takahashi et al: subjective measures of hearing aid ...€¦ · karen sugiura† gene w. bratt§**...

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J Am Acad Audiol 18:323–349 (2007)

*VA Medical Center, Iowa City, IA; †Greater Los Angeles Healthcare System, Los Angeles, CA; ‡VA Medical Center,Washington, DC; §VA Tennessee Valley Healthcare System; **Department of Hearing and Speech Science, Vanderbilt BillWilkerson Center, Vanderbilt University, Nashville, TN; ††VA Cooperative Studies Program Coordinating Center, Hines, IL

Gail Takahashi, Audiology and Speech Pathology Service, VA Medical Center, 601 Highway 6 West, Iowa City, IA 52246;Phone: 319-339-7126; Fax: 319-887-4956; E-mail: [email protected]

This paper was presented in part at the Annual Convention of the American Speech-Language-Hearing Association, November2004, Philadelphia, and at the Annual Meeting of the Association of VA Audiologists, March 2005, Washington, DC.

Supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Healthand by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development.

Subjective Measures of Hearing AidBenefit and Satisfaction in the NIDCD/VAFollow-Up Study

Gail Takahashi*Charles D. Martinez†Sharon Beamer‡Julie Bridges*Douglas Noffsinger†Karen Sugiura†Gene W. Bratt§**David W. Williams††

Abstract

Perceived benefit, satisfaction, and hearing aid use patterns were measuredin a follow-up study to a large-scale multi-site clinical trial conducted in 1996–97.Measures included the Hearing Aid Status Questionnaire, the Profile of HearingAid Benefit, the Glasgow Hearing Aid Benefit Profile, the Satisfaction withAmplification in Daily Life, and the International Outcome Inventory for HearingAids. On the Profile of Hearing Aid Benefit, hearing aid users indicated moreunaided difficulty in easy listening situations and less aided benefit in more difficultlistening situations compared to the original study. Subjects who no longer usedhearing aids indicated less difficulty in unaided situations. All measuresindicated significant long-term subjective benefit and satisfaction with hearingaids. Although understanding speech in noise or in group situations continuesto be problematic, subjects reported wearing their hearing aids almost all ofthe time in both easy and difficult listening situations.

Key Words: Benefit, hearing aids, outcome measures, satisfaction, subjectivemeasures

Abbreviations: AV = Aversiveness of Sounds; BN = Background Noise; DS= Distortion of Sounds; EC = Ease of Communication; FT = Familiar Talkers;Glasgow = Glasgow Hearing Aid Benefit Profile; HASQ = Hearing Aid StatusQuestionnaire; IOI-HA = International Outcome Inventory for Hearing Aids;NIDCD = National Institute on Deafness and Other Communication Disorders;PHAB = Profile of Hearing Aid Benefit; PHAP = Profile of Hearing AidPerformance; RC = Reduced Cues; RV = Reverberation; SADL = Satisfactionwith Amplification in Daily Life; VA = Veterans Affairs; WDRC = wide dynamicrange compression

Both subjective and objective outcomemeasures have been used to assesshearing aid benefit and satisfaction.

This paper focuses on subjective outcomemeasures in a group of 164 participantsfrom the original NIDCD/VA (NationalInstitute on Deafness and OtherCommunication Disorders/Veterans Affairs)cohort of 360 participants who were avail-able for follow-up testing afterapproximately six years of hearing aid use.The specific aims of this follow-up studywere to examine perceived benefit from andsatisfaction with hearing aids after pro-longed hearing aid use, and to comparebenefit and satisfaction measures for cur-rent hearing aid users versus nonusers.

Several questionnaires were used toassess hearing aid satisfaction and benefit.These included the Hearing Aid StatusQuestionnaire (HASQ; Boothroyd andNoffsinger, 2001), the Profile of Hearing AidPerformance (PHAP; Cox and Gilmore,1990), the Profile of Hearing Aid Benefit

(PHAB; Cox and Rivera, 1992), the GlasgowHearing Aid Benefit Profile (referred to inthis paper as “Glasgow”; Gatehouse, 1999),the Satisfaction with Amplification in DailyLife (SADL; Cox and Alexander, 1999), andthe International Outcome Inventory forHearing Aids (IOI-HA; Cox et al, 2000). ThePHAP and PHAB were administered in boththe original and follow-up studies. TheHASQ, Glasgow, SADL, and IOI-HA weredeveloped more recently and were used onlyin the follow-up study.

METHOD

Participants

The number of participants variedslightly depending on the outcome meas-ure and whether or not complete sets of datawere available. All participants had sen-sorineural hearing loss. The mean age ofthe participants was 73.2 years (range = 36

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Sumario

Se midió el beneficio y la satisfacción del paciente y los patrones de uso delauxiliar auditivo (AA) en un estudio de seguimiento de un estudio clínico,multicéntrico, a larga escala, conducido en 1996–97. Las mediciones incluyeronel Cuestionario del Estado de Uso del Auxiliar Auditivo, el Perfil de Beneficiodel Auxiliar Auditivo, El Perfil de Glasgow de Beneficio del Auxiliar Auditivo, laPrueba de Satisfacción con la Amplificación en la Vida Diaria, y el InventarioInternacional de Resultados de Auxiliares Auditivos. En el Perfil de Beneficiode Auxiliares Auditivos, los usuarios de AA indicaron más dificultad sinamplificación en situaciones fáciles de escucha y menor beneficio conamplificación en situaciones difíciles de escucha, comparado con el estudiooriginal. Los sujetos que no volvieron a usar sus AA indicaron menos dificultaden situaciones no amplificadas. Todas las medidas indicaron una satisfaccióny un beneficio subjetivo y significativo a largo plazo, con los AA. Aunqueentender el lenguaje en ruido o en situaciones grupales continúa siendoproblemático, los sujetos reportaron la utilización de sus AA casi todo eltiempo, tanto en situaciones fáciles como difíciles de escucha.

Palabras Clave: Beneficio, auxiliares auditivos, medidas de desempeño,satisfacción, medidas subjetivas

Abreviaturas: AV = Rechazo de Sonidos; BN = Ruido de Fondo; DS =Distorsión de Sonidos; EC = Facilidad de Comunicación; FT = HablantesFamiliares; Glasgow = Perfil de Glasgow de Beneficio del Auxiliar Auditivo; HASQ= Cuestionario del Estado de Uso de los Auxiliar Auditivo; IOI-HA = InventarioInternacional de Desempeño con Auxiliares Auditivos; NIDCD = InstitutoNacional de Sordera y otros Trastornos Comunicativos; PHAB = Perfil deBeneficio del Auxiliar Auditivo; PHAP = Perfil de Desempeño del AuxiliarAuditivo; RC = Claves Reducidas; RV = Reverberación; SADL = Satisfaccióncon la Amplificación en la Vida Diaria; VA = Asuntos de Veteranos; WDRC =Compresión de rango dinámico amplio

to 96 years), 38% were female, and 76%were veterans. Mean thresholds for the par-ticipants in the follow-up study were slightlypoorer compared to the mean thresholds forthese same participants in the originalstudy. See Bratt et al (in this issue) fordetailed information about the participants.

Based upon responses to the IOI-HA,most participants (84%) who were identi-fied as hearing aid users wore their hearingaids at least one hour per day. Of these, 55%were still using the hearing aids they weregiven in the original study. See Peek et al(in this issue) for details about the hearingaids the participants used.

The subjective measures were adminis-tered to those participants available foreither clinic or home visits (total n = 197).Of this cohort, the unaided PHAP wasadministered to 162 hearing aid users and33 nonusers who had not worn hearing aidsduring the preceding month. The Glasgowalso was administered to both hearing aidusers (n = 164) and nonusers (n = 32). Incontrast, the aided PHAP, SADL, and IOI-HA were administered only to currenthearing aid users.

Participants had the option of complet-ing all measures in the follow-up study(including audiometrics, hearing aid elec-troacoustic measurements, speechperception testing, and subjective ques-tionnaires) in one or two visits. If there weretwo visits, all subjective tests were admin-istered during the second visit. Total testingtime for all of the measures was less thanfour hours over the two visits. Less thanone hour was required to complete the sub-jective measures reported in this paper. Theorder of the questionnaire administrationwas not randomized, in an attempt to stan-dardize possible effects of fatigue. By usinga set test order, participants would morelikely have similar relative levels of fatigueon a particular test. Participants were pro-vided breaks as needed.

Hearing Aid Status Questionnaire

No survey tool was found that would pro-vide the information desired about hearingaid usage since the first study. Consequently,the Hearing Aid Status Questionnaire(HASQ; Boothroyd and Noffsinger, 2001; seeAppendix A) was created for the NIDCD/VAstudy to look at several areas. The first area

had to do with whether or not the partici-pants obtained different hearing aids sincethe first study. If they did, reasons for thechange they did were sought, and partici-pants were asked about their satisfactionwith the new devices. The second area con-centrated on how much participants usedtheir hearing aids and in what situations.In the third area, the emphasis was on howmuch trouble participants had when lis-tening in a variety of circumstances,regardless of how much they used hearingaids. The fourth area focused on participantswho seldom or never used hearing aids andasked about the reasons for the lack of usage.Other questions looked at special issues suchas why some participants used only onehearing aid.

One hundred eighty-one of the partici-pating participants completed the HASQ.It was administered by a research audiolo-gist during the first visit after completionof the consent process and prior to per-forming audiometric testing. Questions wereread to the participants, who then gaveverbal responses. A laminated card dis-playing the five choices for each of thequestions was viewable by the subject. Sincenot all questions were applicable to all ofthe participants, sample sizes for the ques-tions varied.

Profile of Hearing Aid Performanceand Profile of Hearing Aid Benefit

The Profile of Hearing Aid Performance(PHAP) consists of 66 items that assesseveryday listening experiences with andwithout hearing aids. For each statementon the PHAP (for example, “I have to askpeople to repeat themselves in one-on-oneconversations in a quiet room”), the subjectmakes a judgment as to the percent of timethe statement is true. There are seven pos-sible choices: Always (99%), Almost Always(87%), Generally (75%), Half-the-time (50%),Occasionally (25%), Seldom (12%), andNever (1%). A higher PHAP score indicatesmore perceived difficulty in a particular lis-tening situation. The Profile of Hearing AidBenefit (PHAB) compares unaided and aidedPHAP scores (unaided PHAP minus aidedPHAP) to provide information about hear-ing aid benefit. A positive PHAB scoreindicates perceived benefit.

There are seven subscales on the

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PHAP/PHAB. Five subscales address speechunderstanding (Ease of Communication[EC], Familiar Talkers [FT], Reverberation[RV], Reduced Cues [RC], and BackgroundNoise [BN]), and two subscales address prob-lems related to environmental sounds anddistorted sounds (Aversiveness of Sounds[AV] and Distortion of Sounds [DS]). ThePHAP/PHAB was administered in the orig-inal study and in the long-term follow-upstudy using a pencil and paper format.

Glasgow Hearing Aid Benefit Profile

The Glasgow Hearing Aid BenefitProfile (Glasgow) consists of four pre-spec-ified listening situations and up to fourclient-specified listening situations, eachof which is evaluated on two scales (InitialDisability, Handicap) prior to being fit withhearing aids and four scales (Use, Benefit,Residual Disability, and Satisfaction) afterbeing fit with hearing aids. The Glasgowwas modeled on the InternationalClassification of Impairments, Disabilities,and Handicaps (World HealthOrganization, 1980), which has since beenupdated (International Classification ofFunctioning, Disability and Health; WorldHealth Organization, 2001).

Only the four pre-specified situations wereused in the follow-up study. They were: (1)Listening to the television with other familyor friends when the volume is adjusted tosuit other people; (2) Having a conversationwith one other person when there is no back-ground noise; (3) Carrying on a conversationin a busy street or shop; and (4) Having aconversation with several people in a group.The questionnaire was administered in aninterview style by the study audiologist.Participants could specify that a given situ-ation was not applicable to them. If thesituation was applicable, there were five pos-sible responses, which varied in wordingdepending on the situation of interest.

Satisfaction with Amplification inDaily Life

The Satisfaction with Amplification inDaily Life (SADL) is a self-administeredquestionnaire that was designed to meas-ure satisfaction with hearing aids. TheSADL asks 15 questions related to hearingaids and uses a seven-category scale to yield

a global score and scores on four subscales(Positive Effect, Service and Cost, NegativeFeatures, and Personal Image). In thefollow-up study, 14 of the 15 questions wereused. The six questions on the PositiveEffect subscale mostly concern the benefitsof hearing aid use (e.g., “Compared to usingno hearing aid at all, do your hearing aidshelp you understand the people you speakwith most frequently?”). The two questionson the Service and Cost subscale addressthe dependability of the hearing aids andthe competency of the provider. The Serviceand Cost subscale has an additional ques-tion related to the reasonableness of thecost of the hearing aids. This question wasomitted since the study hearing aids wereprovided at no cost to the participants. TheNegative Features subscale consists of threeitems that concern background noise, feed-back, and telephone use. Finally, the threequestions on the Personal Image subscalefocus on self-image related to wearing hear-ing aids. Scores represent averageresponses, with higher scores indicatingmore satisfaction. There are additionalquestions after the items on the SADLproper regarding hearing aid experienceand the degree of hearing difficulty with-out a hearing aid (none, mild, moderate,moderate-severe, or severe). The SADL isa relatively new measurement tool and wasadministered only in the follow-up studyusing a pencil and paper format. Data arereported for current hearing aid users only.

International Outcome Inventory forHearing Aids

The International Outcome Inventoryfor Hearing Aids (IOI-HA) is a short self-assessment tool designed to examinehearing aid outcomes in seven areas: use,benefit, activity limitations, satisfaction,participation restrictions, impact on others,and quality of life. There are five possibleresponses for each of seven items, and ahigher score indicates a better outcome. TheIOI-HA is intended to be a supplementaloutcome measure that facilitates compari-son of data across studies.

The IOI-HA was administered using apencil and paper format. It was modifiedfor use in the current study as follows. Thequestion regarding hearing aid use askedabout use in the past month and in the past


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five years rather than in the past two weeks.In addition, time period references (“overthe past month” or “over the past twoweeks”) in the questions regarding partic-ipation restrictions and impact on otherswere omitted. Finally, only the questionregarding hearing aid benefit was the onlyone that referred specifically to “present”hearing aids. In the original IOI-HA allquestions refer to “present” hearing aids.

Statistical Analyses

Statistical comparisons between the orig-inal trial data and the current trial data aswell as comparisons of current aided scoresto unaided scores were conducted usingpaired t-tests. Tests between current hear-ing aid users and nonusers employed atwo-sample t-test for independent groups.T-tests were two sided and considered sig-nificant for p-values less than or equal to0.05. Wilcoxon signed-rank analyses werealso done, and results were similar in almostall cases. Analyses using t-tests turned outto be more conservative in this study andare reported here. All references to corre-lations are Spearman correlationcoefficients. Correlations were consideredsignificant if the p-value was 0.05 or lowerand the absolute value of the correlationcoefficient was 0.5 or greater.

RESULTS

HASQ

Question 3 on the HASQ asked partici-pants who used hearing aids about thefrequency of use in six common listening sit-uations. The situational use patterns areshown in Figure 1. The listening situationsare shown along the horizontal axis. For eachsituation, the height of each bar shows thepercentage of participants who selected agiven hearing aid usage choice (“never,” “occa-sionally,” “about half the time,” “usually,” and“always”). In all six listening situations pre-sented to the participants, with the exceptionof telephone use, more than 50% of the par-ticipants indicated they used their hearingaids all of the time. These situations includeddifficult listening conditions such as “in thecar” or “in noisy situations,” and easier situ-ations such as when listening to the radio ortelevision, or with several other people in aquiet environment. In contrast, only 40% ofthe participants used hearing aids all of thetime when using the telephone, and an equalnumber reported never or only occasionallyusing hearing aids when on the telephone.

Participants who obtained new hearingaids and completed the HASQ (n = 80) ratedthe importance of each of 26 factors in thedecision to change instruments. The factors


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Figure 1. Situation-specific hearing aid usage patterns. Participants were asked how often they used their hear-ing aids in various situations. The listening situations are shown along the horizontal axis. For each situation,the height of each bar shows the percentage of participants who selected a given hearing aid usage choice shownin the legend. The situations were (1) while listening to radio or TV, (2) in quiet with several other people,(3) in quiet with one other person, (4) in the car, (5) in noisy situations, and (6) on the telephone.

and rating scale for HASQ Question 5 arefound in Appendix A. The ten factors mostoften rated as being “moderately,” “very,” or“extremely” important in the decision to getnew hearing aids are shown in Table 1. Thefactor that was at least moderately impor-tant to the greatest number of participantswas the “advice of a hearing professional”(66%). This was followed by a group of fac-tors all related to difficulty in understandingspeech: understanding speech in noise, under-standing speech at a distance in noise,understanding speech at a distance in quiet,understanding certain talkers, and under-standing speech in general. One-third of the

participants rated these factors as being atleast moderately important in the decisionto change instruments. The other top ten fac-tors related to either power needs or aspectsof the sound quality from the hearing aids.HASQ Question 5a asked participants who hadobtained other hearing aids how satisfied theywere with the change. Table 2 shows the distri-bution of the satisfaction ratings. Almost allparticipants were at least “moderately” sat-isfied with the change to new amplification,and most were “very” or “extremely” satisfied.

A small number (n = 27) of participantsin the study reported using only a singleinstrument. HASQ Question 4 asked for the


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Table 1. Factors Related to Participants’ Decisions to Obtain New Hearing Aids in Response to theQuestion “If You Now Use a Different Hearing Aid from the One Provided at the End of the PreviousStudy, How Important Was Each of the Following in Making the Decision to Change?”

FACTOR NOT IMPORTANT OR MODERATELY TO OF LITTLE IMPORTANCE EXTREMELY IMPORTANT

HEARING PROFESSIONAL 33 66

SPEECH IN NOISE 64 37

SPEECH AT A DISTANCE IN NOISE 65 35

CERTAIN TALKERS 66 33

SPEECH AT A DISTANCE IN QUIET 67 33

SPEECH IN GENERAL 71 29

POWER NEED 74 27

SPEECH IN QUIET 76 24

QUALITY SPEECH OTHERS 77 22

WHISTLING 79 22

QUALITY LOUD SOUNDS 80 20

GENERAL SOUND QUALITY 80 21

FREQUENT BREAKDOWN 80 20

QUALITY MUSIC 81 19

INCONVENIENCE 81 18

APPEARANCE 84 16

PAIN IN EAR 85 15

QUALITY SPEECH SELF 86 15

DIRECTIONAL 87 13

NOISE REDUCTION CLAIM 88 12

LOUDNESS DISCOMFORT 90 10

DIGITAL BETTER 90 9

INTERNAL STATIC 91 9

FRIEND 94 7

REPAIR COST 98 2

BATTERY COST 100 0

Note: The column headings indicate the level of importance; the data show the percentage of participants who selected the givenlevel of importance for each factor. Responses of “not at all” and “a little” are grouped together in the left column, and responses of“moderately,” “very,” and “extremely” are grouped together in the right column. Due to rounding, not all rows total 100%.

main reason they used only one hearing aid.The results are shown in Table 3. The reasonmost frequently cited (41%) was that one ofthe two instruments provided in the first clin-ical trial was not functioning properly and wasnot replaced. The next most common reason(22%) for using only one hearing aid was tofacilitate telephone use. Less common reasonsfor using just one device included comfort issues(19%) and the perception that no additional ben-

efit was gained from using a second hearing aid(11%). Two participants (7%) lost one of the orig-inal instruments and had not replaced it.

Forty-four participants who completed theHASQ reportedly had stopped using hearingaids or used them infrequently, that is, lessthan an hour per day. HASQ Question 7 askedhow important each of 21 factors was inmaking that decision. The ten most commonfactors are shown in Table 4. The factors most


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Table 4. Factors Related to Participants’ Decisions to Discontinue Hearing Aid Use in Response tothe Question “If You Have Decided Not to Use Hearing Aids, or If You Use Them Only Occasionally,How Important Was Each of the Following in Making That Decision?”

FACTOR NOT IMPORTANT OR MODERATELY TO OF LITTLE IMPORTANCE EXTREMELY IMPORTANT

DIFFICULTY WITH SPEECH IN NOISE 64 36

DIFFICULTY WITH SPEECH AT A DISTANCE IN QUIET 66 35

DIFFICULTY WITH CERTAIN TALKERS 70 30

NOT ENOUGH DIFFERENCE 73 27

INCONVENIENCE 75 25


WHISTLING 77 22

POOR GENERAL SOUND QUALITY 82 18

POOR QUALITY LOUD SOUNDS 82 18

POOR QUALITY SPEECH OTHERS 84 16

POOR QUALITY MUSIC 86 14

PAIN IN EAR 86 14

DIFFICULTY WITH SPEECH IN GENERAL 87 14

DIFFICULTY WITH SPEECH AT A DISTANCE IN NOISE 88 12

POOR QUALITY SPEECH SELF 89 12

BATTERY COST 90 9

REPAIR COST 90 10


APPEARANCE 93 7

DIFFICULTY WITH SPEECH IN QUIET 95 5


Note: The column headings indicate the level of importance; the data show the percentage of participants who selected the given

level of importance for each factor. Responses of “not at all” and “a little” are grouped together in the left column, and responses of

“moderately,” “very,” and “extremely” are grouped together in the right column. Due to rounding, not all rows total 100%.

Table 2. Reported Degree of Satisfaction Regarding the Change to New Hearing Aids for ThoseParticipants Who Replaced Their Original NIDCD/VA Study Instruments “How satisfied are you with the change?” Not at all A little Moderately Very Extremely

Percent of Participants 3 8 19 48 22

Table 3. Reasons Given for Monaural Use by Participants Who Used Only One Hearing Aid“If you use only one hearing aid, what is Instrument Telephone Comfort Do better Lost onethe main reason?” malfunction use issues with one aid

Percent of Participants 41 22 19 11 7

frequently cited involved difficulty with under-standing speech in three situations: at adistance in noise, in noise, or with certaintalkers. Other factors that were at least mod-erately important in the decision not to usehearing aids included perceptions that theinstruments did not make enough differenceto use, produced loudness discomfort, wereinconvenient to use, or produced feedback.The final three factors all related to soundquality from the hearing aids, including soundquality in general, the sound quality of loudsounds, and the sound quality of the speechof others.

A question of major interest asked partic-ipants to rate how much of a problem theyhad with a wide range of possible hearing aidissues, regardless of how much they used theirhearing aids (HASQ Question 6). The ten mostcommon complaints, rated as presenting mod-erate or greater problems for the participants

who completed the HASQ, are shown in Table5. The five factors rated as being problematicfor the greatest number of participants (42to 83%) all related to difficulties encoun-tered when trying to understand speech:understanding speech at a distance (both innoise and in quiet), understanding speechin noise, understanding certain talkers, andunderstanding speech in general. Problemsmentioned less frequently involved loudnessdiscomfort, sound quality, or feedback issues.

Unaided PHAP

Figure 2 shows the unaided PHAPresults for the participants in the follow-up study (open bars; n = 162) compared tothe results in the original study for thesesame participants (striped bars) and forall participants who completed the PHAPin the original study (filled bars). The


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Table 5. Common Problems Participants Had with Their Hearing Aids in Response to the Question “Atthe Present Time, How Much of a Problem Is Each of the Following? (Answer regardless of how muchyou use hearing aids)”

FACTOR NO OR LITTLE MODERATE TO PROBLEM MAJOR PROBLEM

UNDERSTANDING SPEECH AT A DISTANCE IN NOISE 16 83

UNDERSTANDING CERTAIN TALKERS 28 73

UNDERSTANDING SPEECH IN NOISE 28 73

UNDERSTANDING SPEECH AT A DISTANCE IN QUIET 43 57

UNDERSTANDING SPEECH IN GENERAL 58 42


QUALITY LOUD SOUNDS 66 34

GENERAL SOUND QUALITY 70 30

QUALITY SPEECH OTHERS 70 30

QUALITY MUSIC 73 26

WHISTLING 77 23

UNDERSTANDING SPEECH IN QUIET 82 18

INCONVENIENCE 83 18

QUALITY SPEECH SELF 86 15


APPEARANCE 89 11


REPAIR COST 92 8

BATTERY COST 93 7

PAIN IN EAR 94 7

Note: The column headings indicate the degree of the problem; the data show the percentage of participants who indicated thegiven severity for each factor. Responses of “not a problem” and “a small problem” are grouped together in the left column, andresponses of “a moderate problem,” “a serious problem,” and “a major problem” are grouped together in the right column. Dueto rounding, not all rows total 100%.

height of each bar indicates the averagepercent of time the PHAP statement wastrue for each of the subscales, and errorbars indicate one standard deviation. Ahigher value indicates more difficulty. Asmight be expected, higher scores were evi-dent for the RV, RC, and BN subscales,which reflect more difficult listening sit-uat ions compared to the EC and FTsubscales. Participants who took part inthe follow-up study (open bars) had higherscores compared to scores for these sameparticipants in the original study (stripedbars). This difference was significant forthe EC and FT subscales (p = .013 andp = .003, respectively) and is indicated byan asterisk in Figure 2. In other words,the data suggest that participants nowperceive that they are having more diffi-culty in easy listening conditions whenunaided compared to six years ago. Inaddition, scores from the original studyfor participants who took part in the

follow-up study were higher compared toscores for those who did not participate inthe follow-up study.

Figure 3 shows the unaided PHAPscores for the current hearing aid users(open bars) compared to the nonusers (filledbars) in the follow-up study. Scores for thehearing aid users were significantly higher(p < .001) compared to nonusers on all sub-scales except for AV.

Aided PHAP

Aided PHAP results are shown in Figure4. Again, higher scores were evident for theRV, RC, and BN subscales, which reflectmore difficult listening situations comparedto the EC and FT subscales. This patternwas also found in previous studies (Cox andRivera, 1992; Purdy and Jerram, 1998;Beamer et al, 2000). The original data forthe entire group of participants in the ear-lier study (filled bars) did not differ from


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Figure 2. Average unaided scores for each of the seven subscales on the PHAP: Ease of Communication (EC),Familiar Talkers (FT), Reverberation (RV), Reduced Cues (RC), Background Noise (BN), Aversiveness of Sounds(AV), and Distortion of Sounds (DS). Open bars show data from the follow-up study. Striped bars show data fromthe original study for the subset of participants who agreed to take part in the follow-up study. Filled bars showdata for all participants in the original study. The height of each bar represents the percentage of time the state-ment on the PHAP was true. Higher scores represent more unaided difficulty. Error bars indicate one standarddeviation. Asterisks indicate significant differences between the data in the follow-up study and the original studyfor the same participants.

the original data for the subset of partici-pants who took part in the follow-up study(striped bars). Scores for hearing aid usersin the follow-up study (open bars) were sig-nificantly higher (p < .001) compared to theoriginal data for the same group of partici-pants (striped bars) for all subscales except

for AV, which addresses listening to poten-tially aversive environmental sounds. Theparticipants experience difficulty toleratingenvironmental sounds when wearing hear-ing aids, and this has not changed over time.

Figure 5 compares aided PHAP scoresacross several studies. In general, aided


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Figure 3. Average unaided scores for hearing aid users (unfilled bars) versus nonusers (filled bars) for each ofthe seven subscales on the PHAP. The height of each bar represents the percentage of time the statement on thePHAP was true. Higher scores represent more unaided difficulty. Error bars indicate one standard deviation. Aster-isks indicate significant differences between the hearing aid users and nonusers.

Figure 4. Average aided scores for each of the seven subscales on the PHAP. Open bars show data from thefollow-up study. Striped bars show data from the original study for the subset of participants who agreed to takepart in the follow-up study. Filled bars show data for all participants in the original study. The height of eachbar represents the percentage of time the statement on the PHAP was true. Higher scores represent more aideddifficulty. Error bars indicate one standard deviation. Asterisks indicate significant differences between the datain the follow-up study and the original study for the same participants.

PHAP results from the original NIDCD/VAstudy were similar to data from Beamer etal (2000), and data from both of these stud-ies indicated better aided performancecompared to results from Cox and Gilmore(1990) and Purdy and Jerram (1998). Ageand/or better hearing may account for thebetter perceived aided performance foundby Beamer et al. Participants in that studywere younger (mean age of 57 years) andhad better hearing (normal hearing through2000 Hz).

PHAB

The mean aided PHAP scores (Figure 4)were significantly lower (p < .001) thanunaided PHAP scores (Figure 2) on all sub-scales except for AV, where the aided PHAPscore was significantly higher than theunaided PHAP score (p < .001).Consequently, PHAB scores on all but onesubscale (AV) were positive in both the orig-inal study and the follow-up study, indicatingthat participants continue to perceive ben-efit from amplification (Figure 6).

PHAB data in the follow-up study werealso compared to data from the original studyfor the same group of participants. On aver-

age, the aided and unaided PHAP scoreshave increased since the original study, andthe aided scores have increased more thanthe unaided scores. In other words, the par-ticipants are experiencing increased listeningdifficulties both with and without their hear-ing aids. The relative increase in listeningdifficulty was different for different sub-scales. Although aided PHAP scores weresignificantly higher in the follow-up studycompared to the original study for all sub-scales except AV, unaided PHAP scores inthe follow-up study were significantly higheron only the EC and FT subscales. As a con-sequence, PHAB scores (unaided PHAPminus aided PHAP) were significantly lower(less benefit) for the RV, RC, BN, and DSsubscales but not the EC and FT subscales.Note that benefit is worse in the follow-upstudy on the subscales that focus on moredemanding listening situations.

In order to assess whether the changes onthe PHAB were related to the degree of hear-ing loss, participants were divided into threegroups based on whether their current PHABscores RV, RC, BN, and DS all increased, alldecreased, or were mixed (increased on somesubscales and decreased on others) comparedto scores from the original NIDCD/VA study.


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Figure 5. Comparison of aided PHAP scores to previous studies. Asterisks indicate significant differencesbetween the data in the follow-up study and the original NIDCD/VA study for the same participants.

An analysis of variance on the pure-toneaverage at 1, 2, 3, and 4 kHz indicated nodifference between groups.

PHAB data were also analyzed to deter-mine whether or not an age effect waspresent. Participants were divided into three

age groups: 65 years of age or younger(n = 35; mean = 57 years), 66–75 years of age(n = 39; mean = 70 years), and 75 years ofage or older (n = 82; mean = 81 years). Figure7 shows PHAB scores after adjusting for pure-tone average for each age group. The youngest


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Figure 6. Average PHAB scores for each of the seven subscales. Open bars show data from the follow-up study.Striped bars show data from the original study for the subset of participants who agreed to take part in the follow-upstudy. Filled bars show data for all participants in the original study. The height of each bar represents benefit(unaided PHAP score minus aided PHAP score). Positive scores indicate benefit. Error bars indicate one standarddeviation. Asterisks indicate significant differences between the data in the follow-up study and the original studyfor the same participants.

Figure 7. Average PHAB scores (adjusted for PTA) for each of the seven subscales divided by age group for par-ticipants in the follow-up study. Open bars show data for participants 65 years of age and younger. Light graybars show data for participants between 66 and 75 years of age, inclusive. Black bars show data for participantsover 75 years of age. Positive scores indicate benefit. Error bars indicate one standard deviation. Asterisks indi-cate significant differences between the youngest age group (≤65 years of age) compared to the two older groups.

group (≤65 years; open bars) had significantlyhigher PHAB scores (more benefit) comparedto the two older groups (gray and black bars)on all PHAB subscales except for AV.

Cox and Rivera (1992) suggested thatunaided listening difficulty might predictthe degree of hearing aid benefit but foundthat unaided PHAP scores accounted foronly some of the hearing aid benefitobtained using the PHAB. In the presentstudy, 34.3% of the variance in the PHABscores was accounted for by the unaidedPHAP scores. This was calculated using theaverage adjusted r-squared value from thesimple linear regression, where the PHAPscore was used to predict the PHAB score.

Figure 8 compares the PHAB data fromthe original and follow-up studies to previ-ously published data from Cox and hercolleagues (Cox et al, 1991; Cox and Rivera,1992). The mean ages of the participantsin the Cox studies and the NIDCD/VA stud-ies were approximately the same (range ofthe mean age across the studies was 68 to73 years). In all of these studies, most par-ticipants had mild-to-moderate sensorineuralhearing loss. In the Cox et al (1991) study,57% of the participants had less than oneyear of hearing aid experience, and in theCox and Rivera (1992) study, almost all of

the participants had more than one year ofhearing aid experience. In the currentNIDCD/VA study, all of the current hear-ing aid users had more than one year ofhearing aid experience.

The follow-up data (open bars) are sim-ilar to data from both Cox studies(checkerboard and stippled bars) for mostsubscales. On the AV subscale, however, thebenefit score was less negative in the orig-inal and follow-up NIDCD/VA studiescompared to the Cox studies. The fact thata difference between the Cox studies (circa1990) and the NIDCD/VA studies (circa1996–97 and 2003) was observed on the AVsubscale and not on the other subscalesmight reflect improved hearing aid tech-nology with respect to output limiting. Inthe present study, approximately 22% of theparticipants who were still wearing thesame hearing aids from the originalNIDCD/VA study used peak clipping aids(11% of all participants). When participantswere divided into two groups, those wear-ing the hearing aids from the originalNIDCD/VA study versus those wearingnewer hearing aids, there was no signifi-cant difference on the AV subscale. However,it is possible that there was a largerpercentage of peak clipping aids in the Cox


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Figure 8. Comparison of PHAB scores to previous studies. Error bars indicate one standard deviation.

studies. Note that in the original NIDCD/VAstudy (Larson et al, 2000), where peak clip-ping, compression limiting, and WDRCcircuits were compared, the peak clippingcircuit was associated with a significantlymore negative AV score and a significantlylower DS score (Haskell et al, 2002).

Glasgow Hearing Aid Benefit Profile

Glasgow raw data scores indicated thatparticipants who were current hearing aidusers were very satisfied with their hear-ing aids, with a mean satisfaction score of3.7 (SD = 0.7) on a five-point scale, with ascore of 5 indicating greatest satisfaction.Mean scores for the other five individualscales for the current hearing aid users wereas follows: Initial Disability = 3.3 (SD = 0.8),with 5 indicating greatest disability;Handicap = 2.5 (SD = 1.0), with 5 indicat-ing greatest handicap; Use = 4.3 (SD = 1.0),with 5 indicating the greatest hearing aiduse in situations where participants thinkhearing aids are needed; Benefit = 3.6(SD = 0.6), with 5 indicating most hearingaid benefit; and Residual Disability = 2.0(SD = 0.7), with 5 indicating greatestremaining disability.

Current hearing aid users had higherscores than the nonusers on all of the scales,but only the Initial Disability and Use scales

indicated a statistically significant differ-ence (p < .001). The mean score for nonuserswas 2.6 (SD = 0.7) on the Initial DisabilityScale and 1.5 (SD = 1.0) on the Use scale.The nonusers may have elected not to usetheir hearing aids because they were expe-riencing less difficulty hearing whenunaided (see Peek et al, in this issue).

Figures 9–14 show the results on theGlasgow for each of the scales. In eachfigure, the percentage of participants whoselected one of the possible responses(shown on the x-axis) is indicated for eachof the pre-specified listening situations. Theopen bars indicate conversation in quiet;the light gray bars indicate conversation ina busy street or shop; the dark gray barsindicate conversation with several peoplein a group; and the black bars represent lis-tening to television when the volume isadjusted for others.

Not surprisingly, participants indicatedthey had more difficulty in the televisioncondition and in conversations in back-ground noise and group situations (skewingto the right in Figure 9) compared to con-versation in quiet (skewing to the left). Mostparticipants indicated moderate to greatdifficulty when listening to the televisionand in background noise or group situa-tions. Nevertheless, the degree to whichthis difficulty caused participants to “worry,


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Figure 9. Glasgow results for the question regarding (unaided) disability: “How much difficulty do you have inthis situation?” Open bars show data for conversation in quiet; light gray bars indicate data for conversation in abusy street or shop; dark gray bars indicate data for conversation with several people in a group; and black barsindicate data for listening to television when the volume is adjusted for others. The height of each bar representsthe percentage of participants who selected one of five choices shown on the abscissa. Skewing to the right indi-cates greater difficulty.

be annoyed or upset” was not as skewed butwas more evenly distributed across responsecategories (Figure 10).

Figure 11 indicates that most partici-pants use their hearing aids full time. Inaddition, they wear their hearing aids inmore difficult listening situations aboutas often as in quiet. The majority of par-ticipants also indicated that their hearingaids were a “great help” or that “hearingis perfect” when aided (Figure 12). Again,the pattern of responses was similar acrossthe four pre-specified listening situations.

The fact that use and benefit were high forboth easy and difficult listening situationsis consistent with data obtained using theHASQ.

Figure 13 indicates that most participants,when aided, have no or only slight difficultywhen having a conversation with one otherperson when there is no background noise buthave more difficulty when having conversa-tions in background noise or in groups. Almostall participants were reasonably satisfied,very satisfied, or delighted with their aidsfor all of the pre-specified l istening


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Figure 10. Glasgow results for the question regarding (unaided) handicap: “How much does any difficulty in thissituation worry, annoy or upset you?” The height of each bar represents the percentage of participants whoselected one of five choices shown on the abscissa. Skewing to the left indicates less concern.

Figure 11. Glasgow results for the question regarding use: “In this situation, what proportion of the time do youwear your hearing aid?” The height of each bar represents the percentage of participants who selected one of fivechoices shown on the abscissa.

situations (Figure 14). Participants weremore satisfied with the performance of theirhearing aids in quiet situations comparedto the other conditions.

Figure 15 compares the Glasgow quar-tile scores in the follow-up study (open bars)to data from Gatehouse (1999) (filled bars).Scores were obtained by subtracting 1 fromthe raw score (1–5) and multiplying by 25.The height of the bar indicates the medianscore, and the error bars indicate the 25th

and 75th percentiles. The scores in thefollow-up study were higher than the scoresreported by Gatehouse, reflecting more ini-tial disability and more handicap but alsomore hearing aid usage, reported benefit,and satisfaction. Note that more than 90%of the participants in the Glasgow studywere fit monaurally, and all were fit withbehind-the-ear hearing aids.


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Figure 12. Glasgow results for the question regarding benefit: “In this situation, how much does your hearingaid help you?” The height of each bar represents the percentage of participants who selected one of five choicesshown on the abscissa.

Figure 13. Glasgow results for the question regarding residual disability: “In this situation, with your hearingaid, how much difficulty do you now have?” The height of each bar represents the percentage of participants whoselected one of five choices shown on the abscissa.

Satisfaction with Amplification inDaily Life

Participants in the follow-up study expe-rienced considerable satisfaction with theirhearing aids. The mean global score for cur-rent hearing aid users was 5.5 (SD = .6) ona seven-category scale (Figure 16). Higherscores indicate more satisfaction on each ofthe scales. The lower score on the Negative

Features subscale indicates that someaspects of hearing aid use (feedback,unwanted background noise, telephone com-munication) were less satisfactory.

Overall satisfaction on the SADL corre-lated with the overall score on theInternational Outcome Inventory forHearing Aids (IOI-HA) (r = .63, p < .0001)and satisfaction measured using theGlasgow (r = .54, p < .0001). In addition,


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Figure 14. Glasgow results for question regarding satisfaction: “For this situation how satisfied are you with yourhearing aid?” The height of each bar represents the percentage of participants who selected one of five choices shownon the abscissa.

Figure 15. Comparison of Glasgow results in the follow-up study to data from Gatehouse (1999). The height ofeach bar indicates the median score, and the error bars indicate the 25th and 75th percentiles for each of five areasassessed on the Glasgow. Higher scores indicate more initial disability, more handicap, more reported hearing aiduse, more reported benefit, and more satisfaction, respectively.

each of the SADL subscale scores corre-lated significantly with the global SADLscore, and Glasgow Satisfaction correlatedsignificantly with Glasgow Benefit andGlasgow Residual Disability. There wereno significant correlations between thePHAB results and results on the SADL,Glasgow, or IOI-HA. In addition, there wereno significant correlations between theresults on subjective measures of benefitand satisfaction and the results on objec-tive measures (CST, NU-6; see Shanks etal, in this issue).

The SADL results were similar to resultsfrom other studies (Cox and Alexander,1999, 2001; Hosford-Dunn and Halpern,

2001; McLeod et al, 2001; Humes et al,2002). Note that Cox and Alexander (2001)found that whether or not participants payfor their hearing aids may influence results.Scores on the Service and Cost subscale inthe present study were similar to data fromprevious studies in which aids were pro-vided at no or very low cost.

International Outcome Inventory forHearing Aids

Figures 17 and 18 show the perceivedaverage daily hearing aid use in the pastmonth and past five years, respectively, forcurrent hearing aid users in the follow-up


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Figure 16. SADL results. Mean global score and scores on each of the subscales. Higher scores indicate more sat-isfaction. Error bars indicate one standard deviation.

Figure 17. IOI-HA results for the item “Think about how much you use your hearing aids. On average, how manyhours per day did you use them in the past month?” The height of each bar represents the percentage of partici-pants who selected one of five choices shown on the abscissa.

study as measured using the IOI-HA. Morethan 60% of the participants indicated theyhave worn their hearing aids more thaneight hours each day both in the past monthand for the past five years. Data on hear-ing aid benefit is shown in Figure 19. Allparticipants indicated at least some bene-fit from hearing aids, and over 85% of theparticipants indicated hearing aids help“quite a lot” or “very much” in the situationin which they most wanted to hear better.For that same situation, about 65% of theparticipants indicated they continue to have

slight or no difficulty, and about 30% of theparticipants indicated moderate difficulty(Figure 20). Hearing aid satisfaction(“Considering everything, do you think yourhearing aids are worth the trouble?”) wasvery high, with over 80% of the participantsresponding “very much” (Figure 21). Interms of participation restrictions, morethan 60% of the participants indicated thatwith their hearing aids, their hearing dif-ficulties affect the things that they can doeither “slightly” or “not at all” (Figure 22).For about 20% of the participants, hearing


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Figure 18. IOI-HA results for the item “Think about how much you use your hearing aids. On average, how manyhours per day did you use them during the past 5 years?” The height of each bar represents the percentage of par-ticipants who selected one of five choices shown on the abscissa.

Figure 19. IOI-HA results for the item “Think about the situation where you most wanted to hear better, beforeyou got your present hearing aids. How much have the hearing aids helped in that situation?” The height of eachbar represents the percentage of participants who selected one of five choices shown on the abscissa.

difficulties affect their participation either“quite a lot” or “very much” even whenaided. Over 80% of the participants thoughtthat others were bothered either “slightly”or “not at all” by their hearing difficulties,with only 6% responding “quite a lot” or“very much” (Figure 23). Finally, in termsof quality of life, over 90% of the partici-pants indicated that their hearing aidsmade their enjoyment of life “quite a lotbetter” or “very much better” (Figure 24).

Cox et al (2003) found that subjective

unaided hearing problems were more closelyrelated to responses on the IOI-HA thanmeasures of hearing sensitivity. They devel-oped two sets of norms based on theparticipants’ perceived degree of hearingloss (mild or moderate vs. moderately severeor severe) for participants who obtainedbilateral in-the-ear single-memory, single-channel compression hearing aids (any formof compression) in a private practice set-ting in the preceding 6–12 months. Notethat Cox et al (2003) did not find any


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Figure 20. IOI-HA results for the item “Think again about the situation where you most wanted to hear better.When you use or used your hearing aids, how much difficulty do you STILL have in that situation?” The heightof each bar represents the percentage of participants who selected one of five choices shown on the abscissa.

Figure 21. IOI-HA results for the item “Considering everything, do you think your hearing aids are worth thetrouble?” The height of each bar represents the percentage of participants who selected one of five choices shownon the abscissa.

significant differences on the IOI-HAbetween those who were responsible for theentire cost of their hearing aids and thosewhose private insurance paid the total cost,although those who were responsible forthe entire cost of their hearing aids didreport significantly more daily hearing aiduse compared to those who paid only someof the cost.

Figure 25 shows the IOI-HA resultsfrom the present study (solid bars) sepa-rated into two groups based on theparticipants’ perceived degree of hearing

loss (mild or moderate shown by unfilledbars vs. moderately severe or severe shownby black bars) compared to normative datafrom Cox et al (2003) (patterned bars). Ahigher score indicates a better outcome.Results from the present study indicatedstatistically significant differences betweenthe group with perceived mild or moder-ate hearing loss and the group withperceived moderately severe or severehearing loss on all items except the onepertaining to quality of life. The group withmore perceived hearing loss used their


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Figure 22. IOI-HA results for the item “With your hearing aids, how much have your hearing difficulties affectedthe things you can do?” The height of each bar represents the percentage of participants who selected one of fivechoices shown on the abscissa.

Figure 23. IOI-HA results for the item “With your hearing aids, how much do you think other people are both-ered by your hearing difficulties?” The height of each bar represents the percentage of participants who selectedone of five choices shown on the abscissa.

hearing aids more often, reported morebenefit, indicated more activity limitations,were more satisfied with their hearing aids,reported more participation restrictions,and perceived their hearing difficulties tohave more of an impact on others.

Group data for participants in the pres-ent study with perceived mild or moderatehearing loss in the present study (unfilledbars) and perceived moderately severe orsevere hearing loss (black bars) were sig-nificantly different from the correspondinggroups in Cox et al (2003) (stippled andstriped bars) on all items except hearing

aid use and participation restrictions.Participants in each group in the presentstudy reported more benefit, indicatedfewer activity limitations, were more sat-isfied with their hearing aids, perceivedtheir hearing difficulties to have less of animpact on others, and indicated more ofan improvement in their quality of life.

Note that all of the participants in theCox et al study wore single-channel, single-memory digitally programmable in-the-earhearing aids with a variety of compressioncircuits, and 65% of these aids had manu-ally switchable directional microphones.


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Figure 24. IOI-HA results for the item “Considering everything, how much have your hearing aids changed yourenjoyment of life?” The height of each bar represents the percentage of participants who selected one of five choicesshown on the abscissa.

Figure 25. Results for each of the areas assessed on the IOI-HA separated into groups based on the participants’perceived hearing loss. Results for perceived mild or moderate hearing loss are depicted by the two light-coloredbars on the left side of each grouping. Results for perceived moderately severe or severe hearing loss are depictedby the shaded bars on the right side of each grouping. Solid bars represent data from the present study. Patternedbars represent data from Cox et al (2003).

About 45% of the participants in theNIDCD/VA follow-up study were usinghearing aids obtained sometime after theoriginal study, and the 84% of these neweraids were either digital or digitally pro-grammable analog aids. It is possible thatthe better outcomes seen in the presentstudy compared to the Cox et al norms arerelated in part to differences in hearingaid technology (e.g., multichannel com-pression, microphone technology, etc.);however, this issue cannot be addresseddirectly since specific information aboutthe newer hearing aids worn in the pres-ent study was not obtained.

DISCUSSION

The original NIDCD/VA project (Larsonet al, 2000) was an important large-

scale, multi-site, double-blinded study thatprovided strong evidence regarding theefficacy of hearing aids. The results of thefollow-up study indicate that the benefitprovided by the hearing aids remained sig-nificant some six years later. All of thesubjective results point to considerableperceived benefit and satisfaction fromhearing aids. Results in the follow-up studywere comparable to other studies in theliterature, and in some cases indicatedgreater use, benefit, or satisfaction. Betteroutcomes compared to much earlier stud-ies may have been influenced by a numberof factors, including the fact that only about11% of those in the current study wore aidsthat had peak-clipping circuitry.

Of the subjective measures used in thefollow-up study, only the PHAP/PHAB wasalso used in the original study. Resultsindicated that six years later there is moreperceived unaided difficulty in easy lis-tening situations (EC and FT subscales)and less perceived aided benefit in moredifficult listening situations (RV, RC, BN,DS). One possible explanation for theincreased unaided difficulty in easy lis-tening situations is that hearing thresholdsare now slightly poorer (Bratt et al, in thisissue). Poorer hearing might also accountfor the increased perceived aided difficulty.Note that almost all of the unaided andaided speech intelligibility results (Shankset al, in this issue) were also poorer in thefollow-up study compared to the originalstudy. The fact that there was significantly

less perceived aided benefit in the moredifficult listening situations but not in theeasy listening conditions could be relatedto a decrease in audibility but could alsobe related to other auditory or cognitivefactors related to age. The results are con-sistent with recent studies using objectivemeasures that suggest increased process-ing difficulties with age with more complexstimuli or in unfavorable listening condi-tions (e.g., Pichora-Fuller et al, 1995;Gordon-Salant and Fitzgibbons, 1999;Gordon-Salant and Fitzgibbons, 2001;Souza and Kitch, 2001; Tremblay et al,2004).

Both hearing aid users and nonusers inthe follow-up study completed the Glasgow,the unaided PHAP, and the HASQ.Nonusers perceived significantly less dif-ficulty in unaided situations compared tothe hearing aid users on the PHAP andhad significantly better thresholds andbetter unaided speech discrimination asmeasured using CID W-22 word lists (Brattet al, in this issue). For the nonusers, anyperceived benefit from amplification maynot have outweighed perceived disadvan-tages. On the HASQ, in addit ion todifficulty understanding speech in noise,at a distance, and with certain talkers,nonusers indicated that hearing aids didnot make enough of a difference and wereinconvenient. It is also possible that hear-ing aid use resulted in aversive oruncomfortably loud sounds that outweighedany benefit for the nonusers. Nonusers hadsignificantly lower LDLs (Bratt et al, in thisissue), and, on the HASQ, “discomfort fromloud sounds” was another common reasoncited as to why hearing aids were not beingused.

When presented with an array of pos-sible problems associated with usinghearing aids, ranging from understandingspeech to feedback to appearance to cost,current and previous hearing aid userschose speech understanding in various sit-uations as their major problem, regardlessof how much they used their hearing aids.Specifically, 42 to 84% of all participantslisted speech understanding “at a distancein noise,” “in noise,” “from certain talkers,”“at a distance in quiet,” and “in general”as the top five problems on the HASQ.Often, these were also the reasons partic-ipants switched hearing aids, quit using


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hearing aids, or used them infrequently.On the other hand, participants who usedhearing aids used them half the time ormore for virtually every listening situa-tion, including noisy ones, except whenusing the telephone.

Despite ongoing communication con-cerns, participants who used hearing aidsliked them. Data obtained on the IOI-HArevealed that over 85% of current hearingaid users thought hearing aids helped“quite a lot” or “very much,” and 90%reported hearing aids had improved theirenjoyment of life “quite a lot” or “verymuch.” On the Glasgow, more than 75% ofthe participants were either “reasonablysatisfied,” “very satisfied,” or “delightedwith aid” when in conversational situa-tions in groups or in background, and morethan 70% thought hearing aids were “quitehelpful,” “a great help,” or “hearing is per-fect” in these same situations.

These findings make clear that under-standing speech, particularly in noise, isrecognized by individuals with sen-sorineural hearing loss as the majorchallenge they face. These same individu-als recognize that hearing aids are a majorhelp in dealing with this challenge. Giventhe persistent myth that hearing aids donot help people function better in noise,these findings—apparent in the firstNIDCD/VA trial and reinforced in the cur-rent fol low-up trial—are important.Objective data indicate that hearing aidsare of use in noisy situations. Self-reportdata show that people receive benefit fromhearing aids in noisy listening conditions,and most are satisfied with hearing aidperformance in noisy environments.

In summary, the data obtained in thefollow-up study indicate long-term sub-jective benefit and satisfaction withhearing aids. In addition, hearing aid usersreported wearing their hearing aids almostall of the time in both easy and difficultlistening situations. Although most hear-ing aid users are satisfied with theirhearing aids and perceive significant aidedbenefit in a variety of situations, improv-ing speech understanding in noise, in groupsituations, and on the telephone continueto be areas requiring further work.


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Cox RM, Alexander GC, Beyer CM. (2003) Norms forthe International Outcome Inventory for Hearing Aids.J Am Acad Audiol 14:403–413.

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Cox RM, Hyde M, Gatehouse S, Noble W, Dillon H,Bentler R, Stephens D, Arlinger S, Beck L, WilkersonD, Kramer S, Kricos P, Gagne J-P, Bess F, HallbergL. (2000) Optimal outcome measures, research prior-ities, and international cooperation. Ear Hear21:106S–115S.

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Gatehouse S. (1999) Glasgow hearing aid benefit pro-file: derivation and validation of a client-centeredoutcome measure for hearing aid services. J Am AcadAudiol 10:80–103.

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Gordon-Salant S, Fitzgibbons PJ. (2001) Sources ofage-related recognition difficulty for time-compressedspeech. J Speech Hear Res 44:709–719.

Haskell GB, Noffsinger D, Larson VD, Williams DW,Dobie RA, Rogers JL. (2002) Subjective measures ofhearing aid benefit in the NIDCD/VA clinical trial.Ear Hear 23:301–307.

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Appendix A. Hearing Aid Status Questionnaire (HASQ)

1. Have you obtained new hearing aids since the previous study? Yes No

If Yes: Right ear: Make: ___________ Model: _____________ Type: CIC ITE BTELeft ear: Make: ___________ Model: _____________ Type: CIC ITE BTE

1A. If you still use the same aids, with which program?Right ear: PC CL WDRCLeft ear: PC CL WDRC

2. How often do you use your hearing aids?Never (Skip to Q6) Less than 1 hour a day 1 to 4 hours a day 4 to 8 hours a day More than 8 hours a day

� � � � �

3. If you use your hearing aids, do Never Occasionally About half Usually Alwaysyou do so (Check One): the timea. In quiet with one other person? � � � � �

b. In quiet with several other people? � � � � �

c. In noisy situations? � � � � �

d. When listening to radio or TV? � � � � �

e. In the car? � � � � �

f. On the telephone? � � � � �

g. Other __________________ � � � � �

h. Other___________________ � � � � �

i. Other___________________ � � � � �

4. If you use only one hearing aid, what is the main reason? (Check One)� Your hearing is near-normal in the other ear.� Your hearing is much worse in the other ear.� Adding the other ear makes little difference.� Adding the other ear makes things worse.� One aid broke and you chose not to replace it.� Other ________________________________

5. If you now use a different hearing aid from the one provided at the end of the previous study, how important was each of the following in making the decision to change? (Check One)

Not at all A little Moderately Very Extremelya. Difficulty understanding speech in general: � � � � �

b. Difficulty understanding speech in quiet: � � � � �

c. Difficulty understanding speech in noise: � � � � �

d. Difficulty understanding speech at a distance in quiet: � � � � �

e. Difficulty understanding speech at a distance in noise: � � � � �

f. Difficulty understanding certain talkers: � � � � �

g. Poor general sound quality: � � � � �

h. Poor sound quality of the speech of others: � � � � �

i. Poor general sound quality of my own speech: � � � � �

j. Poor sound quality of loud sounds: � � � � �

k. Poor sound quality of music: � � � � �

l. Internal static: � � � � �

m.Whistling (feedback): � � � � �

n. Pain or soreness around the ear: � � � � �

o. Discomfort from loud sounds: � � � � �

p. Frequent breakdowns: � � � � �

q. Cost of batteries: � � � � �

r. Cost of repair: � � � � �

s. Inconvenience: � � � � �

t. Appearance: � � � � �

u. Need for more power: � � � � �

v. Assumed superiority of digital aids: � � � � �

w. Directional microphones: � � � � �

x. Claims of noise reduction: � � � � �

y. Advice of a hearing professional: � � � � �

z. Advice of a friend: � � � � �


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Not at all A little Moderately Very Extremely5A. How satisfied are you with the change? � � � � �

6. At the present time, how much of a problem is each of the following? (Answer regardless of how much you use hearing aids)(Check One)

Not a A Small A Moderate A Serious A Majorproblem problem problem problem problem

a. Understanding speech in general: � � � � �

b. Understanding speech in quiet: � � � � �

c. Understanding speech in noise: � � � � �

d. Understanding speech at a distance in quiet: � � � � �

e. Understanding speech at a distance in noise: � � � � �

f. Understanding certain talkers: � � � � �

g. General sound quality: � � � � �

h. The sound quality of the speech of others: � � � � �

i. The sound quality of my own speech: � � � � �

j. Poor sound quality of loud sounds: � � � � �

k. Poor sound quality of music: � � � � �

l. Internal static: � � � � �

m.Whistling (feedback): � � � � �

n. Pain or soreness around the ear: � � � � �

o. Discomfort from loud sounds: � � � � �

p. Frequent breakdowns: � � � � �

q. Cost of batteries: � � � � �

r. Cost of repair: � � � � �

s. Inconvenience: � � � � �

t. Appearance: � � � � �

u. Other:____________________ � � � � �

v. Other:____________________ � � � � �

w. Other:____________________ � � � � �

7. If you have decided not to use hearing aids, or if you use them only occasionally, how important was each of the following inmaking that decision? (Check One)

Not at all A little Moderately Very Extremelya. It doesn’t make enough difference: � � � � �

b. Difficulty understanding speech in general: � � � � �

c. Difficulty understanding speech in quiet: � � � � �

d. Difficulty understanding speech in noise: � � � � �

e. Difficulty understanding speech at a distance in quiet: � � � � �

f. Difficulty understanding speech at a distance in noise: � � � � �

g. Difficulty understanding certain talkers: � � � � �

h. Poor general sound quality: � � � � �

i. Poor sound quality of the speech of others: � � � � �

j. Poor sound quality of my own speech: � � � � �

k. Poor sound quality of loud sounds: � � � � �

l. Poor sound quality of music: � � � � �

m.Internal static: � � � � �

n. Whistling (feedback): � � � � �

o. Pain or soreness around the ear: � � � � �

p. Discomfort from loud sounds: � � � � �

q. Frequent breakdowns: � � � � �

r. Cost of batteries: � � � � �

s. Cost of repair: � � � � �

t. Inconvenience: � � � � �

u. Appearance: � � � � �

v. Other:____________________ � � � � �

w. Other:____________________ � � � � �

x. Other:____________________ � � � � �

8. How likely is it that you will seek new hearing aids in the near future? (Check One)Not likely A Little Likely Moderately Likely Very Likely Extremely Likely

� � � � �

9. Do you have any other comments?

takahashi et al: subjective measures of hearing aid ...€¦ · karen sugiura† gene w. bratt§**...

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