Integrating Parents into the Diagnostic and Habilitation Process

Abstract

Newborn hearing screening programs aim to maximize auditory plasticity by making sounds audible for young hearing-impaired infants from the first months of life. The onus of responsibility for using hearing aids and providing a suitable sound environment for the child falls on parents at a very vulnerable time for any family. The role of the audiologist is therefore not just to assess the child's auditory thresholds and provide effective amplification, but perhaps more importantly, to support parents through the stages of grief by fine-tuning the amplification so that parents can see their infant's early responses to sounds. When there are no auditory brainstem testing responses recorded, the audiologist relies on observed responses for setting amplification in the absence of clear targets. It is crucial therefore to coach parents in observing and reporting the baby's changing response profile to speech to allow modification and fine-tuning of the amplification in a systematic way. Audiologists need to apply their understanding of speech acoustics when making changes to amplification to underpin the child's optimal access to speech through residual hearing ability from the first hearing aid fitting. Earmolds are a critical aspect of hearing aid management, with parents who are confident and competent at managing the technology. Many hearing aid fittings on infants have insufficient gains for hearing levels, which negates the potential benefit of early hearing aid fitting. Amplification is the driver of auditory plasticity and the auditory basis for future spoken language through hearing aids and cochlear implants. By more closely fulfilling the needs and expectations of parents, audiologists are better placed to achieve improved speech, language, and social outcomes for children with early identified hearing loss.

Keywords

Hearing aid fitting - newborn hearing screening - family centered management - earmolds

• References

• 1 Mencher GT, Davis AC, DeVoe SJ, Beresford D, Bamford JM. Universal neonatal hearing screening: past, present, and future. Am J Audiol 2001; 10: 3-12
• 2 Bamford J, Uus K, Davis A. Screening for hearing loss in childhood: issues, evidence and current approaches in the UK. J Med Screen 2005; 12: 119-124
• 3 Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics 1998; 102: 1161-1171
• 4 Luterman D, Kurtzer-White E. Identifying hearing loss: parents' needs. Am J Audiol 1999; 8: 13-18
• 5 Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Stud 1999; 23: 197-224
• 6 Watkin P, McCann D, Law C , et al. Language ability in children with permanent hearing impairment: the influence of early management and family participation. Pediatrics 2007; 120: e694-e701
• 7 Yoshinaga-Itano C. Risk and resiliency of infants. Toddlers who are deaf: assessment and intervention issues. In: Zand DH, Pierce KJ, , eds. Resilience in Deaf Children. New York, NY: Springer; 2011: 87-111
• 8 Madell JR. Testing babies: you can do it! Behavioral Observation Audiometry (BOA). Perspectives on Hearing and Hearing Disorders in Childhood. 2011; 21: 59-65
• 9 Fitzpatrick E, Angus D, Durieux-Smith A, Graham ID, Coyle D. Parents' needs following identification of childhood hearing loss. Am J Audiol 2008; 17: 38-49
• 10 Sharma A, Dorman MF, Spahr AJ. A sensitive period for the development of the central auditory system in children with cochlear implants: implications for age of implantation. Ear Hear 2002; 23: 532-539
• 11 Moeller MP, Hoover B, Peterson B, Stelmachowicz P. Consistency of hearing aid use in infants with early-identified hearing loss. Am J Audiol 2009; 18: 14-23
• 12 Bagatto M, Moodie S, Scollie S , et al. Clinical protocols for hearing instrument fitting in the Desired Sensation Level method. Trends Amplif 2005; 9: 199-226
• 13 American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007; 120: 898-921
• 14 Golding M, Pearce W, Seymour J, Cooper A, Ching T, Dillon H. The relationship between obligatory cortical auditory evoked potentials (CAEPs) and functional measures in young infants. J Am AcadAudiol 2007; 18: 117-125
• 15 Carney AE, Moeller MP. Treatment efficacy: hearing loss in children. J Speech Lang Hear Res 1998; 41: S61-S84
• 16 Bagatto MP, Moodie ST, Malandrino AC, Richert FM, Clench DA, Scollie SD. The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP). Trends Amplif 2011; 15: 57-76
• 17 Ching TYC, Hill M, Dillon H. Effect of variations in hearing-aid frequency response on real-life functional performance of children with severe or profound hearing loss. Int J Audiol 2008; 47: 461-475
• 18 Young A, Tattersall H. Universal newborn hearing screening and early identification of deafness: parents' responses to knowing early and their expectations of child communication development. J Deaf Stud Deaf Educ 2007; 12: 209-220
• 19 Strauss S, van Dijk C. Hearing instrument fittings of pre-school children: do we meet the prescription goals?. Int J Audiol 2008; 47 (Suppl. 01) S62-S71
• 20 Berlin C , ed. Hair cells and hearing aids & CD. Albany, NY: Delmar Cengage Learning; 1996