Fitting and usage of hearing instruments in pediatrics - Phonak

Fitting and usage of hearing instruments in pediatrics

»

Christine Jones, AuD

Acknowledgements



Daniel Meier  Maneula Feilner  Dawn Ruley  Angela Pelosi  Katarina Mathes  Pediatric Team: Miranda, Stacey, Lindsay, Dane, Shannon, Lisa, Megan and Dave  All of the centers who participate by sharing their fitting data

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Agenda

1. Overview 2. Use of hearing instruments 3. Application of style and features 4. Provision of frequency lowering 5. Conclusion 3

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Overview

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Cuper

» 6696

Pediatric HI fittings

» 44

US Unique Sites » 36 pediatric clinics » 8 schools

» Data

streamed to a secure server between May-Nov 2013 » Anonymized » HIPPA compliant » Clinic consent 5

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Cystic fibrosis: a case study of getting better

CF mortality rate >20%/yr. Avg life expectancy /= 8 hours/day

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8-10

10-12 12-14 14-24

Application of styles and features

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Device class by age 80% 70% 60% 50% 40%

Economy

30% 20%

Business

10%

First

0% 0-4

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5-8 AGE GROUP

9-18

Style selection by age group 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

BTE RIC CUSTOM

0-4

18

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5-8 AGE GROUP

9-18

Junior mode defaults Program structure

0-3 years

4-8 years

9-18 years

Start-up

Roger/FM+M

Roger/FM+M

SoundFlow

Rx formula

DSL 5 Peds

DSL 5 Peds

DSL 5 Peds

Soundflow

Disabled

Disabled

Enabled

Push button

Disabled

Disabled

Enabled

Volume control

Disabled

Disabled

Enabled

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Start up programs 0-18 7000

6000

5000

50%

4000

35% 3000

2000

10% 1000

4%

0

sound Flow

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calm situation fm

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speech in quiet

school fm mic

speech in noise

Accessible noise solutions 7000

*

6000

Accessible FM/Roger program.

Sound Flow calm situation fm speech in quiet

5000

4000

3000

* * *

speech in noise

Up to 45%of children have

accessible dir mic

school fm mic comfort in noise phone t coil mic public buildings t coil mic music

2000

*

1000

0

21

phone

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manual direction

*

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speech in very loud noise tv t coil mic custom

Active program toggle available 100% 90% 80% 70% 60% 50% 40% 30%

0.81 0.65 0.53

20% 10% 0% 0-4 22

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5-8

9-18

disabled enabled

Automatic program start up or accessible by age group 100% 90%

80% 70% 60% 50%

Start-up

40%

Accessible

30% 20% 10% 0% 0-4 23

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5-8

9-18

Soundflow Programs

Calm situation

Speech in noise

«Calm situation»  Natural sound

«Speech in noise» • Understanding speech in

difficult environment

Comfort in noise

Music

«Comfort in noise» • Pleasant hearing in noise

«Music» • Enjoying music, listening

actively music

Manual Vs. Automatic To optimize the HI for different hearing situations…..

«Additional programs»: ….switch manually between different programs.

«SoundFlow»: …automatically «fades» between the programs.

Soundflow Structure Output of the classifier Front Mic

Calm situation

100%

8:00

SoundFlow

11:00

Actuator steering

15:00

Time

Class proportion

Classifier

Speech in Noise

Noise

Actuators:  Sound Cleaning  Gain

Music

8:00 2013 Dec 10

Time

0% 11:00

15:00

Portable audio recording equipment for children

Method for capturing real life usage and hearing performance Flow of activities

8:00

of soundscape

11:15

of hearing object selection

13:30

16:00

School day (t)

Flow of hearing performance 100% of need 8:00

11:15

13:30

16:00

To investigate: flow of optimal signal processing = ground truth e.g.: static BF strength

? 8:00

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11:15

? 13:30

16:00

School day (t)

Real life examples of classroom listening scenarios

Relevant programs: 1. «Calm situation» 2. «Speech in noise»

Hearing impaired child: Wearing recorder

Time stamp 2013 Dec 10

Provision of frequency lowering

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Use of frequency lowering by age group 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

69%

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65%

67%

76%

partial active

0-4

31

69%

deactivated

5-8

9-18 Ages

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19-65

66-140

Average audiograms for fittings with and without frequency lowering

FrLo off

FrLo on

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Workflow

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Appointments Days between initial fitting and 1st follow-up appt » 60

(0-4) » 80 (5-8) » 90 (9-18)

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Minutes per appointment

18 16 14 12 10 8 6 4 2 0

1st Follow up

0-4

35

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5-8 9-18 Age group

19-65

RECD 100% 90% 80% 70% 60% 50%

Measured RECD

40%

Avg RECD

30% 20% 10% 0% 0-4 36

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5-8

9-18

In summary • Majority of pediatric fittings in US apply validated prescriptive method, •

• •

•

• 37

DSL Children are often given noise solutions such as manual directional microphones programs and automatic programs, but it is unclear 1. how often and how well individual children utilize these features them 2. How well the programs are able to make their listening intent more salient Usage data indicates that children are using devices regularly and point to groups that need more counseling and encouragement. Sound Recover is being disabled more frequently with children with milder and HF hearing loss, indicating there is more work to be done in this area We are developing a research stream to help us better understand the performance of our hearing instruments in school environments There is an opportunity to connect these use patterns to outcomes 2013 Dec 10

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Thank you