Early Adjustment to Amplification Results in Better Outcome Later On Steven L. Benton, Au.D.

Transcription

1 Early Adjustment to Amplification Results in Better Outcome Later On Steven L. Benton, Au.D. Department of Veterans Affairs Medical Center 1670 Clairmont Road Decatur, GA USA

2 Introduction Yund et al (2006): auditory acclimatization is improvement in speech perception that results from learning to use restored speech cues provided by a hearing aid. Turner & Bentler (1996): acclimatization effects not strong enough to impact hearing aid fitting paradigms Taylor (2007): Based on peer-reviewed evidence, the average length of time a patient may require to become accustomed to their hearing aids, regardless of user history, is approximately 30 days. Vestergaard (2006): outcome measures for first-time aid users improve over the first 13 weeks after the fitting, suggesting that outcome measures completed after this time period may accurately reflect true outcomes.

3 MarkeTrak VIII (Kochkin, Kochkin et al, 2010) Hearing aid factors 1. Overall benefit 6. Richness or fidelity of sound 2. Clarity of sound 7. Use in noisy situations 3. Value: price vs. performance 8. Ability to hear in small groups 4. Natural sound 9. Comfort with loud sounds 5. Reliability of the hearing aid 10. Sound of voice: occlusion Dispenser factors 1. Knowledge 2. Professionalism 3. Empathy 1. General health 2. Manual dexterity 3. Education Level 4. Expectations Patient factors 4. Creation of realistic expectations 5. Explained care and maintenance 6. Perceived quality of service 5. Unaided perceived functional handicap 6. Dexterity 7. Age

4 Research Question We were unable to identify any studies that compared the outcomes of hearing aid users who reported they did adjust to their hearing aids by 30 days after the fitting vs. the outcomes of those users who reported they did not adjust. We posed the following question: Does failure to successfully adjust to amplification by approximately 30 days after the fitting have an impact on later self-reported hearing aid outcomes?

5 Subjects Records were reviewed for hearing aid deliveries May 1 July 31, 2007, for the presence of two completed questionnaires: 1. A custom Clinic Questionnaire mailed to veterans three weeks after aid delivery; responses reflected status at approximately 30 days after the fitting. 2. The Satisfaction with Amplification in Daily Life questionnaire, or SADL (Cox et al, 1999, 2001), mailed to veterans 4 months after the fitting. Records indicated that 595 veterans received hearing aids during the review period. We captured 451 of these veterans (75.8%). Both questionnaires were returned by 171 subjects (37.9%).

6 Clinic Survey

7 Satisfaction with Amplification in Daily Life (SADL) Cox & Alexander, 1999, 2001

8 Subject Adjustment Groups The 171 subjects who returned both surveys were divided into two adjustment groups based on their responses to the Clinic Survey question: Have you adjusted to your new hearing aids? n = 131 (77%) n = 40 (23%) X age = 73.8 yrs SD = 8.27 X age = 74.0 yrs SD = Age: p >.05

9 Subject Adjustment Groups: Audiometric Findings Left Ear WRS% PTA-3 PTA-4 Slope Right Ear WRS% PTA-3 PTA-4 Slope WRS% = Word-rec score (Rec. NU6) PTA-3 = 3-freq avg (.5, 1, 2 khz) Figure 1 All p >.05 PTA-4 = 4-freq avg (1, 2, 3, 4 khz) Slope = [.5 4 khz]

10 7 6 Aid Experience New Users Exp d Users Subject Adjustment Groups: Aid Experience, Style & Brand 7 6 Aid Style 7 6 Aid Brand X 2 = 2.56, p >.05 BTE Custom Open Brand A Brand B Brand C X 2 = 2.06, p >.05 X 2 = 2.02, p >.05 Figure 2

11 9 Adjustment at 30 Days: Hours of Daily Use Full-Time Figure 3 Part Time X 2 = 7.93, p <.001

12 Adjustment at 30 Days: Experiencing Common Aid Problems 1. I can t balance the sound 2. They hurt my ears 3. They sound too unnatural 4. They make sounds too loud 5. I can t localize sound 6. They whistle too much 7. Too much background noise 8. I can t operate the controls 9. I can t insert them 10. Other 35% 25% 15% 5% NO Group YES Group Figure 4

13 Adjustment at 30 Days: Experiencing Common Aid Problems Aid Operation Problems 1. I can t balance the sound 8. I can t operate the controls 9. I can t insert them Sound Quality Problems 3. They sound too unnatural 4. They make sounds too loud 6. They whistle too much 35% 25% 15% 5% 7. Too much background noise Aid Operation Sound Quality Figure 5

14 Adjustment at 30 Days: Total Number of Common Aid Problems No Problems 1 or more 2 or more Figure 6 None vs. 1 or more : X 2 = 87.56, p <.001 None vs. 2 or more : X 2 =115.28, p <.001

15 Mean SADL Global and Subscale Scores at 4 months Global Positive Effect Negative Features Personal Image d = 0.67 d = 0.59 d = 0.57 n/s Figure 7 All p <.01 except Personal Image for both appointment groups (p >.05) (Cohen s d)

16 Negative, Neutral and Positive SADL Scores Global Positive Effect Negative Features Personal Image ALL COMBINED* Neg Neut Pos Neg Neut Pos Neg Neut Pos Neg Neut Pos Neg Neut Pos = Negative = Neutral = Positive Figure 8 *X 2 = 28.99, p <.001

17 Early Adjustment at 30 Days: Was an Appointment Requested? Number of Common Aid Problems d = 1.58 No Appt Yes Appt p <.03 p >.05 Figure 9

18 Early Adjustment at 30 Days: Was an Appointment Requested? No Appt Yes Appt Global* Positive Negative* Personal Effect Features Image Figure 10 *p <.02 + = correlation coefficient for # problems = p < No Appt Yes Appt Global * Positive Negative* Personal Effect Features Image

19 Conclusions and Discussion Early adjustment to hearing aids appears to be related to: 1. Longer daily hearing aid use. 2. Greater subjective satisfaction and better outcomes at approximately four months after the fitting. Furthermore: 1. Subjective need for a follow-up appointment at 30 days was related to poorer later outcomes, regardless of subjective adjustment status. 2. Measures obtained at 30 days can provide an accurate measure of a patient s adjustment to amplification. 3. Tools like the custom Clinic Survey described here may prove useful in program evaluation activities.

20 Conclusions and Discussion New program-evaluation project about to begin: Substantially larger subject pool. Substantially improved hearing aid technologies such as: Laser shells Improved noise management Improved feedback management Improved directionality Flagship products from nine on-contract hearing aid manufacturers. ECHO (Cox & Alexander, 2000) completed prior to initial aid counseling and selection. Vestergaard (2006): include expectations surveys as a part of measuring outcomes. Clinic Questionnaire completed at 30 days. SADL (Cox & Alexander, 1999, 2001) completed at 4 months. Special attention to type and number of follow-up visits over the following year.