Infant Hearing Aid Practices and Experiences in Utah
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1 Infant Hearing Aid Practices and Experiences in Utah Karen Muñoz, Utah tate University Rich Harward, Utah Department of Health Day Mullings, Utah chool for the Deaf
2 We will cover JCIH 2007 amplification recommendation Barriers to early amplification Utah agencies Utah surveys: Pediatric audiologists Parent hearing aid experiences Results Next steps
3 Hearing Aid Fitting Goal Hearing aid fitting within 1 month of diagnosis (JCIH, 2007) For parents who choose amplification Intervention before 6 months
4 Barriers to Early Amplification Risk for loss to follow-up after diagnosis / late hearing aid fitting: Medicaid Permanent conductive hearing loss Unilateral hearing loss Mild-moderate degree of hearing loss Distance/geographical access to services Liu, C.,, Farrell, J., MacNeil, J., tone,., & Barfield, W. (2008). Evaluating loss to follow-up in newborn hearing screening in Massachusetts. Pediatrics, 121 (2), e pivak, L., okol, H., Auerbach, C., & Gershkovich,. (2009). Newborn hearing screening follow-up: Factors affecting hearing aid fitting by 6 months of age. American Journal of Audiology, 18,
5 Best Practice Guidelines American Academy of Audiology (2003). Pediatric amplification protocol Guidelines address: Personnel qualifications (e.g., licensure, expertise, equipment) Candidacy election considerations and signal processing Fitting considerations (RECD, use of evidence-based target values, verification) Orientation & training Validation of benefit and follow-up/referrals
6 Utah ystem and Resources 0-3 hearing aid application Primary Pennies UDB loaners Audiological oundbooth Early Fit Hearing Aid Program OAE Equipment onic Kids (3-18 years) Mobile Audiological Evaluation HARP
7 Our Questions What pediatric hearing aid services are available? What challenges are audiologists and parents experiencing? Is access hearing aids (e.g., cost) a barrier for parents? Is access to a skilled pediatric audiologist (e.g., limited geographical locations) a barrier to parents? Are parents knowledgeable and confident in managing their child s hearing aid use?
8 urveys Two surveys developed Pediatric audiology hearing aid services Parent hearing aid experiences Distribution ummer 2010 All Utah audiologists (n = 191) 41 returned (21%) All parents of children enrolled in UDB 0-3 program (n = 150) 40 returned (27%)
9 Results: Audiologist urvey Of the 41 respondents: 25 do not provide pediatric hearing aid services 16 provide pediatric hearing aid services Of the 16 providers: During the six month period prior to completing the survey: 5 audiologist fit children under six months of age 6 children under six months of age were fit
10 Results: Audiologist urvey For children fit ages birth to 5 years Funding sources used to obtain hearing aids: Medicaid Private pay Donation Insurance
11 Results: Audiologist urvey Estimated typical time between diagnosis of hearing loss and fitting: <1 month (n = 6) 1 to 3 months (n = 8) Challenges to fitting infants Parents ability to pay (n=12) Middle ear fluid (n=7) Parent acceptance (n=7) No show for appt (n=4) Cancellations (n=4) Third party payer (n=3) Other health problems (n=2) Medical clearance (n=2) Appt availability (n=1)
12 Results: Audiologist urvey ervices provided: Electroacoustic analysis (11 provide, 5 do not provide) Verification of hearing aid settings (16 provide); method used: 3 sound field testing, 13 real ear; prescriptive formula used: 11 DL 1 manufacturer s proprietary algorithm 4 no response
13 Results: Audiologist urvey
14 Results: Audiologist urvey Use RECD (6 do not include, 10 include); method used: 2 measured values 4 use age-averaged norms 4 use both age-averaged norms and measured values When RECD is included: 2 at initial fitting 2 when new earmolds are fit 1 when earmold impression is taken 1 at hearing evaluation 1 every appointment, if possible
15 Results: Audiologist urvey
16 Results: Audiologist urvey
17 Results: Audiologist urvey Provide parent with a hearing aid care kit 12 provide; 4 do not provide Teach parents how to use a listening stethoscope to check hearing aid function 14 provide instruction; 2 do not Advice regarding frequency of doing a listening check 9 (daily) 1 (2-3 times per week) 1 (weekly)
18 Results: Audiologist urvey
19 Results: Audiologist urvey Recommend use of personal FM systems for children under 5 years of age 6 recommend 7 do not recommend Need more information Cost Cumbersome
20 Results: Parent urvey Of the 40 respondents, 35 were fit with hearing aids Mean Median Range Age at Diagnosis (n=40) Age at Fitting (n=35) Interval between Dx/Fitting
21 Results: Parent urvey
22 Results: Parent urvey Challenges in obtaining hearing aids # % Paying for hearing aids Feeling confident in the skills of the audiologist Other health challenges Middle ear fluid Paying for earmolds 9 26 Finding audiologist who works with young children 8 23 Delay in appointment availability 7 20 Accepting the need for hearing aids 6 17 Obtaining medical clearance 5 14
23 Results: Parent urvey
24 Results: Parent urvey Parent level of agreement with statements (n = 34) tatement NA D D N A A I listen to my child s hearing aids every morning I can tell when my child s hearing aids are not working correctly I can tell when my child needs new earmolds a I am confident in how to manage my child s hearing aid use I am confident that my child s hearing aids are programmed correctly a n = NA = not applicable; D = strongly disagree; D = disagree; N = not sure; A = agree; A = strongly agree
25 Next teps in Utah Utah Department of Health EHDI Program
26 Next teps in Utah Utah chool for the Deaf Mapping Professionals Parent Audiological Consultations Early Intervention Assessment Rural Hearing creening On-site chool Age Programming Implant Mapping Collaboration
27 Next teps NCHAM National study to learn more about parent experiences with hearing aids Distribution Feb-May 2011 Parent upport Organizations Hands & Voices ADC AG Bell
28 Early Amplification What challenges are you facing in your area? What strategies/resources have been helpful?
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