Hearing aids play a crucial role in addressing hearing impairment, a prevalent condition affecting approximately 1.5 billion people worldwide. Among them, around 466 million individuals suffer from moderate to severe hearing loss, including approximately 34 million children. In China alone, there are about 70 million people with hearing disabilities. Various methods, such as external and middle ear surgeries, cochlear implants, auditory brainstem implants, contralateral routing of sound (CROS), and hearing aids, are employed to enhance hearing based on the nature, severity, and location of hearing loss. Among these methods, hearing aids are commonly used and considered a safe intervention, especially for sensorineural and mixed-type hearing loss, as well as cases where post-surgical hearing improvement is unsatisfactory.

The effectiveness of hearing aids varies among individuals, and while most users experience improved auditory-linguistic communication, some may remain dissatisfied despite repeated adjustments. Factors influencing hearing aid effectiveness include the patient's age, speech recognition rate, duration and severity of hearing loss, etiology, hearing aid brand and model, usage time and frequency, fitting and adjustment techniques, and cooperation of both the patient and their family. Accurate assessment of hearing aid effectiveness is crucial, encompassing audibility, intelligibility, satisfaction, and psychological aspects.

Hearing Aid Evaluation Methods:

1. Auditory Assessment

  • 1.1 Audibility Assessment

    Audibility refers to an individual's sensitivity to different frequencies and intensities of sound stimuli. The key to assessing effectiveness lies in determining whether the amplification provided by hearing aids meets the daily requirements of speech communication. The hearing threshold, representing the minimum sound intensity audible to the ear with the hearing aid, is a subjective assessment requiring the patient's cooperation. Probe microphone measurements (PMM) involve measuring actual sound pressure levels near the eardrum using a probe microphone, providing an objective validation of the hearing aid's amplification. Real-ear aided gain (REAG), real-ear unaided gain (REUG), and real-ear insertion gain (REIG) are essential measurements in PMM.

  • 1.2 Intelligibility Assessment

    The ultimate goal for hearing aid users is to understand speech. Speech intelligibility, determined by standardized speech signals, includes speech recognition score (SRS), speech reception threshold (SRT), and speech detection threshold (SDT). The maximum post-fitting speech recognition rate (PBmax) reflects the level of auditory rehabilitation, with a 10% improvement considered effective. Tests like the Hearing in Noise Test (HINT) measure speech recognition in noisy environments. Acceptable Noise Level (ANL) assesses the listener's tolerance for background noise and is valuable in evaluating hearing aid effectiveness in noisy settings.

    CAEP (Cortical Auditory Evoked Potentials): A behavioral test, CAEP reflects brain responses to sound stimuli, correlating well with speech recognition ability. Mismatch Negativity (MMN) is an endogenous potential reflecting the central auditory system's ability to process sound stimulus changes, showing correlation with speech recognition.

2. Questionnaire Assessment

Building upon auditory and intelligibility assessments, questionnaires provide a comprehensive evaluation of hearing aid users' auditory-linguistic abilities, satisfaction, quality of life, and psychological cognitive functions. Specific assessment categories include:

  • 2.1 Auditory-Linguistic Ability Assessment

    Using Client Oriented Scale Improvement (COSI), Speech, Spatial and Qualities of Hearing Scale (SSQ), and Abbreviated Profile of Hearing Aid Benefit (APHAB) allows for the evaluation of improvements in auditory-linguistic abilities post-hearing aid fitting.

  • 2.2 Satisfaction Assessment

    Daily Life Satisfaction with Amplification (SALD) and International Outcome Inventory for Hearing Aids (IOI-HA) focus on assessing satisfaction with hearing aid usage, providing valuable insights into the user's experience.

  • 2.3 Psychological Cognitive Function Assessment

    Addressing the impact of hearing impairment on mental health, assessments such as the Pittsburgh Sleep Quality Index (PSQI), Geriatric Depression Scale-15 (GDS-15), Minimum Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) are essential. These assessments contribute to understanding improvements in psychological well-being, cognition, and memory post-hearing aid use.

3. Evaluation in Special Populations

For infants, young children, and non-responsive adults, objective assessments like Real-Ear Measurements (REM), CAEP, and Sound-Field Auditory Steady-State Response (ASSR) play a crucial role. Parental assessments using tools like Parents' Evaluation of Aural/Oral Performance of Children (PEACH) and Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS) are crucial for evaluating early auditory development in children.

4. Outlook

This article summarizes various methods for assessing hearing aid effectiveness, combining auditory and questionnaire evaluations. A personalized assessment plan should be tailored to individual cases, ensuring efficient, accurate, and comprehensive evaluations. In clinical practice, the integration of both objective and subjective assessments, considering the specific needs and circumstances of each patient, leads to a holistic understanding of hearing aid effectiveness.

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