scholarly journals Stability of Audiometric Thresholds for Children with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Implications for Safety

2016 ◽  
Vol 27 (03) ◽  
pp. 252-263 ◽  
Author(s):  
Ryan McCreery ◽  
Elizabeth Walker ◽  
Meredith Spratford ◽  
Benjamin Kirby ◽  
Jacob Oleson ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Power Law ◽  
Hearing Aids ◽  
Longitudinal Design ◽  
Hearing Aid ◽  
Ear Canal ◽  
Behavioral Threshold ◽  
Behavioral Thresholds ◽  
Safety Limit ◽  
Modified Power Law

Background: Children who wear hearing aids may be at risk for further damage to their hearing from overamplification. Previous research on amplification-induced hearing loss has included children using linear amplification or simulations of predicted threshold shifts based on nonlinear amplification formulae. A relationship between threshold shifts and the use of nonlinear hearing aids in children has not been empirically verified. Purpose: The purpose of the study was to compare predicted threshold shifts from amplification to longitudinal behavioral thresholds in a large group of children who wear hearing aids to determine the likelihood of amplification-induced hearing loss. Research Design: An accelerated longitudinal design was used to collect behavioral threshold and amplification data prospectively. Study Sample: Two-hundred and thirteen children with mild-to-profound hearing loss who wore hearing aids were included in the analysis. Data Collection and Analysis: Behavioral audiometric thresholds, hearing aid outputs, and hearing aid use data were collected for each participant across four study visits. Individual ear- and frequency-specific safety limits were derived based on the Modified Power Law to determine the level at which increased amplification could result in permanent threshold shifts. Behavioral thresholds were used to estimate which children would be above the safety limit at 500, 1000, 2000, and 4000 Hz using thresholds in dB HL and then in dB SPL in the ear canal. Changes in thresholds across visits were compared for children who were above and below the safety limits. Results: Behavioral thresholds decreased across study visits for all children, regardless of whether their amplification was above the safety limits. The magnitude of threshold change across time corresponded with changes in ear canal acoustics as measured by the real-ear-to-coupler difference. Conclusions: Predictions of threshold changes due to amplification for children with hearing loss did not correspond with observed changes in threshold over across 2–4 yr of monitoring amplification. Use of dB HL thresholds and predictions of hearing aid output to set the safety limit resulted in a larger number of children being classified as above the safety limit than when safety limits were based on dB SPL thresholds and measured hearing aid output. Children above the safety limit for the dB SPL criteria tended to be fit above prescriptive targets. Additional research should seek to explain how the Modified Power Law predictions of threshold shift overestimated risk for children who wear hearing aids.

Cortical Auditory-Evoked Potentials (CAEPs) in Adults in Response to Filtered Speech Stimuli

2013 ◽  
Vol 24 (09) ◽  
pp. 807-822 ◽  
Author(s):  
Lyndal Carter ◽  
Harvey Dillon ◽  
John Seymour ◽  
Mark Seeto ◽  
Bram Van Dun
Keyword(s):  
Hearing Loss ◽  
Evoked Potentials ◽  
Hearing Aids ◽  
Auditory Evoked Potentials ◽  
Hearing Aid ◽  
Speech Sounds ◽  
Sensation Level ◽  
Behavioral Threshold ◽  
Speech Stimuli ◽  
Cortical Auditory Evoked Potentials

Background: Previous studies have demonstrated that cortical auditory-evoked potentials (CAEPs) can be reliably elicited in response to speech stimuli in listeners wearing hearing aids. It is unclear, however, how close to the aided behavioral threshold (i.e., at what behavioral sensation level) a sound must be before a cortical response can reliably be detected. Purpose: The purpose of this study was to systematically examine the relationship between CAEP detection and the audibility of speech sounds (as measured behaviorally), when the listener is wearing a hearing aid fitted to prescriptive targets. A secondary aim was to investigate whether CAEP detection is affected by varying the frequency emphasis of stimuli, so as to simulate variations to the prescribed gain-frequency response of a hearing aid. The results have direct implications for the evaluation of hearing aid fittings in nonresponsive adult clients, and indirect implications for the evaluation of hearing aid fittings in infants. Research Design: Participants wore hearing aids while listening to speech sounds presented in a sound field. Aided thresholds were measured, and cortical responses evoked, under a range of stimulus conditions. The presence or absence of CAEPs was determined by an automated statistic. Study Sample: Participants were adults (6 females and 4 males). Participants had sensorineural hearing loss ranging from mild to severe-profound in degree. Data Collection and Analysis: Participants' own hearing aids were replaced with a test hearing aid, with linear processing, during assessments. Pure-tone thresholds and hearing aid gain measurements were obtained, and a theoretical prediction of speech stimulus audibility for each participant (similar to those used for audibility predictions in infant hearing aid fittings) was calculated. Three speech stimuli, (/m/, /t/, and /g/) were presented aided (monaurally, nontest ear occluded), free field, under three conditions (+4 dB/octave, −4 dB/octave, and without filtering), at levels of 40, 50, and 60 dB SPL (measured for the unfiltered condition). Behavioral thresholds were obtained, and CAEP recordings were made using these stimuli. The interaction of hearing loss, presentation levels, and filtering conditions resulted in a range of CAEP test behavioral sensation levels (SLs), from −25 to +40 dB. Results: Statistically significant CAEPs (p < .05) were obtained for virtually every presentation where the behavioral sensation level was >10 dB, and for only 5% of occasions when the sensation level was negative. In these (“false-positive”) cases, the greatest (negative) sensation level at which a CAEP was judged to be present was −6 dB SL. Conclusions: CAEPs are a sensitive tool for directly evaluating the audibility of speech sounds, at least for adult listeners. CAEP evaluation was found to be more accurate than audibility predictions, based on threshold and hearing aid response measures.

An Alternate Method for Determining Functional Gain of Hearing Aids

1984 ◽  
Vol 27 (4) ◽  
pp. 627-633 ◽  
Author(s):  
Diane Rines ◽  
Patricia G. Stelmachowicz ◽  
Michael P. Gorga
Keyword(s):  
Hearing Aids ◽  
Hearing Aid ◽  
Sound Field ◽  
Normal Hearing ◽  
Acoustic Reflex ◽  
Behavioral Threshold ◽  
Hearing Sensitivity ◽  
Behavioral Thresholds ◽  
Acoustic Reflex Threshold ◽  
Functional Gain

The functional gain of a hearing aid typically is determined by comparing aided and unaided behavioral thresholds. With this method, however, true gain may be underestimated in frequency regions of normal or near-normal hearing sensitivity (i.e., in cases of sloping, rising, or trough-shaped audiograms). Internal hearing-aid noise and/or amplified room noise imposes a lower limit on obtainable aided thresholds. In these cases, comparing aided and unaided acoustic-reflex thresholds may be a valuable clinical alternative to traditional means of determining real-ear gain. This study compared sound-field behavioral threshold and acoustic-reflex threshold estimates of functional gain for individuals with a variety of audiometric configurations. The sound-field behavioral threshold measurements were found to underestimate functional gain if unaided thresholds approached the normal hearing range. In regions of greater hearing loss, behavioral and acoustic-reflex estimates of functional gain were in good agreement.

Performance of Custom-Fit versus Fixed-Format Hearing Aids for Precipitously Sloping High-Frequency Hearing Loss

2002 ◽  
Vol 13 (07) ◽  
pp. 356-366
Author(s):  
Therese C. Walden ◽  
Brian E. Walden ◽  
Mary T. Cord
Keyword(s):  
Hearing Loss ◽  
Patient Satisfaction ◽  
Speech Recognition ◽  
Hearing Aids ◽  
High Frequency ◽  
Hearing Aid ◽  
Ear Canal ◽  
High Frequency Hearing Loss ◽  
The Real ◽  
Patient Performance

This study compared the real-ear response provided by custom-fit hearing aids to the closest matching fixed-format disposable hearing aids in patients with precipitous high-frequency hearing loss. Laboratory and field measures of aided performance were obtained to compare patient performance with the custom-fit and fixed-format hearing aids. In addition, coupler versus real-ear response differences were compared for the two hearing aid types. The results revealed that relatively close approximations to the real-ear aided responses of the custom-fit instruments were possible for most participants using seven fixed acoustic formats. No significant differences in mean performance between the two instrument types were observed for aided speech recognition or field ratings of aided performance, although mean patient satisfaction was lower for the disposable hearing aids. The real-ear to coupler difference was greater for the disposable hearing aid than for the custom-fit instruments, presumably owing to its deeper insertion into the ear canal.

The Relationship Between Hearing Loss Self-Management and Hearing Aid Benefit and Satisfaction

2019 ◽  
Vol 28 (2) ◽  
pp. 274-284 ◽  
Author(s):  
Elizabeth Convery ◽  
Gitte Keidser ◽  
Louise Hickson ◽  
Carly Meyer
Keyword(s):  
Decision Making ◽  
Hearing Loss ◽  
Hearing Aids ◽  
Clinical Decision Making ◽  
Hearing Aid ◽  
Well Being ◽  
Self Report ◽  
Self Management ◽  
Hearing Aid Benefit ◽  
The Relationship

Purpose Hearing loss self-management refers to the knowledge and skills people use to manage the effects of hearing loss on all aspects of their daily lives. The purpose of this study was to investigate the relationship between self-reported hearing loss self-management and hearing aid benefit and satisfaction. Method Thirty-seven adults with hearing loss, all of whom were current users of bilateral hearing aids, participated in this observational study. The participants completed self-report inventories probing their hearing loss self-management and hearing aid benefit and satisfaction. Correlation analysis was used to investigate the relationship between individual domains of hearing loss self-management and hearing aid benefit and satisfaction. Results Participants who reported better self-management of the effects of their hearing loss on their emotional well-being and social participation were more likely to report less aided listening difficulty in noisy and reverberant environments and greater satisfaction with the effect of their hearing aids on their self-image. Participants who reported better self-management in the areas of adhering to treatment, participating in shared decision making, accessing services and resources, attending appointments, and monitoring for changes in their hearing and functional status were more likely to report greater satisfaction with the sound quality and performance of their hearing aids. Conclusion Study findings highlight the potential for using information about a patient's hearing loss self-management in different domains as part of clinical decision making and management planning.

FM Verification for the 21 st Century

2008 ◽  
Vol 18 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Leisha Eiten ◽  
Dawna Lewis
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Current Technology ◽  
The Past ◽  
Technological Advances ◽  
Children With Hearing Loss

Background: For children with hearing loss, the benefits of FM systems in overcoming deleterious effects of noise, distance, and reverberation have led to recommendations for use beyond classroom settings. It is important that audiologists who recommend and fit these devices understand the rationale and procedures underlying fitting and verification. Objectives: This article reviews previousguidelines for FM verification, addresses technological advances, and introduces verification procedures appropriate for current FM and hearing-aid technology. Methods: Previous guidelines for verification of FM systems are reviewed. Those recommendations that are appropriate for current technology are addressed, as are procedures that are no longer adequate for hearing aids and FM systems utilizing more complex processing than in the past. Technological advances are discussed, and an updated approach to FM verification is proposed. Conclusions: Approaches to verification andfitting of FM systems must keep pace with advances in hearing-aid and FM technology. The transparency approach addressed in this paper is recommended for verification of FM systems coupled to hearing aids.

Modified Earpieces and CROS for High Frequency Hearing Losses

1968 ◽  
Vol 11 (1) ◽  
pp. 204-218 ◽  
Author(s):  
Elizabeth Dodds ◽  
Earl Harford
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
High Frequency ◽  
Hearing Aid ◽  
Sound Field ◽  
Intensity Level ◽  
Test Results ◽  
High Frequency Hearing Loss ◽  
Increased Sensitivity ◽  
Difficult Cases

Persons with a high frequency hearing loss are difficult cases for whom to find suitable amplification. We have experienced some success with this problem in our Hearing Clinics using a specially designed earmold with a hearing aid. Thirty-five cases with high frequency hearing losses were selected from our clinical files for analysis of test results using standard, vented, and open earpieces. A statistical analysis of test results revealed that PB scores in sound field, using an average conversational intensity level (70 dB SPL), were enhanced when utilizing any one of the three earmolds. This result was due undoubtedly to increased sensitivity provided by the hearing aid. Only the open earmold used with a CROS hearing aid resulted in a significant improvement in discrimination when compared with the group’s unaided PB score under earphones or when comparing inter-earmold scores. These findings suggest that the inclusion of the open earmold with a CROS aid in the audiologist’s armamentarium should increase his flexibility in selecting hearing aids for persons with a high frequency hearing loss.

Feasibility of smartphone-based hearing-aid apps for patients with mild hearing loss: an exploratory pilot study (Preprint)

2020 ◽  
Author(s):  
Willy Nguyen ◽  
Miseung Koo ◽  
Seung Ha Oh ◽  
Jun Ho Lee ◽  
Moo Kyun Park
Keyword(s):  
Hearing Loss ◽  
Hearing Impairment ◽  
Hearing Aids ◽  
Clinical Performance ◽  
Hearing Aid ◽  
National Standards ◽  
Hearing In Noise ◽  
Mild Hearing Loss ◽  
Consumer Devices ◽  
Selection Of

BACKGROUND Underuse of hearing aids is caused by several factors, including the stigma associated with hearing disability, affordability, and lack of awareness of rising hearing impairment associated with the growing population. Thus, there is a significant opportunity for the development of direct-to-consumer devices. For the past few years, smartphone-based hearing-aid apps have become more numerous and diverse, but few studies have investigated them. OBJECTIVE This study aimed to elucidate the electroacoustic characteristics and potential user benefits of a selection of currently available hearing-aid apps. METHODS We investigated the apps based on hearing-aid control standards (American National Standards Institute) using measurement procedures from previous studies. We categorized the apps and excluded those we considered inefficient. We investigated a selection of user-friendly, low-end apps, EarMachine and Sound Amplifier, with warble-tone audiometry, word recognition testing in unaided and aided conditions, and hearing-in-noise test in quiet and noise-front conditions in a group of users with mild hearing impairment (n = 7) as a pilot for a future long-term investigation. Results from the apps were compared with those of a conventional hearing aid. RESULTS Five of 14 apps were considered unusable based on low scores in several metrics, while the others varied across the range of electroacoustic measurements. The apps that we considered “high end” that provided lower processing latencies and audiogram-based fitting algorithms were superior overall. The clinical performance of the listeners tended to be better when using hearing aid, while the low end hearing-aid apps had limited benefits on the users. CONCLUSIONS Some apps showed the potential to benefit users with limited cases of minimal or mild hearing loss if the inconvenience of relatively poor electroacoustic performance did not outweigh the benefits of amplification.

Measurements of Loudness Growth in 1/2-Octave Bands for Children and Adults With Normal Hearing

1999 ◽  
Vol 8 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Melisa R. Ellis ◽  
Michael K. Wynne
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Age Groups ◽  
Lower Boundary ◽  
Normal Hearing ◽  
Boundary Values ◽  
Simple Modification ◽  
Point Data ◽  
Loudness Growth

The loudness growth in 1/2-octave bands (LGOB) procedure has been shown previously to provide valid estimates of loudness growth for adults with normal hearing and those with hearing loss (Allen, Hall, & Jeng, 1990), and it has been widely incorporated into fitting strategies for adult hearing aid users by a hearing aid manufacturer. Here, we applied a simple modification of LGOB to children and adults with normal hearing and then compared the loudness growth functions (as obtained from end-point data) between the two age groups. In addition, reliability data obtained within a single session and between test sessions were compared between the two groups. Large differences were observed in the means between the two groups for the lower boundary values, the upper boundary values, and the range between boundaries both within and across all frequencies. The data obtained from children also had greater variance than the adult data. In addition, there was more variability in the data across test sessions for children. Many test-retest differences for children exceeded 10 dB. Adult test-retest differences were generally less than 10 dB. Although the LGOB with the modifications used in this study may be used to measure loudness growth in children, its poor reliability with this age group may limit its clinical use for children with hearing loss. Additional work is needed to explore whether loudness growth measures can be adapted successfully to children and whether these measures contribute worthwhile information for fitting hearing aids to children.

Hearing Technology Use and Management in School-Age Children: Reports from Data Logs, Parents, and Teachers

2017 ◽  
Vol 28 (10) ◽  
pp. 883-892 ◽  
Author(s):  
Samantha J. Gustafson ◽  
Todd A. Ricketts ◽  
Anne Marie Tharpe
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Parent Report ◽  
School Age Children ◽  
School Age ◽  
Data Logging ◽  
Hearing Aid Use ◽  
System Use ◽  
Children With Hearing Loss

Background: Consistency of hearing aid and remote microphone system use declines as school-age children with hearing loss age. One indicator of hearing aid use time is data logging, another is parent report. Recent data suggest that parents overestimate their children’s hearing aid use time relative to data logging. The potential reasons for this disparity remain unclear. Because school-age children spend the majority of their day away from their parents and with their teachers, reports from teachers might serve as a valuable and additional tool for estimating hearing aid use time and management. Purpose: This study expands previous research on factors influencing hearing aid use time in school-age children using data logging records. Discrepancies between data logging records and parent reports were explored using custom surveys designed for parents and teachers. Responses from parents and teachers were used to examine hearing aid use, remote microphone system use, and hearing aid management in school-age children. Study Sample: Thirteen children with mild-to-moderate hearing loss between the ages of 7 and 10 yr and their parents participated in this study. Teachers of ten of these children also participated. Data Collection and Analysis: Parents and teachers of children completed written surveys about each child’s hearing aid use, remote microphone system use, and hearing aid management skills. Data logs were read from hearing aids using manufacturer’s software. Multiple linear regression analysis and an intraclass correlation coefficient were used to examine factors influencing hearing aid use time and parent agreement with data logs. Parent report of hearing aid use time was compared across various activities and school and nonschool days. Survey responses from parents and teachers were compared to explore areas requiring potential improvement in audiological counseling. Results: Average daily hearing aid use time was ˜6 hr per day as recorded with data logging technology. Children exhibiting greater degrees of hearing loss and those with poorer vocabulary were more likely to use hearing aids consistently than children with less hearing loss and better vocabulary. Parents overestimated hearing aid use by ˜1 hr per day relative to data logging records. Parent-reported use of hearing aids varied across activities but not across school and nonschool days. Overall, parents and teachers showed excellent agreement on hearing aid and remote microphone system use during school instruction but poor agreement when asked about the child’s ability to manage their hearing devices independently. Conclusions: Parental reports of hearing aid use in young school-age children are largely consistent with data logging records and with teacher reports of hearing aid use in the classroom. Audiologists might find teacher reports helpful in learning more about children’s hearing aid management and remote microphone system use during their time at school. This supplementary information can serve as an additional counseling tool to facilitate discussion about remote microphone system use and hearing aid management in school-age children with hearing loss.

An approach to bilateral bone-anchored hearing aid surgery in children: contralateral placement of sleeper fixture

2008 ◽  
Vol 123 (5) ◽  
pp. 555-557 ◽  
Author(s):  
J M Bernstein ◽  
P Z Sheehan
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Conductive Hearing Loss ◽  
Hearing Aid ◽  
Contralateral Side ◽  
Two Stage ◽  
Calvarial Bone ◽  
Optimal Position ◽  
Bone Anchored Hearing Aid ◽  
Conductive Hearing

AbstractObjective:Bone-anchored hearing aid surgery in younger children is a two-stage procedure, with a titanium fixture being allowed to osseointegrate for several months before an abutment is fitted through a skin graft. In the first procedure, it has been usual to place a reserve or sleeper fixture approximately 5 mm from the primary fixture as a backup in case the primary fixture fails to osseointegrate. This ipsilateral sleeper fixture is expensive, is often not used, and is placed in thinner calvarial bone where it is less likely to osseointegrate successfully. The authors have implanted the sleeper fixture on the contralateral side, with the additional objective of reducing the number of procedures for bilateral bone-anchored hearing aid implantation, providing a cost-effective use for the sleeper.Methods:The authors implanted the bone-anchored hearing aid sleeper fixture in the contralateral temporal bone instead of on the ipsilateral side in seven successive paediatric cases with bilateral conductive hearing loss requiring two-stage bone-anchored hearing aids, treated at the Royal Manchester Children's Hospital, UK.Results:The seven patients ranged in age from five to 15 years, with a mean age of 10 years; in addition, a 20-year-old with learning disability was also treated. In each case, the contralateral sleeper fixture was not needed as a backup fixture, but was used in four patients (57 per cent) as the basis for a second-side bone-anchored hearing aid.Conclusions:In children with bilateral conductive hearing loss, in whom a bilateral bone-anchored hearing aid is being considered and the second side is to be operated upon at a later date, we recommend placing the sleeper fixture on the contralateral side at the time of primary first-side surgery. Our technique provides a sleeper fixture located in an optimal position, where it also offers the option of use for a second-side bone-anchored hearing aid and reduces the number of procedures needed.

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