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

Abstract

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.

Teleaudiologia: a contribuição do acesso remoto nos casos de implante coclear – uma revisão sistemática

“…Além dos testes de percepção de fala, a audiometria condicionada e a audiometria de reforço visual (VRA) também podem ser realizadas. Os reforços visuais são obtidos por meio de brinquedos operados pelo assistente de teste por meio de controle remoto ou pedal, resultando em bons resultados e indicando ser possível utilizar estes métodos convencionais pediátricos na teleconsulta 17 .…”

“…Todo o processo de programação é realizado por meio de softwares de programação e um cabo conectado ao dispositivo, de forma síncrona. Neste sentido, antes da programação, é importante que o assistente verifique o sistema de vídeo conferência, para que eventuais dúvidas sejam sanadas 17 .…”

Toward Self-Measures in Cochlear Implants: Daily and “Homemade” Impedance Assessment

“…This progress was supported with the development of remote-access applications and new telecommunication systems (10,11). Audiologists started performing remote fitting and monitoring of implanted patients, allowing medical care while keeping patients at their homes with no significant differences regarding standard programming sessions (10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Expanded use of teleservices in otology and neurotology in response to the COVID‐19 (SARS‐Cov‐2) pandemic

“…[11][12][13][14] Likewise, teleaudiology has been used, albeit sporadically, for audiometric evaluations, while hearing aid and cochlear implant remote programming are emerging practices. [15][16][17][18][19][20][21] Two major obstacles heretofore to the development of teletechnology have been the inability to bill for teleservices, and the need for all platforms-the physician's and the patient's-to be HIPAA compliant. Previously only face-to-face encounters could be reim- For years, before the advent of COVID restrictions, the emerging live-motion technology had been embraced by Deaf and hearing-impaired people.…”

“…Otolaryngologists/head and neck surgeons who serve rural populations have long used telemedicine modalities to accommodate the inherent transportation challenges associated with physically bringing patients and physicians together 11‐14 . Likewise, teleaudiology has been used, albeit sporadically, for audiometric evaluations, while hearing aid and cochlear implant remote programming are emerging practices 15‐21 . Two major obstacles heretofore to the development of teletechnology have been the inability to bill for teleservices, and the need for all platforms—the physician's and the patient's—to be HIPAA compliant.…”