"Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services.

OBJECTIVES: Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. DESIGN: Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). RESULTS: Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. CONCLUSIONS: Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.

Community Health Workers as Patient-Site Facilitators in Adult Hearing Aid Services via Synchronous Teleaudiology: Feasibility Results from the Conexiones Randomized Controlled Trial.

OBJECTIVES: The purpose of this study was to investigate the feasibility of Community Health Workers (CHWs) as patient-site facilitators in teleaudiology-facilitated hearing aid services to improve hearing aid rehabilitation outcomes for older Hispanic/Latino adults in a medically underserved, rural, US-Mexico border community. DESIGN: A total of 28 adults (aged 55 to 89) with bilateral hearing loss participated in this study. Individuals were randomized to one of two teleaudiology intervention arms that differed at the level of the patient-site facilitator. Participants in the experimental group were assisted locally by trained CHW facilitators. Participants in the control group were assisted locally by trained university student facilitators. Synchronous (real-time) teleaudiology hearing aid services took place with participants located at a rural community health center and the clinician located a university 70 miles away. The results of this feasibility study are presented within the reach, effectiveness, adoption, implementation fidelity, and maintenance implementation framework. RESULTS: Regarding reach, the participants in this study population are historically under-represented in research (primarily low-income Hispanic/Latino older adults). A total of 57 individuals were recruited, 47 were consented and assessed for eligibility and 28 individuals met inclusion criteria and were randomized. The average age of participants was 73.9 years, (range: 55 to 89 years) and most individuals were female (75%). Most participants (86%) reported having incomes less than $20,000 annually. Effectiveness results (via the Self Efficacy for Situational Communication Management Questionnaire) showed that both groups (CHW and control) significantly improved listening self-efficacy from pre-fitting baseline and no difference between groups was observed. Regarding datalogging, at the short-term follow-up, participants in the CHW group wore their hearing aids for more hours/day on average compared with participants in the control group. Implementation fidelity was high for both groups. Long-term maintenance of CHW-supported teleaudiology appears feasible given that training and institutional support is in place. CONCLUSIONS: Teleaudiology-delivered hearing aid services were feasible when facilitated locally by trained CHWs. Future efficacy and effectiveness research is warranted with CHWs and teleaudiology, potentially leading to a significant reduction in barriers for rural and medically under-resourced communities.

Community-Based Participatory Research and Human-Centered Design Principles to Advance Hearing Health Equity.

OBJECTIVES: Inclusive and equitable research is an ethical imperative. Community-based participatory research (CBPR) as well as human-centered design are approaches that center partnership between community members and academic researchers. Together, academic-community research teams iteratively study community priorities, collaboratively develop ethical study designs, and co-create innovations that are accessible and meaningful to the community partners while advancing science. The foundation of the CBPR approach is reliant on its core principles of equity, colearning, shared power in decision-making, reciprocity, and mutual benefit. While the CBPR approach has been used extensively in public health and other areas of healthcare research, the approach is relatively new to audiology, otolaryngology, and hearing health research. The purpose of the present article is to advance an understanding of the CBPR approach, along with principles from human-centered design, in the context of research aimed to advance equity and access in hearing healthcare. DESIGN: The literature is reviewed to provide an introduction for auditory scientists to the CBPR approach and human-centered design, including discussion of the underlying principles of CBPR and where it fits along a community-engaged continuum, theoretical and evaluation frameworks, as well as applications within auditory research. RESULTS: Recent applications of CBPR have been framed broadly within the theoretical positions of the socioecological model for a systems-level approach to community-engaged research and the Health Services Utilization model within health services and disparities research using CBPR. Utilizing human-centered design strategies can work in tandem with a CBPR approach to engage a wide range of people in the research process and move toward the development of innovative yet feasible solutions. CONCLUSIONS: Leveraging the principles of CBPR is an intricate and dynamic process, may not be a fit for some topics, some researchers' skillsets, and may be beyond some projects' resources. When implemented skillfully and authentically, CBPR can be of benefit by elevating and empowering community voices and cultural perspectives historically marginalized in society and underrepresented within research. With a focus on health equity, this review of CBPR in the study of hearing healthcare emphasizes how this approach to research can help to advance inclusion, diversity, and access to innovation.

Effect of a Community Health Worker-Delivered Personal Sound Amplification Device on Self-Perceived Communication Function in Older Adults With Hearing Loss: A Randomized Clinical Trial.

Importance: Age-related hearing loss that impairs daily communication is associated with adverse health outcomes, but use of hearing aids by older adults is low and disparities exist. Objective: To test whether an affordable, accessible hearing care intervention, delivered by community health workers using over-the-counter hearing technology, could improve self-perceived communication function among older adults with hearing loss compared with a wait-list control. Design, Setting, and Participants: Open-label randomized clinical trial conducted between April 2018 and October 2019 with 3-month data collection completed in June 2020. The trial took place at 13 community sites, including affordable independent housing complexes (n = 10), senior centers (n = 2), and an older adult social club (n = 1) in Baltimore, Maryland. A total of 151 participants aged 60 years or older with hearing loss were randomized. Interventions: Participants were randomized to receive a community health worker-delivered hearing care intervention (n = 78) or to a wait-list control group (n = 73). The 2-hour intervention consisted of fitting a low-cost amplification device and instruction. Main Outcomes and Measures: The primary outcome was change in self-perceived communication function (Hearing Handicap Inventory for the Elderly-Screening Version [HHIE-S]; score range, 0-40; higher scores indicate poorer function) from baseline to 3 months postrandomization. The average treatment effect was estimated using the doubly robust weighted least squares estimator, which uses an outcome regression model weighted by the inverse probability of attrition to account for baseline covariate imbalance and missing data. Results: Among 151 participants randomized (mean age, 76.7 [SD, 8.0] years; 101 [67.8%] women; 65 [43%] self-identified as African American; 96 [63.6%] with low income [<$25 000 annual household income]), 136 (90.1%) completed 3-month follow-up for the primary outcome. In the intervention group, 90.5% completed the intervention session and reported at least 1 hour of daily amplification use at 3 months postrandomization. Mean scores for the HHIE-S were 21.7 (SD, 9.4) at baseline and 7.9 (SD, 9.2) at 3 months (change of -13.2 [SD, 10.3]) in the intervention group, and 20.1 (SD, 10.1) at baseline and 21 (SD, 9.1) at 3 months (change of 0.6 [SD, 7.1]) in the control group. Self-perceived communication function significantly improved in the intervention group compared with the control group, with an estimated average treatment effect of the intervention of a -12.98-point HHIE-S change (95% CI, -15.51 to -10.42). No study-related adverse events were reported. Conclusions and Relevance: Among older adults with hearing loss, a community health worker-delivered personal sound amplification device intervention, compared with a wait-list control, significantly improved self-perceived communication function at 3 months. Findings are limited by the absence of a sham control, and further research is needed to understand effectiveness compared with other types of care delivery models and amplification devices. Trial Registration: ClinicalTrials.gov Identifier: NCT03442296.

Predicting Hearing Aid Satisfaction in Adults: A Systematic Review of Speech-in-noise Tests and Other Behavioral Measures.

OBJECTIVES: Adults with hearing loss report a wide range of hearing aid satisfaction that does not significantly correlate to degree of hearing loss. It is not clear which auditory behavioral factors do contribute to hearing aid satisfaction. While poor speech understanding in noise is known to contribute to dissatisfaction, there are many categories of this type of assessment. The purpose of this systematic review is to answer the question, "Are behavioral pre-fitting measures using speech and nonspeech materials related to hearing aid satisfaction among adults?" DESIGN: Six electronic databases were searched to find peer-reviewed studies published before June 2020. The included studies reported on the relationship between auditory behavioral measures and hearing aid satisfaction alone or globally with other outcome domains among adults with hearing loss. Six types of behavioral prefitting measures were evaluated: speech recognition in quiet (% correct), speech recognition in noise (% correct), reception thresholds for speech-in-noise, speech-based subjective ratings, dichotic speech tests, and tests using nonspeech material. Each relevant study was independently reviewed by two reviewers. Methodological quality was evaluated in each included study using the American Speech-Language-Hearing Association's level of evidence ratings. RESULTS: There were 1342 articles identified in the systematic review process. After duplicates were removed and specific inclusion criteria were applied, 21 studies were included. All studies included had a 0 to 4 methodological quality rating indicating weak to moderate internal validity. The tests that showed potential for clinical application due to significant correlations with satisfaction were the QuickSIN, the synthetic sentence identification, the hearing in noise test, and the acceptable noise level test. Audibility, as measured by degree of hearing loss, was not significantly correlated to hearing aid satisfaction in the 13 studies that reported on this measure. CONCLUSIONS: Based on this review, results indicated that speech-in-noise tests had the highest associations to hearing aid satisfaction, suggesting a greater role for assessment of speech-in-noise perception in auditory rehabilitation. This is an important finding for clinical practice, given that audibility was not a significant factor in predicting satisfaction. Overall, the results from this review show a need for well-designed, high-quality, prospective studies assessing the predictive value of prefitting measures on hearing aid satisfaction with current hearing aid models.

Feasibility of community health workers as teleaudiology patient-site facilitators: a multilevel training study.

OBJECTIVE: We evaluated the feasibility of a multi-level teleaudiology patient-site facilitator training program for Community Health Workers (CHWs) at a partnering health centre in southern Arizona. DESIGN: Three levels were offered: Introductory, with basic information on hearing loss and teleaudiology; Intermediate, on technology, team roles, and access issues; and Facilitator, on further knowledge and hands-on skills to serve as patient-site facilitators in synchronous hearing aid service delivery. Six domains of feasibility were addressed using a mixed-methods design. Quantitative data included survey responses and observation of hands-on skills. Qualitative data included field notes from group discussion and open-ended survey questions, and were analysed using CHW core competencies. STUDY SAMPLE: Twelve CHWs participated in the introductory training, ten moved on to intermediate, and three continued to the facilitator. RESULTS: Quantitative outcomes indicated that the trainings were feasible according to each of the six domains. CHWs in the facilitator training passed the practical hands-on skill assessment. Qualitative analyses revealed CHWs comments addressed eight of the ten possible CHW core competencies, and focussed on service coordination/navigation, and capacity building. CONCLUSIONS: Teleaudiology trainings for CHWs were feasible, increasing service capacity for a potential pathway to improve access to hearing health care in low-resource areas.

Hearing care across the life course provided in the community.

Untreated hearing loss is recognized as a growing global health priority because of its prevalence and harmful effects on health and well-being. Until recently, little progress had been made in expanding hearing care beyond traditional clinic-based models to incorporate public health approaches that increase accessibility to and affordability of hearing care. As demonstrated in numerous countries and for many health conditions, sharing health-care tasks with community health workers (CHWs) offers advantages as a complementary approach to expand health-service delivery and improve public health. This paper explores the possibilities of task shifting to provide hearing care across the life course by reviewing several ongoing projects in a variety of settings - Bangladesh, India, South Africa and the United States of America. The selected programmes train CHWs to provide a range of hearing-care services, from childhood hearing screening to management of age-related hearing loss. We discuss lessons learnt from these examples to inform best practices for task shifting within community-delivered hearing care. Preliminary evidence supports the feasibility, acceptability and effectiveness of hearing care delivered by CHWs in these varied settings. To make further progress, community-delivered hearing care must build on established models of CHWs and ensure adequate training and supervision, delineation of the scope of practice, supportive local and national legislation, incorporation of appropriate technology and analysis of programme costs and cost-effectiveness. In view of the growing evidence, community-delivered hearing care may now be a way forward to improve hearing health equity.

La perte de l'acuité auditive non traitée est considérée comme une priorité sanitaire de plus en plus importante à l'échelle mondiale en raison de sa prévalence et de ses effets nocifs sur la santé et le bien-être. Jusqu'à récemment, peu de progrès avaient été accomplis pour développer les soins auditifs en dehors des modèles cliniques traditionnels de façon à intégrer des approches de santé publique permettant d'accroître l'accessibilité, notamment économique, des soins auditifs. Comme cela a été démontré dans de nombreux pays et pour de multiples problèmes de santé, transférer des tâches de soins de santé aux agents sanitaires des collectivités présente des avantages en tant qu'approche complémentaire permettant d'étendre la prestation des services de santé et d'améliorer la santé publique. Cette publication étudie les possibilités de transfert de tâches pour dispenser des soins auditifs tout au long de la vie en examinant plusieurs projets en cours à différents endroits ­ Bangladesh, Inde, Afrique du Sud et États-Unis d'Amérique. Les programmes sélectionnés apprennent aux agents sanitaires des collectivités à dispenser divers services de soins auditifs, du dépistage auditif chez les enfants à la gestion de la perte de l'acuité auditive liée à l'âge. Nous évoquons les leçons tirées de ces exemples pour définir les pratiques optimales concernant le transfert des tâches dans le cadre des soins auditifs dispensés dans des structures de proximité. Les observations préliminaires étayent la faisabilité, l'acceptabilité et l'efficacité des soins auditifs dispensés par les agents sanitaires des collectivités dans ces différents contextes. Pour continuer à progresser, les soins auditifs dispensés dans des structures de proximité doivent s'appuyer sur des modèles éprouvés d'agents sanitaires des collectivités. Il convient par ailleurs d'assurer une formation et une supervision adéquates, de délimiter le champ de pratique, d'adopter une législation locale et nationale favorable, d'intégrer une technologie appropriée et d'analyser les coûts du programme et le rapport coût-efficacité. Compte tenu du nombre croissant d'éléments d'appréciation, les soins auditifs dispensés dans des structures de proximité peuvent désormais constituer une solution pour améliorer l'équité en matière de santé auditive.

La pérdida de audición no tratada se reconoce como una prioridad sanitaria mundial cada vez mayor debido a su prevalencia y a sus efectos perjudiciales para la salud y el bienestar. Recientemente, se había avanzado poco en la expansión de la asistencia auditiva más allá de los modelos tradicionales basados en clínicas para incorporar enfoques de salud pública que aumenten la accesibilidad y asequibilidad de la asistencia auditiva. Como se ha demostrado en numerosos países y para muchas condiciones sanitarias, delegar las tareas de atención sanitaria a los trabajadores sanitarios de la comunidad (CHW) ofrece ventajas como enfoque complementario para ampliar la prestación de servicios sanitarios y mejorar la salud pública. Este documento explora las posibilidades de la delegación de funciones para ofrecer atención auditiva a lo largo de toda la vida mediante la revisión de distintos proyectos en curso en una variedad de entornos: Bangladesh, Estados Unidos de América, India y Sudáfrica. Los programas seleccionados capacitan a los CHW para que ofrezcan una amplia gama de servicios de atención auditiva, desde exámenes auditivos para la infancia hasta el tratamiento de la pérdida de audición relacionada con la edad. Discutimos las lecciones aprendidas de estos ejemplos para informar las mejores prácticas sobre la delegación de funciones dentro de la atención auditiva proporcionada en la comunidad. La evidencia preliminar apoya la factibilidad, aceptabilidad y efectividad de la atención auditiva proporcionada por los CHW en estos variados entornos. Para seguir avanzando, la atención auditiva proporcionada en la comunidad debe basarse en modelos establecidos de los CHW y garantizar una formación y supervisión adecuadas, la delimitación del campo de aplicación, el apoyo de la legislación local y nacional, la incorporación de la tecnología adecuada y el análisis de los costes de los programas y la relación coste-eficacia. En vista de las pruebas cada vez más numerosas, la atención auditiva proporcionada en la comunidad puede ser ahora una solución para mejorar la equidad en la salud auditiva.

Self-reported hearing difficulty and its association with general, cognitive, and psychosocial health in the state of Arizona, 2015.

BACKGROUND: Hearing loss is among the leading causes of disability in persons 65 years and older worldwide and is known to have an impact on quality of life as well as social, cognitive, and physical functioning. Our objective was to assess statewide prevalence of self-reported hearing ability in Arizona adults and its association with general health, cognitive decline, diabetes and poor psychosocial health. METHODS: A self-report question on hearing was added to the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a telephone-based survey among community-dwelling adults aged > 18 years (n = 6462). Logistic and linear regression were used to estimate the associations between self-reported hearing loss and health outcomes. RESULTS: Approximately 1 in 4 adults reported trouble hearing (23.2, 95% confidence interval: 21.8, 24.5%), with responses ranging from "a little trouble hearing" to being "deaf." Adults reporting any trouble hearing were at nearly four times higher odds of reporting increased confusion and memory loss (OR 3.92, 95% CI: 2.94, 5.24) and decreased odds of reporting good general health (OR = 0.50, 95% CI: 0.40, 0.64) as compared to participants reporting no hearing difficulty. Those reporting any trouble hearing also reported an average 2.5 more days of poor psychosocial health per month (ß = 2.52, 95% CI: 1.64, 3.41). After adjusting for sex, age, questionnaire language, race/ethnicity, and income category the association between diabetes and hearing loss was no longer significant. CONCLUSIONS: Self-reported hearing difficulty was associated with report of increased confusion and memory loss and poorer general and psychosocial health among Arizona adults. These findings support the feasibility and utility of assessing self-reported hearing ability on the BRFSS. Results highlight the need for greater inclusion of the full range of hearing disability in the planning process for public health surveillance, programs, and services at state and local levels.

Qualitative research methods to investigate communication within a group aural rehabilitation intervention.

Objective: Aural Rehabilitation (AR) aims to minimise negative effects of hearing loss. However, there has been limited study of the lived experience of clients receiving Aural Rehabilitation services, particularly for disparity populations. The purpose of this study is to demonstrate the use of an innovative qualitative approach to investigating communication in an AR setting among Hispanic/Latino older adult dyads. Design: We developed a qualitative phenomenology approach using observation methods to document and analyse how individuals experience living with acquired hearing loss within group AR. Trained observers collected systematic, detailed notes on observations of participants over the course of a 5-week community-based AR intervention. In partnership with audiologists, Community Health Workers facilitated the intervention, which focussed on decreasing negative communication impacts of hearing loss for families. Audiometric data and subjective hearing disability results, using the HHIE-S Spanish version, are presented as additional context for observation outcomes. Study sample: Participants were older Hispanic/Latino adults with hearing loss and their frequent communication partners (five dyads). Results: Four themes related to the experience of communication emerged among dyads in the intervention: (i) emotions related to hearing loss (ii) communication dynamics, (iii) self-management of hearing loss, and (iv) hearing health advocacy. Conclusions: A mixed methods approach that includes group observation would contribute substantially to comprehensively evaluating group AR interventions.

Speech Perception in Noise and Listening Effort of Older Adults With Nonlinear Frequency Compression Hearing Aids.

OBJECTIVES: The purpose of this laboratory-based study was to compare the efficacy of two hearing aid fittings with and without nonlinear frequency compression, implemented within commercially available hearing aids. Previous research regarding the utility of nonlinear frequency compression has revealed conflicting results for speech recognition, marked by high individual variability. Individual differences in auditory function and cognitive abilities, specifically hearing loss slope and working memory, may contribute to aided performance. The first aim of the study was to determine the effect of nonlinear frequency compression on aided speech recognition in noise and listening effort using a dual-task test paradigm. The hypothesis, based on the Ease of Language Understanding model, was that nonlinear frequency compression would improve speech recognition in noise and decrease listening effort. The second aim of the study was to determine if listener variables of hearing loss slope, working memory capacity, and age would predict performance with nonlinear frequency compression. DESIGN: A total of 17 adults (age, 57-85 years) with symmetrical sensorineural hearing loss were tested in the sound field using hearing aids fit to target (NAL-NL2). Participants were recruited with a range of hearing loss severities and slopes. A within-subjects, single-blinded design was used to compare performance with and without nonlinear frequency compression. Speech recognition in noise and listening effort were measured by adapting the Revised Speech in Noise Test into a dual-task paradigm. Participants were required trial-by-trial to repeat the last word of each sentence presented in speech babble and then recall the sentence-ending words after every block of six sentences. Half of the sentences were rich in context for the recognition of the final word of each sentence, and half were neutral in context. Extrinsic factors of sentence context and nonlinear frequency compression were manipulated, and intrinsic factors of hearing loss slope, working memory capacity, and age were measured to determine which participant factors were associated with benefit from nonlinear frequency compression. RESULTS: On average, speech recognition in noise performance significantly improved with the use of nonlinear frequency compression. Individuals with steeply sloping hearing loss received more recognition benefit. Recall performance also significantly improved at the group level, with nonlinear frequency compression revealing reduced listening effort. The older participants within the study cohort received less recall benefit than the younger participants. The benefits of nonlinear frequency compression for speech recognition and listening effort did not correlate with each other, suggesting separable sources of benefit for these outcome measures. CONCLUSIONS: Improvements of speech recognition in noise and reduced listening effort indicate that adult hearing aid users can receive benefit from nonlinear frequency compression in a noisy environment, with the amount of benefit varying across individuals and across outcome measures. Evidence supports individualized selection of nonlinear frequency compression, with results suggesting benefits in speech recognition for individuals with steeply sloping hearing losses and in listening effort for younger individuals. Future research is indicated with a larger data set on the dual-task paradigm as a potential cognitive outcome measure.

The impact of cochlear implantation on cognition in older adults: a systematic review of clinical evidence.

BACKGROUND: Hearing loss is the third most prevalent chronic condition faced by older adults and has been linked to difficulties in speech perception, activities of daily living, and social interaction. Recent studies have suggested a correlation between severity of hearing loss and an individual's cognitive function; however, a causative link has yet to be established. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation. We performed a review to determine the status of the literature on the potential influence of cochlear implantation on cognition in the older adult population. METHODS: Over 3800 articles related to cochlear implants, cognition, and older adults were reviewed. Inclusion criteria were as follows: (1) study population including adults > 65 years, (2) intervention with cochlear implantation, and (3) cognition as the primary outcome measure of implantation. RESULTS: Out of 3,886 studies selected, 3 met inclusion criteria for the review. CONCLUSIONS: While many publications have shown that cochlear implants improve speech perception, social functioning, and overall quality of life, we found no studies in the English literature that have prospectively evaluated changes in cognitive function after implantation with modern cochlear implants in older adults. The state of the current literature reveals a need for further clinical research on the impact of cochlear implantation on cognition in older adults.

Enhancing speech learning by combining task practice with periods of stimulus exposure without practice.

Language acquisition typically involves periods when the learner speaks and listens to the new language, and others when the learner is exposed to the language without consciously speaking or listening to it. Adaptation to variants of a native language occurs under similar conditions. Here, speech learning by adults was assessed following a training regimen that mimicked this common situation of language immersion without continuous active language processing. Experiment 1 focused on the acquisition of a novel phonetic category along the voice-onset-time continuum, while Experiment 2 focused on adaptation to foreign-accented speech. The critical training regimens of each experiment involved alternation between periods of practice with the task of phonetic classification (Experiment 1) or sentence recognition (Experiment 2) and periods of stimulus exposure without practice. These practice and exposure periods yielded little to no improvement separately, but alternation between them generated as much or more improvement as did practicing during every period. Practice appears to serve as a catalyst that enables stimulus exposures encountered both during and outside of the practice periods to contribute to quite distinct cases of speech learning. It follows that practice-plus-exposure combinations may tap a general learning mechanism that facilitates language acquisition and speech processing.

The influence of non-spatial factors on measures of spatial release from masking.

This study tested the hypothesis that the reduction in spatial release from masking (SRM) resulting from sensorineural hearing loss in competing speech mixtures is influenced by the characteristics of the interfering speech. A frontal speech target was presented simultaneously with two intelligible or two time-reversed (unintelligible) speech maskers that were either colocated with the target or were symmetrically separated from the target in the horizontal plane. The difference in SRM between listeners with hearing impairment and listeners with normal hearing was substantially larger for the forward maskers (deficit of 5.8 dB) than for the reversed maskers (deficit of 1.6 dB). This was driven by the fact that all listeners, regardless of hearing abilities, performed similarly (and poorly) in the colocated condition with intelligible maskers. The same conditions were then tested in listeners with normal hearing using headphone stimuli that were degraded by noise vocoding. Reducing the number of available spectral channels systematically reduced the measured SRM, and again, more so for forward (reduction of 3.8 dB) than for reversed speech maskers (reduction of 1.8 dB). The results suggest that non-spatial factors can strongly influence both the magnitude of SRM and the apparent deficit in SRM for listeners with impaired hearing.

Hearing Aid Technology Settings and Speech-in-Noise Difficulties.

PURPOSE: Hearing aids are the primary method to manage hearing loss. However, there are limited recommendations for when and how to set advanced hearing aid features. The purpose of this study is to describe how hearing aid features are utilized in clinically fit devices and to evaluate the relationship between the fitted hearing aid feature and the Quick Speech-in-Noise Test (QuickSIN). METHOD: Data from two laboratories were evaluated retrospectively, resulting in 107 bilateral hearing aid participants who obtained their hearing aids at clinics in their communities. Ages ranged from 60 to 93 years. Degree of speech-in-noise difficulty was evaluated using the QuickSIN (mild, moderate, or severe). Settings for directionality, digital noise reduction (DNR), and hearing assistive technology (HAT) use were documented. Directionality was categorized as omnidirectional, fixed (full-time directional), or adaptive (adjusts automatically based on noise source). DNR was recorded as either on or off. HAT use was recorded as either yes or no. RESULTS: QuickSIN scores ranged from -1.5 to 25 dB SNR loss (M = 7). A moderate correlation was determined for QuickSIN scores and pure-tone averages. Adaptive directionality was used most often, most participants had DNR turned on, and HAT use was low. The biggest contributions to the Chi-square test for directionality and degrees of speech-in-noise difficulty together were fixed/severe, fixed/moderate, and adaptive/mild. CONCLUSIONS: In this clinical sample, there was limited HAT use and advanced features are not set in a way that is consistent with speech-in-noise abilities. It is likely that patients fit with noise management that is not suited to their listening abilities are experiencing increased difficulties in challenging listening environments that could potentially be mitigated with alternative management. Evidence-based research on prefitting measures of speech in noise to help inform patient-centered clinical decisions is needed.

Research Documents for Populations with Limited English Proficiency: Translation Approaches Matter.

To avoid excluding individuals with limited English proficiency from participating in research, the consent form and other documents should be presented to them in their primary language and in a format that is understandable. However, evidence suggests that, when documents are translated for prospective and actual research participants with limited English proficiency, these individuals often fail to engage with the documents and the research in the same terms as their English-speaking counterparts do. We argue that this is because methodological challenges remain after a decision to translate has been made. This study investigated how translation approaches affected reader response and intelligibility. Participants were asked to review two translated versions of a survey (which reflected a functionalist and a literal approach to translation) followed by semistructured interviews. Quantitative and qualitative analysis revealed a preference for a functionalist translation and a higher number of problems raised in regard to the literal translation. The recommendations we offer here include considering the most appropriate translation approach for a specific genre and purpose.

Enhancing perceptual learning by combining practice with periods of additional sensory stimulation.

Perceptual skills can be improved even in adulthood, but this learning seldom occurs by stimulus exposure alone. Instead, it requires considerable practice performing a perceptual task with relevant stimuli. It is thought that task performance permits the stimuli to drive learning. A corresponding assumption is that the same stimuli do not contribute to improvement when encountered separately from relevant task performance because of the absence of this permissive signal. However, these ideas are based on only two types of studies, in which the task was either always performed or not performed at all. Here we demonstrate enhanced perceptual learning on an auditory frequency-discrimination task in human listeners when practice on that target task was combined with additional stimulation. Learning was enhanced regardless of whether the periods of additional stimulation were interleaved with or provided exclusively before or after target-task performance, and even though that stimulation occurred during the performance of an irrelevant (auditory or written) task. The additional exposures were only beneficial when they shared the same frequency with, though they did not need to be identical to, those used during target-task performance. Their effectiveness also was diminished when they were presented 15 min after practice on the target task and was eliminated when that separation was increased to 4 h. These data show that exposure to an acoustic stimulus can facilitate learning when encountered outside of the time of practice on a perceptual task. By properly using additional stimulation one may markedly improve the efficiency of perceptual training regimens.

Weighting function-based mapping of descriptors to frequency-gain curves in listeners with hearing loss.

OBJECTIVES: The frequency-gain curve (FGC) is among the most important parameters to consider when fitting a hearing aid. In practice, a prescriptive FGC, derived from the audiogram, is initially applied. In the subsequent fine-tuning stage, the patient often communicates their concerns about the sound quality using descriptors (e.g., "it sounds hollow") and the clinician modifies the FGC accordingly. In this study, we present and evaluate a method that could enhance this process by rapidly mapping descriptors to FGC shapes. In addition, we begin to use this method to examine the extent to which there is across-individual agreement in how descriptors map to FGC shapes. DESIGN: Ten listeners with hearing loss rated the extent to which each of a series of FGCs captured the meaning of a particular descriptor. Regression analyses were conducted to determine the degree to which these ratings were correlated with the gain values associated with each of 25 frequency bands. The array of slopes of these regression lines across frequency bands is termed the weighting function and was interpreted as the FGC shape that corresponded to the descriptor. We used this procedure to determine the FGC shapes associated with four of the most common descriptors used to describe hearing aid sound quality problems ("tinny," "sharp," "hollow," and "in a barrel, tunnel, or well"). RESULTS: The weighting function shape was highly replicable despite variable listener responses, reached asymptotic performance quickly (<20 ratings), and was predictive of listener responses. On the global level, there was some agreement across individuals about how common descriptors mapped to weighting function shape. However, considerable differences were apparent between individuals in terms of the specifics of that mapping. CONCLUSIONS: The current approach for descriptor-to-FGC mapping is a quick, reliable method for determining individualized changes to the FGC. Given the range of individual differences in the specifics of the descriptor-to-FGC mappings observed, this approach could be useful in a clinical setting to easily quantify these acoustic parameters. Implementation of such procedures could lead to more personalized fine-tuning of amplification devices.

Investigating the Role of Auditory Processing Abilities in Long-Term Self-Reported Hearing Aid Outcomes among Adults Age 60+ Years.

BACKGROUND: Self-reported hearing aid outcomes among older adults are variable and important to improve. The extent of the role of auditory processing in long-term hearing aid outcomes is not well understood. PURPOSE: To determine how auditory processing abilities are related to self-reported hearing aid satisfaction and benefit along with either aided audibility alone or exploratory factors suggested by previous literature. RESEARCH DESIGN: Descriptive analyses and multiple regression analyses of cross-sectional self-reported outcomes. STUDY SAMPLE: Adult participants, >60 years (n = 78), fitted with bilateral hearing aids to treat symmetric, mild to moderate sensorineural hearing loss. DATA COLLECTION AND ANALYSIS: Participants were recruited from a single audiology clinic to complete a series of questionnaires, behavioral assessments, and obtain data from their hearing aids, including real ear measures and data logging of hearing aid use. Multiple linear regressions were used to determine the amount of variance explained by predictive factors in self-reported hearing aid satisfaction and benefit. The primary predictive factors included gap detection threshold, spatial advantage score, dichotic difference score, and aided audibility. Exploratory factors included personality, self-efficacy, self-report of disability, and hearing aid use. All interpretations of statistical significance used p < 0.05. Effect sizes were determined using Cohen's f 2 with a medium effect suggesting clinical relevance. RESULTS: Gap detection threshold was a statistically significant predictor in both primary regression models with a medium effect size for satisfaction and a small effect size for benefit. When additional exploratory factors were included in the regression models with auditory processing abilities, gap detection and self-efficacy were both significant predictors of hearing aid satisfaction with medium effect sizes, explaining 10 and 17% of the variance, respectively. There were no medium effect sizes found for other predictor variables in either the primary or exploratory hearing aid benefit models. Additional factors were statistically significant in the models, explaining a small amount of variance, but did not meet the medium effect size criterion. CONCLUSION: This study provides initial evidence supporting the incorporation of measures of gap detection ability and hearing aid self-efficacy into clinical practice for the interpretation of postfitting long-term hearing aid satisfaction.

Racial/Ethnic and Sex Representation in US-Based Clinical Trials of Hearing Loss Management in Adults: A Systematic Review.

Importance: Although the National Institutes of Health (NIH) mandated the inclusion and reporting of women and racial or ethnic minority groups in NIH-funded research in 1993, little is known regarding the representation of women and racial or ethnic minority groups in trials that investigate hearing loss management. Objective: To assess sex and racial/ethnic representation in US-based clinical trials of hearing loss management in an adult population. Data Sources: Pertinent studies were identified using search strategies in PubMed, Embase, and ClinicalTrials.gov. Study Selection: Our search strategy yielded 6196 studies. We included prospective studies that were written in English, performed in the US, and evaluated hearing loss management in adults, including amplification devices, such as hearing aids or assistive listening devices, cochlear implants, aural rehabilitation, and therapeutics. Given its prevalence, only studies that addressed bilateral sensorineural hearing loss were included. Data Extraction and Synthesis: Data from 125 studies were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses diagram for systematic reviews was used for abstracting data. The guidelines were applied using independent extraction by multiple observers. Results: Among 125 clinical studies performed from January 1990 to July 2020 regarding hearing loss management, only 16 (12.8%) reported race/ethnicity, and 88 (70.4%) reported sex. Of the 16 studies that reported race/ethnicity, only 5 included more than 30% non-White representation. Among the 88 articles that reported sex, 44 (35.2%) reported more than 45% female representation. While the mean number of participants included in the observed trials was 80 (range, 7-644), the median number of participants from racial or ethnic minority groups in studies that reported race/ethnicity was 9 (range, 1-77), and a median of 12 female participants were included in studies with a numerical breakdown by sex. A mean of 41% (range, 1.55%-77.5%) of participants were female among studies that reported sex, and a mean of 30% (range, 1.96%-100%) of participants were from racial or ethnic minority groups among the 16 studies that reported race/ethnicity. Reporting of race/ethnicity varied substantially by funding source and journal type, while reporting by sex differed only by journal type. Conclusions and Relevance: Studies investigating hearing loss management do not adequately reflect the US population. A closer examination of the inclusion of diverse adults in clinical research associated with hearing health may work to ameliorate disparities and contribute to the development of tailored interventions that address the needs of an increasingly diverse US population.

A Community Health Worker Training Program to Deliver Accessible and Affordable Hearing Care to Older Adults.

Community leaders collaborated with human-centered design practitioners and academic researchers to co-develop a community health worker (CHW) training program for delivering community-based hearing care to fellow older adults. When implemented by CHWs, clients' communication function improved comparably with outcomes following professional interventions. Community-based models offer opportunities to advance hearing health.