There is a lot of discussion in pediatric audiology about when to start using remote microphone systems for little ones with hearing loss. The opinions vary from shortly after we fit them with hearing aids (mine) to not until they start school. My view about early use of FM may come from the state of technology when I started in this field in the 1960’s. We did not have hearing aids with enough output to provide good auditory access to children with severe and profound hearing loss. And cochlear implants were not yet available. When FM first became available they were in body worn devices that had hearing aid and remote microphones in them. I fit children with these body worn devices and parents wore the microphones. The kids did well. Parents reported that wearing that microphone around their necks was a constant reminder that they needed to talk talk talk.
The data
Children learn what they hear. Children with hearing loss, like their typical hearing peers, need a lot of language exposure if they are to learn. Research by Hart and Risley (1995) and others have made it clear that the more exposure a child has the better their language is and the higher their IQ is. Research shows that children who wear well fit hearing aids, even 10+ hours/day still have language delays. It is reasonable to conclude that compromised exposure to good linguistic output is a factor in delayed language skills for children with hearing loss. Listening in background noise is a well know problem for children and adults with hearing loss. Remote microphones certainly help reduce the negative effects of background noise.
The Journal of Speech, Language, Hearing Research just published an article which confirms the advantages of early home use of remote microphones. Benitez-Barrera et al (2018) did a study in which then evaluated home use of remote microphone systems on spoken language of caregivers of children with hearing loss. They demonstrates that children who’s parents used a remote microphone system at home had access to approximately 42% more language exposure than when a remote microphone system ways not used.
The reasons for this are multiple. First, even if the child is at distance from the caregiver, and even when there is background noise, she will be receiving a loud and clear signal. In addition, knowing that the child hears what they are saying will encourage caregivers to talk more.
So should all children with hearing loss have remote microphones?
I understand the concern that some audiologists make, that children should not be fit with remote microphones until they are capable of reporting problems with the equipment. I disagree. I understand the concern but the advantages of good language exposure are overwhelming. Certainly for children with hearing aids, the parents can listen to the hearing aid in their daily hearing aid check and can also listen to the remote microphone and will know if it is working. True, this is more difficult to do when children are using cochlear implants but we can observe responses and monitor performance.
The data that supports how much a child benefits from exposure to language is overwhelming. Babies should be fit with remote microphone when they are fit with technology!!! Parents need to demand it. Listening and spoken languages need to demand it. Audiologists need to provide them. Let’s make use of the data have and provide babies with the ability to be the best they can be.
*featured image courtesy hearingfirst
Forget the babies I’ve made remote mics mandatory on *all* of my fittings, starting in September 2012 when GN ReSound came out with their low-latency Mini Mic. Due to short battery life and poor mic quality, I agreed with Jace Wolfe that this solution wasn’t so good for kids. However, in June 2016, GNR fixed the problem with their MultiMic (which GN licensee Cochlear also sells); and it is just about as good as Phonak’s Roger Pen.
The two biggest problems with FM in the past and present, which lead to kids rejecting it, are 216 MHz (N-band) in-band interference (fixed with 2.45 gHz digital transmission), and improper adjusting of the remote/ambient audio balance: Set the mix ratio too high, and Junior can’t hear questions by his peers. Set the mix ratio too low, and ambient noise can predominate.
Dan Schwartz
Auditory Associates
Editor, The Hearing Blog
Atlanta
Hi Jane
While the study shows much more auditory input, do you think there is likely to be an issue with much of this input not having context? I’m thinking that if a parent wears a mini mic and they don’t turn it off when they move away to do something else, the conversation the child is hearing will lack context. It seems to me that people learn language from hearing the language and joining it to meaning gained through context. I wonder if there is need to continue this research and look to see if this 42% increase in language exposure translates across to language cognition and production.
I do agree that many of the concerns about reporting of issues and technical inadequacy of mics have been addressed in recent times with the advent of devices like the Mini Mic. However just the other day I spent 20min trying to get my daughter’s MM2+ to work on our laptop. I am still at a loss as to why it wasn’t working. Haven’t had issues before with the device. My daughter (11yo) is now very capable of providing good self reporting and even self fixing of most issues.
Anyway… interested in your thoughts on the connection with context.
Kind regards
Sym