GN Hearing has announced the launch of ReSound LiNX 3D™,  which is designed to take Smart Hearing to new levels and enable people with hearing loss to hear more, do more, and be more anywhere in life, the company said on their website.

The company reports that its comprehensive ecosystem seamlessly connects hearing aids, all wireless accessories, and smartphone apps to make everything work together. With the introduction of ReSound LiNX 3D and the ReSound Smart Fit™ software, an entirely new hearing care experience is made possible. The new hearing care solution also offers remote fine-tuning and remote hearing aid updates enabled by GN’s proprietary and secure cloud solution. After an initial fit in the clinic, the user can request assistance for any fine-tuning of their settings wherever they are. The hearing care professional can make all fine-tunings remotely to provide a better hearing experience for the user, according to GN.

The new ReSound LiNX 3D, the corresponding Beltone Trust™ hearing aids, and the new cloud integration are designed to offer unprecedented benefits to hearing aid users and to hearing care professionals across three key dimensions:

Sound quality. With ReSound LiNX 3D—GN Hearing’s 5th-generation 2.4 GHz wireless technology and 3rd-generation binaural directionality— hearing aid users will experience excellent sound quality and will hear more than they ever thought possible, says the company. ReSound LiNX 3D delivers clear, natural sound, exceptional speech understanding, and the best sense of where sounds are coming from. Users will experience 360-degree audibility and awareness in quiet and speech-only situations, improved hearing in noise when speech is in the front, and optimized audibility of surrounding sounds.

New fitting software and user app. Together with audiologists, GN Hearing has developed a more efficient and intuitive fitting software, which simplifies the process where the hearing care professional fits and adjusts the hearing aid to the user. This faster and more convenient wireless fitting will save time for both the user and the hearing care professional. It gives hearing care professionals more time for valuable user counseling.

Additionally, a new app allows users to easily personalize and control their sound at any time on-the-go directly from a smartphone (iPhone, Apple Watch, and selected Android models). The app empowers users to take even more control of their hearing experience through a built-in guidance and coaching feature, and gives users direct access to their hearing care professional for efficient optimization without the need for an appointment in a clinic.

Teleaudiology: Hearing care wherever you are. ReSound LiNX 3D is reportedly the only device with complete remote fine-tuning capabilities that allows users to stay in touch with their hearing care professional wherever they are, receiving hearing care and getting new settings via the cloud without having to schedule and travel for a clinic appointment. The unique cloud integration enables hearing care professionals to stay connected with users no matter where they are. Users will be able to share feedback about any hearing difficulty as the situation occurs, rather than trying to remember how to describe it during an adjustment visit to the clinic. Hearing care professionals will have the freedom to offer follow-up services remotely—saving time for both hearing care professionals and users, and creating opportunities for even higher user satisfaction.

Anders Hedegaard

“GN Hearing is thrilled to introduce a quantum leap in sound technologies that will enable users to hear more than they ever thought possible,” said Anders Hedegaard, CEO of GN Hearing in a press statement. “We are excited to deliver completely new dimensions in hearing care that all leads to a better hearing experience for the user and empowers the hearing care professional to better serve their clients. ReSound LiNX 3D transforms the hearing care industry, meets the modern user’s high demands for superb sound quality, and fulfills our company purpose of making life sound better.”

ReSound LiNX 3D—and the corresponding Beltone Trust™—will launch in all primary markets around the world with a full product family in the Top and Plus performance levels.

For more details about ReSound LiNX 3D, visit: www.resoundpro.com.

Source: GN Hearing

Tech Topic | April 2017 Hearing Review

By Paula Folkeard, AuD, Veronika Littmann, PhD, and Susan Scollie, PhD

Study shows that adding a dereverberation program found in the Signia Primax RIC, improved speech intelligibility and reduced listening effort in the majority of the listeners tested using simulated reverberation.

Perceived listening effort refers to the subjective estimate of how taxing it is to listen in a particular environment or during a certain listening task.¹ Both external factors (e.g. noise, reverberation, speaker accent) and internal factors (e.g. hearing loss, motivation, multi-tasking) that negatively affect the perception of speech can increase the amount of effort and cognitive resources required to understand what is being said.^2-5 Studies comparing individuals with normal hearing and those with hearing loss have shown that people with hearing loss report more fatigue from listening (see Hornsby et al⁶ for a comprehensive review of fatigue research) and require more time than those with normal hearing to recover after being in environments requiring them to listen.⁷

Early studies showed that hearing aids can reduce listening effort by improving the audibility of speech,⁸ and advanced features such as digital noise reduction (DNR) and directional microphones (DM), can provide benefit in more complex and difficult listening environments.^9-11 Picou et al¹² noted the mounting evidence that children, older adults, and listeners with hearing loss are more sensitive to the effects of reverberation, suggesting the need for studies to examine the interaction between age, hearing loss, reverberation, and listening effort.

In this study, we investigated the effect of a hearing aid feature,“Reverberant Room,” on listening effort. The Reverberant Room feature combines several processors including DM, DNR, and “EchoShield.” EchoShield is a proprietary digital signal processing algorithm from Sivantos that operates on level differences between the direct sound and the reflected sounds to avoid over-amplifying the reflected sounds which are typically softer than those in the direct sound path.^13,14 We measured both speech recognition and perceived listening effort for adult listeners with hearing loss.

Study Methods

Participants. Data from 20 participants (12 males, 8 females) were collected and analyzed. Participant ages ranged from 39-83 years with an average of 71 years. The average audiometric thresholds in each ear are plotted in Figure 1, along with the range of thresholds.

Figure 1. Average audiometric thresholds (left and right ears) for 20 listeners with hearing loss who participated in this study. Minimum and maximum thresholds are also shown as lower and upper boundaries (thinner lines).

Hearing aids. Participants were fitted binaurally with Signia Primax receiver-in-the-canal (RIC) hearing aids. All hearing aids were fitted with double domes to the receiver appropriate to the level of hearing loss (i.e. S, M, P). Two hearing aid programs were created using the Connexx 8 software: 1) Omni Directional and 2) Reverberant Room. Real-ear verification of the frequency response of the hearing aids was completed using an Audioscan VF2 (software v4.4) to ensure the aids were providing audibility across the frequency response.

Room set up. Participants were seated in the center of a double-walled sound booth surrounded by speakers at 0°, 45°, 90°, 135°, 180°, 225°, 270°, and 315°. The speakers were located at a distance of 110 cm (about 3.5′) from the subject center at a height of 120 cm (about 4′) from the floor to center speaker.

Figure 2. Participant and speaker configuration used during measurements of speech recognition and listening effort.

Speech-in-noise test. Participants were asked to listen to and repeat back Connected Speech Test (CST) sentences.^15,16 Sentences were presented from the eight speakers with time and level differences across the speakers to simulate reverberation. The CST was modified such that 220 unique CST sentences were assembled using Adobe Audition to create four blocks of 55 sentences each. Background noise was created by mixing cafeteria noise and two passages of custom recorded male speech. This background noise was presented from all speakers except the forward-facing speaker (0°). For this study, the noise was presented at a fixed level 55 dB(A).

Procedure. Three blocks were chosen at random to present to the participant (one each for a practice run and for both test conditions: Omni Directional and Reverberant Room). The practice block was completed in the Omni Directional program. During the practice block, the level of the target sentences was varied to obtain a custom signal-to-noise ratio (SNR) for each participant where approximately 70% of the words were understood. The SNR was then fixed at that level for both test conditions. The order of the two test conditions was counterbalanced across participants, and the participants were not aware which program was being used during testing.

Rating scale. At the end of each block, participants were asked to rate the listening effort on a scale that ranged on a continuum from “No Effort” to “Extreme Effort” (cf, Holube et al⁵ and Luts et al¹⁷).

Results

Speech-in-noise scores. Data from the 20 participants were analyzed. Percentage correct scores were transformed to rationalized arcsine units (rau) prior to statistical analysis.¹⁸ A paired-samples t-test indicated a significant difference in scores for the Omni Directional condition (M=67.11, SD=12.54) and the Reverberant Room condition (M=74.14, SD 10.39); [t(19)=-2.616, p = .017].

On an individual basis, 75% of the participants improved their speech-in-noise score when using the Reverberant Room processor (Figure 3). This effect was highly consistent across individuals, with most showing the effect, and with the magnitude of the effect being approximately 10-20% for more than half of the participants. On average, the speech recognition scores in noise showed a 7% improvement with the Reverberant Room processor activated.

Figure 3. Speech-in-noise scores (% correct) using the Reverberant Room and Omni Directional settings of the Signia Primax hearing aid.

Subjective listening effort ratings. On an individual basis, three-quarters of the 20 participants rated the Reverberant Room program as requiring less listening effort than the Omni Directional program (Figure 4). A paired-samples t-test indicated that this difference was significant [t(19)=3.461, p = .003]. On average, the effort rating in the Omni Directional condition (M=5.4, SD=1.28) was about one category more difficult than the Reverberant Room condition (M=4.6, SD 1.3).

The participants who indicated the same or more listening effort in the Reverberant Room program were neither the youngest nor oldest in the group, had a wide range of hearing losses, and half had improved speech intelligibility scores on the Reverberant Room program compared to the Omni Directional program.

Conclusion. Adding a dereverberation program as an option for a hearing aid user improved speech intelligibility and reduced listening effort in the majority of the listeners we tested in the lab using simulated reverberation.

Figure 4. Listening Effort Ratings provided by participants using the Reverberant Room and Omni Directional settings of the Signia Primax hearing aid.

One limitation of this study is that we cannot say which of the Reverberant Room processor’s sub-features (anti-reverberation, directionality, or noise reduction) was primarily responsible for the improvements that were observed. It may be that they contributed individually or synergistically, and this was not assessed in this project.

However, these results are encouraging in several ways. First, the improvement was measured despite the use of a very challenging listening situation, with simulated reverberation and a background of noise that included cafeteria noise and speech mixed together. Second, the improvements were noted for most of the participants in this study. Third, the improvement was noticeable to the participants even under blinded measurement conditions in which they were not aware of which processor offered the Reverberant Room processor. Taken together, these results may indicate that real-world benefit is possible with this processor. Further testing would be needed in reverberant spaces to evaluate this directly.

References

1. Lemke U, Besser J. Cognitive load and listening effort: concepts and age-related considerations. Ear Hear. 2016;37(1):77S-84S.

2. Mattys SL, Davis MH, Bradlow AR, Scott SK. Speech recognition in adverse conditions: A review. J Lang Cogn Proc. 2002. Available at: http://www.mrc-cbu.cam.ac.uk/personal/matt.davis/pubs/mattys_lcp2012.pdf

3. Van Engen KJ, Peelle JE. Listening effort and accented speech. Frontiers Human Neurosci. 2014;8:577. Available at: http://doi.org/10.3389/fnhum.2014.00577

4. Rudner M. Cognitive spare capacity as an index of listening effort. Ear Hear. 2016;37(1):69S-76S.

5. Holube I, Haeder K, Imery C, Weber R. Subjective listening effort and electrodermal activity in listening situations with reverberation and noise. Trends in Hearing. 2016; Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051672

6. Hornsby BWY, Naylor G, Bess FH. A taxonomy of fatigue concepts and their relation to hearing loss. Ear Hear. 2016;37(1):136S-144S.

7. Nachtegaal J, Kuik DJ, Anema JR, Goverts ST, Festen JM, Kramer SE. Hearing status, need for recovery after work, and psychosocial work characteristics: Results from an internet-based national survey on hearing. Int J Audiol. 2009;48(10):684-691.

8. Humes LE, Christensen L, Thomas T, Bess FH, Bentler R. A comparison of the aided performance and benefit provided by a linear and a two-channel wide dynamic range compression hearing aid. J Speech Lang Hear Res. 1999;42(1):65-79.

9. Ricketts T, Hornsby BWY. Sound quality measures for speech in noise through a commercial hearing aid implementing digital noise reduction. J Am Acad Audiol. 2005;16(5):270-277.

10. Desjardins JL, Doherty KA. The effect of hearing aid noise reduction on listening effort in hearing-impaired adults. Ear Hear. 2014;36(6):600-610.

11. Desjardins JL. The effects of hearing aid directional microphone and noise reduction processing on listening effort in older adults with hearing loss. J Am Acad Audiol. 2016;27:29-41.

12. Picou EM, Gordon J, Ricketts TA. The effects of noise and reverberation on listening effort in adults with normal hearing. Ear Hear. 2016;37(1):1-13.

13. Herbig R, Froehlich M. Reducing listening effort via primax hearing technology. June 9, 2016 (Article 17275). Available at: http://www.audiologyonline.com/articles/reducing-listening-effort-via-primax-17275

14. Littmann V, Froehlich M, Beilin J, Branda E, Schaefer PJ. Clinical Studies Show Advanced Hearing Aid Technology Reduces Listening Effort. Hearing Review. 2016;23(4):36.

15. Cox RM, Alexander GC, Gilmore C. Development of the connected speech test (CST). Ear Hear. 1987;85(5):119S-126S.

16. Cox RM, Alexander GC, Gilmore C. Use of the connected speech test (CST) with hearing-impaired listeners. Ear Hear. 1988;9:198-207.

17. Luts H, Eneman K, Wouters J, Schulte M, Vormann M, Buechler M, Houben R, Froehlich M, Grimm G, Leijon A, Lombard A, Mauler D, Spriet A. Multicenter evaluation of signal enhancement algorithms for hearing aids. J Acoust Soc Am. 2010;127(3):1491-1505.

18. Studebaker GA. A “rationalized” arcsine transform. J Speech Hear Res. 1985;28(3):455-462.

CORRESPONDENCE can be addressed to HR or Dr Folkeard at: folkeard@nullnca.uwo.ca

Citation for this article: Folkeard, P, Littmann V, Scollie S. Using a De-reverberation Program to Improve Speech Intelligibility and Reduce Perceived Listening Effort. Hearing Review. 2017;24(4):32-33.

MED-EL, Innsbruck, Austria, announced that they will soon offer ADHEAR technology in the United Arab Emirates (UAE), according to an article in Emirates 24/7 News. The article states that ADHEAR is a non-surgical bone conduction solution for conductive hearing loss that can be used by any age, from infants to the elderly.

The device has two external pieces that consist of an adhesive adaptor and an audio processor. For more information, visit the Emirates 24/7 News website here.

Source: Emirates 24/7 News

Oticon President Gary Rosenblum accepted a Gold Award for Opn’s “Innovation and Excellence in Product Development” at the 2017 Edison Awards Gala in New York City.

Oticon Opn™ has added two new awards to a growing list of accolades from leading international awards competitions, Oticon announced. On April 20, Oticon President Gary Rosenblum accepted a Gold Award for Opn’s “Innovation and Excellence in Product Development” at the 2017 Edison Awards Gala in New York City.  A panel of more than 3,000 academics and leaders in the field of product development, design, engineering, science, and medicine judged this year’s awards finalists, recognizing Opn’s human-centered design and innovation in the Health & Wellness category.

The 2017 Red Dot Awards, one of the most sought-after quality marks for good design, also honored Oticon Opn in April.  The award recognizes Opn’s outstanding design aesthetics that incorporate a variety of technical, performance, and functionality innovations including the world’s first internet connected hearing aid, according to the company. Opn will be among the award-winning designs exhibited at Red Dot Design Museums around the world.

“We are honored that Oticon Opn has been selected for two global awards from a competitive arena that includes hundreds of cutting-edge products from leading US and international companies,” said Rosenblum.  “Opn is making a real difference to the lives of people, young and old, who suffer from hearing loss. With our newly expanded Opn family, we continue to build on paradigm-shifting innovation at the core of Opn to bring the open sound experience to even more people with hearing loss.”

In addition to the Awards Gala, the Edison Awards encompassed a full-day “Meet the Innovators Forum” and “Innovators Showcase” that offered guests a hands-on experience with Opn and many of the winning products.  The annual awards program is named after Thomas Alva Edison, who experienced hearing loss from an early age.  His inventions revolutionized everyday life and showed that hearing loss does not limits a person’s ability to achieve, contribute and quite possibly, change the world.

Source: Oticon

Beltone, Chicago, has launched Beltone Trust™, which is designed to offer unprecedented sound quality and the ability to connect with their hearing care professional outside regularly scheduled appointments, the company announced. As Beltone’s fifth-generation 2.4 GHz wireless solution, Beltone Trust™ reportedly propels the company’s position as the leader in hearing aids for the past 77 years into the future.

Beltone’s all-inclusive hearing care program connects hearing aids, all wireless accessories, and smartphone apps to enable people with hearing loss to live life, and hear life, to the fullest, the company reports. The new Beltone Trust™ features unmatched sound technologies, more convenient fitting software, and new remote fine-tuning, reportedly making it the most advanced and flexible hearing aid experience available today.

These breakthroughs in hearing care are developed with the latest audiological insights and advancements in technology to bring more convenience and efficiency than hearing aid users and professionals ever thought possible.

Unparalleled Sound Quality

With Beltone’s 5th generation 2.4 GHz wireless technology and 3rd generation CrossLink Directionality, hearing aid users will experience exceptional sound quality and hear more than ever before, the company says. Beltone Trust™ reportedly delivers clear, natural sound, excellent speech understanding, and the best sense of where sounds are coming from. Users are said to benefit from 360° audibility and awareness in quiet and speech-only situations, improved hearing in noisy environments, and optimized audibility of surrounding sounds.

Remote Care™: Ground-Breaking Customer Service

Beltone is bringing remote fine-tuning capabilities to the hearing industry for the first time, allowing hearing care professionals to address a wearer’s needs from anywhere around the world. The new Beltone Trust™ hearing aids enable wearers to achieve optimal hearing through a new two-way, fine-tuning process called Remote Care™, which incorporates real world input from wearers via the cloud without having to schedule and travel to an appointment.

The unique cloud integration enables hearing care professionals to connect with wearers no matter where they are. Wearers will be able to share feedback about difficulty hearing in the moment via the Beltone HearMax™ app, rather than trying to remember how to describe issues later during an adjustment visit. Hearing care professionals will also have the freedom to offer follow-up services remotely, saving time for both professionals and users, and creating opportunities for even higher user satisfaction.

Solus Max™ Fitting Software

To support hearing professionals in fitting wearers with Beltone Trust™ hearing aids, Beltone introduces the new Solus Max™ software, which is said to be a powerful fitting tool with a redesigned look and feel. Access to patient information and navigation is faster and easier, leading to better customer satisfaction. With enhanced processing and a comprehensive, easy-to-use portfolio of features that deliver a more comfortable fitting experience for wearers, Solus Max™ is a complete fitting system.

BelCare™: A Lifetime of Care and Protection

Central to Beltone’s customer journey is BelCare™, a program of ongoing care and protection that covers users for the life of their hearing aids. Reportedly one of the most comprehensive hearing care programs available, the company reports that BelCare™ ensures hearing aid users are taken care of from the first screening, through all the years they own their Beltone hearing aids.

While most competitors charge for services like cleaning devices, making adjustments, and scheduling follow-up appointments, Beltone is able to offer this type of coverage for free for the life of the hearing aids.

Safe and Sound Campaign

In conjunction with the launch of Beltone Trust™, Beltone is introducing “Safe and Sound,” a campaign focused on educating consumers about the dangers of hearing loss and the benefits of early treatment and prevention. The “Safe and Sound” initiative features everyday community heroes who struggled with their own hearing loss—hearing loss that threatened to irreparably interrupt every facet of their professional and personal lives. But by devoting time and energy into their hearing health, they were able to once again live life to the fullest. The campaign features individuals who are advocates for hearing loss education and eliminating the stigma of hearing loss.

“We are thrilled to introduce our newest technology—Beltone Trust—to our ever-evolving customers,” said Corrine Perritano, president of Beltone North America. “With its unrivaled sound quality, convenient fitting software, and groundbreaking Remote Care functionality, we’re proud to offer today’s users hearing care wherever they are. And as an added benefit, we are empowering our Beltone hearing care professionals to deliver a whole new level of personalized hearing care and service in a way that is simple and convenient for our customers.”

Source: Beltone

Beltone, Glenview, Ill.—a hearing aid company—and the Edison Awards announced that Beltone’s myPAL accessories were voted a Bronze Winner for innovation. Celebrating 30 years of honoring the best in innovation and excellence in the development of new products and services, Beltone joined hundreds of senior executives from some of the world’s most recognized companies at the April 20 event at The Capitale in New York City to acknowledge the hard work and commitment of all of the 2017 Edison Award winners. The Edison Awards are sponsored by the Edison Universe, a charitable organization dedicated to supporting innovators and inventors.

The Beltone myPAL Pro and myPAL Micro are hearing aid accessories that provide the ultimate experience in personalized sound, according to Beltone. Beltone myPAL accessories are small portable microphones that capture sounds clearly—even in noisy environments—and stream directly into the wearer’s hearing aids, bringing the conversation or entertainment closer to them.

Being recognized with an Edison Award is reportedly one of the highest accolades a company can receive in the name of innovation and business. The awards are named after Thomas Alva Edison (1847-1931) whose inventions and innovative achievements changed the world.

“Our judges recognized Beltone as a true innovator out of the many products in its category,” said Frank Bonafilia, executive director of the Edison Awards.

“The myPAL accessories offer additional, personalized hearing solutions in situations where there’s extra background noise, giving users an enhanced ability to communicate with family and friends,” said Corrine Perritano, president of Beltone North America. “We are thrilled to receive the Bronze distinction from the Edison Awards and excited to continue innovating for our customers.”

Beltone myPAL accessories and other products can be found at more than 1,500 Beltone locations throughout North America. Find a location near you.

For a full list of Edison award winners, visit the Edison Universe website here.

Source: Beltone, Edison Universe

The Hearing Lab at Syracuse University is seeking recruits for a two-week field trial to study how hearing technology could improve hearing in noisy settings, according to a post on the Syracuse University News website. 

Participants must be between 50-60 years old, have normal hearing, and be a native English speaker, according to the post. If chosen, participants will be paid $10 per hour.

For further information on registering for the study, please visit the original post here.

Source: Syracuse University News

Oticon Opn™ captured two Gold Stevie Awards in the 15^th Annual American Business Awards, Oticon announced. The world’s reportedly first Internet-connected hearing aid earned top honors in the Consumer Electronics and Health & Pharmaceutical categories. The two Gold Stevie Awards bring to seven the number of national and international awards won by Oticon Opn in 2017.  Additional honors include a Gold 2017 Edison Award, 2017 CES Innovation Awards in the Tech for a Better World and Wearables categories, a 2017 Red Dot Award, and a 2017 MarCom Award.

Accepting the awards at the Gala, Oticon Executive Director Rasmus Borsting recognized the Oticon teams around the world that contributed to creating Opn, the world’s first Internet-connected hearing aid. “Oticon will continue to build on the innovation at the core of Opn to bring the revolutionary open sound experience and the many possibilities of the Internet of Things to even more people,” he told the audience of more than 550 industry leaders and guests.

It’s been said that judging panels have singled out Opn for outstanding innovation, product quality, and human-centered design in awards competitions that include cutting-edge products from leading US and international companies, according to Oticon. More than 3,600 nominations from organizations of all sizes and in virtually every industry were submitted for consideration in this year’s American Business Awards competition.

Oticon continues to build on the paradigm-shifting innovation at the core of Opn to bring the revolutionary open sound experience and the almost limitless possibilities of the Internet of Things to even more people with hearing loss.

Source: Oticon

Image: Oticon

Research | May 2017 Hearing Review

A comparison of audiology best-practice services versus an OTC delivery model

By Larry E. Humes, PhD, Christine Herring, Dana L. Kinney, MA, Anna K. Main, AuD, Tera M. Quigley, AuD, and Sara E. Rogers, AuD

The authors present a summary of findings from their recent study published in the March 2017 edition of the American Journal of Audiology that compares a professionally driven best-practice hearing aid service delivery model to a version of an over-the-counter (OTC) model. One important message that should not be lost in the extremely relevant findings of this RCT study is that hearing aids are, in fact, efficacious and provide considerable benefit to older adults with mild-to-moderate hearing loss.

Approximately 35% of Americans over age 65 have a significant hearing loss sufficient to make them hearing aid candidates.^1,2 Yet, only about 20% of those older Americans who could benefit from hearing aids actually seek them out, and of those who do, only about 40-60% are satisfied with them and use them regularly.³ These figures for hearing aids, moreover, are similar for the UK and elsewhere.^4,5

The large discrepancy between the number of older adults in need of hearing healthcare and those receiving benefit from hearing aids was one of the motivating factors behind the organization of a National Institute of Deafness and Other Communication Disorders/National Institutes of Health (NIDCD/NIH) working group on accessible and affordable hearing health care for adults with mild-to-moderate hearing loss. This international working group identified research areas that could lead to the improvement of hearing healthcare for adults with such hearing loss; in particular, enhancing the accessibility and affordability of hearing healthcare.⁶

This clinical trial addressed three high-priority research questions identified and summarized by the NIDCD/NIH working group⁶:

1. How can current delivery systems (including the system and the provider) be utilized or modified to increase accessibility and affordability of hearing healthcare?
2. What is the comparative effectiveness between two delivery schemes (current best practice vs others) with technology held constant?
3. What is the minimal hearing health care delivery system needed for successful outcomes and quality care?

Although the study is limited to a generalization of findings due primarily to its white, middle-class, educated study sample, it is unique because it represents:

• The first-ever, placebo-controlled, double-blind randomized clinical trial (RCT) of hearing-aid efficacy in older adults, and
• The first comparison of a standard best-practices audiology-based model to an over-the-counter (OTC) service-delivery model that has the potential to increase accessibility and affordability of hearing aids.

Two recent high-level reports, one by the US President’s Council of Advisors on Science and Technology (PCAST)⁷ and one by the US National Academies of Science, Engineering, and Medicine (NASEM),⁸ have reinforced the importance of these questions in addressing the hearing healthcare needs of millions of older Americans. One of the alternative service-delivery models advocated in the National Academies’ report⁸ is an OTC model, one version of which was examined in this trial. US Senators Warren and Grassley have introduced Federal legislation to open the door for OTC devices and service-delivery on a widespread basis.⁹

No prior placebo-controlled, randomized clinical trial of hearing aid efficacy has been published. As a result, this trial included a comparison of the treatment effects of two service-delivery models for the provision of hearing aids to older adults, each relative to the performance of placebo controls. The two service-delivery models evaluated were the current audiology best practice model and an experimental OTC model that did not involve an audiologist in the delivery of the hearing aids to the patients.

A much more detailed and thorough presentation of this clinical trial and its results has been published in the March 1, 2017 edition of the American Journal of Audiology (AJA).¹⁰ The more detailed and lengthier report targets other audiology professionals, hearing scientists, and hearing-aid dispensers as the primary audience.

In the brief report here, the targeted readership includes many of these same readers, but provides a less dense overview of the primary methods and findings. The anticipated audience is also broader—including many other professionals who might be the initial contact for older adults who express concerns about their hearing or who seek out hearing aids. As will become apparent, one of the important messages from this double-blind placebo-controlled randomized clinical trial is that hearing aids are, in fact, efficacious and provide considerable benefit to older adults with mild-to-moderate hearing loss.

Methods

This was a placebo-controlled, double-blind randomized clinical trial with three parallel branches:

1) Audiology-based (AB) best-practices service delivery;

2) Consumer-decides (CD) or OTC service delivery; and

3) Placebo (P).

The purchase price of the hearing aids provided to the participants was also manipulated: either a “typical” purchase price of $3,600 or a reduced purchase price of $600 for both hearing aids. Purchase price was manipulated because the OTC service-delivery model typically has been envisioned as one that delivers devices at lower prices than the audiology-based best practices service delivery model.

However, there are no data available on the effects of purchase price alone on outcomes. As a result, factorial combinations of service delivery and purchase price were used to evaluate the impact of each of these variables separately and in combination. In the end, no significant (p>0.05) main effects of, or interactions with, purchase price were observed for aided outcome measures. (A full factorial analysis of the six combinations of service delivery and purchase price is presented in detail in the original AJA article.¹⁰) As a result, data for each service-delivery model were pooled across purchase prices in all subsequent presentations of data and analyses in this report.

Subjects and Session 1 procedures. All procedures for this protocol were reviewed and approved by the Indiana University Institutional Review Board (IRB). Participants were recruited primarily by ads posted in local newspapers and around the community. Those interested contacted the Clinical Trials Coordinator (CTC) by phone for an initial eligibility screen and then arranged an initial assessment to make a final determination of eligibility (Session 1). Inclusion and exclusion criteria are provided in detail elsewhere.¹⁰ After informed consent was obtained from each participant for Session 1, measures completed were:

1. A detailed case history;
2. Otoscopic examination of both ears;
3. A complete audiological assessment, including pure-tone audiometry, speech audiometry (both speech-recognition thresholds and word-recognition scores), and immittance measurements (tympanometry and acoustic reflex thresholds), and
4. The Mini Mental State Exam (MMSE).¹¹

A sound-field measure of speech audiometry included in Session 1 was the Connected Speech Test (CST).¹² This unaided CST score was used to block study participants prior to randomization (see below). One of two audiologists, A1 or A2, were assigned to complete these Session 1 measures.

A total of 323 individuals were assessed for eligibility; 188 were eligible for enrollment following Session 1, and 163 of these individuals enrolled. The trial commenced November 2, 2012 and data collection ended August 31, 2016.

The 163 participants who enrolled in the trial were separately consented for participation in Sessions 2 and 3, agreed to return for Session 2 (typically the next day), and were subsequently randomized to one of three groups: AB, CD, or P. Details regarding the randomization process can be found in the previous AJA report.¹⁰ As explained in more detail in that report, the CD and P participants, at the conclusion of the 6-week trial, were given the opportunity for an additional 4-week trial making use of hearing aids delivered via audiology-based best practices. Almost all of these individuals opted for the additional trial period and the results of that additional trial can also be found in the original report.¹⁰ Of the 163 participants who enrolled, 98% self-reported their race as “white” and their ethnicity as “not Hispanic or Latino,” 78% had a college degree, and 80% reported annual household income greater than $45,000. The top portion of Table 1 provides other demographic information for each group.

Study devices. The study devices were ReSound Alera digital, mini behind-the-ear (BTE) open-fit hearing aids having 9 compression channels and 4 programs available. These mini-BTE, open-fit devices are representative of the most popular type of hearing aid sold in the United States to older adults.¹² Default programming for all devices made use of fixed directional microphones, dynamic feedback suppression, and noise reduction. Some placebo devices (N=35) made use of omni-directional microphones and others (N=20) made use of the default directional microphones. With one exception (see below), there were no significant differences (p>.05) in outcome measures between these two placebo implementations, and these data were pooled to represent the entire placebo group (see original report¹⁰ for full details). All markings and materials revealing manufacturer or model of the devices were obscured. Manufacturer and model were revealed to all participants only after the conclusion of the entire trial. All hearing-aid fits were bilateral.

Session 2 procedures. The procedures in Session 2 varied with group assignment. First, for all participants, unaided baseline scores were collected for two self-report outcome measures: The 66-item Profile of Hearing Aid Performance (PHAP)¹³ and the 25-item Hearing Handicap Inventory for the Elderly (HHIE).¹⁴

Audiology best practices (AB) and placebo (P) groups. For groups AB and P, the procedures in Session 2 were nearly identical except that the hearing aids for the placebo participants were programmed to be acoustically transparent (ie, no electroacoustic compensation for the participant’s hearing loss was provided by the placebo devices). For those in group AB, target gain prescriptions were generated using the common NAL-NL2 formula¹⁶ to compensate for the participant’s hearing loss.

For both AB and P participants, verification of the desired acoustic output of the hearing aids was accomplished via a tiny probe-tube microphone inserted into the ear canal, with good matches between prescribed and measured real-ear responses achieved for the AB group.¹⁰ Flat 0-dB insertion gain was also verified with real-ear measurements for the placebos. In both cases, the matching criterion was for measured values to be within 4 dB of target from 250-4000 Hz, but measured values within 7 dB of target were acceptable, especially in the higher frequencies (≥ 2000 Hz).

Audiologist A1 or A2 did the hearing aid programming, real-ear verification, and any required fine-tuning to match targeted output. A third audiologist, A3, was blinded regarding group AB or P and was involved with the remainder of Session 2 for these two groups. This consisted of a 45 to 60-minute hearing aid orientation session, during which audiologist A3 reviewed the components, features, and function of the hearing aids, the insertion and removal of batteries, the insertion and removal of the hearing aids, maintenance practices, telephone use, and adjustment of volume. Supervised hands-on practice was provided for several of these skills. Participants were also counselled about benefits and limitations of hearing aids and effective communication strategies to use. All participants (AB, CD, P) also received a written user’s guide for the hearing aids.

The use of probe-tube microphone measurements to fine-tune the devices to the hearing aid wearer’s hearing loss and the inclusion of hearing aid orientation information, including hands-on practice with these skills, are considered to be to critical aspects of audiology best practices (AB).^17,18 Participants in both AB and P groups received these services; participants in Group CD, however, did not receive real-ear adjustments of their hearing aids’ response or a hearing aid orientation.

Consumer-decides (CD) group. For the CD participants, Session 2 commenced with the CTC escorting the participant to a small room. On a table were containers for the ear tips and tubing to be used and three bins containing 6 hearing aids each, with the hearing aids in each bin differing only in color (grey, beige, brown). Each bin was partitioned into three compartments, each containing a pair of hearing aids labeled X, Y, or Z, and programmed in advance to match the NAL-NL2 acoustic output prescriptions for three of the most common patterns of hearing loss among older adults in the United States.¹⁹

The participant watched a brief instructional video overviewing the hearing aid self-selection process then completed each step of the self-selection process. (This video is available online with the AJA article.¹⁰) A hardcopy of the step-by-step instructions was also provided to the participant with the contents based on work with self-fitting hearing aids.²⁰ The CD participant first selected an appropriate-sized ear tip and tube, then the desired hearing aid color, examining several in a mirror, then the particular acoustic characteristics desired (X, Y, or Z). A compact-disc player was available to provide standardized samples of speech, music, and environmental sounds for listening. Participants were allowed to have a significant other in the room with them during the selection process, but only one opted to do so.

When the participant’s selections were finalized, the participant pressed a button to alert the CTC that the selections had been made. Details regarding the choices made by the CD participants with regard to the tubing, ear tip, and hearing aid gain characteristics selected are provided elsewhere.¹⁰ In general, though, the CD participants tended to select hearing aids programmed with gain somewhat less than that prescribed for their hearing loss as indicated by the NAL-NL2 prescription formula.

Session 3 procedures. During Session 3, typically 6 weeks after the initial fit of the hearing aids in Session 2 (M = 44.5; SD = 10.1 days), either audiologist A1 or A2 (the one not involved in Session 2 programming) obtained electroacoustic performance measures “as worn” for each hearing aid, then inspected the hearing aids, tubes, and ear tips.

Outcome measures were then obtained by another audiologist, A4. A4 was blind to participant group. The primary outcome measure for this trial was the Profile of Hearing Aid Benefit (PHAB). The Profile of Hearing Aid Performance (PHAP) was administered prior to (unaided, Session 2) and following a 6-week period of hearing-aid use (aided, Session 3), with the difference in ratings on the questionnaire used to compute the PHAB scores. The PHAB was chosen because of its comprehensive assessment of self-reported hearing aid benefit, especially with regard to speech communication, across a wide range of everyday listening conditions. It has also been proven to be reliable¹⁴ and was used in one of the few prior clinical trials of hearing aids.²³ The five speech-communication subscales of the PHAB were averaged to form a single global score, PHABglob, as the primary outcome measure in this study. The remaining two subscales deal with the perception of aversive and distorted sounds and were also averaged, yielding PHABavds as another measure. Based on prior research,^14,21 however, hearing aids are not expected to improve the PHABavds scores.

Estimates of treatment effects, effect sizes, and common standard deviations for the primary outcome measure were derived from analyses of the de-identified raw data from an earlier clinical trial of hearing aids.²¹ In that trial, multiple unaided and aided PHAP scores were obtained from over 300 participants. To estimate the placebo effect, no effect was assumed and the difference between two separate unaided measures for the PHAP were computed to calculate the PHABglob measure for the placebos.

For an estimate of the aided benefit, the data for the hearing aid circuit closest to that in the present study (single-channel wide-dynamic-range-compression) were used. A total of 40 random samples of the full data set from this prior trial, targeting 50% of the sample in each group, were selected to generate expected independent-group placebo effects, AB treatment effects, and standard deviations for this outcome measure. This was necessary due to the absence of standard deviations in prior published reports of the PHAB from the prior clinical trial and to the unavailability of comparable PHABglob scores in these and other datasets.

For the primary outcome measure in the proposed project, the PHABglob, the estimate of the mean placebo effect was 0.02 and the mean aided effect was 0.28, yielding a mean treatment effect of 0.26 (SD=0.18) for PHABglob relative to the simulated placebo. Assuming the experimental OTC intervention (CD) was half as effective, PHABglob = 0.13, then a sample size of 31 per group would be needed to detect this difference in outcome between the AB and CD groups with power = 0.80 and a Type 1 error rate of 0.05 (nQuery Advisor, V7.0). When each of the six groups in the full factorial model (3 service delivery arms x 2 purchase-price groups) reached about 80% of the enrollment targets, a preliminary analysis revealed the lack of significant main effects and interactions for purchase-price. Enrollments ceased at this point, given 53-55 participants for each of the three service-delivery groups (AB, CD, P).

The secondary outcome measure to be used in this clinical trial was derived from the unaided and aided CST speech-recognition scores. This measure was included because, unlike the self-report PHAB, the CST assesses unaided and aided speech understanding directly by asking the listener to repeat back sentences heard in a background of competing speech. Moreover, the sentences all relate to a common topic which was provided to the listener prior to presentation. This adds to the face validity of the test as a measure of everyday speech communication which typically involves sentences, competing speech, and topics of conversation known to the listener. Further, the reliability of this test in older adults with impaired hearing had been established.¹² The secondary outcome measure was based on the difference in aided and unaided CST scores, CST benefit. Each CST score was based on two passage pairs or 100 keywords and was obtained for a speech level of 65 dB SPL and a signal-to-babble ratio (SBR) of +3 dB. The speech level and SBR are similar to those used previously for the CST, including in a randomized clinical trial comparing hearing aids.²¹

Because hearing aid outcome in older adults has been demonstrated to be a multidimensional construct with 3-4 dimensions,^22-24 some additional outcome measures were obtained from all participants. These included self-reported benefit measured as the difference between the unaided and aided HHIE scores, using 32 items of a 42-item survey of satisfaction with hearing-aid function,^25,26 referred to here as the Hearing Aid Satisfaction Survey (HASS), and the average daily usage of the hearing aid in hours/day obtained for the datalogging feature of the digital hearing aids used in this trial.

Results

Table 1. [Click on images to enlarge.] Means (M) and standard deviations (SD) for demographic measures, unaided baseline scores, and outcome measures for the audiology best-practices (AB) group (N=53; 28 males), consumer decides (CD) group (N=55; 27 males), and placebo (P) group (N=55; 37 males) in this clinical trial.  Significant (p<.05) ANOVA values [F(df)] are shown in bold. *PTA = pure-tone average with hearing thresholds averaged bilaterally at 500, 1000, and 2000 Hz; HFPTA = high-frequency PTA with hearing thresholds averaged bilaterally at 1000, 2000, and 4000 Hz; ^N = 35 placebos with omni-directional microphones; #For HASS and Usage, per-protocol analyses (N = 154) and df = 2, 151.

The placebo group (P) was included because no prior studies had done so to establish the efficacy of the best-practices audiology-based intervention (AB) group. For the CST benefit measure, only the 35 placebo participants with omni-directional microphones were included because those placebos with directional microphones (N=20) had significantly (p<0.05) greater CST benefit, although this was largely due to differences in unaided performance. For a more detailed description of these two placebo implementations and the analyses of the effects of the microphone setting for the placebo groups, see the AJA report.¹⁰

The filled and unfilled circles in Figure 1 show the mean effects of each treatment, AB or CD, relative to placebo (P). For all outcome measures shown in Figure 1, better performance is indicated by positive values. The horizontal error bars represent 95% confidence intervals about the means.

Figures 1a-c. [Click on image to enlarge.] Means (circles) and 95% confidence intervals (error bars) for difference between treatment (AB, filled; CD, unfilled) and placebo for each of the six outcome measures used in the clinical trial.  Top (1a): PHAB outcome measures, intention-to-treat analysis; Middle (1b): CST (in RAU; N =35 for P) and HHIE benefit, intention-to-treat analysis; Bottom (1c): Satisfaction (HASS) and Usage (hrs/day), per-protocol analysis (N=154).

Figure 1b depicts benefit measures—the difference between aided and unaided values—for both the CST and the HHIE. For the CST, all percent-correct scores were transformed into rationalized arcsine units (RAU) to stabilize the error variance.²⁷ Once again, both the AB and CD models yielded efficacious outcomes relative to the placebo controls and for both of these measures. In addition, the magnitude of the changes in performance for each outcome measure—about 20-25 RAU for the CST and 8-12% for the HHIE—would both be considered to be clinically significant improvements.

Figure 1c shows the results for two additional dimensions of outcome: self-reported satisfaction (HASS) and daily hours of usage (per-protocol analyses; ie, the limited missing data were excluded rather than replaced via regression, N=154). For these outcome measures, only aided post-fit measures are possible, rather than a relative difference from unaided to aided as in the other outcomes in Figure 1. For satisfaction, only the AB group demonstrated significantly (p<0.05) greater satisfaction than the placebos, although the magnitude of this change would not likely be considered to be of clinical or practical significance given that it does not represent a change of at least one unit on the 5-point rating scale. For daily hours of usage, neither group differs significantly (p>0.05) from the placebos.

Effect sizes (Cohen’s d²⁸) were calculated for both AB and CD groups relative to the placebos from the data presented in Table 1. Most of the d values observed in this trial for both groups are considered moderate (three, 0.47-0.69) or large (four, 0.89-1.19) effect sizes.²⁸ Exceptions are PHABavds and Usage for both AB (-0.02, 0.29) and CD (-0.07, 0.03) groups, and HASS for the CD group (0.11). Further, as noted above, the magnitude of the changes for each outcome measure are large enough to be considered clinically significant.

At the end of the trial, each participant who completed the trial (N=154) was asked to indicate, based on their experience over the 6-week trial, whether they were likely to keep the hearing aids or return them for a refund. For the AB group, 81% indicated that they would keep the hearing aids, whereas only 55% of the CD group and 36% of the placebo group planned to keep them. Chi-square testing revealed the AB percentage to be significantly (p<.05) greater than both CD and P percentages, but the difference between the CD and P groups was not significant.

Discussion

This article overviews the key aspects of the first placebo-controlled, double-blind randomized clinical trial of hearing aid efficacy in older adults.¹⁰ Generally, positive outcomes were observed for AB and CD groups. For the primary and secondary outcome measures, PHABglob and CST benefit, respectively, both the AB best-practices and the CD OTC service-delivery models were efficacious. This was also true for another measure of self-reported benefit based on the HHIE and, for the AB model only, for a measure of hearing-aid satisfaction (HASS).

On the other hand, neither AB nor CD participants demonstrated efficacy with regard to average hours of daily usage. This was due, in large part, to the placebo participants wearing their hearing aids an average of nearly 6 hours per day (Table 1). Placebo participants were essentially AB participants with hearing aids programmed to provide no actual acoustic gain to compensate for their hearing loss. As a result, the placebo participants received the same counseling, orientation, and hands-on practice in working with the devices as the AB participants, the latter group averaging closer to 7 hours usage per day. The CD participants, however, received none of this instruction from the audiologist and still used their hearing aids about the same amount of time.

Study limitations. There are limitations to the generalization of these findings due to the primarily white, middle-class, highly educated study sample. Generalization to other samples of older adults with differing demographics is not possible without additional data. Further, it’s important to note that only one device was investigated here: a high-quality, open-fit behind-the-ear hearing aid. It is not possible to generalize these positive findings to other devices, including simpler devices of possibly lesser quality envisioned by some as OTC devices of the future.

The CD service-delivery model examined here and found to be efficacious is only one of several conceivable OTC service-delivery models. As other OTC models develop, their efficacy will also need to be established.

Moreover, it is important to note that all participants in this study received a thorough audiological examination in Session 1 to determine candidacy for the trial hearing aids. It is conceivable that some OTC service-delivery models would forego this initial audiological examination. Of course, the results from the current trial cannot be used to validate other OTC models or clinical protocols which might exclude any of the protocol procedures completed here.

Finally, there were 4 older adults assigned randomly to the CD group who were unable to self-select the tubes, ear tips, and hearing aids—skills that were central to this service-delivery model. This approach is clearly not a universal alternative, as 7% of the CD group was unable to select their devices. This percentage, moreover, may have been higher without the MMSE selection criterion used in this trial or with a less highly educated sample.

Acknowledgements

This article is based on data from a comprehensive paper¹⁰ published in the March 2017 edition of the American Journal of Audiology (also see reference in box below). We thank Kimberly Skinner, AuD, for assistance with data collection and Stephanie Dickinson for help with statistical analyses. This trial was supported by a research grant to the first author from the National Institute of Deafness and other Communication Disorders (NIDCD), R01 DC011771. We also thank Laurel Christensen, Andree Girard, Jennifer Groth, Dena Sloan-Gordon, and Tammara Stender for their assistance with study hearing aid programming and technical support. No funding was received from GN ReSound in support of this trial and all hearing aids were purchased from the manufacturer in large quantities at a price of $100 per hearing aid.

All authors had financial support from the National Institutes of Health (NIH) via a research grant to the university for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

References

1. Schoenborn CA, Marano M. Current estimates from the National Health Interview Survey. Vital Health Stat. 1988;10(166):1-233.

2. Cruickshanks KJ, Zhan W, Zhong W. In Gordon-Salant S, Frisina RD, Popper AN, Fay RR. The Aging Auditory System: Perceptual Characterization and Neural Bases of Presbycusis. Springer Handbook of Auditory Research (SHAR). New York: Springer-Verlag; 2010:259-274.

3. Kochkin S. MarkeTrakVIII: 25-year trends in hearing health market. Hearing Review. 2009; 16(11):12-31. Available at: http://www.hearingreview.com/2009/10/marketrak-viii-25-year-trends-in-the-hearing-health-market

4. Dawes P, Fortnum H, Moore D, et al. Hearing in middle age: A population snapshot of 40- to 69-year olds in the United Kingdom. Ear Hear. 2014; 35, 44-51.

5. Perez E, Edmonds BA. A systematic review of studies measuring and reporting hearing aid usage in older adults since 1999: a descriptive summary of measurement tools. PLOS ONE 2012;7(3):e31831.

6. Donahue A, Dubno JR, Beck L. Guest Editorial: Accessible and affordable hearing health care for adults with mild to moderate hearing loss. Ear Hear. 2010; 31: 2-6.

7. President’s Council of Advisors on Science and Technology. Aging America and Hearing Loss: Imperative of Improved Hearing Technologies. Letter report to the US President, final draft, October 2015; Washington, DC. Available at: http://www.hearing.org/uploadedFiles/Content/HIA_Updates_and_Bulletins/pcast_hearing_tech_letterreport_final.pdf

8. National Academies of Sciences, Engineering, and Medicine. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington, DC: The National Academies Press; 2016. Available at: https://www.nap.edu/catalog/23446/hearing-health-care-for-adults-priorities-for-improving-access-and

9. Warren E, Grassley C. Over-the-counter hearing aids: The path forward. JAMA Internal Medicine. Published online 3/3/17. doi: 10.100/jamainternmed.2017.0464

10. Humes LE, Rogers SE, Quigley TM, Main AK, Kinney DL, Herring C. The effects of service-delivery model and purchase price on hearing aid outcomes in older adults: A factorial randomized double-blind placebo-controlled clinical trial. Am J Audiol. 2017 Mar 1;26(1):53-79. doi: 10.1044/2017_AJA-16-0111.

11. Folstein MF, Folstein SE, White T, Messer MA. Mini-Mental State Examination. 2nd ed. Lutz, Fla: Psychological Assessment Resources;2010.

12. Cox RM, Alexander GC, Gilmore C. Development of the Connected Speech Test (CST). Ear Hear. 1987; 8(5 Suppl): 119S-126S.

13. Kochkin S. MarkeTrak VIII: Mini-BTEs tap new market, users more satisfied. Hear Jour. 2011; 64(3):17-24.

14. Cox RM, Gilmore C. Development of the Profile of Hearing Aid Performance (PHAP). J Speech Hear Res. 1990; 33: 343-357.

15. Ventry IM, Weinstein BE. The Hearing Handicap Inventory for the Elderly: A new tool. Ear Hear. 1982; 3: 128-134.

16. Dillon H, Keidser G, Ching TYC, Flax MR, Brewer S. The NAL-NL2 prescription procedure. Phonak Focus. 2011;40: 1-10.

17. Valente M, Abrams H, Benson D, et al. Guideline for the Audiologic Management of Adult Hearing Impairment. Reston, Va: American Academy of Audiology; 2008. Available at: https://audiology-web.s3.amazonaws.com/migrated/haguidelines.pdf_53994876e92e42.70908344.pdf

18. American Speech-Language-Hearing Association. Hearing Aids for Adults. Hearing Loss (Adults) Online Evidence Map; 2015.

19. Ciletti L, Flamme GA. 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). J Amer Acad Audiol. 2008; 19: 672-685.

20. Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: Design of effective instruction materials. Trends Amplif. 2011; 15: 184-195.

21. Larson VD, Williams DW, Henderson WG, et al. Efficacy of 3 commonly used hearing aid circuits: A crossover trial. J Am Med Assoc. 2000; 284:1806-1813.

22. Humes LE. Issues in evaluating the effectiveness of hearing aids in the elderly: What to measure and when. Sem Hear. 2001; 22(3): 303-314.

23. Humes LE. Modeling and predicting hearing-aid outcome. Trends Amplif. 2003; 7:41-75.

24. Humes LE, Krull V. Evidence about the effectiveness of hearing aids in adults. In: Wong L, Hickson L, eds. Evidence Based Practice in Audiology. San Diego: Plural Publishing;2012.

25. Kochkin S. MarkeTrak V: Consumer satisfaction revisited. Hear Jour. 2000; 53(1): 38-55.

26. Humes LE, Garner CB, Wilson DL, Barlow, NN. Hearing-aid outcome measures following one month of hearing aid use by the elderly. J Speech Lang Hear Res. 2001;44:469-486.

27. Studebaker GA. A “rationalized” arcsine transform. J Speech Hear Res. 1985; 28: 455-462.

28. Cohen J. Statistical Power Analysis for the Behavioral Sciences. London: Routledge;1988.

DEDICATION: This report is dedicated to the memory of Dr Gordon Blackistone Hughes, MD, clinical trials coordinator for the National Institute on Deafness and Other Communication Disorders (NIDCD) from 2008-15. His guidance and assistance throughout this trial were critical to its success and are greatly appreciated by the authors.

CORRESPONDENCE can be addressed to HR or Dr Humes at: humes@nullindiana.edu

About the authors

Larry E. Humes, PhD, is a Distinguished Professor of Speech & Hearing Sciences; Christine Herring is the Clinical Trials Coordinator; and Dana L. Kinney,  MA, Anna K. Main, AuD, Tera Quigley, AuD, and Sara E. Rogers, AuD, are Research Audiologists in the Department of Speech & Hearing Sciences at Indiana University in Bloomington, Ind.

ORIGINAL AJA ARTICLE REFERENCE: Humes LE, Rogers SE, Quigley TM, Main AK, Kinney DL, Herring C. The effects of service-delivery model and purchase price on hearing aid outcomes in older adults: A factorial randomized double-blind placebo-controlled clinical trial. Am J Audiol. 2017;26(1):53-79. doi: 10.1044/2017_AJA-16-0111

Citation for this article: Humes LE, Herring C, Kinney DL, Main AK, Quigley TM, Rogers SE. The effectiveness of hearing aids and two service-delivery models in older adults: A randomized double-blind, placebo-controlled clinical trial. Hearing Review. 2017;24(4):12-19.

The innovative ReSound LiNX 3D™ hearing aids are now available in the U.S. market, taking Smart Hearing to unmatched sound quality and enabling people with hearing loss to hear more, do more, and be more anywhere in life, GN Hearing announced. Building on GN Hearing’s leadership in Smart Hearing, ReSound LiNX 3D represents a breakthrough in teleaudiology by providing a novel remote fine-tuning solution for users wherever they are. GN Hearing A/S is the medical device division of the GN Group, a global leader in intelligent audio solutions.

Hearing care wherever you are
ReSound LiNX 3D is the only hearing aid with complete remote fine-tuning capabilities, according to the company. The unique new feature, ReSound Assist, allows users to stay in touch with their hearing care professional wherever they are, receiving hearing care and getting new settings securely via the cloud without having to schedule and travel for a clinic appointment.

After an initial consultation and fast and convenient fitting at a hearing care professional’s clinic, users can request fine-tunings based on any hearing difficulty as the situation occurs, rather than trying to remember how to describe it during a visit to the clinic. The hearing care professional can make all fine-tunings remotely to provide an even better hearing care experience for the user.

With ReSound LiNX 3D—GN Hearing’s fifth-generation 2.4 GHz wireless technology and third-generation binaural directionality—hearing aid users will experience excellent sound quality, including up to 50% better performance versus other products at identifying speech in various environments; will hear up to 80% more sounds around them; and understand up to 40% more speech in noise*. ReSound LiNX 3D delivers clear exceptional speech understanding and the best sense of where sounds are coming from, said GN Hearing.

A new ReSound Smart 3D app allows users to easily personalize and control their sound at any time on-the-go directly from a smartphone (iPhone, Apple Watch, and selected Android models). Available on the App Store and Google Play, the ReSound Smart 3D app empowers users to take even more control of their hearing experience through a built-in guidance and coaching feature, and gives users direct access to their hearing care professional for efficient optimization with ReSound Assist, without the need for an appointment in a clinic.

Today, the average hearing aid user conducts 4-7 follow-up visits to the clinic to optimize their hearing aid settings. GN Hearing’s new remote fine-tuning capability has the promise to reduce that number, improving health care outcomes, and saving time for the user to focus on other priorities.

“GN Hearing is excited to introduce a quantum leap in sound quality and connectivity, enabling users to take even more control of their personal hearing experience, while offering the option of not having to travel to the clinic,” said Kim Lody, president of GN Hearing North America. “This new teleaudiology solution allows hearing health care professionals to better meet the modern user’s demanding schedule, strengthening their relationship with their patients,” she added.

In addition to personalized settings, GN Hearing’s portfolio of Smart Hearing aids offer direct streaming of sound from Apple devices, allowing wearers to utilize their hearing aids as high-quality stereo headphones to talk on the phone, make FaceTime calls, and listen to music without the need of an additional remote control, accessory, or pendant.

Developed in collaboration with Apple, GN Hearing continues to lead the way in Smart Hearing, introducing the world’s first 2.4 GHz wireless connectivity in 2010, Binaural Directionality in 2012, the first Made for iPhone (MFi) hearing aid in 2013, and the first cloud-based remote fine-tuning today.

* Compared to premium hearing aids from competitive brands: Groth, J., & Cui, T. (2017, April) “How accurate are environmental classifiers in hearing aids?” AudiologyOnline, Article 19796, in press; studies by Groth (2016) “Binaural Directionality III”, and Jespersen et al. (2016) “Effect of directional strategy on audibility of sounds in the environment.” The two latter studies can be reviewed via www.resoundpro.com/white_papers.

Source: GN Hearing

Image: GN Hearing

WebMD—an online publisher of health and wellness news—recently conducted a survey of hearing aid purchasers and healthcare professionals who regularly diagnose hearing loss as part of their practice, Starkey Hearing Technologies said in a blog posting on its website. Results of the survey, commissioned by Starkey, were posted in an infographic on Starkey’s website and included what hearing aid wearers thought of their purchase, and if physicians, audiologists, and other hearing care professionals noticed a difference in patients who wore hearing aids.

Source: Starkey, WebMD

Source: Starkey, WebMD

Image: Starkey 

Oticon was rated best in value, quality, patient satisfaction, and more in a survey of more than 500 hearing care professionals, the company announced.  Hearing Tracker announced the latest in a series of Hearing Tracker/UBS Surveys that explore factors hearing care professionals consider when choosing among leading hearing aid brands. Oticon reportedly ranked number-one in multiple categories—with a 68% rating for patient satisfaction. The March survey was conducted by UBS Evidence Lab, the largest, most experienced primary sell-side research team in the world.

In all four of the attributes survey participants indicated as most important when selecting a hearing aid for patients, Oticon ranked number one. Sound quality was rated as most important, a category in which Oticon earned a 38% rating, more than double the ratings of the next two hearing aid brands, the company said. Oticon also captured top rankings in the next three most important attributes, earning number-one status in reliability, ease of use, and value for money. Oticon also outscored all other brands in ease of use, aesthetics, and support service to the professional.

The study results correlate strongly with a recent Oticon survey of 700 new Oticon Opn™ users who voluntarily mailed response cards to share their personal perceptions of the open sound experience. In the Oticon survey, users (average age 61-70 years old) reported that they hear “better and much better” (96%), “understand more with less effort” (81%), and “keep up with the conversation” (62%).  70% were “very satisfied”– not a surprising result given research that consistently shows a link between sound quality and user satisfaction, said Oticon.

For more information on Oticon Opn and the entire Oticon portfolio of hearing solutions, visit Oticon’s website here.

Source: Oticon 

Connect Hearing, a Chicago-based network of hearing care centers, has expanded its portfolio to include two groundbreaking hearing instruments from Swiss manufacturer Phonak, Stäfa, Switzerland, Connect Hearing announced.  The Bolero™ B and the Virto™ B-Titanium hearing aids bring exciting new technologies to the extensive offering of high-quality hearing devices and accessories currently available to clients at Connect Hearing’s nationwide hearing centers.

Bolero B is a behind-the-ear (BTE) style hearing aid with a rechargeable option, the Bolero B-PR. The Bolero B-PR is Phonak’s first rechargeable standard BTE and features a lithium-ion battery capable of providing 24 hours of life on a single charge, including 80 minutes of wireless streaming.

Virto B-Titanium marks the smallest ever custom hearing aid produced by Phonak. The custom device replaces acrylic materials of the past with medical grade titanium to produce a 50% thinner, yet durable, shell. Worn inside the ear canal, the tiny Virto B-Titanium is extremely discreet, making it especially attractive to first-time hearing aid wearers.

Both options are part of Phonak’s new Belong platform and feature the latest version of AutoSense OS™. AutoSense OS provides a seamless, automatic listening experience by continuously analyzing the listener’s environment and blending multiple features to precisely match that environment without any manual adjustment by the wearer.

“These two new hearing instruments allow Connect Hearing to offer its clients the most exciting and effective hearing technology in the market today,” said VP of Marketing, Patrick Schuerer. “Both longtime and new hearing aid wearers will be impressed by how easy these devices are to wear and how natural they sound.”

Connect Hearing’s nationwide locations offer complimentary hearing consultations to determine if the hearing aids are appropriate for their needs and will provide free take-home trials of the Bolero B-PR as part of its unique “2-Week Free Trial” program. The program allows clients to try hearing aids at home free for 14 days with no obligation and no money down. To find a Connect Hearing location near you and schedule a consultation, please visit https://www.connecthearing.com/hearing-clinics/ or call 1-888-426-6632.

Source: Connect Hearing

Sonic, Somerset, NJ—a manufacturer of hearing care solutions—announced the launch of Enchant, a groundbreaking new hearing aid family that delivers clear, natural sound in a brand new way. Enchant is reportedly the first Sonic hearing aid built on the revolutionary new SoundDNA platform, offering the company’s most automatic, adaptive, and flexible technology to date. SoundDNA powers smart sound processing that enables Enchant to accurately detect environmental changes and optimize sound so patients can keep up in complex sound environments. Add to that the wow of direct no-strings-attached wireless connectivity and Tinnitus SoundSupport in all technology levels, and new Enchant is a choice that will dazzle professionals and patients alike.

“Enchant is instinctively smart, with an exciting combination of faster performance, innovative features, and enhanced functionality,” said Joseph A. Lugara, Sonic president and CEO. “Today’s patients pack a lot into their lives. Listening environments can change in an instant. Enchant lets patients capture the magic of every moment—staying true to Sonic’s 4S Foundation of Sound that is natural, speech understanding in noise, simplicity in everything we do, and style that stands out.”

Speech Variable Processing with SmartCompress

Enchant features SmartCompress, a new breakthrough adaptive compression system that works together with renowned Speech Variable Processing (SVP) to optimize amplification in quiet, noise, and speech settings without the need for a separate environment classification system. This allows Enchant to intelligently adjust amplification in noise and instantly adapt the proper gain and compression. Patients enjoy a natural listening experience with the most optimized amplification without delay.

A Positive SPiN on Speech in Noise

New speech-in-noise SPiN Management is a trio of technologies that enhances speech, reduces noise, and optimizes control. SPiN Directionality enhances sensitivity to sound via an all new directional microphone system. The system operates independently in 16 frequency bands, four times more than in the past, and is completely intuitive without the need for either the hearing care professional or the patient to preselect the directionality pattern. Also operating in 16 bands is SPiN Noise Reduction, an ultra-fast algorithm that acts immediately to preserve high-modulation speech sounds and reduce low-modulation noise. SPiN Engage optimizes the activation of noise reduction technologies to support individual patient needs in changing listening situations.

Tinnitus Relief Sounds

Tinnitus SoundSupport is available in all Enchant technology levels for patients with hearing loss who also experience tinnitus. Patients can choose from a selection of nature or broadband sounds to meet their individual needs.

No-Strings Wireless Connectivity

Enchant offers patients fast and direct wireless connectivity without the need for a “go-between” device. The SoundDNA platform powers the new Dual-Radio System that employs 2.4 GHz technology so patients can stream audio directly to their hearing aids via their iPhone®. The system also incorporates Near Field Magnetic Induction (NFMI) for faster ear-to-ear communication. The SoundLink 2 App for iPhone® and Android^TM smartphones controls wireless operations like volume and program changes, and includes updated features such as “find my hearing aid,” links to instructions, and low battery notification. Patients can also use the RC-A Remote Control to adjust volume and programs and the TV-A Adapter to stream favorite TV programs directly to their hearing aids.

Built-In New Technology

New Extended Dynamic Range (EDR) found exclusively in Enchant¹⁰⁰  expands the dynamic range up to 113 dB SPL. Patients enjoy superior clarity as sound grows in intensity at venues such as movies, theaters, and auditoriums. The SmartMusic program enhances enjoyment of live music without distortion by anticipating the emotion and swell of music and extending the dynamic range to a fixed level 113 dB SPL.

New Enchant is available in three technology levels: Enchant¹⁰⁰, Enchant⁸⁰ ,and Enchant⁶⁰  with popular styles including the miniRITE, miniRITE T (with telecoil), and BTE 105. All Enchant hearing aids have an IP68 rating for protection from dust and water.

Source: Sonic 

Oticon, Inc., Somerset, NJ, is opening a world of sound to teens with the expanded Oticon Opn™ portfolio that incorporates the popular DSL rationale and a new miniRITE-T with telecoil for FM access, Oticon announced. Hearing care professionals can now fit teens with a discreet Opn hearing solution that offers the benefits of Oticon’s open sound experience, direct streaming to iPhone®, and Internet connectivity via the If This Then That (IFTTT.com) network.

“With Oticon Opn, teens can now benefit from a new paradigm that allows them to access and handle multiple speakers simultaneously, even in complex listening situations,” says Donald J. Schum, PhD, VP of audiology. “Opn’s combination of performance, connectivity, and cosmetics provides the advantages teens want and at the same time, gives them the confidence they need to consistently wear their hearing aids throughout the day.”

In a survey of pediatric audiologists conducted by Oticon, “getting teens to consistently wear their hearing aids” was cited as the biggest challenge, followed by “finding a hearing aid that is cosmetically pleasing.”

New Research from Boys Town Research Hospital

In the dynamic conversational give-and-take of school and social settings, young people may not always face the speaker. The open sound experience, powered by OpenSound Navigator™, enables Opn users to focus on a conversation while staying attentive to people and things around them and to switch focus quickly and easily, according to the company. A new study by researchers from Boys Town National Research Hospital found that OpenSound Navigator improves children’s speech understanding in noisy environments when listeners do not directly face or look at the speaker the entire time. OpenSound Navigator allowed the access to other talkers in the environment that is fundamental to incidental learning.

What Teens Want

To learn more about the issues faced by 13-19 year olds with hearing loss, Oticon conducted focus groups with teens and tweens. Top concerns voiced by participants included “size of the hearing aid” and “performance of the hearing aid in noise.” According to Oticon, the majority of teens expressed a desire for a small, slim hearing aid that allows them to “blend in” and feel part of the mainstream. Teens also indicated their preference for a hearing solution that gave them the ability to stream calls and listen to music wirelessly from smartphones.

Opn allows teens to connect to their favorite devices for direct streaming from iPhone® and audio devices. The newest BrainHearing™ solution is reportedly the world’s first hearing aid that connects to the internet via the IFTTT network, a web service that automates other web-based functions to make life easier. Teens can now use their hearing aids with a growing number of IFTTT-compatible products and services from wake-up notices and sports reports to practical considerations such as low battery alerts and connections to smart home devices.

Hearing Care Professional Is Gatekeeper

While teens may search the Internet for entertainment and information throughout the day, they look to hearing care professionals to guide them in the selection of a hearing solution. Oticon said that focus group participants revealed that they do not discuss or search for information about hearing aids but rather trust their hearing care professional to advise them about the hearing aids that are best for them.

Oticon is partnering with the Ida Institute to promote Telecare for Teens, a suite of easy-to-use online tools and resources that equip teens to take on more responsibility for self-management and make more independent judgments about their hearing care needs.  Designed for hearing care professionals to share with teens to prepare for appointments and make counseling more focused and efficient, the tools help identify communication needs and concerns and guide support for teens throughout their hearing journey.

Source: Oticon, Ida Institute

(L-R) Annette Mazevski, AuD, PhD, Manager of Technology Assessment, Oticon, Inc. and Michael Porsbo, Product Manager/Category Manager, Oticon A/S presented “Re-Inventing Hearing Aids with the Internet of Things” at the 2017 IoT World Conference in Santa Clara, California.

Oticon, along with more than 12,000 industry thought leaders, professionals, and investors attended the 2017 Internet of Things (IoT) World Conference, held May 14-17 in Santa Clara, Calif, the company announced. Oticon’s interactive exhibit showcased Oticon Opn™, reportedly the world’s first Internet-connected hearing aid.  In an arena that included advances in smart homes, connected cars, energy, healthcare, and supply chain and logistics, Opn stood out as a healthcare innovation that leveraged the “Internet of Things that Matter” to transform everyday life for people with hearing loss.

Innovators Showcase

Michael Porsbo, product manager/category manager, Oticon A/S, and Annette Mazevski, AuD, PhD, manager of technology assessment, Oticon, Inc., presented “Reinventing Hearing Aids with the Internet of Things” as part of the Conference’s Wearables, AR & VR forum.  As part of the presentation, Porsbo and Mazevski discussed how Opn’s technology and Internet connectivity have made the hearing aid a game changer, not only for people with hearing loss, but for the hearing care industry.

Multiple Award Winner

Oticon Opn is already a winner of major national and international awards including the 2017 Gold Edison Award, two 2017 CES Innovations Awards for Wearable Technology and Tech for a Better World, two 2017 American Business Award Gold “Stevies”, and the 2017 Red Dot Design Award.  According to Oticon, the small, discreet hearing aid can be programmed to talk directly with doorbells, smoke detectors, and other smart devices via the Oticon ON App. In its core function as a listening device, Opn gives users the ability to handle noisy environments with multiple speakers.

Source: Oticon

ZPower—a Camarillo, Calif-based developer of rechargeable, silver-zinc microbatteries—announced its collaboration with the hearing aid manufacturer Oticon to make the award-winning Internet-connected Oticon Opn™ hearing aid rechargeable.

Rechargeable hearing aids are reportedly among the top features sought by hearing aid users. According to a study of over 500 hearing aid users, 70% said they want rechargeable hearing aids even though only 11% said they currently have them.¹ Until recently, rechargeable hearing aids were limited to using lower energy density nickel–metal hydride (NiMH) batteries, which frequently deliver less than a full day of power. This battery chemistry’s limited performance reportedly resulted in a low level of market acceptance, according to ZPower’s announcement. ZPower is changing this with its innovative silver-zinc rechargeable battery technology that delivers a full day of power on a single charge.

ZPower batteries offer hearing aid wearers the confidence of all-day power—with streaming—and the flexibility to interchange ZPower batteries with zinc-air disposable batteries. Additionally, ZPower batteries are non-flammable and recyclable.

“We are proud that Oticon chose ZPower’s rechargeable battery technology for its first rechargeable hearing aid,” said Sara Sable-Antry, VP of sales and marketing for ZPower. “It has been our mission to use ZPower’s innovative silver-zinc battery technology to improve the quality of life of hearing aid wearers, and now, with the launch of the rechargeable Oticon Opn, more patients will benefit from the convenience of reliable, rechargeable hearing aids.”

“Oticon Opn internet-connected hearing aids have unlocked an entirely new experience for wearers who want the power of the internet while hearing better in their daily lives,” said Janne Jakobsen, senior director, Oticon Sales & Marketing. “And now, with the help of ZPower, our new rechargeable solution extends that experience by providing an added degree of confidence that hearing aid wearers deserve.”

To learn more about ZPower batteries, please visit www.zpowerhearing.com. For more information on the entire Oticon Opn family, visit www.oticon.global/opn.

¹ Hearing Tracker Survey, August 2016

Source: ZPower, Oticon