Hearing Aid Selection Research Articles

Patient-oriented hearing aids: the specific features of approach and the results

Selection the type of hearing aid is one of the key elements of the hearing rehabilitation process, directly predetermining its efficacy. The authors suggest a method of selecting the type of hearing aid based on the patient’s needs —HASC (hearing aid selection criteria) questionnaire. The study compares the efficacy of the hearing aid when the type of the device is selected based on HASC data and when the correction was made with another type of hearing aid. When behind-the-ear hearing aids are used instead of the completely-in-canal aids (due to contraindications), which is preferable for the patient, it results in the decrease of service life, overall satisfaction with the device and its appearance, the increase in the number of re-adjustments. Selection of receiver-in-canal hearing aid instead of the completely-in-canal does not reduce its life time. Therefore, the receiver-in-canal hearing aids are an option in cases where there are contraindications to the use of completelyin- canal hearing aids without compromising the effectiveness. The use of the HASC method in audiology practice will improve the efficacy of electroacoustic correction and reduce the number of refuses to use the hearing aids.

Does clinician continuity influence hearing aid outcomes?

Objective: To evaluate whether clinician continuity is associated with successful hearing aid outcomes. Design: A prospective cohort study. Clinician continuity was defined as occurring when a patient was cared for by the same clinician for the hearing assessment, hearing aid selection process, hearing aid fitting and programming, and subsequent hearing aid fine tuning appointments. The hearing aid outcome measures included self-reported hearing aid use, benefit and satisfaction as well as self-reported handling skills and problems experienced with hearing aids. Study sample: Four hundred and sixty-eight adult hearing aid users (mean age 73.9 years ±10.9) and 26 qualified audiologists (mean age 34 years ±6.34) recruited from a single hearing clinic in Perth, Western Australia. Results: There were no significant differences in hearing aid outcomes between participants who experienced clinician continuity and those who did not. Conclusions: Within a controlled practice setting, hearing aid outcomes may not be adversely effected if services are provided by more than one clinician.

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.

Subjective Ratings of Fatigue and Vigor in Adults With Hearing Loss Are Driven by Perceived Hearing Difficulties Not Degree of Hearing Loss.

Anecdotal reports and qualitative research suggests that fatigue is a common, but often overlooked, accompaniment of hearing loss which negatively affects quality of life. However, systematic research examining the relationship between hearing loss and fatigue is limited. In this study, the authors examined relationships between hearing loss and various domains of fatigue and vigor using standardized and validated measures. Relationships between subjective ratings of multidimensional fatigue and vigor and the social and emotional consequences of hearing loss were also explored. Subjective ratings of fatigue and vigor were assessed using the profile of mood states and the multidimensional fatigue symptom inventory-short form. To assess the social and emotional impact of hearing loss participants also completed, depending on their age, the hearing handicap inventory for the elderly or adults. Responses were obtained from 149 adults (mean age = 66.1 years, range 22 to 94 years), who had scheduled a hearing test and/or a hearing aid selection at the Vanderbilt Bill Wilkerson Center Audiology clinic. These data were used to explore relationships between audiometric and demographic (i.e., age and gender) factors, fatigue, and hearing handicap scores. Compared with normative data, adults seeking help for their hearing difficulties in this study reported significantly less vigor and more fatigue. Reports of severe vigor/fatigue problems (ratings exceeding normative means by ±1.5 standard deviations) were also increased in the study sample compared with that of normative data. Regression analyses, with adjustments for age and gender, revealed that the subjective percepts of fatigue, regardless of domain, and vigor were not strongly associated with degree of hearing loss. However, similar analyses controlling for age, gender, and degree of hearing loss showed a strong association between measures of fatigue and vigor (multidimensional fatigue symptom inventory-short form scores) and the social and emotional consequences of hearing loss (hearing handicap inventory for the elderly/adults scores). Adults seeking help for hearing difficulties are more likely to experience severe fatigue and vigor problems; surprisingly, this increased risk appears unrelated to degree of hearing loss. However, the negative psychosocial consequences of hearing loss are strongly associated with subjective ratings of fatigue, across all domains, and vigor. Additional research is needed to define the pathogenesis of hearing loss-related fatigue and to identify factors that may modulate and mediate (e.g., hearing aid or cochlear implant use) its impact.

Self-Assessment of Hearing and Purchase of Hearing Aids by Middle-Aged and Elderly Adults.

Introduction Presbycusis is a consequence of aging. Prescription of hearing aids is part of the treatment, although the prevalence of use by elderly people is still small. Objective To verify whether or not self-assessment of hearing is a predictor for purchase of hearing aids. Methods Quantitative, cross-sectional, descriptive, and observational study. Participants were subjects who sought a private hearing center for selection of hearing aids. During the diagnostic interview, subjects answered the following question: “On a scale of 1 to 10, with 1 being the worst and 10 the best, how would you rate your overall hearing ability?” After that, subjects underwent audiometry, selected a hearing aid, performed a home trial, and decided whether or not to purchase the hearing aid. The variables were associated and analyzed statistically. Results The sample was comprised of 32 subjects, both men and women, with a higher number of women. Mean age was 71.41 ± 12.14 years. Self-assessment of hearing ranged from 2 to 9 points. Overall, 71.9% of the subjects purchased hearing aids. There was no association between scores in the self-assessment and the purchase of hearing aids (p = 0.263). Among those who scored between 2 and 5 points, 64.7% purchased the device; between 6 and 7 points, 76.09% purchased the device; and between 8 and 9 points, 50% purchased the device, respectively. Conclusion There is evidence that low self-assessment scores lead to the purchase of hearing aids, although no significant association was observed in the sample.

Speech Recognition at the Acceptable Noise Level.

The acceptable noise level (ANL) has been proposed as a prehearing aid fitting measure that could be used for hearing aid selection and counseling purposes. Previous work has demonstrated that a listener's ANL is unrelated to their speech recognition in noise abilities. It is unknown what criteria a listener uses when they select their ANL. To date, no research has explored the amount of speech recognized at the listener's ANL. To examine the amount of speech recognized at the listener's ANL to determine whether speech recognition in noise is utilized as a factor for setting ANL. A descriptive quasi-experimental study was completed. For all listeners, ANL was measured and speech recognition in noise was tested at ANL and at two additional signal-to-noise ratio (SNR) conditions based on the listener's ANL (ANL + 5 and ANL - 5). Forty-four older adults served as participants. Twenty-seven participants had normal hearing and seventeen participants had mild to moderately-severe, symmetrical, sensorineural hearing loss. Acceptance of noise was calculated from the measures of most comfortable listening level and background noise level. Additionally, speech recognition in noise was assessed at three SNRs using the quick speech-in-noise test materials. A significant interaction effect of SNR condition and ANL group occurred for speech recognition. At ANL, a significant difference in speech recognition in noise was found across groups. Those in the mid and high ANL groups had excellent speech recognition at their ANL. Speech recognition in noise at ANL decreased with ANL category. For listeners with mid and high ANLs, speech recognition appears to play a primary role in setting their ANL. For those with low ANLs, speech recognition may contribute to setting their ANL; however, it does not appear to be the primary determiner of ANL. For those with very low ANLs, speech recognition does not appear to be significant variable for setting their ANL.

Rehabilitation of Sensorineural Hearing Loss: Hearing Aid

Social concerns about sensorineural hearing loss have been increasing with the advent of an aging society. As most hearing loss is incurable and permanent, audiologic rehabilitation is the only option for restoring hearing. Sensorineural hearing loss includes both sensory loss of the cochlea and functional loss of the 8th cranial nerve. Because sensorineural hearing loss patients often have difficulty in understanding and locating specific sounds amidst the other ambient noise, functional amplification with hearing aids in sensorineural hearing loss is challenging work. By applying digital signal processing techniques to hearing aids, hearing rehabilitation has undergone remarkable development in recent years. Herein, the basic concepts underlying digital signal processing are reviewed briefly, followed by a short historical background of hearing aid development. The principles of hearing aid selection, counselling, frequent problems encountered in hearing aid fitting and validation are also discussed.

Relationship between Otolaryngologic Complaints and Systemic Comorbidities Observed in a Group of Hearing Aid Users.

Introduction Optimization of the selection, adaptation, and benefit of hearing aids is necessary to characterize and manage hearing loss, user expectations, otolaryngologic symptoms, and systemic comorbidities. Objective To compare the occurrence of otologic complaints, systemic diseases, and effective use of hearing aids in men and women with deafness. Methods Patients from a Unified Health System–accredited hearing health service, who reported problems in adapting to their hearing aids, were evaluated by a physician and audiologist. An anamnesis, ENT evaluation, and audiological evaluation were performed. Results During the data collection period, 278 subjects came in for follow-up visits; of these, 61 (21%) reported otologic or operational problems with their equipment. The most prevalent type of hearing loss was basocochlear, a characteristic of presbycusis, in both men and women; the most frequently reported comorbidities were hypercholesterolemia (more significant in women) and hypertension (more significant in men). Fourteen subjects reported using their device discontinuously, with no significant difference between genders; the reasons for discontinuation of use were itching and ringing, with more complaints from women. Conclusion The incidence of systemic and audiological complaints is high in this population. These patients should be evaluated thoroughly, as resolutions of these complaints can contribute to improving the quality of life and assist in the process of hearing aid fitting.

Hearing health network: a spatial analysis

IntroductionIn order to meet the demands of the patient population with hearing impairment, the Hearing Health Care Network was created, consisting of primary care actions of medium and high complexity. Spatial analysis through geoprocessing is a way to understand the organization of such services. ObjectiveTo analyze the organization of the Hearing Health Care Network of the State of Minas Gerais. MethodsCross-sectional analytical study using geoprocessing techniques. The absolute frequency and the frequency per 1000 inhabitants of the following variables were analyzed: assessment and diagnosis, selection and adaptation of hearing aids, follow-up, and speech therapy. The spatial analysis unit was the health micro-region. ResultsThe assessment and diagnosis, selection, and adaptation of hearing aids and follow-up had a higher absolute number in the micro-regions with hearing health services. The follow-up procedure showed the lowest occurrence. Speech therapy showed higher occurrence in the state, both in absolute numbers, as well as per population. ConclusionThe use of geoprocessing techniques allowed the identification of the care flow as a function of the procedure performance frequency, population concentration, and territory distribution. All procedures offered by the Hearing Health Care Network are performed for users of all micro-regions of the state.

Triagem auditiva neonatal: caracterização da demanda/ território e exames auditivos

Objetivo caracterizar a demanda, território e exames auditivos realizados em um Programa de Triagem Auditiva Neonatal. Métodos estudo retrospectivo de uma amostra de 2334 prontuários de recém-nascidos triados, envolvendo a análise de dados referentes à Triagem Auditiva Neonatal, informações dos Recém-nascidos e variáveis demográficas. Resultados foram triados 88% dos recém-nascidos, e destes 16% apresentavam Indicador de Risco para Deficiência Auditiva e 84% não apresentavam. Observou-se que o indicador mais prevalente foi o histórico familiar, e que as chances de passar no teste são menores quando na presença de indicador e quando o recém-nascido apresentava peso inferior a 1.500g. O índice de passa-falha no teste foi de 78% passa e 22% falha. No resultado do teste, maior número de falhas unilaterais, e no reteste falha de 4% sendo a adesão de mais de 70%. Conclusão estudo como este possibilita a busca ativa dos recém-nascidos do grupo de risco para deficiência auditiva em seus respectivos territórios, havendo maior possibilidade de seguimento e assim, chegar ao objetivo primordial da triagem auditiva que é o diagnostico da surdez até o terceiro mês de vida, além de projetar um Programa de Triagem Auditiva Neonatal efetivo em suas etapas: triagem, diagnóstico audiológico, indicação, seleção e adaptação de aparelhos auditivos e re(ha)bilitação auditiva.

Dichotic Hearing in Elderly Hearing Aid Users Who Choose to Use a Single-Ear Device

Introduction Elderly individuals with bilateral hearing loss often do not use hearing aids in both ears. Because of this, dichotic tests to assess hearing in this group may help identify peculiar degenerative processes of aging and hearing aid selection. Objective To evaluate dichotic hearing for a group of elderly hearing aid users who did not adapt to using binaural devices and to verify the correlation between ear dominance and the side chosen to use the device. Methods A cross-sectional descriptive study involving 30 subjects from 60 to 81 years old, of both genders, with an indication for bilateral hearing aids for over 6 months, but using only a single device. Medical history, pure tone audiometry, and dichotic listening tests were all completed. Results All subjects (100%) of the sample failed the dichotic digit test; 94% of the sample preferred to use the device in one ear because bilateral use bothered them and affected speech understanding. In 6%, the concern was aesthetics. In the dichotic digit test, there was significant predominance of the right ear over the left, and there was a significant correlation between the dominant side with the ear chosen by the participant for use of the hearing aid. Conclusion In elderly subjects with bilateral hearing loss who have chosen to use only one hearing aid, there is dominance of the right ear over the left in dichotic listening tasks. There is a correlation between the dominant ear and the ear chosen for hearing aid fitting.

Correlation between the characteristics of resonance and aging of the external ear.

Aging causes changes in the external ear as a collapse of the external auditory canal and tympanic membrane senile. Knowing them is appropriate for the diagnosis of hearing loss and selection of hearing aids. For this reason, the study aimed to verify the influence of the anatomical changes of the external ear resonance in the auditory canal in the elderly. The sample consisted of objective measures of the external ear of elderly with collapse (group A), senile tympanic membrane (group B) and without changing the external auditory canal or tympanic membrane (group C) and adults without changing the external ear (group D). In the retrospective/clinical study were performed comparisons of measures of individuals with and without alteration of the external ear through the gain and response external ear resonant frequency and the primary peak to the right ear. In groups A, B and C was no statistically significant difference between Real Ear Unaided Response (REUR) and Real Ear Unaided Gain (REUG), but not for the peak frequency. For groups A and B were shown significant differences in REUR and REUG. Between the C and D groups were significant statistics to the REUR and REUG, but not for the frequency of the primary peak. Changes influence the external ear resonance, decreasing its amplitude. However, the frequency of the primary peak is not affected.

Little Ears and Brains: Hearing Aids and Intervention

Until recently, the habilitation process of children with hearing impairment has focused on providing access to auditory information through hearing assistive technology (e.g., hearing aids and FM systems). It is apparent from the literature that when selecting hearing aids for the pediatric population cognitive and auditory development must be taken into account. In order for pediatric hearing aid users to utilize the information provided by the hearing aids and be successful, an intervention plan that recognizes the role of cognitive factors such as working memory and attention is necessary. The current state of knowledge related to auditory training will be discussed as well as other factors related to improvement in speech perception. Future directions in auditory training and habilitation efforts will be discussed.

Różnicowanie niedosłuchów ciężkich od głębokich u niemowląt i małych dzieci przy użyciu ASSR „CE-Chirp”

IntroductionOne of the most difficult tasks in pediatric audiology is to assess the precisely hearing level of the child in the first months of life. It is rather impossible to acquire frequency specific responses precisely in hard of hearing infants using tone bursts or clicks. But the distinction between severe and profound hearing loss is clearly meaningful and significant with regard to aural rehabilitation and selection of powerful hearing aids versus cochlear implants.In recent years, the “CE-Chirp” stimuli have been introduced in the “Interacoustics” ASSR system to maintain a larger quantity of hair cells in the response, thus making the response more robust and easier to detect. Input compensation of “CE-Chirp” allows low frequency acoustics segments to initiate before high frequencies, causing sequential frequencies to reach their destinations along the basilar membrane at the same time.Clinical testing involving subjects with normal hearing demonstrates that the Chirp ABR is 1.5–2.0 times larger than the corresponding click ABR. But there is a lack of research that shows convincing advantages of chirps in testing hard of hearing infants. AimThe aim of the study has been to assess hearing levels with ASSR “CE-Chirp” in children who have no, or residual response in the first year of life. Materials and methodsEleven children were included in the study. These patients had no, or residual response between the ages of 3 and 6 months, in click and tone bursts ABR. Eight infants were referred for cochlear implantation.In the ages between 12 and 18 months we tested these hearings using Interacoustics ASSR “CE-Chirp”. ResultsSix patients of the tested group were recognized as severely hard of hearing (mean 60–80dB nHl), three as profoundly hard of hearing (≥90dB nHl). In two children we did not find any response. ConclusionsThe ABR tone bursts and click tests can overestimate hearing loss in the first six months of life.We can evaluate the quantity of hearing more exactly in infants and toddlers, with ASSR “CE-Chirp”.

Incoporating Music Perception and Enjoyment Into Aural Rehabilitation

The author recently completed a 40-year career in audiology with a primary interest in hearing aids and adult aural rehabilitation. He describes how the field of audiology has changed over this period in the areas of hearing aid selection, hearing aid fitting, hearing aid options and distribution, and adult group aural rehabilitation. Suggestions for future directions are made in each of the areas.

Intertester Reliability of the Acceptable Noise Level

The acceptable noise level (ANL) serves to accurately predict the listener's likelihood of success with amplification. It has been proposed as a pre-hearing aid fitting protocol for hearing aid selection and counseling purposes. The ANL is a subjective measure of the listener's ability to accept background noise. Measurement of ANL relies on the tester and listener to follow the instructions set forth. To date, no research has explored the reliability of ANL as measured across clinicians or testers. To examine the intertester reliability of ANL. A descriptive quasi-experimental reliability study was completed. ANL was measured for one group of listeners by three testers. Three participants served as testers. Each tester was familiar with basic audiometry. Twenty-five young adults with normal hearing served as listeners. Each tester was stationed in a laboratory with the needed equipment. Listeners were instructed to report to these laboratories in a random order provided by the experimenters. The testers assessed most comfortable listening level (MCL) and background noise level (BNL) for all 25 listeners. Intraclass correlation coefficients were significant and revealed that MCL, BNL, and ANLs are reliable across testers. Additionally, one-way ANOVAs for MCL, BNL, and ANL were not significant. These findings indicate that MCL, BNL, and ANL do not differ significantly when measured by different testers. If the ANL instruction set is accurately followed, ANL can be reliably measured across testers, laboratories, and clinics. Intertester reliability of ANL allows for comparison across ANLs measured by different individuals. Findings of the present study indicate that tester reliability can be ruled out as a factor contributing to the disparity of mean ANLs reported in the literature.

Wind noise in hearing aids: II. Effect of microphone directivity

Objectives: The objectives were: (1) to examine the effects of a directional microphone with different directivity patterns and different microphone combinations on wind noise levels at the hearing aid output; and (2) to derive strategies appropriate for hearing aid selection and future designs. Design: The in-situ frequency responses of a behind-the-ear hearing aid (BTE1) were matched when the hearing aid was programmed to dipole, hypercardioid, cardioids, or adaptive microphone mode. The in-situ frequency responses of another hearing aid (BTE2) were matched among an omnidirectional microphone (OMNI), an adaptive directional microphone (ADM), and a combination of an omnidirectional microphone at low frequencies and an adaptive directional microphone at high frequencies (MIXED). Flow noise was recorded at flow velocities of 0, 4.5, 9.0, and 13.5 m/s. Measurements were repeated for the hypercardioid pattern of BTE1. Study sample: Flow noise recorded using directional microphones with four directivity patterns and using OMNI, ADM, and MIXED. Results: Directional microphones with different directivity patterns generated similar flow noise levels. ADM yielded higher overall levels than OMNI and MIXED, which had similar overall levels. Conclusions: The adaptive directional microphone is the most versatile microphone for use in wind. The mixed microphone mode is a viable wind noise reduction option.

Transcranial Contralateral Routing of the Signal as a Fitting Option for Patients with Single-Sided Deafness

Patients with single-sided deafness (SSD) often report difficulty recognizing speech when the signal is on the side of the poorer ear. As discussed in this issue of Seminars in Hearing, several fitting options are available for patients with SSD. One option that could take on greater interest due to advancements in multichannel feedback management, noise reduction, and directional microphones is the transcranial contralateral routing of the signal (TCROS). This article reviews previous reports on performance with the TCROS. This article also focuses on the advances in hearing aid technology and how these advances could improve TCROS as a fitting option for patients with SSD. Finally, this article provides information on factors that audiologists should take into consideration for patient and hearing aid selection for TCROS and outlines a procedure to verify performance of TCROS using the real-ear-aided response (REAR) and other real-ear measures (REM).

Potenciais evocados auditivos de estado estável em crianças com perdas auditivas cocleares

auditory steady-state response (ASSR) is indicated as a promising technique in the assessment of the hearing status of children. to investigate the level of agreement between the results of the ASSR and the visual reinforcement audiometry (VRA) in a group of children, thus examining the clinical applicability of this technique in hearing assessment of children. participants were 14 children with ages between 4 and 36 months (mean 16 months) with the diagnosis of cochlear hearing loss. The ASSR was recorded in the frequencies of 0.5, 1, 2 and 4kHz for multiple simultaneous stimulation and the results were compared with the visual reinforcement audiometry (VRA). the intraclass correlation coefficients between ASSR and VRA were 0.90, 0.93, 0.93 and 0.89 respectively for the frequencies of 0.5, 1, 2 and 4kHz, indicating a strong correlation between the techniques. the ASSR can provide accurate information to support the selection of hearing aids for children when it is not possible to perform the VRA.

Management of Hearing Aids Clinic

Hearing loss is a common problem that impacts quality of life for the patient, family members, and caretakers. Population with a significant hearing loss is increasing due to growing older population and new-born hearing screening. Unfortunately, hearing loss is often undiagnosed and untreated. This article summarizes the procedure of hearing aids fitting for those whom with hearing loss, which that can be implemented into an otologic practice. In detail, candidacy, counseling and selection of hearing aids, fitting and verification and finally, validation using questionnaire are reviewed. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:333-9 Key WordsZZHearing aids·Hearing loss.