Play It By Ear Seminar: Day One

SETTING THE STAGE TO MAXIMIZE AUDITORY POTENTIAL: AGRESSIVE AUDIOLOGICAL MANAGEMENT AND USE OF HEARING TECHNOLOGY

Jace Wolfe, Ph.D., CCC-A (Hearts for Hearing)

The Joint Committee on Infant Hearing published its latest position statement on October 1, 2007.  Some of the most significant changes are:

  • A follow-up ABR (Auditory Brainstem Response — “hearing” test) is required for all children who are in the NICU (Neonatal Intensive Care Unit) for more than five (5) days.  This is very important because of the ototoxicity of some life-saving drugs, the high level of noise exposure from NICU medical equipment, and the possibility of underlying health problems and/or syndromes that might cause deafness.

  • Children who have been in the NICU should be given an ABR test, NOT and OAE, because an OAE can miss hearing losses due to auditory dysynchrony (more on that tomorrow), which acocunts for about 20-40% of losses found in NICU babies.

The paradigm for newborn hearing screening is 1-3-4.  Screenings should be done by one month.  Diagnostic tests (if the screening is failed) should be completed by three months, and hearing aids should be fit by four months of age.

Fitting infants with hearing aids is as much an art as it is a science.  A good pediatric audiologist is KEY.  Also, remember that children’s hearing aid needs are VERY different than the needs of adult HA users.  For example, children’s ears are growing so rapidly in infancy that they may need to be fit for new earmolds as many as ten to fifteen times in their first year of life.  Yes, this is expensive and yes, it is time consumbing, but YES your child’s hearing is worth it and YES it is CRUCIAL to achieve a good earmold seal to get children as much access to sound as possible while they are still young.  (Adults, on the other hand, can usually keep the same pair of earmolds until they break or wear out!)  To achieve this good, tight hearing aid fit, find an audiologist who believes in aggressive management of hearing loss, and one who is not afraid to make molds early and often!  Also, lubricants like OtoEase and OtoFirm can help to achieve a tighter seal toward the end of an earmold’s lifetime, but these cremes are expensive and are sold in very small quantities.  Dr. Wolfe recommended Lanolin, a common ointment that is inexpensive and sold in large quantities at almost any drugstore or supermarket.  What a great, cheap fix for a common HA problem!

But what if a child is so deaf that “hearing aids won’t really help them much”?  Hearing aids are STILL worth it for those first few months until they can receive a cochlear implant.  Why?  To maximize what residual hearing they have (no matter how teeny tiny it might be!) and to adjust the child to wearing a hearing device for ALL WAKING HOURS.  It is cruical!

Questions to ask your about “Feedback Cancellation” programs in hearing aids before making the purchase:

  • Does the feedback cancellation program have “phase conversion”?  (This is a fancy way to say that, when the HA detects a feedback squeal, it emits the exact opposite phase wave of that sound, thereby cancelling it out — it’s like adding 5 + -5 = 0… adding the opposite of something to itself yields… nothing!  No feedback!)

  • How much gain (added loudness in dB) will the frequency cancellation program provide?  (A good feedback cancellation program in digital hearing aids should give you at least a 15-20dB gain)

FM Systems (for hearing aids and cochlear implants)

  • The best kind of FM system is a “dynamic FM” — instead of just setting the volume from the FM microphone input to X amount louder than the background noise, no matter how loud that noise might be, dynamic FMs allow you to adjust the loudness of the FM signal as needed.  In a quiet room, the teacher’s voice doesn’t need to be 20dB above the rest of the noise, because there isn’t any, and that would be way to loud!  Conversely, if the room is buzzing with sounds, you have the freedom to up the input from the teacher’s voice via the FM even more than usual.  Also, some of the newer dynamic FM systems automatically mute the microphone when no sound input is detected.  This saves the FM user from hearing “air noise” and static through the microphone, while still allowing them to hear the important things (speech) that they need!

  • Set the HA/CI environmental mic:FM ratio at 1:1.  You do not want to deprive the child of the ability to hear the world around them, you want the FM to be as loud as the sound they get from their regular HA or CI mic.  Make sure to have the audiologist deliberately set this ratio!  The standard FM ratio on the Cochlear Freedom is 3:1 (FM:CI mic).  (Due to this research, which Dr. Wolfe conducted in conjunction with Cochlear, this recommendation will soon be changed, but until then… make sure to double check it yourself!)

  • For Cochlear Freedome users, make sure that the ASC (Auto Sensitivity Control) is ON when using an FM.  This does not compromise the mix ratio between CI:FM.  Dr. Wolfe’s recommendation is ASC plus the ADRO programming strategy for best hearing through a CI with FM.

Unilateral hearing loss is important, too!  Children who are severe-profound in one ear and have typical hearing in the other ear are still TEN TIMES more likely to fail a grade than a child with average hearing.  So, just because you have “one good ear,” that doesn’t mean you don’t deserve the attention of hearing, speech, and language professionals.  We have two ears for a reason, and they are BOTH important!  Research has shown that children with unilateral hearing loss SHOULD receive a hearing aid for that ear by 12 months of age, and an FM system, or at least a soundfield, should be used to assist with listening in noise.  However, no evidence exists to show the benefit of CROS hearing aids in children with unilateral loss — a good digital hearing aid on the “bad ear” will do — no need to confuse things by separating the receiver and the mirophone.

AUDITORY TEACHING STRATEGIES AND TECHNIQUES

Joanna Smith, MS, CCC-SLP, LSLS Cert. AVT and Teresa Caraway, Ph.D., CCC-SLP, LSLS Cert. AVT (both from Hearts for Hearing)

Auditory-Verbal Teaching Techniques and Stategies (with cute names to help you remember to incorporate them EVERY DAY!):

  • Be a Birddog: “I hear that!” point out sounds in your environment to your child all day long!

  • Be a Director: direct your child to listen, “set the stage” for listening opportunities (for example, turn on the water and then say, “Listen!  I hear water.  Look!  The faucet is running!”)

  • Play by Play: use familiar phrases to comment on what the child is doing (like a sportscaster or radio commentator)

  • It’s Your Turn: expect a response from the child, and encourage them to respond with pauses, expectant looks, learning in, use the parent or sibling as a model, or use auditory closure (“Mary had a little _______” have the child fill in the blank or finish sentences for you)

  • Keep ‘Em On Their Toes: make life surprising!  sabotage situations (ask them to bring you some milk when there isn’t any in the fridge — this could lead to a GREAT conversation on so many topics, and helps your child develop problem-solving skills), and use others as models of appropriate language input (if you ask a question and your child doesn’t know how to answer, let them see big sister answer correctly, then give them a chance to try again)

  • Make It Easier: give an optimal listening environment for therapy, and if they still don’t get it, move closer, use acoustic highlighting, or move from an open-ended question to one with a few options for the answer (for example, “What is your favorite food” is a lot harder to answer than “Which do you like better, hot dogs or hamburgers?”)

  • Create a Listening Sandwich:  if you simply must give the child an answer, or provide a visual cue, follow this model: say it – show it – say it.

  • Beyond the Here and Now: expand what your child says — take it to the next level to model more advanced language for them (the child says, “two fish,” you say, “I see two blue fish”)

  • Help Me But Don’t Tell Me: give clues to lead the child to the answer, give suggestions, but don’t give them an easy way out by providing the answer all the time!

  • What Did You Hear: ask the child what he heard or understood — that will give you clues as to where the communication breakdown occurred, and help the child reflect on his/her own listening process and the information they received, and maybe come up with the answer on their own.

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