Consensus on Hearing Aid Candidature and Fitting for Mild Hearing Loss, With and Without Tinnitus

Abstract

Objectives:In many countries including the United Kingdom, hearing aids are a first line of audiologic intervention for many people with tinnitus and aidable hearing loss. Nevertheless, there is a lack of high quality evidence to support that they are of benefit for tinnitus, and wide variability in their use in clinical practice especially for people with mild hearing loss. The aim of this study was to identify a consensus among a sample of UK clinicians on the criteria for hearing aid candidature and clinical practice in fitting hearing aids specifically for mild hearing loss with and without tinnitus. This will allow professionals to establish clinical benchmarks and to gauge their practice with that used elsewhere.Design:The Delphi technique, a systematic methodology that seeks consensus amongst experts through consultation using a series of iterative questionnaires, was used. A three-round Delphi survey explored clinical consensus among a panel of 29 UK hearing professionals. The authors measured panel agreement on 115 statements covering: (i) general factors affecting the decision to fit hearing aids, (ii) protocol-driven factors affecting the decision to fit hearing aids, (iii) general practice, and (iv) clinical observations. Consensus was defined as a priori ≥70% agreement across the panel.Results:Consensus was reached for 58 of the 115 statements. The broad areas of consensus were around factors important to consider when fitting hearing aids; hearing aid technology/features offered; and important clinical assessment to verify hearing aid fit (agreement of 70% or more). For patients with mild hearing loss, the greatest priority was given by clinicians to patient-centered criteria for fitting hearing aids: hearing difficulties, motivation to wear hearing aids, and impact of hearing loss on quality of life (chosen as top five by at least 64% of panelists). Objective measures were given a lower priority: degree of hearing loss and shape of the audiogram (chosen as top five by less than half of panelists). Areas where consensus was not reached were related to the use of questionnaires to predict and verify hearing aid benefit for both hearing and tinnitus; audiometric criteria for fitting hearing aids; and safety of using loud sounds when verifying hearing aid fitting when the patient has tinnitus (agreement of <70%).Conclusions:The authors identified practices that are considered important when recommending or fitting hearing aid for a patient with tinnitus. More importantly perhaps, they identified practical issues where there are divided opinions. Their findings inform the design of clinical trials and open up debate on the potential impact of practice differences on patient outcomes.

Equity and person-centeredness in provision of tinnitus services in UK National Health Service audiology departments

“…The present evaluation raises questions on the feasibility of future research on hearing aids. For example, opinions expressed here on what minimum hearing loss should be present to consider recommending hearing aids to a patient, or the scenarios in which one or two hearing aids might be recommended, contrast with the consensus reported recently by Sereda et al [14] where there was an almost unanimous agreement, for example, that where there is hearing loss and bothersome tinnitus hearing aids should always be fitted bilaterally. A clinical trial protocol which stipulates bilateral fitting in all cases of tinnitus may not be acceptable to the multiple sites that would be required for a large trial.…”

“…Questions were informed by previous evaluations [7,British Tinnitus Association unpublished], personal knowledge of the authors and Department of Health guidelines [8]. Second, questions were generated to capture specific information considered missing from the general tinnitus literature (such as the provision of certain resources) and to capture an opinion on current issues related to tinnitus management (e.g., issues related to hearing aid candidature arising from Sereda et al) [14]. Questions were first drafted separately by individual authors (DJH, EB and DS) and then appraised or reduced by the same authors towards strong face validity and relative merit of the included items.…”

“…However, the lack of a guiding evidence-base or clinical practice guidelines results in differences in their recommendation and use. Sereda et al [14] recently used the Delphi technique [17] to define a set of criteria for hearing aid candidature and use where there is tinnitus and a mild hearing loss. Consensus in that study was defined as ≥70% agreement across the group of 29 experienced audiologists taking part.…”

Tinnitus and Hearing Survey: A Polish Study of Validity and Reliability in a Clinical Population

“…The results of the study demonstrate that the THS-POL is a valid and reliable instrument providing all information necessary to decide whether the tinnitus-specific intervention is required [Sereda et al, 2015[Sereda et al, , 2017. The best use of THS results for the clinician is to guide the conversation to what intervention is available in the patient's personal situation.…”

Study on treatment effect of hearing aids on bilateral prolonged tinnitus in Chinese patients

“…But sometimes the patients felt no changing on their tinnitus. But more and more researches pointed out that the treatment of hearing aids may have certain treat ment effect on the tinnitus associated with hearing loss [5] , and some methods, for example, both tinnitus handicap inventory (THI) and the international outcome inventory for hearing aids could decrease the tinnitus significantly, both of them improved the patients' satisfactions [6] . After the patients wore the hearing aids, background noise was amplified properly, and the hearing aids could have the effect of the tinnitus retraining therapy when the surrounding environment was quiet.…”