Outcome measures in the hearing aid fitting/selection process

Randomised Controlled Trial for the Evaluation of the Efficacy of the IDA's "Living Well" Online Counselling Tool in First-Time Adult Users with Hearing Loss

Effective management of hearing loss through the use of modern hearing aids significantly improves communication and the quality of life for individuals experiencing auditory impairment. Complementary counselling of patients with hearing loss who will be fitted with hearing aids for the first time should be evidence-based and adapted to their individual needs. To date, several counselling protocols and tools have been developed. The aim of this randomised controlled trial study was to investigate the efficacy of the application of the IDA's "Living Well" counselling tool in first-time hearing aid users in terms of the degree of their hearing related handicap (using the Hearing Handicap Inventory (HHI)), their communication coping strategies (using the Communication Profile for the Hearing Impaired (CPHI)) and their overall satisfaction of the hearing aids (using a Likert scale). Both groups (the IDA and the control group) were fitted with hearing aids and received counselling for their hearing aids by the same audiologist. The IDA group attended an additional counselling session about communication coping strategies with the use of the "Living Well" tool. Both groups' participants were seen for their hearing aid fittings 4-6 weeks, 3 and 6 months after their fitting when the HHI and the CPHI were measured. Although there was not a statistically significant difference between the two groups for the primary and secondary outcomes, the IDA group did show a more consistent improvement of their HHI score and less frequent use of maladaptive strategies. The "Living Well" counselling tool proved to be a favourably received and helpful counselling tool in first-time hearing aid users.

Patient-Reported Outcome Measures for Hearing Aid Benefit and Satisfaction: Content Validity and Readability

PURPOSE

Numerous patient-reported outcome measures (PROMs) are available to measure hearing aid benefit and satisfaction. It is unclear to what extent currently available PROMs on hearing aid outcomes, often developed decades ago, meet current guidelines for good content validity and readability. This study evaluated the content validity and readability of PROMs that focus on perceived hearing aid benefit and/or satisfaction.

METHOD

A literature review was conducted to identify eligible instruments. Content validity evaluation included mapping extracted questionnaire items to the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. In addition, study design in content validity methodology was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments study design checklist for PROM instruments. Readability was estimated using the Simple Measure of Gobbledygook measure.

RESULTS

Thirteen questionnaires were identified and evaluated. Item content focused primarily on the components of environmental factors as well as activity limitations and participation restrictions with less emphasis on body functions and personal factors. The content validity methodology analysis revealed an underuse or lack of reporting of a qualitative methodology in assessing patient and professional perspectives. All the included questionnaires exceeded the recommended sixth-grade reading level.

CONCLUSIONS

The categories covered by hearing aid PROMs vary considerably, with no single instrument comprehensively covering all the key ICF components. Future development of hearing aid outcome measures should consider a mixed methodology approach for improved content validity and ensure an appropriate reading level.

Development and Standardization of Hearing Handicap Inventory for Adult (Screening Version) in Nepali Language

Hearing handicap inventory for adult- screening version (HHIA-S) is one of the widely used questionnaire for assessing hearing handicap among adult population over the short period of time. This questionnaire has been translated in many languages worldwide including Indian, Sweden, and Spanish. However, there is lack of such questionnaire in Nepali language. Hence, this study is aimed at developing and standardizing the HHIA-S questionnaire in Nepali language. The English version of the HHIA-S was translated to the Nepali language using the translation-back-translation method. Further, it was given to 10 native Nepali speakers for content validation. The final HHIA-S Nepali version was then administered to 70 normal native Nepali speakers and 50 hearing impaired Nepali speaker. The responses were analyzed, and Cronbach's alpha was calculated to measure the internal consistency of the questionnaire. Results showed that the HHIA-S Nepali version has a Cronbach's alpha score of 0.94 for normal hearing group and 0.93 for hearing impaired group, which is considered good reliability. The HHIA-S Nepali version developed in this study is found to be valid and reliable. Hence, it can be used as a screening tool for assessing hearing handicap among Nepali population.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03082-5.

Effect of Physician Consultation on Satisfaction With Hearing Aid Use: A Randomized Clinical Trial

Importance

Hearing loss is one of the most common chronic disabilities in older adults, yet reported rates of users' satisfaction with hearing aids are low. Some believe that physicians can provide patients who are pursuing a hearing aid fitting an impartial opinion that will improve hearing aid satisfaction.

Objective

To determine whether a physician consultation increased or decreased patients' satisfaction with hearing aids compared with patients undergoing hearing aid fitting with a dispensing audiologist alone.

Design, Setting, and Participants

This multicenter, parallel-group, standard regimen-controlled, randomized clinical trial was conducted in offices of audiologists, family physicians, and a hospital-based neurotologist in Vancouver, British Columbia, Canada, and recruited participants from July 2016 to December 2020 with a 3-month postintervention follow-up. The final data analysis was conducted on March 25, 2022. Adult first-time hearing aid users with averaged sensorineural hearing losses of more than 25 dB were prospectively allocated by random number generation to control and intervention groups. Participants were excluded from analysis if they did not attend follow-up or complete the study questionnaire.

Interventions

Control participants were followed up solely by their dispensing audiologist. The intervention group attended a single structured visit with a physician in addition to their audiologist's determined follow-up.

Main Outcomes and Measures

Primary outcome: hearing aid satisfaction 3 months postfitting as measured by the Satisfaction with Amplification in Daily Life (SADL) questionnaire. Secondary outcome: number of returned hearing aids. Prerecruitment null hypothesis: no intergroup difference in postfitting hearing aid satisfaction. Intergroup difference in mean SADL questionnaire scores analyzed by effect size and the Student t test and proportion of returned hearing aids by the Fischer exact test.

Results

A total of 133 participants (mean [SD] age, 70.9 [8.5] years; 64 women [48.1%]) were recruited. Of these, 51 randomized to the control group (mean [SD] age, 71.7 [8.3] years; 28 women [54.9%]) and 42 to the physician intervention (mean [SD] age, 69.9 [7.6] years; 17 women [40.5%]) had results that were analyzed. There was no clinically meaningful intergroup difference in participants' SADL scores (control: mean [SD] score, 5.33 [0.72]; physician consultation: mean [SD] score, 5.35 [0.61]), the mean difference of 0.02 (95% CI, -0.25 to 0.29), or returned hearing aids (control, 1; physician consultation, 0).

Conclusions and Relevance

The results of this randomized clinical trial suggest that a physician consultation that is focused on hearing change does not alter a patient's satisfaction with hearing aids 3 months postfitting.

Trial Registration

ClinicalTrials.gov Identifier: NCT02842905.

Effect of Hearing Rehabilitation Therapy Program in Hearing Aids Users: A Prospective Randomized Controlled Study

Objectives

Despite sufficient hearing gains, many patients with hearing loss have difficulty using hearing aids due to poor word recognition ability. This study was performed to introduce our hearing rehabilitation therapy (HRT) program for hearing aid users and to evaluate its effect on hearing improvement.

Methods

In this prospective randomized case-control study, 37 participants with moderate or moderate-severe sensorineural hearing loss who had used bilateral hearing aids for more than 3 months with sufficient functional hearing gain were enrolled in this study. Nineteen participants were randomly assigned to the control group (CG) and 18 patients were assigned to participate in our HRT program once a week for 8 consecutive weeks (hearing rehabilitation therapy group [HRTG]). Their hearing results and questionnaire scores for hearing handicap and hearing aid outcomes were prospectively collected and compared between the two groups.

Results

After completing 8 weeks of the HRT program, the HRTG showed a significantly greater improvement in scores for consonant-only and consonant-vowel sound perception than the CG (P<0.05). In addition, the HRTG showed a significant improvement in hearing ability as measured by two questionnaires (P<0.05), while no differences were observed in the CG. However, word and sentence recognition test results did not show significant differences between the two groups.

Conclusion

Even after short-term HRT, patients had subjectively better hearing outcomes and improved phoneme perception ability; this provides scientific evidence regarding a possible positive role for HRT programs in hearing aid users. Further validation in a larger population through a long-term follow-up study is needed.

Hearing aids for mild to moderate hearing loss in adults

BACKGROUND

The main clinical intervention for mild to moderate hearing loss is the provision of hearing aids. These are routinely offered and fitted to those who seek help for hearing difficulties. By amplifying and improving access to sounds, and speech sounds in particular, the aim of hearing aid use is to reduce the negative consequences of hearing loss and improve participation in everyday life.

OBJECTIVES

To evaluate the effects of hearing aids for mild to moderate hearing loss in adults.

SEARCH METHODS

The Cochrane ENT Information Specialist searched the ENT Trials Register; the Cochrane Register of Studies Online; MEDLINE; PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 March 2017.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of hearing aids compared to a passive or active control in adults with mild to moderate hearing loss.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane. The primary outcomes in this review were hearing-specific health-related quality of life and the adverse effect pain. Secondary outcomes were health-related quality of life, listening ability and the adverse effect noise-induced hearing loss. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.

MAIN RESULTS

We included five RCTs involving 825 participants. The studies were carried out in the USA and Europe, and were published between 1987 and 2017. Risk of bias across the studies varied. Most had low risk for selection, reporting and attrition bias, and a high risk for performance and detection bias because blinding was inadequate or absent.All participants had mild to moderate hearing loss. The average age across all five studies was between 69 and 83 years. The duration of the studies ranged between six weeks and six months.There was a large beneficial effect of hearing aids on hearing-specific health-related quality of life associated with participation in daily life as measured using the Hearing Handicap Inventory for the Elderly (HHIE, scale range 1 to 100) compared to the unaided/placebo condition (mean difference (MD) -26.47, 95% confidence interval (CI) -42.16 to -10.77; 722 participants; three studies) (moderate-quality evidence).There was a small beneficial effect of hearing aids on general health-related quality of life (standardised mean difference (SMD) -0.38, 95% CI -0.55 to -0.21; 568 participants; two studies) (moderate-quality evidence). There was a large beneficial effect of hearing aids on listening ability (SMD -1.88, 95% CI -3.24 to -0.52; 534 participants; two studies) (moderate-quality evidence).Adverse effects were measured in only one study (48 participants) and none were reported (very low-quality evidence).

AUTHORS' CONCLUSIONS

The available evidence concurs that hearing aids are effective at improving hearing-specific health-related quality of life, general health-related quality of life and listening ability in adults with mild to moderate hearing loss. The evidence is compatible with the widespread provision of hearing aids as the first-line clinical management in those who seek help for hearing difficulties. Greater consistency is needed in the choice of outcome measures used to assess benefits from hearing aids. Further placebo-controlled studies would increase our confidence in the estimates of these effects and ascertain whether they vary according to age, gender, degree of hearing loss and type of hearing aid.

Adaptation of the speech, spatial, and qualities of hearing scale for use with children, parents, and teachers

Subjective assessment of hearing ability in everyday life complements more objective forms of evaluation. A broad evaluation of the additional benefit provided to children by a second bilateral cochlear implant required such an assessment. As no paediatric tool provided detailed evaluation of performance in the areas of daily listening in which benefit was likely to be demonstrated, an adult questionnaire was adapted. Items of the Speech, Spatial and Qualities of Hearing Scale (SSQ) focused mainly, although not exclusively, on hearing functions requiring the binaural system. The adapted child, parent, and teacher versions of the SSQ retained the structure of rating listening performance in everyday scenarios across the domains of speech perception, spatial hearing, and other qualities of hearing. Modifications were minimized, although deletion of some items and wording changes were required, and some subdomains could not be included. Observation periods were introduced so that parents and teachers observe performance prior to providing ratings. The suggested minimum age is 11 years for the child version and 5 years for the parent and teacher versions. Instructions indicate interview-style administration in which interpretation of the described listening scenarios can be clarified and use of the ruler-style response format demonstrated. Researchers applying the SSQ for parents have reported higher performance ratings for bilateral over unilateral cochlear implants, particularly in the spatial hearing domain. Further research should provide evidence for the target age range, compare child and parent responses, and evaluate modifications for use with younger children.

Level of user satisfaction with hearing AIDS and environment: the international outcome inventory for hearing AIDS

Introduction The main function of hearing is to enable oral communication. Hearing loss impairs communication skills.

Objective To evaluate the level of user satisfaction with hearing aids.

Methods This is a cross-sectional group study comprising 108 subjects (56% men and 44% women). The average age of the subjects was 77 years. These subjects had been recently fitted with their hearing aids and showed sensorineural (90%) and mixed (10%) hearing loss as determined via the Questionnaire International Outcome Inventory for Hearing Aids Outcome Inventory (IOI-HA), which determined the benefit and satisfaction obtained by sound amplification.

Results The hearing aids improved the quality of life of 52.78% of the patients, which was revealed by their high scores (mean = 27.3). The relationship of the user with the environment was significantly better (p < 0.001) than that of the user with the hearing aid.

Conclusion IOI-HA is a simple and easy-to-use tool. Based on the results of this study, we can show a high degree of satisfaction with their hearing aids in the majority of the participants, which improved the quality of life.

Validity and reliability of the hearing handicap inventory for adults

The Hearing Handicap Inventory for Adults (HHIA) translated into Brazilian Portuguese has been used for clinical practice and research purposes; however, information regarding its ease of reading and psychometric properties are still lacking.

AIM

To evaluate the ease of reading and psychometric properties of the Brazilian translation of this tool, including its validity and reliability.

MATERIALS AND METHODS

Prospective study. The questionnaire was applied to 30 normal hearing (Group A) and 113 hearing impaired (Group B) persons. Thirty two participants (group B) answered the questionnaire a second time. The Flesch readability index was calculated for each item in the questionnaire. The internal consistency, test-retest reliability and discriminant validity were evaluated.

RESULTS

Flesch's scores showed that the questionnaire was easy to read. Cronbach's alpha and Pearson's correlation showed high internal consistency. There was no significant difference between test and retest scores. Besides, correlation between these two scores was also high and significant. Student t test indicated significant difference between scores for groups A and B (discriminant validity).

CONCLUSIONS

The Hearing Handicap Inventory for Adults translated into Brazilian Portuguese maintained the reliability and validity of the English version. Further studies are needed to determine the convergent validity and construct validity for this instrument.

[Study of benefit and of acclimatization in recent users of hearing aids]

BACKGROUND

benefit and acclimatization.

AIM

to characterize the short-term benefits presented by adults, recent users of hearing aids, through objective (functional gain) and subjective (self-evaluation questionnaires) procedures. The possible occurrence of the phenomenon of acclimatization was also investigated based on the analysis of the speech recognition percent index (SRPI) before the fitting of the hearing aids and after four and 16/18 weeks of hearing aids use.

METHOD

sixteen subjects, with ages between 17 and 89 years, with symmetric moderate or severe sensorineural hearing loss, recent hearing aid users, were evaluated. The study was divided in three phases: before the hearing aids fitting, and after four and 16/18 weeks following the fitting process. In all of the phases the following procedures were used: pure tone audiometry, speech recognition percent index, speech recognition threshold and the Hearing Handicap Inventory for Elderly Screening Version or the Hearing Handicap Inventory for the Adults Screening Version, and the Abbreviated Profile of Hearing Aid Benefit. After the hearing aid fitting process, subjects were submitted to free field audiometry.

RESULTS

results showed statistically significant differences between objective and subjective measures after the use of hearing aids, indicating short-term benefit. However, as time went by, the benefit obtained with the use of hearing aids did not improve significantly, suggesting that benefit does not increase with time. SRPI as well as subjective measures improved with long-term hearing aid use, but such differences were not statistically significant.

CONCLUSIONS

short-term benefits were obtained with the use of hearing aids, however the phenomenon of acclimatization was not observed through the SRPI.

Prótese auditiva: satisfação do usuário com sua prótese e com seu meio ambiente

OBJETIVO: avaliar o nível de satisfação dos usuários com sua prótese auditiva e com seu meio ambiente. MÉTODOS: estudo descritivo de corte transversal, com 256 indivíduos (m= 48,33%; f= 51,67%), com idade média de 50 anos, recém protetizados, com perda auditiva do tipo sensorioneural (n= 268) e mista (n=32), através do questionário de auto-avaliação International Outcome Inventory for Hearing Aids - IOI-HA para determinar o grau do benefício e a satisfação dada pela amplificação sonora. RESULTADOS: para 68% o uso da prótese melhorou a qualidade de vida, evidenciado pela alta pontuação (média=26,45). A relação do usuário com sua prótese foi significativamente melhor (p<0,001*) do que com o meio ambiente. Na avaliação subjetiva dos problemas auditivos, 78,5% referiram ter problemas de grau leve a moderado e 21,5% de grau moderadamente severo a severo. CONCLUSÃO: o IOI-HA é uma ferramenta, simples, fácil de aplicar além de servir como um instrumento facilitador durante o período de aclimatização com a prótese. A melhora na qualidade de vida foi mais referida pelos homens principalmente em relação ao nível de satisfação com a prótese e a diminuição do impacto da deficiência nos outros. O nível de dificuldades dos problemas subjetivos referenciados na vida diária foi mais útil do que as informações objetivas ilustrada no audiograma. A análise mostrou forte associação entre a percepção do individuo com o grau de sua perda auditiva. Indivíduos com percepção de perda auditiva de grau moderadamente severo ou severo mostram maior restrição de participação em suas vidas.

Satisfaction level with hearing aid in the daily life of Army Healthcare System users

The objective of the present study was to investigate satisfaction levels with hearing aids in daily life of Army Health System users, in addition to associated factors. Adults and seniors from 3^rd Military Area that had purchased hearing aids within the years 1998 and 2003 were selected to answer SADL (Satisfaction with Amplification in Daily Life) questionnaire. We excluded patients aged less than 18 years; those that had acquired hearing aid for less than 6 weeks, and patients with severe comprehension and expression limitation. The results showed that patients were considerably satisfied with the use of aids. There was lower satisfaction level with the negative factor subscale of SADL (Satisfaction with Amplification in Daily Life), especially in relation to telephone using. The factors that were associated with satisfaction were linked to the person and, mainly, to auditory rehabilitation. The data showed that, beyond the selection of the most technically appropriate hearing aid, it is highly important to follow auditory rehabilitation programs including home trials, guidance and counseling so that patients can have realistic expectations.

Satisfação com a prótese auditiva na vida diária em usuários do Sistema de Saúde do Exército

O objetivo deste estudo foi investigar o nível de satisfação com a prótese auditiva na vida diária em usuários do Sistema de Saúde do Exército e fatores associados. Foram selecionados adultos e idosos, usuários do convênio de saúde da 3ª Região Militar, que adquiriram prótese auditiva entre os anos de 1998 e 2003, para responderem ao questionário SADL (Satisfaction with Amplification in Daily Life). Foram excluídos do estudo indivíduos com idade inferior a 18 anos; que adquiriram a prótese auditiva há menos de 6 semanas; com grave limitação da capacidade de compreensão e expressão; e que não concordaram em participar da pesquisa. Os resultados mostraram que os pacientes estavam consideravelmente satisfeitos com o uso da prótese auditiva. Houve menor satisfação na subescala fatores negativos do SADL, especialmente em relação ao uso do telefone. Tiveram associação com a satisfação fatores ligados à pessoa e, principalmente, à reabilitação auditiva. Os dados mostraram que, além da seleção da prótese tecnicamente mais adequada, tem fundamental importância a implantação de programas de reabilitação auditiva, com experiência domiciliar, orientações e aconselhamento, buscando que o paciente tenha expectativas realistas.

Longitudinal changes in hearing aid satisfaction and usage in the elderly over a period of one or two years after hearing aid delivery

OBJECTIVE

The objective of this study was to measure hearing aid satisfaction and usage for extended periods of time, up to 2 yr after hearing aid delivery, to determine whether longitudinal changes occur in the elderly for these outcome measures.

DESIGN

A longitudinal study of hearing aid satisfaction and usage was performed in a group comprised of 134 elderly hearing aid wearers with these outcome measures obtained at 1, 6, and 12 mo postfit. A total of 49 of the original 134 elderly returned 2 yr after hearing aid delivery to complete the satisfaction and usage measures again. Multiple self-report measures of hearing aid satisfaction and hearing aid usage were obtained at each follow-up session.

RESULTS

Most between-interval comparisons of the various measures of satisfaction and usage failed to reveal significant changes over time. However, some significant changes were observed in both satisfaction and usage. When such changes occurred, they were always in a direction that suggested a decrease in satisfaction or usage over time. Correlations across various postfit interval pairs were found to be positive, statistically significant, and moderate to strong in strength for all measures of satisfaction and usage.

CONCLUSIONS

Although there were slight declines in hearing aid usage and satisfaction over time, measures of hearing aid satisfaction obtained at 1 mo postfit and of hearing aid usage obtained at 6 mo postfit are generally stable for up to 2 yr after hearing aid delivery.

A comparison of two measures of hearing aid satisfaction in a group of elderly hearing aid wearers

OBJECTIVE

The objective of this study was to compare the results of two measures of hearing aid satisfaction, an indirect measure (Satisfaction with Amplification in Daily Living, SADL; Cox & Alexander, 1999) and a direct measure (an expanded version of the MarkeTrak-IV survey; Kochkin, 1996), in a group of elderly hearing aid wearers.

DESIGN

A total of 43 elderly hearing aid wearers completed both satisfaction measures (order counterbalanced across wearers) after 1 mo of wearing 2-channel wide dynamic range compression (WDRC) in-the-canal (ITC) hearing aids. A correlational research design was employed.

RESULTS

The elderly hearing aid wearers in this study yielded results on each measure of hearing aid satisfaction that were generally consistent with those found previously in larger groups of similar samples. The correlation between each measure of satisfaction (r = 0.75) was positive, moderately strong, and significant (p < 0.01) for the global scores of the SADL and MarkeTrak-IV scales.

CONCLUSIONS

Although different approaches to the measurement of satisfaction were followed in the development of the SADL (indirect approach) and the MarkeTrak-IV (direct measurement) scales, similar results were obtained with each scale. The 15-item SADL instrument, however, is much shorter than the MarkeTrak-IV instrument and, as a result, is more efficient to administer clinically.

A multi-center, double blind clinical trial comparing benefit from three commonly used hearing aid circuits

OBJECTIVE

Although numerous studies have demonstrated that hearing aids provide significant benefit, carefully controlled, multi-center clinical trials have not been conducted. A multi-center clinical trial was conducted to compare the efficacy of three commonly used hearing aid circuits: peak clipping, compression limiting, and wide dynamic range compression.

DESIGN

Patients (N = 360) with bilateral, sensorineural hearing loss were studied using a double blind, three-period, three-treatment crossover design. The patients were fit with each of three programmable hearing aid circuits. Outcome tests were administered in the unaided condition at baseline and then after 3 mo usage of each circuit, the tests were administered in both aided and unaided conditions. The outcome test battery included tests of speech recognition, sound quality and subjective scales of hearing aid benefit, including patients' overall rank-order rating of the three circuits.

RESULTS

Each hearing aid circuit improved speech recognition markedly, with greater improvement observed for soft and conversationally loud speech in both quiet and noisy listening conditions. In addition, a significant reduction in the problems encountered in communication was observed. Some tests suggested that the two compression hearing aids provided a better listening experience than the peak clipping hearing aid. In the rank-order ratings, patients preferred the compression limiting hearing aid more frequently than the other two hearing aids.

CONCLUSIONS

The three hearing aid circuits studied provide significant benefit both in quiet and in noisy listening situations. The two compression hearing aids appear to provide superior benefits compared to the linear circuit, although the differences between the hearing aids were smaller than the differences between unaided and aided conditions.

Hearing-aid outcome measured following one month of hearing aid use by the elderly

This study reports the results of a large number of hearing-aid outcome measures obtained from 173 elderly hearing-aid wearers following one month of hearing-aid use. All participants in this study were fit binaurally with identical full-concha in-the-ear (ITE) hearing aids having linear Class-D amplifiers with output-limiting compression. Outcome measures included several measures of speech recognition, as well as several self-report measures of hearing-aid performance, benefit, satisfaction, and use. Comparison of mean data from this sample of hearing-aid wearers to other larger sets of data, obtained previously for several of these measures of hearing-aid outcome evaluated in isolation, indicated that the participants in this study were representative of the participants in other larger-scale studies. Subsequent principal-components factor analysis of the data from this study indicated that there were seven distinct dimensions of hearing-aid outcome. Attempts to document the effectiveness and efficacy of hearing aids for elderly persons with impaired hearing will be most complete when assessing performance along all seven dimensions of hearing-aid outcome. Clinically efficient procedures for doing so are discussed.

Hearing aids

The first step in the hearing aid fitting and selection process is to determine the patient's hearing disability, motivation, lifestyle, finances, and cosmetic concerns. Most hearing impairments can be helped with a modern hearing aid. With a symmetric hearing loss, a binaural fitting provides the most benefit and should be attempted initially. The binaural fitting may not be successful in cases with large asymmetries in auditory function. The advances in electronic technology, such as the digital hearing aid, are moving faster than the research to determine which is the most effective signal processing method. The near future should yield more significant improvements in hearing aids that will provide a better quality of life of the hearing-impaired population.