The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial
Larry E Humes, Sara E Rogers, Tera M Quigley, Anna K Main, Dana L Kinney, Christine Herring, Larry E Humes, Sara E Rogers, Tera M Quigley, Anna K Main, Dana L Kinney, Christine Herring
Abstract
Objectives: The objectives of this study were to determine efficacy of hearing aids in older adults using audiology best practices, to evaluate the efficacy of an alternative over-the-counter (OTC) intervention, and to examine the influence of purchase price on outcomes for both service-delivery models.
Design: The design of this study was a single-site, prospective, double-blind placebo-controlled randomized trial with three parallel branches: (a) audiology best practices (AB), (b) consumer decides OTC model (CD), and (c) placebo devices (P). Outcome measures were obtained after a typical 6-week trial period with follow-up 4-week AB-based trial for those initially assigned to CD and P groups.
Setting: Older adults from the general community were recruited via newspaper and community flyers to participate at a university research clinic.
Participants: Participants were adults, ages 55-79 years, with mild-to-moderate hearing loss. There were 188 eligible participants: 163 enrolled as a volunteer sample, and 154 completed the intervention.
Intervention(s): All participants received the same high-end digital mini-behind-the-ear hearing aids fitted bilaterally. AB and P groups received best-practice services from audiologists; differing mainly in use of appropriate (AB) or placebo (P) hearing aid settings. CD participants self-selected their own pre-programmed hearing aids via an OTC model.
Primary and secondary outcome measures: Primary outcome measure was a 66-item self-report, Profile of Hearing Aid Benefit (Cox & Gilmore, 1990). Secondary outcome measure was the Connected Speech Test (Cox, Alexander, & Gilmore, 1987) benefit. Additional measures of hearing-aid benefit, satisfaction, and usage were also obtained.
Results: Per-protocol analyses were performed. AB service-delivery model was found to be efficacious for most of the outcome measures, with moderate or large effect sizes (Cohen's d). CD service-delivery model was efficacious, with similar effect sizes. However, CD group had a significantly (p < .05) lower satisfaction and percentage (CD: 55%; AB: 81%; P: 36%) likely to purchase hearing aids after the trial.
Conclusions: Hearing aids are efficacious in older adults for both AB and CD service-delivery models. CD model of OTC service delivery yielded only slightly poorer outcomes than the AB model. Efficacious OTC models may increase accessibility and affordability of hearing aids for millions of older adults. Purchase price had no effect on outcomes, but a high percentage of those who rejected hearing aids paid the typical price (85%).
Trial registration: Clinicaltrials.gov: NCT01788432; https://ichgcp.net/clinical-trials-registry/NCT01788423.
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References
- American National Standards Institute. (2009). Specifications of hearing aid characteristics (ANSI S3.22). New York, NY: Author.
- American National Standards Institute. (2010). Specifications for audiometers (ANSI S3.6). New York, NY: Author.
- American National Standards Institute. (2012). Methods for calculation of the speech intelligibility index (ANSI S3.5-1997) (R2012). New York, NY: Author.
- American National Standards Institute. (2013). Maximum permissible ambient noise levels for audiometric test rooms (ANSI S3.1-1999) (R2013). New York, NY: Author.
- American Speech-Language-Hearing Association. (2015). Hearing aids for adults [Practice Portal]. Rockville, MD: Author; Retrieved from
- Caposecco A., Hickson L., & Meyer C. (2011). Assembly and insertion of a self-fitting hearing aid: Design of effective instruction materials. Trends in Amplification, 15, 184–195.
- Chung K., Neuman E., & Higgins M. (2008). Effects of in-the-ear microphone directionality on sound direction identification. The Journal of the Acoustical Society of America, 123, 2264–2275.
- Ciletti L., & Flamme G. A. (2008). Prevalence of hearing impairment by gender and audiometric configuration: Results from the National Health and Nutrition Examination Survey (1999–2004) and the Keokuk County Rural Health Study (1994–1998). Journal of the American Academy of Audiology, 19, 672–685.
- Cohen J. (1988). Statistical power analysis for the behavioral sciences. London, England: Routledge.
- Cox R. M., Alexander G. C., & Gilmore C. (1987). Development of the Connected Speech Test (CST). Ear and Hearing, 8(5, Suppl.), 119S–126S.
- Cox R. M., Alexander G. C., Taylor I. M., & Gray G. A. (1997). The Contour Test of loudness perception. Ear and Hearing, 18, 388–400.
- Cox R. M., & Gilmore G. C. (1990). Development of the Profile of Hearing Aid Performance (PHAP). Journal of Speech and Hearing Research, 33, 343–357.
- Cox R. M., Johnson J. A., & Xu J. (2014). Impact of advanced hearing aid technology on speech understanding for older listeners with mild to moderate, adult-onset, sensorineural hearing loss. Gerontology, 60, 557–568.
- Cox R. M., Johnson J. A., & Xu J. (2016). Impact of hearing aid technology on outcomes in daily life I: The patients' perspective. Ear and Hearing, 37, e224–e237.
- Cruickshanks K. J., Zhan W., & Zhong W. (2010). Epidemiology of age-related hearing impairment. In Gordon-Salant S., Frisina R. D., Fay R. R., & Popper A. N. (Eds.), The aging auditory system (Springer Handbook of Auditory Research 34, pp. 259–274). New York, NY: Springer-Verlag.
- Cunningham D., Williams K. J., & Goldsmith L. J. (2001). Effects of providing and withholding postfitting fine-tuning adjustments on outcome measures in novice hearing aid users: A pilot study. American Journal of Audiology, 10, 13–23.
- Department of Veterans Affairs. (2006). Speech recognition and identification materials, disc 4.0. Mountain Home, TN: VA Medical Center.
- Dillon H., Keidser G., Ching T. Y. C., Flax M. R., & Brewer S. (2011). The NAL-NL2 prescription procedure. Phonak Focus, 40, 1–10.
- Doherty K. A., & Desjardins J. L. (2012). The Practical Hearing Aids Skills Test–Revised. The American Journal of Audiology, 21(1), 100–105.
- Donahue A., Dubno J. R., & Beck L. (2010). Guest Editorial: Accessible and affordable hearing health care for adults with mild to moderate hearing loss. Ear and Hearing, 31, 2–6.
- Folstein M. F., Folstein S. E., White T., & Messer M. A. (2010). Mini-Mental State Examination–2nd Edition. Lutz, FL: Psychological Assessment Resources.
- Gorsuch R. (1983). Factor analysis (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
- Hirsh I. J., Davis H. D., Silverman S. R., Reynolds E. G., Eldert E., & Benson R. W. (1952). Development of materials for speech audiometry. Journal of Speech and Hearing Disorders, 17, 321–327.
- Humes L. E. (2001). Issues in evaluating the effectiveness of hearing aids in the elderly: What to measure and when. Seminars in Hearing, 22(3), 303–316.
- Humes L. E. (2003). Modeling and predicting hearing-aid outcome. Trends in Amplification, 7(2), 41–75.
- Humes L. E., Ahlstrom J. B., Bratt G. W., & Peek B. F. (2009). Studies of hearing aid outcome measures in older adults: A comparison of technologies and an examination of individual differences. Seminars in Hearing, 30, 112–128.
- Humes L. E., Garner C. B., Wilson D. L., & Barlow N. N. (2001). Hearing-aid outcome measures following one month of hearing aid use by the elderly. Journal of Speech, Language, and Hearing Research, 44, 469–486.
- Humes L. E., & Krull V. (2012). Hearing aids for adults. In Wong L. & Hickson L. (Eds.), Evidence-based practice in audiology: Evaluating interventions for children and adults with hearing impairment (Chapter 4). San Diego, CA: Plural.
- International Conference on Harmonization. (1998). ICH Topic E 9: Statistical principles for clinical trials. London, England: European Medical Association; Retrieved from
- Johnson E. E. (2013). Modern prescription theory and application: Realistic expectations for speech recognition with hearing aids. Trends in Amplification, 17, 143–170.
- Johnson J. A., Xu J., & Cox R. M. (2016). Impact of hearing aid technology on outcomes in daily life II: Speech understanding and listening effort. Ear and Hearing, 37, 529–540.
- Kasewurm G. (2014). An independent practice's guide to battling big box retail and commoditization in hearing healthcare: How your business can thrive and win in the face of dramatic distribution changes. Hearing Review, 21(7), 18–21.
- Kochkin S. (1993a). MarkeTrak III: Why 20 million in U.S. don't use hearing aids for their hearing loss. Part I. The Hearing Journal, 46(1), 20–27.
- Kochkin S. (1993b). MarkeTrak III: Why 20 million in U.S. don't use hearing aids for their hearing loss. Part II. The Hearing Journal, 46(2), 26–31.
- Kochkin S. (1993c). MarkeTrak III: Why 20 million in U.S. don't use hearing aids for their hearing loss. Part III. The Hearing Journal, 46(4), 36–37.
- Kochkin S. (2000). MarkeTrak V: Consumer satisfaction revisited. The Hearing Journal, 53(1), 38–55.
- Kochkin S. (2005). MarkeTrak VII: Hearing loss population tops 31 million. The Hearing Review, 12(7), 16–29.
- Kochkin S. (2009). MarkeTrak VIII: 25-year trends in hearing health market. The Hearing Review, 16(11), 12–31.
- Kochkin S. (2011). MarkeTrak VIII: Mini-BTEs tap new market, users more satisfied. The Hearing Journal, 64(3), 17–24.
- Kochkin S., Beck D. L., Christensen L. A., Compton-Conley C., Fligor B. J., Kricos P. B., … Turner R. G. (2010). MarkeTrak VIII: The impact of the hearing healthcare professional on hearing aid user success. The Hearing Review, 17(4), 12–34.
- Kuk F., Korhonen P., Lau C., Keenan D., & Norgaard M. (2013). Evaluation of a pinna compensation algorithm for sound localization and speech perception in noise. American Journal of Audiology, 22(1), 84–93.
- Larson V. D., Williams D. W., Henderson W. G., Luethke L. E., Beck L. B., Noffsinger D., … Rappaport B. Z. (2000). Efficacy of 3 commonly used hearing aid circuits: A crossover trial. Journal of the American Medical Association, 284, 1806–1813.
- Mueller H. G., & Picou E. M. (2010). Survey examines popularity of real-ear probe-microphone measures. Hearing Journal, 63(5), 27–32.
- The National Academies of Sciences, Engineering, and Medicine. (2016). Hearing health care for adults: Priorities for improving access and affordability. Washington, DC: Author.
- Ortman J. M., Velkoff V. A., & Hogan H. (2014). An aging nation: The older population in the United States (P25-1140). Washington, DC: U.S. Census Bureau.
- Perez E., & Edmonds B. A. (2012). A systematic review of studies measuring and reporting hearing aid usage in older adults since 1999: A descriptive summary of measurement tools. PLOS ONE, 7(3), e31831.
- President's Council of Advisors on Science and Technology. (2015, September). Aging America and hearing loss: Imperative of improved hearing technologies [Letter report]. Washington, DC: Author.
- Sanders J., Stoody T., Weber J., & Mueller H. G. (2015). Manufacturers' NAL-NL2 fittings fail real-ear verification. The Hearing Review 21(3), 24–30.
- Schoenborn C. A., & Marano M. (1988). Current estimates from the National Health Interview Survey. Vital Health Statistics, 10(166), 1–233.
- Strom K. E. (2008). The HR 2008 dispenser survey. The Hearing Review, 15(6), 1–22.
- Studebaker G. A. (1985). A “rationalized” arcsine transform. Journal of Speech and Hearing Research, 28, 455–462.
- Valente M., Abrams H., Benson D., Chisolm T., Citron D., Hampton D., … Sweetow R. (2006). Guidelines for the audiologic management of adult hearing impairment. Reston, VA: American Academy of Audiology.
- Ventry I. M., & Weinstein B. E. (1982). The Hearing Handicap Inventory for the Elderly: A new tool. Ear and Hearing, 3, 128–134.
- Zimmerman A. (2004, March 24). The noisy debate over hearing aids: Why so expensive? The Wall Street Journal, p. A1.
Source: PubMed