MeasuringSound-ProcessorThresholdLevelsforPediatricCochlearImplantRecipientsUsingVisualReinforcement

AudiometryviaTelepractice

JoshuaD.SevierAuDSangsookChoiPhD

MichelleL.HughesPhD

ACIA2017,SanFrancisco

JoshuaSevier•  Noconflictstodisclose

Introduction

•  Why is telepractice needed for CI recipients?

Reason #1: Lots of visits!

Introduction

•  Whyisteleprac7ceneededforCIrecipients?

Reason#2:CIcenters(especiallypediatricones)arenotoneverycorner!

Introduction

•  Whyisteleprac7ceneededforCIrecipients?

Reason#2:CIcentersarenotoneverycorner!

Omaha:3CIcenters

7-hrdrive

Introduction Specific to pediatrics: •  Special techniques

–  Conditioned play audiometry (CPA) –  Visual reinforcement audiometry

(VRA)

•  Special equipment –  Toys/games –  Lighted/animated objects

Introduction •  Previous research:

–  Threshold (T) and upper-comfort (M/C) levels in adults & adolescents are not significantly different between remote and in-person measures. (Ramos et al., 2009; McElveen et al., 2010; Wesarg et al., 2010; Hughes et al., 2012; Eikelboom et al., 2014; Kuzovkov et al., 2014)

–  Only one study has been done using CPA (Hughes et al., 2017)

–  No study has been done utilizing VRA with this population

Study Goals

•  Compare in-person vs. remote behavioral thresholds (T-levels) in young children with Cis via VRA

•  Hypothesis: T-levels not significantly different between conditions

VRA Methods

•  Goal: 20 pediatric CI recipients

–  Data to Date: 16 recipients –  Age at Test: 1.1—3.4 y –  Avg. Duration CI Use: 0.66y (~8m) –  Devices: 3 Cochlear, 11 Advanced Bionics, 2 MED-EL

Methods

•  2 visits –  ABBA design (A = in-person, B = remote) –  Both visits at BTNRH

•  T-levels averaged across visits for each condition due to limited hit rate.

Visit 1 Visit 2

In-person (A) Remote (B)

Remote (B) In-person (A)

VRA MethodsIn-Person Condition:

•  Audiologist controls programming software

•  Child seated to avoid visual cues from computer or audiologist

•  Play assistant engages child in behavioral task

•  Other outcome measures: –  Hit Rate –  Test Time –  Parent/caregiver questionnaire

VRA In-Person Session

VRA MethodsRemote Condition:

•  Audiologist remotely controls programming software at recipient site (requires peripheral hardware at recipient site)

•  Child seated to avoid visual cues from videoconferencing system

•  Same play assistant engages child

in behavioral task

VRA Remote Session

VRA Results T levels: •  No significant effect of condition or electrode (p>0.6)

Basal

T-Le

vel (

nC)

02468

101214 Middle

02468

101214

Apical

02468

101214

N = 16

In-person Remote In-person Remote In-person Remote

VRA Results Hit Rate: •  No significant difference in #

attempts (p = 0.3) –  In-Person = 6.9 attempts –  Remote = 7.2 attempts

•  No significant difference in Hit Rate (p = 0.9) –  In-Person = 77.8% –  Remote = 76.8%

rem hits&&miss : 53.0000 rem hits&&miss : 47.0000

Hits

Hits & Misses - VRA group

Num

ber o

f Beh

avio

ral R

espo

nses

2

4

6

8

10

12 In-PersonRemote

Hits Misses Total Tries

N = 16

VRA Results Test Time:

•  2-way RM ANOVA: –  No significant effect of Visit or Condition (p > 0.2) –  Visit 1 = 13.5 min; Visit 2 = 12.3 min –  In person = 12.5 min; Remote = 13.3 min

VRA Results Questionnaire:

•  50% of respondents reported it can be hardship to attend programming appointments

•  81% of respondents said they would use telepractice “some or all of the time” for routine programming needs

•  100% of respondents did not feel overwhelmed at all by the distance technology

Conclusions

•  T levels are not significantly different between in-person and remote conditions à it can be done!

•  Activation or device/equipment checks should

be done in-person.

References •  Eikelboom,R.H.,Jayakody,D.M.P.,Swanepol,D.W.,Chang,S.,&Atlas,M.D.(2014).Valida7onofremote

mappingofcochlearimplants.JTelemedTelecare,20(4),171-177.•  Franck,K.,Pengelly,M.,Zerfoss,S.(2006).Telemedicineoffersremotecochlearimplantprogramming.Volta

Voices,January/February2006.•  Hughes,M.L.,Goehring,J.L.,Baudhuin,J.L.,Diaz,G.R.,Sanford,T.,Harpster,R.,&Valente,D.L.(2012).Useof

telehealthforresearchandclinicalmeasuresincochlearimplantrecipients:Avalida7onstudy.JournalofSpeech,Language,andHearingResearch,55(4),1112-1127.

•  Hughes,M.L.,Goehring,J.L.,Miller,M.K.,Robinson,S.N.(2016).Pediatriccochlearimplantmappingviateleprac7ce.Perspec7ves,volume,pages.

•  Kuzovkov,V.,Yanov,Y.,Levin,S.,Bovo,R.,Rosignoli,M.,Eskillson,G.,Willbas,S.(2014).RemoteprogrammingofMED-ELcochlearimplants:users’andprofessionals’evalua7onoftheremoteprogrammingexperience.ActaOto-Laryngologica,134(7),709-716.

•  McElveen,J.T.,Blackburn,E.L.,Green,J.D.,McLear,P.W.,Thimsen,D.J.,&Wilson,B.S.(2010).Remoteprogrammingofcochlearimplants:Atelecommunica7onsmodel.Otology&Neurotology,31,1035-1040.

•  Ramos,A.,Rodríguez,C.,Mar7nez-Beneyto,P.,Perez,D.,Gault,A.,Falcon,J.C.,&Boyle,P.(2009).Useoftelemedicineintheremoteprogrammingofcochlearimplants.ActaOto-Laryngologica,129,533-540.

•  Wesarg,T.,Wasowski,A.,Skarzynski,H.,Ramos,A.,Gonzalez,J.C.,Kyriafinis,G.,Junge,F.Novakovich,A.,Mauch,H.,&Laszig,R.(2010).RemotefilnginNucleuscochlearimplantrecipients.ActaOto-Laryngologica,130,1379-1388.

Acknowledgements Assistance with data collection: •  Jenny Goehring •  Sara Robinson •  Jacquelyn Baudhuin •  Maggie Miller •  Rachel Scheperle

Technical assistance: •  Roger Harpster •  Dave Jenkins •  Todd Sanford Funding: NIH, NIDCD R01 DC013281 and P30DC04662

ThanksforstickingaroundonaSaturday!

JoshuaSevier,Au.D.

Joshua.Sevier@boystown.org