Country-specific "Good Practice Procedures"

Additonal to the shared "Good Practice Procedures" the following country-specific extension are proposed by the following institutes for the respective countries (DE-HZO = Germany; NL-AMC = Netherlands; UK-RNID = UK):

Pre-fitting
DE-HZO
NL-AMC
UK-RNID
Questionnaire
HörTech inventory "Oldenburg Inventar I" or COSI + if necessary HörTech inventory "Oldenburg Inventar R" (can be completed at home)
Glasgow Hearing Aid Benefit Profile (GHABP: Gatehouse, 1999) initial assessment; Speech, Spatial and Qualities of Hearing Scale (SSQ).
Glasgow Hearing Aid Benefit Profile Part 1
Speech audiometry in quiet
Hearing loss for numbers; UCL for numbers/speech; with masking of better ear. Performance-intensity function, intelligibility at 65 dB SPL, optimal intelligibility; left/right. Comparison with predictions based on pure tone thresholds
Speech audiogram with monosyllabic words (complete performance intensity functions from threshold to uncomfortable loudness level, materials from Bosman and Smoorenburg (1995). Comparison of pure tone audiogram and speech audiogram.
No proposals to use speech tests prior to fitting
Speech audiometry in noise
One sentence test S0N90 or S0N-90 (whichever side would be aided monaurally).
Set-up: Adaptive Göttingen (Kollmeier & Wesselkamp, 1997) or Oldenburg (Wagener, Kuhnel, & Kollmeier, 1999) sentence test.
Noise presentation level 65 or 75 dB SPL depending on hearing loss (noise has to be perceived).
Stationary speech shaped noise + (additionally) one measurement with speech simulating fluctuating noise.
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. We use sentence materials from Plomp and Mimpen (1979), or Versfeld et al. (2000) with an adaptive procedure.
No proposals to use speech tests prior to fitting
Loudness scaling
Adaptive loudness scaling (ACALOS: Brand & Hohmann, 2002) left/right narrow band at 0.5, 1.5 & 4 kHz (if 4 kHz not measurable, 3 kHz) & left/right/binaural broad band (sentence). Plug ear not in use in sound field measurements
Adaptive loudness scaling per ear using the ACALOS-procedure for the following signals: narrow band Low-Noise Noise (Pumplin, 1985) at 0.75 and 3 kHz; broad-band low-noise noise (speech spectrum). Preferred setting through headphones. In case of sound field measurements, earplug in ear contralateral to test ear.
 
Hearing aid fitting
DE-HZO
NL-AMC
UK-RNID
Fitting and fine tuning
Trial fitting of at least 3 hearing aids at least one without available without extra payment.
Prescriptive fitting of one or two 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).

Often only one hearing aid model is selected and fitted per ear in UK.

Evaluation measurements
DE-HZO
NL-AMC
UK-RNID
Selection

The subjectively favoured hearing aid is measured.

If several hearing aids are rated subjectively the same, a sentence test in noise or a loudness scaling can be comparatively performed.

As HZO

In NHS service, generally only one aid fitted to each ear at a time. This is constrained by state funding of hearing aid provision.

Speech audiometry in quiet (sound field)
Propose testing at 65 and 80 dB SPL; the hearing aids are used in the preferred gain setting.
Freiburg test (one syllable words) at 65 and 80 dB SPL
CVC-words (Bosman and Smoorenburg, 1995) at 65 dB SPL, with hearing aids used in the preferred gain setting.
Not likely to be adopted for routine use in UK, but could be adopted as a valuable investigative tool.
Speech audiometry in noise (sound field)
Monaural fitting: 1 sentence test S0N90 or S0N-90.
Bilateral fitting: 3-5 sentence tests S0N90 or S0N-90.
Adaptive Göttingen or Oldenburg sentence test.
Noise presentation level 65 or 75 dB SPL (same as unaided). Stationary speech shaped noise + (additionally) one measurement with speech simulating fluctuating noise
Both stationary and fluctuating noise with the same long-term average spectrum as the speaker. Sentence materials from Plomp and Mimpen (1979), or Versfeld et al. (2000).
Not likely to be adopted for routine use in UK, but valuable as investigative tool. Adaptive sentence intelligibility similar to USA HINT protocols (Nilsson, Soli, & Sullivan, 1994) likely to be well accepted in UK
(NB HINT based on well-established UK BKB sentence materials, Bench, Kowal and Bamford, 1979).
Loudness scaling (sound field)
 
 
Stimuli: narrow band noise at 0.5, 1.5 & 4 kHz (if 4 kHz not measurable, 3 kHz) & left/right/binaural broad-band speech (sentence).
Stimuli: narrow band “Low-Noise” Noise (Pumplin, 1985) at 0.75 and 3 kHz; broad-band low-noise noise (speech spectrum).
 
Horizontal localization (sound 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). The measurements are performed both aided and unaided.
 
Questionnaire
HörTech inventory "Oldenburg Inventar I" or COSI+ optional HörTech inventory
"Oldenburg Inventar R" & "Hörgeräte-Bewertung" (rating of hearing aid system)
 
Overall rating by means of International Outcome Inventory for Hearing Aids (IOI-HA: Cox, Alexander, & Beyer, 2003) proposed for 6 months after fitting
Inventory of hearing aid benefit in real life with Glasgow Hearing Aid Benefit Profile.
 
Comparison of the GHABP results with a reference group of users in terms of use, benefit, residual disability, and satisfaction.
 
Overall rating by means of International Outcome Inventory for Hearing Aids (IOI-HA: Cox, Alexander, & Beyer, 2003).
 
For more detailed measures of auditory disability and handicap, the Amsterdam Inventory of Auditory Disability and Handicap (AIADH) can be used (optional).
Glasgow Hearing Aid Benefit Profile part 2.
 
UK philosophy is that the most important evaluation measure is of the real-life benefit as an outcome of the entire rehab process (including counselling etc) - since ultimate benefit depends on how well device is used as well as how well it is fitted.