Summary of the Clinical Practice Guideline

Article Citation

American Academy of Audiology Clinical Practice Guidelines: Pediatric Amplification

American Academy of Audiology. (2013).
Reston (VA): American Academy of Audiology, 5-60.
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American Academy of Audiology

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Description

This guideline provides recommendations for the selection, fitting, and verification, and outcomes assessment of amplification for children under the age of 18.

Evidence Ratings for This Document

Levels of evidence are provided and defined as:

  • Level 1: Systematic reviews and meta-analyses of randomized controlled trials
  • Level 2: Randomized controlled trials
  • Level 3: Non-randomized intervention studies
  • Level 4: Descriptive studies (cross-sectional surveys, cohort studies, case-control designs)
  • Level 5: Case studies
  • Level 6: Expert opinion

Recommendations were graded based on strength of evidence and defined as:

  • Grade A: Consistent level 1 or 2 studies
  • Grade B: Consistent level 3 or 4 studies or extrapolations from level 1 or 2 studies
  • Grade C: Level 5 studies or extrapolations from level 3 and 4 studies
  • Grade D: Level 6 evidence or troubling inconsistencies or inconclusive studies at any level

Recommendations from This Guideline

What are Recommendations?

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Treatment

"Children with auditory neuropathy spectrum disorder (ANSD) should have a trial with amplification unless it can be established that the child is responsive to speech sounds at conversational levels without hearing aids. The hearing aid prescription should be altered as further information about hearing thresholds becomes available" (Grade B Evidence; p. 13).

Keywords: Devices, Hearing Aids

Candidates for amplification include:

  • Children with aidable unilateral hearing loss (Grade C Evidence);
  • Children with minimal and mild hearing loss (Grade C Evidence);
  • Children with auditory neuropathy spectrum disorder, if speech at conversational levels is not easily audible due to poor hearing sensitivity (Grade B Evidence).

Keywords: Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Hearing Aids, Hearing Aids, Devices, Devices, Disorders of the Ear, Disorders of the Ear

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Assessment

"Children with profound hearing loss by auditory brainstem response should not be excluded from receiving hearing aids prior to evaluation for a cochlear implant" (Grade D Evidence; p. 13).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Devices, Cochlear Implants, Hearing Aids, Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Devices, Devices

"Estimates of speech audibility using the Speech Intelligibility Index (SII) can be used to evaluate speech audibility for hearing aid fittings once primary verification has been completed through the verification software or computer programs" (Grade B and C Evidence; p. 36).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices, Speech Perception, Speech Perception

"Ongoing audiologic assessment and hearing aid verification are necessary to maintain audibility with the potential for fluctuation or progression of hearing loss, in addition to normal ear canal growth" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Treatment

"Identify prior skin reactions in order to minimize incidence of contact dermatitis with earmold impression and/or earmolds" (Grade B Evidence; p. 23).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Tubing size, occlusion, and receiver placement are individual choices based on patient communication needs, ear canal dimensions, hearing loss severity and configuration, and patient preferences" (p. 18). 

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with permanent conductive hearing loss should be fit with air conduction hearing aids when anatomically possible" (p. 13).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Monitor temporary threshold shift (TTS) if overamplification is suspected" (Grade B Evidence; p. 22).

Keywords: Follow-up, Follow-Up, Hearing Aids, Devices, Hearing Aids, Risk Factors, Hearing Aids, Risk Factors, Follow-up, Risk Factors, Devices, Devices

"Patient/family education and adjustment counseling (social and emotional support) should be provided as part of routine audiologic follow-up to ensure children and their parents and caregivers have the knowledge and assistance necessary to support consistent use of intervention strategies, including but not limited to hearing aid and other technology use [including tools and instructions to ensure proper function] and communication strategies as well as healthy psychosocial development" (Grade C Evidence; p. 46).

Keywords: Follow-up, Follow-Up, Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Compensatory Strategies, Counseling and Education, Devices, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Follow-up, Devices, Aural Habilitation, Devices

"Utilize tamper resistant battery doors to decrease the likelihood of battery ingestion" (p. 22).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Risk Factors, Risk Factors, Devices, Devices

"Resources for financial support and funding to offset the cost of hearing aids should be provided, as concern for the cost of devices is often cited by parents as delaying the initiation of amplification" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with minimal hearing loss should be considered for remote microphone technology to improve signal to noise ratio" (p. 13).

Keywords: Hearing Assistive Technology Systems (HATS), Devices, Hearing Assistive Technology Systems (HATS), Devices

"Each child who receives a cochlear implant in one ear and who has residual hearing in the other ear should be fit with a hearing aid in that ear for providing bilateral stimulation" (Grade B Evidence; p. 48). "Bimodal fitting should be provided even when residual hearing in the non-implanted ear is limited to frequencies below 500 Hz" (Grade B Evidence, p. 48). "The hearing aid should be optimized with the cochlear implant by balancing loudness of sounds between ears" (Grade B Evidence; p. 48).

Keywords: Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Cochlear Implants, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Cochlear Implants, Hearing Aids, Devices, Disorders of the Ear

"Children with profound hearing loss by auditory brainstem response should not be excluded from receiving hearing aids prior to evaluation for a cochlear implant" (Grade D Evidence; p. 13).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Devices, Cochlear Implants, Hearing Aids, Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Devices, Devices

"Outcome assessment should be carried out after introduction of new features in hearing aids ... [because] children’s performance is affected by:

  • variations in gain-frequency response slope of >3 dB/octave (Grade A and B Evidence);
  • directionality of microphones;
  • presence or absence of noise reduction;
  • and applications of frequency compression or transposition in hearing aids" (p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Parental reports provide a reliable and sensitive method for evaluating alternative gain-frequency responses in hearing aids for [infants and young] children" (Grade B Evidence; p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Devices

"In order to validate benefits and/or assist with fine-tuning, every child should receive an outcomes assessment after amplification is provided" (p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Estimates of speech audibility using the Speech Intelligibility Index (SII) can be used to evaluate speech audibility for hearing aid fittings once primary verification has been completed through the verification software or computer programs" (Grade B and C Evidence; p. 36).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices, Speech Perception, Speech Perception

"A standard real speech or a speech-like signal should be used when attempting verification of prescriptive methods for which the targets are based on speech inputs. That is, the preferred hearing aid verification method should include a test signal that produces an output similar to the output for a speech signal of the same input level ... [It may be] necessary to disable features that react differently to speech versus non-speech sounds, and the resulting measurement may then not be indicative of the hearing aid’s performance when the features are re-enabled" (Grade A Evidence; p. 34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The response of the hearing aid should be measured for a variety of input levels to estimate the audibility of speech and ensure that the maximum output does not exceed prescribed levels" (Grade B Evidence; p. 32).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Independent pediatric-focused and pediatric-validated prescriptive targets, normative data, and fitting methods that take into account the unique developmental and auditory needs of children should be used for pediatric hearing aid verification instead of manufacturer’s proprietary prescriptive approaches" (Grade A and B Evidence; p. 32).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The impact of hearing aid signal processing and features such as directional microphones, digital noise reduction, feedback suppression and frequency lowering on audibility should be verified, if these features are determined to be appropriate.... If utilized with children, the impact of these features on audibility of speech should be evaluated during the verification process. If the signal processing strategy includes automatic activation of any features, verification of feature activation should be included" (pp. 33-34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"All verification should be performed after the activation of any modern feedback suppression algorithm as it is a common process for manufacturers to limit accessible gains during the initialization process of the feedback suppression algorithm" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"In cases of bone conduction hearing aids, real-ear probe microphone measures cannot be conducted (when there is no acoustic signal in the ear canal), and the aided audiogram may be the most readily available verification option" (Grade D Evidence; p. 40).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Measurement of aided sound field thresholds should not be used as a method of hearing aid verification" (Grade B Evidence; p. 39).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Real-ear output response measurements with the use of real-ear to coupler difference (RECD) to correct threshold and resulting target data in the child's ear or 2 cc coupler measurements with measured or average RECD should be used for verification" (Grade B Evidence; p. 34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Fine tuning and the accompanying verification and outcome assessment should have the goal of providing the least possible effect (distortion) that allows access to high frequency sound" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Approach venting cautiously in pediatric earmolds because of space limitations" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use pediatric ear hooks to promote retention of BTEs [behind-the-ear style hearing aids]" (p. 20) and "filtered ear hooks to ensure a smooth frequency response" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Several recommendations were provided pertaining to earmold fitting:

  • "Provide a long, but comfortable earmold canal length to reduce the occlusion effect and to provide increased output in the ear canal due to decreased volume between the earmold and eardrum" (p. 20).
  • "Guard against reverse horns created by crimping the end of the sound channel in small earmolds" (p. 20).
  • "Be proactive regarding earmold replacement due to the child's growth" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Bilateral amplification is routinely recommended unless contraindicated" (Grade B Evidence; p. 15). "If the unilateral hearing loss is aidable then a monaural fitting would be considered" (Grade B Evidence; p. 15).

Keywords: Hearing Aids, Hearing Aids, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

Amplitude compression should be employed and the prescription of gain should ensure that a range of input levels are sufficiently compressed to reduce sensitivity to loud sounds and restore speech audibility at low levels. "Compression characteristics should also minimize alteration of speech cues" (p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use a validated, pediatric-focused prescriptive formula and account for the real-ear to coupler difference (RECD) when prescribing gain or output for a child in order to avoid overamplification" (Grade B, C, and D Evidence; p. 22).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with aidable unilateral hearing loss should be considered candidates for amplification due to evidence for potential developmental and academic delays" (Grade C Evidence, p. 13)

Keywords: Hearing Aids, Hearing Aids, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

"On average, digital noise reduction is not expected to negatively impact speech recognition ability in children. The prescription of digital noise reduction should be done with the understanding that different implementations of this technology vary in their electroacoustic behavior and that prioritizing comfort or the acceptance of background noise may negatively impact speech audibility" (Level B Evidence; pp. 26-27).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices

"All children with hearing loss should be considered candidates for FM use. When appropriately prescribed, FM systems will provide improvements in signal-to-noise ratio that are similar or superior to directional microphones" (Grade B Evidence; p. 26).

Keywords: Hearing Assistive Technology Systems (HATS), Devices, Hearing Assistive Technology Systems (HATS), Devices

"Full-time directional processing is not recommended. This feature may be recommended for children, although there are common listening environments in which directional technology is not desirable" (Grade A and C Evidence; p. 26).

"Hearing aids that automatically switch between directional and omnidirectional modes depending on which mode produces the signal with the greater apparent signal-to-noise ratio should be considered" (Grade C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Frequency lowering should not be prescribed until electroacoustic verification has revealed that high-frequency speech audibility cannot be restored through conventional means" (Grade A. B, and C Evidence; p. 26).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices

"Fitting of any frequency lowering algorithm should be accompanied by behavioral validation" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"There is evidence to suggest that frequency lowering may improve detection and recognition of high-frequency consonants for children with high-frequency hearing loss ranging from moderate to profound" (Grade B and C Evidence; p. 26).

"There are also data that suggest acclimatization to frequency lowered amplification may increase both acceptance of and performance with a given frequency lowering technique" (Grade B and C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Extended high-frequency bandwidth (up to 9000 Hz) will improve audibility for sounds such as /s/ that represent an essential cue for the recognition of plural or possessive statements in the English language" (Grade B Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The prescription of expansion in children should be done with the understanding that prioritizing comfort in quiet environments may have a negative effect on audibility of low level speech inputs" (Grade B and C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Compression limiting will provide superior sound quality as compared to hearing aids that limit maximum output through peak clipping" (Grade C Evidence; p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Amplitude compression should be employed and the prescription of gain should ensure that a range of input levels are sufficiently compressed to reduce sensitivity to loud sounds and restore speech audibility at low levels (Grades B and C Evidence).

"Selection of compression characteristics should also minimize alteration of speech cues. The generation of pediatric-focused target gains should be done with an independent prescriptive procedure" (Grades A and C Evidence; p. 25). 

"Multi-channel compression should be selected for the management of frequency specific audibility" (Grade C Evidence; p 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"De-activate or lock volume controls, or utilize wide dynamic range compression thereby eliminating the need for volume control manipulation for audibility and comfort" (p. 22).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use automatic feedback suppression in order to resolve feedback issues, either temporarily while awaiting new earmolds or permanently if needed to achieve the prescribed gains. Use feedback cancellation (which does not reduce the gain below the value that applies in the absence of feedback oscillation) in preference to feedback management systems that operate by reducing gain in one or more frequency regions, at one or more input levels, until feedback oscillation ceases" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Behind-the-ear hearing aids (BTEs) are the style of choice while the child’s ear is still growing" (p.18) and "may provide appropriate coupling to a variety of assistive listening devices that may assist in educational and social settings" (p.18).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Candidacy for bone conducted devices may include children with unilateral hearing losses (Level B Evidence) or children with permanent conductive hearing losses (Level C Evidence) only if anatomy is insufficient for coupling with air conduction hearing aids.

Keywords: Hearing Aids, Other Implants (e.g. ABI/Osseointegrated), Hearing Aids, Other Implants (ABI/Middle Ear/Osseointegrated), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Osseointegrated Implants, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

Candidates for amplification include:

  • Children with aidable unilateral hearing loss (Grade C Evidence);
  • Children with minimal and mild hearing loss (Grade C Evidence);
  • Children with auditory neuropathy spectrum disorder, if speech at conversational levels is not easily audible due to poor hearing sensitivity (Grade B Evidence).

Keywords: Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Hearing Aids, Hearing Aids, Devices, Devices, Disorders of the Ear, Disorders of the Ear

"A minimum of four to seven software adjustment bands (i.e., handles) should be selected for the digitally programmed hearing aid (Grade C Evidence) ... There should not be a disadvantage to increasing the number of bands beyond seven. The system also should allow sufficient flexibility to accommodate the child’s growth, any progression or fluctuation in hearing thresholds, and any related changes to frequency shaping" (p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Ongoing audiologic assessment and hearing aid verification are necessary to maintain audibility with the potential for fluctuation or progression of hearing loss, in addition to normal ear canal growth" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Service Delivery

"Monitor temporary threshold shift (TTS) if overamplification is suspected" (Grade B Evidence; p. 22).

Keywords: Follow-up, Follow-Up, Hearing Aids, Devices, Hearing Aids, Risk Factors, Hearing Aids, Risk Factors, Follow-up, Risk Factors, Devices, Devices

"Referral to otolaryngology, ophthalmology and medical genetics should be provided for all children who are hard of hearing" (Grade D Evidence; p. 46).

Keywords: Provider, Provider, Referral, Referral, Provider, Referral

"Parent-to-parent support should be offered to families and caregivers of children with hearing loss" (Grade C Evidence; p. 46).

Keywords: Group Treatment, Group Treatment, Group Treatment

"Patient/family education and adjustment counseling (social and emotional support) should be provided as part of routine audiologic follow-up to ensure children and their parents and caregivers have the knowledge and assistance necessary to support consistent use of intervention strategies, including but not limited to hearing aid and other technology use [including tools and instructions to ensure proper function] and communication strategies as well as healthy psychosocial development" (Grade C Evidence; p. 46).

Keywords: Follow-up, Follow-Up, Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Compensatory Strategies, Counseling and Education, Devices, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Follow-up, Devices, Aural Habilitation, Devices

"Referral for early intervention and educational services should occur in a timely manner in compliance with local, state and federal regulations" (Grade D Evidence; p. 46).

Keywords: Educational/IEP Considerations, Early Intervention Program, Referral, Referral, Early Intervention Program, Referral

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Assessment

"Children with profound hearing loss by auditory brainstem response should not be excluded from receiving hearing aids prior to evaluation for a cochlear implant" (Grade D Evidence; p. 13).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Devices, Cochlear Implants, Hearing Aids, Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Devices, Devices

"Ongoing audiologic assessment and hearing aid verification are necessary to maintain audibility with the potential for fluctuation or progression of hearing loss, in addition to normal ear canal growth" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Treatment

"Identify prior skin reactions in order to minimize incidence of contact dermatitis with earmold impression and/or earmolds" (Grade B Evidence; p. 23).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Tubing size, occlusion, and receiver placement are individual choices based on patient communication needs, ear canal dimensions, hearing loss severity and configuration, and patient preferences" (p. 18). 

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with permanent conductive hearing loss should be fit with air conduction hearing aids when anatomically possible" (p. 13).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Monitor temporary threshold shift (TTS) if overamplification is suspected" (Grade B Evidence; p. 22).

Keywords: Follow-up, Follow-Up, Hearing Aids, Devices, Hearing Aids, Risk Factors, Hearing Aids, Risk Factors, Follow-up, Risk Factors, Devices, Devices

"Patient/family education and adjustment counseling (social and emotional support) should be provided as part of routine audiologic follow-up to ensure children and their parents and caregivers have the knowledge and assistance necessary to support consistent use of intervention strategies, including but not limited to hearing aid and other technology use [including tools and instructions to ensure proper function] and communication strategies as well as healthy psychosocial development" (Grade C Evidence; p. 46).

Keywords: Follow-up, Follow-Up, Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Compensatory Strategies, Counseling and Education, Devices, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Follow-up, Devices, Aural Habilitation, Devices

"Utilize tamper resistant battery doors to decrease the likelihood of battery ingestion" (p. 22).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Risk Factors, Risk Factors, Devices, Devices

"For infants, the only way to fully eliminate feedback may be to use an offsite/remote microphone. Caution must be used when considering this as a full time option because the child may not hear his/her own babbling/speech sounds if the microphone is not near the child’s mouth" (p. 20).

Keywords: Hearing Aids, Devices

"Resources for financial support and funding to offset the cost of hearing aids should be provided, as concern for the cost of devices is often cited by parents as delaying the initiation of amplification" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with profound hearing loss by auditory brainstem response should not be excluded from receiving hearing aids prior to evaluation for a cochlear implant" (Grade D Evidence; p. 13).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Devices, Cochlear Implants, Hearing Aids, Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Devices, Devices

"Outcome assessment should be carried out after introduction of new features in hearing aids ... [because] children’s performance is affected by:

  • variations in gain-frequency response slope of >3 dB/octave (Grade A and B Evidence);
  • directionality of microphones;
  • presence or absence of noise reduction;
  • and applications of frequency compression or transposition in hearing aids" (p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Parental reports provide a reliable and sensitive method for evaluating alternative gain-frequency responses in hearing aids for [infants and young] children" (Grade B Evidence; p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Devices

"In order to validate benefits and/or assist with fine-tuning, every child should receive an outcomes assessment after amplification is provided" (p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"A standard real speech or a speech-like signal should be used when attempting verification of prescriptive methods for which the targets are based on speech inputs. That is, the preferred hearing aid verification method should include a test signal that produces an output similar to the output for a speech signal of the same input level ... [It may be] necessary to disable features that react differently to speech versus non-speech sounds, and the resulting measurement may then not be indicative of the hearing aid’s performance when the features are re-enabled" (Grade A Evidence; p. 34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The response of the hearing aid should be measured for a variety of input levels to estimate the audibility of speech and ensure that the maximum output does not exceed prescribed levels" (Grade B Evidence; p. 32).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Independent pediatric-focused and pediatric-validated prescriptive targets, normative data, and fitting methods that take into account the unique developmental and auditory needs of children should be used for pediatric hearing aid verification instead of manufacturer’s proprietary prescriptive approaches" (Grade A and B Evidence; p. 32).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The impact of hearing aid signal processing and features such as directional microphones, digital noise reduction, feedback suppression and frequency lowering on audibility should be verified, if these features are determined to be appropriate.... If utilized with children, the impact of these features on audibility of speech should be evaluated during the verification process. If the signal processing strategy includes automatic activation of any features, verification of feature activation should be included" (pp. 33-34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"All verification should be performed after the activation of any modern feedback suppression algorithm as it is a common process for manufacturers to limit accessible gains during the initialization process of the feedback suppression algorithm" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"In cases of bone conduction hearing aids, real-ear probe microphone measures cannot be conducted (when there is no acoustic signal in the ear canal), and the aided audiogram may be the most readily available verification option" (Grade D Evidence; p. 40).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Measurement of aided sound field thresholds should not be used as a method of hearing aid verification" (Grade B Evidence; p. 39).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Real-ear output response measurements with the use of real-ear to coupler difference (RECD) to correct threshold and resulting target data in the child's ear or 2 cc coupler measurements with measured or average RECD should be used for verification" (Grade B Evidence; p. 34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Fine tuning and the accompanying verification and outcome assessment should have the goal of providing the least possible effect (distortion) that allows access to high frequency sound" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Approach venting cautiously in pediatric earmolds because of space limitations" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use pediatric ear hooks to promote retention of BTEs [behind-the-ear style hearing aids]" (p. 20) and "filtered ear hooks to ensure a smooth frequency response" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Several recommendations were provided pertaining to earmold fitting:

  • "Provide a long, but comfortable earmold canal length to reduce the occlusion effect and to provide increased output in the ear canal due to decreased volume between the earmold and eardrum" (p. 20).
  • "Guard against reverse horns created by crimping the end of the sound channel in small earmolds" (p. 20).
  • "Be proactive regarding earmold replacement due to the child's growth" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Bilateral amplification is routinely recommended unless contraindicated" (Grade B Evidence; p. 15). "If the unilateral hearing loss is aidable then a monaural fitting would be considered" (Grade B Evidence; p. 15).

Keywords: Hearing Aids, Hearing Aids, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

Amplitude compression should be employed and the prescription of gain should ensure that a range of input levels are sufficiently compressed to reduce sensitivity to loud sounds and restore speech audibility at low levels. "Compression characteristics should also minimize alteration of speech cues" (p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use a validated, pediatric-focused prescriptive formula and account for the real-ear to coupler difference (RECD) when prescribing gain or output for a child in order to avoid overamplification" (Grade B, C, and D Evidence; p. 22).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with aidable unilateral hearing loss should be considered candidates for amplification due to evidence for potential developmental and academic delays" (Grade C Evidence, p. 13)

Keywords: Hearing Aids, Hearing Aids, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

"Full-time directional processing is not recommended. This feature may be recommended for children, although there are common listening environments in which directional technology is not desirable" (Grade A and C Evidence; p. 26).

"Hearing aids that automatically switch between directional and omnidirectional modes depending on which mode produces the signal with the greater apparent signal-to-noise ratio should be considered" (Grade C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Fitting of any frequency lowering algorithm should be accompanied by behavioral validation" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"There is evidence to suggest that frequency lowering may improve detection and recognition of high-frequency consonants for children with high-frequency hearing loss ranging from moderate to profound" (Grade B and C Evidence; p. 26).

"There are also data that suggest acclimatization to frequency lowered amplification may increase both acceptance of and performance with a given frequency lowering technique" (Grade B and C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Extended high-frequency bandwidth (up to 9000 Hz) will improve audibility for sounds such as /s/ that represent an essential cue for the recognition of plural or possessive statements in the English language" (Grade B Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The prescription of expansion in children should be done with the understanding that prioritizing comfort in quiet environments may have a negative effect on audibility of low level speech inputs" (Grade B and C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Compression limiting will provide superior sound quality as compared to hearing aids that limit maximum output through peak clipping" (Grade C Evidence; p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Amplitude compression should be employed and the prescription of gain should ensure that a range of input levels are sufficiently compressed to reduce sensitivity to loud sounds and restore speech audibility at low levels (Grades B and C Evidence).

"Selection of compression characteristics should also minimize alteration of speech cues. The generation of pediatric-focused target gains should be done with an independent prescriptive procedure" (Grades A and C Evidence; p. 25). 

"Multi-channel compression should be selected for the management of frequency specific audibility" (Grade C Evidence; p 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"De-activate or lock volume controls, or utilize wide dynamic range compression thereby eliminating the need for volume control manipulation for audibility and comfort" (p. 22).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use automatic feedback suppression in order to resolve feedback issues, either temporarily while awaiting new earmolds or permanently if needed to achieve the prescribed gains. Use feedback cancellation (which does not reduce the gain below the value that applies in the absence of feedback oscillation) in preference to feedback management systems that operate by reducing gain in one or more frequency regions, at one or more input levels, until feedback oscillation ceases" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Behind-the-ear hearing aids (BTEs) are the style of choice while the child’s ear is still growing" (p.18) and "may provide appropriate coupling to a variety of assistive listening devices that may assist in educational and social settings" (p.18).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Candidacy for bone conducted devices may include children with unilateral hearing losses (Level B Evidence) or children with permanent conductive hearing losses (Level C Evidence) only if anatomy is insufficient for coupling with air conduction hearing aids.

Keywords: Hearing Aids, Other Implants (e.g. ABI/Osseointegrated), Hearing Aids, Other Implants (ABI/Middle Ear/Osseointegrated), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Osseointegrated Implants, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

Candidates for amplification include:

  • Children with aidable unilateral hearing loss (Grade C Evidence);
  • Children with minimal and mild hearing loss (Grade C Evidence);
  • Children with auditory neuropathy spectrum disorder, if speech at conversational levels is not easily audible due to poor hearing sensitivity (Grade B Evidence).

Keywords: Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Hearing Aids, Hearing Aids, Devices, Devices, Disorders of the Ear, Disorders of the Ear

"A minimum of four to seven software adjustment bands (i.e., handles) should be selected for the digitally programmed hearing aid (Grade C Evidence) ... There should not be a disadvantage to increasing the number of bands beyond seven. The system also should allow sufficient flexibility to accommodate the child’s growth, any progression or fluctuation in hearing thresholds, and any related changes to frequency shaping" (p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Ongoing audiologic assessment and hearing aid verification are necessary to maintain audibility with the potential for fluctuation or progression of hearing loss, in addition to normal ear canal growth" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Service Delivery

"Monitor temporary threshold shift (TTS) if overamplification is suspected" (Grade B Evidence; p. 22).

Keywords: Follow-up, Follow-Up, Hearing Aids, Devices, Hearing Aids, Risk Factors, Hearing Aids, Risk Factors, Follow-up, Risk Factors, Devices, Devices

"Referral to otolaryngology, ophthalmology and medical genetics should be provided for all children who are hard of hearing" (Grade D Evidence; p. 46).

Keywords: Provider, Provider, Referral, Referral, Provider, Referral

"Parent-to-parent support should be offered to families and caregivers of children with hearing loss" (Grade C Evidence; p. 46).

Keywords: Group Treatment, Group Treatment, Group Treatment

"Patient/family education and adjustment counseling (social and emotional support) should be provided as part of routine audiologic follow-up to ensure children and their parents and caregivers have the knowledge and assistance necessary to support consistent use of intervention strategies, including but not limited to hearing aid and other technology use [including tools and instructions to ensure proper function] and communication strategies as well as healthy psychosocial development" (Grade C Evidence; p. 46).

Keywords: Follow-up, Follow-Up, Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Compensatory Strategies, Counseling and Education, Devices, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Follow-up, Devices, Aural Habilitation, Devices

"Referral for early intervention and educational services should occur in a timely manner in compliance with local, state and federal regulations" (Grade D Evidence; p. 46).

Keywords: Educational/IEP Considerations, Early Intervention Program, Referral, Referral, Early Intervention Program, Referral

Go to Map

Assessment

"Children with profound hearing loss by auditory brainstem response should not be excluded from receiving hearing aids prior to evaluation for a cochlear implant" (Grade D Evidence; p. 13).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Devices, Cochlear Implants, Hearing Aids, Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Devices, Devices

"Estimates of speech audibility using the Speech Intelligibility Index (SII) can be used to evaluate speech audibility for hearing aid fittings once primary verification has been completed through the verification software or computer programs" (Grade B and C Evidence; p. 36).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices, Speech Perception, Speech Perception

"Self-reports are sensitive to differences in hearing aid gains for school-aged children" (Grade A and B Evidence, p. 42).

Keywords: Devices, Hearing Aids, Questionnaires (Caregiver/Self-report)

"Ongoing audiologic assessment and hearing aid verification are necessary to maintain audibility with the potential for fluctuation or progression of hearing loss, in addition to normal ear canal growth" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Treatment

"Identify prior skin reactions in order to minimize incidence of contact dermatitis with earmold impression and/or earmolds" (Grade B Evidence; p. 23).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Tubing size, occlusion, and receiver placement are individual choices based on patient communication needs, ear canal dimensions, hearing loss severity and configuration, and patient preferences" (p. 18). 

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with permanent conductive hearing loss should be fit with air conduction hearing aids when anatomically possible" (p. 13).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Monitor temporary threshold shift (TTS) if overamplification is suspected" (Grade B Evidence; p. 22).

Keywords: Follow-up, Follow-Up, Hearing Aids, Devices, Hearing Aids, Risk Factors, Hearing Aids, Risk Factors, Follow-up, Risk Factors, Devices, Devices

"Patient/family education and adjustment counseling (social and emotional support) should be provided as part of routine audiologic follow-up to ensure children and their parents and caregivers have the knowledge and assistance necessary to support consistent use of intervention strategies, including but not limited to hearing aid and other technology use [including tools and instructions to ensure proper function] and communication strategies as well as healthy psychosocial development" (Grade C Evidence; p. 46).

Keywords: Follow-up, Follow-Up, Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Compensatory Strategies, Counseling and Education, Devices, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Follow-up, Devices, Aural Habilitation, Devices

"Resources for financial support and funding to offset the cost of hearing aids should be provided, as concern for the cost of devices is often cited by parents as delaying the initiation of amplification" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with minimal hearing loss should be considered for remote microphone technology to improve signal to noise ratio" (p. 13).

Keywords: Hearing Assistive Technology Systems (HATS), Devices, Hearing Assistive Technology Systems (HATS), Devices

"Each child who receives a cochlear implant in one ear and who has residual hearing in the other ear should be fit with a hearing aid in that ear for providing bilateral stimulation" (Grade B Evidence; p. 48). "Bimodal fitting should be provided even when residual hearing in the non-implanted ear is limited to frequencies below 500 Hz" (Grade B Evidence, p. 48). "The hearing aid should be optimized with the cochlear implant by balancing loudness of sounds between ears" (Grade B Evidence; p. 48).

Keywords: Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Cochlear Implants, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Cochlear Implants, Hearing Aids, Devices, Disorders of the Ear

"Children with profound hearing loss by auditory brainstem response should not be excluded from receiving hearing aids prior to evaluation for a cochlear implant" (Grade D Evidence; p. 13).

Keywords: Cochlear Implants, Hearing Aids, Cochlear Implants, Hearing Aids, Devices, Cochlear Implants, Hearing Aids, Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Auditory Brainstem Response (ABR), Devices, Devices

"Outcome assessment should be carried out after introduction of new features in hearing aids ... [because] children’s performance is affected by:

  • variations in gain-frequency response slope of >3 dB/octave (Grade A and B Evidence);
  • directionality of microphones;
  • presence or absence of noise reduction;
  • and applications of frequency compression or transposition in hearing aids" (p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"In order to validate benefits and/or assist with fine-tuning, every child should receive an outcomes assessment after amplification is provided" (p. 41).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"For children older than about 6 years of age, paired-comparisons judgments may be used reliably to identify the optimal frequency response among a small set of alternatives. This assessment method may be more sensitive than speech perception testing, and is useful in identifying the way in which gain-frequency responses may be modified to meet individual needs" (Grade A and B Evidence; p. 41).

Keywords: Devices, Hearing Aids

"Estimates of speech audibility using the Speech Intelligibility Index (SII) can be used to evaluate speech audibility for hearing aid fittings once primary verification has been completed through the verification software or computer programs" (Grade B and C Evidence; p. 36).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices, Speech Perception, Speech Perception

"A standard real speech or a speech-like signal should be used when attempting verification of prescriptive methods for which the targets are based on speech inputs. That is, the preferred hearing aid verification method should include a test signal that produces an output similar to the output for a speech signal of the same input level ... [It may be] necessary to disable features that react differently to speech versus non-speech sounds, and the resulting measurement may then not be indicative of the hearing aid’s performance when the features are re-enabled" (Grade A Evidence; p. 34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The response of the hearing aid should be measured for a variety of input levels to estimate the audibility of speech and ensure that the maximum output does not exceed prescribed levels" (Grade B Evidence; p. 32).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Independent pediatric-focused and pediatric-validated prescriptive targets, normative data, and fitting methods that take into account the unique developmental and auditory needs of children should be used for pediatric hearing aid verification instead of manufacturer’s proprietary prescriptive approaches" (Grade A and B Evidence; p. 32).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The impact of hearing aid signal processing and features such as directional microphones, digital noise reduction, feedback suppression and frequency lowering on audibility should be verified, if these features are determined to be appropriate.... If utilized with children, the impact of these features on audibility of speech should be evaluated during the verification process. If the signal processing strategy includes automatic activation of any features, verification of feature activation should be included" (pp. 33-34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"All verification should be performed after the activation of any modern feedback suppression algorithm as it is a common process for manufacturers to limit accessible gains during the initialization process of the feedback suppression algorithm" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"In cases of bone conduction hearing aids, real-ear probe microphone measures cannot be conducted (when there is no acoustic signal in the ear canal), and the aided audiogram may be the most readily available verification option" (Grade D Evidence; p. 40).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Measurement of aided sound field thresholds should not be used as a method of hearing aid verification" (Grade B Evidence; p. 39).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Real-ear output response measurements with the use of real-ear to coupler difference (RECD) to correct threshold and resulting target data in the child's ear or 2 cc coupler measurements with measured or average RECD should be used for verification" (Grade B Evidence; p. 34).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Fine tuning and the accompanying verification and outcome assessment should have the goal of providing the least possible effect (distortion) that allows access to high frequency sound" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Approach venting cautiously in pediatric earmolds because of space limitations" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use pediatric ear hooks to promote retention of BTEs [behind-the-ear style hearing aids]" (p. 20) and "filtered ear hooks to ensure a smooth frequency response" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Several recommendations were provided pertaining to earmold fitting:

  • "Provide a long, but comfortable earmold canal length to reduce the occlusion effect and to provide increased output in the ear canal due to decreased volume between the earmold and eardrum" (p. 20).
  • "Guard against reverse horns created by crimping the end of the sound channel in small earmolds" (p. 20).
  • "Be proactive regarding earmold replacement due to the child's growth" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Bilateral amplification is routinely recommended unless contraindicated" (Grade B Evidence; p. 15). "If the unilateral hearing loss is aidable then a monaural fitting would be considered" (Grade B Evidence; p. 15).

Keywords: Hearing Aids, Hearing Aids, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

Amplitude compression should be employed and the prescription of gain should ensure that a range of input levels are sufficiently compressed to reduce sensitivity to loud sounds and restore speech audibility at low levels. "Compression characteristics should also minimize alteration of speech cues" (p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use a validated, pediatric-focused prescriptive formula and account for the real-ear to coupler difference (RECD) when prescribing gain or output for a child in order to avoid overamplification" (Grade B, C, and D Evidence; p. 22).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Children with aidable unilateral hearing loss should be considered candidates for amplification due to evidence for potential developmental and academic delays" (Grade C Evidence, p. 13)

Keywords: Hearing Aids, Hearing Aids, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

"On average, digital noise reduction is not expected to negatively impact speech recognition ability in children. The prescription of digital noise reduction should be done with the understanding that different implementations of this technology vary in their electroacoustic behavior and that prioritizing comfort or the acceptance of background noise may negatively impact speech audibility" (Level B Evidence; pp. 26-27).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices

"All children with hearing loss should be considered candidates for FM use. When appropriately prescribed, FM systems will provide improvements in signal-to-noise ratio that are similar or superior to directional microphones" (Grade B Evidence; p. 26).

Keywords: Hearing Assistive Technology Systems (HATS), Devices, Hearing Assistive Technology Systems (HATS), Devices

"Full-time directional processing is not recommended. This feature may be recommended for children, although there are common listening environments in which directional technology is not desirable" (Grade A and C Evidence; p. 26).

"Hearing aids that automatically switch between directional and omnidirectional modes depending on which mode produces the signal with the greater apparent signal-to-noise ratio should be considered" (Grade C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Frequency lowering should not be prescribed until electroacoustic verification has revealed that high-frequency speech audibility cannot be restored through conventional means" (Grade A. B, and C Evidence; p. 26).

Keywords: Hearing Aids, Devices, Hearing Aids, Devices

"Fitting of any frequency lowering algorithm should be accompanied by behavioral validation" (p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"There is evidence to suggest that frequency lowering may improve detection and recognition of high-frequency consonants for children with high-frequency hearing loss ranging from moderate to profound" (Grade B and C Evidence; p. 26).

"There are also data that suggest acclimatization to frequency lowered amplification may increase both acceptance of and performance with a given frequency lowering technique" (Grade B and C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Extended high-frequency bandwidth (up to 9000 Hz) will improve audibility for sounds such as /s/ that represent an essential cue for the recognition of plural or possessive statements in the English language" (Grade B Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"The prescription of expansion in children should be done with the understanding that prioritizing comfort in quiet environments may have a negative effect on audibility of low level speech inputs" (Grade B and C Evidence; p. 26).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Compression limiting will provide superior sound quality as compared to hearing aids that limit maximum output through peak clipping" (Grade C Evidence; p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Amplitude compression should be employed and the prescription of gain should ensure that a range of input levels are sufficiently compressed to reduce sensitivity to loud sounds and restore speech audibility at low levels (Grades B and C Evidence).

"Selection of compression characteristics should also minimize alteration of speech cues. The generation of pediatric-focused target gains should be done with an independent prescriptive procedure" (Grades A and C Evidence; p. 25). 

"Multi-channel compression should be selected for the management of frequency specific audibility" (Grade C Evidence; p 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"De-activate or lock volume controls, or utilize wide dynamic range compression thereby eliminating the need for volume control manipulation for audibility and comfort" (p. 22).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Use automatic feedback suppression in order to resolve feedback issues, either temporarily while awaiting new earmolds or permanently if needed to achieve the prescribed gains. Use feedback cancellation (which does not reduce the gain below the value that applies in the absence of feedback oscillation) in preference to feedback management systems that operate by reducing gain in one or more frequency regions, at one or more input levels, until feedback oscillation ceases" (p. 20).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Behind-the-ear hearing aids (BTEs) are the style of choice while the child’s ear is still growing" (p.18) and "may provide appropriate coupling to a variety of assistive listening devices that may assist in educational and social settings" (p.18).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Candidacy for bone conducted devices may include children with unilateral hearing losses (Level B Evidence) or children with permanent conductive hearing losses (Level C Evidence) only if anatomy is insufficient for coupling with air conduction hearing aids.

Keywords: Hearing Aids, Other Implants (e.g. ABI/Osseointegrated), Hearing Aids, Other Implants (ABI/Middle Ear/Osseointegrated), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Osseointegrated Implants, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Devices, Disorders of the Ear, Disorders of the Ear

Contralateral Routing of Signal (CROS) may be considered for children with severe or profound unilateral hearing losses, depending on the child’s age and ability to control their environment (Grade C Evidence); however, "an FM system with a wireless remote microphone receiver coupled to the open, good ear may be preferable to a CROS configuration in classroom situations" (Grade B Evidence; p. 16).

Keywords: Devices, Hearing Aids, Hearing Assistive Technology Systems (HATS)

Candidates for amplification include:

  • Children with aidable unilateral hearing loss (Grade C Evidence);
  • Children with minimal and mild hearing loss (Grade C Evidence);
  • Children with auditory neuropathy spectrum disorder, if speech at conversational levels is not easily audible due to poor hearing sensitivity (Grade B Evidence).

Keywords: Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Disorders of the Ear, Unilateral Hearing Loss/Single-Sided Deafness (SSD), Unilateral Hearing Loss/Single-Sided Deafness (SSD), Devices, Hearing Aids, Hearing Aids, Hearing Aids, Devices, Devices, Disorders of the Ear, Disorders of the Ear

"Self-reports are sensitive to differences in hearing aid gains for school-aged children" (Grade A and B Evidence, p. 42).

Keywords: Devices, Hearing Aids, Questionnaires (Caregiver/Self-report)

"A minimum of four to seven software adjustment bands (i.e., handles) should be selected for the digitally programmed hearing aid (Grade C Evidence) ... There should not be a disadvantage to increasing the number of bands beyond seven. The system also should allow sufficient flexibility to accommodate the child’s growth, any progression or fluctuation in hearing thresholds, and any related changes to frequency shaping" (p. 25).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

"Ongoing audiologic assessment and hearing aid verification are necessary to maintain audibility with the potential for fluctuation or progression of hearing loss, in addition to normal ear canal growth" (Grade C Evidence; p. 46).

Keywords: Hearing Aids, Hearing Aids, Devices, Hearing Aids, Devices, Devices

Service Delivery

"Monitor temporary threshold shift (TTS) if overamplification is suspected" (Grade B Evidence; p. 22).

Keywords: Follow-up, Follow-Up, Hearing Aids, Devices, Hearing Aids, Risk Factors, Hearing Aids, Risk Factors, Follow-up, Risk Factors, Devices, Devices

"Referral to otolaryngology, ophthalmology and medical genetics should be provided for all children who are hard of hearing" (Grade D Evidence; p. 46).

Keywords: Provider, Provider, Referral, Referral, Provider, Referral

"Parent-to-parent support should be offered to families and caregivers of children with hearing loss" (Grade C Evidence; p. 46).

Keywords: Group Treatment, Group Treatment, Group Treatment

"Patient/family education and adjustment counseling (social and emotional support) should be provided as part of routine audiologic follow-up to ensure children and their parents and caregivers have the knowledge and assistance necessary to support consistent use of intervention strategies, including but not limited to hearing aid and other technology use [including tools and instructions to ensure proper function] and communication strategies as well as healthy psychosocial development" (Grade C Evidence; p. 46).

Keywords: Follow-up, Follow-Up, Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Compensatory Strategies, Counseling and Education, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Compensatory Strategies, Counseling and Education, Devices, Hearing Aids, Hearing Assistive Technology Systems (HATS), Aural Habilitation/Rehabilitation, Follow-up, Devices, Aural Habilitation, Devices

"Referral for early intervention and educational services should occur in a timely manner in compliance with local, state and federal regulations" (Grade D Evidence; p. 46).

Keywords: Educational/IEP Considerations, Early Intervention Program, Referral, Referral, Early Intervention Program, Referral

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