Mehta, Kinjal; (2020) Impact of Introducing Cortical Auditory Evoked Potentials (CAEP) into the Newborn Hearing Assessment Pathway. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Cortical Auditory Evoked Potentials (CAEPs) are electrophysiological responses in the cortex in response to sounds. In recent years it has become possible to measure CAEPs and the technology is clinically available. The aim of this research was to demonstrate if CAEPs are feasible to use in a clinical setting and to see if the CAEPs were helpful in optimising hearing aid use for infants under 6 months by showing if a child could detect speech tokens when aided. Recording of CAEPs with speech tokens presented in the free field was introduced into the audiology pathway for infants with a PCHI in 2011-2015 at a UK clinical service. Thirty-four children had followed an audiology pathway prior to CAEP introduction and forty-four children followed a pathway after the introduction of CAEP (using unaided and aided responses). Results showed that the median age at hearing aid fitting prior to CAEP introduction was 9.2 months and after the inclusion of CAEPs reduced to 3.9 months. The current study demonstrates that the inclusion of CAEP recording in the pathway facilitated earlier hearing aid fitting for milder-impairments. Two studies were conducted to better understand these findings. The first was a focus group to determine the factors that influenced parents’ acceptance of early aiding or early referral for cochlear implants. Eight sets of parents participated and they discussed all factors that affected their decision making process. The findings showed that hearing the speech tokens and seeing the clear pass/fail response was helpful for parents. The second study evaluated clinicians’ viewpoints. A questionnaire was developed and completed by 49 clinicians around the world (including the UK). Clinicians used the CAEPs to verify or modify hearing aid fittings and to counsel parents, reinforcing the need for hearing aids. The impact of the research has resulted in earlier hearing aid fitting, cochlear implant referrals and improved hearing aid use for children under the age of 6 months and allowed for honest, informative discussions with families.

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