Karen F. Muñoz

Teleintervention for Infants and Young Children Who Are Deaf or Hard-of-Hearing

Advancements in videoconferencing equipment and Internet-based tools for sharing information have resulted in widespread use of telemedicine for providing health care to people who live in remote areas. Given the limited supply of people trained to provide early-intervention services to infants and young children who are deaf or hard-of-hearing, and the fact that many families who need such services live significant distances from each other and from metropolitan areas, such “teleintervention” strategies hold promise for providing early-intervention services to children who are deaf or hard-of-hearing. Unfortunately, little is known about the cost-effectiveness of such teleintervention services. In this article we outline the rationale for using teleintervention services for children who are deaf or hard-of-hearing, describe a teleintervention program that has been serving relatively large numbers of children in Australia since 2002, and summarize what we know about the cost-effectiveness of such an approach. We conclude by summarizing the type of research needed to decide whether teleintervention should be used more frequently with children who are deaf or hard-of-hearing and the potential relevance of the teleintervention approach for the development of intervention systems in the United States.

Pediatric Hearing Aid Use: How Can Audiologists Support Parents To Increase Consistency?

BACKGROUND Children need consistent access to the full range of speech sounds for spoken language development, making daily hearing aid management a fundamental component of effective intervention. In addition to receiving services from professionals with expertise in childhood hearing loss, parents play a central role in the intervention process. However, parents can experience an array of barriers and challenges in learning to cope with the demands of daily management. Feedback about hearing aid use time might offer parents insight into challenges and lead to the identification of strategies to increase use, optimizing child outcomes. PURPOSE This exploratory study had 2 primary purposes: (1) to examine hearing aid use time for a cohort of children 7 mo to 6 yr of age and (2) to examine whether hearing aid use time increased when parents were given periodic objective feedback (i.e., data-logging results) about average daily use time. RESEARCH DESIGN A retrospective chart review was used to collect data on eligible participants. RESULTS Findings for 29 children (7 mo to 6 yr of age) revealed variability in hours of hearing aid use and an increase in hours of use with age and severity of hearing loss. Reports of typical hearing aid use from seven parents revealed that parents overestimated use by an average of 3.36 hr. Review of challenges reported revealed issues with retention, awareness of the effect of nonuse on average daily access to sound, and lack of perceived benefit of hearing aid use. Hearing aid use increased with communication about data logging for some, but not all, parents. CONCLUSIONS For effective integration of essential hearing aid management skills into the daily lives of primary caregivers, audiologists must consider caregiver needs in the overall child management and monitoring plan. The ability to optimize child outcomes might depend in part on the extent audiologists embrace family-centered services, engage in collaborative problem solving, and support parents in applying individualized strategies.

Parent hearing aid experiences in the United States.

BACKGROUND Children born with permanent hearing loss have the opportunity to receive services earlier as a result of newborn hearing screening (NHS). We conducted a survey to address three aspects within the early hearing detection and intervention (EHDI) process: (1) timeliness of service delivery, (2) hearing device access, and (3) hearing aid management. Parent experiences provide valuable information in identifying existing challenges for these components of the EHDI system. PURPOSE The aim was to investigate parent experiences as they access and manage hearing aids for their child. RESEARCH DESIGN A cross-sectional, population-based survey was used. STUDY SAMPLE Three hundred fifty-two completed surveys from parents of children born between 1977 and 2010 were returned from 45 states in the United States. DATA COLLECTION AND ANALYSIS Responses were obtained online and through the mail, and were analyzed using descriptive statistics. RESULTS Over time, the age of hearing loss identification has decreased to a median of 2 mo, age of first hearing aid fitting has decreased to a median of 5 mo, and the delay between hearing loss identification and hearing aid fitting has remained the same with a median of 2 mo. For children born between 2007 and 2010, the top three challenges parents reported in obtaining hearing aids were (1) paying for hearing aids, (2) accepting the need for hearing aids, and (3) wait time for an appointment. Almost one-half (48%) of the parents reported that they did not receive adequate support from their audiologist in how to check the function of their childs hearing aids. CONCLUSIONS Significant progress has been made over the past two decades in reducing the age of hearing loss identification and hearing aid fitting for children who do not pass the NHS. However, many children continue to experience delays between hearing loss diagnosis and hearing aid fitting that exceed Joint Committee on Infant Hearing recommendations. The experiences parents reported provide valuable information about areas that need further investigation to improve the process for children with hearing loss.

Ambient noise impact on accuracy of automated hearing assessment.

Abstract Objective: The aim of this study was to determine the effect of ambient noise on the accuracy of thresholds obtained using the KUDUwave portable clinical audiometer as compared to those obtained using a GSI-61 clinical audiometer in a sound booth. Design: Pure-tone air conduction thresholds were obtained in three conditions: (1) with a clinical audiometer in a quiet sound booth, (2) with the KUDUwave in a quiet sound booth, and (3) with the KUDUwave with 40 dBA of background noise. Study sample: A total of 31 individuals ranging in age from 15 to 80 years participated in the study, 21 with normal hearing and ten with hearing loss. Results: Eighty-nine percent of thresholds obtained with the KUDUwave in quiet, and 92% of thresholds obtained with the KUDUwave in background noise were within 5 dB of those obtained with the clinical audiometer. Accuracy was poorer at 250 Hz and 8000 Hz. Conclusion: Ambient noise typical of that found in a non-sound-treated room, did not affect the accuracy of air conduction hearing thresholds obtained with the KUDUwave. The KUDUwave may be a viable method of testing when a clinical audiometer and sound booth are not available.

Pediatric hearing aid use: Parent-reported challenges

Objectives: The aim of this study was to investigate parent-reported challenges related to hearing aid management and parental psychosocial characteristics during the first 3 years of the child’s life. Design: Using a cross-sectional survey design, surveys were distributed to parents of children with hearing loss via state Early Intervention programs in Utah and Indiana. Packets contained one family demographic form and two sets of three questionnaires to obtain responses from mothers and fathers separately: the Parent Hearing Aid Management Inventory explored parent access to information, parent confidence in performing skills, expectations, communication with the audiologist, and hearing aid use challenges. The Acceptance and Action Questionnaire measured psychological flexibility, experiential avoidance, and internal thought processes that can affect problem-solving ability and decrease an individual’s ability to take value-based actions. The Patient Health Questionnaire identified symptoms of depression. Thirty-seven families completed questionnaires (35 mothers and 20 fathers). Results: Most responses were parents of toddlers (M = 22 months) who had been wearing binaural hearing aids for an average of 15 months. Both mothers and fathers reported that even though the amount of information they received was overwhelming, most (84%) preferred to have all the information at the beginning, rather than to receive it over an extended time period. Parents reported an array of challenges related to hearing aid management, with the majority related to daily management, hearing aid use, and emotional adjustment. Sixty-six percent of parents reported an audiologist taught them how to complete a listening check using a stethoscope, however, only one-third reported doing a daily hearing aid listening check. Both mothers and fathers reported a wide range of variability in their confidence in performing activities related to hearing aid management, and most reported minimal confidence in their ability to troubleshoot hearing aid problems. More than half of the parents reported child behavior and activities, such as playing outside, as a major hearing aid use challenge. Parents reported hearing aids were worn all waking hours by 35% of children and less than 5 hr/day by 31%. Almost half of the parents (47%) did not feel that they had enough time to talk about their emotions when speaking with their audiologist(s), 69% reported the audiologist did not help them know what to expect related to emotions about their child’s hearing loss, and 22% reported symptoms of depression. Conclusions: Parents reported an array of challenges, even after their child had been wearing hearing aids for a prolonged time, revealing critical implications for how to provide audiological care. Audiologists have an important role in partnering with parents to identify and jointly problem-solving challenges related to their child’s hearing aid use. Supporting parents includes not only addressing technical aspects of hearing testing and hearing aid function but also addressing parent thoughts, feelings, and emotions.

Audiologist Practices: Parent Hearing Aid Education and Support

BACKGROUND Early identification of hearing loss has led to routine fitting of hearing aids in infants and young children. Amplification provides opportunities to optimize child development, although it also introduces challenges for parents to navigate. Audiologists have a central role in providing parents with support to achieve effective management strategies and habits. PURPOSE The purpose of this study was to explore current practices of pediatric audiologists who work with children birth to 5 yr of age, regarding their support of parent learning in achieving effective hearing aid management, identify existing gaps in service delivery, and to determine if audiologists were receptive to receiving training related to effective approaches to provide counseling and support to parents. RESEARCH DESIGN A cross-sectional, population-based survey was used. STUDY SAMPLE Three hundred and forty-nine surveys were analyzed from pediatric audiologists who provided services to children birth to 5 yr of age. Responses were received from 22 states in the United States. DATA COLLECTION AND ANALYSIS Responses were collected through the mail and online. Descriptive statistics were used to analyze the information. RESULTS More than half (61%) of the audiologists in the study had been providing pediatric hearing aid services to children birth to 5 yr of age for >10 yr. Of the audiologists who reported monitoring hours of hearing aid use, the majority reported that they used data logging (90%). More than half of the audiologists (57%) who shared data logging with parents reported that they encountered defensiveness from parents when addressing hearing aid use. Information and skills that were not routinely provided by one-third to one-half of the audiologists included the following: how to get access to loaner hearing aids (30%), available hearing aid options/accessories (33%), available financial assistance (36%), how to teach hearing aid management to other caregivers (38%), how to do hearing aid maintenance (44%), and how to do a Ling 6 sound check (52%). Many audiologists reported they did not frequently collaborate with speech-language pathologists (48%), early interventionists (47%), or physicians (68%). More than half of the audiologists indicated a desire for more training in counseling skills, for all 14 items queried, to support parents with hearing aid management (53-79%), regardless of their previous training experience. CONCLUSIONS For young children with hearing loss to achieve optimal benefit from auditory experiences for speech and language development, they need evidence-based, comprehensive, and coordinated hearing aid management. Audiologists have an important role for teaching information and skills related to hearing aids, supporting parent learning, and collaborating with other providers. Pediatric audiologists in this study recognized and desired the need for further training in counseling skills that can better prepare them to meet the emotional needs of parents in the hearing aid management process.

Audiologists’ Communication Behavior During Hearing Device Management Appointments.

Abstract Objective: The aim of this exploratory study was to describe audiologist communication behaviours during appointments for hearing device monitoring and management before and after participation in counselling skills training. Design: The study used a longitudinal design with three assessment points over 6 months. Study sample: The sample included 10 audiologists and audiology graduate students interacting in a professional setting with their clients. Results: Audiologists reported improvement in their counselling skills from pre-training to follow-up, which was consistent with objective findings that audiologist relative speaking time decreased from pre-training to post-training as well as from pre-training to follow-up. Observer-rated scores of participants’ counselling skills; however, yielded no significant differences across time. Conclusions: Some improvement was noted in audiologists’ counselling behaviour following a 1-day communication skills workshop and continued learning support. It is evident; however, that further training, such as increased training and performance feedback, is needed to maintain and enhance audiologist progress in the various aspects of counselling.

Effectiveness of questionnaires for screening hearing of school-age children: A comprehensive literature review

Abstract Objective: The purpose of this study was to review the literature on the effectiveness of parent or teacher-completed questionnaires as a tool to screen school-aged children for permanent hearing loss. Design: A rapid evidence assessment was completed to provide a summary of information published between 1980 and 2013 in English or Spanish. To identify relevant publications, a database search was conducted using nine databases. Study sample: Seven studies were identified for inclusion in the review. Results: Authors of three of the studies recommended use of the questionnaire as a method for screening hearing in school-aged children, and authors of four of the studies did not recommend use of the questionnaire. However, only one of the seven studies provided good evidence that questionnaires are an effective way of identifying hearing loss among children. Conclusions: There is insufficient evidence that parent or teacher completed questionnaire screening can be reliably used to identify children in need of further hearing assessment. It is clear that more research is needed before concluding that questionnaires are an effective and low-cost tool for use to screen children for permanent hearing loss.

Counseling Training in AuD Programs: A Syllabi Review.

36 The Hearing Journal August 2017 A cross many health professions, the important role of counseling within service delivery is increasingly recognized for playing a crucial part in the emotional and psycho-social well-being of patients. How providers communicate with patients and attend to the emotional aspects of care can influence treatment adherence (Med Care. 2009;47[8]:826), retention and comprehension of information (Med Care. 1988;26[7]:657), and the development of trust within the relationship (PEC. 2015;98[12]:1550). Thus, gaining insight into how audiology graduate programs train students in counseling can guide future efforts to enhance preparation of audiologists in this area. The importance of including counseling training in audiology programs is not a new concept. Two meaningful studies were conducted to describe the status of counseling training in communicative disorder programs (both speech-language pathology and audiology) for students earning a master’s degree in the United States (ASHA. 1986;28[9]:49; ASHA. 1994;36[6]:65). Both studies

Counselling users of hearing technology: a comprehensive literature review

Abstract Objective: The purpose of this review is to determine the scope of peer-reviewed empirical research related to counselling in audiology with patients using hearing technology and to identify limitations and gaps to guide recommendations for future research. Design: A rapid evidence assessment was used to identify relevant articles for the review. Study sample: Eighteen articles met the inclusion criteria. Results: Three themes were identified: (1) audiologist counselling perspectives, (2) counselling communication trends in practice and (3) audiologist experiences with professional training and reported patient outcomes. Findings revealed audiologists are more confident providing information than counselling that addresses adjustment aspects, and other communication gaps have been observed. Conclusions: There is limited research related to counselling in audiology. Audiologists continue to report a need for more training in counselling in their graduate programmes. Additional research is needed to determine effective ways to implement counselling in practice and to improve graduate student supervision for the development of counselling competencies and confidence in using skills in practice.