Subjective ratings of noise-reduction hearing aids

The effectiveness of seven commercially available noise-reduction hearing aids was evaluated using subjective ratings of continuous discourse. Subjective scales of listening comfort, speech quality, speech understanding, noise interference, and overall liking were used. Fifteen experienced hearing-aid users participated. Two hearing aids that used amplitude compression (Audiotone A-54 and Telex 363C), two hearing aids that used the Zeta Noise Blocker (two versions of a Maico SP147), and three hearing aids that proportionally attenuated the low-frequencies (Rion HB-69AS, Richards ASE-B, and Siemens 283 ASP) were evaluated. None of the noise-reduction hearing aids significantly altered group performance on any subjective scale. Individually, however, subjects responded differently to different noise-reduction hearing aids, indicating that some noise-reduction hearing aids may help some hearing-impaired individuals.     

Adaptación transcultural al español del instrumento de evaluación de calidad de vida en pacientes usuarios de audífonos «Effectiveness of Auditory Rehabilitation»

Introduction and objectivesIt is becoming increasingly important to have reliable and valid questionnaires. This becomes especially important when evaluating hearing loss.The aim of this work was to validate «Effectiveness of Auditory Rehabilitation» (EAR) questionnaire for the Spanish-speaking population. This instrument assesses quality of life and hearing aspects in patients using hearing aids.Material and methodCross-sectional validation study. A cultural adaptation through the use of English to Spanish translations and re-translations was carried out. The validity and reliability of the newly adapted instrument were evaluated.ResultsA total of 69 individuals (44 older adults and 25 younger adults) were examined. The pure-tone averages were 47.3 dB and 47.1 dB for the left and right ears, respectively. The mean maximum speech discrimination in silence for monosyllables were 83.3% and 82.9% for the left and right ears, respectively. Internal consistency presented Cronbach alpha values of 0.85 and 0.77 for the internal and external dimensions, respectively. The intraclass correlation coefficients were 0.80 for the internal module and 0.85 for the external module. Construct validity reported a correlation coefficient of 0.71 at baseline and 0.76 at 3 months after the initial assessment for the internal module, and 0.62 at baseline and 0.74 at 3 months after the initial assessment for the external module. The size effects were 1.3 and 1.1 for the internal and external modules, respectively.ConclusionsThe Spanish version of the EAR questionnaire seems to be a reliable and valid instrument. The evaluation of audiological aspects, as well as aspects relating to aesthetics and comfort are the main strengths of this instrument. Finally, the EAR scale is more sensitive to change than other scales.     

The cost-effectiveness of hearing-aid fitting in the Netherlands

OBJECTIVE: To determine the cost-effectiveness of hearing-aid fitting. DESIGN: Cost-effectiveness analysis using a Markov model based on aggregate data and results from a prospective intervention study. SETTING: The cost-effectiveness study was based in the general community. The prospective study was hospital based, as 85% of the first-time hearing-aid users attend a hospital in the process of hearing-aid fitting. PATIENTS: The prospective intervention study included adult first-time hearing-aid users with no contraindications for hearing-aid use. INTERVENTION: The usual process of hearing-aid fitting in the Netherlands. MAIN OUTCOME MEASURE: Costs per quality-adjusted life-year (QALY). The QALYs were based on EuroQol scores. We included direct and indirect costs in the analysis. RESULTS: The mean improvement on the EuroQol measure was 0.03 (95% confidence interval [CI], -0.03 to 0.08), and on the hearing-specific visual analog scale, 0.27 (95% CI, 0.22-0.31). The base-case outcome based on the EuroQol was 15 807/QALY (US dollars 17 072/QALY) (CI, -24 239/QALY to 3718/QALY). CONCLUSIONS: On the basis of this base-case estimate, fitting of hearing aids is considered a cost-effective health care intervention. The CI indicates that the result is not unambiguously positive, probably because the EuroQol lacked sensitivity for the evaluation of hearing-aid fitting. Until now, no study has found an effect of hearing-aid fitting on generic quality of life. Therefore, measures are needed that are suitable for the evaluation of the effects of interventions for sensory disabilities, such as the fitting of hearing aids, on generic quality of life.     

Self-reported disability and handicap after hearing-aid fitting and benefit of hearing aids: comparison of fitting procedures, degree of hearing loss, experience with hearing aids and uni- and bilateral fittings

Self-reported outcome on hearing disability and handicap as well as overall health-related quality of life were measured after hearing-aid fitting in a large-scale clinical population. Fitting was performed according to two different procedures in a double-blind study design. We used a comparative procedure based on optimizing speech intelligibility scores and a strictly implemented fitting formula. Hearing disability and handicap were assessed with the hearing handicap and disability inventory and benefit of hearing aids with the abbreviated profile of hearing aid benefit. Effects on health-related quality of life and depression were assessed with the EuroQol-5D questionnaire and the geriatric depression scale. We found that hearing-aid fitting according to either procedure had a significantly positive effect on disability and handicap associated with hearing loss. This effect lasted for several months. Only the effect on disability persisted after 1-year of follow-up. Self-reported benefit from hearing aids was comparable for both fitting procedures. Unaided hearing disability was more pronounced in groups of participants with greater hearing loss, while the benefit of hearing aids was independent from the degree of hearing impairment. First-time hearing aid users reported greater benefit from their hearing aids. The added value from a bilateral hearing-aid fitting was not significant. Overall health-related quality of life and incidence of depression did not alter after hearing-aid fitting.     

Application of the health belief model: Development of the hearing beliefs questionnaire (HBQ) and its associations with hearing health behaviors

Abstract

Objective: To develop a hearing beliefs questionnaire (HBQ) that assesses hearing beliefs within the constructs of the health belief model, and to investigate whether HBQ scores are associated with hearing health behaviors. Design: A 60-item version of the questionnaire was developed and completed by 223 participants who also provided information about their hearing health behaviors (help seeking, hearing-aid acquisition, and hearing-aid use). Study sample: Individuals aged between 22 and 90 years recruited from a primary care waiting area at a Veterans hospital. Seventy-six percent were male, 80% were Veterans. Results: A 26-item version of the HBQ with six scales was derived using factor analysis and reliability analyses. The scales measured: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and cues to action. HBQ scores differed significantly between individuals with different hearing health behaviors. Logistic regression analyses resulted in robust models of hearing health behaviors that correctly classified between 59% and 100% of participant hearing health behaviors. Conclusions: The HBM appears to be an appropriate framework for examining hearing health behaviors, and the HBQ is a valuable tool for assessing hearing health beliefs and predicting hearing health behaviors.     

Hearing-aid counseling: Comparison of single-session informational counseling with single-session performance-perceptual counseling

Abstract Objective: Hearing-aid counseling can improve outcome but programs are often too resource-intensive to be clinically practical. Here we examined the effectiveness of single-session informational counseling with single-session performance-perceptual counseling. Design: Two forms of counseling were compared: informational counseling (IC) and performance-perceptual counseling (PPC). IC focused on discussing communication strategies and tips for hearing-aid use. PPC addressed the discrepancy between measured and perceived ability to understand speech. Outcomes were measured eight-to-ten weeks post-counseling using quantitative and qualitative measures: Hearing handicap inventory, abbreviated profile of hearing aid benefit, psychosocial impact of assistive devices scale (PIADS), international outcome inventory for hearing aids, and a semi-structured exit interview. Study sample: Seventy-four hearing aid-users with symmetrical sensorineural hearing loss participated. Results: Scores on the hearing questionnaires showed no change following either form of counseling. Scores on the PIADS improved for participants as a whole, and the semi-structured interview revealed increased hearing-aid use, better understanding and acceptance of hearing loss, increased use of communication strategies, and improved ability to explain hearing difficulties to others. Conclusions: A single session of hearing-aid counseling can improve hearing-aid use and satisfaction. Open-ended interview and/or quality of life measures are more sensitive to these benefits than hearing questionnaires.     

Determinants of hearing-aid adoption and use among the elderly: A systematic review

Objective: While the benefits of hearing aids among older adults with presbycusis have been well documented, there is limited research on hearing-aid usage. The aim of this review is to synthesize current evidence to identify the determinants of hearing-aid adoption and use among the elderly. Design: Systematic review. Study sample: Articles were identified through systematic searches in the Web of Science, Medline, CINAHL, and a manual search. Studies that explore the potential determinants of hearing-aid usage were to be included. Results: A total of twenty-two articles were reviewed. Four audiological determinants (the severity of hearing loss, the type of hearing aids, background noise acceptance, and insertion gain) and seven non-audiological determinants (self-perceived hearing problems, expectation, demographics, group consultation, support from significant others, self-perceived benefit, and satisfaction) were identified as affecting the adoption and use of hearing aids. Conclusions: There is a need to explore the influence of significant others, health professionals, and user demographics on hearing rehabilitation for future research. The determinants identified in this review depicted the stage progression of the trans-theoretical model (TTM) in explaining an individual's readiness to hearing-aid usage.     

Hearing difficulties, uptake, and outcomes of hearing aids in people 85 years of age

OBJECTIVE: The aim of this study was to investigate self-reported hearing difficulties, uptake, and hearing-aid outcomes and their relationships to demographic, cognitive, psychosocial, and health variables in 85 year olds. DESIGN AND STUDY SAMPLE: Three hundred and forty-six elderly adults participated in a survey that included questionnaires and home visits. Fifty-five percent of participants admitted to having hearing difficulties, and 59% of these owned hearing aids. The participants' most frequently cited reason for not acquiring hearing aids was that they did not think their hearing problem was perceived as severe enough. Participants with hearing difficulties who did not own hearing aids showed worse general and mental health. Many of the elderly participants were successful in their rehabilitation, and their hearing-aid outcomes were similar to those of a younger group, with the exception of a greater proportion of non-users among the elderly. CONCLUSION: Many older people with self-reported hearing difficulties do not acquire hearing aids, despite this study's findings that older people are likely to have success with hearing rehabilitation. It is important to make greater efforts to try to increase elderly adults' awareness of hearing loss and the benefits of hearing rehabilitation.     

Comparison of speech perception in background noise with acceptance of background noise in aided and unaided conditions.

Background noise is a significant factor influencing hearing-aid satisfaction and is a major reason for rejection of hearing aids. Attempts have been made by previous researchers to relate the use of hearing aids to speech perception in noise (SPIN), with an expectation of improved speech perception followed by an increased acceptance of hearing aids. Unfortunately, SPIN was not related to hearing-aid use or satisfaction. A new measure of listener reaction to background noise has been proposed. The acceptable noise level (ANL), expressed in decibels, is defined as a difference between the most comfortable listening level for speech and the highest background noise level that is acceptable when listening to and following a story. The ANL measure assumes that speech understanding in noise may not be as important as is the willingness to listen in the presence of noise. It has been established that people who accept background noise have smaller ANLs and tend to be "good" users of hearing aids. Conversely, people who cannot accept background noise have larger ANLs and may only use hearing aids occasionally or reject them altogether. Because this is a new measure, it was important to determine the reliability of the ANL over time with and without hearing aids, to determine the effect of acclimatization to hearing aids, and to compare the ANL to well-established measures such as speech perception scores collected with the SPIN test. Results from 50 listeners indicate that for both good and occasional hearing aid users, the ANL is comparable in reliability to the SPIN test and that both measures do not change with acclimatization. The ANLs and SPIN scores are unrelated. Although the SPIN scores improve with amplification, the ANLs are unaffected by amplification, suggesting that the ANL is inherent to an individual and can be established prior to hearing aid fitting as a possible predictor of hearing-aid use.     

Identifying the needs of elderly, hearing-impaired persons: the importance and utility of hearing aid attributes

Older patients represent the majority of hearing-aid users. The needs of elderly, hearing-impaired subjects are not entirely identified. The present study aims to determine the importance of fundamental hearing-aid attributes and to elicit the utility of associated hypothetical hearing aids for older patients. This was achieved using a questionnaire-based conjoint analysis--a decompositional approach to preference measurement offering a realistic study design. A random sample of 200 experienced hearing-aid users participated in the study. Though three out of the six examined attributes revealed age-related dependencies, the only significant effect was found for the attribute "handling", which was considerably more important for older than younger hearing-aid users. A trend of decreasing importance of speech intelligibility in noise and increasing significance of speech in quiet was observed for subjects older than 70 years. In general, the utility of various hypothetical hearing aids was similar for older and younger subjects. Apart from the attribute "handling", older and younger subjects have comparable needs regarding hearing-aid features. On the basis of the examined attributes, there is no requirement for hearing aids designed specifically for elderly hearing-aid users, provided that ergonomic features are considered and the benefits of modern technology are made fully available for older patients.     

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.     

Sounds perceived as annoying by hearing-aid users in their daily soundscape

Abstract

Background: The noises in modern soundscapes continue to increase and are a major origin for annoyance. For a hearing-impaired person, a hearing aid is often beneficial, but noise and annoying sounds can result in non-use of the hearing aid, temporary or permanently. Objective: The purpose of this study was to identify annoying sounds in a daily soundscape for hearing-aid users. Design: A diary was used to collect data where the participants answered four questions per day about annoying sounds in the daily soundscape over a two-week period. Study sample: Sixty adult hearing-aid users. Results: Of the 60 participants 91% experienced annoying sounds daily when using hearing aids. The annoying sound mentioned by most users, was verbal human sounds, followed by other daily sound sources categorized into 17 groups such as TV/radio, vehicles, and machine tools. When the hearing-aid users were grouped in relation to age, hearing loss, gender, hearing-aid experience, and type of signal processing used in their hearing aids, small and only few significant differences were found when comparing their experience of annoying sounds. Conclusions: The results indicate that hearing-aid users often experience annoying sounds and improved clinical fitting routines may reduce the problem.     

Reduction in caregiver-identified problem behaviors in patients with Alzheimer disease post-hearing-aid fitting.

Studies and clinical procedures related to patients with Alzheimer disease (AD) largely have ignored the hearing ability of either the patient or caregiver. Yet the majority of treatment and investigation depends on or presupposes communication ability. Further, caregiver complaints often center around communication-based issues. Hearing deficits may be the most frequently unrecognized condition in patients with AD because patients either communicate adequately in quiet or the impairment is masked by other behavioral symptoms of AD. The current investigation identified individuals with AD with perceived and measured hearing impairment, provided amplification management, and evaluated the impact of treatment on caregiver-identified problem behaviors believed to be related to hearing status. Specifically, treatment compliance (hearing-aid use) and treatment efficacy (reduction in perceived hearing handicap and problem behaviors) were measured in the current investigation. A multiple-baseline design across individuals with multiple dependent variables was used to evaluate the reduction of problem behaviors post-hearing-aid treatment. Eight participants were included and 1 to 4 problem behaviors were significantly reduced for each patient after hearing-aid treatment. All participants were able to complete the necessary evaluation for hearing-aid fitting and wore their hearing aids between 5 and 15 hours per day by the end of the study. This investigation employed novel methodology in the areas of on-site hearing evaluation and hearing-aid selection, advanced hearing-aid technology, and primary data recording of caregiver-identified problem behaviors by caregivers.     

Relationship between consonant recognition and subjective ratings of hearing aids

The relationships between consonant recognition performance and subjective ratings (using continuous discourse and nonsense syllables as stimuli) of speech understanding, listening comfort, quality, noise interference and overall liking were examined in quiet and in noise using hearing-impaired subjects and seven different hearing aids. Correlations among the subjective scales varied depending on test conditions and test stimuli. Scores on the speech understanding and overall liking scales correlated moderately with scores on a consonant-recognition test presented in noise and when syllables were used as the materials for judgments. The overall liking scale (for a hearing aid) correlated with all other subjective scales and consonant recognition performance. However, the relative contribution of each subjective scale to overall liking varied depending on test conditions and test materials.     

Comparison of onset and steady-state responses of hearing aids: implications for use of the auditory brainstem response in the selection of hearing aids

Input-output (I/O) functions of hearing aids were measured in response to a 2000-Hz tone burst, having 0.5 ms rise/fall time and 10 ms duration. I/O functions, measured with a hearing-aid analyzer, served as reference conditions. Hearing-aid outputs at onset and during the steady-state portion of the waveform differed; these differences often depended upon stimulus rate. The relation between onset and steady-state estimates of output were not always predictable from hearing-aid attack and release times. These findings indicate that the steady-state output limitation characteristics of hearing aids cannot be estimated from their onset responses. In turn, this suggests that ABR measurements may not provide accurate estimates of the compressive characteristics of hearing aids.     

The occlusion effect in unilateral versus bilateral hearing aids

The benefit of bilateral hearing aids is well documented, but many hearing-aid users still wear only one aid. It is plausible that the occlusion effect is part of the reason for some hearing-aid users not wearing both hearing aids. In this study we quantified the subjective occlusion effect by asking ten experienced users of bilateral hearing aids and a reference group of ten normal-hearing individuals to rate the naturalness of their own voice while reading a text sample aloud. The subjective occlusion effect was evaluated in the unilateral versus bilateral condition for a variety of vent designs in earmolds and in a custom hearing aid. The subjective occlusion effect was significantly higher for bilateral hearing aids with all vent designs with the exception of a non-occluding eartip option. The subjective occlusion effect was reduced with the more open vent designs in both the unilateral and bilateral conditions. Assuming that the occlusion effect is a barrier to bilateral hearing aid use, these results indicate that open-hearing-aid fittings can help promote the use of two aids.     

Validation of the Chinese version “satisfaction with amplification in daily life (SADL)” survey for hearing-aid users

Abstract

Objective: Satisfaction with amplification in daily life (SADL) may quantify satisfaction with hearing aids. We translated and validated a Chinese version of SADL (CSADL). Design: The SADL was translated from English to Mandarin Chinese by two bilingual physicians. The CSADL was administered to hearing-aid users and tested for reliability and validity. Study sample: There were 155 hearing-aid users who completed the CSADL prospectively, and 39 subjects were retested after 4 to 6 weeks for test-retest reliability. Results: The CSADL had good internal consistency (Cronbach α = 0.63 to 0.92), within survey reliability (r = 0.54 to 0.69; P ≤ .05), and test-retest reliability (r = 0.93 to 0.98; P ≤ .05). The CSADL dimensions correlated well with worse-ear speech discrimination score (P ≤ .05). The CSADL global score significantly correlated with the general health (r = 0.236; P ≤ .05), vitality (r = 0.162; P ≤ .05), social functioning (r = 0.190; P ≤ .05), and mental health (r = 0.224; P ≤ .05) subscales of the Mandarin Chinese Taiwan version of the medical outcome 36-item short-form health survey. Conclusions: The CSADL is a valid and reliable questionnaire to evaluate satisfaction among Chinese hearing-aid users.     

Acceptable noise level (ANL) with Danish and non-semantic speech materials in adult hearing-aid users

Abstract Objective: The acceptable noise level (ANL) test is used for quantification of the amount of background noise subjects accept when listening to speech. This study investigates Danish hearing-aid users' ANL performance using Danish and non-semantic speech signals, the repeatability of ANL, and the association between ANL and outcome of the international outcome inventory for hearing aids (IOI-HA). Design: ANL was measured in three conditions in both ears at two test sessions. Subjects completed the IOI-HA and the ANL questionnaire. Study sample: Sixty-three Danish hearing-aid users; fifty-seven subjects were full time users and 6 were part time/non users of hearing aids according to the ANL questionnaire. Results: ANLs were similar to results with American English speech material. The coefficient of repeatability (CR) was 6.5-8.8 dB. IOI-HA scores were not associated to ANL. Conclusions: Danish and non-semantic ANL versions yield results similar to the American English version. The magnitude of the CR indicates that ANL with Danish and non-semantic speech materials is not suitable for prediction of individual patterns of future hearing-aid use or evaluation of individual benefit from hearing-aid features. The ANL with Danish and non-semantic speech materials is not related to IOI-HA outcome.     

Self-report outcome in new hearing-aid users: Longitudinal trends and relationships between subjective measures of benefit and satisfaction

This study focussed on self-report outcome in new hearing-aid users. The objectives of the experiment were changes in self-report outcome over time, and relationships between different subjective measures of benefit and satisfaction. Four outcome inventories and a questionnaire on auditory lifestyle were administered to 25 hearing-aid users repeatedly after hearing-aid fitting, and assessments took place one week, four weeks, and 13 weeks after hearing-aid provision. The results showed that, for first-time users who used their hearing aids more than four hours per day, self-reported outcome increased over 13 weeks in some scales, although there was no change in amplification during this time. Furthermore, it was found that, for data collected immediately post-fitting, some subscales were much less face valid than for data collected later. This result indicates that the way in which hearing-aid users assess outcome changes over time. The practical consequence of the results is that early self-report outcome assessment may be misleading for some self-report outcome schemes.     

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL)

Objective: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting. Design: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique. Study sample: A total of 132 adults with hearing impairment. Results: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (～18 dB) than first-time hearing-aid users (～10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs. Conclusions: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.