Stability of Audiometric Thresholds for Children with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Implications for Safety

Background:Children who wear hearing aids may be at risk for further damage to their hearing from overamplification. Previous research on amplification-induced hearing loss has included children using linear amplification or simulations of predicted threshold shifts based on nonlinear amplification formulae. A relationship between threshold shifts and the use of nonlinear hearing aids in children has not been empirically verified.Purpose:The purpose of the study was to compare predicted threshold shifts from amplification to longitudinal behavioral thresholds in a large group of children who wear hearing aids to determine the likelihood of amplification-induced hearing loss.Research Design:An accelerated longitudinal design was used to collect behavioral threshold and amplification data prospectively.Study Sample:Two-hundred and thirteen children with mild-to-profound hearing loss who wore hearing aids were included in the analysis.Data Collection and Analysis:Behavioral audiometric thresholds, hearing aid outputs, and hearing aid use data were collected for each participant across four study visits. Individual ear- and frequency-specific safety limits were derived based on the Modified Power Law to determine the level at which increased amplification could result in permanent threshold shifts. Behavioral thresholds were used to estimate which children would be above the safety limit at 500, 1000, 2000, and 4000 Hz using thresholds in dB HL and then in dB SPL in the ear canal. Changes in thresholds across visits were compared for children who were above and below the safety limits.Results:Behavioral thresholds decreased across study visits for all children, regardless of whether their amplification was above the safety limits. The magnitude of threshold change across time corresponded with changes in ear canal acoustics as measured by the real-ear-to-coupler difference.Conclusions:Predictions of threshold changes due to amplification for children with hearing loss did not correspond with observed changes in threshold over across 2‐4 yr of monitoring amplification. Use of dB HL thresholds and predictions of hearing aid output to set the safety limit resulted in a larger number of children being classified as above the safety limit than when safety limits were based on dB SPL thresholds and measured hearing aid output. Children above the safety limit for the dB SPL criteria tended to be fit above prescriptive targets. Additional research should seek to explain how the Modified Power Law predictions of threshold shift overestimated risk for children who wear hearing aids.