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

Consumer Perspectives on Improving Hearing Aids: A Qualitative Study

PURPOSE

Hearing aids play a pivotal role in mitigating the impact of hearing loss, yet their adoption and consistent usage remains suboptimal. Understanding the hearing aid needs of individuals with hearing loss is important to support uptake, use, and outcomes. The current study describes users' perspectives on how hearing aids can be improved.

METHOD

A cross-sectional, qualitative, content analysis design was used for an open-ended question from an online survey, exploring user perspectives on hearing aid improvements. Participants were adult hearing aid users in the United States, surveyed from the HearingTracker and Lexie Hearing user database.

RESULTS

A total of 628 participants (Mage = 66 years) were surveyed. The majority of participants used bilateral, behind-the-ear hearing aids that were obtained either through a hearing health care professional or online. Three domains, highlighting areas for hearing aid improvement, were identified. (a) The hearing aid features domain described user issues surrounding physical appearance and fit, general features, streaming, battery functionality, adjustments, smartphone applications, and hearing aid-related accessories. There was dissatisfaction with aesthetics and functionality, with a notable desire for improvements in physical appearance and fit (n = 161), and features to improve self-efficacy. (b) The sound quality domain described user issues surrounding sound perception and difficult situations. Participants highlighted unmet needs for clarity, especially in noisy environments (n = 143). (c) The service-delivery domain described user issues surrounding audiology services and general satisfaction, with criticisms centered on the high cost of hearing aids (n = 193) and the credibility of hearing health care professionals.

CONCLUSIONS

Hearing aid users appreciated current technological advances but expressed a need for improvements, to better align devices with their requirements. Key areas included physical aesthetics, user control over device adjustments, sound clarity, cost accessibility, and trust between the user and hearing health care professional. Future designs should focus on features enhancing user autonomy and self-efficacy.

Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran)

The present study seeks to evaluate the factors determining the continuance intention to use hearing aids in older adults. This cross-sectional study was carried out in 2021. The technology post-acceptance model (PAM) framework was used to develop a model for the continuance intention to use hearing aids. In total, 300 hearing aid users aged ≥60 years, who were selected via a randomized stratified sampling method, completed the self-evaluation tools used in this study. With a mean age of 71.38 years (SD = 8), the participants comprised 50.7% and 49.3% females and males, respectively. The path analysis results showed that the continuance intention to use hearing aids was positively and significantly influenced by the actual use of hearing aids, the perceived benefits, satisfaction, confirmation, self-efficacy in using hearing aids, an extraverted personality trait, self-perceived hearing handicap, and perceived social support. The main results of the present study can help hearing care providers develop a better understanding of older users to design effective rehabilitation strategies and ensure their continuance intention to use hearing aids.

Cortical sensory gating and reactions to dynamic speech-in-noise in older normal-hearing and hearing-impaired adults

OBJECTIVE

To examine whether cortical sensory gating predicts how older adults with and without hearing loss perform the Tracking of Noise Tolerance (TNT) test.

DESIGN

Single-blind mixed design. TNT performance was defined by average tolerated noise relative to speech levels (TNTAve) and by an average range of noise levels over a two-minute trial (excursion). Sensory gating of P1-N1-P2 components was measured using pairs of 1 kHz tone pips.

STUDY SAMPLE

Twenty-three normal-hearing (NH) and 16 hearing-impaired (HI) older adults with a moderate-to-severe degree of sensorineural hearing loss.

RESULTS

NH listeners tolerated significantly more noise than HI listeners, but the two groups did not differ in their excursion. Both NH and HI listeners exhibited significant gating of P1 amplitudes and N1P2 peak-to-peak amplitudes with no difference in gating magnitudes between listener groups. Sensory gating magnitudes of P1 and N1P2 did not predict TNTAve scores, but N1P2 gating negatively predicted excursion after accounting for listener age and hearing thresholds.

CONCLUSIONS

Listeners' reactivity to a roving noise (excursion), but not their average noise tolerance (TNTAve), was predicted by sensory gating at N1P2 generators. These results suggest that temporal aspects of speech-in-noise processing may be affected by declines in the central inhibition of older adults.

Speech-in-Noise Testing: An Introduction for Audiologists

Speech-in-noise testing has been proposed as a useful part of the audiometric test battery dating back to the earliest years of the field of audiology. Many speech-in-noise tests have been developed and used to varying degrees. However, multiple barriers have prevented speech-in-noise testing from being used widely in the clinic. The purpose of this article is to provide a resource to audiologists and other hearing health professionals who want to know (1) what tests are available for use, (2) the rationale behind specific tests, and (3) important considerations when selecting one or more tests to use clinically. In addition, data are presented for four speech-in-noise tests with the purpose of comparing outcomes as a function of age and hearing status. The four tests (QuickSIN, Words in Noise [WIN], Listening in Spatialized Noise-Sentences [LiSN-S], and Coordinate Response Measure [CRM]) were completed by 30 individuals from three groups: 10 young adults with normal hearing, 10 older adults with normal hearing, and 10 older adults with hearing loss. The results suggest that, despite significant differences in performance between groups, group overlap was present such that some individuals from one group performed similar to some individuals of other groups; therefore, individual performance was more important than associated group. When selecting an appropriate speech-in-noise test to use clinically, audiologists should carefully consider the purpose of their testing and the type of information they desire as an outcome. A quick-resource table and appendix is provided to aid audiologists and other health professionals in their selection of an appropriate speech-in-noise test.

Validation of the acoustic change complex (ACC) prediction model to predict speech perception in noise in adult patients with hearing loss: a study protocol

BACKGROUND

Speech perception tests are essential to measure the functional use of hearing and to determine the effectiveness of hearing aids and implantable auditory devices. However, these language-based tests require active participation and are influenced by linguistic and neurocognitive skills limiting their use in patients with insufficient language proficiency, cognitive impairment, or in children. We recently developed a non-attentive and objective speech perception prediction model: the Acoustic Change Complex (ACC) prediction model. The ACC prediction model uses electroencephalography to measure alterations in cortical auditory activity caused by frequency changes. The aim is to validate this model in a large-scale external validation study in adult patients with varying degrees of sensorineural hearing loss (SNHL) to confirm the high predictive value of the ACC model and to assess its test-retest reliability.

METHODS

A total of 80 participants, aged 18-65 years, will be enrolled in the study. The categories of severity of hearing loss will be used as a blocking factor to establish an equal distribution of patients with various degrees of sensorineural hearing loss. During the first visit, pure tone audiometry, speech in noise tests, a phoneme discrimination test, and the first ACC measurement will be performed. During the second visit (after 1-4 weeks), the same ACC measurement will be performed to assess the test-retest reliability. The acoustic change stimuli for ACC measurements consist of a reference tone with a base frequency of 1000, 2000, or 4000 Hz with a duration of 3000 ms, gliding to a 300-ms target tone with a frequency that is 12% higher than the base frequency. The primary outcome measures are (1) the level of agreement between the predicted speech reception threshold (SRT) and the behavioral SRT, and (2) the level of agreement between the SRT calculated by the first ACC measurement and the SRT of the second ACC measurement. Level of agreement will be assessed with Bland-Altman plots.

DISCUSSION

Previous studies by our group have shown the high predictive value of the ACC model. The successful validation of this model as an effective and reliable biomarker of speech perception will directly benefit the general population, as it will increase the accuracy of hearing evaluations and improve access to adequate hearing rehabilitation.

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.

Combined effects of age and hearing impairment on utterances and requests for clarification in spontaneous conversation and a referential communication task

BACKGROUND

The impact of hearing impairment is typically studied in terms of its effects on speech perception, yet this fails to account for the interactive nature of communication. Recently, there has been a move towards studying the effects of age-related hearing impairment on interaction, often using referential communication tasks; however, little is known about how interaction in these tasks compares to everyday communication.

AIMS

To investigate utterances and requests for clarification used in one-to-one conversations between older adults with hearing impairment and younger adults without hearing impairment, and between two younger adults without hearing impairment.

METHODS & PROCEDURES

A total of 42 participants were recruited to the study and split into 21 pairs, 10 with two younger adults without hearing impairment and 11 with one younger adult without hearing impairment and one older participant with age-related hearing impairment (hard of hearing). Results from three tasks-spontaneous conversation and two trials of a referential communication task-were compared. A total of 5 min of interaction in each of the three tasks was transcribed, and the frequency of requests for clarification, mean length of utterance and total utterances were calculated for individual participants and pairs.

OUTCOMES & RESULTS

When engaging in spontaneous conversation, participants made fewer requests for clarification than in the referential communication, regardless of hearing status/age (p ≤ 0.012). Participants who were hard of hearing made significantly more requests for clarification than their partners without hearing impairment in only the second trial of the referential communication task (U = 25, p = 0.019). Mean length of utterance was longer in spontaneous conversation than in the referential communication task in the pairs without hearing impairment (p ≤ 0.021), but not in the pairs including a person who was hard of hearing. However, participants who were hard of hearing used significantly longer utterances than their partners without hearing impairment in the spontaneous conversation (U = 8, p < 0.001) but not in the referential communication tasks.

CONCLUSIONS & IMPLICATIONS

The findings suggest that patterns of interaction observed in referential communication tasks differ to those observed in spontaneous conversation. The results also suggest that fatigue may be an important consideration when planning studies of interaction that use multiple conditions of a communication task, particularly when participants are older or hard of hearing.

WHAT THIS PAPER ADDS

What is already known on this subject Age-related hearing impairment is known to affect communication; however, the majority of studies have focused on its impact on speech perception in controlled conditions. This indicates little about the impact on everyday, interactive, communication. What this study adds to the existing knowledge We investigated utterance length and requests for clarification in one-to-one conversations between pairs consisting of one older adult who is hard of hearing and one younger adult without hearing impairment, or two younger adults without hearing impairment. Results from three tasks (two trials of a referential communication task and spontaneous conversation) were compared. The findings demonstrated a significant effect of task type on requests for clarification in both groups. Furthermore, in spontaneous conversation, older adults who were hard of hearing used significantly longer utterances than their partners without hearing impairment. This pattern was not observed in the referential communication task. What are the potential or actual clinical implications of this work? These findings have important implications for generalizing results from controlled communication tasks to more everyday conversation. Specifically, they suggest that the previously observed strategy of monopolizing conversation, possibly as an attempt to control it, may be more frequently used by older adults who are hard of hearing in natural conversation than in a more contrived communication task.

Factors influencing hearing aid use, benefit and satisfaction in adults: a systematic review of the past decade

OBJECTIVE

This systematic review examined the audiological and non-audiological factors that influence hearing aid use, benefit and satisfaction in adults based on studies published during the last decade (2010 and 2023).

DESIGN

Studies were identified by using PRISMA guidelines for systematic searches on five platforms (Web of Science, Scopus, PubMed, EBSCOhost including CINAHL and Academic Search Complete). The National Institute of Health Quality assessment tool and the Oxford Centre for Evidence Based Medicine tool were used for quality assessment and grading of level of evidence.

RESULTS

Forty-six articles were included in the review. A total of 101 significant factors influencing hearing aid use (n = 47), benefit (n = 17) and satisfaction (n = 37) were identified. Clear determinants of hearing aid use, benefit and satisfaction included hearing sensitivity, self-reported hearing difficulty, speech perception, attitude and beliefs. 34 cross-sectional studies in this review were graded level 4, 9 cohort studies rated level 3, and 3 randomised control trials rated level 2.

CONCLUSION

Factors associated with hearing aid outcomes identified in the past decade support previous evidence. New factors like social networks and service-delivery models, have also been identified. These factors require further investigations through high quality studies to further strengthen existing evidence.

Consumer Survey on Hearing Aid Benefit and Satisfaction

PURPOSE

There is unexplained variability in self-reported hearing aid outcomes. The aim of this study was to evaluate determinants of hearing aid benefit and satisfaction ratings using a large-scale customer survey and to analyze the relation between demographic variables, hearing aid attributes, benefit, and satisfaction.

METHOD

The study used a retrospective design wherein 2,109 hearing aid users, recruited by Hearing Tracker and Hearing Loss Association of America, completed an online survey. The survey included questions about demographics, perceived hearing loss, devices, service delivery, cost, benefit, and satisfaction. The analytic approach included descriptive summaries and regression models to evaluate potential determinants of hearing aid benefit and satisfaction ratings.

RESULTS

Hearing aid sound quality, fit and comfort, and battery life were related to both benefit and satisfaction. Respondents who rated these outcomes favorably were also likely to benefit from, and be satisfied with, their hearing aids. Benefit was also related to degree of hearing loss, hearing aid experience, and cost. Hearing aid users with greater self-perceived hearing loss, more hearing aid experience, and more expensive hearing aids reported more benefit. Satisfaction was also related to age, employment status, and brand. Younger respondents, those who were students, and those using certain brands reported more satisfaction.

CONCLUSIONS

The results highlight importance of good hearing aid outcomes (quality, fit/comfort, and battery life) for benefit and satisfaction ratings. Professionals who fit hearing aids should strive to focus on achieving these outcomes and researchers should strive to explain the remaining variability in ratings of benefit and satisfaction.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22280854.

Stability of neural representations in the auditory midbrain across the lifespan despite age-related brainstem delays

The extent to which aging of the central auditory pathway impairs auditory perception in the elderly independent of peripheral cochlear decline is debated. To cause auditory deficits in normal hearing elderly, central aging needs to degrade neural sound representations at some point along the auditory pathway. However, inaccessible to psychophysical methods, the level of the auditory pathway at which aging starts to effectively degrade neural sound representations remains poorly differentiated. Here we tested how potential age-related changes in the auditory brainstem affect the stability of spatiotemporal multiunit complex speech-like sound representations in the auditory midbrain of old normal hearing CBA/J mice. Although brainstem conduction speed slowed down in old mice, the change was limited to the sub-millisecond range and only minimally affected temporal processing in the midbrain (i.e. gaps-in-noise sensitivity). Importantly, besides the small delay, multiunit complex temporal sound representations in the auditory midbrain did not differ between young and old mice. This shows that although small age-related neural effects in simple sound parameters in the lower brainstem may be present in aging they do not effectively deteriorate complex neural population representations at the level of the auditory midbrain when peripheral hearing remains normal. This result challenges the widespread belief of 'pure' central auditory decline as an automatic consequence of aging, at least up to the inferior colliculus. However, the stability of midbrain processing in aging emphasizes the role of undetected 'hidden' peripheral damage and accumulating effects in higher cortical auditory-cognitive processing explaining perception deficits in 'normal hearing' elderly.

Noise-Induced Hearing Loss

Noise-induced hearing loss (NIHL) is the second most common cause of sensorineural hearing loss, after age-related hearing loss, and affects approximately 5% of the world's population. NIHL is associated with substantial physical, mental, social, and economic impacts at the patient and societal levels. Stress and social isolation in patients' workplace and personal lives contribute to quality-of-life decrements which may often go undetected. The pathophysiology of NIHL is multifactorial and complex, encompassing genetic and environmental factors with substantial occupational contributions. The diagnosis and screening of NIHL are conducted by reviewing a patient's history of noise exposure, audiograms, speech-in-noise test results, and measurements of distortion product otoacoustic emissions and auditory brainstem response. Essential aspects of decreasing the burden of NIHL are prevention and early detection, such as implementation of educational and screening programs in routine primary care and specialty clinics. Additionally, current research on the pharmacological treatment of NIHL includes anti-inflammatory, antioxidant, anti-excitatory, and anti-apoptotic agents. Although there have been substantial advances in understanding the pathophysiology of NIHL, there remain low levels of evidence for effective pharmacotherapeutic interventions. Future directions should include personalized prevention and targeted treatment strategies based on a holistic view of an individual's occupation, genetics, and pathology.

Design and Development of a Spanish Hearing Test for Speech in Noise (PAHRE)

BACKGROUND

There are few hearing tests in Spanish that assess speech discrimination in noise in the adult population that take into account the Lombard effect. This study presents the design and development of a Spanish hearing test for speech in noise (Prueba Auditiva de Habla en Ruido en Español (PAHRE) in Spanish). The pattern of the Quick Speech in Noise test was followed when drafting sentences with five key words each grouped in lists of six sentences. It was necessary to take into account the differences between English and Spanish.

METHODS

A total of 61 people (24 men and 37 women) with an average age of 46.9 (range 18-84 years) participated in the study. The work was carried out in two phases. In the first phase, a list of Spanish sentences was drafted and subjected to a familiarity test based on the semantic and syntactic characteristics of the sentences; as a result, a list of sentences was selected for the final test. In the second phase, the selected sentences were recorded with and without the Lombard effect, the equivalence between both lists was analysed, and the test was applied to a first reference population.

RESULTS

The results obtained allow us to affirm that it is representative of the Spanish spoken in its variety in peninsular Spain.

CONCLUSIONS

In addition, these results point to the usefulness of the PAHRE test in assessing speech in noise by maintaining a fixed speech intensity while varying the intensity of the multi-speaker background noise. The incorporation of the Lombard effect in the test shows discrimination differences with the same signal-to-noise ratio compared to the test without the Lombard effect.

Speech-in-noise testing: Innovative applications for pediatric patients, underrepresented populations, fitness for duty, clinical trials, and remote services

Speech perception testing, defined as providing standardized speech stimuli and requiring a listener to provide a behavioral and scored response, has been an integral part of the audiologic test battery since the beginning of the audiology profession. Over the past several decades, limitations in the diagnostic and prognostic validity of standard speech perception testing as routinely administered in the clinic have been noted, and the promotion of speech-in-noise testing has been highlighted. This review will summarize emerging and innovative approaches to speech-in-noise testing with a focus on five applications: (1) pediatric considerations promoting the measurement of sensory and cognitive components separately; (2) appropriately serving underrepresented populations with special attention to racial, ethnic, and linguistic minorities, as well as considering biological sex and/or gender differences as variables of interest; (3) binaural fitness for duty assessments of functional hearing for occupational settings that demand the ability to detect, recognize, and localize sounds; (4) utilization of speech-in-noise tests in pharmacotherapeutic clinical trials with considerations to the drug mechanistic action, the patient populations, and the study design; and (5) online and mobile applications of hearing assessment that increase accessibility and the direct-to-consumer market.

Factors Affecting the Use of Speech Testing in Adult Audiology

OBJECTIVE

The aim of this study was to evaluate hearing health care professionals' (HHPs) speech testing practices in routine adult audiology services and better understand the facilitators and barriers to speech testing provision.

DESIGN

A cross-sectional questionnaire study was conducted.

STUDY SAMPLE

A sample (N = 306) of HHPs from the public (64%) and private (36%) sectors in the United Kingdom completed the survey.

RESULTS

In the United Kingdom, speech testing practice varied significantly between health sectors. Speech testing was carried out during the audiology assessment by 73.4% of private sector HHPs and 20.4% of those from the public sector. During the hearing aid intervention stage, speech testing was carried out by 56.5% and 26.5% of HHPs from the private and public sectors, respectively. Recognized benefits of speech testing included (a) providing patients with relatable assessment information, (b) guiding hearing aid fitting, and (c) supporting a diagnostic test battery. A lack of clinical time was a key barrier to uptake.

CONCLUSIONS

Use of speech testing varies in adult audiology. Results from this study found that the percentage of U.K. HHPs making use of speech tests was low compared to that of other countries. HHPs recognized different benefits of speech testing in audiology practice, but the barriers limiting uptake were often driven by factors derived from decision makers rather than clinical rationale. Privately funded HHPs used speech tests more frequently than those working in the public sector where time and resources are under greater pressure and governed by guidance that does not include a recommendation for speech testing. Therefore, the inclusion of speech testing in national clinical guidelines could increase the consistency of use and facilitate the comparison of practice trends across centers.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044457.

Profiling hearing aid users through big data explainable artificial intelligence techniques

Debilitating hearing loss (HL) affects ~6% of the human population. Only 20% of the people in need of a hearing assistive device will eventually seek and acquire one. The number of people that are satisfied with their Hearing Aids (HAids) and continue using them in the long term is even lower. Understanding the personal, behavioral, environmental, or other factors that correlate with the optimal HAid fitting and with users' experience of HAids is a significant step in improving patient satisfaction and quality of life, while reducing societal and financial burden. In SMART BEAR we are addressing this need by making use of the capacity of modern HAids to provide dynamic logging of their operation and by combining this information with a big amount of information about the medical, environmental, and social context of each HAid user. We are studying hearing rehabilitation through a 12-month continuous monitoring of HL patients, collecting data, such as participants' demographics, audiometric and medical data, their cognitive and mental status, their habits, and preferences, through a set of medical devices and wearables, as well as through face-to-face and remote clinical assessments and fitting/fine-tuning sessions. Descriptive, AI-based analysis and assessment of the relationships between heterogeneous data and HL-related parameters will help clinical researchers to better understand the overall health profiles of HL patients, and to identify patterns or relations that may be proven essential for future clinical trials. In addition, the future state and behavioral (e.g., HAids Satisfiability and HAids usage) of the patients will be predicted with time-dependent machine learning models to assist the clinical researchers to decide on the nature of the interventions. Explainable Artificial Intelligence (XAI) techniques will be leveraged to better understand the factors that play a significant role in the success of a hearing rehabilitation program, constructing patient profiles. This paper is a conceptual one aiming to describe the upcoming data collection process and proposed framework for providing a comprehensive profile for patients with HL in the context of EU-funded SMART BEAR project. Such patient profiles can be invaluable in HL treatment as they can help to identify the characteristics making patients more prone to drop out and stop using their HAids, using their HAids sufficiently long during the day, and being more satisfied by their HAids experience. They can also help decrease the number of needed remote sessions with their Audiologist for counseling, and/or HAids fine tuning, or the number of manual changes of HAids program (as indication of poor sound quality and bad adaptation of HAids configuration to patients' real needs and daily challenges), leading to reduced healthcare cost.

Remote Monitoring of Adult Cochlear Implant Recipients Using Digits-in-Noise Self-Testing

PURPOSE

The COVID-19 pandemic has accelerated the uptake and scope of telehealth. This study determined the accuracy and reliability of a smartphone digits-in-noise (DIN) test when conducted by adult cochlear implant (CI) recipients in a simulated home environment compared with a clinic setup. Perceptions of remote monitoring using speech-in-noise (SIN) testing were also explored.

METHOD

Thirty-three adult CI recipients between 18 and 78 years of age (M = 46.7, SD = ±20.4) conducted the DIN test in a simulated home environment and a clinic setup. Test-retest reliability across the two environments and comparisons between test settings were evaluated. A survey explored the perceptions of adult CI recipients regarding remote monitoring and use of the DIN self-test.

RESULTS

Mean-aided speech reception thresholds (SRTs) in the clinic and simulated home environment test conditions and clinic and simulated home environment retest conditions did not differ significantly. Mean test-retest SRTs in the clinic and simulated home environment were significantly different (p < .05). High intraclass correlation coefficient and low standard error of measurement scores reflected good and excellent reliability between test-retest measures and between clinic and simulated home environment measures. Most participants were positive about the possibility of using the DIN test at home to self-assess speech perception, although some test adjustments such as including training items and a less adverse starting signal-to-noise ratio may be required.

CONCLUSION

Adult CI recipients can use the smartphone DIN test to self-assess aided SIN performance in a home environment with accuracy and reliability relatively similar to clinic testing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044418.

Harnessing the Power of Artificial Intelligence in Otolaryngology and the Communication Sciences

Use of artificial intelligence (AI) is a burgeoning field in otolaryngology and the communication sciences. A virtual symposium on the topic was convened from Duke University on October 26, 2020, and was attended by more than 170 participants worldwide. This review presents summaries of all but one of the talks presented during the symposium; recordings of all the talks, along with the discussions for the talks, are available at https://www.youtube.com/watch?v=ktfewrXvEFg and https://www.youtube.com/watch?v=-gQ5qX2v3rg . Each of the summaries is about 2500 words in length and each summary includes two figures. This level of detail far exceeds the brief summaries presented in traditional reviews and thus provides a more-informed glimpse into the power and diversity of current AI applications in otolaryngology and the communication sciences and how to harness that power for future applications.

APSO Standards: Implementing Hearing Aid Needs Assessments and Measuring Related Outcomes

The proportion of individuals who pose to benefit from the use of hearing aids is much smaller than those who adopt them. Likewise, many adults who try hearing devices abandon using them after a short period of time. Most factors related to hearing aid use are unrelated to a patient's hearing loss severity. Hearing loss treatment requires more than the provision of hearing aids as a sole intervention. Adoption rates could be improved through the implementation of evidence-based clinical protocols which maximize patients' success. Recently, the Audiology Practice Standards Organization (APSO) released evidence-based, formal standards of practice addressing hearing aid selection, fitting, and rehabilitation for adult and geriatric patients. Notably, the standards acknowledge the importance of an amplification needs assessment, including hearing aid outcomes measurement. In this brief narrative, we describe Standards 3 and 14 ( Needs Assessment and Hearing Aid Outcomes Measurement ) and offer an example of the clinical implementation of a comprehensive needs assessment and hearing aid outcomes measurement currently being used in a multisite, longitudinal clinical trial.

Hearing Aid Technology Settings and Speech-in-Noise Difficulties

PURPOSE

Hearing aids are the primary method to manage hearing loss. However, there are limited recommendations for when and how to set advanced hearing aid features. The purpose of this study is to describe how hearing aid features are utilized in clinically fit devices and to evaluate the relationship between the fitted hearing aid feature and the Quick Speech-in-Noise Test (QuickSIN).

METHOD

Data from two laboratories were evaluated retrospectively, resulting in 107 bilateral hearing aid participants who obtained their hearing aids at clinics in their communities. Ages ranged from 60 to 93 years. Degree of speech-in-noise difficulty was evaluated using the QuickSIN (mild, moderate, or severe). Settings for directionality, digital noise reduction (DNR), and hearing assistive technology (HAT) use were documented. Directionality was categorized as omnidirectional, fixed (full-time directional), or adaptive (adjusts automatically based on noise source). DNR was recorded as either on or off. HAT use was recorded as either yes or no.

RESULTS

QuickSIN scores ranged from -1.5 to 25 dB SNR loss (M = 7). A moderate correlation was determined for QuickSIN scores and pure-tone averages. Adaptive directionality was used most often, most participants had DNR turned on, and HAT use was low. The biggest contributions to the Chi-square test for directionality and degrees of speech-in-noise difficulty together were fixed/severe, fixed/moderate, and adaptive/mild.

CONCLUSIONS

In this clinical sample, there was limited HAT use and advanced features are not set in a way that is consistent with speech-in-noise abilities. It is likely that patients fit with noise management that is not suited to their listening abilities are experiencing increased difficulties in challenging listening environments that could potentially be mitigated with alternative management. Evidence-based research on prefitting measures of speech in noise to help inform patient-centered clinical decisions is needed.

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

BACKGROUND

Self-reported hearing aid outcomes among older adults are variable and important to improve. The extent of the role of auditory processing in long-term hearing aid outcomes is not well understood.

PURPOSE

To determine how auditory processing abilities are related to self-reported hearing aid satisfaction and benefit along with either aided audibility alone or exploratory factors suggested by previous literature.

RESEARCH DESIGN

Descriptive analyses and multiple regression analyses of cross-sectional self-reported outcomes.

STUDY SAMPLE

Adult participants, >60 years (n = 78), fitted with bilateral hearing aids to treat symmetric, mild to moderate sensorineural hearing loss.

DATA COLLECTION AND ANALYSIS

Participants were recruited from a single audiology clinic to complete a series of questionnaires, behavioral assessments, and obtain data from their hearing aids, including real ear measures and data logging of hearing aid use. Multiple linear regressions were used to determine the amount of variance explained by predictive factors in self-reported hearing aid satisfaction and benefit. The primary predictive factors included gap detection threshold, spatial advantage score, dichotic difference score, and aided audibility. Exploratory factors included personality, self-efficacy, self-report of disability, and hearing aid use. All interpretations of statistical significance used p < 0.05. Effect sizes were determined using Cohen's f ² with a medium effect suggesting clinical relevance.

RESULTS

Gap detection threshold was a statistically significant predictor in both primary regression models with a medium effect size for satisfaction and a small effect size for benefit. When additional exploratory factors were included in the regression models with auditory processing abilities, gap detection and self-efficacy were both significant predictors of hearing aid satisfaction with medium effect sizes, explaining 10 and 17% of the variance, respectively. There were no medium effect sizes found for other predictor variables in either the primary or exploratory hearing aid benefit models. Additional factors were statistically significant in the models, explaining a small amount of variance, but did not meet the medium effect size criterion.

CONCLUSION

This study provides initial evidence supporting the incorporation of measures of gap detection ability and hearing aid self-efficacy into clinical practice for the interpretation of postfitting long-term hearing aid satisfaction.