Cox data: Average ratings for both sets of instruments for each
category (percent preference for each condition)
Slide 2
Clinical Tip From This Article? The differences among PSAPs,
Entry Level and Premier hearing aids may not be as large as some
people believe. The differences among PSAPs, Entry Level and
Premier hearing aids may not be as large as some people believe.
Caveat 1: They were all fitted to NL2 targets. Caveat 2: These were
laboratory measures.
Slide 3
The first of the peer-reviewed studies from the Cox data:
Slide 4
What they did... Compared examples of premium hearing aids, to
entry level hearing aids for two different leading manufacturers.
Compared examples of premium hearing aids, to entry level hearing
aids for two different leading manufacturers. Each device was
fitted to NAL-NL2 targets. Each device was fitted to NAL-NL2
targets. The participants used each pair of hearing aids for one
month. The participants used each pair of hearing aids for one
month.
Slide 5
Laboratory and real-world measures: Speech-in-noise testing
completed at three different levels. Speech-in-noise testing
completed at three different levels. Self-assessment scales:
Self-assessment scales: APHAB SSQ (SSQ-B) DOSO Hearing Quality of
Life Scale Hearing Quality of Life Scale Patient Diary for everyday
listening: Recording of both positive and negative experiences
Patient Diary for everyday listening: Recording of both positive
and negative experiences
Slide 6
Mean audiograms for the two groups
Slide 7
Comparison of the features of the different products
Slide 8
Results for the objective speech-in-noise testing
Slide 9
Overall results from the APHAB
Slide 10
Overall averaged score for real-world speech understanding from
the three self-assessment inventories
Slide 11
Distribution of the positive comments from the Patient Diary,
categorized by different general topics for the four different
instruments (Note: Tall bars are good)
Slide 12
Distribution of the negative comments from the Patient Diary,
categorized by different general topics for the four different
instruments (Note: Short bars are good)
Slide 13
What about the Quality of Life findings?
Slide 14
How much did hearing aid use improve Hearing Quality of Life?
Mean ratings for all products were here But again, no differences
among products was observed
Slide 15
Clinical Tip From This Article? Given the consistency of the
laboratory results, and the different real-world measures, it would
seem that at least for speech understanding, there is not a
significant difference among the different Tiers of hearing aid
products. Given the consistency of the laboratory results, and the
different real-world measures, it would seem that at least for
speech understanding, there is not a significant difference among
the different Tiers of hearing aid products.
Slide 16
Clinical Tip From This Article? Points made by the authors: If
you look closely at the basic research on all these speical
features, this finding would be more or less expected. If you look
closely at the basic research on all these speical features, this
finding would be more or less expected. This relationship will
probably not change, as when a new Top Tier product is introduced
(which may have enhanced features), the previous Top Tier product
becomes Entry Level, so differences remain minimal among products.
This relationship will probably not change, as when a new Top Tier
product is introduced (which may have enhanced features), the
previous Top Tier product becomes Entry Level, so differences
remain minimal among products.
Slide 17
Lets talk about trainable
Slide 18
Data obtained with 3 rd generation trainable hearing aids.
(Palmer, AudiologyOnline, 2012) One of the purposes of the study
was to examine the effects of the start time of the training. All
participants were new hearing aid users (fitted to NAL- NL1):
Control group (n=18) = training was off and then turned on at the
second visit Experimental group (n=18) = training was on from the
beginning Following training, comparisons made to the original NAL
fitting, and comparative speech testing
Slide 19
General findings regarding trained gain and real world loudness
judgments Gain for soft was reduced slightly for both groups, but
somewhat more for the group who had trained from the beginning:
Control: SII for soft speech reduced ~2% Experimental: SII for soft
speech reduced ~4% Real-world loudness judgments (PAL ratings): No
difference from programmed to trained gain. No difference between
groups.
Slide 20
Training had no positive or negative effect on overall HINT
performance for either group
Slide 21
Preferences for trained gain versus original programmed gain
(65% selected the trained gain; )
Slide 22
More research with trainable hearing aids (Research from the
NAL) Real-life efficacy and reliability of training a hearing aid
Keidser G, & Alamudi K Ear & Hearing, 2013, 34(5)
Slide 23
What they did... Test devices enabled training of the
compression characteristics in four frequency bands and in six
sound classes Test devices enabled training of the compression
characteristics in four frequency bands and in six sound classes
Participants wore the devices programmed to NAL-NL2 for 3 weeks and
trained the devices from the prescribed response for three weeks
Participants wore the devices programmed to NAL-NL2 for 3 weeks and
trained the devices from the prescribed response for three
weeks
Slide 24
What they did... They compared their trained response with the
prescription (NAL-NL2) They compared their trained response with
the prescription (NAL-NL2) The devices were reset to the
prescription, and 19 participants repeated the training and
comparison trials The devices were reset to the prescription, and
19 participants repeated the training and comparison trials During
the comparison trial, participants made daily diary ratings of
satisfaction with the programs, and a structured interview was
completed During the comparison trial, participants made daily
diary ratings of satisfaction with the programs, and a structured
interview was completed
Slide 25
What they found... What they found...
Slide 26
What they found... About half made insufficient changes and
could not distinguish between the prescribed and trained responses
About half made insufficient changes and could not distinguish
between the prescribed and trained responses For t hose who made
sufficient changes, training was effective for 75 to 80% and tended
to result in higher overall satisfaction with the devices For t
hose who made sufficient changes, training was effective for 75 to
80% and tended to result in higher overall satisfaction with the
devices
Slide 27
Clinical Tip From These Articles? Not everyone is a good
candidate for trainable hearing aids, but for those who are...
Training appears to improve the overall fitting for the majority,
and does not have any downside. Not everyone is a good candidate
for trainable hearing aids, but for those who are... Training
appears to improve the overall fitting for the majority, and does
not have any downside. Note: A peripheral finding (and clinical
gold nugget) is that the NAL-NL2 is a pretty darn good starting
point.
Slide 28
Picture of the pet we would expect Todd Ricketts to own
Slide 29
Picture of the pet Todd actually owns
Slide 30
If these two fellows had the same hearing loss, would you fit
them with the same signal processing?
Slide 31
Is there a hearing aid for the thinking person? Hafter, E.
JAAA, 2010; 21:594-600
Slide 32
A discussion paper related to potential cognitive effects that
can relate to performance using hearing aids The role of top-down
processing in the success of amplification? The role of top-down
processing in the success of amplification? What happens when two
different patients, asked to respond to a change in a complex
sound, do so on the basis of different stimulus features? What
happens when two different patients, asked to respond to a change
in a complex sound, do so on the basis of different stimulus
features? The use of different listening strategies? The use of
different listening strategies? The role of training? The role of
training?
Slide 33
Example: Visual reaction time Speech-in-noise testing was
conducted at varying SNRs. Speech-in-noise testing was conducted at
varying SNRs. Testing was conducted with DNR-On and DNR-Off Testing
was conducted with DNR-On and DNR-Off For the visual reaction
measurement, (occurring concurrently with the speech recognition
task) subjects were asked to quickly indentify a number as either
odd or even. For the visual reaction measurement, (occurring
concurrently with the speech recognition task) subjects were asked
to quickly indentify a number as either odd or even.