Introduction:
As an audiologist with over two decades of experience, I have witnessed the remarkable evolution of hearing aid technology and the methods used to select the best devices for each individual. From the early days of analog hearing aids to the cutting-edge digital devices available today, the industry has made significant strides in improving the lives of those with hearing loss. However, with these advancements come new challenges in ensuring that each person receives the most appropriate hearing aid for their unique needs. In this article, I will take you on a journey through the history of hearing aid selection methods, from the introduction of lifestyle charts to the development of speech in noise testing and matching, and finally, to our latest innovation, CogniMatch. By understanding the pros and cons of each approach, you'll be better equipped to make informed decisions about your hearing health.
Background:
Digital hearing aids first appeared commercially available in 1996 with the Widex's Senso. Since then all hearing aids have gradually changed over to digital and now it is almost impossible to find any analogue hearing aids at all. Before digital hearing aids, one of the biggest selection criteria for a hearing aid was whether it had the correct adjustment characteristics to suit a patient's hearing results. These are foundational decisions, which are still made to this day, but are much less critical due to the flexibility of modern digital hearing aids. Today, I can adjust many factors in the hearing aids, whereas analogue hearing aids often only had 1 to 4 different trimpots, adjusted via a screwdriver. There was a time when programmable analogue hearing aids came on the market, that could be adjusted via computer, but they were soon replaced by more flexible digital equivalents. I was lucky to start working in the field when we had analogue timpot aids, programmable analogue as well as early digital hearing aids available. So I have seen these amazing changes occur right in front of my eyes. Through the rest of the article, I will share my opinions and insights into the changing ways hearing aids are selected and how that might affect your hearing outcomes. It is not my intent to judge any clinician or organisation, using their choice of selection methodology as each has its own merits.
Hearing Aid Technology levels and lifestyle charts
The exact date when this hearing aid selection tool started being used extensively in day-to-day practice appears to be lost to the annals of history. I've searched far and wide, but cannot find any concrete data. I recall first seeing the hearing aid lifestyle chart back in the mid-2000s. I believe it might have been Bernafon who first introduced it. One article that did come up, was indeed linked to Bernafon and lifestyle selection in 2007.
It is my belief that lifestyle charts came into being due to the capabilities unlocked through digital processing in hearing aids. Much of these technologies were focused on improving (or at least trying to) speech understanding in noise. Digital processing also meant it was much easier for hearing aid manufacturers to tier their hearing aids based on features. These tiers are still used to this day and typically range from Premium (Some call this level Elite, just to confuse matters), with all the bells and whistles down to the most Basic level of technology and around 2-3 levels between the two extremes.
Lifestyle charts are quite useful, which may be why they are still extensively used, in simplifying the differences between technology levels to end users. It is also an effective sales tool, to help the client choose a hearing aid. Unfortunately, despite its usefulness, in my view, it has several drawbacks and has not kept pace with developments in audiology.
My biggest issue with Lifestyle charts is that they oversimplify things. They only consider the hearing aid technology levels and assume averages when it comes to your unique hearing abilities. For simplicity's sake, it assumes that every client's hearing is the same and that higher tiers of technology will always be better, which is very far from the truth. This could also be why some clients are disillusioned with their hearing aids and their inability to achieve this average expected performance as suggested by the ratings on these charts. It tends to favour premium (top-end) hearing aids for everyone who has any social life at all because only top-end seems to be able to cope well with most situations. This could make people feel that a hearing aid that works for them is unaffordable and may lead a lower uptake of hearing rehabilitation. Considering the importance of optimal hearing to cognitive health, this is far from ideal in my opinion.
I have written extensively along with examples of how such a selection methodology can lead to less-than-optimal outcomes. You can dive into the details here if you'd like to learn more.
Lifestyle charts are still being used to this day and will probably be with us for some time to come. It is probably still the most common method used to this day, despite being, in my opinion, grossly inaccurate.
Speech in noise testing allows for a more personalised approach
Considering that the inability to hear speech clearly in noise is one of the top complaints of people exploring hearing aids, speech-in-noise testing is a great step in the right direction towards improving the hearing aid selection process. The QuickSIN TM test was introduced in 2001 before lifestyle charts became all the rage. Unfortunately, like much else in audiology it was slow to take off and has only recently been used more widely. I only got to work with it for the first time in 2009, when I started Value Hearing, as none of my previous employers had it available in the clinic. I had been following the research for years at this time, so immediately understood the value it could bring to my practice.
The QuickSIN TM is a simple one-minute speech-in-noise test, where the client has to repeat 6 sentences, one after the other. With each sentence the level of the background speech babble increases. The audiologist scores the number of keywords repeated correctly by the client and you receive a Signal to Noise ratio loss score in decibels (dB). This Score indicates how much louder you need speech to be compared to the noise. Based on your score, the QuickSIN TM manual suggests one of 4 categories. These range from hearing better than normal in noise to needing maximal improvement in noise. You can infer 3 different technology recommendations from this: Omni-Directional microphones as found in the most basic hearing aids, Directional microphones (as found in all but the most basic hearing aids), or FM Systems (a system of microphones and hearing aid receivers, that pick sound up at its source bypassing the environmental noise to a great extent). Unfortunately, the categories are very broad and do not align well with technology-level tiers. What it does do in its basic form is help you differentiate the need for basic technology from the need for other technology levels. It also helps somewhat to create realistic expectations, as a very poor ability to hear in noise, could mean that even a premium hearing aid will not be enough, hence the need for FM systems.
The advantage of the QuickSIN TM is that it has lots of research behind it, is quick and painless to administer, and helps the audiologist get closer to a recommendation that is likely to be successful than using a lifestyle chart alone. Our internal data of thousands of clients (n=7903) and the distribution of their SNR results suggest that if the QuickSIN TM manual is followed precisely then 55.14% of clients (if all needed hearing aids) would have been recommended basic hearing aids and 33.28% would have been recommended a level above the most basic type. The remaining 11.38% would have been recommended FM systems.
The biggest drawback to the QuickSIN TM is that it is only available in English and does not offer sufficient granularity, as can be seen above to find the exact technology level to start from. I believe this might be due to most of the QuickSIN TM research is only based on small sample sizes of 100 people or less.
Finding a clinic that uses the QuickSIN TM consistently in the prescribed manner is certainly a step up from the average provided by lifestyle charts alone.
Speech in Noise Matching to the rescue
Being someone who tends to connect the dots and find innovative solutions, I started my practice back in 2009, following the QuickSIN TM process closely. I am the kind of person that reads everything I can to understand my field deeply, but also to extract ideas and innovations. This is what led me to experiment with the QuickSIN TM results and find a way to use these results to match the client to a technology tier.
My attendance at the EUHA conference in Hanover, Germany in 2010 inspired me to explore more deeply. At the EUHA conference, I attended presentations on the latest hearing aid technologies, by hearing aid engineers, from various brands. In more than one of these talks, the engineers were able to assign Signal-to-noise ratio improvements to various hearing aid technologies. Immediately, I started wondering if one could match these improvements based on specific features to a client's Signal-to-noise ratio loss as obtained using the QSin test. Once I arrived back in the clinic, I started experimenting with the idea and paid close attention to how clients with different SNR losses responded to technologies with different SNR improvements. I slowly adapted my selection process to fine-tune my thinking as well as the process and landed on a selection process that builds upon the QuickSIN TM procedure while offering much finer levels of granularity. More granularity means moving from an average prescription towards a much more personalised hearing aid prescription.
Over time I was able to match a client's hearing test performance to a specific technology level and I developed processes and tools to allow our then growing number of clinicians to use this in their cases as well.
Those clinicians who have worked with us in the past, but have gone elsewhere, continue to use this methodology, albeit in a more limited manner than afforded by our custom-built tools.
Compared to the standard QuickSIN TM results distribution, using the same data (n=7903), we can see more granularity in this method and it aligns nicely with the various technology levels. Essential technology (20.03%), Standard technology (13.24%), Advanced technology (20.16%), Premium Technology (11.38%) and FM system (11.38%).
We've been refining and improving this methodology over the years. Still, it was only a single-star rating comparing your overall ability to hear in noise with the technology to a person with normal hearing. It lacked clarity on how a particular client would do in situations specific to them. For instance, someone might have a score indicating premium technology, but their lifestyle is sedentary. How do you decide what technology this person needs? So even though this is a more advanced model of hearing aid selection, it was still not quite where I wanted it to be, but at the time my lack of technical skills, limited further development.
Experimental Hearing Solution Modelling (Cognimatch)
This brings me to our latest innovation, CogniMatch which is still considered experimental, and is continually being improved. It builds upon the solid foundations of the QuickSIN TM process. As a result, it achieves at least the accuracy of Speech in Noise matching, but in a much more personalised manner.
CogniMatch developed from my decision to self-learn computer programming during the Covid lockdowns. This allowed me to move our Speech in Noise Matching process as described above from an Excel sheet into the cloud. It also opened up a world of possibilities for expanding the process.
CogniMatch benefits from several granular improvements over the older methodologies. It moves away from relying on averages to make the selection, to very granular data about your hearing loss (Audiogram, speech in quiet, speech in noise), your hearing goals and situations (including factors that vary in situations such as environmental noise type, distance from the person speaking, speech level, your ability to see the other person's face, and the number of people in the situation), and the specific hearing aid (style, adaptation level, venting, microphone type, streaming, FM system use, noise reduction type, technology level and more).
Using all this information about you, your hearing loss, your specific hearing goals in specific situations, and the specific characteristics of available hearing aids, we can use a complex mathematical model to show how well a given hearing aid is expected to perform for you, compared to someone with normal hearing, in the specific situations where you are having difficulty. This is similar to what an audiologist would try to do in their heads, but with all the factors that CogniMatch uses, there are Trillions of different combinations to consider, which is impossible for even the smartest human being!
The predictions of CogniMatch are compared with your real-life outcomes and over time the model is tweaked in an ongoing manner to deliver constantly improving predictions. While in its experimental phase, the predictions of Cognimatch are compared to Speech in noise matching results to ensure you are never worse off compared to the older methodologies.
CogniMatch delivers several benefits over older methodologies.
Our clients benefitted:
- Personalised Recommendations: CogniMatch takes into account your unique hearing loss, lifestyle, and specific hearing goals to provide tailored hearing aid recommendations that are far more accurate than traditional methods.
- Realistic Expectations: By considering factors such as environmental noise, distance from the speaker, and speech levels, CogniMatch can give you a clear understanding of how a hearing aid will perform in your daily life, setting realistic expectations before you even try them on.
- Interactive and Engaging: CogniMatch is an interactive visual tool that not only helps you understand the selection process but also empowers you to explore how different factors can impact your hearing experience.
- Improved Outcomes: With CogniMatch, you can be confident that you're receiving the most appropriate hearing aid for your needs, leading to higher satisfaction rates and better hearing outcomes.
- Time-Saving: By accurately matching you with the right hearing aid from the start, CogniMatch can help reduce the need for multiple appointments and trial periods, saving you valuable time.
- Cutting-Edge Technology: CogniMatch utilises the latest advancements in AI and mathematical modeling to provide you with the most up-to-date and accurate hearing aid recommendations available.
- Potential Cost Savings: By accurately matching you with the most appropriate hearing aid technology from the start, CogniMatch can help you avoid unnecessary expenses on features or technology levels that may not provide significant benefits for your specific hearing needs and lifestyle. This targeted approach ensures that you invest in the right solution for you, potentially saving you money in the long run by reducing the need for upgrades or replacements due to dissatisfaction with your initial choice.
For Clinicians:
- Confident Recommendations: CogniMatch empowers clinicians to make confident, data-driven recommendations that are tailored to each client's unique needs and goals.
- Improved Efficiency: By streamlining the selection process and reducing the need for trial and error, CogniMatch allows clinicians to serve more clients effectively.
- Enhanced Client Satisfaction: With more accurate recommendations and better hearing outcomes, clinicians can expect to see higher levels of client satisfaction and loyalty.
- Reduced Returns: By matching clients with the most suitable hearing aids from the outset, CogniMatch can help minimise the likelihood of returns and exchanges.
- Continuous Improvement: As CogniMatch continues to learn and refine its predictions based on real-world outcomes, clinicians can benefit from an ever-evolving tool that stays at the forefront of hearing aid selection.
- Competitive Advantage: By offering CogniMatch, clinicians can differentiate themselves from competitors and attract clients who are seeking the most advanced and personalised hearing solutions available.
In summary, CogniMatch represents a groundbreaking approach to hearing aid selection that benefits both clients and clinicians alike. By harnessing the power of AI, mathematical modeling, and personalised data, CogniMatch is poised to revolutionise the way we approach hearing aid fittings, ultimately leading to better hearing outcomes and improved quality of life for those with hearing loss.
NOTE: Cognimatch has just had a major update since its initial release a little over a year ago. It now provides more accurate predictions than before and also presents it in an easy-to-understand method. I have also been using the latest in AI to help set up the factors relating to your given situations, which has improved overall accuracy tremendously.
CogniMatch is currently only available at Value Hearing via our Hearing Aid Assessment process. Make sure to ask your audiologist about this when presenting for your appointment.
Conclusion:
The evolution of hearing aid selection methods has been a fascinating journey, driven by technological advancements and a growing understanding of the unique needs of individuals with hearing loss. From the early days of lifestyle charts to the cutting-edge CogniMatch system, audiologists have been striving to provide more personalized and effective solutions for their clients. By taking into account factors such as hearing loss, speech understanding in noise, lifestyle, and specific hearing goals, we can now offer hearing aid recommendations that are tailored to each individual's needs. As an audiologist, I am excited to be at the forefront of this innovation, and I am committed to helping my clients achieve the best possible outcomes with their hearing aids. If you're considering hearing aids or looking to upgrade your current devices, I encourage you to seek out an audiologist who uses advanced selection methods like CogniMatch to ensure that you receive the most appropriate solution for your unique hearing needs.
Limited time offer
Even though the previous version CogniMatch has been in use for over 12 months, the latest update is new to our clinicians. As such they might be a bit clumsy operating the tool as they get used to it.
As it adds tremendous value to our Hearing Aid Assessment process, we will be increasing the price of our Hearing Aid Assessments by May 2024. While our clinicians get used to working with the updated CogniMatch, we will be offering our Hearing Aid Assessments, booked before May 2024 at no charge. This way you can still benefit from the updated CogniMatch, but at no charge while our clinicians gain experience in using it with clients. Book your Hearing Aid Assessment today and experience the insights offered by CogniMatch.
Book now to avoid disappointment as there are only limited time slots available before the offer expires. Click here to book your Hearing Test online or call us on 1300 586 104 during office hours (Mon - Fri 9 am to 5 pm)
