Assessing the effectiveness of amplification for children in real life

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Assessing the effectiveness of amplification for
children in real life
Mandy Hill, Louise Reynolds, Teresa Ching
National Acoustic Laboratories,
Australia Australian Hearing Cooperative Research
Centre for Cochlear Implant and Hearing aid
Innovation, Australia
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Prescribing hearing aids for children

• Prescriptive procedure is valid on average
• Individual needs may vary
• Effective amplification is crucial to
  facilitating normal speech and language
  development

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Rationale for using parents and teachers
observations

• Audiologists need to find out
• the childs response to amplification in real
  life
• Are the hearing aids accepted?
• Are there any problems in usage?
• How does the child respond to speech and other
  sounds around them in different situations?
• Teachers and parents have many opportunities to
  obtain the relevant information
• useful for understanding the childs needs
• for devising individual habilitation programmes

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Teachers and Parents Evaluation of Aural/oral
performance of Children

• Structured interview using the T.E.A.C.H.
  P.E.A.C.H. questionnaires
• Probe areas
• use of device
• listening in quiet
• listening in noise
• recognition/alertness to environmental sounds

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Scope of questions

• Use of device
• Usage routine, problems
• Quiet, one-to-one, small group lt3 persons
• respond to name, respond to verbal instructions,
  initiate/participate in conversation
• Noise, group gt 2 persons
• respond to name, follow verbal instructions,
  initiate/participate in conversation
• Environment
• Alertness and recognition

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Administration of questionnaires

• Structured interview using questionnaires
• Informants preview questions and record examples
  
• Same questions are asked at the interview,
  examples are recorded.

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Scoring

• Scoring on a 5-point scale
• proportion of time or frequency of occurrence of
  aural/oral behaviour in specific situations
• Overall score, sub-scale scores
• Global Rating

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Hearing aid evaluation

• To examine validity and reliability of functional
  assessment by comparing paired comparisons
  results with functional assessment results

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• Subjects
• Seven children (Mean age10.5 yrs, range 8 - 14
  yrs)

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Comparison responses
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Evaluating hearing aid characteristics

• Children wore hearing aids set according to each
  frequency response for three weeks and for 3
  times in a random order.
• At the end of each trial period, the parent,
  teacher, and child were interviewed separately.
• All 9 trials were double-blind.
• All interviews were recorded on tape, and scored
  by a second scorer.
• Children also took paired-comparisons test

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Paired comparisons testing

• Child wears programmable hearing aids
• Listens to a story amplified with different
  frequency responses in pairs
• Chooses one that makes speech easiest to
  understand.

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Validity Questionnaire scores agree with
childrens preferences based on paired comparisons
Parent

score
Teacher

score
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Summary NAL Evaluation and Fine-Tuning using
Functional Assessment

• For school-aged children, valid (good agreement
  between teacher, parent and child evaluations,
  and with paired comparison evaluation) and
  repeatable.
• Can procedure be effective with young children?

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Method

• Children lt 6 years with moderate to profound
  hearing losses were recruited
• Multi-site trial Victoria, Adelaide, Sydney

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• Subjects

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Method

• Each child wore hearing aids set to 3 different
  frequency responses each for a two-week trial
  period. Trial repeated for at least one
  frequency response.
• Template derived from baseline interview

• At the end of each trial period, the parent and
  early-intervention teacher of the child were
  interviewed separately.

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Method

• All trials were double-blind the interviewer,
  the parent, and the teacher did not know which
  frequency response was on trial.
• Interviews were recorded on tape whenever
  possible, and scored by a second scorer.
• Trials in progress

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Repeatability
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Validity
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Validity
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Validity
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Hearing aid evaluationCase study
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MS
Parent
Teacher
Comparison
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Summary

• Systematic evaluation based on observations of
  teachers and parents of hearing impaired children
  to determine the relative effectiveness of
  amplification in real life.
• Reliable (repeatable) and valid (good agreement
  between teacher and parent evaluations for young
  children (lt 6 years).
• Useful tool to identify problems and guide
  management of children

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Where to get information?
Teresa.Ching_at_nal.gov.au Mandy.Hill_at_hearing.com.au