Category Archives: Tech Tips

Evaluating Benefit and Monitoring Progress in Young Children with a Bone Conduction Hearing Device

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.

References

1. Bagatto, M. P., S. T. Moodie, R. C. Seewald, D. J. Bartlett, and S. D. Scollie. 2011. “A Critical Review of Audiological Outcome Measures for Infants and Children.” Trends in Amplification 15 (1): 23–33. doi:10.1177/1084713811412056.

2. Bagatto, M., S. Moodie, A. Malandrino, C. Brown, F. Richert, D. Clench, and S. Scollie. 2016. “Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program.” Journal of the American Academy of Audiology 27 (3): 188–203. doi:10.3766/jaaa.15051.

3. Dave Gordey & Marlene Bagatto (2020): Fitting bone conduction hearing devices to children: audiological practices and challenges, International Journal of Audiology, DOI: 10.1080/14992027.2020.1814970

4. Keidser, G., H. Dillon, L. Carter, and A. O’Brien. 2012. “NAL-NL2 Empirical Adjustments.” Trends in Amplification 16 (4): 211–223. doi:10.1177/1084713812468511.

5. Scollie, S., Seewald, R., Cornelisse, L., Moodie, S., Bagatto, M., Laurnagaray, D., … & Pumford, J. 2005. The desired sensation level multistage input/output algorithm. Trends in Amplification, 9 (4): 159–197.

6. Sininger, Y. S., A. Grimes, and E. Christensen. 2010. “Auditory Development in Early Amplified Children: Factors Influencing Auditory-Based Communication Outcomes in Children with Hearing Loss.” Ear and Hearing 31 (2): 166–185. doi:10.1097/AUD.0b013e3181c8e7b6.

7. Tomblin, J. B., E. A. Walker, R. W. McCreery, R. M. Arenas, M. Harrison, and M. P. Moeller. 2015. “Outcomes of Children with Hearing Loss: Data Collection and Methods.” Ear and Hearing 36 (01): 14S–23S. doi:10.1097/AUD.0000000000000212.

8. Uhler, K., Warner-Czyz, A., Gifford, R. and PMSTB Working Groups. 2017. “Pediatric Minimum Speech Test Battery” J Am Acad Audiol 28:232–247. DOI: 10.3766/jaaa.15123

The Benefits of OpenSound Navigator in Children with Hearing Loss

Fitting children with advanced sound processing algorithms in their hearing devices is not always straightforward. Does the clinical evidence support it? Will it provide more access to all sounds, promote incidental learning, and improve speech understanding in challenging environments? These questions are frequently considered, and a conservative approach is often taken. Whereas, when fitting adults, there is typically clinical evidence to support advanced sound processing and they are better at reporting sound quality issues, so audiologists are more likely to take a less conservative fitting approach. However, if we take too much of a conventional approach with children, are we missing an opportunity to provide improvements in sound quality, hearing in noise, and reduced listening effort?

In 2019, OpenSound NavigatorTM was incorporated into the Ponto 4 sound processor. The success of this sound processing strategy had been seen in Oticon hearing aids with many research studies documenting the benefits provided to patients. So, what is unique about OpenSound Navigator that might provide optimal benefit for children with hearing loss?

OpenSound Navigator is a groundbreaking speech enhancement algorithm that preserves speech and reduces noise in complex sound environments. OpenSound Navigator operates as a holistic system that handles all sound environments from the quietest to the noisiest, by selectively reducing the dominant noise sources while preserving speech in all directions. OpenSound Navigator adapts seamlessly without modes or mode switches. Utilizing an omnidirectional beam that captures a 360° sound panorama of the environment along with a back-facing cardioid that estimates noise from the sides and back provides users with a natural sound experience.

Research has been conducted in children using OpenSound Navigator. Browning et al, 2019 demonstrated OpenSound Navigator improves speech recognition in noise for children. In fact, with speech to the front and noise from behind, OpenSound Navigator provided an average 5 dB SNR improvement as compared to an omnidirectional microphone. Elaine Ng, 2017 further demonstrated that OpenSound Navigator reduces perceived listening effort during a speech recognition task. This benefit is particularly important because hearing loss imposes increased fatigue and effort as experienced by children. Oticon Medical’s BrainHearing™ technology is designed to support the unique day-to-day challenges and developmental needs of children. Together with hearing technology prescribed according to best practice, OpenSound Navigator delivers an optimized speech signal and hence provides these children with the optimal conditions to listen and learn.

Based on the supporting research, we recommend the fitting of OpenSound Navigator in a child’s Ponto™ 4 sound processor starting at one year of age. From ages one to four years, we suggest OpenSound Navigator is active with the transition set to low, and then as the child ages to four years and older, the transition can be adjusted to medium or high similar to adult recommendations. These are the default pediatric settings incorporated into Genie Medical (2019) fitting software. To summarize, unlike conventional directionality and noise reduction technology, OpenSound Navigator does not require children to look directly at the talker the whole time to enjoy better speech understanding in noise. Young listeners may move around freely and can still experience the benefits of OpenSound Navigator.

Another important feature of OpenSound Navigator is that it preserves interfering speech coming from different directions. This new technology allows access to other talkers in the environment, which is fundamental to incidental learning for school-age children.

The groundbreaking technology of OpenSound Navigator marks a breakthrough in the development of speech enhancement systems. It is not only designed to improve acoustics at the child’s ears, but also to facilitate the brain’s own processing. It does not isolate the front talker but preserves access to all talkers. Its accurate and fast spatially informed noise estimator allows the Balance module to selectively attenuate noise sources at given locations. The Noise Removal module removes the remaining noise even between words. OpenSound Navigator opens many possibilities for new pediatric users.

To learn more about the clinical evidence supporting OpenSound Navigator in children we encourage you to register for our upcoming training on April 21, 2021 or reach out to your regional clinical specialist.

About the Author

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the Training Manager for Oticon Medical.

 

References:

Jenna M. Browning, Emily Buss, Mary Flaherty, Tim Vallier, and Lori J. Leibolda American Journal of Audiology Vol. 28, 101–113, March 2019

Elaine Ng, E. 2017. Benefits of OpenSound Navigator in children. Oticon Whitepaper.

Genie Medical (2019) Fitting Software

 

Clinical Test Protocol for Evaluating Bone Anchored Hearing Benefit During Patient Trial Process

Bone anchored hearing implants are beneficial hearing solutions designed to improve patients’ hearing through direct bone conduction. They are indicated for use in patients who have conductive or mixed hearing loss or in patients with single-sided deafness (SSD).

Adult candidates considering a bone anchored solution have the opportunity to experience sound through an acute simulation during a routine evaluation appointment.  It is during that appointment that the audiologist typically will counsel on device, discuss the benefits and outcomes, and provide the opportunity for the patient to hear sound through a clinic demo device, such as a Ponto 3 SuperPower or a Ponto 4 sound processor. This simulation provides significant value to the patient considering non-surgical versus surgical treatment options.

As clinicians, we are taught the importance of verifying device benefit for patients with hearing loss when considering their hearing device options, and then again as they are being fit with their device. In fact there are well-established protocols and tools in place for hearing aid verifications and cochlear implant assessments. However, there are few recognized protocols in place for validating benefit in a patient using a bone anchored device. It is for this reason that Oticon Medical has developed a bone anchored hearing system test protocol to assess benefit and compare performance with various hearing technologies.

At Oticon Medical, we understand the demands placed on our clinics each day and also know the importance of providing best audiological practice to patients considering a bone anchored solution.  Therefore, we took on the goal developing a simple test protocol for audiologists using the resources already available in their clinic.

The protocol consists of a laminated card outlining four straightforward steps to verify benefit with a bone anchored system or compare performance between different solutions and a test record sheet for documenting the patient’s results. Using published research from Snapp, et al (2010) we modified their suggested protocol to create our version that reinforces the use of a test band for simulations, sound field speech in noise testing using the QuickSin, and the administration of a self-assessment questionnaire. Finally, the protocol outlines additional verification measures that can be completed as well as highlighting the proper reimbursement codes that may be used for this appointment. The protocol is recommended for all bone anchored hearing loss indications.

To learn more about this protocol, we encourage you to register for our upcoming training on February 24, 2021 or reach out to your regional clinical specialist.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the Training Manager for Oticon Medical.

References:

QuickSin Speech-in-Noise Test. User Manual. Etymotic Research Inc. Version 1.3

Current Procedural Terminology (CPT) Codes. Audiology. American Medical Association 2019

Snapp, H.A. et al (2010) A Clinical Protocol for Predicting Outcomes with an Implantable Prosthetic Device (BAHA) in Patients with Single-Sided Deafness. J Am Acad Audiol, 21: 654-662.

Strengthening Connections in Challenging Environments with the EduMic

Whether a child’s learning environment is in the classroom or virtually from their home, the ability to control the acoustics is difficult and underscores the need to optimize the overall speech signal.  Providing clear access to speech is critical for them to learn. Research has shown that children need quieter conditions and better signal-to-noise ratios than adults to have good speech understanding (Bradley & Sato, 2008). This is because children with developing language and auditory systems have a smaller vocabulary and are unable to rely on the redundancy of language to fill in missing words (Neuman, Wroblewski, Hajicek, & Rubenstein, 2010). Other studies have shown that an inability to understand the teacher due to poor listening conditions directly impacts the learning of new concepts (Yang & Bradley, 2009; Leibold, Hillock-Dunn, Duncan, Roush, & Bess, 2013). The exertion of mental energy and listening effort are also much higher when poor acoustic conditions exist (Bess, Gustafson, & Hornsby, 2014; McGarrigle, Gustafsson, Hornsby, & Bess, 2019).

The EduMic classroom solution

With the release of the EduMic™, Oticon Medical offers a unique solution for children to optimize listening effort in challenging environments. The EduMic – a remote microphone system (RMS) –features 2.4 GHz wireless technology and integrates with the Ponto 4 sound processor.  Built on the Velox STM platform, the EduMic features advanced signal processing, including Open Sound NavigatorTM technology. The EduMic preserves speech, operating within a wide bandwidth of 150 Hz to 10000 Hz while analyzing, balancing and applying noise removal to the streamed signal.  To improve the signal in outdoor environments, the EduMic also features Wind Noise Management, which employs an added level of “cleaning” to the signal.

While the primary function of the EduMic is in the microphone and transmitter mode, it has additional modes that are useful in and outside the classroom. The EduMic can stream stereo audio from various sources by connecting via a 3 mm jack cable, connecting to Frequency Modulation (FM) and Digital Modulation (DM) devices via a universal receiver, or it can function in telecoil mode. Additional features to help with the management of the device include LED indicators, a retention clip and protective skins.  The EduMic is robust and durable, provides stable transmission of the speech signal and provides the user with approximately 10 hours of use on a single battery charge based on internal device testing (EduMic Technical Data Sheet).   Figure 1 highlights the EduMic design and functionality.

Clinical evidence concerning EduMic supports both device usability and the improvement of speech understanding in complex listening environments. In fact, when the EduMic was subjectively evaluated by a group of educators, 80 percent reported a preference towards the EduMic over a competitive remote microphone system (RMS) and described it as “easy to use and comfortable to wear” (Gordey & Rumley, 2019).  When assessing the effectiveness in a noisy environment using a simulated classroom study design, the EduMic demonstrated improved speech understanding in children with hearing loss in both noise and noise plus reverberation environments when compared to using their hearing aids alone (Gordey & Rumley, 2019).

We encourage the use of the EduMic in all environments, including a child’s home where incidental learning occurs. This powerful solution provides children with an effortless transition into any environment because of its ease of use.  Finally, this product is a great balance of design and usability combined with advanced hearing technology to optimize the learning experiences of children with hearing loss.

To learn more about the EduMic and how it might benefit your patients contact your clinical specialist.

References:

Bess, F. H., Gustafson, S. J., & Hornsby, B. W. (2014). How Hard Can It Be to Listen? Fatigue in School-Age Children with Hearing Loss. Journal of Educational Audiology, 20, 1-14.

Bradley, J. S., & Sato, H. (2008). The intelligibility of speech in elementary school classrooms. The Journal of the Acoustical Society of America, 123(4), 2078-2086.

Gordey, D. and Rumley, J. (2019). Enhanced Learning with the EduMic. White Paper. Oticon, Inc.

Leibold, L. J., Hillock-Dunn, A., Duncan, N., Roush, P. A., and Buss, E. (2013). Influence of hearing loss on children’s identification of spondee words in a speech-shaped noise or a two-talker masker. Ear Hear. 34, 575–584.

McGarrigle, R., Gustafson, S. J., Hornsby, B. W., and Bess, F. H. (2019). Behavioral measures of listening effort in school-age children: examining the effects of signal-to-noise ratio, hearing loss, and amplification. Ear Hear. 40, 381–392.

Yang, W., & Bradley, J. S. (2009). Effects of room acoustics on the intelligibility of speech in classrooms for young children. The Journal of the Acoustical Society of America, 125(2), 922-933.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the training manager for Oticon Medical.