Verification and validation of hearing aids: Opportunity not an obstacle

A comparison of automated verification using paediatric hearing aids

OBJECTIVE

Best-practice guidelines recommend the use of hearing aid verification in children; however, this is not always performed. Automated hearing aid verification has been reported to be more accurate and efficient than manual verification in adults, but it is not known if this transfers to the paediatric population.

DESIGN

A within-group design compared manual and automated hearing aid verification on four measures; fitting accuracy, prescription targets, completion time, and the speech intelligibility index.

SAMPLE

Twenty paediatric patient hearing aid profiles (M = 8.25 years) with unilateral or bilateral hearing aids.

RESULTS

A Wilcoxon-signed rank test indicated manual verification achieved a significantly closer match to target at 0.5 kHz, by an average of 1 dB. There were no significant differences at any other frequency. Across 80 comparisons (four frequencies measured in 20 listeners), 82.5% of automated verifications were identical to, or within 1 dB of, manual verifications. A paired-samples t-test confirmed automated verification to be an average of 91.9 seconds faster than manual verification.

CONCLUSION

Automated verification was able to provide an accurate match to target within recommended tolerances for hearing aid fittings and was significantly quicker than manual verification. These data suggest that automated verification of hearing aids could play a role in paediatric audiological management.

Associations between aided speech audiometry and subjective assessment of hearing aid outcomes

OBJECTIVE

This study aimed to analyse outcomes with hearing aid (HA) use and to determine whether common audiological tests, including pure-tone audiometry or word recognition test, correlate with HA wearers' subjective benefit.

DESIGN

A retrospective chart review.

STUDY SAMPLE

A total of 129 patients who adopted new HAs between January 2011 and December 2018 were enrolled. Outcome measures including pure tone thresholds, word recognition score (WRS), and self-reported questionnaires were obtained 1, 4, and 12 months post fit.

RESULTS

The mean aided threshold and WRS at each post-fit visit significantly improved from the unaided condition. Self-reported outcomes confirmed by the Hearing Handicap Inventory for the Elderly (HHIE) scores significantly improved compared to the unaided condition at 1- and 4-month follow-up. Results of the regression analysis indicated that the aided WRS score is a significant factor at all post-fit visits that explains less than 10% of the variance in HHIE scores.

CONCLUSIONS

Aided WRS is the factor most associated with subjectively reported HA outcomes, both in the short- and long term. Therefore, aided WRS should be considered as a useful tool for evaluating HA benefits, even after the prolonged use of HAs.

The Intersection of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs

Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA's health rehabilitation services. The experts' recommendations in this study may be applicable to other countries' health systems, as health rehabilitation services are not well optimized globally.

Adopting Change and Incorporating Technological Advancements in Audiology Education, Research, and Clinical Practice

PURPOSE

With the rapid development of new technologies and resources, many avenues exist to adapt and grow as a profession. Embracing change can lead to growth, evolution, and new opportunities. Audiologists have the potential to harness many of these technological advancements to improve patient health care. Adoption and incorporation of these new technologies will likely benefit educational experiences, research methods, clinical practice, and clinical outcomes.

METHOD

This commentary highlights some historical perspectives and accepted practices while illustrating opportunities to embrace new ideas and technologies. We also provide examples of how such adoption may yield positive outcomes. Specifically, we address embracing technology in audiology education, how artificial intelligence may influence patient performance in realistic listening scenarios, the convergence between hearing aids and consumer electronics, and the emergence of audiology telehealth services and their inclusion in clinical practice. Models of change are also discussed and related to audiology.

CONCLUSION

This commentary aims to be a call to action for the entire profession of audiology to consider conscientiously the adoption of useful, evidence-based technological advancements in education, research, and clinical practice.

The Intelligibility of the Reversed-Stethoscope Technique in Age-Related Hearing Loss

Background

This study evaluated the effectiveness of the reverse stethoscope technique in improving speech intelligibility. In this technique, a clinician places the earpieces of their stethoscope into the ears of a hearing-impaired patient and speaks into the chest piece.

Methods

The International Speech Test Signal was presented to four Littman® stethoscope models and a Pocketalker® personal voice amplifier using an Audioscan® hearing instrument test box. The acoustic outputs of the stethoscopes and voice amplifier were measured across the frequency spectrum of speech. The Speech Intelligibility Index of the resulting speech was calculated for natural speech and for each device in relation to 10 standardized hearing losses representing the population of older adults.

Results

For each of the 10 hearing losses, the speech signal emitted by the stethoscopes was quieter and yielded lower speech intelligibility scores than regular speech. In contrast, the voice amplifier provided mid- and high-frequency amplification and improved speech intelligibility scores for all but the mildest hearing losses.

Conclusions

The reverse stethoscope technique worsens the clarity of speech and should not be used with older, hearing-impaired patients. Instead, clinicians should use regular speech or, preferably, personal voice amplifiers.

Verification and Validation: Just the Standards

The Audiology Practice Standards Organization (APSO) has published its second audiology standard. This second standard is focused on adult hearing aid fittings. These standards put forward information about verification that should be completed on hearing aids before, during, and after a fitting. Validation following the verification of the hearing aids to ensure patient satisfaction with the devices is also included in the standards. The goal of this article is to provide clinicians with the guidelines related to hearing aid verification and validation while also providing information about how to put these standards into clinical practice.

Audiometric profiles and patterns of benefit: a data-driven analysis of subjective hearing difficulties and handicaps

OBJECTIVE

Hearing rehabilitation attempts to compensate for auditory dysfunction, reduce hearing difficulties and minimise participation restrictions that can lead to social isolation. However, there is no systematic approach to assess the quality of the intervention at an individual level that might help to evaluate the need of further hearing rehabilitation in the hearing care clinic.

DESIGN

A data-driven analysis on subjective data reflecting hearing disabilities and handicap was chosen to explore "benefit patterns" as a result of rehabilitation in different audiometric groups. The method was based on (1) dimensionality reduction; (2) stratification; (3) archetypal analysis; (4) clustering; (5) item importance estimation.

STUDY SAMPLE

572 hearing-aid users completed questionnaires of hearing difficulties (speech, spatial and qualities hearing scale; SSQ) and hearing handicap (HHQ).

RESULTS

The data-driven approach revealed four benefit profiles that were different for each audiometric group. The groups with low degree of high-frequency hearing loss (HLHF) showed a priority for rehabilitating hearing handicaps, whereas the groups with HLHF > 50 dB HL showed a priority for improvements in speech understanding.

CONCLUSIONS

The patterns of benefit and the stratification approach might guide the clinical intervention strategy and improve the efficacy and quality of service in the hearing care clinic.

Open Speech Platform: Democratizing Hearing Aid Research

Hearing aids help overcome the challenges associated with hearing loss, and thus greatly benefit and improve the lives of those living with hearing-impairment. Unfortunately, there is a lack of adoption of hearing aids among those that can benefit from hearing aids. Hearing researchers and audiologists are trying to address this problem through their research. However, the current proprietary hearing aid market makes it difficult for academic researchers to translate their findings into commercial use. In order to abridge this gap and accelerate research in hearing health care, we present the design and implementation of the Open Speech Platform (OSP), which consists of a co-design of open-source hardware and software. The hardware meets the industry standards and enables researchers to conduct experiments in the field. The software is designed with a systematic and modular approach to standardize algorithm implementation and simplify user interface development. We evaluate the performance of OSP regarding both its hardware and software, as well as demonstrate its usefulness via a self-fitting study involving human participants.

Factors Influencing Hearing Aid Adoption

In the field of audiology, change is inevitable: changes in technologies with hearing devices, changes in consumer knowledge, and changes in consumer-driven solutions. With these changes, the audiologist must adapt to meet the needs of the consumer. There are potential predictors that the audiologist could use to determine who is more likely to pursue and use amplification; by using these data, the audiologists may increase their productivity and increase patient satisfaction. The goal of this article is to investigate the MarkeTrak 10 (MT10) data to determine the trends in adoption and use of hearing aids as well as examine predictive factors that can be used to determine hearing aid adoption.

Protocolo clínico para Serviços de Saúde Auditiva na atenção a adultos e idosos

RESUMO Objetivo Desenvolver um protocolo clínico para o atendimento ao paciente no processo de seleção, verificação e validação das próteses auditivas e estabelecer a representação gráfica do protocolo por meio de um fluxograma com algoritmos. Método Foi realizado um estudo bibliográfico para levantamento dos procedimentos necessários na elaboração de protocolos clínicos em saúde e quanto aos principais procedimentos em cada etapa do processo de seleção e adaptação de próteses auditivas. Posteriormente, foi realizada a elaboração por extenso do protocolo, que passou pela avaliação de oito fonoaudiólogos quanto ao conteúdo e aplicabilidade. Houve a adequação dos fatores levantados pelos profissionais e elaboração do documento final, além da constituição de um fluxograma com algoritmos do processo. Resultados: O protocolo foi desenvolvido após extenso levantamento de literatura; todos os fonoaudiólogos participantes referiram ser de grande valia a utilização do instrumento em sua prática clínica; e, ao final, houve a constituição do fluxograma com algoritmos, realizada após a elaboração do protocolo por extenso, originando o Procedimento Operacional Padrão no processo de seleção e adaptação de próteses auditivas. Conclusão O protocolo clínico para o atendimento ao paciente no processo de seleção, verificação e validação do uso das próteses auditivas foi desenvolvido e validado por meio de sua aplicação por profissionais, o que gerou, posteriormente, a representação gráfica do protocolo e suas etapas por meio de um fluxograma com algoritmos.

Conventional Amplification for Children and Adults with Severe-to-Profound Hearing Loss

The primary goal of amplification is to restore audibility without causing discomfort; for someone with severe-to-profound hearing loss, the reduced dynamic range poses unique challenges in hearing-assistive device fitting. These challenges, including physiological limitation, processing difficulties, technology constraints, and other confounding factors, must be considered when selecting, fitting, and counseling for appropriate amplification. Many of the advanced features in hearing aids do not adequately address the unique characteristics of patients with severe-to-profound hearing loss. This review article will attempt to unravel some of the challenges and associated considerations when fitting adults and children with severe-to-profound hearing loss.