RP204 - Telehealth and Hearing Aid Fittings: Can "Best-Practice" Include a Fully Remote Audiogram and Hearing Aid Fitting at Home?

This presentation will describe a recent study regarding in-situ audiometry in the first-fittings of hearing aids. Real Ear Measures (REMs) were used to compare the actual differences between an in-person clinical fitting using traditionally obtained thresholds, relative to a home-based, remote fitting using in-situ audiometric thresholds. Results show no meaningful differences in the real ear aided response between the two fittings. The outcome of this study may encourage hearing healthcare professionals (HCP’s) to use Remote Support and provide the confidence that a remote based fitting is not detrimental to their patients and is not significantly different than the clinic-based fitting.

Summary:

The primary purpose of this study was to confirm that the REMs obtained from a fitting based on audiometric thresholds from an in-situ test in the patients’ home are not statistically different (+/- 5 dB) from those that are obtained after a “traditional” hearing aid fitting using clinically obtained thresholds from inside a soundbooth. A previous study, completed in July 2020 (during active Covid), was able to show that telehealth visits including in-situ audiometry are a reliable way to program hearing aids; however whether the differences between the two fittings would yield REM data to support this was not accomplished at that time due to the ongoing pandemic. The initial study indicated that while the low frequency thresholds obtained in a home setting via telehealth were higher than the participant actual thresholds, no significant subjective differences were noted between the two fittings.  This current study provides the opportunity to measure, objectively via REMs, the actual differences between an in-person clinical fitting using traditionally obtained thresholds, to a home-based, remote fitting using in-situ thresholds. The objective of this study is to confirm that the differences between the two fittings are less than +/- 5dB.

Methods:
20 participants with mild to severe hearing loss were fitted with Receiver in the Canal (RIC) hearing aids, appropriate strength receivers and vented domes. All participants had audiograms conducted in a lab sound booth at Visit 1, before the hearing aids were fitted. The hearing aids were programmed to NAL-NL2 targets at 100% gain and a feedback test was run.  The sessions were saved to the Noah 4 database and the participant was released to a 2-week home trial.

 Visit 2 was conducted during the home trial via a telehealth session: the investigator was in the lab on a laptop and the study participant was in their home environment with their hearing aids on and connected via Bluetooth to the telehealth app. Once both parties were connected in a telehealth session, a new audiogram was obtained via in-situ measurement. The fitting was updated accommodate the new, in-situ responses and the targets were recalculated. The session was saved to the Noah 4 database.

At Visit 3, REMs were taken two times: once with the fitting from the in-situ audiogram, and again with the restored fitting based on the lab audiogram.  Each participant was placed approximately 1m from the speaker prior to probe microphone being calibrated and inserted into the ears using the measurement software’s probe insertion assistant. ISTS stimulus of 50, 65, and 80 dB SPL inputs were evaluated and MPO was measured using a pure-tone sweep at 90 dB SPL.

Results:
Results show there is neither a statistically significant, nor clinically significant difference in hearing aid fittings based on REM data whether they were fit based on an audiogram performed in clinic, or an in-situ audiogram performed in the participant's home environment.


Conclusion:  
In conclusion, the results of this investigation provide evidence that hearing aid fittings can be similar, whether the participant has their audiogram and fitting performed in clinic or via telehealth from their home.