By Hsuan-Mei Hong; Yi-ping Chang, PhD; Pei-Hua Chen, PhD; Ying-Chuan Julie Ma, AuD
When a child is diagnosed with hearing loss, parents have considerable information to digest and numerous choices to make. Parents must understand their child's audiometric results, the impact of hearing loss on the child's development, obtainable technologies, and available habilitation programs, particularly manual and total (manual combined with oral), and oral communication. If parents choose an oral communication mode, audiological management is a vital foundation for listening and spoken language outcomes. Audiological management includes understanding children's audiometric status, fitting and handling the hearing technology, and monitoring children's hearing status.
IMPLEMENTATION AND ASSESSMENT OF AUDIOLOGICAL MANAGEMENT
In our study, we investigated the degree of implementation of audiological management by parents of children with hearing loss who were newly enrolled in aural habilitation program provided by the Children's Hearing Foundation (CHF) in Taiwan (Hong, et al., 2018). A clinical assessment tool—the Audiological Management Checklist (AMC)—was developed by CHF's experienced pediatric audiologists. The AMC consists of 20 items that can be divided into three dimensions: audiometric status understanding, hearing technology handling, and audiological monitoring. Detailed descriptions and sample items for each dimension in AMC are presented in Table 1. A rating of 0, 1, or 2 was assigned to each item, where a higher rating indicates a higher degree of understanding or implementation by parents. The total score of AMC was 40. The parents and the auditory-verbal specialists of 95 children with hearing loss were recruited in the study. These children had been receiving auditory-verbal programs from the CHF for less than one year prior to initial assessment; these children were selected because the parents may not be as familiar with audiological management as those who had enrolled in the programs for a longer period. In addition, these children may have been wearing hearing devices with relative inconsistency compared with those who had been enrolled in the programs for a longer period. The parents' implementation of audiological management was evaluated using AMC by auditory-verbal specialists and the parents themselves. Based on the initial assessment, pediatric audiologists counseled the parents on how to improve for the items they received low ratings for. Follow-up assessments were conducted at six months.
Table 1. Audiological Management Checklist
|Audiometric status understanding (5 items)||To evaluate the degree of parents' understanding of their child's audiometric status. ||"Do you know your child's degree of hearing loss?"|
|Hearing technology handling (10 items)||To evaluate the degree of understanding of hearing technology settings and degree of familiarity with hearing device handling. ||"Do you understand the program settings in the hearing device?"|
|Audiological monitoring (5 items)||To evaluate parents' sensitivity to possible variations in their child's hearing performance and whether they regularly monitor their child's hearing status. ||"Do you regularly apply speech sound tests to monitor your child's detection performance?"|
The study results revealed that after being counseled by pediatric audiologists, most (87% based on parents' self-ratings; 89% based on the auditory-verbal specialists' ratings) parents' implementations of audiological management improved compared with the initial assessment. The parents' mean rating of the two assessments significantly increased from 33.78 to 37.19 (t = -9.82; p < 0.001), whereas the auditory-verbal specialists' mean rating significantly increased from 26.29 to 32.62 (t = -7.24; p < 0.001). AMC is a useful tool for audiologists and early intervention professionals to evaluate the audiological management status of parents who lacked knowledge of audiological management. Based on the results of AMC evaluation, the audiologists and hearing health care professionals provided advice to meet the parents' needs. In this study, the results revealed that the parents' ratings were significantly higher than the auditory-verbal specialists' ratings for both assessments (t = -11.08, p < 0.001 for the initial assessment; t = -7.65, p < 0.001 for the follow-up assessment); the differences between the ratings from the parents and the auditory-verbal specialists reduced at follow-up compared with the initial assessment. These results indicated that the observation of parents became more consistent with that of the auditory-verbal specialists after counseling from pediatric audiologists.
Table 2 summarizes the results for the most successful and most poorly implemented dimensions for both evaluators and for both assessments. Dimensions of "audiometric status understanding" and "hearing technology handling" were the most successfully implemented for the auditory-verbal specialists and parents at initial and follow-up assessments, respectively. However, "audiological monitoring" was found to be the most poorly implemented dimension based on the ratings from parents and auditory-verbal specialists at both initial and follow-up assessments.
Parents of children with hearing loss must develop habits for monitoring their child's hearing status or maintaining their child's hearing technology in daily life. Our study found that these habits take time to develop. Notably, although "audiological monitoring" was the most poorly implemented dimension, it was the most improved dimension after counseling from pediatric audiologists.
Table 2. Dimension implementation comparison of the ratings from parents and auditory-verbal specialists at the initial and follow-up assessments.
| || ||Parents' rating results||Auditory-verbal specialists' rating results|
|Initial assessment ||The most successfully implemented dimension ||Audiometric status understanding ||Hearing technology handling |
|||The most poorly implemented dimension ||Audiological monitoring|||
|Follow-up assessment ||The most successfully implemented dimension ||Hearing technology handling||Hearing technology handling|
|||The most poorly implemented dimension |
(also the most improved dimension)
SUGGESTIONS FOR PARENTS AND HEARING CARE PROVIDERS
The results revealed that although the parents' audiological management improved after receiving some counseling from audiologists, they still poorly monitored the audiological condition of their children. Therefore, we suggest that in aural (re)habilitation, hearing care providers should provide parents with additional support to better monitor their children's hearing status.
Parents spend considerably more time with their children. Thus, they can provide valuable information about their children that providers may not be able to observe in therapy sessions or audiometric exams. Their reports are often utilized to evaluate the effectiveness of hearing amplification or the auditory skills development of children. However, our study showed a significant difference between ratings from parents and that of hearing care providers. Nonetheless, professionals should consider parents' self-evaluation to improve audiological management at home.
About the Authors: Hsuan-Mei Hong is a research assistant of Speech and Hearing Science Research Institute at Children's Hearing Foundation (CHF) in Taiwan, where Dr. Yi-ping Chang is the director. She's also an adjunct assistant professor in the Department of Audiology and Speech-Language Pathology at Mackay Medical College in Taiwan. Dr. Pei-Hua Chen is a research fellow of Speech and Hearing Science Research Institute at CHF, focusing on the application of psychometric in children with hearing loss. Dr. Ying-Chuan Julie Ma is a pediatric audiologist and the director of audiology at CHF. She's also an adjunct assistant professor at Mackay Medical College and an adjunct lecturer at Chung Yuan Christian University.