Audiologists who dispense hearing aids know and recognize “the levels”. Entry-level, Premium, Ultra-Premium, Double-Diamond Platinum. Maybe I went a little overboard with that last one, but most audiologists have a hierarchy of hearing-aid technology that they present to patients to help find the right features for their needs. Naturally, audiologists will often ask about the appropriate level of technology for their pediatric patients. Do we provide the highest level of technology that the family or funding program can provide? Are basic, entry-level hearing aids sufficient to give children what they need to develop speech and language? Is the right answer somewhere in the middle?
These are important questions. First, we have evidence that providing amplification early and consistently can help to minimize communication delays in children. The decisions we make about early amplification could have long-term developmental implications. No pressure. Audiologists also bear the responsibility of being fiscally responsible to either the child’s family or to the funding organization that is paying for the child’s hearing aids. Either way, our goal is to balance the developmental needs of the child with the financial realities of the family or funding agency.
What evidence do we have to guide these clinical decisions? Unfortunately, research does not tell us which level of technology will give kids the best outcomes. In fact, such evidence does not exist even for adults. The absence of such a study is at least due in part to the fact that the technology levels that we know and love are primarily marketing strategies. Thus, the actual differences between the categories of technology are subtle and vary widely across manufacturers. That is not to suggest that the distinctions between technology levels in hearing aids are arbitrary. Differences in hearing-aid technology could impact developmental outcomes. Rather, it is important to recognize that the lack of a consistent definition about what constitutes entry-level versus Double-Diamond Platinum (there I go again) would make such a study difficult to perform. We also know that these categories change every year with the introduction of new and improved hearing-aid signal processing.
Fortunately, there are a few things we do know about what children need from their hearing aids that can provide guidance. Children need consistent audibility of speech to give them the experience they need to develop language. How much audibility is enough? The amount of audibility that can be provided varies as a function of degree and configuration of hearing loss, but the experts at the University of Western – Ontario have developed a protocol to assist audiologists in knowing how much audibility to expect based on the degree of hearing loss (for more information, click here). In our multicenter, longitudinal study of children with hearing loss who wear hearing aids (for more information, click here), the amount of audibility provided by the hearing aid is an important predictor of developmental outcomes. For the most part, audibility can be achieved for a large range of hearing losses using entry-level technology.
Audiologists should also consider connectivity to hearing assistance technology (like FM systems) and other devices, such as tablets and smart phones, when making decisions about the level of hearing-aid technology. Even young children are using these technologies to interact with friends and relatives from a distance. With some manufacturers, connectivity requires a higher level of technology, whereas in other cases connectivity can be achieved with a basic level of technology and the purchase of additional accessories. Selecting a more basic level of technology to allow families or funding agencies to purchase the accessories needed to promote communication access in a wide range of situations is often more important than selecting the highest level of hearing-aid technology. Decisions about the level of hearing-aid technology for children should be based on an assessment of the child’s listening needs, verifying that the device provides sufficient audibility, and ensuring that the child can use their hearing aid to access a wide range of communication opportunities. In the meantime, research will continue to attempt to identify hearing-aid features that can provide the best acoustic signal to support communication development.
Ryan McCreery, Ph.D. is the Associate Director of Audiology and a Staff Scientist at Boys Town National Research Hospital in Omaha, Nebraska. His research involves identifying factors that influence speech recognition in children and optimizing hearing-aid signal processing for children. Ryan is a co-investigator on the Outcomes for Children with Hearing Loss (OCHL) multi-center research study. You can contact Ryan at firstname.lastname@example.org.