Hearing Aid Fitting Research Articles

Universal neonatal hearing screening and delayed hearing loss or late-developmental hearing loss

ObjectiveTo determine the percentage of children with permanent bilateral postnatal hearing loss in order to study its incidence, related risk factors, diagnosis and treatment. MethodsRetrospective study to collect data on children diagnosed with hearing loss outside the neonatal period in the Hearing Loss Unit of the Hospital Universitario Central de Asturias, from April 2014 to April 2021. Results52 cases met the inclusion criteria. The detection rate of congenital hearing loss in the neonatal screening programme in the same study period was 1.5 children per thousand newborns per year, adding postnatal hearing loss results in a rate of infant bilateral hearing loss of 2.7 children per thousand (55.5% and 44.4% respectively). Thirty-five children presented risk factors for hearing loss, of which 23 were at retrocochlear risk. The mean age at referral was 91.9 (18–185) months. Hearing aid fitting was indicated in 44 cases (84.6%). Cochlear implantation was indicated in eight cases (15.4%). DiscussionAlthough congenital hearing loss accounts for the majority of childhood deafness, postnatal hearing loss has a significant incidence. This may be mainly due to: (1) that hearing impairment may arise in the first years of life, (2) that mild hearing loss as well as hearing loss in severe frequencies are undetectable by neonatal screening in some cases, (3) that some children may have false negative results. Conclusionpostnatal hearing loss requires identification of risk factors and long-term follow-up of children with hearing loss, as it needs to be detected and treated early.

Association between hearing loss and deprivation among Welsh adults: a cross-sectional observational study

ObjectiveTo index levels of hearing loss with respect to area-level indices of deprivation in a Welsh population.DesignA cross-sectional observational study of all adults (aged >18) that attended Abertawe Bro Morgannwg...

Case Reports of Hearing Aid Fitting in Bimodal Cochlear Implant Adults

The purpose of this case study is to investigate the bimodal benefits and clinical applications of bimodal hearing aid fitting. Bimodal hearing aid fitting was conducted with four bimodal cochlear implant adults. In order to evaluate bimodal benefits, speech recognition tests in quiet and noise conditions and “Speech, Spatial and Qualities of Hearing Scale (SSQ)” questionnaire were performed before and 1 month after bimodal hearing aid fitting. Four cases showed critical improvements in speech recognition tests and SSQ questionnaire scores. Four bimodal users showed improvement in speech perception and SSQ questionnaire after bimodal fitting. Clinical application of bimodal hearing aid fitting will be necessary to improve bimodal benefits and maintain good audibility of the contralateral ear of bimodal users.

Survey of Auditory Training Awareness for Hearing Professionals and Elderly Individuals Using Hearing Aids

Purpose: The purpose of this study was to identify the demand for auditory training provision and survey beneficiary experience.Methods: A total of 161 participants (80 hearing professionals and 81 elderly hearing aid users) were surveyed online or in-person. Both groups completed 26 questions related to their experience of providing or receiving auditory training, awareness of need, and preference.Results: The hearing professional group was strongly aware of the need to provide auditory training to improve communication problems in elderly individuals using hearing aids, and the absence of a systematic auditory training program was the biggest factor in not providing auditory training. The elderly hearing aid user group also recognized the need for auditory training to improve communication problems, but they responded that the hassle of visiting a clinic for training and lack of training time were factors that made participation in auditory training difficult.Conclusion: Hearing professionals should expand the scope of aural rehabilitation services to provide effective auditory training programs that fit the concept of rehabilitation, rather than simply providing hearing aid fitting management services to improve communication skills. Therefore, hearing professionals should conduct an intervention program after hearing aid fitting for elderly hearing aid users so that hearing rehabilitation can be comprehensively performed according to auditory and cognitive perceptual changes. In addition, efforts are required to solve limitations that make it difficult for elderly individuals who use hearing aids to participate in auditory training, such as the development of a web-based auditory training program.

Effectiveness of an Over-the-Counter Self-fitting Hearing Aid Compared With an Audiologist-Fitted Hearing Aid

Hearing loss is a highly prevalent condition, with numerous debilitating consequences when left untreated. However, less than 20% of US adults with hearing loss use hearing aids. Over-the-counter (OTC) hearing aids became available in October 2022 to improve access and affordability. However, clinical effectiveness studies of available OTC hearing aids using the existing devices in the market are limited. To compare the clinical effectiveness of a self-fitting OTC hearing aid with remote support and a hearing aid fitted using audiologist-fitted best practices. This randomized clinical effectiveness trial was conducted between April 14 and August 29, 2022. Sixty-eight adults with self-perceived mild to moderate hearing loss were recruited and randomly assigned to either the self-fitting or the audiologist-fitted group. Following bilateral hearing aid fitting, participants first completed a 2-week, take-home field trial without any support. Access to fine-tuning for both groups was only available after the 2-week trial. Support and adjustment were provided remotely for the self-fitting group per request and by the audiologist for the audiologist-fitted group. Participants were then reassessed after an additional 4-week take-home trial. A commercially available self-fitting OTC hearing aid was provided to participants in the self-fitting group who were expected to set up the hearing aids using the commercially supplied instructional material and accompanying smartphone application. In the audiologist-fitted group, audiologists fitted the same hearing aid according to the National Acoustics Laboratories nonlinear version 2 algorithm for prescriptive gain target using real-ear verification with hearing aid use instruction. The primary outcome measure was self-reported hearing aid benefit, measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB). Secondary measures included the International Outcome Inventory for Hearing Aids (IOI-HA) and speech recognition in noise measured using an abbreviated speech-in-noise test and a digits-in-noise test. All measures were completed at baseline and at 2 intervals following hearing aid fitting (2 and 6 weeks). Sixty-four participants were included in the analytic sample (33 men [51.6%]; mean [SD] age, 63.6 [14.1] years), with equal numbers of participants (n = 32) randomized into each group. The groups did not differ significantly in age (effect size r = -0.2 [95% CI, -0.3 to 0.2]) or 4-frequency pure-tone average (effect size r = 0.2 [95% CI, -0.1 to 0.4]). After the 2-week field trial, the self-fitting group had an initial advantage compared with the audiologist-fitted group on the self-reported APHAB (Cohen d = -0.5 [95% CI, -1.0 to 0]) and IOI-HA (effect size r = 0.3 [95% CI, 0.0-0.5]) but not speech recognition in noise. At the end of the 6-week trial, no meaningful differences were evident between the groups on any outcome measures. In this randomized clinical effectiveness trial, self-fitting OTC hearing aids with remote support yielded outcomes at 6 weeks post fitting comparable to those of hearing aids fitted using audiologist best practices. These findings suggest that self-fitting OTC hearing aids may provide an effective intervention for mild to moderate hearing loss. ClinicalTrials.gov Identifier: NCT05337748.

A 15-year Review of 260 Children With Auditory Neuropathy Spectrum Disorder: II. Management and Outcomes.

Following a review of the demographic and clinical characteristics of all pediatric patients diagnosed with auditory neuropathy spectrum disorder (ANSD) by a pediatric health care system from 2005 to 2020, the present report highlights the type and timing of intervention and outcomes in the same 260 patients with ANSD. This was a retrospective study reviewing the demographic data, medical history, imaging studies, audiological and speech language data, type of audiological intervention (hearing aids or cochlear implants), and mode of communication in 260 pediatric patients diagnosed with ANSD over a 15-year period. A significant decrease over time in the age at hearing aid fitting was observed. While a similar reduction in the age at implantation occurred over time, cochlear implantation is still rarely performed by 12 months of age in most ANSD patients. Among bilateral ANSD patients fitted with hearing aids, the majority (89.2%) did not benefit from conventional amplification and most received cochlear implants. Some hearing aid benefit for speech and language development was observed in 5.8%, though communication difficulties were persistent and most used a combination of oral and sign language for communication. Only six patients (5%) received significant benefit from their hearing aids for speech and language development. This review of ANSD management over a 15-year period reveals that hearing aids are not a viable option to develop speech and language for most infants and children with ANSD. This finding confirms previous reports and suggest that while hearing aid trials are warranted, children must be tracked closely so as to avoid delays in decision making. Cochlear implantation constitutes the major (if not only) rehabilitative intervention that allows for speech perception in patients who do not benefit from conventional amplification.

Hearing loss classification algorithm based on the insertion gain of hearing aid

AbstractHearing loss is one of the most prevalent chronic health problems worldwide and a common intervention is the wearing of hearing aids. However, the tedious fitting procedures and limited hearing experts pose restrictions for the popularity of hearing aids. This paper introduced a hearing loss classification method based on the insertion gain of hearing aids, which aims to simplify the fitting procedure and achieve a fitting-free effect of the hearing aid, in line with current research trends in key algorithms for fitting-free hearing aids. The proposed method innovatively combines the insertion gain of hearing aids with the covariates of patient’s gender, age, wearing history to form a new set of hearing loss vectors, and then classifies the hearing loss into six categories by unsupervised cluster analysis method. Each category of representative parameters characterizes a typical type of hearing loss, which can be used as the initial parameter to improve the efficiency of hearing aid fitting. Compared with the traditional audiogram classification method AMCLASS (Automated Audiogram Classification System), the proposed classification method reflect the actual hearing loss of hearing impaired patients better. Moreover, the effectiveness of the new classification method was verified by the comparison between the obtained six sets of representative insertion gains and the inferred hearing personalization information.

Cribado auditivo neonatal universal e hipoacusia diferida o de desarrollo tardío

ObjectiveTo determine the percentage of children with permanent bilateral postnatal hearing loss in order to study its incidence, related risk factors, diagnosis and treatment. MethodsRetrospective study to collect data on children diagnosed with hearing loss outside the neonatal period in the Hearing Loss Unit of the Hospital Universitario Central de Asturias, from April 2014 to April 2021. Results52 cases met the inclusion criteria. The detection rate of congenital hearing loss in the neonatal screening programme in the same study period was 1.5 children per thousand newborns per year, adding postnatal hearing loss results in a rate of infant bilateral hearing loss of 2.7 children per thousand (55.5% and 44.4% respectively). Thirty-five children presented risk factors for hearing loss, of which 23 were at retrocochlear risk. The mean age at referral was 91.9 (18-185) months. Hearing aid fitting was indicated in 44 cases (84.6%). Cochlear implantation was indicated in eight cases (15.4%). DiscussionAlthough congenital hearing loss accounts for the majority of childhood deafness, postnatal hearing loss has a significant incidence. This may be mainly due to: 1) that hearing impairment may arise in the first years of life, 2) that mild hearing loss as well as hearing loss in severe frequencies are undetectable by neonatal screening in some cases, 3) that some children may have false negative results. ConclusionPostnatal hearing loss requires identification of risk factors and long-term follow-up of children with hearing loss, as it needs to be detected and treated early.

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.

Consumer Survey on Hearing Aid Benefit and Satisfaction.

There is unexplained variability in self-reported hearing aid outcomes. The aim of this study was to evaluate determinants of hearing aid benefit and satisfaction ratings using a large-scale customer survey and to analyze the relation between demographic variables, hearing aid attributes, benefit, and satisfaction. The study used a retrospective design wherein 2,109 hearing aid users, recruited by Hearing Tracker and Hearing Loss Association of America, completed an online survey. The survey included questions about demographics, perceived hearing loss, devices, service delivery, cost, benefit, and satisfaction. The analytic approach included descriptive summaries and regression models to evaluate potential determinants of hearing aid benefit and satisfaction ratings. Hearing aid sound quality, fit and comfort, and battery life were related to both benefit and satisfaction. Respondents who rated these outcomes favorably were also likely to benefit from, and be satisfied with, their hearing aids. Benefit was also related to degree of hearing loss, hearing aid experience, and cost. Hearing aid users with greater self-perceived hearing loss, more hearing aid experience, and more expensive hearing aids reported more benefit. Satisfaction was also related to age, employment status, and brand. Younger respondents, those who were students, and those using certain brands reported more satisfaction. The results highlight importance of good hearing aid outcomes (quality, fit/comfort, and battery life) for benefit and satisfaction ratings. Professionals who fit hearing aids should strive to focus on achieving these outcomes and researchers should strive to explain the remaining variability in ratings of benefit and satisfaction. https://doi.org/10.23641/asha.22280854.

EEG Alpha Band Responses Reveal Amplification Benefits in Infants with Hearing Loss.

Our objective was to examine the effects of hearing aid amplification on auditory detection and discrimination in infants who were hard of hearing (IHH) using a physiological measure of auditory perception. We recorded EEG from 41 sleeping IHH aged 1.04 to 5.62 months while presenting auditory stimuli in a mismatch response paradigm. Responses were recorded during two listening conditions for each participant: aided and unaided. Temporal envelopes of the mismatch response in the EEG alpha band (6-12 Hz) were extracted from the latent, time-frequency transformed data. Aided alpha band responses were greater than unaided responses for the deviant trials but were not different for the standard trials. Responses to the deviant trials were greater than responses to the standard trials for the aided conditions but were not different for the unaided conditions. These results suggest that the alpha band mismatch can be used to examine both detection and discrimination of speech and non-speech sounds in IHH. With further study, the alpha band mismatch could expand and refine our abilities to validate hearing aid fittings at younger ages than current clinical protocols allow.

Exploring the impact hearing differences have on the development of speech perception during infancy

Early periods of perceptual skill development are driven by the dynamic interplay between language experiences and maturation of auditory sensory pathways. Among infants with normal hearing (INH), the first year of life is a seminal period for refining speech perception abilities shaped by exposure to language. Research suggests that refinement of speech discrimination abilities depends on an infant’s exposure to speech sounds, thus infants who are hard-of-hearing (IHH) are susceptible to atypical development during this period. Currently, the impact of inconsistent auditory cue access on development of speech perception is unknown among IHH. To investigate this, our lab has employed both electroencephalography (EEG) and a conditioned head turn (CHT) paradigm to examine auditory cue access and speech perception abilities, respectively, over the first year of life. We will provide a broad overview of our recent and continuing work among IHH and INH using EEG and CHT findings which suggest: (1) early EEG measures of cue access predict later behavioral speech perception abilities, (2) hearing age (duration of time between hearing aid fitting and testing) is related to speech perception abilities measured by CHT, and (3) a significant relationship between infant speech perception and both spoken expressive and receptive language abilities.

Comparison of hearing aid fitting effectiveness with audiograms from either user-operated or traditional audiometry in a clinical setting: a study protocol for a blinded non-inferiority randomised controlled trial

IntroductionThere is a worldwide need to enhance the capacity of audiometry testing. The objective of this study is to compare the User-operated Audiometry (UAud) system with traditional audiometry in a...

A hearing aid “test drive”: Using virtual acoustics to accurately demonstrate hearing aid performance in realistic environments

A common challenge for audiologists when fitting hearing aids is that quiet clinics are unlike the noisy, reverberant places where patients report difficulty. This prevents direct user feedback about hearing aid performance. Virtual acoustics can allow a patient to experience a hearing aid in such environments, without leaving the clinic. A virtual reality (VR) audio-visual demonstration has been created which “test drives” hearing aid features in real-world scenarios, dynamically rendered over custom wired hearing aids and headphones. The scenes were created from 360° photographs and acoustic measurements made in real rooms. A room acoustic model was used for the simulation, tuned to match the measured data. Audio was rendered using principal component-base amplitude panning (PCBAP), which can provide dynamic VR audio with broadband magnitude and phase accuracy. This talk will provide comparisons between PCBAP and higher-order Ambisonics (HOA) for rendering hearing aid beamformers in anechoic and reverberant environments. Results show that PCBAP can render a beamformer’s directivity broadband with 2 to 3 dB error (95%) using only 36 filters in both anechoic and reverberant conditions. Even seventh-order HOA (64 filters) does not achieve similar performance. The talk will also include videos of the demonstration, highlighting viability for clinical applications.

Investigation of hearing aid fitting according to the national acoustic laboratories’ prescription for non-linear hearing aids and the desired sensation level methods in Japanese speakers: a crossover-controlled trial

ObjectiveSome studies have directly compared the National Acoustic Laboratories’ prescription for non-linear hearing aids (HAs) version 2 (NAL-NL2) and Desired Sensation Level for non-linear HAs version 5 (DSLv5), although none were performed in Japan. As the Japanese language is a tonal language that has different linguistic characteristics than those of the studied languages, we compared the outcomes of the NAL-NL2 and DSLv5 in hearing-impaired Japanese participants. MethodsA crossover-controlled trial was conducted on 18 first-time HA users with bilateral moderate sensorineural hearing loss. Participants wore HAs adjusted with each prescriptive method for four weeks. The prescriptions were assessed using speech discrimination testing and the abbreviated profile of hearing aid benefit (APHAB). Consequently, participants were asked to select their preferred prescription and determine which was better for “listening to a conversation” and when “noisy.” ResultsThe mean DSLv5 real ear insertion gain for an input level of 65 dB sound pressure level (SPL) was higher than that of the NAL-NL2 at 250 and 500 Hz. The average speech discrimination score was 78 ± 14% at a 65-dB SPL and 75 ± 17% at an 80-dB SPL for the NAL-NL2, and 79 ± 11% at a 65-dB SPL and 77 ± 17% at an 80-dB SPL for the DSLv5. These differences were not significant. No significant differences were observed in APHAB subscale scores between the two prescription methods. Ultimately, 11 (61%) and 7 (39%) participants preferred the NAL-NL2 and DSLv5, respectively, with no significant differences. ConclusionAlthough the gain of the NAL-NL2 is smaller than that of the DSLv5, both had the same hearing effect. Therefore, the NAL-NL2 may be more useful than the DSLv5 in Japanese.

The mismatch response in normal hearing adults: a performance comparison with stimuli relevant for objective validation of hearing aid fittings

Objective A long-standing observation is that the Mismatch Response (MMR) has the potential to offer a clinically feasible index of sound discrimination. However, findings that positively identify MMRs at the individual level have been mixed, even for those who are normally hearing and who can discriminate sounds behaviourally. This complicates interpretation when an MMR is not observed. The objective of this study was to determine the reliability of the MMR using an optimised paradigm and a range of stimuli relevant to audiological applications in relation to objective verification of hearing aid fittings. Design MMRs were measured using an optimised 3-deviant paradigm in response to a range of sounds designed for aided and unaided sound field assessments, including complex tones (CTs) and speech-like signals. Study sample Seventeen normally hearing adults (18–56 years). Results The most robust MMRs were recorded in response to CTs; responses were positively identified in 50 out of 51 instances (98%), assessed via objective Hotelling’s T 2 bias-free statistical analyses. Conclusions The results indicate that CTs in conjunction with optimised recording and analysis parameters offer the potential to elicit robust MMRs, supporting future utilisation of MMRs for clinical audiological applications.

Research on Customer Relationship Management Strategy of "Hearing Aid Fitting" Based on Refined Data Analysis

Wearing hearing aids can help hearing impaired patients enter the sound world, so as to improve their quality of life. Hearing aid fitting is highly professional and requires long-term after-sales service. This paper takes 300 impaired patients and 50 hearing aid fitters of Siemens hearing aid fitting Engineer as the research object to analyze the main influencing factors of hearing impaired patients' purchase of hearing aids and the key factors to improve long-term satisfaction. Hearing aid effect, wearing comfort and service quality significantly affect the long-term satisfaction of hearing-impaired patients. Brand, price, refined customer relationship maintenance and technical personification have a positive impact on customer repeat purchase and recommendation.

Data-driven audiogram classifier using data normalization and multi-stage feature selection

Audiograms are used to show the hearing capability of a person at different frequencies. The filter bank in a hearing aid is designed to match the shape of patients’ audiograms. Configuring the hearing aid is done by modifying the designed filters’ gains to match the patient’s audiogram. There are few problems faced in achieving this objective successfully. There is a shortage in the number of audiologists; the filter bank hearing aid designs are complex; and, the hearing aid fitting process is tiring. In this work, a machine learning solution is introduced to classify the audiograms according to the shapes based on unsupervised spectral clustering. The features used to build the ML model are peculiar and describe the audiograms better. Different normalization methods are applied and studied statistically to improve the training data set. The proposed Machine Learning (ML) algorithm outperformed the current existing models, where, the accuracy, precision, recall, specificity, and F-score values are higher. The reason for the better performance is the use of multi-stage feature selection to describe the audiograms precisely. This work introduces a novel ML technique to classify audiograms according to the shape, which, can be integrated to the future and existing studies to change the existing practices in classifying audiograms.

Honoring the Contributions of Pat Stelmachowicz to the Field of Pediatric Audiology

My first encounter with Dr. Pat Stelmachowicz was during my first week in an audiology clinical placement at Boys Town National Research Hospital (BTNRH) during my graduate program over 20 years ago. I was sitting at the lunch table with much of the audiology staff, still trying to figure out how I had managed to land a clinical placement at such an amazing place with so many people who cared about pediatric audiology. Pat came into the room and started asking the clinical audiologists questions about how they were fitting hearing aids for children who were coming into the clinic. I assumed from the interaction that Pat was another audiologist on staff that I had yet to meet, as there were nearly 20 on staff at the time. I had no idea that I was having lunch with a leading scientist in pediatric audiology who had created an environment that would allow clinical audiologists to actively engage in research to support our patients. This very first interaction with Pat exemplified the qualities that made her a great mentor to many audiologists and scientists.

Predictors of successful natural sleep MRI for sensorineural hearing loss in infants.

Cochlear implantation (CI) in children with sensorineural hearing loss (SNHL) before 12 months of age (mo) improves language outcomes. MRI is important to assess CI candidacy. Anesthesia before 3 years old may increase risk of neurocognitive delay. Natural sleep MRI (NS-MRI) is an emerging technique to avoid anesthesia in infants, but relies on successful sleep for adequate imaging. Our multidisciplinary team hypothesized the following predictors of successful NS-MRI for CI evaluation: age, distance travelled, comorbidities, primary language, insurance type, HL characteristics, time and duration of MRI. We performed retrospective review of children 0-12mo who attempted NS-MRI. The NS-MRI was successful if imaging was sufficient for definitive clinical management per the managing otolaryngologist. Among 26 patients (29 scans), the median age was 3.2mo (range: 1.2-6.8mo), distance travelled was 16.3 miles (range: 0.9 to 365 miles), 12 (46%) children had medical comorbidities. 8 (31%) had public insurance. 10 (38%) had bilateral HL. 52% (15/29) of scans were successful. Patients with comorbidities had significantly lower odds of successful NS-MRI (OR 0.09; 95% CI 0.01-0.54). Success was not associated with age, distance travelled, insurance type, primary language, HL characteristics, time or duration of MRI on univariable analysis. All 11 children who failed NS-MRI underwent hearing-aid fitting and/or imaging with sedation and CI as clinically indicated before 12mo. NS-MRI was successful in 52% of infants, regardless of age, demographics, HL or MRI characteristics. Unsuccessful NS-MRI did not result in delayed intervention. NS-MRI is an effective consideration for a broad range of infants with SNHL.