A Grounded Theory to Explain Parent Prioritization of Hearing Care When Children Have Down Syndrome

The purpose of this study was to describe the decision-making process parents experience when prioritizing hearing care while caring for children who are deaf or hard-of-hearing with Down Syndrome. To achieve this, parents of children who are deaf or hard-of-hearing with Down Syndrome were recruited, and in-depth interviews were conducted to develop a grounded theory that may explain the decision-making process for how parents prioritize effective hearing care and management. The resulting theory indicated that the higher the extent of professional engagement, parent perception of benefit, parent activation, and engagement of family support, the higher the priority for hearing care and management will be. The results of this study may inform audiologists and other professionals interacting with this sub-population of parents and children regarding how parent needs and challenges may extend beyond those present when children are deaf or hard-of-hearing alone. This may, in turn, inform how person-centered care is delivered to meet these needs

Counseling in Audiology: AuD Students’ Perspectives and Experiences

Counseling in audiology is an important aspect of service delivery. How audiologists interact with patients and foster counseling relationships to help patients and families understand and live with hearing loss can impact outcomes of audiological interventions. Currently, variability exists in how graduate training programs are teaching counseling skills, and the extent to which counseling skills development is supported in clinical experiences is unclear. This article seeks to explore the perspectives related to the importance of counseling and counseling training experiences received through clinical instruction of Au.D. students beginning their final year of study, to identify where counseling training might be limited, and to examine how counseling skills might be better supported. Findings revealed that students generally appreciate the importance of counseling in audiology. Data suggest that how students are supported in developing counseling skills appears to be variable and unstructured

Parent Challenges, Perspectives and Experiences Caring for Children Who are Deaf or Hard-of-Hearing With Other Disabilities: A Comprehensive Review

Objective: The purpose of this literature review was to explore parent challenges in caring for children who are deaf or hard of hearing with other disabilities and discuss implications for audiologists related to supporting families. Design: A comprehensive literature review was conducted, and through qualitative analysis, emergent themes were identified, and a narrative summary generated. Study sample: Nine research studies were included in this review. Combined, these studies reflect a sample of 111 children, 23 families and 41 parents. Results: Three broad themes were identified, and include parent-reported challenges related to family, professional and child variables. Sub-themes were identified within each broad theme to further describe parent experiences, such as challenges related to decision-making and planning, interprofessional collaboration, and child communication and behaviours. Conclusions: Parents of children with hearing loss and additional disabilities face unique challenges related to family, professional and child variables that could impact how they manage their child’s hearing care

Factors Associated with the Psychosocial Wellbeing Among Parents of Children who are Deaf or Hard-of-hearing

Purpose: To identify factors associated with low psychosocial wellbeing among parents of children who are deaf or hard-of-hearing. Method: A cross sectional survey that included instruments to measure psychological distress, functional impairment, and psychological inflexibility. Two hundred and ninety-six parents completed the survey. Results: Analyses revealed that lower income, presence of additional disabilities, younger child age, and psychological inflexibility were factors associated with low parent psychosocial wellbeing. Conclusions: Parents of younger children who are deaf or hard-of-hearing with low income, have children with additional disabilities, and higher psychological inflexibility may experience lower psychosocial wellbeing. Clinicians serving families may need to provide additional and/or different support for parents in adapting to and managing their child’s hearing loss

Well-being of Parents of Children Who Are Deaf or Hard of Hearing

Purpose: The purpose of this study was to explore factors influencing the well-being of parents who have children who are deaf or hard of hearing (DHH) and to compare their experiences to non-clinical samples. Method: A cross-sectional online survey was used to collect data (N = 296). Results: Data analyses revealed the majority of parents of children who are DHH were functioning similarly to or better than the non-clinical samples in our comparison and within the non-clinical range for the included measures. No relationship was found between factors related to child age or timing of services (age at diagnosis, time between diagnosis and amplification fitting, age fit with hearing technology, child’s current age) and parent psychosocial functioning. Conclusions: While most parents are likely to be functioning well, knowing when a parent is experiencing challenges has important implications for clinical practice, including supporting parents in finding solutions when sub-optimal daily intervention practices are occurring. Audiologists can incorporate strategies to identify parents that may be experiencing challenges into their routine practice

Hearing Care and Management Priority Among Parents of Children with Down Syndrome: A Grounded Theory

Objective: This study qualitatively explored the factors that influence how parents of children who are Deaf or hard-of-hearing with Down syndrome prioritize hearing care and management and developed an associated theory to explain that priority. Design: Grounded theory was used for the purposes of this qualitative study. Data were collected using in-depth interviews which were analyzed using a three-tiered qualitative coding process. Study Sample: Eighteen mothers of children who are Deaf or hard-of-hearing with Down syndrome participated in this study. Results: The higher the extent of engaged professional support, perception of benefit for child, parent activation, and family engagement, the higher the priority for hearing care and management will likely be among parents of children who are Deaf or hard-of-hearing with Down syndrome. Conclusions: Understanding how parents of children who are Deaf or hard-of-hearing with Down syndrome decide to prioritize hearing care and management has implications for how hearing health providers and others provide care to parents to enhance priority for hearing-related needs

eHealth Parent Education for Hearing Aid Management: A Pilot Randomized Controlled Trial

Objective: Parents frequently experience challenges implementing daily routines important for consistent hearing aid management. Education that supports parents in learning new information and gaining confidence is essential for intervention success. We conducted a pilot study to test an eHealth program to determine if we could implement the program with adherence and affect important behavioral outcomes compared to treatment as usual. Design: Randomized controlled trial Study sample: Parents of children birth to 42 months who use hearing aids. Eighty-two parents were randomly assigned to the intervention or treatment-as-usual group. Four parents assigned to the intervention group did not continue after baseline testing. Results: The intervention was delivered successfully with low drop out (10%), high session completion (97%), and high program adherence. The intervention conditions showed significantly greater gains over time for knowledge, confidence, perceptions, and monitoring related to hearing aid management. Significant differences between groups were not observed for hearing aid use time. Conclusion: We found that we could successfully implement this eHealth program and that it benefitted the participants in terms of knowledge and confidence with skills important for hearing aid management.Future research is needed to determine how to roll programs like this out on a larger scale

Primary Extracranial Meningiomas: An Analysis of 146 Cases

Primary extracranial meningiomas are rare neoplasms, frequently misdiagnosed, resulting in inappropriate clinical management. To date, a large clinicopathologic study has not been reported. One hundred and forty-six cases diagnosed between 1970 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. Histologic features were reviewed, immunohistochemistry analysis was performed (n = 85), and patient follow-up was obtained (n = 110). The patients included 74 (50.7%) females and 72 (49.3%) males. Tumors of the skin were much more common in males than females (1.7:1). There was an overall mean age at presentation of 42.4 years, with a range of 0.3–88 years. The overall mean age at presentation was significantly younger for skin primaries (36.2 years) than for ear (50.1 years) and nasal cavity (47.1 years) primaries. Symptoms were in general non-specific and reflected the anatomic site of involvement, affecting the following areas in order of frequency: scalp skin (40.4%), ear and temporal bone (26%), and sinonasal tract (24%). The tumors ranged in size from 0.5 up to 8 cm, with a mean size of 2.3 cm. Histologically, the majority of tumors were meningothelial (77.4%), followed by atypical (7.5%), psammomatous (4.1%) and anaplastic (2.7%). Psammoma bodies were present in 45 tumors (30.8%), and bone invasion in 31 (21.2%) of tumors. The vast majority were WHO Grade I tumors (87.7%), followed by Grade II (9.6%) and Grade III (2.7%) tumors. Immunohistochemically, the tumor cells labeled for EMA (76%; 61/80), S-100 protein (19%; 15/78), CK 7 (22%; 12/55), and while there was ki-67 labeling in 27% (21/78), <3% of cells were positive. The differential diagnosis included a number of mesenchymal and epithelial tumors (paraganglioma, schwannoma, carcinoma, melanoma, neuroendocrine adenoma of the middle ear), depending on the anatomic site of involvement. Treatment and follow-up was available in 110 patients: Biopsy, local excision, or wide excision was employed. Follow-up time ranged from 1 month to 32 years, with an average of 14.5 years. Recurrences were noted in 26 (23.6%) patients, who were further managed by additional surgery. At last follow-up, recurrent disease was persistent in 15 patients (mean, 7.7 years): 13 patients were dead (died with disease) and two were alive; the remaining patients were disease free (alive 60, mean 19.0 years, dead 35, mean 9.6 years). There is no statistically significant difference in 5-year survival rates by site: ear and temporal bone: 83.3%; nasal cavity: 81.8%; scalp skin: 78.5%; other sites: 65.5% (P = 0.155). Meningiomas can present in a wide variety of sites, especially within the head and neck region. They behave as slow-growing neoplasms with a good prognosis, with longest survival associated with younger age, and complete resection. Awareness of this diagnosis in an unexpected location will help to avoid potential difficulties associated with the diagnosis and management of these tumors