Fitting Hearing Aids Using Clinical Measures of Loudness Discomfort Levels: An Evidence-Based Review of Effectiveness

2005 ◽  
Vol 16 (07) ◽  
pp. 461-472 ◽  
Author(s):  
Gustav H. Mueller ◽  
Ruth A. Bentler
Keyword(s):  
Hearing Aids ◽  
Statistical Power ◽  
Hearing Aid ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Strong Recommendation ◽  
Hearing Aid Fitting ◽  
Fitting Procedure ◽  
Clinical Measurements ◽  
Clinical Measures

Clinical measurement of the loudness discomfort level (LDL) historically has been part of the hearing aid fitting procedure, and this clinical practice remains popular today. LDL measurements also are recommended in contemporary hearing aid fitting protocols. Yet, surveys show that many hearing aid users are dissatisfied with the loudness of their hearing aids. In this evidence-based review article, we evaluate the effectiveness of clinical LDL measurements. Specifically, we asked the question "Are the clinical measurements of LDL for adult patients predictive of aided acceptance and satisfaction of loudness for high inputs in the real world?" Nearly 200 articles were reviewed; three met the criteria set forth in this review. The evidence supported using unaided LDLs for selecting the maximum real-ear output of hearing aids. No study using aided LDLs or aided loudness verification met the criteria. The level of the evidence for the three articles using unaided LDLs was low; no higher than Level 4. The limited number of studies, the level of evidence, and the statistical power of the studies prevents us from making a strong recommendation concerning the clinical use of LDL measures. Additional research in this area, especially research employing randomized controlled trials would be a useful addition to this body of literature.

Fitting Hearing Aids to Adults Using Prescriptive Methods: An Evidence-Based Review of Effectiveness

2005 ◽  
Vol 16 (07) ◽  
pp. 448-460 ◽  
Author(s):  
Gustav H. Mueller
Keyword(s):  
Outcome Measures ◽  
Hearing Aids ◽  
Real World ◽  
Statistical Power ◽  
Hearing Aid ◽  
Research Review ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Common Reference ◽  
Fitting Procedure

The use of a prescriptive fitting approach for hearing aid selection has been a common practice for the past 60–70 years. While there are prescriptive approaches that have been validated, in recent years it has become popular to deviate from these validated methods and use manufacturers' proprietary algorithms, which in many cases are significantly different. This research review was designed to examine if there was evidence supporting the use of specific gain requirements for hearing aid fitting. Specifically, the question that was asked was "Are there real-world outcome measures from adult patients that show a preference for the gain prescribed by a specific prescriptive fitting procedure?" Inclusion criteria were as follows: adult subjects, consistent technology (e.g., different prescriptive methods compared using same hearing aids), real-ear verification of gain, and real-world outcome measures. For this review, in addition to subjective responses, preferred use gain was considered a real-world outcome measure. The National Acoustic Laboratories' revised (NAL-R), revised for severe/profound (NAL-RP), and the National Acoustic Laboratories—Non-Linear 1 (NAL-NL1) prescriptive methods were used as a common reference, as they have been the most commonly studied methods with adults.Eleven studies were identified that met the inclusion criteria. Eight of the studies supported gain similar to that prescribed by the NAL-R or NAL-RP methods; three studies supported prescribed gain less than the NAL-R or NAL-RP. There was no evidence that gain greater than that prescribed by the NAL methods should be used. The level of evidence was moderate, as the supporting studies were either Level 2 or Level 4, and the statistical power of the studies was low.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Comparison of In-the-Ear and Over-the-Ear Hearing Aid Fittings

1986 ◽  
Vol 51 (4) ◽  
pp. 362-369 ◽  
Author(s):  
Donna M. Risberg ◽  
Robyn M. Cox
Keyword(s):  
Hearing Aids ◽  
High Frequency ◽  
Comparative Evaluation ◽  
Speech Intelligibility ◽  
Hearing Aid ◽  
Hearing Aid Fitting ◽  
The Difference ◽  
Functional Gain ◽  
The Relationship

A custom in-the-ear (ITE) hearing aid fitting was compared to two over-the-ear (OTE) hearing aid fittings for each of 9 subjects with mild to moderately severe hearing losses. Speech intelligibility via the three instruments was compared using the Speech Intelligibility Rating (SIR) test. The relationship between functional gain and coupler gain was compared for the ITE and the higher rated OTE instruments. The difference in input received at the microphone locations of the two types of hearing aids was measured for 10 different subjects and compared to the functional gain data. It was concluded that (a) for persons with mild to moderately severe hearing losses, appropriately adjusted custom ITE fittings typically yield speech intelligibility that is equal to the better OTE fitting identified in a comparative evaluation; and (b) gain prescriptions for ITE hearing aids should be adjusted to account for the high-frequency emphasis associated with in-the-concha microphone placement.

scholarly journals Auditory Profile-based Hearing-aid Fitting: A Proof-Of-Concept Study

2020 ◽  
Author(s):  
Raul Sanchez-Lopez ◽  
Michal Fereczkowski ◽  
Sébastien Santurette ◽  
Torsten Dau ◽  
Tobias Neher
Keyword(s):  
Hearing Aids ◽  
Hearing Aid ◽  
Data Driven ◽  
Proof Of Concept ◽  
Hearing Aid Fitting ◽  
Concept Study ◽  
Pure Tone Audiogram ◽  
Comprehensive Test ◽  
Study Support

AbstractObjectiveThe clinical characterization of hearing deficits for hearing-aid fitting purposes is typically based on the pure-tone audiogram only. In a previous study, a group of hearing-impaired listeners were tested using a comprehensive test battery designed to tap into different aspects of hearing. A data-driven analysis of the data yielded four clinically relevant patient subpopulations or “auditory profiles”. In the current study, profile-based hearing-aid settings were proposed and evaluated to explore their potential for providing more targeted hearing-aid treatment.DesignFour candidate hearing-aid settings were implemented and evaluated by a subset of the participants tested previously. The evaluation consisted of multi-comparison preference ratings carried out in realistic sound scenarios.ResultsListeners belonging to the different auditory profiles showed different patterns of preference for the tested hearing-aid settings that were largely consistent with the expectations.ConclusionThe results of this proof-of-concept study support further investigations into stratified, profile-based hearing-aid fitting with wearable hearing aids.

scholarly journals A Study on the Preferred Real-Ear Insertion Gain of Multi-Channel Hearing Aid for the Korean with Sensorineural Hearing Loss

2020 ◽  
Vol 16 (2) ◽  
pp. 85-94
Author(s):  
Eojini Bang ◽  
Kyoungwon Lee
Keyword(s):  
Word Recognition ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Hearing Aid Fitting ◽  
High Frequencies ◽  
Frequency Bands ◽  
Before And After ◽  
Fitting Procedures ◽  
Linear Version ◽  
Gain Adjustment

Purpose: This study aimed to compare the preferred real-ear insertion gain for Korean (PREIG-K) wearing multi-channel hearing aid with the National Acoustics Laboratories-Non-Linear version 2 (NAL-NL2; National Acoustic Laboratories) gains in order to develop Korean hearing aid fitting formula.Methods: A total of thirty one (62 ears) Korean hearing aid users were included in this study. All subjects wore in-the-canal or custom hearing aids in both ears. Individual hearing aid fitting procedures involved to adjust the gains for 50, 65, and 80 dB sound pressure level of speech across low, high, and wideband frequency bands based on participant’s subjective responses. In addition, only the high frequency bands of 1 kHz or more of the PREIG-K were re-adjusted to be the same as NAL-NL2 gain and then the word recognition scores (WRSs) were compared before and after the adjusting gain. Results: The results showed that the PREIG-K increased up to 1.5 kHz with the maximum amount, then the PREIG-K decreased across the frequencies. For all half octave frequencies, the PREIG-Ks were substantially less than the NAL-NL2. When the PREIG-K of high frequencies were re-adjusted same as the NAL-NL2 gains, the WRSs of the PREIG-K were not significantly different before and after gain adjustment. The slopes up to 1.5 kHz frequencies of the PREIG-K were steeper than the slopes of NAL-NL2 gain, however similar to the slope of manufactures’ fitting formulae.Conclusion: The development of an effective hearing aid fitting formula for improving the communication abilities of hearing-impaired Korean will require further experiments considering the language, physical characteristics, and word recognition used by Koreans.

scholarly journals Perception of One’s Own Voice After Hearing-Aid Fitting for Naive Hearing-Aid Users and Hearing-Aid Refitting for Experienced Hearing-Aid Users

2020 ◽  
Vol 24 ◽  
pp. 233121652093246
Author(s):  
Johanna Hengen ◽  
Inger L. Hammarström ◽  
Stefan Stenfelt
Keyword(s):  
Hearing Impairment ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Control Group ◽  
Voice Perception ◽  
Hearing Aid Fitting ◽  
Before And After ◽  
Vocal Intensity ◽  
First Time

Dissatisfaction with the sound of one’s own voice is common among hearing-aid users. Little is known regarding how hearing impairment and hearing aids separately affect own-voice perception. This study examined own-voice perception and associated issues before and after a hearing-aid fitting for new hearing-aid users and refitting for experienced users to investigate whether it was possible to differentiate between the effect of (unaided) hearing impairment and hearing aids. Further aims were to investigate whether First-Time and Experienced users as well as users with dome and mold inserts differed in the severity of own-voice problems. The study had a cohort design with three groups: First-Time hearing-aid users going from unaided to aided hearing ( n = 70), Experienced hearing-aid users replacing their old hearing aids ( n = 70), and an unaided control group ( n = 70). The control group was surveyed once and the hearing-aid users twice; once before hearing-aid fitting/refitting and once after. The results demonstrated that own-voice problems are common among both First-Time and Experienced hearing-aid users with either dome- or mold-type fittings, while people with near-normal hearing and not using hearing aids report few problems. Hearing aids increased ratings of own-voice problems among First-Time users, particularly those with mold inserts. The results suggest that altered auditory feedback through unaided hearing impairment or through hearing aids is likely both to change own-voice perception and complicate regulation of vocal intensity, but hearing aids are the primary reason for poor perceived sound quality of one’s own voice.

Evaluation of the Self-Fitting Process with a Commercially Available Hearing Aid

2017 ◽  
Vol 28 (02) ◽  
pp. 109-118 ◽  
Author(s):  
Elizabeth Convery ◽  
Gitte Keidser ◽  
Mark Seeto ◽  
Margot McLelland
Keyword(s):  
Hearing Loss ◽  
Success Rate ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Low Cost ◽  
The Self ◽  
Fine Tuning ◽  
Successful Outcome ◽  
Fitting Procedure ◽  
Fitting Hearing Aids

Background: Hearing aids and personal sound amplification products that are designed to be self-fitted by the user at home are becoming increasingly available in the online marketplace. While these devices are often marketed as a low-cost alternative to traditional hearing health-care, little is known about people’s ability to successfully use and manage them. Previous research into the individual components of a simulated self-fitting procedure has been undertaken, but no study has evaluated performance of the procedure as a whole using a commercial product. Purpose: To evaluate the ability of a group of adults with a hearing loss to set up a pair of commercially available self-fitting hearing aids for their own use and to investigate factors associated with a successful outcome. Research Design: An interventional study that used regression analysis to identify potential contributors to the outcome. Study Sample: Forty adults with mild to moderately severe hearing loss participated in the study: 20 current hearing aid users (the “experienced” group) and 20 with no previous amplification experience (the “new” group). Twenty-four participants attended with partners, who were present to offer assistance with the study task as needed. Data Collection and Analysis: Participants followed a set of written, illustrated instructions to perform a multistep self-fitting procedure with a commercially available self-fitting hearing aid, with optional assistance from a lay partner. Standardized measures of cognitive function, health literacy, locus of control, hearing aid self-efficacy, and manual dexterity were collected. Statistical analysis was performed to examine the proportion of participants in each group who successfully performed the self-fitting procedure, factors that predicted successful completion of the task, and the contributions of partners to the outcome. Results: Fifty-five percent of participants were able to successfully perform the self-fitting procedure. Although the same success rate was observed for both experienced and new participants, the majority of the errors relating to the hearing test and the fine-tuning tasks were made by the experienced participants, while all of the errors associated with physically customizing the hearing aids and most of the insertion errors were made by the new participants. Although the majority of partners assisted in the self-fitting task, their contributions did not significantly influence the outcome. Further, no characteristic or combination of characteristics reliably predicted which participants would be successful at the self-fitting task. Conclusions: Although the majority of participants were able to complete the self-fitting task without error, the provision of knowledgeable support by trained personnel, rather than a fellow layperson, would most certainly increase the proportion of users who are able to achieve success. Refinements to the instructions and the physical design of the hearing aid may also serve to improve the success rate. Further evaluation of the range of self-fitting hearing aids that are now on the market should be undertaken.

Hearing Aid Outcomes: Effects of Gender and Experience on Patients' Use and Satisfaction

2009 ◽  
Vol 20 (07) ◽  
pp. 422-432 ◽  
Author(s):  
Victoria A. Williams ◽  
Carole E. Johnson ◽  
Jeffrey L. Danhauer
Keyword(s):  
Quality Of Life ◽  
Hearing Aids ◽  
Statistical Power ◽  
Hearing Aid ◽  
Normative Study ◽  
Digital Hearing Aids ◽  
Specific Questionnaire ◽  
Significant Difference ◽  
Experience Effects

Purpose: To use the International Outcome Inventory for Hearing Aids (IOI-HA) with patients having advanced hearing aid technology to assess their satisfaction and benefit focusing on gender and experience effects, compare to norms, and use the IOI-HA and a practice-specific questionnaire to monitor the quality of the services provided by a dispensing practice. Research Design: A study of 160 potential participants who had worn their newly purchased multichannel digital hearing aids having directional microphones for at least three months, completed a trial period, and should have had time to acclimatize to them. English-speaking, private or insurance paying, competent, adult patients from a private practice were mailed a 12-item practice-specific questionnaire and the seven-item IOI-HA. Results: Of the160 questionnaires mailed, 73 were returned for a 46% return rate. Of those, 64 were useable. Participants included male (34) and female (30), new (30) and previous (34) hearing aid users, who self-selected their participation by returning the questionnaires. The practice-specific questionnaire assessed patients' demographics and the quality of services received. The IOI-HA was analyzed according to an overall score and on two different factor scores. A power analysis revealed that 19 respondents per group were needed for the IOI-HA results to have a statistical power of .80 and probability of a Type II error of .20 for detecting a significant difference at the p < 0.05 level. Similar to earlier studies, no significant differences were observed either for any of the main effects or interactions for gender or user experience for the two IOI-HA factors and overall scores. A significant, but weak, positive correlation (r = .34; df = 63; p < .05) was observed between patients' overall satisfaction as indicated from the IOI-HA and the practice-specific quality assurance satisfaction question. T-tests on IOI-HA items 4 (satisfaction) and 7 (quality of life) revealed that the present participants' responses were significantly higher than for those in the normative study. Conclusions: Gender and hearing aid experience did not influence these patients' responses on the IOI-HA, and all respondents were satisfied with their hearing aids and the practice that dispensed them. No major differences were found between these patients' IOI-HA results and normative data suggesting that both sets of respondents were satisfied with their hearing aids. However, limited statistical comparisons for the satisfaction and quality of life items revealed significant differences in favor of these participants' scores over those in the normative study. This suggested that the advanced hearing aid technology used here had a positive effect on patients' ratings and that the IOI-HA norms should be updated periodically to reflect changes in technology.

Large Vestibular Aqueduct Syndrome: A Case Study

2005 ◽  
Vol 16 (10) ◽  
pp. 822-828 ◽  
Author(s):  
Jackie L. Clark ◽  
Ross J. Roeser
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Behavioral Testing ◽  
Hearing Aid Fitting ◽  
Hearing Sensitivity ◽  
Vestibular Aqueduct ◽  
Brainstem Response ◽  
Large Vestibular Aqueduct Syndrome ◽  
Large Vestibular Aqueduct

A 23-month-old female was referred for hearing aid fitting after failing newborn hearing screening and being diagnosed with significant hearing loss through subsequent diagnostic testing. Auditory brainstem response (ABR) and behavioral testing revealed a moderate-to-severe bilateral mixed hearing loss. Prior to the hearing aid evaluation, tympanostomy tubes had been placed bilaterally with little or no apparent change in hearing sensitivity. Initial testing during the hearing aid fitting confirmed earlier findings, but abnormal middle ear results were observed, requiring referral for additional otologic management. Following medical clearance, binaural digital programmable hearing aids were fit using Desired Sensation Level parameters. Behavioral testing and probe microphone measures showed significant improvements in audibility. Decrease in hearing sensitivity was observed six months following hearing aid fitting. Radiological studies, ordered due to the mixed component and decreased hearing sensitivity, revealed large vestibular aqueduct syndrome (LVAS). Based on the diagnosis of LVAS, a cochlear implant was placed on the right ear; almost immediate speech-language gains were observed.

scholarly journals A Study on the Korean Conversation Speech Level and Spectrum in Sound-Treated Environment

2020 ◽  
Vol 16 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Young Kwon Han ◽  
Kyoungwon Lee
Keyword(s):  
Hearing Aids ◽  
Hearing Aid ◽  
Conversational Speech ◽  
Hearing Aid Fitting ◽  
Importance Function ◽  
Speech Spectrum ◽  
Males And Females ◽  
Korean Type

Purpose: Several studies have reported the differences between Korean and other countries’ speech in long-term average speech spectrum (LTASS) and band importance function. Authors tried to identify the conversational speech level, the resulting spectrum, and the LTASS for Korean. The purpose of this study was to support the production of a Korean-type hearing aid fitting formula to effectively improve the sound quality of hearing aids and the communication abilities with hearing aids, and to standardize the sound stimuli required to measure the performance of hearing aids. Methods: A total of 73 participants with normal hearing and with no specific voice and language deficits was voluntarily recruited from capital, Gyeongsang and Jeolla areas. The conversational speech level was measured by vocalizing ‘soft,’ ‘moderate,’ ‘raised,’ and ‘loud’ at a distance of 1.0 m from the speaker. And LTASS was measured by vocalizing it at a distance of 0.2 m from the speaker. Results: There was a difference in the mean of males and females in the conversation level, but no significant regional differences were shown. The conversational speech level corresponding to 30th, 65th, and 99th percentiles was 59.67, 64.74, and 79.07 dB sound pressure level, respectively. And the speech spectrum of 30th, 65th, and 99th percentile and LTASS showed in different forms from the international speech test signal. Conclusion: The results of this study should help to calculate the Korean type hearing aid fitting formula and should be used as the basic data to determine the characteristics of the sound stimuli when measuring the performance of the hearing aid.

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