A naturalistic approach to assessing hearing aid candidacy and motivating hearing aid use

Background: Although the benefits of amplification for persons with impaired hearing are well established, many potential candidates do not obtain and use hearing aids. In some cases, this is because the individual is not convinced that amplification will be of sufficient benefit in those everyday listening situations where he or she is experiencing difficulties. Purpose: To describe the development of a naturalistic approach to assessing hearing aid candidacy and motivating hearing aid use based on patient preferences for unamplified and amplified sound samples typical of those encountered in everyday living and to assess the validity of these preference ratings to predict hearing aid candidacy. Research Design: Prospective experimental study comparing preference ratings for unamplified and amplified sound samples of patients with a clinical recommendation for hearing aid use and patients for whom amplification was not prescribed. Study Sample: Forty-eight adults self-referred to the Army Audiology and Speech Center for a hearing evaluation. Data Collection and Analysis: Unamplified and amplified sound samples were presented to potential hearing aid candidates using a three-alternative forced-choice paradigm. Participants were free to switch at will among the three processing options (no gain, mild gain, moderate gain) until the preferred option was determined. Following this task, each participant was seen for a diagnostic hearing evaluation by one of eight staff audiologists with no knowledge of the preference data. Patient preferences for the three processing options were used to predict the attending audiologists' recommendations for amplification based on traditional audiometric measures. Results: Hearing aid candidacy was predicted with moderate accuracy from the patients' preferences for amplified sounds typical of those encountered in everyday living, although the predictive validity of the various sound samples varied widely. Conclusions: Preferences for amplified sounds were generally predictive of hearing aid candidacy. However, the predictive validity of the preference ratings was not sufficient to replace traditional clinical determinations of hearing aid candidacy in individual patients. Because the sound samples are common to patients' everyday listening experiences, they provide a quick and intuitive method of demonstrating the potential benefit of amplification to patients who might otherwise not accept a prescription for hearing aids.