The Placebo Effect and the Influence of Participant Expectation on Hearing Aid Trials

Focusing on positive listening experiences improves hearing aid outcomes in first-time hearing aid users: a randomized controlled trial

OBJECTIVE

The objective of this study was to investigate whether positive focus (PF), an intervention that asks hearing aid users to focus on positive listening experiences, improves hearing aid outcomes for first-time hearing aid users.

DESIGN

The participants were randomised into a control or PF group. They were fitted with hearing aids and followed for six months after fitting. The PF group was asked to report positive listening experiences in their daily life via an app. Participants in both groups were periodically prompted by the app to answer questionnaires about hearing aid satisfaction and benefit. Two follow-up visits at approximately one and six months were performed.

STUDY SAMPLE

20 adult first-time hearing aid users in the control and 18 in the PF group.

RESULTS

Hearing aid satisfaction and benefit scores were significantly better in the PF group, already at two weeks and throughout the six months. In the PF group, the hearing aid outcomes were positively correlated with the number of submitted positive reports.

CONCLUSIONS

These results point to the importance of asking first-time hearing aid users to focus on positive listening experiences and to reflect upon them. This can lead to improved short- and long-term hearing aid outcomes.

Focusing on positive listening experiences improves hearing aid outcomes in experienced hearing aid users

OBJECTIVE

The purpose of this study was to investigate whether focusing on positive listening experiences improves hearing aid outcomes in experienced hearing aid users.

DESIGN

The participants were randomised into a control or positive focus (PF) group. At the first laboratory visit, the Client-Oriented Scale of Improvement (COSI) questionnaire was administered followed by hearing aid fitting. The participants wore the hearing aids for three weeks. The PF group was asked to report their positive listening experiences via an app. During the third week, all the participants answered questionnaires related to hearing aid benefit and satisfaction. This was followed by the second laboratory visit where the COSI follow-up questionnaire was administered.

STUDY SAMPLE

Ten participants were included in the control and eleven in the PF group.

RESULTS

Hearing aid outcome ratings were significantly better in the PF group in comparison to the control group. Further, COSI degree of change and the number of positive reports were positively correlated.

CONCLUSIONS

These results point to the importance of asking hearing aid users to focus on positive listening experiences and talk about them. The potential outcome is increased hearing aid benefit and satisfaction which could lead to more consistent use of the devices.

Focusing on Positive Listening Experiences Improves Speech Intelligibility in Experienced Hearing Aid Users

Negativity bias is a cognitive bias that results in negative events being perceptually more salient than positive ones. For hearing care, this means that hearing aid benefits can potentially be overshadowed by adverse experiences. Research has shown that sustaining focus on positive experiences has the potential to mitigate negativity bias. The purpose of the current study was to investigate whether a positive focus (PF) intervention can improve speech-in-noise abilities for experienced hearing aid users. Thirty participants were randomly allocated to a control or PF group (N = 2 × 15). Prior to hearing aid fitting, all participants filled out the short form of the Speech, Spatial and Qualities of Hearing scale (SSQ12) based on their own hearing aids. At the first visit, they were fitted with study hearing aids, and speech-in-noise testing was performed. Both groups then wore the study hearing aids for two weeks and sent daily text messages reporting hours of hearing aid use to an experimenter. In addition, the PF group was instructed to focus on positive listening experiences and to also report them in the daily text messages. After the 2-week trial, all participants filled out the SSQ12 questionnaire based on the study hearing aids and completed the speech-in-noise testing again. Speech-in-noise performance and SSQ12 Qualities score were improved for the PF group but not for the control group. This finding indicates that the PF intervention can improve subjective and objective hearing aid benefits.

Cochlear Implant Upper Stimulation Levels: eSRT vs. Loudness Scaling

OBJECTIVE

To assess the difference in speech recognition and sound quality between programming upper stimulation levels using behavioral measures (loudness scaling) and electrically evoked stapedial reflex thresholds (eSRTs).

STUDY DESIGN

Double-blinded acute comparison study.

SETTING

Cochlear implant (CI) program at a tertiary medical center.

PATIENTS

Eighteen adult (mean age = 60 years) CI users and 20 ears.

MAIN OUTCOME MEASURES

Speech recognition scores and sound quality ratings.

RESULTS

Mean word and sentence in noise recognition scores were 8 and 9 percentage points higher, respectively, for the eSRT-based map. The sound quality rating was 1.4 points higher for the eSRT-based map. Sixteen out of 20 participants preferred the eSRT-based map.

CONCLUSIONS

Study results show significantly higher speech recognition and more favorable sound quality using an eSRT-based map compared with a loudness-scaling map using a double-blinded testing approach. Additionally, results may be understated as 18 of 20 ears had eSRTs measured before study enrollment. Results underscore the importance of incorporating eSRTs into standard clinical practice to promote best outcomes for CI recipients.

Clinical Trials and Outcome Measures in Adults With Hearing Loss

Clinical trials are designed to evaluate interventions that prevent, diagnose or treat a health condition and provide the evidence base for improving practice in health care. Many health professionals, including those working within or allied to hearing health, are expected to conduct or contribute to clinical trials. Recent systematic reviews of clinical trials reveal a dearth of high quality evidence in almost all areas of hearing health practice. By providing an overview of important steps and considerations concerning the design, analysis and conduct of trials, this article aims to give guidance to hearing health professionals about the key elements that define the quality of a trial. The article starts out by situating clinical trials within the greater scope of clinical evidence, then discusses the elements of a PICO-style research question. Subsequently, various methodological considerations are discussed including design, randomization, blinding, and outcome measures. Because the literature on outcome measures within hearing health is as confusing as it is voluminous, particular focus is given to discussing how hearing-related outcome measures affect clinical trials. This focus encompasses how the choice of measurement instrument(s) affects interpretation, how the accuracy of a measure can be estimated, how this affects the interpretation of results, and if differences are statistically, perceptually and/or clinically meaningful to the target population, people with hearing loss.

Descriptions of Hearing Aids Influence the Experience of Listening to Hearing Aids

OBJECTIVES

Experiences can be strongly influenced by expectations. In hearing healthcare, previous studies have shown that descriptions of hearing aids or contextual factors during the hearing aid fitting process can change subjective and even objective outcomes with hearing aids via the placebo effect. Personality factors have also been shown to affect susceptibility to placebo effects. The purposes of the present study were to (a) investigate the effects of communicating narratives designed to foster positive, negative, or neutral expectations about hearing aids on short-term patient outcomes, and (b) to determine if the degree to which the narratives affected end-user outcomes could be predicted by personality factors.

DESIGN

Nineteen adults between the ages of 54 and 81 (mean age = 68.5, SD = 8.9) had 3 separate research appointments, each exposing them to a different narrative condition: positive, negative, or neutral. the appointment was designed to look and feel like a "traditional" hearing aid fitting appointment, during which the experimenter introduced (i.e., the narrative condition) and fit a pair of hearing aids, the participant was asked to provide their initial feedback about the hearing aids, and the participant performed speech-in-noise testing. Unbeknownst to the research participant, the hearing aids fitted at all three appointments were the same, and the only difference between the three appointments was the way the hearing aids were described to the participants.

RESULTS

The results of this study showed that communication of a positive narrative about hearing aids before a hearing aid fitting led to better speech-in-noise performance on the QuickSIN as compared with performance following the negative or neutral narrative conditions. Also, the positive narrative led to the perception that acclimatization to the hearing aids would occur faster than the negative or neutral narrative conditions. Notably, the effect of communication of a positive narrative was stronger for individuals who scored higher on agreeableness, and susceptibility to positive and negative messaging was stronger for individuals low in neuroticism.

CONCLUSIONS

The study suggests that short-term evaluations of hearing aids can be strongly influenced by narratives as provided by the hearing healthcare provider at the time of a hearing aid fitting.

The perceptual limitations of troubleshooting hearing-aids based on patients' descriptions

OBJECTIVES

Hearing-aid frequency-gain responses are routinely adjusted by clinicians to patient preferences and descriptions. This study measured the minimum gain adjustments required to elicit preferences, and the assignment of descriptors to gain adjustments, to perceptually evaluate description-based troubleshooting.

DESIGN

Participants judged whether short sentences with ±0-12 dB gain adjustments in one of three frequency bands were "better", "worse" or "no different" from the same sentence at their individual real-ear or prescribed gain. If judged "better" or "worse", participants were then asked to assign one of the six common sound-quality descriptors to their preference.

STUDY SAMPLE

Thirty-two adults (aged 51-75 years) all with hearing-aid experience.

RESULTS

Median preference thresholds, the minimum gain adjustments to elicit "better" or "worse" judgments, ranged from 4 to 12 dB, increasing with frequency. There was some between-participant agreement in preferences: participants generally preferred greater low-frequency gain. Within-participant reliability for preferences was moderate. There was, however, little between-participant agreement in descriptor selection for gain adjustments. Furthermore, within-participant reliability for descriptor selection was lacking.

CONCLUSIONS

The scale of gain adjustments necessary to elicit preferences, along with the low agreement and reliability in descriptors for these adjustments questions the efficiency and efficacy of current description-based troubleshooting, especially with short speech stimuli.

Achieved Gain and Subjective Outcomes for a Wide-Bandwidth Contact Hearing Aid Fitted Using CAM2

Supplemental Digital Content is available in the text.

Objectives:

The objective of this study was to test the ability to achieve, maintain, and subjectively benefit from extended high-frequency amplification in a real-world use scenario, with a device that restores audibility for frequencies up to 10 kHz.

Design:

A total of 78 participants (149 ears) with mild to moderately-severe sensorineural hearing loss completed one of two studies conducted across eight clinical sites. Participants were fitted with a light-driven contact hearing aid (the Earlens system) that directly drives the tympanic membrane, allowing extended high-frequency output and amplification with minimal acoustic feedback. Cambridge Method for Loudness Equalization 2 - High Frequency (CAM2)-prescribed gains for experienced users were used for initial fitting, and adjustments were made when required according to participant preferences for loudness and comfort or when measures of functional gain (FG) indicated that more or less gain was needed. Participants wore the devices for an extended period. Prescribed versus adjusted output and gain, frequency-specific FG, and self-perceived benefit assessed with the Abbreviated Profile of Hearing Aid Benefit, and a custom questionnaire were documented. Self-perceived benefit results were compared with those for unaided listening and to ratings with participants’ own acoustic hearing aids.

Results:

The prescribed low-level insertion gain from 6 to 10 kHz averaged 53 dB across all ears, with a range from 26 to 86 dB. After adjustment, the gain from 6 to 10 kHz decreased to an average of 45 dB with a range from 16 to 86 dB. Measured FG averaged 39 dB from 6 to 10 kHz with a range from 11 to 62 dB. Abbreviated Profile of Hearing Aid Benefit results revealed a significant improvement in communication relative to unaided listening, averaging 28 to 32 percentage points for the background noise, reverberation, and ease of communication subscales. Relative to participants’ own hearing aids, the subscales ease of communication and aversiveness showed small but significant improvements for Earlens ranging from 6 to 7 percentage points. For the custom satisfaction questionnaire, most participants rated the Earlens system as better than their own hearing aids in most situations.

Conclusions:

Participants used and reported subjective benefit from the Earlens system. Most participants preferred slightly less gain at 6 to 10 kHz than prescribed for experienced users by CAM2, preferring similar gains to those prescribed for inexperienced users, but gains over the extended high frequencies were high relative to those that are currently available with acoustic hearing aids.

The Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor: multicentric evaluation of outcomes in adults and children

Objective: This study evaluated the outcomes of the Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor.Design: Neuro One users were upgraded to Neuro 2. Monosyllabic word identification was evaluated in adults with Neuro One after ≥5 months, with Neuro 2 at upgrade, and with Neuro 2 after 3 months. Self-reported listening ability, satisfaction, and usability were measured in adults and children.Study sample: Participants were 44 adults and 26 children.Results: Speech identification scores in quiet and noise were 58% and 45% with Neuro One and 67% and 55% with Neuro 2 after 3 months, respectively. Hearing impairment duration and number of active electrodes significantly predicted speech identification in noise with Neuro 2. Significantly higher questionnaire ratings were obtained for Neuro 2 than Neuro One regarding listening ability in complex listening situations, comfort and music, as well as nine aspects of satisfaction and usability.Conclusion: This study demonstrates the clinical superiority of the Neuro 2 sound processor over Neuro One in terms of speech identification in quiet and in noise and reported patient benefit and satisfaction. Given the study design, sources of improvement may include factors unrelated to the sound processor itself.

Controlled comparative clinical trial of hearing benefit outcomes for users of the Cochlear™ Nucleus® 7 Sound Processor with mobile connectivity

OBJECTIVES

To assess subjective benefits and objective speech recognition performance following a take-home trial with the new Cochlear™ Nucleus^® 7 Sound Processor (SP), in experienced users of compatible cochlear implants from Cochlear Limited.

METHODS

A total of 37 adult participants were fitted with the Nucleus 7 SP and used the device for up to one year. Baseline speech recognition was assessed at the initial fitting session, using each participant's own SP, and Client Oriented Scale of Improvement (COSI) goals were identified. Speech recognition was measured after 3 months of device use and outcomes of the COSI and a non-validated Processor Comparison Questionnaire (PCQ) were collected. After 11 months, a subset of subjects were tested on speech recognition delivered via direct wireless streaming from an Apple^® smartphone to the SP and compatible hearing aid on the opposite side (if worn).

RESULTS

The COSI and PCQ instruments both indicated significant improvement in perceived subjective benefits in comparison to the participants' previous SPs. Direct streaming via an Apple mobile phone showed improvements when compared with the acoustic alone condition. Standard speech recognition in quiet and noise was equivalent to that obtained using a previous generation SP which uses the same basic processing as the Nucleus 7 Sound Processor.

CONCLUSIONS

The incremental refinements provided by the Nucleus 7 Sound Processor provide real-world benefits in key areas such as upgraded wireless connectivity. The COSI proved to be an effective tool for individualized assessment of specific benefits that may not be addressed by more standardized instruments.

Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology

OBJECTIVES

In this article, we explore two manipulations of "meaning response," intended to either "impart" meaning to participants through the manipulation of a few words in the test instructions or to "invite" meaning by making the participant feel involved in the setting of their preferred sound.

DESIGN

In experiment 1, 59 adults with normal hearing were randomly assigned to one of the two groups. Group 1 was told "this hearing in noise test (HINT) you are about to do is really hard," while the second group was told "this HINT test is really easy." In experiment 2, 59 normal-hearing adults were randomly assigned to one of two groups. Every participant was played a highly distorted sound file and given 5 mystery sliders on a computer to move as often and as much as they wished until the sound was "best" to them. They were then told we applied their settings to a new file and they needed to rate their sound settings on this new file against either (1) another participant in the study, or (2) an expert audiologist. In fact, we played them the same sound file twice.

RESULTS

In experiment 1, those who were told the test was hard performed significantly better than the easy group. In experiment 2, a significant preference was found in the group when comparing "my setting" to "another participant." No significant difference was found in the group comparing "my setting" to the "expert."

CONCLUSIONS

Imparting or inviting meaning into the context of audiological outcome measurement can alter outcomes even in the absence of any additional technology or treatment. These findings lend support to a growing body of research about the many nonauditory factors including motivation, effort, and task demands that can impact performance in our clinics and laboratories.

Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids

OBJECTIVE

The device-oriented subjective outcome (DOSO) is a device-oriented questionnaire, intended to minimise the influence of personality on self-reported measures. The aim of this study was to provide normative data with 2015-era hearing aid technologies.

DESIGN

This retrospective study evaluated data from records of three clinical trials. The DOSO was administered for the participants' own devices as a part of the intake and after using research devices in the field.

STUDY SAMPLE

The DOSO data were collected from 132 experienced bilateral hearing aid wearers who participated in the clinical trials.

RESULTS

The DOSO data collected with the participants' own devices were compared to the interim normative data collected between 2004 and 2005. The DOSO subscale scores from the participants' own devices were significantly higher than those from the interim norms, except Listening Effort subscale. To demonstrate the utility of the new norms, a separate set of DOSO data collected from the same participants after using research hearing aids were contrasted to the new normative data. After accounting for possible placebo effects, the DOSO data with research devices revealed additional self-reported benefit of technological advancements.

CONCLUSIONS

Norms for the DOSO are recommended for evaluating hearing aids with more recent technologies.

Evaluation of Auditory Functioning and Rehabilitation Using Patient-Reported Outcome Measures

There is lack of a systematic approach concerning how to select an adequate hearing aid and how to evaluate its efficacy with respect to the personal needs of rehabilitation. The goal of this study was to examine the applicability and added value of two widely used self-reporting questionnaires in relation to the evaluation of hearing aid fitting. We analyzed responses, pre- and postfitting, from 1,319 subjects who completed the Client Oriented Scale of Improvement (COSI) and a slightly adapted version of the Amsterdam Inventory for Auditory Disability and Handicap (in Dutch: AVAB). Most COSI responses were at or near the maximum possible score. Results show a close relation between COSI's degree of change and final ability (Spearman's rho = 0.71). Both AVAB and COSI showed a significant effect of hearing aid experience, but-in contrast to AVAB-COSI did not show a significant effect of the degree of hearing loss. In addition, a Friedman test showed significant differences between six dimensions of auditory functioning for both AVAB and COSI, although post hoc analysis revealed that for COSI, the dimension speech in quiet explained most variation between dimensions. In conclusion, the effects of hearing loss were more salient in AVAB, while both AVAB and COSI showed differences regarding hearing aid experience. Combining the advantages of both methods results in a detailed evaluation of hearing aid rehabilitation. Our results therefore suggest that both methods should be used in a complementary manner, rather than separately.

Is there evidence for the added value and correct use of manual and automatically switching multimemory hearing devices? A scoping review

OBJECTIVES

To review literature on the use of manual and automatically switching multimemory devices by hearing aid and CI recipients, and to investigate if recipients appreciate and adequately use the ability to switch between programmes in various listening environments.

DESIGN

Literature was searched using PubMed, Embase and ISI/Web of Science. Additional studies were identified by screening reference and citation lists, and by contacting experts.

STUDY SAMPLE

The search yielded 1109 records that were screened on title and abstract. This resulted in the full-text assessment of 37 articles.

RESULTS

Sixteen articles reported on the use of multiple programmes for various listening environments, three articles reported on the use of an automatic switching mode. All studies reported on hearing aid recipients only, no study with CI recipients fulfilled the selection criteria.

CONCLUSIONS

Despite the high number of manual and automatically switching multimemory devices sold each year, there are remarkably few studies about the use of multiple programmes or automatic switching modes for various listening environments. No studies were found that examined the accuracy of the use of programmes for specific listening environments. An automatic switching device might be a solution if recipients are not able, or willing, to switch manually between programmes.

Improvement of older-person-specific QOL after hearing aid fitting and its relation to social interaction

PURPOSE

This study aimed to investigate whether hearing aids use is associated with improvement of older-person-specific QOL and whether social interactions modify the association.

METHODS

The WHOQOL-OLD questionnaire was answered by 105 older adults aged 60 to 90 years who were newly fitted hearing aids on the day of fitting and at 2 - 6 months afterward. The associations between the daily hours of hearing aid usage and social relations with changes in the WHOQOL-OLD total score after hearing aids fitting were estimated adjusting for possible confounders.

RESULTS

Older persons with hearing loss experienced significant increases in WHOQOL-OLD total score after hearing aid fitting. Regular use of hearing aid was associated with a greater increase in the total score. The combined categorical variable of social relations and hearing aid usage revealed no separate effects of these two variables, but a combined effect; only those with frequent social interactions who used their hearing aid regularly had a significantly greater increase in WHOQOL-OLD total score.

CONCLUSION

This study's findings indicate that hearing aid fitting may be associated with a subsequent improvement in older-person-specific QOL by improvements in hearing due to the hearing aid, and possibly enhanced communication opportunities.

Clinical evaluation of an over-the-counter hearing aid (TEO First®) in elderly patients suffering of mild to moderate hearing loss

Background

Presbycusis has a direct influence on autonomy of the elderly but hearing aids lack of affordability. Moreover a recent review demonstrate that electroacoustic characteristics of OTC hearing aids were generally not suitable for the elderly people. In our study, we assessed the clinical value of a new over-the-counter (OTC) hearing aid device (TEO First®) in the elderly.

Method

This prospective monocentric open label study included patients over 60 years of age with a mild to moderate presbycusis. Patients were assessed with acceptable noise level test (ANL), pure tone (PTA) and speech (SA) audiometry in silent and noisy environment, with and without TEO First®. A Glasgow Hearing Aid Benefit Profile, acceptability and satisfaction surveys were completed after one month of using the device.

Results

Thirty one patients were included. There was an improvement of hearing with TEO First® in silence (SA: +39.2 %, p < 0.01; PTA: -9.04 dB, p < 0.01) or in noise (SA +47.7 %, p < 0.01; PTA: -5.23 dB, p < 0.05). After one month of use of the device, quality of life has improved with regards to the following parameters: decrease of perceived hearing difficulties during conversation without background noise (-9.6 % p = 0.018), in conversation with several people (-16.2 % p = 0.0076), decrease of negative emotions while watching TV (-18.5 % p = 0.011), during conversation without background noise (-16.5 % p = 0.0024), during conversation in noisy background (-17.1 % p = 0.027) and during conversation with several people (-20 % p = 0.014). The acceptability of the device was low to moderate.

Conclusion

TEO First® is an effective OTC hearing aid that improves the patient’s quality of life.

Trial registration

Current Controlled Trials NCT01815788

Effect of a Bluetooth-Implemented Hearing Aid on Speech Recognition Performance

Objectives:

The object was to evaluate speech perception improvement through Bluetooth-implemented hearing aids in hearing-impaired adults.

Methods:

Thirty subjects with bilateral symmetric moderate sensorineural hearing loss participated in this study. A Bluetooth-implemented hearing aid was fitted unilaterally in all study subjects. Objective speech recognition score and subjective satisfaction were measured with a Bluetooth-implemented hearing aid to replace the acoustic connection from either a cellular phone or a loudspeaker system. In each system, participants were assigned to 4 conditions: wireless speech signal transmission into hearing aid (wireless mode) in quiet or noisy environment and conventional speech signal transmission using external microphone of hearing aid (conventional mode) in quiet or noisy environment. Also, participants completed questionnaires to investigate subjective satisfaction.

Results:

Both cellular phone and loudspeaker system situation, participants showed improvements in sentence and word recognition scores with wireless mode compared to conventional mode in both quiet and noise conditions ( P < .001). Participants also reported subjective improvements, including better sound quality, less noise interference, and better accuracy naturalness, when using the wireless mode ( P < .001).

Conclusions:

Bluetooth-implemented hearing aids helped to improve subjective and objective speech recognition performances in quiet and noisy environments during the use of electronic audio devices.

Preliminary comparison of bone-anchored hearing instruments and a dental device as treatments for unilateral hearing loss

OBJECTIVE

To compare the effectiveness of two types of treatment for unilateral hearing loss (UHL), bone-anchored hearing instruments (BAHI) and a dental device (SoundBite).

DESIGN

Either BAHI or SoundBite were worn for 30 days, and then the devices were swapped and the second device was worn for 30 days. Measures included unaided and aided sound-field thresholds, sound localization, and perception of speech in babble. The APHAB questionnaire was administered for each trial period.

STUDY SAMPLE

Nine adult BAHI wearers with UHL.

RESULTS

Mid-frequency aided thresholds were lower for SoundBite than for BAHI. Both devices gave benefits for localization after 30 days, but there was no difference between devices. Speech perception was better for both devices than for unaided listening when the target speech came from the poorer hearing side or in front, and the interfering babble came from the better-hearing side. There was no consistent difference between devices. APHAB scores were better for SoundBite than for BAHI.

CONCLUSIONS

Speech perception and sound localization were similar for the two types of device, but the SoundBite led to lower aided thresholds and better APHAB scores than the BAHI.