Predicting Success With Hearing Aids
Condition: Hearing Loss; Presbycusis
MeSH terms: Hearing Loss; Deafness; Presbycusis
Study type: Observational

Summary: 
      The primary complaint of individuals with hearing loss is difficulty understanding speech in
      the presence of background noise. Although hearing aids help individuals understand speech in
      background noise better, there is a high rate of hearing aid rejection in part due to
      continued difficulty understanding speech in complex listening situations. The results of
      this study may demonstrate that speech-in-noise test results can be a predictor of hearing
      aid success. The results of this study also may lead to further studies that can evaluate
      interventions to improve hearing aid success for individuals who are identified as
      unsuccessful hearing aid users.
    

Detailed description: 
      As numerous studies have reported, the most common complaint that individuals with
      sensorineural hearing loss have about their hearing is that they can hear speech but they
      cannot understand speech, especially in background noise. For this type of hearing loss and
      most other types of hearing losses, hearing aids are the intervention of choice. The majority
      of individuals who receive hearing aids are successful hearing-aid users in that both
      subjectively and objectively they function better with their hearing aids than without
      hearing aids. Other individuals are unsuccessful hearing-aid users because for a variety of
      reasons their perception is that the hearing aids do not enable them to function better. Two
      studies (Popelka et al., 1998; Kockchin, 2000) indicate that about 25% of individuals who
      receive hearing aids can be considered unsuccessful hearing-aid users. If potentially
      (un)successful hearing-aid users can be identified, then audiologic rehabilitation programs
      can be designed for use with potentially successful hearing-aid users and more extensive
      audiologic rehabilitation programs can be designed for use with those individuals who are
      potentially unsuccessful hearing-aid users.

      Data from a recent series of studies by N b lek and her colleagues (1991, 2004) indicate that
      successful and unsuccessful hearing-aids users can be predicted based on their performance on
      a subjective speech-in-noise task in which a most comfortable listening level is established
      for a travelogue story and the level of a multitalker babble is established that permits
      following the travelogue. The difference between these two levels is the acceptable noise
      level (ANL). Based on the ANL data, N b lek et al. (2006) report with 85% confidence those
      individuals who are successful hearing-aid users and those who are unsuccessful hearing-aid
      users. One premise of this proposal is that the ANL is in fact an estimate in the subjective
      realm of the signal-to-noise (S/N) at which the listener is comfortable listening to a speech
      signal in background noise.

      Recently in our laboratory the words-in-noise (WIN) test was developed that involves the
      presentation of words in multitalker babble at signal-to-babble (S/B) ratios from 24- to 0-dB
      in 4-dB decrements. The 50% point on the function is calculated with the Spearman-K rber
      equation. This objective instrument provides an average 8-dB separation in recognition
      performances between listeners with normal hearing and listeners with hearing loss. The 50%
      points for the listeners with normal hearing are 0- and 6-dB S/B, whereas the 50% points for
      the listeners with hearing loss are 8- and 16-dB S/B. Thus, not only is the WIN very
      sensitive to the effects of hearing loss on speech understanding, but the WIN provides a
      range of performances by listeners with hearing loss.

      The proposed study is designed to answer the following two key questions:

        1. What is the relationship between ANL performance (subjective paradigm) and WIN
           performance (objective paradigm) in both unaided and aided conditions?

        2. How well do the ANL and WIN scores predict subjective hearing-aid outcome domains (use,
           satisfaction, benefit, and global)?

      In addition, the study design enables multiple comparisons to be made among several of the
      study variables and among many traditional variables such as age, pure-tone thresholds, and
      word-recognition abilities in quiet.

      Future goals beyond this proposal involve the development (1) of systematic protocols to
      select amplification devices or specific features for amplification based on WIN or ANL
      performance, and (2) of audiologic rehabilitation programs that can be administered quickly
      and effectively (depending on the category of hearing-aid success that was determined from
      performances on the WIN or ANL) to veterans who are receiving hearing aids.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        adults with sensorineural hearing loss
      
Keywords: hearing loss; hearing aids