Sheila Moodie

The Desired Sensation Level Multistage Input/Output Algorithm

The Desired Sensation Level (DSL) Method was revised to support hearing instrument fitting for infants, young children, and adults who use modern hearing instrument technologies, including multichannel compression, expansion, and multimemory capability. The aims of this revision are to maintain aspects of the previous versions of the DSL Method that have been supported by research, while extending the method to account for adult-child differences in preference and listening requirements. The goals of this version (5.0) include avoiding loudness discomfort, selecting a frequency response that meets audibility requirements, choosing compression characteristics that appropriately match technology to the users needs, and accommodating the overall prescription to meet individual needs for use in various listening environments. This review summarizes the status of research on the use of the DSL Method with pediatric and adult populations and presents a series of revisions that have been made during the generation of DSL v5.0. This article concludes with case examples that illustrate key differences between the DSL v4.1 and DSL v5.0 prescriptions.

Clinical Protocols for Hearing Instrument Fitting in the Desired Sensation Level Method

A discussion of the protocols used particularly in the clinical application of the Desired Sensation Level (DSL) Method is presented in this chapter. In the first section, the measurement and application of acoustic transforms is described in terms of their importance in the assessment phase of the amplification fitting process. Specifically, the implications of individual ear canal acoustics and their impact on accurately defining hearing thresholds are discussed. Detailed information about the statistical strength of the real-ear-to-coupler difference (RECD) measurement and how to obtain the measure in young infants is also provided. In addition, the findings of a study that examined the relationship between behavioral and electrophysiologic thresholds in real-ear SPL is described. The second section presents information related to the electroacoustic verification of hearing instruments. The RECD is discussed in relation to its application in simulated measurements of real-ear hearing instrument performance. In particular, the effects of the transducer and coupling method during the RECD measurement are described in terms of their impact on verification measures. The topics of insertion gain, test signals, and venting are also considered. The third section presents three summary tables that outline the hearing instrument fitting process for infants, children, and adults. Overall, this chapter provides both clinical and scientific information about procedures used in the assessment and verification stages of the DSL Method.

The DSL Method for Pediatric Hearing Instrument Fitting: Historical Perspective and Current Issues

The Desired Sensation Level (DSL) Method was originally developed in the early 1980s to provide clinicians with a systematic, science-based approach to pediatric hearing instrument fitting that ensures audibility of amplified speech by accounting for factors that are uniquely associated with the provision of amplification to infants and young children who have hearing loss. This review identifies and describes several of the primary factors that have been considered in the development of the DSL Method. Specifically, the issues discussed relate to: (1) the definition and measurement of relevant acoustic, electroacoustic and audiometric variables; (2) how the external ear acoustics of infants and young children are accounted for in the DSL Method for both audiometric assessment and in the fitting of amplification; and (3) how the DSL Method has evolved concurrently with developments in hearing instrument and electroacoustic measurement technologies. Finally, current issues in the field are identified that have motivated the development of version 5.0 of the DSL Method for hearing instrument fitting.

The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP)

This study proposed and evaluated a guideline for outcome evaluation for infants and children with hearing loss who wear hearing aids. The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP) was developed following a critical review of pediatric outcome evaluation tools and was systematically examined by the Network of Pediatric Audiologists of Canada. It consists of tools to gather clinical process outcomes as well as functional caregiver reports. The UWO PedAMP was administered to a clinical population of infants and children with hearing aids. Sixty-eight children were administered the functional outcome evaluation tools (i.e., caregiver reports) a total of 133 times. Clinical process outcomes of hearing aid verification (e.g., real-ear-to-coupler difference) revealed typical aided audibility (e.g., Speech Intelligibility Index). Results for the LittlEARS® questionnaire revealed that typically developing children with hearing loss who wear hearing aids are meeting auditory development milestones. Children with mild to moderate comorbidities displayed typical auditory development during the 1st year of life after which development began to decline. Children with complex factors related to hearing aid use had lower scores on the LittlEARS, but auditory development was in parallel to norms. Parents’ Evaluation of Aural/Oral Performance (PEACH) results indicated no age effect on scoring for children above 2 years of age; however, the effect of degree of hearing loss was significant. This work provides clinicians with a systematic, evidence-based outcome evaluation protocol to implement as part of a complete pediatric hearing aid fitting.

A Critical Review of Audiological Outcome Measures for Infants and Children

Outcome evaluation is an important stage in the pediatric hearing aid fitting process, however a systematic way of evaluating outcome in the pediatric audiology population is lacking. This is in part due to the need for an evidence-based outcome evaluation guideline for infants and children with hearing loss who wear hearing aids. As part of the development of a guideline, a critical review of the existing pediatric audiology outcome evaluation tools was conducted. Subjective outcome evaluation tools that measure auditory-related behaviors in children from birth to 6 years of age were critically appraised using a published grading system (Andresen, 2000). Of the tools that exist, 12 were appraised because they met initial criteria outlined by the Network of Pediatric Audiologists of Canada as being appropriate for children birth to 6 years of age who wear hearing aids. Tools that were considered for the guideline scored high in both statistical and feasibility criteria. The subjective outcome evaluation tools that were ultimately chosen to be included in the guideline were the LittlEARS Auditory Questionnaire (Tsiakpini et al., 2004) and the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005b) due to the high grades they received in the critical review and their target age ranges. Following this critical review of pediatric outcome evaluation tools, the next step was for the Network Clinicians to evaluate the guideline (Moodie et al., 2011b).

Fit to targets, preferred listening levels, and self-reported outcomes for the DSL v5.0a hearing aid prescription for adults

Abstract Study objective: This study evaluated how closely the DSL v5.0a prescription could be approximated with hearing aids, its relationship to preferred listening levels (PLLs) of adults with acquired hearing loss, and the self-reported outcomes of the resulting fittings. Participants: Thirty adults with varying degrees and configurations of hearing loss ranging from mild to severe. Methods: Hearing aid output was measured after the initial fitting to DSL v5.0a targets and after determination of the PLL after approximately 90 days. The Client Oriented Scale of Improvement (COSI) was used to evaluate outcome. Results: The 95% confidence interval of fits to target ranged from 5.8 to 8.4 dB across frequency. The DSL v5.0a adult algorithm approximated the PLLs of the participants within 2.6 dB on average. Hearing aid fittings provided positive subjective outcome improvements on the COSI. Conclusions: Findings suggest that the use of DSL v5.0a for the fitting of hearing aids on adults with acquired hearing loss was feasible and provided an appropriate initial fitting. Sumario Objetivo del estudio: Este estudio evaluó qué tanto puede satisfacer una prescripción DSL v5.0a con auxiliares auditivos, su relación con los niveles preferidos de escucha (PLLs) en adultos con pérdida auditiva adquirida y los resultados de los auto reportes de las adaptaciones resultantes. Participantes: Treinta adultos con variados grados y configuraciones de pérdidas auditivas, entre leves y severas. Métodos: Se midió la salida del auxiliar auditivo después de la adaptación por metas DSL v5.0a y después de determinar los PLL, al cumplirse aproximadamente 90 días. Para evaluar los resultados, se usó la Escala de Mejoría Orientada hacia el Cliente (COSI). Resultados: 95% de intervalo de confianza de adaptaciones relacionadas con blancos, entre 5.8 a 8.4 dB en todas las frecuencias. El algoritmo en adultos del DSL v5.0a se aproximó a los PLLs de los participantes en un promedio de 2.6 dB. Las adaptaciones de auxiliares auditivos dieron resultados subjetivos positivos con el COSI. Conclusiones: los hallazgos sugieren que el uso de DSL v5.0a para la adaptación de auxiliares auditivos en adultos con pérdidas auditivas adquiridas fue factible y permitió una adaptación inicial apropiada.

Knowledge Translation in Audiology: Promoting the Clinical Application of Best Evidence

The impetus for evidence-based practice (EBP) has grown out of widespread concern with the quality, effectiveness (including cost-effectiveness), and efficiency of medical care received by the public. Although initially focused on medicine, EBP principles have been adopted by many of the health care professions and are often represented in practice through the development and use of clinical practice guidelines (CPGs). Audiology has been working on incorporating EBP principles into its mandate for professional practice since the mid-1990s. Despite widespread efforts to implement EBP and guidelines into audiology practice, gaps still exist between the best evidence based on research and what is being done in clinical practice. A collaborative dynamic and iterative integrated knowledge translation (KT) framework rather than a researcher-driven hierarchical approach to EBP and the development of CPGs has been shown to reduce the knowledge-to-clinical action gaps. This article provides a brief overview of EBP and CPGs, including a discussion of the barriers to implementing CPGs into clinical practice. It then offers a discussion of how an integrated KT process combined with a community of practice (CoP) might facilitate the development and dissemination of evidence for clinical audiology practice. Finally, a project that uses the knowledge-to-action (KTA) framework for the development of outcome measures in pediatric audiology is introduced.

External validation of the LittlEARS® Auditory Questionnaire with English-speaking families of Canadian children with normal hearing

OBJECTIVE To examine the external validity of the United Kingdom English version of the LittlEARS(®) Auditory Questionnaire with English-speaking families of Canadian children with normal hearing. METHODS The United Kingdom English version of the LittlEARS was administered to English-speaking families of 130 children with normal hearing in Ontario, Canada. Total scores for these children were compared to German-derived normative values. RESULTS There was no significant difference between Canadian and German norms when using the United Kingdom English version of the LittlEARS Auditory Questionnaire. CONCLUSIONS The United Kingdom English version of the LittlEARS Auditory Questionnaire is appropriate for use with English-speaking families of normal hearing Canadian children.

Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program.

BACKGROUND Guidelines and protocols for pediatric hearing aid fitting are necessary to meet the goals of Early Hearing Detection and Intervention (EHDI) programs. The American Academy of Audiology published an update to their Pediatric Amplification Guideline in 2013. Ontarios Infant Hearing Program (IHP) offers specific protocols that aim to fulfill recommended guidelines. It has recently been updated to align with the American Academy of Audiology Guideline and other evidence. PURPOSE A summary of the updates to the Ontario IHPs Amplification Protocol is described. In addition, data illustrating hearing-related outcomes of the program are offered. RESEARCH DESIGN The updated Ontario protocol is based on evidence, wherever possible. Where research is not yet available, clinical decision support has been described in a systematic way. Outcomes of the Ontario IHP were obtained through a longitudinal clinical observation study. STUDY SAMPLE One hundred and fifteen children with hearing loss, who wore hearing aids, were included in the outcome analyses (mean = 28.6 mo; range = 1.3-115.3 mo). Hearing losses ranged from mild to profound, unilateral or bilateral sensorineural (pure-tone average = 52.3 dB HL). They were recruited from four IHP clinics within Ontario. Children with complexities in addition to hearing loss were included. INTERVENTION The children were fitted with hearing aids following Ontarios Amplification Protocol. DATA COLLECTION AND ANALYSES During routine clinical appointments, IHP Audiologists administered questionnaires to the parents of their pediatric patients using a systematic outcome measurement protocol (University of Western Ontario Pediatric Audiological Monitoring Protocol). Hearing aid fitting details (e.g., speech intelligibility index) were also gathered to describe the quality of the hearing aid fittings in relation to the functional outcomes. Regression analyses were conducted to characterize scores on the questionnaires and the impact of important variables. Children with complexities were analyzed separately from those who were typically developing. RESULTS Important updates to Ontarios Amplification Protocol offer new details about candidacy considerations as well as technical updates. Outcomes from the IHP reveal protocol elements can be executed clinically and when they are, typically developing children who wear hearing aids are meeting auditory development and performance milestones. CONCLUSIONS Updates to Ontarios Amplification Protocol are necessary to support the evolution of EHDI programs and the evidence which sustains them. With advances in technology and additional research, pediatric hearing aid fitting will continue to progress and support systematic measurement of outcomes for children who wear hearing aids. The application of state-of-the-art hearing aid fitting practices to the pediatric population within EHDI programs supports good outcomes for infants and children with hearing loss.

Parent-to-Parent Support for Parents With Children Who Are Deaf or Hard of Hearing: A Conceptual Framework

BACKGROUND Parent-to-parent support for parents with children who are deaf or hard of hearing (D/HH) is identified as an important component of Early Hearing Detection and Intervention (EHDI) programs for children with hearing loss. PURPOSE The specific aim of this review was to identify the constructs and components of parent-to-parent support for parents of children who are D/HH. RESEARCH DESIGN An extensive scoping literature review identified 39 peer-reviewed articles published from 2000 to 2014. Studies were selected and reviewed based on standardized procedures. RESULTS Data were identified, extracted, and organized into libraries of thematic and descriptive content. A conceptual framework of parent-to-parent support for parents of children who are D/HH was developed and presented in a comprehensive, bidirectional informational graphic. The constructs and components of the conceptual framework are (a) well-being: parent, family, and child; (b) knowledge: advocacy, system navigation, and education; and (c) empowerment: confidence and competence. CONCLUSION The findings from this scoping review led to the development of a structured conceptual framework of parent-to-parent support for parents of children who are D/HH. The conceptual framework provides an important opportunity to explore and clearly define the vital contribution of parents in EHDI programs.