Mueller H Gustav
Department of Hearing and Speech Sciences, Graduate Studies and Research, Vanderbilt University, Nashville, TN 37232-8242, USA.
J Am Acad Audiol. 2005 Jul-Aug;16(7):448-60. doi: 10.3766/jaaa.16.7.5.
The use of a prescriptive fitting approach for hearing aid selection has been a common practice for the past 60-70 years. While there are prescriptive approaches that have been validated, in recent years it has become popular to deviate from these validated methods and use manufacturers' proprietary algorithms, which in many cases are significantly different. This research review was designed to examine if there was evidence supporting the use of specific gain requirements for hearing aid fitting. Specifically, the question that was asked was "Are there real-world outcome measures from adult patients that show a preference for the gain prescribed by a specific prescriptive fitting procedure?" Inclusion criteria were as follows: adult subjects, consistent technology (e.g., different prescriptive methods compared using same hearing aids), real-ear verification of gain, and real-world outcome measures. For this review, in addition to subjective responses, preferred use gain was considered a real-world outcome measure. The National Acoustic Laboratories' revised (NAL-R), revised for severe/profound (NAL-RP), and the National Acoustic Laboratories-Non-Linear 1 (NAL-NL1) prescriptive methods were used as a common reference, as they have been the most commonly studied methods with adults. Eleven studies were identified that met the inclusion criteria. Eight of the studies supported gain similar to that prescribed by the NAL-R or NAL-RP methods; three studies supported prescribed gain less than the NAL-R or NAL-RP. There was no evidence that gain greater than that prescribed by the NAL methods should be used. The level of evidence was moderate, as the supporting studies were either Level 2 or Level 4, and the statistical power of the studies was low.
在过去的60到70年里，采用规定性适配方法来选择助听器一直是一种常见的做法。虽然有些规定性方法已经得到验证，但近年来，偏离这些经过验证的方法而使用制造商的专有算法变得很流行，而这些算法在很多情况下有很大差异。本研究综述旨在检验是否有证据支持在助听器适配中使用特定的增益要求。具体而言，所提出的问题是：“成年患者的实际结果测量是否表明对特定规定性适配程序所规定的增益有偏好？”纳入标准如下：成年受试者、一致的技术（例如，使用相同助听器比较不同的规定性方法）、增益的真耳验证以及实际结果测量。对于本综述，除了主观反应外，偏好使用增益也被视为一种实际结果测量。国家声学实验室修订版（NAL-R）、针对重度/极重度修订版（NAL-RP）以及国家声学实验室非线性1版（NAL-NL1）规定性方法被用作共同参考，因为它们是对成年人研究最多的方法。确定了11项符合纳入标准的研究。其中8项研究支持与NAL-R或NAL-RP方法规定的增益相似；3项研究支持规定的增益低于NAL-R或NAL-RP。没有证据表明应使用大于NAL方法规定的增益。证据水平为中等，因为支持性研究要么是2级要么是4级，而且这些研究的统计效力较低。
