Providing early access to sound is critical for children with prelingual hearing loss to develop speech and language skills on par with their typical hearing peers (Sininger, Grimes, and Christensen 2010; Bagatto et al. 2011, 2016; Tomblin et al. 2015). Evidence-based prescriptive formulae, such as DSL v 5.0 and NAL-NL2, are available in hearing aid fitting software and real-ear verification measures when fitting air conduction hearing aids to infants and children who have hearing loss (Scollie et al. 2005; Keidser et al. 2012).
However, strategies for fitting a bone conduction hearing device (BCHD) to a young child is lacking. Additionally, the use of a consistent protocol within pediatric clinics for children with a BCHD has not been well defined. In fact, a survey completed by Gordy and Bagatto (2020) found that audiologists are seeking guidance on how to provide optimal amplification to children who use BCHDs, and the aided audiogram is the only consistent measure used to verify BCHD fittings.
Given the limited availability of clinical tools, such as a skull simulator and prescriptive targets, audiologists need to consider other subjective test measures to use when fitting young children that are readily available in most pediatric audiology clinics. These include, but are not limited to, parent report measures (e.g., The Auditory Skills Checklist, LittleEARs,) the Ling Six Sound Test, closed-set and open-set speech perception test measures, as well as standardized speech and language assessment measures.
As a leading manufacturer of bone anchored hearing solutions, we felt compelled to develop a suggested assessment protocol for monitoring the auditory skills of children ages three-to-five years fit with the Ponto bone anchored hearing system. This blog provides an overview of a straightforward assessment process that clinicians can incorporate into their fitting and management of young children with a BCHD.
Leveraging the Pediatric Minimum Speech Test Battery (PMSTB) developed by Kristin Uhler and colleagues in 2017, we created a streamlined assessment protocol for audiologists to consider when fitting young children with a BCHD. This protocol is purely based on subjective assessment measures and a way for clinics to establish consistency among audiologists. Beginning by verifying that a young child can detect the Ling Six Sounds, an audiologist would move to a closed-set speech perception test measure designed to evaluate a child’s pattern perception abilities and word identification skills. Assuming the child demonstrated consistent word identification we suggest evaluating how the child responds to recorded open-set word and sentence recognition test measures. Finally, we recommend using a parent report measure to end the evaluation.
The protocol consists of a laminated card outlining the straightforward steps to evaluating benefit using a combination of speech perception measures, a parent report measure, and aided soundfield testing. The protocol provides guidance on the test administration, including suggested test level in dBA and calibration of the audiometric equipment. A suggested test measures flow chart is provided along with a record sheet to document the child’s results. The protocol is recommended for all BCHD indications for a child ages three-to-five years.
Until a standardized objective verification protocol using a skull simulator with prescriptive targets is developed for young children, we would encourage clinicians to consider using this protocol or something similar to monitor a young child’s auditory development with a BCHD.
To learn more about this protocol, we encourage you to reach out to your regional clinical specialist.
About the Author
Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for 29 years. She is presently the Training Manager for Oticon Medical.
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