Evaluation of hearing aid manufacturers\u27 software-derived fittings to DSL v5.0 pediatric targets

Background Hearing aid prescriptive methods are a commonly recommended component of evidence-based preferred practice guidelines and are often implemented in the hearing aid programming software. Previous studies evaluating hearing aid manufacturers\u27 software-derived fittings to prescriptions have shown significant deviations from targets. However, few such studies examined the accuracy of softwarederived fittings for the Desired Sensation Level (DSL) v5.0 prescription. Purpose The purpose of this study was to evaluate the accuracy of software-derived fittings to the DSL v5.0 prescription, across a range of hearing aid brands, audiograms, and test levels. Research Design This study is a prospective chart review with simulated cases. Data Collection and Analysis A set of software-derived fittings were created for a sixmonth- old test case, across audiograms ranging from mild to profound. The aided output from each fitting was verified in the test box at 55-, 65-, 75-, and 90-dB SPL, and compared with DSL v5.0 child targets. The deviations from target across frequencies 250-6000 Hz were calculated, together with the root-mean-square error (RMSE) from target. The aided Speech Intelligibility Index (SII) values generated for the speech passages at 55- and 65-dB SPL were compared with published norms. Study Sample Thirteen behind-the-ear style hearing aids from eight manufacturers were tested. Results The amount ofdeviation per frequencywas dependent on the test level and degree of hearing loss. Most software-derived fittings for mild-to-moderately severe hearing losses fell within_ 5 dB of the target formost frequencies. RMSE results revealed more than 84% of those hearing aid fittings for the mild-to-moderate hearing losseswere within 5 dB at all test levels. Fittings for severe to profound hearing losses had the greatest deviation from target and RMSE. Aided SII values for the mild-to-moderate audiograms fell within the normative range forDSL pediatric fittings, although they fellwithin the lower portion of the distribution. For more severe losses, SII values for some hearing aids fell below the normative range. Conclusions In this study, use of the software-derived manufacturers\u27 fittings based on the DSL v5.0 pediatric targets set most hearing aids within a clinically acceptable range around the prescribed target, particularly for mild-to-moderate hearing losses. However, it is likely that clinician adjustment based on verification of hearing aid output would be required to optimize the fit to target, maximize aided SII, and ensure appropriate audibility across all degrees of hearing loss

Development and initial evaluation of the Hearing Aid Attribute and Feature Importance Evaluation (HAFIE) questionnaire

Objectives: To develop and validate a novel questionnaire aimed at providing a structured, evidence-based methodology for hearing aid recommendation and selection using self-reported importance ratings for different modern hearing aid features. Design: The initial questionnaire items were created through a concept mapping approach that involved input from hearing aid users. Hearing care professional focus groups (n¼10) were conducted to assess questionnaire content and design, and to guide modifications. Validation of this initial 34-item version of the questionnaire was conducted using an anonymous online survey tool (Qualtrics). Exploratory factor analysis was used to assess the factor structure of the dataset, using principal axis factoring. Questionnaire reliability and inter-item correlation were assessed. Items with low factor loading and high cross-loading were removed. Study sample: Two hundred and eighteen adult participants with a self-reported hearing loss (median age ¼ 48 years, range ¼ 18–95 years) completed the questionnaire. Results: Analysis and item removal resulted in a 28-item questionnaire. Three factors were identified, dividing the hearing aid features into the subscales: “Advanced connectivity & streaming”, “Physical attributes & usability”, and “Sound quality & intelligibility”. Conclusion: This study has resulted in a patient-oriented questionnaire that allows clinicians to gather patient input in a structured manner

Perceptual benefits of extended bandwidth hearing aids with children: A within-subject design using clinically available hearing aids

© American Speech-Language-Hearing Association. All rights reserved. Purpose: The aim of the study was to investigate the achieved audibility with clinically available, modern, high-end, behind-the-ear hearing aids fitted using the Desired Sensation Level v5.0 child prescription for a clinical sample of children with hearing impairment and the effect of the extended bandwidth provided by the hearing aids on several outcome measures. Method: The achieved audibility was measured using the maximum audible output frequency method. Twenty-eight children (7–17 years old) with mild to severe hearing losses completed this study. Two hearing aid conditions were fitted for each participant: an extended bandwidth condition, which was fitted to targets as closely as possible, and a restricted bandwidth condition, for which aided output was restricted above 4.5 kHz. Consonant discrimination in noise, subjective preference, aided loudness growth, and preferred listening levels were evaluated in both conditions. Results: The extended bandwidth hearing aid fittings provided speech audibility above 4.5 kHz for all children, with an average maximum audible output frequency of 7376 Hz (SD = 1669 Hz). When compared to a restricted bandwidth, the extended bandwidth condition led to an improvement of 5.4% for consonant discrimination in noise scores, mostly attributable to /s/, /z/, and /t/ phoneme perception. Aided loudness results and preferred listening levels were not significantly different across bandwidth conditions; however, 65% of the children indicated a subjective preference for the extended bandwidth. Conclusion: The study suggests that providing the full bandwidth available, with modern, behind-the-ear hearing aids, leads to improved audibility, when compared to restricted bandwidth hearing aids, and that it leads to beneficial outcomes for children who use hearing aids, fitted to the Desired Sensation Level v5.0 child prescription, without causing significant increases in their loudness perception

Validation of an integrated pressure level measured earmold wideband real-ear-to-coupler difference measurement

Objective: To validate measurement of predicted earmold wideband real-ear-to-coupler difference (wRECD) using an integrated pressure level (IPL) calibrated transducer and the incorporation of an acoustically measured tubing length correction. Design: Unilateral earmold SPL wRECD using varied hearing aid tubing length and the proposed predicted earmold IPL wRECD measurement procedure were completed on all participants and compared. Study Sample: 22 normal hearing adults with normal middle ear status were recruited. Results: There were no clinically significant differences between probe-microphone and predicted earmold IPL wRECD measurements between 500 and 2500 Hz. Above 5000 Hz, the predicted earmold IPL wRECD exceeded earmold SPL wRECDs due to lack of standing wave interference. Test-retest reliability of IPL wRECD measurement exceeded the reliability of earmold SPL wRECD measurement across all assessed frequencies, with the greatest improvements in the high frequencies. The acoustically measured tubing length correction largely accounted for acoustic effects of the participant’s earmold. Conclusions: IPL-based measurements provide a promising alternative to probe-microphone earmold wRECD procedures. Predicted earmold IPL wRECD is measured without probe-microphone placement, agrees well with earmold SPL wRECDs and is expected to extend the valid bandwidth of wRECD measurement

An examination of clinical uptake factors for remote hearing aid support: a concept mapping study with audiologists

© 2020 The Authors. Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of British Society of Audiology, International Society of Audiology, and Nordic Audiological Society. Objective: To develop a conceptual framework around the factors that influence audiologists in the clinical uptake of remote follow-up hearing aid support services. Design: A purposive sample of 42 audiologists, stratified according to client-focus of either paediatric or adult, were recruited from professional associations in Ontario, Canada, as members of the six-step, participatory-based concept mapping process. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: Six main themes emerged from this research according to overall level of importance: (1) technology and infrastructure; (2) audiologist-centred considerations; (3) hearing healthcare regulations; (4) client-centred considerations; (5) clinical implementation considerations; and (6) financial considerations. Subthemes were identified at the group-level and by subgroup. These highlight the importance of TECH factors (accessible Technology, Easy to use, robust Connection, and Help available), as well as the multi-faceted nature of the perceived attitudes/aptitudes across stakeholders. Conclusion: Findings can be utilised in tailored planning and development efforts to support future research, knowledge dissemination, best-practice protocol/guideline development, and related training to assist in the clinical uptake of remote follow-up hearing aid support services, across variable practice contexts

Hearing Aid Attribute & Feature Importance Evaluation (HAFIE) questionnaire

HAFIE questionnair

A Pilot Study on Cortical Auditory Evoked Potentials in Children: Aided CAEPs Reflect Improved High-Frequency Audibility with Frequency Compression Hearing Aid Technology

Background. This study investigated whether cortical auditory evoked potentials (CAEPs) could reliably be recorded and interpreted using clinical testing equipment, to assess the effects of hearing aid technology on the CAEP. Methods. Fifteen normal hearing (NH) and five hearing impaired (HI) children were included in the study. NH children were tested unaided; HI children were tested while wearing hearing aids. CAEPs were evoked with tone bursts presented at a suprathreshold level. Presence/absence of CAEPs was established based on agreement between two independent raters. Results. Present waveforms were interpreted for most NH listeners and all HI listeners, when stimuli were measured to be at an audible level. The younger NH children were found to have significantly different waveform morphology, compared to the older children, with grand averaged waveforms differing in the later part of the time window (the N2 response). Results suggest that in some children, frequency compression hearing aid processing improved audibility of specific frequencies, leading to increased rates of detectable cortical responses in HI children. Conclusions. These findings provide support for the use of CAEPs in measuring hearing aid benefit. Further research is needed to validate aided results across a larger group of HI participants and with speech-based stimuli

Modified Multiple Stimulus With Hidden Reference and Anchors–Gabrielsson Total Impression Sound Quality Rating Comparisons for Speech in Quiet, Noise, and Reverberation

Purpose: The purpose of the study was to obtain, analyze, and compare subjective sound quality data for the same test stimuli using modified multistimulus MUSHRA (Multiple Stimulus with Hidden Reference and Anchors) based procedures (viz., MUSHRA with custom anchors and MUSHRA without anchor) and the single-stimulus Gabrielsson\u27s total impression rating procedure. Method: Twenty normally hearing young adults were recruited in this study. Participants completed sound quality ratings on two different hearing aid recording data sets—Data Set A contained speech recordings from four different hearing aids under a variety of noisy and processing conditions, and Data Set B contained speech recordings from a single hearing aid under a combination of different noisy, reverberant, and signal processing conditions. Recordings in both data sets were rated for their quality using the total impression rating procedure. In addition, quality ratings of Data Set A recordings were obtained using a MUSHRA with custom anchors, while the ratings of Data Set B recordings were collected using a MUSHRA without anchor. Results: Statistical analyses revealed a high test–retest reliability of quality ratings for the same stimuli that were rated multiple times. In addition, high-interrater reliability was observed with all three rating procedures. Further analyses indicated (a) a high correlation between the total impression rating and the two modified MUSHRA ratings and (b) a similar relationship between the average and standard deviation of the subjective rating data obtained by the total impression rating and MUSHRA with custom anchors on Data Set A, and the total impression rating and the MUSHRA without anchor on Data Set B. Conclusion: Both sound quality procedures, namely, the MUSHRA-based procedures and the total impression rating scale, obtained similar quality ratings of varied hearing aid speech recordings with high reliability

Audiometric Assessment for Children aged 6 to 60 months

This protocol addresses procedures for audiometric assessment of hearing thresholds in infants and young children using behavioural measures of threshold and associated measures in a test battery. The scope of this document includes these assessments as funded by MCCSS for the Ontario Infant Hearing Program (IHP). In infants and young children, modified operant conditioning is used to obtain systematic behavioural responses to sound from older infants and young children. These conditioned responses are used as the basis of behavioural audiometry until the child is developmentally able to complete standard audiometry, at about 3 to 5 years of age in typically developing children (Sabo et al., 2003)

Effects of earlens lens placement on sound field thresholds, tympanometric measurements and wideband acoustic immittance

Objective: The Earlens is a direct-drive hearing device consisting of a lens which physically displaces the umbo to achieve appropriate gain. The objective is to determine the clinical acceptability of clinical immittance measurements in Earlens wearers. Design: Controlled before-after within-subjects repeated measures study. Study sample: Data is reported for measurements obtained on 15 subjects (average age of 72.2 years) with data from 30 ears. Results: There was a small effect of lens placement on sound field thresholds in most subjects. The largest damping effect of 4 dB was observed at 1000 Hz. An average reduction of 0.17 mL was identified in compliance following lens placement (p \u3c 0.05). An effect of the lens on power absorbance obtained at ambient and peak pressure was found. The lens resulted in an increase in power absorbance at low frequencies (below 500 Hz) and a decrease in the mid to high-frequency range of approximately 500–3500 Hz (p \u3c 0.05). Conclusions: Lens wear had a small effect on audiometric thresholds and tympanometry for most patients. Clinicians who use compliance and power absorbance should take into consideration lens effects on these measurements. Additional work is required to develop clinical normative ranges of these measures for wearers of the Earlens