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Impact of Hearing Aid Technology on Outcomes in Daily Life II: Speech Understanding and Listening Effort

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

doi: 10.1097/AUD.0000000000000327
Research Articles

Objectives: Modern hearing aid (HA) devices include a collection of acoustic signal-processing features designed to improve listening outcomes in a variety of daily auditory environments. Manufacturers market these features at successive levels of technological sophistication. The features included in costlier premium hearing devices are designed to result in further improvements to daily listening outcomes compared with the features included in basic hearing devices. However, independent research has not substantiated such improvements. This research was designed to explore differences in speech-understanding and listening-effort outcomes for older adults using premium-feature and basic-feature HAs in their daily lives.

Design: For this participant-blinded, repeated, crossover trial 45 older adults (mean age 70.3 years) with mild-to-moderate sensorineural hearing loss wore each of four pairs of bilaterally fitted HAs for 1 month. HAs were premium- and basic-feature devices from two major brands. After each 1-month trial, participants’ speech-understanding and listening-effort outcomes were evaluated in the laboratory and in daily life.

Results: Three types of speech-understanding and listening-effort data were collected: measures of laboratory performance, responses to standardized self-report questionnaires, and participant diary entries about daily communication. The only statistically significant superiority for the premium-feature HAs occurred for listening effort in the loud laboratory condition and was demonstrated for only one of the tested brands.

Conclusions: The predominant complaint of older adults with mild-to-moderate hearing impairment is difficulty understanding speech in various settings. The combined results of all the outcome measures used in this research suggest that, when fitted using scientifically based practices, both premium- and basic-feature HAs are capable of providing considerable, but essentially equivalent, improvements to speech understanding and listening effort in daily life for this population. For HA providers to make evidence-based recommendations to their clientele with hearing impairment it is essential that further independent research investigates the relative benefit/deficit of different levels of hearing technology across brands and manufacturers in these and other real-world listening domains.

Modern hearing aid devices comprise a collection of acoustic signal processing features designed to lessen auditory disability in a variety of daily listening environments. Features incorporated into premium-level hearing aids are assumed to result in further improvements to daily listening outcomes compared with features incorporated into basic-level hearing aids. Overall, comparisons of speech understanding and listening effort outcomes obtained in the laboratory and in daily life with premium and basic levels of hearing aid technologies did not support this assumption.

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

The authors have no conflicts of interest to disclose.

Received July 29, 2015; accepted March 31, 2016.

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

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