Editorial: The Era of the Outcome Measure

T he short history of hearing aid fitting can be divided into three eras . The first era, from roughly 1946 to about 1970, might be described as the era of the PB list. A fitting was successful when the aided speech recognition score for single-syllable words was optimized. The second era, from the 1970s to the present, might be described as the era of the engineering solution . A fitting was successful when the aided gain across frequencies matched a predetermined formula. The third era, which is just beginning, might be described as the era of the outcome questionnaire. A fitting is successful when the hearing aid user says it is successful (the ultimate statement of accountability). In this issue of JAAA, Robyn Cox and Genevieve Alexander remind us of just how complex outcome measurement can be . In the paper, "Expectations About Hearing Aids and Their Relationship to Fitting Outcome," they report results on the administration of two measures to novice hearing aid users. To investigate the impact of prefitting expectations on postfitting success, they devised a new questionnaire, Consequences of Hearing aid Ownership (ECHO) . It probes the individual's expectations about hearing aid use, employing the same four domains as the previously developed outcome questionnaire, Satisfaction with Amplification in Daily Life (SADL) . The ECHO was administered to a group of hearing-impaired subjects just prior to being fitted with aids . About 1 year later, the SADL questionnaire was administered. The authors asked to what extent the prefitting ECHO results matched the postfitting SADL scores . Among the many sobering findings were the sometimes unrealistic expectations of novice users and how their prefitting concerns about the stigma of hearing aid use were greater than the concerns of experienced users. The study shows, moreover, that there is little, if any, relationship between prefitting expectation and postfitting satisfaction. In the domains of Service and Cost, Negative Features, and Personal Image, there were only very weak correlations between expectation and satisfaction . The strongest correlation (r = .51) was noted in the domain of "positive effect ." Satisfaction was greatest among those who anticipated that the aid would be helpful both acoustically and psychologically. But even here there was a good deal of variance in satisfaction not accounted for by prefitting expectation. Also noteworthy were the widely varying profiles of prefitting expectation across the four domains of the questionnaire. Cox and Alexander suggest that such profiles may be useful not only in evaluating individual differences in expectation but also as counseling tools, especially for significant others . There is a wealth of useful information in this paper for audiologists to weigh and ponder as we enter the era of the outcome measure.