Pediatric AR Flashcards
Joint Commission on Infant Hearing (JCIH) Position Statement (2013)
The Joint Commission on Infant Hearing (JCIH) Position Statement (2013) indicates that all children who are identified with hearing loss of any degree should receive appropriate monitoring and immediate follow-up intervention services where appropriate.
(AAA, 2013) #1
As a child with bilateral, mild-severe sensorineural hearing loss from 1500-8000 Hz, Jake is a hearing aid candidate.
The ideal hearing aid fitting for Jake is a binaural, behind-the-ear solution that offers direct audio input capabilities and other pediatric amplification features (AAA, 2013).
(Hood, 1997; Kuk & Marcoux, 2002).
Binaural hearing aids are important to ensure 1) consistent audibility, 2) the appropriate development of sound localization abilities, and 3) the ability to experience release of masking in noise given his bilateral hearing loss (Hood, 1997; Kuk & Marcoux, 2002).
(AAA, 2013) #2
o Jake’s hearing aids will be coupled to his ears with soft earmolds to protect his outer ear from harm if struck during hearing aid (AAA, 2013).
o Additionally, his hearing aids will utilize tamper resistant battery doors to reduce the risk of battery ingestion leading to toxicity and asphyxiation (AAA, 2013).
o The hearing aids will be programmed with wide dynamic range compression (WDRC) signal processing to eliminate the need for volume control manipulation while maintaining audibility and comfort as recommended by the American Academy of Audiology (AAA) Clinical Practice Guidelines (CPG) on Pediatric Amplification (2013).
o The hearing aids will be fit using a validated, pediatric-focused prescriptive formula which accounts for the real-ear to coupler difference (RECD) when prescribing gain for Jake to avoid over-amplification (AAA, 2013).
(Ching et al., 2010a, 2010b; Scollie et al., 2010a, 2010b).
o While both NAL-NL2 pediatric and DSL V5 Pediatric are generally appropriate options, some evidence suggests that children prefer the higher gain from the DSL prescription for listening to soft sounds or sounds from behind them (Ching et al., 2010a, 2010b; Scollie et al., 2010a, 2010b).
(Peleva et al., 2014).
In addition, pediatric patients with a history of cisplatin chemotherapy may have increased susceptibility to noise-induced damage to the auditory system; as such, Jake’s parents will be counseled from about the importance of hearing protection from noise (Peleva et al., 2014).
(AAA, 2013; Foley et al., 2009).
Jake’s hearing aids will be fitted with an omnidirectional microphone configuration; in addition, remote microphone (FM) technology to improve SNRs in specific environments is recommended for educational and social development purposes (AAA, 2013; Foley et al., 2009).
(Ching et al., 2009; Ricketts & Galster, 2008) / (AAA, 2013; Ching et al., 2009; Ricketts et al. 2007; Ricketts & Picou, 2013)
Yet, children orient their heads to the target talker less than half of the time (Ching et al., 2009; Ricketts & Galster, 2008) and decrements in performance are possible when using directional microphones and the beam is aimed away from the target talker (AAA, 2013; Ching et al., 2009; Ricketts et al. 2007; Ricketts & Picou, 2013)
(Zanin & Rance, 2016).
Both students with hearing loss and teachers report functional hearing advantages in the classroom when using remote microphone/FM technology in concert with their standard hearing devices compared to the standard hearing aids alone (Zanin & Rance, 2016).
(AAA, 2008).
o In the home environment, Jake’s parents can use a FM/remote microphone technology to support clear access to their own voice in situations such as in the car, on the playground, and in any other situation where distance, noise, and reverberation can inhibit effective communication (AAA, 2008).
(US Department of Education, 2006).
” Children with disabilities are protected under the Individuals with Disabilities Education Act (IDEA) (US Department of Education, 2006). “Hearing impairment” and “deafness” are categorized as disabilities under this law.
o Part B of IDEA is applicable to children aged 3 to 21 and addresses the academic, developmental, and functional need of the child.
o Under this law, schools are required to provide a free and appropriate education in the least restrictive environment as described in the child’s individualized education plan (IEP).
(Aragon & Yoshinaga-Itano, 2012).
o In support for the provision of an IEP for Jake, it is important to consider that even if technology is fit correctly, children cannot learn to listen and use spoken language at age-appropriate levels unless they are exposed to spoken language and research indicates this exposure should far exceed the usual input available to children with normal hearing (Aragon & Yoshinaga-Itano, 2012).
(AAA, 2013). #3
” Additionally, children who use hearing aids must develop the ability to use information acquired while hearing amplified, processed sound.
o Children fit with hearing aids that fail to render audible the full set of speech cues are at risk of deficits in speech production and/or learning (AAA, 2013).
(Burkhalter et al., 2011).
o Children should be taught as early as the preschool years to manage their own amplification and to report when their devices are not working. Without routine monitoring, up tp 50% of the amplification used by children today in educational settings are likely to function inappropriately (Burkhalter et al., 2011).
(Ching et al., 2000).
” Two tools that will be used to capture parent and teacher input regarding Jake’s use of the amplification are the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) and the Teachers’ Evaluation of Aural/Oral Performance of Children (TEACH).
o These tools are designed for children age 3-7 years (Ching et al., 2000). The PEACH and TEACH tools consist of an interview with parent or teacher with 15 questions targeting the child’s everyday environment.
