hearing aid; digital hearing aid
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Introduction
An electronic amplifying device worn in the ear designed to provide assistance for patients with hearing impairment. It consists of a receiver, an amplifier & a microphone.
Classification
types of hearing aids
digital hearing aid
- behind the ear[5]
- mild to profound hearing loss
- advantages
- greatest power
- available options
- telecoil
- direct audio input
- directional microphone
- earmold can be changed separately
- disadvantages
- more conspicuous
- may be more difficult to insert than in-the-ear aids
- difficult to use with headphones
- in the ear
- mild to severe hearing loss
- advantages
- disadvantages
- more conspicuous than CIC or canal aid
- may be difficult to use with headphones
- canal aid
- mild to moderate hearing loss
- advantages
- less conspicuous than larger aids
- telecoil available in some models
- may be able to use with headphones
- disadvantages
- dexterity may be a problem
- small size may limit available features
- completely in the canal (CIC)
- mild to moderate hearing impairment
- advantages
- almost invisible
- less occlusion of the auditory canal allows more natural sound
- easier to use with headphones or telephone
- disadvantages:
- dexterity may be a problem
- small size may limit available features
- expensive
- shorter battery life
bone-anchored hearing aid
- bone conduction aid; bone-anchored hearing aid[8]
- mild to severe unilateral conductive hearing loss[3]
- refer to otolaryngology if conductive hearing loss[3]
- advantages
- useful if ear canal unable to tolerate hearing aid
- disadvantages
- may not be useful for sensorineural hearing loss
- mild to severe unilateral conductive hearing loss[3]
low tech hearing aid
- body worn
- severe to profound hearing loss
- advantages
- greatest separation of microphone from receiver reduces feedback
- disadvantages
- most conspicuous
- body level microphone is subject to noise from clothing
- microphone is on chest or at waist, whereas speech is usually directed at ear level
- hand-wired system such as Pocket Talker*
novel hearing aids
- 1st completely implanted hearing system (Esteem)[4]
- 1st self-fitting hearing aid controlled by the user[15]
* least expensive
Indications
- hearing impairment
- persons with > 40 db hearing loss should be considered for hearing aid
- treatment of choice for presbycusis (age-related sensorineural hearing loss)
- characteristics of patients more likely to use a hearing aid:
- those who have hearing difficulty with background noise
- those who assess their hearing as < 70% of normal
*
- indications for physician examination[3]
- cerumen impactation or foreign body in external auditory canal
- earache
- active drainage from the ear within 90 days
- dizziness, acute or chronic
- indications for otolaryngology[3]
- unilateral hearing loss with onset within 90 days
- air-bone gap >= 15 dB at 500, 1000 or 2000 Hz
- history of tympanic membrane perforation or surgery
- deformity of external auditory canal
Advantages
- improved social function
- improved emotional well-being
- improved communication function
- diminished depression
- may attenuate cognitive decline[16]
- may reduce 3 year cognitive decline in older adults at increased risk[19]
- not likely to benefit persons at low risk of cognitive decline[19]
- may reduce 3 year cognitive decline in older adults at increased risk[19]
- helpful: understanding speech, listening to television, movies
- use of hearing aids in hearing impaired elderly reduces emergency department visits, hospitalizations, & number of nights spent in a hospital[13]
- associated with better hearing-specific health-related quality of life[14]
- consistent hearing aid use by elderly with hearing impairment is associated with lower risk of falls[20] Disadvantates:
- not helpful: in noisy or crowded situations
- Medicare does NOT cover hearing aids
Procedure
Hearing aid selection:
- based on formula that uses threshold measurements
- considerations
- gain averages across all frequencies, selected to match degree of loss
- frequency response chosen to differentially amplify specific frequency regions which may be differentially impaired
- maximum output should be chosen according to the of the patient's dynamic range
Barriers to successful hearing aid use:
- cost (largest obstacle $700-2500 in 2001)*
- lesser self-perceived handicap
- higher educational levels
- older age
- greater speech recognition threshold gains
- worse vision
- social stigma from wearing hearing aids
Additional potential barriers:
- difficulties with the small controls due to arthritis
- excessive feedback from earmold fittings
Adjustment may take weeks to months & is motivation-dependent. Involvement of a hearing aid specialist for identification of appropriate equipment & training & counseling.
Physician-patient interaction:
- minimize background noise
- use good lighting
- face the person at eye level
- encourage patient to wear their hearing aid to office visits
- speak clearly, rather than shouting
- use gestures & write down important instructions
Notes
- expected lifetime of a hearing aid is 3-5 years, although some hearing aids may last longer[3]
- best functional communication with hearing aids is facilitated by 3-6 counseling sessions with the patient & partner/caregiver
- caregiver alone may be adequate if patient is cognitively impaired
- sessions cover personal adjustment, operation & use of the device
- sessions establish realistic expectations
- instructional brochures that accompany the device are generally not helpful[3]
- the FDA requires that hearing specialists obtain a written statement from the patient confirming that his/her ears have been medically evaluated & that the patient is approved for fitting of a hearing aid
- the statement must be signed by a licensed physician & dated within the previous 6 months
- most diseases of the middle ear that result in conductive hearing loss may be treated medically or surgically
- patients >= 18 years of age may sign a waiver for medical evaluation, but this is to be discouraged[3]
- hearing aids (both ears) cost $2200-$5400 in 2013, in contrast to assistive listening devices $100 & up[5]
- FDA announced plans in December 2016 to consider making over-the-counter (OTC) hearing aids available[9]
- OTC hearing aids became available Oct 2022[18]
- OTC hearing aids may produce clinical outcomes similar to those of an audiologist fitted hearing aid[18]
- baseline exams of hearing loss & ear pathology performed[18]
- average cost for OTC hearing aids is $1600 vs several thousand dollars for audiologist fitted hearing aid[18]
More general terms
More specific terms
Additional terms
References
- ↑ Stedman's Medical Dictio&nary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Mangione C. In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ 4.0 4.1 FDA NEWS RELEASE March 17, 2010 FDA Approves First Totally Implanted Hearing System Esteem approved to treat sensorineural hearing loss http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm204956.htm
- ↑ 5.0 5.1 5.2 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Chisolm TH1 Johnson CE, Danhauer JL A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults. J Am Acad Audiol. 2007 Feb;18(2):151-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17402301
- ↑ Laplante-Levesque A, Hickson L, Worrall L. What makes adults with hearing impairment take up hearing AIDS or communication programs and achieve successful outcomes? Ear Hear. 2012 Jan-Feb;33(1):79-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21841487
- ↑ 8.0 8.1 de Wolf MJ, Shival ML, Hol MK et al Benefit and quality of life in older bone-anchored hearing aid users. Otol Neurotol. 2010 Jul;31(5):766-72. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20581615 [PubMed - indexed for MEDLINE]
de Wolf MJ, Hol MK, Mylanus EA, Cremers CW. Bone-anchored hearing aid surgery in older adults: implant loss and skin reactions. Ann Otol Rhinol Laryngol. 2009 Jul;118(7):525-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19708493 - ↑ 9.0 9.1 9.2 Kelley KJ, Sadoughi S, Saitz R Over-the-Counter Hearing Aids Could Be on the Way. Physician's First Watch, Dec 8, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
FDA News Release. Dec 7, 2916 FDA takes steps to improve hearing aid accessibility. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm532005.htm
Senator Elizabeth Warren. Press Release Dec 5, 2016 Sens. Warren, Grassley Introduce Legislation to Make Hearing Aids More Accessible and Affordable. Bipartisan Bill Endorsed by Hearing Loss Association of America, AARP, the Consumer Technology Association, Bose, and the Gerontological Society of America. Evidence Shows Pricey Hearing Aids Could Be Sold Safely "For A Fraction" Of Current Costs. https://www.warren.senate.gov/?p=press_release&id=1314
Executive Office of the President President's Council of Advisors on Science and Technology Washington DC, 20502 October 2015 https://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_hearing_tech_letterreport_final.pdf
National Academies of Sciences Release Report on Hearing Aid Accessibility, Affordability. The Hearing Review. June 2, 2106 http://www.hearingreview.com/2016/06/national-academies-sciences-release-report-hearing-aid-accessibility-affordability/ - ↑ 10.0 10.1 Warren E, Grassley C. Over-the-Counter Hearing AidsThe Path Forward. JAMA Intern Med. Published online March 3, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28257536 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2606426
- ↑ 11.0 11.1 Boyles S Study Boosts Case for OTC Hearing Aids - Performed nearly as well as prescription devices, but not yet legal for sale. MedPage Today. July 03, 2017 https://www.medpagetoday.com/PublicHealthPolicy/FDAGeneral/66400
- ↑ 12.0 12.1 Reed NS, Betz J,Kendig N et al Personal Sound Amplification Products vs a Conventional Hearing Aid for Speech Understanding in Noise. JAMA. 2017;318(1):89-90 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28672306 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2635618
- ↑ 13.0 13.1 Mahmoudi E, Zazove P, Meade M et al Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss. JAMA Otolaryngol Head Neck Surg. April 26, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29710214 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2678187
Wallhagen MI Hearing Aid Use and Health Care Costs Among Older Adults. JAMA Otolaryngol Head Neck Surg. April 26, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29710191 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2678182 - ↑ 14.0 14.1 Kitterick PT, Ferguson MA Hearing Aids and Health-Related Quality of Life in Adults With Hearing Loss. JAMA. 2018;319(21):2225-2226 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29872841 https://jamanetwork.com/journals/jama/fullarticle/2683199
- ↑ 15.0 15.1 FDA News Release. Oct 5, 2018 FDA allows marketing of first self-fitting hearing aid controlled by the user. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622692.htm
- ↑ 16.0 16.1 Yeo BSY, Song HJJMD, Toh EMS et al Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia. A Systematic Review and Meta-analysis. JAMA Neurol. Published online December 5, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36469314 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799139
Denham MW, Weitzman RE, Golub JS Hearing Aids and Cochlear Implants in the Prevention of Cognitive Decline and Dementia - Breaking Through the Silence. JAMA Neurol. Published online December 5, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36469311 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799142 - ↑ Gallagher NE, Woodside JV Factors Affecting Hearing Aid Adoption and Use: A Qualitative Study. J Am Acad Adiol. 2018;29(4):300-312 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29664724
- ↑ 18.0 18.1 18.2 18.3 18.4 De Sousa KC et al. Effectiveness of an over-the-counter self-fitting hearing aid compared with an audiologist-fitted hearing aid: A randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2023 Apr 13; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37052929 PMCID: PMC10102918 Free PMC article https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2803832
- ↑ 19.0 19.1 19.2 Lin FR, Pike JR, Albert MS et al Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet 2023. July 17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37478886 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01406-X/fulltext
- ↑ 20.0 20.1 Campos L, Prochazka A, Anderson M et al Consistent hearing aid use is associated with lower fall prevalence and risk in older adults with hearing loss. J Am Geriatr Soc. 2023 Oct;71(10):3163-3171. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37314100 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18461
- ↑ Hearing Aids http://www.nidcd.nih.gov/health/hearing/hearingaid.asp