Hearing Aid Outcome Tools: What Are We Really Measuring? A Case Study

ABSTRACT

Measuring hearing aid benefit has been a task audiologists have dealt with since the beginning of our profession. Historically, benefit has been based on comparing aided and unaided speech reception thresholds, and speech recognition ability with several different hearing aids. When this procedure was found to lack validity, functional gain of hearing aids was assessed using different prescriptive approaches. More recently, real ear measurements have provided a more objective way of measuring aided benefit based on different target gain prescriptions. Although these measures provide a starting point for assessing the appropriateness of a particular fitting, hearing aid outcome measures have attempted to assess an individual's perceived reduction in hearing handicap in a quantitative way.

The Hearing Handicap Inventory for the Elderly (HHIE) and HHIE, screening version (HHIE-S) have been used to measure an individual's perceived hearing handicap and as such have been helpful as counseling and orientation tools. More recently, these tools have been used as pre- and postfitting measures to attempt to quantify an individual's reduction in perceived handicap following amplification. A significant reduction in perceived handicap following the introduction of amplification would seem to indicate a successful fitting. Likewise, an individual reporting good subjective benefit with a hearing aid would probably demonstrate a significant reduction in perceived handicap following the introduction of amplification. However, this relationship remains to be demonstrated. Each individual brings different goals and expectations to the hearing aid fitting process. The degree to which a given hearing loss affects an individual's life may be related to lifestyle, occupation, academic concerns, psychological factors, and the influence of significant others.

The two cases presented bring into question the validity of using only hearing handicap scales as prefitting and postfitting measures to assess benefit with amplification.

Two individuals were fit binaurally, one with multichannel, multimemory digital hearing aids and one with analog wide dynamic range compression (WDRC) hearing aids. Both individuals exhibited a sloping high-frequency sensorineural hearing loss with fair to good speech recognition ability bilaterally. Although both individuals indicated that they were satisfied with amplification, their HHIE-S scores were quite different. The individual wearing digital hearing aids wore his aids only 3 hours per day and demonstrated no reduction in perceived handicap as measured by the HHIE-S. The individual wearing the analog WDRC hearing aids wore his aids 14 hours per day and revealed a significant reduction in perceived handicap as measured by the HHIE-S.

The results of these two case studies raise questions about the use of hearing handicap scales as pre- and postfitting tools to assess the benefits of amplification. Among the issues to be considered in the future are frequency of hearing aid use and its relation to hearing aid satisfaction, individual patients' expectations, and the administration of scales at various intervals after hearing aid fitting to chart long-term success.

KEYWORDS

Hearing aid benefit - hearing aid expectations - HHIE-S - impairment - outcomes - perceived handicap

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