Hearing Care Professionals Research Articles

How do adults with hearing loss, family members, and hearing care professionals respond to the stigma of hearing loss and hearing aids?

Objective To investigate the perspectives and experiences of adults with hearing loss (HL), their family members, and hearing care professionals on how they respond to the stigma of HL and hearing aids (HAs). Design Qualitative descriptive approach using semi-structured interviews. Study sample Three participant groups were recruited, including 20 adults over the age of 50 years with HL, 20 family members who had a close relationship to the adults with HL, and 25 hearing care professionals. Results Three themes described how adults with HL, family members, and hearing care professionals respond to the stigma of HL and HAs, namely: (1) some people tell others about their HL and HAs and some people don’t; (2) telling or not telling depends on the situation; and (3) people deal with the stigma of HL and HAs in different ways. Conclusions This study revealed a range of volitional responses to the stigma of HL and HAs. People affected by HL may not tell others about their HL and/or HAs because of the stigma, and these volitional responses are influenced by situational cues. Adults with HL and family members manage the stigma of HL and HAs in different ways and require a person-centred approach.

The experience of stigma related to hearing loss and hearing aids: perspectives of adults with hearing loss, their families, and hearing care professionals

Objectives To explore when and how stigma-induced identity threat is experienced by adults with hearing loss (HL) and their family members (affiliate stigma) from the perspectives of adults with HL, their family members, and hearing care professionals. Design Qualitative descriptive methodology with semi-structured interviews. Study sample Adults with acquired HL (n = 20), their nominated family members (n = 20), and hearing care professionals (n = 25). Results All groups of participants believed that both HL and hearing aids were associated with stigma for adults with HL. Two themes were identified, specifically: (1) an association between HL and hearing aids and the stereotypes of ageing, disability, and difference; and (2) varied views on the existence and experience of stigma for adults with HL. Hearing care professionals focused on the stigma of hearing aids more than HL, whereas adult participants focused on stigma of HL. Family member data indicated that they experienced little affiliate stigma. Conclusions Stigma-induced identity threat related to HL and, to a lesser extent, hearing aids exists for adults with HL. Shared perceptions that associate HL and hearing aids with ageing stereotypes were reported to contribute to the identity threat, as were some situational cues and personal characteristics.

Consumer and audiologist perspectives on hearables: a qualitative study

Objective We aimed to explore (i) what adults with hearing difficulties want and need from hearables, which we defined as any non-medical personal sound amplification product, and (ii) what hearing care professionals think about hearables. Design This was an exploratory, qualitative study conducted using separate focus groups with adults with hearing difficulties and audiologists. Data were analysed inductively using reflexive thematic analysis. Study sample Participants were 12 adults with hearing difficulties and 6 audiologists. Results Adults with hearing difficulties expressed desire for trustworthy information and support, described evaluating hearables and other devices according to diverse personal criteria, and expressed willingness to vary their budget according to product quality. Audiologists expressed views that hearables are an inferior product but useful tool, that it is not necessarily their role to assist with hearables, that hearables are a source of uncertainty, and that the provision of hearables by audiologists is not currently practical. Conclusion Adults with hearing difficulties may have complex reasons for considering hearables and may desire a high level of clinical support in this area. Ongoing research into the efficacy and effectiveness of hearables is needed together with research into effective strategies to incorporate hearables into clinical practice.

Viewpoint on the Benefit of Hearing Care on Cognitive Health.

The purpose of this article is to provide a viewpoint on the recently published results showing the positive effect hearing intervention can have on mitigating the risk of cognitive decline in elderly individuals with hearing impairment. We intend to trigger a broader discussion on the implications of these results from an implementation science perspective. Recently published results were reviewed and contextualized. In our view, these recent findings provide a great opportunity for hearing care professionals to change the perspective on hearing care being an essential service that contributes not only to managing challenges with audibility but to enabling healthy living and aging. As exciting as these findings are, from our perspective, they are also a call to action for the audiology field in terms of clinical implementation science. The findings guide us toward a more interprofessional approach in order to develop and test new, more holistic models of hearing care.

Screening and Recognition of Cognitive Impairment in Older People Visiting Hearing Aid Dispensers in the Netherlands

ObjectivesThis study aims to determine how prevalent suspected cognitive impairment is in older people visiting hearing aid dispensers, and to assess whether hearing aid dispensers’ judgment on cognition was in accordance with the outcome of a cognitive screening. DesignThis observational study was conducted between April and May 2022. Setting and ParticipantsFour private hearing aid retail stores in the Netherlands, where cognitive impairment was screened in people aged ≥60 years. MethodsThe Mini-Cog was used for cognitive screening. In addition, hearing aid dispensers were asked to provide their professional judgment if they suspected cognitive impairment. ResultsOf the total 239 older individuals screened, 133 were men [56%, mean age: 79 years (SD 8.6)], and 51 (21.3%) had abnormal outcomes on the Mini-Cog test. The recognition of possible cognitive impairment by the hearing aid dispensers compared to the outcome of the Mini-Cog resulted in correct predictions for 183 of the 239 individuals. Conclusion and ImplicationsCognitive screening in hearing-impaired older adults who visit a hearing aid dispenser suggests that cognitive impairment might be present in approximately 1 in 5 individuals. Hearing aid dispensers' response to the presence of a cognitive impairment was in 2 of 3 in accordance with an abnormal outcome on cognitive screening. To improve hearing care for people with cognitive impairment, it might be important to enhance hearing care professionals’ recognition of cognitive impairment in older individuals.

Promoting hearing and cognitive health in audiologic rehabilitation for the well-being of older adults

Objective With our aging population, an increasing number of older adults with hearing loss have cognitive decline. Hearing care practitioners have an important role in supporting healthy aging and should be knowledgeable about cognitive decline and associated management strategies to maximize successful hearing intervention. Methods A review of current research and expert opinion. Results This article outlines the association between hearing loss and cognitive decline/dementia, hypothesized mechanisms underlying this, and considers current research into the effects of hearing intervention on cognitive decline. Cognition into old age, cognitive impairment, dementia, and how to recognize cognitive decline that is not part of normal aging are described. Screening of older asymptomatic adults for cognitive decline and practical suggestions for the delivery of person-centered hearing care are discussed. Holistic management goals, personhood, and person-centered care in hearing care management are considered for older adults with normal cognitive aging through to dementia. A case study illustrates important skills and potential management methods. Prevention strategies for managing hearing and cognitive health and function through to older age, and strategies to maximize successful hearing aid use are provided. Conclusion This article provides evidence-based recommendations for hearing care professionals supporting older clients to maximize well-being through the cognitive trajectory.

Opinions of hearing-impaired individuals about social media: A preliminary study

Objectives: The study examined the opinions of hearing-impaired individuals about the content on social media platforms, their social media usage tendencies, and their feelings, thoughts, and experiences during their use. Patients and Methods: Forty individuals aged 18 years and older who are native Turkish speakers diagnosed with hearing loss regardless of the type and degree of hearing loss participated in this cross-sectional survey study between November 1, 2021, and September 1, 2022. Individuals with advanced vision problems and illiterate individuals were excluded from the study. The questionnaire consisted of four sections: (i) demographic data and hearing loss characteristics; (ii) social media usage and purposes; (iii) opinions about the content on social media; and (iv) feelings, thoughts, and experiences about social media. Responses were evaluated on a 5-point Likert-type scale. Results: The most common purposes of using social media were doing research and getting information about hearing loss and the technologies they use. Of the participants, 45.5% stated that they do not prefer their devices to be seen in the photos they share on social media platforms and that they are undecided about the ease of use of existing social media platforms for the hearing impaired. Conclusion: It is important to determine what hearing-impaired individuals feel about hearing loss and technologies, both to guide hearing care professionals and health institutions in creating content on these issues and to improve these platforms.

Centering on People: How Hearing Care Professionals Can Adapt to Consumers' Need and Outcomes.

Audiology is experiencing exponential growth in technology, service, and provision options. These advancements give hearing care professionals the opportunity to revise, potentially improve, and adapt to the modern hearing care landscape to better serve the modern consumer. Consumer needs guide care planning and delivery, with the goal of achieving outcomes that are important to both the consumer and the clinician. The changes available to the hearing care industry can also enable consumers' needs to be identified and served in a more holistic and personalized manner than has previously been possible. The purpose of this article is to explain and encourage hearing care professionals to adopt a mindset of doing whatever is reasonable and clinically appropriate to meet the need and desires of the consumer by implementing choice in service, technology, and channel across whichever model of care adopted by a provider.

Social-emotional well-being and adult hearing loss: clinical recommendations

Aim: Best-practice in audiological rehabilitation takes a holistic client- and family-centred approach and considers hearing care in the context of personal well-being. Hearing loss not only impairs the ability to hear, but can also compromise the ability to communicate, thus negatively impacting both social and emotional well-being. Hearing care professionals play a key role in fostering their client’s well-being. This paper aims to provide evidence-based recommendations to ensure inclusion of social-emotional well-being in audiologic rehabilitation clinical practice. Methods: A review of current research and expert opinion. Results: This guide proposes a 5-step plan which includes: identifying the client’s social-emotional well-being; including family members in audiological rehabilitation; incorporating social-emotional needs and goals in an individualized management plan; relating identified hearing needs and goals to rehabilitation recommendations; and using counselling skills and techniques to explore and monitor social-emotional well-being. Each component of the 5-step plan is discussed and clinical considerations are presented. Conclusion: These comprehensive recommendations provide guidance to hearing care professionals looking to ensure clients’ social-emotional well-being are considered throughout the rehabilitation journey.

Ambient Noise in Candidate Rooms for User-Operated Audiometry.

Hearing loss is a widespread problem while treatment is not always accessible, mainly because of the limited availability of hearing care professionals and clinics. In this work, part of the User-Operated Audiometry project, we investigate the acoustic environment of inexpensive non-sound-treated rooms that could be used for unsupervised audiometric testing. Measurements of 10 min of ambient noise were taken from 20 non-sound-treated rooms in libraries and private and public clinics, nine of which were measured twice. Ambient noise was compared against two traditional audiometric sound-treated rooms and Maximum Permissible Ambient noise levels by ISO 8231-1, while factoring for the attenuation by the DD450 circumaural headphones provided. In most non-sound-treated rooms, MPAs were violated only by transient sounds, while the floor-noise level was below MPAs. Non-sound-treated rooms' ambient noise levels presented with much larger fluctuations compared to sound-treated rooms. Almost all violations occurred at low to mid-low frequencies. Our results suggest that large-scale implementation of user-operated audiometry outside traditional audiometric rooms is possible, at least under some realizable conditions. Circumaural headphones' attenuation is probably a necessary condition for all cases. Depending on the room, an online system making decisions based on ambient noise might also be included in combination with active attenuation.

Hearing Aid User Perspectives: Reasons and Recommendations for Prescription and Over-The-Counter Device Uptake

Hearing Aid User Perspectives: Reasons and Recommendations for Prescription and Over-The-Counter Device Uptake

Characterization and Prediction of Speech Intelligibility at the Output of Hearing Aids in a Noisy Working Environment.

Hearing aids are more and more technically advanced, but do not necessarily guarantee the reproduction of useful signals in all working environments. This is particularly the case for speech intelligibility. This study focuses on the prediction of hearing aid performance in the case of a moderate deafness setting, in service and industrial work environments. To improve intelligibility, hearing aids propose signal processing options such as noise reduction and compression. These processes can transform hearing aids into nonlinear systems. The aim of this study is to develop a nonlinear method for the characterization of hearing aids. The method is based on the synchronized swept sine (SSS) signal method.[16] The SSS method is applied for determining hearing aid frequency responses fitted according to the present methodology and several processing options. The characterization of hearing aid's program containing the noise reduction function is specifically analyzed. Indeed, to be fully active and efficient, the hearing aid, with the noise reduction feature activated, needs to be immersed in a noisy environment which does not allow nonlinear characterization. A linear approach is taken to study this feature. Three hearing aids commonly sold by hearing care professionals are studied here; all of them have three different programs. The characterization for each program is discussed. The statistical study showed that the intelligibility, assessed using the speech transmission index in these sound environments, is well estimated for every program, although certain differences are observed when the compression effect is too high in the service work sector. The characterizations of hearing aids using the programs studied did not highlight the presence of frequency nonlinearities. The characterization method could not take into account amplitude nonlinearities when there is too much gain compression in the hearing process. Globally, all the hearing aid programs provided a very significant improvement in intelligibility in service and industrial work contexts.

Implementation science challenges: hearing care professionals identify barriers to clinical research

Objectives Conducting research in clinical settings is challenging. The aim of this study was to increase our understanding of hearing care professionals’ perceptions of barriers to participating in such research. Design A modified group concept mapping approach was used to gain anonymous responses from 124 hearing care professionals to the statement: “One reason why it is hard to conduct intervention research studies in my centre/practice is….”. Participants were asked for reasons other than ‘time’ as this is universally reported as a barrier to clinical research. Results A total of 107 distinct reasons were provided by participants and these were sorted into 5 clusters: “Competing demands/pressures” (18 statements), “Not a priority for management/organisation” (14 statements), “Lack of opportunity/support” (19 statements), “Clinician’s knowledge, confidence, and beliefs” (24 statements), and “Recruitment/adherence to protocols is challenging” (32 statements). Identified barriers were generally similar to those reported in other healthcare settings, with unique barriers being those associated with a fear of scrutiny and lack of trust in the “academic elite”. Conclusion Findings highlight the importance of researchers, clinicians, and clinic managers working together at all stages of the research process in order for clinical research to be successful.

Relating Factors and Trends in Hearing Device Adoption Rates to Opportunities for Hearing Health Care Providers.

As with many professions, audiology is continuing to evolve. More specifically in terms of hearing device technology, we see evolution in remote accessibility to providers, public knowledge of devices, and services provided by hearing care professionals. Each of these topics plays a role in an individual's decision to pursue any sort of hearing care services. Given the variety of new devices soon coming to the market (over-the-counter devices), it is important for the audiologist to understand patient motivators and how they have a great impact on both the practice of audiology as well as the patient's overall satisfaction. The goal of this article is to investigate the MarkeTrak 2022 data to determine the trends in adoption and use of hearing aids as well as examine predictive factors that can be used to better understand hearing aid adoption.

Hearing Aid Benefit and Satisfaction Results from the MarkeTrak 2022 Survey: Importance of Features and Hearing Care Professionals.

The hearing aid market is rapidly evolving with advancements in features and potential changes in service delivery models, including the new over-the-counter device category. Data from the MarkeTrak 2022 survey indicate most hearing aid owners report regular quality-of-life benefits from hearing aids, even more than in previous surveys. The increased likelihood of hearing aid benefits might be attributable to modern hearing aid features advancements, such as wireless connectivity and rechargeable batteries. Hearing aid satisfaction rates have been relatively stable over the years, indicating that more than 80% of hearing aid owners are satisfied with their devices. Hearing aid satisfaction rates do not appreciably vary by fitting channel; hearing aid owners fitted in person, fitted remotely, or self-fit are similarly likely to report high satisfaction with their device. However, only respondents in the in-person channel gave establishment ratings (reflecting their willingness to recommend) that resulted and reflected a positive net promoter score. Given the potential for net promoter scores to be related to brand growth and customer loyalty, this finding has implications for the development of over-the-counter hearing aid service-delivery models. Additional work is warranted to explore the factors that negatively affect hearing aid owners' satisfaction with the companies delivering limited services.

The Acoustics of Instant Ear Tips and Their Implications for Hearing-Aid Fitting.

Objectives:Today, approximately 70 to 80% of hearing aid fittings are made with silicone instant ear tips rather than custom earmolds. Nevertheless, little is known about the impact of instant ear tips on the acoustic coupling between the hearing aid receiver and the individual ear canal, even though it can have a major impact on the overall sound of the hearing aids. This study aimed to investigate the acoustic properties of different instant ear tip types and their across-subject variability, the within-subject reliability of those properties, and the influence of the users’ level of experience with ear-tip insertion on the acoustics. Furthermore, subjective ratings of occlusion produced by the ear tips were considered.Design:Five types of instant ear tips (Open, Tulip, Round [2-vent], Round [1-vent], Double Domes) provided by the hearing aid manufacturer Widex were considered in this study. Probe-microphone measurements were performed at the eardrums of 30 participants (60 ears). In the first experiment, the real ear occluded insertion gain and the vent effect (VE) were measured, and the listeners rated the subjective occlusion experienced with each ear tip. In the second experiment, the same measurements were repeated six times per participant. The within-subject variability of the acoustic ear tip properties was investigated as well as the impact of the degree of users’ experience with ear tip insertion on the resulting real ear measurements.Results:All tested ear tips were, on average, acoustically transparent up to 1 kHz except Double Domes, which were only transparent up to 600 Hz. Distinct VE profiles were found for each ear tip type, but a large across-subject variability was observed for both real ear occluded insertion gain and VE. However, the within-subject reliability was high. The measured VE was highly correlated with the perceived occlusion. Finally, no significant effect of the level of experience in ear tip insertion on the acoustic properties of the ear tips was found, but the within-subject variability was larger in the less experienced group.Conclusions:These results suggest that the acoustic properties of instant ear tips and their coupling to the individual ear canal impact the resulting hearing aid fitting and should be considered by the hearing care professionals and reflected in the fitting software. The high within-subject reliability indicates that the ear tip acoustics remain stable for the individual in daily use. Finally, real ear measurements should be considered an essential part of the hearing aid fitting process in clinical practice to ensure an optimal fit for the individual hearing aid user.

Approach and solutions to congenital hearing impairment in Cameroon: perspective of hearing professionals

ObjectivesTo bring out the diagnostic attitude of hearing professionals in Cameroon towards congenital hearing impairment (CHI), assess availability of tests, neonatal screening, and create a national map of availability of treatment opportunities.MethodsWe conducted a cross-sectional online-based survey from June to December 2021, concerning ear–nose–throat (ENT) specialists, hearing care professionals, speech therapists and ENT nurses. A Google Forms online questionnaire was used to collect data, filled by eligible professionals involved in hearing care in Cameroon.ResultsA total of 93 professionals working in 31 different health facilities participated. A cumulative percentage of 79.9% of ENTs were found in just two out of 10 regions. Specialists sought by ENTs for assessment of patients with CHI included neurologists/neuro-pediatricians (96.8%), pediatricians (47.6%), other ENTs (34.9%), and psychologists (3.2%). Investigations requested included auditory-evoked brainstem response (ABR; 87.3%), otoacoustic emissions recording (OAE; 71.4%), and tympanometry (66.7%). There were eight OAE and nine ABR machines in the country. Twenty-five (88.6%) out of 31 facilities with otolaryngologists did not carry out systematic neonatal screening. Reasons included unavailability of equipment (21; 84%), and administrative delays (14; 56%). Sixteen (51.6%) facilities had ENTs with additional training in otologic surgery and 11 (35.5%) were equipped to perform ear surgery. Three centers (9.7%) specialized in hearing aid provision and maintenance services. Three hospitals (9.7%) had performed cochlear implantation.ConclusionOur results show scarcity and overt unevenness in distribution of specialists, equipment and solutions to CHI in Cameroon. A serious negative health care consequence of this shortage is the unavailability of universal newborn hearing screening and implementation programs.

Self-reported listening effort in adults with and without hearing loss: the Danish version of the Effort Assessment Scale (D-EAS)

Purpose Hearing-impaired individuals experience higher levels of listening effort in challenging situations, affecting their communication in daily life. The purpose of this study was to linguistically and culturally adapt the Effort Assessment Scale (EAS) into Danish (D-EAS) and to investigate its reliability and validity in normal-hearing and hearing-impaired listeners. Methods The translation and cross-cultural adaptation of the EAS aligns with recommendations to adapt hearing-related questionnaires for different languages and cultures. Participants were 157 listeners (85 females) aged 20–86 years (Mage = 62.5, SD = 16.8), with (non-hearing aid and hearing aid users) and without hearing loss. Results Reliability analysis showed good internal consistency for the six items in the D-EAS (Cronbach's α= 0.93). Exploratory and confirmatory factor analyses showed that D-EAS is a one-dimensional instrument. Significant differences were observed across items and overall scores between normal hearing (NH) and hearing loss groups. Conclusions The D-EAS reliably estimates self-perception of listening effort in adults with and without hearing loss and is sensitive to the impact of hearing loss. Thus, the D-EAS can provide hearing care professionals and hearing researchers with valuable insights into people's self-perception of listening effort to help guide clinical and other rehabilitation decisions. Implications for Rehabilitation The Effort Assessment Scale (EAS) into Danish (D-EAS) is a reliable tool to estimate self-perception of listening effort in hearing-impaired adults. The D-EAS could be a helpful tool providing insights about aspects of hearing disability that is not commonly addressed with the traditional hearing assessments. The D-EAS can be incorporated in the hearing rehabilitation process as a tool for evaluating self-perception of listening effort in daily life situations. The D-EAS is easy to administer and requires a short time to answer, allowing its use by clinicians and hearing researchers in different settings.

Cognitive screenings in otolaryngology? The time has come

The demographics and communicative disorders which traverse aging, neurocognitive disorders and auditory problems are staggering. Lancet Public Health1 estimates 57 million people globally with dementia in 2019 and by 2050 there will be 153 million cases. People seek counsel from hearing care professionals (HCPs) because of complaints and observations such as they cannot understand speech-in-noise (SIN), and/or they are not sure what someone just said, and/or they cannot recall the details of a recent conversation. For many, the complaints and observations of hearing and listening disorders are the same as, and may overlap with complaints and observations of, mild cognitive impairment and other neurocognitive disorders. In this article we review the current knowledge related to cognition and audition; we explore the practical reasons for incorporating cognitive screening into otolaryngology clinics, with specific regard to patients with hearing and listening problems. We review and explore auditory and cognitive disorders and we specify that these are not silos. That is, they may (and often do) occur in-isolation or in-tandem. We will review multiple studies which demonstrate that for some people, some of the time, early detection of neurocognitive anomalies may help facilitate an improved cognitive trajectory via hearing aid amplification, cochlear implantation, and through attending to modifiable risk factors.

Telerehabilitation of hearing-impaired children during COVID-19 pandemic

To evaluate advantages and effectiveness of remote rehabilitation services for hearing-impaired children at Center of Pediatric Audiology during COVID-19 pandemic. 181 children with different types and degrees of permanent hearing loss, their parents and 10 hearing care professionals (audiologists, speech-language therapists) were included in the study. 2115 rehabilitation services were provided during 3 months: video- and text consultations, video lessons with child, sending homework to parents, etc. The results of questionnaires showed that, on specialists' and parents' opinion, remote rehabilitation care is effective tool for hearing impaired children during emergency situations. TeleCare allowed to improve parents' abilities to manage with children by themselves, their understanding goals and methods of rehabilitation, improving child's hearing and speech skills. 95% of parents were satisfied by remote rehabilitation. Advantages and problems of remote hearing rehabilitation were analyzed from the sides of professionals and parents. The most challenging activities for professionals during TeleCare were: evaluation of HA/CI effectiveness, diagnosis and developing of hearing and speech. The experience of remote hearing rehabilitation in emergency situation allows to conclude that this type of care could be useful in clinical practice after pandemic for parents consulting and for children with motor problems.