Hearing loss Management

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.
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.

  • 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.

 

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:

  1. Direct audio input. FM systems should be considered when the child becomes older and more mobile and needs to listen from greater distances.
  2. Flexibility in setting the electroacoustic parameters of the hearing aid is essential such as in digital and digitally programmable hearing aids.
  3. 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.
  4. 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.
  5. Binaural amplification should always be provided to young children with binaural hearing loss unless there is a medical contraindication.
  6. A bone conduction hearing aid may be appropriate if the loss is conductive and BTs cannot be used due to medical or physical contraindications.
  7. 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.

 

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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