What are the internal and external non-auditory factors, according to AAA?
Internal:
- Cognitive function (are they experiencing cognitive decline?)
- Dexterity abilities
- Vision abilities (can they see the hearing aid?)
- New user or experienced hearing aid user
- Overall health
- Tinnitus
External
- Occupational demands and recreational habits
- Patient support systems
What are the audiological candidacy factors?
1) Degree of hearing loss
- any thresholds >15 dB makes a patient a candidate for hearing aids
- any thresholds > 70 dB calls to question whether the patient is a CI candidate
2) Configuration of hearing loss
- What are the technical implications of fitting that kind of hearing loss?
3) Word recognition ability
- Don’t rule out a hearing aid based on word rec scores
What are the non-audiological candidacy factors?
- Motivation
- Expectations
- Appearance
- Cost
- Technology
- Physical function
- Communicative needs
- Lifestyle
Describe “Motivation” as a non-audiological candidacy factor.
Acknowledgement
- Has the patient acknowledged that they have a hearing loss?
Needs (DISABILITY)
- How often is that patient in a situation where they can’t hear?
Consequences (HANDICAP)
- Does the patient avoid activities because of their hearing loss?
Self-image
- How does the patient think others are going to view them?
Influence of Others
- Has the patient been pressured or encouraged by their family to pursue hearing aids?
Fear or uncertainity
- Is the patient uncertain in how to manage the hearing aids?
Describe “Expectations” as a non-audiological candidacy factor.
Expectations: patient and their family
- The patient’s expectations will be similar to the family’s expectations
How will the hearing aids help?
- There will be situations where the hearing aids will not help
What have others said about hearing aids?
Describe “Appearance” as a non-audiological candidacy factor.
- Cosmetic concerns
- Size
- Self-perception
- People tend to prefer smaller hearing aids rather than bigger hearing aids
- People think that hearing aids will make them look old
Describe “Cost” as a non-audiological candidacy factor.
- Financial cost
- Convenience
- Effect on self-image
- It is not just a financial cost, it is the cost of wearing the hearing aids
- Is it inconvenient for a patient to change their batteries every 7 days?
- Some patients can lose sight of all the benefits that come with wearing hearing aids
- Never make the assumption of what the patient can and cannot afford
Describe “Technology” as a non-audiological candidacy factor.
- How does the patient feel about computers, cell phones, etc.?
- Does the patient want an instrument that does all the work for them, or do they want control?
Describe “Physical Function” as a non-audiological candidacy factor.
- Manual Dexterity
- Consider the battery size
- Standard BTES are not recommended for older patients
- Can put a pull string on CICs and other hearing aids for older patients
- The pull string an help the older patients take the hearing aids out
Describe “Communicative Needs” as a non-audiological candidacy factor.
- Listening environment
- Technology affects candidacy
- What kinds of environments is the person in?
- What is life like on a day to day basis?
Describe “Lifestyle” as a non-audiological candidacy factor.
- Working or retired
- Daily activities - in quiet, noise, or both?
- Who are the daily communication partners?
- When might the patient need to communicate?
- Hearing aid recommendations depend on each individual patient
What are other factors that could impact a person’s decision to purchase hearing aids?
1) Age
2) Personality
3) CAPD
4) Tinnitus
5) Cognitive capability
- If the patient wants to wait until they’re older, they may not be as successful
- CAPD does not rule out hearing aid candidacy
- There is a benefit to fitting HAs on people with CAPD
What are the contraindications for fitting hearing aids without medical clearance?
- Sudden onset hearing loss
- Rapidly progressive hearing loss
- Pain in either ear
- Recent onset of tinnitus
- Unilateral tinnitus
- Unilateral assymetrical hearing loss of unknown origin
- Vertigo
- Headaches
- Conductive hearing loss of unknown origin
- Otitis media or externa, if it’s not already being treated
- Foreign body
- Cerumen accumulation
- Atresia
This list means that the patient should go to a medical doctor medical clearance
What are the benefits of binaural amplification?
- Better localization
- Better sound quality (subjective)
- Greater ease of listening (subjective)
- More balanced listening (subjective)
- Speech intelligibility
- Binaural summation
- Binaural integration
- Improved speech intelligibility in noise
What is the “recipe” for selecting hearing aids?
1) Determine listening needs
2) Determine limitations re: hearing aid use
3) Set treatment goals
4) Select the style
5) Select the features
6) Select the level of technology
7) Select the specific make/model
What tools can be used to determine listening needs and limitations?
1) Abbreviated Profile of Hearing Aid Benefit (APHAB)
- 24 items, 4 subscales
1. Ease of communication
2. Reverberation
3. Background noise
4. Aversiveness
- Unaided score can give insight into the degree of self-perceived handicap
2) Hearing Handicap Inventory (HHIE/HHIA)
- More specific to evaluating change in hearing handicap rather than hearing disability
- Subscales
1. Emotional
2. Social/situational
3) Expected Consequences of Hearing Aid Ownership (ECHO)
4) Hearing Aid Selection Profile (HASP) or Characteristics of Amplification Tool (COAT)
5) Client Oriented Scale of Improvement (COSI)
- Self-report questionnaire: patient nominates up to 5 situations in which they are looking for improvement
- Statistically valid
- More specific to the individual hearing aid user
- Looks at degree of change and final ability
What are the AAA guidelines for fitting hearing aids?
1) Assessment and Goal Setting
- Auditory assessment & diagnosis
- Self-perception of communication needs
- Non-auditory needs assment
2) Technical Aspects of Treatment
- Hearing Aid Selection
- Quality control
- Fitting & verification
- Hearing assistive technology (HAT)
3) Orientation, counseling, and follow-up
4) Assessing Outcomes
What are the ASHA guidelines for fitting hearing aids?
1) Comprehensive Audiologic Assessment
- Audiologic assessment
- Candidacy and rehabilitation assessment
2) Treatment Planning
3) Hearing Aid Selection
- EA Characteristics
- Non-EA characteristics
4) Verification
- Quality control
- Physical fit
- Performance
5) Hearing Aid Orientation
6) Validation Measures
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Lecture 1: Introduction to Hearing Aids12
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Lecture 2: Hearing Aid Selection Process18
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Lecture 3: Ear Impressions, Ear molds, and Hearing Aid Styles20
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Lecture 4: Hearing Aid Components32
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Lecture 5: Electroacoustic Measures25
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Lecture 7: Hearing Aid Features19
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Lecture 6: Signal Processing & Compression31
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Lecture 8: Prescribing Hearing Aid Performance28
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Final Exam Review48
