PP1105 - Management of Functional Hearing Deficits in Children with Normal Peripheral Hearing

Abstract:
Guidelines have emphasized the importance of investigating the functional auditory abilities of children referred for hearing assessments. Children with normal pure tone audiograms report listening and communication difficulties associated with deficits in managing auditory information. However, investigating children with auditory deficits (e.g., auditory processing) may be challenging, as test batteries and recommendations for treatment are highly variable. Survey and interview research explored North American Audiologists’ assessment and management practices of children with normal peripheral audiograms who report functional hearing deficits.

Summary:

Rationale/Purpose
The pure-tone audiogram is a well-established, clinical measurement to identify and measure hearing loss. However, it may not be representative of an individual’s functional hearing abilities in their everyday communication environments (Phatak et al., 2019). For example, for children with auditory processing difficulties, a normal audiogram would not accurately represent their hearing and listening challenges (Keith & Purdy, 2014). Developed guidelines have emphasized the importance of audiologists investigating the functional auditory abilities of children in their listening environments (CISG, 2012). The assessment and management of children who demonstrate functional hearing deficits has been viewed as challenging, with test batteries and recommendations for treatment being highly variable (Geffner et al., 2018). The purpose of this study was to investigate the current assessment and management practices of North American Audiologists who see children with functional hearing deficits.

Methods
A group of researchers, clinical, and educational audiologists formed a working group to explore current audiological practice challenges when managing children who have functional hearing deficits and normal peripheral hearing. A mixed methods study using survey and interview research included a web-based survey that was distributed to over 200 pediatric audiologists in North America. The purpose was to gather information about the systems and procedures utilized when working with children and their families who report hearing deficits and have normal peripheral hearing. In addition, semi-structured online interviews were conducted with participants who volunteered from the survey.

Results
Fifty-one participants completed the survey (n=51), with nearly all survey participants (93%) recommending additional testing and/or interventions when seeing children and their families who report functional hearing deficits and have normal peripheral hearing. Participants reported several different assessments to determine children’s functional hearing abilities. Also, survey responses indicated a variety of intervention recommendations. They included compensatory strategies, auditory training, a trial period with ear-level remote microphone technology, low gain hearing aids, and low gain hearing aids plus remote microphone technology. To assess hearing technology benefit, outcome measures such as aided speech testing in quiet and in noise and functional listening questionnaires were used. Six participants completed semi-structured interviews. Interviews were transcribed and coded, and thematic analysis completed. Major themes included communication access, support for social relationships, promoting individual participation, and clinical uncertainty.

Conclusions:
In this study, most clinical audiologists provided additional assessments beyond the audiogram to investigate the reported functional listening deficits of children with normal peripheral hearing. The assessment and management of children who demonstrate functional hearing deficits continues to be viewed as challenging. Clinical Audiologists felt uncertain about the selection of test batteries and providing recommendations for treatment, with many describing a failure-based approach. When hearing technology was fit, clinicians used outcome measures similar to those used with children who have hearing loss and wear hearing aids.