1Department of Audiology, Boys Town National Research Hospital, Omaha, Nebraska, USA; 2Department of Speech Pathology & Audiology, University of Iowa, Iowa City, Iowa, USA; and 3Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Ear Hear. 2013 Nov-Dec;34(6):701-10. doi: 10.1097/AUD.0b013e31828f1033.
Hearing aids (HAs) provide the basis for improving audibility and minimizing developmental delays in children with mild to severe hearing loss. Multiple guidelines exist to recommend methods for optimizing amplification in children, but few previous studies have reported HA fitting outcomes for a large group of children. The present study sought to evaluate the proximity of the fitting to prescriptive targets and aided audibility of speech, as well as survey data from pediatric audiologists who provided HAs for the children in the present study. Deviations from prescriptive target were predicted to have a negative impact on aided audibility. In addition, children who were fitted using verification with probe microphone measurements were expected to have smaller deviations from prescriptive targets and greater audibility than cohorts fitted without these measures.
HA fitting data from 195 children with mild to severe hearing losses were analyzed as part of a multicenter study evaluating outcomes in children with hearing loss. Proximity of fitting to prescriptive targets was quantified by calculating the average root-mean-square (RMS) error of the fitting compared with Desired Sensation Level prescriptive targets for 500, 1000, 2000, and 4000 Hz. Aided audibility was quantified using the Speech Intelligibility Index. Survey data from the pediatric audiologists who fit amplification for children in the present study were collected to evaluate trends in fitting practices and relate those patterns to proximity of the fitting to prescriptive targets and aided audibility.
More than half (55%) of the children in the study had at least 1 ear that deviated from prescriptive targets by more than 5 dB RMS on average. Deviation from prescriptive target was not predicted by pure-tone average, assessment method, or reliability of assessment. Study location was a significant predictor of proximity to prescriptive target with locations that recruited participants who were fit at multiple clinical locations (University of Iowa and Boys Town National Research Hospital) having larger deviations from target than the location where the participants were recruited primarily from a single, large pediatric audiology clinic (University of North Carolina). Fittings based on average real-ear to coupler differences resulted in larger deviations from prescriptive targets than fittings based on individually measured real-ear to coupler differences. Approximately 26% of the children in the study has aided audibility less than 0.65 on the Speech Intelligibility Index (SII). Aided audibility was significantly predicted by the proximity to prescriptive targets and pure-tone average, but not age in months.
Children in the study had a wide range of fitting outcomes in terms of proximity to prescriptive targets (RMS error) and aided speech audibility (SII). Even when recommended HA verification strategies were reported, fittings often exceeded the criteria for both proximity to the prescriptive target and aided audibility. The implications for optimizing amplification for children are also discussed.
助听设备（HA）为改善轻度至重度听力损失儿童的可听度和最小化发育延迟提供了基础。有多个指南建议优化儿童放大的方法，但以前的研究很少报告大量儿童的 HA 适配结果。本研究旨在评估适配与处方目标的接近程度以及言语的助听可听度，并调查为研究中的儿童提供 HA 的儿科听力学家的数据。预计与处方目标的偏差会对助听可听度产生负面影响。此外，预计使用探头麦克风测量进行验证适配的儿童与没有这些措施的儿童相比，与处方目标的偏差更小，助听可听度更高。
作为评估听力损失儿童结局的多中心研究的一部分，分析了 195 名轻度至重度听力损失儿童的 HA 适配数据。通过计算与 500、1000、2000 和 4000 Hz 的所需感觉水平处方目标相比的适配 RMS 误差的平均值，来量化适配与处方目标的接近程度。使用言语可懂度指数来量化助听可听度。收集为本研究中儿童进行放大适配的儿科听力学家的调查数据，以评估适配实践的趋势，并将这些模式与适配与处方目标的接近程度和助听可听度联系起来。
研究中超过一半（55%）的儿童至少有一只耳朵的平均 RMS 误差超过处方目标 5dB。与纯音平均值、评估方法或评估可靠性相比，与处方目标的偏差并非预测因素。研究地点是接近处方目标的重要预测因素，在那些招募在多个临床地点进行适配的参与者的地点（爱荷华大学和博爱城国家研究医院），与主要从一个大型儿科听力诊所招募参与者的地点（北卡罗来纳大学）相比，偏离目标的程度更大。基于平均真耳-耦合器差异的适配导致与处方目标的偏差大于基于个体测量的真耳-耦合器差异的适配。研究中约有 26%的儿童言语可懂度指数（SII）的助听可听度小于 0.65。助听可听度与接近处方目标和纯音平均值显著相关，但与月龄无关。
本研究中，儿童在接近处方目标（RMS 误差）和言语助听可听度（SII）方面的适配结果差异较大。即使报告了推荐的 HA 验证策略，适配通常也超过了接近处方目标和助听可听度的标准。还讨论了为儿童优化放大的意义。
