Question
With trainable hearing aids, does the research support not turning on the training feature until after the patient has had time to try the initial hearing aid settings? If the initial settings are verified to a prescriptive target, I wouldn’t want to risk having the patient train the hearing aid away from those settings until they’ve had time to try them.
Answer
Todd Ricketts: This is a great question and something that manufacturers have struggled with as well. With the current generation of trainable hearing aids, manufacturers are making the training occur a little more slowly. At this time, I’m not aware of a lot of data to support when training should begin. My own bias is if you have a patient who seems very motivated to train their hearing aids, then turning on training at the initial visit may be the way to go. After the initial programming, such a patient may say, “The hearing aid sounds okay, but I really would like to be able to adjust it.” This is probably a subset of our patients. If you have a patient that says, “I am really happy with how the hearing aid sounds and I do not want to mess with it,” that person may not be a good candidate for using a training feature. If they come back at their follow-up fit and they are still very happy with the programming and show no interest in adjusting the hearing aids, I probably would not turn the feature on at all. Gus, do you have an opinion on this?
Gus Mueller: Catherine Palmer conducted research a couple years ago which looked at when training should be started, and her results have some bearing on this question. She looked at two groups of new users, with 18 people in each group. One group was fitted with hearing aids verified to NAL-NL1 targets, began training immediately, and trained for two months. The second group was fit with hearing aids also verified to NAL-NL1, used the hearing aids for a month, and then did training for the second month. On average, both groups trained gain down a little fro soft inputs from the initial NAL setting. The Speech Intelligibility Index (SII) for soft inputs went down ~4% for the group that trained two months, and ~2% for the group that trained one month. Either way, neither group trained the settings down by a large amount, and maybe bothjust ended up closer to what are now the NAL-NL2 settings. HINT findings were not impacted by the training for either group (when compared to the NAL fit) and the majority (about 2/3) of both groups preferred their trained settings. You can read more in Catherine’s AudiologyOnline article.
Regarding Todd’s comments, I agree that if the patients seem happy at the initial fitting, maybe with training they could make the fitting worse, or be less happy with the result. However, the alternative outcome is that they could be even happier with training. We shouldn’t assume they will make things worse with training, and in fact, our research on this topic shows that this rarely happens. For more information, check out my course on AudiologyOnline.
Editor’s note: This Ask the Expert was adapted from the webinar, Vanderbilt’s Audiology Journal Club: Hearing Aid Features and Benefits – Research Evidence. To view the course in its entirety, register here.
