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Client, Hearing aid and Subjective Variables as Predictors of Hearing Aid Success: 

Client, Hearing aid and Subjective Variables as Predictors of Hearing Aid Success Suzanne C Purdy National Acoustic Laboratories and J Chris K Jerram Audiology Section, The University of Auckland Presented at Audiological Society of Australia Conference, Adelaide, Australia, 6-9 June 2000

Topics: 

Topics Aim Outcome measures Predictors of outcome Methodology Results Conclusions

Overall Aim: 

Overall Aim To determine demographic, technical and subjective predictors of hearing aid outcome

Measuring Hearing Aid Outcome: 

Measuring Hearing Aid Outcome Hours of hearing aid use Satisfaction Overall (Dillon et al 1997; Purdy & Jerram 1998) Profile (SADL, Cox & Alexander 1999) Benefit Objective (aided-unaided real ear SPL / speech %) Subjective (APHAB, Cox & Alexander 1995)

Measuring Hearing Aid Outcome: 

Measuring Hearing Aid Outcome Psychosocial depression social activity personal relationships health status cognitive status life satisfaction emotional stability anxiety Mulrow et al 1990 Bridges & Bentler 1998 Garsteki & Erler 1998 Crandell 1998 Kochkin & Rogin 2000

Predictors of Hearing Aid Outcome: 

Predictors of Hearing Aid Outcome Demographic factors age degree of hearing loss gender Poor health, impaired cognition, social isolation, central auditory deficits in the elderly impact on hearing aid success Greater hearing loss  more aid use, poorer performance, greater benefit

Predictors of Hearing Aid Outcome: 

Predictors of Hearing Aid Outcome Hearing instrument factors age of instrument hearing aid style technology (compression, multiple memories / microphones / channels) Better satisfaction with newer instruments and higher performance instruments Higher benefit in noise with dual microphone technology

Predictors of Hearing Aid Outcome: 

Predictors of Hearing Aid Outcome Subjective factors personal adjustment to hearing loss attitude to hearing aids expectations of hearing aids personality Better outcomes if more outward-looking personality, less depressed, more positive attitude towards hearing aids

Methodology 1. : 

Methodology 1. 12 private, 7 public clinics n=225 consent forms Questionnaires received back from n=200 (89%) personal adjustment to hearing loss hearing aid attitudes and expectations unaided listening (Modified APHAB) Hearing aid fitting and trial

Methodology 2. : 

Methodology 2. Post-fitting questionnaires n=162 (81%) aided listening (Modified APHAB) overall satisfaction hours of use Demographic, hearing loss and hearing aid details from audiologists

Statistical Analysis : 

Statistical Analysis Internal reliability of questionnaires Relationship between outcome measures Ordinal logistic regression analysis to investigate the effects on outcome of: age, gender, employment status, public/private clinic, prior aid experience, degree of hearing loss, monaural/bilateral fitting, aid style, aid I/O characteristics, “high tech” features, personal adjustment to hearing loss, attitudes to hearing aids, aid expectations

Questionnaires 1. : 

Questionnaires 1. Communication Profile for the Hearing Impaired (CPHI) “Personal Adjustment” Acceptance of Loss Stress Denial “Sometimes I’m ashamed of my hearing loss” “When I have trouble hearing, I feel frustrated” “When I can’t understand what’s being said, I feel tense and anxious”

Questionnaires 2. : 

Questionnaires 2. Hearing Attitudes in Rehabilitation (HARQ) Factor 1. Hearing Aid Stigma “It would make me feel old to wear a hearing aid” “If I wear an aid, people will probably think I’m a bit stupid”

Questionnaires 3. : 

Questionnaires 3. Seyfried (1990) Expectations Questionnaire “My hearing aids will fit comfortably” “My hearing aids will make speech sounds more distinct”

Subject Characteristics : 

Subject Characteristics 81 men, 81 women 31-88 years (mean 70.5, sd 10.8 years) 47% public, 53% private 62% some prior hearing aid experience Sensorineural hearing loss

Average Pure Tone Audiogram: 

Average Pure Tone Audiogram

Hearing Aid Fitting (n=162): 

Hearing Aid Fitting (n=162) 26% 1-4 hrs use 69% 4+ hrs use Bilateral 59% BTE 22% ITE/ITC 73% CIC 5%

Hearing Aid Outcomes: 

Hearing Aid Outcomes

Significant Predictors of Outcomes: 

Significant Predictors of Outcomes

Better CPHI Acceptance of Loss and higher Expectations associated with more aid use: 

Better CPHI Acceptance of Loss and higher Expectations associated with more aid use

Conclusions 1.: 

Conclusions 1. Questionnaires’ internal reliability good after elimination of some items from Expectations and Attitudes scales Relationships between outcomes people who were more satisfied and had higher benefit wore their aids more satisfaction most strongly related to benefit in difficult listening situations

Conclusions 2.: 

Conclusions 2. Demographic factors not significant “High tech” affected outcome WDRC aids associated with higher difficult listening benefit but milder losses Multiple memory associated with higher satisfaction and higher easy listening benefit (multiple channel also easy listening benefit) On average satisfaction was highest (82%) for multiple microphone aids but not significant due to few subjects (n=15)

Conclusions 3.: 

Conclusions 3. Attitude not predictive of outcome Higher expectations associated with more hearing aid use and greater benefit in easy and difficult listening situations Better personal adjustment to hearing loss (Acceptance of Loss subscale) associated with more hearing aid use This research was supported by the Deafness Research Foundation of New Zealand.