Pediatric Support: Issues, Tools & Services
Download PDF Douglas L. Beck Au.D.
Maureen Doty Tomasula M.A. CCC-A
Oticon, Inc., Somerset, NJ Introduction When a child has hearing loss, it is enormously important to identify, diagnose and initiate treatment and aural rehabilitation immediately. Families are often unprepared to enter the world of childhood hearing loss, yet they immediately face many choices, a totally foreign vocabulary, a plethora of articles to read and sometimes advice, which may be biased -- despite the best intentions One of the immediate goals for the professional is to initiate an action plan with input, buy-in and commitment from the family. To accomplish this extraordinarily important task, the professional needs counseling and
instructional tools for the child, family and teachers. There are many resources available on the Internet to assist families in obtaining information, but not all families have web access. Additionally, some of the information may be dated, incorrect or confusing. Further, the Internet does not typically provide direct dialog between the audiologist and the family and dialog is a very important part of the process. Effective aural rehabilitation can take many forms depending on the individual needs of the child, the given situation and many related factors. Nonetheless, hearing aids are the treatment pursued for the majority of hearing impaired children and therefore, hearing aids allow the child to access the world of sound.
Providing maximal hearing aid amplification for children is a formidable and challenging task. Helping families understand the use of these devices and instructing them to incorporate 'auditory training' activities into their daily lives requires professional guidance with appropriate support materials. In tandem with hearing aids designed for children, we believe it is our responsibility to provide tools and services which facilitate an efficient, effective and ever-improving auditory experience for the hard-of-hearing child, as well as educational materials to support the parents' involvement. Oticon has been a leader in pediatric amplification for almost 30 years. As the complexity and range of amplification solutions and educational choices have increased, Oticon has responded by creating new support materials for families and professionals. Pediatric Philosophy: 1- Oticon's pediatric philosophy is simple. We strive to make it easier to help children with hearing problems achieve their full potential. Listening to the needs of the hard-of-hearing child, their family and professionals inspires us and facilitates our innovation. 2- Children are not "systems people." Our products are designed to be child-friendly and easy to use correctly. 3- Our solutions go beyond technology. We're committed to the bigger picture; sharing knowledge, fighting stigma, developing support materials to stimulate speech and to make learning fun. Multimedia Approaches: Many of our tools are offered as multimedia presentations on CD, DVD and/or as Internet downloads. Multimedia tools are fun, challenging and interesting, and children, teachers and parents find them to be educational. Research has shown multimedia-based instruction increases the speech,
language and auditory abilities of children with hearing impairment (see Mander, Wilton, Townsend and Thomson, 1995; Schopmeyer, et al, 2000). Therefore, whenever possible, we recommend incorporating multimedia tools to maximally impact the audiology experience for the client/patient, the parent, family, teacher and other stakeholders (Beck & McQuire, 2006). Oticon Pediatric Tools & Materials: 1. OtiKids 
In the early-mid 1990s, "Oticon 4 Kids" was inaugurated. The name was soon changed to OtiKids and the award winning website (www.otikids.com) was launched. OtiKids represents a philosophy and a commitment to pediatric hearing aid fittings. OtiKids is a comprehensive hearing care support program for children, parents, families, hearing healthcare professionals and teachers, offering informational brochures, story books, and multimedia tools. The OtiKids website (www.otikids.com) features sections for parents, teachers, siblings, grandparents and has recommended readings and hyperlinks to additional hearing-related websites. 2. The Children's Outcome Worksheets The Children's Outcome Worksheets (COW) is a fast and efficient way to
identify and document the specific needs of children ages 4 through 12 years, as identified by the child, parent and teacher (i.e., multiple observers). This unique tool allows a quick analysis to document short-term variations in performance secondary to changes in the amplification strategy. The COW was inspired by the Client Oriented Scale of Improvement (COSI) from Dillon and Ginis (1997). The COW encourages and incorporates input from the child, teacher(s) and parent(s) and allows a post-treatment re-evaluation in the form of a "final ability"
statement. Like the COSI, the COW consists of four steps; 1- establishing needs and expectations, 2- post-fitting assessment to determine if the established needs and expectations were successfully addressed, 3- categorizing the stated needs, and 4- determining the degree of change. The COW is available as a PDF through Oticon's Genie fitting software. It is also available in a printed version with a supporting "News From Oticon" document which describes the development and implementation of the COW in clinical practice. The COW is available as a PDF through our Oticon's Genie fitting software. It is also available in a printed version with a supporting "News From Oticon" document (Williams, 2005) which describes the development and implementation of the COW in clinical practice. 3. Otto's World of Sound Otto's World of Sound is a multimedia-based learning tool for young children, ages 2 through 8 years, to help them improve their auditory skills. Otto's World of Sound CD is sent automatically with all hearing aids ordered for children under 8 years of age. Otto, the OtiKid's mascot, is the friendly guide through the World of Sound. By clicking into any of ten different sound environments, children learn to associate particular sounds with visual images. Written and spoken vocabulary associated with the pictures and sounds enhance the child's learning. These fast and fun exercises reinforce the child's discrimination and identification abilities. Sounds vary in frequency and relative intensity, ranging from crowds, bells, pianos and birds, to raking leaves, drums, vacuum cleaners and electric shavers. Children appreciate this easy-to-navigate and fun method to learning sounds commonly associated with everyday and easily recognizable visual representations. Otto's World of Sound involves parents in their child's developmental process, uses engaging games and uses a monitored progress approach to motivate the child. The child's task expands as the child learns, so the child is comfortably challenged and engaged in the process. 4. Having Hearing Aids Although we offer a multitude of support products for parents and children, much more than can be listed here, one of our most popular products was written by 9 year old Peter Augustine, in 2003. The colorful booklet describes Peter's experience as a young boy with hearing loss, the hearing test procedure and what it's like to wear and rely on hearing aids. All text and illustrations are by Peter. 5. Materials in Spanish Many of our pamphlets and other tools are available in Spanish. For example; Parent's Guide, Family Notebook, the OtiKids Hearing Aid Care Kit, All About FM, Otto's World of Sounds, the Listening Check Instructions and others, are available in Spanish. Please note, the "User Instruction Booklet" which accompanies most of our hearing instruments are also available in Spanish. Many of these same products (and others) are available in a variety of languages. Please speak with your Oticon representative to learn about the complete list of offerings and languages. 6. E-Caps 
The Electronic Client Assisted Product Selection (e-Caps) is one of the most exciting multimedia tools available. e-Caps is available as a stand-alone CD for professionals at no charge. e-Caps allows the child and parent(s) to explore the advantages of advanced technology hearing aid fittings and to review situations in which specific technologies offer advantages (see Beck and McGuire, 2006). Additional support materials within e-Caps includes; About Hearing (describes and demonstrates the differences between sensorineural hearing loss and conductive hearing loss), Your Hearing (a personalized audiogram demonstrating sound examples with respect to loudness and pitch), Situations (describes and demonstrates many common listening situations), Personal Goals (personalized to meet the needs of the specific client), Aural Rehab (addresses communicative strategies, assistive listening devices and also features hearing aid use and care videos such as; inserting hearing aids, removing hearing aids, cleaning the hearing aids, changing the battery, turning the hearing aids on and off, using the telephone, using the volume control, using the push button) and finally, Report (allows the professional to click and print specific areas for attention and follow-up, and to print a report for the patient, their physician or the chart). 7. Hearing Aids with a Pediatric Emphasis 
Although most of our hearing aids are appropriate for pediatric applications, Sumo DM is one of the few digital signal processing (DSP) hearing aids designed especially for the pediatric population. Quick and easy verification of switch position and program settings are important to the caregiver. Sumo DM is unique in that it has an easily visible LED indicating changes in volume, program and battery status. The Sumo DM is a small super power hearing instrument with reliable FM connectivity - the audio shoe interlocks into the battery door - for a very secure connection. Many of our hearing aid products (i.e., Tego and Tego Pro) allow "manual override" of automatic features and tamper resistant options. Most of our hearing aids are DAI and FM compatible and are packaged in moisture
resistant shells with attractive and fun colors. Sumo DM and the new advanced Safran hearing instrument includes the DSL 5.0 m[i/o] rationale to maximize pediatric hearing fittings (see below), representing another milestone in pediatric hearing aid fittings. 8. Genie Software The proprietary Genie hearing aid fitting software is interactive. There is a vast quantity of text, pictures, graphs, photos and sound files available throughout Genie to help involve the client/patient/child/parent in the process. Genie emphasizes the importance of more than pure-tone thresholds, for optimal hearing aid fittings. For example; age, hearing aid experience, individual patient/client-based needs, lifestyles, listening and learning environments, real-ear data, hearing aid styles and more, are incorporated into hearing aid prescriptions through the Genie software. Because young children (less than seven years of age) have smaller ear canals than adults, it is important to use pediatric fitting guides to assure that the Real-Ear-Coupler-Difference (RECD) and related values are appropriate for the child. Recording the child's age within the software helps Genie select the correct RECD, REUR and assures the correct gain and MPO will be prescribed. RECD values can be ascertained by three protocols; averaged data based on age can be selected (see above), actual real ear measures can be used from the client, or data can be imported from NOAH. The new DSL 5.0 m[i/o] rationale introduces a new standard for pediatric hearing aid fittings and is available in Genie 7.0. DSL 5.0 allows children more access to speech information and allows increased compatibility with today's advanced technology hearing aids. Additionally, DSL 5.0 addresses conductive hearing loss, binaural fittings and addresses severe and profound hearing loss. 9. Professional Publications Professionals who address and manage hearing healthcare for children must remain abreast of the latest research findings. Some of our recent publications include: "Incorporating Functional Auditory Measures into Pediatric Practice: An introductory guide for pediatric hearing professionals" by Anne Marie Tharpe and Traci Schmidtke Flynn (2005). This popular document addresses audiologic assessment tools for children ages 0-3 years, 3-5 years, and 5 and older. Importantly, this guide reviews 14 pediatric functional assessment measures (ABEL, CHILD, COW, ELF, IT-MAIS, LIFE, LITTLE EARS, LSQ, MAIS, PEACH, P-APHAB, PreSchool SIFTER, SIFTER, TEACH), their purpose and references. "SuperPower For Kids: A Clinical Evaluation" by Randi Pogash and Mark Flynn (2003). This article examined whether children with profound hearing loss could realize benefits similar to those with severe hearing loss, via multi-channel non-linear amplification (MCNL). Children with profound hearing loss did benefit from MCNL in noisy and adverse listening situations. "Pediatrics and Advanced Hearing Aid Technology" by Douglas L. Beck and Donald J. Schum (2006). This article examined demographics, etiologies and other factors impacting the pediatric hard-of-hearing population. New technologies (for example; automatic adaptive directionality, multi-channel non-linear amplification, noise reduction etc) and their applicability to the pediatric population were explored. "The FM Advantage in the Real Classroom" by Traci Schmidtke, Mark Flynn and Melanie Harvey (2004). This article examined "real world" classrooms and difficulties associated with learning in disadvantageous acoustic environments and the statistically significant benefits obtained via FM systems. 10. Client/patients and family-based publications: Of significant importance to the family of hard-of-hearing children are the materials provided by their professionals. In addition to the materials outlined above, Oticon has made available a client-patient-family based soft cover book edited by Dr. David Luterman. Children with Hearing Loss-A Family Guide including chapters titled; "The Emotional Impact of Hearing Loss," "Hearing Loss and the Family," "Hearing Aids and Cochlear Implants," "Listening as a gateway to Learning" and "What parents Should Know: The Educational system." For more information, contact Auricle Ink Publishers, Sedona, Arizona (www.hearingproblems.com) ISBN 0-9661826-5-0. Summary: Providing hearing aid amplification for children is a formidable and multi-faceted task. Along with the provision of hearing aids designed for children, we provide tools and services to facilitate an efficient, effective and ever-improving auditory experience for the hard-of-hearing child, the parents, the teachers and other involved professionals. Making it easier to help children with hearing problems achieve their full potential is our mission. We endeavor to achieve this through the provision of appropriate, well designed, thoughtful and long-lasting hearing aids and related tools and services to support the hard-of-hearing child. References: Beck, D.L. and McQuire, R. (2006): MultiMedia: Better Tools Facilitate a Better Process. Hearing Review. April, 2006 Beck, D.L., and Schum, D.J. (2006): Pediatrics and Advanced Hearing Aid Technology,
http://www.audiologyonline.com/articles/arc_disp.asp?article_id=1529 Dillon, H. and Ginis, J. A. (1997): The Client Oriented Scale of Improvement (COSI) and it's Relationship to Several Other Measures of Benefits and Satisfaction Provoded by Hearing Aids. JAAA 8:27-43. Mander, R., Wilton, K.M., Townsend, M.A.R., & Thomson, P. (1995): Personal Computers and Process Writing: A written Language Intervention for Deaf Children. British Journal of Educational Psych. 65, 441-453. Pogash, R., and Flynn, M. (2003): Super-Power for Kids: A Clinical Evaluation. Audiological Research Documentation, News From Oticon, April, 2003. Schmidtke-Flynn, T., Flynn, M.C. and Harvey, M. (2004): The FM Advantage in he Real Classroom. Audiological Research Documentation, News From Oticon. December, 2004. Schopmeyer, B., Mellon, N., Dobaj, H., Frant, G. & Niparko, J.K. (2000):
Use of FastForward to Enhance Language Development in Children with Cochler Implants. Annals of Otology, Rhinology and Laryngology, 109, 95-98. Tharpe, A.M., and Schmidtke Flynn, T. (2005): Incorporating Functional Auditory Measures into Pediatric Practice: An introductory guide for pediatric hearing professionals. Williams, C. (2005): The Children's Outcome Worksheets. Audiological Research Documentation, News From Oticon. January, 2005.
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