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Pediatric Amplification
سال ارائه مقاله : 2013//
سال پذيرش : 2013//
نوع مقاله : Guide Line
دسته بندي :

خلاصه :

This document was prepared by the American Academy of Audiology Task Force on Pediatric Amplification. The
specific goal of this document is to provide a set of statements, recommendations, and strategies for best practices
specific to the application of amplification as part of a comprehensive treatment plan for the audiologic management
of children with hearing loss. Specific statements and recommendations were made by initially reviewing the existing
scientific evidence published in peer-reviewed and non-peer-reviewed journals. When direct evidence was not
available, both indirect evidence (often evidence from adults), and consensus practice were considered in making
recommendations. In some cases recommendations are based on acoustic or physical facts where an empirical
evidence base is not necessary and would not be expected (known as First Principles). This guideline addresses the
technical aspects of hearing aid selection, fitting, verification, and outcomes assessments. This guideline does not
address treatment solely with cochlear implants, but does touch on cochlear implants used in conjunction with a
hearing aid on the contralateral ear.
This guideline is not intended to serve as a standard to dictate precisely how hearing aids should be selected, verified,
or validated. This guideline is meant to provide the evidence base from which the clinician can make individualized
decisions for each patient. In addition, the guideline can help inform physicians, reimbursement agencies, government
agencies, the hearing health-care industry, patients, families, and caregivers about what research evidence
demonstrates are current best practices related to amplification. Finally, although this guideline addresses the technical
aspects involved in the fitting of hearing aids, the audiologist is reminded that the process of fitting hearing aids is an
ongoing one requiring joint participation of the audiologist, patient, and family/caregivers. As indicated, input should also
be sought from the Early Intervention provider, the classroom teacher, and other pertinent stakeholders.
The process of developing this guideline was evidence-based when possible. Evidence-based practice integrates
clinical expertise with the best available clinical evidence derived from systematic research. Where evidence is
ambiguous or conflicting, or where scientific data are lacking, the clinical expertise of the task force was used to guide
the development of consensus-based recommendations.
The previous document, Pediatric Amplification Guidelines (2003), comprised eight areas of focus: 1) audiologic
candidacy criteria, 2) principles underlying effective amplification, 3) signal processing and features, 4) fitting/verification,
5) other verification tools, 6) outcomes assessment, 7) management, follow-up and referrals, and 8) use of hearing aids
with other hearing technologies. In the literature search for the present document, task force members first sought to
identify studies at the top of the hierarchy of study types (see Table 1). Once definitive clinical studies that provided valid
relevant information were identified, the search stopped. The search was extended to studies/reports of lower quality
only if there were no higher quality studies. Traditionally, the highest levels of evidence include systematic reviews/
meta-analyses of randomized controlled trials and randomized controlled trials (Levels 1 and 2). The crossover design
is a valuable variation of the randomized controlled trial. Subjects are first identified and then randomized into treatment
groups with each group receiving a different treatment. After experiencing the treatment for a specified period, each
subject “crosses over” and receives the other treatment for a period of time. In a crossover design, all subjects produce
data from all of the treatments. In this manner, there are no issues related to group equivalence when the treatments are
compared. For these reasons, studies implementing crossover designs were labeled as Level 2 in this document.


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