LM108 - The State of Audibility in Pediatric Hearing Aid Users: What Do We Know, Where Do We Go?

Abstract:
Sufficient audibility and consistent hearing aid use play important roles in ensuring children with hearing loss can develop age-appropriate listening and spoken language skills. Sufficient audibility can be achieved through the appropriate selection of hearing aids and the use of real ear probe mic measures to match hearing aid output to prescriptive targets and optimize speech intelligibility. Additionally, full-time use of appropriately fit hearing aids needs to be achieved to maximize listening and spoken language outcomes. This learning module will provide audiologists with useful tools and the framework to improve audibility and support families to achieve full-time hearing aid use.

Summary:
As pediatric audiologists, we want to ensure that children with hearing loss reach their full potential. To accomplish that, we must use evidence-based practices for fitting and monitoring hearing aid (HA) use and benefit. Many formative studies have been instrumental in developing candidacy for amplification, developing and validating hearing aid prescriptive targets (i.e. Desired Sensation Level (DSL)) and evaluating outcomes of children with hearing loss as they relate to audibility and consistent device use. However, more research is needed to understand how different metrics of audibility and device use relate to outcomes. Our clinic follows evidence based practices and uses a collaborative care approach with listening and spoken language therapists providing care alongside audiologists. Despite providing high quality care, concerns remain for hearing aid wear time while ensuring children have adequate audibility.

Our team started an initiative to improve wear time (and subsequently audibility). This was accomplished by monthly meetings to develop and implement a protocol as well as routinely staff patients with low wear time. A review of the literature on audibility and hearing aid use as well as clinic generated data led us to ask questions about how audibility and hearing aid use were correlated. A retrospective study was then conducted in our clinic to answer questions about the current trends in hearing aid device selection and fitting and to examine the relationship between audibility, device use, and outcomes to guide best-practices in hearing aid fitting and management. Using data from over 500 hearing aid fittings, we evaluated factors (i.e. age, degree of hearing loss, unaided SII, aided SII) that influence consistent device use and evaluated the relationship between audibility and listening and spoken language outcomes. This data sought to identify audiometric factors that contributed to device use or non-use beyond the well-known patient and socio-economic factors (i.e. maternal education). These data provided information on factors being used to determine HA candidacy, as well as which metrics were helpful to quantify our hearing aid fittings and adjustments. Our primary goal is to determine how these metrics relate to outcomes for pediatric hearing aid users.

This presentation will provide a refresher on existing literature including the importance of sufficient audibility and review critical components of a hearing aid fitting (real ear to coupler difference and verification of pediatric prescriptive targets using real ear probe mic measurements). Attendees will learn how to use related metrics such as the speech intelligibility index to quantify hearing aid benefit, and in cases where audibility may be compromised, attendees will learn strategies to improve audibility. Our goal is to provide audiologists with clinically relevant tools to collect and report hearing aid fitting metrics (i.e. speech intelligibility index) and use this information to counsel families on the importance of full-time hearing aid use.