Hearing Health

Why Hearing Aid Validation is Critical to Success With Hearing Aids

Dr. Cliff Olson
October 11, 2018
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Why Hearing Aid Validation is Critical to Success With Hearing Aids

Why Hearing Aid Validation is Critical to Success With Hearing Aids. Dr. Cliff Olson, Audiologist and founder of Applied Hearing Solutions in Anthem Arizona discusses why Validating hearing aid performance is as critical as Real Ear Measures.

You’ve constantly heard me talk about real ear measurement as a form of hearing aid verification to ensure that your hearing aids are programmed correctly to your hearing loss prescription.

Validation is necessary to ensure that you’re actually receiving real world benefit with hearing aids. Even though verification, like real ear measurement, isn’t occurring very often, at least validation is happening more often.

Validation of Your Hearing Aid Experience

A pie chart from Marketrak VIII, which looks at data from the hearing aid industry, reveals the results of a survey consisting of 787 subjects. It indicates that approximately 69% of these subjects reported that their hearing care provider validated their hearing aid fitting.

Now just to be clear, hearing aid validation does not mean that your hearing care provider is asking you “how does that sound?” during your initial hearing aid fitting appointment. Hearing aid validation should be a measurable outcome. Measurable validation is obtained by a pre- and post-outcome measure, typically in the form of a questionnaire. These are the three different types of validation measures that I like to use in my clinic.

The Client Oriented Scale of Improvement (COSI)

The Client Oriented Scale of Improvement, aka the COSI, is an excellent way to evaluate improvement due to hearing aids. Essentially, you identify key areas that you want to hear better in, at the beginning of your treatment with hearing aids. Then, you score your perceived improvement upon the completion of your fitting period. There are a number of factors that go into how you will rank your degree of change with hearing aids, but in general, you should be in the “Better” categories and not in the “Worse” or “No Difference” categories. Your final hearing abilities should also be in the higher levels of satisfaction.

If you are not ranking high in these categories, there is a good chance either your expectations are unrealistic, you are in the wrong level of hearing aid technology based on your needs, or your hearing aids were not fitted and programmed properly to your hearing loss prescription.

The Abbreviated Profile of Hearing Aid Benefit (APHAB)

The APHAB uses 24 predetermined questions, each on the seven-point Likert Scale. The scale ranges from Never to Always. It evaluates four different categories of performance, including Ease of Communication, Reverberation, Background Noise, and Aversiveness. The questionnaire is to be completed once the before the hearing aid treatment and again after completion of the hearing aid fitting period to compare results before and after treatment.

In terms of validation questionnaires, the APHAB is an absolute stud, especially for nerds like me who love comparing outcome scores to norms! You can download these questionnaires in paper format, but the excitement comes when you use the scoring software. In the scoring software, you can compare untreated scores to your treated scores; you can also compare your outcomes with the norms of other hearing aid users for each of the four subcategories.

If you want to see a highly detailed analysis of your improvement with hearing aids, the APHAB is the perfect validation questionnaire for you.

The International Outcome Inventory for Hearing Aids (IOIHA)

This questionnaire is perfect for individuals who have already had hearing aids and are performing well with them. It is a short, seven-item questionnaire that identifies how long a hearing aid user wears their hearing aids, along with other questions that identify how much success and satisfaction a user is having with their hearing aids. This can uncover specific areas that should be targeted for improvement, and it can also be completed after adjustment of the user’s current hearing aids or after a fitting period with new hearing aids to determine how big the improvement is.

Evaluating How Well You are Performing

Evaluating how well you are performing with your hearing aids should not be done in the form of “how do you think you are doing with your hearing aids?” There should be a very specific set of criteria you are using to evaluate how well you’re performing in the real world, in a variety of different situations.

While we’re not specifically discussing verification methods like real ear measurement, when you do real ear measurement as a form of hearing aid verification, it gives you better scores on these validation measures – meaning that you get more benefit in the real world. This is proven by research.

That being said, when you perform verification and validation together, not one or the other, but both of them together, then you know that you’re going to be getting the maximum amount of benefit out of your hearing devices – meaning that you are going to actually get what you paid for. Furthermore, it actually reduces the number of visits you have to make to your hearing care professional. This saves you both time and money!

The next time you get hearing aids, not only should you expect that your hearing care provider perform real ear measurement on you – you should also expect that they ask you to complete a validation questionnaire to ensure that you get the maximum of benefit with your hearing aids in the real world.

Video Transcript

Hearing Aid Validation is different from Hearing Aid Verification.  Verification is an objective measure to ensure that hearing aid programming is done properly. Validation is to ensure that the programming and features are providing a significant Real World benefit.  While Verification like Real Ear Measurement is significantly under performed by hearing care professionals, Validation is performed more often.  Approximately 69% of patients reported having Validation measures performed during a hearing aid fitting, which was indicated by a study in Marketrak 8.  

Just to be clear...Validation is not a provider asking "How does that sound?".  Validation should be a measurable outcome.  This means that you should be evaluated pre and post hearing aid fitting.  Your Post hearing aid scores should be significantly better than your Pre hearing aid scores.  There are several Hearing Aid Validation assessments/questionnaires.  Three of my favorite are:1. The Client Oriented Scale of Improvement (COSI) - This assessment utilizes common listening situations of a hearing aid user.  On this scale, the hearing aid user can determine if the hearing aids are Worse, No Different, Slightly Better, Better, or Much Better in a particular situation.  If you don't answer in one of the "Better" categories on this assessment, either your expectations aren't realistic, you are in the wrong level of hearing aid technology, or your hearing aids were not programmed properly.  

2.  The Abbreviated Profile of Hearing Aid Benefit (APHAB) - The APHAB uses 24 pre-determined situations that can be ranked on a 7 point Likert scale ranging from Never to Always.  It evaluates 4 different areas of performance including:  Ease of Communication, Reverberation, Background Noise, and Aversiveness.  Once completed before and after treatment, it gives a detailed scoring profile that compares pre and post outcomes, as well as comparisons to Norms of other individuals with hearing loss.  If you like data, this is the perfect questionnaire for you.

3. The International Outcome Inventory for Hearing Aids (IOI-HA) - The IOI-HA is perfect for existing hearing aid users to determine if their hearing aids are providing benefit.  It is a short 7 item questionnaire that determines how long a user wears their hearing aids per day and other questions to identify how much satisfaction they are receiving.  It can also be used as a pre/post measure of improvement with hearing aids. Once again, Validation is NOT asking "How does that sound".  There should be a clear set of measurable criteria to determine subjective benefit with hearing aids.  

Even though this video isn't about Verification, it is important to note that Verification significantly improves subjective Validation outcomes.  The #1 most important form of Verification is Real Ear Measurement.  If you have Verification and Validation performed together, it will ensure you get what you paid for and reduce the amount of follow-up visits that your require which saves time and money. So the next time that you get a set of hearing aids, not only should you expect the programming of those devices to be verified using Real Ear Measurement, you should also expect to complete a Validated questionnaire to ensure you are receiving the maximum amount of benefit in the real world.

Dr. Cliff Olson
Audiologist & YouTuber

Dr. Cliff is an unwavering supporter of Hearing Aid Best Practices and advocate for individuals with hearing loss, which inspired him to develop the Dr. Cliff Approved Provider Network.

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Dr. Cliff Olson

Audiologist & YouTuber