Evidence for Audiologic Rehab

Evidence for Hearing Aids for Children and speech, language and hearing development

Clear strong consistent evidence that HAs help children develop speech, language and hearing

Even for children with mild and unilateral HL

Evidence for early fitting of HAs for children

Ample strong evidence to support this

daily wearing time related to language development

• earlier child is identified and fitted with HAs, the better the outcomes

Evidence for 2 HAs over 1 HA in children

Clear, strong, consistent evidence to support this intervention

even for children with asymmetrical HL

Evidence for use of directional microphones in HAs for children

Mixed evidence

Competing issues for benefit of directional microphones

• Lack of access to incidental speech when in directional mode

• Improvement of access to speech compared to background noise when in directional mode

Evidence that HAs are effective in helping adults manage HL

Strong compelling evidence to support this intervention

Evidence that HAs are effective in helping adults with mild HL

Moderate evidence to support this

“large beneficial effects” (including improved quality of life and being able to help people hear and understand others) for adults with mild to moderate HL

Evidence to support the use of 2 HAs or 1 HA

No clear strong evidence to support this, mixed evidence

Unaided ear effect

Unaided ear effect

• decrease in the ability to understand speech over time in the unaided ear when only one ear is aided

• not everyone experiences it and some people can recover from it

• important factor to discuss when considering only wearing 1 HA

• speech understanding scores decrease over time in unaided ear

 

Evidence for DNR improving speech understanding in noise

• No evidence to support that it does this directly

• Clear evidence that it reduces listening effort - reducing fatigue to improve overall listening ability

Evidence for directional microphone's ability to improve speech understanding in noise

• Mixed and limited evidence - some studies found limited benefit while others found more benefit

• Compared with other tech, directional microphones are the only tech that has demonstrated improvement in understanding speech in background noise

• Difficult to measure in lab, may be only measurable with ecological (real-world) outcomes

Evidence for non-invasive BC devices showing improved speech understanding in children

• Ample-moderate evidence to support this, likely because BC HAs often precursor for bone anchored HAs

• non-invasive BC devices = soft-band BC

• strong evidence that BC HAs work well for children who can’t use AC HAs

Evidence for invasive BC devices showing improved speech understanding in children

• Stronger evidence than non-invasive devices

• Invasive = bone anchored

Evidence for bone-anchored HA providing children with access to auditory info to develop speech and language

• Long-standing evidence to support this

• Can access speech sounds, to improve their speech, language and auditory development

Evidence for the use of BC devices in adults

Limited evidence supporting this, compared with AC devices

• some evidence supporting use of BC devices in adults with unilateral HL

Evidence for use on bone anchored HAs in adults

More evidence supporting this compared to using BC devices

• evidence still limited, but some shows improvements: directional hearing and quality of life

• study reported speech understanding improvements for different types of bone anchored HAs in adults

Surgical complications with bone anchored HAs in adults

Fewer complications reported

• don’t have a lot to lose and can be removed

Evidence for passive ear implants for children

Limited evidence as not very common (used to replace functioning of 1 or more parts of middle ear, typically stapes)

• mostly for conditions acquired as an adult

Evidence for active middle ear implants for children

Moderate and consistent evidence

however, effect sizes aren’t large

Improvements in:

• quality of life

• directional hearing - safety implications

• understanding speech

• audiological findings (puretone, speech understanding)

Evidence for passive middle ear implants for adults

Moderate, consistent, positive evidence

• much more evidence focused on where device should be implanted

Evidence for active middle ear implants for adults

Strong, consistent evidence

• quality of life

• speech understanding

• audiological improvement (puretone, speech understanding in quiet)

• study found benefits were stable over time

• relatively few surgical complications

Evidence for cochlear implants for children

• deaf culture considerations and implications

• long-standing strong, consistent evidence of positive outcomes for CI in children

• key to successful outcomes in early implantation

• children with CIs will benefit from SLT intervention

Characters of speech of children with HL

•Reduced prosody of speech (monotone)

• Slowed rate of speaking

• Inaccurate vowel production

• Inaccurate and inconsistent voicing

• Increased breathiness in speech

• Errors in articulation, particularly changing fricatives to stops • Lack of use and understanding of pragmatic aspects of speech

Evidence for cochlear implants for adults

Strong, consistent, positive outcomes for adult CI recipients

Improved:

• access to speech

• speech understanding

• quality of life

• cognitive performance (compared to adults without CIs - longitudinal study of effects of CI on cognitive decline)

• directional microphones in CIs linked to better speech understanding in noise

Evidence for HAT

• limited evidence to support HAT (alone) in adults or children

• HAT with HA and implants related to improved academic performance in children

• some limited evidence to demonstrate positive outcomes in adults

Evidence for instruction

Instruction involves providing written instructions

Evidence suggests:

• that both written and verbal instructions are important, as written audiological reports and verbal language of clinicians can be difficult to understand

• reducing reading grade level can help improve people’s understanding of the content and be able to act on the info provided

Evidence for speechreading training for children

Strong evidence to support this compared to adults

• computerised training has some support

• even support for children without HL (phonological awareness)

Evidence for auditory training for children

Strong evidence to support this

• computerised training has most support

• shown to improve all aspects of audition (auditory detection, auditory discrimination, speech recognition and auditory memory)

Evidence for speechreading training in adults

Some limited evidence that it improves speech understanding

• important to involve family members, so practicing with frequent communication partners, and can help increase awareness and involvement of communication process

Evidence for auditory training in adults

More and stronger evidence to support the use of auditory training compared to speechreading in adults

• lack of support for computerised AT

• at-home AT linked with improvement in working memory, attention and communication

Evidence for counselling related to HL with children

Limited evidence to support this

Group counselling shown to improve problem solving and reduce aggression in children with HL

Evidence for information counselling for caregivers

Some limited, weak evidence to support this

• evidence demonstrates that information counselling can be biased

Evidence for counselling related to HL for adults

Very weak and limited evidence to support this

• counselling not usually done separately

• so can’t say that there is evidence regarding effectiveness of counselling alone on improving participation restrictions in adults with HL

• can infer effectiveness of personal adjustment counselling as part of AR