Abstract
PurposeThis dual-aim study was intended to develop and validate a new fitting paradigm for over-the-counter (OTC) hearing aids. Aim 1 was undertaken to create a limited set of evidence-based preconfigured gain–frequency responses (“presets”) for use in OTC devices. Aim 2 tested the efficacy of the presets relative to best-practice verification and determined the best method(s) for older adults to self-select amplification from the set.MethodIn Aim 1, audiometry data from 267 older adults with mild-to-moderate sensorineural hearing loss were obtained from the National Health and Nutrition Examination Survey database. Using these data and the National Acoustic Laboratories–Non-Linear 2 (NAL-NL2) prescriptive formula, a set of four presets were created that can fit a large percentage of older Americans with presbycusis. In Aim 2, 37 older adults with hearing loss used five methods to select presets. The selection methods were select-by-audiogram, select-by-self-test, select-by-trying, select-by-questionnaire, and random assignment. Using a crossover design, each participant completed speech recognition testing and sound quality ratings in quiet and noise for all selection methods and a verified NAL-NL2 condition.ResultsThe set of presets can fit 67.9% of older Americans with mild-to-moderate hearing loss (Aim 1). Controlling for hearing thresholds and sound quality ratings, liner mixed-effects models indicated that speech recognition scores for select-by-audiogram, select-by-self-test, and select-by-trying were not statistically different from the NAL-NL2 condition. Statistical analysis indicated that select-by-self-test produced outcomes most consistent with individual outcomes for the NAL-NL2 condition (Aim 2).ConclusionThis newly developed fitting paradigm may provide efficacy comparable to best-practice verification and could be used in OTC hearing aids.
Highlights
In order to produce quality outcomes, OTC hearing aids must have appropriate gain characteristics for the OTC target population—namely, older adults with mild-tomoderate age-related hearing loss
Research on the electroacoustic properties and gain–frequency responses of currently available personal sound amplification products (PSAPs) and OTC devices suggest cause for concern
The results demonstrate that a set of four gain– frequency responses can fit approximately 70% of older adults with mild-to-moderate hearing loss in the audiometric range defined by this study (PTA at 500, 1000, and 2000 Hz of ≥ 25 and ≤ 55 dB HL with no threshold poorer than 65 dB HL from 500 to 6000 Hz)
Summary
In order to produce quality outcomes, OTC hearing aids must have appropriate gain characteristics for the OTC target population—namely, older adults with mild-tomoderate age-related hearing loss. Results from previous studies indicate that many OTC devices produce excessively high levels of low-frequency gain with little to no usable highfrequency gain, rendering them most appropriate for rising hearing losses (Chan & McPherson, 2015; Cheng & McPherson, 2000). This pattern of gain is wholly inappropriate for the treatment of presbycusis, which is most commonly characterized as a sloping high-frequency hearing loss. Such devices could produce poor outcomes by failing to provide adequate gain for high frequencies where hearing loss is present
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