Feasibility of a more unified approach to hearing aid fitting and rehabilitation: views of professional end-users in Germany, the Netherlands, and the UK

One goal of HearCom is to make a proposal for a model of good practice in the procedures and evaluations associated with hearing aid fitting and disseminate this on the internet. Given the goals of the HearCom project the rehabilitation procedures focus on adults. For young children many aspects of the rehabilitation process would need to be treated differently. Our proposals aim towards a definition of appropriate procedures at each stage from initial contact, through hearing aid fitting, evaluation of benefit, and follow up. The "Good Practice Procedures" are listed in the corresponding section.

A further goal is to consider the feasibility of a more common approach to hearing aid fitting in Europe. There will, of course, be some limits to a common approach because individual countries operate very different systems for the provision and fitting of hearing aids. But these constraints can be separated from general considerations of good practice. Further, there are a number of countries within and soon joining the EC that presently lack well-developed procedures for hearing aid provision and evaluation. Beyond this, even in countries with sophisticated systems in place, it is of particular interest for HearCom to consider new or improved assessments associated with hearing aid fitting that may be brought into much more widespread use by the application of information technology and where appropriate, internet support. 

If changes to the procedures used in practice are to be achieved, it is important to discover the attitudes of the target user groups to the proposals. To this end, we have performed a user evaluation of the proposed good practice procedures with hearing aid audiologists and dispensers in the three involved countries Germany (DE), the Netherlands (NL) and the United Kingdom (UK), which represent advanced good practice in this field. The procedures covered include those in current use and assessments drawn from up-to-date research. We recognized the need to also take into account the views of hearing-impaired people. Therefore a focus group study was carried out in Germany to interview this group.

The questions posed in these user evaluations considered the usage and applicability of procedures both in current practice, and also in an alternative scenario in which conditions were ideal, without the present constraints of time and facilities.

This work is reported in full in deliverable D-6-2. The web pages here give a brief overview of some of the key points.

Survey of well-known procedures

Some of the procedures included in the questionnaire are well known in the three countries surveyed. Responses for these procedures are important for several reasons

  • To check our expectation of common usage
  • To discover if professional users find the procedure of limited use, and would prefer that it be excluded from the standard set of procedures
  • To discover if professional users felt the need for the procedure to be improved

Attitudes to procedures that are novel or less standard

For the HearCom project as a whole, the main interest is in users’ attitudes to procedures that are not standard practice, but have been identified within the project as valuable assessments that can be made widely available and cost/time effective through the application of information technology.

Proposals for more ideal good practice made for Germany (Hörzentrum Oldenburg HZO), the Netherlands (Academisch Medisch Centrum Amsterdam AMC) and the UK ( The Royal National Institute for Deaf People RNID) have been compared. The major areas where the HearCom proposals go beyond standard practice, and where the views of professional users are hence of particular interest were as follows.

Benefit Questionnaires

While these are part of standard UK practice for NHS provision (as part of the standards set by the recent state-funded “Modernising NHS Hearing Aid Services” programme) there is no consistent use of this approach in Dutch and German practice. The Dutch proposal matches the procedures already used in the UK NHS in the use of the Glasgow Hearing Aid Benefit Profile (Gatehouse, 1999).

Speech testing

Standards for speech tests vary greatly. German and Dutch practice involve simple word and number-based speech tests in the quiet while UK standards make no use of speech testing. We suggest standards for speech testing in noise and specific methods for speech tests in quiet that are not generally used at present. While UK standards do not provide for any speech testing, it seems likely that practice in the UK could be extended to make use of standard speech testing methods in cases where routine fitting and evaluation seem to give less than ideal results. For example, there will be some cases where subjective benefit is less than expected, or where there is a need to choose between several alternative hearing aids or fits of one hearing aid.

Insertion gain measures

Indications are that insertion gain measures are not standard in the Netherlands, while they are part of the routine procedures in the UK and Germany. Common standards throughout Europe would be desirable.

Loudness scaling

Loudness scaling measures (Brand & Hohman, 2002) are not presently in standard use, but were advocated in D-6-1 by both HZO and AMC.

Sound Localisation

Measures of binaural hearing are part of standard practice at present in the Netherlands and Germany. A sound localisation procedure was advocated by AMC that may be of particular importance in optimizing the fitting of binaural hearing aids.

Focus on professional users

This evaluation is largely concerned with the views of the professionals who are involved in the day-to-day management of hearing aid provision. Their willingness to adopt new procedures is a key factor in any future harmonization, both in directly determining the likely uptake of new or revised procedures, or for procedures that are less familiar to these users, by signalling the degree to which education and explanation would be needed to introduce changes in practice.

Main study and preliminary pilot work

The main user evaluation dataset discussed in this report was collected from an internet questionnaire completed by professionals directly involved in the provision of hearing aids across the three countries involved. The questionnaire design was informed by a prior and more detailed evaluation using focus group methodology that was performed only in Germany.

Study of views of hearing impaired persons

While the views of professionals are of key importance to any shift in practice, we cannot contemplate major changes without also having some insight into the views of hearing impaired people. We have, therefore, also employed a focus group approach to elicit the views of a group of hearing-impaired people. This data was collected only in Germany. 

Professional user groups

There are significant national differences in the roles and titles of the professionals engaged in hearing aid provision and the execution of the associated procedures. Read more about the different rehabilitation pathways in the three participating countries.