Virtual Hearing Aid Care Clinical Practice Guidance Document v1.9 (Draft)

This document provides clinical practice guidance around virtual hearing aid care including services provided at a distance and delivered directly to a client by a provider and/or using facilitator-supported services and specialized equipment. Guidance is provided for services including virtual hearing aid programming, verification, validation, and management (counselling and education). Implementation guidance is focused on processes including technical requirements for virtual service delivery, considering client factors, care type, and timepoint in the care process. This guidance document was developed as part of a grant funded project entitled “A team-based approach to action - rapid implementation of innovative virtual audiology services in response to COVID-19” from Western University’s Faculty of Health Sciences Strategic COVID-19 Research Support, a project initiated in July 2020. Guidance is based on evidence resulting from several literature reviews and is the result of an international collaboration. This document has been reviewed by hearing healthcare providers and clinician/scientist leaders in the field of audiology, across multiple clinical and academic sites

A Scoping Review of Technology and Infrastructure Needs in the Delivery of Virtual Hearing Aid Services

Purpose: The digital health revolution has brought forward integral technological advancements enabling virtual care as a readily accessible delivery model. Despite this forward momentum, the field of audiology still faces barriers that impede the uptake of virtual services into routine clinical practice. The aim of this study was to gather, synthesize, and summarize the literature around virtual hearing aid intervention studies and the related technology and infrastructure requirements. Method: A scoping review was conducted using MEDLINE, CINAHL, Scopus, Nursing and Allied Health, and Web of Science databases. Objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol. Results: The 11 studies identified through this review related to virtual hearing aid services delivered by a licensed health care provider and/or facilitator(s) specific to hearing aid management, programming, verification, and validation services. Service delivery models varied according to patient population, technology experience, type(s) and time course of care, type of remote location, and technology/support requirements. Barriers and facilitators to implementation-related themes including technology access and function, client sociotechnical, convenience, education and training, interaction quality, service delivery, and technology innovation. Conclusions: This scoping review provides evidence around the technology and infrastructure required for full integration of virtual hearing aid services into practice and according to care type. Low-tech versus high-tech requirements may be used to guide virtual service delivery triaging efforts. Research and development efforts in the areas of pediatrics, clinical support tools, and hearing aid/app-based solutions will support further uptake of virtual service delivery in audiology

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

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

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

A Scoping Review of Virtual Focus Group Methods Used in Rehabilitation Sciences

Virtual methods for conducting focus group studies are increasingly being used in many fields, including rehabilitation sciences. This is partly due to the current pandemic, and the need for social distancing, however, may also relate to factors such as convenience and practicality. Virtual research methods enable investigators to collect data at a distance from the participant(s) through the use of technology-mediated data collection methods incorporating new tools and technologies. The aim of this scoping review was to identify, synthesize, and present current evidence related to the methods for conducting virtual focus groups. A comparison of asynchronous and synchronous data collection methods was conducted. The objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol. The 40 articles in this review included virtual focus group research conducted in rehabilitation sciences including data collection conducted using both synchronous (22.5%) and asynchronous (77.5%) models and using a defined moderation method. Three modes of focus group discussion were reported including email, chat-based, and videoconferencing; these were facilitated through the various technology platforms reported in the review. Reported barriers and facilitators to conducting virtual focus group research were extracted and summarized. Commonly reported facilitators to virtual focus group research included the ability to recruit participants from diverse geographical locations and the participants’ ability to engage at times convenient to them. Both computer literacy and access to technology were reported as common barriers. This review highlighted the need for further research and guidance around virtual focus groups conducted using face-to-face synchronous methods and with younger participants groups

Sound quality effects of an adaptive nonlinear frequency compression processor with normal-hearing and hearing-impaired listeners

© 2019 American Academy of Audiology. All rights reserved. Background: Frequency lowering (FL) technology offers a means of improving audibility of high-frequency sounds. For some listeners, the benefit of such technology can be accompanied by a perceived degradation in sound quality, depending on the strength of the FL setting. Purpose: The studies presented in this article investigate the effect of a new type of FL signal processing for hearing aids, adaptive nonlinear frequency compression (ANFC), on subjective speech quality. Research Design: Listener ratings of sound quality were collected for speech stimuli processed with systematically varied fitting parameters. Study Sample: Study 1 included 40 normal-hearing (NH) adult and child listeners. Study 2 included 11 hearing-impaired (HI) adult and child listeners. HI listeners were fitted with laboratory-worn hearing aids for use during listening tasks. Intervention: Speech quality ratings were assessed across test conditions consisting of various strengths of static nonlinear frequency compression (NFC) and ANFC speech. Test conditions included those that were fine-tuned on an individual basis per hearing aid fitting and conditions that were modified to intentionally alter the sound quality of the signal. Data Collection and Analysis: Listeners rated speech quality using the MUlti Stimulus test with Hidden Reference and Anchor (MUSHRA) test paradigm. Ratings were analyzed for reliability and to compare results across conditions. Results: Results show that interrater reliability is high for both studies, indicating that NH and HI listeners from both adult and child age groups can reliably complete the MUSHRA task. Results comparing sound quality ratings across experimental conditions suggest that both the NH and HI listener groups rate the stimuli intended to have poor sound quality (e.g., anchors and the strongest available parameter settings) as having below-average sound quality ratings. A different trend in the results is reported when considering the other experimental conditions across the listener groups in the studies. Speech quality ratings measured with NH listeners improve as the strength of ANFC decreases, with a range of bad to good ratings reported, on average. Speech quality ratings measured with HI listeners are similar and above-average for many of the experimental stimuli, including those with fine-tuned NFC and ANFC parameters. Conclusions: Overall, HI listeners provide similar sound quality ratings when comparing static and adaptive forms of frequency compression, especially when considering the individualized parameter settings. These findings suggest that a range in settings may result in above-average sound quality for adults and children with hearing impairment. Furthermore, the fitter should fine-tune FL parameters for each individual listener, regardless of type of FL technology

Perceived Sound Quality Dimensions Influencing Frequency-Gain Shaping Preferences for Hearing Aid-Amplified Speech and Music

© The Author(s) 2021. Hearing aids are typically fitted using speech-based prescriptive formulae to make speech more intelligible. Individual preferences may vary from these prescriptions and may also vary with signal type. It is important to consider what motivates listener preferences and how those preferences can inform hearing aid processing so that assistive listening devices can best be tailored for hearing aid users. Therefore, this study explored preferred frequency-gain shaping relative to prescribed gain for speech and music samples. Preferred gain was determined for 22 listeners with mild sloping to moderately severe hearing loss relative to individually prescribed amplification while listening to samples of male speech, female speech, pop music, and classical music across low-, mid-, and high-frequency bands. Samples were amplified using a fast-acting compression hearing aid simulator. Preferences were determined using an adaptive paired comparison procedure. Listeners then rated speech and music samples processed using prescribed and preferred shaping across different sound quality descriptors. On average, low-frequency gain was significantly increased relative to the prescription for all stimuli and most substantially for pop and classical music. High-frequency gain was decreased significantly for pop music and male speech. Gain adjustments, particularly in the mid- and high-frequency bands, varied considerably between listeners. Music preferences were driven by changes in perceived fullness and sharpness, whereas speech preferences were driven by changes in perceived intelligibility and loudness. The results generally support the use of prescribed amplification to optimize speech intelligibility and alternative amplification for music listening for most listeners

Families\u27 Experiences in the Virtual Hanen More Than Words Program During the COVID-19 Pandemic

Abstract Purpose: The COVID-19 pandemic required most pediatric rehabilitation programs to shift to a virtual delivery format without the benefits of evidence to support this transition. Our study explored families\u27 experiences participating virtually in More Than Words, a program for parents of autistic children, with the goal of generating new evidence to inform both virtual service delivery and program development. Method: Twenty-one families who recently completed a virtual More Than Words program participated in a semistructured interview. The interviews were transcribed and analyzed in NVivo using a top-down deductive approach that referenced a modified Dynamic Knowledge Transfer Capacity model. Results: Six themes capturing families\u27 experiences with different components of virtual service delivery were identified: (a) experiences participating from home, (b) accessing the More Than Words program, (c) delivery methods and program materials, (d) the speech-language pathologist-caregiver relationship, (e) new skills learned, and (f) virtual program engagement. Conclusions: Most participants had a positive experience in the virtual program. Suggested areas for improvement included the time and length of intervention sessions and increasing social connections with other families. Practice considerations related to the importance of childcare during group sessions and having another adult to support the videorecording of parent-child interactions. Clinical implications include suggestions for how clinicians can create a positive virtual experience for families