Initial-Fit Approach Versus Verified Prescription: Comparing

Self-Perceived Hearing Aid Benefit

Abrams, H., Chisolm, T., McManus, M., McArdle, R.

Journal of the American Academy of Audiology, 23(10), 768-778

What they did . . . 22 experienced hearing aid users Crossover design with two

intervention groups: ½ were first fitted with hearing aids via the manufacturer’s first fit

Second group were first fitted with hearing aids verified with probe-mic (REAR) to NAL-NL1 prescription

After real-world use (4-6 weeks), all then “crossed-over” to other fitting

APHAB benefit scores for the two conditions

APHAB scores significantly better for those fitted to the NAL

15/22 preferred the verified prescription fitting

Preference for “initial” versus “verified prescriptive” fitting plotted as a function of difference in APHAB

Global score.

Clinical Tip From

This Article?

Yes, fitting to target does matter. And yes, the only way you will know if you’ve fit to target is to verify with probe-mic measures!

MarkeTrak VIII and hearing aid verification—and

satisfaction?A publication from Sergei Kochkin (2010, Hearing Review), “with a

little help from his friends.”

But that wasn’t evenALL the authors

Some of the primary purposes of the survey: Determine overall satisfaction

with amplification Determine common fitting

practices (as reported by the patients)

Determine if fitting practices influence satisfaction

Determine if specific aspects of fitting/verification impact satisfaction more significantly than others.

Brief review of procedures:

A short screening survey was sent to 80,000 members of the National Family Organization households (balanced for age, income, market, etc).

This survey was completed by 46,843; 14,623 stated that at least one family member had a hearing loss; 3789 were owners of hearing aids.

In 2009, a detailed seven-page survey was sent to the hearing aid owners. There was a response rate of 84% (3174).

Narrowing this data base to individuals who had hearing aids that were no more than four years old: 1141 experienced users and 884 new users.

Mean age (~71 years), gender (~55% male) and hearing aid age (~1.8 years) was similar for both groups

Survey items related to testing, verification, overall hearing aid fitting, and audiologic rehabilitation. (respondents indicated whether they received this testing/service—could respond “not sure.”)

Hearing tested in sound booth Loudness discomfort measurement Real-ear measurement used for verification Measurement of objective benefit (e.g., pre-

post measurement of speech understanding) Measurement of subjective benefit Patient satisfaction measurement Auditory retraining software therapy Enrolled in aural rehabilitation group Received self-help book/literature/video Referred to self-help group (e.g, HLAA).

Three items that probably relate to most all of you . . .

Hearing tested in sound booth Loudness discomfort measurement Real-ear measurement used for verification Measurement of objective benefit (e.g., pre-

post measurement of speech understanding) Measurement of subjective benefit Patient satisfaction measurement Auditory retraining software therapy Enrolled in aural rehabilitation group Received self-help book/literature/video Referred to self-help group (eg, HLAA).

What percent got what testing?

The testing that was conducted was not significantly different for new versus vs. experienced users, or audiologists vs. HISs:

LDL (Loudness) Measures 68% Real-ear Measures 42% Objective benefit measure

67%

So what about the patients success with hearing aids?

Overall success was measured using a statistical composite of the following factors:

Hearing aid use Benefit and Satisfaction

1. Satisfaction with hearing aids to “improve hearing”

2. Perception of problem resolution for 10 different listening situations (only ones that applied to them)

3. Satisfaction for different listening situations

Patient purchase recommendations (e.g., recommend hearing aids for friends?)

What we really want to know:Was there a significant relationship between

the testing conducted at the time of the fitting, and subsequent real-world satisfaction with

hearing aids?

Or not?

Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

Recall that overall 68% of allpatients received this testing

Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

This is in agreement with a previous MarkeTrak finding that conducting a structured satisfaction survey improves overall patient satisfaction by 7%.

Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

The effect of the overall protocol (# of tests administered) on patient satisfaction:

What they do at that

“office down the street”

Reasonable

Goal?

Clinical Tip From

This Article?

There is a relationship between verification/validation and hearing aid satisfaction. Simply, more verification leads to happier patients.

Caveat : We really don’t know if this is because the patients have a better fitting following the verification, or, do they simply have more confidence in the fitting because of the thoroughness and added counseling?

In general, we’ll talk about four important components of fitting hearing aids:

Pre-fitting considerationsSelection of technologyVerification of the fittingPost-fitting follow-up and

counseling

The effects of hearing aid use on listening effort and mental

fatigue associated with sustained speech processing

demands

Ben Hornsby (a Vandy guy)Ear and Hearing, 2013, 34 (5), 523-534

What the research was all about . . .

Quantify the impact of hearing aid use and advanced signal processing on measures of listening effort and auditory mental fatigue

What he did . . .

16 adults (47-69 years); Mild to severe sloping SNHL

Dual-task paradigmWord recognitionWord RecallVisual Reaction Time (RTs)

What he did . . .

Fitted with hearing aids; Used in real world 2 weeks prior to each test condition

Subjective ratings of listening effort during the day

Ratings of fatigue and attentiveness immediately before and after the dual-task

What he found. . .

Word recall was better and RTs were faster in aided compared to unaided

Word recognition and recall were resistant to mental fatigue

Subjective and objective measures of listening effort and fatigue weren’t correlated

Age and degree of hearing loss weren’t predictive

Clinical Tip From

This Article?

We sometimes forget some of the more subtle benefits of hearing aid use, such as improved dual tasking—in this case word recall and reaction time.

And finally . . . How about some really “current” research

findings--Last month’s meeting at Lake Tahoe!

Have you ever wondered: How large does an SNR advantage need to be

before it’s meaningful to a patient?

On a meaningful increase in signal-to-noise ratio

McShefferty D., Whitmer W., Akeroyd M.

(verbally; 7 days ago)

In the clinic, the JND for an SNR change?

3 dB

But what if the judgments were not just about JNDs, but . . . Would you be willing to go see

an audiologist for this increase in SNR?

Would you be willing to swap devices for this increase in SNR?

What SNR then became meaningful?

6 dB

Clinical Tip From

This Article?

If your patient is a previous hearing aid user, it’s pretty unlikely that the new hearing aids will provide a 3 dB advantage to what they were already wearing. A 6 dB advantage? Only with a remote microphone!