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Impact of Hearing Aid Technology on Outcomes in Daily Life I: The Patients’ Perspective

Cox, Robyn M.; Johnson, Jani A.; Xu, Jingjing

doi: 10.1097/AUD.0000000000000277
e-Research Articles

Objectives: One of the challenges facing hearing care providers when recommending hearing aids is the choice of device technology level. Major manufacturers market families of hearing aids that are described as spanning the range from basic technology to premium technology. Premium technology hearing aids include acoustical processing capabilities (features) that are not found in basic technology instruments. These premium features are intended to yield improved hearing in daily life compared with basic-feature devices. However, independent research that establishes the incremental effectiveness of premium-feature devices compared with basic-feature devices is lacking. This research was designed to explore reported differences in hearing abilities for adults using premium- and basic-feature hearing aids in their daily lives.

Design: This was a single-blinded, repeated, crossover trial in which the participants were blinded. All procedures were carefully controlled to limit researcher bias. Forty-five participants used carefully fitted bilateral hearing aids for 1 month and then provided data to describe the hearing improvements or deficiencies noted in daily life. Typical participants were 70 years old with mild to moderate adult-onset hearing loss bilaterally. Each participant used four pairs of hearing aids: premium- and basic-feature devices from brands marketed by each of two major manufacturers. Participants were blinded about the devices they used and about the research questions.

Results: All of the outcomes were designed to capture the participant’s point of view about the benefits of the hearing aids. Three types of data were collected: change in hearing-related quality of life, extent of agreement with six positively worded statements about everyday hearing with the hearing aids, and reported preferences between the premium- and basic-feature devices from each brand as well as across all four research hearing aids combined. None of these measures yielded a statistically significant difference in outcomes between premium- and basic-feature devices. Participants did not report better outcomes with premium processing with any measure.

Conclusions: It could reasonably be asserted that the patient’s perspective is the gold standard for hearing aid effectiveness. While the acoustical processing provided by premium features can potentially improve scores on tests conducted in contrived conditions in a laboratory, or on specific items in a questionnaire, this does not ensure that the processing will be of noteworthy benefit when the hearing aid is used in the real world challenges faced by the patient. If evidence suggests the patient cannot detect that premium features yield improvements over basic features in daily life, what is the responsibility of the provider in recommending hearing aid technology level? In the present research, there was no evidence to suggest that premium-feature devices yielded better outcomes than basic-feature devices from the patient’s point of view. All of the research hearing aids were substantially, but equally, helpful. Further research is needed on this topic with other hearing aids and other manufacturers. In the meantime, providers should insist on scientifically credible independent evidence to support effectiveness claims for any hearing help devices.

Hearing aid providers are faced with the challenge of recommending the most appropriate technology level for each patient. Premium technology is more costly but is claimed to yield better hearing outcomes than basic technology, despite the lack of independent evidence to support these claims. This research explored differences in effectiveness for premium and basic technology hearing aids used by older adults in blinded field trials. Outcome measures captured the reported benefits or deficits yielded by each type of hearing aid in the individual’s everyday life situations. All tested devices were helpful. However, premium and basic technology devices were equally effective.Supplemental Digital Content is available in the text.

School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee, USA.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (

All authors contributed equally to this study.

The authors have no conflicts of interest to disclose.

Received June 30, 2015; accepted December 17, 2015.

Address for correspondence: Jani A. Johnson, School of Communication Sciences & Disorders, University of Memphis, 4055 North Park Loop, Memphis, TN 38152, USA. E-mail:

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