.Signal Transparency of Remote Microphone Technology in Pediatric Bone Conduction Device Users

INTRODUCTION: Competing noise in the environment negatively affects speech intelligibility, particularly when listening at a distance. This is especially true for children with hearing loss in classroom environments where the signal-to-noise ratio is often poor. Remote microphone technology has been shown to be highly beneficial at improving the signal-to-noise ratio in hearing device users. Children with bone conduction devices, however, often must rely on indirect transmission of the acoustic signal for commonly used classroom-based remote microphone listening (e.g., digital adaptive microphone) which may negatively affect speech intelligibility. There are no studies on the effectiveness of using a relay method of signal delivery using remote microphone technology to improve speech intelligibility in adverse listening environments in bone conduction device users. METHODS: Nine children with irresolvable conductive hearing loss and 12 adult controls with normal hearing were included for study. Controls were bilaterally plugged to simulate conductive hearing loss. All testing was conducted using the Cochlear™ Baha® 5 standard processor coupled with either the Cochlear™ Mini Microphone 2+ digital remote microphone or the Phonak Roger™ adaptive digital remote microphone. Speech intelligibility in noise was evaluated in the (1) bone conduction device processor alone, (2) bone conduction device + personal remote microphone, and (3) bone conduction device + personal remote microphone + adaptive digital remote microphone listening conditions at -10 dB, 0 dB, and +5 dB signal-to-noise ratios. RESULTS AND CONCLUSIONS: Speech intelligibility in noise improved significantly in the bone conduction device + personal remote microphone condition over the bone conduction device alone, demonstrating significant benefit for listening at poor signal-to-noise ratios in children with conductive hearing loss using bone conduction devices with personal remote microphone use. Experimental findings demonstrate poor signal transparency when using the relay method. Coupling of the adaptive digital remote microphone technology to the personal remote microphone negatively affects signal transparency, and no hearing in noise improvements are observed. Significant gains in speech intelligibility are consistently observed for direct streaming methods and are confirmed in adult controls. Behavioral findings are supported by objective verification of the signal transparency between the remote microphone and the bone conduction device.

Paediatric audiology measures for Spanish-speaking patients: current practice & state of knowledge.

OBJECTIVE: The objective of this study was to obtain an understanding of audiologists' knowledge of Spanish speech perception materials for the paediatric hearing loss population. DESIGN: An electronic survey, the Knowledge of Spanish Audiology & Speech Tools (KSAST) was distributed via Qualtrics to audiologists who worked with Spanish-speaking children. STUDY SAMPLE: One hundred and fifty-three audiologists practicing in the United States completed the electronic survey over a period of six months. RESULTS: Audiologists lacked knowledge of current Spanish measures and there was no consensus on what providers were administering for the paediatric population. The largest gaps in knowledge existed for the infancy through early childhood age groups. Notably, even when Spanish measures exist, audiologists reported feeling uncomfortable using them in clinic due to a variety of reasons (e.g., did not know how to access measure, did not know how to administer). CONCLUSIONS: This study highlights the lack of consensus in managing Spanish-speaking patients with hearing loss. There is a lack of validated age-appropriate measures to accurately assess speech perception for Spanish-speaking children. Future research should focus on improving training on management of Spanish-speaking patients, as well as development of speech measures and best practice guidelines for this population.

Quality of Life-CI: Development of an Early Childhood Parent-Proxy and Adolescent Version.

OBJECTIVES: Severe to profound hearing loss is associated with communication, social, and behavioral difficulties that have been linked to worse health-related quality of life (HRQoL) compared to individuals with normal hearing. HRQoL has been identified as an important health outcome that measures functional ability, particularly for chronic conditions and disabilities. The current study developed the QoL-cochlear implant (CI) for early childhood and adolescents using the recommended Food and Drug Administration and European Medicines Agency guidelines on patient-reported outcomes. DESIGN: Three phases of instrument development were conducted for both the early childhood (0 to 5 years old; parent proxy) and adolescent/young adult (13 to 22 years old) versions of the QoL-CI. Phase 1 included the development of our conceptual framework, which informed the discussion guides for stakeholder focus groups (e.g., audiologists, physicians, and therapists) at CI clinics in Miami and Philadelphia (n = 39). Open-ended interviews with parents (N = 18 for early childhood; N = 6 for adolescent/young adult version) and adolescents/young adults using CIs (n = 17) were then completed at both sites during phase 2. All interviews were transcribed and coded to identify common themes, which were then used to draft items for the QoL-CI. Both versions of the QoL-CI were developed using Qualtrics to allow for quick, easy electronic administration of the instruments on a tablet device. Last, phase 3 included cognitive testing in a new sample (N = 19 early childhood, N = 19 adolescent) to ensure that the draft instruments were clear, comprehensive, and easy to use. RESULTS: Participant responses obtained via the open-ended interviews yielded an early childhood and adolescent version of the QoL-CI that was reportedly easy to complete and comprehensive. The final QoL-CI Early Childhood instrument yielded 35 questions across eight functional domains (environmental sounds, communication, social functioning, behavior, CI device management and routines, school, CI benefits, and early intervention). Similarly, the final QoL-CI adolescent/young adult version consisted of 46 items across eight domains (noisy environments, communication, CI usage and management, advocacy, social functioning, emotional functioning, acceptance, and independence). CONCLUSIONS: The QoL-CI is a condition-specific QoL instrument that can be used for children ages birth through 22 years. These instruments capture the "whole" child by not only focusing on communication and auditory skills but also academic, social and emotional functioning. Once validated, these CI-specific measures will enable providers to track long-term outcomes and evaluate the efficacy of new interventions to improve overall CI use and QoL for pediatric and young adult users.

Functional Hearing Preservation in Cochlear Implantation: The Miami Cocktail Effect.

OBJECTIVE: To investigate if pharmacological treatment with prednisone and L-N-acetylcysteine (STE + NAC) influence functional hearing preservation in cochlear implant (CI) surgery. STUDY DESIGNS: Preimplantation and postimplantation longitudinal case-control study. SETTING: Tertiary referral center. PATIENTS: Pediatric and adult recipients of CI with preimplantation functional hearing defined as an average of air-conducted thresholds at 125, 250, and 500 Hz (low-frequency pure-tone average [LFPTA]) <80 dB. INTERVENTIONS: Preimplantation and postimplantation audiometry. Weight-adjusted oral prednisone and L-N-acetylcysteine starting 2 days before surgery (Miami cocktail). Prednisone was continued for 3 days and L-N-acetylcysteine for 12 days after surgery, respectively. Cochlear implantation with conventional length electrodes. MAIN OUTCOME MEASURES: Proportion of patients with LFPTA <80 dB, and LFPTA change at 1-year postimplantation. RESULTS: All 61 patients received intratympanic and intravenous dexamethasone intraoperatively, with 41 patients receiving STE + NAC and 20 patients not receiving STE + NAC. At 1-year postimplantation, the proportion of functional hearing preservation was 83% in the STE + NAC group compared with 55% of subjects who did not receive STE + NAC ( p = 0.0302). The median LFPTA change for STE + NAC-treated and not treated subjects was 8.33 dB (mean, 13.82 ± 17.4 dB) and 18.34 dB (mean, 26.5 ± 23.4 dB), respectively ( p = 0.0401, Wilcoxon rank test). Perioperative STE + NAC treatment resulted in 10 dB of LFPTA better hearing than when not receiving this treatment. Better low-frequency preimplantation hearing thresholds were predictive of postimplantation functional hearing. No serious side effects were reported. CONCLUSION: Perioperative STE + NAC, "The Miami Cocktail," was safe and superior to intraoperative steroids alone in functional hearing preservation 1-year after cochlear implantation.

Parents of children with hearing loss: Impact and exposure of COVID-19 on mental health.

The aim of this study was to evaluate the impact and exposure of COVID-19 on parent mental health (e.g., depression, anxiety, and post-traumatic stress disorder (PTSD), for parents of children with hearing loss. The survey was distributed via an electronic survey to families subscribed to a pediatric program listserv as part of a university medical center. Fifty-five percent of parents reported elevated symptoms of anxiety, while 16% scored in the clinically significant range for depression. In addition, 20% of parents reported elevated symptoms of PTSD. Liner regressions found that impact of COVID-19 predicted anxiety symptoms, while both impact and exposure predicted depression and PTSD symptoms. In addition, both impact and exposure predicted COVID related parental distress. Exposure and impact of COVID-19 has had negative consequences on parents of children with hearing loss. Although exposure influenced parental mental health, impact uniquely affected depression and PTSD. Results highlight the need for mental health screening, as well implementation of psychological interventions using telehealth or in-person consultations. Future work should focus on post-pandemic challenges, including long-term psychological functioning due to the established relationship between parental mental health and pediatric outcomes.

Impact of Auditory-Oral Education on Device Use in Children With Hearing Loss.

PURPOSE: This study examined changes in datalogging for children attending an auditory-oral educational program with integrated audiology services versus children attending a mainstream or nonspecialized program. METHOD: Eighty children participated in this study, half of which were enrolled in an auditory-oral educational program versus the nonspecialized or mainstream setting. Datalogging for cochlear implant and hearing aid users was obtained via retrospective medical and educational chart review from 2016 to 2019. RESULTS: Results demonstrated that at post-enrollment, children attending the auditory-oral educational program significantly increased device wear time (as measured by average hours/day) when compared to the control group. Children using hearing aids enrolled in the specialized educational program obtained the largest improvement in overall wear time, averaging an increase of 5 hr/day of device use from pre- to post-enrollment. CONCLUSIONS: This is the first study to document the association of specialized educational programs on device use. Clinical and educational programs should collaborate to provide integrated services to lessen family burden and increase a child's device use and retention.

Prevalence of Depression and Anxiety in Adolescents With Hearing Loss.

OBJECTIVE: To develop and implement a universal screening protocol for depression and anxiety in adolescents serviced in an otology and audiology practice and to estimate the prevalence of depression and anxiety in adolescents with hearing loss, while also comparing rates by degree of hearing loss and type of hearing device used. STUDY DESIGN: Cross-sectional. SETTING: University tertiary medical center. PATIENTS: One hundred four adolescents 12- to 18-years-old who attended an otology clinic in a large metropolitan hospital in the southeastern United States. MAIN OUTCOME MEASURE: (s): Depression (PHQ-8), anxiety (GAD-7), degree of hearing loss, type of hearing loss, and type of hearing device utilized. RESULTS: Twenty-five percent of adolescents scored above the clinical cutoff on at least one of the depression and/or anxiety measures, with 10% scoring in the elevated range on both measures. Specifically, 17% scored above the cutoff on the PHQ-8 and 16% scored in the clinically significant range for the GAD-7. An additional 30 and 21% scored in the at-risk range for depression and anxiety, respectively. Older adolescents were more likely to score within the elevated range for depression (r = 0.232, p = 0.026). Also, adolescents with severe to profound hearing loss had higher rates of depression and anxiety. CONCLUSIONS: Integration of mental health screening is needed in otology and audiology practices both to identify those who require psychological support and to provide appropriate treatment to reduce long-term impact of hearing loss on quality of life and mental health functioning in adolescents.

Comparisons of performance in pediatric bone conduction implant recipients using remote microphone technology.

OBJECTIVES: For children with hearing loss, remote microphone (RM) technology can significantly improve access to speech in environments with poor signal-to-noise ratios (SNRs), such as classrooms. Yet, this has never been studied in bone conduction device (BCD) users, a common treatment for children with irresolvable conductive hearing loss resulting from anatomical malformations of the outer ear. The objective of this study was to investigate the benefits of RM technology on speech perception in noise in pediatric BCD users with Microtia/Atresia. A secondary aim was to assess parent and child perceptions of RM technology before and after exposure to RM technology. METHODS: Participants included 10 pediatric bone conduction implant users with unilateral conductive hearing loss ages 7-17 years, and their guardians. Speech perception in noise for soft and moderate inputs was assessed with and without RM technology. Guardians actively observed the child's hearing performance with and without the RM and were asked to complete a questionnaire assessing their perceptions about their child's performance. Children were also administered the questionnaire prior to and immediately following exposure to the RM technology. RESULTS: Participants showed improved speech understanding in noise for both soft and moderate speech inputs when using the RM with their BCD compared to their BCD alone. Questionnaire results indicated good parent-child agreement. Further, significant improvements were reported for child understanding speech, parent hearing domains after exposure to the RM. No significant differences were noted for ease of use/likability. CONCLUSIONS: Significant hearing in noise benefits were observed with RM technology for children using BCDs. Consistent with objective findings, children reported improved speech understanding with the RM. Improved parental perceptions of hearing benefit following exposure to the RM suggests that active participation may serve as an effective strategy to help improve parent understanding of the benefits of RM technology for their child.