Impact of Hearing Aid Technology on Outcomes in Daily Life II: Speech Understanding and Listening Effort

Objectives: Modern hearing aid (HA) devices include a collection of
acoustic signal-processing features designed to improve listening outcomes
in a variety of daily auditory environments. Manufacturers market
these features at successive levels of technological sophistication. The
features included in costlier premium hearing devices are designed to
result in further improvements to daily listening outcomes compared
with the features included in basic hearing devices. However, independent
research has not substantiated such improvements. This research
was designed to explore differences in speech-understanding and listening-
effort outcomes for older adults using premium-feature and basicfeature
HAs in their daily lives.
Design: For this participant-blinded, repeated, crossover trial 45 older
adults (mean age 70.3 years) with mild-to-moderate sensorineural hearing
loss wore each of four pairs of bilaterally fitted HAs for 1 month. HAs
were premium- and basic-feature devices from two major brands. After
each 1-month trial, participants’ speech-understanding and listeningeffort
outcomes were evaluated in the laboratory and in daily life.
Results: Three types of speech-understanding and listening-effort data
were collected: measures of laboratory performance, responses to standardized
self-report questionnaires, and participant diary entries about
daily communication. The only statistically significant superiority for the
premium-feature HAs occurred for listening effort in the loud laboratory
condition and was demonstrated for only one of the tested brands.
Conclusions: The predominant complaint of older adults with mildto-
moderate hearing impairment is difficulty understanding speech in
various settings. The combined results of all the outcome measures
used in this research suggest that, when fitted using scientifically based
practices, both premium- and basic-feature HAs are capable of providing
considerable, but essentially equivalent, improvements to speech
understanding and listening effort in daily life for this population. For HA
providers to make evidence-based recommendations to their clientele
with hearing impairment it is essential that further independent research
investigates the relative benefit/deficit of different levels of hearing technology
across brands and manufacturers in these and other real-world
listening domains.