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Pediatric Amplification Midterm
What is hearing loss in children considered? - ANS An emergency! (neurodevelopmental emergency) What is the most frequently identified congenital condition at birth? - ANS Hearing loss What does hearing loss negatively affect? - ANS Speech, language, academic, emotional, and psychosocial development What helps foster neural connections? - ANS Hearing assistive devices When is neuroplasticity best? - ANS first 3.5 years of life Auditory centers of the brain need to be __________ or will reorganize themselves for other sensory input. - ANS stimulated What was the average age to be identified for hearing loss (before NBHS)? - ANS 2 years EHDI Guidelines - ANS 1- Screening 3- Diagnosis 6-Early intervention What are barriers to the EHDI guidelines? - ANS Middle ear status, parent denial, comorbidities, access to care, cost What can an audiologist do to overcome EHDI guideline barriers? - ANS Why is early intervention not early enough? - ANS Cumulative auditory experience (begins in a mother's womb) What are malleable factors? - ANS Things you can change
Malleable factors examples - ANS speech and sound quality through amplification, duration and consistency of hearing aid use, quality and quantity of linguistic input in the child's environment What are non-malleable factors? - ANS Things we cannot change Non-malleable factors examples - ANS Additional disabilities, family socio-economic status, degree of hearing loss, age of intervention What percentage of children with hearing loss have additional disabilities? - ANS 40% How can mild/minimal hearing loss affect a child? - ANS Mild/minimal hearing loss still has an impact on speech intelligbility What are the necessary referrals? - ANS Early intervention, IDPH, pediatrician Stages of the Grief Cycle - ANS Shock/disbelief/denial Guilt Bargaining Anger Depression Acceptance What is the overall goal of pediatric amplification? - ANS For the child to have as much access to the auditory environment as possible What are other goals of pediatric amplification? - ANS Minimize distortion, use appropriate signal processing, maximize audibility of desired signal and reduce noise, provide ease of connection to external devices, daily consistent use What is the minimum amount of information we need to fit a child with a hearing aid? - ANS One low frequency and one high frequency in each ear and AC + BC thresholds
Noise Reduction - ANS Reduces steady-state, non-modulated noise (ex. vacuum, appliances, fans), doesn't improve SNR only cmfort, no degradation of speech signal, no improvement in SPIN, is needed depending on child's environment Feedback Management - ANS Be mindful of manufacturers feedback suppression methods with gain reducing or phase cancelling Why are proprietary methods not recommended? - ANS Have not been validated for use with children When do you switch kids over to adult prescriptive methods? - ANS When the child is old/competent enough to have a say in their hearing aids (don't have to switch, personal preference) What should be done prior to a hearing aid fitting? - ANS Audiogram in Noah and Verifit, connect hearing aids, select DSL targets, verify directionality, start up program, volume control disabled, data logging enabled NAL - ANS better for speech in noise & comfort in loud environments DSL - ANS better than NAL because it has best soft speech audibility What is real ear/REAR better for? - ANS Verification of vented ear molds What are simulated real ear and RECD better for? - ANS Verification of unvented molds or when a child cannot sit still What are examples of validation? - ANS Parent reports, teacher reports, self report Parent Report Examples - ANS IT-MAIS/MAIS LittlEARS PEACH Teacher Report Examples - ANS TEACH SIFTER
Self Report Examples - ANS COST COW SELF How can we verify validation reports? - ANS Data logging and speech perception testing COW - ANS Ped version of COSI Free 4-12y 5 categories (1-5 rating scale) 3 sections: child needs, parent's needs, teacher's needs Negative: NO validity measures SELF - ANS IT-MAIS/MAIS - ANS Free Interview format 10 questions (5 point rating scale, 40 points) No norms Negative: unreliable parent response, designed for CI/HA of mild-severe only LittlEARS - ANS Free-$ Track auditory development 0-24m Children w/ CI/HA 35 y/n questions Reliable, valid, norms in manual Perform before PEACH Negative: Ceiling effects PEACH - ANS Free
What is AAA candidacy for pediatric amplification? - ANS Any child with any degree or type of HL that could affect developmental process, mild/minimal HL, unilateral HL, conductive HL, ANSD, severe to profound HL (CI) What should you do in terms of amplification of a child with ANSD? - ANS Trial with amplification if poor speech rec/thresholds, monitor What are LING 6 sounds for? - ANS Roughly asses full spectrum of speech and can be used in aided testing (verification/validation) TRUE/FALSE Kids mainly listen to men so need access to low frequency sounds. - ANS FALSE What are reasons pediatrics have different listening needs than adults? - ANS Kids need higher SNR, more processing time, less reverberation, they are in more complex listening environments that can impair them more, are learning language RECD should be measured.... - ANS at every appointment, each time there is programming or ear mold change (can be done with earmold) What are the best microphone types for children? - ANS Adaptive directionality or omnidirectional paired with an FM system Peds vs. Adult HL configuration - ANS Peds: more variability (cookie bite, asymmetric, progressive, unilateral) What are appropriate referrals for peds? - ANS Early intervention, ENT, ophthalmology, genetics, DPH, pediatrician
