Direct Hearing Aid Research Articles

Assessment of Hearing Aid Benefit Using Patient-Reported Outcomes and Audiologic Measures

Purpose: To determine the contributions to hearing aid benefit of patient-reported outcomes and audiologic measures. Methods: Independent review was conducted on audiologic and patient-reported outcomes of hearing aid benefit collected in the course of a middle ear implant FDA clinical trial. Unaided and aided data were extracted from the preoperative profiles of 95 experienced hearing aid users, and the relationships between a patient-reported outcome and audiologic measures were assessed. The following data were extracted: unaided and aided pure-tone or warble-tone thresholds (PTA), word recognition in quiet (NU-6), Speech Perception in Noise (low-/high-context SPIN), and patient-reported benefit (Abbreviated Profile of Hearing Aid Benefit, APHAB). Hearing aid benefit was defined as the difference in thresholds or scores between unaided and aided conditions, as measured in the sound field. Correlations were computed among audiologic measures and global APHAB and subscale scores of hearing aid benefit. Results: Significant improvements in all audiologic measures and APHAB scores were observed comparing unaided to aided listening (all p < 0.001). However, correlations between audiologic and patient-reported measures of aided performance or hearing aid benefit were low-to-weak or absent. No significant correlations were found between aided audiologic measures (PTA, NU-6, SPIN) and any aided APHAB scores (all p > 0.0125), and significant relationships for hearing aid benefit were absent with only few exceptions. Hearing aid benefit defined by global APHAB using NU-6 and SPIN scores showed significant but weak positive correlations (r = 0.37, p < 0.001; r = 0.28, p = 0.005, respectively) and ease of communication APHAB subscale scores (r = 0.32, p < 0.001; r = 0.33, p = 0.001, respectively). Conclusion: Hearing aid benefit assessed with audiologic measures were poor predictors of patient-reported benefit. Thus, patient-reported outcomes may provide a unique assessment of patient-perceived benefit from hearing aids, which can be used to direct hearing aid programming, training, or recommendations of alternative hearing services.

Power Direct Bone Conduction Hearing Aid System

The hearing aid system ( 102 ) has a sound-to-vibration conversion circuitry including a microphone system ( 108 ), an electronic amplifier ( 114 ) and a vibrator ( 120 ). A housing ( 121 ) accommodates the vibrator ( 120 ). The vibrator ( 120 ) is connected to an abutment ( 124 ) that goes through the skin. The abutment ( 124 ) is connected to a fixture ( 126 ) that is anchored in the skull bone ( 128 ). The sound-to-vibration conversion circuitry has an AfD converter ( 212 ) that converts an analogue microphone signal into a digital signal.

HNO-ärztliche Hörgeräte-Direktversorgung: Empfehlungen zur Vermeidung und Behandlung von Komplikationen bei der Ohrabdrucknahme

In times of budgeting, rising costs and monetary losses, an increasing number of ENT specialists considers the hearing system sector due to the distinct undersupply and the expected demographic development to be a market of the future and appropriate to enlarge their field of competence. Exact prevalence of direct hearing aid provision by German otorhinolaryngologists as well as its complication rate are not well-known. Retrospectively, all patients were evaluated who presented at our department with complications in the context of outpatient direct hearing aid supply within the last 3 years. Inappropriate fitting contains the danger of malformed or displaced ear impressions with various injury patterns comprising the external auditory canal, tympanic membrane and ossicular chain. Practical advices for prevention of complications include the accurate modeling and placement of sufficient impression pads behind the second bend of the auditory canal, using an adequate type of impression material as well as performing the correct application procedures. Recommendations for diagnostic patterns and treatment of complications after taking ear impressions are presented, the differences between German "traditional" and "direct" hearing aid provision are critically discussed.

Patient Preferences for Direct Hearing Aid Provision by a Private Dispenser. A Discrete Choice Experiment

Our objective was to elicit patient preferences for transferring elements of hearing aid provision from the medical sector [Ear Nose and Throat (ENT) specialists and audiological centers] to private hearing aid dispensers, and to understand the trade-offs between different elements of hearing aid provision. A discrete choice experiment was administered from 150 hearing-impaired persons in the Netherlands. Mean age was 71 (range 18-95) and 57% were male. Participants preferred the initial assessment at the dispenser, higher accuracy in identifying persons in need of medical care, shorter duration of the total hearing aid provision, and a follow-up at the ENT specialist. They required compensation of at least euro 17 per 2 mo extra duration, euro 54 for an initial assessment at the ENT specialist, euro 119 per 10% decrease in accuracy, and euro 227 to forgo the follow-up at the ENT specialist. Preferences were influenced by sex, age, educational level, and experience with hearing aid provision. Hearing-impaired persons are receptive to transferring elements of hearing aid provision from the medical sector to private dispensers. Although safety and efficiency issues should also be considered, from the present study we can conclude that in the organization of hearing aid provision hearing-impaired persons prefer an initial assessment at a private dispenser when the dispenser is at least 95% as accurate as the ENT specialist, and prefer a follow-up visit at the ENT specialist.

Potential barriers and facilitators for implementation of an integrated care pathway for hearing-impaired persons: an exploratory survey among patients and professionals

BackgroundBecause of the increasing costs and anticipated shortage of Ear Nose and Throat (ENT) specialists in the care for hearing-impaired persons, an integrated care pathway that includes direct hearing aid provision was developed. While this direct pathway is still under investigation, in a survey we examined expectations and potential barriers and facilitators towards this direct pathway, of patients and professionals involved in the pathway.MethodsTwo study populations were assessed: members of the health professions involved in the care pathway for hearing-impaired persons (general practitioners (GPs), hearing aid dispensers, ENT-specialists and clinical audiologists) and persons with hearing complaints. We developed a comprehensive semi-structured questionnaire for the professionals, regarding expectations, barriers, facilitators and conditions for implementation. We developed two questionnaires for persons with hearing complaints, both regarding evaluations and preferences, and administered them after they had experienced two key elements of the direct pathway: the triage and the hearing aid fitting.ResultsOn average GPs and hearing aid dispensers had positive expectations towards the direct pathway, while ENT-specialists and clinical audiologists had negative expectations. Professionals stated both barriers and facilitators towards the direct pathway. Most professionals either supported implementation of the direct pathway, provided that a number of conditions were satisfied, or did not support implementation, unless roughly the same conditions were satisfied. Professionals generally agreed on which conditions need to be satisfied. Persons with hearing complaints evaluated the present referral pathway and the new direct pathway equally. Many, especially older, participants stated however that they would still visit the GP and ENT-specialist, even when this would not be necessary for reimbursement of the hearing aid, and found it important that the ENT-specialist or Audiological Centre evaluated their hearing aid.ConclusionThis study identified professional concerns about the direct pathway for hearing-impaired persons. Gaps exist in expectations amongst professions. Also gaps exist between users of the pathway, especially between age groups and regions. Professionals are united in the conditions that need to be fulfilled for a successful implementation of the direct pathway. Implementation on a regional level is recommended to best satisfy these conditions.

Hearing-aid anchoring element

A hearing aid anchoring fixture (104) for anchoring a direct bone conduction hearing aid (108) to the skull bone (106), comprising a threaded portion (110) that has at least one cutting edge (118). Each cutting edge (118) has an adjacent cavity (120) having a volume Vc. The threaded portion (110) has a thread depth dt being half of the difference between the maximum outer diameter d1 of the threaded portion (120) and the inner diameter d2 of the thread, where dt is at least 10% of the maximum outer diameter d1 of the threaded portion (110) and where dt is less than 20% of the maximum outer diameter d1 of the threaded portion (110). The fixture (104) may be equipped with a flange portion (114) that has an outer diameter d3 being greater than the maximum diameter d1 of the threaded portion (110).

Direct hearing aid referrals: a prospective study.

General practitioners from a designated catchment area were invited to participate in a direct hearing aid referral project and were issued with a standard referral form outlining the criteria for referral. A total of 175 patients was referred with a fully completed referral form and were initially assessed by a senior audiology technician or higher grade. A total of 135 patients (77%) was suitable for hearing aid fitting and 40 (23%) were considered to be inappropriate referrals, of which 17 (9.7%) required further referral for an ENT opinion. For the purpose of safety, each patient was independently examined by an ENT doctor. The management decisions of the audiology technicians were in total agreement with those of the ENT doctors. Our results also suggested that patients below the age of 60 are generally unsuitable for direct referral.

Assessment of a direct referral hearing aid clinic.

A direct referral hearing aid clinic (DRHAC) was set up at the Manor Hospital, Walsall, in which patient management was undertaken by an experienced senior medical technical officer in audiology and re-evaluated by an otolaryngologist. After 2 years of offering the service, we audited our experience which is presented in part one of this article. We attempted to assess the referral protocol in part two of the article. During the 2 years, general practitioners referred 458 first-time hearing aid users to the DRHAC. Of these, 91.3% were satisfactorily managed by the audiology department, although only 241 (52.6%) fitted the guidelines developed by the liaison group of the Technicians, Therapists and Scientists in Audiology (TTSA), a lower percentage than expected by the liaison group. All patients who failed to fulfil the TTSA guidelines at the DRHAC were further studied. This revealed that none of the TTSA criteria could be disregarded, but that relying on the experience of the general practitioner and audiologist is an appropriate method for excluding those patients requiring otolaryngological evaluation. It also indicated that the age of 60 years is a suitable limit for patient referrals.

Direct referral hearing aid provision in the over sixties age group

A prospective study was designed in which General Practitioners were issued with a standard referral letter for hearing aid provision. Unknown to the General Practitioner an independent otolaryngologist assessment was obtained at the time of first attendance. Three hundred consecutive patients selected by General Practitioners applying these guidelines were seen in a designated hearing aid clinic staffed by audiological technicians of senior grade or above. Referral pro formata were incomplete in 75 patients who were not assessed. Ninety-four patients (31 per cent) (95 per cent confidence interval 29-36 per cent) were accepted by the audiologist. Obstructing wax was the most common criterion failed. Clinical agreement between audiologist and otolaryngologist was 57 per cent greater than chance. None of the cases of clinical disagreement altered treatment. A direct referral system as proposed could have processed only 31 per cent of 300 referrals. However, experienced technical staff reliably detected otological pathology and with aural toilet facilities 91 per cent of 225 patients (confidence interval 88-94 per cent) were aided.

Direct contact hearing aid apparatus

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Direct bone conduction hearing aid device

A direct bone conduction hearing aid device is disclosed and includes a sound processor for receiving sound and generating an amplified electromagnetic signal in response thereto. This signal is transmitted to a subcutaneously implanted vibration generating means which is secured to a skull bone of the user and which includes magnetic means. An analog signal causes the magnet to vibrate and these vibrations are transmitted to the skull bone and thence to the cochlea to create the perception of sound.

Direct Hearing Aid Referrals: A Three-Year Report

A three-year report on the use of the direct recommendation method of hearing aid referral is discussed in detail. Five points are stressed: (1) the necessity for a complete otolaryngologic and audiologic evaluation of all potential hearing aid wearers, (2) the importance of the initial counseling session, (3) the value of patient reaction to an exposure period with the hearing aid, (4) the evaluation of the hearing aid and final counseling session, and (5) a summary of the three-year data.