hi HealthInnovations Methods for Prescribing Hearing Device Gain: Reliability and Accuracy

Two versions are described of a self-test of hearing. The hi HealthInnovations Clinic Version is designed to allow self-measurement of pure tone air conduction thresholds at selected frequencies from 500 – 6000 Hz. The Home Version can be accessed via the internet, and combines data from a number of sources (questionnaire, uncalibrated measurement of selected AC thresholds, age, and gender) to estimate hearing status based on publicly-available US demographic data. Both versions are designed to identify persons who could benefit from openfit hearing devices (symmetrical, mild-moderate hearing losses), to program open-fit devices appropriately for those persons, and to make appropriate referrals for persons who are not candidates. Data are reported on: 1) reliability and accuracy of AC thresholds measured using a calibrated beta version of the Clinic Version software; and 2) accuracy of the Home Version gain prescription methods for 144 subjects with known symmetrical audiograms. Open-fit hearing devices do not require custom ear impressions and earmolds, and therefore the same device can fit most ears, using a limited number of tubing, connector, and tip sizes. This flexibility of physical fit has the potential to increase greatly access to hearing devices for people who are open-fit candidates. Studies in the United Kingdom have already shown that open-fit devices can make hearing health care more accessible and less costly (Smith et al., 2008). hi HealthInnovations makes available technologically advanced open-fit hearing devices to persons who are candidates for them. Candidacy is assessed using tests that the potential hearing device user can take either in a health care provider’s office or at home via the internet, using a variety of platforms. The purpose of this article is to describe the methods developed for these self-tests and report the results of studies evaluating their reliability and accuracy. The goals of the hiHealthInnovations hearing tests are: 1. Accurately assess the hearing of users for the purposes of identifying people who could potentially benefit from open-fit hearing devices; 2. Make appropriate audiological and medical referrals for persons who are not candidates for open-fit devices so that they may get the custom earpieces, hearing device programming, and individualized assistance that they need 3. For those users who are candidates, provide open-fit hearing devices accurately programmed for them according to methods that meet current audiological standards of practice. Two Versions of Hearing Test The Clinic Version will be available on iPad and in an Adobe AIR version that will run on PC and Mac computers. This version will use custom-designed earphones for which reference equivalent threshold sound pressure levels have been determined according to the methods described in ANSI S3.6 – 2010, and that may be calibrated in an HA-1 coupler. The resulting thresholds are used to program the hearing devices in one memory with the parameters prescribed by NAL-NL2 (Keidser et al., 2011). The two additional memories bracket the NAL prescription in order to accommodate individual preferences for variations from NAL. The Home Version will be available on iPad, iPhone, iPod, and Android platforms as well as in a Flash version that runs on PC and Mac computers. Any commercially-available earphones may be used with the home version; insert earphones are recommended. Devices are also programmed using NAL-NL2, as described later in this article.