The Hearing Aid Dispenser as the Key Factor in Determining Successful Use of a Hearing Aid

Editor: When people ask me which hearing aid they should get, I reply that, in my opinion, the person who fits the aid is much more important than the aid you choose. Dr. Ross might agree with that.

This article was originally published in "Hearing Loss" magazine, and is reprinted with the author's kind permission. This is part one of two parts.

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Since l989 Sergei Kochkin, Executive Director of the Better Hearing Institute, has been the undisputed demographic "guru" of the hearing aid industry. Through his frequent MarkeTrak surveys, he has provided the hearing aid industry with information on the number and types of aids sold, average costs, user characteristics, return and non-use rates, problems noted, and so on. In a recent survey (The Hearing Review, April 2010) he co-authored an article called "The Impact of the Hearing Healthcare Professional on Hearing Aid User Success." What gives this article an extra boost of saliency is that he was joined by a virtual "who's-who" of leading Audiologists, thirteen as co-authors and five as reviewers. By being listed as co-authors and reviewers, these professionals are, in fact, endorsing its findings

The basic population surveyed was drawn from the 80,000 members of the National Family Opinion panel. This panel consists of families demographically balanced using the latest census information. Several thousand new and experienced users of hearing aids less than four years old were drawn from this larger group and completed a detailed, seven-page survey. This procedure ensured: (1) that the results reflect hearing aid fitting procedures throughout the entire country and (2) that only the newest aids and current practices were sampled. It is, in brief, a valid sample of the current hearing aid fitting realities confronting hearing aid users.

One could hardly find a more important topic for consumers than this one. What this article does is take a closer look at the entire process - from selection and follow-up procedures to the personal characteristics of the dispenser. Basically, it is looking at what factors, under the control of the healthcare professional, most likely determine how successful a hearing aid user will be with his or her hearing aids. It is an article that every hearing aid dispenser should read very carefully - and then read it again. In this article, I will discuss some of the key points.

It doesn't take a rocket scientist to understand what should be done; we've known for a number of years what the various components of a "best practices" protocol should include. These have been published by the American Academy of Audiology and the American Speech-Hearing-Language Association and frequently cited in the professional literature. But knowing is one thing and actually doing is something else. The consumer survey queried whether such components as the following were included (essentially these appear to be a restatement of the recommended "best practices" protocol):

* Hearing tested in sound booth.
* Real-ear verification measurements (considered a primary factor)
* Subjective and objective benefit measurements
* Loudness discomfort measurements
* Consumer satisfaction measurements
* And a number of other components which broadly fit into the category of Aural Rehabilitation. These included auditory retraining software therapy, group follow-up program, utilization of self-help books and videos, and referral to a self-help group such as the Hearing Loss Association of America (specifically cited).

The survey also queried the respondents on the fit and comfort of their aids, whether desirable sound quality had been achieved, the attributes of the hearing health professional and the office, how many fitting visits took place and, finally, the number of counseling hours provided. .

All of the above factors, separately and in combination, were then related to determine whether, and the degree to which, a person could be considered successfully fit with a hearing aid. The following, common-sense, criteria of success were used:

* Hours per day the hearing aid was used - or if it was used at all
* Rating of the aid's ability to "improve their hearing'
* Estimate of hearing problems specifically resolved by using hearing aids
* Number of listening situations, selected from a list of 19 possible ones, in which they were satisfied or very satisfied that hearing improvements were noted
* The respondent's satisfaction: Would he or she repurchase aid and recommend it and/or the dispenser to others?

The results proved to be extremely interesting and have direct implications for current clinical practices. It turns out that those people who are administered five of the specific tests in the protocol are much more likely to be satisfied users of hearing aids than those people who did not receive them. These are:

* Objective benefit measurement. This would include one of a selection of speech perception tests, preferably in the presence of noise.
* Subjective benefit measurement. An example of this type of test is the Abbreviated Profile of Hearing Aid Benefit (or APHAB). This is a 24 item test which queries people on their speech understanding in everyday types of listening environments.
* Loudness discomfort measures. These determine the maximum tolerable loudness level, preferably while wearing the hearing aid.
* Real-Ear (probe-tube microphone) test. This test measures the actual sound levels exiting the hearing aid receiver while the hearing aid is being worn by the user.
* Patient satisfaction measurement. A good example - there are a number of others - of a patient satisfaction measure is the Satisfaction with Amplification in Daily Life scale (or SADL - Audiologists do love their acronyms!).

Here's Part Two