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Randomized Trial of Amplification Strategies
Bevan Yueh, MD;
Pamela E. Souza, PhD, CCC-A;
Jennifer A. McDowell, MS;
Margaret Patricia Collins, MS, CCC-A;
Carl F. Loovis, PhD, CCC-A;
Susan C. Hedrick, PhD;
Scott D. Ramsey, MD, PhD;
Richard A. Deyo, MD, MPH
Arch Otolaryngol Head Neck Surg. 2001;127:1197-1204.
Background Little is known about quality of life after the use of specific types
of hearing aids, so it is difficult to determine whether technologies such
as programmable circuits and directional microphones are worth the added expense.
Objective To compare the effectiveness of an assistive listening device, a nonprogrammable
nondirectional microphone hearing aid, with that of a programmable directional
microphone hearing aid against the absence of amplification.
Design Randomized controlled trial.
Setting Audiology clinic at the VA Puget Sound Health Care System, Seattle,
Wash.
Patients Sixty veterans with bilateral moderate to severe sensorineural hearing
loss completed the trial. Half the veterans (n = 30) had hearing loss that
the Veterans Affairs clinic determined was rated as "service connected," which
meant that they were eligible for Veterans Affairs–issued hearing aids.
Intervention Veterans with non–service-connected hearing loss, who were ineligible
for Veterans Affairs–issued hearing aids, were randomly assigned to
no amplification (control arm) or to receive an assistive listening device.
Veterans with service-connected loss were randomly assigned to receive either
the nonprogrammable hearing aid that is routinely issued ("conventional")
or a programmable aid with a directional microphone ("programmable").
Main Outcome Measures Hearing-related quality of life, self-rated communication ability, adherence
to use, and willingness to pay for the amplification devices (measured 3 months
after fitting).
Results Clear distinctions were observed between all 4 arms. The mean improvement
in hearing-related quality of life (Hearing Handicap Inventory for the Elderly)
scores was small for control patients (2.2 points) and patients who received
an assistive listening device (4.4 points), excellent for patients who received
a conventional device (17.4 points), and substantial for patients who received
a programmable device (31.1 points) (P<.001 by
the analysis of variance test). Qualitative analyses of free-text diary entries,
self-reported communication ability (Abbreviated Profile of Hearing Aid Benefit)
scores, adherence to hearing aid use, and willingness to pay for replacement
devices showed similar trends.
Conclusions A programmable hearing aid with a directional microphone had the highest
level of effectiveness in the veteran population. A nonprogrammable hearing
aid with an omnidirectional microphone was also effective compared with an
assistive listening device or no amplification.
From the Health Services Research and Development Service (Drs Yueh
and Hedrick and Ms McDowell), the Surgery and Perioperative Care Service (Dr
Yueh), and the Rehabilitation Care Service (Ms Collins and Dr Loovis), VA
Puget Sound Health Care System, Seattle, Wash; and the Center for Cost and
Outcomes Research (Drs Yueh, Ramsey, and Deyo) and the Departments of Otolaryngology/Head
and Neck Surgery (Dr Yueh), Speech and Hearing Sciences (Dr Souza), Health
Services (Drs Yueh, Hedrick, Ramsey, and Deyo), and Internal Medicine (Drs
Ramsey and Deyo), University of Washington, Seattle.
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