Tag Archives: pediatrics

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

Supporting Early Access to Sound with the Ponto Loaner Program

Sound matters to everyone with a hearing loss but is critical to children who are in their formative years of speech and language development. Children need early stimulation of the inner ear (cochlea) for development of neural connections within the auditory cortex.  Oticon Medical’s Ponto Loaner Program is designed to ensure these children receive premium hearing care as soon as possible, while patiently waiting for third-party insurance approval. This month’s blog focuses on increasing awareness of this program and reviewing the enhancements that have been implemented.

Children ages 0-18 years of age who are candidates for a bone conduction hearing device are eligible for the Ponto Loaner Program at no cost to the families or clinic. Navigating the third-party reimbursement process for families of children with hearing loss can take several months. Our goal is to ensure that children requiring immediate hearing assistance have access to the technology needed for speech and language development while insurance reimbursement is secured.

The Ponto Loaner Program is an easily accessible and simple process for families to complete

We understand that families can feel overwhelmed as they begin the journey to better hearing for their child. We also know that hearing clinics have limited time and resources to spend on third-party insurance negotiations. This is where the services we provide at Oticon Medical can provide much needed support! Our Insurance Support Department has specialists available to guide families through the third-party reimbursement process and alleviate the burden placed on clinics.

So how does this program work?

The Ponto Loaner Program is an easy process to complete by either the parent(s) or clinic. The length of the loan period is three months from the date of shipment. During this three-month loan period we work with the family to secure reimbursement from their insurance provider for the Ponto sound processor and accessories. Making it easier on clinics, we empower families to take the lead with this program and hold ultimate responsibility for final payment of the product.

Components of the Ponto Loaner Program consist of a one-page order form from which the type and color of the sound processor(s) is selected as well as the color of the softband and additional accessories. The completed Ponto Loaner form can be emailed, faxed, or mailed to our Insurance Support Department for processing. Upon receipt and verification, we ship a new Ponto sound processor(s) with accessories to either the clinic or family depending on what was specified on the order form. The processor and accessories are exclusive to that child and cannot be transferred to another child.

Additional Ponto Loaner Program features include access to repair services and one-time loss and damage coverage should the family need it during the loaner period. Pediatric-friendly components to ensure product safety are also provided to the family. Once third-party reimbursement has been secured, the loaner program ends with the option to keep the sound processor and accessories already dispensed or to return them for a different color and/or style of sound processor. All program services are provided for free to our families and clinics.

What are the benefits of this program?

The program’s benefits to the child and their family include immediate access to advanced hearing technology, guidance, and support from our dedicated Insurance Support Department to secure third-party reimbursement and a lifelong service and technology commitment from Oticon Medical!

The advantages of the Ponto Loaner Program for the clinician include instant support for any child up to 18 years of age who is a candidate for a bone conduction hearing device, a simple streamlined process to obtain premium technology for the patient, and ongoing assistance to the clinic with their reimbursement needs.

To learn more about this program and begin benefiting from its features please contact your regional clinical specialist.

 About the Author

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 29 years. She is presently the Training Manager for Oticon Medical.

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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