Initial-Fit Approach Versus Verified Prescription: Comparing Self-Perceived Hearing Aid Benefit

1. Initial-Fit Approach Versus Verified Prescription: Comparing Self-Perceived Hearing Aid Benefit Abrams, H., Chisolm, T., McManus, M., McArdle, R. Journal of the American Academy of Audiology, 23(10), 768-778

2. What they did . . . 22 experienced hearing aid users Crossover design with two intervention groups: ½ were first fitted with hearing aids via the manufacturer’s first fit Second group were first fitted with hearing aids verified with probe-mic (REAR) to NAL-NL1 prescription After real-world use (4-6 weeks), all then “crossed-over” to other fitting

3. APHAB benefit scores for the two conditions

4. Preference for “initial” versus “verified prescriptive” fitting plotted as a function of difference in APHAB Global score. APHAB scores significantly better for those fitted to the NAL 15/22 preferred the verified prescription fitting

5. Clinical Tip From This Article? Yes, fitting to target does matter. And yes, the only way you will know if you’ve fit to target is to verify with probe-mic measures!

6. MarkeTrak VIII and hearing aid verification—and satisfaction?A publication from Sergei Kochkin (2010, Hearing Review), “with a little help from his friends.”

7. But that wasn’t evenALL the authors

8. Some of the primary purposes of the survey: • Determine overall satisfaction with amplification • Determine common fitting practices (as reported by the patients) • Determine if fitting practices influence satisfaction • Determine if specific aspects of fitting/verification impact satisfaction more significantly than others.

9. Brief review of procedures: • A short screening survey was sent to 80,000 members of the National Family Organization households (balanced for age, income, market, etc). • This survey was completed by 46,843; 14,623 stated that at least one family member had a hearing loss; 3789 were owners of hearing aids. • In 2009, a detailed seven-page survey was sent to the hearing aid owners. There was a response rate of 84% (3174). • Narrowing this data base to individuals who had hearing aids that were no more than four years old: 1141 experienced users and 884 new users. • Mean age (~71 years), gender (~55% male) and hearing aid age (~1.8 years) was similar for both groups

10. Survey items related to testing, verification, overall hearing aid fitting, and audiologic rehabilitation. (respondents indicated whether they received this testing/service—could respond “not sure.”) • Hearing tested in sound booth • Loudness discomfort measurement • Real-ear measurement used for verification • Measurement of objective benefit (e.g., pre-post measurement of speech understanding) • Measurement of subjective benefit • Patient satisfaction measurement • Auditory retraining software therapy • Enrolled in aural rehabilitation group • Received self-help book/literature/video • Referred to self-help group (e.g, HLAA).

11. Three items that probably relate to most all of you . . . • Hearing tested in sound booth • Loudness discomfort measurement • Real-ear measurement used for verification • Measurement of objective benefit (e.g., pre-post measurement of speech understanding) • Measurement of subjective benefit • Patient satisfaction measurement • Auditory retraining software therapy • Enrolled in aural rehabilitation group • Received self-help book/literature/video • Referred to self-help group (eg, HLAA).

12. What percent got what testing? The testing that was conducted was not significantly different for new versus vs. experienced users, or audiologists vs. HISs: • LDL (Loudness) Measures 68% • Real-ear Measures 42% • Objective benefit measure 67%

13. So what about the patients success with hearing aids? Overall success was measured using a statistical composite of the following factors: • Hearing aid use • Benefit and Satisfaction 1. Satisfaction with hearing aids to “improve hearing” 2. Perception of problem resolution for 10 different listening situations (only ones that applied to them) 3. Satisfaction for different listening situations • Patient purchase recommendations (e.g., recommend hearing aids for friends?)

14. What we really want to know:Was there a significant relationship between the testing conducted at the time of the fitting, and subsequent real-world satisfaction with hearing aids? Or not?

15. Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331) Recall that overall 68% of all patients received this testing

16. Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331) This is in agreement with a previous MarkeTrak finding that conducting a structured satisfaction survey improves overall patient satisfaction by 7%.

17. Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

18. Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

19. Satisfaction vs. testing for individuals who were either >1 s.d. above the mean (n=407) or >1 s.d. below the mean (n=331)

20. The effect of the overall protocol (# of tests administered) on patient satisfaction: Reasonable Goal? What they do at that “office down the street”

21. Clinical Tip From This Article? There is a relationship between verification/validation and hearing aid satisfaction. Simply, more verification leads to happier patients. Caveat : We really don’t know if this is because the patients have a better fitting following the verification, or, do they simply have more confidence in the fitting because of the thoroughness and added counseling?

22. In general, we’ll talk about four important components of fitting hearing aids: • Pre-fitting considerations • Selection of technology • Verification of the fitting • Post-fitting follow-up and counseling

23. The effects of hearing aid use on listening effort and mental fatigue associated with sustained speech processing demands Ben Hornsby (a Vandy guy) Ear and Hearing, 2013, 34 (5), 523-534

24. What the research was all about . . . Quantify the impact of hearing aid use and advanced signal processing on measures of listening effort and auditory mental fatigue

25. What he did . . . 16 adults (47-69 years); Mild to severe sloping SNHL Dual-task paradigm Word recognition Word Recall Visual Reaction Time (RTs)

26. What he did . . . Fitted with hearing aids; Used in real world 2 weeks prior to each test condition Subjective ratings of listening effort during the day Ratings of fatigue and attentiveness immediately before and after the dual-task

27. What he found. . . Word recall was better and RTs were faster in aided compared to unaided Word recognition and recall were resistant to mental fatigue Subjective and objective measures of listening effort and fatigue weren’t correlated Age and degree of hearing loss weren’t predictive

28. Clinical Tip From This Article? We sometimes forget some of the more subtle benefits of hearing aid use, such as improved dual tasking—in this case word recall and reaction time.

29. And finally . . . How about some really “current” research findings--Last month’s meeting at Lake Tahoe!

30. Have you ever wondered: How large does an SNR advantage need to be before it’s meaningful to a patient? On a meaningful increase in signal-to-noise ratio McShefferty D., Whitmer W., Akeroyd M. (verbally; 7 days ago)

31. In the clinic, the JND for an SNR change? 3 dB

32. But what if the judgments were not just about JNDs, but . . . • Would you be willing to go see an audiologist for this increase in SNR? • Would you be willing to swap devices for this increase in SNR? What SNR then became meaningful?

33. 6 dB

34. Clinical Tip From This Article? If your patient is a previous hearing aid user, it’s pretty unlikely that the new hearing aids will provide a 3 dB advantage to what they were already wearing. A 6 dB advantage? Only with a remote microphone!