Summary of the Clinical Practice Guideline

Article Citation

Clinical Practice Guideline: Audiologic Management of Adult Hearing Impairment

College of Speech and Hearing Professionals of British Columbia. (2016).
Vancouver (Canada): College of Speech and Hearing Professionals of British Columbia, 1-40.
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College of Speech and Hearing Professionals of British Columbia (Canada)

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Article Details

Description

This guideline prepared by the American Academy of Audiology Task Force for Guidelines for the College of Speech and Hearing Health Professionals of British Columbia provides recommendations on the provision of a comprehensive treatment plan for the audiologic management of adults with hearing impairment.

Evidence Ratings for This Document

Quality of evidence rating and grade of recommendation were assigned to each recommendation statement based on the following rating scheme:

Quality of Evidence
  • Level 1 - Systematic reviews and meta-analysis of randomized controlled trials (RCT) or other high-quality studies
  • Level 2 - Well-designed RCT
  • Level 3 - Non-randomized treatment studies
  • Level 4 - Cohort studies, case-control studies, cross-sectional surveys, and uncontrolled experiments
  • Level 5 - Case report
  • Level 6 - Expert Opinion
Grade of Recommendation
  • Grade A - Level 1 or 2 evidence with consistent conclusions
  • Grade B - Level 3 or 4 studies or extrapolated evidence (generalized to a situation where it is not fully relevant) from Level 1 or 2 studies
  • Grade C - Level 5 studies or extrapolated evidence from Level 3 or 4 studies
  • Grade D - Level 6 evidence or inconsistent or inconclusive studies of any level or any studies that have a high risk of bias

Recommendations from This Guideline

What are Recommendations?

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Assessment

For adults with hearing loss, audiologists should conduct hearing aid device fitting and verification.
  • "Electroacoustic verification of all hearing aids (new and repaired) is recommended" (Level 6, Grade D; p. 23).
  • "Verification of features and physical parameters is also recommended prior to the hearing aid fitting" (Level 6, Grade D; p. 23).
  • Hearing aid fitting and verification may include reviewing the choice of assessment signal, physical fit, occlusion effect, gain verification, output verification, aided soundfield threshold, and additional verification of special features (e.g., telecoil output, directional efficacy) (Level 1-4, 6, Grades A-D).

Keywords: Hearing Aids, Hearing Aids, Devices

For adults with hearing loss, assessment and device fitting should involve the following:
  • "Each patient should receive formal self-assessment instrument(s)/inventory(s) prior to fitting to establish communication needs, function, and goals" (Level 3, Grade B; p. 8).
  • "Goals should be patient specific and composed of both cognitive and affective characteristics" (Level 3, Grade B; p. 9).
  • "Post-fitting administration of these instrument(s) is necessary to validate benefits/satisfaction from amplification" (Level 3, Grade B; p. 9).
  • Audiologists should consider and screen for non-auditory factors that can impact successful prognosis and refer to other providers for additional assessment or support as needed (Levels 2, 4-6; Grades A-D).

Keywords: Hearing Aids

Treatment

For adults with hearing loss, post-fitting counseling and follow-up should be provided in a group or individual format and should include the individual's primary communication partner (Levels 2-4, 6, Grades A-B, D).

Keywords: Hearing Aids, Group Treatment, Counseling and Education, Aural Rehabilitation, Devices

For adults with hearing loss, education and counseling on hearing aid device use should be provided to the patient and any appropriate family members or caregivers. Education should address hearing aid features, insertion and removal, battery use, care and cleaning, comfort, feedback, telephone use, warranty, wearing schedule, goals and expectations, adjusting amplification across settings and environment, hearing and listening strategies, speechreading, monaural/binaural hearing aid use, and post-fitting care (Levels 3-4, Grades B-C).

Keywords: Hearing Aids, Counseling and Education, Aural Rehabilitation, Devices

For adults with hearing loss, hearing assistive technology should be considered as a management option in addition to hearing aids (Levels 4-6, Grades B-D). Counseling and education should be provided to ensure optional FM (frequency modulated) system use. FM systems and hearing aid microphones should be individualized to adjust for the individual's relative gains. Audiologists should establish goals and provide corresponding instruction for FM system use across several weeks of use (Level 4, Grades B-C).

Keywords: Hearing Assistive Technology Systems (HATS), Devices

For adults with hearing loss, audiologists should conduct hearing aid device fitting and verification.
  • "Electroacoustic verification of all hearing aids (new and repaired) is recommended" (Level 6, Grade D; p. 23).
  • "Verification of features and physical parameters is also recommended prior to the hearing aid fitting" (Level 6, Grade D; p. 23).
  • Hearing aid fitting and verification may include reviewing the choice of assessment signal, physical fit, occlusion effect, gain verification, output verification, aided soundfield threshold, and additional verification of special features (e.g., telecoil output, directional efficacy) (Level 1-4, 6, Grades A-D).

Keywords: Hearing Aids, Hearing Aids, Devices

For adults with hearing loss, audiologists should consider the following device characteristics when selecting a hearing aid: style, occlusion, type of volume control, monaural versus binaural amplification, DAI (direct auditory input) and telecoil circuitry, gain processing, frequency shaping, output and OSPL90 (maximum hearing aid output), multiple device memories, digital noise reduction, digital feedback suppression/cancellation, switchable directional/omnidirectional microphone, and other special technologies and applications (e.g., bone-anchored hearing aids, contralateral routing of the signal) as needed (Levels 1-5, Grades A-D).

Keywords: Hearing Aids, Hearing Assistive Technology Systems (HATS), Osseointegrated Implants (Including Semi-Implantable Bone Devices), Devices

Service Delivery

For adults with hearing loss, post-fitting counseling and follow-up should be provided in a group or individual format and should include the individual's primary communication partner (Levels 2-4, 6, Grades A-B, D).

Keywords: Hearing Aids, Group Treatment, Counseling and Education, Aural Rehabilitation, Devices

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