Dataset Information

Survey of Current Practice in the Fitting and Fine-Tuning of Common Signal-Processing Features in Hearing Aids for Adults.

ABSTRACT: BACKGROUND:Current guidelines for adult hearing aid fittings recommend the use of a prescriptive fitting rationale with real-ear verification that considers the audiogram for the determination of frequency-specific gain and ratios for wide dynamic range compression. However, the guidelines lack recommendations for how other common signal-processing features (e.g., noise reduction, frequency lowering, directional microphones) should be considered during the provision of hearing aid fittings and fine-tunings for adult patients. PURPOSE:The purpose of this survey was to identify how audiologists make clinical decisions regarding common signal-processing features for hearing aid provision in adults. RESEARCH DESIGN:An online survey was sent to audiologists across the United States. The 22 survey questions addressed four primary topics including demographics of the responding audiologists, factors affecting selection of hearing aid devices, the approaches used in the fitting of signal-processing features, and the strategies used in the fine-tuning of these features. STUDY SAMPLE:A total of 251 audiologists who provide hearing aid fittings to adults completed the electronically distributed survey. The respondents worked in a variety of settings including private practice, physician offices, university clinics, and hospitals/medical centers. DATA COLLECTION AND ANALYSIS:Data analysis was based on a qualitative analysis of the question responses. The survey results for each of the four topic areas (demographics, device selection, hearing aid fitting, and hearing aid fine-tuning) are summarized descriptively. RESULTS:Survey responses indicate that audiologists vary in the procedures they use in fitting and fine-tuning based on the specific feature, such that the approaches used for the fitting of frequency-specific gain differ from other types of features (i.e., compression time constants, frequency lowering parameters, noise reduction strength, directional microphones, feedback management). Audiologists commonly rely on prescriptive fitting formulas and probe microphone measures for the fitting of frequency-specific gain and rely on manufacturers' default settings and recommendations for both the initial fitting and the fine-tuning of signal-processing features other than frequency-specific gain. CONCLUSIONS:The survey results are consistent with a lack of published protocols and guidelines for fitting and adjusting signal-processing features beyond frequency-specific gain. To streamline current practice, a transparent evidence-based tool that enables clinicians to prescribe the setting of other features from individual patient characteristics would be desirable.

SUBMITTER: Anderson MC

PROVIDER: S-EPMC6366669 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Survey of Current Practice in the Fitting and Fine-Tuning of Common Signal-Processing Features in Hearing Aids for Adults.

Anderson Melinda C MC Arehart Kathryn H KH Souza Pamela E PE

Journal of the American Academy of Audiology 20180201 2

<h4>Background</h4>Current guidelines for adult hearing aid fittings recommend the use of a prescriptive fitting rationale with real-ear verification that considers the audiogram for the determination of frequency-specific gain and ratios for wide dynamic range compression. However, the guidelines lack recommendations for how other common signal-processing features (e.g., noise reduction, frequency lowering, directional microphones) should be considered during the provision of hearing aid fittin ...[more]

PMID: 29401059

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Project description:ObjectivesPrevious work has suggested that individual characteristics, including amount of hearing loss, age, and working memory ability, may affect response to hearing aid signal processing. The present study aims to extend work using metrics to quantify cumulative signal modifications under simulated conditions to real hearing aids worn in everyday listening environments. Specifically, the goal was to determine whether individual factors such as working memory, age, and degree of hearing loss play a role in explaining how listeners respond to signal modifications caused by signal processing in real hearing aids, worn in the listener's everyday environment, over a period of time.DesignParticipants were older adults (age range 54-90 years) with symmetrical mild-to-moderate sensorineural hearing loss. We contrasted two distinct hearing aid fittings: one designated as mild signal processing and one as strong signal processing. Forty-nine older adults were enrolled in the study and 35 participants had valid outcome data for both hearing aid fittings. The difference between the two settings related to the wide dynamic range compression and frequency compression features. Order of fittings was randomly assigned for each participant. Each fitting was worn in the listener's everyday environments for approximately 5 weeks before outcome measurements. The trial was double blind, with neither the participant nor the tester aware of the specific fitting at the time of the outcome testing. Baseline measures included a full audiometric evaluation as well as working memory and spectral and temporal resolution. The outcome was aided speech recognition in noise.ResultsThe two hearing aid fittings resulted in different amounts of signal modification, with significantly less modification for the mild signal processing fitting. The effect of signal processing on speech intelligibility depended on an individual's age, working memory capacity, and degree of hearing loss. Speech recognition with the strong signal processing decreased with increasing age. Working memory interacted with signal processing, with individuals with lower working memory demonstrating low speech intelligibility in noise with both processing conditions, and individuals with higher working memory demonstrating better speech intelligibility in noise with the mild signal processing fitting. Amount of hearing loss interacted with signal processing, but the effects were small. Individual spectral and temporal resolution did not contribute significantly to the variance in the speech intelligibility score.ConclusionsWhen the consequences of a specific set of hearing aid signal processing characteristics were quantified in terms of overall signal modification, there was a relationship between participant characteristics and recognition of speech at different levels of signal modification. Because the hearing aid fittings used were constrained to specific fitting parameters that represent the extremes of the signal modification that might occur in clinical fittings, future work should focus on similar relationships with more diverse types of signal processing parameters.

Project description:ObjectivesHearing aids provide various signal processing techniques with a range of parameters to improve the listening experience for a hearing-impaired individual. In previous studies, we reported significant differences in signal modification for mild versus strong signal processing in commercially available hearing aids. In this study, the authors extend this work to clinically prescribed hearing aid fittings based on best-practice guidelines. The goals of this project are to determine the range of cumulative signal modification in clinically fit hearing aids across manufacturers and technology levels and the effects of listening conditions including signal to noise ratio (SNR) and presentation level on these signal modifications.DesignWe identified a subset of hearing aids that were representative of a typical clinical setting. Deidentified hearing aid fitting data were obtained from three audiology clinics for adult hearing aid users with sensorineural hearing loss for a range of hearing sensitivities. Matching laboratory hearing aids were programmed with the deidentified fitting data. Output from these hearing aids was recorded at four SNRs and three presentation levels. The resulting signal modification was quantified using the cepstral correlation component of the Hearing Aid Speech Quality Index which measures the speech envelope changes in the context of a model of the listener's hearing loss. These metric values represent the hearing aid processed signal as it is heard by the hearing aid user. Audiometric information was used to determine the nature of any possible association with the distribution of signal modification in these clinically fit hearing aids.ResultsIn general, signal modification increased as SNR decreased and presentation level increased. Differences across manufacturers were significant such that the effect of presentation level varied differently at each SNR, for each manufacturer. This result suggests that there may be variations across manufacturers in processing various listening conditions. There was no significant effect of technology level. There was a small effect of pure-tone average on signal modification for one manufacturer, but no effect of audiogram slope. Finally, there was a broad range of measured signal modification for a given hearing loss, for the same manufacturer and listening condition.ConclusionsThe signal modification values in this study are representative of commonly fit hearing aids in clinics today. The results of this study provide insights into how the range of signal modifications obtained in real clinical fittings compares with a previous study. Future studies will focus on the behavioral implications of signal modifications in clinically fit hearing aids.

Project description:BackgroundThe main clinical intervention for mild to moderate hearing loss is the provision of hearing aids. These are routinely offered and fitted to those who seek help for hearing difficulties. By amplifying and improving access to sounds, and speech sounds in particular, the aim of hearing aid use is to reduce the negative consequences of hearing loss and improve participation in everyday life.ObjectivesTo evaluate the effects of hearing aids for mild to moderate hearing loss in adults.Search methodsThe Cochrane ENT Information Specialist searched the ENT Trials Register; the Cochrane Register of Studies Online; MEDLINE; PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 March 2017.Selection criteriaRandomised controlled trials (RCTs) of hearing aids compared to a passive or active control in adults with mild to moderate hearing loss.Data collection and analysisWe used the standard methodological procedures expected by Cochrane. The primary outcomes in this review were hearing-specific health-related quality of life and the adverse effect pain. Secondary outcomes were health-related quality of life, listening ability and the adverse effect noise-induced hearing loss. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.Main resultsWe included five RCTs involving 825 participants. The studies were carried out in the USA and Europe, and were published between 1987 and 2017. Risk of bias across the studies varied. Most had low risk for selection, reporting and attrition bias, and a high risk for performance and detection bias because blinding was inadequate or absent.All participants had mild to moderate hearing loss. The average age across all five studies was between 69 and 83 years. The duration of the studies ranged between six weeks and six months.There was a large beneficial effect of hearing aids on hearing-specific health-related quality of life associated with participation in daily life as measured using the Hearing Handicap Inventory for the Elderly (HHIE, scale range 1 to 100) compared to the unaided/placebo condition (mean difference (MD) -26.47, 95% confidence interval (CI) -42.16 to -10.77; 722 participants; three studies) (moderate-quality evidence).There was a small beneficial effect of hearing aids on general health-related quality of life (standardised mean difference (SMD) -0.38, 95% CI -0.55 to -0.21; 568 participants; two studies) (moderate-quality evidence). There was a large beneficial effect of hearing aids on listening ability (SMD -1.88, 95% CI -3.24 to -0.52; 534 participants; two studies) (moderate-quality evidence).Adverse effects were measured in only one study (48 participants) and none were reported (very low-quality evidence).Authors' conclusionsThe available evidence concurs that hearing aids are effective at improving hearing-specific health-related quality of life, general health-related quality of life and listening ability in adults with mild to moderate hearing loss. The evidence is compatible with the widespread provision of hearing aids as the first-line clinical management in those who seek help for hearing difficulties. Greater consistency is needed in the choice of outcome measures used to assess benefits from hearing aids. Further placebo-controlled studies would increase our confidence in the estimates of these effects and ascertain whether they vary according to age, gender, degree of hearing loss and type of hearing aid.

Dataset Information

Survey of Current Practice in the Fitting and Fine-Tuning of Common Signal-Processing Features in Hearing Aids for Adults.

Publications

Survey of Current Practice in the Fitting and Fine-Tuning of Common Signal-Processing Features in Hearing Aids for Adults.

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