Sereda Magdalena, Hoare Derek J, Nicholson Richard, Smith Sandra, Hall Deborah A
1National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom; 2Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; and 3Nottingham Audiology Services, Nottingham University Hospitals National Institutes of Health Trust, Nottingham, United Kingdom.
Ear Hear. 2015 Jul-Aug;36(4):417-29. doi: 10.1097/AUD.0000000000000140.
In many countries including the United Kingdom, hearing aids are a first line of audiologic intervention for many people with tinnitus and aidable hearing loss. Nevertheless, there is a lack of high quality evidence to support that they are of benefit for tinnitus, and wide variability in their use in clinical practice especially for people with mild hearing loss. The aim of this study was to identify a consensus among a sample of UK clinicians on the criteria for hearing aid candidature and clinical practice in fitting hearing aids specifically for mild hearing loss with and without tinnitus. This will allow professionals to establish clinical benchmarks and to gauge their practice with that used elsewhere.
The Delphi technique, a systematic methodology that seeks consensus amongst experts through consultation using a series of iterative questionnaires, was used. A three-round Delphi survey explored clinical consensus among a panel of 29 UK hearing professionals. The authors measured panel agreement on 115 statements covering: (i) general factors affecting the decision to fit hearing aids, (ii) protocol-driven factors affecting the decision to fit hearing aids, (iii) general practice, and (iv) clinical observations. Consensus was defined as a priori ≥70% agreement across the panel.
Consensus was reached for 58 of the 115 statements. The broad areas of consensus were around factors important to consider when fitting hearing aids; hearing aid technology/features offered; and important clinical assessment to verify hearing aid fit (agreement of 70% or more). For patients with mild hearing loss, the greatest priority was given by clinicians to patient-centered criteria for fitting hearing aids: hearing difficulties, motivation to wear hearing aids, and impact of hearing loss on quality of life (chosen as top five by at least 64% of panelists). Objective measures were given a lower priority: degree of hearing loss and shape of the audiogram (chosen as top five by less than half of panelists). Areas where consensus was not reached were related to the use of questionnaires to predict and verify hearing aid benefit for both hearing and tinnitus; audiometric criteria for fitting hearing aids; and safety of using loud sounds when verifying hearing aid fitting when the patient has tinnitus (agreement of <70%).
The authors identified practices that are considered important when recommending or fitting hearing aid for a patient with tinnitus. More importantly perhaps, they identified practical issues where there are divided opinions. Their findings inform the design of clinical trials and open up debate on the potential impact of practice differences on patient outcomes.
在包括英国在内的许多国家，助听器是许多耳鸣患者和可借助助听器改善听力损失患者听力干预的一线选择。然而，缺乏高质量证据支持其对耳鸣有益，且在临床实践中其使用存在很大差异，尤其是对于轻度听力损失患者。本研究的目的是在英国临床医生样本中就助听器候选标准以及专门为有或无耳鸣的轻度听力损失患者验配助听器的临床实践达成共识。这将使专业人员能够确立临床基准，并将自己的实践与其他地方的实践进行比较。
采用德尔菲技术，这是一种通过使用一系列迭代问卷进行咨询以寻求专家共识的系统方法。三轮德尔菲调查探讨了29名英国听力专业人员小组之间的临床共识。作者衡量了小组对115条陈述的一致性，这些陈述涵盖：（i）影响验配助听器决定的一般因素，（ii）协议驱动的影响验配助听器决定的因素，（iii）一般实践，以及（iv）临床观察。共识定义为小组内先验一致性≥70%。
115条陈述中有58条达成了共识。达成共识的广泛领域围绕验配助听器时要考虑的重要因素；提供的助听器技术/特性；以及验证助听器适配性的重要临床评估（一致性达到70%或更高）。对于轻度听力损失患者，临床医生最优先考虑以患者为中心的助听器验配标准：听力困难、佩戴助听器的意愿以及听力损失对生活质量的影响（至少64%的小组成员将其选为前五项）。客观指标的优先级较低：听力损失程度和听力图形状（不到一半的小组成员将其选为前五项）。未达成共识的领域涉及使用问卷来预测和验证助听器对听力和耳鸣的益处；验配助听器的听力测定标准；以及当患者有耳鸣时在验证助听器适配性时使用大声响的安全性（一致性<70%）。
作者确定了在为耳鸣患者推荐或验配助听器时被认为重要的做法。也许更重要的是，他们确定了存在不同意见的实际问题。他们的研究结果为临床试验的设计提供了信息，并引发了关于实践差异对患者预后潜在影响的讨论。
