Paediatric amplification protocol, based on individualization of the hearing aids’ fitting parameters

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Abstract

Background. There are no paediatric amplification clinical practice guidelines in Russia at the moment. At the same time the technological progress of hearing aids’ (HA), new algorithms and functions requires the objective evidence of safety and effectiveness for the hearing impaired children. For these reasons paediatric amplification algorithm was developed by the authors. Besides the standard procedures the algorithm includes an objective electroacoustic verification of the output parameters and separate HA functions. The research is devoted to the investigation of the protocol’s advantages.

Aim — development and evaluation the paediatric amplification protocol, based on objective electroacoustic verification of the output and functions of hearing aid.

Materials and Methods. Prospective, randomized, controlled clinical trial was performed. Two protocols’ effectiveness were compared. Standard protocol (control group) is based on the subjective verification. Experimental protocol suggests an electroacoustic verification of the output and different HA functions: feedback cancellation, amplitude and frequency compression, microphone directionality, digital noise reduction (experimental group). Each group included 56 children (3–17 years old) with permanent hearing loss from moderate to moderately-severe degree. Initial amplification was performed for each child; the results were estimated in 1, 3 and 6 months using PEACH and LIFE questionnaires, speech audiometry and phoneme testing. DataLogging and first fitting appointment time were also estimated.

Results. In preschool-age children of the experimental group post-amplification PEACH results were 6% better than in controls. In school-age children (LIFE questionnaire) results were 11% better comparing with control group. Speech intelligibility in quiet was 3.1% (p > 0.05) higher for pre-schoolers in the experimental group and 9.3% (p < 0.01) higher for school-age children comparing with control group. Speech intelligibility in noise was higher in experimental group than in control: 7.8% (p < 0.05) in pre-schoolers and 13% (p < 0.01) for school-age children. Phoneme recognition was better in experimental group as well: 4.5% (p < 0.05) in pre-schoolers and 9.8% (p < 0.01) in school-agers than in control group. After HA fitting following an experimental protocol DataLogging time was 11–12% longer in comparison with standard procedure. On the other hand, experimental protocol took in average 1.5 hours for the first fitting and standard protocol — 53 minutes.

Conclusions. Protocol of paediatric amplification based on objective electroacoustic verification of HA output and functions allows to significantly increase the effectiveness of hearing rehabilitation in children.

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About the authors

Gaziz Sh. Tufatulin

Saint Petersburg Scientific Research Institute of Ear, Throat, Nose and Speech; Center of Paediatric Audiology; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: dr.tufatulin@mail.ru
ORCID iD: 0000-0002-6809-7764
SPIN-code: 2802-5522

MD, PhD

Russian Federation, 26/4 Esenina str., Saint Petersburg, 194356; Saint Petersburg; Saint Petersburg

Yuri K. Yanov

North-Western State Medical University named after I.I. Mechnikov

Email: 9153764@mail.ru
ORCID iD: 0000-0001-9195-128X
SPIN-code: 4406-5143

MD, PhD, Professor, Academician of the RAS

Russian Federation, Saint Petersburg

Sergei A. Artyushkin

Saint Petersburg Scientific Research Institute of Ear, Throat, Nose and Speech

Email: sergei.artyushkin@szgmu.ru
ORCID iD: 0000-0003-4482-6157
SPIN-code: 5140-4055

MD, PhD, Professor

Russian Federation, 26/4 Esenina str., Saint Petersburg, 194356

Vladimir V. Dvoryanchikov

Saint Petersburg Scientific Research Institute of Ear, Throat, Nose and Speech; North-Western State Medical University named after I.I. Mechnikov

Email: 3162256@mail.ru
ORCID iD: 0000-0002-0925-7596
SPIN-code: 3538-2406

MD, PhD, Professor

Russian Federation, 26/4 Esenina str., Saint Petersburg, 194356; Saint Petersburg

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Supplementary files

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2. Fig.1. Verification of the SA in the real ear: A - position of the patient in front of the speaker (in the ear - probe-microphone and SA); B - measurement result (explanation in the text)

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3. Fig.2. Digital noise reduction function verification algorithm (Scollie S. et al., 2016)

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4. Fig.3. Verification of the digital noise reduction function: A - activation of the function in response to a loud speech stimulus (inadequate functioning); B - after adjusting the settings, noise reduction does not turn on in response to a loud speech stimulus; B—noise reduction is activated in response to a noise signal, gain limitation occurs primarily in the low-frequency range

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5. Fig.4. The patient's position when verifying the direction of the microphone: A - front position in relation to the speaker; B - rear position

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6. Fig.5. Verification of microphone direction: A – omnidirectional microphone mode; B—fixed directional mode. The solid line is the anterior position of the patient, the dotted line is the posterior position of the patient. The table at the bottom shows the digital sound pressure values (dB SPL)

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7. Fig.6. Determination of the maximum audible output frequency (MAOF): 1 - target value (DSL v.5) for the ISTS input signal level of 55 dB SPL; 2 - for a level of 65 dB SPL; 3 - for a level of 75 dB SPL; 4—target saturation level (VUSD90); 5–8 - actual output of the SA in the real ear at input signal levels of 55, 65, 75 and 90 dB SPL, respectively; 9 — Ultrasound audiogram

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8. Fig.7. Electroacoustic assessment of indications for frequency reduction: A - frequency reduction is indicated; B - frequency reduction is not shown. 1 — target output of SA (DSL v.5); 2 — SA response to the ISTS stimulus, 65 dB SPL; 3 — ultrasound audiogram; 4 — SA output in response to stimulus “C”. Frequency downshift disabled

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9. Fig.8. Frequency Down Function Verification

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10. Fig.9. Research design

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11. Fig. 10. The frequency of the need to correct the default settings of the SA functions in children in the experimental group. Values are the number of cases.

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12. Fig. 11. Results of the PEACH (A) and LIFE (B) questionnaires before and at various periods after hearing aid

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13. Fig. 12. Results of speech audiometry in silence in SA at various periods after hearing aid

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14. Fig. 13. Phoneme recognition assessment results

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15. Fig. 14. Average time of use of hearing aids (hours/day) in various periods after hearing replacement. Vertical lines - standard deviation

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16. Fig. 15. Average time for initial tuning of the SA when using experimental and standard tuning protocols in preschool and school-age children. Vertical lines - standard deviation

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