Outcome Measures of Hearing Aid Performance Flashcards
why do we need outcome meaures?
How do we know that the patient is getting the best possible result from the hearing aid we’ve fitted?
✓ We have selected an appropriate aid and earmould…
✓ We have chosen aid settings according to a fitting rule…
How do we know that what we have done is right for that patient???
ASK THE PATIENT!!!
* Immediately after fitting the aid
* At the hearing aid review appointment
what do we do immediately after fitting the aid?
- Ask the patient:
1. Is the aid comfortable in the ear?
2. What do they think about the quality of sound: - Own voice
- Audiologist’s voice
- Other sounds
- Loudness of sound
what do we do in the review appointment?
- Ask the patient:
1. How long does he/she wear the aid each day?
2. What do they think of the sound quality?
3. Are there any particular problem situations?
4. How does their own voice sound?
5. Any problems with loud sounds?
6. Any problems with acoustic feedback?
7. Can he/she insert/remove mould?
8. Is the aid comfortable to wear? - BUT the answers may be affected by patient factors such as:
Aid acceptance
Wanting to please relative/audiologist
why do we measure outcomes?
- Provide more objective measures of aid performance than patient reports
- Patient orientated
- to assess patient’s needs
- to assess effectiveness of rehabilitation and need for further help
- Service orientated
- to evaluate service
- to evaluate changes to service
what are some types of outcome measures?
- Audibility:
- Aided Thresholds
- Speech tests
- Technical outcomes:
- Real Ear Measurements (REMs)
- Self report questionnaires:
- Hearing aid benefit – most often used
- Satisfaction with aids
- Satisfaction with services
- QoL – rarely used in routine clinics
what are some tests of audibility?
- Aided Thresholds
- A measurement of functional gain
- Functional Gain = Unaided threshold - Aided threshold
- Aided threshold = 30dB SPL
- Unaided threshold = 70dBSL
- Functional gain = 70-30=40 dB
- Sound field presentation e.g. warble tones / narrow band noise
- Historically used before REM
- Still useful where REM impossible e.g. congenital atresia of external
meatuses
what are the advantages of aided thresholds?
May be useful to demonstrate to others (parent, significant other) that the
HA is making a difference
what are the disadvantages of aided thresholds?
- Time- consuming to perform
- Results can be variable
- Does not measure dynamic aspects of HA performance e.g. wide dynamic
range compression
What is the purpose of speech tests in audiology?
Speech tests are used to evaluate a client’s hearing for speech comprehension. They are essential for assessing the effectiveness of hearing aids and ensuring adequate speech development in hearing-impaired children.
What steps are necessary for reliable results when conducting speech tests?
To ensure reliable results, speech tests should be conducted prior to fitting a hearing aid (either unaided or with previous aids) or changes to settings. Additionally, the tests should be repeated after fitting or adjustments, and again after a period of “settling in” time to account for adaptation to the hearing aid.
How do Speech in Noise Tests contribute to audiological assessments?
These tests help demonstrate functional improvements following hearing aid fittings or adjustments. By assessing speech intelligibility in realistic noisy environments, audiologists can evaluate the effectiveness of hearing aids and make appropriate changes to settings to improve performance in challenging listening situations.
Why is it important to conduct speech tests in different conditions?
Testing speech comprehension in various conditions allows audiologists to assess how well a client can understand speech in real-world scenarios. This includes assessing performance in noisy environments, which is a common challenge for individuals with hearing loss even when wearing hearing aids.
What are the different types of speech tests available in audiology?
There are various types of speech tests, including those using monosyllables, spondees, or sentence lists. These tests can involve live voice or recorded speech, be conducted in quiet or in noise, and may include visual information (audio-visual) or be auditory alone. Examples include AB Wordlists and BKB Sentences.
Can Real Ear Measurements be conducted with or without the hearing aid in place?
Yes, Real Ear Measurements can be performed with or without the hearing aid in place, allowing audiologists to assess the output of the hearing aid accurately.
what are the advantages of speech tests?
- High “face validity”
- Can readily demonstrate difference between unaided & aided situation to patient / others
- Some tests e.g. FAAF can identify particular speech sounds which are causing difficulty
- Auditory alone v Audio-visual can demonstrate the importance of visual cues to communication
what are the disadvantages of speech tests?
- Cannot replicate real-life listening conditions easily in the clinic
- May be time consuming to do
- Results dependent on measurement conditions e.g. noise/no noise, signal-to-noise ratio
- Unless many items are used, the % difference between conditions A & B has to be quite large for
statistical significance
What are Real Ear Measurements (REMs) in audiology?
Real Ear Measurements are a method of measuring the output of a hearing aid in the ear canal of the wearer.
What is the purpose of Speech in Noise Testing in audiology?
Speech in Noise Testing evaluates speech intelligibility in the presence of background noise. This is crucial because difficulties in understanding speech in noisy environments are among the most common complaints for individuals with hearing impairment, even when they wear hearing aids.
Can you provide examples of Speech in Noise Tests used in audiology?
- Hearing in Noise Test (HINT) (Nilsson, Soli, and Sullivan, 1994)
- Words in Noise (WIN) (Wilson, 2003; Wilson and Burks, 2005)
- QuickSIN (Etymotic Research, 2001; Killion et al., 2004)
- Bamford-Kowal-Bench Speech in Noise Test (BKB-SIN) (Etymotic Research, 2005; Bench, Kowal, and Bamford, 1979; Niquette et al., 2003)
How are Real Ear Measurements conducted?
During Real Ear Measurements, a small “probe tube” microphone is inserted into the ear canal, while a reference microphone is placed next to the pinna. Sound stimuli are then produced, and the sound level within the canal is compared to the level at the reference microphone.
What types of measurements can be obtained through Real Ear Measurements?
Real Ear Measurements can provide various measurements, including but not limited to, sound pressure level (SPL), frequency response, and real-ear-to-coupler difference (RECD). These measurements offer valuable insights into how the hearing aid performs in the individual’s ear canal.
what are the advantages of Real Ear Measurements (REMs)?
- Produces an entirely objective measure of what the aid is doing
- Little patient co-operation required
- Quick and easy to perform
- Gives information about the whole frequency range
- Can immediately demonstrate the effect of changes to the hearing aid settings
- Good test-retest repeatability
what are the disadvantages of Real Ear Measurements (REMs)?
- They are only as good as the prescription formula used. This can be a problem as
prescription rule developments usually follow developments in technology. This means that
current formulas don’t take the latest technologies into account. - Audiologists (and Audiology services) can become too REMs driven and forget about the
needs of the patients. - Cannot perform if excessive wax or infection are present in the ear canal.
- Results can be affected by changes in the placement of the probe mic.
- Can be difficult to perform on children.
What is data logging in relation to hearing aids?
Data logging involves the collection and analysis of hearing aid data concerning user habits.
How does data logging benefit audiological practice?
Data logging provides objective information about how hearing aids are used and the environments users encounter daily. This data can aid in counseling sessions and assist in customizing hearing aid programming to best suit individual lifestyles.
What ethical considerations are associated with data logging in audiology?
Patients should be made aware of the data logging feature on their hearing aids and give consent for its activation. Ethical issues, such as privacy concerns and data security, need to be carefully addressed by audiologists.
What are structured questionnaires in audiology and what do they assess?
Structured questionnaires are tools used to assess various aspects related to hearing aid usage. Common focuses include hearing aid benefit, satisfaction with the device, and satisfaction with audiological services.
-GHABP
-COSI
what are advantages of structured questionnaires?
- Allow comparisons:
- Before and after fitting (or modifying) the aid
- To normative data
- Enable services to gather data about the local population
what are disadvantages of structured questionnaires?
- Measure different things
- Can be time consuming
- The patient may not be able to complete the questionnaire
What is the purpose of using outcome measures in audiology?
Outcome measures are utilized to evaluate the success of the fitting and fine-tuning process in audiology.
What combination of outcome measures is typically employed in audiological practice?
Typically, a combination of outcome measures is utilized to gather comprehensive information about the effectiveness of the fitting process.
How should the selection of outcome measures be adapted for individual clients?
The selection of outcome measures should be tailored to each client’s specific circumstances. For example, if a patient is unable to complete a questionnaire, it may be omitted, or audibility tests may be utilized if REMs cannot be performed.
What specific outcome measures are commonly used in the UK to assess the benefit to the user?
In the UK, Real Ear Measurements (REMs) and structured questionnaires are commonly employed to assess the benefit experienced by the user.
