Ontario Infant Hearing Program: Protocol for the Provision of Amplification
Ontario Ministry of Children and Youth Services. (2014).
Toronto, ON (Canada): Ontario Ministry of Children and Youth Services, (Version 2014.01), 1-100.
This guideline updates and supersedes previous Ontario Hearing Infant Protocol documents regarding amplification provision. The current guidance provides recommendations to audiologists about providing amplification to infants and preschool-aged children with permanent childhood hearing impairment. The following summary highlights broad recommendations to consider. See the Ontario Infant Hearing Program’s full text document for all of the recommended steps for providing amplification to infants and young children.
Child Amplification Laboratory, National Centre for Audiology, University of Western Ontario (Canada); Ministry of Children and Youth Services (Ontario, Canada)
Infants identified with permanent childhood hearing loss should be provided amplification between 3 and 6 months of age.
Infants and young children with permanent childhood hearing loss should be considered candidates for hearing assistive technology systems (e.g., FM system). See "Section 4.5: Other Assistive Technology" and "Addendum 6: Remote Microphone Hearing Assistance Technologies" of the full Ontario Infant Hearing Program text for details on FM verification and other resources.
Infants and young children diagnosed with permanent childhood hearing loss, including auditory neuropathy spectrum disorder and retrocochlear disorders, should be considered candidates for hearing device amplification. Non-electrocoustic characteristics (e.g., style of the hearing aid, monaural versus binaural fitting) and electroacoustic characteristics should be considered when selecting an amplification device. Ear impressions should be obtained to fabricate personal earmolds.
Audiologists trained in amplification provision protocol should prescribe and dispense amplification devices to infants and young children identified with permanent childhood hearing loss. Infants and young children should be referred to an otolaryngologist for consultation.
When conducting device verification, "the prescribed hearing instrument shall be adjusted to approximate the target electroacoustic values for gain and maximum output that were specified according to the … [child’s] Prescription" (p. 15) using real ear measurements. See "Section 5: Verification of Amplification" of the full document for a detailed description of verification.
Infants and young children fitted with amplification devices should receive regular follow-up care to assess outcomes of the intervention and to adjust the device as needed. During the device trial period, the child and family should have a minimum of 2 follow-up visits within 60 days. Additional follow-up visits should be scheduled on an ongoing, individual basis.
Evaluation of infants and young children for the provision of a hearing device should include otoscopy, measurement of real-ear-to-coupler difference, and auditory brainstem response or behavior-based audiometry (e.g., visual reinforcement audiometry, conditioned play audiometry)
Parents and caregivers of infants and young children with permanent childhood hearing loss should be provided instruction and counseling of hearing device care and use. See "Section 6: Information and Instruction" of the full Ontario Infant Hearing Program document for additional details and information.
