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      The Acoustic Environments in Which Older Adults Wear Their Hearing Aids: Insights From Datalogging Sound Environment Classification

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          Abstract

          Purpose

          This report presents data on the acoustic environments in which older adults with age-related hearing loss wear their hearing aids.

          Method

          This is an observational study providing descriptive data from 2 primary datasets: (a) 128 older adults wearing hearing aids for an average of 6 weeks and (b) 65 older adults wearing hearing aids for an average of 13 months. Acoustic environments were automatically and continuously classified about every 4 s, using the hearing aids' signal processing, into 1 of 7 acoustic environment categories.

          Results

          For both groups, older adults wore their hearing aids about 60% of the time in quiet or speech-only conditions. The automatic classification of sound environments was shown to be reliable over relatively short (6-week) and long (13-month) durations. Moreover, the results were shown to have some validity in that the obtained acoustic environment profiles matched a self-reported measure of social activity administered prior to hearing aid usage. For a subset of 56 older adults with data from both the 6-week and 13-month wear times, the daily amount of hearing aid usage diminished but the profile of sound environments frequented by the wearers remained stable.

          Conclusions

          Examination of the results from the automatic classification of sound environments by the hearing aids of older adults provides reliable and valid environment classifications. The present data indicate that most such wearers choose generally favorable acoustic environments for hearing aid use.

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          Most cited references22

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          The hearing handicap inventory for the elderly: a new tool.

          This report describes the development and standardization of the Hearing Handicap Inventory for the Elderly (HHIE). This self-assessment tool is designed to assess the effects of hearing impairment on the emotional and social adjustment of elderly people. The inventory is comprised of two subscales: a 13-item subscale explores the emotional consequences of hearing impairment; a 12-item subscale explores both social and situational effects. The inventory was administered to 100 elderly subjects (mean age = 75 years) with hearing threshold levels in the better ear ranging from normal to severe. The reliability of the HHIE was evaluated by assessing its internal consistency through the computation of Chronbach's alpha. Alpha values ranged from 0.88 (social/situational subscale) to 0.95 for the entire inventory. Split-half reliabilities were equally high. The validity of the HHIE was not directly evaluated. Certain aspects of the data, however, support the construct validity of the instrument, while analysis of the questions themselves appears to attest to its content validity. Possible uses of the inventory were described and suggestions were made regarding future research on the instrument. The reliability and validity of the HHIE as well as its brevity, simplicity, and ease of administration and interpretation all recommend its use in assessing hearing handicap in the elderly.
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            Estimation of Signal-to-Noise Ratios in Realistic Sound Scenarios.

            Both in the design of hearing-device features, such as noise reduction, and in the evaluation measurements of such features, there is a need for more information about the sound scenarios hearing-device users encounter. The limitations of adaptive speech tests as outcome measures in the evaluation of hearing-device features have been discussed. The obvious alternative to adaptive speech testing is to test at a fixed signal-to-noise ratio (SNR). However, the question is which SNRs should be used if the test reflects real-life situations.
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              The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial

              Objectives The objectives of this study were to determine efficacy of hearing aids in older adults using audiology best practices, to evaluate the efficacy of an alternative over-the-counter (OTC) intervention, and to examine the influence of purchase price on outcomes for both service-delivery models. Design The design of this study was a single-site, prospective, double-blind placebo-controlled randomized trial with three parallel branches: (a) audiology best practices (AB), (b) consumer decides OTC model (CD), and (c) placebo devices (P). Outcome measures were obtained after a typical 6-week trial period with follow-up 4-week AB-based trial for those initially assigned to CD and P groups. Setting Older adults from the general community were recruited via newspaper and community flyers to participate at a university research clinic. Participants Participants were adults, ages 55–79 years, with mild-to-moderate hearing loss. There were 188 eligible participants: 163 enrolled as a volunteer sample, and 154 completed the intervention. Intervention(s) All participants received the same high-end digital mini-behind-the-ear hearing aids fitted bilaterally. AB and P groups received best-practice services from audiologists; differing mainly in use of appropriate (AB) or placebo (P) hearing aid settings. CD participants self-selected their own pre-programmed hearing aids via an OTC model. Primary and Secondary Outcome Measures Primary outcome measure was a 66-item self-report, Profile of Hearing Aid Benefit (Cox & Gilmore, 1990). Secondary outcome measure was the Connected Speech Test (Cox, Alexander, & Gilmore, 1987) benefit. Additional measures of hearing-aid benefit, satisfaction, and usage were also obtained. Results Per-protocol analyses were performed. AB service-delivery model was found to be efficacious for most of the outcome measures, with moderate or large effect sizes (Cohen's d). CD service-delivery model was efficacious, with similar effect sizes. However, CD group had a significantly (p < .05) lower satisfaction and percentage (CD: 55%; AB: 81%; P: 36%) likely to purchase hearing aids after the trial. Conclusions Hearing aids are efficacious in older adults for both AB and CD service-delivery models. CD model of OTC service delivery yielded only slightly poorer outcomes than the AB model. Efficacious OTC models may increase accessibility and affordability of hearing aids for millions of older adults. Purchase price had no effect on outcomes, but a high percentage of those who rejected hearing aids paid the typical price (85%). Trial Registration Clinicaltrials.gov: NCT01788432; https://clinicaltrials.gov/ct2/show/NCT01788423 Supplemental Materials https://doi.org/10.23641/asha.5382499
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                Author and article information

                Journal
                Am J Audiol
                Am J Audiol
                AJA
                American Journal of Audiology
                American Speech-Language-Hearing Association
                1059-0889
                1558-9137
                December 2018
                06 December 2018
                1 June 2019
                : 27
                : 4
                : 594-603
                Affiliations
                [a ]Department of Speech and Hearing Sciences, Indiana University, Bloomington
                Author notes

                Disclosure: Larry Humes was hired by GN Hearing as a part-time consultant effective September 1, 2018, long after this study had been conducted and accepted for publication.

                Correspondence to Larry E. Humes: humes@ 123456indiana.edu

                Editor-in-Chief: Sumitrajit (Sumit) Dhar

                Editor: Ryan McCreery

                Article
                10590889002700040594
                10.1044/2018_AJA-18-0061
                6436453
                30267099
                bf78d6cd-6cd6-4150-8abc-43995ee54d78
                Copyright © 2018 The Authors

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 04 April 2018
                : 18 May 2018
                : 13 June 2018
                Page count
                Pages: 10
                Funding
                This work was supported, in part, by the National Institute on Deafness and other Communication Disorders Research Grant R01-DC011771, awarded to the first author. The manufacturer of the hearing aids, GN ReSound, made the study hearing aids available to the investigators at cost.
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                Research Articles

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