Techniques for Remotely Programming Children With Cochlear Implants Using Pediatric Audiological Methods via Telepractice

Abstract

Purpose: The purpose of this report is to describe the equipment setup and techniques for successfully testing behavioral thresholds in young children with cochlear implants (CIs) using telepractice. We will also discuss challenges associated with pediatric CI programming that are unique to the use of distance technology, and we will describe ways to overcome those challenges. Last, we will review the results from 2 recent studies specifically targeted toward testing behavioral thresholds in young children with CIs.

Method: Conditioned play audiometry or visual reinforcement audiometry was used to measure behavioral thresholds (T levels) for 35 young children with CIs (n = 19 for conditioned play audiometry and n = 16 for visual reinforcement audiometry). Participants were tested in the traditional in-person condition and in the remote condition using an AB-BA study design over 2 visits.

Results: There was no significant difference in T levels between the in-person and remote conditions, indicating that it is feasible to test young children using conventional pediatric testing procedures via remote technology. The primary challenges encountered were in regard to proper camera and video monitor placement at the remote site and the timing of communication between the audiologist and test assistant.

Conclusions: The results from studies to date suggest that distance technology can be used successfully to program CI sound processors for young children using standard, age-appropriate testing techniques. The alternative of remote testing has substantial implications for reducing time and travel burdens for families, potentially leading to the construction of appropriate maps for young children with CIs in a timelier manner.

Figures

Figure 1.

Schematic illustration of equipment and participant setup for remote testing. Left: cochlear implant (CI) audiologist site. Right: remote site with the child, caregiver, and test assistant. VR = visual reinforcer. Adapted from Hughes et al. (in press).

Figure 2.

Bar graphs depicting mean T levels (bar height) and standard errors (whiskers) for measures made in the traditional in-person condition (white bars) versus the remote condition (gray bars). Data are averaged across all participants and tested electrodes. Left panel: results for the younger age group, obtained using visual reinforcement audiometry (VRA; data from Hughes et al., in press). Right panel: results for the older age group, obtained using conditioned play audiometry (CPA; data from Goehring & Hughes, 2017). The number of participants is noted in each panel. Means are denoted on each bar. nC = nanocoulomb.