Virtual Hearing Aid Care – Clinical Practice Guidance Document

This document was informed by literature reviews conducted in accordance with the Joanna Briggs Institute’s guide to evidence synthesis (Aromataris & Munn, 2017; https://joannabriggs.org) and includes evidence related to client candidacy, delivery models, modalities of delivery, and outcomes of virtual hearing aid fitting and management. This document provides clinical practice guidance for virtual hearing aid fitting and management processes and technological requirements in the delivery of such services (herein referred to as virtual hearing aid care). Virtual hearing aid care can include services delivered directly to a client by a provider or using facilitator-supported services and specialized equipment, depending on client factors, type of care, and the timepoint in the care process (e.g., initial versus follow-up appointments). This document will address virtual care including the following types of hearing aid care: o Programming o Verification o Validation o Management (counselling and education) Currently, virtual hearing aid care is better suited to follow-up appointments

Toward an Individual Binaural Loudness Model for Hearing Aid Fitting and Development

The individual loudness perception of a patient plays an important role in hearing aid satisfaction and use in daily life. Hearing aid fitting and development might benefit from individualized loudness models (ILMs), enabling better adaptation of the processing to individual needs. The central question is whether additional parameters are required for ILMs beyond non-linear cochlear gain loss and linear attenuation common to existing loudness models for the hearing impaired (HI). Here, loudness perception in eight normal hearing (NH) and eight HI listeners was measured in conditions ranging from monaural narrowband to binaural broadband, to systematically assess spectral and binaural loudness summation and their interdependence. A binaural summation stage was devised with empirical monaural loudness judgments serving as input. While NH showed binaural inhibition in line with the literature, binaural summation and its inter-subject variability were increased in HI, indicating the necessity for individualized binaural summation. Toward ILMs, a recent monaural loudness model was extended with the suggested binaural stage, and the number and type of additional parameters required to describe and to predict individual loudness were assessed. In addition to one parameter for the individual amount of binaural summation, a bandwidth-dependent monaural parameter was required to successfully account for individual spectral summation.

Accuracy of an Automated Hearing Aid Fitting Using Real Ear Measures Embedded in a Manufacturer Fitting Software

Background Hearing aid fitting guidelines recommend real ear measures (REM) to verify hearing aid performance. Unfortunately, approximately 70 to 80% of clinicians do not use REM, but instead download manufacturer first-fit. Studies report differences in performance between first-fit and programmed-fit with greatest differences in the higher frequencies. Recently, hearing aid and real ear analyzer (REA) manufacturers allow REA communication with hearing aid software feature to automatically program hearing aids to target. Little research is available reporting the accuracy of this feature. Purpose The aim of the study is to examine whether differences exist at 50, 65, and 80 dB SPL between two ReSound first-fit formulae (Audiogram+ and NAL-NL2) using ReSound AutoREM and Aurical NAL-NL2 Research Design The study design is of repeated measure type. Study Sample The study sample includes 48 ears. Data Collection and Analysis For the two fitting formulae, AutoREM real ear insertion gain (REIG) was measured at 50, 65, and 80 dB SPL and compared with measures from Aurical NAL-NL2. Results Mean AutoREM REIG for ReSound NAL-NL2 was 3 to 8 dB below Aurical NAL-NL2 for 50 dB SPL, within 1 to 3 dB for 65 dB SPL and 1 to 5 dB above for 80 dB SPL. Mean AutoREM REIG for Audiogram + was 1 to 12 dB below Aurical NAL-NL2 for 50 dB SPL, within 2 to 5 dB for 65 dB SPL and 1 to 7 dB above NAL-NL2 for 80 dB SPL. Conclusion Relative to the Aurical NAL-NL2, AutoREM REIG50 for Audiogram + and ReSound NAL-NL2 was lower. Relative to the Aurical NAL-NL2, AutoREM REIG65 for Audiogram + was higher at 1,000 Hz and lower at 4,000 to 6,000 Hz and for ReSound NAL-NL2 it was lower at 500 Hz and 4,000 Hz and higher at 3,000 Hz. Relative to the Aurical NAL-NL2, AutoREM REIG80 for Audiogram + was higher at 500 to 3,000 Hz and 6,000 Hz and ReSound NAL-NL2 was higher at 500 to 6,000 Hz. Because of wide intersubject variability clinicians should continue to use REM as a “check and balance” when using AutoREM.

Hearing aids reduce daily-life fatigue and increase social activity: a longitudinal study

People with hearing loss experience fatigue, and it is unknown whether this is alleviated by treatment with hearing aids. The objective of this study was to address this issue, and to investigate the possible concomitant effect of hearing-aid fitting on activity levels. An intervention group (n=53) who were due to be fitted with their first ever hearing aid(s) and a control group (n=53) who had hearing loss but no change in hearing aid status completed a battery of self-report outcome measures four times: once before fitting, and at two weeks, three months and six months post fitting. Self-report outcome measures at each assessment captured fatigue, listening effort, hearing handicap, auditory lifestyle, social participation restrictions and work, social and physical activity levels. Hearing-aid fitting led to a significant reduction in listening-related fatigue, but not general fatigue, in the intervention group compared to the control group. Additionally, social activity level increased and social participation restriction decreased significantly after hearing aid fitting in the intervention group compared to the control group. No significant interaction was found between working status and change in listening-related fatigue score. This study is the first to make longitudinal measurement of fatigue before and after first-ever hearing aid fitting and to identify an increase in social activity level after hearing aid fitting. These findings have important implications for future research and the clinical practice of hearing aid fitting.

The Use of Same-Day Hearing Aid Fitting with Telehealth Follow-up Care: A Case Study of a Veteran Presenting with Tinnitus and Auditory Processing Disorder Symptoms

Providing same-day hearing aid fitting appointments to patients being seen in an audiology clinic for an audiometric evaluation may help decrease clinic wait times and reduce the need for future in-person appointments. Prior to 2020, the Veterans Administration (VA) Healthcare System did not allow hearing aid manufacturers to provide functional demonstration (demo) hearing aids to VA audiology clinics. Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) pandemic, this rule was changed to minimize the number of required in-person VA audiology appointments. The audiology clinic at the Pittsburgh VA Healthcare System developed a hearing aid fitting protocol using demo hearing aids to provide same-day hearing aid fitting appointments. This case study pertains to a female Veteran who presented to the clinic with complaints of decreased hearing and bothersome tinnitus. The patient completed a comprehensive audiometric evaluation, auditory processing disorder screening, hearing aid evaluation, and hearing aid fitting in the clinic. All follow-up appointments were scheduled to be completed via telehealth. The initial findings in this case study indicate that same-day hearing aid fittings can be successful for some patients. Future telehealth follow-up appointments will determine this patient's level of success using hearing aid–related outcome measures.