Factors influencing degree of hearing loss at presentation,hearing aid choice,and usage in first time hearing aid users in Singapore

Abstract

Objective: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore.

Design: Retrospective cross-sectional study.

Study sample: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013.

Results: Half of the subjects presented with more severe (>55?dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4?h of daily HA usage.

Conclusions: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly.     

Older adults’ experiences and issues with hearing aids in the first six months after hearing aid fitting

Objectives: This study describes older adults’ experiences with a new hearing aid (HA) during the first 6 months after fitting. Design: In a longitudinally designed study, experiences and issues with HA use were assessed at a six-month follow-up appointment in individual structured interviews lasting 30?min. Associations between HA experiences and demographic factors, degree of hearing loss, and an objective measure of HA use (datalogging) were also examined. Study sample: 181?HA recipients (≥60 years) attending a six-month follow-up appointment. Results: Participants reported an average of 1.4 issues (range 0–5, median?=?1, mode?=?1) with HA use, the most common pertaining to the earmold (26.5%), sound quality (26.0%) and handling (25.5%). Participants who reported at least one issue had fewer hours of use per day, but were not more likely to be non-users (<30?min/day). Non-users (15.5%) were more likely to report no need for a HA and handling issues. Conclusions: Most older adults use their HAs regardless of reported issues. However, handling issues and no perceived need may interfere with HA usage among some adults with hearing impairment. Moreover, reported issues were associated with less frequent HA use. Follow-up support is thus important to address issues that may interfere with optimal use.     

Quality of life in persons with hearing loss: a study of patients referred to an audiological service

Abstract

Objective: To investigate the relationship between hearing loss (HL) and general quality of life (QoL) in adults seeking hearing aids (HAs).

Design: The patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire’s general part and a questionnaire measuring self-assessed communication ability (Abbreviated Profile of hearing Aid Benefit—APHAB). These responses were compared with EORTC scores from a general population and patients with former head and neck cancer.

Study sample: One-hundred and fifty-eight adults with HL were recruited prior to hearing aid (HA) fitting with one half seeking renewal of their HA.

Results: General QoL scores among patients with HL were similar to those in the general population, but higher than in many chronic serious diseases. Patients with unilateral HL reported slightly worse social function and more fatigue than patients with bilateral HL. Self-assessed communication ability correlated with general QoL scores. Also, we found that best ear pure tone average (PTA), cognitive and physical QoL function predicted APHAB scores.

Conclusion: In the investigated HL group, general QoL scores seem to be relatively close to those seen in the general population.     

Spanish Study Group on Cochlear Implants for Persons with Marginal Benefit from Acoustic Amplification

Recently the U.S. Food and Drug Administration approved the use of cochlear implants (CI) in patients with severe-to-profound sensorineural hearing loss with marginal benefit (&lt;30% speech discrimination) from hearing aids (HA). A multicentre trial was developed to determine whether this approval could be applied to the Spanish population. Nine postlingual adults from 3 centres were selected for the study. The mean preoperative unaided PTA threshold (0.25 to 4 KHz) was 108.6 dB HL for the poorer ear and 99.8 dB HL for the better. In all subjects the poorer ear was implanted with a Mini Nucleus^® 22 device. A single subject design study was used to compare performance with HA preoperatively and with CI postoperatively, or CI with contralateral HA. PTA measures and Spanish open set speech recognition tests were used. Comparing pre-implant levels with results after 6 months of CI use, all subjects improved significantly on all test measures: i) Mean aided soundfield threshold: 73.6 dB vs 39.8 dB ii) Mean bisyllablic recognition: 20% vs 57% iii) Mean consonant discrimination: 20% vs 49% iv) Mean CID sentences: 22% vs 73%. Five subjects discontinued use of the contralateral HA after implantation, three continued occasionally to use the HA, and one continued to use both on a full-time basis. Patients performed significantly better post-implant on speech recognition compared with their best pre-implant HA scores. Therefore the CI appears an appropriate treatment for Spanish speakers with a severe-to-profound hearing loss and marginal benefits with HA.     

Clinical study of a digital vs an analogue hearing aid.

Digital signal processing in hearing instruments has brought new perspectives to the compensation of hearing impairment and may result in alleviation of the adverse effects of hearing problems. This study compares a commercially available digital signal processing hearing aid (HA) (Senso) with a modern analogue HA with programmable fitting (Logo). The HAs tested are identical in appearance and, in spite of a different mode of operation, the study design ensured blinding of the test subjects. Outcome parameters were: improvements in speech recognition score in noise (deltaSRSN) with the HAs; overall preference for HA; overall satisfaction; and various measures of HA performance evaluated by a self-assessment questionnaire. A total of 28 experienced HA users with sensorineural hearing impairment were included and 25 completed the trial. No significant differences were found in deltaSRSN between the two HAs. Eleven subjects indicated an overall preference for the digital HA, 10 preferred the analogue HA and 4 had no preference. Concerning overall satisfaction, 8 subjects rated the digital HA superior to the analogue one, whereas 7 indicated a superior rating for the analogue HA and 10 rated the HAs equal. Acceptability of noise from traffic was the only outcome parameter which gave a significant difference between the HAs in favour of the digital HA. It is concluded that there are no significant differences in outcome between the digital and analogue signal processing HAs tested by these experienced HA-users.     

Progression of hearing loss and choice of hearing aids by patients in their 60s, 70s,and 80s and older: experience in the Japanese super-aged era

Abstract

Background: Demographic data of patients with sensorineural hearing loss (SNHL) in super-aged societies are still limited.

Aims/objectives: To report audiometric statistics of SNHL and hearing aid (HA) use in patients in their 60s, 70s, and 80s and older during the super-aged era.

Material and methods: Medical charts and audiograms of 2064 older patients with SNHL who visited a Japanese University Hospital in 2007–2018 were retrospectively reviewed. Among 270 patients referred to the HA service unit (HASU), the percentage of final decisions to continue using HAs was calculated.

Results: The average pure tone thresholds on initial visit to the clinic were 56.9, 60.6, 69.4, and 82.4?dB HL in patients in their 60s, 70s, 80s, and 90s, respectively. The rates of progression were 0.25, 0.87, 1.19, and 1.37?dB/year in patients in their 50s, 60s, 70s, and 80s, respectively. The percentage of patients in HASU who chose to use HAs did not differ among the 60s (59.3%), 70s (51.2%), and 80s and older (58.2%).

Conclusions and significance: The clinical picture of patients with SNHL in their 70s and 80s differs because progression accelerates exponentially through these ages. HAs can be recommended to older adult patients in all the age groups.     

Hearing aid noise suppression and working memory function

Objective: Research findings concerning the relation between benefit from hearing aid (HA) noise suppression and working memory function are inconsistent. The current study thus investigated the effects of three noise suppression algorithms on auditory working memory and the relation with reading span. Design: Using a computer simulation of bilaterally fitted HAs, four settings were tested: (1) unprocessed, (2) directional microphones, (3) single-channel noise reduction, and (4) binaural coherence-based noise reduction. Settings 2–4 were matched in terms of the speech-weighted signal-to-noise ratio (SNR) improvement. Auditory working memory was assessed at +6?dB SNR using listening span and N-back paradigms. Study sample: Twenty experienced HA users aged 55–80?years with large differences in reading span. Results: For the listening span measurements, there was an influence of HA setting on sentence-final word recognition and recall, with the directional microphones leading to ～6% better performance than the single-channel noise reduction. For the N-back measurements, there was substantial test-retest variability and no influence of HA setting. No interactions with reading span were found. Conclusion: HA noise suppression may affect the recognition and recall of speech at positive SNRs, irrespective of individual reading span. Future work should improve the reliability of the auditory working memory measurements.     

Hearing progress and fluctuations in bimodal–binaural hearing users (unilateral cochlear implants and contralateral hearing aid)

Conclusions. Mean scores achieved using a cochlear implant (CI) plus a hearing aid (HA) were consistently higher (statistically non-significant) than those for CI alone. The addition of a contralateral HA partially compensated for the negative hearing fluctuations as well as for the slow initial progress with the CI. Objectives. To examine hearing progress over the first 3 years after unilateral cochlear implantation in users who had residual hearing in the non-implanted ear at the time of surgery and continued to use a HA in that ear thereafter. Patients and methods. Thirteen patients were followed up for 36months after continuous concomitant use of a CI and a contralateral HA. To evaluate hearing progress, sentence identification in background noise (presentation level, 55dB; S/N ratio, +10 dB) was tested for CI alone and for CI with contralateral HA (CI+HA). Subjects were tested after 6, 12, 18, 24, and 36months of concomitant use of both devices. Mixed regression model was used to evaluate the group's progression of scores and the added value of a contralateral HA over time. Results. When last tested (36 months after CI) the mean group score for CI alone was 72.6%±19.3%, and 12/13 patients scored at least 65% with either CI alone or CI+HA. Mean scores achieved using CI+HA were consistently higher than those for CI alone. Percentage improvement in CI+HA relative to CI alone was highest (19.2%) after 18 months of concomitant usage and then diminished gradually to 7.7% at 36months. Most patients showed some negative fluctuations in performance with CI alone at some point during the 36months of post-CI follow-up.     

Counselling of hearing aid users is highly cost-effective

Hearing aids (HAs) are often left unused. Several investigations have shown that the use of HAs and the skills to use them can be significantly improved through counselling. Follow-up counselling is often restricted by increased cost. The objective of the study was to assess the cost and the effect of follow-up counselling on HA use. In a prospective pre-post design study, 98 first-time HA users were counselled 6 months after the fitting of a HA, and the use of and benefit from HAs were measured by means of an interview and the short form of the hearing handicap inventory for the elderly (HHIE-S) and the EuroQoL (EQ-5D) questionnaires. The results obtained before and 6 months after counselling were compared and the cost of counselling was calculated. After follow-up counselling, over half of the occasional users of a HA and as many as one third of the non-users became regular users. The number of regular users increased by 16 subjects, and non-users decreased from 29 subjects to 17. The HHIE-S results showed a significant positive change, but the EQ-5D results showed practically no change. The additional expense of follow-up counselling at home was approximately 8.8% (€83 per visit) of the calculated €942 cost of fitting a HA. Bringing one unused HA into regular use required €508. The results show that HA use and the consequent benefit can be significantly increased through counselling. The expense caused by follow-up counselling at home is highly acceptable in addition to the cost of fitting a HA.     

Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment

Objective: The aims of this study were: to investigate the referral rates of postlingually deafened adult cochlear implant (CI) candidates from a hearing aid (HA) clinic for a CI candidacy assessment and to gain insight about factors influencing the referral pathways to CI assessments. Design: Two methodologies were used: a retrospective cohort study reviewing clinical files and a questionnaire to clinicians. Study sample: The files of 1249 adult clients from the HA clinic who had average puretone hearing thresholds greater or equal to 65?dB?HL in the better hearing ear and unaided phoneme recognition scores of less than 50% in both ears were reviewed. All of the clinicians completed the online questionnaire. Results: Eighteen adults met the CI candidacy criteria, of whom 16 (89%) had a CI discussion with their audiologist, with 11 (61%) being referred for a CI evaluation. Of these 11, four proceeded to implantation. Questionnaire responses revealed the need for better information on candidacy and referral guidelines for HA audiologists, in addition to enhanced communication between HA and CI clinics. Conclusions: Overall the results indicate that the referral pathway to obtain a CI assessment is a barrier contributing to the low CI penetration rate in adults.     

Preliminary evidence of asymmetry in uncomfortable loudness levels after unilateral hearing aid experience: Evidence of functional plasticity in the adult auditory system

The aim of the study was to compare uncomfortable loudness levels (ULLs) in a group of adults before and after unilateral hearing aid experience. Twelve participants presented with a symmetrical hearing loss consistent with natural ageing. Pure tones were presented to each ear separately, commencing at 60?dB HL and increased in 5-dB step sizes until ULL was reached. The post-fitting ULLs were typically measured three years after fitting. Hearing thresholds were symmetrical and remained unchanged after fitting. Mean ULL values were symmetrical before fitting. The mean ULL values increased (i.e. greater tolerance) in both ears after fitting; however, the increase was greatest in the fitted ear: 14.5 and 7?dB at 2000–4000?Hz in the fitted and not-fitted ear, respectively. A separate two-factor repeated ANOVA (ear and frequency) was performed on the pre and post-fitting ULL data. There was no statistically significant difference for ear (p?>?0.05) when comparing the pre-fitting ULLs. However, there was a statistically significant difference for ear (p?<?0.01) when comparing post-fitting ULLs. The underlying mechanism for the asymmetry is unknown but it is consistent with learning induced reorganization within the auditory system.     

Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation

Abstract

Objective: Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children. Design: Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers. Study sample: Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25–120?dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study). Results: Speech perception outcomes suggested that children with a PTA greater than 60?dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82?dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation. Conclusions: Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60?dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.     

The non-use of hearing aids in people aged 75 years and over in the city of Kuopio in Finland

Hearing loss is one of the most prevalent chronic conditions affecting the health of the aged. It is typically medically non-treatable, and hearing aid (HA) use remains the treatment of choice. However, only 15–30% of older adults with hearing impairment possess an HA. Many of them never use it. The purpose of our study was to investigate the use of provided HAs and reasons for the non-use of HAs. This population-based survey was set in the city of Kuopio in eastern Finland. A total of 601 people aged 75 years or older participated in this study. A geriatrician and a trained nurse examined the subjects. Their functional and cognitive capacity was evaluated. A questionnaire about participants socioeconomic characteristics and the use of HAs were included in the study protocol. The subjects who had an HA were assigned to three groups on the basis of HA use: full-time users, part-time users and non-users. Inquiries were made about the subjective reasons for the non-use of HAs. An HA had been prescribed earlier to 16.6% of the study group. Fourteen percent of the females and 23% of the males had been provided with an HA. The HA owners were older than persons who had not been provided with an HA. Twenty-five percent of the HA owners were non-users, and 55% were full-time users. A decline in cognitive or functional capacity and low income explained the non-use of HAs. The most common subjective reasons for the non-use of HAs were that the use did not help at all (10/24), the HA was broken (4/24) or it was too complicated to use (5/24). The non-use of HAs is still common among the aged. Elderly people who have been provided with an HA and who have a cognitive or functional decline are at risk to be a non-user of an HA. Therefore, they need special attention in counseling.     

Assessment of basal sound identification skills and communication abilities in profoundly deaf children fitted with hearing aids or a cochlear implant

Basal auditory functions and early verbal communication skills were examined in young, profoundly deaf children with hearing aids or a cochlear implant. The hearing aid users (n = 23) were subdivided on the basis of their (unaided) hearing thresholds into: group A (pure tone average (PTA) at 0.5, 1 and 2 kHz: 90–100 dB HL); group B (PTA: 100–110 dB HL); and group C (PTA > 110 dB HL). All the children with a cochlear implant (n = 20) had a profound sensorineural hearing loss with a PTA that exceeded 120 dB HL. Functional hearing was evaluated by means of basal sound identification. The child’s communication abilities with hearing aids or a cochlear implant were assessed using structured observations on the Scales of Early Communication Skills for Hearing Impaired Children. The basal auditory functions on a sound identification level improved over time in the cochlear implant users and groups A and B. Hardly any improvement was seen in group C. The performance of all the groups (either hearing aid or cochlear implant) on the Scales of Early Communication Skills for Hearing Impaired Children at 6 months after fitting the device and at later evaluations, was close to the average level for their age.     

The auditory acclimatization effect in sensorineural hearing-impaired listeners: evidence for functional plasticity

The present study provides new data on perceptual and physiological modifications associated with hearing aid (HA) fitting. Eight sensorineural hearing-impaired (SNHI) listeners participated. They had symmetrical hearing loss and were being fitted with binaural HAs for the first time. Perceptual performances were measured four times during auditory rehabilitation, using an intensity discrimination task and a loudness-scaling task. Pure tones of two different frequencies were used, one well amplified by HAs and the other weakly amplified. Two intensity levels were also tested, one rated 'soft' by SNHI listeners and the other 'loud'. Auditory brainstem responses (ABRs) to click stimulation were recorded. All measures were performed without HA. Results were consistent with the auditory acclimatization effect: most modifications induced by HA fitting were found at loud intensity levels and at high frequency, i.e., for acoustic information that was newly available to the listener. While both ears had similar hearing loss and aided gains, some differences between ears appeared in both perceptual tasks and in ABRs. In the right ear, a shortening of wave V latency paralleled perceptual modifications. The present results suggest that HA-fitting induces functional plasticity at the peripheral level of the auditory system.     

Reference thresholds for the TEN(HL) test for people with normal hearing

Objective: To estimate normative values and repeatability of thresholds for the TEN(HL) test for diagnosing dead regions in the cochlea, as a function of signal frequency, TEN(HL) level, age and gender. Design: The TEN(HL) test was administered twice for each ear of each participant using signal frequencies from 0.5 to 4?kHz and TEN(HL) levels of 30, 50 and 70?dB HL/ERB_N. Study sample: In all, 29 young participants and 8 older participants were tested. All had normal audiograms with no history of hearing problems. Results: There was good repeatability across sessions. There was no significant effect of ear, gender or age group. The average signal-to-TEN ratio (STR) at threshold was close to 0?dB. For low signal frequencies, the STR at threshold varied only slightly with TEN(HL) level, but for the signal frequencies of 3 and 4?kHz the STR at threshold increased to about +2.7?dB for the TEN(HL) level of 70?dB/ERB_N. Conclusions: For a high TEN(HL) level, the “normal” STR at threshold at 3 and 4?kHz is closer to +2?dB than to 0?dB. Further research is needed to assess whether the TEN(HL)-test criteria need to be modified when testing at high frequencies and high levels.     

Patient selection for incus body coupling of a totally implantable middle ear implant

Objective—To evaluate audiologic selection criteria for incus body coupling (IBC) of a totally implantable middle ear implant (TI-MEI) for the treatment of sensorineural hearing loss (SNHL). Material and Methods—The protocol is specified in the Investigational Device Exemption of a Food and Drug Administration-approved multicenter clinical trial. The prospective study compared pre- and postoperative hearing levels using each patient as their own control. In addition, an implant on/off comparison was made. All patients had a follow-up interval of at least 6 months. Audiologic assessment tests included speech discrimination in quiet as the primary efficacy variable and pure-tone audiometry (aided thresholds), gain, speech recognition in noise and subject satisfaction using standardized questionnaires and visual analog scales (VASs) as secondary efficacy variables. The study group of patients (n = 13) was divided into 3 subgroups based on their pure-tone and speech discrimination scores: Group A consisted of 6 patients, Group B 9 patients and Group C of all 13 patients. All patients suffered from long-standing bilateral moderate to severe SNHL. Five patients were dissatisfied hearing aid (HA) users and eight subjects could not wear HAs. All patients were implanted with a TI-MEI which was coupled to the incus body. The amplification level of the device was set postoperatively using inductive digital fitting based on "most comfortable loudness" specifications. Results—The implant produced median improvements from 30% (optimally fit bilateral HAs; n = 5) and 50% (HA non-users; n = 8) to 70% word recognition at 60 dB SPL. Average word recognition scores at 60, 80 and 90 dB SPL in Groups A and B showed increases from 42% (interquartile range +27%, -12%) to 93.5% (+3%, -5%) and 92.5% (+3%, -7%), respectively. In the presence of background noise, the sentence recognition threshold ranged from -2 to 1 dB signal-to-noise ratio. Maximum amplification was 50 dB at 3 kHz and 55 dB at 4 kHz. In Groups A and B, VASs revealed improvements in both natural sound impression and clarity from 62-70% of a natural sound impression to maximum scores of 100%. Using the standardized Gothenburg profile, subjective evaluations of hearing, orientation, social behavior and self-confidence reached 96-98%, 92-96% and 84-92% of the maximum score for Groups A-C, respectively. Conclusions—In selected cases, IBC of the TI-MEI investigated herein may be indicated for the treatment of SNHL, provided the following four conditions are met. First, the patient does not derive sufficient benefit from conventional HAs. Second, the specific indication for IBC is restricted to situations that do not allow the coupling of the MEI to the long incus process (e.g. due to an anatomical variation of facial nerve location). Third, IBC is restricted to patients with a steeply sloped moderate to severe high frequency SNHL, amounting to 90 dB HL from 3 to 8 kHz. Patients with low frequency SNHL should not be operated on with the IBC technique, as maximum low frequency hearing loss at 0.5 kHz must not exceed 30 dB. Fourth, Schueller's X-ray should reveal normal mastoid pneumatization. Being restricted to a 6-month follow-up period, this paper provides early clinical results and no clinical evidence of long-term efficiency of the implant.