Evaluation of the Baha SoundArc in children.

OBJECTIVE: The Baha SoundArc coupling system has been developed as a non-surgical coupling of a Baha sound processor to the skull allowing the transfer of vibrational energy to the cochlear partition via bone conduction pathways. Today, there are several alternatives to this non-surgical approach as the Baha headband/test band, or the Baha Softband, or adhesive patches. Each of these current options have benefits and liabilities. The aim of the study was to evaluate pediatric experience and performance when using two non-surgical options, the Baha SoundArc compared to the Baha Softband. METHODS: Twenty-five children with unilateral mixed or conductive hearing loss aged 5-12 years of age evaluated the use of the Baha SoundArc compared to their existing Baha Softband in a one month take home trial. Participants had a minimum of 3 months experience using the control, Baha Softband. Participants were assessed at baseline and one month following fit of the Baha SoundArc. Measures included an experience and use patient reported outcome, speech perception testing in quiet using Phonetically Balanced Kindergarten (PBK) words, and sound field audiometry. RESULTS: Mean aided soundfield thresholds across the frequency range were 27.6 dB HL for Softband and 26.0 dB HL for SoundArc, which were not significantly different (P = >.05). Mean word recognition score was 80.8% when aided with the Softband device and 85.1% with the SoundArc, which was also not significantly different (P = >.05). Most children favored the aesthetics and usability of the SoundArc over Softband, but comfort ratings were largely similar for both devices. CONCLUSIONS: Bone conduction sound processors mounted on a SoundArc or a Softband resulted in comparable improvements in aided thresholds and speech understanding in children suffering from conductive or mixed hearing loss. Both wearing modalities can be considered equivalent in terms of audiological outcomes, although both patients and clinicians preferred the usability and aesthetics of the SoundArc. The SoundArc provides an alternative wearing option for patients that may otherwise be discouraged by the aesthetics and usability of the Softband device. GOV IDENTIFIER: NCT03333577.

Exploring Factors Responsible for Delay in Pediatric Cochlear Implantation.

OBJECTIVE: To identify and characterize demographic and socioeconomic factors associated with delays in cochlear implantation (CI) in children. STUDY DESIGN: Retrospective. SETTING: Tertiary pediatric CI referral center. PATIENTS: All patients under 18 years of age receiving CI between March 2018 and February 2020. INTERVENTIONS: CI. MAIN OUTCOME MEASURES: Primary outcome measures included age at implantation and time from hearing loss diagnosis and candidacy evaluation to CI. RESULTS: Seventy-two patients were identified (44% women, average age at implantation 4.9 yr). Age at implantation was older in patients with public, rather than private, insurance (6.0 ±â€Š0.8 yr versus 3.1 ±â€Š0.7 yr, p = 0.007) and those from low-income areas (8.6 ±â€Š7.6 yr versus 2.4 ±â€Š3.0 yr, p = 0.007). Time between hearing loss diagnosis and implantation was longer in publicly insured patients (4.1 ±â€Š0.6 yr versus 2.2 ±â€Š0.5 yr, p = 0.014). Time between identification as a CI candidate and implantation was longer in publicly insured patients (721 ±â€Š107d versus 291 ±â€Š64 d, p = 0.001). Among children with congenital profound hearing loss, publicly insured patients continued to be older at implantation (1.9 ±â€Š0.2 versus 1.0 ±â€Š0.2 yr, p = 0.008). Latinx children were more often publicly insured whereas white children were more often privately insured (p < 0.05). Publicly insured patients had delays in the pre-CI workup, including, in no particular order, vestibular evaluation (621 ±â€Š132 d versus 197 ±â€Š67 d, p = 0.007), developmental evaluation (517 ±â€Š106 d versus 150 ±â€Š56 d, p = 0.003), speech evaluation (482 ±â€Š107 d versus 163 ±â€Š65 d, p = 0.013), and children's implant profile (ChIP) assessment (572 ±â€Š107d versus 184 ±â€Š59d, p = 0,002). On ChIP evaluation, concerns regarding educational environment and support were higher in Spanish-speaking children (p = 0.024; p = 2.6 × 10-4) and children with public insurance (p = 0.016; p = 0.002). CONCLUSIONS: Disparities in access to CI continue to affect timing of pediatric cochlear implantation.

Auditory Processing Disorder: What Does It Mean and What Can Be Done?

CASE: Julian, an 11-year-old boy in the sixth grade with a compliant disposition and a positive attitude, has had a significant decline in his academic performance over the last 2 years. He spends much of his time in the nurse's office with headaches and fatigue. He reports that he cannot concentrate or follow along in class. Vision and hearing screenings were normal.Julian's teachers report that although he has no behavior problem, he is inattentive and does not put forth the effort she feels he is capable of giving. He does not seem to be listening, and he is distracted by everyone around him. He often claims that he did not hear or understand the things that teachers explained several times. When teachers talk to him directly, he starts an assignment and usually finishes his work on time. Teachers observe that he has "attention-deficit hyperactive disorder (ADHD) like tendencies." A recent psychoeducational evaluation qualified Julian for special education services under specific learning disability in the area of auditory processing. An individual education plan will be developed within the next 2 weeks.Key indicators used to make this determination included the following: average standard scores on nonverbal tests of cognitive development, a below-average score in overall auditory processing (with particularly low scores in auditory reasoning and auditory memory), average scores in the areas of general memory and attention/concentration, and below-average composite scores in reading and written expression.Following a review of the assessment report, Julian's parents remain concerned about the possibility of ADHD. Prior to the special education assessment, the school provided the Vanderbilt Assessment Scales for Julian's parents to share with his doctors; it revealed elevated scores in ADHD symptoms (predominantly inattentive subtype). Julian's parents would like to learn about options for treatment that might improve his attention.