Effect of Determinants of Health on the Hearing Care Framework: An Economic Perspective.

Hearing care is expanding accessibility to consumers through new service delivery channels and methods of technology distribution (see Brice et al, this issue). This diversification has the potential to overcome longstanding consumer disparities (e.g., health, socioeconomic, psychological, environmental) in receiving care and provider constraints (e.g., accessibility, geography, direct access) to delivering care that adversely impacts quality of life (e.g., social isolation, depression, anxiety, self-esteem). In this article, the reader is provided with an overview of health outcomes factors (i.e., determinants of health)-in the context of an economic framework (i.e., supply, demand)-and their effect on consumer behavior and provider preferences toward hearing healthcare services. This overview also affords readers with strategic business insights to assess and integrate future hearing care services and technology to consumers in their local markets.

Argumentum ad Ignorantiam: Smartphone-Connected Listening Devices.

In this article, we review the current literature assessing the application and benefits of connected hearing technologies, as well as their potential to improve accessibility to and affordability of hearing healthcare. Over the past decade, there has been a proliferation of hearing devices that connect wirelessly to smartphone technologies via Bluetooth. These devices include (1) smartphone-connected hearing aids that must be obtained from a licensed audiologist or hearing aid dispenser; (2) direct-to-consumer devices, such as personal sound amplification products; and (3) smartphone-based hearing aid applications (or apps). Common to all these connected devices is that they permit the user to self-adjust and customize their device programs via an accompanying smartphone app. There has been a growing body of literature assessing connected hearing devices in adults living with hearing loss. Overall, the evidence to date supports the notion that all connected hearing devices can improve accessibility to and affordability of amplification. It is unclear, however, whether connected technologies are a clinically effective alternative to traditional hearing aids. Even so, the impact of connectivity is especially pertinent given the sudden disruption caused by the recent global COVID-19 pandemic, whereby connected technologies enable patients to receive treatment through mobile-based, tele-audiology platforms.

Influence of Provider Interaction on Patient's Readiness Toward Audiological Services and Technology.

BACKGROUND: Patients and providers recognize the importance of patient-centered care. Clinical interactions, however, suggest that audiologists maintain their traditional provider-centered approach. PURPOSE: The primary purpose of this study was to assess the degree to which provider interaction influenced patient readiness toward audiological services using the neobehavioral concept of need recognition described in consumer decision-making. RESEARCH DESIGN: We used a randomized, within-group experimental approach using survey responses to quantify predisposed expectations on ten dimensions toward service and technology provision 2 weeks before and 2 weeks after an audiological assessment. Responses were also categorized as a function of the respondent-perceived professional setting of the provider (medical, rehabilitation, and consumer electronics). STUDY SAMPLE: Survey respondents included 618 adults {186 males (mean age = 63.1 years; standard deviation [SD] = 5.3) and 432 females [mean age = 58.4 years; SD = 6.2]} from across the United States. DATA COLLECTION AND ANALYSIS: Data were analyzed using two approaches. First, we used a two-step cluster analysis procedure that revealed natural groupings (i.e., profiles) of respondent characteristics of the ten dimensions. Second, we compared within-group mean differences between pre- and postappointment responses using a univariate analysis of variance, with mean differences reported as a function of professional setting and preappointment responses serving as the control condition. RESULTS: Results revealed that the predisposed expectation profiles among the ten dimensions differed among the professional settings, with rehabilitation having the highest mean response values and consumer electronics having the least mean response values. A descriptive analysis indicated that respondents in the rehabilitation and medical settings presented the greatest interest in amplification before the patient-provider interaction, but the least interest afterward. In addition, postappointment analyses revealed that providers failed statistically to meet patients' predisposed expectations in all three settings. CONCLUSIONS: Overall, most respondents' predisposed expectations were unmet during their interaction with an audiologist. These expectations differed across professional settings, with the greatest unmet expectations observed in the rehabilitative and medical settings. Patient readiness is influenced by the behavior of the provider which, at present, appears to be a barrier to patients' acceptance of treatment options.

Feasibility of Using a Smartphone-Based Hearing Aid Application to Improve Attitudes Toward Amplification and Hearing Impairment.

Objective The objective of the study was to determine whether short-term experience (i.e., 4 weeks) with a smartphone-based hearing aid application (SHAA) might positively improve attitudes toward amplification uptake and hearing impairment. Method We recruited 15 experienced hearing aid wearers who had ceased wearing their devices for > 1 year (i.e., "In-the-Drawer" group) and 15 individuals with self-reported hearing difficulties who had yet to adopt hearing aids (i.e., "First-Time" group). We obtained participant attitudes pre- and post-SHAA using 3 surveys and analyzed perceptible changes in attitude for each survey. Comparative findings were then generalized to the health belief model in the context of perceived benefits (i.e., efficacy of an action to reduce risk) and reduced perceived barriers (i.e., tangible and psychological costs that inhibit compliance and adoption). Results A short trial period with an SHAA appears to modify the psychological perception toward amplification and reduce listener perception with respect to hearing difficulties in both groups. Conclusion A short trial period with an SHAA improved the perceived benefits and reduced the perceived barriers in the average First-Time listener, who often delays adoption of traditional amplification. The same trial period was also found to improve perceived benefits and reduce perceived barriers for the average In-the-Drawer listener, but to a lesser degree than their First-Time counterparts.

Benefits and Shortcomings of Direct-to-Consumer Hearing Devices: Analysis of Large Secondary Data Generated From Amazon Customer Reviews.

Purpose The current study was aimed at understanding the benefits and shortcomings of direct-to-consumer hearing devices (DCHDs) by analyzing the large text corpus of secondary data generated from Amazon customer reviews. Method Secondary data were generated manually by gathering user feedback for 62 different DCHDs (cost range: $9.95-$635) on the Amazon.com website, which included 11,258 unique Amazon-verified customer reviews. The data were analyzed using both quantitative and qualitative analyses methods. Results The cluster analysis of large data corpus resulted in 7 unique clusters, which were labeled as (a) Issues related to fit and comfort (15%), (b) Friends and family recommendations (11.8%), (c) Issues related to sound quality (11.9%), (d) Listening and conversation (16.1%), (e) Positive customer service (12.1%), (f) General usage and customer service (14.7%), and (g) Cost and affordability (17.3%). Exploratory analysis also revealed an association between customer ratings and cost in relation to these clusters (i.e., customer reviews). For example, customer reviews about cheaper DCHDs are related to issues about sound quality, whereas reviews about expensive DCHDs are related to cost and affordability of the device. The qualitative content analysis resulted in 8 main themes, which include (a) intrinsic factors, (b) extrinsic factors, (c) supplemental items, (d) ease of use, (e) interaction with support services, (f) reasons for purchase, (g) experiences, and (h) general information. Conclusions The study using the text mining techniques highlights the benefits and shortcomings of DCHDs that are currently available in the U.S. market. Our findings relate well to the published study results of electroacoustic analysis on similar products, which provide clinicians with knowledge related to DCHDs that they can convey to consumers during clinical consultations. The findings may also be of interest to the hearing instrument industry from the perspective of developing products based on user feedback.

Negative Effect of Acoustic Panels on Listening Effort in a Classroom Environment.

BACKGROUND: Acoustic panels are used to lessen the pervasive effects of noise and reverberation on speech understanding in a classroom environment. These panels, however, predominately absorb high-frequency energy important to speech understanding. Therefore, a classroom environment treated with acoustic panels might negatively influence the transmission of the target signal, resulting in an increase in listening effort exerted by the listener. PURPOSE: Acoustic panels were installed in a public school environment that did not meet the ANSI-recommended guidelines for classroom design. We assessed the modifications to the acoustic climate by quantifying the effect of (1) acoustic panel (i.e., without, with) on the transmission of a standardized target signal at different seat positions (i.e., A-D) using the Speech Transmission Index (STI) and (2) acoustic panel and seat position on listening-effort performance in a group of third-grade students having normal-hearing sensitivity using a dual-task paradigm. RESEARCH DESIGN: STI measurements are described qualitatively. We used a repeated-measures randomized design to assess listening-effort performance of monosyllabic words in a primary task and digit recall in a secondary task for the independent variables of acoustic panel and seat position. STUDY SAMPLE: Twenty-seven, third-grade students (12 males, 15 females), ranging in age from 8.3 to 9.4 yr (mean = 8.7 yr, standard deviation = 0.7), participated in this study. DATA COLLECTION AND ANALYSIS: Qualitatively, we performed STI measurements under both testing conditions (i.e., panel and seat location). For the primary task of the dual-task paradigm, participants heard a ten-item list of monosyllabic words (i.e., ten words per list) recorded through a manikin in the classroom environment without and with acoustic panels and at different seat positions. Participants were asked to repeat each word exactly as it was heard. During the secondary task, participants were shown a single, random string of five digits before the presentation of the monosyllabic words. After each list in the primary task was completed, participants were asked to recall the string of five digits verbatim. RESULTS: Word-recognition and digit-recall performance decreased with the presence of acoustic panels and as the distance from the target signal to a given seat location increased. The results were validated using the STI, as indicated by a decrease in the transmission of the target signal in the presence of acoustic panel and as the distance to a given seat location increased. CONCLUSIONS: The inclusion of acoustic panels reduced the negative effects of noise and reverberation in a classroom environment, resulting in an acoustic climate that complied with the ANSI-recommended guidelines for classroom design. Results, however, revealed that participants required an increased amount of mental effort when the classroom was modified with acoustic treatment compared to no acoustic treatment. Independent of acoustic treatment, mental effort was greatest at seat locations beyond the critical distance (CD). With the addition of acoustic panels, mental effort was found to increase significantly at seat locations beyond the CD compared to the unmodified room condition. Overall, results indicate that increasing the distance between the teacher and child has a detrimental impact on mental effort and, ultimately, academic performance.

Application of the Consumer Decision-Making Model to Hearing Aid Adoption in First-Time Users.

Since 1980, hearing aid adoption rates have remained essentially the same, increasing at a rate equal to the organic growth of the population. Researchers have used theoretical models from psychology and sociology to determine those factors or constructs that lead to the adoption of hearing aids by first-time impaired listeners entering the market. In this article, a theoretical model, the Consumer Decision-Making Model (CDM), premised on the neobehavioral approach that considers an individual's psychological and cognitive emphasis toward a product or service, is described. Three theoretical models (i.e., transtheoretical, social model of disability, Health Belief Model), and their relevant findings to the hearing aid market, are initially described. The CDM is then presented, along with supporting evidence of the model's various factors from the hearing aid literature. Future applications of the CDM to hearing health care also are discussed.

A meta-analysis to compare speech recognition in noise with bilateral cochlear implants and bimodal stimulation.

OBJECTIVE: This investigation quantified the relative benefits of binaural CI arrangements (i.e., bilateral, bimodal) for three binaural phenomena (i.e., binaural squelch, binaural summation, head-shadow effect) and sensitivity of two speech-recognition test paradigms (i.e., adaptive and fixed). DESIGN: A repeated-measures meta-analytical approach was used to compare effect sizes between binaural CI arrangements for each of the three binaural-listening phenomena and between the two test paradigms. STUDY SAMPLE: A total of 95 effect sizes were calculated and analyzed from 42 peer-reviewed studies published between January 2000 and April 2011. RESULTS: Findings revealed significant effect sizes for both CI arrangements for the binaural phenomena of summation and head-shadow effect. A significant effect size for binaural squelch was determined only for bilateral CI users. Further, the two paradigms resulted in similar effect sizes for bilateral and bimodal users, with the exception of binaural squelch. Here, significant effect sizes were significant only in the fixed-testing paradigm. CONCLUSIONS: The average user of binaural CI arrangements realizes the binaural phenomena of summation and the head-shadow effect, but only the bilateral CI arrangement is afforded the advantage of binaural squelch. Statistically, listeners fit with bilateral CIs have a slight advantage in binaural performance over those using bimodal stimulation.

Application of paired-comparison methods to hearing AIDS.

The method of paired comparisons was introduced into the hearing aid literature nearly 50 years ago. Over time, studies have found paired comparisons to be sensitive, valid, and reliable in determining either the perceptual difference or relative ranking among hearing aids and electroacoustic characteristics. With the increasing number of adjustable electroacoustic parameters in today's digital hearing aids-and the lack of procedural guidelines necessary to fit many of them-the method of paired comparisons provides the clinician with the ability to compare different devices, electroacoustic characteristics, memory settings, or combinations of these variables under the listener's everyday listening conditions. Furthermore, this procedure provides the clinician with the ability to individualize the prescriptive approach-which is predicated mainly on hearing threshold data and listening in quiet-so that a combination of parameters can be set to optimize the user's listening needs in a given environment. In this article, the authors present an overview of the theoretical principle supporting this procedure, the various paired-comparison strategies and associated approaches, the advantages of this method, and recommended procedures for implementing the method of paired comparisons in the fitting of today's sophisticated hearing aids.

A meta-analytic comparison of binaural benefits between bilateral cochlear implants and bimodal stimulation.

A meta-analytic approach was used to examine sixteen peer-reviewed publications related to speech-recognition performance in noise at fixed signal-to-noise ratios for participants who use bilateral cochlear implants (CIs) or bimodal stimulation. Two hundred eighty-seven analyses were conducted to compare the underlying contributions of binaural summation, binaural squelch, and the head-shadow effect compared to monaural conditions (CI or hearing aid). The analyses revealed an overall significant effect for binaural summation, binaural squelch, and head shadow for the bilateral and bimodal listeners relative to monaural conditions. In addition, all within-condition (bilateral or bimodal) comparisons were significant for the three binaural effects, with the exception of the bimodal condition compared to a monaural CI. No significant differences were detected between the bilateral and bimodal listeners for any of the binaural phenomena. Clinical implications and recommendations are discussed as they relate to empirical findings.

Speech-clarity judgments of hearing-aid-processed speech in noise: differing polar patterns and acoustic environments.

This investigation assessed the extent to which listeners' preferences for hearing aid microphone polar patterns vary across listening environments, and whether normal-hearing and inexperienced and experienced hearing-impaired listeners differ in such preferences. Paired-comparison judgments of speech clarity (i.e. subjective speech intelligibility) were made monaurally for recordings of speech in noise processed by a commercially available hearing aid programmed with an omnidirectional and two directional polar patterns (cardioid and hypercardioid). Testing environments included a sound-treated room, a living room, and a classroom. Polar-pattern preferences were highly reliable and agreed closely across all three groups of listeners. All groups preferred listening in the sound-treated room over listening in the living room, and preferred listening in the living room over listening in the classroom. Each group preferred the directional patterns to the omnidirectional pattern in all room conditions. We observed no differences in preference judgments between the two directional patterns or between hearing-impaired listeners' extent of amplification experience. Overall, findings indicate that listeners perceived qualitative benefits from microphones having directional polar patterns.

Effects of economy and FDA intervention on the hearing aid industry.

PURPOSE: The purpose of this study was to examine the effects of the economy and the Food and Drug Administration's (FDA) intervention on the hearing aid industry. METHOD: A 3-stage least squares regression technique was used to analyze the hearing aid market. RESULTS: Our results show that, while recessionary periods reduced both demand and supply, the demand side of the hearing aid industry is significantly more responsive to changes in the economy. Further, the demand function within the hearing aid industry is inelastic. Finally, negative media coverage from nationally televised reports during the FDA's intervention between the 2nd quarter of 1993 and the 3rd quarter of 1994 did not significantly affect the market demand of hearing aids. CONCLUSIONS: The demand for hearing aids increases in a flourishing economy and decreases during periods of recession. The negative media campaign from the FDA's intervention between the 2nd quarter of 1993 and the 3rd quarter of 1994 had essentially little effect on the end user. The repercussions of the FDA's intervention have resulted, however, in a reduction in the market supply of hearing aids and an increase in their cost due to manufacturer-sponsored clinical trials.

Methods and applications of the audibility index in hearing aid selection and fitting.

During the first half of the 20th century, communications engineers at Bell Telephone Laboratories developed the articulation model for predicting speech intelligibility transmitted through different telecommunication devices under varying electroacoustic conditions. The profession of audiology adopted this model and its quantitative aspects, known as the Articulation Index and Speech Intelligibility Index, and applied these indices to the prediction of unaided and aided speech intelligibility in hearing-impaired listeners. Over time, the calculation methods of these indices-referred to collectively in this paper as the Audibility Index-have been continually refined and simplified for clinical use. This article provides (1) an overview of the basic principles and the calculation methods of the Audibility Index, the Speech Transmission Index and related indices, as well as the Speech Recognition Sensitivity Model, (2) a review of the literature on using the Audibility Index to predict speech intelligibility of hearing-impaired listeners, (3) a review of the literature on the applicability of the Audibility Index to the selection and fitting of hearing aids, and (4) a discussion of future scientific needs and clinical applications of the Audibility Index.