9 - Pediatrics & Geriatrics Flashcards
What are 5 special considerations for fitting HAs on children?
1) Small ears and ear acoustics (Differences in RECD, REUR, ear canal resonances)
2) Physical fit of the hearing aids & earmolds (as ears grow will have to change earmolds to have a good acoustic coupling)
3) Fitting methods and recommended gain (DSL v5, children get more gain than adults)
4) Listening needs and listening environments
5) Hearing aid technology & features
What are the 4 the purposes of providing amplification to children?
1) To give them access to the auditory environment
2) Access to speech
3) Improve functional auditory capacity and participation
4) Audibility across the LTASS
What is an essential component of fitting HAs on children?
Regular, reliability and validity measures of a child’s progress in meeting intervention goals in amplification must be determined; needs can rapidly change over time
What are the early intervention and guidelines by the AAA?
- Children are learning language, they do not have the capacity to “fill in the blanks” for sounds that are not audible in the way that adult listeners have (must make sure that information is accessible to them)
- Children who use hearing aids must develop the ability to use information acquired while hearing amplified, processed sounds.
- Children fit with hearing aids that fail to render audible the full set of speech cues are at risks of deficits in speech production and/or learning
- Enhanced audibility is required to support better speech understanding, either increased level, increased SNR, or improvement of the listening environment.
- Prescriptive targets for children may specify greater outputs in quiet environments than adults
- Children’s hearing aid use is typically meditated by a caregiver. Caregiver training may be a unique challenge of the pediatric population
How do you obtain threshold information in children?
- Need estimated threshold for at least one low frequency (500 Hz) & one high frequency (~2000Hz, or 4000 Hz) in each ear
- Rely on frequency specific ABR, ASSR (if available), or VRA if old enough
- Amplification CANNOT be delayed in infants because you don’t “have enough” threshold information
What can you use for threshold estimates for children?
Electrophysiologic estimates of hearing sensitivity can be used as part of the complete audiological test battery
What is the best electrophysiologic threshold estimate to use?
- FS-ABR (frequency-specific auditory brainstem response)
- Threshold estimates can overestimate the behavioural audiogram by 5-30dB!
- Use of correction factors: Electrophysiologic threshold obtained in dB nHL can be used to predict behavioural thresholdin dB eHL
- dB nHL - correction = dB eHL (eHL = estimation)
What is this audiogram showing?
Circles = nHL values (frequency specific ABR values that were obtained)
+ = the eHL
How do you input the eHL and nHL into verefit?
- If eHL is selected (you have already provided the correction factor), the Verifit treats the value as a behavioral threshold (dB nHL - correction = dB eHL)
- If nHL is selected, the Verifit converts the value to eHL before the dB SPL transformation
Compared to adults, the ears of infants and young children show differences in what 2 things?
RECD and REUG (because it has to do with physical volume and size of the ear canal)
What changes as children grow?
RECD and REUG (the difference becomes less and less as they grow and become more adult like)
What is a possible reason that high frequency roll-off (above 2KHz) is happening?
Shallow placement of probe tube
What is a possible reason that LF values are negative
- from -1 to -9 dB SPL is happening?
Slit leak (e.g., foam tip is too small)
What is a possible reason that LF values are negative
-more than -10 dB SPL is happening?
Perforated TM or PE tube
What is a possible reason that Increased values in low and mid frequencies is happening?
Middle ear effusion
What do the lines on this picture mean?
Green line: coupler response
Purple: individual measurement
Dashed black line: age normative RECD value
Turquoise: difference
Explain the REUG in children?
- The resonance frequency is much higher in young children than it is for adults (about 2-3 times higher)
- As a child ages, the peak begins to decrease/ shift to a lower resonant frequency
- The most rapid changes occur in the first 20 months of life, stabilizing after 24 months
- This is due to the changes in the physical properties of a growing ear canal!
How much gain do children need?
- Children with hearing loss need more audibility (i.e., more gain) than adults to learn speech and language
- We need to maximize audibility (they can’t fill in the blanks)
Why do adults have less gain than children?
- Adults have less gain provided than children (across the board; mild, moderate, and sever HLs)
- That’s why we need to input age in the fitting software (to have accurate gain parameters)
- If we don’t input age, we could be under amplifying gain
Should you use propieratary formulas or the DSL-v5 on children?
- If proprietary methods are used… Expect large variability in responses!
- It is recommended to use the DSL-v5 fitting formula
Children require more ____ than adults when learning language
Audibility
Children require better ____ for optimal performance
S/N
Should children have advanced features on their HAs?
- Features that reduce gain or audibility may be problematic for children learning language (e.g., noise reduction system, DM)
- Advanced hearing aid features are primarily developed for adults and tested on adult (very few studies on advanced features for children under 5 years of age)
What 5 factors do you have to take into account for managing noise in pediatric fittings?
1) Hearing aid program options (how is ANR activated, accessed, and monitored)
2) Hearing aid ANR options (how strong is ANR, does ANR impact speech)
3) Report of loudness discomfort (in what circumstances, is it situational)
4) Child factors (developmental status, dexterity)
5) Family factors (involving parents in decision and monitoring)
Should children use noise reduction?
- NR can reduce gain & audibility
- Consider activating NR with school age children, if speech audibility is not compromised
- Verify the performance of the noise reduction system by comparing the hearing aid response to speech and noise inputs
Why are omni mics better than DM mics for children?
Omni mic may be better than adaptive DM for young children. Why?
- Overhearing and incidental learning
Talker of interest is not always at the front
- Small children don’t always orient their head towards the talker
- Classroom environments
- e.g., looking down when taking notes – remote mic better than DM in class.
Frequent ____ due to feedback as the child outgrows the earmolds
Earmold remakes
____ must be addressed to best ensure that gain is adequate, and feedback annoyance is minimal
Feedback
What is the importance os s/z audibility for language development?
- To show plural (One cup. Two cups.)
- To show third person present tense (I eat. He eats.)
- To show present tenses on some verbs (He put it on. He puts in on).
- To show possession (John’s dog.)
- To show possessive pronouns (Is that her? Is that hers?)
- To contract “is” (That is mine. That’s mine.)
- To contract “us” (Let us go. Let’s go.)
- To contract “has” (What has happened? What’s happened?)
- To contact “does” (What does it mean? What’s it mean?)
- To change adjective to noun (I like short pants. I like shorts.)
- To change adverb to noun (He went in and out. The ins and outs are tricky.)
- To show female gender (The host was an actor. The hostess was an actress.)
The use of ____ HA is recommended for children who would otherwise not be able to hear high frequency speech cues
Frequency lowering
What 5 factors do you need to consider for frequency lowering in a child’s HA?
1) Hearing instrument (is bandwidth restricted, does the aid offer FL)
2) Fit to target (does the child have access to female /s/ without frequency lowering)
3) Configuration & degree of loss (candidacy more likely is loss is high frequency or severe to profound)
4) Child factors (depending on developmental status; can they respond or discriminate)
5) Caregiver/intervention report (depending on developmental stats; can they respond or discriminate)
What is the MAOF?
Maximum audible output frequency
How is MAOF used for frequency lowering?
- Performing REMs to determine if high-frequency speech stimuli is audible without the use of frequency lowering strategies
- We can use the the MAOF as a guideline