Aided cortical testing - the clinician's perspective

The Interacoustics Academy presents an interview with Aoife O'Meara, Senior Pediatric Audiologist at the Children & Young People's Audiology Centre at Guy's and St Thomas' NHS Foundation Trust in London, UK, to discuss the aided cortical test, how it has been implemented within the service and the benefits the test brings to different patient cohorts.

You can read the full transcript below.

Aided cortical patient groups

So, thanks for joining us today Aoife. Can you tell us a little bit about how you're using cortical testing in the sound field in your clinic?

1. Infants with permanent hearing loss

So, we use corticals for several reasons in our clinic, but the main reason is for our newborn population. Our newborns come from the newborn hearing screening. They will have an ABR test.

Quite often the children that we see in the corticals are children that have been born with a hearing loss and most of them have been fitted with hearing aids and some have not.

For our children that require hearing aids, we really like to use corticals when they're about four to five months old to help us validate the programming of their hearing aids and to ensure that they are fitted sufficiently for them.

2. Infants with temporary conductive loss (OME)

The other cohorts of children are, for instance, children who have glue ear and are experiencing temporary conductive hearing losses.

When they're about four to five months old, if the glue ear is still present, we like to use a cortical to make a judgment as to whether that child needs a form of hearing device such as a bone conduction hearing aid.

3. Children suspected of ANSD

There is another cohort such as children who are presenting with patterns of results that suggest ANSD. We know that with children that present with potential ANSD, some of them might need a hearing device and some may not.

We are then very dependent on parental reporting and questionnaires to decide whether that child needs a hearing device before they are at the behavioral testing stage.

Having a cortical can really help us make a management decision as to whether that child requires a hearing device before they turn eight months old and before we can test them behaviorally.

4. Patients with complex/additional needs

Perfect. It sounds like you're using this test in a lot of patient groups. Are there any other patient groups that we haven't talked about so far?

Yes, so we also see a lot of children with additional needs or complex needs. Some of these children might not test behaviorally or we might not have had sufficient information about their hearing quite some time.

If we feel like they will sit still and engage with our toys and be attentive in the test as well as tolerate the electrodes, we will consider a cortical assessment for them. However, again, it requires a lot of judgment as to whether that child will tolerate the testing as quite often, they do tend to be a little bit older.

Aided cortical advantages

Absolutely, but nice to have an additional tool in the toolbox. Since you've had the test, what advantages have you seen that it brings to your clinic and into the patient care itself?

So having corticals bridges a gap between and especially for our newborns. Quite often we will see them for their ABR assessment when they're a couple of weeks old and we have no other forms of testing a child's hearing until they're at least eight months old where we can then start performing VRA.

Especially for our children and our newborns that have been fitted with hearing aids, having corticals in between where we can complete corticals about four to five months old really bridges the gap. Having that cortical in between again allows us to make sure that the hearing aids are set up appropriately.

For instance, a hearing aid might not be loud enough for a child and if we're noticing that they're not hearing the softest sounds with their hearing aids, that allows us to make a management decision for instance to increase their hearing aids and then repeat the cortical.

If in the repeat cortical it shows that yes, now they are now accessing those softer sounds, we know that we made the right management decision for that child.

Implementing aided cortical testing

So having access to a new test is great and it's fantastic to hear that you're seeing many different patient populations with this test.

But you also then have to start to integrate that alongside all the other tests that you're currently doing. How have you gone about doing that in your clinic?

1. Room setup and equipment

So, it does take a little bit of preparation time.

The first thing I would say is that it's important to have a dedicated room where you can have enough space to set up the equipment and to have toys.

I would say it's helpful to have the cortical equipment on the Eclipse as a lot of our experienced clinicians who are trained in corticals are also trained in ABRs and are used to using the Eclipse.

The Eclipse itself is easy to use, and I would say that the equipment is also easy to calibrate. It literally takes a couple of seconds, which is fantastic, especially when you're in quite a busy clinic.

It's helpful to have equipment that's simple and easy and effective to use.

2. Dedicated number of clinicians

I would say it's also important to have a small, dedicated number of clinicians that will perform corticals. In our experience and in our hospital, we perform about four to six sessions of corticals a month.

So again, like ABRs, it's important that the clinicians are competent in corticals and keep up with their clinical skills.

3. Appropriate toys

The other thing is having appropriate toys. So, in our experience, we have spent quite some time looking at our toys and our resources and figuring out what works for our patients.

In our experience, we find that light-up toys and books are good methods of engaging with the child. We also have the option of a projector and putting on some YouTube videos or other videos that might help us engage with the child.

4. Communication between the tester and engager

Having good communication as well between the tester and the engager is also very important. We know that when the child's attention starts to veer off, that we might not get the result that we might be expecting.

And it's therefore important that, particularly for the engager, that they've got lots of different toys and things that they can use to really help that child stay engaged with the test.

Recommendation of aided cortical testing

So, with all that experience that you've had and all those patient groups that you're seeing, would you recommend aided cortical testing to other clinicians around the world?

Yes, absolutely. I think corticals are a fantastic method of testing and are super important for that in-between methods that I spoke about earlier on between the ABR and the behavioral assessments.

I really believe that corticals are a useful counseling tool for our patients and especially for our patients who have hearing losses and are fitted with hearing aids or who might not yet be fitted with hearing aids.

It's a useful management tool and allows us to really counsel our parents and allow them to understand a bit more around their child's hearing loss and coping with their hearing aids.