Archive | 2019
Pediatric Amplification Management: Parent Experiences Monitoring Children’s Aided Hearing
Abstract
Objective: Investigate parents’ experiences monitoring aided hearing for children who use hearing aids, bone conduction hearing aids, and cochlear implants. Design: A cross-sectional survey design, using three survey instruments, was used to collect parent data. Study Sample: A total of 178 parents of children birth to six years were included in the analysis (81 hearing aid; 61 cochlear implant; 36 bone conduction hearing aid). Results: Surveys explored hearing device use and monitoring. Variability was found for hearing aid use and many parents reported being unaware if their child’s device had data logging capability. Parents varied widely in how often they checked hearing device function, and approximately half did not have access to loaner hearing devices when repairs were required. Variance was observed in how often professionals explored how children are hearing at home through use of parent-report questionnaires, and related to audiology-specific services aimed at monitoring and maintaining audibility during routine appointments (e.g., checking program settings when new earmolds are received, frequency of earmold replacement, checking data logging). Conclusion: This study revealed variability in hearing device use and monitoring for audibility by professionals and parents. Implications from this study suggest parent-professional partnerships would benefit from better understanding of barriers/facilitators for parent learning and implementation of key monitoring tasks. Acronyms: AAA = American Academy of Audiology; BCHA = bone conduction hearing aids; CI = cochlear implant; HA = hearing aid; FM = frequency modulation; RECD = real-ear-to-coupler-difference Correspondence concerning this article should be addressed to: Karen Muñoz, EdD, Department of Communicative Disorders and Deaf Education, Utah State University, 1000 Old Main Hill, Logan, UT, 84322. Phone: 435-797-8240; Email: [email protected] Early identification of hearing loss through newborn screening has become a standard of care in the United States (Centers of Disease Control and Prevention, 2017). Early screening allows for intervention within the first few months of life (Joint Committee on Infant Hearing, 2007), giving parents an opportunity to access needed services. For children learning to communicate using spoken language, consistent auditory access to speech sounds using hearing technology is necessary to achieve optimal language outcomes (Tomblin et al., 2015). Both audiologists and parents play critical roles in monitoring aided hearing and when there are gaps in managing hearing care, audibility is inconsistent. Appropriate hearing device programming is fundamental for audibility. Audiologists program hearing devices specifically for each child based on their individual hearing needs and it is necessary to monitor device settings over time. For example, children who use hearing aids are fit with new earmolds as they grow because the size of their ear canal increases. To accommodate for physical changes, a measurement (called real-ear-to-couplerdifference [RECD]) should be completed when new earmolds are fit to the child. Hearing aid programming adjustments, based on the child’s current hearing thresholds and RECD, are then made to maintain sufficient sound pressure levels for audibility (American Academy of Audiology [AAA], 2013; Seewald & Scollie, 2003). Even when hearing devices are programmed appropriately, hearing in noisy environments can be challenging. The use of a personal frequency modulation (FM) system in conjunction with hearing devices improves audibility by helping children access speech when listening in more adverse environments (AAA, 2008). 74 Daily hearing device management is also fundamental for audibility. Parents are responsible for having their children wear their devices and for checking that devices are functioning. Young children are in a critical language learning period and device use of less than 10 hours per day has been found to negatively affect language development (Tomblin et al., 2015). Parents have reported that various child factors (e.g., child behavior) and parent factors (e.g., frustration, depression) interfere with how often children wear their hearing devices (Caballero et al., 2017; Isarin et al., 2015; Muñoz et al., 2016; Walker et al., 2013), and wide variability has been found in average hours of use (Muñoz et al., 2015; Walker et al., 2013). Data logging is a feature built into most hearing devices. Parents and audiologists can use data logging to routinely monitor hours of use and to help recognize when device problems occur. Data logging allows the audiologist to view the average amount of time the child is wearing the device. Even when children wear their hearing devices consistently, however, audibility is compromised if the devices are not functioning. Parents have reported a lack of training in how to check devices and/or not having needed tools (Muñoz, Blaiser, & Barwick, 2013; Muñoz, et al., 2015), and this can result in infrequent monitoring of device function (Burkhalter, Blalock, Herring, & Skaar, 2011; Isarin et al., 2015; Muñoz et al., 2013; Watermeyer, Kanji, & Sarvan, 2017). Routine monitoring by audiologists and parents is necessary to determine hearing device benefit and to identify changes or problems in audibility that need attention. Parents’ observations of how their child is functioning at home and in other environments can be obtained by using questionnaires, and audiologists can assess aided speech perception during monitoring appointments (AAA, 2008, 2013). Parents can also use the Ling-Six sound test every day to check that their child is perceiving speech sounds represented across the frequency range (AAA, 2008). When device malfunctions occur, loaner hearing devices can be provided while the child’s device is out for repair, so audibility is not compromised. Given that audibility can be affected by multiple factors (e.g., device use, device function) that ultimately influence child outcomes, understanding parents’ experiences can provide important insights about how audiologists and parents can more effectively partner in this journey. The purpose of this study was to investigate parents’ experiences monitoring aided hearing for children who use hearing aids, bone conduction hearing aids, and cochlear implants.