Hearing Aid Evaluation Research Articles

Using Alpha-Band Power to Evaluate Hearing Aid Directionality Based on Multistream Architecture

Using Alpha-Band Power to Evaluate Hearing Aid Directionality Based on Multistream Architecture

Barriers to Meeting National Early Hearing Detection and Intervention Guidelines in a Diverse Patient Cohort.

To determine our audiology clinics status in meeting the Joint Committee on Infant Hearing recommended 1-3-6 benchmarks for identification and intervention for congenital sensorineural hearing loss and identify those factors contributing to delay in identification and intervention. This is a retrospective case series. Children with sensorineural hearing loss who underwent auditory brainstem response (ABR) testing, hearing aid evaluation, or cochlear implant mapping at our tertiary pediatric medical center between January 2018 and December 2021 were included. Simple and multiple linear regression analyses were used to identify social, demographic, and health factors associated with primary outcomes, defined as age at hearing loss identification, age at intervention (here defined as amplification start), and interval between identification and intervention. Of 132 patients included, mean age was 2.4 years, 48% were male, and 51% were Hispanic. There was significant association between each Hispanic ethnicity (p = 0.005, p = 0.04, respectively), insurance type (p = 0.02, p = 0.001, respectively), and later age at identification and intervention. In multivariable analyses, Hispanic ethnicity was significantly associated with both delays in identification and intervention (p = 0.03 and p = 0.03, respectively), and public insurance was associated with delays in intervention (p = 0.01). In addition, the total number of ABRs was significantly associated with both older age of identification and intervention (p < 0.001, p < 0.001, respectively). Mediator analysis demonstrated that the effect of ethnicity on age at identification is mediated by the total number of ABRs performed. A significant association between total number of ABRs and age at identification and intervention for children with hearing loss exists. Hispanic ethnicity was associated with delays in meeting milestones, further mediated by the number of ABRs, providing a potential avenue for intervention in addressing this disparity.

Pediatric Hearing Aid Daily Wear Time Is Significantly Impacted by Clinician-Family Language Discordance.

The purpose of this study was to evaluate the potential contribution of limited English proficiency on daily hearing aid wear time for children with hearing loss. A retrospective chart review was completed to evaluate hearing aid wear time based on data logging information available at the time of a follow-up visit following an initial hearing aid fitting. Children were included in the study if they had permanent bilateral hearing loss and were less than 60 months of age at the time of their first follow-up visit. Wear time was compared between children who attended an interpreter-mediated appointment and those who did not have an interpreter present. The presence of an interpreter at the appointment was the study indicator that the family had limited English proficiency. Children from families with limited English proficiency exhibited significantly shorter daily wear time (M = 1.3 hr) than their peers whose families were English-proficient speakers, thus, having a shared language with their audiologists (M = 5.2 hr). Results of this study suggest that family-clinician language discordance might put children at greater risk of shorter hearing aid wear time than children whose caregivers share a common language with their child's audiologist. There can be many linguistic, cultural, and educational factors that contribute to hearing aid wear time in children whose families have limited English proficiency as well as different approaches to improving that wear time. Efforts should ensure that hearing and hearing aid-related information is accessible to all families, especially those with clinician-family language discordance. Such efforts can include, among others, training that improves clinicians' cultural and linguistic responsiveness to the diverse families they serve.

A Novel Ear Impression-Taking Method Using Structured Light Imaging and Machine Learning: A Pilot Proof of Concept Study with Patients' Feedback on Prototype.

Taking an ear impression is a minimally invasive procedure. A review of existing literature suggests that contactless methods of scanning the ear have not been developed. We proposed to establish a correlation between external ear features with the ear canal and with this proof of concept to develop a prototype and an algorithm for capturing and predicting ear canal information. We developed a novel prototype using structured light imaging to capture external images of the ear. Using a large database of existing ear impression images obtained by traditional methods, correlation analyses were carried out and established. A deep neural network was devised to build a predictive algorithm. Patients undergoing hearing aid evaluation undertook both methods of ear impression-taking. We evaluated their subjective feedback and determined if there was a close enough objective match between the images obtained from the impression techniques. A prototype was developed and deployed for trial, and most participants were comfortable with this novel method of ear impression-taking. Partial matching of the ear canal could be obtained from the images taken, and the predictive algorithm applied for a few sample images was within good standard of error with proof of concept established. Further studies are warranted to strengthen the predictive capabilities of the algorithm and determine optimal prototype imaging positions so that sufficient ear canal information can be obtained for three-dimensional printing. Ear impression-taking may then have the potential to be automated, with the possibility of same-day three-dimensional printing of the earmold to provide timely access.

Measurement of the Mechanical Impedance of Ear Cartilage and Development of a Coupler for Vibrator Evaluation of Cartilage Conduction Hearing Aids

Cartilage conduction hearing aids (CCHAs) are new devices that have attracted attention in recent years for external auditory canal atresia. In these devices, a vibrator is attached to the ear cartilage to transmit sound through vibration. In this study, we measure the mechanical impedance of the ear concha auriculae, which represents the mechanical load on the vibrator. To evaluate the output of the CCHAs, we develop a coupler simulating the ear cartilage that measures the sound pressure corresponding to the eardrum sound pressure of the normal ear. Consequently, the mechanical impedance of the developed coupler is several times larger than that of the human ear cartilage measured in this study; however, it is an acceptable value considering the difference in the contact area. The output sound pressure of the vibrator with the coupler simulating the ear cartilage roughly simulates the sound pressure in the ear canal with normal hearing (with the ear canal sealed). In this study, the measured mechanical impedance of the human ear cartilage is approximately 20 dB less than that of the mechanical coupler specified in IEC (International Electrotechnical Commission) 60318-6 for the evaluation of the bone conduction vibrator.

Assessing Speech Audibility via Syllabic-Rate Neural Responses in Adults and Children With and Without Hearing Loss.

An objective method for assessing speech audibility is essential to evaluate hearing aid benefit in children who are unable to participate in hearing tests. With consonant-vowel syllables, brainstem-dominant responses elicited at the voice fundamental frequency have proven successful for assessing audibility. This study aimed to harness the neural activity elicited by the slow envelope of the same repetitive consonant-vowel syllables to assess audibility. In adults and children with normal hearing and children with hearing loss wearing hearing aids, neural activity elicited by the stimulus /su∫i/ or /sa∫i/ presented at 55-75 dB SPL was analyzed using the temporal response function approach. No-stimulus runs or very low stimulus level (15 dB SPL) were used to simulate inaudible conditions in adults and children with normal hearing. Both groups of children demonstrated higher response amplitudes relative to adults. Detectability (sensitivity; true positive rate) ranged between 80.1 and 100%, and did not vary by group or stimulus level but varied by stimulus, with /sa∫i/ achieving 100% detectability at 65 dB SPL. The average minimum time needed to detect a response ranged between 3.7 and 6.4 min across stimuli and listener groups, with the shortest times recorded for stimulus /sa∫i/ and in children with hearing loss. Specificity was >94.9%. Responses to the slow envelope of non-meaningful consonant-vowel syllables can be used to ascertain audible vs. inaudible speech with sufficient accuracy within clinically feasible test times. Such responses can increase the clinical usefulness of existing objective approaches to evaluate hearing aid benefit.

Factors associated with delayed referral and hearing rehabilitation for congenital sensorineural hearing loss

ObjectivesTo identify the impact of social determinants of health and clinical status on referral and intervention for congenital sensorineural hearing loss. Study designRetrospective chart review of children with confirmed sensorineural or mixed hearing loss between 2013 and 2021 at a single academic medical institution. MethodsReferral rates and timing for hearing rehabilitation, rates and timing of completed evaluation, and rate and timing of amplification were recorded. Patient demographics included gestational age, race, ethnicity, sex, hearing loss severity, and CMV status. ResultsThere were 216 children with confirmed sensorineural or mixed hearing loss, of which 77 had a unilateral hearing loss and 89 a severe or profound hearing loss. Delayed referral for hearing aid evaluation was noted in premature patients (median 375 days premature, median 147 term; p < 0.01) and publicly insured patients (median 215 days, median 123 private; p = 0.04). Delayed time to hearing aid fitting was noted for non-white patients (median 325 days, median 203 white patients; p < 0.01), publicly insured patients (median 309 days, median 212 private insurance; p < 0.02), and premature patients (median 462 days, median 224 term; p = 0.03). White patients were more likely to be referred for cochlear implant (p = 0.03).Privately insured patients and patients with a positive CMV test were more likely to be referred for cochlear implant evaluation, be seen in the cochlear implant clinic, and undergo implantation (p < 0.05). Non-white patients had a delay in cochlear implantation referral (median 928 days, median 398 days white patients; p = 0.05). Prolonged interval between evaluation in cochlear implant clinic to implantation was noted for privately insured patients (median 125 days; median 78 days publicly insured; p = 0.05). ConclusionsSociodemographic factors were significantly associated with hearing amplification referral rates and time until amplification for children with identified congenital sensorineural hearing loss. For cochlear implantation, insurance type, CMV status were significantly associated with rate and timing of cochlear implant pathway.

Development and perceptual evaluation of hearing aids using interactive virtual environments

In hearing research, it has been shown that the realism of the test conditions has an influence on speech intelligibility thresholds, the subject's behavior, learning abilities and listening effort. This talk presents two multimodal experiment setups that aim to bridge the differences between the laboratory and reality, focusing on the development and perceptual evaluation of hearing devices. The first laboratory uses 360° video and higher order ambisonics stimuli, a head-mounted display, and a VR perceptual evaluation interface to asses the effect of hearing devices on noise intrusiveness, speech quality, and naturalness. The second laboratory is a large loudspeaker array inside of which subjects movements and behavior can be tracked and videos can be projected on walls. This talk will introduce several challenges encountered in the audio reproduction in these two laboratories and will also present a broad overview of solutions used and developed to ensure the validity of the experimental conditions.

Predicting Hearing aid Benefit Using Speech-Evoked Envelope Following Responses in Children With Hearing Loss.

Electroencephalography could serve as an objective tool to evaluate hearing aid benefit in infants who are developmentally unable to participate in hearing tests. We investigated whether speech-evoked envelope following responses (EFRs), a type of electroencephalography-based measure, could predict improved audibility with the use of a hearing aid in children with mild-to-severe permanent, mainly sensorineural, hearing loss. In 18 children, EFRs were elicited by six male-spoken band-limited phonemic stimuli--the first formants of /u/ and /i/, the second and higher formants of /u/ and /i/, and the fricatives /s/ and /∫/--presented together as /su∫i/. EFRs were recorded between the vertex and nape, when /su∫i/ was presented at 55, 65, and 75 dB SPL using insert earphones in unaided conditions and individually fit hearing aids in aided conditions. EFR amplitude and detectability improved with the use of a hearing aid, and the degree of improvement in EFR amplitude was dependent on the extent of change in behavioral thresholds between unaided and aided conditions. EFR detectability was primarily influenced by audibility; higher sensation level stimuli had an increased probability of detection. Overall EFR sensitivity in predicting audibility was significantly higher in aided (82.1%) than unaided conditions (66.5%) and did not vary as a function of stimulus or frequency. EFR specificity in ascertaining inaudibility was 90.8%. Aided improvement in EFR detectability was a significant predictor of hearing aid-facilitated change in speech discrimination accuracy. Results suggest that speech-evoked EFRs could be a useful objective tool in predicting hearing aid benefit in children with hearing loss.

Wirksamkeit der Hörgeräteversorgung bei hochgradigem Hörverlust

HintergrundIn der Praxis liegt das unilaterale Einsilberverstehen mit Hörgerät bei 65 dB SPL (EV65(HG)) häufig unter dem maximalen Einsilberverstehen aus dem Sprachaudiogramm (mEV), insbesondere bei Hörgeräteträgern mit hochgradigem Hörverlust. Diese Arbeit zielte darauf ab, den Wirkungsgrad Q der Hörgeräteversorgung, den Quotienten aus EV65(HG) und mEV, bei Hörgeräteträgern mit hochgradigem bis an Taubheit grenzendem Hörverlust zu untersuchen.Material und MethodenEs wurden Daten aus In-situ-Messungen, dem Reinton- und Sprachaudiogramm und dem Sprachverstehen mit und ohne Hörgerät von 93 Ohren von 64 Patienten ausgewertet. Die Patienten stellten sich im Jahr 2019 für eine Hörgerätekontrolle in unserem Hörzentrum vor. Es wurden die Abweichung der in-situ gemessenen frequenzabhängigen Ausgangspegelwerte von den Zielvorgaben der präskriptiven Anpassformeln NAL-NL2 und DSL v5.0 analysiert. Für die Parameter EV65(HG) und Q wurden jeweils die Spearman-Korrelationskoeffizienten für den Sprachverständlichkeitsindex (SII) berechnet.ErgebnisseBei mehr als 67 % der Hörgeräteeinstellungen stimmten die Ausgangspegelwerte mit den Zielkurven für NAL-NL2 oder DSL v5.0 im Bereich von ±5 dB für Frequenzen von 0,5 bis 4 kHz für 65 dB SPL überein. Trotzdem wurde das mEV mit Hörgerät bei 65 dB SPL nicht erreicht (mittlere Abweichungen: 34,4 %). EV65(HG) und Q waren jedoch am besten, wenn Zielwerte für DSL v5.0 bei 65 dB SPL erreicht wurden, was mit einem höheren SII einhergeht.SchlussfolgerungFür Hörgeräteträger mit hochgradigem bis an Taubheit grenzendem Hörverlust führen die Anpassformeln NAL-NL2 und DSL v5.0 nicht zu einer solchen Verstärkung, dass bei Alltagssprache von 65 dB SPL das mEV erreicht wird. Es bleibt zu untersuchen, ob alternative Präskriptionen mit besserer Hörbarkeit für Eingangspegel von 50 und 65 dB SPL den Wirkungsgrad der Hörgeräteversorgung verbessern könnten.

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.

Automated Forced-Choice Tests of Speech Recognition.

This project was undertaken to develop automated tests of speech recognition, including speech-recognition threshold (SRT) and word-recognition test, using forced-choice responses and computerized scoring of responses. Specific aims were (1) to develop an automated method for measuring SRT for spondaic words that produces scores that are in close agreement with average pure-tone thresholds and (2) to develop an automated test of word recognition that distinguishes listeners with normal hearing from those with sensorineural hearing loss and which informs the hearing aid evaluation process. An automated SRT protocol was designed to converge on the lowest level at which the listener responds correctly to two out of two spondees presented monaurally. A word-recognition test was conducted with monosyllabic words (female speaker) presented monaurally at a fixed level. For each word, there were three rhyming foils, displayed on a touchscreen with the test word. The listeners touched the word they thought they heard. Participants were young listeners with normal hearing and listeners with sensorineural hearing loss. Words were also presented with nonrhyming foils and in an open-set paradigm. The open-set responses were scored by a graduate student research assistant. The SRT results agreed closely with the pure-tone average (PTA) obtained by automated audiometry. The agreement was similar to results obtained with the conventional SRT scoring method. Word-recognition scores were highest for the closed-set, nonrhyming lists and lowest for open-set responses. For the hearing loss participants, the scores varied widely. There was a moderate correlation between word-recognition scores and pure-tone thresholds which increased as more high frequencies were brought into the PTA. Based on the findings of this study, a clinical protocol was designed that determines if a listener's performance was in the normal range and if the listener benefited from increasing the level of the stimuli. SRTs obtained using the automated procedure are comparable to the results obtained by the conventional clinical method that is in common use. The automated closed-set word-recognition test results show clear differentiation between scores for the normal and hearing loss groups. These procedures provide clinical test results that are not dependent on the availability of an audiologist to perform the tests.

Evaluation of adhesive bone conduction hearing aid in pediatric patients with unilateral congenital aural atresia

Objective: To evaluate the auditory efficacy and subjective satisfaction of adhesive bone conduction hearing aid in children with unilateral congenital aural atresia (UCAA). Methods: Ten subjects (5 males and 5 females) diagnosed with UCAA with an average age of 8.3 years old (ranged from 5 to 15) were included in Beijing Tongren Hospital, Capital Medical University from January to August 2019. The free sound field hearing threshold, word recognition score in quiet, speech reception threshold in noise and sound localization ability (results were measured by RMS error) tests were performed in unaided and aided situation, respectively. Subjective satisfaction questionnaires were also distributed to subjects. Paired t test and Wilcoxon signed rank test were used as statistical analysis methods. Results: The average hearing threshold in aided condition was improved by (21.9±4.4) dB (t=15.8，P<0.05). Speech recognition abilities were generally improved both under quiet and noise (P<0.05);however, when the binaural summation, squelch and head shadow effects were analyzed respectively, the binaural squelch effect was not statistically improved (P>0.05), while the other effects were improved in aided condition (P<0.05). In sound localization test, there was no significant difference of the RMS error value between the unaided and aided situation (P>0.05). The subjects got high satisfaction rates in three subjective questionnaires. Conclusion: The adhesive bone conduction hearing aid can provide significant audiological benefit for children with UCAA as well as raising the quality of their life.

Evaluating the benefit of hearing aids with motion-based beamformer adaptation in a real-world setup

Objective Conventional directional hearing aid microphone technology may obstruct listening intentions when the talker and listener walk side by side. The purpose of the current study was to evaluate hearing aids that use a motion sensor to address listening needs during walking. Design Each participant completed two walks in randomised order, one walk with each of two hearing aid programs: (1) conventional beamformer adaptation that activated an adaptive, multiband beamformer in loud environments and (2) motion-based beamformer adaptation that activated a pinna-mimicking microphone setting when walking was detected. Participants walked along a pre-defined track and completed tasks assessing speech understanding and environmental awareness. Study Sample Participants were 22 older adults with moderate-to-severe hearing loss and experience using hearing aids. Results More participants preferred the motion-based than conventional beamformer adaptation for speech understanding, environmental awareness, overall listening, and sound quality (p < 0.05). Measures of speech understanding (p < 0.01) and localisation of sound stimuli (p < 0.05) were significantly better with motion-based than conventional beamformer adaptation. Conclusions The results suggest that hearing aid users can benefit from beamforming that uses motion sensor input to adapt the signal processing according to the user’s activity. The real-world setup of this study had limitations.

Factors Affecting the Adoption and Use of Hearing Aids among Older Adults: A Systematic Review

Objective: The most effective modality for presbycusis is using hearing aids. However, the rate of adoption and use of hearing aids among the elderly is not in line with the expectations. This review investigates the current evidence to identify factors affecting the adoption and use of hearing aids among the elderly with hearing loss. Design: This is a systematic review whose sample includes English articles published in peer-reviewed journals from January 2015 to October 2020. The search was conducted in PubMed, Web of Science, ProQuest, and Scopus electronic databases. Study selection, data extraction, and quality assessments were performed by two independent reviewers. Results: In the 22 studies included in this review, a number of factors, including demographic status (economic status and level of education), auditory factors (hearing loss severity, presence of tinnitus, and the sound quality of hearing aids), attitudinal and psychosocial factors (self-perceived hearing problems, perceived self-efficacy, perceived benefit, support from significant others, and extrovert and ambivert personality types) were identified as variables potentially impacting the adoption and use of hearing aids. Conclusion: The results show that demographic, attitudinal, and psychosocial factors, as well as auditory factors, play an influential role in the adoption and use rate of hearing aids among older populations suffering from hearing loss. Therefore, it is necessary to consider these factors in order to formulate hearing healthcare policies and adopt targeted and appropriate interventions in the process of prescribing, adjusting, and evaluating hearing aids. PROSPERO registration: The protocol of this systematic review was published in the International prospective register of systematic reviews (PROSPERO) with registration number: CRD42021227684 (https://www.crd.york.ac.uk/prospero/display_ record.php?ID=CRD42021227684)

The Use of Same-Day Hearing Aid Fitting with Telehealth Follow-up Care: A Case Study of a Veteran Presenting with Tinnitus and Auditory Processing Disorder Symptoms.

Providing same-day hearing aid fitting appointments to patients being seen in an audiology clinic for an audiometric evaluation may help decrease clinic wait times and reduce the need for future in-person appointments. Prior to 2020, the Veterans Administration (VA) Healthcare System did not allow hearing aid manufacturers to provide functional demonstration (demo) hearing aids to VA audiology clinics. Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) pandemic, this rule was changed to minimize the number of required in-person VA audiology appointments. The audiology clinic at the Pittsburgh VA Healthcare System developed a hearing aid fitting protocol using demo hearing aids to provide same-day hearing aid fitting appointments. This case study pertains to a female Veteran who presented to the clinic with complaints of decreased hearing and bothersome tinnitus. The patient completed a comprehensive audiometric evaluation, auditory processing disorder screening, hearing aid evaluation, and hearing aid fitting in the clinic. All follow-up appointments were scheduled to be completed via telehealth. The initial findings in this case study indicate that same-day hearing aid fittings can be successful for some patients. Future telehealth follow-up appointments will determine this patient's level of success using hearing aid-related outcome measures.

Speech and Sound Quality Recognition in Adults Bimodal Cochlear Implant Listeners

Purpose: Recent bimodal studies identified a lack of bimodal evaluation and fitting protocols to improve bimodal benefits. The purpose of this study is to measure bimodal benefits in speech and sound quality recognition and identify bimodal fitting issues with adult cochlear implant listeners to establish bimodal fitting guidelines and evaluation protocol.Methods: A total of 20 adult cochlear implant users were participated in this study. The experimental procedures included basic evaluation, hearing aid evaluation, and bimodal benefits evaluation. In order to evaluate bimodal benefits, speech and sound quality recognition tests were performed. Matrix sentences in quiet and noise (5 and 10 dB sound pressure level), consonant-vowel-consonant words, and story comprehension tasks were provided. Participants judged sound qualities for six sound quality dimensions and a tester performed real ear measurements to verify hearing aid gains.Results: Results showed that bimodal listeners had some bimodal benefits in the sentence and monosyllabic word recognition in quiet. The benefits of sound quality judgments were also observed for six sound quality dimensions. Bimodal cochlear implant listeners of this study demonstrated less real-ear insertion gains than target gains across test frequencies.Conclusion: Speech and sound quality recognition tests are useful tools to measure bimodal benefits. Additional care for bimodal listeners is needed to optimize bimodal fitting and improve the quality of bimodal hearing aid fitting services.

Evaluation of Extended-Wear Hearing Aids as a Solution for Intermittently Noise-Exposed Listeners With Hearing Loss.

Many individuals with noise-related hearing loss continue working in environments where they are periodically exposed to high levels of noise, which increases their risk for further hearing loss. These individuals often must remove their hearing aids in operational environments because of incompatibility with the mandated personal protective equipment, thus reducing situational awareness. Extended-wear hearing aids might provide a solution for these individuals because they can be worn for weeks or months at a time, protect users from high-level noise exposures, and are compatible with communication headsets, earmuffs, and other types of personal protective equipment. The purpose of this study was to evaluate localization ability and speech understanding, feasibility of fitting and use, and acceptability in terms of comfort in a population of noise-exposed, active duty Service members. Participants in the study were active duty Service members who were experienced hearing aid users and were currently using standard hearing aids bilaterally. Participants were fitted with extended-wear hearing aids for up to 14 weeks. Laboratory measures included functional gain, sound localization, and speech recognition (in quiet and in noise). Performance was compared between unaided, standard hearing aids, extended-wear hearing aids, and extended-wear hearing aids combined with a tactical communication device (3M Peltor ComTac). In addition, self-perceived benefit between extended-wear hearing aids and standard hearing aids was compared. The extended-wear hearing aids provided more attenuation of external sound when turned off compared to standard hearing aids. Speech understanding in quiet and in noise was comparable between extended-wear hearing aids and standard hearing aids and was better when a tactical communication device was worn in addition to extended-wear hearing aids. Localization with extended-wear hearing aids was the worst, intermediate with the standard hearing aids, and the best when the ears were unaided. The extended-wear hearing aids and standard hearing aids provided similar self-perceived communication benefits relative to unaided ears. Device failure and issues with extended-wear hearing aids fit and comfort contributed to a high participant withdrawal rate. Overall, the hearing benefits of extended-wear hearing aids for Service members with hearing loss were comparable to those obtained with standard hearing aids, except for sound localization, which was poorer with extended-wear hearing aids. Extended-wear hearing aids provide the additional benefits of protecting the ears from high-level impulsive noise and being compatible with tactical communication and protection systems and other existing personal protective equipment and communication gear. The withdrawal rate in this study, however, suggests that extended-wear hearing aids may not be suitable for active duty Service members in locations where properly trained hearing professionals are not available to replace or re-insert extended-wear hearing aids when needed due to discomfort or device failure.

The Impact of Senior Mobility Funding on Hearing Aid Acquisition and Compliance to Hearing Aid Use in a Singapore Hospital.

Background and ObjectivesIn 2013, the Singapore government reviewed and expanded the Senior Mobility Fund (SMF) to provide subsidy for assistive devices, including hearing aids (HA). While SMF has improved accessibility to HA, its impact on HA acquisition has not been determined. The study aims to elucidate the influence of SMF on HA acquisition and the relationship between financial funding and compliance to HA use.Subjects and MethodsRetrospective review of 643 patients seen between January 2017 to January 2018 at the earnose and throat specialist outpatient clinic, who were referred for a hearing aid evaluation. Of the 643 patients, 109 patients with baseline hearing handicap (HH) scores recorded, and no formal diagnosis of cognitive impairment were included. The patients were grouped according to SMF eligibility and clinical data were obtained.ResultsThe odds ratio for acquiring HA was significantly higher with SMF, regardless of HH scores. When looking at actual degree of hearing loss (DHL), HA uptake was significantly higher in the least severe of DHL categories. There is no relationship between SMF and compliance to HA use. However, HH score is positively correlated with data log in regression analyses.ConclusionsSMF appears to influence HA acquisition. Especially in financially funded patients with low self-perceived HH, the benefits of HA may be underappreciated given the few hours of HA use. Further studies are warranted to investigate the impact of financial funding on outcomes of HA users to help policy planners and clinicians be prudent in the utilization of SMF.

Evaluation of Hearing Aids in Everyday Life Using Ecological Momentary Assessment: What Situations Are We Missing?

Background Ecological momentary assessment (EMA) is a method to evaluate hearing aids in everyday life that uses repeated smartphone-based questionnaires to assess a situation as it happens. Although being ecologically valid and avoiding memory bias, this method may be prone to selection biases due to questionnaires being skipped or the phone not being carried along in certain situations. Purpose This investigation analyzed which situations are underrepresented in questionnaire responses and physically measured objective EMA data (e.g., sound level), and how such underrepresentation may depend on different triggers. Method In an EMA study, 20 subjects with hearing impairment provided daily information on reasons for missed data, that is, skipped questionnaires or missing connections between their phone and hearing aids. Results Participants often deliberately did not bring the study phone to social situations or skipped questionnaires because they considered it inappropriate, for example, during church service or when engaging in conversation. They answered fewer questions in conversations with multiple partners and were more likely to postpone questionnaires when not in quiet environments. Conclusion Data for social situations will likely be underrepresented in EMA. However, these situations are particularly important for the evaluation of hearing aids, as individuals with hearing impairment often have difficulties communicating in noisy situations. Thus, it is vital to optimize the design of the study to find a balance between avoiding memory bias and enabling subjects to report retrospectively on situations where phone usage may be difficult. The implications for several applications of EMA are discussed. Supplemental Material https://doi.org/10.23641/asha.12746849.