Self-Adjusted Amplification by Experienced Hearing Aid Users Alexandra Lithgow, Carol Mackersie, Ph.D., Arthur Boothroyd, Ph.D.

Background Problem: Barriers: Not enough individuals who could benefit from amplification get hearing aids Approximately 14% of adults over 50 who could benefit from amplification actually pursue the acquisition of hearing aids1 Barriers: Cost & accessibility

PSAPs & OTC Hearing Aids Patients: May turn to PSAPs as a more affordable & accessible option PCAST: Called for increased accessibility & affordability of hearing aids2 FDA: Announced commitment to consideration of OTC hearing aids3 Audiological Concerns: Over Amplification: Under Amplification: Further damage hearing Lack of benefit

Potential Solution Primary Concerns: Self Fitting Hearing Aids Fewer office visits Can they do it? How do patient adjustments compare to how we would fit? How do they compare to targets? Decreased costs Increased accessibility Primary Concerns:

Present Study Focused on experience hearing aid users Also looked at sensitivity to noise Do individuals w/ higher sensitivity select output levels below prescribed targets? Research Question: When given the opportunity to adjust the amplitude and spectrum of speech, do hearing-aid users match the familiar characteristics of their current conventionally fit aids?

Participants 13 experienced hearing aid users Mean Range Age 72 60-89 Years of HA Experience 6.08 1-20 4 Frequency HFA 47.21 36.25-70 MOCA Score 27 21-30

Materials: Software: Speech Materials: Spectral adjustment using Goldilocks by Arthur Boothroyd, Ph.D. Adjustments centered around 707 Hz Low frequencies – cut up to -20 dB available High frequencies – boost up to 8 dB/octave available Step sizes – 5 dB Speech Materials: Sets of 4-word sentences recorded in quiet Presented through Etymotic ER-5A insert earphone

Procedure 1 2 3 Hearing assessment User-Adjustments Initial self-adjust Speech recognition testing Second self-adjust 3 Real ear measures & NAL-NL2 targets

Results – Adjusted vs. Starting All participants able to make adjustments 77% of participants did not require assistance

Results – Adjusted vs. Own Aid & NAL Prescription Initial Self-Adjustment Second Self-Adjustment

Results – Relations between self-adjustment and other variables No significant relationship between self-adjustments and: Age 4 frequency HFA Years of HA experience Sensitivity to noise

Key Findings Experienced HA users initially biased towards familiar amplification Speech testing may have led them to seek more high-frequency output, as prescribed by NAL-NL2 1 2

Limitations Self-fitting performed in quiet Goldilocks gain curves led to high mid frequencies to meet 3-4 kHz targets Lack of control group without speech recognition testing

Benefits of Self-Adjusted Amplification to Audiologists: Increased Time: Lighten case-load allowing more time for: Difficult cases Follow up & management of hearing loss Increased Reach: Allows us to overcome barriers and reach more patients in need of hearing health care

In Conclusion Audiologist-fit amplification Gold Standard: Audiologist-fit amplification Self-Fit HAs Potential option for patients who cannot readily access or afford audiologist-fit amplification

Acknowledgements Funding provided by NIDCD 1R21DC015046. We are grateful to Mark Datuin and Lauren Rynders who assisted with experimental setup and data collection

References 1Chien, W., & Lin, F. R. (2012). Prevalence of Hearing Aid Use Among Older Adults in the United States. Archives of internal medicine, 172(3), 292-293. doi:10.1001/archinternmed.2011.1408 2President's Council of Advisors on Science and Technology. (2015). Aging America & hearing loss: Imperative of improved hearing technologies. Retrieved from http://hearingloss.org/content/pcast-new-report-aging-and-hearing-loss 3U.S. Food & Drug Administration. (2016). FDA takes steps to improve hearing aid accessibility. Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm532005.htm

Questions?