Lucille B. Beck

Optimal Outcome Measures, Research Priorities, and International Cooperation

&NA; The participants in the Eriksholm Workshop on “Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids” debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self‐report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health‐care delivery systems. A set of seven core items is proposed for further study.

Guest editorial: accessible and affordable hearing health care for adults with mild to moderate hearing loss.

The National Institute on Deafness and Other Communication Disorders/National Institutes of Health (NIDCD/NIH) sponsored a research working group on Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss on August 25 - 27, 2009 in Bethesda, Maryland. The purpose of the working group was to develop a research agenda to increase accessibility and affordability of hearing health care for adults with mild to moderate hearing loss, including accessible and low cost hearing aids. For the purposes of the working group, mild HL was defined as 26-40 dB HL averaged across 0.5 - 4.0 kHz, and moderate HL was defined as 41-60 dB HL averaged across 0.5 - 4.0 kHz. Why is this working group important at this time? Hearing loss (HL) is a public health issue and is among the leading public health concerns. Approximately 17% of American adults, or 36 million people, report some degree of HL1. HL is the third most prevalent chronic health condition facing seniors2. Yet, fewer than 20% of those with HL who require intervention and treatment seek help for their condition3. Untreated HL has social and economic ramifications. Most hearing aid users have lived with HL for over 10 years and their impairments have progressed to moderate-to-severe levels before seeking a hearing aid4. For many reasons, the current hearing health care (HHC) system in the United States is not meeting the needs of the vast majority of adults with HL. As the lead Federal agency to promote the Nations HHC, NIDCD has the responsibility and is actively seeking to address this problem from the public health perspective. NIDCD Senate Report Language for FY2010 appropriations “recommends that the NIDCD support research to develop, improve and lower the cost of hearing aids...”5. Further, Healthy People 2020, a U.S. Department of Health and Human Services (HHS) activity that provides science-based, 10-year national objectives for promoting health and preventing disease, includes increasing the adoption rate of hearing aid usage as a Healthy People 2020 goal6. NIDCD is committed to addressing these recommendations and goals through well-developed and targeted research initiatives.

The role of outcomes data in health-care resource allocation.

&NA; The purpose of this article was to provide information about the importance of outcome measures in the health‐care resource allocation scenario. The increasing focus on outcome measures as a more suitable way to demonstrate the value of services is discussed. Health‐care trends toward the use of data from patient outcomes to justify treatment needs and reimbursement are described. Important outcomes including patient satisfaction, functional status, and quality of life are presented. Outcome assessment strategies and requirements are considered in the wider context of evidence‐based practice, clinical practice guidelines, and performance measures. An outcomes management approach using the World Health Organizations classification system is suggested. Examples of audiological rehabilitation with hearing aids are provided to illustrate the application of outcome measures to hearing health care.

A multi-center, double blind clinical trial comparing benefit from three commonly used hearing aid circuits.

Objective Although numerous studies have demonstrated that hearing aids provide significant benefit, carefully controlled, multi-center clinical trials have not been conducted. A multi-center clinical trial was conducted to compare the efficacy of three commonly used hearing aid circuits: peak clipping, compression limiting, and wide dynamic range compression. Design Patients (N = 360) with bilateral, sensorineural hearing loss were studied using a double blind, three-period, three-treatment crossover design. The patients were fit with each of three programmable hearing aid circuits. Outcome tests were administered in the unaided condition at baseline and then after 3 mo usage of each circuit, the tests were administered in both aided and unaided conditions. The outcome test battery included tests of speech recognition, sound quality and subjective scales of hearing aid benefit, including patients’ overall rank-order rating of the three circuits. Results Each hearing aid circuit improved speech recognition markedly, with greater improvement observed for soft and conversationally loud speech in both quiet and noisy listening conditions. In addition, a significant reduction in the problems encountered in communication was observed. Some tests suggested that the two compression hearing aids provided a better listening experience than the peak clipping hearing aid. In the rank-order ratings, patients preferred the compression limiting hearing aid more frequently than the other two hearing aids. Conclusions The three hearing aid circuits studied provide significant benefit both in quiet and in noisy listening situations. The two compression hearing aids appear to provide superior benefits compared to the linear circuit, although the differences between the hearing aids were smaller than the differences between unaided and aided conditions.

Relative effects of low-frequency amplification on syllable recognition and speech quality

A moderate-bandwidth master hearing aid was used to study the relationships among low-frequency response, syllable recognition scores, and perceived speech quality. As measured on KEMAR, this hearing aid provided true high-frequency emphasis in all conditions, with three degrees of relative low-frequency de-emphasis. Subjects were 12 listeners with gradually sloping sensorineural hearing loss bilaterally. Contrary to common expectations, increased low-frequency response yielded a substantial enhancement in speech quality under both quiet and babble conditions, as well as a modest improvement in syllable recognition in quiet. Furthermore, low-frequency amplification, as used in this study, resulted in no observable degradation in syllable recognition in the presence of multitalker babble. The findings have clinical implications in the evaluation and selection of hearing aids when optimization of speech quality is desired.

Issues in the assessment and use of hearing aid technology

Issues of importance in the assessment and use of hearing aid technology are discussed. The roles of the consumer and federal legislation are considered. Developing technology and its impact on hearing aid selection and evaluation procedures are highlighted. The role of electroacoustic measures for specification of the functional performance of new technology is suggested. Strategies for assessing hearing aid performance are suggested, along with the need to develop a consensus regarding speech perception measures for hearing aid evaluation.

A Correction for Converting 2 cm3 Coupler Responses to: Insertion Responses for Custom In-The-Ear Nondirectional

A correction for custom in-the-ear nondirectional hearing aids is obtained for converting a frequency response measured using a 2 cm3 coupler to an insertion response, approximating that measured using a manikin and ear simulator. The results are compared to those of a previous published study. The methods used for obtaining the responses make use of a signal analyzer with discrete Founer transform capabilities.

Comprehensive measurements of the characteristics of compression hearing aids

Current standardized methods for the measurement of hearing‐aid performance (Specification of Hearing Aid Characteristics, S3.22‐1976, American National Standards Institute, New York) call for the measurement of two special characteristics of compression hearing aids, namely the dynamic and input‐output characteristics, at 2 kHz. A more thorough characterization of compression hearing aids requires measurements at more than one volume‐control setting to determine if the compression is controlled by the input or output signal. Also useful are random‐noise transfer functions and transmissibility measurements to determine the response to multifrequency signals, input‐output characteristics at several frequencies to determine the compression behavior in various frequency bands, and correlation coefficients to examine the influence of nonlinearities and internal noise in the hearing aid upon its performance. Measurements of these parameters are shown at two volume‐control settings for several commercially avai...