evidence regarding the effectiveness of hearing aids in ... · cst-52 db s/b ratio (db)-6 -3 0 3 6...
TRANSCRIPT
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Evidence Regarding the
Effectiveness of Hearing Aids in
Older Adults
Larry E. Humes
Department of Speech & Hearing Sciences
Indiana University
Bloomington, IN
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Do Hearing Aids Help?
• Yes, but how can this be demonstrated?---
What is the EVIDENCE that they do?
– ―Hearing Aid Outcome Measures‖
• Used to demonstrate or document the benefits of
hearing aids to consumers, clinicians, HA
manufacturers, and various third-party payers
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Overview of Today‘s Talk
• Brief review of types of hearing-aid
outcome measures
• Review of research on types of outcomes
to measure
• What does the evidence say re: HA
outcome measures identified?
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Overview of Today‘s Talk
• Brief review of types of hearing-aid
outcome measures
• Review of research on types of outcomes
to measure
• What does the evidence say re: HA
outcome measures identified?
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Hearing-Aid Outcome
Measures
Objective Performance and Benefit
Subjective Benefit
Satisfaction
Usage
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Objective Performance and Benefit
Aided and Unaided
Speech Recognition
– Materials
• Syllables, words,
sentences
– Listening Conditions
• Speech Level
• Background
• Azimuth
0
20
40
60
80
100
Quiet Noise Reverb
Aided % Unaided %
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Subjective Benefit
• Subjective Scales
• Assessment of
CHANGE from
Unaided to Aided
• Examples
– HAPI or SHAPIE
– Benefit Profiles
• PHAB, APHAB, COSI
– Hearing Handicap
• HHIE
0
10
20
30
40
50
60
70
Soc Emo TOTAL
HHIE-aided HHIE-unaided
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Hearing Aid Satisfaction
Rate your satisfaction with
the following HA
features (VS,S,N,D,VD)
• Overall fit/comfort
• Hearing aid size
• Visibility to others
• Ease of adjusting volume
• Whistling/feedback
• Clearness of sound
Rate your satisfaction with the HA in the following listening situations
• Conversation with 1 person
• In small groups
• Outdoors
• In large groups
• Watching TV
• On the telephone
MarkeTrak series, S. Kochkin
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Hearing Aid Usage
• Objective Measures
– ―Datalogger‖
– Battery weight
• Subjective Measures
– single reports of ―typical usage‖
– diaries or use ―logs‖
– average hours used per day vs.
recommended hours
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Overview of Today‘s Talk
• Brief review of types of hearing-aid
outcome measures
• Review of research on types of outcomes
to measure
• What does the evidence say re: HA
outcome measures identified?
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Many Outcome Measures
• How are they related?
• Do they all measure the same thing?
• Do they interact in a simple or complex
manner?
• Are some more important than others?
• ????
Usage
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Our Approach to Sorting this
Out
• Obtain multiple measures of hearing-aid outcome from large numbers of hearing aid wearers at the same time
• Examine associations (correlations) among measures
• Determine if the large set of outcome measures can be reduced to a smaller set (factor analysis)
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The IU Studies
(IU-1 to IU-4)
KEY COLLABORATORS:
Nathan Amos
Amy Arthur
Nancy Barlow
Gretchen Burk
Carolyn Garner
Lisa Goerner
Dana (Wilson) Kinney
Elizabeth Thompson
+ many students!
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Common Features across IU
Studies • Shared set of 12 outcome measures
• Outcome measures completed at 4-6
weeks post-fit
• Strict protocol followed in each study, with
many common features across studies
– Older adults with typical bilateral sloping
hearing loss as participants
– Similar gain targets and real-ear verification
– Same core team of clinicians in same clinic
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Three Outcome Factors Emerged
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Hearing Aid Outcome Measures Factor Analysis Results (N=368)
Self-Report Measures
Speech-Recognition Measures
“Benefaction” Usage Aided
Performance
r = 0.47 r = 0.12
Three factors emerged; % variance = 74.6
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Overview of Today‘s Talk
• Brief review of types of hearing-aid
outcome measures
• Review of research on types of outcomes
to measure
• What does the evidence say re: HA
outcome measures identified?
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Evidence about Effectiveness of Hearing
Aids in Older Adults (Humes & Krull, 2012)
• Conducted Medline/PubMed search
– Keywords: hearing aid, outcomes, adults
– Restricted to articles published >1990 in
English
• 783 articles identified on first pass
• Initial review of titles reduced pool to 165
• Review of 165 abstracts resulted in 33
articles reviewed and analysed (1
randomized controlled trial)
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Evidence about Hearing Aids (Humes & Krull, 2012)
• Of the 33 articles reviewed
– 27 studies of some aspect of benefaction
– 12 studies of usage
– 8 studies used the IOI-HA
– 9 studies of aided (and unaided) speech
recognition
• ALL STUDIES were performed with older
adults typically having mild-to-moderate
sloping sensorineural hearing loss and
fitted bilaterally with real ear
measurements used to verify the fitting
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Evidence about Hearing Aids (Humes & Krull, 2012)
• Overall, POSITIVE outcomes
observed across studies
– Reductions in activity limitations and
participation restrictions
– Typical ratings of ‗satisfied‘ and ‗helpful‘
– Typical aid use of ‗about three quarters
of the time‘ or ‗4-8 hrs/day‘
– Significantly better aided than unaided
speech understanding
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EXAMPLE: NIDCD/VA Study—Aided
and Unaided Speech-Recognition Performance
CST-52 dB
S/B Ratio (dB)
-6 -3 0 3 6
PE
RC
EN
T C
OR
RE
CT
0
10
20
30
40
50
60
70
80
90
100
CST-62 dB
S/B Ratio (dB)
-6 -3 0 3 6
PE
RC
EN
T C
OR
RE
CT
0
10
20
30
40
50
60
70
80
90
100
CST-74 dB
S/B Ratio (dB)
-6 -3 0 3 6P
ER
CE
NT
CO
RR
EC
T0
10
20
30
40
50
60
70
80
90
100
UNAIDED
AIDED
Quiet
NIDCD/VA Study (Larson et al., 2000), N = 320
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EXAMPLE: Analysis of IOI-HA
(Mild-Moderate Hearing Loss)
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Good News, but Some Caveats
• In all studies reviewed
– Older adults with primarily mild-to-moderate
sensorineural hearing loss
– Bilateral fits for hearing aids
– REM used for verification
• Cannot generalize positive findings to
other patients or practices (i.e., young
adults, severe hearing loss, monaural fits,
no verification with REM)
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Another Caveat: Evidence is mostly Level 3
Hierarchies of Evidence (adapted from Cox, 2005)
Level Type of Evidence
1 Systematic reviews and meta-analyses
of studies that are of high-level or
randomized controlled trials (RCT)
2 Well-designed RCT
3 Treatment studies that are not randomized
(e.g., nonequivalent group designs, separate sample
pretest/postest design and time-series designs)
4 Non-treatment studies
(e.g., cohort studies, case-control studies, cross-
sectional studies, and uncontrolled experiments)
5 Case studies
6 Expert comments
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Overview of Today‘s Talk
• Brief review of types of hearing-aid
outcome measures
• Review of research on types of outcomes
to measure
• What does the evidence say re: HA
outcome measures identified?
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EXAMPLE: NIDCD/VA Study
• N = 320-330 elderly adults
• Binaural fit of ITE‘s with 3 different circuits (crossover design) – Linear with PC
– Linear with OLC
– Single-channel WDRC
• Multiple measures of outcome obtained (especially speech recognition and subjective benefit)
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EXAMPLE: Humes et al. (2001)-Aided
and Unaided Speech Recognition
Listening Conditions (dB SPL/SBR)
65/+8 50/Q 65/+8 80/0
Pe
rce
nt C
orr
ect
0
20
40
60
80
100
Unaided
Aided
N = 173
*
**
NST CST
Benefit
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EXAMPLE: Analysis of IOI-HA
(Moderate-Severe Hearing Loss)
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EXAMPLE:
Humes et al.
(2001) –HA
Satisfaction
SATISFACTION RATING
0 1 2 3 4
Fit/Comfort
Visibility
Size
Ease-Battery
Battery Life
Clarity/Tone
Whistle/Feedbac
Ease-Volume
Reliability
Appearance
Improves Hearin
Use in Noise
On-going Expens
Value
Natural Sound
Localization
Freq Cleaning
Warranty
Packaging
Humes et al. (2001) (N = 172)
MarkeTrak V Norms (N = 524)
SATISFACTION RATING
0 1 2 3 4
One-on-one
Small Group
Outdoors
Large Group
Concert/Movie
Place of Worshi
TV
Restaurant
Car
Telephone
Professionalism
Friendliness
Knowledge
Patience
Expl HE Purpose
Expl HE Results
Expl HA Use
Expl HA Care
Expl HA Expect
Time Spent
Office Appear
Qual Serv After
Promptness Serv
“Satisfied” “Satisfied”
Hearing Aid Features
Dispenser Factors
Listening Situations
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Norms (Humes et al., 2009)
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Norms (Humes et al., 2009)