Anderson Melinda C, Arehart Kathryn H, Souza Pamela E
University of Colorado School of Medicine, Aurora, CO.
University of Colorado, Boulder, CO.
J Am Acad Audiol. 2018 Feb;29(2):118-124. doi: 10.3766/jaaa.16107.
Current guidelines for adult hearing aid fittings recommend the use of a prescriptive fitting rationale with real-ear verification that considers the audiogram for the determination of frequency-specific gain and ratios for wide dynamic range compression. However, the guidelines lack recommendations for how other common signal-processing features (e.g., noise reduction, frequency lowering, directional microphones) should be considered during the provision of hearing aid fittings and fine-tunings for adult patients.
The purpose of this survey was to identify how audiologists make clinical decisions regarding common signal-processing features for hearing aid provision in adults.
An online survey was sent to audiologists across the United States. The 22 survey questions addressed four primary topics including demographics of the responding audiologists, factors affecting selection of hearing aid devices, the approaches used in the fitting of signal-processing features, and the strategies used in the fine-tuning of these features.
A total of 251 audiologists who provide hearing aid fittings to adults completed the electronically distributed survey. The respondents worked in a variety of settings including private practice, physician offices, university clinics, and hospitals/medical centers.
Data analysis was based on a qualitative analysis of the question responses. The survey results for each of the four topic areas (demographics, device selection, hearing aid fitting, and hearing aid fine-tuning) are summarized descriptively.
Survey responses indicate that audiologists vary in the procedures they use in fitting and fine-tuning based on the specific feature, such that the approaches used for the fitting of frequency-specific gain differ from other types of features (i.e., compression time constants, frequency lowering parameters, noise reduction strength, directional microphones, feedback management). Audiologists commonly rely on prescriptive fitting formulas and probe microphone measures for the fitting of frequency-specific gain and rely on manufacturers' default settings and recommendations for both the initial fitting and the fine-tuning of signal-processing features other than frequency-specific gain.
The survey results are consistent with a lack of published protocols and guidelines for fitting and adjusting signal-processing features beyond frequency-specific gain. To streamline current practice, a transparent evidence-based tool that enables clinicians to prescribe the setting of other features from individual patient characteristics would be desirable.
目前的成人助听器验配指南建议采用基于真耳验证的处方验配原则，该原则在确定频率特异性增益和宽动态范围压缩比率时需考虑听力图。然而，这些指南缺乏关于在为成年患者提供助听器验配和微调服务时应如何考虑其他常见信号处理功能（如降噪、频率降低、方向性麦克风）的建议。
本次调查旨在确定听力学家在为成人提供助听器时，如何就常见信号处理功能做出临床决策。
向美国各地的听力学家发送了一份在线调查问卷。22个调查问题涉及四个主要主题，包括受访听力学家的人口统计学信息、影响助听器设备选择的因素、信号处理功能验配中使用的方法以及这些功能微调中使用的策略。
共有251名从事成人助听器验配工作的听力学家完成了此次电子分发的调查问卷。受访者工作于各种场所，包括私人诊所、医生办公室、大学诊所和医院/医疗中心。
数据分析基于对问题回答的定性分析。对四个主题领域（人口统计学、设备选择、助听器验配和助听器微调）的调查结果进行了描述性总结。
调查回复表明，听力学家在根据特定功能进行验配和微调时所采用的程序各不相同，因此用于频率特异性增益验配的方法与其他类型的功能（即压缩时间常数、频率降低参数、降噪强度、方向性麦克风、反馈管理）不同。听力学家通常依靠处方验配公式和探针麦克风测量来进行频率特异性增益的验配，并在除频率特异性增益之外的信号处理功能的初始验配和微调中依赖制造商的默认设置和建议。
调查结果与缺乏关于除频率特异性增益之外的信号处理功能验配和调整的已发表方案及指南一致。为了简化当前的实践，需要一个透明的循证工具，使临床医生能够根据个体患者特征来规定其他功能的设置。
