Predictors of Hearing Aid Use in the Advanced Digital Era: An Investigation of Benefit, Satisfaction, and Self-Efficacy.

BACKGROUND: Untreated sensorineural hearing loss (SNHL) has been linked to depression, social isolation, anxiety, and a reduction in health-related quality of life (QoL), and is independently associated with cognitive decline. Only one in five persons with SNHL pursues amplification; 76-97% of those having hearing aids report regular or occasional use. Although hearing aid use during all waking hours is advocated for children, recommendations for adults are not as clear. Treatment outcomes, including benefit, satisfaction, and self-efficacy with hearing aids, may be predictors of self-reported hearing aid use, which is useful in clinical practice. PURPOSE: The aim of this study was to determine average hours of self-reported daily hearing aid use by adults and if treatment outcome measures of benefit, satisfaction, and self-efficacy with hearing aids can predict self-reported daily hearing aid use in adults. RESEARCH DESIGN: The present study was a prospective cross-sectional survey with retrospective chart review. STUDY SAMPLE: The study sample consisted of 152 experienced adult advanced digital technology (ADT) hearing aid users between 18 and 90 years of age who were patients in a two-office private practice in California. DATA COLLECTION AND ANALYSIS: A postal survey was sent to 500 experienced adult ADT hearing aid users. Participants completed the Visual Analog Scale for Daily Use of Hearing Aids (VASuse) and validated measures of (1) self-efficacy, (2) satisfaction, and (3) benefit. Retrospective data were collected for all respondents via chart review. Multivariable linear regression was used to explore relationships between treatment outcomes and hearing aid use. RESULTS: Experienced hearing aid users wore their hearing aids an average of 12.0 h/day. Daily hearing aid use was significantly associated with residual participation restriction (RPR) on the International Outcome Inventory for Hearing Aids (IOI-HA) item 5 (p = 0.02). The VASuse was significantly associated with the IOI-HA factor 1, "Me and My Hearing Aids" (p = 0.03), an aggregate measure of satisfaction, benefit, and QoL. CONCLUSIONS: Participants reported wearing their hearing aids an average of 12.0 h/day. Self-reported daily hearing aid use was associated with a combination of satisfaction, benefit, and increased QoL, and with RPR. The interconnectedness of satisfaction, benefit, and QoL positively affected hearing aid use, and greater levels of RPR seemed to discourage hearing aid use. If hearing aid owners are inconsistent or nonusers, then counseling and outcome measures should be used in the domains of satisfaction, benefit, and QoL. Future research should involve additional ADT hearing aid users with different experience levels across various study sites.

Large Vestibular Aqueduct Syndrome: Parents' and Audiologists' Perspectives.

BACKGROUND: Large vestibular aqueduct syndrome (LVAS) is an auditory disorder that is difficult to diagnose and manage; it is confirmed when the vestibular aqueduct is >1.5 mm in diameter. Diagnosis of LVAS in children can devastate parents and challenge healthcare professionals who serve these patients and their families. PURPOSE: This study surveyed parents of children with LVAS about their knowledge of and experiences with LVAS and their attitudes about the support provided to them by healthcare professionals. This study also surveyed audiologists about their knowledge of and experiences with LVAS and their level of confidence in serving families with children having this disorder. RESEARCH DESIGN: Cross-sectional survey. STUDY SAMPLE: 100 parents, mostly mothers, and 144 audiologists responded to invitations to participate in surveys designed to elicit information about their knowledge of, experiences with, and attitudes toward LVAS. DATA COLLECTION AND ANALYSIS: Invitations via links to participate in a survey on surveymonkey.com were posted in LVAS support group pages on Facebook.com for parents and sent to audiologists randomly selected from the American Academy of Audiology Membership Directory. Descriptive statistics were used to analyze trends in parents' and audiologists' responses. RESULTS: A response rate could not be obtained for the parents' survey because it was impossible to know how many parents actually viewed the invitation to participate via Facebook.com. The response rate for the audiologists' survey was 10%. Most of the parents reported that their children had clinical trajectories similar to those of cases reported in the literature, and said they needed more information from their healthcare providers, especially pediatricians and primary care physicians. Most of the audiologists felt confident in their knowledge of and/or skills in aiding in the diagnosis and/or treatment of LVAS, except for issues surrounding cochlear implants. Audiologists were interested in obtaining continuing education about LVAS from multiple sources. CONCLUSIONS: Parents of children having LVAS need greater support from their healthcare providers, who in turn need additional information on the topic and should collaborate for supportive and appropriate interprofessional care.

Effects of Including Information about Hidden Hearing Loss in an Adopt-A-Band Program on College Band Members' Attitudes toward Healthy Hearing Behaviors.

Young musicians may be at risk for developing cochlear synaptopathy (CS), or hidden hearing loss (HHL), that could lead to permanent music-induced hearing loss (MIHL). Patients with CS often complain of tinnitus and/or difficulty understanding speech in noisy situations, even though traditional audiometric testing indicates normal hearing. The aim of this article was to determine the effects of including information about HHL on an Adopt-A-Band program involving college band members' concern about and self-efficacy toward the prevention of MIHL. We conducted a single-blinded, randomized clinical trial. Forty-eight band members participated in this study. Band members were randomly assigned to two Adopt-A-Band presentations, one with and one without information on HHL. Including information about HHL had no effect on these band members' concerns about and self-efficacy toward the prevention of MIHL. However, the Adopt-A-Band program resulted in significantly increased concern for MIHL by 39.5% ( p < 0.0001, 95% confidence interval [CI]: 25-54.2), self-efficacy in its prevention by 79.1% ( p < 0.0001, 95% CI: 66.9-91.2), and plans to use musicians' earplugs while playing by 67.4% ( p < 0.0001, 95% CI: 53.4-81.45). Although inclusion of information about HHL did not have a significant effect, the Adopt-A-Band program, in general, significantly increased the immediate intent of these students to practice healthy hearing behaviors. Future research is needed to determine the long-term effects of using the Adopt-A-Band program with university marching bands' use of healthy hearing behaviors.

Hearing Aids as a Treatment for Tinnitus Patients with Slight to Mild Sensorineural Hearing Loss.

Persons with clinically significant tinnitus also may have mild sensorineural hearing loss (MSNHL). The purpose of this study was to describe patients with tinnitus and MSNHL and factors predicting hearing-aid uptake (HAU). We conducted a retrospective chart review with regression modeling of patients presenting to a specialty tinnitus clinic over a 2.5-year period. Stepwise logistic regression on data from patient charts was conducted. Of 133 patients seen, two-thirds had MSNHL (95% confidence interval [CI]: 58.9-75.0; mean age = 53.4 years; standard deviation = 14.5); approximately 50% had severe-to-catastrophic tinnitus. Logistic regression indicated that four-frequency pure-tone average (FFPTA; left) ( ß = 0.3899, χ2 = 10.96, degrees of freedom [DF] = 1, p = 0.0009) and age ( ß = 0.1273, χ2 = 4.86, DF = 1, p = 0.0274) were positively associated with HAU; tinnitus severity was inversely related ( ß = - 1.0533, χ2 = 4.24, DF = 1, p = 0.0395). Adjusting for key variables, odds of receiving hearing aids was 1.14 (95% CI: 1.01-1.27) times higher with every year increase in age, 1.48 (95% CI: 1.17-1.86) times higher per one point increase in FFPTA (left), and 0.35 (95% CI: 0.13-0.95) times less per one point increase in tinnitus severity score. Reasons why HAU was not high for this special sample of young adults with severe tinnitus and MSNHL are discussed; hearing aid treatment requires extensive counseling and follow-up for this population.

Disruptive Hearing Technologies and Mild Sensorineural Hearing Loss I: Accessibility and Affordability Issues.

Limited accessibility to and affordability of hearing health care (HHC) and hearing aids (HAs) are two reasons why people do not seek treatment for their hearing losses. This article is the first in a series of two and discusses affordability issues (i.e., billing models, cost-effectiveness, insurance coverage, and reimbursement) related to and provides a historical context for the Over-the-Counter Hearing Aid Act of 2017. This piece of legislation supports development of a new class of over-the-counter HAs that represents a disruptive technology that may transform the HHC industry by reducing costs specific to the device. A discussion of ethical issues and the importance of using evidence-based practice guidelines set the stage for the second article in this series, which reviews relevant research on issues pertaining to persons with mild hearing loss.

Disruptive Hearing Technologies and Mild Sensorineural Hearing Loss II: Current Research on Affordable Hearing Technologies and Direct-to-Consumer Models.

Recently, President Trump signed into law the Food and Drug Administration (FDA) Reauthorization Act of 2017, which included the Over-the-Counter Hearing Aid Act designed to provide greater public accessibility to and affordability of amplification for individuals with self-identified mild and moderate hearing loss through the provision of over-the-counter (OTC) hearing aids (HAs) with a direct-to-consumer (DTC) delivery model. American Speech-Language-Hearing Association and American Academy of Audiology Position Statements on OTC HAs state that these devices should only be used for adults with mild hearing losses. DTC amplification and service delivery has been available to consumers in a variety of forms for a significant period of time. However, FDA-regulated OTC HAs will not be available as described in the new law until the FDA publishes the required guidance related to the technology, safety, and labeling of such devices. With the clear similarities in mind between present and future amplification options, a literature search was conducted to review studies assessing outcomes for low-cost and DTC HAs and service-delivery models to inform what we may expect as OTC HAs enter the market. Nine studies were identified which assessed: (1) electroacoustic capabilities of low-cost and DTC HAs, (2) use of these devices in field trials, or (3) efficacy of DTC models. None of the studies reported outcomes specifically for participants with mild hearing loss. The studies had poor external validity because none included all factors that would exist in realistic uses of OTC HAs within a DTC model. Additional research will be needed as OTC HAs become available and different delivery models are proposed.

Benefits from, Satisfaction with, and Self-Efficacy for Advanced Digital Hearing Aids in Users with Mild Sensorineural Hearing Loss.

Little evidence is available regarding outcomes of advanced digital technology (ADT) hearing aid wearers with mild sensorineural hearing loss (MSNHL). The purpose of this article is to report the characteristics of and outcomes for this population. A cross-sectional research design was employed with 56 participants from a private practice setting. The International Outcomes Inventory for Hearing Aids (IOI-HA), Satisfaction with Amplification in Daily Life (SADL), and the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA) were completed, scored, and compared with normative data. Results revealed that ADT aids were worn 10.5 hours/day, were mostly advanced to premium (55%), had an average cost per aid of $2,138 (SD = $840), and provided significant benefit (IOI-HA overall score: mean = 4.1; SD = 0.6) and satisfaction (SADL global score: mean = 5.4; SD = 0.8) to users who had good overall self-efficacy (MARS-HA composite score: mean = 81.7; SD = 12.8). Patients were most dissatisfied with and had the least self-efficacy for managing background noise and advanced handling of their devices. ADT hearing aid users with MSNHL achieved excellent outcomes, but ongoing follow-up and counseling from hearing health care providers may be important for successful management of background noise and mastery of advanced handling skills.

Effectiveness of Auditory Measures for Detecting Hidden Hearing Loss and/or Cochlear Synaptopathy: A Systematic Review.

Standard audiometric evaluations are not sensitive enough to identify hidden hearing loss (HHL) and/or cochlear synaptopathy (CS). Patients with either of these conditions frequently present with difficulty understanding speech in noise or other complaints such as tinnitus. The purpose of this systematic review is to identify articles in peer-reviewed journals that assessed the sensitivity of audiologic measures for detecting HHL and/or CS, and which showed potential for use in a clinical test battery for these disorders. A reference librarian submitted specific boolean terminology to MEDLINE, Embase, and Web of Science. The authors used a consensus approach with specially designed score sheets for the selection of titles, abstracts, and then articles for inclusion in the systematic review and for quality assessment. Fifteen articles were included in the systematic review. Seven articles involved humans; seven involved animals, and one study used both humans and animals. Results showed that pure-tone audiometry to 20 kHz, otoacoustic emissions, electrocochleography, auditory brainstem response (ABR), electrophysiological tests, speech recognition in noise with and without temporal distortion, interviews, and self-report measures have been used to assess HHL and/or CS. For HHL, ultra-high-frequency audiometry may help identify persons with sensory hair cell loss that does not show up on standard audiograms. Promising nonbehavioral measures for CS included ABR wave I amplitude, the summating potential-to-action potential ratio, and speech recognition in noise with and without temporal distortion. Self-report questionnaires also may help identify auditory dysfunction in persons with normal hearing.

Toward the Future of Early Intervention for Adult Hearing Loss.

This issue of Seminars in Hearing has focused on the early intervention of adult sensorineural hearing loss (SNHL). Contributions to this monograph have taken a contemporary issues approach to the prevention, diagnosis, and treatment of mild SNHL. This article looks toward the future and discusses clinical and research implications for the early intervention of adult SNHL.

Developing Foundational Counseling Skills for Addressing Adherence Issues in Auditory Rehabilitation.

Successfully getting patients with confirmed hearing loss to use hearing aids is a major challenge for hearing health care professionals. Treatment adherence has been defined as the active involvement of patients in collaborating with health care providers to plan and manage treatment regimens. Counseling patients with hearing loss on adherence to recommendations of hearing aid uptake and utilization is dependent upon building a patient-centered therapeutic relationship during the initial diagnostic evaluation. The purpose of this article is to provide resources, tools, and engaging learning activities for training students on the development of a hierarchy of counseling skills: informational counseling (e.g., checking comprehension and problem clarification), communication skills (e.g., promotion of shared-communication space, congruence, listening with the third ear, unconditional positive regard, and empathy), and health behavior change (e.g., Motivational Interviewing and the Teach-Back Method) that are prerequisites for addressing treatment adherence.

Didactic Content and Experiential Aging Simulation for Developing Patient-Centered Strategies and Empathy for Older Adults.

The number of people over 65 years of age is increasing, and many of those individuals will have sensorineural hearing loss in addition to other chronic health conditions. Future hearing health care providers need to be sensitive to the needs of elderly patients. The purpose of this article is to describe an experiential learning curriculum used in the Doctor of Audiology program in the Department of Communication Sciences and Disorders at the University of Oklahoma Health Sciences Center. The curriculum uses simulations of sensory disorders common in the elderly to transform knowledge and active experience into patient-centered, empathetic counseling skills and strategies to use with older adults with hearing loss.

Hearing Aid Benefit in Patients with Mild Sensorineural Hearing Loss: A Systematic Review.

BACKGROUND: Untreated sensorineural hearing loss (SNHL) is associated with chronic health-care conditions, isolation, loneliness, and reduced quality of life. Although hearing aids can minimize the negative effects of SNHL, only about one in five persons with SNHL seeks help for communication problems. Many persons wait 10 yr or more from the time they first notice a problem before pursuing amplification. Further, little information about the benefits of amplification is available for persons with mild SNHL (MSNHL), who likely defer treatment even longer. PURPOSE: To conduct a systematic review to weigh the evidence regarding benefits derived from the use of amplification by adults with MSNHL. RESEARCH DESIGN: Systematic review with meta-analysis. STUDY SAMPLE: Adult hearing aid wearers with bilateral average pure-tone thresholds ≤45 dB HL at 500, 1000, 2000, and 4000 Hz. DATA COLLECTION AND ANALYSIS: PubMed, Cumulative Index to Nursing and Allied-Health Literature, Cochrane Collaboration, and Google Scholar were searched independently by the authors during September 2013. The authors used a consensus approach to assess the quality and extract data for the meta-analysis. RESULTS: Of 106 articles recovered for full-text review, only 10 met inclusion criteria (at least Level IV of evidence and involved and reported separate pre-/postfitting hearing aid outcomes for patients with MSNHL). Included studies involved mainly middle-aged to elderly patients using hearing aids of various styles and circuitry. Results from all of the studies indicated positive benefits from amplification for patients with MSNHL. Data from five studies were suitable for a meta-analysis, which produced a small-to-medium effect size of 0.85 (95% confidence intervals = 0.44-1.25) after adjusting for a small publication bias. This evidence confirmed benefits from the use of amplification in adults with MSNHL. CONCLUSIONS: Evidence exists supporting the notion that adults with MSNHL benefit from hearing aids. This information is important and useful to audiologists, patients, and third-party payers, even considering that most of the studies in this systematic review were limited, somewhat dated, and used analog and early digital technology available when the studies were conducted. Clinical recommendations may be even stronger as future studies become available for patients fit with modern styles and high-technology hearing aids.

Will parents participate in and comply with programs and regimens using xylitol for preventing acute otitis media in their children?

PURPOSE: Antiadhesive properties in xylitol, a natural sugar alcohol, can help prevent acute otitis media (AOM) in children by inhibiting harmful bacteria from colonizing and adhering to oral and nasopharyngeal areas and traveling to the Eustachian tube and middle ear. This study investigated parents' willingness to use and comply with a regimen of xylitol for preventing AOM in their preschool- and kindergarten-aged children. METHOD: An Internet questionnaire was designed and administered to parents of young children in preschool and kindergarten settings. RESULTS: Most parents were unaware of xylitol's use for AOM and would not likely comply with regimens for preventing AOM in their children; however, parents having previous knowledge of xylitol and whose children had a history of AOM would be more likely to do so. CONCLUSIONS: Generally, most of these parents did not know about xylitol and probably would not use it to prevent ear infections. Unfortunately, these results parallel earlier findings for teachers and schools, which present obstacles for establishing ear infection prevention programs using similar protocols for young children. The results showed that considerable education and age-appropriate vehicles for administering xylitol are needed before establishing AOM prevention programs in schools and/or at home.

AuD-degree holders in tenure-track positions: survey of program chairpersons and AuD-degree holders.

BACKGROUND: The doctor of audiology (AuD) degree is now the entry-level degree for the profession of audiology. Typically, AuD programs train professionals for clinical careers, while those offering PhDs educate students for university teaching and research positions. Some in the communication sciences and disorders have predicted that there could be a shortage of PhDs in academic institutions over the next decade as senior faculty members with PhDs retire, AuD programs expand, and likely fewer students complete PhD degrees or elect to pursue careers in academia. If a PhD shortage becomes a reality, then one solution might be to include AuDs as candidates for vacant academic tenure-track positions. PURPOSE: To survey AuD-degree holders' (AuDs') and program chairpersons' (chairs') views about AuDs in academic tenure-track positions. RESEARCH DESIGN: National Internet survey Data Collection and Analysis: Two questionnaires were designed for this study. One was e-mailed to 1575 "AuDs in general" (randomly sampled from the American Academy of Audiology Membership Directory) and 132 "AuDs in academia." The other was e-mailed to 64 chairs from programs offering the AuD. The two surveys included similar questions so that comparisons could be made across groups. Potential respondents were e-mailed an informational letter inviting them to participate by completing a survey on SurveyMonkey within a 2 wk period in March and April 2010. This process resulted in three data sets: (1) AuDs in general, (2) AuDs in academia, and (3) program chairs. RESULTS: Return rates were 25, 26, and 45% for the three sampling methods for recruiting AuDs in general, AuDs in academia, and program chairs, respectively. Of the respondents, few AuDs held academic tenure-track positions or had achieved rank and tenure success in them. Those AuDs in academia usually had to meet the same or similarly rigorous criteria (with heavier emphasis on teaching than on research) for advancement as did PhD faculty. Overall, AuDs tended to believe that AuDs could be appointed to and succeed at tenure-track positions; chairs reported that such appointments were not permitted in most programs, did not personally believe that AuDs should hold these positions, and felt that AuDs would have more difficulty than PhDs in achieving success in them. Obstacles to AuDs' success in tenure-track positions reported by all three groups included lack of research skills and mentors, biases from faculty within and outside of audiology departments, and poorer pay than could be earned in the private sector. CONCLUSIONS: Considerable variability existed in the types of and titles for faculty positions held by AuDs in academia. Few AuDs were employed in tenure-track positions. Contrary to many of the chairs' responses, most AuDs felt they would be successful in such positions. Many of the AuDs suggested that universities with AuD programs should add more research and mentorship opportunities and tenure tracks for clinicians. Most respondents believed there is a need for both AuDs and PhDs in academic programs. These findings should be of interest to AuDs, chairs, and other stakeholders in academia, and the survey responses identified some areas warranting future investigation.

Survey of audiologists and cerumen management.

PURPOSE: Cerumen management (CM) is within the scope of practice of audiology, and the Doctor of Audiology (AuD) is now the entry-level degree for persons practicing the profession. However, little recent information is available about whether and how CM is presently being taught in AuD programs or even if and how audiologists are currently practicing CM. This study surveyed audiologists about their training for, experience with, opinions about, and practices involving CM. METHOD: A questionnaire was designed for this study and was e-mailed with a link to Survey monkey.com in April and May 2011 to 1,575 audiologists with AuD degrees, randomly sampled from the American Academy of Audiology's membership directory. RESULTS: The return rate was 29% (447 returned). Overall, 69% of these audiologists performed CM compared to only 29% reported in earlier studies.More audiologists in private practice (87%) performed CM than those in medical settings (65%). Almost half (48%) of the audiologists who had completed residential AuD programs believed that their training programs inadequately prepared them to perform CM. CONCLUSION: More audiologists are performing CM than in the past. The respondents reported that they were inadequately trained in CM and believed that educational programs need to improve their coverage of CM.

Survey of high school students' perceptions about their iPod use, knowledge of hearing health, and need for education.

PURPOSE: High school students' knowledge about hearing health and their perceptions of how they use personal listening devices (PLDs) including iPods were surveyed to determine the need, content, and preferred format for educational outreach to them. METHOD: This study was a descriptive convenience survey of students at a California high school. An 83-item questionnaire was administered in December 2009 to assess students' demographics, knowledge of hearing health, perceived iPod use, and risk activities. RESULTS: The response rate was 56%. Most of the students perceived that they used iPods safely. However, responses indicated that many of the respondents could be at risk of injury to themselves or others if they became unaware of their surroundings while listening to iPods. Some students were knowledgeable about hearing health and safe iPod use, but most needed information about hearing loss and hearing conservation. CONCLUSION: Most of the students needed education (e.g., via health classes or the Internet) about hearing health, the warning signs of hearing loss, and how to prevent hearing loss. Resources for educational audiologists are provided.

Is mother-child transmission a possible vehicle for xylitol prophylaxis in acute otitis media?

OBJECTIVE: Xylitol can be a prophylaxis for acute otitis media (AOM), especially when administered via chewing gum, but that vehicle has limitations for children. This review sought evidence for links of mother-child transmission of bacteria and as a vehicle for xylitol as a prophylaxis for dental caries and its translation to AOM in infants and young children. DESIGN: Qualitative systematic review. METHOD: Combining output from 43 search strings used earlier and submitting 20 new strings to PubMed resulted in 14 studies (six were excluded; eight were included). Included studies had to be published in English-language, peer-reviewed journals; involve mothers using xylitol; and assess bacteria or caries in their children. Evaluation forms were completed for search, retrieval, and quality assessment of included studies. RESULTS: The studies showed that mothers' chewing xylitol gum was a prophylaxis against bacteria and caries in their children. A mother-child transmission model was presented as a possible vehicle for use in comprehensive prevention programs for AOM. CONCLUSIONS: Potential for xylitol use to prevent AOM warrants further study. A mother-child model may apply to AOM for transmission of bacteria and as a prophylaxis, but alternative vehicles like nasal sprays should be investigated for ease of use and effectiveness.

Survey of K-3rd-grade teachers' knowledge of ear infections and willingness to participate in prevention programs.

PURPOSE: Ear infections are prevalent in kindergarten through 3rd-grade (K-3rd) children and can affect their performance at school. Chewing gum, when administered by parents and teachers, can help prevent ear infections in children. This pilot study surveyed K-3rd-grade teachers in the Santa Barbara School Districts to assess their knowledge about ear infections and their willingness to participate in ear infection prevention programs. METHOD: A 37-item questionnaire was developed and was e-mailed to a convenience sample of 112 teachers in February 2010. RESULTS: Response rate was 26%; 29 teachers responded. Most respondents were experienced females ≥ 36 years of age who said that their education provided no information about ear infections. Less than half said that they knew signs of ear infections or that ear infections could be prevented, but more than half believed that ear infections could hinder children's development and quality of life. All of the schools and almost all of the teachers did not permit chewing gum on campus or in their classrooms, but most teachers said they would participate in ear infection prevention programs, let students chew xylitol gum if it prevented ear infections, and wanted more information on this topic. CONCLUSION: Although teachers said they would participate in ear infection prevention programs, obstacles were identified that could preclude the use of xylitol chewing gum. Prevention programs should be developed, but xylitol gum prophylaxis regimens may be better directed at in-home use.