The impact of using the Ida "My Hearing Explained" tool on audiologists' language and patient understanding of hearing test results: a comparison with standard audiogram explanations.

OBJECTIVE: Explore the impact of Ida's "My Hearing Explained" (MHE) tool on audiologists' language and patients' understanding/interpretation of hearing test results. DESIGN: Audiologists were video-recorded in two sequential conditions: 1) giving standard audiogram explanations to 13 patients and, 2) following discretionary self-training, giving explanations using the MHE tool (nine patients). Outcomes of interest were audiologists' language complexity, use of jargon, and audiologist-patient interactivity. Semi-structured patient interviews, conducted 1-7 days after appointments, were analysed using inductive qualitative content analysis. Patient recall was verified. STUDY SAMPLE: Four audiologists from one United Kingdom audiology service, and 22 patients (mean age 63.5 yrs) participated. RESULTS: In comparison to standard audiogram explanations, audiologists' language was simpler and audiologist-patient interactivity greater with the MHE tool. Interview data analysis revealed differences between explanation types within the themes of "Understanding" and "Interpretation." 54% (standard audiogram) and 22% (MHE tool) of patients expressed a desire for takeaway information. 31% (standard audiogram) and 67% (MHE tool) of patients reported their explanation helped them relay their results to others. Four patients (one receiving the MHE tool) incorrectly recalled information, suggesting inadequate understanding in these cases. CONCLUSIONS: The MHE tool has potential for improving the accessibility and comprehensibility of hearing test results.

Predicting Individual Hearing-Aid Preference From Self-Reported Listening Experiences in Daily Life.

OBJECTIVES: The study compared the utility of two approaches for collecting real-world listening experiences to predict hearing-aid preference: a retrospective questionnaire (Speech, Spatial, and Qualities of Hearing Scale [SSQ]) and in-situ Ecological Momentary Assessment (EMA). The rationale being that each approach likely provides different and yet complementary information. In addition, it was examined how self-reported listening activity and hearing-aid data-logging can augment EMAs for individualized and contextualized hearing outcome assessments. DESIGN: Experienced hearing-aid users (N = 40) with mild-to-moderate symmetrical sensorineural hearing loss completed the SSQ questionnaire and gave repeated EMAs for two wear periods of 2-weeks each with two different hearing-aid models that differed mainly in their noise reduction technology. The EMAs were linked to a self-reported listening activity and sound environment parameters (from hearing-aid data-logging) recorded at the time of EMA completion. Wear order was randomized by hearing-aid model. Linear mixed-effects models and Random Forest models with five-fold cross-validation were used to assess the statistical associations between listening experiences and end-of-trial preferences, and to evaluate how accurately EMAs predicted preference within individuals. RESULTS: Only 6 of the 49 SSQ items significantly discriminated between responses made for the end-of-trial preferred versus nonpreferred hearing-aid model. For the EMAs, questions related to perception of the sound from the hearing aids were all significantly associated with preference, and these associations were strongest in EMAs completed in sound environments with predominantly low SNR and listening activities related to television, people talking, nonspecific listening, and music listening. Mean differences in listening experiences from SSQ and EMA correctly predicted preference in 71.8% and 72.5% of included participants, respectively. However, a prognostic classification of single EMAs into end-of-trial preference with a Random Forest model achieved a 93.8% accuracy when contextual information was included. CONCLUSIONS: SSQ and EMA predicted preference equally well when considering mean differences, however, EMAs had a high prognostic classifications accuracy due to the repeated-measures nature, which make them ideal for individualized hearing outcome investigations, especially when responses are combined with contextual information about the sound environment.

Combining Cardiovascular and Pupil Features Using k-Nearest Neighbor Classifiers to Assess Task Demand, Social Context, and Sentence Accuracy During Listening.

In daily life, both acoustic factors and social context can affect listening effort investment. In laboratory settings, information about listening effort has been deduced from pupil and cardiovascular responses independently. The extent to which these measures can jointly predict listening-related factors is unknown. Here we combined pupil and cardiovascular features to predict acoustic and contextual aspects of speech perception. Data were collected from 29 adults (mean  =  64.6 years, SD  =  9.2) with hearing loss. Participants performed a speech perception task at two individualized signal-to-noise ratios (corresponding to 50% and 80% of sentences correct) and in two social contexts (the presence and absence of two observers). Seven features were extracted per trial: baseline pupil size, peak pupil dilation, mean pupil dilation, interbeat interval, blood volume pulse amplitude, pre-ejection period and pulse arrival time. These features were used to train k-nearest neighbor classifiers to predict task demand, social context and sentence accuracy. The k-fold cross validation on the group-level data revealed above-chance classification accuracies: task demand, 64.4%; social context, 78.3%; and sentence accuracy, 55.1%. However, classification accuracies diminished when the classifiers were trained and tested on data from different participants. Individually trained classifiers (one per participant) performed better than group-level classifiers: 71.7% (SD  =  10.2) for task demand, 88.0% (SD  =  7.5) for social context, and 60.0% (SD  =  13.1) for sentence accuracy. We demonstrated that classifiers trained on group-level physiological data to predict aspects of speech perception generalized poorly to novel participants. Individually calibrated classifiers hold more promise for future applications.

Evaluating Real-World Benefits of Hearing Aids With Deep Neural Network-Based Noise Reduction: An Ecological Momentary Assessment Study.

PURPOSE: Noise reduction technologies in hearing aids provide benefits under controlled conditions. However, differences in their real-life effectiveness are not established. We propose that a deep neural network (DNN)-based noise reduction system trained on naturalistic sound environments will provide different real-life benefits compared to traditional systems. METHOD: Real-life listening experiences collected with Ecological Momentary Assessments (EMAs) of participants who used two premium models of hearing aid are compared. One hearing aid model (HA1) used traditional noise reduction; the other hearing aid model (HA2) used DNN-based noise reduction. Participants reported listening experiences several times a day while ambient SPL, SNR, and hearing aid volume adjustments were recorded. Forty experienced hearing aid users completed a total of 3,614 EMAs and recorded 6,812 hr of sound data across two 14-day wear periods. RESULTS: Linear mixed-effects analysis document that participants' assessments of ambient noisiness were positively associated with SPL and negatively associated with SNR but were not otherwise affected by hearing aid model. Likewise, mean satisfaction with the two models did not differ. However, individual satisfaction ratings for HA1 were dependent on ambient SNR, which was not the case for HA2. CONCLUSIONS: Hearing aids with DNN-based noise reduction resulted in consistent sound satisfaction regardless of the level of background noise compared to hearing aids implementing noise reduction based on traditional statistical models. While the two hearing aid models also differed on other parameters (e.g., shape), these differences are unlikely to explain the difference in how background noise impacts sound satisfaction with the aids. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25114526.

Remote hearing-aid delivery and support: perspectives of patients and their hearing care providers.

OBJECTIVE: To explore the perspectives of patients and hearing care providers (HCPs) about an adult remote hearing-aid delivery service implemented during the COVID-19 pandemic. DESIGN: Service evaluation via surveys. The patient survey measured satisfaction with the service, perceived hearing-aid handling skills, and preferences for future services. The HCP survey explored the impact of teleaudiology on outcomes compared to in-person care and factors important for successful teleaudiology. STUDY SAMPLE: 378 patients and 14 HCPs. RESULTS: Patients were highly satisfied with the service and self-reported good hearing-aid handling skills. However, 2 in 3 patients said they would prefer a future hearing-aid fitting to be in-person rather than remote. HCPs thought teleaudiology had positive impacts on convenience, accessibility, and flexibility, but negative impacts on communication, rapport, and the quality of care. HCPs considered computer literacy and individual preferences to be important for successful remote care; the age of the patient was considered less important. CONCLUSIONS: Patients were generally highly satisfied with the service and for 1 in 3 it was their preferred mode of future hearing-aid fitting. Future services should be aware that a one-size-fits-all approach will not satisfy all patients and that teleaudiology should be offered on the basis of individual preference.

Reporting of auditory symptoms over time: (in)consistencies, expectations and the nocebo effect.

Objective: Consistent symptom reporting for conditions like tinnitus that do not have an associated sign is critical for evaluating severity and intervention effectiveness, and for interpreting research findings. There is little research examining reporting of tinnitus and hearing difficulty over time. We address this here by comparing reported hearing difficulty and tinnitus at two time-points.Design: A cross-sectional study comparing symptom reporting in March 2019 and August/September 2021 using data from two online surveys of the same cohort. Although each survey was designed to address a different question, both asked about symptoms of tinnitus and hearing difficulties and enabled this exploratory analysis.Study sample: 6881 members of the UK general public aged 18+ years.Results: Inconsistent reporting was evident - many participants who reported experiencing tinnitus and/or hearing difficulties in 2019, said in 2021 that they had never had such symptoms before. Additionally, reports of new tinnitus/hearing difficulties in 2021 were unexpectedly high, equating to 18-month incidence rates of 13.6% and 11.7%, respectively.Conclusions: Psychosocial factors, expectations and context impact symptom reporting. This should be considered when treating patients and interpreting research findings. Using real-time data collection methods could thus provide a better understanding of experiences of tinnitus and hearing.

Do UK audiologists feel able to address the hearing, social and emotional needs of their adult patients with hearing loss.

OBJECTIVE: The aim of this project was to investigate the provision of counselling in adult audiological rehabilitation and to highlight training barriers and needs. DESIGN: A service evaluation in which respondents completed a survey in which they rated their knowledge, confidence and competence in addressing the hearing, social and emotional needs of their patients. They were also asked to define counselling. SAMPLE: 64 UK practising audiologists in adult audiological rehabilitation, aged 20->60 years (84% females, 16% males), with a range of years in clinical practice. RESULTS: Counselling definitions fell into three main categories: the audiologist as the doer, the audiologist as the facilitator, and the audiologist and patient as partners. Respondents reported feeling more able to counsel the hearing related needs of their patients, than emotional or social needs. There were significant positive statistical associations between counselling training completed and self-rated counselling abilities for managing emotional needs. Clinical experience was not associated with self-rated counselling. Lack of supervision and training were identified as some of the main barriers to providing emotional support. Almost all respondents reported a desire for further training in delivering emotional support, with the belief that this would improve services and patient outcomes. CONCLUSIONS: UK audiologists demonstrated person-centred thinking through their definitions of counselling. However, they reported significant barriers in being able to support the needs of adults with hearing loss. Training needs around emotional support in audiology counselling are not currently being met. It is important for clinical training programmes to address this gap by incorporating more counselling courses into their curricula.

Fitting a Hearing Aid on the Better Ear, Worse Ear, or Both: Associations of Hearing-aid Fitting Laterality with Outcomes in a Large Sample of US Veterans.

Longitudinal electronic health records from a large sample of new hearing-aid (HA) recipients in the US Veterans Affairs healthcare system were used to evaluate associations of fitting laterality with long-term HA use persistence as measured by battery order records, as well as with short-term HA use and satisfaction as assessed using the International Outcome Inventory for Hearing Aids (IOI-HA), completed within 180 days of HA fitting. The large size of our dataset allowed us to address two aspects of fitting laterality that have not received much attention, namely the degree of hearing asymmetry and the question of which ear to fit if fitting unilaterally. The key findings were that long-term HA use persistence was considerably lower for unilateral fittings for symmetric hearing loss (HL) and for unilateral worse-ear fittings for asymmetric HL, as compared to bilateral and unilateral better-ear fittings. In contrast, no differences across laterality categories were observed for short-term self-reported HA usage. Total IOI-HA score was poorer for unilateral fittings of symmetric HL and for unilateral better-ear fittings compared to bilateral for asymmetric HL. We thus conclude that bilateral fittings yield the best short- and long-term outcomes, and while unilateral and bilateral fittings can result in similar outcomes on some measures, we did not identify any HL configuration for which a bilateral fitting would lead to poorer outcomes. However, if a single HA is to be fitted, then our results indicate that a better-ear fitting has a higher probability of long-term HA use persistence than a worse-ear fitting.

Combining Multiple Psychophysiological Measures of Listening Effort: Challenges and Recommendations.

About one-third of all recently published studies on listening effort have used at least one physiological measure, providing evidence of the popularity of such measures in listening effort research. However, the specific measures employed, as well as the rationales used to justify their inclusion, vary greatly between studies, leading to a literature that is fragmented and difficult to integrate. A unified approach that assesses multiple psychophysiological measures justified by a single rationale would be preferable because it would advance our understanding of listening effort. However, such an approach comes with a number of challenges, including the need to develop a clear definition of listening effort that links to specific physiological measures, customized equipment that enables the simultaneous assessment of multiple measures, awareness of problems caused by the different timescales on which the measures operate, and statistical approaches that minimize the risk of type-I error inflation. This article discusses in detail the various obstacles for combining multiple physiological measures in listening effort research and provides recommendations on how to overcome them.

Copresence Was Found to Be Related to Some Pupil Measures in Persons With Hearing Loss While They Performed a Speech-in-Noise Task.

OBJECTIVES: To assess if a manipulation of copresence was related to speech-in-noise task performance, arousal, and effort of persons with hearing loss. Task-related arousal and effort were measured by means of pupillometry. DESIGN: Twenty-nine participants (mean age: 64.6 years) with hearing loss (4-frequency pure-tone average [4F-PTA] of 50.2 dB HL [SD = 8.9 dB] in the right ear and 51.3 dB HL [SD = 8.7 dB] in the left ear; averaged across 0.5, 1, 2, and 4 kHz) listened to and repeated spoken Danish sentences that were masked by four streams of continuous speech. Participants were presented with blocks of 20 sentences, during which copresence was manipulated by having participants do the task either alone or accompanied by two observers who were recruited from a similar age group. The task was presented at two difficulty levels, which was accomplished by fixing the signal-to-noise ratio of the speech and masker to match the thresholds at which participants were estimated to correctly repeat 50% (difficult) or 80% (easy) of the sentences in a block. Performance was assessed based on whether or not sentences were repeated correctly. Measures of pupil size (baseline pupil size [BPS], peak pupil dilation [PPD], and mean pupil dilation [MPD]) were used to index arousal and effort. Participants also completed ratings of subjective effort and stress after each block of sentences and a self-efficacy for listening-questionnaire. RESULTS: Task performance was not associated with copresence, but was found to be related to 4F-PTA. An increase in BPS was found for copresence conditions, compared to alone conditions. Furthermore, a post-hoc exploratory analysis revealed that the copresence conditions were associated with a significantly larger pupil size in the second half of the task-evoked pupil response (TEPR). No change in PPD or MPD did was detected between copresence and alone conditions. Self-efficacy, 4F-PTA, and age were not found to be related to the pupil data. Subjective ratings were sensitive to task difficulty but not copresence. CONCLUSION: Copresence was not found to be related to speech-in-noise performance, PPD, or MPD in persons with HL but was associated with an increase in arousal (as indicated by a larger BPS). This could be related to premobilization of effort and/or discomfort in response to the observers' presence. Furthermore, an exploratory analysis of the pupil data showed that copresence was associated with greater pupil dilations in the second half of the TEPR. This may indicate that participants invested more effort during the speech-in-noise task while in the presence of the observers, but that this increase in effort may not necessarily have been related to listening itself. Instead, other speech-in-noise task-related processes, such as preparing to respond, could have been influenced by copresence.

Dementia and hearing-aid use: a two-way street.

OBJECTIVES: Hearing-aid use may reduce risk of dementia, but cognitive impairment makes use more challenging. An observed association between reduced hearing-aid use and incident dementia could reflect either or both of these causal paths. The objective was to examine the effects of each path while minimising contamination between paths. METHODS: Health records data from 380,794 Veterans who obtained hearing aids from the US Veterans Affairs healthcare system were analysed. Analysis 1 (n = 72,180) used multivariable logistic regression to model the likelihood of incident dementia 3.5-5 years post hearing-aid fitting for patients free of dementia and mild cognitive impairment (MCI). Analysis 2 (n = 272,748) modelled the likelihood of being a persistent hearing-aid user at 3 years 2 months after fitting, contrasting subgroups by level of cognitive function at the time of fitting. Analysis time windows were optimized relative to dataset constraints. Models were controlled for available relevant predictors. RESULTS: The adjusted OR for incident dementia was 0.73 (95% CI 0.66-0.81) for persistent (versus non-persistent) hearing-aid users. The adjusted OR for hearing-aid use persistence was 0.46 (95% CI 0.43-0.48) in those with pre-existing dementia (versus those remaining free of MCI and dementia). CONCLUSION: Substantial independent associations are observed in both directions, suggesting that hearing-aid use decreases risk of dementia and that better cognitive function predisposes towards persistent use. Research studying protective effects of hearing-aid use against dementia needs to account for cognitive status. Clinically, hearing devices and hearing care processes must be accessible and usable for all, regardless of their cognitive status.

Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review.

Introduction: Face coverings and distancing as preventative measures against the spread of the Coronavirus disease 2019 may impact communication in several ways that may disproportionately affect people with hearing loss. A scoping review was conducted to examine existing literature on the impact of preventative measures on communication and to characterize the clinical implications. Method: A systematic search of three electronic databases (Scopus, PubMed, CINAHL) was conducted yielding 2,158 articles. After removing duplicates and screening to determine inclusion eligibility, key data were extracted from the 50 included articles. Findings are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, including the PRISMA-ScR checklist. Results: Studies fell into three categories: Studies addressing the impacts of personal protective equipment (PPE) and/or distancing on communication in healthcare contexts (n = 20); studies examining the impact of preventative measures on communication in everyday life (n = 13), and studies measuring the impact of face coverings on speech using acoustic and/or behavioral measures (n = 29). The review revealed that masks disrupt verbal and non-verbal communication, as well as emotional and social wellbeing and they impact people with hearing loss more than those without. These findings are presumably because opaque masks attenuate sound at frequencies above 1 kHz, and conceal the mouth and lips making lipreading impossible, and limit visibility of facial expressions. While surgical masks cause relatively little sound attenuation, transparent masks and face shields are highly attenuating. However, they are preferred by people with hearing loss because they give access to visual cues. Conclusion: Face coverings and social distancing has detrimental effects that extend well beyond verbal and non-verbal communication, by affecting wellbeing and quality of life. As these measures will likely be part of everyday life for the foreseeable future, we propose that it is necessary to support effective communication, especially in healthcare settings and for people with hearing loss.

Shedding Light on SARS-CoV-2, COVID-19, COVID-19 Vaccination, and Auditory Symptoms: Causality or Spurious Conjunction?

There are reports of associations between SARS-CoV2, COVID-19, COVID-19 vaccines, and auditory symptoms (hearing difficulty, tinnitus). However, most studies have relied on self-report and lack baseline and/or non-COVID control groups. This makes it problematic to differentiate if symptoms are associated with SARS-CoV2, COVID-19, the vaccine, psychosocial factors or recall bias. In this study, we differentiate these by comparing hearing and tinnitus survey data collected pre- and during the pandemic. The survey conducted during the pandemic asked about the onset and change in three types of symptom. Type One-known association (loss of smell, memory/concentration issues, persistent fatigue), Type Two-indeterminate association (auditory symptoms), and Type Three-no established association with COVID-19 (toothache). We hypothesized that if auditory symptoms are directly associated with COVID-19, their onset and change would be similar to Type One symptoms, but if indirectly associated (reflecting psychosocial factors and/or recall bias) would be more similar to Type Three symptoms. Of the 6,881 individuals who responded, 6% reported confirmed COVID-19 (positive test), 11% probably had COVID-19, and 83% reported no COVID-19. Those with confirmed or probable COVID-19 more commonly reported new and/or worsened auditory symptoms than those not reporting COVID-19. However, this does not imply causality because: (1) new auditory symptoms coincided with COVID-19 illness among just 1/3 of those with confirmed or probable COVID-19, and another 1/3 said their symptoms started before the pandemic-despite reporting no symptoms in the pre-pandemic survey. (2) >60% of individuals who had COVID-19 said it had affected their Type 3 symptoms, despite a lack of evidence linking the two. (3) Those with confirmed COVID-19 reported more Type 1 symptoms, but reporting of Type 2 and Type 3 symptoms did not differ between those with confirmed COVID-19 and those without COVID-19, while those who probably had COVID-19 most commonly reported these symptom types. Despite more reports of auditory symptoms in confirmed or probable COVID-19, there is inconsistent reporting, recall bias, and possible nocebo effects. Studies that include appropriate control groups and use audiometric measures in addition to self-report to investigate change in auditory symptoms relative to pre-COVID-19 are urgently needed.

Impact of Hearing Loss on Communication During Remote Health Care Encounters.

Introduction: Satisfaction with telemedicine is generally high; however, it can lead to communication problems for people with hearing loss (HL), especially when encounters are conducted by telephone, because of the inability to see the face and lips on which many people with HL rely. Despite acknowledgement that HL might affect telemedicine outcomes, no studies have directly examined this. The primary aims of this study were to determine whether and how HL impacts patient satisfaction and willingness to use telemedicine. Methods: Opinions about telemedicine were assessed in a survey of 383 members of the general public. Data regarding reported hearing ability, use of hearing assistive technology, and preferred form of communication (oral/aural vs. sign language) were also collected; people with HL were intentionally oversampled. Survey items included closed set and open-ended responses. Results: People with HL declined the offer of telemedicine appointments, rated telemedicine outcomes significantly less positively, and had stronger preferences for in person care than did people without HL. Explanations provided for this were directly associated with hearing-related difficulties or the indirect consequences of those difficulties. HL resulted in concerns about communication during the appointment, a lack of privacy when an intermediary helped with communication during the appointment, worries that critical information has been misheard/missed, and anxiety/stress. Conclusions: The needs of people with HL during telemedicine encounters must be addressed to ensure equitable access. Health care providers should take responsibility to communicate clearly with people with HL and individuals with HL should be willing to advocate for their needs and use special access tools during telemedicine appointments.

Barriers and facilitators to delivery of group audiological rehabilitation programs: a survey based on the COM-B model.

OBJECTIVE: To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices. DESIGN: A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis. STUDY SAMPLE: Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting. RESULTS: Clinicians appeared to positively view the provision of group audiological rehabilitation services, yet were limited in their ability to deliver these services due to organisational barriers. Although some organisational barriers were non-modifiable by the clinician (such as group AR services not prioritised within their workplace, a lack of support from colleagues/managers, lack of resources, and a lack of funding for the delivery of group AR services), others were within the clinicians' ability to change (such as habit formation for recommending these services during clinical appointments). Participants expressed a desire for resources to assist them in delivering group AR, including downloadable lesson plans and information sheets for clients, clinician training videos and client educational videos. Clinicians called for increased diversity in program offerings, specifically relating to the emotional, relational and social impacts of hearing loss. CONCLUSIONS: These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services.