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 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.

Pediatric Audiology in North America: Current Clinical Practice and How It Relates to the American Academy of Audiology Pediatric Amplification Guideline

2016 ◽  
Vol 27 (03) ◽  
pp. 166-187 ◽  
Author(s):  
Sheila Moodie ◽  
Eileen Rall ◽  
Leisha Eiten ◽  
George Lindley ◽  
Dave Gordey ◽  
...  
Keyword(s):  
Clinical Practice ◽  
North America ◽  
Data Collection ◽  
Practice Guidelines ◽  
Best Practice ◽  
Intervention Program ◽  
Hearing Aid ◽  
Evidence Based ◽  
Pediatric Audiology ◽  
Family Centered

Background: There is broad consensus that screening and diagnosis of permanent hearing loss in children must be embedded within a comprehensive, evidence-based, family-centered intervention program. Clinical practice guidelines (CPGs) for pediatric hearing assessment and hearing aid verification aim to reduce variability in practice and increase the use of effective evidence-based diagnostic and treatment options so that optimal outcomes may be achieved. To be of value, guidelines must be translated and implemented into practice and ongoing monitoring of their use in practice should occur. Purpose: This paper provides the results of two studies that aim to examine current pediatric audiology and amplification practice in North America. Research Design: A concurrent embedded mixed methods design was used. Study Sample: An electronic survey was distributed to North American audiologists who delivered pediatric audiology services with 350 audiologists participating in study 1 and 63 audiologists participating in study 2. Data Collection and Analysis: A quantitative approach was the predominant method of data collection. Respondents were prompted to provide additional qualitative text and detail regarding their quantitative response choice. This qualitative text was used during the analysis phase and combined with quantitative results to assist understanding of respondents’ knowledge, skills, and barriers/facilitators to implement best practice in pediatric amplification. Results: Approximately 70% of audiologists reported using best-practice protocols for pediatric hearing aid fitting. Despite widespread knowledge and increased use of CPGs over the last 18 yrs, results of these studies show that variation in practice patterns continue to exist. Several examples of implementation challenges are discussed with recommendations provided. Conclusions: In order for audiologists working with children who are deaf or hard of hearing and their families to achieve the principles of family-centered early intervention, practice guidelines must continue to be developed, disseminated, and translated as they have a positive impact on the services provided. Researchers and clinical audiologists who deliver services must continue to collaborate to understand the “how” and “why” of implementing guidelines into practice and to identify the barriers/facilitators encountered in trying to do so.

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.

Factors Ensuring Consistent Audibility in Pediatric Hearing Aid Fitting

2002 ◽  
Vol 13 (09) ◽  
pp. 503-520
Author(s):  
Francis Kuk ◽  
Andre Marcoux
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Precise Determination ◽  
Feedback Cancellation ◽  
Directional Microphones ◽  
Multichannel Processing ◽  
Important Objective ◽  
Fitting Hearing Aids

Ensuring consistent audibility is an important objective when fitting hearing aids to children. This article reviews the factors that could affect the audibility of the speech signals to children. These factors range from a precise determination of the child's hearing loss to an accurate specification of gain in the chosen hearing aids. In addition, hearing aid technology and features such as multichannel processing, directional microphones, and feedback cancellation that could affect the achievement of consistent audibility are reviewed.

Using a health improvement methodology to standardise leg ulcer management

2020 ◽  
Vol 25 (Sup9) ◽  
pp. S20-S25
Author(s):  
Kirsten Mahoney ◽  
Wendy Simmonds
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
Best Practice ◽  
Leg Ulcer ◽  
Health Improvement ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Poor Patient ◽  
Pdsa Cycle

Despite guidelines, best-practice statements and CQUIN targets, venous leg ulcers have been highlighted as an area that continues to demonstrate lack of evidence-based practice and variation in practice, which contribute to poor patient outcomes and escalating costs. Leg ulcer services that use a systematic and standardised approach to leg ulcer management are highly successful in improving healing rates, preventing recurrence and contributing to patients' wellbeing. This article seeks to explore the use of the plan-do-study-act (PDSA) cycle in clinical practice to improve and standardise leg ulcer management.

Review of Recent Research on the Selection of Frequency-Gain Characteristics for Hearing Aids

1980 ◽  
Vol 89 (5_suppl) ◽  
pp. 79-83
Author(s):  
Richard Lippmann
Keyword(s):  
Hearing Aids ◽  
Speech Intelligibility ◽  
Signal To Noise Ratio ◽  
Hearing Aid ◽  
Linear Amplification ◽  
Percentage Points ◽  
Gain Characteristic ◽  
The Relationship ◽  
Fitting Hearing Aids ◽  
Selection Of

Following the Harvard master hearing aid study in 1947 there was little research on linear amplification. Recently, however, there have been a number of studies designed to determine the relationship between the frequency-gain characteristic of a hearing aid and speech intelligibility for persons with sensorineural hearing loss. These studies have demonstrated that a frequency-gain characteristic that rises at a rate of 6 dB/octave, as suggested by the Harvard study, is not optimal. They have also demonstrated that high-frequency emphasis of 10–40 dB above 500–1000 Hz is beneficial. Most importantly, they have demonstrated that hearing aids as they are presently being fit do not provide maximum speech intelligibility. Percent word correct scores obtained with the best frequency-gain characteristics tested in various studies have been found to be 9 to 19 percentage points higher than scores obtained with commercial aids owned by subjects. This increase in scores is equivalent to an increase in signal-to-noise ratio of 10 to 20 dB. This is a significant increase which could allow impaired listeners to communicate in many situations where they presently cannot. These results demonstrate the need for further research on linear amplification aimed at developing practical suggestions for fitting hearing aids.

Evaluation of the Self-Fitting Process with a Commercially Available Hearing Aid

2017 ◽  
Vol 28 (02) ◽  
pp. 109-118 ◽  
Author(s):  
Elizabeth Convery ◽  
Gitte Keidser ◽  
Mark Seeto ◽  
Margot McLelland
Keyword(s):  
Hearing Loss ◽  
Success Rate ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Low Cost ◽  
The Self ◽  
Fine Tuning ◽  
Successful Outcome ◽  
Fitting Procedure ◽  
Fitting Hearing Aids

Background: Hearing aids and personal sound amplification products that are designed to be self-fitted by the user at home are becoming increasingly available in the online marketplace. While these devices are often marketed as a low-cost alternative to traditional hearing health-care, little is known about people’s ability to successfully use and manage them. Previous research into the individual components of a simulated self-fitting procedure has been undertaken, but no study has evaluated performance of the procedure as a whole using a commercial product. Purpose: To evaluate the ability of a group of adults with a hearing loss to set up a pair of commercially available self-fitting hearing aids for their own use and to investigate factors associated with a successful outcome. Research Design: An interventional study that used regression analysis to identify potential contributors to the outcome. Study Sample: Forty adults with mild to moderately severe hearing loss participated in the study: 20 current hearing aid users (the “experienced” group) and 20 with no previous amplification experience (the “new” group). Twenty-four participants attended with partners, who were present to offer assistance with the study task as needed. Data Collection and Analysis: Participants followed a set of written, illustrated instructions to perform a multistep self-fitting procedure with a commercially available self-fitting hearing aid, with optional assistance from a lay partner. Standardized measures of cognitive function, health literacy, locus of control, hearing aid self-efficacy, and manual dexterity were collected. Statistical analysis was performed to examine the proportion of participants in each group who successfully performed the self-fitting procedure, factors that predicted successful completion of the task, and the contributions of partners to the outcome. Results: Fifty-five percent of participants were able to successfully perform the self-fitting procedure. Although the same success rate was observed for both experienced and new participants, the majority of the errors relating to the hearing test and the fine-tuning tasks were made by the experienced participants, while all of the errors associated with physically customizing the hearing aids and most of the insertion errors were made by the new participants. Although the majority of partners assisted in the self-fitting task, their contributions did not significantly influence the outcome. Further, no characteristic or combination of characteristics reliably predicted which participants would be successful at the self-fitting task. Conclusions: Although the majority of participants were able to complete the self-fitting task without error, the provision of knowledgeable support by trained personnel, rather than a fellow layperson, would most certainly increase the proportion of users who are able to achieve success. Refinements to the instructions and the physical design of the hearing aid may also serve to improve the success rate. Further evaluation of the range of self-fitting hearing aids that are now on the market should be undertaken.

Fitting Hearing Aids Using Clinical Measures of Loudness Discomfort Levels: An Evidence-Based Review of Effectiveness

2005 ◽  
Vol 16 (07) ◽  
pp. 461-472 ◽  
Author(s):  
Gustav H. Mueller ◽  
Ruth A. Bentler
Keyword(s):  
Hearing Aids ◽  
Statistical Power ◽  
Hearing Aid ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Strong Recommendation ◽  
Hearing Aid Fitting ◽  
Fitting Procedure ◽  
Clinical Measurements ◽  
Clinical Measures

Clinical measurement of the loudness discomfort level (LDL) historically has been part of the hearing aid fitting procedure, and this clinical practice remains popular today. LDL measurements also are recommended in contemporary hearing aid fitting protocols. Yet, surveys show that many hearing aid users are dissatisfied with the loudness of their hearing aids. In this evidence-based review article, we evaluate the effectiveness of clinical LDL measurements. Specifically, we asked the question "Are the clinical measurements of LDL for adult patients predictive of aided acceptance and satisfaction of loudness for high inputs in the real world?" Nearly 200 articles were reviewed; three met the criteria set forth in this review. The evidence supported using unaided LDLs for selecting the maximum real-ear output of hearing aids. No study using aided LDLs or aided loudness verification met the criteria. The level of the evidence for the three articles using unaided LDLs was low; no higher than Level 4. The limited number of studies, the level of evidence, and the statistical power of the studies prevents us from making a strong recommendation concerning the clinical use of LDL measures. Additional research in this area, especially research employing randomized controlled trials would be a useful addition to this body of literature.

scholarly journals Experiences of hearing aid use among patients with mild cognitive impairment and Alzheimer’s disease dementia: A qualitative study

2020 ◽  
Vol 8 ◽  
pp. 205031212090457
Author(s):  
Sarah Gregory ◽  
Jo Billings ◽  
Danielle Wilson ◽  
Gill Livingston ◽  
Anne GM Schilder ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Future Research ◽  
Structured Interviews ◽  
Hearing Aid Use ◽  
Age Range

Objectives: Hearing aid usage supports communication and independence; however, many do not use their hearing aids. This study explored the experiences of hearing aid use in adults with mild cognitive impairment or Alzheimer’s disease. Methods: Participants completed semi-structured interviews which were analysed using thematic analysis. Ten people (six males, age range 75–86 years old) with mild cognitive impairment or Alzheimer’s disease who had been fitted with hearing aids were recruited to the study. Results: We identified four major themes: (1) memory and other cognitive barriers to using hearing aids, (2) practical aspects of hearing aids, (3) benefits of hearing aids, and (4) ambivalence towards hearing aids. Conclusions: Participants perceived a significant impact of cognitive impairment on the experience of using hearing aids. This population may benefit from targeted strategies to support use of hearing aids. The findings from this study can inform future research to optimise use of hearing aids in this population.

Quality In, Quality Out: Supporting Good Outcomes for Children Who Wear Hearing Aids

2013 ◽  
Vol 23 (2) ◽  
pp. 31-42
Author(s):  
Marlene P. Bagatto
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Hearing Aid Fitting ◽  
Essential Components ◽  
Stage Process ◽  
Outcomes For Children ◽  
Key Aspects ◽  
Speech And Language Development ◽  
Fitting Hearing Aids

Fitting hearing aids to infants with hearing loss can be completed in a systematic and evidence-based manner. This is because there are clinical protocols and technologies available so that pediatric audiologists can fit hearing aids to their patients with hearing loss during the early months of life. Early hearing aid fitting supports speech and language development, however, the way in which the hearing aid is fitted can significantly impact the infant’s progress. A four-stage process for infant hearing aid fitting is offered as a framework with which to execute the essential components of the procedure. Key aspects of the pediatric hearing aid fitting process are described with a focus on elements that may impact an infant’s progress with hearing aids if not implemented.

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