Client Oriented Scale Of Improvement Research Articles

Client Oriented Scale of Improvement in First-Time and Experienced Hearing Aid Users: An Analysis of Five Predetermined Predictability Categories through Audiometric and Speech Testing.

Objectives: The aim of our investigation was to explore the relationship between unaided pure-tone and speech audiometry and self-reported aided performance measured according to five predetermined COSI categories among first-time hearing aid users and experienced hearing aid users. Methods: Data from 286 patients were retrospectively evaluated. We divided the sample into first-time hearing aid users (G1) and experienced hearing aid users (G2). The correlation between unaided tonal and speech audiometry and five preliminary selected client-oriented scale of improvement (COSI) categories was studied. Results: A greater percentage of hearing aid users aged >80 years and a higher prevalence of severe-to-profound hearing loss in G2 group were observed (p < 0.05). For the total cohort, a mean hearing threshold of 60.37 ± 18.77 db HL emerged in the right ear, and 59.97 ± 18.76 db HL was detected in the left ear (p > 0.05). A significant statistical difference was observed in the group of first-time hearing aid users for the "Television/Radio at normal volume" item, where patients with a lower speech intellection threshold (SIT) were associated with higher COSI scores (p = 0.019). Studying the relationship between the speech reception threshold (SRT) and the COSI item "conversation with 1 or 2 in noise" evidenced worse speech audiometry in patients who scored ≤2 among experienced hearing aid users (p = 0.00012); a higher mean 4-8 kHz frequencies threshold for the better ear was found within the G2 group among those who scored ≤2 in the COSI item "conversation with 1 or 2 in quiet" (p = 0.043). Conclusions: Our study confirms a poor correlation between unaided tonal and speech audiometry and self-reported patient assessment. Although we included only five COSI categories in this study, it is clear that unaided audiometric tests may drive the choice of proper hearing rehabilitation, but their value in predicting the benefit of hearing aids remains limited.

DESIGN AND IMPLEMENTATION OF THE ACHIEVE HEARING INTERVENTION

Abstract The ACHIEVE trial required the development of a manualized best-practice hearing intervention designed to meet the needs of older adults with mild-moderate hearing loss. The hearing intervention (HI) was developed using an iterative process including input from a diverse professional panel and a feasibility study to confirm that expected outcomes from a best-practices, evidence-based HI would be obtained. The HI involves use of hearing aids and related technologies along with counselling, coaching and education to support self-management of hearing loss. The HI is delivered in four sessions after the completion of a comprehensive hearing evaluation. Individualized goals are developed using the Client Oriented Scale of Improvement (COSI), which guides selection of hearing aids and other technologies to meet prioritized listening needs and assessment of how well those needs are met. The most frequent COSI listening goal categories included: Conversation in Noise (n= 413; 29%), Conversations in Quiet (n= 296; 21%), and TV/Radio at Normal Volume (n= 280; 20%). Three levels of hearing aid technology differing by the number of signal processing approaches included were: Basic (n=223, 20%), Advanced (n=662, 56%), and Premium (n=283, 24%). Additional hearing assistive technologies included streaming devices, TV connectors, and remote microphones were provided. We discuss how the baseline audiological results and individualized goal setting informed delivery of the HI and how the use of manualization allowed us to maintain excellent treatment fidelity throughout the clinical trial.

Focusing on positive listening experiences improves hearing aid outcomes in experienced hearing aid users

Objective The purpose of this study was to investigate whether focusing on positive listening experiences improves hearing aid outcomes in experienced hearing aid users. Design The participants were randomised into a control or positive focus (PF) group. At the first laboratory visit, the Client-Oriented Scale of Improvement (COSI) questionnaire was administered followed by hearing aid fitting. The participants wore the hearing aids for three weeks. The PF group was asked to report their positive listening experiences via an app. During the third week, all the participants answered questionnaires related to hearing aid benefit and satisfaction. This was followed by the second laboratory visit where the COSI follow-up questionnaire was administered. Study sample Ten participants were included in the control and eleven in the PF group. Results Hearing aid outcome ratings were significantly better in the PF group in comparison to the control group. Further, COSI degree of change and the number of positive reports were positively correlated. Conclusions These results point to the importance of asking hearing aid users to focus on positive listening experiences and talk about them. The potential outcome is increased hearing aid benefit and satisfaction which could lead to more consistent use of the devices.

Development of a Predictive Model for Individualized Hearing Aid Benefit.

To develop a model to predict individualized hearing aid benefit. To provide interpretations of model predictions on global and individual levels. We compiled a data set of patients with hearing loss who trialed hearing aids and completed the Client Oriented Scale of Improvement (COSI) questionnaire, a validated patient-reported outcome measure of hearing aid benefit. Features included demographic, medical, and audiological measures. The outcome was the COSI score for change in listening ability with hearing aids, scaled from 1 to 5. Model development was performed using fivefold cross-validation repeated three times with hyperparameter tuning. Model performance was assessed using the root mean squared error (RMSE) of the COSI scores. Model interpretation was performed using Shapley Additive Explanations. The data set comprised 1,286 patients across 3,523 listening situations. The best performing model was random forest with an RMSE of 0.80, found to be significantly better than the next best model (eXtreme gradient boosting with RMSE of 0.85, p < 0.01). The most important features in predicting hearing aid benefit were shorter duration of hearing aid use, higher pure-tone average in the better hearing ear, and younger age. We have developed a predictive model for hearing aid benefit that can also provide individualized explanations of model predictions. Predictive modeling could be a useful tool in assessing a patient's candidacy and predicted benefit from hearing aids.

Feasibility and Assessment of a Hybrid Audiology Service Delivery Model for Older Adult Hearing Aid Users: A Pilot Study.

The aim of this study was to provide insight for the feasibility and outcomes of hybrid (combination of in-person office and Internet-based appointments) audiology services. This pilot included two phases. First, we surveyed audiologists regarding what elements of a best-practice, in-person delivery of a hearing intervention could be delivered via Internet-based appointments. Next, we piloted the feasibility and assessed outcomes of the procedures identified. Ten first-time hearing aid users aged 70 years and older were fit with Phonak Audeo M90-312T hearing aids. Two Internet-based follow-up appointments were completed using the myPhonak app. We administered the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), the Client Oriented Scale of Improvement (COSI), the Quick Speech-in-Noise Test (QuickSIN), and real-ear aided responses (REARs) to determine whether participants experienced improvements on hearing-related outcomes. The Telehealth Acceptance Questionnaire (TAQ) and the Visit-Specific Satisfaction Questionnaire (VSQ-9) were administered to gauge comfort with telehealth and satisfaction with Internet-based appointments. Survey results revealed that after an initial in-person appointment, nearly all follow-up hearing intervention components could be delivered remotely. We performed Wilcoxon signed-ranks tests to determine if the baseline and outcome results differed for outcomes. Baseline scores improved after 6 weeks (ps = .02 and. 005 for QuickSIN and HHIE-S) for speech-in-noise performance and self-perceived hearing difficulties. REARs from 500 to 4000 Hz measured after 6 weeks did not differ from baseline (ps = .612 and .398 for the right and left ears), suggesting no significant deviation from prescriptive targets because of remote fitting adjustments. All participants reported improvement in COSI goals after the intervention. TAQ results suggested that comfort with telehealth improved after attending Internet-based appointments (p = .005). VSQ-9 results revealed no differences in reported patient satisfaction between in-person and Internet-based appointments. We were able to develop a feasible hybrid audiology service delivery model for older adults. Our results enhance the evidence base for the implementation of telehealth audiology services.

Influence of Auditory Training on Acceptable Noise Level Scores in Elderly Persons with Hearing Impairment.

To study the Influence of Auditory Training on acceptable noise level (ANL) scores in elderly persons with hearing impairment. Quasi-experimental study design. A total of 20 bilateral mild to moderately severe sensorineural hearing loss participants with "high" ANL scores were taken into the study and randomly allocated to experimental and control groups. In the time frame, the experimental group provided 12 sessions of speech in noise training with a hearing aid and the baseline measures were repeated in both groups. The Acceptable noise level and Speech in Noise scores significantly improved post-training only in the experimental group. They also showed a significant difference "Client Oriented Scale of Improvement (COSI)" scale in the domain "Conversation in Noise". Acceptable noise level is susceptible to training similar to that of speech in noise score. It provides hope to the individuals who are poor candidates to the hearing aids.

Maximizing Cochlear Implant Outcomes with Short-Term Aural Rehabilitation.

Increasing numbers of adults are receiving cochlear implants (CIs) and many achieve high levels of speech perception and improved quality of life. However, a proportion of implant recipients still struggle due to limited speech recognition and/or greater communication demands in their daily lives. For these individuals a program of aural rehabilitation (AR) has the potential to improve outcomes. The study investigated the effects of a short-term AR intervention on speech recognition, functional communication, and psychosocial outcomes in post lingually deafened adult CI users. The experimental design was a multisite clinical study with participants randomized to either an AR treatment or active control group. Each group completed 6 weekly 90-minute individual treatment sessions. Assessments were completed pretreatment, 1 week and 2 months post-treatment. Twenty-five post lingually deafened adult CI recipients participated. AR group: mean age 66.2 (48-80); nine females, four males; months postactivation 7.7 (3-16); mean years severe to profound deafness 18.4 (2-40). Active control group: mean age 62.8 (47-85); eight females, four males; months postactivation 7.0 (3-13); mean years severe to profound deafness 18.8 (1-55). The AR protocol consisted of auditory training (words, sentences, speech tracking), and psychosocial counseling (informational and communication strategies). Active control group participants engaged in cognitive stimulation activities (e.g., crosswords, sudoku, etc.). Repeated measures ANOVA or analysis of variance, MANOVA or multivariate analysis of variance, and planned contrasts were used to compare group performance on the following measures: CasperSent; Hearing Handicap Inventory; Nijmegen Cochlear Implant Questionnaire; Client Oriented Scale of Improvement; Glasgow Benefit Inventory. The AR group showed statistically significant improvements on speech recognition performance, psychosocial function, and communication goals with no significant improvement seen in the control group. The two groups were statistically equivalent on all outcome measures at preassessment. The robust improvements for the AR group were maintained at 2 months post-treatment. Results of this clinical study provide evidence that a short-term AR intervention protocol can maximize outcomes for adult post lingually deafened CI users. The impact of this brief multidimensional AR intervention to extend CI benefit is compelling, and may serve as a template for best practices with adult CI users.

Hearing Disabilities and the Effectiveness of Rehabilitation in Different Age Groups.

To assess differences in hearing disabilities between different age groups and the effectiveness of rehabilitation with hearing aids. Retrospective chart review. First line hearing aid dispensers. First-time hearing aid users divided in a younger group aged 18 to 65 years (119 subjects) and an elderly group aged 70 years and older (213 subjects). Rehabilitative. Weighted pure tone averages (PTA) were calculated using the binaural impairment model. The patient-reported outcome measures (PROMs) Amsterdam Questionnaire for Auditory Disabilities (AVAB), and client oriented scale of improvement (COSI) were collected pre- and post-fitting. To analyze whether age group, weighted PTA, and type of auditory dimension influences AVAB, linear regression and two-way ANalysis Of VAriance models were used. The weighted PTA of the young group was significantly lower than of the elderly group. In the regression model differences between age groups were found to be significant for pre-AVAB and for AVAB benefit. The two-way ANalysis Of VAriance showed that the effect of age on pre- and post-AVAB scores was not influenced by PTA or the type of auditory dimension. Younger first-time hearing aid users experience more auditory disabilities, despite better hearing levels than their elderly counterparts. Their disabilities are rehabilitated more effectively by hearing aids.

Hearing Aid Use, Satisfaction in Older Adults: Will Physician Visits Make a Difference?

Hearing Aid Use, Satisfaction in Older Adults: Will Physician Visits Make a Difference?

First United Kingdom experience of the novel Osia active transcutaneous piezoelectric bone conduction implant

Bone conduction hearing devices are widely used and indicated in cases of conductive, mixed or single-sided deafness where the conventional hearing aids are not indicated or tolerated. This prospective study aims to investigate the surgical and hearing outcomes of a novel active piezoelectric transcutaneous bone conduction device (t-BCD). Prospective data were collected from the first 10 patients who underwent implantation with the t-BCD Osia (Cochlear, Australia) (between Dec 2018 and March 2019) in a tertiary referral centre. The main outcome measures include: surgical outcome, free field speech testing with speech recognition thresholds, audiological gain and patient-reported outcomes including the 'Glasgow Benefit Inventory' (GBI) and the 'Client Oriented Scale of Improvement (COSI). The mean length of surgery was 70.6min (range 50-87, SD = 9.5). Mean skin thickness measured was 5.6mm (range 4-8, SD = 1.1). There were two post-operative wound infections which settled conservatively. One required revision surgery to thin skin. The average gain in hearing with the implant was + 39.4dB. Pre-implantation mean unaided SRT was 38.1dB (SD = 7.8) and the post-implantation mean-aided SRT was 22.7dB (SD = 4.6) (p = 0.000078). There was improvement in COSI domains. The mean Glasgow disability score dropped from 52% pre-implantation to 20% post-implantation (p = 0.001). This new active t-BCHD provides excellent audiological gain and improvement in speech recognition. Patient-reported outcomes have also been very positive. The surgery was straightforward with no major surgical complications reported. Further studies will be required to examine long-term outcomes in larger number of patients.

A Client Oriented Scale of Improvement in Tinnitus for Therapy Goal Planning and Assessing Outcomes.

There is a need to develop methods to help clinicians work with clients to select and personalize tinnitus therapies. The use of validated measures to determine treatment success is also essential for research and clinical practice. A goal planning method widely used in audiologic rehabilitation is the client oriented scale of improvement (COSI). A modified version of the COSI has been used to identify tinnitus treatment goals and outcomes (client oriented scale of improvement in tinnitus [COSIT]). The aims of this study were to identify treatment goals in a clinic sample and ascertain the convergent validity of the COSIT to three widely used standardized questionnaires. A retrospective evaluation of client treatment goals using thematic analysis and correlational analysis of secondary research data comparing the COSIT to tinnitus handicap questionnaire (THQ), tinnitus handicap inventory (THI), and tinnitus functional index (TFI). One hundred and twenty-two adult patients and research participants attending the University of Auckland Hearing and Tinnitus Clinic. Specific treatment goals were categorized into 11 themes. The most common treatment goals (>10% of responses) were: (1) Reducing tinnitus' effects on Hearing. (2) Improved wellbeing and being less depressed. (3) Coping with or controlling the tinnitus. (4) Managing the effect of the environment (context) on tinnitus. (5) Improving sleep. (6) Understanding tinnitus. Individuals differed in their complaints and priorities for treatment. The COSIT showed moderate convergent validity with the THQ, THI, and TFI indicating that the total scores measured similar constructs. The COSIT is a pragmatic method for determining tinnitus treatment goals and priorities in a format that should be familiar to audiologists.

Controlled comparative clinical trial of hearing benefit outcomes for users of the Cochlear™ Nucleus® 7 Sound Processor with mobile connectivity

Objectives: To assess subjective benefits and objective speech recognition performance following a take-home trial with the new Cochlear™ Nucleus® 7 Sound Processor (SP), in experienced users of compatible cochlear implants from Cochlear Limited.Methods: A total of 37 adult participants were fitted with the Nucleus 7 SP and used the device for up to one year. Baseline speech recognition was assessed at the initial fitting session, using each participant’s own SP, and Client Oriented Scale of Improvement (COSI) goals were identified. Speech recognition was measured after 3 months of device use and outcomes of the COSI and a non-validated Processor Comparison Questionnaire (PCQ) were collected. After 11 months, a subset of subjects were tested on speech recognition delivered via direct wireless streaming from an Apple® smartphone to the SP and compatible hearing aid on the opposite side (if worn).Results: The COSI and PCQ instruments both indicated significant improvement in perceived subjective benefits in comparison to the participants’ previous SPs. Direct streaming via an Apple mobile phone showed improvements when compared with the acoustic alone condition. Standard speech recognition in quiet and noise was equivalent to that obtained using a previous generation SP which uses the same basic processing as the Nucleus 7 Sound Processor.Conclusions: The incremental refinements provided by the Nucleus 7 Sound Processor provide real-world benefits in key areas such as upgraded wireless connectivity. The COSI proved to be an effective tool for individualized assessment of specific benefits that may not be addressed by more standardized instruments.

An Analysis Study of Features for Hearing Aid Satisfaction Questionnaires: Satisfaction with Amplification in Daily Life, Client Oriented Scale of Improvement, International Outcome Inventory for Hearing Aids

Purpose: This study was aimed to provide translated questionnaires in Korean including Satisfaction with Amplification in Daily Life (SADL), Client Oriented Scale of Improvement (COSI), and International Outcome Inventory for Hearing Aids (IOI-HA) and analyze their reliabilities and validities for measuring and improving hearing-aid satisfaction level in Korea. Methods: Fifty people who were fitted with their new hearing-aids participated (70.4 ± 12.4). All the participants answered Korean-IOI-HA and newly translated SADL and COSI in Korean to measure hearing aid satisfaction, when they visited the hearing-aid centers where they were fitted hearing-aids initially. The hearing-aid types were Completely In the Canal for 29, In The Canal for 10, and Receiver In the Canal for 11. Monaural and binaural users were 20 and 30, respectively. Out of fifty, fifteen performed test-retest measurements. Results: Translated SADL, COSI, and IOI-HA’s means and Cronbach’s alpha values were 4.76 and 0.83, 3.60 and 0.83, and 3.73 and 0.70. There was a significant correlation coefficient among three questionnaires. No significant difference according to hearing-aid types was found. A significant difference for the wearing manners between bilateral and unilateral hearing aids was found. The correlations between test and retest were 0.83 for SADL, 0.71 for COSI, and 0.74 for IOI-HI indicating good reliabilities. Conclusion: The translated versions of SADL, COSI and IOI-HA were validated as useful tools for measuring satisfaction of hearing-aids and the fitting in Korea. Using these questionnaires, better satisfaction level of hearing-aids in Korea could be provided in the future.

Sound therapy and aural rehabilitation for tinnitus: a person centred therapy framework based on an ecological model of tinnitus

Purpose: Tinnitus is a common oto-neurological complaint often accompanying hearing loss. In this perspective on rehabilitation we describe a framework for sound therapy and aural rehabilitation of tinnitus based on the ecological model of tinnitus.Method: A thematic network analysis-based approach was used to relate aural rehabilitation methods to the ecological model of tinnitus and the client-oriented scale of improvement in tinnitus.Results: Aural rehabilitation methods were mapped to concepts of: (1) Context, (2) presence of sound and (3) reaction to sound. A global theme was: adaptation to sound. The framework is the result of an iterative and cumulative research program exploring tinnitus as the outcome of the relationship between individual psychoacoustics and psychosocial factors including context of perception.Conclusions: The intent of this framework is to help guide audiologists managing tinnitus. The framework has been useful in our clinic as illustrated by a case study. The benefits of this approach relative to standard care needs to be independently ascertained.Implications for RehabilitationTinnitus is a common oto-neurological complaint that when severe can be very disabling.Tinnitus is very heterogeneous as a consequence of this no one treatment is suitable for everyone.The sound therapy and aural rehabilitation for tinnitus framework is designed to assist audiologists in clinical planning that addresses individual needs.The framework is the result of an iterative and cumulative research program exploring tinnitus as the outcome of the relationship between individual psychoacoustics and psychosocial factors including context of perception.

Evaluation of Auditory Functioning and Rehabilitation Using Patient-Reported Outcome Measures.

There is lack of a systematic approach concerning how to select an adequate hearing aid and how to evaluate its efficacy with respect to the personal needs of rehabilitation. The goal of this study was to examine the applicability and added value of two widely used self-reporting questionnaires in relation to the evaluation of hearing aid fitting. We analyzed responses, pre- and postfitting, from 1,319 subjects who completed the Client Oriented Scale of Improvement (COSI) and a slightly adapted version of the Amsterdam Inventory for Auditory Disability and Handicap (in Dutch: AVAB). Most COSI responses were at or near the maximum possible score. Results show a close relation between COSI’s degree of change and final ability (Spearman’s rho = 0.71). Both AVAB and COSI showed a significant effect of hearing aid experience, but—in contrast to AVAB—COSI did not show a significant effect of the degree of hearing loss. In addition, a Friedman test showed significant differences between six dimensions of auditory functioning for both AVAB and COSI, although post hoc analysis revealed that for COSI, the dimension speech in quiet explained most variation between dimensions. In conclusion, the effects of hearing loss were more salient in AVAB, while both AVAB and COSI showed differences regarding hearing aid experience. Combining the advantages of both methods results in a detailed evaluation of hearing aid rehabilitation. Our results therefore suggest that both methods should be used in a complementary manner, rather than separately.

Single-center Experience of Over a Hundred Implantations of a Transcutaneous Bone Conduction Device.

To assess outcomes with a novel passive transcutaneous bone conduction device (t-BCD). Prospective data collection and patient review. Tertiary referral center. Patients who underwent implantation with the t-BCD between November 2013 and September 2016. Implantation of BAHA Attract. Surgical outcome, patient reported outcomes including the "Glasgow Benefit Inventory" and the "Client Oriented Scale of Improvement" for adults and the "Speech, Spatial and Qualities of Hearing scale" (SSQ-12) for children. One hundred five patients were implanted. Numbness superior to the incision was commonly noticed. Four patients (3.8%) developed skin tenderness and redness that settled with conservative measures. Among those patients who had a conversion from a percutaneous Bone Conduction Hearing Device (BCHD) to the t-BCD (n=15), 1 (0.9%) developed seroma and 2 (1.9%) developed skin dehiscence at the edge of the implant magnet. Significant improvement in Client Oriented Scale of Improvement and Glasgow Benefit Inventory scores with a global satisfaction of 84% and 77.4% was observed for those previously aided and unaided respectively, with use of the device. A 22% improvement in SSQ-12 mean score was observed in the pediatric population. This is the largest single-center series reported on this t-BCD. The complication rate is small but caution is required in patients of conversion from a percutaneous BCHD. The patients' satisfaction is high and the need for aftercare is minimal. Cost-effectiveness evaluation of these devices, development of core outcome sets and well-designed, prospective trials to compare the different BCHDs should be the focus of future research.

Translation and Standardization for a Korean Version of the Client Oriented Scale of Improvement

Background and Objectives Client Oriented Scale of Improvement (COSI) has been designed to identify client needs, changes in listening ability, and final listening ability in situations important to each client. The aim of this study was to translate COSI into Korean with subsequent linguistic validation and to determine the reliability of the Korean version of the COSI (K-COSI). Subjects and Method An expert panel translated the original version of COSI into the Korean language. A bilingual translator back-translated the translated version into English, which was subsequently compared with the original English version. K-COSI was administered at 14 referral hospitals, to 128 patients with hearing disability after cognitive debriefing. Reliability was assessed using correlation study. Results K-COSI showed an excellent test-retest correlation and high reliability in degree of change (Spearman correlation=0.89, interclass correlation coefficient=0.922). It also showed a fair test-retest correlation and high reliability in final hearing ability (Spearman correlation=0.49, interclass correlation coefficient=0.353) Conclusion K-COSI proved to be highly reliable. The results suggest that the adapted Korean version of COSI is a reliable and valid measure for Korean-speaking patients with hearing loss. Key words: Hearing aids ㆍ Hearing disability ㆍ Korean ㆍ Questionnaire ㆍ Standardization

Comparison of two hearing aid fitting formulae in improving the patients’ satisfaction with amplification for experienced hearing aid users

Introduction The effectiveness of real word satisfaction is very important for optimal hearing aid (HA) fitting, which can be assessed using self-report questionnaires. The Client Oriented Scale of Improvement (COSI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) are useful tools for assessing the effectiveness of HA in achieving patient satisfaction. Patients and methods This study included 20 hearing-impaired adults. Their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss and had previous experience with HAs. Their ages ranged from 18 to 60 years, and the mean duration of HA experience was 3.85±5.02 years. Participants were examined in three scheduled sessions: unaided, aided National Acoustics Laboratories-Nonlinear 2 (NAL-NL2), and aided desired sensation level (DSL) v5. Each session was scheduled 2 months after the previous session. Patient satisfaction was assessed using the COSI and APHAB questionnaires for each HA fitting formulae. Results Both formulae have improved patient’s five client needs of the COSI; however, NAL-NL2 had better final ability score compared with DSL v5. Using the APHAB questionnaire, both formulae have decreased the listening difficulty score significantly. Using APHAB questionnaire, NAL-NL2 showed significantly less listening difficulty compared with DSL v5 as regards difficulties in ease of communication, broadband noise, and reverberation. However, both formulae did not improve ‘aversiveness’ conditions. Conclusion Questionnaires are equally important to audiometric tests and should not be underestimated and hence should be relied upon it in HA-fitting verification.

The application of mandarin acceptable noise level and COS in hearing aid fitting for presbyacusis

Objective:The purpose of this study was to inquiry into the application of mandarin acceptable noise level(M-ANL) and client oriented scale of improvement in evaluation of hearing aid fitting for presbyacusis. Method:Thirty-two adults with presbycusis who used the hearing aid for the first time were selected for the study. M-ANL tests were done prior to the hearing aid fitting. Six weeks later, these patients were asked to fill in questionnaire of client oriented scale of improvement (COSI).The subjects were divided into 3 groups according to the time of hearing aid using in their daily lives: less than one hour per day, 1 to 4 hours per day and more than 4 hours per day. The relativity of M-ANL and the score of COSI were compared. Result:①There were significant differences of the M-ANL among 3 groups(P<0.05); ②The scores of COSI of group 1(less than one hour per day) was lower than group 2(1 to 4 hours per day), while there were no significant differences between the scores of group 2(1 to 4 hours per day) and group 3(more than 4 hours per day); ③There was good correlation between the score of M-ANL and COSI. Conclusion:M-ANL can forecast the satisfaction of hearing aids fitting. And COSI can play an effective role in outcome measurement.

A Profiling System for the Assessment of Individual Needs for Rehabilitation With Hearing Aids.

This study focuses on the development of a profiling system to specify the needs of hearing-aid candidates. As a basis for the profile of compensation needs, we used a slightly modified version of the Amsterdam Inventory of Disability and Handicap, combined with the well-known Client-Oriented Scale of Improvement (COSI). The first questionnaire results in scores for six audiological dimensions: detection, speech in quiet, speech in noise, localization, focus or discrimination, and noise tolerance. The goal of this study was to determine whether the six dimensions derived from the disability questionnaire are appropriate to also categorize individual COSI targets. The results show a good agreement between eight audiologists in the categorization of COSI goals along the six dimensions. The results per dimension show that the dimension focus or discrimination can be regarded as superfluous. Possible additional dimensions were tinnitus and listening effort. The results indicate that it is possible to translate individual user needs (administered using COSI) into more general dimensions derived from a disability questionnaire. This allows to summarize the compensation needs for individual patients in a profile of general dimensions, based on the degree of disability and the individual user needs. This profile can be used as a starting point in hearing aid selection. This approach also offers a well-structured method for the evaluation of the postfitting results.