Consumers are more likely to follow through with purchasing hearing aids—and are more likely to report satisfaction with them—when an audiologist following best practices is involved in the process, indicates the first placebo-controlled, double-blind, randomized clinical trial of hearing aid outcomes.
In the study, participants who received customized hearing aid programming and real-ear verification, education, and related counseling from an audiologist were nearly one and a half times more likely to keep their hearing aids than those who did not. With 81 percent of those in the “audiology best practices” group and only 55 percent of those in the “consumer-decides” group electing to purchase the hearing aids after six weeks, the study found a 26 percentage-point higher rate of adoption for the “audiology best practices” group.
The study was led by Larry Humes, a distinguished professor in the Department of Speech and Hearing Sciences at Indiana University Bloomington, and was published in March in the American Journal of Audiology.
To reach its results, the study assigned 154 adults, ages 55 to 79 years, with symmetrical, mild–moderate sensorineural hearing loss into three groups: a placebo (P) group, an audiology “best practices” (AB) group (in which an audiologist guided device selection and fitted the aids) and a “consumer-decides” (CD) group (in which consumers self-selected and self-fitted). Regardless of group assignment, all participants received the exact same high-end, digital, mini-behind-the-ear hearing aids fitted bilaterally (ReSound Alera 9), but the provision of services differed, as did the programming options (see chart below).
The CD model of hearing aid delivery tested in the study is not the typical “consumer does everything” model associated with over-the-counter (OTC) dispensing, as Humes explains in a video. Among the important ways it differs from “consumer does everything” OTC are that participants:
- Received a comprehensive audiologic examination that identified any concomitant conditions that might affect hearing or cognitive ability.
- Did not have a wide array of choices. They could choose only one type of hearing aid—a high-end one with three pre-set programming options.
- Watched an instructional video on the self-selection process. Three notebook binders of step-by-step instructions were also provided.
- Were able to try the hearing aids, with the various sizes of domes, tubes and the three pre-set programming options, for as long as they needed to make their selection. They could also use a tablet computer to listen to speech, music and other sounds to help them compare options.
A key outcome of interest in this study was the perceived real-world benefit of the hearing aids in everyday life as judged by the users on the Profile of Hearing Aid Performance (PHAP): The scores for the AB and CD groups on this measure were significantly better than the P group, but did not differ significantly from one another. The same pattern of findings was observed for the secondary outcome measure in this study: perception of speech in noise.
The study also found that the CD group demonstrated significantly lower hearing aid satisfaction scores than the AB group on the Hearing Aid Satisfaction Survey. In addition, the participants in both the AB and CD groups reported 12–18 percentage points of improvement on a measure of perceived hearing handicap (Handicap Inventory for the Elderly), both significantly better than the placebo group.
Hearing aid cost was not a significant factor for any of the outcome measures, but it did have some bearing on the final decision to purchase hearing aids. A significantly higher percentage of those who were not likely to retain their hearing aids at the end of the six-week trial had paid the higher purchase price ($3,600 versus $600 per pair).
At the end of the six-week trial, 81 percent of those who received the AB model decided to keep their hearing aids, compared with 55 percent of the CD group and 35 percent of the P group. When offered an additional four-week trial with programming, hearing aid orientation, and counseling from an audiologist, 95 percent of those in the CD and P groups combined took the opportunity, and 91 percent of those ultimately purchased the hearing aids.
After using their hearing aids for six weeks, participants in both the CD and AB groups performed significantly better than the P group on the Connected Speech Test. Those CD and P participants who later received continued services from audiologists reported significantly greater benefit and greater satisfaction with their hearing aid and they were more likely to purchase the hearing aids at the end of the study. These statistically significant advantages for the audiology best-practices group are clinically important because when hearing aid users experience benefits early on, they may be more motivated to continue using the aids.
“In sum,” continues Humes, “audiology-based services have been doing a good job for the 20 percent seeking help. The CD approach, and OTC approach in general, however, target the other 80 percent—those who don’t seek services through the conventional pathway.” The fact that most of the outcomes were similar for the AB and CD approaches is encouraging, Humes says, for the 80 percent not being served currently. “As those who enter the hearing health care arena through such CD or OTC pathways will probably need additional help in the future, they would likely turn to health care professionals, such as audiologists, for such assistance. This would be even more likely if the audiologist’s practice facilitated their initial entry into the CD/OTC pathway, perhaps by incorporating such service-delivery options within their practices.”
At present, there is no FDA regulatory classification specific for OTC hearing aids, though the FDA has moved in that direction. In response to recently introduced OTC hearing aids legislation in Congress, ASHA released a position statement reiterating the value of the audiology best-practices model, but positing that in some cases OTC hearing aids may be appropriate as “an early gateway,” specifically for adults with mild hearing loss, with the hearing aids restricted in gain and output thresholds. The statement also maintains that OTC hearing aids should not be a substitute for coverage of audiologic services by third-party payers.
For more in-depth analysis of this study and discussion of policy implications, watch for an article in the May issue of The ASHA Leader.
Margaret Rogers, PhD, CCC-SLP, is ASHA’s chief staff officer for science and research. firstname.lastname@example.org