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
