Hammershøi, Dorte

Narayanan, Sreeram Kaithali

Piechowiak, Tobias

Ravn, Gert

Rye, Palle

Schmidt, Jesper Hvass

Storbjerg Houmøller, Sabina

Wolff, Anne

English

BackgroundIt is essential to understand the relation between the individual real-ear insertion gain (REIG) and self-reported outcome measures. A large cohort study can provide insight into the efficacy of current practices in hearing aid (HA) rehabilitation according to the accuracy of the fitted gain. Methods and MaterialsA total of 1231 participants with a valid REIG for both ears at 65 dB input level having answered all the questions in the Danish version of the IOI-HA and the SSQ administered in the BEAR project were included in the study. The participants included both first-time (n = 895) and experienced HA users. The differences in gain from individual REIG to that prescribed by four generic gain prescriptions, namely, NAL-NL2, NAL-RP, one-third gain (OTG) rule, and the half-gain (HG) rule was calculated. Clustering of these individual gain differences to the four generic prescriptions was performed using the k-means method. The resulting cluster was then used as a single categorical unit representing the gain prescribed to the individual HA user. Multiple linear regression analysis was performed for the SSQ data, and an ordinal regression analysis was used for the IOI-HA data.Results The k-means clustering resulted in two significant clusters characterized by gain differences at higher frequencies. The analysis showed that patients closely fitted to NAL-NL2, NAL-RP, and OTG reported higher IOI-HA Factor 1 scores (introspection about the HA) than the cluster of patients fitted away from these gain prescriptions. The multiple linear regression of SSQ showed a contrasting result for gain differences to OTG, where a better SSQ speech domain was reported by patients that were fitted away from OTG prescription. A significantly higher SSQ speech domain score was reported for patients with a higher gain difference to HG, analogous to OTG. Further analysis showed that this effect originated from the gain difference at 8000 Hz between the clusters. If excluded, the cluster was no longer a significant predictor of SSQ speech domain score for the gain difference to OTG and HG prescriptions.ConclusionThe findings from the study suggest a correlation between the actual fitted gain and self-reported outcome. <br/

    Aalborg UniversitetRelation Between Self-Reported Outcomes and Real-Ear Insertion Gain as a Functionof Generic Fitting PrescriptionsNarayanan, Sreeram Kaithali; Rye, Palle; Piechowiak, Tobias; Ravn, Gert; Wolff, Anne;Storbjerg Houmøller, Sabina; Schmidt, Jesper Hvass; Hammershøi, DortePublication date:2021Link to publication from Aalborg UniversityCitation for published version (APA):Narayanan, S. K., Rye, P., Piechowiak, T., Ravn, G., Wolff, A., Storbjerg Houmøller, S., Schmidt, J. H., &Hammershøi, D. (2021). Relation Between Self-Reported Outcomes and Real-Ear Insertion Gain as a Functionof Generic Fitting Prescriptions. Abstract from 15th Congress of European Federation of Audiology Societies.General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            - Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            - You may not further distribute the material or use it for any profit-making activity or commercial gain            - You may freely distribute the URL identifying the publication in the public portal -Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Downloaded from vbn.aau.dk on: November 19, 2022Methods and Materials In the first work package of the Better hEAring Rehabilitation (BEAR) project, REMswere conducted on participants to observe the gain provided by the hearing aid andnot verify the fit against a target.REM was performed two months after the initial fitting during the follow-up visit. REMwas performed in a standard clinical room with the signal presented from aloudspeaker 1-meter in front of the participants using the REM module (REM440) inInteracoustics Affinity 2.0. A total of 1684 real-ear measurements were extracted.Bilaterally fitted participants with valid real-ear measurements and having answeredall the questions in the International Outcome Inventory for Hearing Aids (IOI-HA)and short version of Speech, Spatial, and Qualities of Hearing (SSQ) questionnaireswere considered in the analysis. The demographics of the 1231 participantsconsidered are shown in Table 1.Relation Between Self-Reported Outcomes and Real-Ear Insertion Gain as a Function of Generic Fitting PrescriptionsSreeram Kaithali Narayanan1*, Palle Rye1, Tobias Piechowiak2, Gert Ravn3, Anne Wolff4, Sabina S Houmøller5,6, Jesper Hvass Schmidt5,6, & Dorte Hammershøi11 Section for AI and Sound, Department of Electronic Systems, Aalborg University, Aalborg, Denmark2 GN Resound A/S, Ballerup, Denmark3 Force Technology, Aarhus, Denmark4Department of Otolaryngology, Head and Neck Surgery, and Audiology, Aalborg University Hospital 5Research Unit for ORL – Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark 6OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, DenmarkBackground Real-ear measurements (REM) are traditionally used as a tool to verify a hearingfitting. To fully understand the efficacy of a hearing aid it is essential to understand therelation between the individual real-ear insertion gain (REIG) and self-reportedoutcome measures. A large cohort study can provide insight into the effectiveness ofcurrent practices in hearing aid (HA) rehabilitation with respect to the fitted gain.The aim of the study is to understand whether the differences in insertion gains fromthe first fit to generic prescriptions can predict the self-reported hearing aid outcomesfor first-time and experienced hearing aid users. This will help explain the relationshipbetween the prescribed gain and self-reported outcomes.ConclusionsThe  analysis suggested that self-reported benefit indicated by IOI-HA item-2 scores are significantly better for HA fitted closely to NAL-NL2, NAL-RP and OTG prescriptions.In terms of SSQ, average speech domain scores were higher for participants not fitted close to OTG or HG prescriptions. This effect was restricted to gain difference at 8000 Hz, which might not have any clinical implication.Overall the study established a relation between REIG and the self-reported outcomes obtained through the use of SSQ and IOI-HA questionnaires. An effect was only found for one item (benefit) in the IOI-HA.Results  The gain difference to generic prescription is determined, and the results are shown in Figure 2. It can be seen thatindividual REIG is very close to  NAL-NL2. A distinctive dip at 1 kHz for gain difference to NAL-RP is evident. Gaindifference to OTG also follows a similar trend to NAL-NL2 at higher frequencies.The clustering of the gain differences resulted in two significant clusters in all the cases. It can be seen that clusters are characterized by the gain differences at higher frequencies starting from 1 kHz. This is illustrated in Figure 3.Table 1: Demographic properties of the population under study. NAL-NL2 NAL-RP OTGHA usage time (hours) 0.12 (0.01) *** 0.12 (0.01) *** 0.10 (0.02) ***PTA (best ear) 0.43 (0.12) *** 0.44 (0.12) *** 0.41 (0.12) ***Cluster 2 (ref. Cluster 1) -0.25 (0.11) * -0.22 (0.11) * -0.51 (0.22) *WRS: Cluster 2 NA 0.24 (0.11) * NAOTG HGR2=0.09,Prob>F =0.00R2=0.10,Prob>F =0.00Coef. (95%CI) Coef. (95%CI)Constant 3.19 (2.59;3.79) *** 3.26 (2.63;3.89) ***Cluster 2 (ref. Cluster 1) 0.30 (0.06; 0.54) * 0.37 (0.13; 0.62) **User Type (first time) (ref: Experienced ) 1.67 (1.15; 2.20) *** 1.67 (1.15; 2.20) ***HA usage time (hours) 0.07 (0.03; 0.11) *** 0.06 (0.02; 0.10) **WRS (best ear) 0.67 (0.34; 1.00) *** 0.71 (0.38; 1.04) ***Gender (male) (ref. female) 1.37 (0.69; 2.05) *** 1.33 (0.64; 2.02) ***User Type (first time): Gender (male) -0.97 (-1.53; -0.40) *** -0.97 (-1.53; -0.40) ***User Type (first time): WRS (best ear) -0.34 (-0.60; -0.08) * -0.32 (-0.58; -0.06) *User Type (first time): Acoustic CouplingUser Type (first time): Støbt (kanal)/mikro prop -0.93 (-1.66; -0.20) * -1.01 (-1.75; -0.27) **Acoustic Coupling: HA usage timeClosed dome: HA usage time NA 0.11 (0.03;0.19) **Number of participantsN =1231Mean age, years (±SD) (range)67.5 (11)(19-100)Gender, n (%) Female 718 (59)HA experience, n (%)First-time users 895 (73)Mean PTA, dB H.L. (±SD)Better ear Worst ear 36(12)42(13)Fitting, n (%)ProprietaryNAL-NL1Others (NAL-NL2, DSL, and others)1162 (94) 28 (2)41 (4)Table 3: Coefficient of stepwise multiple linear regression on SSQ subscales of speech formodels with the cluster as one of the significant predictors.Table 2: Odd-ratios of the ordinal logistic regression model for IOI-HA outcome for item 2(Benefit) for three gain differences (NAL-NL2, NAL-RP, and OTG), which effect of the clusterwas found statistically significant.Analysis of IOI-HAOrdinal logistic regression was performedusing a step-wise approach on IOI-HAindividual item scores.The cluster was a significant predictor of IOI-HA item 2 that relates to the benefit dimension.No significant effect of the cluster wasobserved for other items in IOI-HA.The result showed that the participants fittedaway from the generic prescription had asignificantly lower item 2 score.Analysis of SSQStep-wise linear regression was performed onSSQ speech, spatial, and quality domainscores, and the cluster was a significantpredictor of SSQ speech domain scores in thecase of OTG and HG.Participants fitted away from genericprescriptions reported better speech domainscores. Post-hoc analysis suggests that gaindifferences at 8 kHz are determinant to thiseffect.As most of the participants were fitted with undisclosed manufacturer-specificproprietary prescriptions, we could not compare the hearing aid fitting to the actualtargets. Instead, we choose to compare the REIG to four different genericprescriptions, namely, NAL-NL2, NAL-RP, one-third gain rule (OTG), and half-gain(HG) rule.The gain differences from measured REIG and REIG prescribed by generic gainprescription were calculated. The differences were calculated at an input level of 65dB SPL, which is considered a typical speech level.Later these gain differences were clustered into two significant clusters using k-means clustering. Thus the assigned cluster can be a characterizing factorconcerning the deviation from a given target.Ordinal logistic (for IOI-HA) and linear regression (for SSQ) were performed. Theindependent variable included in the analyses were age, gender, average pure-tonehearing thresholds from 500 Hz to 4000 Hz (PTA), hearing aid experience (UserType; experienced and first-time users), Word-Recognition Score (WRS), interauralasymmetry defined as PTA difference > 10 dB hearing-loss between best and worstear, the average per day use time (HA usage time), and type of acoustic coupling(open, closed, semi-open, custom ear-mold, etc.).The Figure 1 illustrates the design of analysis used in this study.Figure 1: Schematic illustrating the study designFigure 2: Boxplot showing the of difference in gain from individual REIG to generic prescription for a 65 dB SPL input. A value of0 dB represents no difference between REIG and the generic prescription considered.Figure 3: The gain differences to generic gain prescriptions were clustered in to two clusters and the plot shows the clustercentroids at frequencies from 250 Hz to 8000 Hz for better ear.Data for Analysis Audiometric dataDemographic dataSelf-reportedoutcome measures(IOI-HA and SSQ)Real-earmeasurementHearing aid andhearing aid log dataData ProcessingCalculate the difference between individual REIG to generic gain prescriptionsk-means clusteringAnalysisOrdinal regression analysis of IOI-HA dataMultiple linear regression analysis of SSQ data 

Relation Between Self-Reported Outcomes and Real-Ear Insertion Gain as a Function of Generic Fitting Prescriptions

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Relation Between Self-Reported Outcomes and Real-Ear Insertion Gain as a Function of Generic Fitting Prescriptions

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