Hearing-loss-dependent personalization

Transcription

1 PAGE 1 HEARING LOSS DEPENDENT PERSONALIZATION TECH PAPER ULTIMO 2015 Hearing-loss-dependent personalization INTRODUCTION In the meeting between clinician and patient with severe to profound hearing loss, the latter is in many instances the expert on exactly his or her hearing loss, extensive experiences with hearing loss, coping with the challenges that severe hearing impairment introduces and the sound and use of specific features at least for his or her situation and hearing. This does not mean that the clinician has nothing to offer: quite the contrary, in fact. Sitting across from a skilled hearing aid user sometimes makes the job even harder, as the clinician must be the technology expert with a wide knowledge of what is on the market, and a recommendation of what will work, how it will work, and how fast it will work. Furthermore, the clinician is still the clinician and remains the clinical expert with knowledge of hearing loss, progression of hearing loss, etc. Thus, at the consultation between a long-time, perhaps even life-long, user of amplification and the audiologist, two experts meet, bringing important and unique information and experiences to the table. By incorporating both the professional knowledge of the audiologist and the feedback and guidance from the user, the optimal hearing aid fit can be obtained (Laplante-Lévesque et al. 2013). Personalization with Oticon fitting software, Genie, using the personal profiles and YouMatic offers a unique combination of patient-centered care with individual settings within the hearing aid. And since all users are different, and users with severe to profound hearing loss experience different challenges in their hearing aid use, the way we tap in to the user s needs and preferences must be adapted to fit these needs. Hearing-loss-dependent personalization is now complete with the inclusion of the severe to profound group. This tech paper describes how patients with severe to profound hearing loss will receive personalized fittings of hearing aids and how the improvements in the Oticon solution have been developed and tested. Julie Neel Weile, MA Research Audiologist Oticon A/S

2 PAGE 2 HEARING LOSS DEPENDENT PERSONALIZATION Successful treatment and patient-centered care Patient-centered care and shared decision-making are concepts that are well established and proven to increase patient satisfaction, patient adherence to treatment, and sense of self-management (DiMatteo et al., 2011). DiMatteo et al. point to three important actions for improved adherence to treatment: ensuring that the client has the right information, that the client is motivated, and that the client can manage the practical side of the treatment. This all seems straightforward, perhaps even obvious. Still, a recent study by Grenness et al. concluded that very little of the time spent in the counseling phase between clinician and hearing aid user (or new user) was spent on patient-centered communication. A recent study by Poost-Foroosh et al. investigated which factors in the interaction between client and clinician are perceived as most important by the respective parties. Clients rated items concerning information about the hearing aids, the thoroughness and accuracy of testing, and the recommendation based on medical decision the highest. Clinicians on the other hand rated items of client readiness, client lifestyle, and the individuality of every client the highest. The severe to profound hearing aid user or rather users! As previously mentioned, the group of people with severe to profound hearing loss is very diverse in terms of how well they get by with amplification and what the amplification should do for them. Some detect small changes in the processing of minor details in speech and some use the amplification for awareness and sense of environment. Likewise, the relationship with loudness is variable: some will want everything the instrument can give while others experience loudness discomfort close to that of a normal hearing person. To uncover these individual differences and preferences, and use them actively in the hearing aid fitting, Oticon has introduced hearing-loss-dependent personalization in Genie Oticon fitting software. Personalization for all hearing losses With the launch of Genie , gain and noise management prescription and the dynamic behavior of these, i.e. Personalization, have been adapted to support fittings for the severe to profound user group. Personalization in Genie is thus adjusted to also meet the special needs of the more severely hearingimpaired patient group and is of course available across hearing aid families. Personalization is effectuated through the prescription, one of the three of a total of five personal profiles. Personalization for Power includes four new questions and supportive sound demos. The questions and sound demos have been developed in close cooperation with the users. First the draft questions were devised by combining knowledge about the audiology of the severe to profound hearing loss with the relevant technical handles. Subsequently a survey was administered to the relevant user group in order to test the validity of the questions and to perform a statistical analysis to achieve the right spread in the answers to the questions. A good question for mapping individual preferences is one where everyone does not answer the same, so it provides the clinician with specific knowledge of this user and not only users in general. Asking whether hearing in noise is difficult for a severe or profoundly? Uncovering preferences and engaging the client in the hearing-impaired Mismatch person is less interesting, because: fitting while gaining relevant information for setting of course it is difficult. The intriguing aspect relating to the hearing aid is very much in accordance with these hearing in noise in this context is rather: How does the scientific findings. It is our job to provide the Long-Term right tool Memory user want the hearing aid to help him or her in a situation with noise? The instrument could try to remove Incoming Speech to achieve this. What you want to hear Effort Clear Distorted Match the noise, but this may also include noise that is the conversation around the table at the restaurant or the background music at the bar that the client wants to hear. Alternatively, the instrument could leave the surroundings relatively unaltered, only removing any unpleasant transient sounds, leaving the sorting of the environment up to the wearer. Or perhaps something in between. In the personalization process during a hearing aid fitting, the answering of questions must have an effect on the settings within the instrument. Thus, by indicating that surroundings are often too loud, parameters affecting this aspect should change (e.g. MPO should be lowered). If soft sounds are often too soft, compression could be increased. If more help is needed in less complex situations, directional microphones should kick in earlier, etc.

3 PAGE 3 HEARING LOSS DEPENDENT PERSONALIZATION In the survey validation of the new questions for severe to profound users, 89 hearing-impaired individuals participated. Eight questions were surveyed. Four questions made the cut based on their ability to divide the group of users. These became the statements found in the Preference Manager in Genie The answers to the questions in the Preference Manager can be seen as weights going in each direction. Therefore, consistently choosing the option going toward a sound picture with louder sound and many details, while only sometimes feeling disturbed by sound in the surroundings will prescribe an Exact profile with a suggestion of perhaps considering going even further in the direction of a Lively one. Statement I am easily disturbed by sounds around me when the listening environment becomes noisy I prefer listening to louder speech even if it becomes unclear I prefer to hear as much sound as possible even if it is pretty loud I prefer a more comfortable sound even if it takes away the softer details in the sound Options A B Only Sometimes No No No The other way around, answering in the direction of wanting more comfort, feeling disturbed by loud sounds, and in general wanting less sound will prescribe a Gentle profile and suggest going in the direction of Steady if the hearing aid user wants even more comfort and less disturbance. As previously mentioned, the group of people with severe to profound hearing loss is very diverse in terms of how well they get by with amplification and what the amplification should do for them. Some can sense changes in the instruments that alter just small details in speech while others use their hearing aid only for sound awareness and sense of environment. Exact profile Gentle profile

4 PAGE 4 HEARING LOSS DEPENDENT PERSONALIZATION The sound demos were tested with an internal group of severe to profoundly hearing-impaired users at Oticon Headquarters. All users found the sound demos relevant, were able to hear differences between the A/B pair of sound samples, and have a preference for one or the other. When working with patients with severe to profound hearing losses, the sound demos are played with the patient wearing hearing aids. In the course of many internal tests involving these users, we found that some responded well to the questions and easily related to the described situations. Others found the questions less straightforward and preferred the sound demos where they heard a difference between the two scenarios. Personalization with Oticon instruments and Genie offers patient-centered care, including the patient in the fitting by letting her or him uncover personal preferences to sound and creating a hearing solution that the client is satisfied with. References 1. Laplante-Lévesque A, Jensen LD, Dawes P, Nielsen C (2013) Optimal Hearing Aid Use: Focus Groups With Hearing Aid Clients and Audiologists. Ear & Hearing, 34: PubMed: 2. DiMatteo MR, Haskard-Zolnierek KB, Martin LR (2011) Improving patient adherence: a three-factor model to guide practice. The Health Psychology Review, 1 18, ifirst, available from ResearchGate.net: adherence_a_three-factor_model_to_guide_practice 3. Grenness C, Hickson L, Laplante-Lévesque A, Meyer C, Davidson B (2015) The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations. Journal of the American Academy of Audiology, 26 (1), PubMed: 4. Poost-Foroosh L, Jennings MB, Cheesman M, (2015) Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions. Journal of the American Academy of Audiology, 23 (3); PubMed:

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