Investigating Device Candidacy in Children with Moderate-to-Severe Hearing Loss - PROJECT SUMMARY/ABSTRACT Currently, our field lacks clear clinical consensus on which hearing device is most appropriate for children after diagnosis of bilateral sensorineural hearing loss. Evidence supports the recommendation of hearing aids (HAs) for children with mild to moderate hearing loss, and cochlear implants (CIs) for children with severe-to-profound loss. However, device candidacy for children with moderate-to-severe hearing loss is less defined, with limited evidence supporting device recommendations for these children. This lack of evidence has resulted in doubtful and inconsistent decision making for professionals and parents, leaving these children waiting until they show significant delays before changing course of intervention and/or children significantly underperforming relative to their maximum potential. To address this gap, the long-term goal of this research program is to refine device candidacy via a longitudinal investigation of outcomes of children with moderate-to-severe hearing loss to characterize development concurrently in children with HAs and children with CIs. To inform this long-term goal, we propose a short-term goal of cross-sectionally investigating how auditory access (e.g., unaided hearing, aided hearing, device use) predicts outcomes in current HA users (Aim 1) and in children who transitioned from HAs to CIs (Aim 2). This proposal is grounded in the central hypothesis that the benefit of HAs (i.e., well-fitted, consistently worn HAs) will reduce as unaided hearing worsens, and that this point of diminishing returns may serve as an indicator of CI candidacy for children with moderate-to-severe hearing loss. In Aim 1, we will evaluate candidacy factors in children with moderate-to-severe hearing loss who use hearing aids. We will prospectively assess multidisciplinary factors that are formally and informally considered when determining whether a child could benefit from a CI. Audiometric, child, and family variables will be investigated as predictors of spoken language, academic performance, and psychosocial outcomes. We anticipate that audiometric factors will predict these outcomes, but additional variance will be explained by family and child factors, helping to differentiate children who lack auditory access from those who may benefit from other supports. In Aim 2, we will examine the impact of pre-implant auditory access on post-implantation outcomes in children with cochlear implants. We will retrospectively review multi-site clinical data to describe how pre-CI hearing (e.g., aided and unaided hearing, device use) impacts post-CI auditory skills, speech perception, and language outcomes. We hypothesize that age at implantation and amount of HA use prior to implantation will predict outcomes after implantation, but effects will be contingent on the magnitude of pre-CI hearing. Results from this project will advance scientific knowledge and clinical practice by improving predictions of performance in children with moderate-to-severe hearing loss. This proposed work serves as a first step towards more individualized recommendations for device candidacy for children who are deaf and hard of hearing, supporting the goals of the strategic plan of the NIH related to precision medicine.
