Hearing loss Management >> Hearing Aid Evaluation and Fitting
Hearing Aid Evaluation and Fitting
The hearing aid evaluation will help
determine which of the many types of hearing aids would be most
suitable for a given individual. While the overall goals are the same
for both children and adults, the evaluation process itself differs.
Evaluation
and Fitting of Hearing Aids for Adults
The first step in
the process is to determine the patient's lifestyle, listening needs, and
hearing concerns. Technology has advanced rapidly in this area and
there are many different types of systems available, including
programmable systems, digital signal processing, directional
microphones for noise control, and multiple memory devices.
- Individual need - Understanding the
individual needs of each patient is the first step in finding the
best hearing aids for each individual.
- Selection - The next step is to
select the best option. In some cases, patients will try different
styles, types and circuits to assess their preferences. The
selected devices are tested in the patient's ears and the settings
of the hearing aids are adjusted based on the person's hearing
loss. Patients also may be asked to try the hearing aid in
different situations to determine how comfortable they are with
it. This process is repeated in order to "fine tune" the
devices to meet the individual needs.
- Operation, Care and Maintenance - During the hearing aid fitting, patients are instructed
in the operation, care, and maintenance of their hearing aids. All
patients are given a one week trial period in which the hearing
aids can be worn at home, at work, and during social activities.
During the trial period, the patient contacts the audiologist to
discuss problems and ask questions.
- Adjustment - If adjustments are
necessary, another visit is scheduled.
- Warranty - All hearing aids
purchased at JISH come with a 1-2-year manufacturer's warranty and
free hearing-aid related services for 1-2 years.
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Evaluation
and Fitting of Hearing Aids for Infants and Young Children
Fitting hearing aids for children is more
difficult than for adults because children cannot help decide which
circuit sounds best or whether sounds from the hearing aid are too
loud.
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Selection - because hearing aids
will be used to help develop speech and language skills, it is
important to find devices that will allow the child to hear soft,
average, and loud speech. It is also crucial to determine the
sound levels that the hearing aid produces in the child's ear in
order to avoid rejection of the hearing aids and or further damage
to the inner ear. Based on the child's age and other physical
characteristics as well as the type, degree, and configuration of
hearing loss, the audiologist determines circuitry and other
options. A computerized hearing aid-fitting program, usually known
as real and simulated real
ear measurements (REM) designed exclusively for young
children, is used to set hearing aid characteristics.
- Hearing Aid Operation and
Maintenance - Parents are given detailed instructions in
the operation of the hearing aids, shown how to perform a
listening check, and how to care for the devices.
- Assistive Listening Devices - In some cases,
specialized devices may be recommended instead of, or in addition
to, hearing aids.
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FITTING PROCESS:
For a variety
of reasons, real-ear measures are the preferred method to document
hearing instrument performance. A proven alternative to traditional
probe-microphone measures is to obtain real-ear to coupler differences
(RECD). The RECD, measured with the infant's own ear mold can be used
in combination with test-box measures to predict real-ear responses.
Prescriptive approaches are used to fit hearing aids for babies. Desired
Sensation Level (DSL) is a common method used for pediatric fittings.
HEARING
AID CONSIDERATIONS:
Selected
hearing aids for children should be digital, or digitally programmable,
allowing tremendous flexibility regarding hearing aid adjustments, and
the changes likely to be needed over time. Continuous monitoring and
testing should be performed on the child until consistent and reliable
hearing thresholds can be determined. The audiologist should determine
the best "follow-up"
schedule based on the individual needs of the child.
Hearing aid selection for most
children should consider the following:
- Direct audio input. FM
systems should be considered when the child becomes
older and more mobile and needs to listen from greater distances.
- Flexibility in
setting the electroacoustic parameters of the hearing aid is
essential such as in digital and digitally programmable hearing
aids.
- The physical fit of
the hearing aids and ear molds is important for both comfort and
retention. Soft material is recommended for safety and comfort.
They should be replaced at least 3 or 4 times a year and whenever
feedback is excessive at optimal settings or the fit becomes loose
or comfort issues occur. Retention devices and options:
"Huggies", toupee tape, cords, "Critter
Clips," headbands.
- Behind-the-ear
hearing aids are the style of choice for most children. In-the-ear
hearing aids are not generally recommended for infants and young
children due to their small ear canal sizes and rapid growth of
the outer ear.
- Binaural
amplification should always be provided to young children with binaural hearing loss unless there is a
medical contraindication.
- A bone conduction
hearing aid may be appropriate if the loss is conductive and BTs cannot be used due to medical or
physical contraindications.
- Cochlear
implants may be considered if the child has a profound
sensorineural hearing loss bilaterally, has used appropriate hearing
aids consistently for 6 months, has been enrolled in an early
intervention program, exhibits minimal or no benefit from hearing
aids, and meets medical candidacy and age requirements
VALIDATION
OF AIDED AUDITORY FUNCTION:
The golden
rule: The hearing aids should provide the child with an audible,
comfortable, and clear sound in order for him to able to acquire and
develop spoken language. Validation for pediatric hearing aid fittings
is of course challenging. However, there are available tools to help
confirm suitable hearing aid fittings.
FOLLOW-UP
Periodic
audiologic re-evaluation is essential: For example, rechecks at 2-3
month intervals for the first year of amplification and every 6 months
until age 5 and annually thereafter. The frequency of follow-up may
need to be increased if fluctuation/progression of the hearing loss is
noted and/or if progress is not as might be expected. Ongoing
communication between the clinical audiologist and the members of the
early team is critical.
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Recent studies have shown that
children who are fitted with amplification within the first 3-9 months
of life develop significantly better speech and language skills than
children who are fitted later.
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