Factors in the Effective Use of Hearing Aids Among Subjects With Age-Related Hearing Loss: A Systematic Review

Journal of Clinical Medicine

Morvan, P., Buisson-Savin, J., et al. (2024).

Journal of Clinical Medicine, 13(14), 4027.

<div>This systematic review investigates factors that affect the use of hearing aids (HA) in individuals with bilateral presbycusis, or age-related hearing loss (ARHL).</div>

Fondation Pour l’Audition (France)

From 2005 to May 2024

<div>Randomized controlled trials, non-randomized controlled interventions, and observational studies</div>

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<div>Three main factors contributed to the adoption and consistent use of HA in adults with ARHL as follows:</div> <div> <ul> <li><strong style="color: rgb(110, 98, 89);">Signal processing:</strong> <ul> <li>Compression: Individuals with active daily lives showed better results with wide dynamic range compression, while individuals with quiet lifestyles performed better with linear compression.</li> <li>Microphone Directionality: While both fixed and adaptive directional microphones significantly improved speech-in-noise intelligibility, adaptive directional microphones also enhanced listening ability in crowded settings.</li> <li>Noise Reduction: Individuals experienced improved comfort and reduced listening effort, but no improvement in comprehension in noise. Noise reduction combined with directional microphones improved comfort and understanding in noise.</li> <li>Hearing Aid Fitting: Closed or lightly vented earmolds improved signal processing efficiency and signal-to-noise ratio; however, open earmolds provided more comfort. Real ear verification ensured that individuals achieved the prescribed gain and aided in fitting personalization.</li> <li>Processing Channels: An increased number of signal processing channels from 32 to 64 did not impact comfort, satisfaction, or speech comprehension in quiet or noise.</li> <li>Anti-feedback: Anti-feedback systems did not significantly degrade the quality of music or speech intelligibility.</li> </ul> </li> <li><strong>HA fitting:&nbsp;</strong> <ul> <li>Prescription Formulas: Individuals experienced more comfort with NAL-NL1 and NAL-NL2 prescription rules compared to manufacturers' methods; however, DSL-v5-type formulas showed greater efficiency of speech-in-quiet intelligibility.</li> <li>Bilateral Fitting: Individuals with bilateral HAs demonstrated better spatial localization, sound detection, and speech-in-quiet intelligibility.</li> </ul> </li> <li><strong>Patient-centered approach:</strong> <ul> <li>Patient-centered care: Individuals who provided feedback during fitting and who were involved in the planning of their goals demonstrated greater adherence and use of their HAs and improved quality of life.</li> </ul> </li> </ul> <div>Limitations to this review include the potential for language and publication biases as well as the small sample sizes and heterogeneity of the included studies.</div> </div>

<div>Individuals with ARHL reported greater satisfaction with their HAs with the following factors:</div> <div> <ul> <li>activated non-linear frequency compression;</li> <li>enabled Wide Dynamic Range Compression or Channel Free compression and noise reducers; and</li> <li>optimized high-frequency settings.</li> </ul> </div> <div>Limitations to this review include the potential for language and publication biases as well as the small sample sizes and heterogeneity of the included studies.</div>

<div>When fitting individuals with ARHL with HAs, combining the device adjustment period with specific training improved compliance, though not significantly. Participants reported:</div> <div> <ul> <li>increased acceptance of their hearing loss;</li> <li>no difference between gradual acclimation and conventional follow-up; and</li> <li>additional benefits for those with previous hearing fitting experience.</li> </ul> </div> <div>Limitations to this review include the potential for language and publication biases as well as the small sample sizes and heterogeneity of the included studies.</div>

<div>Over-the-counter devices demonstrated inferior outcomes compared to conventional HAs for adults with ARHL; however, patients who purchased conventional HAs showed a higher likelihood of rejecting their device.</div> <div>&nbsp;</div> <div>Limitations to this review include the potential for language and publication biases as well as the small sample sizes and heterogeneity of the included studies.</div>

<div>Individuals with ARHL accepted the basic settings of assistive listening devices (i.e., smartphone applications, T-coil) in 75% of situations.&nbsp;</div> <div>&nbsp;</div> <div>Limitations to this review include the potential for language and publication biases as well as the small sample sizes and heterogeneity of the included studies.</div>