Title: Do Hearing Aid Audiologists Need Evidence Based Practice
1Do Hearing Aid Audiologists Need Evidence Based
Practice?
- Brian Taylor, Au.D.
- Global Training Manager
- Amplifon, Milan, Italy
2The 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.
3My Bias
- How is Cuba and the hearing aid selection
process alike??
4Clinical 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)
5Review of EBP
- What is it?
- How does it work?
- Why is it important?
- Its not new 1995 first audiology papers appeared
6What is it?
- A way to make clinical decisions using current
best evidence. Does our recommendation work under
real world conditions?
7How?
- Generate a focused, clinical question
- Find the best evidence
- Evaluate the evidence
- Generate a recommendation using the evidence
- Cox, 2005
8Step 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?
9Step 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
10Step 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)
11Step 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
12Step 5Make a Recommendation Based on Your
Reading of the Evidence
13Levels 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
14Study 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
15Practical 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
16Why?
- Improves credibility of profession
- Improves quality of care (effectiveness)
- Improves efficiency of care (costs)
-
- Bess, 1995
- 4. Boosts confidence of service provider
17EB Concept in Practice
- Used to modify or change current clinical
practices or bahaviors - Used to make better hearing aid selection
decisions
18Practices (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
19Popular clinical practice
- Using the thresholds on the audiogram to predict
real world hearing aid benefit.
20Audiogram
21Conclusion
- 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)
22Popular clinical practice
- Relying on marketing claims to make decisions in
regard to advances hearing aid features.
23April, 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
24In practice
- Modulation based DNR is on 89 of all my fittings
(Johnson, HJ, 2008) - DNR improves speech intelligibility in noise
25EB 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
26Conclusion
- Although DNR does not improve speech
understanding in noise, there is evidence from
well designed studies saying it DNR does improve
listening comfort.
27Back to the original question.
- Do audiologists need evidence-based practice?
- Hint Its about the consumer, not the profession
28Benefits 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