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Objective: The majority of individuals with hearing loss worldwide reside in low- and middle-income countries (LMICs), but there is limited information regarding the characteristics of hearing loss in these regions. This descriptive study aims to address this knowledge gap by analysing audiogram patterns in LMIC populations. Greater knowledge about the properties of hearing loss in LMICs allows for improved planning of interventions., Study Sample: Retrospective data from 23 collaborating centres across 16 LMICs were collected. All participants were adults seeking help for hearing problems. A machine learning approach was utilised to classify the hearing threshold data and identify representative profiles. The study comprised 5773 participants., Results: The results revealed mildly sloping audiometric patterns with varying severity. The patterns differed from previous studies conducted in high-income regions which included more steeply sloping losses. The findings also indicated a higher proportion of more severe levels of hearing loss., Conclusions: These variations could be attributed to population-level differences in the causative mechanisms of hearing loss in LMICs, such as a higher prevalence of infectious disease-related hearing loss. The results may also reflect differences in health seeking behaviours. This study highlights the need for tailored, scalable, hearing interventions for LMICs.

Objective: This study aimed to provide normative ranges of Chinese smartphone-based digits-in-noise (DIN) test results, to explore the association between speech reception threshold (SRT) and pure-tone average (PTA) threshold, and to verify the effectiveness and feasibility of the Chinese DIN., Design: Chinese-speaking adult subjects with varying types, symmetry and degrees of hearing loss, were recruited. All participants completed a pure-tone audiometric hearing test and DIN test with dichotic and antiphasic stimulus presentation., Study Sample: The overall sample consisted of 191 subjects, 24 with normal hearing and 167 with hearing loss., Results: There was a positive correlation between antiphasic DIN SRTs and PTA thresholds. Receiver operating characteristic curves (ROC) were calculated based on the classification of poorer ears. When SRT was ≥ -15.8 dB, it suggested the possible presence of mild or more severe hearing loss; when SRT was ≥ -14.2 dB, it suggested the possible presence of moderate or more severe hearing loss., Conclusion: The Chinese DIN SRT showed a highly positive correlation with PTA and exhibited high sensitivity and specificity in detecting hearing loss. Poorer ear PTA was the primary predictor of the antiphasic DIN SRT. The present results verify the validity of the Chinese DIN in its purpose of hearing screening.

Adequate early childhood development is critical for later-life success. Developmental profiles of specific populations are required to support implementation of early intervention services. Three hundred fifty-three caregivers of children with mean age 17.9 months (SD = 10.5) were selected from a primary healthcare clinic. Overall positive identification of signs of a developmental delay, with the Bayley Scales of Infant and Toddler Development III, was 51.8% ( n = 183). Logistic regression analysis determined the effect of age and gender on results. Prevalence of developmental delay increased with age from 33.1% for children under 12 months to 61.7% and 66.3% for children between 13-24 months and 25-36 months, respectively. Females were 1.82 times (95% CI [1.16, 2.85]) more likely to have had no signs of developmental delay; 2.30 times (95% CI [1.14, 4.65]) in motor and 2.06 times (95% CI [1.23, 3.45]) in adaptive behaviour domains. One-third of children presented with low levels of adaptive behaviour functioning. One hundred and one (28.6%) participants across age groups displayed superior social-emotional ability, possibly due to familial structures and relationships. One-third of children presented with poor adaptive behaviour function, attributed to cultural differences. This study contributes to information on developmental characteristics of children in South Africa., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To investigate the gain provided by self-fitting over-the-counter (SF-OTC) hearing aids compared to clinical NAL-NL2 targets, the differences between various FDA-approved SF-OTC devices, and potential changes in gain over time., Methods: Two experiments were conducted: (1) a cross-sectional comparison of six SF-OTC hearing aids (n = 43) and (2) a longitudinal evaluation of gain within five days of self-fitting and four additional time points (n = 15). Real-ear measurements (REMs) were used to measure gain., Results: SF-OTC hearing aid gain corresponded with 10 dB SPL but not 5 dB SPL criteria from NAL-NL2 targets. Differences between NAL-NL2 targets and gain did not differ significantly between devices. There were no significant changes in gain over time for any input level., Conclusions: SF-OTC hearing aids generally provide user-selected gain levels lower than clinical targets, particularly at higher frequencies. The gain remains stable over time, indicating limited user adjustment after initial fitting. OTC hearing aid manufacturers should consider implementing fitting algorithms that allow for gradual user acclimatization.

Purpose: Objective audiological assessments provide valuable insights on physiological dimensions of hearing loss (HL), but not on lived experiences and functional limitations perceived by individuals. This study employed the multidimensional ICF framework to explore how demographic and diagnostic variables predict self-reported disability in adults with HL., Method: This cross-sectional study included 571 participants from India (94), South Africa (79), Sweden (219), and the USA (179). Responses from structured interviews based on the ICF were measured against demographic and diagnostic variables., Results: 74.6% of the participants were hearing aid (HA) users with moderate-to-severe HL. Five statistically significant predictors were identified; HA usage, degree of HL, level of education, age, and income bracket. The predictors were associated with the ICF components; body functions (b126, b210, b230, b240), activity and participation (d310, d350) and environmental factors (e125, e250, e310, e355, e410, e460)., Conclusions: This study emphasises that an individual's experience with HL is significantly influenced by various factors beyond the severity of the HL itself. This underscores the ICF's utility in capturing the complex interplay of biopsychosocial factors on HL. Identifying significant predictors could aid in tailoring interventions to improve health outcomes and quality of life for individuals with HL.

Purpose: Over-the-counter (OTC) hearing aids can potentially improve access to hearing-health careand enable individuals with mild-to-moderate hearing loss to self-manage their condition. This study com-pared the usability and performance of a range of self-fitting over-the-counter (OTC-SF) hearing aids., Research Design: This cross-sectional study evaluated six OTC-SF hearing aids., Study Sample: Forty-three adults with self-perceived mild-to-moderate hearing difficulties participatedin this study., Data Collection and Analysis: Participants were randomly assigned to two of six OTC-SF hearingaids and used the manufacturer-provided instructions and smartphone applications. These hearingaids included HP Hearing PRO, Jabra Enhance Plus, Lexie B2 Powered by Bose, Lexie Lumen,Soundwave Sontro, and Sony CRE-C10. Usability was assessed based on the fitting time, hearing aidskills and knowledge (HASK), self-reported ease of the SF process, and Post-Study System UsabilityQuestionnaire (PSSUQ) results. Performance was evaluated using the judgment of sound quality (JSQ)test and speech-in-noise benefit using the digits-in-noise and quick speech-in-noise tests., Results: Fitting time ranged from 14.4 to 27.1 min, with Lexie Lumen requiring the longest time (27.1 min;standard deviation [SD], 5.9 min) and HP Hearing PRO requiring the shortest time (14.4 min; SD = 1.9 min).The HASK scores varied, with Soundwave Sontro achieving the highest score (8.9/10) and HP Hear-ing PRO achieving the lowest score (6.8/10). Self-reported ease of SF and PSSUQ scores did notdiffer significantly between the OTC-SF hearing aids. Overall sound quality and clarity ratings signifi-cantly differed, with Lexie B2 receiving the highest rating (8.1/10 and 7.5/10) and HP Hearing PROreceiving the lowest rating (6.3/10 and 5.1/10). Speech-in-noise benefit did not differ significantlybetween devices. A thematic analysis identified seven themes of the participants' SF experiencesand six themes of the researcher's field notes. Participants generally considered OTC-SF hearing aidsuser-friendly, although issues with Bluetooth connectivity, handling and insertion, and sound quality werenoted by the researcher as common challenges., Conclusions: Usability and performance of OTC-SF hearing aids were similar across devices in termsof useability and speech-in-noise benefits. However, the devices exhibited variations in fitting time,HASK, and sound quality, including the overall impression and clarity. These findings can support thedecisions of consumers and recommendations of health-care professionals. Further research of thelong-term usability and selection processes of OTC-SF hearing aids is necessary.

Background:  Hearing aid verification is required to objectively measure hearing aid outputs by ensuring that the amplified speech spectrum closely approximates the prescription goals., Objectives:  This study aimed to determine audiologists' perceptions and practices regarding hearing aid verification and identify facilitators and barriers to its use., Method:  A cross-sectional national e-survey included questions related to demographics, perceptions of verification, verification practices and two open-ended questions regarding the facilitators and barriers to conducting hearing aid verification in South Africa., Results:  Seventy-eight South African audiologists, with experience ranging from less than a year to 34 years, completed the online survey. Of these, 76.3% conduct hearing aid verification, while 23.7% seldom or never perform this verification. Among the audiologists who conducted verification, 81.0% reported performing it on both adults and children. More than three-quarters (86.6%) indicated that they conduct verification only during the initial fitting, while half (53.8%) do so only when a problem arises. Thematic analysis revealed the following barriers to verification: improper equipment, a lack of equipment, non-standard clinical practices and time constraints., Conclusion:  There are several challenges faced by South African audiologists in performing verification. It may be feasible to address these barriers by raising awareness about the value of verification, offering training, and advocating for the purchase and utilisation of verification equipment.Contribution: This study's findings provide information on the current practices of hearing aid verification in a socioeconomically diverse setting. Furthermore, it highlights important challenges such as a lack of equipment as well as time constraints.

Objective: This study aimed to explore the main reasons for hearing aid uptake from a user perspective and recommendations to others with hearing difficulties., Design: A cross-sectional survey design was used. Responses to a single open-ended question were analysed using qualitative content analysis., Study Sample: Participants (n = 642) included adult hearing aid users sampled from the Hearing Tracker website community and Lexie Hearing user databases in the United States., Results: Participants had a mean age of 65.4 years (13.7 SD) and included 61.8% males, 37.7% females, 0.3% non-binary, and 0.2% preferred not to say. Reasons for hearing aid uptake were categorised into three domains (personal impact, social difficulties, and auditory difficulties), containing 11 main categories and 48 sub-categories. User recommendations to others with hearing difficulties constituted eight main categories (timely help, trial period, support, affordability, technology, direct-to-consumer hearing aids, adjustments, and advocacy) and 32 sub-categories., Conclusions: The decision to take up hearing aids included intrinsic factors like readiness to change and extrinsic factors such as the availability of finances. The most frequent recommendation to others was not to delay seeking hearing help and to get hearing aids. Our findings may support strategies to facilitate behaviour change for improved hearing aid uptake.

Objective: This systematic review aims to examine the current literature on help-seeking, hearing device uptake, and hearing health outcomes in individuals with subclinical hearing loss., Design: Systematic review., Study Sample: Searches of three databases (CINAHL, MEDLINE (PubMed), and Scopus) yielded nine studies meeting the inclusion criteria. The quality of the included studies was determined using the National Institute of Health quality assessment tool. The studies' level of evidence was determined according to the Centre for Evidence-Based Medicine., Results: All included studies involved adult participants. Three studies examined help-seeking. Self-reported difficulty, poor speech-in-noise performance, and emotional responses to the hearing difficulty were identified as factors influencing help-seeking. Six studies examined the use of hearing devices as an intervention, including hearing aids ( n  = 4), hearables ( n  = 1), and FM systems ( n  = 1). Using hearing devices improved self-perceived hearing difficulty, speech-in-noise understanding, and motivation to address hearing difficulties. No studies focused on hearing device uptake. The quality assessment indicated limited methodological rigour across the studies, with varying levels of evidence., Conclusions: Current evidence supports the use of hearing devices as an intervention for individuals with subclinical hearing loss. However, more research is essential, particularly focusing on help-seeking, diagnosis, treatment, and long-term outcomes using well-controlled study designs.

Objective: Employing automated language analysis, specifically Meaning Extraction Method (MEM) and Principal Component Analysis (PCA), to identify key factors in open-text responses about hearing aid experiences., Design: Exploratory, cross-sectional design, using an online questionnaire. Responses to a single open-ended question were analysed using MEM, PCA, regression, and correlation analyses., Study Sample: Participants (n = 538) included adult hearing aid users sampled from the Hearing Tracker website community and Lexie Hearing user databases in the United States., Results: The MEM-derived items revealed six factors related to hearing aid experiences: (1) life change, (2) social situation, (3) quality of life, (4) impact and speech understanding, (5) communication and interaction, and (6) music and environmental sounds. IOI-HA item 3 had the most statistically significant correlations with PCA factors. Quantile regression revealed that factors one and two significantly predicted the IOI-HA total score. Positive correlations were observed between self-reported hearing difficulty and factors one, four, and five, as well as between factor one and general health and factor two and physical activity., Conclusion: Natural language analysis of open-ended textual responses can offer valuable insights into hearing aid users' experiences. Future studies should aim to refine this methodology to enhance clinical relevance and generalisability.

Purpose: This study explored user perspectives on the relationship between hearing aid cost and uptake, as well as cost-related recommendations for others with hearing difficulties, in a sample of prescription and over-the-counter (OTC) hearing aid users., Method: A secondary analysis was conducted on a cross-sectional survey using qualitative content analysis to analyze responses related to the cost of hearing aids. The study included a total of 241 adult participants, comprising 179 prescription hearing aid users from the Hearing Tracker website and 62 OTC hearing aid users from the Lexie Hearing U.S. database., Results: Prescription users had a mean age of 66.7 years ( SD = 13.2), including 62.0% males, 37.4% females, and 0.6% nonbinary individuals. OTC users had a mean age of 63.0 years ( SD = 13.4), with 48.4% males and 51.6% females. Three overarching domains were identified: perceived enablers to hearing aid uptake related to the cost, perceived barriers to hearing aid uptake related to the cost, and recommendations to others with hearing difficulties related to the cost, with 14 categories recognized for prescription users and 12 for OTC users. Both groups identified the high cost of hearing aids and lack of insurance coverage as significant barriers to uptake. Many prescription users reported external support (e.g., financial support and health insurance coverage) as an enabler, while OTC users frequently mentioned the affordability of OTC devices. The most common recommendation among prescription users was to seek professional support, whereas OTC users recommended researching hearing aids before making a purchase., Conclusions: Cost and insurance coverage consistently emerge as primary barriers to hearing aid adoption for both prescription and OTC users. To foster greater accessibility, initiatives should target these financial obstacles. Additional research is warranted on the relationship between hearing aid cost and uptake, especially among OTC users and those seeking financial assistance., Supplemental Material: https://doi.org/10.23641/asha.26496922.

Purpose: Hearing aids play a pivotal role in mitigating the impact of hearing loss, yet their adoption and consistent usage remains suboptimal. Understanding the hearing aid needs of individuals with hearing loss is important to support uptake, use, and outcomes. The current study describes users' perspectives on how hearing aids can be improved., Method: A cross-sectional, qualitative, content analysis design was used for an open-ended question from an online survey, exploring user perspectives on hearing aid improvements. Participants were adult hearing aid users in the United States, surveyed from the HearingTracker and Lexie Hearing user database., Results: A total of 628 participants ( M age = 66 years) were surveyed. The majority of participants used bilateral, behind-the-ear hearing aids that were obtained either through a hearing health care professional or online. Three domains, highlighting areas for hearing aid improvement, were identified. (a) The hearing aid features domain described user issues surrounding physical appearance and fit, general features, streaming, battery functionality, adjustments, smartphone applications, and hearing aid-related accessories. There was dissatisfaction with aesthetics and functionality, with a notable desire for improvements in physical appearance and fit ( n = 161), and features to improve self-efficacy. (b) The sound quality domain described user issues surrounding sound perception and difficult situations. Participants highlighted unmet needs for clarity, especially in noisy environments ( n = 143). (c) The service-delivery domain described user issues surrounding audiology services and general satisfaction, with criticisms centered on the high cost of hearing aids ( n = 193) and the credibility of hearing health care professionals., Conclusions: Hearing aid users appreciated current technological advances but expressed a need for improvements, to better align devices with their requirements. Key areas included physical aesthetics, user control over device adjustments, sound clarity, cost accessibility, and trust between the user and hearing health care professional. Future designs should focus on features enhancing user autonomy and self-efficacy.

Importance: Fewer than 20% of US adults with hearing loss use hearing aids due to barriers like high cost. Over-the-counter (OTC) hearing aids offer a potential solution, incorporating self-fitting strategies via smartphone apps. Self-fitting strategies have been validated for Food and Drug Administration (FDA)-approved OTC hearing aids compared with prescription-based approaches. However, no direct comparative analysis exists between in situ audiometry and self-adjustment strategies using self-fitting OTC (OTC-SF) hearing aids., Objective: To compare self-adjustment and in situ audiometry self-fitting strategies in OTC-SF hearing aids for adults with mild to moderate hearing difficulties., Design Settings and Participants: A crossover, within-participant pseudorandomized clinical trial was conducted between July and November 2023. Twenty-eight participants were pseudo-randomly assigned to 1 of the 2 self-fitting strategies, and they experienced both interventions for 4 consecutive weeks., Interventions: The self-adjustment group manually adjusted settings, including overall gain and spectral tilt, using Lexie B2 hearing aids, while the in situ audiometry group used Lexie B2 Plus hearing aids (Lexie Hearing by hearX Group), with an automated fitting based on in situ tests conducted through the app., Main Outcomes and Measures: The primary outcome was Abbreviated Profile of Hearing Aid Benefit (APHAB). Secondary outcomes were International Outcome Inventory for Hearing Aids (IOI-HA), speech-in-noise tests (DIN and QuickSIN), and real-ear measurements (REMs). Measures were completed at baseline and after the 4-week field trial using each strategy., Results: Twenty-eight participants (mean [SD] age, 60.2 [12.0] years) were included; 14 men and 14 women. Self-adjustment and in situ audiometry strategies produced no clinically meaningful differences across various outcome measures, including overall APHAB benefit (Cohen d = 0.2; 95% CI, -0.2 to 0.6) and overall IOI-HA satisfaction (Rosenthal r = 0.0; 95% CI, -0.3 to 0.2). Self-adjustment users reported higher satisfaction (Rosenthal r = -0.4; 95% CI, -0.6 to -0.1) and longer daily use (Rosenthal r = -0.3; 95% CI, -0.5 to 0.0) compared with those using in situ audiometry. No clinically meaningful differences were observed in speech-in-noise benefit and real-ear measurements., Conclusion and Relevance: In this clinical trial of OTC-SF hearing aids, self-adjustment and in situ audiometry strategies resulted in similar outcomes. However, self-adjustment may produce higher satisfaction and longer daily use, highlighting the potential advantages of active user involvement in the fitting process. Further investigation is needed for long-term outcomes., Trial Registration: ClinicalTrials.gov Identifier: NCT05782153.

Importance: With rising interest in over-the-counter (OTC) hearing aids as an alternative to traditional audiologist-fit devices, understanding their long-term efficacy is crucial. However, given the novelty of the US Food and Drug Administration category of OTC hearing aids, minimal evidence currently supports their long-term efficacy., Objective: To compare the long-term self-reported outcomes at 8 months of self-fit OTC hearing aids to the same hearing aids fit by audiologists., Design, Setting, and Participants: Building on a previous randomized clinical trial, this follow-up comparative effectiveness research study reassessed a number of the original participants that were not lost to follow-up. Participants were initially divided into those with self-fit OTC hearing aids and those with audiologist-fit devices. Approximately 8 months after fitting, participants completed self-reported questionnaires. Missing data were addressed through multiple imputation. The original noninferiority trial was conducted at the University of Pretoria in South Africa from April 2022 to August 2022. The current analysis took place between July 7, 2023, to November 20, 2023., Interventions: In the original trial, participants in the self-fit device group received a pair of OTC hearing aids and independently fit them with remote support as needed. The audiologist-fit device group received the same hearing aids fit by a certified audiologist using best practices., Main Outcomes and Measures: The main outcomes were self-reported hearing aid benefit, measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the International Outcome Inventory for Hearing Aids (IOI-HA)., Results: Of 64 participants in the trial, 44 participants were included in the extension study (21 [47.7%] in the audiologist-fit group; 23 [52.3%] in the self-fit group). The mean (SD) age of these participants was 63.0 (13.2) years, and 21 (47.7%) were male. At the long-term follow-up, self-fit and audiologist-fit groups showed no significant differences in the APHAB global score (mean difference, 0.02 [95% CI, -7.1 to 7.1]; Cohen d, 0.01 [95% CI, -0.5 to 0.5]) or the IOI-HA total score (mean difference, 1.5 [95% CI, -1.4 to 4.4]; Cohen d, 0.3 [95% CI, -0.2 to 0.8]). From 6 weeks to 8 months, no clinically meaningful group-time interaction was found between groups for the APHAB global score (Cohen d, 0.1 [95% CI, -0.2 to 0.3]), but a significant interaction for the IOI-HA total score was found (Cohen d, -0.6 [95% CI, -0.8 to -0.3]), with the self-fit group generally performing better., Conclusion: This comparative effectiveness research study demonstrated that self-fit OTC hearing aids can offer comparable long-term benefits to audiologist-fit hearing aids for individuals with mild to moderate hearing loss.

Objective: This systematic review examined the audiological and non-audiological factors that influence hearing aid use, benefit and satisfaction in adults based on studies published during the last decade (2010 and 2023)., Design: Studies were identified by using PRISMA guidelines for systematic searches on five platforms (Web of Science, Scopus, PubMed, EBSCOhost including CINAHL and Academic Search Complete). The National Institute of Health Quality assessment tool and the Oxford Centre for Evidence Based Medicine tool were used for quality assessment and grading of level of evidence., Results: Forty-six articles were included in the review. A total of 101 significant factors influencing hearing aid use ( n  = 47), benefit ( n  = 17) and satisfaction ( n  = 37) were identified. Clear determinants of hearing aid use, benefit and satisfaction included hearing sensitivity, self-reported hearing difficulty, speech perception, attitude and beliefs. 34 cross-sectional studies in this review were graded level 4, 9 cohort studies rated level 3, and 3 randomised control trials rated level 2., Conclusion: Factors associated with hearing aid outcomes identified in the past decade support previous evidence. New factors like social networks and service-delivery models, have also been identified. These factors require further investigations through high quality studies to further strengthen existing evidence.

Background: This study aimed to examine whether individuals with chronic tinnitus report more positive experiences following internet-based cognitive behavioral therapy (CBT)., Methods: A mixed-methods design was used, nested in clinical trials evaluating internet interventions for tinnitus. Participants ( n = 164) completed online questionnaires (both structured and open-ended) providing demographic information as well as health variables (e.g., tinnitus distress, anxiety, depression, insomnia). An open-ended question listing positive effects or outcomes related to having tinnitus was also included. Responses to the open-ended questions were analyzed using qualitative content analysis., Results: Of the 164 eligible participants, 32.3% ( n = 53) provided at least 1 positive experience both at pre- and post-intervention, with 9.1% ( n = 19) providing positive experiences only at pre-intervention, 49 (29.9%) providing positive experiences only at post-intervention, and 28.7% ( n = 47) of the participants did not provide any positive experiences on either measurement occasion. Significantly more positive experiences were reported following the intervention in the overall sample ( p < 0.0001, paired sample t -test). In addition, participants who reported positive experiences in both pre- and post-intervention also reported more positive experiences following intervention ( p = 0.008, paired sample t -test)., Conclusions: Internet-based CBT can help individuals with tinnitus to think more positively by changing unhelpful thought patterns. Open-ended questions can supplement structured questionnaires to measure treatment outcomes.

Objective: Developments in smartphone technology and the COVID-19 pandemic have highlighted the feasibility and need for remote, but reliable hearing tests. Previous studies used remote testing but did not directly compare results in the same listeners with standard lab or clinic testing. This study investigated validity and reliability of remote, self-administered digits-in-noise (remote-DIN) compared with lab-based, supervised (lab-DIN) testing. Predictive validity was further examined in relation to a commonly used self-report, Speech, Spatial, and Qualities of Hearing (SSQ-12), and lab-based, pure tone audiometry., Design: DIN speech reception thresholds (SRTs) of adults (18-64 y/o) with normal hearing (NH, N = 16) and hearing loss (HL, N = 18), were measured using English-language digits (0-9), binaurally presented as triplets in one of four speech-shaped noise maskers (broadband, low-pass filtered at 2, 4, 8 kHz) and two phases (diotic, antiphasic)., Results: High, significant intraclass correlation coefficients indicated strong internal consistency of remote-DIN SRTs, which also correlated significantly with lab-DIN SRTs. There was no significant mean difference between remote- and lab-DIN on any tests. NH listeners had significantly higher SSQ scores and remote- and lab-DIN SRTs than listeners with HL. All versions of remote-DIN SRTs correlated significantly with pure-tone-average (PTA), with the 2-kHz filtered test being the best predictor, explaining 50% of the variance in PTA. SSQ total score also significantly and independently predicted PTA (17% of variance) and all test versions of the remote-DIN, except the antiphasic BB test., Conclusions: This study underscores the effectiveness of remote DIN test and SSQ-12 in assessing auditory function. These findings suggest the potential for wider access to reliable hearing assessment, particularly in remote or underserved communities.

Objective: This study aimed to explore meaningful life changes due to hearing aid use in adult users., Design: A cross-sectional survey design was used with open-ended questions analysed using inductive qualitative content analysis., Study Sample: US-based adult hearing aid users (n = 653) from the Hearing Tracker website community and Lexie Hearing database., Results: Participants had a mean age of 65.4 years (13.6 SD), including 61.2% males, 38.3% females (0.5% other). Analysis of 2122 meaning units from responses identified two broad domains: 'meaningful benefits' (n = 1709; 80.5%) and 'remaining difficulties' (n = 413; 19.5%). The meaningful benefits domain included five categories (27 sub-categories): (a) psychosocial benefits, (b) improvements in hearing, (c) personal benefits, (d) hearing aid features and connectivity, and (e) situational benefits. Participants reported enhanced relationships and improved occupational functioning as key benefits. The remaining difficulties domain contained four categories (25 sub-categories): (a) hearing aid limitations, (b) hearing and communication issues, (c) situational difficulties, and (d) personal issues. Notable difficulties included hearing aid design issues and challenges in noisy environments., Conclusion: Hearing aid users reported diverse benefits and persistent challenges related to device use, illustrating the complexity of their lived experiences. These findings can inform empathetic, effective rehabilitation strategies and user-centric hearing aid technologies.

Objectives: Hearing loss prevalence is increasing, with an estimated 2.5 billion people affected globally by 2050. Scalable service delivery models using innovative technologies and task-shifting are World Health Organization priorities to improve access to hearing care, particularly in low- and middle-income countries. Smartphone-facilitated audiometry in the community using hearing aids covered by noise-attenuating ear cups ("in-situ") could support more accessible hearing care when provided by less trained individuals such as community health workers (CHWs). This study aimed to determine the validity of this method for potential hearing aid fitting. Study objectives included determining the maximum permissible ambient noise level (MPANL), inter-device reliability, clinical threshold accuracy, reliability, and performance in real-world settings., Design: Experiment 1: 15 normal-hearing adult participants were evaluated to determine MPANLs for circumaural Peltor 3M earcups covering Lexie Lumen hearing aids with smartphone-facilitated in-situ audiometry. MPANLs were calculated by measuring the difference in attenuation between thresholds obtained with standard headphones and in-situ hearing aids. Experiment 2: Pure-tone frequency and intensity output of 14 same-model Lexie Lumen hearing aids were measured to determine inter-device reliability. Pure-tone stimuli were measured and analyzed to determine sound pressure levels in decibels and pure-tone frequency when connected to a test box 2cc coupler. Experiment 3: 85 adult participants were tested in a sound booth to determine the accuracy of automated in-situ pure-tone audiometry (PTA) compared to clinical PTA (500, 1000, 2000, 3000, 4000, 6000 Hz) facilitated by an audiologist. The first 39 participants were tested twice to determine test-retest reliability. Experiment 4: In a community setting, 144 adult participants were tested with automated in-situ audiometry facilitated by CHWs using a smartphone app. These participants were subsequently tested with automated mobile PTA (500, 1000, 2000, 4000 Hz). An additional 44 participants were tested twice to determine test-retest reliability., Results: Experiment 1: MPANLs of the Peltor 3M earcup-covered hearing aids were higher than standard headphones across all frequencies, ranging from 24 to 47.3 dB SPL. Experiment 2: Inter-device performance reliability was high, with all inter-device differences across all intensities and frequencies less than 3 dB. Frequency output was consistent and differed less than 0.7% between devices. Experiments 3 and 4: 85.2% and 83.3% of automated in-situ audiometry thresholds were within 10 dB of thresholds obtained in the sound booth and in a community setting, respectively. Acceptable test-retest intraclass correlation coefficient (ICC) was evident across all thresholds obtained in a sound booth (ICC = 0.85 to 0.93) and in a community setting (ICC = 0.83 to 0.97)., Conclusions: Smartphone-facilitated in-situ audiometry allows for reliable and valid community-based testing. A simple smartphone user interface and automated in-situ audiometry allow CHWs with minimal training to facilitate the testing. With the additional capability to program hearing aids via the smartphone after the initial test, this approach would have the potential to support widespread access to personalized hearing aid fittings facilitated by CHWs in low- and middle-income countries. This approach also supports self-fitting options based on in-situ thresholds, enabling testing and fitting via over the counter hearing aids., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The aim of this study was to examine the hearing health care experience of satisfied and dissatisfied consumers as reported on Google reviews., Method: Using qualitative thematic analysis, open-text responses from Google regarding hearing health care clinics across 40 U.S. cities were examined. During the original search, 13,168 reviews were identified. Purposive sampling led to a total of 8,420 five-star reviews and 321 one-star reviews. The sample consisted of 500 five-star (satisfied) and 234 one-star (dissatisfied) reviews, describing experiences with audiology clinics, excluding reviews related to ear, nose, and throat services; other medical specialties; and those not relevant to hearing health care., Results: Satisfied and dissatisfied consumer reviews yielded nuanced dimensions of the hearing health care consumer experience, which were grouped into distinct domains, themes, and subthemes. Six and seven domains were identified from the satisfied and dissatisfied reviews, encompassing 23 and 26 themes, respectively. The overall experience domain revealed emotions ranging from contentment and gratitude to dissatisfaction and waning loyalty. The clinical outcomes domain highlights the pivotal contribution of well-being and hearing outcomes to the consumer experience, while the standard of care domain underscores shared expectations for punctuality, person-centered care, and efficient communication. Facility quality, professional competence, and inclusive care were also highlighted across positive and negative reviews., Conclusions: Findings indicate dimensions of satisfied and dissatisfied hearing health care consumer experiences, identifying areas for potential service refinement. These consumer experiences inform person-centric service delivery in hearing health care.

The aim of this study was to examine the relationship between an American English Digits in Noise (DIN) test and commonly used audiological measures to evaluate the DIN test's ability to detect hearing loss and validate hearing aid fitting. QuickSIN and DIN tests were completed by participants with untreated hearing loss ( n = 46), prescription hearing aids ( n = 15), and over-the-counter (OTC) hearing aids ( n = 12). Performance on the QuickSIN showed moderate positive correlations with DIN for untreated hearing loss participants and prescription hearing aid users, but not for OTC hearing aid users. For untreated hearing loss participants, both QuickSIN and DIN tests showed positive moderate to strong correlations with high frequency puretone averages. In OTC users, DIN scores did not significantly change over a 6-month time period and were better when conducted remotely compared to in-person testing. Our results suggest that the DIN test may be a feasible monitoring option for individuals with hearing loss and those fitted with hearing aids. However, due to small sample size in this pilot study, future research is needed to examine DIN test's utility for fitting and validating OTC hearing aids.

Objective: Appropriate speech-in noise assessment is challenging in multilingual populations. This study aimed to assess whether first preferred language affected performance on an English Digits-in-noise (DIN) test in the local Asian multilingual population, controlling for hearing threshold, age, sex, English fluency and educational status. A secondary aim was to determine the association between DIN test scores and hearing thresholds., Design: English digit-triplets in noise testing and pure-tone audiometry were conducted. Multiple regression analysis was performed with DIN scores and hearing thresholds as dependent variables. Correlation analysis was performed between DIN-SRT and hearing thresholds., Study Sample: 165 subjects from the Singapore Longitudinal Ageing Study, a population-based longitudinal study of community-dwellers over 55 years of age., Results: Mean DIN speech reception threshold (DIN-SRT) was -5.7 dB SNR (SD 3.6; range 6.7 to -11.2). Better ear pure tone average and English fluency were significantly associated with DIN-SRT., Conclusions: DIN performance was independent of first preferred language in a multilingual ageing Singaporean population after adjusting for age, gender and education. Those with poorer English fluency had a significantly lower DIN-SRT score. The DIN test has the potential to provide a quick, uniform method of testing speech in noise in this multilingual population.

Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests. Author De Wet Swanepoel declares: Consultation, equity and potential royalties, hearX Group, Pretoria, South Africa. Author Carrie Nieman declares: Volunteer membership on the nonprofit board of directors for the Hearing Loss Association of America and Access HEARS. No other authors have competing interests to declare., (Copyright: © 2024 Dillard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The stigma associated with wearing hearing aids, known as the "hearing aid effect," remains a significant issue in hearing healthcare. Despite notable changes in the look and feel of hearing aids over the last decade, little is known about the influence of socioeconomic factors on the perception of different hearing devices in a socioeconomically diverse setting. Therefore, the objective of the study is to determine the hearing aid effect across a range of hearing devices and its association with socioeconomic factors, namely, area of residence and level of education across African communities., Methods: The study used a cross-sectional design with 322 participants (161 rural, 161 urban), mean age 31.9 years (14.7 SD). Participants rated photographs of seven different styles of devices (standard behind-the-ear hearing aid [BTE HA] with an ear mould, mini BTE HA with a slim tube [ST], in-the-canal [ITC] HA, AirPod, receiver in canal [RIC], completely-in-canal HA, and Personal Sound Amplification Product [PSAP]) worn by a peer model using a validated scale of eight attributes (attractiveness, age, success, hardworking, trustworthiness, intelligence, friendliness, education). The ratings of the BTE HA with ear mould were used as a benchmark for comparison., Results: No hearing aid effect was observed across all participants (n = 322) with device ratings ranging between neutral and positive. Significant differences between device ratings were evident for attractiveness for ST and PSAP and trustworthiness for ITC. In terms of residence, urban participants provided more favourable ratings compared to rural participants, with significant differences across three attribute ratings: hardworking for ST; attractiveness, hardworking for ITC; age for RIC and AirPod; and hardworking for PSAP. For level of education, significant differences were found for attributes of attractiveness (H = 13.5; p = 0.001) for ITC; attractiveness (H = 14.7; p = 0.001) for PSAP; age (H = 9.5; p = 0.009) for RIC; age (H = 14.3; p &lt; 0.001) and intelligence (H = 15.1; p &lt; 0.001) for AirPod; and hardworking (H = 11.9; p = 0.003) for ST., Conclusion: Overall, participants had a neutral to positive view of hearing devices with preferences for less visible, conventionally styled devices. Socioeconomic variables such as educational attainment and geographical location influence perceptions of hearing devices emphasizing the importance of taking these aspects into account when prescribing hearing devices., (© 2023 S. Karger AG, Basel.)

Purpose: This study aims to identify and describe factors that influence hearing aid outcomes including social networks, self-reported mental health, and service delivery models., Method: A prospective cross-sectional online survey was sent to hearing aid users recruited through an online platform (http://www.hearingtracker.com) between October and November 2021. The survey contained questions on patient demographics, audiological variables, general health and social factors, and self-reported hearing aid outcomes using the International Outcome Inventory for Hearing Aids (IOI-HA). Regression models evaluated potential contributing factors of hearing aid outcomes on the IOI-HA., Results: Three hundred ninety-eight hearing aid users completed the survey with an average age of 66.6 ( SD = 13.0) years, of which 59.3% were male. Positive contributing factors of hearing aid outcomes (IOI-HA total score) were social network of people with hearing loss with hearing aids ( p < .010; Exp[B] = 0.03, 95% CI [0.01, 0.1]), self-reported mental health ( p < .05; Exp[B] = 0.6, 95% CI [0.01, 1.2]), work situation ( p < .001; Exp[B] = 1.9, 95% CI [0.7, 2.8]), quality of life ( p < .005; Exp[B] = 1.2, 95% CI [0.3, 1.1]), and self-reported hearing difficulty ( p < .02; Exp[B] = 0.8, 95% CI [0.2, 1.5]). Negative contributing factors of hearing aid outcomes included social networks of people with hearing loss without hearing aids ( p < .001; Exp[B] = -0.1, 95% CI [-0.2, -0.2]) and service delivery model of private or university clinic compared to big-box retailers ( p < .001; Exp[B] = -1.6, 95% CI [-2.7, -0.7])., Conclusions: Novel factors including social network of persons with hearing loss who use hearing aids, self-reported mental health, service delivery model, and work situation are significant contributors to hearing aid outcomes. These newly identified factors can inform public hearing health promotion and individualized audiological care to optimize hearing aid outcomes., Supplemental Material: https://doi.org/10.23641/asha.24060486.

Objectives: The objective of this study is (1) to assess whether the presentation level of the antiphasic digits-in-noise (DIN) test affects the speech recognition threshold (SRT), (2) to evaluate how accurately simulated unilateral and bilateral conductive hearing loss is detected (CHL) and (3) to determine whether increasing the presentation level normalises the antiphasic DIN SRT., Design: Participants performed antiphasic and diotic DINs at different presentation levels with unilateral, bilateral or no earplugs., Study Sample: Twenty-four and twelve normal hearing adults., Results: Without earplugs, antiphasic DIN SRTs did not differ between 60 and 80 dB SPL. At 60 dB SPL, the antiphasic DIN correctly classified 92% of the unilateral earplug cases; the diotic DIN 25%. The binaural intelligibility level difference did not differ between the no-earplug condition and the condition with bilateral earplugs when the presentation was increased with the attenuation level., Conclusions: In normal hearing participants, diotic and antiphasic DIN SRTs are independent of presentation level above a minimum level of 60 dB SPL. The antiphasic DIN is more sensitive than the diotic DIN for detecting unilateral CHL; not for bilateral CHL. The effect of CHL on DIN SRTs can be largely compensated by increasing the presentation level. Audibility plays an important role in the antiphasic and diotic DIN.

Objectives: Self-assessment instruments are commonly used in audiological rehabilitation. However, several studies highlight the lack of multidimensionality in existing outcome measures, with the consequence that they only partially capture aspects of functioning in everyday life for people living with hearing loss. This study aimed to develop and investigate the content validity of a self-assessment instrument based on the validated Brief International Classification of Functioning, Disability, and Health Core Set for Hearing Loss., Design: The design was a two-part instrument development study. The first part focused on the item-generation process of the instrument, named the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) during an experts' workshop. The second part focused on international content validation of the instrument using group interviews. Strategic sampling was used and 30 adults with hearing loss from India, South Africa, and the United States participated in the group interviews., Results: The expert's workshop resulted in the first version of the HFEQ containing 30 items. The results from group interviews show that the content of the HFEQ was considered to be valid concerning its relevance, comprehensiveness, and comprehensibility. A majority (73%) of the HFEQ items were perceived by the participants as relevant and easy to comprehend. For the remaining 27% of the items, the content was perceived to be relevant in all countries, but some terms and expressions were reported to require rewording or clearer examples. These modifications will be made in the next step of the development process., Conclusion: Content validation of the HFEQ demonstrates promising results, with participants perceiving the content as relevant and comprehensible. Further psychometric validation is required to investigate other psychometric properties, such as construct validity and reliability. The HFEQ has the potential to become a valuable new instrument for assessing everyday functioning in people with hearing loss in audiological rehabilitation and in research., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Numerous patient-reported outcome measures (PROMs) are available to measure hearing aid benefit and satisfaction. It is unclear to what extent currently available PROMs on hearing aid outcomes, often developed decades ago, meet current guidelines for good content validity and readability. This study evaluated the content validity and readability of PROMs that focus on perceived hearing aid benefit and/or satisfaction., Method: A literature review was conducted to identify eligible instruments. Content validity evaluation included mapping extracted questionnaire items to the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. In addition, study design in content validity methodology was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments study design checklist for PROM instruments. Readability was estimated using the Simple Measure of Gobbledygook measure., Results: Thirteen questionnaires were identified and evaluated. Item content focused primarily on the components of environmental factors as well as activity limitations and participation restrictions with less emphasis on body functions and personal factors. The content validity methodology analysis revealed an underuse or lack of reporting of a qualitative methodology in assessing patient and professional perspectives. All the included questionnaires exceeded the recommended sixth-grade reading level., Conclusions: The categories covered by hearing aid PROMs vary considerably, with no single instrument comprehensively covering all the key ICF components. Future development of hearing aid outcome measures should consider a mixed methodology approach for improved content validity and ensure an appropriate reading level.

Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa., Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities., Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis., Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well., Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care., (©Caitlin Frisby, Robert H Eikelboom, Faheema Mahomed-Asmail, Hannah Kuper, David R Moore, Tersia de Kock, Vinaya Manchaiah, De Wet Swanepoel. Originally published in JMIR Formative Research (https://formative.jmir.org), 23.08.2023.)