Impact of Hearing Aid Service-delivery Model and Technology on Patient Outcomes

NCT ID: NCT03579563

Last Updated: 2024-10-10

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

290 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-22

Study Completion Date

2023-12-22

Brief Summary

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Age-related hearing loss is a big problem in the United States because many people have it and it affects their quality of life. Hearing aids can help, but not many people use them. One reason is that getting hearing aids can be expensive and difficult. People usually have to visit doctors, like audiologists, many times to get their hearing tested and have the hearing aids fitted and adjusted. This process is called the AUD service model in this study. Hearing aids come with different technologies and features, like directional microphones and noise reduction algorithms. These features can make hearing aids work better but also make them more expensive, which can be another barrier for people who need them.

Recently, over-the-counter (OTC) hearing aids have become available. These hearing aids are cheaper and easier to get because people can buy them directly and fit them on their own without seeing a doctor. This is called the OTC service model in this study. Another service model that could be great is a "hybrid" service model, where professionals help fit the OTC hearing aids. This hybrid model can make hearing aids both affordable and high quality.

Studies have shown that the OTC service model works as well as the AUD service model. Additionally, other research has found no big differences in how well high-end and low-end hearing aids work for patients. However, no one has studied the different service models and technology levels together in one study, and no one has looked at how well the hybrid service model (called the OTC+ service model in this study) works.

The goal of this study is to find out how the different ways of fitting hearing aids (AUD, OTC+, and OTC) and the different technology levels (high-end and low-end) affect patient outcomes. The study will take place at two sites and will be a randomized controlled trial. Participants will be randomly assigned to one of six groups, which are combinations of the three service models and two technology levels. Measurements will be taken before the hearing aids are fitted and again six to seven weeks after fitting to see how well the hearing aids are working for the patients.

Detailed Description

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Age-related hearing loss presents a significant national challenge due to its high prevalence and significant quality-of-life consequences. Although hearing aids (HAs) are the primary choice for managing age-related hearing loss, their adoption rate remains low. One commonly reported reason for not adopting HAs is the financial and physical barriers associated with traditional hearing healthcare, which involves multiple visits to licensed professionals (such as audiologists) for diagnosis and a lengthy process of fitting and fine-tuning prescription HAs. This traditional service-delivery model is referred to as the AUD service model.

Additionally, a variety of technologies and features have been implemented in HAs, including multi-channel wide dynamic range compression, directional microphones, noise reduction algorithms, and wireless functionality. These technologies have evolved from basic algorithms into more sophisticated and complex designs. The high-end technologies and features often make HAs more expensive, further exacerbating the accessibility and affordability issues of traditional hearing healthcare.

In recent years, over-the-counter (OTC) HAs have emerged as an alternative to address some of the affordability and accessibility issues of the AUD service. This direct-to-consumer model enables users to self-determine hearing loss, self-fit OTC HAs, and self-manage the device without the need for professional support. This direct-to-consumer model is referred to as the OTC service model. Additionally, it has been advocated that a hybrid service model, where professionals fit OTC HAs (referred to as the OTC+ service model), could offer affordable and quality amplification interventions.

Previous clinical trials have shown that the OTC service model yields outcomes comparable to the AUD service model. Furthermore, prior research has found no statistically significant or clinically important differences in patient outcomes between high-end and low-end HAs. However, no prior research has systematically examined the effectiveness of HA fitting service models and HA technology levels in the same study. Additionally, no prior research has investigated the patient outcomes of the OTC+ service model.

The objective of the study is to determine the effect of HA fitting services (AUD, OTC+, and OTC) and technology levels (high-end and low-end) on patient outcomes. This is a two-site randomized controlled trial. Participants will be randomly assigned to one of six parallel arms, which are factorial combinations of three service models (AUD, OTC+, and OTC) and two HA technology levels (high-end and low-end). Baseline measures will be administered before HA fitting and patient outcomes will be assessed six to seven weeks post-HA fitting.

Conditions

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Presbycusis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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AUD/High-end

In this group, the audiologist-based fitting will be used to provide high-end hearing aids.

Group Type ACTIVE_COMPARATOR

AUD fitting

Intervention Type OTHER

Prescription hearing aids will be fitted by audiologists using established procedures.

High-end HA

Intervention Type DEVICE

High-end hearing aids will be used.

OTC+/High-end

In this group, audiologists will provide brief services to fit high-end OTC hearing aids

Group Type EXPERIMENTAL

OTC+ fitting

Intervention Type OTHER

Audiology professionals provide brief services to fit preset-based OTC hearing aids, which are simulated using prescription hearing aids.

High-end HA

Intervention Type DEVICE

High-end hearing aids will be used.

OTC/High-end

In this group, high-end OTC hearing aids will be provided to subjects.

Group Type EXPERIMENTAL

OTC fitting

Intervention Type OTHER

In this group, preset-based OTC hearing aids, which are simulated using prescription hearing aids, will be provided to subjects. Subjects will take the full initiative and responsibility for learning and using hearing aids.

High-end HA

Intervention Type DEVICE

High-end hearing aids will be used.

AUD/Low-end

In this group, the audiologist-based fitting will be used to provide low-end hearing aids.

Group Type ACTIVE_COMPARATOR

AUD fitting

Intervention Type OTHER

Prescription hearing aids will be fitted by audiologists using established procedures.

Low-end HA

Intervention Type DEVICE

Low-end hearing aids will be used.

OTC+/Low-end

In this group, audiologists will provide brief services to fit low-end OTC hearing aids.

Group Type EXPERIMENTAL

OTC+ fitting

Intervention Type OTHER

Audiology professionals provide brief services to fit preset-based OTC hearing aids, which are simulated using prescription hearing aids.

Low-end HA

Intervention Type DEVICE

Low-end hearing aids will be used.

OTC/Low-end

In this group, low-end OTC hearing aids will be provided to subjects.

Group Type EXPERIMENTAL

OTC fitting

Intervention Type OTHER

In this group, preset-based OTC hearing aids, which are simulated using prescription hearing aids, will be provided to subjects. Subjects will take the full initiative and responsibility for learning and using hearing aids.

Low-end HA

Intervention Type DEVICE

Low-end hearing aids will be used.

Interventions

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AUD fitting

Prescription hearing aids will be fitted by audiologists using established procedures.

Intervention Type OTHER

OTC+ fitting

Audiology professionals provide brief services to fit preset-based OTC hearing aids, which are simulated using prescription hearing aids.

Intervention Type OTHER

OTC fitting

In this group, preset-based OTC hearing aids, which are simulated using prescription hearing aids, will be provided to subjects. Subjects will take the full initiative and responsibility for learning and using hearing aids.

Intervention Type OTHER

High-end HA

High-end hearing aids will be used.

Intervention Type DEVICE

Low-end HA

Low-end hearing aids will be used.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* adult-onset, bilateral, mild-to-moderately severe sensorineural hearing loss

* Puretone average across 500, 1000, 2000, and 4000 Hz between 25 and 55 dB HL
* Thresholds from 500-4000 Hz no poorer than 65 dB HL, with up to 2 thresholds outside this criterion by \< 10 dB still being eligible.
* no previous hearing aid experience

Exclusion Criteria

* Non-native speaker of English
Minimum Eligible Age

55 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Vanderbilt University Medical Center

OTHER

Sponsor Role collaborator

National Institute on Deafness and Other Communication Disorders (NIDCD)

NIH

Sponsor Role collaborator

Yu-Hsiang Wu

OTHER

Sponsor Role lead

Responsible Party

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Yu-Hsiang Wu

Associate Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Yu-Hsiang Wu, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Iowa

Locations

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University of Iowa

Iowa City, Iowa, United States

Site Status

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status

Countries

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United States

References

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Abrams HB, Chisolm TH, McManus M, McArdle R. Initial-fit approach versus verified prescription: comparing self-perceived hearing aid benefit. J Am Acad Audiol. 2012 Nov-Dec;23(10):768-78. doi: 10.3766/jaaa.23.10.3.

Reference Type BACKGROUND
PMID: 23169194 (View on PubMed)

Abrams HB, Hnath-Chisolm T, Guerreiro SM, Ritterman SI. The effects of intervention strategy on self-perception of hearing handicap. Ear Hear. 1992 Oct;13(5):371-7. doi: 10.1097/00003446-199210000-00013.

Reference Type BACKGROUND
PMID: 1487096 (View on PubMed)

Bainbridge KE, Ramachandran V. Hearing aid use among older U.S. adults; the national health and nutrition examination survey, 2005-2006 and 2009-2010. Ear Hear. 2014 May-Jun;35(3):289-94. doi: 10.1097/01.aud.0000441036.40169.29.

Reference Type BACKGROUND
PMID: 24521924 (View on PubMed)

Callaway SL, Punch JL. An electroacoustic analysis of over-the-counter hearing aids. Am J Audiol. 2008 Jun;17(1):14-24. doi: 10.1044/1059-0889(2008/003).

Reference Type BACKGROUND
PMID: 18519576 (View on PubMed)

Donahue A, Dubno JR, Beck L. Guest editorial: accessible and affordable hearing health care for adults with mild to moderate hearing loss. Ear Hear. 2010 Feb;31(1):2-6. doi: 10.1097/AUD.0b013e3181cbc783. No abstract available.

Reference Type BACKGROUND
PMID: 20040828 (View on PubMed)

Gopinath B, Schneider J, Hartley D, Teber E, McMahon CM, Leeder SR, Mitchell P. Incidence and predictors of hearing aid use and ownership among older adults with hearing loss. Ann Epidemiol. 2011 Jul;21(7):497-506. doi: 10.1016/j.annepidem.2011.03.005. Epub 2011 Apr 21.

Reference Type BACKGROUND
PMID: 21514179 (View on PubMed)

Lin FR, Thorpe R, Gordon-Salant S, Ferrucci L. Hearing loss prevalence and risk factors among older adults in the United States. J Gerontol A Biol Sci Med Sci. 2011 May;66(5):582-90. doi: 10.1093/gerona/glr002. Epub 2011 Feb 27.

Reference Type BACKGROUND
PMID: 21357188 (View on PubMed)

Takahashi G, Martinez CD, Beamer S, Bridges J, Noffsinger D, Sugiura K, Bratt GW, Williams DW. Subjective measures of hearing aid benefit and satisfaction in the NIDCD/VA follow-up study. J Am Acad Audiol. 2007 Apr;18(4):323-49. doi: 10.3766/jaaa.18.4.6.

Reference Type BACKGROUND
PMID: 17580727 (View on PubMed)

Wu YH, Stangl E, Branscome K, Oleson J, Ricketts T. Hearing Aid Service Models, Technology, and Patient Outcomes: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2025 Jul 1;151(7):684-692. doi: 10.1001/jamaoto.2025.1008.

Reference Type DERIVED
PMID: 40372746 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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1R01DC015997-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

201804771

Identifier Type: -

Identifier Source: org_study_id

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