How reliable are patients’ estimates of their daily hearing aid use?
Solheim, J. & Hickson L. (2017). Hearing aid use in the elderly as measured by data-logging and self-report. International Journal of Audiology, 56, 472-479.
When the 3M MemoryMate hearing aid was introduced in 1987, it was the first hearing aid to measure and record the number of hours the hearing aid was worn in various memories (data-logging). Despite the fact that today’s instruments are capable of capturing a greater, more extensive array of factual information, many clinicians especially value and rely on the information about duration of usage, as it provides hard data that can help in counseling and adjustment to amplification (Bertoli, et al., 2009; Gaffney, 2008; LaPlante-Levesque, Nielsen, Jensen, & Naylor, 2014; McMillan, Durai, & Searchfield, 2017; Stark & Hickson, 2004).
There are two ways to measure how many hours a hearing aid is being used daily: subjectively, in which the patient is asked to estimate the hours the hearing aids have been worn, and objectively, in which the actual hours of usage are recorded by data-logging within the hearing aids. Studies that have compared self-reported usage to actual usage determined by data-logging have found a systematic discrepancy; the self-reported hours routinely exceed the objective measurements (Gaffney, 2008; Humes, Halling, & Coughlin, 1996; Laplante-Levesque, Nielsen, Jensen, & Naylor, 2014; Maki-Torkko, Sorr, & Laukli, 2001; Taubman, Palmer, Durrant, & Pratt, 1999). Patients consistently report they have worn the hearing aids for longer periods than the data-logging reveals.
The goals of this study were two-fold. The first goal was to collect hearing aid use data via objective and subjective means for a group of patients over 60 years of age during the first six months following the hearing aid fitting. The second goal was to evaluate whether or not patient knowledge of a six-month follow-up appointment affected hearing aid use. To accomplish this second goal, the patients were randomly divided into two study groups: an intervention group in which patients were given an appointment for a six-month follow-up at the time of the hearing aid fitting, and a control group in which no follow-up appointment was discussed. All patients received the same sequence of fitting procedures, including clearance by a physician, a comprehensive audiological workup, the hearing aid fitting, and a one-month trial before final acceptance into the study. After six-months, both groups were contacted and informed that their hearing aid usage would be documented during the up-coming appointment, but the methodology for collecting this information was not revealed. Subjective data was collected by asking the patients a simple question: What would you estimate your hearing aid use in hours a day for the last six months to be?
The researchers included 93 patients in the intervention group and 88 patients in the control group. The mean age for the entire cohort was 79.2 years, and slightly more than half were women. The average hearing threshold for the better ear was 49.4 dB; 86.2% of participants were fitted bilaterally, and 55.2% were experienced hearing aid users.
The results were reported two ways. First, for all subjects in the study, including those who did not wear the hearing aids at all, the average usage of hearing aids as recorded by data-logging was 6.12 hours per day, while self-reported daily usage was significantly higher, 8.39 hours per day, an approximate difference of two hours. Second, the average usage for subjects who wore the aids at least 30 minutes each day was 7.24 hours daily as recorded by data-logging, while self-reported daily usage was significantly higher, 9.58 hours per day, an approximate difference of two hours. This study, in agreement with the others mentioned above, clearly indicates that there is a substantial, systematic discrepancy between patients’ estimates and the information provided by data-logging. These studies revealed that patients tend to overestimate hearing aid use by approximately one to four hours.
As expected, the authors identified several factors that predicted increased hearing aid usage: more severe hearing loss, prior hearing aid experience, and increasing age. Gender and number and type of hearing aid(s) worn were unrelated to usage. Regression analyses indicated that the degree of hearing loss was the strongest predictor of hearing aid use whether measured by self-report or by data-logging.
Finally, advance knowledge of the six-month follow-up appointment had no impact; both the intervention and the control group had similar follow-up appointment attendance rates and similar data-logged and self-reported hearing aid usage. The follow-up attendance rate was approximately 75%; based on this, the authors conclude that patients perceive value in attending a follow-up visit.
Bertoli, S., Staehlin, K., Zemp, E., Schindler, C., Bodmer, D., & Probst, R. (2009). Survey on hearing aid use and satisfaction in Switzerland and their determinants. International Journal of Audiology, 48, 183-195.
Gaffney, P. (2008). Reported hearing aid use versus data-logging in a VA population. Hearing Review, 6.
Humes, L.E., Halling, D., & Coughlin, M. (1996). Reliability and stability of various hearing- aid outcome measures in a group of elderly hearing-aid wearers. Journal of Speech and Hearing Research, 39, 923-935.
LaPlante-Levesque, A., Nielsen, C., Jensen, L.D., & Naylor, G. (2014). Patterns of hearing aid usage predict hearing aid use amount (data-logged and self-reported) and over-report. Journal of the American Academy of Audiology, 25, 187-198.
Maki-Torkko, E.M., Sorr, M.J., & Laukli, E. (2001). Objective assessment of hearing aid use. Scandinavian Audiology, 30, 81-82.
McMillan, A., Durai, M., & Searchfield, G.D. (2017). A survey and clinical evaluation of hearing aid data-logging: A valued but underutilized hearing aid fitting tool. Speech, Language and Hearing, Published Online.
Stark, P. & Hickson, L. (2004). Outcomes of hearing aid fitting for older people with hearing impairment and their significant others. International Journal of Audiology, 43, 309-398.
Taubman, L., Palmer, C.V., Durrant, J.D., & Pratt, S. (1999). Accuracy of hearing aid use time as reported by experienced hearing aid wearers. Ear and Hearing, 20, 299-305.