room). CONCLUSIONS: The results suggest that it is difficult for stakeholders to identify pediatric audiology facilities that serve infants less than 6 months of age and that there is variability among facilities in test batteries and wait times for an appointment. Implications exist for diagnostic accuracy and timeliness of diagnosis.