Does premium listening require premium hearing aids?
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1 Does premium listening require premium hearing aids? Effectiveness of basic and premium hearing aids on speech understanding and listening effort outcomes. Jani Johnson, Jingjing Xu, Robyn Cox Presented at the International Adult Aural Rehabilitation Conference, St. Pete, FL, June 2015
2 For many adults seeking help for hearing difficulties The first step toward aural rehabilitation is selection of a hearing aid.
3 Levels of Hearing Aid Technology Mid-level Premium Basic
4 Several features that target speech understanding and listening effort differ for premium and basic hearing aids Premium Basic More
5 Premium tech = premium listening? Premium technologies are accompanied by explicit and implicit promises of improved performance with these devices. Many audiologists feel pressured to recommend higher-cost technologies to ensure that their clients have access to the best listening assistance available, and to provide the best basis for optimizing their clients listening skills.
6 Premium tech = premium listening? Premium tech = premium cost Older adults are at risk for reduced SES. For these patients increased costs for premium devices are major financial sacrifices
7 The problem: Independent research has not demonstrated that use of premium-level technology results in better everyday speech understanding or listening effort outcomes than use of basic-level technology. Such evidence is needed to help end-users make cost-effective decisions when purchasing hearing aids.
8 Purpose This research evaluated exemplars of basic and premium hearing aid technology from two major hearing aid manufacturers with the goal of evaluating speech understanding and listening effort performance in the laboratory and in the real-world.
9 Research Questions In the laboratory and in daily life, are speech understanding and listening effort: 1. Better with hearing aids compared to without? 2. Further improved with examples of premium hearing aids compared to basic?
10 Hearing thresholds (db HL) Participants 45 participants (30M, 15F) Age: 61 to 81 (M=70.3, SD=5.5) Symmetric mild to moderate sensorineural hearing loss English as first language Right Left Frequency (Hz)
11 Design (e.g.) Counterbalanced Brand A Brand B Prefit Basic Premium Premium Basic Counterbalanced Counterbalanced
12 Hearing aid fittings Bilateral, with appropriate coupling Fitted using best-practice protocols, starting with NAL targets Features set to manufacturers recommendations. 3 manually selectable programs: everyday - default automatic look and listen - fixed front-facing directional speech finder - for 360 listening
13 Outcomes Assessed prior to the first hearing aid fitting*, and again after a 4 week acclimatization with each pair of hearing aids Self-report measures: Abbreviated Profile of Hearing Aid Benefit (APHAB) Cox & Alexander, 1995 Device-Oriented Subjective Outcome (DOSO) Scale Cox, Alexander & Xu, 2014 Speech, Spatial, and Qualities of Hearing Scale (-Benefit) (SSQ & SSQ- B) Gatehouse & Noble, 2004; Jensen et al., 2009 In the laboratory American Four Alternative Auditory Feature (AFAAF) test. Xu & Cox, 2014 Three simulated environments with soft, average, and loud noise. * Responses to the SSQ were collected pre-hearing aid fitting only Responses to the DOSO and SSQ-B questionnaires were collected post-hearing aid fitting only
14 Laboratory Outcome Measure AFAAF Example prompt: Can you hear OLD clearly? Select from: HOLD, OLD, COLD, GOLD 80 items for each listening environment. HA set to default program LF noise HF noise Speech signal HF noise
15 Laboratory Outcome Measure Speech Understanding: Proportion correct scores were converted to rationalized arcsine units (RAUs) for analysis. Studebaker, 1985 Listening Effort Measured simultaneously with speech understanding. Rated after blocks of 20 words. Ratings were averaged for each environment. LF noise HF noise HF noise 105 Speech signal
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17 Statistical comparisons A priori planned contrasts of: Unaided and Aided (Question 1) Basic and Premium (Question 2) Basic and Premium (Brand A) Basic and Premium (Brand B)
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19 Question 1- Was speech understanding better with hearing aids compared to without? In the laboratory In daily life
20 Speech understanding (RAU) Question 1- Was Aided better than Unaided? 100 p <.001 Speech: 62 db SPL +5 db SNR Unaided Basic A Basic B Premium A Premium B Average listening levels
21 Question 1- Was Aided better than Unaided?
22 Question 1- Was speech understanding better with hearing aids compared to without? In the laboratory: In daily life:
23 Question 2- Was speech understanding further improved with examples of Premium hearing aids compared to Basic hearing aids? In the laboratory
24 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 NS Speech: 55 db SPL +10 db SNR Basic Premium Unaided Basic A Basic B Soft listening levels Premium A Premium B
25 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 NS Speech: 55 db SPL +10 db SNR Basic A Premium A Unaided Basic A Basic B Soft listening levels Premium A Premium B
26 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 NS Speech: 55 db SPL +10 db SNR Basic B Premium B Unaided Basic A Basic B Soft listening levels Premium A Premium B
27 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 Basic NS Premium Speech: 62 db SPL +5 db SNR Unaided Basic A Basic B Premium A Premium B Average listening levels
28 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 Basic A NS Premium A Speech: 62 db SPL +5 db SNR Unaided Basic A Basic B Premium A Premium B Average listening levels
29 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 Basic B NS Premium B Speech: 62 db SPL +5 db SNR Unaided Basic A Basic B Premium A Premium B Average listening levels
30 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 Basic NS Premium Speech: 70 db SPL 0 db SNR Unaided Basic A Basic B Loud listening levels Premium A Premium B
31 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 Basic A NS Premium A Speech: 70 db SPL 0 db SNR Unaided Basic A Basic B Loud listening levels Premium A Premium B
32 Speech understanding (RAU) Question 2- Was Premium better than Basic? 100 Basic B NS Premium B Speech: 70 db SPL 0 db SNR Unaided Basic A Basic B Loud listening levels Premium A Premium B
33 Question 2- Was speech understanding further improved with examples of Premium hearing aids compared to Basic hearing aids? In daily life
34 Speech Understanding Benefit Question 2- Was Premium better than Basic? NS Basic Premium Basic A Basic B Premium A Premium B Three questionnaires combined
35 Speech Understanding Benefit Question 2- Was Premium better than Basic? NS Basic A Premium A Basic A Basic B Premium A Premium B Three questionnaires combined
36 Speech Understanding Benefit Question 2- Was Premium better than Basic? NS Basic B Premium B Basic A Basic B Premium A Premium B Three questionnaires combined
37 Question 2- Was speech understanding further improved with examples of Premium hearing aids compared to Basic hearing aids? In the laboratory: In daily life: These findings held when exemplars from each brand were compared separately.
38
39 Question 1- Was listening effort reduced with hearing aids compared to without? In the lab
40 Listening Effort Rating Question 1- Was Aided less than Unaided? More effort 7 6 p <.001 Speech: 62 db SPL +5 db SNR Less effort Unaided Basic A Basic B Premium A Premium B Average listening levels
41 Question 1- Was Aided less than Unaided?
42 Question 1- Was listening effort reduced with hearing aids compared to without? In daily life
43 Question 1- Was listening effort reduced with hearing aids compared to without? 5 Brand A 5 Brand B Listening Effort Benefit (SSQ-B) Better Worse More Effort Unaided Listening Effort (SSQ) Listening Effort Benefit (SSQ-B) 4 p <.001 p <.001 Basic A UN v Basic A Premium A UN v Premium A Less Effort Better Worse More Effort Basic B UN vs. Basic B Premium B UN v Premium B Less Effort Unaided Listening Effort (SSQ)
44 Question 1- Was listening effort reduced with hearing aids compared to without? In the laboratory: In daily life:
45 Question 2- Was listening effort further reduced with examples of Premium hearing aids compared to Basic hearing aids? In the laboratory In daily life
46 Question 1- Is Premium better than Basic?
47 Question 1- Is Premium better than Basic?
48 Question 1- Is Premium better than Basic?
49 Question 2- Was listening effort further improved with examples of Premium hearing aids compared to Basic hearing aids? In the laboratory: In daily life: Overall, these findings held when exemplars from each brand were compared separately. For loud-level speech listening effort was less with Brand B s premium aids. This difference was small.
50 Summary Using exemplars of basic and premium hearing aid technology from two major hearing aid manufacturers, speech understanding and listening effort in the laboratory and in daily life overall were: 1. Better with hearing aids compared to without. 2. Not further improved with examples of premium hearing aids compared to basic.
51 Take home message Older adults with uncomplicated, adult-onset, mild to moderate SNHL can receive substantial speech understanding and listening effort benefit with modern hearing devices when they are fitted using best-practice protocols. Premium-feature hearing aids are not a requirement for optimal listening for older adults with mild to moderate hearing impairment.
52 Take home message We should shift focus from technologic details to person-centered rehabilitation. More independent effectiveness research is needed for different hearing aid technologies across manufacturers.
53 Acknowledgement This project was supported by NIDCD 53
54 References Cox, R.M. & Alexander, G.C. (1995) The abbreviated profile of hearing aid benefit. Ear Hear, 16, Cox, R.M., Alexander, G.C., Xu, J. (2014). Development of the Device- Oriented Subjective Outcome (DOSO) Scale. JAAA, 25, Gatehouse, S., & Noble, W. (2004). The Speech, Spatial, and Qualities of Hearing Scale (SSQ). IJA, 43, Jensen, N.S., Akeroyd, M.A., Noble, W., & Naylor, G. (2009). The Speech, Spatial and Qualities of Hearing Scale (SSQ) as a benefit measure: Fourth NCRAR International Conference, Portland, OR. Studebaker, G.A. (1985). A rationalized arcsine transform. JSLHR, 28, Xu, J. & Cox, R.M. (2014). Recording and evaluation of an American dialect version of the four alternative auditory feature test. JAAA, 25,
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