MM301 - A Novel Masking Conditioning and Cross-check Technique to Evaluate Pediatric Patients

Abstract:
Conventional methods for teaching pediatric audiometric testing techniques do not necessarily take into account conditioning children with minimal language to a masking task. Adults and older children can understand instructions to ignore a masker and listen for a target stimulus, but children with minimal language can respond variably to the addition of a masker in a detection task. This session will teach a novel conditioning and cross-check technique not currently found in the pediatric audiologic evaluation literature. Description of the technique, along with illustrative case studies will be presented.

Summary:
Conventional methods for teaching pediatric audiometric testing techniques do not necessarily take into account conditioning children with minimal language to a masking task. Adults and older children can understand instructions to ignore a masker and listen for a target stimulus, but children with minimal language can respond variably to the addition of a masker in a detection task. Clinically, audiologists find that a child may not “condition” to the desired stimulus in the presence of masking noise. The conditioning technique to be described in this session involves presenting the masker and stimulus to the same ear with an adequate sensation level of the target stimulus. Although this approach is behavioral, it aligns with intentions from the Crosscheck Principle (Jerger & Hayes, 1976; Hall, 2016) by supporting audiologic findings by showing a child is still conditioned to the masked behavioral task. It can be performed using a standard two-channel audiometer system.

As will be illustrated in clinical case studies, this technique is particularly useful for assessing young children with single sided deafness (no response in one ear at the limits of the audiometric equipment) who require visual reinforcement audiometry. When faced with unmasked thresholds that exceed the interaural attenuation, traditional practices involve adding an effective masker to the better ear and conditioning a child to a stimulus at a level louder than the unmasked threshold. However, in a case of single sided deafness, the child cannot hear the stimulus in the presence of effective masking, leading to an unclear conditioned response from the child.

Furthermore, in a single sided deafness case, accuracy of results can insure appropriate audiometric and medical management. An unclear differentiation between unilateral moderately-severe unmasked audiogram versus a unilateral profound hearing loss might influence a hearing aid recommendation or cochlear implant consideration, respectively.

The technique to be presented can be particularly helpful in improving results accuracy and a clinician’s assessment for reliability of thresholds by conditioning with the stimulus and masker in the same ear - the ear with a known hearing level - then transitioning the stimulus to the test ear. This type of cross-check can also be utilized to determine whether a child fatigued or habituated to the stimuli in the masking condition. It can be applied to frequency-specific or speech testing.

To this author’s knowledge, this conditioning technique is not currently found in the pediatric audiologic evaluation literature, course curriculums, nor practice guidelines. By attending this session, clinicians will be able to implement this diagnostic skill into their everyday practice, thereby improving accuracy and confidence in behavioral testing when indicated.

Brief Summary of Clinical Takeaways:
For clinicians who test young children, the technique described in this session can aid in conditioning to audiometric testing with a masker in place by presenting both the stimulus and masker to the better hearing ear. It also serves as a cross-check for thresholds to insure accurate behavioral test results.