Factors affecting the use and perceived benefit of ITE and BTE hearing aids

Comparing criteria for deviation from hearing aid prescriptive targets in children

OBJECTIVE

To determine if a stricter criterion for paediatric hearing aid fitting for proximity of fit-to-target of <3 dB root-mean-square (RMS) error produces better audibility and outcomes compared to the current <5 dB criterion, and to examine the relationship between aided audibility and RMS error by degree of hearing loss.

DESIGN

We evaluated the influence of unaided hearing level on the relationship between RMS error and aided audibility. We assessed the effect of RMS error category (<3, 3-5, >5 dB) on aided audibility, speech recognition, expressive vocabulary, and morphosyntax.

STUDY SAMPLE

The study included 2314 hearing aid verification measurements from 307 children with hearing aids.

RESULTS

Children who met a <3 dB criterion had higher aided audibility than children who met no criterion (>5 dB error). Results showed no differences in speech recognition or vocabulary by error category, but children with <3 dB error demonstrated better morphosyntax than children with 3-5 and >5 dB RMS error.

CONCLUSIONS

Fittings that are close to prescriptive targets provide a more positive outcome for children with hearing aids. Using probe microphone measures to adjust hearing aids to within 3 dB may benefit language abilities in children.

Improving speech intelligibility in noise and spatial perception: the critical role of hearing aid microphone position

Introduction

Hearing aid (HA) manufacturers have introduced behind-the-ear (BTE) models where the microphone is positioned in the ear canal, which could impact auditory performance by distorting the pinna's acoustic cues. This study aimed to compare two different BTE HAs with varying microphone positions: the receiver in the ear (RITE) and the transducer in the ear (TIE).

Methods

The study involved 10 participants who had never used HAs before. They used both RITE and TIE HAs bilaterally for 3 weeks. Auditory performance was assessed through free field hearing assessments (hearing thresholds, speech recognition threshold, and speech discrimination score), the Turkish Matrix Sentence Test (TURMatrix), a sound localization test, and the Satisfaction with Amplification in Daily Living (SADL) questionnaire.

Results

There was no significant difference between TIE and RITE in the free field hearing assessments. However, TIE outperformed RITE in non-adaptive TURMatrix scores in quiet, adaptive TURMatrix scores in noise, and sound localization accuracy at various angles. SADL sub-scores (Positive Effect, Service and Cost, and Personal Image) and overall satisfaction scores were significantly better for TIE.

Discussion

The microphone position in HAs can influence auditory performance. This study demonstrated that TIE provided better speech intelligibility, localization accuracy, and user satisfaction compared to RITE.

Premium versus entry-level hearing aids: using group concept mapping to investigate the drivers of preference

OBJECTIVES

To investigate the difference in outcome measures and drivers of user preference between premium and entry-level hearing aids using group concept mapping.

DESIGN

A single-blind crossover trial was conducted. Aided behavioural outcomes measured were loudness rating, speech/consonant recognition, and speech quality. Preference between hearing aids was measured with a 7-point Likert scale. Group concept mapping was utilised to investigate preference results. Participants generated statements based on what influenced their preferences. These were sorted into categories with underlying themes. Participants rated each statement on a 5-point Likert scale of importance.

STUDY SAMPLE

Twenty-three adult participants (mean: 62.4 years; range: 24-78) with mild to moderately severe bilateral SNHL (PTA_{500-4000 Hz} > 20 dB HL).

RESULTS

A total of 83 unique statements and nine distinct clusters, with underlying themes driving preference, were generated. Clusters that differed significantly in importance between entry-level and premium hearing aid choosers were: Having access to smartphone application-based user-controlled settings, the ability to stream calls and music, and convenience features such as accessory compatibility.

CONCLUSION

This study has identified non-signal-processing factors which significantly influenced preference for a premium hearing aid over an entry-level hearing aid, indicating the importance of these features as drivers of user preference.

Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics

Direct-to-consumer (DTC) hearing devices can be purchased without consulting a hearing health professional. This project aims to compare 28 DTC devices with the most popular hearing aid supplied by the U.K. National Health Service (NHS). The comparison was based on technical performance, cosmetic acceptability, and the ability to match commonly used gain and slope targets. Electroacoustic performance was evaluated in a 2-cc coupler. Match to prescription target for both gain and slope was measured on a Knowles Electronic Manikin for Acoustic Research using a mild and also a moderate sloping hearing loss. Using an online blinded paired comparison of each DTC and the NHS reference device, 126 participants (50 were hearing aid users and 76 were nonhearing aid users) assessed the cosmetic appearance and rated their willingness-to-wear the DTC devices. The results revealed that higher purchase prices were generally associated with a better match to prescribed gain–frequency response shapes, lower distortion, wider bandwidth, better cosmetic acceptability, and higher willingness-to-wear. On every parameter measured, there were devices that performed worse than the NHS device. Most of the devices were rated lower in terms of aesthetic design than the NHS device and provided gain–frequency responses and maximum output levels that were markedly different from those prescribed for commonly encountered audiograms. Because of the absence or inflexibility of most of the devices, they have the potential to deliver poor sound quality and uncomfortably loud sounds. The challenge for manufacturers is to develop low-cost products with cosmetic appeal and appropriate electroacoustic characteristics.

Hearing aid or "band aid"? Evaluating large scale hearing aid donation programmes in the Philippines

Objective: This study aimed to evaluate the effectiveness of two large scale hearing aid donation programmes in the Philippines.Design: Real ear measurements were made on all hearing aids, for comparison to NAL-RP prescription targets. Performance measures and the International Outcomes Inventory for Hearing Aids (IOI-HA) data was collected from a subsample of participants.Study sample: A total of 101 and 153 low socioeconomic status participants were sampled just after, or 6 months after receiving their hearing devices in each of the programmes evaluated, respectively.Results: Of the 189 hearing aids sampled at fitting, and the 195 hearing aids sampled at 6 months post fitting, less than 2% were within ±5dB of prescription target. At 6 months post fitting IOI-HA outcomes were essentially comparable to those described in the literature but were not a good predictor of fit to prescriptive target.Conclusions: Objective measures of hearing aid outcome were poor and showed no relationship to subjective outcome measures. Although able to fit large numbers in short time frames, to avoid a band aid solution, changes to such programmes should be made including: a focus on those with aidable hearing losses, increased opportunity for follow up care, and improved device quality.

The Effect of Memory Span and Manual Dexterity on Hearing Aid Handling Skills in New and Experienced Hearing Aid Users

Purpose The aim of the study was to determine the effect of memory function and manual dexterity on new and experienced hearing aid users' abilities to use and care for their hearing aids. Method New and experienced hearing aid users were administered the Practical Hearing Aid Skills Test-Revised (PHAST-R; Doherty & Desjardins, 2012 ), a measure of a hearing aid user's ability to use and care for their hearing aids. The test was administered during their 30-day hearing aid check or yearly hearing evaluation appointment. Participants were also administered the Digit Span Test of memory function ( Wechsler, 1997 ) and the Nine-Hole Peg Test of manual dexterity ( Mathiowetz, Weber, Kashman, & Volland,1985 ). Results Participants with poorer memory span function performed significantly poorer on the PHAST-R than participants with better memory span. However, no significant relationship between manual dexterity and PHAST-R performance was observed. Experienced hearing aid users who were recently reoriented on how to use and care for their hearing aids performed significantly better on the PHAST-R compared to new hearing aid users and experienced hearing aid users who had not received a hearing aid orientation within the last year. Cleaning the hearing aid and telephone use were the 2 PHAST-R tasks that all hearing aid clients needed the most recounseling on. Conclusion Memory span is significantly related to an individual's ability to correctly use and care for their hearing aids regardless of whether they are new or experienced hearing aid users.

A preliminary investigation into hearing aid fitting based on automated real-ear measurements integrated in the fitting software: test-retest reliability, matching accuracy and perceptual outcomes

OBJECTIVE

The recent integration of automated real-ear measurements (REM) in the fitting software facilitates the hearing aid fitting process. Such a fitting strategy, TargetMatch (TM), was evaluated. Test-retest reliability and matching accuracy were quantified, and compared to a REM-based fitting with manual adjustment. Also, it was investigated whether TM leads to better perceptual outcomes compared to a FirstFit (FF) approach, using software predictions only. Design and study sample: Ten hearing impaired participants were enrolled in a counterbalanced single-blinded cross-over study comparing TM and FF. Aided audibility, speech intelligibility and real-life benefits were assessed. Repeated measurements of both TM and REMs with manual adjustment were performed.

RESULTS

Compared to a REM-based fitting with manual adjustment, TM had higher test-retest reliability. Also, TM outperformed the other fitting strategies in terms of matching accuracy. Compared to a FF, improved aided audibility and real-life benefits were found. Speech intelligibility did not improve.

CONCLUSIONS

Preliminary data suggest that automated REMs increase the likelihood of meeting amplification targets compared with a FF. REMs integrated in the fitting software provide additional reliability and accuracy compared to traditional REMs. Findings need to be verified in a larger and more varied sample.

Hearing aid fitting and developmental outcomes of children fit according to either the NAL or DSL prescription: fit-to-target, audibility, speech and language abilities

OBJECTIVE

This study examined the influence of prescription on hearing aid (HA) fitting characteristics and 5-year developmental outcomes of children.

DESIGN

A randomised controlled trial implemented as part of a population-based study on Longitudinal Outcomes of Children with Hearing Impairment (LOCHI).

STUDY SAMPLE

Two-hundred and thirty-two children that were fit according to either the National Acoustic Laboratories (NAL) or Desired Sensation Level (DSL) prescription.

RESULTS

Deviation from targets and root-mean-square error in HA fitting revealed no significant difference between fitting prescriptions. Aided audibility quantified by using the Speech Intelligibility Index (SII) model showed that DSL provided higher audibility than NAL at low and medium input levels but not at high input level. After allowing for hearing loss desensitisation, differences in audibility between prescription groups were significant only at low input level. The randomised trial of prescription that was implemented for 163 children revealed no significant between-group differences in speech production, perception, and language; but parent-rated functional performance was higher for the DSL than for the NAL group.

CONCLUSIONS

Proximity to prescriptive targets was similar between fitting prescriptions. The randomised trial revealed differences in aided audibility at low input level between prescription groups, but no significant differences in speech and language abilities.

Are hearing aid owners able to identify and self-report handling difficulties? A pilot study

OBJECTIVE

Although clinician administered surveys evaluating hearing aid handling skills exist, the development of a self-administered version may reduce clinical load, save consultation time, and facilitate more frequent use than face-to-face consultations allow. However, there is currently no evidence to support whether hearing aid owners can accurately self-report hearing aid handling skills via self-report survey that systematically evaluates the ability to accurately perform the individual aspects of hearing aid handling required for effective hearing aid management.

DESIGN

An explorative pilot study using a prospective research design.

STUDY SAMPLE

Nineteen adult hearing aid owners, aged between 65 and 93 years.

RESULTS

The self-administered survey demonstrated high sensitivity when compared with clinician evaluation of skills, with 93% of participants accurately self-identifying and reporting whether hearing aid handling skill training was required.

CONCLUSIONS

Hearing aid owners are able to accurately self-report hearing aid handling difficulties when provided with an itemised list of skills.

Longitudinal Predictors of Aided Speech Audibility in Infants and Children

OBJECTIVES

Amplification is a core component of early intervention for children who are hard of hearing, but hearing aids (HAs) have unique effects that may be independent from other components of the early intervention process, such as caregiver training or speech and language intervention. The specific effects of amplification are rarely described in studies of developmental outcomes. The primary purpose of this article is to quantify aided speech audibility during the early childhood years and examine the factors that influence audibility with amplification for children in the Outcomes of Children with Hearing Loss study.

DESIGN

Participants were 288 children with permanent hearing loss who were followed as part of the Outcomes of Children with Hearing Loss study. All of the children in this analysis had bilateral hearing loss and wore air-conduction behind-the-ear HAs. At every study visit, hearing thresholds were measured using developmentally appropriate behavioral methods. Data were obtained for a total of 1043 audiometric evaluations across all subjects for the first four study visits. In addition, the aided audibility of speech through the HA was assessed using probe microphone measures. Hearing thresholds and aided audibility were analyzed. Repeated-measures analyses of variance were conducted to determine whether patterns of thresholds and aided audibility were significantly different between ears (left versus right) or across the first four study visits. Furthermore, a cluster analysis was performed based on the aided audibility at entry into the study, aided audibility at the child's final visit, and change in aided audibility between these two intervals to determine whether there were different patterns of longitudinal aided audibility within the sample.

RESULTS

Eighty-four percent of children in the study had stable audiometric thresholds during the study, defined as threshold changes <10 dB for any single study visit. There were no significant differences in hearing thresholds, aided audibility, or deviation of the HA fitting from prescriptive targets between ears or across test intervals for the first four visits. Approximately 35% of the children in the study had aided audibility that was below the average for the normative range for the Speech Intelligibility Index based on degree of hearing loss. The cluster analysis of longitudinal aided audibility revealed three distinct groups of children: a group with consistently high aided audibility throughout the study, a group with decreasing audibility during the study, and a group with consistently low aided audibility.

CONCLUSIONS

The current results indicated that approximately 65% of children in the study had adequate aided audibility of speech and stable hearing during the study period. Limited audibility was associated with greater degrees of hearing loss and larger deviations from prescriptive targets. Studies of developmental outcomes will help to determine how aided audibility is necessary to affect developmental outcomes in children who are hard of hearing.

Hearing aid handling skills: relationship with satisfaction and benefit

PURPOSE

To evaluate hearing aid handling skills for new and experienced users and to assess if such skills influence user's benefit and satisfaction.

METHODS

Seventy four participants (mean age of 70.43), experienced (n=37) or new hearing aid users (n=37) performed the tasks of "Practical Hearing Aid Skills Test" (PHAST), which were scored on a five-point Likert scale - higher scores indicate better hearing aid handling skills. Experienced users answered the International Outcome Inventory for Hearing Aids (IOI-HA) and the hearing aid benefit for handicap reduction was calculated by the hearing handicap inventory (HHIA/HHIE).

RESULTS

Medians for PHAST total scores of 79 and 71% were obtained for experienced and new users, respectively - there were no significant difference between groups. Lower PHAST scores were observed for the tasks of volume control manipulation and telephone usage. Moderate correlations were obtained between IOI benefit and quality of life items and the PHAST scores. There was no correlation between the results of PHAST and demographic data of the participants.

CONCLUSION

There was no difference in handling skills between new and experienced hearing aid users. Handling skills affected hearing aid benefit.

Characteristics of hearing aid fittings in infants and young children

OBJECTIVES

Hearing aids (HAs) provide the basis for improving audibility and minimizing developmental delays in children with mild to severe hearing loss. Multiple guidelines exist to recommend methods for optimizing amplification in children, but few previous studies have reported HA fitting outcomes for a large group of children. The present study sought to evaluate the proximity of the fitting to prescriptive targets and aided audibility of speech, as well as survey data from pediatric audiologists who provided HAs for the children in the present study. Deviations from prescriptive target were predicted to have a negative impact on aided audibility. In addition, children who were fitted using verification with probe microphone measurements were expected to have smaller deviations from prescriptive targets and greater audibility than cohorts fitted without these measures.

DESIGN

HA fitting data from 195 children with mild to severe hearing losses were analyzed as part of a multicenter study evaluating outcomes in children with hearing loss. Proximity of fitting to prescriptive targets was quantified by calculating the average root-mean-square (RMS) error of the fitting compared with Desired Sensation Level prescriptive targets for 500, 1000, 2000, and 4000 Hz. Aided audibility was quantified using the Speech Intelligibility Index. Survey data from the pediatric audiologists who fit amplification for children in the present study were collected to evaluate trends in fitting practices and relate those patterns to proximity of the fitting to prescriptive targets and aided audibility.

RESULTS

More than half (55%) of the children in the study had at least 1 ear that deviated from prescriptive targets by more than 5 dB RMS on average. Deviation from prescriptive target was not predicted by pure-tone average, assessment method, or reliability of assessment. Study location was a significant predictor of proximity to prescriptive target with locations that recruited participants who were fit at multiple clinical locations (University of Iowa and Boys Town National Research Hospital) having larger deviations from target than the location where the participants were recruited primarily from a single, large pediatric audiology clinic (University of North Carolina). Fittings based on average real-ear to coupler differences resulted in larger deviations from prescriptive targets than fittings based on individually measured real-ear to coupler differences. Approximately 26% of the children in the study has aided audibility less than 0.65 on the Speech Intelligibility Index (SII). Aided audibility was significantly predicted by the proximity to prescriptive targets and pure-tone average, but not age in months.

CONCLUSIONS

Children in the study had a wide range of fitting outcomes in terms of proximity to prescriptive targets (RMS error) and aided speech audibility (SII). Even when recommended HA verification strategies were reported, fittings often exceeded the criteria for both proximity to the prescriptive target and aided audibility. The implications for optimizing amplification for children are also discussed.

Rehabilitation approaches to promote successful unilateral and bilateral fittings and avoid inappropriate prescription

Successful hearing aid fitting occurs when the person fitted wears the aid/s on a regular basis and reports benefit when the aid/s is used. A significant number of people fitted with unilateral or bilateral hearing aids for the first time do not continue to use one or both aids in the long term. In this paper, factors consistently found in previous research to be associated with unsuccessful fitting are explored; in particular, the negative attitudes of some clients towards hearing aids, their lack of motivation for seeking help, inability to identify goals for rehabilitation, and problems with the management of the devices. It is argued here that success in hearing aid fitting involves the same dynamics as found with other assistive technologies (e.g., wheelchairs, walking frames), and is dependent on a match between the characteristics of a prospective user, the technology itself, and the environments of use (Scherer, 2002). It is recommended that for clients who identify concerns about hearing aids, or who are unsure about when they would use them, and/or are likely to have problems with aid management, only one aid be fitted in the first instance, if hearing aid fitting is to proceed at all. Rehabilitation approaches to promote successful fitting are discussed in light of results obtained from a survey of clients who experienced both successful and unsuccessful aid fitting.

Do Experienced Hearing Aid Users Know How to Use Their Hearing Aids Correctly?

Purpose

To assess experienced hearing aid users' ability to use their hearing aids correctly.

Method

In this study, we developed the Practical Hearing Aid Skills Test (PHAST) to objectively test a hearing aid user’s ability to manipulate his or her hearing aids. The PHAST requires hearing aid users to perform 8 hearing aid care and use tasks that are basic skills typically taught to new hearing aid users at the time of their hearing aid fitting. The PHAST was administered to a group of 50 experienced hearing aid users. In addition, participants were administered questionnaires about hearing aid satisfaction (i.e., Satisfaction With Amplification in Daily Life; R. M. Cox & G. C. Alexander, 1999), benefit (i.e., Abbreviated Profile of Hearing Aid Benefit; R. M. Cox & G. C. Alexander, 1995), and use.

Results

Participants' performance on the PHAST ranged from 48% to 100%, and the scores were normally distributed around the mean (78.56%). No significant relationship was observed between the PHAST and any of the other tests administered in this study. The only variable significantly associated with participants' performance on the PHAST was age.

Conclusions

Results from this study suggest that experienced hearing aid users range from having an excellent understanding of how to use their hearing aids to a poor understanding. The variability in performance among experienced hearing aid users highlights the importance of directly assessing a client’s ability to use his or her hearing aids.

An overview of dual sensory impairment in older adults: perspectives for rehabilitation

Dual sensory impairment (DSI) refers to the presence of both hearing loss and vision loss. The occurrence of DSI is particularly prevalent among the aging population, with studies showing between 9% and 21% of adults older than 70 years having some degree of DSI. Despite this, there is little direction regarding recommended clinical practice and rehabilitation of individuals with DSI. It is assumed that the problems encountered by individuals with DSI are considerably greater than the effects of vision impairment or hearing impairment alone, because when these two sensory impairments are combined, the individual is seriously deprived of compensatory strategies that make use of the nonimpaired sense. In this article, the literature available regarding DSI is summarized, and research needs regarding rehabilitation strategies are outlined and discussed. Simple suggestions for addressing DSI are provided that use available tools and technology.

Hearing aid satisfaction: what does research from the past 20 years say?

Hearing aid satisfaction is a pleasurable emotional experience as an outcome of an evaluation of performance. Many tools have been designed to measure the degree of satisfaction overall, or along the dimensions of cost, appearance, acoustic benefit, comfort, and service. Various studies have used these tools to examine the relationships between satisfaction and other factors. Findings are not always consistent across studies, but in general, hearing aid satisfaction has been found to be related to experience, expectation, personality and attitude, usage, type of hearing aids, sound quality, listening situations, and problems in hearing aid use. Inconsistent findings across studies and difficulties in evaluating the underlying relationships are probably caused by problems with the tools (eg, lack of validity) and the methods used to evaluate relationships (eg, correlation analyses evaluate association and not causal effect). Whether satisfaction changes over time and how service satisfaction contributes to device satisfaction are unclear. It is hoped that this review will help readers understand current satisfaction measures, how various factors affect satisfaction, and how the way satisfaction is measured may be improved to yield more reliable and valid data.

Reasons for referral and attitudes toward hearing aids: do they affect outcome?

Many patients attending for a hearing aid are not self motivated, but in the majority of cases motivated by a relative. In this study, we have examined whether the reason for referral (self motivated or other) and the attitude toward a hearing aid at assessment affect outcome measures. One hundred and forty first-time hearing aid users were assessed at their initial hearing aid consultation and at review 3 months later. The reason for referral was not found to affect outcome measures. However, attitude towards a hearing aid was found to be significantly related to both satisfaction with it and its use at review. The importance of the attitude toward a hearing aid supports previous work and reiterates the importance of tailoring auditory rehabilitation towards the needs of the individual.