Question
Would you fit open style amplification on a 3 year old with normal hearing through 2K, notching to 50dB loss at 3-6k, returning to normal at 8k?
Answer
The first point is clearly this 3 year old should receive amplification with the hearing loss detailed. I would not be opposed to fitting the child as mentioned with an open style hearing aid IF all the questions one should ask about appropriateness have been addressed. When dispensing the open ear hearing aids for a child, there are some specific considerations that would include:
Physical activity - 3 year-olds are known to be quite rambunctious and not necessarily very agile; meaning they are likely to fall and bump more frequently than say a 7 or 10 year old child. Consequently, choice of earmold will be dictated by child activity level. It is possible to have open style earmolds made with helix locks for the normal active child. However, if the child has significant motor function delays that prohibits gross motor movement then an open dome coupling ear to hearing aid is a possibility.
Cognitive and Speech Development - Special considerations (such as FM system, speech therapy, etc) would have to be made if this 3 year-old has not achieved speech & language milestones using 3 - 4 word utterances, with some wh- questions, etc. Consequently, if the child has significant speech and language delays, a hearing aid allowing an FM boot with T-coil would be advantageous to maximize therapy and language enrichment times.
Verification Measures - should show this child is receiving the appreciable benefit from 3 - 6 kHz. This can be confirmed either with simulated or real ear probe microphone measures and soundfield audiometry. Since many of the instruments that specialize in open ear fits are now toting benefits up to 8 kHz, this is an important aspect I would want to investigate.
It is fortunate we live in an exciting day and age that we are able to remediate such a hearing loss that perhaps 20 years ago would have been prohibitive due to amplification limitations. If I felt I addressed all the issues and document rationale and benefit I would fit the child with an open ear fit hearing aid with the various optional components added.
Dr. Jackie L. Clark has been a dispensing audiologist for 20 years. She is a currently a senior audiologist at UT Dallas/Callier Center, and has been on faculty at UT Dallas, Behavioral & Brain Sciences - AuD Program for 10 years (teaching Pediatric Audiology, Introductory Audiology and Advanced Clinical Audiology). She resides in Flower Mound, Texas. Dr. Clark can be contacted at jclark@utdallas.edu