Hearing aids for children with conductive hearing loss : outcomes and caregiver experiences

Abstract

Hearing aids (HAs) are considered an alternative to surgical intervention for otitis media (OM). However, it is essential to determine whether they are an effective management option for children with CHL in a low-to-middle-income country (LMIC) such as South Africa, as well as what caregivers’ experiences are regarding this form of management. The aim of this study, therefore, was to describe the outcomes and caregiver experiences of children with conductive hearing loss (CHL) fitted with behind-the-ear (BTE) HAs.

This study was carried out in two phases. Phase 1 involved a retrospective review of clinical data from children aged 0-13 years with CHL who were fitted with BTE HAs between January 2017 and March 2020 at Red Cross War Memorial Children’s Hospital (RCWMCH). The study sample included 19 children (mean age 88.6 months; 36.9 SD; range 14.0-149.0) with CHL fitted with BTE HAs (11 bilateral and 8 unilateral) and with available outcome data. HA fitting details were obtained for 17 participants and outcomes at the one-month post-hearing aid fitting were documented in terms of daily HA use (data-logging) (n=14/19) and caregiver and teacher reported auditory behaviour obtained through the Parents’ Evaluation of Aural/oral performance of Children (PEACH) (n=12/19) and the Teachers’ Evaluation of Aural/oral performance of Children (TEACH) (n=13/19) respectively. Phase 2 involved a telephonic survey with caregivers of phase 1 participants (n=13/19), to explore their perceptions and experiences.

Average HA use was 6.2 h/day (2.6 SD; range 3.8-10.1) for unilateral HA users and 6.5 h/day (2.0 SD; range 4.1-10.3) for bilateral HA users. PEACH results indicated 83.3% of paediatric HA users used their HAs more than 75% of the time at home; with more than half (58.3%) of the paediatric HA users showing typical auditory behaviour after one month of HA use. TEACH results indicated that 92.3% of paediatric HA users used their HAs more than 75% of the time at school. Paediatric HA users performed better in quiet than in noise, with limited sensitivity to loud sounds at home and school. Caregivers who participated in the telephonic survey reported HA use of more than five hours a day for most children (76.9%). All caregivers reported perceived benefit from their children’s use of HAs and most caregivers (76.9%) indicated that their children provided positive feedback regarding wearing their HAs.

Children in this study sample used their BTE HAs for comparable hours reported for children with sensorineural hearing loss (SNHL), but not for the recommended use required for optimal language development (10 h/day). Caregivers were supportive of HA use for CHL, with perceived benefits equivalent to expectations. The challenges experienced by caregivers are similar to those reported in high-income countries regarding stigma and device compliance. Children with CHL demonstrate clear benefit from using BTE HAs.