Comparison of Hearing Aid Fitting Effectiveness With Audiograms From Either User-Operated or Traditional Audiometry in a Clinical Setting.

Background: The constrained accessibility of hearing tests for clinical decision-making is a significant challenge within the hearing rehabilitation system. With the ongoing global aging of the population, the challenge will most likely become more significant in the future, as a larger portion of the population will profit from hearing aids (HA). Consequently, there is a global need to expand the capacity of audiometry. One promising avenue for expanding this capacity is the integration of user-operated audiometry (UAud). Numerous studies have consistently demonstrated that user-operated audiometry exhibits reliability and accuracy comparable to traditional audiometry. However, its clinical adoption and acceptance remain limited, partly due to its value for clinical use as a base for HA fitting remains unclear. In this study, we sought to address this gap by comparing the effectiveness of HA fitting based on the UAud system to that based on traditional audiometry in a clinical setting.
Methods: The design was a blinded non-inferiority randomized controlled trial. 215 adults referred for hearing aid treatment were included in the analysis. Participants was tested using both traditional audiometry as well as the UAud system (which is based on the AMTAS method) at baseline. Participants were randomized to receive HAs fitted based on either UAud (UAud group) or traditional audiometry (control group). Outcome measures were assessed at two time points: baseline and a follow-up conducted a minimum of 12 weeks after hearing aid fitting. The primary outcome was changes in self-assessed hearing, assessed by the Speech, Spatial and Qualities of Hearing Scale (SSQ12) overall score from baseline to follow-up. Secondary outcomes include aided speech-in-noise performance assessed by speech reception thresholds in noise (SRTN) using the Hearing In Noise Test (HINT) at follow-up, as well as changes in the SSQ12 subscales scores between baseline and follow-up.
Results: Both groups exhibited a significant improvement in SSQ12 scores. A constrained linear mixed model analysis demonstrated that the UAuds group’s before-after changes in self-assessed hearing was non-inferior to that of the control group, as the differences in SSQ12 scores improvements were not statistically significant, and the upper bound of the 95% confidence interval for the difference between group means fell below the predefined non-inferiority margin. The UAud group also demonstrated non-inferiority to the control group across all secondary outcome measures.
Conclusions: As the outcome of HA fitting based on UAud was non inferior to that based on traditional audiometry, it’s suitable for clinical use as a base for HA fitting in the general clinical practice. The use of UAud could play an important role for clinicians in need of effectively treatment of the growing number of HA users in the future.