The Promise of Assistive Technology to Enhance Activity and Work Participation (2017) / Chapter Skim
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5 Selected Hearing Technologies
5 Selected Hearing Technologies
Pages 165-208
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. Conditions such as otitis media, ear canal blockage, and some forms 1 Sections of this chapter draw heavily on a recent report titled Hearing Health Care for Adults (NASEM, 2016)
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Therefore, common interventions for sensorineural hearing loss amplify sound and, if possible, improve the audibility of speech and other sounds. These interventions include hearing aids, assistive listening devices, aural rehabilitation services, and training to improve communication and coping strategies.
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. Most participants with hearing loss had bilateral symmetrical loss, which is consistent with sensorineural hearing loss acquired in adulthood being the predominant type among adults.
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Using these data, Chien and Lin (2012) found that approximately 3.8 million, or 14.2 percent, of individuals in the United States who had hearing loss wore hearing aids (see Table 5-2)
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as "any wearable instrument or device designed for, offered for the purpose of, or represented as aiding persons with or compensating for, impaired hearing."4 Components of hearing aids include the microphone, analog-to-digital converter, digital sound processor, output transducer, and battery. Unlike glasses that can correct vision loss, current hearing aids cannot correct or restore normal hearing.
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TABLE 5-1 Prevalence of and Numbers of Individuals with Hearing Loss, by Age and Severity: 170 National Health and Nutrition Examination Survey, United States, 2001–2010
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2016. Prevalence of hearing loss by severity in the United States.
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(18.5–25.8) Estimated total number of individuals with hearing aids and with hearing loss, 3.8c 26.7 respectively, in millions NOTE: CI = confidence interval.
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In addition to hearing aids, hearing assistive technologies (discussed below) and auditory rehabilitation may be useful for individuals with mild to moderate hearing loss.
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However, PSAPs are not meant to compensate for hearing impairment. Wireless Connectivity in Hearing Aids Wireless connectivity in hearing aids mitigates many communication issues through use of a remote microphone.
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. Wireless FM transmissions can be processed by some hearing aids.
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. Hearing Assistive Technologies: "Encompasses a wide range of products -- from traditional hearing aids regulated as medical devices to consumer- technology products and hearing assistive technologies -- with the overall goal of enabling the user to hear and communicate better in their homes (e.g., television)
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CLINICAL CONSIDERATIONS Clinical considerations in addressing hearing loss include the functioning of affected individuals, particularly, in the present context, their functioning at work; the effectiveness of hearing aids and other assistive devices; and factors affecting the success of treatment. Functioning The World Health Organization has identified participation in work as one of the major areas of life (WHO, 2001)
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. The longitudinal Blue Mountains Health Study evaluated the effect of hearing impairment on independence and use of support services.
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As noted by Mäki-Torkko and colleagues (2001, p. 8) , "only a few studies on hearing aid outcomes meet strict scientific criteria and even fewer studies correlate rehabilitation outcome with the degree of hearing impairment disability or handicap." Although studies have examined the use of hearing aids and owners' satisfaction with and barriers to their use, outcome measures used to assess the efficacy and effectiveness of hearing aids vary widely.
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Department of Veterans Affairs (VA) and the National Institute on Deafness and Other Communication Disorders examined the benefits of hearing aids among 360 participants with sensorineural hearing loss.
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examined speech understanding among 25 participants (with bilateral mild to moderate sensorineural hearing loss) who used four types of hearing aids (two basic and two premium level)
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In almost all instances, users will benefit from some type of assistive technology in one-on-one communication in a quiet environment. Hearing aids, remote microphone technology, and PSAPs generally are used most successfully when the listener is in close proximity to the speaker, has no other auditory distractions, and can utilize speech reading (Mueller et al., 2006; Nilsson et al., 1992)
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Pure tones can be delivered through headphones or delivered to the skull using a bone oscillator. When headphones are used, pure tones are delivered to each of the ears individually; the sound travels through each ear canal and middle ear to the cochlea within the inner ear (termed "airconduction" hearing)
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If an individual shows disproportionately poor speech recognition relative to his or her thresholds for pure tones, changes to the function of the cochlea, auditory vestibular nerve, brainstem, or central processing may be suspected. While speech testing can guide a clinician in the development of a rehabilitation plan, there can be many variables that prevent speech testing from being an objective way of demonstrating the overall benefit that one can achieve from wearing hearing aids.
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Use of Results The results of an audiological evaluation should be used to address the following: • whether the individual's hearing loss is due to a medical condition that requires care • whether the hearing loss is great enough to interfere with the indi vidual's functioning and, if so, whether the person's complaints are traceable to the deficit • whether psychosocial factors can explain any mismatch between the individual's complaints and his or her measured hearing loss and, if so, whether further evaluation or referral is necessary • if there is no such mismatch, what treatment approach (e.g., tech nologies, rehabilitation) will best maximize the person's functioning • if the person's hearing impairment is not of sufficient magnitude to indicate disease or compromise full functioning, whether there is a risk of that occurring in the future and, if so, whether there are ways to mitigate that risk
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Selection, Fitting, Maintenance, and Use of Hearing Products and Technologies Users of hearing products and technologies receive services that most commonly include the provision of and assistance with the use of hearing aids, consisting of device selection, fitting, verification, and validation, within the context of the functional communication assessment.9,10 According to U.S. best practices in audiology, selection of a hearing aid is based on "an individual's needs and requirements for hearing aid gain, ear canal geometry, occlusion, special features (e.g., directional microphone, noise reduction circuit, feedback suppression, telecoil)
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; and to ensure that the device provides optimal performance and that hearing is stable. Although health care professionals who treat patients with hearing loss most commonly provide services and support for hearing aids, they may offer similar services for other hearing assistive technologies that they do not dispense.
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. Auditory rehabilitation is intended to help individuals with hearing loss learn how to live with that loss, to provide information on the use of hearing aids and other hearing assistive technologies, to teach strategies for better listening and communication, and in some cases to offer psychosocial support (ASHA, 2017a; Boothroyd, 2010; Sweetow and Palmer, 2005)
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Such hearing loss is generally at a level at which conventional hearing aids cannot fully mitigate communication impairments. Therefore, the current criteria for hearing disability in SSA's Listing of Impairments generally reflect a level of hearing loss severity at which amplification with a hearing aid is insufficient to substantially mitigate impairments and restrictions on participation due to hearing loss.
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. This program requires that each state provide minimum hearing health care services to its beneficiaries that include diagnosis, treatment, and hearing aids.
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The benchmark insurance plans selected by states may not include hearing health care services or hearing aids for adults, and if this is the case, their expanded Medicaid program (if they have one) and the plans offered in their marketplace are not required to do so either.
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Hearing aids provided through the VA cost qualified recipients very little or nothing; in most cases, however, veterans can qualify only if they have a predefined minimum hearing loss that resulted from active military service (Beck, 2015) .12 Veterans also may be eligible for service-connected disability compensation for hearing impairment based on results from unaided pure tone audiometry and unaided speech recognition scores.
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Hearing Instrument Specialists Hearing instrument specialists, also known as hearing aid specialists, "identify individuals with hearing loss, assess their need for hearing aids, dispense hearing aids, and educate patients and their family members about their hearing loss" (NASEM, 2016, p.
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Primary Care Providers Primary care providers may often be the first to assess and diagnose patients with hearing loss, and they may even provide treatment to these patients without referring them to a hearing health care specialist. A primary care provider can treat outer or middle ear infections, identify and discontinue ototoxic medications, and conduct simple hearing screening tests and primary otologic examinations.
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5-9. The vast majority of individuals do not have insurance that covers hearing aids or related services.
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5-3. Even with advances in technology, hearing aids and other hearing assistive devices may help but do not fully mitigate impairments or restrictions on participation caused by hearing loss.
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2014. Is there a preference between hearing aids and personal sound amplification products (PSAPs)
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2009. Do experienced hearing aid users know how to use their hearing aids correctly?
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2009. Real-world benefit from directional microphone hearing aids.
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2015. Benefits of nonlinear frequency compression in adult hearing aid users.
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2005. Fitting hearing aids to adults using prescriptive methods: An evi dence-based review of effectiveness.
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2002. Speech recognition perfor mance of patients with sensorineural hearing loss under unaided and aided conditions using linear and compression hearing aids.
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2014. Comparison of speech recognition with adaptive digital and FM remote microphone hearing assistance technology by listeners who use hearing aids.
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Intended Use Use Hearing Aid(s) $1,000– 15–30%d of Situational to all • ild to profound M $4,000 / adults with waking hours hearing loss ear hearing loss (Chien and Lin, • bility to insert A (Kochkin, (Blackwell et 2012)
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loss et al., 2005) hearing aid • Benefit in compatible noise may phones be limited • Routine hearing evaluations to reprogram as needed • Cost also includes professional services to fit, program, verify, and counsel client Immediate • Benefits Low in noise 4–6 years 1–2 check- • Portability to short limited to a (Thibodeau, ups annually of the device term single talker 2014)
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Select 1 1–2 3 3–4 3–4 Personal Sound Amplification Products (non-customized ear-level devices) b NOTES: Ranking scale 1–5, 1, most if not all, will benefit to 5, less likely to receive benefit.
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SELECTED HEARING TECHNOLOGIES 207 Sound Locali zation Communi- Listening (as cation via One- Without required Telephone on-One Small Large Visual for (conference Communi- Group Group Distance Cues safety call) in cation Discussions Discussions Listening (videos, at work/ Quiet in Noise in Noise in Noise in Noise phone)
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