Modified Physiological Hearing Screening: Interim Protocol For Ontario Infants During the COVID-19 Pandemic

This protocol describes interim procedures for a modified physiological hearing screen for Ontario infants who are over 8 weeks corrected age and who were not offered a newborn hearing screen through the Infant Hearing Program (IHP) due to service interruptions as a result of the COVID-19 pandemic. The scope of this document includes details of the modified hearing screen as funded by the Ministry of Children, Community and Social Services (MCCSS) for the Ontario IHP. It will remain in effect as an interim service during the global pandemic and will be recalled at the discretion of the MCCSS

Language Development Services Guidelines Ontario Infant Hearing Program

The IHP Language Development Pathway (LDP) is comprised of the nine steps summarized in the table below (Coutu et al., 2015).While the pathway intends to capture the process for providing language development services, the sequence of steps may not occur exactly as outlined below(e.g.,some steps may be initiated or occur at the same time).The steps may not be sequential and are not intended to describe separate and/or different appointments.The table provides an overview of the service providers who may be supporting a child who is D/HH and their family,during each step in the process. It is not intended to be exhaustive of all professionals who may be working with a child and/or their family

Development and Evaluation of an Audiological Outcome Measure Guideline for Use with Infants, Toddlers, and Preschool Children

The goals of the current work were to: 1) identify caregiver report questionnaires for inclusion in an outcome evaluation guideline for infants, toddlers, and preschool children who wear hearing aids and 2) evaluate the chosen tools to determine their usefulness for the population of interest. A critical review of auditory-related subjective outcome evaluation tools for infants, toddlers, and preschool children is presented (Chapter 2). Good psychometric properties and clinical feasibility were considered important elements for the guideline (Andresen, 2000). Existing norms for the chosen questionnaires were validated with normal hearing children from Canadian English-speaking families (Chapters 3 and 5). Finally, The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP), how it was used to collect clinical data with children who wear hearing aids, and their performance on the questionnaires is provided (Chapter 4). Children with comorbidities and complex factors related to hearing aid use were also investigated. The results of this work revealed two caregiver report questionnaires that were suitable for use within the UWO PedAMP (Chapter 2): the LittlEARS® Auditory Questionnaire (Tsiakpini, et al., 2004) and the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005). Both questionnaires were considered feasible for clinical use (Moodie, et al., 2011) and are supported by good psychometric properties. Norms for the questionnaires were found to be appropriate for use with normal hearing children (Chapters 3 and 5). Outcomes of children with hearing loss who wear hearing aids were investigated using the UWO PedAMP (Chapter 4). Results indicated typically developing children fitted with hearing aids displayed auditory development and performance similar to their normal hearing peers. Children with comorbidities displayed borderline normal auditory development which progressed as they got older. Children with complex factors related to hearing aid use displayed borderline normal development up to 12 months of age where it began to decline. This work also demonstrated that the UWO PedAMP can be used in a clinical setting to evaluate the outcome of hearing aid fitting to infants, toddlers, and preschool children. This is an important finding since outcome evaluation guidelines for this population are lacking

Evaluation of hearing aid manufacturers\u27 software-derived fittings to DSL v5.0 pediatric targets

Background Hearing aid prescriptive methods are a commonly recommended component of evidence-based preferred practice guidelines and are often implemented in the hearing aid programming software. Previous studies evaluating hearing aid manufacturers\u27 software-derived fittings to prescriptions have shown significant deviations from targets. However, few such studies examined the accuracy of softwarederived fittings for the Desired Sensation Level (DSL) v5.0 prescription. Purpose The purpose of this study was to evaluate the accuracy of software-derived fittings to the DSL v5.0 prescription, across a range of hearing aid brands, audiograms, and test levels. Research Design This study is a prospective chart review with simulated cases. Data Collection and Analysis A set of software-derived fittings were created for a sixmonth- old test case, across audiograms ranging from mild to profound. The aided output from each fitting was verified in the test box at 55-, 65-, 75-, and 90-dB SPL, and compared with DSL v5.0 child targets. The deviations from target across frequencies 250-6000 Hz were calculated, together with the root-mean-square error (RMSE) from target. The aided Speech Intelligibility Index (SII) values generated for the speech passages at 55- and 65-dB SPL were compared with published norms. Study Sample Thirteen behind-the-ear style hearing aids from eight manufacturers were tested. Results The amount ofdeviation per frequencywas dependent on the test level and degree of hearing loss. Most software-derived fittings for mild-to-moderately severe hearing losses fell within_ 5 dB of the target formost frequencies. RMSE results revealed more than 84% of those hearing aid fittings for the mild-to-moderate hearing losseswere within 5 dB at all test levels. Fittings for severe to profound hearing losses had the greatest deviation from target and RMSE. Aided SII values for the mild-to-moderate audiograms fell within the normative range forDSL pediatric fittings, although they fellwithin the lower portion of the distribution. For more severe losses, SII values for some hearing aids fell below the normative range. Conclusions In this study, use of the software-derived manufacturers\u27 fittings based on the DSL v5.0 pediatric targets set most hearing aids within a clinically acceptable range around the prescribed target, particularly for mild-to-moderate hearing losses. However, it is likely that clinician adjustment based on verification of hearing aid output would be required to optimize the fit to target, maximize aided SII, and ensure appropriate audibility across all degrees of hearing loss

What do Speech-Language Pathologists want to know when assessing vocal development in children who are deaf/Hard-of-Hearing?

Abstract Purpose: Delays in vocal development are an early predictor of ongoing language difficulty for children who are deaf/hard-of-hearing (CDHH). Despite the importance of monitoring early vocal development in clinical practice, there are few suitable tools. This study aimed to identify the clinical decisions that speech-language pathologists (SLPs) most want to make when assessing vocal development and their current barriers to doing so. Method: 58 SLPs who provide services to CDHH younger than 22 months completed a survey. The first section measured potential barriers to vocal development assessment. The second section asked SLPs to rate the importance of 15 clinical decisions they could make about vocal development. Results: SLPs believed assessing vocal development was important for other stakeholders, and reported they had the necessary skills and knowledge to assess vocal development. Barriers primarily related to a lack of commercially available tests. SLPs rated all 15 clinical decisions as somewhat or very important. Their top 5 decisions included a variety of assessment purposes that tests are not typically designed to support, including measuring change, differential diagnosis, and goal setting. Conclusions: SLPs wish to make a number of clinical decisions when assessing vocal development in CDHH but lack access to appropriate tools to do so. Future work is needed to develop tools that are statistically equipped to fulfill these purposes. Understanding SLPs’ assessment purposes will allow future tests to better map onto the clinical decisions that SLPs need to make to support CDHH and their families and facilitate implementation into clinical practice

Audiometric Assessment for Children aged 6 to 60 months

This protocol addresses procedures for audiometric assessment of hearing thresholds in infants and young children using behavioural measures of threshold and associated measures in a test battery. The scope of this document includes these assessments as funded by MCCSS for the Ontario Infant Hearing Program (IHP). In infants and young children, modified operant conditioning is used to obtain systematic behavioural responses to sound from older infants and young children. These conditioned responses are used as the basis of behavioural audiometry until the child is developmentally able to complete standard audiometry, at about 3 to 5 years of age in typically developing children (Sabo et al., 2003)

Risk factors for hearing loss in children: A systematic literature review and meta-analysis protocol

Background: Hearing loss in newborns and children is a public health concern, due to high prevalence and negative effects on their development. Early detection and intervention of childhood hearing loss may mitigate these negative effects. Population-based newborn hearing screening programs have been established worldwide to identify children at risk for congenital hearing loss and to follow children at risk for late onset or progressive hearing loss. This article presents the protocol for a systematic review that aims to review the risk factors associated with permanent hearing loss in children, including congenital, early, or late onset. Risk factors associated with progressive hearing loss will be investigated as a secondary aim. Methods: Scientific literature from the following databases will be investigated: MEDLINE, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), Embase, and CINAHL. The primary outcome is a permanent bilateral or unilateral hearing loss with congenital onset or onset during childhood (birth to 18 years). The secondary outcome is progressive hearing loss. Studies must report data on risk factors associated with permanent hearing loss; risk factors may be present at birth or later and result in immediate or delayed hearing loss. Randomized controlled trials, quasi-experimental studies, nonrandomized comparative and non-comparative studies, and case series will be included. The risk of bias will be assessed using the Qualitative Assessment Tool for Quantitative Studies (McMaster University). If aggregation of data is possible for a subsection of studies, we will pool data using meta-analysis techniques. If aggregation of data is not possible, a qualitative synthesis will be presented. We will assess the quality and strength of the overall body of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Discussion: The resulting information will inform the update of a provincial audiological surveillance protocol for the Ontario Infant Hearing Program and will be applicable to early hearing detection and intervention (EHDI) programs worldwide. Systematic review registration: We have registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018104121

Usability and Feasibility of a Spoken Language Outcome Monitoring Procedure in a Canadian Early Hearing Detection & Intervention Program: Results of a 1-Year Pilot

Abstract Purpose: Best practice recommendations for Early Hearing Detection and Intervention (EHDI) programs include routine spoken language outcome monitoring. The present article reports on pilot data that evaluated the usability and feasibility of a spoken language outcome monitoring procedure developed for Ontario’s Infant Hearing Program (IHP). This procedure included both Program-level monitoring using omnibus language tests from birth to 6;0 and individual vulnerability monitoring of key domains of spoken language known to be at risk in children who are deaf/hard-of-hearing. Methodology: Speech-language pathologists (SLPs) in the IHP piloted the new procedures for one year and provided feedback on the procedure through surveys at the end of the pilot. Results: Data was suggestive that the Program-level procedure might be sensitive to change over time and known predictors of spoken language outcomes. Some, but not all, Program-level test scores were predicted by the presence of additional developmental factors. None of the test scores were significantly predicted by severity of hearing loss. Depending on the tests and scores used, some aspects of the Program-level procedure to change over time. There was insufficient evidence to support individual vulnerability monitoring. SLPs reported significant concerns about the time involved in implementing both procedures. Conclusions: This article describes preliminary evidence suggesting that the Program-level procedure might be feasible to implement and useful for evaluating EHDI programs. Future evaluations are needed to determine whether the procedure can be accurately implemented to scale in the IHP, and whether the data that results from the procedure can meaningfully inform stakeholders’ decision-making

Usability and Feasibility of a Spoken Language Outcome Monitoring Procedure in a Canadian Early Hearing Detection & Intervention Program: Results of a 1-Year Pilot

Purpose: Best practice recommendations for Early Hearing Detection and Intervention (EHDI) programs include routine spoken language outcome monitoring. The present article reports on pilot data that evaluated the usability and feasibility of a spoken language outcome monitoring procedure developed for Ontario’s Infant Hearing Program (IHP). This procedure included both Program-level monitoring using omnibus language tests from birth to 6 years of age and individual vulnerability monitoring of key domains of spoken language known to be at risk in children who are deaf or hard of hearing. Methodology: Speech-language pathologists (SLPs) in the IHP piloted the new procedures for one year and provided feedback on the procedure through surveys at the end of the pilot. Results: Data was suggestive that the Program-level procedure might be sensitive to change over time and known predictors of spoken language outcomes. Some, but not all, Program-level test scores were predicted by the presence of additional developmental factors. None of the test scores were significantly predicted by severity of hearing loss. Depending on the tests and scores used, some aspects of the Program-level procedure were sensitive to change over time. There was insufficient evidence to support individual vulnerability monitoring. SLPs reported significant concerns about the time involved in implementing both procedures. Conclusions: This article describes preliminary evidence suggesting that the Program-level procedure might be feasible to implement and useful for evaluating EHDI programs. Future evaluations are needed to determine whether the procedure can be accurately implemented to scale in the IHP, and whether the data that results from the procedure can meaningfully inform stakeholders’ decision-making

Relationship of Head Circumference and Age in the Prediction of the Real-Ear-to-Coupler Difference (RECD)

Background Pediatric hearing instrument fitting is optimally performed with individually obtained real-ear-to-coupler difference (RECD) measurements. If these measurements cannot be obtained, predicted values based on age are used. Recent evidence obtained from children aged 3-11 years suggests that head circumference (HC) may be a viable alternative or addition to age for use in RECD prediction. Purpose The purpose of the present study was to determine if HC can be used to predict RECDs in infants, children, and adults. Research Design A correlational design was used. HC and RECD values were measured in all participants. Study Sample Participants were 278 North American infants and children (136 males and 142 females) aged 1.6 months to 11 years and 109 adults (42 males and 67 females) aged 18 years to 83 years. Data Collection and Analysis After otoscopic inspection and immittance measurements were performed to assess candidacy for inclusion in the study, HC was measured twice for all participants and a single RECD measure was obtained for each participant at twelve frequencies (250 through 12500 Hz). The reliability of HC measurements was assessed with an intraclass correlation analysis. Linear regression analyses were performed with age and HC as predictor variables and RECDs as the dependent variable. Results Analysis indicated good reliability of the HC measurement. The relationships between RECD and HC were comparable with the relationships between RECD and age. Combining HC and age did not improve predictive accuracy. Conclusions HC can be used in children and adults as an alternative metric in the prediction of RECDs when individual RECDs cannot be obtained