Is the outcome of fitting hearing aids to adults affected by whether an audiogram-based prescription formula is individually applied? A systematic review protocol.
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ABSTRACT: Introduction
Hearing aids are typically programmed using the individual's audiometric thresholds. Developments in technology have resulted in a new category of direct-to-consumer devices, which are not programmed using the individual's audiometric thresholds. This review aims to identify whether programming hearing aids using the individual's audiogram-based prescription results in better outcomes for adults with hearing loss.Methods and analysis
The methods of this review are reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. On 23 August 2020, eight different databases were systematically searched without any restrictions: EMBASE, MEDLINE, PubMed, PsycINFO, Web of Science, Cochrane Library, Emcare and Academic Search Premier. To ensure that this review includes the most recent evidence, the searches will be repeated at the final write-up stage. The population of interest of this review will be adults with any degree or type of hearing loss. The studies should compare hearing aids programmed using an audiogram-based prescription (and verified in the real ear) with those not programmed on the basis of the individual's audiogram. The primary outcome of interest is consumers' listening preferences. Hearing-specific health-related quality of life, self-reported listening ability, speech intelligibility of words and sentences in quiet and noisy situations, sound quality ratings and adverse events are the secondary outcomes of interest. Both randomised and non-randomised controlled trials will be included. The quality of each individual study and the overall evidence will be assessed using Downs and Black's checklist and the Grading of Recommendations, Assessment, Development and Evaluations tool, respectively.Ethics and dissemination
We will only retrieve and analyse data from published studies, so no ethical approval is required. The review findings will be published in a peer-reviewed journal and presented at scientific conferences.Prospero registration number
CRD42020197232.
SUBMITTER: Almufarrij I
PROVIDER: S-EPMC8330563 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesWe developed a framework for objectively comparing hearing aids, independent of brand, type, or product family. This was done using a large dataset of commercially available hearing aids. To achieve this, we investigated which hearing aid features are suitable for comparison, and are also relevant for the rehabilitation of hearing impairment. To compare hearing aids objectively, we distinguished populations of hearing aids based on a set of key hearing aid features. Finally, we describe these hearing aid subpopulations so that these could potentially be used as a supporting tool for the selection of an appropriate hearing aid.DesignIn this study, we used technical (meta-)data from 3911 hearing aids (available on the Dutch market in March 2018). The dataset contained about 50 of the most important characteristics of a hearing aid. After cleaning and handling the data via a well-defined knowledge discovery in database procedure, a total 3083 hearing aids were included. Subsequently, a set of well-defined key hearing aid features were used as input for further analysis. The data were split into an in-the-ear style hearing aid subset and a behind-the-ear style subset, for separate analyses. The knowledge discovery in databases procedure was also used as an objective guiding tool for applying an exploratory cluster analysis to expose subpopulations of hearing aids within the dataset. The latter was done using Latent Class Tree Analysis, which is an extension to the better-known Latent Class Analysis clustering method: with the important addition of a hierarchical structure.ResultsA total of 10 hearing aid features were identified as relevant for audiological rehabilitation: compression, sound processing, noise reduction (NR), expansion, wind NR, impulse (noise) reduction, active feedback management, directionality, NR environments, and ear-to-ear communication. These features had the greatest impact on results yielded by the Latent Class Tree cluster analysis. At the first level in the hierarchical cluster model, the two subpopulations of hearing aids could be divided into 3 main branches, mainly distinguishable by the overall availability or technology level of hearing aid features. Higher-level results of the cluster analysis yielded a set of mutually exclusive hearing aid populations, called modalities. In total, nine behind-the-ear and seven in-the-ear modalities were found. These modalities were characterized by particular profiles of (complex) interplay between the selected key features. A technical comparison of features (e.g., implementation) is beyond the scope of this research.ConclusionsCombining a large dataset of hearing aids with a probabilistic hierarchical clustering method enables analysis of hearing aid characteristics which extends beyond product families and manufacturers. Furthermore, this study found that the resulting hearing aid modalities can be thought of as a generic alternative to the manufacturer-dependent proprietary "concepts," and could potentially aid the selection of an appropriate hearing aid for technical rehabilitation. This study is in line with a growing need for justification of hearing aid selection and the increasing demand for evidence-based practice.
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Project description:(1) Introduction: The validity of self-reported hearing disability measures has been assessed using their correlation with the pure-tone average (PTA) hearing loss for non-cognitively impaired adults. However, for people with cognitive impairment, factors in addition to the PTA can play a role in their self-reported difficulties. Patients with cognitive impairment may experience more hearing difficulties due to their brain processing sounds abnormally, irrespective of PTA. (2) Methods: Three groups of hearing aid users who had normal cognition, mild cognitive impairment and dementia were recruited. Self-reported hearing abilities were assessed with the modified Amsterdam inventory for auditory disability (mAIAD) and the speech, spatial and qualities of hearing scale (SSQ). (3) Results: The SSQ and mAIAD scores were highly correlated with each other for all three groups. However, a correlation with objective PTA was found in the normal cognition but not the cognitively impaired groups. Self-reported hearing scores were associated with cognitive scores for the dementia group (4) Discussion: In people with combined cognitive and hearing impairment, PTA alone may be a poor predictor of hearing abilities. Subjective hearing questionnaires together with hearing tests may provide a better understanding of their hearing difficulties.
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Project description:BackgroundCurrent 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.PurposeThe purpose of this survey was to identify how audiologists make clinical decisions regarding common signal-processing features for hearing aid provision in adults.Research designAn 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 sampleA 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 analysisData 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.ResultsSurvey 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.ConclusionsThe 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.
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Project description:TV listening plays a large role in the lives of hearing-impaired (HI) individuals. Yet, few studies have examined TV listening in this group. In this paper, we report the findings of an online survey on TV listening conducted among HI individuals with and without hearing aids (HAs) in the United States in 2015. The research investigated if and in what form TV listening experiences of unaided and aided HI individuals might differ with regard to their viewing habits, difficulties they experience, and compensation strategies they employ. 515 HI people of ages 50+ years participated, 260 of whom owned HAs. HA users reported that they watched TV or video on average for 6 hours 10 min per day, 57 minutes longer than the duration reported by non-HA owners. Furthermore, HA users indicated fewer difficulties when watching TV than non-HA owners, suggesting that HA usage alleviated difficulties with TV listening. Nevertheless, the most frequent problems were still encountered by more than 39% of the HA users. Difficulties increased with greater self-reported unaided hearing disability, and female participants indicated more problems than male participants. Finally, those with carpeted floors reported fewer difficulties than those without carpets. The most frequently used compensation strategies were changing TV or HA volumes and using closed captioning. Only few HA users used audio streaming accessories. Given the exploratory nature of this study, further research is needed to inform interventions and improve the TV listening experiences of HI viewers.
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Project description:Hearing in noise is a core problem in audition, and a challenge for hearing-impaired listeners, yet the underlying mechanisms are poorly understood. We explored whether harmonic frequency relations, a signature property of many communication sounds, aid hearing in noise for normal hearing listeners. We measured detection thresholds in noise for tones and speech synthesized to have harmonic or inharmonic spectra. Harmonic signals were consistently easier to detect than otherwise identical inharmonic signals. Harmonicity also improved discrimination of sounds in noise. The largest benefits were observed for two-note up-down "pitch" discrimination and melodic contour discrimination, both of which could be performed equally well with harmonic and inharmonic tones in quiet, but which showed large harmonic advantages in noise. The results show that harmonicity facilitates hearing in noise, plausibly by providing a noise-robust pitch cue that aids detection and discrimination.
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Project description:The threshold equalizing noise (TEN(HL)) is a clinically administered test to detect cochlear "dead regions" (i.e., regions of loss of inner hair cell [IHC] connectivity), using a "pass/fail" criterion based on the degree of elevation of a masked threshold in a tone-detection task. With sensorineural hearing loss, some elevation of the masked threshold is commonly observed but usually insufficient to create a "fail" diagnosis. The experiment reported here investigated whether the gray area between pass and fail contained information that correlated with factors such as age or cumulative high-level noise exposure (>100 dBA sound pressure levels), possibly indicative of damage to cochlear structures other than the more commonly implicated outer hair cells. One hundred and twelve participants (71 female) who underwent audiometric screening for a sensorineural hearing loss, classified as either normal or mild, were recruited. Their age range was 32 to 74 years. They were administered the TEN test at four frequencies, 0.75, 1, 3, and 4 kHz, and at two sensation levels, 12 and 24 dB above their pure-tone absolute threshold at each frequency. The test frequencies were chosen to lie either distinctly away from, or within, the 2 to 6 kHz region where noise-induced hearing loss is first clinically observed as a notch in the audiogram. Cumulative noise exposure was assessed by the Noise Exposure Structured Interview (NESI). Elements of the NESI also permitted participant stratification by music experience. Across all frequencies and testing levels, a strong positive correlation was observed between elevation of TEN threshold and absolute threshold. These correlations were little-changed even after noise exposure and music experience were factored out. The correlations were observed even within the range of "normal" hearing (absolute thresholds ≤15 dB HL). Using a clinical test, sensorineural hearing deficits were observable even within the range of clinically "normal" hearing. Results from the TEN test residing between "pass" and "fail" are dominated by processes not related to IHCs. The TEN test for IHC-related function should therefore only be considered for its originally designed function, to generate a binary decision, either pass or fail.
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Project description:IntroductionClinically, recording hearing detection thresholds and representing them in an audiogram is the most common way of evaluating hearing loss and starting the fitting of hearing devices. As an extension, we present the loudness audiogram, which does not only show auditory thresholds but also visualizes the full course of loudness growth across frequencies. The benefit of this approach was evaluated in subjects who rely on both electric (cochlear implant) and acoustic (hearing aid) hearing.MethodsIn a group of 15 bimodal users, loudness growth was measured with the cochlear implant and hearing aid separately using a loudness scaling procedure. Loudness growth curves were constructed, using a novel loudness function, for each modality and then integrated in a graph plotting frequency, stimulus intensity level, and loudness perception. Bimodal benefit, defined as the difference between wearing a cochlear implant and hearing aid together versus wearing only a cochlear implant, was assessed for multiple speech outcomes.ResultsLoudness growth was related to bimodal benefit for speech recognition in noise and to some aspects of speech quality. No correlations between loudness and speech in quiet were found. Patients who had predominantly unequal loudness input from the hearing aid, gained more bimodal benefit for speech recognition in noise compared to those patients whose hearing aid provided mainly equivalent input.ConclusionResults show that loudness growth is related to bimodal benefit for speech recognition in noise and to some aspects of speech quality. Subjects who had different input from the hearing aid compared to CI, generally gained more bimodal benefit compared to those patients whose hearing aid provided mainly equivalent input. This suggests that bimodal fitting to create equal loudness at all frequencies may not always be beneficial for speech recognition.
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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.
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Project description:ObjectivesUsher syndrome is the leading cause of hereditary deaf-blindness. Most patients with Usher syndrome type IIa start using hearing aids from a young age. A serious complaint refers to interference between sound localisation abilities and adaptive sound processing (compression), as present in today's hearing aids. The aim of this study was to investigate the effect of advanced signal processing on binaural hearing, including sound localisation.Design and participantsIn this prospective study, patients were fitted with hearing aids with a nonlinear (compression) and linear amplification programs. Data logging was used to objectively evaluate the use of either program. Performance was evaluated with a speech-in-noise test, a sound localisation test and two questionnaires focussing on self-reported benefit.ResultsData logging confirmed that the reported use of hearing aids was high. The linear program was used significantly more often (average use: 77%) than the nonlinear program (average use: 17%). The results for speech intelligibility in noise and sound localisation did not show a significant difference between type of amplification. However, the self-reported outcomes showed higher scores on 'ease of communication' and overall benefit, and significant lower scores on disability for the new hearing aids when compared to their previous hearing aids with compression amplification.ConclusionsPatients with Usher syndrome type IIa prefer a linear amplification over nonlinear amplification when fitted with novel hearing aids. Apart from a significantly higher logged use, no difference in speech in noise and sound localisation was observed between linear and nonlinear amplification with the currently used tests. Further research is needed to evaluate the reasons behind the preference for the linear settings.
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Project description:The aim of this study was to compare elderly individuals who are hearing impaired but inexperienced in using hearing aids (hearing aid non-users; HA-NU) with their aided counterparts (hearing aid users; HA-U) across various auditory and non-auditory measures in order to identify differences that might be associated with the low hearing aid uptake rate. We have drawn data of 72 HA-NU and 139 HA-U with a mild-to-moderate hearing loss, and matched these two groups on the degree of hearing impairment, age, and sex. First, HA-NU and HA-U were compared across 65 auditory, cognitive, health-specific, and socioeconomic test measures as well as measures assessing technology commitment. Second, a logistic regression approach was performed to identify relevant predictors for using hearing aids. Finally, we conducted a sensitivity analysis for the matching approach. Group comparisons indicated that HA-NU perceive their hearing problem as less severe than their aided counterparts. Furthermore, HA-NU showed worse technology commitment and lower socioeconomic status than HA-U. The logistic regression revealed self-reported hearing performance, technology commitment, and the socioeconomic and health status as the most important predictors for using hearing aids.
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