Hearing Aid Candidates Research Articles

Demographic and Audiological Characteristics of Candidates for Over-the-Counter Hearing Aids in the United States.

This report presents descriptive data on the demographic and audiological characteristics of US adults with perceived mild-to-moderate hearing loss, the primary candidates for over-the-counter (OTC) hearing aids. The analyses are descriptive and present population-weighted responses for various self-reported demographic and audiological variables for adults with mild or moderate perceived hearing trouble. Results of pure-tone audiometry and immittance measures are also presented. Nationally representative datasets from the National Health and Nutrition Examination Surveys (NHANES) for 2011 to 2012, 2015 to 2016, and 2017 to 2020, the three most recent NHANES datasets with audiological information, were used. The NHANES datasets indicated that there are 49.5 million adults in the United States with perceived mild-to-moderate hearing trouble. Results indicated that OTC hearing-aid candidates are most frequently 50 to 69 years of age, married, and identify as non-Hispanic White race/ethnicity. Most of these individuals graduated from high school, had several risk factors for hearing loss, had not had a hearing test in the past 5 years, and had never used hearing aids or assistive listening devices previously. The typical audiometric profile was a bilaterally symmetrical sloping hearing loss with slight to mild hearing loss above 2000 Hz. Group data showed normal immittance measures and absence of otoscopic abnormalities except for the presence of excessive (not impacted) cerumen in about 13% of the OTC hearing-aid candidates. Tens of millions of US adults have perceived mild-to-moderate hearing trouble but have not pursued assistance, either through obtaining a hearing test or acquiring prescription hearing aids.

Is Age a Limiting Factor for Audiological Results in Active Middle Ear Implants?

Active middle ear implants (AMEI) are implantable options for patients with sensorineural, conductive, or mixed hearing loss who are not good candidates for hearing aids. The aim of this study was to compare audiological, surgical, quality of life, and sound quality outcomes in adults <60 and ≥60 years receiving an AMEI. Twenty adult patients who underwent AMEI implantation were divided into two groups, <60 and ≥60 y. Preoperative tests included pure-tone average and speech discrimination score (SDS) at 65 dB for disyllabic words in quiet. Postoperative measures included AMEI-aided bone conduction threshold, free-field warble-tone threshold, and SDS at 65 dB for disyllabic words in quiet 12 months after the AMEI fitting. Subjective benefit was evaluated using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Glasgow Benefit Inventory (GBI), and Hearing Implant Sound Quality Index (HISQUI19). Mean functional gain was 32 and 30 dB, and SDS at 65 dB improved from 19 to 95% and from 31 to 84% in the <60 and ≥60 y groups, respectively. All NCIQ domains improved following surgery, and all patients had a positive overall GBI score. The mean HISQUI19 score was 97 in both age groups. AMEIs are an effective hearing restoration method for older adults suffering from conductive or mixed hearing loss.

Designing a Hearing Health Care Smartphone App With Ecological Momentary Assessment: A Qualitative Study of Audiologists' Perspectives.

The purpose of this study was to explore the perspectives of audiologists to provide input into development of a smartphone application (app) to document the real-life listening difficulties and the listening environment of hearing aid candidates and users. Two focus groups were conducted. Facilitators utilized a topic guide to generate participants' input and perspectives. The focus groups were audio-recorded and transcribed verbatim. The transcripts were then qualitatively analyzed using content analysis. The study samples were 10 audiologists (seven females) with 2- to 10-plus years of hearing aid fitting experience. Three main categories were identified: (a) The mobile device app could provide meaningful information to help audiologists to counsel their clients, (b) the app could give clients an insight into their hearing difficulties, and (c) the app could help clients to self-manage their hearing condition. These findings suggest that audiologists may better understand their clients' real-life listening difficulties through the use of a mobile device app; however, further research is required to harness the benefits of such an app.

A comparative study between audiological and speech outcomes of non-implantable wearing options for BAHA in the pediatric population

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to determine the audiological benefit of the current BAHAs sound processor worn on a SoundArc and to compare it to the known Softband in terms of soundField hearing thresholds and speech understanding in patients who have purely conductive, mixed, or SSD hearing loss.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional study looking at children with conductive, mixed, or SSD hearing loss who are not candidates for middle ear surgery, canalplasty, or standard hearing aids. At the baseline visit, pure-tone audiograms were obtained, including masked/unmasked air- and bone conduction thresholds with speech recognition scores. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; After two weeks of using programmed processors with Softband and SoundArc, all children were examined. The threshold for aided pure-tone audiometry was tested twice through each of the two transmission paths. The aided pure-tone audiometry threshold demonstrated a statistically significant improvement in PTA. The mean air-conduction thresholds for frequencies (0.5 to 4 kHz) were 63 dB, while the aided mean thresholds with the device (with Softband and SoundArc) was 35 dB. When compared to the unaided scenario, a statistically significant improvement of 98 percent (SoundArc) to 96 percent (Softband) was found at 65 dBSPL. There were no statistically significant differences between any of the ensembles (p=0.261).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results of our study suggest that subjects with conductive, mixed, or single-sided deafness hearing loss aided with BAHA sound processor worn on SoundArc or on a Softband can cause a significant improvement in terms of soundfield hearing threshold and speech understanding when compared to unaided conditions.&lt;/p&gt;

Incorporating hearing screening to an otolaryngology surgical mission in the rural Dominican Republic

IntroductionHearing loss disproportionately affects low- and middle-income countries. Children with undiagnosed hearing loss may have difficulty with learning, language development, and behavior. The aim of this study was to understand the extent of hearing loss and common otologic disorders among school-age children in the rural western region of the Dominican Republic and to chronical the early stages of a limited-resource, locally-sustained hearing screening program in tandem with a bi-annual surgical mission. MethodsHearing screenings were performed for 528 school-age children (1056 ears, age 5–17 years old) over 5 days in a village hospital in Peralta, DR. Testing initially included otoscopy and screening audiometry. Children who referred or could not be conditioned underwent distortion product otoacoustic emissions (OAEs), and tympanometry. Children who referred following both screening audiometry and OAEs were considered to have hearing loss. Those with normal tympanograms were considered potential hearing aid candidates. ResultsAbnormal ear examination/otoscopic results were present in 43 children (8.1%) and included: microtia/atresia, impacted cerumen, ear canal foreign body, serous otitis media, otitis externa, and tympanosclerosis. 55 of 528 school-age children referred following screening audiometry and 7 were unable to condition. Of these 62 children, 56 tolerated OAEs and 20 referred following OAEs (3.8%). Fourteen children had type B or C tympanogram and 6 school-age children who were determined to have chronic otitis media with effusion (COME) underwent myringotomy and pressure equalization tube placement. Ten of 528 children (1.9%) had normal tympanometry and otoscopy, and referred following screening audiometry and OAEs suggesting the patients may be potential hearing aid candidates. ConclusionsThe prevalence of hearing loss in this cohort of children in the rural, western Dominican Republic was high at roughly 4% with roughly 2% of children being potential hearing aid candidates. Nearly 10% of children screened had an abnormal otologic examination; sometimes easily remedied by otolaryngologic intervention. With the support of local leadership, it is feasible to incorporate hearing services into otolaryngology outreach and build locally sustainable programs.

Emotional Responses to Non-Speech Sounds for Hearing-aid and Bimodal Cochlear-Implant Listeners.

The purpose of this project was to evaluate differences between groups and device configurations for emotional responses to non-speech sounds. Three groups of adults participated: 1) listeners with normal hearing with no history of device use, 2) hearing aid candidates with or without hearing aid experience, and 3) bimodal cochlear-implant listeners with at least 6 months of implant use. Participants (n = 18 in each group) rated valence and arousal of pleasant, neutral, and unpleasant non-speech sounds. Listeners with normal hearing rated sounds without hearing devices. Hearing aid candidates rated sounds while using one or two hearing aids. Bimodal cochlear-implant listeners rated sounds while using a hearing aid alone, a cochlear implant alone, or the hearing aid and cochlear implant simultaneously. Analysis revealed significant differences between groups in ratings of pleasant and unpleasant stimuli; ratings from hearing aid candidates and bimodal cochlear-implant listeners were less extreme (less pleasant and less unpleasant) than were ratings from listeners with normal hearing. Hearing aid candidates’ ratings were similar with one and two hearing aids. Bimodal cochlear-implant listeners’ ratings of valence were higher (more pleasant) in the configuration without a hearing aid (implant only) than in the two configurations with a hearing aid (alone or with an implant). These data support the need for further investigation into hearing device optimization to improve emotional responses to non-speech sounds for adults with hearing loss.

Hearing Aid Selection: Closed- versus Open-canal Fitting Hearing Aids

To select hearing aid is an essential process for successful hearing rehabilitation. The purpose of this study is to review hearing aid selection considerations between receiver in-the-canal (RIC) and custom hearing aid (CHA) in order to guide appropriate selection of the hearing aid. This study discussed three key factors in the hearing aid selection including physical, acoustic and electroacoustic characteristics and other aspects. Advantages of RIC types are comfort to wear, reduction of the occlusion effect, presence of directional microphones, on-site fit, easy connectivity with other devices, and use of rechargeable batteries. On the other hand, the CHA types have their advantage in terms of being comfort to wear with masks, proper insertion and placement, reduction of the acoustic feedback, good approximation of frequency response curve, improvement of speech in noise perception, expanded hearing aid candidacy with varying hearing thresholds, and easy telephone use. We concluded that appropriate selection of the hearing aid would contribute to successful hearing rehabilitation, if considering physical, psycho-social, and acoustical characteristics.

Smartphone-Connected Hearing Aids Enable and Empower Self-Management of Hearing Loss: A Qualitative Interview Study Underpinned by the Behavior Change Wheel.

To identify patient-reported barriers and facilitators to using smartphone-connected hearing aids, using the Behavior Change Wheel (BCW) to understand experiences and how these can be addressed. A single-center, prospective, observational study. Eight hearing aid users (new = 1, existing = 7; mean age = 71.75 years, SD = 5.23, range = 65 to 81 years) were identified through convenience sampling from 44 participants who took part in a 7-week evaluation of smartphone-connected hearing aids controlled by a prototype app. The app allowed users to manually control settings such as gain, noise reduction, and microphone directionality, preset, and customized programmes. Participants were assigned to one of two focus groups following trial of the app. Focus group transcripts were thematically analyzed and underpinned by the COM-B (Capability, Opportunity, Motivation-Behavior) model and Theoretical Domains Framework to identify barriers and facilitators to using smartphone-connected hearing aids (the target behavior). Mapping of themes to the BCW allowed use of the Behavior Change Technique Taxonomy (version 1) to identify behavior change techniques that audiologists could implement in clinical practice to address the barriers and facilitators. Capability: The app increased participants' knowledge of hearing aid controls, encouraging use of the app for improved hearing loss self-management. However, barriers to using the app included perception of insufficient digital literacy skills for smartphone-connected hearing aid use and an increased cognitive load caused by decisions over which controls to use. Opportunity: Perceived smartphone norms (i.e., acceptable occasions to use smartphones) and differing listening contexts acted as both facilitators and barriers. Motivation: The ability to control hearing aid settings in any listening situation (e.g., to reduce noise) empowered users to successfully self-manage their hearing loss, leading to greater confidence and participation in everyday life. The app also reduced hearing aid-related and self-stigma, and the ability to self-adjust hearing aids benefitted both participants and communication partners. It was the adjustability and interaction afforded by the app that empowered users, rather than the hearing aid technology itself. Perceived beliefs and knowledge about digital literacy skills, and specifically abilities to use a smartphone, were perceived to be barriers in this typically older population, particularly when they compared themselves to younger generations. Using the Behavior Change Technique Taxonomy (version 1), behavior change techniques that could be used by audiologists to address these barriers included enablement, goal setting, reframing perceptions toward technology, and addressing patient educational needs. Smartphone-connected hearing aids, when used in their everyday lives, were viewed positively by participants across a range of domains, empowering them and enabling hearing loss self-management. Audiologists should consider smartphone-connected hearing aid candidacy for all who have access to smartphones and are willing to use one. Use of the BCW has identified that modifiable barriers to using smartphone-connected hearing aids exist. Audiologists could use these evidence-based behavior change techniques to support patients in adopting and using these technologies to successfully self-manage hearing loss. Overall, by reframing smartphone technologies as a tool to remain connected with society, smartphone-connected hearing aids could shift the power of managing hearing loss from clinician to patient.

Current Estimate of Hearing Aid Utilization in the United States.

To present key data from a private marketing report that characterizes US hearing aid (HA) utilization, HA candidate and user population sizes, and HA pricing. HA candidates and users in the United States. Hearing amplification. HA utilization, HA candidate and user population sizes, HA market size and value, and HA pricing. In 2015, an estimated 8.5 million HA users accounted for a total of 15.4 million individual HA devices in the United States. Approximately 81% of HA users owned bilateral devices. In 2015, approximately 87% of devices were purchased as replacements by current HA users, while the remaining 13% of devices were purchased by new HA users. HA utilization rates among the candidate population approximated 21% in 2015, which was stable over the 3-year study period. In 2015, there was a net increase of 696,060 individuals who met HA candidacy criteria but did not undergo treatment with HAs, adding to the backlog of 31.0 million untreated HA candidates who existed before that year. The HA market was valued at $6.0 billion in 2015, with an average retail selling price of $1798 per device ($3596 per pair). In the same year, the average manufacturer selling price was $495 per device ($990 per pair), or nearly 1 quarter of the retail price. HAs are substantially under-utilized in the United States with an annually growing backlog of untreated HA candidates.

Health Literacy and Hearing Healthcare Use.

To assess whether health literacy is associated with: 1) degree of hearing loss at initial presentation for audiogram and 2) hearing aid adoption for hearing aid candidates. We identified 1376 patients who underwent audiometric testing and completed a brief health literacy questionnaire at our institution. The association between health literacy and degree of hearing loss at initial presentation was examined using linear regression, adjusted for age, gender, marital status, education level, race, language, employment status, and insurance coverage. The association between health literacy and hearing aid adoption was examined in the subset of patients identified as hearing aid candidates using logistic regression, adjusted for demographic factors and insurance coverage. Patients with inadequate health literacy were more likely to present with more severe hearing loss (adjusted mean pure-tone average [PTA] difference, 5.38 dB, 95% confidence interval [CI] 2.75 to 8.01). For hearing aid candidates (n = 472 [41.6%]), health literacy was not associated with hearing aid adoption rate (odds ratio [OR] 0.85, 95% CI 0.40 to 1.76). Hearing aid coverage through Medicaid (OR 2.22, 95% CI 1.13 to 4.37), and moderate (OR 2.70, 95% CI 1.58 to 4.69) or moderate-severe (OR 2.23, 95% CI 1.19 to 4.16) hearing loss were associated with hearing aid adoption. In our population, patients with low health literacy are more likely to present with higher degrees of hearing loss, but no less likely to obtain hearing aids compared with patients with adequate health literacy. Hearing loss severity and hearing aid coverage by insurance appear to be the main drivers of hearing aid adoption. 3 Laryngoscope, 131:E1688-E1694, 2021.

Reliability of Primary Health Care Audiograms by Non-qualified Examiners-An Analysis of 1,224 Cases.

To evaluate the accuracy of primary health care audiograms conducted by non-qualified examiners in a non-standard acoustic environment. Retrospective chart review. Referring primary health care institutions and hospital hearing center. One thousand two hundred twenty four adult patients evaluated for hearing aid fitting at North Karelia Central hospital in years 2017 and 2018. Intraclass correlation coefficient (ICC), mean threshold differences, and mean absolute errors were used to assess agreement between primary health care and hospital audiograms. Primary health care audiometry sensitivity, specificity and positive (PPV) and negative (NPV) predictive values were calculated for hearing aid candidacy in general and open ear mold candidacy in particular. ICC for both better ear hearing level (BEHL0.5,1,2,4 kHz) and pure-tone average (PTA0.5,1,2,4 kHz) in frequencies 0.5, 1, 2, and 4 kHz was 0.82, and in individual full octave frequencies from 0.125 to 8 kHz ranged from 0.70 to 0.83. Mean threshold differences in BEHL0.5,1,2,4 kHz and PTA0.5,1,2,4 kHz were 1.8 and 1.6 dB and mean absolute errors 4.9 and 5.3 dB, respectively. Sensitivity for hearing aid candidacy was 0.97, specificity 0.58, PPV 0.92, and NPV 0.79. Primary health care audiometry is reasonably accurate, allowing preselection of patients to adequate hearing care pathways.

Understanding Listening-Related Fatigue: Perspectives of Adults with Hearing Loss

Objective Adults with hearing loss (AHL) often report feeling fatigued after being in situations that require prolonged listening, an experience referred to as listening-related fatigue. We conducted focus groups to identify key domains and constructs of listening-related fatigue. Our goal was to create a theoretical framework for understanding listening-related fatigue that could guide the development of a reliable and valid assessment tool. Design Eight focus group discussions were conducted using a moderator’s guide. Discussions were recorded, transcribed, coded, and analysed to identify common themes related to listening-related fatigue. A hierarchical coding manual was developed iteratively as new themes and subcategories were identified during the analysis process. Study Sample Forty-three adults (11 males; aged 20 to 77 years) with varying degrees of hearing loss participated in the focus groups. Participants included primarily hearing aid users (n = 34), hearing aid candidates (n = 6), and a small group of cochlear implant users (n = 3). Results Qualitative analyses revealed the multidimensional nature of listening-related fatigue for AHL, including physical, mental, emotional, and social domains. These varied experiences were influenced by the external (acoustic/environmental) characteristics of the listening situation, the internal state of the listener (cognitive/motivational), and coping strategies implemented to modify the listening experience. The use of amplification had both positive and negative effects on listening-related fatigue. Conclusions For some AHL, the consequences of listening-related fatigue can be significant, negatively impacting their quality of life. Data from these focus groups provides a framework for understanding the experience of listening-related fatigue among AHL. This is a critical first step in the development of a tool for measuring listening-related fatigue in this at-risk group.

Determining unilateral or bilateral hearing aid preference in adults: a prospective study

Objective Despite high rates of bilateral hearing aid fitting globally, a number of adults continue to reject one hearing aid. The current study aimed to identify a clinically suitable tool for determining, pre-fitting, which clients might prefer one hearing aid. Study Sample: Ninety-five new adult hearing aid candidates, aged 49–87 years, were assessed prior to a first hearing aid fitting. Sixty-eight participants adhered to the prescribed protocol for both bilateral and unilateral hearing aid use. Design Performance was assessed on a modified version of the Listening in Spatialised Noise – Sentences test (LiSN-S), the Dichotic Digits difference Test, the Experiential Hearing Aid simulator, and the Grooved Pegboard Test. All participants were fitted bilaterally, but were instructed to alternate between unilateral and bilateral hearing aid use over fourteen weeks post-fitting. Participants’ wearing preferences were assessed via a short questionnaire. Results 78% of participants expressed an overall preference for bilateral hearing aid use. Only the LiSN-S bilateral advantage test outcomes significantly correlated with overall wearing preference. Conclusions Although the LiSN-S bilateral advantage score related to overall wearing preference, the accuracy of the predictor was too low to warrant implementation of this test prior to hearing aid fitting. The current practice of recommending bilateral hearing aid use continues to be the best option for clinicians.

Earmold Foreign Bodies in the Middle Ear Necessitating Surgical Removal: Why Otology Specialists Should Screen Candidates for Hearing Aids.

Earmold Foreign Bodies in the Middle Ear Necessitating Surgical Removal: Why Otology Specialists Should Screen Candidates for Hearing Aids.

Who are good adult candidates for cartilage conduction hearing aids?

Cartilage conduction hearing aids (CC-HAs) are novel hearing aids using the third hearing pathway of cartilage conduction. We assessed the efficacy of CC-HAs in adult hearing-loss patients who had various anatomical conditions of their ear canal(s) and determined who are good candidates for CC-HAs. Patients (n = 37) were categorised into three groups of participants based on ear canal anatomy: (1) canal stenosis; (2) abnormal canal; (3) normal canal. After a 1-month free trial of normal usage, CC-HA-aided and unaided hearing thresholds (43 fitted ears) were determined using standard audiograms, after which participants could choose to purchase the device or not. Group and subgroup purchase rates were calculated along with the purchase reason (or not). Subgroup binary analysis of purchase rates was done according to hearing loss severity (< 70dB and ≥ 70dB) of unaided average air conduction (AC) hearing thresholds. CC-HA provided hearing improvements in all frequencies within each group. Overall, 60.47% of participants purchased a CC-HA after the trial. Over 70% participants with canal stenosis purchased CC-HAs, regardless of their AC hearing thresholds (severe vs. mild), and significantly more mild-loss participants in the abnormal canal group purchased their trial CC-HA compared to severe-loss participants (85.71% vs. 20%). Adult patients with ear canal stenosis or closure are the best candidates for CC-HAs, regardless of their hearing thresholds. Patients with more severe hearing loss accompanied by ear canal anomalies and patients with normal canal anatomy may not be good candidates.

Online support group users’ perceptions and experiences of bone-anchored hearing aids (BAHAs): a qualitative study

Objective: Better understanding of the decision-making process for bone-anchored hearing aid (BAHA) candidates has been identified by clinicians as a research priority. This study aimed to understand experiences and perceptions of BAHA candidates and users who use online support groups.Design: One thousand posts retrieved from a public UK-based online support group were thematically analysed.Study sample: Messages were posted by 270 BAHA users and candidates.Results: Individuals used the online group to obtain information about BAHAs and support for decision-making regarding accepting BAHA surgery and wearing a percutaneous device. BAHA users evaluated the efficacy of the system, perceiving it to be highly effective in improving their hearing. The BAHA influenced individuals’ self-image and impacted their social lives. Fears of surgery and post-implantation infections were regarded as challenges to be faced when choosing to accept implantation.Conclusions: BAHA candidates found the online support group useful in helping them to decide whether or not to proceed with surgery, and the personal experiences of BAHA users were predominantly positive. However, it is not clear to what extent such positive experiences are representative of BAHA users more generally, and candidates need to be aware of this when using these groups to support decision-making.

Making Audiology Work During COVID-19 and Beyond

Making Audiology Work During COVID-19 and Beyond

How Theory Can Influence Hearing Aid Use

How Theory Can Influence Hearing Aid Use

Where Do We Go From Here? Some Messages to Take Forward Regarding Children With Mild Bilateral and Unilateral Hearing Loss.

Purpose This epilogue discusses messages that we can take forward from the articles in the forum. A common theme throughout the forum is the ongoing need for research. The forum begins with evidence of potential progressive hearing loss in infants with mild bilateral hearing loss, who may be missed by current newborn hearing screening protocols, and supports the need for consensus regarding early identification in this population. Consensus regarding management similarly is a continuing need. Three studies add to the growing body of evidence that children with mild bilateral or unilateral hearing loss are at risk for difficulties in speech understanding in adverse environments, as well as delays in language and cognition, and that difficulties may persist beyond early childhood. Ambivalence regarding if and when children with mild bilateral or unilateral hearing loss should be fitted with personal amplification also impacts management decisions. Two articles address current evidence and support the need for further research into factors influencing decisions regarding amplification in these populations. A third article examines new criteria to determine hearing aid candidacy in children with mild hearing loss. The final contribution in this forum discusses listening-related fatigue in children with unilateral hearing loss. The absence of research specific to this population is evidence for the need for further investigation. Ongoing research that addresses difficulties experienced by children with mild bilateral and unilateral hearing loss and potential management options can help guide us toward interventions that are specific for the needs of these children.

Audibility-Based Hearing Aid Fitting Criteria for Children With Mild Bilateral Hearing Loss.

Purpose Because of uncertainty about the level of hearing where hearing aids should be provided to children, the goal of the current study was to develop audibility-based hearing aid candidacy criteria based on the relationship between unaided hearing and language outcomes in a group of children with hearing loss who did not wear hearing aids. Method Unaided hearing and language outcomes were examined for 52 children with mild-to-severe hearing losses. A group of 52 children with typical hearing matched for age, nonverbal intelligence, and socioeconomic status was included as a comparison group representing the range of optimal language outcomes. Two audibility-based criteria were considered: (a) the level of unaided hearing where unaided children with hearing loss fell below the median for children with typical hearing and (b) the level of unaided hearing where the slope of language outcomes changed significantly based on an iterative, piecewise regression modeling approach. Results The level of unaided audibility for children with hearing loss that was associated with differences in language development from children with typical hearing or based on the modeling approach varied across outcomes and criteria but converged at an unaided speech intelligibility index of 80. Conclusions Children with hearing loss who have unaided speech intelligibility index values less than 80 may be at risk for delays in language development without hearing aids. The unaided speech intelligibility index potentially could be used as a clinical criterion for hearing aid fitting candidacy for children with hearing loss.