Case example 1: Michael - Case examples - Development and Evaluation of an Audiological Outcome

4.5 Case examples

4.5.1 Case example 1: Michael

Michael was born full-term without complications with no reported family history of hearing loss. He was identified with a mild sloping to moderately-severe sensorineural hearing loss in both ears (PTA right = 43.3 dB HL; PTA left = 46.6 dB HL) when he was approximately four months old. Prior to obtaining hearing aids, Michael’s mother

completed the LittlEARS Auditory Questionnaire. The total unaided LittlEARS score was six. As seen on the score sheet shown in Figure 4-10, Michael was meeting minimum auditory development milestones for his age without hearing aids. At five months of age, Michael was fitted binaurally with hearing aids and the fit to targets were assessed during electroacoustic verification. Hearing aid fitting details were recorded on the Hearing Aid Fitting Summary form. Following a fit to targets assessment, the SII values were transferred to the Aided SII Normative Values Worksheet to determine whether the child had typical audibility from the hearing aids. In this example, the SII for an average speech input for the right (86%) and left (82%) ears fell within the 95% confidence interval (dashed lines) for Michael’s degree of hearing loss (Figure 4-11). When compared to aided SII norms, it can be seen that both hearing aids were providing a typical degree of audibility for Michael’s degree of hearing loss for an average speech input. If the SII values fell below the lower dashed line, the values would be considered to be lower than a typical SII for Michael’s degree of hearing loss. If this situation occurred, the clinician could consider modifying the hearing aid fitting to obtain a closer match to targets and thus an improved SII value prior to proceeding with the functional outcome evaluation tools in the UWO PedAMP.

Figure 4-10: LittlEARS score sheet for Case Example: Michael. The solid line indicates the minimum expected score, the small dashed line indicates the average expected score and the large dashed line indicates the maximum expected score from the German-derived norms. Circles represent the LittlEARS Score (y-axis) plotted by the child’s age in months (x-axis). The open circle is the unaided score and the filled circles represent scores in the aided condition. Scores in the non-shaded region

indicate the child is meeting auditory development milestones for his age and scores in the shaded region indicate the child is not meeting auditory development milestones for his age. Michael was meeting minimum auditory development milestones for his age prior to being fitted with amplification. While wear the hearing aids, Michael’s scores improved to where he was showing progress and meeting auditory development milestones for his age.

Reprinted from Bagatto, M. P., Moodie, S. T., Malandrino, A. C., Richert, F. M., Clench, D. A., & Scollie, S. D. (2011). The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP). Trends in Amplification, 15(1), 57-76. Copyright SAGE Publications, Inc. Reprinted with permission.

After experience with the hearing aids for one month, Michael’s mother completed the LittlEARS questionnaire thinking about Michael’s auditory behaviours while wearing the hearing aids. The score was 13 at approximately six months of age, indicating that

Michael was meeting typical auditory development milestones for his age in the aided

condition (Figure 4-10). At the three-month hearing aid follow-up appointments, when Michael was nine and 12 months of age, he was still meeting auditory development milestones for his age with scores of 23 and 34, respectively, on the LittlEARS (Figure 4- 10). Since Michael’s score on the most recent LittlEARS exceeded a score of 27, which is considered the ceiling score for the UWO PedAMP, the PEACH was administered at his next followup appointment. He scored 75% on the overall, quiet, and noise subscales, which is in the target performance range for the PEACH (Figure 4-12). As discussed above, given that Michael was less than 2 years of age at the time of administration of the PEACH, performance on the tool may improve as he gets older. This example illustrates the result from the group analysis that some children may be too young for the PEACH and scores should be interpreted with caution. For this reason, our current

recommendation is that the LittlEARS should be administered until the child is at least two years of age and continues to meet the ceiling score criteria.

0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 110 120 S II ( % , 6 5 d B S P L S p e e c h )

Pure Tone Average (dB HL)

X

O

Figure 4-11: Aided SII values for Case Example: Michael. SII values (y-axis) for an average speech input are plotted for the right (O) and left (X) hearing aid fittings by Michael’s PTA (x-axis). Since the symbols fall within the 95%

confidence intervals (dashed lines), it can be concluded that Michael’s hearing aid fitting is providing a typical degree of audibility for his degree of hearing loss, in both ears.

15 months

Michael’s results on the UWO PedAMP indicate that intervention with hearing aids (e.g., clinical process) and supporting communication development intervention resulted in functional outcome evaluation scores that show good auditory development and performance.

Figure 4-12: PEACH score sheet for Case Example: Michael. The PEACH percentage scores (y-axis) are plotted within each subscale (x-axis) for this case example. Results indicate the Michael is demonstrating typical auditory

performance while wearing the hearing aids.

In document Development and Evaluation of an Audiological Outcome Measure Guideline for Use with Infants, Toddlers, and Preschool Children (Page 108-113)