Question
For patients who are hesitant about wearing two hearing aids, does it matter if I fit one hearing aid to start and then add the second hearing aid at a later time, or is it better to start with two even if they are a bit reluctant?
Answer
Great question, as this comes up every now and then in clinical practice. One thing that certainly does matter is your counseling regarding the use of one versus two hearing aids on the day of the fitting. We examined that in a couple studies back in the late 1980s during my military days, and you’ll find a report on our findings in the first ever issue of the Journal of the American Academy of Audiology (Montgomery, McCarthy, & Mueller, 1990). Our general finding was that if the patients are told they will do best with two hearing aids, they will probably do best with two hearing aids!
Just recently, however, Lavie, Banai, Attais, and Karni, (2013) studied your question in a somewhat different way. They included 36 subjects with bilateral, symmetrical hearing losses and fit one group simultaneously (both ears at once) and one group sequentially (one at a time with a month lapse in between). Participants returned to the clinic every 10 days for an interview, where the researchers made a compliance score based on four factors (overall use of the hearing aids, patient report of hearing quality, patient report of comfort with the hearing aids, and patient report of satisfaction). They also collected data logging from the hearing aids.
After the first month, interview scores for both groups were very similar, where roughly 75% of participants had high compliance by their definition. In the second month, there was no change in compliance scores for the simultaneous group, but the sequential group was different. Recall that this group had gone one month with one hearing aid and then fit the next month with the second hearing aid. Nearly 71% of this group had reduced compliance in the second month. In other words, they were less happy, and only 25% had high compliance. The compliance score went from 75% to 25%, presumably because they were fitted with a second hearing aid.
The simultaneous group used their hearing aids for an average of five hours a day, which was consistent over the two-month trial. The sequential group, however, reduced the use for the ear originally fitted by about an hour a day, from 7.6 hours to 6.4 hours, and usage for the second aid was significantly lower, at only 4.5 hours a day.
The authors speculated that several of the participants were disappointed when they received the second hearing aid. Perhaps they had the notion that if one is good, two will be doubly good. The authors speculated that the sequential group may have had auditory deprivation because they were fitted with only one hearing aid for a month, although I personally don’t believe that is likely to happen after only one month of hearing aid use.
In the end, of course it doesn’t really matter why it happened. It appears that if a patient is a reasonable candidate for using two hearing aids, we should fit them with two hearing aids on day one. And, based on our earlier research, toss in some good pro-bilateral counseling.
This Ask the Expert was taken from the Siemens Expert Series text course, Day-to-Day Hearing Aid Fittings: Clinical Nuggets from Recent Research.
References
Lavie, L., Banai, K., Attais, J., & Karni, A. (2013). Better together: Reduced compliance after sequential vs. simultaneous bilateral hearing aid fitting. American Journal of Audiology, 23(1), 93-98.
McCarthy, P.A., Montgomery, A.A., & Mueller, H.G. (1990). Decision making in rehabilitative audiology. Journal of the American Academy of Audiology, 1(1), 23-30.
