Effectiveness of basic and premium hearing aid features for older adults

描述(申请人提供)：大约三分之一的老年人有听力损失，但只有不到25%的有问题的人寻求帮助。在轻度至中度听力损失的人中，求助率甚至更低：10%或更低。这种情况具有重大的社会后果，因为未经治疗的听力问题已被证明会导致社会、情感和沟通困难，以及经济上的不利因素。助听器是治疗大多数老年人听力损失的第一种也是最有效的治疗方法。因此，提高这一群体的助听器采用率是一个重要的公共卫生优先事项。已经确定了老年人采用助听器的几个障碍。主要障碍之一是最先进(高级)现代助听器的成本，每台助听器往往约为2000美元或更多。高级助听器包含最先进的现有技术。然而，成本低得多的(基本级别)现代助听器也是可用的。基本级别的助听器包括不那么复杂的技术，但与过去提供的助听器相比，仍然非常先进。基础水平的助听器很可能对许多患有轻中度听力损失的老年人有很大帮助。但是，尽管这类信息在促进以证据为基础的听力保健实践方面具有明显的重要性，但探索使用基本级和高级助听器的患者在实验室，特别是真实世界结果方面的差异的独立(即非制造商)数据非常有限。因此，当向患者推荐助听器时，从业者必须主要依靠未经证实的制造商关于功能好处的声明。不足为奇的是，高端设备经常被推荐。在这项研究中，长期目标是推进为轻度至中度听力损失的老年人提供助听器的科学基础。将对基本级助听器和高级助听器的效果进行测定和比较。此外，将制定以证据为基础的指导方针，以便利为特定个人选择适当的特征水平。这项研究计划是一个盲目、重复、交叉的设计。每位参赛者将完成两次交叉试验，试验间隔一段时间。每一次试验都将采用6家主要制造商之一的最新助听器。在每个交叉试验中，将测量基本级设备对和匹配的高级设备对的结果。结果将通过标准化的自我报告和访谈在四个方面进行客观量化：言语理解、听力努力、本地化和声音可接受性。研究结果将帮助从业者、第三方付款人和知情患者就合适的助听器做出更多基于证据的决定。从长远来看，这将提高助听器配件的成本效益，并支持创造和使用更实惠的设备，有效地优化轻度至中度听力损失老年人的听力体验。

DESCRIPTION (provided by applicant): About one-third of older adults have a hearing loss, but fewer than 25% of those who have the problem seek help. Among people with mild to moderate hearing loss, the rate of help-seeking is even lower: 10% or less. There are significant societal ramifications of this situation because untreated hearing problems have been shown to cause social, emotional, and communication difficulties as well as economic disadvantages. Hearing aids are the first and most effective treatment for the hearing loss sustained by most older adults. Thus, it is an important public health priority to increase the hearing aid adoption rate in this group. Several barriers to adoption of hearing aids by older adults have been identified. One of the primary barriers is the cost of the most advanced (premium-level) modern hearing aids, which tend to be about $2000 or more per instrument. Premium-level hearing aids contain the most sophisticated existing technology. However, much less-costly (basic-level) modern hearing aids are available. Basic-level devices include less sophisticated technology but still are very advanced compared to hearing aids available in the past. It is likely that basic-level hearing aids would be substantially helpful for many older adults with mild-moderate hearing loss. But there are very limited independent (i.e., non-manufacturer) data that explore the differences in laboratory and, especially, real world outcomes for patients using basic-level versus premium-level hearing aids, despite the obvious importance of this type of information in promoting evidence-based practice in hearing health care. As a result, when recommending hearing aids to patients, practitioners must rely mostly on unsupported manufacturer claims about feature benefits. Not surprisingly, premium-level devices are very frequently recommended. In this research, the long-term goal is to advance the scientific basis of hearing aid provision for older adults with mild to moderate hearing loss. The effectiveness of basic-level hearing aids and premium-level hearing aids will be determined and compared. In addition, evidence-based guidelines will be formulated to facilitate the selection of the appropriate feature level for a particular individual. The research plan is a blinded, repeated, crossover design. Each participant will complete two crossover trials separated by a washout period. Each trial will feature current hearing aids from one of 6 major manufacturers. In each crossover trial, outcomes will be measured for a basic-level device pair and a matching premium-level device pair. Outcomes will be quantified objectively, by standardized self-report, and qualitatively by interview, in each of four domains: speech understanding, listening effort, localization, and sound acceptability. The results will help practitioners, third-party payers, and informed patients to make more evidence-based decisions about appropriate hearing aids. In the long run, this will improve the cost-effectiveness of hearing aid fittings and support efforts to create and utilize more affordable devices that effectively optimize the listening experience for older adults with mild to moderate hearing loss.