Hearing Aid Fitting for Adult and Geriatric Patients: A Standard Explored

Audiology Practice Standards Organization (APSO) is an organization established for the purpose of publishing and maintaining standards for audiology practice. Standard 2.1, Hearing Aid Fitting for Adult and Geriatric Patients, was published based on current literature and accepted clinical practice and documents the professional work audiologists perform to determine candidacy, select, fit, verify, and follow up with adult patients receiving hearing aids. This 15-item standard is listed below and is available at: www.audiologystandards.org/standards/current.php

While hearing aid technology has changed rapidly, the actual process of what is considered to be the standard for hearing aid fitting has not changed much in the last decade. So, what is the difference between a standard and guideline? Really, it is the “what” versus the “how.” The standard is the minimum practice, whereas a guideline may state more than one way to go about completing the task. The goal of a standard is to give minimal acceptable practice, not to address outcomes.

The process by which APSO develops their standards is explained on their Web site (www.audiologystandards.org). First, they create a subject-matter expert team consisting of clinicians and researchers familiar with the subject area. These experts create the initial standards list. The list then goes to a second team that reviews the standards. Finally, the standard is published for public opinion. The comments from the public opinion are incorporated into the standard and it is then subject to review by an ethics panel and an attorney before being approved by the APSO Board of Directors for publication.

That being said, it is worth exploring the literature that founded the Standard for Hearing Aid Fitting for Adult and Geriatric Patients. That is the goal of this edition of Seminars in Hearing. Each of the standards was explored and the literature that supports this standard is further described. The reader will find article in this edition dedicated to each of the 15 elements of Standard 2.1: Hearing Aid Fitting for Adult and Geriatric Patients.

Standard 2.1: Hearing Aid Fitting for Adult and Geriatric Patients

1. The hearing aid selection and fitting process is based on a comprehensive, valid audiological assessment. Each step of the selection and fitting process and the rationale is documented, where appropriate.

2. Patient communication is conducted in a clear, empathetic manner consistent with the patient's communication mode, comprehension, and their health literacy level. Patient-centered and family-centered care is provided. The patient is encouraged to include communication partners (e.g., family members, significant others, companions) throughout the selection, fitting, and follow-up process.

3. A needs assessment is conducted in determining candidacy and in making individualized amplification recommendations. A needs assessment includes audiologic, physical, communication, listening, self-assessment, and other pertinent factors affecting patient outcomes.

4. Pre-fitting testing includes assessment of speech recognition in noise, unless clinically inappropriate, and frequency-specific loudness discomfort levels. Other validated measures of auditory and non-auditory abilities are considered, as appropriate for the individual patient.

5. Fitting of bilateral hearing aids is the recommended protocol if the patient is a candidate for hearing aids in both ears and it is supported by the needs assessment.

6. The hearing aid style and the ear coupling are chosen to be appropriate for the degree and configuration of the hearing loss. Style and coupling should reflect any physical limitations of the patient. Patient input regarding acceptable styles is taken into account.

7. The recommended hearing aids include signal processing and features that support the patient's listening needs. They have the appropriate gain and output, including reserve gain, to meet frequency-specific fitting targets as defined by a validated prescriptive method.

8. Assistive technology and accessories are considered to facilitate accessibility to other devices and to satisfy the patient's listening and communication needs.

9. An assessment of initial product quality is completed, using standard electroacoustic measures to verify either manufacturer or published specifications.

10. Hearing aids are fitted so that various input levels of speech result in verified ear canal output that meets the frequency-specific targets provided by a validated prescriptive method. The frequency-specific maximum power output is adjusted to optimize the patient's residual dynamic range and ensure that the output does not exceed the patient's loudness discomfort levels.

11. Following individualized verification of hearing aid gain and output, if the fitting is not acceptable to the patient, minor deviations in gain and output may be necessary.

12. Orientation is device- and patient-centered and includes use, care, and maintenance of the hearing aid(s) and accessories.

13. Counseling is conducted to ensure appropriate adjustment to amplification and to address other concerns regarding communication. Additional rehabilitative audiology is recommended if deemed appropriate.

14. Hearing aid outcome measures are conducted. These may include validated self-assessment or communication inventories and aided speech recognition assessment.

15. Short- and long-term follow-up is conducted to ensure that post-fitting needs are addressed. This includes updated audiological assessment, hearing aid adjustments and routine maintenance as needed to ensure the devices are functioning properly and appropriately for the patient.

    We hope this edition supports your work in the area of amplification.

    Enjoy.

Publication History

Article published online:
26 July 2022