Initial-Fit Approach Versus Verified
Prescription: Comparing SelfPerceived Hearing Aid Benefit
Abrams, H., Chisolm, T., McManus, M.,
McArdle, R.
Journal of the American Academy of
Audiology, 23(10), 768-778
What they did . . .
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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
APHAB benefit scores for the two conditions
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
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!
MarkeTrak VIII and hearing aid
verification—and satisfaction?
A publication from Sergei Kochkin
(2010, Hearing Review), “with a little
help from his friends.”
But that wasn’t even
ALL the authors
Some of the primary purposes
of the survey:
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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.
Brief review of procedures:
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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
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.”)
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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).
Three items that probably relate
to most all of you . . .
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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).
What percent got what testing?
The testing that was conducted was
not significantly different for new
versus vs. experienced users, or
audiologists vs. HISs:
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LDL (Loudness) Measures
Real-ear Measures
Objective benefit measure
68%
42%
67%
So what about the patients success
with hearing aids?
Overall success was measured using a statistical
composite of the following factors:
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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?)
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?
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
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%.
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)
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)
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)
The effect of the overall protocol (# of
tests administered) on patient satisfaction:
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?
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
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
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
What he did . . .
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16 adults (47-69 years); Mild to
severe sloping SNHL
Dual-task paradigm
Word recognition
Word Recall
Visual Reaction Time (RTs)
What he did . . .
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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 dualtask
What he found. . .
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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
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.
And finally . . . How about some really
“current” research findings--Last
month’s meeting at Lake Tahoe!
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)
In the clinic, the JND
for an SNR change?
3 dB
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?
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What SNR then became meaningful?
6 dB
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!