Initial Opinion, collected by the Project Partners

Unaided measurements

Counselling and preliminary audiological talk
  • Counselling/information about course of hearing aid provision.
  • General information about assets and drawbacks of hearing aids, specific characteristics, possible applications.
  • Free interview about problems and expectations.
  • Informing / Integrating the family of the customer
Medical anamnesis
  • Structured interview about medical history and complaints (e.g. sudden deafness, otitis media, ear pain, ear surgery, tinnitus, congenital hearing loss, dizziness
  • Otoscopy
  • Tuning fork testing (optional)
  • Tympanometry (optional)
Questionnaire
  • Collecting individual problems and aims, e.g.:
    • COSI, “Oldenburg Inventory I
    • Glasgow Hearing Aid Benefit Profile (GHABP) initial assessment;
    • Speech, Spatial and Qualities of Hearing Scale (SSQ).
Standard audiometry in quiet (headphones)
  • Pure tone audiogram air and bone conduction with adequate masking.
  • Speech audiogram with monosyllabic words (complete performance intensity functions from threshold to uncomfortable loudness level, intelligibility at 65 dB SPL)
  • Comparison pure tone audiogram and speech audiogram.
Speech audiometry in noise (headphones)
  • Assessment of the critical signal to noise ratios for sentences per ear in both stationary and fluctuating noise with the same long-term average spectrum as the speaker, S0N90 or S0N-90. Materials e.g.:
    • Adaptive Göttingen or Oldenburg sentence test, noise presentation level 65 or 75 dB SPL
    • Plomp and Mimpen (1979)
    • Versfeld et al. (2000) with an adaptive procedure.
Loudness scaling
  • Adaptive loudness scaling per ear using the ACALOS-procedure for the following signals (alternative):
    • Narrow band at 0.5, 1.5, 4 kHz
    • narrow band Low-Noise Noise (LNN) at 0.75 and 3 kHz;
    • broad band low-noise noise (speech spectrum).
Preferred setting through headphones. In case of free field measurements, earplug in ear contralateral to test ear.
(Horizontal) localization
  • Short noise bursts are presented from different azimuths (usually presented by nine to thirteen loudspeakers in half a circle from -90 to +90°).
During the focus group discussion the following point was added due to the opinion of the present hearing aid dispensers:
Speech-tests in quiet
  • Other than “Freiburger”-speech-test materials

 

Hearing aid fitting (+ Defining goals for rehabilitation and technical options)

Defining goals
  • Defining goals for rehabilitation based on anamnestic data, the unaided measurements, results of the questionnaires.
  • Counselling about realistic expectations.
Technical options
  • Choice of ear(s) to be fitted.
  • Choice of type of hearing aid(s).
  • Specification of type of earmould.
Earmould
  • Taking ear-impressions, Administration for production of earmould.
Fitting and fine tuning
  • Prescriptive fitting of at least 3 hearing aids according to manufacturer or generic fitting rules (usually one basic aid with full reimbursement of the costs and one more complex hearing aid with an own financial contribution).
  • Testing at least 3 hearing aids in everyday life.
  • First rating of speech intelligibility and sound quality.
  • Fine tuning of at least one hearing aid (in several sessions).
  • If necessary, gradual build-up.
  • Real-ear measurements
Questionnaires (optional)
  • Rating of hearing aid system: “Oldenburg inventory R + I”, COSI
Counselling
  • Explanation of handling and care, service, and usage.

 

Evaluation measurements (“Aided Measurements”)

Selection
  • The subjectively favoured hearing aid is measured as result of fitting. If several hearing aids are rated subjectively the same, a sentence test in noise or a loudness scaling can be comparatively performed.
Speech audiometry in quiet (free field)
  • Intelligibility measured for each individual aided ear (contra-lateral ear blocked) and for both ears bilaterally fitted with hearing aids, if applicable.
  • The speech is presented at different levels and the hearing aids are used in the preferred gain setting.
Speech audiometry in noise (free field)
  • Permanent noise at 65 and 75 dB SPL.
Aided loudness scaling (free field)
  • Adaptive loudness scaling (free field) per ear using e.g. the ACALOS-procedure.
Horizontal localization (free field)
  • Short noise bursts are presented from different azimuths (usually presented by nine to thirteen loudspeakers in half a circle from -90 to +90 degrees).
Questionnaire
  • Inventory of hearing aid benefit in real life (Oldenburg Inventories, COSI)
Documentation
  • Settings of the selected hearing aids
  • Insertion gain measurements ↔ Real-ear measurements (at different levels, with basic features switched on/off) à The selected hearing aids are characterised with real-ear measurements using a broadband speech noise at three levels: 55, 65, and 80 dB SPL. The hearing aids are used in the preferred gain setting. The hearing aids are measured after deactivation of noise reduction circuitry in an omni-directional mode. The curves obtained are compared with generic prescription rules for non-linear hearing aids (usually NAL-NL1 of DSL i/o).
During the focus group discussion the following point was added due to the opinion of the present hearing aid dispensers:
Speech-tests in quiet
  • Other than “Freiburger”-speech-test materials

 

Follow-up

Closing of provision
  • Explain handling and care of the hearing aid to the user
  • Arrange regular checkups
  • Hearing pass as documentation for the user
  • Present information about accessories to the user
  • Complete formal fitting documentation
Additional rehabilitation needs
  • Counselling about other training (speech-reading, hearing strategies and communication training).
  • Strategies to encourage the hearing impaired to wear the hearing aids (intrinsic motivation).
  • Determine need of other action (compare expectation with achieved aims), e.g. audiological therapy, psychosocial consulting.
Follow-up appointments along 5 years
  • Open repair-service (without appointment)
  • After half a year: Monitoring the user contentment (COSI, IOI-HA)
  • 2 check-up dates (hearing device) per year
  • 2 check-up dates (handling) per year
  • 2 check-up dates (outer ear with and without hearing device with regards to dents and skin irritation)
  • Service
During the focus group discussion the following point was added based on input from the participating hearing aid dispensers:
Closing of provision
  • Integrating the family of the customer