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J Am Acad Audiol. 2008 Nov-Dec;19(10):758-73.

Using trainable hearing aids to examine real-world preferred gain.

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Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA.



While there have been many studies of real-world preferred hearing aid gain, few data are available from participants using hearing aids with today's special features activated. Moreover, only limited data have been collected regarding preferred gain for individuals using trainable hearing aids.


To determine whether real-world preferred hearing aid gain with trainable modern hearing aids is in agreement with previous work in this area, and to determine whether the starting programmed gain setting influences preferred gain outcome.


An experimental crossover study. Participants were randomly assigned to one of two treatment groups. Following initial treatment, each subject crossed to the opposite group and experienced that treatment.


Twenty-two adults with downward sloping sensorineural hearing loss served as participants (mean age 64.5; 16 males, 6 females). All were experienced users of bilateral amplification.


Using a crossover design, participants were fitted to two different prescriptive gain conditions: VC (volume control) start-up 6 dB above NAL-NL1 (National Acoustic Laboratories-Non-linear 1) target or VC start-up 6 dB below NAL-NL1 target. The hearing aids were used in a 10 to 14 day field trial for each condition, and using the VC, the participants could "train" the overall hearing aid gain to their preferred level. During the field trial, daily hearing aid use was logged, as well as the listening situations experienced by the listeners based on the hearing instrument's acoustic scene analysis. The participants completed a questionnaire at the start and end of each field trial in which they rated loudness perceptions and their satisfaction with aided loudness levels.


Because several participants potentially experienced floor or ceiling effects for the range of trainable gain, the majority of the statistical analysis was conducted using 12 of the 22 participants. For both VC-start conditions, the trained preferred gain differed significantly from the NAL-NL1 prescriptive targets. More importantly, the initial start-up gain significantly influenced the trained gain; the mean preferred gain for the +6 dB start condition was approximately 9 dB higher than the preferred gain for the -6 dB start condition, and this difference was statistically significant (p < .001). Partial eta squared (n2) = 0.919, which is a large effect size. Deviation from the NAL-NL1 target was not significantly influenced by the time spent in different listening environments, amount of hearing aid use during the trial period, or amount of hearing loss. Questionnaire data showed more appropriate ratings for loudness and higher satisfaction with loudness for the 6 dB below target VC-start condition.


When trainable hearing aids are used, the initial programmed gain of hearing instruments can influence preferred gain in the real world.

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