Pediatric Hearing Aid Selection

Question 1

What are the three important components to the hearing aid selection and fitting process for infants and young children?

Answer 1

Pay attention to the quality and quantity of the auditory input received by the child (maximize speech and language development)
Initial electroacoustic characteristics are tentative
Hearing aid selection is an ongoing process that is part of a complete habilitative program

Question 2

Who makes the final decision about the size and style of the hearing aid?

Answer 2

Parent
It is essential that they understand the likely serious consequences of their choice if different from the audiologist’s

Question 3

What is the preferred style when fitting infants and children?

Answer 3

BTE

Question 4

What are advantages of BTE’s?

Answer 4

Allows for rapid growth
Can have loaner devices when they need to be repaired (in need of less repairs than other styles)
Direct audio input capabilities
Greater electroacoustic flexibility
Safety (soft earmold for play, less of a risk for swallowing parts of the device)
Increases distance btw mic and receiver to limit feedback

Question 5

How do you take an impression for a young child?

Answer 5

Same as adults with some adaptation
Smallest otoblocks may need to be trimmed down
Pay special attention to canal length while doing otoscopy (shorter overall length)
Knowing the average canal length by age can be useful

Question 6

How far should you insert an otoblock for 1 to 3 month olds?

Answer 6

6 to 8 mm

Question 7

How far should you insert an otoblock for a 6 to 12 month old (and older)?

Answer 7

9 to 12 mm

Question 8

Why do you not want to use ITE’s for children?

Answer 8

They are continuously growing
They will need to have a new hearing aid every few months

Question 9

Can we use RIC’s in kids?

Answer 9

More likely to fall out (domes instead of mold)
Really small (more likely to put the device in their mouth)
Receiver length may not be the right size
Receiver wire may be damaged

Question 10

What earmold material is mostly used for pediatrics?

Answer 10

Vinyl
Soft but rigid enough to keep the sound bore open when it is inserted into the canal.
Can be modified easily
Accepts adhesive readily to hold the tubing firmly in place

Question 11

What tubing is used for pediatrics?

Answer 11

Standard #13 if the sound bore is large enough
May not be able to be fully inserted into the mold, but partial insertion is fine too
Ear canal portion may not be able to accommodate the tubing size

Question 12

What mold/shell style is recommended for young children’s earmolds?

Answer 12

Full shell
Retention and feedback prevention
Easy to place rather than some other styles

Question 13

When should earmolds be replaced?

Answer 13

When the coupling between the ear and the hearing aid becomes compromised by either the child’s ear canal growth or shrinkage of the earmold

Question 14

What are the signs that an earmold needs to be replaced?

Answer 14

Feedback when the mold is fully inserted
When the retention of the device on the child’s ear becomes poorer

Question 15

In general, how often should earmolds be replaced for children under 1 year?

Answer 15

Every 3 months

Question 16

In general, how often should earmolds be replaced for children who are 1 to 5 years?

Answer 16

Every 6 to 12 months

Question 17

Are there pediatric sized earhooks?

Answer 17

Yes
Provides more retention for the pediatric population
Manufacturers routinely send pediatric-sized filtered earhooks when BTE hearing aids are ordered for a child

Question 18

Can pediatrics use slim tubes?

Answer 18

Yes, they are an alternative coupling for BTE’s
Available in standard and power versions and multiple lengths
A dome or custom tip can be snapped onto the end of the SlimTube
Advantage: a cosmetically discreet solution
Disadvantage: maximum gain and output is reduced 5-10 dB

Question 19

What are the three main problems that small ear canal sizes of children can cause?

Answer 19

The angle of the tube and the close proximity of the earmold to the tip of the earhook can pull the hearing aid away from the head (can hollow out some of the mold around the tubing (on the outside of the mold) and that will cause the tubing to bend less sharply)
Difficult to achieve a 2mm sound bore (this will resolve with age and growth)
Difficult or impossible to use acoustic modifications like venting due to small size (resolves with age and growth)

Question 20

Is a lack of vent problematic in children?

Answer 20

OE should be less problematic for these children
Size of the canal is smaller, so the resonance is higher
The OE is less noticeable or bothersome to them (bc it happens at lower frequencies)

Question 21

How can you help the retention in baby’s ears?

Answer 21

Pediatric-sized earhooks
Double-sided tape on the device
Extra stiff moisture resistant tubing on the earmold
Huggie Aids
Retention cables are available to ensure that a hearing aid that falls out of the ear is not lost

Question 22

Are tamper resistant battery doors used for pediatrics?

Answer 22

Yes
Should be implemented because hearing aids are toxic if ingested

Question 23

Should there be a volume control cover or lock on pediatric devices?

Answer 23

Yes
To ensure that the infant is wearing the hearing aids at the prescribed volume setting at all times

Question 24

Should early stimulation be binaural?

Answer 24

Yes
Binaural stimulation is essential for the neural development that enables binaural processing of sounds
Early hearing aid fitting increases the likelihood that children will become successful users of bilateral hearing aids when they are older

Question 25

What are some advantages of binaural stimulation?

Answer 25

Head shadow (intensities are different between ears, helps with localization)
Binaural summation (perceive sounds louder by 2 to 3 dB)
Binaural squelch (central phenomenon; compare SNR when listening to one ear vs two ears and uses this information to clean the signal)

Question 26

What is evidence for withdrawing amplification from one ear?

Answer 26

Consistent and prolonged rejection of one hearing aid by the child after the clinician has made every effort to fine-tune the fitting for earmold comfort and loudness comfort
Reports from the parent that the child functions better with one hearing aid
Poorer speech test results when fitted bilaterally than when fitted unilaterally

Question 27

Is it common to use DSL for peds?

Answer 27

Yes
Provides more amplification (output) which may help children in specific listening situations
Some people think DSL is too loud

Question 28

What are the two prescriptive methods validated for children?

Answer 28

DSL and NAL-NL2

Question 29

What should the selection of electroacoustic characteristic include when fitting an infant?

Answer 29

Sufficient gain, level-dependent processing, and frequency shaping to allow the hearing aid to be adjusted to a child’s individualized DSL v5 prescription
The hearing aid(s) selected shall avoid unnecessary distortion
The hearing aid(s) selected shall provide electroacoustic flexibility

Question 30

Do children, and infants in particular, need amplification characteristics different from those needed by adults with the same degree of loss?

Answer 30

Yes
Normal hearing infants need the level to be 26 dB higher than that needed by adults to have the same accuracy
They also need an SNR 7 dB higher than that needed by adults to achieve the same performance in noise
Five-year old children need an SNR 3 to 5 dB higher than that needed by older children or adults

Question 31

Is the LDL for hearing-impaired children aged 7 to 14 the same as that for hearing-impaired adults?

Answer 31

Yes, they are the same with the same pure tone threshold losses
We would not want to prescribe any more high-level gain and OSPL90 for infants than we do for adults

Question 32

Will children benefit from more gain in high-level sounds than adults?

Answer 32

No

Question 33

Will children benefit from more gain in medium-level sounds than adults?

Answer 33

Yes
They prefer more gain
It seems unlikely that higher gain provides greater speech intelligibility for mid level sounds, but it may reduce listening effort

Question 34

Will children benefit from more gain in low-level sounds than adults?

Answer 34

Yes
Increasing the gain for low-level sounds may also increase the distance over which children can hear or overhear comments

Question 35

What are the fitting objectives for adults?

Answer 35

To minimize the effects of hearing loss by providing amplification that improves audibility but does not cause loudness discomfort

Question 36

What are the fitting objectives for children?

Answer 36

To ensure sufficient access to speech sounds to acquire speech and language

Question 37

Are directional mics beneficial for children?

Answer 37

Only method to improve SNR ratio
Dependent on the ability of the child to orient toward to target talker
Full time use if not recommended for infants and young children (unable to orient)
Can be activated for school-age children in specific situations

Question 38

Should feedback cancellation be enabled for children?

Answer 38

Allows you to supply more gain
Might result in some artifact, but it’s not as bad as the feedback itself
You should monitor to ensure high frequency gain is stable To ensure there is no slit leak
You should never use this feature to prolong earmold use (I cannot hear feedback, so it must be an ok fit)
Can effect the high frequency information that the children are getting
Disable to feature and listen for feedback (ensure it is a good fit)

Question 39

What is the only feature that helps with the SNR?

Answer 39

Directional mics

Question 40

Should digital noise reduction be turned on for children?

Answer 40

Can have the same benefits for children as it does adults (increased listening comfort, decreased listening effort, unchanged speech intelligibility)
It is possible that gain reductions that occur from DNR might affect children in ways that would not be predictable
Evidence on these improvements for children are limited (for infants and preschool children)
May be an effective signal processing feature for school-age children

Question 41

Should frequency lowering be used for children?

Answer 41

If kids have high frequency thresholds in the severe or profound range, they need it to hear those cues
High frequency speech sounds will go to the areas where they can hear it, and they will learn how to produce those sounds
Use the weakest setting, just so the sounds are detectable (limits changes to sound quality)

Question 42

Should assistive listening devices be used for children?

Answer 42

Yes
Helps improve SNR
Helps improve distance
Improves rate of language acquisition (getting optimal SNR for a longer period of time)

Question 43

Should you convey the expectations for the child and when milestones are expected to occur to parents?

Answer 43

Yes
The parents are the people best placed to confirm the achievement of these milestones, or to raise an alarm if the milestones are delayed by an abnormal amount

Question 44

What will parents need to know about caring for the hearing aids?

Answer 44

Cleaning the earmold and hearing aid
Checking batteries
Performing listening checks
Putting the hearing aids on
Setting the controls (if any)
Carrying out activities (like talking and playing) that promote their use
Avoiding hazards like moisture

Question 45

Do parents need to know how to troubleshoot hearing aids?

Answer 45

Yes
When listening checks reveal a problem, parents need to know how to diagnose common faults like cracked or loose tubing, weak batteries, moisture, and internal noise
They need to know what they can fix themselves and what they need help for

Question 46

What are some safety issues for hearing aids?

Answer 46

Battery and hearing aid ingestion (pets especially)
Battery explosion
Noise induced hearing loss
Physical impact
Warning sounds

Question 47

Are periodic evaluations essential for pediatrics?

Answer 47

Yes
1 month following initial fitting
2-3 month intervals thereafter for the first year of amplification
Every 4-6 months until age 5
Yearly for ages >5 years
A similar schedule is important for older children with a new diagnosis since progressive loss is a possibility
Periodic immittance testing should conduced in every visit

Question 48

May the frequency of evaluations need to be increased if there is fluctuation or progression of the hearing loss?

Answer 48

Yes

Question 49

How often should earmolds be checked and remade?

Answer 49

As necessary
Often every 2-3 months during periods of rapid growth

Question 50

Should you help parents understand that more consistent hearing aid use have better outcomes?

Answer 50

Yes
You should discuss the importance of device use for the developing child
Should discuss retention options too
Should explain data logging and how it can be beneficial to parents

Question 51

For a child to maximize his or her mastery of language, should hearing aids be consistently worn?

Answer 51

Yes
And they must be functioning correctly
The child must also be receiving rich, stimulating auditory input, and be engaging in meaningful listening activities