Hearing Aid Fitting Research Articles

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.

Combining MUSHRA Test and Fuzzy Logic in the Evaluation of Benefits of Using Hearing Prostheses

Assessing the effectiveness of hearing aid fittings based on the benefits they provide is crucial but intricate. While objective metrics of hearing aids like gain, frequency response, and distortion are measurable, they do not directly indicate user benefits. Hearing aid performance assessment encompasses various aspects, such as compensating for hearing loss and user satisfaction. The authors suggest enhancing the widely used APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire by integrating it with the MUSHRA test. APHAB, a self-completed questionnaire for users, evaluates specific sound scenarios on a seven-point scale, with each point described by a letter, percentage, and description. Given the complexities, especially for older users, we propose converting the seven-point APHAB scale to a clearer 100-point MUSHRA scale using fuzzy logic rules. The paper starts with presenting the goals of the study, focused on the assessment of the benefits of hearing aid use, especially in the case of the elderly population. The introductory part includes an overview of methods for evaluating the effectiveness of hearing aid use. Then, the methodology for the data collection is presented. This is followed by a method modification that combines the MUSHRA (MUltiple Stimuli with Hidden Reference and Anchor) test and fuzzy logic processing and the commonly used hearing aid benefit assessment questionnaire, APHAB (Abbreviated Profile of Hearing Aid Benefit). The results of such a process are examined. A summary of the findings is given in the form of fuzzy logic-based rules, followed by a short discussion. Finally, the overall conclusion and possible future directions for the method development are presented.

Do individual perceptual abilities affect speech recognition with spatial hearing aid processing?

Individuals with hearing loss experience persistent communication difficulties in noisy conditions, even with specialized hearing aid (HA) processing. Little is known about how HA processing interacts with auditory perceptual abilities required for speech-in-noise listening, possibly leading to mismatched parameters for certain listeners. We investigated how speech recognition with spatial HA processing—intended to reduce signals from off-axis locations—is affected by individual auditory perceptual abilities. 16 listeners with hearing loss completed a sentence recognition in noise task with wearable HAs in omnidirectional processing or binaural beamforming settings. On- (0°) or off-axis ( + 90°) target sentences were mixed with gender-matched two-talker maskers that were either spatially separated or co-located. The Portable Automated Rapid Testing program was used to obtain individual binaural (Spatial Release from Masking task) and monaural processing (Spectrotemporal Modulation Detection task) measures. Data show positive associations between perceptual abilities and speech recognition with omnidirectional processing across target and noise locations and negative associations with beamforming for off-axis targets in spatially separated noise. Relative associations of binaural and monaural processing abilities varied by test condition. The study has implications for individualizing spatial processing parameters in clinical HA fittings. [Work supported by NIH-K01DC018324.]

Comparing the benefits of hearing aids and cochlear implants in real-world listening environments

Comparing outcomes between patients with bilateral hearing aids (HAs), bilateral cochlear implants (CIs), and bimodal fittings (CI + HA) are difficult because of the variations in hearing performance between the different devices and patient groups. This may impact patient counselling, device selection, and hearing outcomes for listeners with more severe hearing loss. This study seeks to identify the factors impacting the listening abilities of adults fitted with bilateral HAs, bilateral CIs, and bimodal fittings in noisy environments by comparing outcomes from commonly used clinical tests and a new task that emphasises realistic listening in background noise. By identifying these limiting factors from a variety of tests, optimising hearing aid fittings, and comparing between device configuration groups, the study will help understand where hearing aid devices no longer meet satisfactory individual outcomes, and a cochlear implant may improve long-term performance. This approach pushes toward considering real-world outcomes through realistic test measures when informing clinical counsel and device implantation or configuration recommendations. As such, adults with hearing loss can receive more tailored advice that validates their daily listening concerns and clinicians are granted a better understanding of how to improve the quality of life for their clients.

Exploring the effect of sound scene on self-directed hearing-aid gain adjustment

Self-directed gain adjustments may present a plausible solution for fitting a hearing-aid (HA) without the requirement of audiometric tests. In the current experiment, users interacted with their hearing aids using a touchscreen-enabled mobile device while a continuous speech stimulus with background noise was played in the sound field, simulating real-world sound scenes. They explored different settings by dragging a cursor on the touchscreen, experiencing real-time audio changes, and identifying their preferred amplification level. Thirteen older adults with self-identified hearing difficulties participated in the study (RHHI score ≥6). The self-fitting procedure was conducted in two sound scenes: Restaurant and Traffic. The speech level was set at 60 dB-A in both sound scenes, and the signal-to-noise ratios were 5 and 10 dB for the Restaurant and Traffic scenes, respectively. Following the self-fitting procedure, real-ear aided responses were measured for the amplification profiles obtained using the two sound scenes. The real-ear aided responses for the two scenes resembled each other, with a median correlation coefficient across participants of 0.81. Nevertheless, a marginally significant difference was found between them, mostly driven by higher or lower frequency regions. This suggests that scene-specific adjustments of hearing-aid fitting may be beneficial for some users.

The Complexity of Hearing Aid Fitting: Children with Congenital Hearing Loss and Middle Ear Dysfunction.

The early diagnosis of hearing loss (HL) and hearing rehabilitation facilitate language and communication development. Some children exhibit mixed HL due to middle ear effusion (MEE) or acute otitis media (AOM). Mixed HL can affect HL evaluation and hearing aid (HA) fitting. The present study retrospectively evaluated the prevalence of MEE/AOM among children with congenital sensorineural HL (SNHL) who were fitted with HAs and its effect on the HA fitting. Thirty-six HA fittings carried out between 2017 and 2020 at one rehabilitation center were examined. Medical and audiological information was retrieved for children between 6 and 32 months old. The number of appointments and HA fitting times were recorded. Twenty-eight children were included in the study. Eighteen children, in addition to SNHL, had a conductive component resulting from MEE/AOM. The children with these pathologies required significantly more HA fitting sessions and hearing tests, fewer real ear to coupler difference (RECD) measurements and longer HA fitting periods. The findings indicate that a large number of children fitted with HAs have an additional conductive component that makes the fitting process longer. Since early rehabilitation is necessary for language development, otolaryngologists should be aware of the adverse effects of MEE/AOE on the HA fitting process. It is important to inform parents that when there is a conductive component, the HA fitting process may take longer and that treatment by an otolaryngologist is vital. This study stresses the importance of multidisciplinary cooperation for optimal HA fitting.

In-situ hearing threshold estimation using Gaussian process classification

One in six Americans suffers from hearing loss. While treatment with amplification is possible for many, the acceptance rate of hearing aids is low. Poor device fitting is one of the reasons. The hearing aid fitting starts with a detailed hearing assessment by a trained audiologist in a sound-controlled environment, using standard equipment. The hearing aid is adjusted step-by-step, following well-described procedures based on the audiogram. However, for many patients in rural settings, considerable travel time to a hearing center discourages them from receiving a hearing test and treatment. We hypothesize that hearing assessment with the patient’s hearing aid can reliably substitute the hearing test in the clinic. Over-the-counter hearing aids could be programmed from a distance and fine-tuned by the hearing aid wearer. This study shows that a patient-controlled hearing assessment via a hearing aid in a non-clinical setting is not statistically different from an audiologist-controlled hearing assessment in a clinical setting. The differences in hearing obtained with our device and the Gaussian Process are within 3 dB of the standard audiogram. At 250 Hz, the sound delivery with the hearing aid used in this study added an additional reduction of sound level, which was not compensated.

Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study.

The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care.

Predicting wideband real-ear-to-coupler differences in children using wideband acoustic immittance.

Individual differences in ear-canal acoustics introduce variability into hearing aid output that can affect speech audibility. Measuring ear-canal acoustics in young children can be challenging, and relying on normative real-ear-to-coupler difference (RECD) transforms can lead to large fitting errors. Acoustic immittance measures characterize the impedance of the ear and are more easily measured than RECD. Using 226 Hz tympanometry to predict the RECD is more accurate than using age-based average RECD values. The current study sought to determine whether wideband acoustic immittance measurements could improve predictions of wideband real-ear-to-coupler difference (wRECD). 150 children ages 2-10 years with intact tympanic membranes underwent wRECD and wideband acoustic immittance measures in each ear. Three models were constructed to predict each child's measured wRECD: the age-based average wRECD, 226 Hz admittance wRECD, and wideband absorbance wRECD. The average age-based wRECD model predicted the child's measured wRECD within 3 dB in 62% of cases, but both the 226 Hz admittance and wideband absorbance wRECD were within 3 dB in 90% of cases. Using individual 226 Hz or wideband absorbance to predict wRECD improved the accuracy and precision of transforms used for pediatric hearing aid fitting.

The Benefit of Binaural Hearing Among Listeners with Sensorineural Hearing Loss

The performance of binaural processing may be disturbed in the presence of hearing loss, especially of sensorineural type. To assess the impact of hearing loss on speech perception in noise regarding binaural processing, series of speech recognition measurements in controlled laboratory conditions were carried out. The spatial conditions were simulated using dummy head recordings played back on headphones. The Intelligibility Level Difference (ILD) was determined by measuring the change in the speech reception thresholds (SRT) between two configurations of a masking signal source (N) and a speech source (S), namely the S0N90 condition (where numbers stand for angles in horizontal plane) and the co-located condition (S0N0). To disentangle the head shadow effect (better ear effect) from binaural processing in the brain, the difference between binaural and monaural S0N90 condition (so-called Binaural Intelligibility Level Difference, BILD) value was calculated. Measurements were performed with a control group of normal-hearing listeners and a group of sensorineural hearing-impaired subjects. In all conditions performance of the hearing-impaired listeners was significantly lower than normal-hearing ones, resulting in higher SRT values (3 dB difference in the S0N0 configuration, 7.6 dB in S0N90 and 5 dB in monaural S0N90). The SRT improvement due to the spatial separation of target and masking signal (ILD) was also higher in the control group (8.1 dB) than in hearing-impaired listeners (3.5 dB). Moreover, a significant deterioration of the binaural processing described by BILD was found in people with sensorineural deficits. This parameter for normal-hearing listeners reached a value of 3 to 6 dB (4.6 dB on average) and decreased more than two times in the hearing-impaired group to 1.9 dB on average (with a deviation of 1.4 dB). These findings could not be explained by individual average hearing threshold (standard in audiological diagnostics) only. The outcomes indicate that there is a contribution of suprathershold deficits and it may be useful to consider binaural SRT measurements in noise in addition to the pure tone audiometry resulting in better diagnostics and hearing aid fitting.

Assessment of the Effectiveness of a Short-term Hearing Aid Use in Patients with Different Degrees of Hearing Loss

The study presents evaluating the effectiveness of the hearing aid fitting process in the short-term use (7 days). The evaluation method consists of a survey based on the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire. Additional criteria such as a degree of hearing loss, number of hours and days of hearing aid use as well as the user’s experience were also taken into consideration. The outcomes of the benefit obtained from the hearing aid use in various listening environments for 109 hearing aid users are presented, including a degree of their hearing loss. The research study results show that it is possible to obtain relevant and reliable information helpful in assessing the effectiveness of the shortterm (7 days) hearing aid use. The overall percentage of subjects gaining a benefit when communicating in noise is the highest of all the analyzed and the lowest in the environment with reverberation. The statistical analysis performed confirms that in the listening environments in which conversation is held, a subjective indicator determined by averaging benefits for listening situations individually is statistically significant with respect to the degree of hearing loss. Statistically significant differences depending on the degree of hearing loss are also found separately for noisy as well as reverberant environments. However, it should be remembered that this study is limited to three types of hearing loss, i.e. mild, moderate and severe. The acceptance of unpleasant sounds gets the lowest rating. It has also been observed that in the initial period of hearing aid use, the perception of unpleasant sounds has a big influence on the evaluation of hearing improvement.

Development of the Polish Speech Test Signal and its Comparison with the International Speech Test Signal

The aim of this study was to create a single-language counterpart of the International Speech Test Signal (ISTS) and to compare both with respect to their acoustical characteristics. The development procedure of the Polish Speech Test Signal (PSTS) was analogous to the one of ISTS. The main difference was that instead of multi-lingual recordings, speech recordings of five Polish speakers were used. The recordings were cut into 100–600 ms long segments and composed into one-minute long signal, obeying a set of composition rules, imposed mainly to preserve a natural, speech-like features of the signal. Analyses revealed some differences between ISTS and PSTS. The latter has about twice as high volume of voiceless fragments of speech. PSTS’s sound pressure levels in 1/3-octave bands resemble the shape of the Polish long-term average female speech spectrum, having distinctive maxima at 3–4 and 8–10 kHz which ISTS lacks. As PSTS is representative of Polish language and contains inputs from multiple speakers, it can potentially find an application as a standardized signal used during the procedure of fitting hearing aids for patients that use Polish as their main language.

A Case of External Auditory Canal Inflammatory Polyp Induced by a Hearing Aid Mold Impression Foreign Body

Hearing aids are becoming more popular as the elderly population grows, but complications related to their use are also increasing. We present a rare case where an ear mold impression entered the mastoid cavity during fitting, causing delayed inflammation about 10 years later. Unlike most reported cases, this patient did not experience immediate symptoms during the impression-making process. Our case highlights the importance of thorough physical examination by an otolaryngologist, including assessment of the tympanic membrane and external auditory canal, when fitting hearing aids to prevent similar complications.

Clinical Applications of Otoacoustic Emission: A Review of the Indications in Aminu Kano Teaching Hospital Northern Nigerian

Context: An otoacoustic emission (OAE) is a low-level sound emitted by the cochlea either spontaneously or evoked by an auditory stimulus. Objectives: To determine cochlea status, specifically outer hair cells (OHC), and to determine the indications and utilization of Otoacoustic emission in Aminu Kano Teaching Hospital. Settings and Design: This was a 3 years retrospective analysis in which all patients that had Otoacoustic Emission in Aminu Kano Teaching Hospital from January 1, 2018 to December 31, 2021. Materials and Methods: The records were retrieved and the basic demographic data, indications, and findings were extracted and entered into the Excel spreadsheet. Statistical Analysis Used: Retrospective analysis of the indications of otoacoustic emission testing was done by analyzing the records of 146 patients. The data were extracted and analyzed using SPSS version 22.0 and the result presented in tables. Results: Hearing loss accounted for 37% of OAE testing done (55 patients). Hearing loss from febrile illness accounted for 12.3% (18 patients) and 12% resulted from congenital hearing loss (16 patients). Conclusion: OAEs continue to play an important role in routine audiological assessments with ever-expanding applications. There is, however, marked under-utilization of the investigation. Hopefully, the scope of applications will broaden to include hearing aid fitting and intraoperative monitoring, and using OAE as “acoustic fingerprints” becomes a reality. There is a need for more commitment by the ORL Surgeons.

Assessing Benefit of Hearing Aid Using Shortened Hearing Aid Performance Inventory

The ultimate goal of aural rehabilitation plan is successful use of amplification device in everyday communication. Insufficient quantitative information is present about the benefits of hearing aids in Pakistan. Objective: To fill this gap and gather quantitative data regarding benefit derive from hearing aids. Hence current study assessed hearing aid benefit using shortened hearing aid performance inventory, while comparing it with different parameters of hearing aid use and demographics like gender. Methods: This Cross-Sectional study was conducted at Isra Institute of Rehabilitation Sciences, Isra University, Pakistan from December 2020 to May 2021. Study recruited a sample of N=377 hearing aid users, of both genders, aged 18 to 60 years, who were using hearing aids for at least 2 months, utilizing non-probability, convenient sampling. Patient’s pure tone audiogram and shortened hearing aid performance inventory (SHAPI) was used for data collection. SPSS version-20.0 was used for data collection. T-test and Anova statistics used for data analysis with p&lt;0.05 considered significant. Results: Out of 370 individuals’ majority (71.6%) were males with mean age of 44.63 ± 12.99 years. Mean SHAPI score was 2.24 ± 0.68. There was significant association with duration of hearing aid use, hearing aid technology, hearing aid fitting and gender of participants. Conclusions: Current study revealed a low SHAPI mean score indicating benefit and satisfaction in different listening situations among hearing aid users. Benefit derived from hearing aid is significantly affected by factors like gender, hearing aid fitting, hearing aid technology and duration of hearing aid use.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults.

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.

The effect of hearing aid treatment on health-related quality of life in older adults with hearing loss

Objective To investigate the effect of hearing aid (HA) intervention on long-term health-related quality of life (HRQoL) changes in first-time and experienced HA users using the 15D questionnaire. Secondly, the study explored the relationship between clinical parameters and changes in 15D scores. Design A prospective observational study. Study sample The study population included 1562 patients (1113 first-time and 449 experienced HA users) referred for HA rehabilitation. All patients responded to the 15D at baseline, two months after HA fitting, and at long-term follow-up (698 ± 298 d). Results Among both first-time and experienced HA users, significant improvements in hearing-dimension (15D-3) score were observed at two-month follow-up which sustained at long-term follow-up. 15D total scores significantly decreased at long-term follow-up. Self-reported hearing abilities, word recognition scores, and HA use time were significantly and positively correlated to increased 15D. Conclusions Both groups of HA users reported improved hearing-related QoL after HA treatment which sustained at long-term follow-up but the improvement in total 15D total score did not sustain for either group. The results suggest that HA intervention positively affects hearing-related QoL among older adults with hearing loss, and the findings support the use of 15D as a tool for the evaluation of HA treatment effects.

Cognitive function and hearing loss: A longitudinal investigation of the effect of hearing aid use on cognitive performance in older adults

AbstractBackgroundHearing loss is highly prevalent in older adults and has been identified as the largest single potentially modifiable risk factor for dementia. Although hearing aids are a successful treatment for hearing loss, it is unknown whether their use can delay the onset of cognitive decline or improve cognitive function. Less than 20% of adults who would benefit from hearing aids actually using them. Results at 18‐ and 36‐months post‐hearing aid fitting in this prospective Australian longitudinal study will be presented.MethodParticipants were assessed before and every 18 months after hearing aid fitting. Results were compared with those of a control group of participants of a cohort study of aging in older adults (AIBL) and also with a large normative group using the cognitive assessment tool. Assessments included cognitive function (visually presented computerized assessment battery), hearing, speech perception, quality of life, activity, diet, loneliness and isolation, anxiety, depression, medical health, and genetic riskResultAfter 18 months of hearing aid use there was no significant cognitive decline for hearing aid participants, and group mean scores for executive function significantly improved, with stability or improvement for 92%. Comparative group results showed no improvement at 18 months. At 36‐month follow‐up, after almost 18 months of repeated COVID lockdowns, hearing aid use had decreased, and loneliness had increased. The previously observed improvement in executive function was no longer evident, but performance on 4/5 subtests remained stable.ConclusionThis is the first study to follow participants for this length of time. After 36 months of hearing aid use, most participants had remained stable, and a subset had improved cognitive function. These results suggest that hearing aid use may not only delay cognitive decline but could improve cognitive function. This study will continue to investigate whether cognitive function could continue to improve for some participants, and the longer‐term trajectory of effects of hearing aid use.

Impact of hearing aid technology level at first-fit on self-reported outcomes in patients with presbycusis: a randomized controlled trial.

To provide clinical guidance in hearing aid prescription for older adults with presbycusis, we investigated differences in self-reported hearing abilities and hearing aid effectiveness for premium or basic hearing aid users. Secondly, as an explorative analysis, we investigated if differences in gain prescription verified with real-ear measurements explain differences in self-reported outcomes. The study was designed as a randomized controlled trial in which the patients were blinded towards the purpose of the study. In total, 190 first-time hearing aid users (>60years of age) with symmetric bilateral presbycusis were fitted with either a premium or basic hearing aid. The randomization was stratified on age, sex, and word recognition score. Two outcome questionnaires were distributed: the International Outcome Inventory for Hearing Aids (IOI-HA) and the short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ-12). In addition, insertion gains were calculated from real-ear measurements at first-fit for all fitted hearing aids. Premium hearing aid users reported 0.7 (95%CI: 0.2; 1.1) scale points higher total SSQ-12 score per item and 0.8 (95%CI: 0.2; 1.4) scale points higher speech score per item, as well as 0.6 (95%CI: 0.2; 1.1) scale points higher qualities score compared to basic-feature hearing aid users. No significant differences in reported hearing aid effectiveness were found using the IOI-HA. Differences in the prescribed gain at 1 and 2kHz were observed between premium and basic hearing aids within each company. Premium-feature devices yielded slightly better self-reported hearing abilities than basic-feature devices, but a statistically significant difference was only found in three out of seven outcome variables, and the effect was small. The generalizability of the study is limited to community-dwelling older adults with presbycusis. Thus, further research is needed for understanding the potential effects of hearing aid technology for other populations. Hearing care providers should continue to insist on research to support the choice of more costly premium technologies when prescribing hearing aids for older adults with presbycusis. Clinical Trial Registration: https://register.clinicaltrials.gov/, identifier NCT04539847.

Amplification of the poorer ear by StereoBiCROS in case of asymmetric sensorineural hearing loss: effect on tinnitus.

Tinnitus is prevalent among patients suffering from Single-Sided Deafness (SSD) and Asymmetrical Hearing Loss (AHL). In addition to bothersome tinnitus in the poorer ear, these patients also report issues with understanding speech in noise and sound localization. The conventional treatment options offered to these patients to improve auditory abilities are cochlear implantation, bone conduction devices or Contralateral Routing Of Signal (CROS) hearing aids. It was recently found that the benefit of cochlear implantation for tinnitus associated with AHL/SSD was greater than the other two approaches. It is conceivable that the lack of stimulation provided to the poorer ear in these last approaches explains their modest impact on tinnitus perception. A new technology that combines the ability to reroute the sound from the poorer ear to the good ear (CROS system) while still stimulating the poorer ear with conventional sound amplification has recently been developed: the StereoBiCROS system. The aim of this study was to investigate the effects of this new device on tinnitus. Twelve AHL and two SSD patients aged 70.7 ± 7.9 years with tinnitus were fitted with bilateral hearing aids that included 3 programs: Stereophonic, BiCROS and StereoBiCROS (CROS + bilateral amplification). The short-and long-term effect of the approach on tinnitus was assessed using a tinnitus Loudness Visual Analog Scale (VAS) and the Tinnitus Handicap Inventory (THI), respectively. Both the VAS and the THI were used before and one month after the hearing aid fitting. Of the 14 patients who used their hearing aids daily (12.6 ± 1.6 h per day) the StereoBiCROS program was the most used program (81.8 ± 20.5% of the time). The average THI total score decreased from 47 (± 22) to 15 (± 16) (p = 0.002) and the VAS-Loudness score decreased from 7 (± 1) to 2 (± 2) (p < 0.001) after the one-month trial period. In conclusion, StereoBiCROS stimulation strategy seems to offer an effective alternative to reduce tinnitus handicap and loudness for patients with AHL/SSD and tinnitus. This effect may be driven by sound amplification of the poorer ear.