Prevalence and characteristics of hearing and vision loss in preschool children from low income South African communities: results of a screening program of 10,390 children.

BACKGROUND: The majority of children with sensory impairments live in low- and middle-income countries. More studies of hearing and vision impairment prevalence are needed, in order to generate more accurate estimates of trends in sensory impairments. This study aimed to estimate the prevalence and describe the characteristics of hearing and vision loss among preschool children (4-7 years) in an underserved South African community following community-based mobile health (mHealth) supported hearing and vision services. METHODS: A screening program of sensory impairments was undertaken of children attending preschools in the communities of Khayelitsha and Mitchell's Plain, Cape Town, from September 2017 until June 2019. Hearing and vision screening were done by trained community health workers using mHealth technology. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were conducted using smartphones that host point-of-care validated and calibrated hearing and vision testing applications (hearTest app, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). Descriptive statistical analysis and logistic regression analysis were conducted after extracting data from a secure cloud-based server (mHealth Studio, hearX Group) to Microsoft Excel (2016). RESULTS: A total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6 and 4.4% of children failed hearing and vision screening respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was done on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.05), but not for hearing loss (p = 0.06). Gender was not a significant predictor of hearing (p = 0.22) or vision loss (p = 0.20). CONCLUSIONS: Hearing loss is prevalent in at least 22 per 1000 and vision loss in at least 23 per 1000 preschool children in an underserved South African community. Timely identification of sensory losses can be facilitated through community-based hearing and vision services supported by mHealth technology.

Using smartphone technology to support the adult audiologic rehabilitation journey.

OBJECTIVE: Although the availability of mobile device applications (apps) to support people with hearing impairment is rapidly increasing, there are few reports of the use of such apps by the target population. The aim of this paper is to describe research that has applied apps at various stages of the adult rehabilitation journey. DESIGN: A summary of studies utilising apps to investigate (1) the hearing difficulties and acoustic environments of adults with mild hearing impairment, (2) hearing aid benefit in this population and (3) useability of an app to guide hearing aid handling tasks. STUDY SAMPLE: Older adults with no previous experience with hearing aids, who owned a smartphone or tablet and were confident in using apps. Participant samples ranged from 10 (hearing aid benefit pilot study, mean age = 70 years) to 30 participants (app useability study, mean age = 69 years). RESULTS: All studies showed that smartphone apps can provide real-world insights during the early stages of the patient journey and hearing aid management support during the latter stages. App useability was rated positively by participants. CONCLUSION: Smartphone apps may be used as a feasible complement to face-to-face interaction in audiology practice.

Changing the narrative for hearing health in the broader context of healthy living: a call to action.

OBJECTIVE: To discuss the steps necessary to facilitate hearing health care in the context of well-being and healthy living. DESIGN: Common themes among the articles in this special supplement of the International Journal of Audiology were used to identify issues that must be addressed if audiology is to move from being hearing-focussed to taking a holistic perspective of hearing care in the context of healthy aging. These are discussed within the context of other published literature. RESULTS AND CONCLUSIONS: Three needs were identified: (i) Increased interdisciplinary education to raise awareness of the interplay between hearing and health. (ii) Increased emphasis on counselling education in audiology programs so that audiologists are equipped with the knowledge, competence and confidence to provide counselling and emotional support to their patients, beyond care. (iii) Redefinition of therapeutic goal setting and hearing outcomes to include aspects of well-being, so that audiologists can capture and patients realise that that good hearing outcomes can have a direct positive impact on a person's quality of life that extends beyond their improved ability to hear. It was emphasised that each of these needs to be considered within the context of the audiologists' scope of practice and audiologists' well-being.

From Healthy Hearing to Healthy Living: A Holistic Approach.

The negative consequences of hearing loss go beyond difficulties with communication, having been identified as a major risk factor for injury and illness, social isolation, depression, overall quality of life, and mortality. Hearing loss affects the individual, their families and social network, the broader healthcare system, and the economy. Recognizing that there are multifactorial considerations associated with understanding and mitigating the consequences of hearing loss, great benefit is gained by taking an interdisciplinary, interprofessional, holistic approach to studying hearing loss in research and in developing holistic clinical strategies targeted at prevention, diagnosis, treatment, and social policy. Within the framework of this supplement focused on the role of ecological validity in hearing-related research and application, this article provides a general commentary on how ecological validity can be considered with a holistic perspective in mind. First, we consider how a holistic approach can be applied within clinical practice, how it can be applied to laboratory-based research to increase ecological validity, and how it can be applied to professional training and education within both research and clinical domains. Second, we discuss the associations between hearing loss and dementia as an example of how these holistic principles can be applied. The main goal of highlighting these approaches and principles is to motivate a change in the narrative about hearing loss from a focus in research and application on promoting healthy hearing, to a focus on living well.

Auditory Training Supports Auditory Rehabilitation: A State-of-the-Art Review.

OBJECTIVES: Auditory training (AT), which is active listening to various auditory stimuli, aims to improve auditory skills. There is evidence that AT can be used as a tool in auditory rehabilitation to improve speech perception and other auditory cognitive skills in individuals with hearing impairment. The present state-of-the-art review examines the effect of AT on communication abilities in individuals with hearing impairment. In particular, transfer of AT effects on performance in untrained speech perception tasks was evaluated. DESIGN: PubMed, Medline, and Web of Science databases were searched using combinations of key words with restriction to the publication date from December 2012 until December 2018. The participant, intervention, control, outcome, and study design criteria were used for the inclusion of articles. Only studies comparing effects in an intervention group to a control group were considered. The target group included individuals with a mild to moderately severe hearing impairment, with and without hearing-aid experience. Out of 265 article abstracts reviewed, 16 met the predefined criteria and were taken for review. RESULTS: The majority of studies that were included in this state of- the-art review report at least one outcome measure that shows an improvement in non-trained tasks after a period of intense AT. However, observed shortcomings are that a comparison between studies remains difficult as training benefits were assessed with various outcome measures. Also, the sustainability of training benefits was not investigated sufficiently. CONCLUSIONS: Recent evidence suggests that intensive auditory (-cognitive) training protocols are a valid tool to improve auditory communication skills. Individuals with hearing impairment seem to benefit the most using a combination of sensory rehabilitation with hearing aids and AT to enhance auditory rehabilitation. Long term benefits of AT are still not consistently observed and should be in the focus of future research.

Physiological Monitoring and Hearing Loss: Toward a More Integrated and Ecologically Validated Health Mapping.

With an ongoing shift from managing disease toward the inclusion of maintaining health and preventing disease, the world has seen the rise of increasingly sophisticated physiological monitoring and analytics. Innovations range from wearables, smartphone-based spot monitoring to highly complex noncontact, remote monitoring, utilizing different mechanisms. These tools empower the individual to better navigate their own health. They also generate powerful insights towards the detection of subclinical symptoms or processes via existing and novel digital biomarkers. In that context, a topic that is receiving increasing interest is the modulation of human physiology around an individual "baseline" in everyday life and the impact thereof on other sensorineural body functions such as hearing. More and more fully contextualized and truly long-term physiological data are becoming available that allows deeper insights into the response of the human body to our behavior, immediate environment and the understanding of how chronic conditions are evolving. Hearing loss often goes hand in hand with chronic conditions, such as diabetes, cognitive impairment, increased risk of fall, mental health, or cardiovascular risk factors. This inspires an interest to not only look at hearing impairment itself but to take a broader view, for example, to include contextualized vital signs. Interestingly, stress and its physiological implications have also been shown to be a relevant precursor to hearing loss and other chronic conditions. This article deduces the requirements for wearables and their ecosystems to detect relevant dynamics and connects that to the need for more ecologically valid data towards an integrated and more holistic mapping of hearing characteristics.

The Quest for Ecological Validity in Hearing Science: What It Is, Why It Matters, and How to Advance It.

Ecological validity is a relatively new concept in hearing science. It has been cited as relevant with increasing frequency in publications over the past 20 years, but without any formal conceptual basis or clear motive. The sixth Eriksholm Workshop was convened to develop a deeper understanding of the concept for the purpose of applying it in hearing research in a consistent and productive manner. Inspired by relevant debate within the field of psychology, and taking into account the World Health Organization's International Classification of Functioning, Disability, and Health framework, the attendees at the workshop reached a consensus on the following definition: "In hearing science, ecological validity refers to the degree to which research findings reflect real-life hearing-related function, activity, or participation." Four broad purposes for striving for greater ecological validity in hearing research were determined: A (Understanding) better understanding the role of hearing in everyday life; B (Development) supporting the development of improved procedures and interventions; C (Assessment) facilitating improved methods for assessing and predicting ability to accomplish real-world tasks; and D (Integration and Individualization) enabling more integrated and individualized care. Discussions considered the effects of variables and phenomena commonly present in hearing-related research on the level of ecological validity of outcomes, supported by examples from a few selected outcome domains and for different types of studies. Illustrated with examples, potential strategies were offered for promoting a high level of ecological validity in a study and for how to evaluate the level of ecological validity of a study. Areas in particular that could benefit from more research to advance ecological validity in hearing science include: (1) understanding the processes of hearing and communication in everyday listening situations, and specifically the factors that make listening difficult in everyday situations; (2) developing new test paradigms that include more than one person (e.g., to encompass the interactive nature of everyday communication) and that are integrative of other factors that interact with hearing in real-life function; (3) integrating new and emerging technologies (e.g., virtual reality) with established test methods; and (4) identifying the key variables and phenomena affecting the level of ecological validity to develop verifiable ways to increase ecological validity and derive a set of benchmarks to strive for.

Hearing and vision screening for preschool children using mobile technology, South Africa.

OBJECTIVE: To implement and evaluate a community-based hearing and vision screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology (mHealth) and delivered by community health workers (CHWs). METHODS: We trained four CHWs to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017-December 2018. CHWs screened children aged 4-7 years using mHealth software applications on smartphones. We used logistic regression analysis to evaluate the association between screening results and age, sex and test duration, and, for hearing, excessive background noise levels. RESULTS: CHWs screened 94.4% (8023/10 362) of eligible children at 271 centres at a cost of 5.63 United States dollars per child. The number of children who failed an initial hearing and visual test was 435 (5.4%) and 170 (2.1%), respectively. Hearing test failure was associated with longer test times (odds ratio, OR: 1.022; 95% confidence interval, CI: 1.021-1.024) and excessive background noise levels at 1 kilohertz (kHz) (e.g. OR for left ear: 1.688; 95% CI: 1.198-2.377). Visual screening failure was associated with longer test duration (OR: 1.003; 95% CI: 1.002-1.005) and younger age (OR: 0.629; 95% CI: 0.520-0.761). Of the total screened, 111 (1.4%) children were diagnosed with a hearing and/or visual impairment. CONCLUSION: mHealth-supported CHW-delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions.

The Emotional Communication in Hearing Questionnaire (EMO-CHeQ): Development and Evaluation.

OBJECTIVES: The objectives of this research were to develop and evaluate a self-report questionnaire (the Emotional Communication in Hearing Questionnaire or EMO-CHeQ) designed to assess experiences of hearing and handicap when listening to signals that contain vocal emotion information. DESIGN: Study 1 involved internet-based administration of a 42-item version of the EMO-CHeQ to 586 adult participants (243 with self-reported normal hearing [NH], 193 with self-reported hearing impairment but no reported use of hearing aids [HI], and 150 with self-reported hearing impairment and use of hearing aids [HA]). To better understand the factor structure of the EMO-CHeQ and eliminate redundant items, an exploratory factor analysis was conducted. Study 2 involved laboratory-based administration of a 16-item version of the EMO-CHeQ to 32 adult participants (12 normal hearing/near normal hearing (NH/nNH), 10 HI, and 10 HA). In addition, participants completed an emotion-identification task under audio and audiovisual conditions. RESULTS: In study 1, the exploratory factor analysis yielded an interpretable solution with four factors emerging that explained a total of 66.3% of the variance in performance the EMO-CHeQ. Item deletion resulted in construction of the 16-item EMO-CHeQ. In study 1, both the HI and HA group reported greater vocal emotion communication handicap on the EMO-CHeQ than on the NH group, but differences in handicap were not observed between the HI and HA group. In study 2, the same pattern of reported handicap was observed in individuals with audiometrically verified hearing as was found in study 1. On the emotion-identification task, no group differences in performance were observed in the audiovisual condition, but group differences were observed in the audio alone condition. Although the HI and HA group exhibited similar emotion-identification performance, both groups performed worse than the NH/nNH group, thus suggesting the presence of behavioral deficits that parallel self-reported vocal emotion communication handicap. The EMO-CHeQ was significantly and strongly (r = -0.64) correlated with performance on the emotion-identification task for listeners with hearing impairment. CONCLUSIONS: The results from both studies suggest that the EMO-CHeQ appears to be a reliable and ecologically valid measure to rapidly assess experiences of hearing and handicap when listening to signals that contain vocal emotion information.

Adults with mild hearing impairment: Are we meeting the challenge?

OBJECTIVE: Acquired hearing impairment is recognized by the World Health Organization as the third leading cause of disability, with a mild impairment being the most prevalent. The aim of this study was to review research literature concerned with adults with acquired mild hearing impairment; the definitions and prevalence, the resulting activity limitations and participation restrictions, and hearing-aid interventions. DESIGN: This study involved a systematized review of research literature identified through searches in citation databases and through reference checking. STUDY SAMPLE: A total of 151 papers were identified and of these, 33 papers were included in this review. RESULTS: Prevalence rates are significantly influenced by the definition used for mild hearing impairment, and range from 1 in 3 to 1 in 5 adults. The weak correlations between audiological assessments and self-reported difficulties suggest that further assessment of individuals with mild hearing impairment is warranted. The most common intervention is the provision of hearing aids with varying rates of use, benefit, and satisfaction. CONCLUSIONS: The development of appropriate audiological assessment in the clinic, and further evaluation of the real-world listening needs and performance of people with mild hearing impairment is required to provide a more effective pathway for this clinical population.

A survey of the attitudes of practitioners toward teleaudiology.

UNLABELLED: Abstract Objective: To survey hearing healthcare practitioners' (1) attitudes toward teleaudiology appointments, (2) willingness to conduct different clinical tasks via teleaudiology, and (3) willingness to conduct a teleaudiology appointment with different patient populations. DESIGN: All participants were asked to complete the Attitudes toward Teleaudiology Scale for Practitioners (ATS-P), a 46-item online survey designed for this study. STUDY SAMPLE: The responses from 202 hearing healthcare practitioners working in Canada were collected. The sample consisted of 152 audiologists, 49 hearing instrument specialists, and one who did not specify a category. RESULTS: The majority of respondents indicated that teleaudiology is likely to have a minimal effect on the quality of hearing healthcare in audiology and the quality of client-practitioner interactions, although many respondents indicated that teleaudiology would have a positive effect on accessibility to service. Nevertheless, a small minority of respondents indicated that teleaudiology would have a negative impact on quality of care in audiology. CONCLUSIONS: Willingness to use teleaudiology depended on a combination of the clinical tasks to be performed and the patient populations to be served. These findings can help guide the successful implementation of teleaudiology services.

Viewpoint on the Benefit of Hearing Care on Cognitive Health.

PURPOSE: The purpose of this article is to provide a viewpoint on the recently published results showing the positive effect hearing intervention can have on mitigating the risk of cognitive decline in elderly individuals with hearing impairment. We intend to trigger a broader discussion on the implications of these results from an implementation science perspective. METHODS: Recently published results were reviewed and contextualized. RESULTS: In our view, these recent findings provide a great opportunity for hearing care professionals to change the perspective on hearing care being an essential service that contributes not only to managing challenges with audibility but to enabling healthy living and aging. CONCLUSION: As exciting as these findings are, from our perspective, they are also a call to action for the audiology field in terms of clinical implementation science. The findings guide us toward a more interprofessional approach in order to develop and test new, more holistic models of hearing care.

Real-life and real-time hearing aid experiences: Insights from self-initiated ecological momentary assessments and natural language analysis.

Introduction: Smartphone technology can provide an effective means to bring real-life and (near-)real-time feedback from hearing aid wearers into the clinic. Ecological Momentary Assessment (EMA) encourages listeners to report on their experiences during or shortly after they take place in order to minimize recall bias, e.g., guided by surveys in a mobile application. Allowing listeners to describe experiences in their own words, further, ensures that answers are independent of predefined jargon or of how survey questions are formulated. Through these means, one can obtain ecologically valid sets of data, for instance during a hearing aid trial, which can support clinicians to assess the needs of their clients, provide directions for fine-tuning, and counselling. At a larger scale, such datasets would facilitate training of machine learning algorithms that could help hearing technology to anticipate user needs. Methods: In this retrospective, exploratory analysis of a clinical data set, we performed a cluster analysis on 8,793 open-text statements, which were collected through self-initiated EMAs, provided by 2,301 hearing aid wearers as part of their hearing care. Our aim was to explore how listeners describe their daily life experiences with hearing technology in (near-)real-time, in their own words, by identifying emerging themes in the reports. We also explored whether identified themes correlated with the nature of the experiences, i.e., self-reported satisfaction ratings indicating a positive or negative experience. Results: Results showed that close to 60% of listeners' reports related to speech intelligibility in challenging situations and sound quality dimensions, and tended to be valued as positive experiences. In comparison, close to 40% of reports related to hearing aid management, and tended to be valued as negative experiences. Discussion: This first report of open-text statements, collected through self-initiated EMAs as part of clinical practice, shows that, while EMA can come with a participant burden, at least a subsample of motivated hearing aid wearers could use these novel tools to provide feedback to inform more responsive, personalized, and family-centered hearing care.

Hearing Aid Adoption is Associated with the Type of Significant Other in Attendance at Hearing Care Appointments.

There is increasing evidence to suggest that the implementation of family-centered care practices in clinical audiology yields positive patient outcomes. Previous work showed that significant-other attendance at audiology appointments, a recommended practice consistent with family-centered care, was associated with greater odds of hearing aid adoption and increased satisfaction with hearing aids. The primary goal of this retrospective explorative study was to investigate the unexplored question of whether an association exists between the type of significant other (SO) in attendance at appointments and hearing aid adoption. The study sample consisted of adult patients from a chain of private clinics in the United Kingdom who either attended their audiology appointment with a SO (n = 10,015) or alone (n = 37,152). Six SO types were identified and classified: partner (n = 6,608), parent (n = 76), child (n = 2,577), sibling (n = 208), friend (n = 518), and carer (n = 28). In addition to replicating previous findings which showed that significant-other attendance at audiology appointments was positively associated with hearing aid adoption, results from the current paper also revealed that the odds of hearing aid adoption were greater if the SO was of a stronger relationship tie (i.e., partners, parents, children, and siblings) and not a weaker relationship tie (i.e., friends, carers). These findings suggest that an extension of the non-audiological factor of significant-other attendance during the hearing rehabilitation process should be considered: the relationship type patients have with their significant others.

Hearing aid Experiences of Adult Hearing aid Owners During and After Fitting: A Systematic Review of Qualitative Studies.

There has been an increasing number of qualitative studies exploring the experiences and perceptions of adult hearing aid owners throughout their hearing aid journey. As these studies and reported experiences vary greatly, a systematic review was conducted to identify and synthesize the key concepts in adult hearing aid owners' experiences during and after fitting. A systematic search of three electronic databases was conducted, yielding 443 results. Articles were evaluated for inclusion based on pre-determined eligibility criteria, including conventional, smartphone-connected, and direct-to-consumer hearing devices. Twenty-five studies met the inclusion criteria. The quality of the included articles was evaluated using the Rating of Qualitative Research scale. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Synthesis Without Meta-Analysis (SWiM) were followed. A narrative synthesis was conducted, and studies were grouped into three main domains, namely experiences of owners related to a) hearing aid adoption and fitting (n = 3), b) hearing aid use (n = 20), and c) hearing aid sub-optimal use (n = 25). Hearing aid owners mainly reported on how their attitude towards hearing aids affected experiences during the fitting stage. Improved psychosocial functioning was the most prevalent perceived benefit of hearing aid use. Owners described sub-optimal use in terms of hearing device-related and non-device-related concepts. The COM-B (capability, opportunity, motivation-behavior) model is used to discuss specific service-delivery, hearing-device, and hearing-aid-owner related concepts and clinical implications, including behavior change techniques to enhance understanding of the concepts that hearing aid owners perceive as essential to improve hearing aid experiences.

Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols.

Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < .001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = .251) and age (p = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = .204), gender (p = .314), and age (p = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.

The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function?

Hearing loss is a modifiable risk factor for dementia in older adults. Whether hearing aid use can delay the onset of cognitive decline is unknown. Participants in this study (aged 62-82 years) were assessed before and 18 months after hearing aid fitting on hearing, cognitive function, speech perception, quality of life, physical activity, loneliness, isolation, mood, and medical health. At baseline, multiple linear regression showed hearing loss and age predicted significantly poorer executive function performance, while tertiary education predicted significantly higher executive function and visual learning performance. At 18 months after hearing aid fitting, speech perception in quiet, self-reported listening disability and quality of life had significantly improved. Group mean scores across the cognitive test battery showed no significant decline, and executive function significantly improved. Reliable Change Index scores also showed either clinically significant improvement or stability in executive function for 97.3% of participants, and for females for working memory, visual attention and visual learning. Relative stability and clinically and statistically significant improvement in cognition were seen in this participant group after 18 months of hearing aid use, suggesting that treatment of hearing loss with hearing aids may delay cognitive decline. Given the small sample size, further follow up is required.

Time of Day and Hearing Aid Adoption.

To date, there is little understanding of how contextual factors may influence the decisions individuals make regarding the adoption of options for hearing rehabilitation. This explorative retrospective study investigated whether hearing aid adoption and return rates are associated with the time of the day at which an appointment takes place. The study sample consisted of 24,842 patients experiencing their first audiology appointment. It was observed that hearing aid adoption was significantly associated with appointment times whereby lower hearing aid adoption rates were observed at noon and 4 p.m. It was also observed that hearing aid return rates were significantly associated with appointment times whereby lower return rates were observed at noon and 4 p.m. In light of the methodology employed in the study, it is not possible to unequivocally determine why time of day is associated with hearing aid adoption and return rates. Several possible explanations for the patterns of associations are discussed. In light of previous research observing that hunger lowers risk tolerance and glucose consumption increases risk tolerance, the results are consistent with an interpretation based on risk-aversion resulting from hunger. To establish causality between hunger and decision-making in audiology, additional research employing experimental methodologies are necessary.

Do Hearing Aids Address Real-World Hearing Difficulties for Adults With Mild Hearing Impairment? Results From a Pilot Study Using Ecological Momentary Assessment.

Current approaches to the measurement of hearing aid benefit typically use clinical or laboratory-based speech perception tests or retrospective self-report surveys. However, when assessing hearing aid outcomes in adults with mild hearing impairment, the traditional outcome measures may not be sufficiently sensitive. An alternative to these techniques are approaches that capture data about real-world experiences as they are experienced, such as ecological momentary assessment. This single-subject experimental design pilot study investigated the feasibility of using ecological momentary assessment in assessing whether hearing aids make a difference to the real-world listening experiences of adults with mild hearing impairment. Ten participants with an average age of 70 years and no previous amplification experience answered survey questions on their listening experiences over a 4-week period (1 week without hearing aids, 2 weeks with hearing aids, and 1 week without hearing aids). A total of 860 surveys were collected. Participants reported significantly better speech understanding and less listening effort during the 2-week trial with hearing aids compared to baseline conditions. In addition, they reported that they were significantly less hampered by their hearing difficulties and had greater enjoyment of listening events with wearing hearing aids. Individual variation in hearing aid benefit was evident. This pilot study showed that ecological momentary assessment has potential to quantify self-reported aided benefit for individuals with mild hearing impairment fitted with hearing aids. This research also highlighted that a real-world approach is needed to explore individualized outcomes and provide different insights to standardized questionnaires.