Hearing Aid Services Research Articles

Comprehensive Hearing Aid Intervention at a Free Subspecialty Clinic

ImportanceProviding a model of a comprehensive free audiologic program may assist other health care professionals in developing their own similar program.ObjectiveTo describe the structure, feasibility, and outcomes of a free subspecialty clinic providing hearing aids to develop a paradigm for other programs interested in implementing similar projects.Design, Setting, and ParticipantsA retrospective case series was conducted from September 1, 2013, through March 31, 2016. In a partnership between a free independent clinic for indigent patients and an academic medical center, 54 indigent patients were referred to the clinic for audiograms. A total of 50 of these patients had results of audiograms available for review and were therefore included in the study; 34 of these 50 patients were determined to be eligible for hearing aid fitting based on audiometric results.ExposuresFree audiometric testing, hearing aid fitting, and hearing aid donation.Main Outcomes and MeasuresThe number of hearing aids donated, number of eligible patients identified, number of patients fitted with hearing aids, and work effort (hours) and start-up costs associated with implementation of this program were quantified.ResultsA total of 54 patients (31 women [57.4%] and 23 men [42.6%]; median age, 61 years; range, 33-85 years) had audiograms performed, and 84 hearing aids were donated to the program. The patients were provided with free audiograms, hearing aid molds, and hearing aid programming, as well as follow-up appointments to ensure continued proper functioning of their hearing aids. Since 2013, a total of 34 patients have been determined to be eligible for the free program and were offered hearing aid services. Of these, 20 patients (59%) have been fitted or are being fitted with free hearing aids. The value of services provided is estimated to be $2260 per patient.Conclusions and RelevanceIt is feasible to provide free, comprehensive audiologic care, including hearing aids and fitting, in a well-established, free clinic model. The opportunity for indigent patients to use hearing aids at minimal personal cost is a major step forward in improving access to high-quality care.

TeleAudiology in the Veterans Health Administration.

To assess effectiveness of TeleAudiology for hearing aid services. Retrospective case-control. Ambulatory Veterans Health Administration and Community-Based Outpatient Clinics (CBOCs). 42,697 veterans who received hearing aids from January through September, 2014. TeleAudiology (TA) and conventional in-person (IP) audiology care. International Outcome Inventory for Hearing Aids (IOI-HA) outcomes data. The IOI-HA is a 7-item survey used to assess hearing aid effectiveness. Scored from 7 to 35 points, higher scores are more favorable. Among veterans nationwide who received hearing aids and completed the IOI-HA survey, 1,009 received TA and 41,688 received IP care. TA and IP groups have comparable mean IOI-HA values (TA = 29.6, SD = 3.9; IP = 28.7, SD = 4.2). Although comparison showed a statistically significant difference (p < 0.0001, t test), principally because of large sample size, the distinction is not clinically meaningful.Subgroup analysis of veterans from San Francisco and six affiliated CBOCs showed 169 received TA and 338 received IP care. TA and IP groups have similar mean age (TA = 74, SD = 9.8; IP = 76, SD = 10.3) and sex distribution (TA male = 100%; IP male = 96%) with statistically significant (p < 0.01, t test) but clinically insignificant differences. Mean IOI-HA scores (TA = 30.7, SD = 3.6; IP = 30.5, SD = 3.1) are not different between groups (p > 0.05, t test). TA and IP encounters to provide hearing aid services to veterans are comparable, as both are highly effective based on IOI-HA results. The noninferiority of TA suggests its adoption to non-veterans may improve access while preserving high satisfaction. Financial impact of migration to TA will require future econometric analysis.

Patient Complexity Charge Matrix for Audiology Services: A New Perspective on Unbundling.

Traditional approaches to unbundling hearing aid services often take existing bundled charges and then separate the charges across all potential services associated with dispensing the devices. However, this method results in every patient being charged the same amount even though the complexity of the service varies across patients. We describe a model of charging for hearing aid services that takes into account three elements associated with patient services (i.e., assessing hearing status, audiologic decision making and interpretation, and counseling and treatment options) and two levels of complexity (straightforward and complex). Using this approach, there is negligible long-term financial impact on a practice however patients will perceive a lower overall cost for amplification. Additionally, this approach provides a payment structure more representative of the professional value of each visit.

Audiologist Practices: Parent Hearing Aid Education and Support.

Early identification of hearing loss has led to routine fitting of hearing aids in infants and young children. Amplification provides opportunities to optimize child development, although it also introduces challenges for parents to navigate. Audiologists have a central role in providing parents with support to achieve effective management strategies and habits. The purpose of this study was to explore current practices of pediatric audiologists who work with children birth to 5 yr of age, regarding their support of parent learning in achieving effective hearing aid management, identify existing gaps in service delivery, and to determine if audiologists were receptive to receiving training related to effective approaches to provide counseling and support to parents. A cross-sectional, population-based survey was used. Three hundred and forty-nine surveys were analyzed from pediatric audiologists who provided services to children birth to 5 yr of age. Responses were received from 22 states in the United States. Responses were collected through the mail and online. Descriptive statistics were used to analyze the information. More than half (61%) of the audiologists in the study had been providing pediatric hearing aid services to children birth to 5 yr of age for >10 yr. Of the audiologists who reported monitoring hours of hearing aid use, the majority reported that they used data logging (90%). More than half of the audiologists (57%) who shared data logging with parents reported that they encountered defensiveness from parents when addressing hearing aid use. Information and skills that were not routinely provided by one-third to one-half of the audiologists included the following: how to get access to loaner hearing aids (30%), available hearing aid options/accessories (33%), available financial assistance (36%), how to teach hearing aid management to other caregivers (38%), how to do hearing aid maintenance (44%), and how to do a Ling 6 sound check (52%). Many audiologists reported they did not frequently collaborate with speech-language pathologists (48%), early interventionists (47%), or physicians (68%). More than half of the audiologists indicated a desire for more training in counseling skills, for all 14 items queried, to support parents with hearing aid management (53-79%), regardless of their previous training experience. For young children with hearing loss to achieve optimal benefit from auditory experiences for speech and language development, they need evidence-based, comprehensive, and coordinated hearing aid management. Audiologists have an important role for teaching information and skills related to hearing aids, supporting parent learning, and collaborating with other providers. Pediatric audiologists in this study recognized and desired the need for further training in counseling skills that can better prepare them to meet the emotional needs of parents in the hearing aid management process.

Hearing Aids for Holocaust Survivors

Hearing Aids for Holocaust Survivors

Moderate-medicalisation and an age-neutral NHS hearing aid service

Age-related hearing loss is one of the most common chronic health conditions experienced by adults. However, many individuals who would benefit from a hearing aid do not seek help, and many that do seek help, experience symptoms for several years prior to attending a hearing assessment. One of the main reasons for delayed access and poor hearing aid uptake is the stigma associated with hearing loss. Recently, there have been several calls to promote earlier and easier access. Recommendations such as the de-medicalisation of NHS hearing aid services have been suggested. In agreement with this, this article argues that approaches to reduce hearing loss stigma should be prioritised. However, it also proposes that a reduced form of medicalisation, rather than a de-medicalised approach is required. Furthermore, in addition to what it refers to as ‘moderate-medicalisation’, this article argues that a less ‘older-age-focused’ NHS hearing service will facilitate earlier access to assessment and hearing technology. Some service delivery changes that will promote moderate-medicalisation and an age-neutral service are suggested.

In Timor-Leste, a Bumpy, but Rewarding, Road to Hearing Healthcare

In Timor-Leste, a Bumpy, but Rewarding, Road to Hearing Healthcare

Pilot Study to Evaluate Hearing Aid Service Delivery Model and Measure Benefit Using Self-Report Outcome Measures Using Community Hearing Workers in a Developing Country

Hearing loss is a major handicap in developing countries with paucity of trained audiologists and limited resources. In this pilot study trained community health workers were used to provide comprehensive hearing aid services in the community. One hundred and eleven patients were fitted with semi-digital hearing aid and were evaluated over a period of six months. They were assessed using self-report outcome measure APHAB. Results show that trained CHWs are effective in detecting disabling hearing loss and in providing HAs. APHAB can identify and pick up significant improvements in communication in daily activities and provides a realistic expectation of the benefits of a hearing aid. The model of using trained CHWs to provide rehabilitative services in audiology along with self-report outcome measures can be replicated in other developing countries.

Adult bone anchored hearing aid services in the United Kingdom: Building a consensus for development

Aims and ObjectivesIn October 2009, a multi-disciplinary group of UK clinicians met to review issues relating to bone-anchored hearing-aid (BAHA) development. The aim was to help define a model for BAHA services and service development via a process of widespread consultation with UK BAHA professionals.MethodsA modified Delphi technique was used. Statements were proposed by the lead group and sent out for consultation. Those with ≥90% agreement were approved without further discussion. Statements with 50–89% agreement were discussed by the lead group to determine whether they should be included in the final document. Any statement with <50% agreement was removed without discussion. A second consultation was then made, and the process repeated. This led to a final set of consensus statements.ResultsThe final consensus comprises 33 statements validated by the modified Delphi process. All of these statements achieved >75% agreement, with only six statements having <90% agreement. When these statements were presented to the UK BAHA Professionals group at their annual conference there was 89% agreement from the group for the consensus statements to be accepted.DiscussionThe levels of agreement for the final questionnaire show that the mandate for the consensus statements was exceptionally high. Implementation of the consensus is discussed, as are each of the key areas of the consensus, such as funding and minimum assessment standards.

Insights from the experiences of older people with hearing impairment in the United Kingdom: recommendations for nurse‐led rehabilitation

This study aims to explore, and develop a greater understanding of the experience of living with age-related hearing impairment from the perspectives of older people themselves to highlight possible recommendations for the improvement of hearing aid (HA) services and rehabilitation. Hearing impairment (HI) is one of the most common chronic conditions affecting older people. HI can have a huge impact on a wide variety of life factors including physical, mental and social health and can lead to a reduction in quality of life. With the current ageing population, the numbers living with hearing impairment in old age is likely to increase. Currently, the diagnosis of hearing impairment in older people can be slow with individuals living with hearing impairment for around 10 years before being diagnosed. The research utilises a descriptive qualitative method in the form of descriptive thematic analysis. Findings are reported from semi-structured interviews with nine participants with self-reported HI, aged 61-93. Themes include; the loss itself, communication, using HAs, isolation, and coping strategies. The results highlight the need for early diagnosis of HI and the development of nurse-led rehabilitation strategies and support services that address the felt stigma and potentially isolating experiences of older people with HI.

International outcome inventory for hearing aids (IOI-HA): Results from the Chinese version

Objective: The purpose of this study is to present normative data on the Chinese version of the international outcome inventory for hearing aids (IOI-HA) and examine the effective-ness of the hearing aid service. Design: Cross-sectional study. The IOI-HA was administered in a paper and pencil format. Study sample: The IOI-HA and self-designed questionnaire were mailed to 1502 experienced hearing-aid users who received their hearing aids from 14 hearing service centers in mainland China. In all, 1049 completed responses were included in the final analysis, and descriptive statistics were reported. Results: The mean scores of each item of the IOI-HA ranged from 3.55 to 4.16. The IOI-HA scores showed a skewed distribution, with the maximum frequency for a score of 4 or 5. The total IOI-HA scores ranged from 9 to 35, and the mean total score was 26.3. The results compared favorably with the previous reports, and slightly higher than the published norms, indicating a high level of self-reported outcomes. Conclusiones: The IOI-HA could be used as an effective tool to measure the general effectiveness of the hearing aid outcomes in China. The implementation of the IOI-HA is time-efficient, imposing little burden on the clinician and patient.SumarioObjetivo: El propósito de este estudio es presentar datos normativos de la versión en chino del Inventario Internacional de Resultados con Auxiliares Auditivos (IOI-HA) y examinar la efectividad del servicio de auxiliares auditivos. Diseño: Estudio transversal. El IOI-HA fue administrado en formato de papel y lápiz. Muestra Del Estudio: El IOI-HA y un cuestionario auto-diseñado fueron enviados por correo a 1502 usuarios con experiencia de auxiliares auditivos, quien habían recibido sus auxiliares auditivos de 14 centros de servicio auditivo en China continental. Globalmente, 1049 respuestas completas fueron incluidas en el análisis final, y se reportaron estadísticas descriptivas. Resultados: Los puntajes medios de cada ítem del IOI-HA fluctuaron de 3.55 a 4.16. Los puntajes del IOI-HA mostrados una distribución sesgada, con la mayor frecuencia para un puntaje de 4 o 5. Los puntajes totales del IOI-HA variaron de 9 a 35, el puntaje medio total fue de 26.3. Los resultados se compararon favorablemente con los reportes previos, y levemente más altos que las normas publicadas, indicando un alto nivel de resultados auto-reportados. Conclusiones: El IOI-HA puede servir como una herramienta efectiva para medir la efectividad general de los resultados en la adaptación de auxiliares auditivos en China. La implementación del IOI-HA es tiempo-efectivo, imponiendo una carga pequeña sobre el clínico y el paciente.

Audiology Health Plan Contracting

Audiology Health Plan Contracting

Case Study on Hearing Aid Counseling and Marketing for Effective Audiologic Services

The purpose of this study was to discuss effective skills in audiologic counseling and marketing with hearing-impaired adults in hearing aid rehabilitation. These two approaches have common goals of letting local customers understand the quality of hearing aid services and disseminating them to prospective customers. Hearing aid services often required effective approaches to satisfy the various needs of customers in regard to their social, motivational, and emotional states. Therefore, proactive listening and empathy were emphasized in this study to develop effective counseling and marketing approaches. Personality types were classified into four categories: Driving, Expressive, Amiable, and Analytical (Wilson Learning Corporation, 1978). Favorable outcomes were obtained for these approaches and customized strategies could be good supplements for evidence based practices in hearing aid services. KEY WORDS：Audiologic service·Counseling·Hearing aid·Marketing·Social styles.

Otitis media in Aboriginal children: The discordance between burden of illness and access to services in rural/remote and urban Australia

To compare the burden of otitis media (OM) managed by Aboriginal Medical Service (AMS) practitioners and the availability of specialist ear health services in rural/remote versus urban Australian settings. We mailed questionnaires to all Australian AMS medical practitioners managing children in December 2006. Questions addressed the frequency of childhood OM cases seen, and the availability and waiting times for audiology; ear, nose and throat (ENT); and hearing-aid services. We compared rural/remote and urban practitioner's responses using the c2 test with clustering adjustments. Questionnaires were returned by 63/87 (72%) AMSs and by 131/238 (55%) eligible practitioners. Rural/Remote practitioners reported managing a greater number of children with OM per week than urban practitioners (1 df, P = 0.02) and a larger proportion of the children they managed having OM (1 df, P = 0.009). More rural/remote than urban practitioners reported relevant services were not available locally: audiology (11.1 vs. 0%, P = 0.038), ENT (33.3 vs. 3.9%, P = 0.0004) and hearing-aid provision (37.7 vs. 1.9%, P < 0.0001). More rural/remote practitioners reported audiology waiting times longer than the recommended 3 months (18.3 vs. 1.9%, P = 0.007). Equal proportions reported ENT waiting times longer than the recommended 6 months (13.9 vs. 11.3%, P = 0.7). Rural/Remote AMS practitioners manage a greater OM burden than urban AMS practitioners, but affected children have less access to specialist ear health services and longer waiting times. One in five rural/remote Aboriginal children wait longer than recommended for audiology testing, and one in eight Aboriginal children nationwide wait longer than recommended for ENT services.

Remote probe microphone measurement to verify hearing aid performance

We assessed the feasibility of obtaining probe microphone measurements of hearing aids at a distance. Face-to-face and remote probe microphone measurements were carried out in 60 hearing aid users (mean age 67 yrs) with uni- or bilateral hearing losses (105 ears tested). The participant and a facilitator were located in a room equipped with a probe microphone system interfaced to a PC. Desktop videoconferencing and application sharing was used to allow an audiologist in another room to instruct the facilitator and control the equipment via the LAN. There were significant correlations between face-to-face and remote real ear unaided response (REUR), aided response (REAR) and insertion gain (REIG) at seven discrete frequencies from 250 to 6000 Hz. Differences between face-to-face and remote responses were within the reported variability for probe microphone measurements themselves. The results show that remote probe microphone measurements are feasible and might improve the quality of public hearing aid services and professional training in Brazil.

A Multicenter Trial of an Assess-and-Fit Hearing Aid Service Using Open Canal Fittings and Comply Ear Tips

Large potential benefits have been suggested for an assess-and-fit approach to hearing health care, particularly using open canal fittings. However, the clinical effectiveness has not previously been evaluated, nor has the efficiency of this approach in a National Health Service setting. These two outcomes were measured in a variety of clinical settings in the United Kingdom. Twelve services in England and Wales participated, and 540 people with hearing problems, not previously referred for assessment, were included. Of these, 68% (n = 369) were suitable and had hearing aids fitted to NAL NL1 during the assess-and-fit visit using either open ear tips, or Comply ear tips. The Glasgow Hearing Aid Benefit Profile was used to compare patients fitted with open ear tips with a group of patients from the English Modernization of Hearing Aid Services evaluation, who used custom earmolds. This showed a significant improvement in outcome for those with open ear tips after allowing for age and hearing loss in the analysis. In particular, the benefits of using bilateral open ear tips were significantly larger than bilateral custom earmolds. This assess-and-fit model showed a mean service efficiency gain of about 5% to 10%. The actual gain will depend on current practice, in particular on the separate appointments used, the numbers of patients failing to attend appointments, and the numbers not accepting a hearing aid solution for their problem. There are potentially further efficiency and quality gains to be made if patients are appropriately triaged before referral.

Outcome Measurement for Patients Receiving Hearing Aid Services

The purpose of this paper is to describe a useful patient report outcome measure for a hearing aid program that can be completed annually, with limited staff resources, and can be used to document performance excellence. The International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire was mailed to all patients receiving new hearing aids and rehabilitative services during a 1 year period at Mayo Clinic (Rochester, MN). The data were analyzed to assess outcomes. Overall, patients reported a high level of satisfaction and an improved quality of life. The results compared favorably with published norms and with the previous year's results. The IOI-HA was implemented easily with little incremental cost. An annual project such as the one described can be used to demonstrate to administrators, patients, and payers that the clinic's rehabilitative hearing aid services have positive outcomes and that program quality is being monitored.

Effectiveness of group versus individual hearing aid visits

Demand for hearing aid services in the Veterans Health Administration increased over 300% from 1996 to 2005, challenging the delivery of timely, high-quality care. Using group visits may help meet these needs, but whether this approach would still provide high-quality rehabilitation is unclear. This study determined whether group visits worsen hearing aid outcomes. It included a retrospective observational cohort in veterans seeking hearing aids at the Department of Veterans Affairs Puget Sound Health Care System from September 2004 to March 2005, when the clinic was using both individual and group visits. Medical records were reviewed for all new hearing aid patients seen during this period. Hearing-related outcome questionnaires were compared between patients seen for individual versus group fitting and/or follow-up visits. Results revealed that hearing thresholds were similar between patients seen individually and in groups. Of 74 patients who returned self-administered questionnaires after the follow-up, those who received both fitting and follow-up in a group format reported similar hearing handicap and better hearing-related function, satisfaction, and adherence than patients who received individual visits. Group visits did not appear to yield worse outcomes in this nonrandomized retrospective chart review. Definitive statements must await randomized comparisons.

A survey of public health policy on bilateral fittings and comparison with market trends: The evidence-base required to frame policy

This report presents a review of the situation in a number of countries with respect to public health policy for funding of hearing aid services in general and support to bilateral fittings in particular. The data show considerable variations among the countries studied in number of hearing aids fitted per 1000 inhabitants, differing by a factor of 6 between the extremes. Also the percentage of bilateral fittings differs with an average estimated to be of the order of 50%. For hearing-impaired children, bilateral fittings are given full financial support in most countries studied. The data presented indicate the need for a reliable, scientifically valid evidence-base regarding bilateral hearing aid fitting.

Challenges in management of childhood sensorineural hearing loss in sub-Saharan Africa, Nigeria

The evaluation of a hearing-impaired child attempts to determine the aetiology, the degree of hearing loss and intervention to aid speech and language. This remains a challenge to practising otolaryngologists, especially in the developing countries as 85-90% of causes of hearing losses were never discovered leading to delayed intervention and irreversible effects. In a review of children presenting at the otolaryngology outpatient in the University College Hospital, Ibadan, Nigeria, sensorineural hearing loss was found in 103, giving a hospital prevalence rate of 14%, we still perceived this figure to be unrepresentatively and low, probably due to poor access to medicare, poverty and other factors. Genetic factor accounted for 25%, followed by measles infections 13% and meningitis 8%. About 60% of them had educationally significant hearing loss at presentation. Access to hearing aid was poor as only 12.5% of the patients could afford it and the rest were managed by deaf training. We conclude by suggesting an audiologic programme which has the comprehensive function of neonatal and infant hearing screening, subsidized hearing aid services and hearing rehabilitation surgery.