LM405 - Cases and FAQs: Demonstrating the Benefit of Hearing Aids for Functional Hearing Difficulties

Abstract:
Research and clinical evidence demonstrate that appropriately fit hearing aids are a safe and effective treatment option for adults with functional hearing difficulties (i.e., suprathreshold auditory complaints and deficits in the presence of normal pure-tone thresholds). The purpose of this presentation is to provide clinical cases that demonstrate the subjective and objective benefits that can be achieved for adults with functional hearing difficulties. Frequently asked questions about treating adults with functional hearing difficulties with hearing aids will also be addressed. This presentation is part 2 of a series; part 1 presents a hearing aid fitting protocol for this population.

Summary:
Ten to 25% of young to middle-aged adults and as many as 51% of older adults with normal pure-tone thresholds perceive hearing difficulties and/or suprathreshold speech-in-noise problems, referred to here as functional hearing difficulties (FHD). FHD is commonly reported in patient populations with known insults to the auditory system, including traumatic brain injury or noise exposure; however, many instances of FHD are idiopathic. These prevalence estimates represent as many as 25.3 million adults who struggle with speech understanding and communication in challenging acoustic environments, despite clinically normal pure-tone hearing. Importantly, adults with FHD are known to exhibit help-seeking behavior and are motivated to address their FHD. It has been reported that approximately 10% of referrals to ENT clinics for hearing difficulty were adults with pure-tone thresholds within the normal range (PTA ≤25 dB HL). In a recent survey, 45% of responding audiologists reported seeing 1-3 FHD patients per month in their practice. This represents a growing population of patients seeking hearing help from audiologists.

A growing body of research evidence supports the use of mild-gain amplification as a safe and effective treatment option for adults who experience FHD. To date, three clinical trials using mild-gain amplification to treat FHD have been reported. Results across studies consistently demonstrate both subjective (reduced hearing handicap) and objective (improved speech-in-noise performance) benefits for participants. Clinical evidence also supports the use of mild-gain, appropriately fit hearing aids to treat FHD. Our clinic routinely fits hearing aids on adults with FHD. We follow a modified fitting protocol originally described by Kuk et al. (2008) and used by Roup et al. (2018) (described in another Learning Module submission). A review of our clinical data demonstrates that adults with FHD perceive significant benefits from mild gain and appropriately fit amplification and most patients with FHD are willing to pay for the hearing aids out of pocket.

The purpose of this Learning Module is to present three cases of adults with FHD who have been successfully fit with mild-gain, appropriately fit hearing aids. Case history, background information, and subjective and objective outcomes will be presented for each case. Additionally, a portion of this Learning Module will be devoted to addressing Frequently Asked Questions related to fitting hearing aids in this population. Anecdotally, concerns have been expressed over the provision of amplification for adults whose pure-tone thresholds are within the normal range. We will address these concerns in a Frequency Asked Questions format, including questions related to the ethics and safety of fitting hearing aids on individuals with FHD and normal pure-tone thresholds. Funding of hearing aids for patients with FHD will also be discussed.