Final Exam, Case #1 Flashcards
What referrals should be made and why?
It was recommended to the child’s parents that they pursue a medical evaluation to determine if there are any potential conditions that could be the cause of the child’s hearing loss. Further medical evaluation is also necessary to identify the likelihood of progressive hearing loss or precautions to minimize the likelihood of progression. The child’s parents were provided with referral sources to otolaryngology, ophthalmology, and medical genetics for medical follow-up. To further address the parents’ concern for speech and language delays, recommendations were provided for speech-language therapy and early-intervention services. Lastly, referrals were made to the parents for financial programs that could help them to purchase hearing aids, if finances become a concern (AAA Pediatric Amplification Guidelines, 2013).
What steps should be taken to select and program hearing aids?
The results from today’s testing were reviewed with the child’s parents and a bilateral hearing aid fitting was recommended. It was explained that their daughter was a candidate for bilateral amplification since she has a permanent, bilateral peripheral hearing loss. The goal of a bilateral fitting is to provide the child with as much access to the speech stimulus as possible, to help facilitate normal language development and academic success (Pediatric Working Group, 1996). A behind-the-ear (BTE) style was selected due to expected changes in ear canal size. As the patient grows up, her ear canal will grow. The BTE style is traditionally coupled to an earmold, which is a relatively inexpensive piece to replace as the ear canal style changes. Additionally, the BTE style may provide the features, such as built-in FM receivers and telecoil, that could benefit the patient later in life, particularly in academic settings. Standard BTE devices also can couple to assistive listening devices that may assist in academic and social settings (AAA Pediatric Amplification Guidelines, 2013). Lastly, the BTE style is more durable than other devices, making it an ideal selection for a young and growing child (Taylor and Mueller, 2017).
The parents of the patient were provided information on different manufacturers that sell pediatric hearing aids. It was suggested that they consider devices sold by Oticon or Phonak. These companies produce pediatric hearing instruments that are designed specifically for children and their families. In particular, these companies place advanced features into entry level hearing aids, providing a significant financial advantage. The child’s parents were also shown the different color options for the devices.
When programming hearing aids for a pediatric patient, selecting the appropriate prescriptive method that considers the development and auditory needs of children is essential for a successful fitting. Most hearing aid manufacturers have custom hearing aid prescriptions that are designed for the adult population. For this child, the Desired Sensation Level (DSL) prescription is recommended (AAA Pediatric Amplification Guidelines, 2013). The goal of this prescription method is to provide the child with amplified speech sounds that are audible, comfortable, and undistorted across the frequency fitting range. This method also considers age-appropriate acoustic characteristics that vary with age, such as external ear resonance characteristics and Real-Ear-to-coupler difference (RECD) (Pediatric Working Group, 1996). Additionally, a focus on high-frequency amplification is essential for appropriate speech and language development. The higher frequencies will be appropriately amplified to provide the child with speech information, which is contained in the high frequencies (AAA Pediatric Amplification Guidelines, 2013).
What methods should be used to validate the hearing aid fitting and why?
To verify the fitting, the RECD measurement will be used. This measurement is used to convert the coupler measurements of the hearing instruments to estimate the sound pressure level (SPL) in the child’s ear. This measurement is expected to produce a more accurate conversion from dB Hearing Level to dB SPL, which helps to calculate appropriate gain targets based on SPL thresholds (AAA Pediatric Amplification Guidelines, 2013). RECD is a tool that helps to predict the Real-Ear Aided Response (REAR) of the patient’s devices and may improve the accuracy of the fitting when real-ear measurements (REM) cannot be performed (Scollie, et al., 2011). This verification option is appropriate for children who cannot sit still for REM (AAA Pediatric Amplification Guidelines, 2013). While RECD is a viable verification tool to improve overall fitting accuracy, manual programming adjustments may be required to optimize the audible bandwidth of the speech signal (Scollie et al., 2011). RECD should always be measured after each earmold is replaced (Pediatric Working Group, 1996).
Subjective parental reports will assist in validating the fitting. Different subjective questionnaires assess whether or not the amplification needs of the patient are met. Questionnaires are designed based on the patient’s cognitive and physical age. For this particular patient, the following questionnaires could be utilized: Developmental Index of Audition and Listening (DIAL), Functional Auditory Performance Indicators (FAPI), Infant-Toddler Meaningful Auditory Intgration Scale (IT-MAIS), LittlEARS, and the Parent’s Evaluation of Audral/oral Performance of Children (PEACH) (AAA Pediatric Amplification Guidelines, 2013). As an example, LittlEARS is a clinician-driven, interview-style questionnaire that has normative data and critical difference scores, which allow the clinician to determine if the amplification is providing significant benefit (AAA Pediatric Amplification Guidelines, 2013).
Based on best practices, what follow up schedule should be recommended, which procedures should be conducted and why?
To ensure a successful fitting, it was recommended to the parents that their child be seen by an audiologist every three months during the first two years of using their devices. If there are no concerns following that time period, they should be seen every six months (Pediatric working group, 1996). An aggressive follow-up schedule is necessary to monitor potential progressive and/or fluctuation hearing loss (Tharpe, 1996). All follow-up appointments should include the following clinical procedures: audiometric evaluation, electroacoustic analysis and listening checks of hearing instruments, and re-evaluation of RECD and/or other probe microphone measurements (Pediatric Working Group, 1996).
