AMPLIFICATION AND CI REFERRAL GUIDELINES
Most Infants and children with bilateral hearing loss and many with unilateral loss benefit from some form of personal amplification
- Should definitely be considered for infants and children when the pure tone average or high frequency pure tone average is greater than 25dB HL in at least one ear.
- Should be considered when the pure tone average of either ear is greater than 15dB HL and the child is exhibiting speech and language difficulties due to fluctuating or mild hearing loss.
- Should be assessed for appropriateness for infants and young children with unilateral loss. Depending on the amount of residual hearing, a hearing aid may be indicated. Contralateral routing of signals (CROS) is not currently recommended for children.
- Definitive resolution of otitis media (OM) should never delay the fitting of an amplification device. The infant should be referred to the physician for medical management and the audiologist should monitor the status of the OM when determining appropriate prescriptive targets during the hearing aid fitting.
Timeline for amplification fitting:
If the family chooses personal amplification for their child, hearing aid selection should occur within 1 month of initial confirmation of hearing loss even if additional audiologic assessment is ongoing.
Amplification/Hearing Aid fitting Guidelines:
The goal of the amplification device fitting is to provide the infant with maximum access to all of the acoustic features of speech within an intensity range that is safe and comfortable. Amplified speech should be comfortably above the infant's sensory threshold but below the level of discomfort across the speech range.
- The hearing aid size, make and model should be appropriate for the child's age and development.
- For infants under 6 months of age, hearing aid fitting will usually be based on physiologic measures alone using real-ear measurements.
- Behavioral threshold assessment using VRA should be obtained as soon as possible to cross-check and augment physiologic findings. (JCIH, 2007).
- Long term monitoring of the validity of the fitting and refinement of the gain and output targets is necessary.
- Age appropriate hearing aid prescriptive formulas (such as DSL) that incorporate the use of individual real-ear measurements that account each infant's ear canal acoustics and hearing loss should be used for fitting infants.
Complementary or alternative technology, such as FM systems or cochlear implants may be recommended as the primary or secondary listening device, depending on the degree of the infant's hearing loss, the goals of auditory habilitation, the infant's acoustic environment, and the family's informed choices.
Pediatric Referral for Cochlear Implant:
Cochlear implantation (CI) should be given careful consideration for any child. Since the benefit of CI is variable, a trial fitting of a traditional hearing aid at this time is still recommended by JCIH. The decision to discontinue the hearing aid should be made on the basis of the benefit derived from the amplification.
According to the current FDA guidelines, a cochlear implant:
- Is appropriate for children over 12 months of age with profound bilateral sensorineural hearing loss.
- May be considered for children 12 months and older with severe bilateral sensorineural hearing loss who are not developing speech and language skills on target after attempting conventional hearing aid use.
- May be considered for children 12 months and older diagnosed with auditory neuropathy/dys-synchrony who are not developing speech and language skills on target. A hearing aid trial in patients with AN/AD is still indicated in most cases.
- The presence of developmental conditions (e.g., developmental delay, autism) in addition to hearing loss should not preclude the considerations of a CI for an infant or child who is deaf.