“How much does s/he wear the hearing aid each day?” This is the question I used to ask parents of their infants or young children who were deaf or hard of hearing and wore a hearing aid.
“All the time.”
“Whenever s/he is awake.”
“From morning until bedtime.”
These were the most common replies. I was quite content with them, since full-time hearing aid use was our goal. Until recently, it was rare for me to probe further into the issue. Then several important developments changed my perspective and forced me to think about new ways to support parents and caregivers and to encourage consistent hearing aid use.
The first major development was the widespread availability of data-logging systems in hearing aids. In addition to tracking other interesting pieces of information, many hearing aids calculate the average amount of time they're used each day, a metric that can be monitored through the manufacturer's programming software.
Oftentimes, parent or caregiver reports of hearing aid use in our clinic were consistent with the information collected by the hearing aid data logging. In other cases, however, there was a large disparity between the two, with parents or caregivers reporting full-time use and data logging suggesting only limited use. We know that hearing aids provide critical access to the acoustic cues needed to promote speech and language development, and we would repeatedly convey this fact to parents during counseling sessions and hearing aid appointments.
Two recent research studies have helped redefine our expectations for hearing aid use in children and shed light on the factors that can influence how much these young patients wear the devices.
Work by Jones and Launer, for example, suggested that approximately 40 percent of children used their hearing aids for four hours or less per day (paper presented at: A Sound Foundation Through Early Amplification; Nov. 8-10, 2010; Chicago). This figure is based on data from 5,000 children with hearing loss. The number of hours of hearing aid use increased with age, which is consistent with clinical experience; compared with older children, getting infants and toddlers to keep their hearing aids in their ears is more of a challenge. However, clinicians would likely raise concerns if their pediatric patients were using their hearing aids for four hours or less per day.
A study by Walker and colleagues found reasonable agreement between parent reports and data logging, with the former exceeding the latter by an average of two hours (Lang Speech Hear Serv Sch 2013;44:73-88). However, when parents reported 12 hours of daily use, the data-logging value ranged from two to 15 hours. This variability indicates that while many parents are reliable reporters of their children's hearing aid use, others may be reporting what they think the audiologist wants to hear. Both studies suggest that there may be a significant gap between clinician and parent expectations of hearing aid use in children.
FOCUS ON SPECIFIC SITUATIONS
How can audiologists more accurately estimate hearing aid use and encourage parents and caregivers to support consistent wear without becoming the data-logging police?
The first step is to build rapport and provide support for parents and caregivers by setting realistic expectations. While full-time use should always be our ultimate goal, we should start by acknowledging the difficulty of promoting hearing aid wear in children. This acknowledgement can spark conversations about these challenges and strategies to address them.
Data logging should be clearly presented to parents and families as a way to help monitor the function and effectiveness of hearing aids. Parents may express concerns about privacy; however, a demonstration of the type of information that is available from the system can assure them that the data is aggregated over many hours of use and that the information received by the hearing aid is not being recorded. The option to disable data logging should be provided if there are persistent concerns. Additionally, a discussion of the differences between parent report and data logging should be handled carefully, as the validity of specific data-logging systems has not been established.
Changing the questions we ask parents and caregivers about hearing aid use can help better reveal successes and challenges. Moeller and colleagues (Am J Audiol 2009;18:14-23) asked parents about hearing aid use in different listening situations, such as while the child is having a meal, riding in the car, or playing. Identifying situations where hearing aid use is successful and confirming situations that are more challenging is an alternative to simply asking about the amount of hearing aid use (see the table on page 16). This approach allows clinicians to highlight the importance of using hearing aids during highly communicative situations, such as when reading a book with the child, and to work with parents to develop strategies for facilitating hearing aid use in the difficult situations. Importantly, addressing specific situations gives the clinician an opportunity to emphasize the positive steps parents and caregivers have made toward achieving consistent hearing aid use.
The best-fit hearing aid is not beneficial if the child never uses it. Discussing the particular listening situations where hearing aid use is successful and most challenging can be much more informative than simply asking how much time the child is able to wear the device.