Association between the home-to-healthcare center distance and hearing aid abandonment among older adults.

Background: Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment. Objective: To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system. Methods: 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects. Results: Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04-1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity. Conclusion: A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

Modeling the Intelligibility Benefit of Active Noise Cancelation in Hearing Devices That Improve Signal-to-Noise Ratio.

The extent to which active noise cancelation (ANC), when combined with hearing assistance, can improve speech intelligibility in noise is not well understood. One possible source of benefit is ANC's ability to reduce the sound level of the direct (i.e., vent-transmitted) path. This reduction lowers the "floor" imposed by the direct path, thereby allowing any increases to the signal-to-noise ratio (SNR) created in the amplified path to be "realized" at the eardrum. Here we used a modeling approach to estimate this benefit. We compared pairs of simulated hearing aids that differ only in terms of their ability to provide ANC and computed intelligibility metrics on their outputs. The difference in metric scores between simulated devices is termed the "ANC Benefit." These simulations show that ANC Benefit increases as (1) the environmental sound level increases, (2) the ability of the hearing aid to improve SNR increases, (3) the strength of the ANC increases, and (4) the hearing loss severity decreases. The predicted size of the ANC Benefit can be substantial. For a moderate hearing loss, the model predicts improvement in intelligibility metrics of >30% when environments are moderately loud (>70 dB SPL) and devices are moderately capable of increasing SNR (by >4 dB). It appears that ANC can be a critical ingredient in hearing devices that attempt to improve SNR in loud environments. ANC will become more and more important as advanced SNR-improving algorithms (e.g., artificial intelligence speech enhancement) are included in hearing devices.

In-situ Audiometry Compared to Conventional Audiometry for Hearing Aid Fitting.

The use of in-situ audiometry for hearing aid fitting is appealing due to its reduced resource and equipment requirements compared to standard approaches employing conventional audiometry alongside real-ear measures. However, its validity has been a subject of debate, as previous studies noted differences between hearing thresholds measured using conventional and in-situ audiometry. The differences were particularly notable for open-fit hearing aids, attributed to low-frequency leakage caused by the vent. Here, in-situ audiometry was investigated for six receiver-in-canal hearing aids from different manufacturers through three experiments. In Experiment I, the hearing aid gain was measured to investigate whether corrections were implemented to the prescribed target gain. In Experiment II, the in-situ stimuli were recorded to investigate if corrections were directly incorporated to the delivered in-situ stimulus. Finally, in Experiment III, hearing thresholds using in-situ and conventional audiometry were measured with real patients wearing open-fit hearing aids. Results indicated that (1) the hearing aid gain remained unaffected when measured with in-situ or conventional audiometry for all open-fit measurements, (2) the in-situ stimuli were adjusted for up to 30 dB at frequencies below 1000 Hz for all open-fit hearing aids except one, which also recommends the use of closed domes for all in-situ measurements, and (3) the mean interparticipant threshold difference fell within 5 dB for frequencies between 250 and 6000 Hz. The results clearly indicated that modern measured in-situ thresholds align (within 5 dB) with conventional thresholds measured, indicating the potential of in-situ audiometry for remote hearing care.

Binaural hearing aid intervention for a patient with nonserviceable hearing loss after surgery for vestibular schwannoma: A case report.

A vestibular schwannoma is a benign tumor; however, the schwannoma itself and interventions can cause sensorineural hearing loss. Most vestibular schwannomas are unilateral tumors that affect hearing only on one side. Attention has focused on improving the quality of life for patients with unilateral hearing loss and therapeutic interventions to address this issue have been emphasized. Herein, we encountered a patient who was a candidate for hearing preservation surgery based on preoperative findings and had nonserviceable hearing after the surgery, according to the Gardner-Robertson classification. Postoperatively, the patient had decreased listening comprehension and ability to localize sound sources. He was fitted with bilateral hearing aids, and his ability to localize sound sources improved. Although the patient had postoperative nonserviceable hearing on the affected side and age-related hearing loss on the unaffected side, hearing aids in both ears were useful for his daily life. Therefore, the patient was able to maintain a binaural hearing effect and the ability to localize the sound source improved. This report emphasizes the importance of hearing preservation with vestibular schwannomas, and the demand for hearing loss rehabilitation as a postoperative complication can increase, even if hearing loss is nonserviceable.

How Hearing Loss and Cochlear Implantation Affect Verbal Working Memory: Evidence From Adolescents.

PURPOSE: Verbal working memory is poorer for children with hearing loss than for peers with normal hearing (NH), even with cochlear implantation and early intervention. Poor verbal working memory can affect academic performance, especially in higher grades, making this deficit a significant problem. This study examined the stability of verbal working memory across middle childhood, tested working memory in adolescents with NH or cochlear implants (CIs), explored whether signal enhancement can improve verbal working memory, and tested two hypotheses proposed to explain the poor verbal working memory of children with hearing loss: (a) Diminished auditory experience directly affects executive functions, including working memory; (b) degraded auditory inputs inhibit children's abilities to recover the phonological structure needed for encoding verbal material into storage. DESIGN: Fourteen-year-olds served as subjects: 55 with NH; 52 with CIs. Immediate serial recall tasks were used to assess working memory. Stimuli consisted of nonverbal, spatial stimuli and four kinds of verbal, acoustic stimuli: nonrhyming and rhyming words, and nonrhyming words with two kinds of signal enhancement: audiovisual and indexical. Analyses examined (a) stability of verbal working memory across middle childhood, (b) differences in verbal and nonverbal working memory, (c) effects of signal enhancement on recall, (d) phonological processing abilities, and (e) source of the diminished verbal working memory in adolescents with cochlear implants. RESULTS: Verbal working memory remained stable across middle childhood. Adolescents across groups performed similarly for nonverbal stimuli, but those with CIs displayed poorer recall accuracy for verbal stimuli; signal enhancement did not improve recall. Poor phonological sensitivity largely accounted for the group effect. CONCLUSIONS: The central executive for working memory is not affected by hearing loss or cochlear implantation. Instead, the phonological deficit faced by adolescents with CIs denigrates the representation in storage and augmenting the signal does not help.

Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss.

OBJECTIVE: In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. METHODS: A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. RESULTS: There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p < .01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p < .01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p < .05) and at all months for VAS-1 (tinnitus severity) (p < .05) and VAS-2 (tinnitus discomfort) (p < .05). CONCLUSION: In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55 dB HL in a relatively short period of 1 month.

Deep learning-based auditory attention decoding in listeners with hearing impairment.

Objective.This study develops a deep learning (DL) method for fast auditory attention decoding (AAD) using electroencephalography (EEG) from listeners with hearing impairment (HI). It addresses three classification tasks: differentiating noise from speech-in-noise, classifying the direction of attended speech (left vs. right) and identifying the activation status of hearing aid noise reduction algorithms (OFF vs. ON). These tasks contribute to our understanding of how hearing technology influences auditory processing in the hearing-impaired population.Approach.Deep convolutional neural network (DCNN) models were designed for each task. Two training strategies were employed to clarify the impact of data splitting on AAD tasks: inter-trial, where the testing set used classification windows from trials that the training set had not seen, and intra-trial, where the testing set used unseen classification windows from trials where other segments were seen during training. The models were evaluated on EEG data from 31 participants with HI, listening to competing talkers amidst background noise.Main results.Using 1 s classification windows, DCNN models achieve accuracy (ACC) of 69.8%, 73.3% and 82.9% and area-under-curve (AUC) of 77.2%, 80.6% and 92.1% for the three tasks respectively on inter-trial strategy. In the intra-trial strategy, they achieved ACC of 87.9%, 80.1% and 97.5%, along with AUC of 94.6%, 89.1%, and 99.8%. Our DCNN models show good performance on short 1 s EEG samples, making them suitable for real-world applications. Conclusion: Our DCNN models successfully addressed three tasks with short 1 s EEG windows from participants with HI, showcasing their potential. While the inter-trial strategy demonstrated promise for assessing AAD, the intra-trial approach yielded inflated results, underscoring the important role of proper data splitting in EEG-based AAD tasks.Significance.Our findings showcase the promising potential of EEG-based tools for assessing auditory attention in clinical contexts and advancing hearing technology, while also promoting further exploration of alternative DL architectures and their potential constraints.

Study protocol for Hear Me Read (HMR): A prospective clinical trial assessing a digital storybook intervention for young children who are deaf or hard of hearing.

Since the early 2000's, digital reading applications have enhanced the language and literacy skills of typically hearing young children; however, no digital storybook intervention currently exists to scaffold the early language and literacy skills of their peers who are deaf or hard of hearing. To address this gap, our research team developed a novel digital storybook intervention called Hear Me Read with the aim of enhancing the therapeutic, language, and literacy benefits of speech-language therapy. This prospective clinical trial (registered at clinicaltrials.gov, NCT#: 05245799) aims to determine the efficacy of adding Hear Me Read to in-person speech-language therapy for children aged three to five years who are deaf or hard of hearing. Fifty caregivers, their child, and their child's treating speech-language pathologist participate in the trial for 12 months. In the first six months, children attend standard-of-care speech-language therapy sessions. In the second six months, children continue to attend standard-of-care speech-language therapy sessions and use the Hear Me Read application, via a study supplied iPad. The primary outcome of this trial is that, compared to in-person speech-language therapy alone, in-person speech-language therapy with Hear Me Read will improve vocabulary, speech, and language outcomes in children aged three to five years who are deaf or hard of hearing. The secondary outcome is that, compared to in-person speech-language therapy alone, in-person speech-language therapy with Hear Me Read will improve literacy outcomes in children aged three to five years who are deaf or hard of hearing. The goal of this intervention is to help children who are deaf or hard of hearing achieve their vocabulary, speech, language, and literacy goals through interactive digital storybook reading.

An Exploration of the Memory Performance in Older Adult Hearing Aid Users on the Integrated Digit-in-Noise Test.

This study aimed to preliminarily investigate the associations between performance on the integrated Digit-in-Noise Test (iDIN) and performance on measures of general cognition and working memory (WM). The study recruited 81 older adult hearing aid users between 60 and 95 years of age with bilateral moderate to severe hearing loss. The Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) was used to screen older adults for mild cognitive impairment. Speech reception thresholds (SRTs) were measured using 2- to 5-digit sequences of the Mandarin iDIN. The differences in SRT between five-digit and two-digit sequences (SRT5-2), and between five-digit and three-digit sequences (SRT5-3), were used as indicators of memory performance. The results were compared to those from the Digit Span Test and Corsi Blocks Tapping Test, which evaluate WM and attention capacity. SRT5-2 and SRT5-3 demonstrated significant correlations with the three cognitive function tests (rs ranging from -.705 to -.528). Furthermore, SRT5-2 and SRT5-3 were significantly higher in participants who failed the MoCA-BC screening compared to those who passed. The findings show associations between performance on the iDIN and performance on memory tests. However, further validation and exploration are needed to fully establish its effectiveness and efficacy.

Does Intraoperative Extracochlear Electrocochleography Correlate With Postoperative Audiometric Hearing Thresholds in Cochlear Implant Surgery? A Retrospective Analysis of Cochlear Monitoring.

In recent years, tools for early detection of irreversible trauma to the basilar membrane during hearing preservation cochlear implant (CI) surgery were established in several clinics. A link with the degree of postoperative hearing preservation in patients was investigated, but patient populations were usually small. Therefore, this study's aim was to analyze data from intraoperative extracochlear electrocochleography (ECochG) recordings for a larger group.During hearing preservation CI surgery, extracochlear recordings were made before, during, and after CI electrode insertion using a cotton wick electrode placed at the promontory. Before and after insertion, amplitudes and stimulus response thresholds were recorded at 250, 500, and 1000 Hz. During insertion, response amplitudes were recorded at one frequency and one stimulus level. Data from 121 patient ears were analyzed.The key benefit of extracochlear recordings is that they can be performed before, during, and after CI electrode insertion. However, extracochlear ECochG threshold changes before and after CI insertion were relatively small and did not independently correlate well with hearing preservation, although at 250 Hz they added some significant information. Some tendencies-although no significant relationships-were detected between amplitude behavior and hearing preservation. Rising amplitudes seem favorable and falling amplitudes disadvantageous, but constant amplitudes do not appear to allow stringent predictions.Extracochlear ECochG measurements seem to only partially realize expected benefits. The questions now are: do gains justify the effort, and do other procedures or possible combinations lead to greater benefits for patients?

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.

The Classroom Communication and Collaboration Appraisal: A Comprehensive Tool for Assessing Communication and Collaboration in Classroom Environments.

PURPOSE: The aim of this research note is to introduce a new appraisal form, the Classroom Communication and Collaboration (C3) Appraisal, designed to evaluate communication and collaboration within classroom settings. METHOD: A comprehensive synthesis of the key skills from a broad range of publications on successful communication and collaboration in the classroom was conducted. The resulting appraisal comprises 39 items across six scales: crafting clear messages, appropriateness of communication exchange, active listening, pragmatics and discourse, communication breakdown, and collaboration. To demonstrate its application, an exemplar usage of the C3 Appraisal involving a hearing child and a child with hearing loss engaged in a collaborative learning task is presented. RESULTS: The C3 Appraisal allowed for the quality and successfulness of the collaborative learning task between the two children to be assessed and quantified across the six scales. CONCLUSIONS: These findings highlight the utility of the C3 Appraisal as a valuable tool for evaluating communication and collaboration in classroom environments. Next steps are to test the reliability and validity of the C3 Appraisal on a large data set.

Focusing on Positive Listening Experiences Improves Speech Intelligibility in Experienced Hearing Aid Users.

Negativity bias is a cognitive bias that results in negative events being perceptually more salient than positive ones. For hearing care, this means that hearing aid benefits can potentially be overshadowed by adverse experiences. Research has shown that sustaining focus on positive experiences has the potential to mitigate negativity bias. The purpose of the current study was to investigate whether a positive focus (PF) intervention can improve speech-in-noise abilities for experienced hearing aid users. Thirty participants were randomly allocated to a control or PF group (N = 2 × 15). Prior to hearing aid fitting, all participants filled out the short form of the Speech, Spatial and Qualities of Hearing scale (SSQ12) based on their own hearing aids. At the first visit, they were fitted with study hearing aids, and speech-in-noise testing was performed. Both groups then wore the study hearing aids for two weeks and sent daily text messages reporting hours of hearing aid use to an experimenter. In addition, the PF group was instructed to focus on positive listening experiences and to also report them in the daily text messages. After the 2-week trial, all participants filled out the SSQ12 questionnaire based on the study hearing aids and completed the speech-in-noise testing again. Speech-in-noise performance and SSQ12 Qualities score were improved for the PF group but not for the control group. This finding indicates that the PF intervention can improve subjective and objective hearing aid benefits.

Reliability and Validity of the Turkish Version of the Vanderbilt Fatigue Scale for Adults.

PURPOSE: Listening-related fatigue (LRF) is a prominent topic of research interest. The purpose of this study is to investigate the reliability and validity of the Turkish version of the 40-item Vanderbilt Fatigue Scale for Adults (TR-VFS-A-40). METHOD: This study included 317 adults with no hearing loss and 260 adults with hearing loss in the study group, totaling 577 adults aged 18-75 years. While 31 adults in the study group did not use any hearing technology, there were 96 hearing aid users and 123 cochlear implant (CI) users. A subset of 80 CI users completed the TR-VFS-A-40 a second time, 2 weeks later, to assess test-retest reliability. Intraclass correlation coefficients were used to assess test-retest reliability. Cronbach's alpha was used to evaluate internal consistency. To examine construct validity, a confirmatory factor analysis (CFA) was performed. For concurrent validity analysis, the Checklist Individual Strength (CIS) and TR-VFS-A-40 scores were analyzed using the Spearman correlation test. RESULTS: Cronbach's alpha values were excellent for the total scale of .987 and the cognitive, emotional, physical, and social subscales (.953, .954, .955, and .946, respectively). Analyses of concurrent validity revealed strong and significant correlations between CIS and TR-VFS-A-40 scores, indicating a good concurrent validity. The CFA determined that the construct validity of the TR-VFS-A-40 was satisfactory. CONCLUSION: The TR-VFS-A-40 is a valid and reliable measure of LRF. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25457752.

Teleaudiology Services in Australia: A National Survey of Hearing Health Care Consumers Amid the COVID-19 Pandemic.

PURPOSE: The aim of this study was to investigate the perspectives of Australia-based hearing health care consumers regarding the (a) provision and utilization of teleaudiology services, (b) experiences with teleaudiology, and (c) barriers and enablers to future teleaudiology use. METHOD: A national prospective self-report online survey was completed between April and October 2020, amid COVID-19. Data were analyzed using descriptive statistics (closed-answer items) and content analysis (open-text responses). A total of 381 participants (Mage = 72.07 years ± 10.08, 142 females) were recruited from different states and territories of Australia. RESULTS: Despite positive outcomes reported by those who undertook teleaudiology appointments during COVID-19, results indicate low-consumer teleaudiology uptake. It can be inferred that consumers were not aware of teleaudiology as an appointment option, clinicians/clinic staff had not informed and/or supported teleaudiology as an option, and biases existed that prevented teleaudiology being more widely adopted. It is unclear whether consumers who were eligible for government subsidies understood that teleaudiology appointments were reimbursed through government funding. Barriers to future teleaudiology uptake were largely related to concerns regarding confidentiality and privacy. CONCLUSION: Low consumer uptake of teleaudiology appointments appears to be driven by consumer preference for in-person services, which appears to be driven by lack of knowledge regarding the availability and effectiveness of teleaudiology. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25619808.

Reduced Tolerance for Risky Play in Primary Caregivers of Children With Hearing Loss.

PURPOSE: It is known that taking appropriate risks during play is crucial for the development of a child's creativity, problem-solving abilities, resilience, self-confidence, and skills in evaluating risky situations. However, communication problems resulting from hearing loss (HL) can affect a child's ability to hear danger and warning signals during play, potentially leading to injury. This study investigates the attitudes of parents or caregivers with children with HL toward risky play. METHOD: The study included 170 caregivers of children with normal hearing (NH; n = 103) and cochlear implant and/or hearing aids users (n = 67) aged 3-13 years. The primary caregiver completed the Tolerance for Risk in Play Scale (TRIPS), and the caregivers of children with HL also completed the Auditory Behavior in Everyday Life (ABEL) questionnaire. RESULTS: TRIPS total scores were significantly higher in the NH group (p < .05). Mothers of children with HL had lower TRIPS scores than mothers of children with NH (p < .05). Similarly, lower TRIPS scores were found in the lower income group with HL (p < .05). A weak positive correlation was observed between TRIPS and both the ABEL total score (p < .05, r = .207) and ABEL auditory awareness score (p < .05, r = .204) in the hard of hearing group. CONCLUSIONS: The study found that caregivers of children with HL have less tolerance for risky play. Additionally, caregivers of children with better auditory skills were more tolerant of risky play. Therefore, it is suggested that caregivers of children using appropriate hearing devices should be informed that they do not need to be overly restrictive during play, and these children should be encouraged to engage in risky play.

Communication between healthcare professionals and patients with hearing loss: A systematic review and meta-analysis.

PURPOSE: We aimed to systematically review and meta-analyze published evidence on modes of communication between healthcare professionals and patients with hearing loss. METHODS: MEDLINE/PubMed, Scopus, CINAHL, ScienceDirect, and Thai Journals Online Complete databases were searched. A meta-analysis was performed using a random-effects model. Data on the prevalence and types of communication between healthcare professionals and patients with any extent of hearing loss were extracted. RESULTS: Twenty studies were included. Using a hearing aid (pooled prevalence, 57.4%; 95% CI, 11.4%-103.4%, N = 3, I2 = 99.33) and gestures (pooled prevalence = 54.8%, 95%CI: 17.4% to 92.1%, N = 7, I2 = 99.68) were the most commonly reported modes of communication. Few healthcare professionals could use sign language, and limited access to qualified interpreters was common. CONCLUSION: Communication barriers exist. Qualified sign language interpreters and assistive technology should be used to improve communication.

Perceptions of Hearing Health Care: A Qualitative Analysis of Satisfied and Dissatisfied Online Reviews.

PURPOSE: The aim of this study was to examine the hearing health care experience of satisfied and dissatisfied consumers as reported on Google reviews. METHOD: Using qualitative thematic analysis, open-text responses from Google regarding hearing health care clinics across 40 U.S. cities were examined. During the original search, 13,168 reviews were identified. Purposive sampling led to a total of 8,420 five-star reviews and 321 one-star reviews. The sample consisted of 500 five-star (satisfied) and 234 one-star (dissatisfied) reviews, describing experiences with audiology clinics, excluding reviews related to ear, nose, and throat services; other medical specialties; and those not relevant to hearing health care. RESULTS: Satisfied and dissatisfied consumer reviews yielded nuanced dimensions of the hearing health care consumer experience, which were grouped into distinct domains, themes, and subthemes. Six and seven domains were identified from the satisfied and dissatisfied reviews, encompassing 23 and 26 themes, respectively. The overall experience domain revealed emotions ranging from contentment and gratitude to dissatisfaction and waning loyalty. The clinical outcomes domain highlights the pivotal contribution of well-being and hearing outcomes to the consumer experience, while the standard of care domain underscores shared expectations for punctuality, person-centered care, and efficient communication. Facility quality, professional competence, and inclusive care were also highlighted across positive and negative reviews. CONCLUSIONS: Findings indicate dimensions of satisfied and dissatisfied hearing health care consumer experiences, identifying areas for potential service refinement. These consumer experiences inform person-centric service delivery in hearing health care.

Smartphone-Facilitated In-Situ Hearing Aid Audiometry for Community-Based Hearing Testing.

OBJECTIVES: Hearing loss prevalence is increasing, with an estimated 2.5 billion people affected globally by 2050. Scalable service delivery models using innovative technologies and task-shifting are World Health Organization priorities to improve access to hearing care, particularly in low- and middle-income countries. Smartphone-facilitated audiometry in the community using hearing aids covered by noise-attenuating ear cups ("in-situ") could support more accessible hearing care when provided by less trained individuals such as community health workers (CHWs). This study aimed to determine the validity of this method for potential hearing aid fitting. Study objectives included determining the maximum permissible ambient noise level (MPANL), inter-device reliability, clinical threshold accuracy, reliability, and performance in real-world settings. DESIGN: Experiment 1: 15 normal-hearing adult participants were evaluated to determine MPANLs for circumaural Peltor 3M earcups covering Lexie Lumen hearing aids with smartphone-facilitated in-situ audiometry. MPANLs were calculated by measuring the difference in attenuation between thresholds obtained with standard headphones and in-situ hearing aids. Experiment 2: Pure-tone frequency and intensity output of 14 same-model Lexie Lumen hearing aids were measured to determine inter-device reliability. Pure-tone stimuli were measured and analyzed to determine sound pressure levels in decibels and pure-tone frequency when connected to a test box 2cc coupler. Experiment 3: 85 adult participants were tested in a sound booth to determine the accuracy of automated in-situ pure-tone audiometry (PTA) compared to clinical PTA (500, 1000, 2000, 3000, 4000, 6000 Hz) facilitated by an audiologist. The first 39 participants were tested twice to determine test-retest reliability. Experiment 4: In a community setting, 144 adult participants were tested with automated in-situ audiometry facilitated by CHWs using a smartphone app. These participants were subsequently tested with automated mobile PTA (500, 1000, 2000, 4000 Hz). An additional 44 participants were tested twice to determine test-retest reliability. RESULTS: Experiment 1: MPANLs of the Peltor 3M earcup-covered hearing aids were higher than standard headphones across all frequencies, ranging from 24 to 47.3 dB SPL. Experiment 2: Inter-device performance reliability was high, with all inter-device differences across all intensities and frequencies less than 3 dB. Frequency output was consistent and differed less than 0.7% between devices. Experiments 3 and 4: 85.2% and 83.3% of automated in-situ audiometry thresholds were within 10 dB of thresholds obtained in the sound booth and in a community setting, respectively. Acceptable test-retest intraclass correlation coefficient (ICC) was evident across all thresholds obtained in a sound booth (ICC = 0.85 to 0.93) and in a community setting (ICC = 0.83 to 0.97). CONCLUSIONS: Smartphone-facilitated in-situ audiometry allows for reliable and valid community-based testing. A simple smartphone user interface and automated in-situ audiometry allow CHWs with minimal training to facilitate the testing. With the additional capability to program hearing aids via the smartphone after the initial test, this approach would have the potential to support widespread access to personalized hearing aid fittings facilitated by CHWs in low- and middle-income countries. This approach also supports self-fitting options based on in-situ thresholds, enabling testing and fitting via over the counter hearing aids.

How Individuals Shape Their Acoustic Environment: Implications for Hearing Aid Comparison in Ecological Momentary Assessment.

OBJECTIVES: When using ecological momentary assessment (EMA) to compare different hearing aid programs, it is usually assumed that for sufficiently long study durations similar situations will be experienced in both programs. However, conscious or subconscious adaptation of situations to one's hearing ability (e.g., asking a conversation partner to speak up, increasing TV volume)-which might be different across the time spent in different hearing aid programs-may challenge this assumption. In the present study, we investigated how test participants modify their acoustic environment and if these modifications depend on the hearing program. DESIGN: Twenty-nine experienced hearing aid users were provided with hearing aids containing two hearing programs differing in directionality and noise reduction (NR). The hearing programs called NR-on and NR-off changed each day automatically. Over the course of 3 weeks, participants were asked to answer a questionnaire every time they encountered an acoustic situation they modified or would have liked to modify to improve the listening situation. Objective data on sound pressure level and classification of the acoustic situation were collected from the hearing aids. At the beginning of the study participants recollected modifications of the acoustic environments they typically do when using their own hearing aids and reported on the frequency of this behavior. RESULTS: During the field trial, participants reported on average 2.3 situations per day that they modified or would have liked to modify. Modifications were usually performed quickly after the onset of the situation and significantly improved the pleasantness of the listening situation. While the number of the reported situations did not differ between the programs, modifications increasing the volume of the target signal and increasing the hearing aid volume were more frequent for the NR-on hearing program. Changes in the objective data at the time of the modification were consistent with the reported modifications. Further, the usage time as well as the distribution of the acoustic situations over the entire study period differed between the two hearing programs. CONCLUSIONS: The large improvement in pleasantness due to the modification might explain the generally positive ratings observed in EMA studies. Furthermore, the results found here suggest that caution is needed when comparing ratings of audiological attributes in EMA, because the different modification behavior across hearing programs may lead to an underestimation of hearing problems and reduced sensitivity when comparing two technologies.