Counseling during Real Ear Measurements: The Clients' Perspective

2021 ◽  
Author(s):  
Angela Ryall ◽  
Lorienne M. Jenstad ◽  
John Pumford ◽  
Tami Howe ◽  
Garnet Grosjean
Keyword(s):  
Focus Groups ◽  
Hearing Aids ◽  
Visual Information ◽  
Best Practice ◽  
Qualitative Content Analysis ◽  
Hearing Aid ◽  
Added Value ◽  
Centered Care ◽  
Prior Literature ◽  
First Time

Abstract Background When dispensing hearing aids, audiologists must follow validated fitting and verification procedures to ensure that the hearing aids are properly fitted to the client's hearing. Real ear measurements (REMs) are best practice for verifying hearing aids. Prior literature regarding REMs has mainly focused on the clinicians' perspective. Purpose This study investigated informational counseling throughout REMs by gathering perspectives of first-time hearing aid users regarding the content and format of counseling. Research Design The study used an interpretive description approach with focus groups. Study Sample There were 16 adult participants (4 males, 12 females) who were first-time hearing aid users and who all had memory of REMs occurring during their own hearing aid verification. Intervention We investigated the addition of informational counseling during REM verification. Data Collection and Analysis Four focus groups were conducted to elicit feedback on a demonstration of informational counseling during REM hearing aid verification. The data from the focus groups were transcribed verbatim and analyzed using qualitative content analysis. Results Analysis revealed positive aspects, negative aspects, and suggested changes in relation to the verbal and visual information presented during the REM verification demonstration. These data fell into two broad categories: the interaction and transaction of informational counseling. Conclusion Most clients were interested in learning more about REMs if the information was accessible. Results provide recommendations for clinical audiologists and REM system manufacturers to make the information presented during informational counseling more client-friendly and individualized for client-centered care. To continue exploring this new inquiry, further experimental research is required to determine if there is any added value of incorporating informational counseling during REMs.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

scholarly journals Survey of Hearing Aid Conditions for Hearing Impaired Persons While Driving

2020 ◽  
pp. 132-136
Author(s):  
Hiroshi Ikeda ◽  
Shigeyuki Minami
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Visual Information ◽  
Hearing Aid ◽  
Hearing Impaired ◽  
Safe Driving ◽  
Actual Usage ◽  
Hearing Ability ◽  
Acquired Hearing Loss ◽  
The Impact

Hearing impaired persons are required to drive with hearing aids to supplement their hearing ability, however, there has not been sufficient discussion regarding the impact of the use of a hearing aid on driving a vehicle. In order to investigate the actual usage and driving conditions of using hearing aids while driving a vehicle, this paper uses a questionnaire to survey (1) how easy it is to drive when wearing hearing aids, and (2) how often hearing aids are not worn while driving. Concerning the ease of driving when wearing a hearing aid, it was suggested that people with congenital hearing loss were more likely to rely on visual information, and those with acquired hearing loss continue to use their experience of hearing. When the level of disability is high, it is difficult to drive when using the hearing aid, and when the disability level is low, it is easier to drive. Regarding the frequency of driving without wearing hearing aids, about 60 % of respondents had such an experience. Those who often drive without hearing aids had experienced headaches due to noise from wearing hearing aids compared to those who wear hearing aids at all times. Hearing aids are necessary assistive devices for hearing impaired persons to obtain hearing information, and to provide a safe driving environment. Therefore, this paper addresses issues to maintain a comfortable driving environment while wearing a hearing aid.

Heterogeneity in Vison, Hand Function, Cognition, and Health Literacy Among Older Veterans: Impacts, Outcomes, and Clinical Recommendations for First-Time Hearing Aid Users

2021 ◽  
Author(s):  
Gabrielle H. Saunders ◽  
Leslie Grush ◽  
Jay Vachhani ◽  
Katharina V. Echt ◽  
Susan Griest ◽  
...  
Keyword(s):  
Health Literacy ◽  
Cognitive Function ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Hand Function ◽  
Care Quality ◽  
Community Dwelling ◽  
Clinical Practices ◽  
Combining Data ◽  
First Time

Abstract Background Age-related changes (both normal and pathological), and health literacy are relevant to audiological practice. Changes associated with the musculoskeletal, vascular, and nervous systems drive manual, visual, and cognitive function. These in turn affect the capabilities required for effective hearing aid (HA) skill acquisition, use, and management. Meanwhile, health literacy influences the ability to gain access to, understand, and use information, which is important for promoting and maintaining HA use and management. Understanding the interindividual variability of these variables can help audiologists characterize those individuals who might have suboptimal HA outcomes. This knowledge can then inform better clinical practices and guide implementation of processes to improve care quality and outcomes. Purpose The aim of the study is to assess the variation in manual, visual, and cognitive function, and health literacy, among community-dwelling older individuals, and to determine whether and which of these variables are associated with reported HA outcome and/or the knowledge and skill to manage HAs. Research Design Data presented here were collected as part of an efficacy trial of four variants of HA orientation. The data were collected at baseline (prior to HA fitting) and after 4 to 8 weeks of HA use. Study Sample The study sample consists of 265 U.S. Veterans aged 51 to 87 years with no previous HA experience who were scheduled to receive their first pair of HAs from the Veterans Administration. Data Collection and Analysis We assessed baseline measures of hand function, vision, cognition, and health literacy just prior to participants receiving their first pair of HAs. HA management skills and knowledge, and HA outcome were measured after 4 to 8 weeks of HA use using the Hearing Aid Skills and Knowledge (HASK) and International Outcomes Inventory for Hearing Aids (IOI-HA), respectively. Data collected here was compared with published norms to assess variation in baseline measures. Associations between baseline performance and outcomes data were examined using t-tests comparing participants who performed at or above age-based norms with those who performed below age-based norms. Results Participants' performance on the baseline measures was highly variable, with the proportions of individuals performing below norms varying by test measure. When combining data across the nine baseline measures, approximately 10% of participants performed below published norms on five or more measures, and 85% performed below norms on at least one measure. Poor manual dexterity, ability to learn a new task, and ability to draw inferences from spoken information negatively impacted HA management and outcome. Conclusion There was a considerable heterogeneity among a community-dwelling sample of first time HA users in terms of sensory, cognitive, and motor function. Clinicians should consider modifying their clinical practice to account for such heterogeneity and best support their patients in adapting to new HAs.

scholarly journals Differences in Word and Phoneme Recognition in Quiet, Sentence Recognition in Noise, and Subjective Outcomes between Manufacturer First-Fit and Hearing Aids Programmed to NAL-NL2 Using Real-Ear Measures

2018 ◽  
Vol 29 (08) ◽  
pp. 706-721 ◽  
Author(s):  
Michael Valente ◽  
Kristi Oeding ◽  
Alison Brockmeyer ◽  
Steven Smith ◽  
Dorina Kallogjeri
Keyword(s):  
Speech Recognition ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Monosyllabic Word ◽  
Phoneme Recognition ◽  
Double Blind ◽  
Sentence Recognition ◽  
Subjective Outcomes ◽  
Fitting Hearing Aids

AbstractThe American Speech-Language-Hearing Association (ASHA) and American Academy of Audiology (AAA) have created Best Practice Guidelines for fitting hearing aids to adult patients. These guidelines recommend using real-ear measures (REM) to verify that measured output/gain of hearing aid(s) match a validated prescriptive target. Unfortunately, approximately 70–80% of audiologists do not routinely use REM when fitting hearing aids, instead relying on a manufacturer default “first-fit” setting. This is problematic because numerous studies report significant differences in REM between manufacturer first-fit and the same hearing aids using a REM or programmed-fit. These studies reported decreased prescribed gain/output in the higher frequencies for the first-fit compared with the programmed fit, which are important for recognizing speech. Currently, there is little research in peer-reviewed journals reporting if differences between hearing aids fitted using a manufacturer first-fit versus a programmed-fit result in significant differences in speech recognition in quiet, noise, and subjective outcomes.To examine if significant differences were present in monosyllabic word and phoneme recognition (consonant-nucleus-consonant; CNC) in quiet, sentence recognition in noise (Hearing in Noise Test; HINT), and subjective outcomes using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Speech, Spatial and Qualities of Hearing (SSQ) questionnaires between hearing aids fit using one manufacturer’s first-fit and the same hearing aids with a programmed-fit using REM to National Acoustic Laboratories Nonlinear Version 2 (NAL-NL2) prescriptive target.A double-blind randomized crossover design was used. Throughout the study, one investigator performed all REM whereas a second investigator measured speech recognition in quiet, noise, and scored subjective outcome measures.Twenty-four adults with bilateral normal sloping to moderately severe sensorineural hearing loss with no prior experience with amplification.The hearing aids were fit using the proprietary manufacturer default first-fit and a programmed-fit to NAL-NL2 using real-ear insertion gain measures. The order of the two fittings was randomly assigned and counterbalanced. Participants acclimatized to each setting for four weeks and returned for assessment of performance via the revised CNC word lists, HINT, APHAB, and SSQ for the respective fitting.(1) A significant median advantage of 15% (p < 0.001; 95% CI: 9.7–24.3%) for words and 7.7% (p < 0.001; 95% CI: 5.9–10.9%) for phonemes for the programmed-fit compared with first-fit at 50 dB sound pressure level (SPL) and 4% (p < 0.01; 95% CI: 1.7–6.3%) for words at 65 dB SPL; (2) No significant differences for the HINT reception threshold for sentences (RTS); (3) A significant median advantage of 4.2% [p < 0.04; 95% confidence interval (CI): −0.6–13.2%] for the programmed-fit compared with the first-fit for the background noise subscale problem score for the APHAB; (4) No significant differences on the SSQ.Improved word and phoneme recognition for soft and words for average speech in quiet were reported for the programmed-fit. Seventy-nine percent of the participants preferred the programmed-fitting versus first-fit. Hearing aids, therefore, should be verified and programmed using REM to a prescriptive target versus no verification using a first-fit.

scholarly journals Perception of One’s Own Voice After Hearing-Aid Fitting for Naive Hearing-Aid Users and Hearing-Aid Refitting for Experienced Hearing-Aid Users

2020 ◽  
Vol 24 ◽  
pp. 233121652093246
Author(s):  
Johanna Hengen ◽  
Inger L. Hammarström ◽  
Stefan Stenfelt
Keyword(s):  
Hearing Impairment ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Control Group ◽  
Voice Perception ◽  
Hearing Aid Fitting ◽  
Before And After ◽  
Vocal Intensity ◽  
First Time

Dissatisfaction with the sound of one’s own voice is common among hearing-aid users. Little is known regarding how hearing impairment and hearing aids separately affect own-voice perception. This study examined own-voice perception and associated issues before and after a hearing-aid fitting for new hearing-aid users and refitting for experienced users to investigate whether it was possible to differentiate between the effect of (unaided) hearing impairment and hearing aids. Further aims were to investigate whether First-Time and Experienced users as well as users with dome and mold inserts differed in the severity of own-voice problems. The study had a cohort design with three groups: First-Time hearing-aid users going from unaided to aided hearing ( n = 70), Experienced hearing-aid users replacing their old hearing aids ( n = 70), and an unaided control group ( n = 70). The control group was surveyed once and the hearing-aid users twice; once before hearing-aid fitting/refitting and once after. The results demonstrated that own-voice problems are common among both First-Time and Experienced hearing-aid users with either dome- or mold-type fittings, while people with near-normal hearing and not using hearing aids report few problems. Hearing aids increased ratings of own-voice problems among First-Time users, particularly those with mold inserts. The results suggest that altered auditory feedback through unaided hearing impairment or through hearing aids is likely both to change own-voice perception and complicate regulation of vocal intensity, but hearing aids are the primary reason for poor perceived sound quality of one’s own voice.

Comparisons of Client and Clinician Views of the Importance of Factors in Client-Clinician Interaction in Hearing Aid Purchase Decisions

2015 ◽  
Vol 26 (03) ◽  
pp. 247-259 ◽  
Author(s):  
Laya Poost-Foroosh ◽  
Mary Beth Jennings ◽  
Margaret F. Cheesman
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Purchase Decisions ◽  
Shared Decision ◽  
Centered Care ◽  
Importance Ratings ◽  
The Mean ◽  
Client Needs

Background: Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology–related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Purpose: Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. Research Design: A cross-sectional approach was used to obtain online and paper-based concept ratings. Data Collection and Analysis: Participants were 43 adults (age range, 45–85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated “the importance of each of the statements in a person’s decision to purchase a hearing aid” on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. Results: There was a significant difference in the mean ratings for clients and clinicians for the concepts understanding and meeting client needs, conveying device information by clinician, supporting choices and shared decision making, and factors in client readiness. Three concepts—understanding and meeting client needs, conveying device information by clinician, and supporting choices and shared decision making—were rated as more important by clients than by clinicians. One concept (ie, factors in client readiness) was rated as more important by clinicians than by clients. Conclusions: The concepts rated as most important by clients and clinicians are consistent with components of several existing models of client-centered and patient-centered care. These concepts reflect the clients’ perception of the importance of their involvement in the decision-making process. A preliminary model of client-centered care within the hearing aid uptake process and implications for clinical audiology are described.

Enhanced Speechreading Performance in Young Hearing Aid Users in China

2019 ◽  
Vol 62 (2) ◽  
pp. 307-317 ◽  
Author(s):  
Jianghua Lei ◽  
Huina Gong ◽  
Liang Chen
Keyword(s):  
Young Adults ◽  
Speech Perception ◽  
Hearing Impairment ◽  
Hearing Aids ◽  
Visual Information ◽  
Hearing Aid ◽  
Visual Speech ◽  
Positive Correlation ◽  
Visual Speech Perception

Purpose The study was designed primarily to determine if the use of hearing aids (HAs) in individuals with hearing impairment in China would affect their speechreading performance. Method Sixty-seven young adults with hearing impairment with HAs and 78 young adults with hearing impairment without HAs completed newly developed Chinese speechreading tests targeting 3 linguistic levels (i.e., words, phrases, and sentences). Results Groups with HAs were more accurate at speechreading than groups without HA across the 3 linguistic levels. For both groups, speechreading accuracy was higher for phrases than words and sentences, and speechreading speed was slower for sentences than words and phrases. Furthermore, there was a positive correlation between years of HA use and the accuracy of speechreading performance; longer HA use was associated with more accurate speechreading. Conclusions Young HA users in China have enhanced speechreading performance over their peers with hearing impairment who are not HA users. This result argues against the perceptual dependence hypothesis that suggests greater dependence on visual information leads to improvement in visual speech perception.

Parent-Professional Partnerships: Managing Behavior to Increase Hearing Aid Use

2017 ◽  
Vol 2 (9) ◽  
pp. 66-71
Author(s):  
Elizabeth Preston ◽  
Michael Twohig ◽  
Karen Muñoz
Keyword(s):  
Child Behavior ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Spoken Language ◽  
Behavior Changes ◽  
Longitudinal Case Study ◽  
Negative Behaviors ◽  
Hearing Aid Use

For development of spoken language, children need to consistently use appropriately fitted amplification. There is extensive variability in hearing aid use, particularly with younger children (Muñoz, Preston, & Hicken, 2014; Walker et al., 2013), and parents have reported challenges influencing how much children use their hearing aids including negative behaviors (Muñoz et al., 2015; Muñoz et al., 2016). Audiologists need to incorporate approaches to behavior changes with the families, which is often not a skill we have been trained to focus on. Teaching the parents a few simple steps might drastically reduce problematic actions and increase desired ones. Setting up a plan where the caregiver systematically reinforces what is wanted, ignores what is not wanted, and only punishes what is dangerous is one strategy that can be used. As part of a longitudinal case study, Muñoz et al. (2017) found that with the support of the audiologist, the parent learned how to provide positive reinforcements that motivated her child and increased the amount of time she provided individual attention. When child behavior interferes with hearing aid use, audiologists have an important role in partnering with parents to explore and address the issues in order to provide best practice.

A Comparison of Personal Sound Amplification Products and Hearing Aids in Ecologically Relevant Test Environments

2018 ◽  
Vol 27 (4) ◽  
pp. 581-593 ◽  
Author(s):  
Lisa Brody ◽  
Yu-Hsiang Wu ◽  
Elizabeth Stangl
Keyword(s):  
Speech Recognition ◽  
Hearing Aids ◽  
Speech Intelligibility ◽  
Best Practice ◽  
Hearing Aid ◽  
Recognition Performance ◽  
Sound Quality ◽  
Listening Effort ◽  
Speech Intelligibility Index ◽  
Sound Amplification

Purpose The aim of this study was to compare the benefit of self-adjusted personal sound amplification products (PSAPs) to audiologist-fitted hearing aids based on speech recognition, listening effort, and sound quality in ecologically relevant test conditions to estimate real-world effectiveness. Method Twenty-five older adults with bilateral mild-to-moderate hearing loss completed the single-blinded, crossover study. Participants underwent aided testing using 3 PSAPs and a traditional hearing aid, as well as unaided testing. PSAPs were adjusted based on participant preference, whereas the hearing aid was configured using best-practice verification protocols. Audibility provided by the devices was quantified using the Speech Intelligibility Index (American National Standards Institute, 2012). Outcome measures assessing speech recognition, listening effort, and sound quality were administered in ecologically relevant laboratory conditions designed to represent real-world speech listening situations. Results All devices significantly improved Speech Intelligibility Index compared to unaided listening, with the hearing aid providing more audibility than all PSAPs. Results further revealed that, in general, the hearing aid improved speech recognition performance and reduced listening effort significantly more than all PSAPs. Few differences in sound quality were observed between devices. All PSAPs improved speech recognition and listening effort compared to unaided testing. Conclusions Hearing aids fitted using best-practice verification protocols were capable of providing more aided audibility, better speech recognition performance, and lower listening effort compared to the PSAPs tested in the current study. Differences in sound quality between the devices were minimal. However, because all PSAPs tested in the study significantly improved participants' speech recognition performance and reduced listening effort compared to unaided listening, PSAPs could serve as a budget-friendly option for those who cannot afford traditional amplification.

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