Hearing aid functioning in the preschool setting: Stepping back in time?

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Abstract

Purpose

In order for children with hearing impairment to receive maximum benefit from preschool programs, their amplification devices must be functioning appropriately. The purpose of this study, therefore, was to investigate the functionality of hearing aids in a preschool setting.

Methods

Forty-four hearing aids worn by 24 preschool children, whose ages ranged from three to five years, (mean age = 45.2 months, median age = 48 months) from four state funded aural/oral habilitation preschools were evaluated using listening checks and visual examinations. Hearing aids passing both evaluations were given a pass rating and those failing one or more of the evaluations were given a fail rating. Causes of fail rates were documented.

Results

Over half of the hearing aids tested were determined to have at least one or more problems (n = 27). These problems were detected using listening and visual checks.

Conclusions

Failure rates based on basic listening and visual checks among the hearing aids examined in this study demonstrated no improvement over those reported in the 1970's. The results re-emphasize the need for a national dialogue on this topic.

Introduction

In spite of the need for continuous amplification, poor functionality of hearing aids in school settings has historically been problematic. Early studies of hearing aid function published in the 1960's and 1970's indicated that between 40% and 69% of hearing aids were malfunctioning on a given day [1], [2], [3]. Although the most recent studies, published in the 1980's and early 1990's, indicated some improvement in functionality, the percentage of students with poorly functioning hearing aids remained concerning. One study in 1983 examined 66 hearing aids of 44 school-aged students using both listening checks and electroacoustic analysis. Of these hearing aids, 25% were judged unsatisfactory. The variables studied included: battery voltage, physical condition (cord, tubing, etc.), wire connectivity, and frequency response [4]. A second study in 1988 examined the hearing aids of 43 school-aged children using both listening checks and electroacoustic analysis and found that 22% of the children had hearing aids that did not pass their functionality tests [5]. In past studies that have reported the source of poor functioning, the most common issues reported were faulty batteries, poor fitting ear molds and cracked, hard or loose tubing [6], [7], [8], [9].

The majority of studies previously published examined the functionality of hearing aids in kindergarten through grade 12. Less is known about how well hearing aids are functioning within preschool settings. The limited data available on preschool hearing aid functioning suggests the situation is no better than functionality reported in the schools [10]. A 1987 study reported a 29.5% malfunction rate over a 60 day period based on listening and visual checks and electroacoustical analysis for the hearing aids of 10 children enrolled in university sponsored aural/oral habilitation program [8]. A more recent study performed typically-recommended daily listening evaluations on the hearing aids of 15 preschoolers and found 33% to be unsatisfactory [7].

The preschool setting presents unique challenges for ensuring consistent amplification functionality. In the school setting, older children who use hearing aids can be a key member of the monitoring program as they are better able to assess the functioning of their hearing aid. However, it is more difficult to determine if an infant or preschooler's amplification devices are functioning at an appropriate level because of the child's limited communication and ability to participate in the monitoring plan. It is imperative to utilize all available technology and techniques to assess if amplification is functioning for younger children. These assessment techniques may include visual and listening inspection of the hearing aids, as well as gross electroacoustic analysis. Visual and listening checks are sufficient for identifying the most common malfunctions, including weak and dead batteries, earmold problems and mechanical problems [4].

Children with hearing impairment need to be aided early, and their amplification devices must be functioning at a level that is appropriate for their type and degree of hearing impairment in order for the children to receive the maximum benefit of educational programs. Unlike adults, children lack the necessary linguistic knowledge to fill in gaps in the auditory signal [11]. Therefore, any interruption in the speech signal could result in decreased comprehension of auditory information and interfere with the child's ability to benefit from classroom activities and peer interaction. Infants and preschoolers are still acquiring language; incomplete or interrupted modeling of that language could result in further delayed speech or language development [12], [13]. Additionally, poor functioning amplification devices could lead to inappropriate classroom behaviors. Teachers involved in a 1983 hearing aid monitoring program reported a decrease in inappropriate behaviors as hearing aid function improved [4]. Finally, consistent amplification is also necessary to ensure compliance with federal requirements for providing adequate intervention. As outlined in Individuals with Disabilities Education Act (IDEA) “each public agency shall insure that the hearing aids worn by children who are deaf and hard of hearing in school are functioning properly.”

In order for children with hearing impairment to receive maximum benefit from preschool programs, their amplification devices must be functioning well and consistently. This study investigated the functionality of hearing aids in a preschool setting. For the purpose of this study, hearing aids were evaluated using a basic functionality test consisting of traditional visual and listening checks.

Section snippets

Participants

Forty-four hearing aids worn by 24 preschool children, whose ages ranged from three to five years, (mean age = 45.2 months, median age = 48 months) from four state funded aural/oral habilitation preschools were tested using listening and visual examinations. Four preschools that service children with hearing impairment were identified through educational administrators throughout the state of Alabama. These preschools were part of the Alabama Institute for the Deaf and Blind (AIDB) preschools

Visual inspection

The results from the visual inspection are summarized in Table 2. In particular, for the visual inspection of both the hearing aid and earmold, 22 (50%) passed and 22 (50%) failed. Seventeen of the 44 hearing aids (38%) had one visual problem; 4 (9%) of the hearing aids had two visual problems; and 1(2%) of the hearing aids had three visual problems. Of the 22 hearing aids that failed the visual inspection, 13 (30%) had hard or cracked tubing in the earmold, 9 (20%) had earmold problems (poor

Discussion

As previously discussed, poor functionality of children's hearing aids is not a new phenomenon. The current research findings highlight the “good news” and the “bad news” related to how far we have come in ensuring hearing aid functionality for children. The “bad news” is that the overall failure rates continue to be high. One limitation of this investigation is the fact that the teachers were not made blind to the aim of the study. It is possible that results could have been even worse if they

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