Discussion of the online questionnaire findings

Summary of the results

The variations of current practice between countries are more or less to be expected based on the differences in service structure between the countries. For instance, the Dutch hearing aid dispensers do not use tympanometry, and the UK professionals make little use of speech tests. However, the interest expressed in making use of new procedures in the ideal situation was very little affected by the different (historical) philosophies in practice and service structures, which is encouraging for the prospect of gaining acceptance for more common proctaice across Europe.

Questionnaires

Questionnaires were popular in current practice in the three countries, and were very much favoured for use in an ideal world. The three countries were together in their favour of these tools and wanted to see improvements in them. The questionnaires used prior to fitting and post fitting were all considered to be important in the patient pathway. From the final questions it was clear that many professionals are interested in using European-wide standardized questionnaires. We therefore strongly recommend the HearCom portal to investigate the possibility to present currently available questionnaires to the professionals. The prospect of standardizing such questionnaires might serve possible future European projects.

Speech tests

Speech tests were also popular, but interest varied somewhat between countries. It was clear that professionals did want to use speech tests in an ideal world both before and after fitting and the open-set sentence and single word materials were the most popular for most of the types of speech test The different test conditions and preferred materials are set out below. There was little difference in users’ views for pre-fitting compared to post-fitting speech tests.

Speech intelligibility in quiet

For speech in quiet, professionals in the Netherlands and Germany are currently using mostly single word materials. In an ideal world situation, the open-set sentence and single word materials seemed to be the most popular for all countries and German professionals were also interested in closed set sentence materials. There was less interest in the use of nonsense word tests.

Speech intelligibility in noise

For speech in noise, currently professionals seem to be using the open-set sentence materials as well as the single words and numbers. In an ideal world most professionals were interested in using the open-set sentences and single words, with professionals in Germany also being interested, as for tests in quiet, in the closed-set sentences, and also showing interest in the use of digit materials. Less interest was shown in the use of nonsense materials.

Adaptive speech audiometry in quiet

Professionals in the Netherlands are currently using mostly the open-set sentence and single words materials whereas those in Germany were mostly using the single words. In an ideal world, most professionals favoured the open-set sentence and single word materials. Less interest was shown in closed-set sentences and nonsense words.

Adaptive speech audiometry in noise

Professionals in the Netherlands were currently using the open-set sentence materials, whereas some German professionals were using single words and digit materials. In an ideal world, the use of open-set sentences was favoured by professionals, especially those in NL. The single words and closed-set sentence materials were also favoured by those in DE. Less interest was shown in the nonsense materials in an ideal world.

The results also show that professionals in Germany and the Netherlands are currently using speech tests more often than those in the UK. This is to be expected, as speech testing is not part of the recommended procedures for the adult NHS hearing aid service. However it was encouraging that UK professionals were interested in using certain speech tests in an ideal world. Overall, single words and open-set sentence materials were the most popular in an ideal world for most of the types of speech test.

We conclude that professionals in all three countries are likely to be willing to adopt speech tests as these become available in forms that are easy and quick to use. However, we need to bear in mind that preferences for speech materials and test conditions may reflect the familiarity of particular types of materials and testing conditions. While single word materials and fixed level tests are currently most popular, this most likely represents practice based on older technology such as recorded tapes or audio CDs. There are good scientific reasons to propose the routine use of other speech test approaches, for example, using sentence materials in adaptive signal–to-noise conditions. It is likely, though, that some education of hearing aid professionals will be needed to ensure a good uptake of these methods. The focus group discussions with hearing impaired people indicate that speech tests using sentences in noise are likely to be well-accepted by clients as these have an obvious relevance to their everyday hearing difficulties.

Psychoacoustic tests

Sound localisation tests were popular already in Germany and the Netherlands and popular for all countries in an ideal world. It is clear that professionals in the UK were not as enthusiastic about this type of test, but this could be because very few currently use the test and might not be aware of its benefits. A similar picture was seen for testing before and after fitting.

Loudness scaling tests were also more popular in an ideal world in Germany and the Netherlands than in the UK – but again this test is hardly used in the UK at present and so people may not be aware of its benefits. A similar picture was seen before and after fitting.

Even though there is low use of the TEN (Threshold Equalizing Noise) test and temporal and frequency resolution tests, they were popular in an ideal world, especially in the Netherlands. The BILD (Binaural Intelligibility Level Difference ) test was popular in all countries in an ideal world. It is surprising that even though the UK professionals do not seem to be using this test at present, they were very enthusiastic about it in an ideal world and so are obviously aware of its benefits.

Fitting techniques were also important to professionals. They wanted to see improvements in the fitting rules and were enthusiastic about interactive fitting tools, which is encouraging because of further work in Hercom. It is also noteworthy that UK professionals were interested in fitting alternative hearing aids for comparison purposes although this is not standard practice. Real ear measures were also popular but many professionals wanted to see improvements.

Half of professionals would be interested in allowing patients to assess benefit via the internet on their own. They are sceptical about patients adjusting their hearing aids. However this scepticism does not mean that we should not pursue this line of research. Both the answers and the comments for these questions indicate that some professionals regard remote testing and self-fitting of hearing aids as developments that would are unacceptable because they lack what is seen as necessary skilled input.. This can become an important aspect if such procedures are developed or introduced.

Comparison between real and ideal worlds

The respondents were asked to select which procedures they would like to use in both real world and ideal world situations. The real world allowed them to select changes to their current practice, given the time and other constraints within appointments that they face currently. Professionals were also asked to select procedures for an ideal world situation, which was a situation without any constraints. Differences between these two worlds give a picture of the types of tests that professionals do not feel they have the time and resources to do, but would like to.

When comparing all collected results from the two situations for the three countries as a whole (see HearCom Deliverable D-6-2 , Chapter 9) , it is clear that there are differences between the two worlds for certain procedures. For Stage 1 procedures, there are differences between the two worlds (more use of procedures in an ideal world than in the real world) for most of the procedures listed. The procedures that did not have any or large differences between the two worlds were procedures such as the discussions about hearing loss, medical history and otoscopy, which were all considered important currently, as well as in the two improved worlds. Tuning fork tests also showed no difference between real and ideal worlds, although less than half of respondents favoured these. All of the questionnaires would be used more in an ideal world than in an improved real world except the hearing difficulties in different situation prior to fitting, as the two values were very high in both worlds as well as the current situation. Most of the speech tests would be used more in an ideal world, except the speech intelligibility testing in quiet for single words (high favour in both worlds), the adaptive tests in quiet for closed set and single words (high favour in both worlds) and the adaptive tests in noise for numbers. Psychoacoustic procedures such as loudness scaling, sound localisation, temporal and frequency resolution, TEN and BILD tests were all favoured more in an ideal world than in the real world.

For stage 2, most of the procedures were similarly rated for the real and ideal situations, except the interactive fitting procedures and using an alternative hearing aid for comparison, where more professionals would want to use them in an ideal world than in the real world. This was mainly due to an increase in the number of UK professionals interested in using such approaches in an ideal world, compared to those in the Netherlands and Germany, since professionals in the latter two countries were already using such procedures.

For stage 3, about two thirds of the procedures would be used more in an ideal world without time constraints than in the real world where time is constrained as in current practice. The questionnaire procedures were mostly favoured more in an ideal world than in the real world, with the exception of those addressing “hearing difficulties after fitting” and “sound quality and satisfaction” which all had similar values in both worlds. The use of a daily diary for patients was also seen as more favourable in an ideal world, given more time. Overall the largest differences between real and ideal worlds were seen in Stage 1. The open-set speech materials seemed to have the largest differences for each type of speech test. In addition large differences were seen for the frequency and temporal resolution tests and the BILD test.

However, some procedures were favoured as much in the real world as in the ideal one. These included: comparing more than one hearing aid with speech or loudness scaling tests, speech intelligibility tests in quiet with single worlds (high favour in both worlds), speech intelligibility tests in noise with closed set, nonsense and single words (high favour in both worlds), adaptive tests in quiet for single words (high favour in both worlds), adaptive tests in noise for single words and numbers.

It is therefore clear that many of the procedures listed in the survey would be used more in an ideal world than in the real world. This may be due to time constraints in current patient pathways. It is clear however that there are many procedures that professionals would like to use, and presumably would see benefiting their patients, if they had the time to do them. It was also clear as is noted in the main results section that for many procedures in an ideal world, in particular the questionnaires, professionals would like to see them improved. These results are important as they allow professional bodies and service developers to see the types of procedures that professionals would

  1. view as important in any situation (high numbers in both real and ideal world situations) and
  2. view as important if more resources and time were available.