The past decade has been characterized by significant changes in the distribution and sale of hea... more The past decade has been characterized by significant changes in the distribution and sale of hearing aids. Alternatives to the clinical technology, clinical channel, clinical service (i.e., traditional) hearing healthcare delivery model have been driven by growth in hearing aid dispensaries housed in large retail establishments and direct-to-consumer hearing aid sales by internet-based companies unaffiliated with major hearing aid manufacturers (e.g., Eargo). These developments have been accompanied by acceleration in the growth of teleaudiology services as a direct result of the COVID-19 pandemic. The resulting development of nontraditional hearing aid distribution and sales models can be categorized into distinct archetypes as reviewed earlier in this publication. This article will review the Clinical Technology–Consumer Channel–Clinical Service model as exemplified by Jabra Enhance. We will describe a completely digital model of hearing aid distribution and sales that maintains the professional service component throughout the client journey to include an online tone test, the use of a risk mitigation questionnaire, virtual consultations, remote hearing aid adjustments, and the establishment and monitoring of client-centered treatment goals. Furthermore, this article will review the Jabra Enhance model within the context of consumer healthcare decision-making theory with a focus on the Consumer Decision-Making Model.
Journal of Rehabilitation Research and Development, 2003
A speech-in-multitalker-babble test instrument was developed for use in a Department of Veterans ... more A speech-in-multitalker-babble test instrument was developed for use in a Department of Veterans Affairs (VA) multicenter study examining the effects of hearing loss on selfperceived quality of life. Word recognition in quiet and in multitalker babble was measured on 24 listeners with normal hearing and 24 listeners with sensorineural hearing loss. The protocol involved the presentation of 10 monosyllabic words (each in a unique babble segment) at each of seven signal-tobabble (S/B) ratios from 24 dB to 0 dB, with the babble fixed at 60 dB HL (hearing loss). Word recognition in quiet at 60 dB and 80 dB HL for both groups was >90% correct. Two trials on the task were conducted. In babble, the 50% correct points were at 4.1 dB and 9.4 dB S/B for the listeners with normal hearing and hearing loss, respectively, with the 90th percentile for the listeners with normal hearing at 6 dB S/B. Twenty-two of the twenty-four listeners with hearing loss had 50% correct points outside of the 90th percentile for listeners with normal hearing. Test-retest reliability was excellent.
The purpose of this study was to conduct a cost-utility analysis comparing two treatment approach... more The purpose of this study was to conduct a cost-utility analysis comparing two treatment approaches: (1) hearing aid use alone (HA) and (2) hearing aid use with short-term group postfitting audiologic rehabilitation (HA + AR). A total of 105 veterans, 67 males and 38 females, with at least a mild sensorineural hearing loss participated in this study. The SF-36V was administered to each participant before and after treatment. This instrument measures both mental component summary (MCS) scales and physical component summary (PCS) scales of quality of life. As a whole, the participants exhibited a statistically significant improvement in mean MCS scores pre- to postintervention, with average improvements of 1.4 and 3.0 points for the HA and HA + AR groups, respectively. With the use of the MCS scores, the results of a cost-utility analysis revealed that HA treatment cost $60.00 per quality-adjusted life year (QALY) gained, while HA + AR cost only $31.91 per QALY gained, making HA + AR the more cost-effective treatment.
Journal of The American Academy of Audiology, Jun 1, 2019
Background: The low uptake of hearing aids in the United States has been attributed to a number o... more Background: The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use. Purpose: The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss. Research Design: The study used a cross-sectional survey design. Study Sample: Five hundred and twelve participants completed an electronic survey. Data Collection and Analysis: The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach's alpha. Results: Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales. Conclusions: The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.
The goal of this study was to determine whether hearing aids in combination with computer-based a... more The goal of this study was to determine whether hearing aids in combination with computer-based auditory training improve audiovisual (AV) performance compared with the use of hearing aids alone. Twenty-four participants were randomized into an experimental group (hearing aids plus ReadMyQuips [RMQ] training) and a control group (hearing aids only). The Multimodal Lexical Sentence Test for Adults (Kirk et al., 2012) was used to measure auditory-only (AO) and AV speech perception performance at three signal-to-noise ratios (SNRs). Participants were tested at the time of hearing aid fitting (pretest), after 4 weeks of hearing aid use (posttest I), and again after 4 weeks of RMQ training (posttest II). Results did not reveal an effect of training. As expected, interactions were found between (a) modality (AO vs. AV) and SNR and (b) test (pretest vs. posttests) and SNR. Data do not show a significant effect of RMQ training on AO or AV performance as measured using the Multimodal Lexical Sentence Test for Adults.
In the coming decades, Americans with hearing and cognitive deficits will represent a growing pro... more In the coming decades, Americans with hearing and cognitive deficits will represent a growing proportion of the population. This article describes the rationale and goals of the second Starkey Research Summit, which was convened to better understand the challenges that an aging demographic represents to the future of hearing health care. A multidisciplinary group of scientists representing audiology, cognitive science, psychology, aging, and hearing science met in the fall of 2011 to explore key issues associated with the convergence of aging, hearing loss, and cognitive deficit. Four major topic areas were identified for discussion and further exploration: (a) the effects of aging on auditory processing and cognition; (b) the effects of hearing technology on auditory processing and cognition in the elderly; (c) the effects of training on auditory processing and cognition in the elderly; and (d) the effects of aging on hearing help-seeking behavior. A brief overview of each of the four major topic areas, to include the identification of unmet research needs, was prepared and is included in this issue of the American Journal of Audiology.
The objectives of this study were to investigate the effects of hearing aid use and the effective... more The objectives of this study were to investigate the effects of hearing aid use and the effectiveness of ReadMyQuips (RMQ), an auditory training program, on speech perception performance and auditory selective attention using electrophysiological measures. RMQ is an audiovisual training program designed to improve speech perception in everyday noisy listening environments. Design: Participants were adults with mild to moderate hearing loss who were first-time hearing aid users. After 4 weeks of hearing aid use, the experimental group completed RMQ training in 4 weeks, and the control group received listening practice on audiobooks during the same period. Cortical late event-related potentials (ERPs) and the Hearing in Noise Test (HINT) were administered at prefitting, pretraining, and post-training to assess effects of hearing aid use and RMQ training. An oddball paradigm allowed tracking of changes in P3a and P3b ERPs to distractors and targets, respectively. Behavioral measures were also obtained while ERPs were recorded from participants. Results: After 4 weeks of hearing aid use but before auditory training, HINT results did not show a statistically significant change, but there was a significant P3a reduction. This reduction in P3a was correlated with improvement in d prime (d′) in the selective attention task. Increased P3b amplitudes were also correlated with improvement in d′ in the selective attention task. After training, this correlation between P3b and d′ remained in the experimental group, but not in the control group. Similarly, HINT testing showed improved speech perception post training only in the experimental group. The criterion calculated in the auditory selective attention task showed a reduction only in the experimental group after training. ERP measures in the auditory selective attention task did not show any changes related to training. Conclusions: Hearing aid use was associated with a decrement in involuntary attention switch to distractors in the auditory selective attention task. RMQ training led to gains in speech perception in noise and improved listener confidence in the auditory selective attention task.
Journal of The American Academy of Audiology, Feb 1, 2007
This is the final report of the American Academy of Audiology Task Force on the Health-Related Qu... more This is the final report of the American Academy of Audiology Task Force on the Health-Related Quality of Life (HRQoL) Benefits of Amplification in A d u l t s. A systematic review with meta-analysis examined evidence pertaining to the use of hearing aids for improving HRQoL for adults with sensorineural hearing loss (SNHL). Relevant search strings applied to the C E N T R A L, CINAHL, Cochrane reviews, ComDisDome, EBMR, and PubMed databases identified randomized controlled trial, quasi-experimental, and nonexperimental pretest/posttest designed studies. Sixteen studies met a priori criteria for inclusion in this review. A r a n d o me ffects meta-analysis showed differential results for generic versus disease-specific HRQoL measures for within-and betweensubject designs. Although generic measures used for within-subject designs did not demonstrate HRQoL benefits from hearing aids, mean effect sizes and confidence intervals for within-subject designs and disease-specific instruments suggested that hearing aids have a small-to-medium impact on HRQoL. F u r t h e r, the between-subject studies supported at least a small effect for generic measures, and when measured by disease-specific instruments, hearing aids had medium-to-large effects on adults' HRQoL. This review concludes that hearing aids improve adults' H R Q o L by reducing psychological, social, and emotional effects of SNHL. Future studies should include control groups using randomized controlled trials.
This article describes the perspectives of hearing device manufacturers regarding the exciting de... more This article describes the perspectives of hearing device manufacturers regarding the exciting developments that the Internet makes possible. Specifically, it proposes to join forces toward interoperability and standardization of Internet and audiology. A summary of why such a collaborative effort is required is provided from historical and scientific perspectives. A roadmap toward interoperability and standardization is proposed. Information and communication technologies improve the flow of health care data and pave the way to better health care. However, hearing-related products, features, and services are notoriously heterogeneous and incompatible with other health care systems (no interoperability). Standardization is the process of developing and implementing technical standards (e.g., Noah hearing database). All parties involved in interoperability and standardization realize mutual gains by making mutually consistent decisions. De jure (officially endorsed) standards can be developed in collaboration with large national health care systems as well as spokespeople for hearing care professionals and hearing device users. The roadmap covers mutual collaboration; data privacy, security, and ownership; compliance with current regulations; scalability and modularity; and the scope of interoperability and standards. We propose to join forces to pave the way to the interoperable Internet and audiology products, features, and services that the world needs.
Table 1 shows the breakdown of demographic characteristics for the overall group and separately f... more Table 1 shows the breakdown of demographic characteristics for the overall group and separately for the Experimental (n=15) and Control (n=15) groups. Mean age for the overall group was 67 years with 67% male. 22 participants reported their tinnitus to be "always" present, and 27 had experienced their tinnitus for 3 or more years. 40% of the overall group reported a "big" to "very big" problem with their tinnitus, 57% reported a "moderate" problem, and 3% reported a "slight" problem with their tinnitus. A Chi-Square analysis revealed no significant differences (p>0.05) between the two groups within each of the demographic characteristics.
Journal of the Acoustical Society of America, Oct 1, 2022
Speech perception testing, defined as providing standardized speech stimuli and requiring a liste... more Speech perception testing, defined as providing standardized speech stimuli and requiring a listener to provide a behavioral and scored response, has been an integral part of the audiologic test battery since the beginning of the audiology profession. Over the past several decades, limitations in the diagnostic and prognostic validity of standard speech perception testing as routinely administered in the clinic have been noted, and the promotion of speech-in-noise testing has been highlighted. This review will summarize emerging and innovative approaches to speech-in-noise testing with a focus on five applications: (1) pediatric considerations promoting the measurement of sensory and cognitive components separately; (2) appropriately serving underrepresented populations with special attention to racial, ethnic, and linguistic minorities, as well as considering biological sex and/or gender differences as variables of interest; (3) binaural fitness for duty assessments of functional hearing for occupational settings that demand the ability to detect, recognize, and localize sounds; (4) utilization of speech-in-noise tests in pharmacotherapeutic clinical trials with considerations to the drug mechanistic action, the patient populations, and the study design; and (5) online and mobile applications of hearing assessment that increase accessibility and the direct-to-consumer market.
The past decade has been characterized by significant changes in the distribution and sale of hea... more The past decade has been characterized by significant changes in the distribution and sale of hearing aids. Alternatives to the clinical technology, clinical channel, clinical service (i.e., traditional) hearing healthcare delivery model have been driven by growth in hearing aid dispensaries housed in large retail establishments and direct-to-consumer hearing aid sales by internet-based companies unaffiliated with major hearing aid manufacturers (e.g., Eargo). These developments have been accompanied by acceleration in the growth of teleaudiology services as a direct result of the COVID-19 pandemic. The resulting development of nontraditional hearing aid distribution and sales models can be categorized into distinct archetypes as reviewed earlier in this publication. This article will review the Clinical Technology–Consumer Channel–Clinical Service model as exemplified by Jabra Enhance. We will describe a completely digital model of hearing aid distribution and sales that maintains the professional service component throughout the client journey to include an online tone test, the use of a risk mitigation questionnaire, virtual consultations, remote hearing aid adjustments, and the establishment and monitoring of client-centered treatment goals. Furthermore, this article will review the Jabra Enhance model within the context of consumer healthcare decision-making theory with a focus on the Consumer Decision-Making Model.
Journal of Rehabilitation Research and Development, 2003
A speech-in-multitalker-babble test instrument was developed for use in a Department of Veterans ... more A speech-in-multitalker-babble test instrument was developed for use in a Department of Veterans Affairs (VA) multicenter study examining the effects of hearing loss on selfperceived quality of life. Word recognition in quiet and in multitalker babble was measured on 24 listeners with normal hearing and 24 listeners with sensorineural hearing loss. The protocol involved the presentation of 10 monosyllabic words (each in a unique babble segment) at each of seven signal-tobabble (S/B) ratios from 24 dB to 0 dB, with the babble fixed at 60 dB HL (hearing loss). Word recognition in quiet at 60 dB and 80 dB HL for both groups was >90% correct. Two trials on the task were conducted. In babble, the 50% correct points were at 4.1 dB and 9.4 dB S/B for the listeners with normal hearing and hearing loss, respectively, with the 90th percentile for the listeners with normal hearing at 6 dB S/B. Twenty-two of the twenty-four listeners with hearing loss had 50% correct points outside of the 90th percentile for listeners with normal hearing. Test-retest reliability was excellent.
The purpose of this study was to conduct a cost-utility analysis comparing two treatment approach... more The purpose of this study was to conduct a cost-utility analysis comparing two treatment approaches: (1) hearing aid use alone (HA) and (2) hearing aid use with short-term group postfitting audiologic rehabilitation (HA + AR). A total of 105 veterans, 67 males and 38 females, with at least a mild sensorineural hearing loss participated in this study. The SF-36V was administered to each participant before and after treatment. This instrument measures both mental component summary (MCS) scales and physical component summary (PCS) scales of quality of life. As a whole, the participants exhibited a statistically significant improvement in mean MCS scores pre- to postintervention, with average improvements of 1.4 and 3.0 points for the HA and HA + AR groups, respectively. With the use of the MCS scores, the results of a cost-utility analysis revealed that HA treatment cost $60.00 per quality-adjusted life year (QALY) gained, while HA + AR cost only $31.91 per QALY gained, making HA + AR the more cost-effective treatment.
Journal of The American Academy of Audiology, Jun 1, 2019
Background: The low uptake of hearing aids in the United States has been attributed to a number o... more Background: The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use. Purpose: The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss. Research Design: The study used a cross-sectional survey design. Study Sample: Five hundred and twelve participants completed an electronic survey. Data Collection and Analysis: The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach's alpha. Results: Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales. Conclusions: The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.
The goal of this study was to determine whether hearing aids in combination with computer-based a... more The goal of this study was to determine whether hearing aids in combination with computer-based auditory training improve audiovisual (AV) performance compared with the use of hearing aids alone. Twenty-four participants were randomized into an experimental group (hearing aids plus ReadMyQuips [RMQ] training) and a control group (hearing aids only). The Multimodal Lexical Sentence Test for Adults (Kirk et al., 2012) was used to measure auditory-only (AO) and AV speech perception performance at three signal-to-noise ratios (SNRs). Participants were tested at the time of hearing aid fitting (pretest), after 4 weeks of hearing aid use (posttest I), and again after 4 weeks of RMQ training (posttest II). Results did not reveal an effect of training. As expected, interactions were found between (a) modality (AO vs. AV) and SNR and (b) test (pretest vs. posttests) and SNR. Data do not show a significant effect of RMQ training on AO or AV performance as measured using the Multimodal Lexical Sentence Test for Adults.
In the coming decades, Americans with hearing and cognitive deficits will represent a growing pro... more In the coming decades, Americans with hearing and cognitive deficits will represent a growing proportion of the population. This article describes the rationale and goals of the second Starkey Research Summit, which was convened to better understand the challenges that an aging demographic represents to the future of hearing health care. A multidisciplinary group of scientists representing audiology, cognitive science, psychology, aging, and hearing science met in the fall of 2011 to explore key issues associated with the convergence of aging, hearing loss, and cognitive deficit. Four major topic areas were identified for discussion and further exploration: (a) the effects of aging on auditory processing and cognition; (b) the effects of hearing technology on auditory processing and cognition in the elderly; (c) the effects of training on auditory processing and cognition in the elderly; and (d) the effects of aging on hearing help-seeking behavior. A brief overview of each of the four major topic areas, to include the identification of unmet research needs, was prepared and is included in this issue of the American Journal of Audiology.
The objectives of this study were to investigate the effects of hearing aid use and the effective... more The objectives of this study were to investigate the effects of hearing aid use and the effectiveness of ReadMyQuips (RMQ), an auditory training program, on speech perception performance and auditory selective attention using electrophysiological measures. RMQ is an audiovisual training program designed to improve speech perception in everyday noisy listening environments. Design: Participants were adults with mild to moderate hearing loss who were first-time hearing aid users. After 4 weeks of hearing aid use, the experimental group completed RMQ training in 4 weeks, and the control group received listening practice on audiobooks during the same period. Cortical late event-related potentials (ERPs) and the Hearing in Noise Test (HINT) were administered at prefitting, pretraining, and post-training to assess effects of hearing aid use and RMQ training. An oddball paradigm allowed tracking of changes in P3a and P3b ERPs to distractors and targets, respectively. Behavioral measures were also obtained while ERPs were recorded from participants. Results: After 4 weeks of hearing aid use but before auditory training, HINT results did not show a statistically significant change, but there was a significant P3a reduction. This reduction in P3a was correlated with improvement in d prime (d′) in the selective attention task. Increased P3b amplitudes were also correlated with improvement in d′ in the selective attention task. After training, this correlation between P3b and d′ remained in the experimental group, but not in the control group. Similarly, HINT testing showed improved speech perception post training only in the experimental group. The criterion calculated in the auditory selective attention task showed a reduction only in the experimental group after training. ERP measures in the auditory selective attention task did not show any changes related to training. Conclusions: Hearing aid use was associated with a decrement in involuntary attention switch to distractors in the auditory selective attention task. RMQ training led to gains in speech perception in noise and improved listener confidence in the auditory selective attention task.
Journal of The American Academy of Audiology, Feb 1, 2007
This is the final report of the American Academy of Audiology Task Force on the Health-Related Qu... more This is the final report of the American Academy of Audiology Task Force on the Health-Related Quality of Life (HRQoL) Benefits of Amplification in A d u l t s. A systematic review with meta-analysis examined evidence pertaining to the use of hearing aids for improving HRQoL for adults with sensorineural hearing loss (SNHL). Relevant search strings applied to the C E N T R A L, CINAHL, Cochrane reviews, ComDisDome, EBMR, and PubMed databases identified randomized controlled trial, quasi-experimental, and nonexperimental pretest/posttest designed studies. Sixteen studies met a priori criteria for inclusion in this review. A r a n d o me ffects meta-analysis showed differential results for generic versus disease-specific HRQoL measures for within-and betweensubject designs. Although generic measures used for within-subject designs did not demonstrate HRQoL benefits from hearing aids, mean effect sizes and confidence intervals for within-subject designs and disease-specific instruments suggested that hearing aids have a small-to-medium impact on HRQoL. F u r t h e r, the between-subject studies supported at least a small effect for generic measures, and when measured by disease-specific instruments, hearing aids had medium-to-large effects on adults' HRQoL. This review concludes that hearing aids improve adults' H R Q o L by reducing psychological, social, and emotional effects of SNHL. Future studies should include control groups using randomized controlled trials.
This article describes the perspectives of hearing device manufacturers regarding the exciting de... more This article describes the perspectives of hearing device manufacturers regarding the exciting developments that the Internet makes possible. Specifically, it proposes to join forces toward interoperability and standardization of Internet and audiology. A summary of why such a collaborative effort is required is provided from historical and scientific perspectives. A roadmap toward interoperability and standardization is proposed. Information and communication technologies improve the flow of health care data and pave the way to better health care. However, hearing-related products, features, and services are notoriously heterogeneous and incompatible with other health care systems (no interoperability). Standardization is the process of developing and implementing technical standards (e.g., Noah hearing database). All parties involved in interoperability and standardization realize mutual gains by making mutually consistent decisions. De jure (officially endorsed) standards can be developed in collaboration with large national health care systems as well as spokespeople for hearing care professionals and hearing device users. The roadmap covers mutual collaboration; data privacy, security, and ownership; compliance with current regulations; scalability and modularity; and the scope of interoperability and standards. We propose to join forces to pave the way to the interoperable Internet and audiology products, features, and services that the world needs.
Table 1 shows the breakdown of demographic characteristics for the overall group and separately f... more Table 1 shows the breakdown of demographic characteristics for the overall group and separately for the Experimental (n=15) and Control (n=15) groups. Mean age for the overall group was 67 years with 67% male. 22 participants reported their tinnitus to be "always" present, and 27 had experienced their tinnitus for 3 or more years. 40% of the overall group reported a "big" to "very big" problem with their tinnitus, 57% reported a "moderate" problem, and 3% reported a "slight" problem with their tinnitus. A Chi-Square analysis revealed no significant differences (p>0.05) between the two groups within each of the demographic characteristics.
Journal of the Acoustical Society of America, Oct 1, 2022
Speech perception testing, defined as providing standardized speech stimuli and requiring a liste... more Speech perception testing, defined as providing standardized speech stimuli and requiring a listener to provide a behavioral and scored response, has been an integral part of the audiologic test battery since the beginning of the audiology profession. Over the past several decades, limitations in the diagnostic and prognostic validity of standard speech perception testing as routinely administered in the clinic have been noted, and the promotion of speech-in-noise testing has been highlighted. This review will summarize emerging and innovative approaches to speech-in-noise testing with a focus on five applications: (1) pediatric considerations promoting the measurement of sensory and cognitive components separately; (2) appropriately serving underrepresented populations with special attention to racial, ethnic, and linguistic minorities, as well as considering biological sex and/or gender differences as variables of interest; (3) binaural fitness for duty assessments of functional hearing for occupational settings that demand the ability to detect, recognize, and localize sounds; (4) utilization of speech-in-noise tests in pharmacotherapeutic clinical trials with considerations to the drug mechanistic action, the patient populations, and the study design; and (5) online and mobile applications of hearing assessment that increase accessibility and the direct-to-consumer market.
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