Questionnaires on satisfaction of amplification in children : a systematic review

Purpose: To perform a systematic review of the literature on questionnaires to assess the benefits of using hearing aids in children. Methods: A literature search was conducted in the data-bases Web of Science and Virtual Health Library (BIREME). The selection criteria included: title consistent with the purpose of this review; participants necessarily being children using hearing aids; and questionnaires to assess the benefits and satisfaction. Results: More evidence was found in studies that used the scale Parent’s Evaluation of Aural/Oral Performance of Children (PEACH), making it possibly the most consistent scale on the subjective evaluation of the use of amplification in children. Conclusion: There is a paucity of studies with this approach; however, the results showed the importance of researches in this area, which turns the subject into an important field

of the use of amplification in children.Conclusion: There is a paucity of studies with this approach; however, the results showed the importance of researches in this area, which turns the subject into an important field of research.

INTRODUCTION
Recent advances in the treatment of the hearing impairment have made possible the access to the auditory perception of speech sounds for children with sensorineural hearing impairment, providing valuable benefits to the communication and quality of life of children with hearing impairment.
The technological advance of the amplification systems, specifically the hearing aids (AASI), brings the necessity to evaluate the impact and the resultant benefits of these resources in the auditory abilities of its users as well as in the services rendered by the programs of auditory rehabilitation (1,2) .
The questionnaires to the parents of children who use AASI are a complementary tool that provides higher understanding of the specific difficulties of the child and assists in the best adjust of the used devices and in the accompaniment of the intervention in this population, helping to verify if the rehabilitation results are being reached.
Regarding to the presented problem, the objective of this study was to carry out a systematic review of the literature about questionnaires that evaluate benefits of the AASI use in children.

METHODS
Considering that the systematic review is carried out from the formularization of specific questions that direct the search of publications, the question of this study investigation was: "Which are the satisfaction evaluation questionnaires related to the use of AASI in children with hearing impairment?" The search strategy used was by means of "research through DeCS/MeSH keywords."The combination between the keywords was carried out: "Child"; "Hearing AIDS"; "Patient Satisfaction"; "Hearing Loss"; "Questionnaires"; "Child"; "Patient Satisfaction"; "Auditory Prosthesis"; "Questionnaires." The bibliographical research was carried out in the databases Web of Science (www.isiknowledge.com) and in BIREME -Biblioteca Virtual em Saúde (BVS) (www.bireme.br) that includes the databases LILACS, MEDLINE, Biblioteca Cochrane, SciELO and IBECS (Table 1).There was no restriction regarding to the year of publication, the studies published until December of 2012 were analyzed.
For the selection and evaluation of the raised scientific studies in the electronic search, the criteria were established considering: type of studies (systematic reviews, meta-analysis and randomized controlled studies), participants (children who use hearing aids), the adopted intervention (use of questionnaires) and the evaluation of the results (evaluation of the benefit and satisfaction questionnaires).
In the search were evaluated and chosen only the studies whose heading, summary or body of the article had relation with the focus of the present study.After the selection of the summaries of found studies, pertinent to the proposed question was carried out the recovery of articles in complete text.The data of each one of the potentially relevant articles for systematic review were collected by means of a protocol form by two reviewers.

RESULTS
Duplicated publications (31) and those which did not have the corresponding content to the proposed objective were excluded (378).At the end of the survey, six relevant articles (3)(4)(5)(6)(7)(8) were selected for the systematic review, one of them was carried out in Brazil and the other five in another countries.Table 2 presents the main aspects of the studies selected for the systematic review.
Among the six studies (3)(4)(5)(6)(7)(8) selected for this systematic review, only two articles (7,8) had answered to the main question, that was the use of questionnaire for the benefit and satisfaction evaluation in children who use AASI.

DISCUSSION
The questionnaires to the parents of the children who use AASI have become one of the main allies of the physicians to evaluate the benefits and the satisfaction regarding to the amplification use (7) .
The studies (8,9) considered more specific to the ultimate topic of this systematic review had used the scale Parent's Evaluation of Aural/Oral Performance of Children, which was developed with the objective to evaluate the effectiveness of the amplification in children with different ages and hearing impairment levels.It is a measure of the functional performance of the child in situations of daily life based on the parents' systematic observations.
The fact of being a measure of the functional evaluation makes Parent' s Evaluation of Aural/Oral Performance of Children extremely important to the audiology professionals, therefore the analysis of its answers turns possible the accompaniment of the audiologic intervention, offering useful information about the efficiency of the hearing aids, going well with the objective evaluations.
In a different way of the literature about benefits and satisfaction of the amplification use in children, the literature about this same thematic in adults and aged is enough ample (10,11) .There is an increase need of evaluating not only clinical measures of effectiveness related to the communicative abilities, but also the involved aspects in the effectiveness of the treatment, as, for example, the satisfaction and the quality of life.
The questionnaires have become one of the main allies of the physicians to evaluate the benefits and the satisfaction regarding to the amplification use, therefore the results of the child auditory behavior and the parents' opinion about the amplification use are equally important to taking decisions.These decisions include the choice of the amplification and its adjustments, the therapeutical aims for the auditory and language abilities, the educational option and the need of interventions and/or devices of another origin (12,13) .
It is important to highlight that the ability of evaluating the associated satisfaction with the AASI used in children with hearing impairment is an important field of performance and research in the Educational Audiology area, once found the few studies in the literature about this thematic.

CONCLUSION
The literature is scarce when considered the developed studies with the objective of validating questionnaires to the functional benefit evaluation and satisfaction in children regarding to the AASI use, making the subject an important investigation field.
*TMM and ADC were responsible for the data collection and tabulation; MFCGM has collaborated with the collection and tabulation and the supervising of the data collection; MANSM has followed the data collection and collaborated with the data analysis; RTSJ, ALMM and MCB were responsible for the project and delineation of the study and general orientation of the execution stages and the manuscript elaboration.Transversal study Freitas e Costa, 2007 (6) 31 children Elaborated by the researcher herself -To verify the difficulties related to the use and the batteries and ear mold management, also the amplification characteristics.
-To argue about the several involved aspects in the adaptation process of the cochlear implants, guidance and accompaniment in this study group.

Transversal study
Ching and Hill, 2007 (8) 65 children Parent's Evaluation of Aural/Oral Performance of Children (PEACH) -To develop a subjective measure to quantify the effectiveness of the amplification in children in their daily routine, independently of their age and level of hearing loss.Transversal study Ching et al., 2010 (9) 48 children Parent's Evaluation of Aural/ Oral Performance of Children (PEACH)/Teacher's Evaluation of Aural/Oral Performance of Children (TEACH) -To study judgments of speech intelligibility and daily performance children with hearing impairment using the hearing aids comparing the prescriptive rules NAL-NL1 and DSL.Double-blind longitudinal study

Table 1 .
Publication number found for database in accordance with the keywords

Table 2 .
Relation of the studies analyzed for systematic review