Impact of hearing aid technology level at first-fit on self-reported outcomes in patients with presbycusis: a randomized controlled trial.

To provide clinical guidance in hearing aid prescription for older adults with presbycusis, we investigated differences in self-reported hearing abilities and hearing aid effectiveness for premium or basic hearing aid users. Secondly, as an explorative analysis, we investigated if differences in gain prescription verified with real-ear measurements explain differences in self-reported outcomes. The study was designed as a randomized controlled trial in which the patients were blinded towards the purpose of the study. In total, 190 first-time hearing aid users (>60 years of age) with symmetric bilateral presbycusis were fitted with either a premium or basic hearing aid. The randomization was stratified on age, sex, and word recognition score. Two outcome questionnaires were distributed: the International Outcome Inventory for Hearing Aids (IOI-HA) and the short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ-12). In addition, insertion gains were calculated from real-ear measurements at first-fit for all fitted hearing aids. Premium hearing aid users reported 0.7 (95%CI: 0.2; 1.1) scale points higher total SSQ-12 score per item and 0.8 (95%CI: 0.2; 1.4) scale points higher speech score per item, as well as 0.6 (95%CI: 0.2; 1.1) scale points higher qualities score compared to basic-feature hearing aid users. No significant differences in reported hearing aid effectiveness were found using the IOI-HA. Differences in the prescribed gain at 1 and 2 kHz were observed between premium and basic hearing aids within each company. Premium-feature devices yielded slightly better self-reported hearing abilities than basic-feature devices, but a statistically significant difference was only found in three out of seven outcome variables, and the effect was small. The generalizability of the study is limited to community-dwelling older adults with presbycusis. Thus, further research is needed for understanding the potential effects of hearing aid technology for other populations. Hearing care providers should continue to insist on research to support the choice of more costly premium technologies when prescribing hearing aids for older adults with presbycusis. Clinical Trial Registration: https://register.clinicaltrials.gov/, identifier NCT04539847.

Can real-ear insertion gain deviations from generic fitting prescriptions predict self-reported outcomes?

OBJECTIVE: The aim of this study was to determine whether the differences in insertion gains from the first fit to generic prescriptions of hearing aids can predict the self-reported hearing aid (HA) outcomes for first-time and experienced HA users. DESIGN: This was a prospective observational study. STUDY SAMPLE: The study included 885 first-time and 330 experienced HA users with a valid real-ear measurement on both ears and answers to the abbreviated version of the Speech, Spatial, and Quality of Hearing (SSQ12) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires. RESULTS: K-means clustering of gain differences between individual real-ear insertion gain to three generic gain prescriptions (NAL-NL2, NAL-RP, and one-third gain rules) was performed. The gain difference at higher frequencies generally differentiated the clusters. The experienced users in the cluster with fittings closest to NAL-NL2 and NAL-RP prescription were found to exhibit a higher IOI-HA Factor 1 score (representing the overall benefit of the hearing aid use). The gain differences to generic prescription did not affect other self-reported outcomes for first-time and experienced HA users. CONCLUSION: The experienced HA users with minimal gain deviations from generic prescriptions reported better self-perceived benefits than users with larger deviations. However, this was not apparent in first-time users.

Towards Auditory Profile-Based Hearing-Aid Fittings: BEAR Rationale and Clinical Implementation.

(1) Background: To improve hearing-aid rehabilitation, the Danish 'Better hEAring Rehabilitation' (BEAR) project recently developed methods for individual hearing loss characterization and hearing-aid fitting. Four auditory profiles differing in terms of audiometric hearing loss and supra-threshold hearing abilities were identified. To enable auditory profile-based hearing-aid treatment, a fitting rationale leveraging differences in gain prescription and signal-to-noise (SNR) improvement was developed. This report describes the translation of this rationale to clinical devices supplied by three industrial partners. (2) Methods: Regarding the SNR improvement, advanced feature settings were proposed and verified based on free-field measurements made with an acoustic mannikin fitted with the different hearing aids. Regarding the gain prescription, a clinically feasible fitting tool and procedure based on real-ear gain adjustments were developed. (3) Results: Analyses of the collected real-ear gain and SNR improvement data confirmed the feasibility of the clinical implementation. Differences between the auditory profile-based fitting strategy and a current 'best practice' procedure based on the NAL-NL2 fitting rule were verified and are discussed in terms of limitations and future perspectives. (4) Conclusion: Based on a joint effort from academic and industrial partners, the BEAR fitting rationale was transferred to commercially available hearing aids.