A qualitative review of parents’ perspectives on the value of CAEP recording in influencing their acceptance of hearing devices for their child

Factors that influence health service access in deaf and hard-of-hearing children: a narrative review

OBJECTIVES

Early diagnosis and intervention of deaf and hard-of-hearing (DHH) children leads to improved language and psychosocial outcomes. However, many child, parent and provider related factors can influence access to early intervention services, including hearing devices. This narrative review aims to explore factors that influence health service access in DHH children.

DESIGN

A systematic search was conducted to identify articles that explored factors that influenced health service access in DHH children in countries with Universal Newborn Hearing Screening, published between 2010 and 2022.

STUDY SAMPLES

Fifty-nine articles met the inclusion criteria for data extraction. This included 4 systematic reviews, 2 reviews, 39 quantitative and 5 mixed methods studies and 9 qualitative studies.

RESULTS

The identified factors were grouped into the following themes: (a) demographic factors, (b) family related factors, (c) child related factors, (d) factors specific to hearing devices, (e) service delivery, f) telehealth and (g) COVID-19.

CONCLUSION

This review provided a comprehensive summary of multiple factors that affect access to health services in DHH children. Psychosocial support, consistent clinical advice, allocation of resources to rural communities and use of telehealth are possible ways to address barriers and improve health service access.

Acoustic change complex for assessing speech discrimination in normal-hearing and hearing-impaired infants

OBJECTIVE

This study examined (1) the utility of a clinical system to record acoustic change complex (ACC, an event-related potential recorded by electroencephalography) for assessing speech discrimination in infants, and (2) the relationship between ACC and functional performance in real life.

METHODS

Participants included 115 infants (43 normal-hearing, 72 hearing-impaired), aged 3-12 months. ACCs were recorded using [szs], [uiu], and a spectral rippled noise high-pass filtered at 2 kHz as stimuli. Assessments were conducted at age 3-6 months and at 7-12 months. Functional performance was evaluated using a parent-report questionnaire, and correlations with ACC were examined.

RESULTS

The rates of onset and ACC responses of normal-hearing infants were not significantly different from those of aided infants with mild or moderate hearing loss but were significantly higher than those with severe loss. On average, response rates measured at 3-6 months were not significantly different from those at 7-12 months. Higher rates of ACC responses were significantly associated with better functional performance.

CONCLUSIONS

ACCs demonstrated auditory capacity for discrimination in infants by 3-6 months. This capacity was positively related to real-life functional performance.

SIGNIFICANCE

ACCs can be used to evaluate the effectiveness of amplification and monitor development in aided hearing-impaired infants.

Predicting Hearing aid Benefit Using Speech-Evoked Envelope Following Responses in Children With Hearing Loss

Electroencephalography could serve as an objective tool to evaluate hearing aid benefit in infants who are developmentally unable to participate in hearing tests. We investigated whether speech-evoked envelope following responses (EFRs), a type of electroencephalography-based measure, could predict improved audibility with the use of a hearing aid in children with mild-to-severe permanent, mainly sensorineural, hearing loss. In 18 children, EFRs were elicited by six male-spoken band-limited phonemic stimuli--the first formants of /u/ and /i/, the second and higher formants of /u/ and /i/, and the fricatives /s/ and /∫/--presented together as /su∫i/. EFRs were recorded between the vertex and nape, when /su∫i/ was presented at 55, 65, and 75 dB SPL using insert earphones in unaided conditions and individually fit hearing aids in aided conditions. EFR amplitude and detectability improved with the use of a hearing aid, and the degree of improvement in EFR amplitude was dependent on the extent of change in behavioral thresholds between unaided and aided conditions. EFR detectability was primarily influenced by audibility; higher sensation level stimuli had an increased probability of detection. Overall EFR sensitivity in predicting audibility was significantly higher in aided (82.1%) than unaided conditions (66.5%) and did not vary as a function of stimulus or frequency. EFR specificity in ascertaining inaudibility was 90.8%. Aided improvement in EFR detectability was a significant predictor of hearing aid-facilitated change in speech discrimination accuracy. Results suggest that speech-evoked EFRs could be a useful objective tool in predicting hearing aid benefit in children with hearing loss.

Experienced hearing aid users' perspectives of assessment and communication within audiology: a qualitative study using digital methods

OBJECTIVE

To explore experienced hearing aid users' perspectives of audiological assessments and the patient-audiologist communication dynamic during clinical interactions.

DESIGN

A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice.

STUDY SAMPLES

Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 - 86 years; 9 males, 11 females).

RESULTS

Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology.

CONCLUSION

To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users' value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient-audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

Potential Destructive Binaural Interaction Effects in Auditory Steady-State Response Measurements

An aided sound-field auditory steady-state response (ASSR) has the potential to be used to objectively validate hearing-aid (HA) fittings in clinics. Each aided ear should ideally be tested independently, but it is suspected that binaural testing may be used by clinics to reduce test time. This study simulates dichotic ASSR sound-field conditions to examine the risk of making false judgments due to unchecked binaural effects. Unaided ASSRs were recorded with a clinical two-channel electroencephalography (EEG) system for 15 normal hearing subjects using a three-band CE-Chirp® stimulus. It was found that the noise corrected power of a response harmonic can be suppressed by up to 10 dB by introducing large interaural time differences equal to half the time period of the stimulus envelope, which may occur in unilateral HA users. These large interaural time differences also changed the expression of ASSR power across the scalp, resulting in dramatically altered topographies. This would lead to considerably lower measured response power and possibly nondetections, evidencing that even well fit HAs are fit poorly (false referral), whereas monaural ASSR tests would pass. No effect was found for simulated lateralizations of the stimulus, which is beneficial for a proposed aided ASSR approach. Full-scalp ASSR recordings match previously found 40 Hz topographies but demonstrate suppression of cortical ASSR sources when using stimuli in interaural envelope antiphase.

Assessment of the cochlear implant pathway for newborn hearing screening referrals

OBJECTIVE

To evaluate the cochlear implant (CI) assessment pathway for children referred through the newborn hearing screening programme (NHSP) and identify potential reasons for delay in CI surgery at a large UK centre.

METHODS

Retrospective analysis of electronic notes of children referred through NHSP from 2016 to 2019. Key points in the assessment pathway from referral to switch-on were assessed.

RESULTS

Of the 46 referrals, 44 went on to have CI surgery. Median age at CI surgery was 15 months (interquartile range (IQR) 13 to 17 months). Only 5% of referrals were implanted before the age of 12 months. Delayed referral and the presence of otitis media with effusion (OME) were associated with delayed implantation. The median period of monitoring for OME was 48 days (IQR 20 to 93 days), with a natural resolution rate of only 11%. The median time from surgery to switch-on was 5 weeks (IQR 4.1 to 5.4 weeks).

CONCLUSION

Achieving implantation prior to the age of 12 months for NHSP referrals can be challenging for a variety of reasons. The delays in the system and the steps that our implant programme has taken to address these will be highlighted.

Applying Spike-density component analysis for high-accuracy auditory event-related potentials in children

OBJECTIVE

Overlapping neurophysiological signals are the main obstacle preventing from using cortical auditory event-related potentials (AEPs) in clinical settings. Children AEPs are particularly affected by this problem, as their cerebral cortex is still maturing. To overcome this problem, we applied a new version of Spike-density Component Analysis (SCA), an analysis method recently developed, to isolate with high accuracy the neural components of auditory responses of 8-year-old children.

METHODS

Electroencephalography was used with 33 children to record AEPs to auditory stimuli varying in spectrotemporal features. Three different analysis approaches were adopted: the standard AEP analysis procedure, SCA with template-match (SCA-TM), and SCA with half-split average consistency (SCA-HSAC).

RESULTS

SCA-HSAC most successfully allowed the extraction of AEPs for each child, revealing that the most consistent components were P1 and N2. An immature N1 component was also detected.

CONCLUSION

Superior accuracy in isolating neural components at the individual level was demonstrated for SCA-HSAC over other SCA approaches even for children AEPs.

SIGNIFICANCE

Reliable methods of extraction of neurophysiological signals at the individual level are crucial for the application of cortical AEPs for routine diagnostic exams in clinical settings both in children and adults.

Towards early intervention of hearing instruments using cortical auditory evoked potentials (CAEPs): A systematic review

As a result of newborn hearing screening, hearing aids are usually prescribed and fitted by 2-3 months of age. However, the assessment data used for prescribing hearing aids in infants and toddlers are limited in quality and quantity. There is great interest in finding appropriate physiological measures that can be help to facilitate and improve the management process of hearing impaired children. It seems that cortical auditory evoked potentials (CAEPs) can provide information before it is possible to obtain reliable information from behavioral assessment procedures. This article will review the studies conducted in this area during the past15 years to determine the advantages, disadvantages and future research areas of CAEPs as an objective method in the management of hearing impaired children.