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Do Hearing Aid Audiologists Need Evidence Based Practice

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Title: Do Hearing Aid Audiologists Need Evidence Based Practice


1
Do Hearing Aid Audiologists Need Evidence Based
Practice?
  • Brian Taylor, Au.D.
  • Global Training Manager
  • Amplifon, Milan, Italy

2
The Evolution of Health Care
  • Patient Centered Model
  • Lets learn as much as we can about your
    condition, and match the treatment to the
    disease, using the best available evidence to
    guide us.
  • Medical Model
  • You have a disease, take this pill.

3
My Bias
  • How is Cuba and the hearing aid selection
    process alike??

4
Clinical Decision Making Process
  • Intuition and experience
  • Obsolete knowledge gained in school
  • Long-standing traditions
  • Information learned from manufacturers
  • Copy what others are doing well (Best Practice
    Approach)
  • Evidence from well designed, clinically relevant
    studies (EBP Approach)

5
Review of EBP
  • What is it?
  • How does it work?
  • Why is it important?
  • Its not new 1995 first audiology papers appeared

6
What is it?
  • A way to make clinical decisions using current
    best evidence. Does our recommendation work under
    real world conditions?

7
How?
  • Generate a focused, clinical question
  • Find the best evidence
  • Evaluate the evidence
  • Generate a recommendation using the evidence
  • Cox, 2005

8
Step 1 Generate a Focused Question
Is Digital Noise Reduction (as implemented in
digital hearing aids) effective in real world
listening situations in an adult population?
9
Step 2 Go to Pub Med and conduct key word
searches
  • Digital noise reduction
  • Hearing aids 46
  • A. Benefit 10
  • B. Satisfaction 5
  • C. Clinical Effectiveness 2
  • D. Usage 0
  • E. Real World 2

10
Step 3 Narrow the Search
  • Carefully read all the abstracts (15)
  • Eliminate all those that pertain to children, and
    implement DNR in analog hearing aids (e.g., ASP)
  • Those that make the cut (9) carefully read the
    entire article
  • Eliminate all those that didnt use actual
    hearing aids, or were conducted in lab conditions
    only (5)

11
Step 4 Grade the Evidence
  • Pay attention to
  • Number of subjects (N 25 or more)
  • Blinding of subjects
  • Blinding of authors
  • Study design
  • Grade the evidence based on the study design

12
Step 5Make a Recommendation Based on Your
Reading of the Evidence
13
Levels of Evidence
  • Level 1a Meta-analysis of well-designed
    randomized control trials
  • Level 1b Well-designed randomized control
    trials
  • Level 2a Well-designed controlled study without
    randomization
  • Level 2b Well-designed quasi-experimental study
  • Level 3 Well-designed non-experimental study
    (case studies)
  • Level 4 Expert opinion or consensus statement

14
Study Design
  • Randomized
  • Subjects are assigned to one of two groups
    (treatment and control) using a specific
    randomization method
  • Non-Randomized
  • A study that does not use a control group

15
Practical Short Cut
  • Look for published meta-analysis
  • Peer reviewed July/Aug 2005 JAAA
  • Non-peer reviewed Audiology Online
  • AAA Clinical Protocol Guidelines Valente,
    Audiology Online

16
Why?
  • Improves credibility of profession
  • Improves quality of care (effectiveness)
  • Improves efficiency of care (costs)
  • Bess, 1995
  • 4. Boosts confidence of service provider

17
EB Concept in Practice
  • Used to modify or change current clinical
    practices or bahaviors
  • Used to make better hearing aid selection
    decisions

18
Practices (examples)
  • LDL testing at pre-fitting appointment
  • Speech audiometry quiet vs. noise, words vs.
    sentences, live vs. recorded voice
  • Counseling gain for experienced vs. new hearing
    aid users, when is maximum benefit achieved
  • Use of probe microphone to verify a prescriptive
    fitting target

19
Popular clinical practice
  • Using the thresholds on the audiogram to predict
    real world hearing aid benefit.

20
Audiogram
21
Conclusion
  • Audiometric data is a poor predictor of real
    world benefit.
  • Personality seems to be a better predictor of
    success with amplification than the audiogram
    (Cox, et al, 2007)

22
Popular clinical practice
  • Relying on marketing claims to make decisions in
    regard to advances hearing aid features.

23
April, 2007 Hearing Journal
  • Best-in-class feedback cancellation
  • Hands-free advanced directional systems
  • More bandwidth for more speech access
  • 360 degrees of directionality
  • Most sophisticated DSP platform

24
In practice
  • Modulation based DNR is on 89 of all my fittings
    (Johnson, HJ, 2008)
  • DNR improves speech intelligibility in noise

25
EB Review of DNR
  • No significant improvement is speech
    intelligibility with DNR on (less than 10
    studies in peer-reviewed journals)
  • Limited studies (4 or 5 ) show that DNR improves
    listener comfort
  • Bentler, JAAA, 2005 EB review of DNR

26
Conclusion
  • Although DNR does not improve speech
    understanding in noise, there is evidence from
    well designed studies saying it DNR does improve
    listening comfort.

27
Back to the original question.
  • Do audiologists need evidence-based practice?
  • Hint Its about the consumer, not the profession

28
Benefits of EBP for the Hearing Aid Audiologist
in the UK
  • More efficient appointments
  • Waste less time doing unnecessary tests
  • Make better selection decisions (rely less on
    hunches)
  • Challenge marketing claims presented to you by
    manufacturers (Wheres the Beef)
  • Improved confidence in recommendations
  • Results in higher levels of patient satisfaction
    and business revenue

29
  • Thanks for your attention
  • Brian.taylor_at_amplifon.com
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