Outcomes for wearers of hearing aids and improving

hearing aid technology

Harvey Dillon

NALCRC Hear

Denis Byrne OrationCanberra, 2008.

Who benefits from hearing aids?

What can hearing aids do for people with hearing loss?

How can we make hearing aids work better?

Dillon, NAL

The bits of this talk ….

• Who’s got hearing aids• Who should have hearing aids• Who’s got hearing aids but shouldn’t• How people misjudge their hearing• Why hearing aids are sometimes useless• How technology is changing candidacy• Hearing aids of the future • What we should do differently now

Dillon, NAL

Who is using hearing aids?Of those with >25 dB 4FAHL in better ear

Don’t have

67 %Don’t use

10 %

Use

23 %

Source: Blue Mountains Study (Mitchell, Hartley et al)

Australia UK

Davis (2003)

USA

Kochkin (1992)

Dillon, NAL

Percentage penetration of hearing aids

1%11%

57%

107%

17%

55%

92%

0%

20%

40%

60%

80%

100%

120%

0-24 25-44 45-64 65-120

Hearing threshold (4FA dB HL)

Perc

enta

ge o

f peo

ple

with

he

arin

g ai

ds

Mitchell (2002)

Dillon, NAL

Hearing loss in the futureProportion of population with >=25 dB 4FAHL

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2003 2006 2011 2021 2031

Year

Per

cent

age

of

popu

latio

n70 & over

60-69

50-59

15-49

Sources:

ABS series B

Sth Aust population study

Possible further increase from:

Personal stereo use ↑

Rock music ↑

Power tools ↑

Premature baby survival ↑

And decrease from:

War exposure ↓

Manufacturing ↓

Rubella epidemics ↓

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Growth in people with hearing loss (>25 dB 4FAHL better ear)

0

1

2

3

4

5

2000 2005 2010 2015 2020 2025 2030Peo

ple

wit

h h

eari

ng

lo

ss (

mil

lio

n)

Blue squares = 2.5% compound

growth

Source: Hartley & Dillon, unpublished data

Over 55 years

Over 65 years

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Growth in OHS voucher numbers

0

50,000

100,000

150,000

200,000

250,000

2000 2002 2004 2006 2008

Year

OH

S v

ou

cher

s is

sued

Blue squares = 9% compound growth

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Penetration:Hearing aid owners as a proportion of those with >25 dB 4FAHL better ear

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2000 2010 2020 2030

Year

Pe

net

ratr

atio

n r

ate

Hearing impaired growth: 2.5%

OHS vouch

ers: 9%

OHS vouchers: 5%

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Conundrum

1. Older people more likely to need a hearing aid

2. Younger people more likely to adapt well to using a hearing aid

• Alberti (1977); Brooks (1985)

ImplicationWe need to know who will benefit from a

hearing aid so those people get them as soon as possible

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What should penetration be?

Who does benefit from a hearing aid?

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ExperimentTo determine the minimum hearing loss for which

clients will receive benefit from hearing aids. – Previous research has not indicated a close

relationship between benefit and hearing thresholds. – Some people with very mild losses are being fitted in

the current scheme.– It is extremely unlikely that people with normal

hearing would benefit from hearing aids.

Should be possible to find the minimum aidable hearing loss

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Procedure

• 400 clients sampled from OHS voucher database– 41,521 new clients fitted Feb to Sept, 2004

• Audiometric and other details obtained from selected clients’ files

• Questionnaire sent to selected clients

– International Outcome Inventory for Hearing Aids

– Plus 6 purpose-designed questions

• Selected clients followed up by phone or additional mail to get a high response rate (effectively 86%)

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Hearing loss characteristics of study sample

0

20

40

60

80

100

0 20 40 60 80 100 120

3 FA Hearing Loss (dB)

Pe

rce

nta

ge

of

po

pu

lati

on

Better ear

Worse ear

Left fitted

Right fitted

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Usage of hearing aids

21%

10%

35%

19%

13%

None< 1 hr/day

1-4 hrs /day4-8 hrs /day

> 8 hrs /day

Q 3: Daily us age

0

20

40

60

80

100

120

Num

ber o

f clie

nts

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Factor analysis of questionnaireFactor Loadings

Factor 1 Factor 2 Factor 3

Q1: want aids 0.69 0.30 0.21

Q2: difficulty unaided 0.70 0.41 0.25

Q3: use 0.74 -0.18 0.08

Q4: benefit 0.82 -0.32 0.00

Q5: residual difficulty 0.03 -0.76 -0.33

Q6: Worth it 0.83 -0.33 -0.00

Q7: Residual handicap -0.29 -0.56 -0.06

Q8: Bother to others -0.18 -0.68 -0.26

Q9: Quality of life 0.82 -0.32 0.02

Q10: Replace them 0.34 -0.15 -0.23

Q11: Face vision -0.29 -0.42 0.74

Q12: paper vision -0.22 -0.47 0.70

Proportion of variance 0.32 20 0.12

International Outcomes Inventory

for Hearing Aids

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Factor analysis of questionnaireFactor Loadings

Factor 1 Factor 2 Factor 3

Q1: want aids 0.69 0.30 0.21

Q2: difficulty unaided 0.70 0.41 0.25

Q3: use 0.74 -0.18 0.08

Q4: benefit 0.82 -0.32 0.00

Q5: residual difficulty 0.03 -0.76 -0.33

Q6: Worth it 0.83 -0.33 -0.00

Q7: Residual handicap -0.29 -0.56 -0.06

Q8: Bother to others -0.18 -0.68 -0.26

Q9: Quality of life 0.82 -0.32 0.02

Q10: Replace them 0.34 -0.15 -0.23

Q11: Face vision -0.29 -0.42 0.74

Q12: paper vision -0.22 -0.47 0.70

Proportion of variance 0.32 20 0.12

Composite benefit Composite difficulty Vision

International Outcomes Inventory

for Hearing Aids

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Simple correlations

People who more strongly wanted to get hearing aids:• Use them more (Q3)• Benefit from them more (Q4)• Say they are worth it (Q6)• Improve their enjoyment of life by using them (Q9)• Would replace their hearing aids if lost (Q10)

People who had the most difficulty unaided:• Use their hearing aids more (Q3)• Benefit from them more (Q4)• Say they are worth it (Q6)• Improve their enjoyment of life by using them (Q9)• Would replace their hearing aids if lost (Q10)

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Use

Benefit

Satisfaction

QOL

+

+

+

Composite Benefit

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Nu

mb

er

of p

eo

ple

N o us e

7%

9%

4%

1%0% 0% 0% 0% 0% 0%

0.51.0

1.52.0

2.53.0

3.54.0

4.55.0

5.50

5

10

15

20

25

30

35

40

<1 hour per day

0%1%

2%3%

2% 2%

0% 0% 0% 0%

0.51.0

1.52.0

2.53.0

3.54.0

4.55.0

5.5

1 to 4 hours per day

0% 0% 0%

3%

7%

11%10%

4%

0% 0%

0.51.0

1.52.0

2.53.0

3.54.0

4.55.0

5.5

4 to 8 hours per day

0% 0%1% 0%

1%

4%

6%6%

2%

0%

0.51.0

1.52.0

2.53.0

3.54.0

4.55.0

5.50

5

10

15

20

25

30

35

40

>8 hours per day

0% 0% 0%1% 0%

2% 2%

5%4%

0%

0.51.0

1.52.0

2.53.0

3.54.0

4.55.0

5.5

Composite benefit for different daily usage

High use goes with high benefit and

vice-versa

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What might account for variation in benefit?

• Hearing loss

• Age

• Gender

• Type of hearing aid

• Difficulty listening unaided

• Original desire to get hearing aids

• Visual ability

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Q1 : W a n t h e a rin g a id s

No

of o

bs

Q 2: N o d if f ic u lty una ided

1 2 3 4 50

10

20

30

40

50

60

Q 2: S light d if f ic ult y una ided

1 2 3 4 5

Q 2: Moderate d if f ic u lty unaided

1 2 3 4 5

Q 2: Q uite a lo t o f d if f ic u lty unaided

1 2 3 4 50

10

20

30

40

50

60

Q 2: Very m uc h dif ic ulty una ided

1 2 3 4 5

Difficulty hearing unaided and wish to get hearing aids

Unaided difficulty related to wish to get

hearing aids

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Desire to get hearing aids

+ Need

Difficulty listening unaided

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Composite benefit

Composite difficulty

Better ear 3FA 0.09 -0.18

Worse ear 3FA 0.13 -0.17

Better ear 4FA 0.08 -0.23

Worse ear 4FA 0.13 -0.20

Age -0.15 0.03

Need strength 0.51 -0.44

Vision summary -0.08 0.19

Relationship between predictors and outcomes

Only self-assessed need predicts outcomesDillon, NAL

Effect of hearing loss on benefit

10-19 20-29 30-39 40-49

4FA H L in better ear (dB H L)

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Com

posite benefit

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Effect of hearing loss on benefit

0 -9 .91 0 -1 9 .9

2 0 -2 9 .93 0 -3 9 .9

4 0 -4 9 .95 0 -5 9 .9

6 0 -6 9 .9

Po o re r e a r 3 FA ra n g e (d B H L )

1 .0

1 .5

2 .0

2 .5

3 .0

3 .5

4 .0

4 .5

5 .0

Co

mp

osite

be

ne

fit

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How is composite benefit related to need?

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Benefit versus need

1 1.5 2 2.5 3 3.5 4 4.5 5

S trength of need

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Com

posi

te b

enef

it

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“I don’t wear my hearing aids – never did. I don’t know

why they gave them to me.”- Participant 1-089

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Benefit for different degrees of hearing lossCurrent effect: F(14, 173)=.72691, p=.74537

1 1.5 2 2.5 3 3.5 4 4.5

Need strength

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Com

posi

te b

enef

it

Worse ear 4FA: 20-29 Worse ear 4FA: 30-39 Worse ear 4FA: 40-49

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Benefit for different hearing aid typesCurrent effect: F(12, 259)=1.3462, p=.19262

1.5 2 2.5 3 3.5 4 4.5

Need strength

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Com

posi

te b

enef

it

ITE BTE ITC

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Benefit for top-up and free-to-clientTop-up effect: F(8, 298)=1.2330, p=.27927

1 1.5 2 2.5 3 3.5 4 4.5 5

Need strength

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Com

posi

te b

enef

it

Free-to-client Top-up

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Are outcomes affected by the provider the client goes to?

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Benefit for different contractors

Contractor C clients get less benefit, on average

A B C D E

Contractor group

1.8

2.0

2.2

2.4

2.6

2.8

3.0

3.2

3.4

3.6

3.8

4.0

4.2C

om

po

site

be

ne

fit

P=0.0004

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Why?

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Hearing loss for different contractors

Contractor C clients are less deaf

A B C D E

Contractor group

30

32

34

36

38

40

42

44

46

48

50

52

54W

ors

e e

ar

4F

A (

dB

HL

)

8 dB

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Need strength for different contractors

Contractor C clients express less need for assistance

A B C D E

Contractor group

1.8

2.0

2.2

2.4

2.6

2.8

3.0

3.2

3.4

3.6

3.8N

ee

d s

tre

ng

th

0.8 scale points

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Which: hearing loss or need?

• Allow for differences in hearing loss difference in benefit remains (p=0.002)

• Allow for the differences in need difference in benefit disappears (p=0.33)

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Benefit vs Needs applies to all contractorsContrac tor C ex c luded

Current effec t: F (8, 231)= 7.0382, p= .00000

1 1.5 2 2.5 3 3.5 4 4.5 5

Need s trength

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Com

posite benefit: =("Q

3: use" + "Q

4: benefit" + "Q

6: Worth

it" + "Q

9: QO

L")/4

Contractors A, B, D and E

Contrac tor C alone

Current effec t: F (7, 68)= 8.7632, p= .00000

1 1.5 2 2.5 3 3.5 4 4.5

Need s trength

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Com

posite benefit: =("Q

3: use" + "Q

4: benefit" + "Q

6: Worth

it" + "Q

9: QO

L")/4

Contractor C

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Implication

Benefit is much more strongly determined by need than by hearing loss.

“Need” = difficulty listening unaided + desire to get hearing aids in first place

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Why don’t people with hearing loss acquire hearing aids?

“My hearing loss is not bad enough to need them” (Kochkin, 1993) – beliefs about difficulties they are having– beliefs about hearing aid likely benefits– beliefs about emotional consequences of

wearing hearing aids– beliefs about practical issues (expense,

complexity, manipulation)

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People act rationally, in their best interests, based on their beliefs

Health belief model

Hearingloss

Cost

Difficulties experienced:

frequency, severity

Self-image

Ability to manage

Hearing aideffectiveness

Effect on others’ view

Inconven-ience

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People act rationally, in their best interests, based on their beliefs

Health belief model

Hearingloss

Cost

Difficulties experienced: frequency, severity

Self-image

Ability to manage

Hearing aideffectiveness

Effect on others’ view

Inconven-ience

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People act rationally, in their best interests, based on their beliefs

Health belief model

Hearing

loss

Cost

Difficulties

experienced:

frequency, severity

Self-

image

Ability to

manageHearing aid

effectivenessEffect on

others’ view

Inconven

-ience

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Dominant community belief

I don’t want hearing aids

Circle of negative beliefs

Hearing aids don’t workAcquire hearing

aids anyway

“Prove” that hearing aids don’t work

Tell everyone

positive

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Expectations and benefit• Higher expectations greater use and benefit (Jerram &

Purdy, 2001)• Higher expectations higher benefit (Cox & Alexander).

Expectations

Outcomes

Satisfaction

Use, benefit

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What can a hearing aid actually do?

1. Amplify soft sounds

2. Emphasise frontal sounds

250125 500 1k 2k 4k 8k

0

20

40

60

80

100

120

Frequency (Hz)

Hea

ring

thre

shol

d (

dB

HL)

35 dB 4FA HL

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1. Amplifying soft sounds

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100 1000 10000

Frequency (Hz)

Spe

ech

leve

l and

thre

shol

d (d

B S

PL)

Speech at 55 dB SPL

Speech intelligibility index = 0.45 Percent words in sentences correct = 93%Dillon, NAL

Amplifying speech (quiet; no reverberation)

People with mild to moderate loss can cope reasonably well in quiet.

0

20

40

60

80

100

40 50 60 70 80

Speech level (dB SPL)

Inte

llig

ibil

ity

(% c

orr

ect)

Unaided

Aided

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2. Speech in noise and reverberation

Noise and reverberation both usually have biggest effect on low frequencies

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Amplifying soft sounds

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100 1000 10000

Frequency (Hz)

Spe

ech

leve

l and

thre

shol

d (d

B S

PL)

Speech at 55 dB SPL

Speech intelligibility index = 0.45 Percent words in sentences correct = 93%Dillon, NAL

Amplifying soft sounds

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100 1000 10000

Frequency (Hz)

Spe

ech

leve

l and

thre

shol

d (d

B S

PL)

Speech at 55 dB SPL

Speech intelligibility index = 0.24 Percent words in sentences correct = 72%Dillon, NAL

Solution

A directional microphone to lift the speech in front, but not the noise

but …..

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Room acoustics

Distance

SPL

Critical distance

Direct

Reverberant

Total

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Room acoustics

Distance

SPL

Critical distance

Direct

Reverberant

Total

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Implication for beliefs about hearing?

Speech with no noise, no reverberation I can understand! My hearing is OK

Louder speech, noise, reverberation I can’t understand The noise makes it hard to understand, (My hearing is fine)

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Implication for beliefs about hearing aids

Speech with no noise, no reverberation Hearing aid helps, if needed

Close speech, directional microphone, noise & reverberation

Hearing aid helps

Distant speech, directional microphone, noise & reverberation

Hearing aid doesn’t help

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Impact of untreated hearing loss

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Impact of untreated hearing loss on health

• Proven links between hearing loss and:– low mood / emotional state, greater depression– reduced capability for self-sufficiency, restricted social

relationships– reduced life expectancy

• Asserted links between hearing loss and:– loneliness, – anxiety, – paranoia, – exhaustion, – insecurity, – loss of group affiliation, – loss of intimacy, – anger

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Effects of hearing loss?

Hearing loss

Depression

Mortality

Cardio-vascular disease

Activity restriction

We just can’t deduce causation from these surveys of healthDillon, NAL

Effects of hearing aids?

Hearing loss

Mortality

Depression

Isolation

Anxiety

Insecurity

etcDillon, NAL

Cross-sectional studies

Hearing loss

Hearing loss and hearing aids

Less isolation.More able to deal

with problems

Better:

Mood / less depression

Emotional state

Self-sufficiency

Social relationships

Life expectancyDillon, NAL

Cross-sectional studies

Hearing loss

Hearing loss and hearing aids

Better:

Mood / less depression

Emotional state

Self-sufficiency

Social relationships

Life expectancy

Pro-active people

Fatalistic people

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Cross-sectional studies

Hearing loss

Hearing loss and hearing aids

Unwell people, with hearing loss

Attend to major sickness

Healthy people, with hearing loss

Better:

Mood / less depression

Emotional state

Self-sufficiency

Social relationships

Life expectancy

Attend to hearing loss

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Longitudinal studies

Hearing loss

Better:

Social relationships

Cognitive functioning

Memory

Learning ability

Less depression

Less paranoia

+

Mulrow et al (1990); Dye & Peak (1983)

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Aged-care facilities

Hearing loss Appearance of dementia

Reduced auditory

stimulation

Cognitivedecline

Actual dementia ??

Improved services Improved quality of lifeDillon, NAL

Technology advances in the last decade

• Integrated wireless receiver• Adaptive directional microphones• Multi-channel noise reduction• Feedback cancelling • Environment sensing• Wireless-linked hearing aids• Impulse noise rejection• Wax guards• Data logging• Integrated rechargeable batteries

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So why no increase in satisfaction?

• Increase in laboratory-measured benefit• No increase in real-world reported satisfaction

Technology advance

Marketing, hype, cost Expectations increase

Performance increases (a little)

Gap between performance and expectations - ??

Satisfaction?

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Some technology advances in the next few years- from the CRC for Hearing, including NAL

• Trainable hearing aids• Improved occlusion reduction• Improved intelligibility in noise

• Hybrid cochlear implants and hearing aids• Fully implanted devices (implants and hearing aids)?

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Moving on from Moving on from prescriptionsprescriptions

The trainable hearing aidThe trainable hearing aid

Justin Zakis, Gitte Keidser, Justin Zakis, Gitte Keidser,

Hugh Mcdermott, Liz Convery Hugh Mcdermott, Liz Convery

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Trainable aid – general structure

Programmable amplifier

Learning algorithms

Acoustic measurement

module User control(s)

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Aid user adjusts settings...Aid user adjusts settings...Trainable Aid

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Aid user adjusts settings...Aid user adjusts settings...Trainable Aid

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...the hearing aid takes note...the hearing aid takes noteTrainable Aid

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Process repeats for other Process repeats for other soundssounds

Trainable Aid

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After training, preferred After training, preferred settingssettingsare automatically applied...are automatically applied...

Trainable Aid

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Trainable Aid

After training, preferred After training, preferred settingssettingsare automatically applied...are automatically applied...

Dillon, NAL

Trainable Aid

After training, preferred After training, preferred settingssettingsare automatically applied...are automatically applied...

Dillon, NAL

Trainable Aid

After training, preferred After training, preferred settingssettingsare automatically applied...are automatically applied...

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Trainable aid philosophyTrainable aid philosophy

Prescribe what can be prescribed, Prescribe what can be prescribed, automatically and in minimum automatically and in minimum clinical timeclinical time

Leave the rest to the client (and Leave the rest to the client (and the intelligence of the hearing the intelligence of the hearing aid)aid)

Fine tuning

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Training gain, CT, CR.

0

5

10

15

20

25

30

30 40 50 60 70 80 90

Input level (dB SPL)

Gai

n (

dB

)

CR

CT

Gain

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Active occlusion reductionActive occlusion reduction

Jorge Mejia, John Coelho (deceased) Jorge Mejia, John Coelho (deceased)

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H/ACanal

Cartilage

HearingAid

Electronic Venting

C

B

A∑

-

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Vent and amplification path transmission

-20

-15

-10

-5

0

5

10

15

20

125 250 500 1k 2k 4k 8k

Frequency (Hz)

Inse

rtio

n g

ain

(d

B)

Amplified path

Vent path

Combined path

Directional mic

Adaptive noise suppression

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Occlusion reduction: Mean and Standard Deviation

Note that feedback gain was adjusted for all subjects, filter settings remain the same

(22 ears)

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Super-directional hearing in Super-directional hearing in noisenoise

Jorge MejiaJorge Mejia

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Improving understanding in Improving understanding in noisenoise

Wireless transmission Wireless transmission √ √ √√ √ √ Directional microphones Directional microphones √√ (Adaptive noise suppression)(Adaptive noise suppression)√√

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Physical arrangement simulated

6 mm

6 mm

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Loss of SNR in hearing loss

0

2

4

6

8

10

12

14

16

0 20 40 60 80 100

Hearing loss (dB)

Incr

ease

in S

NR

nee

ded

(d

B)

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Blind source separation matrix(Inverse based on initial 100 ms of signal)

Jorge MejiaDillon, NAL

The result ?

• Hearing impaired people who can understand better in noise than people with normal hearing.

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Things in your ears

• Now: – mobile phones, – MP3 players, – portable DVD players, – personal digital assistants, – and of course ….. hearing aids.

• In the future: – personal navigation aids,– Voice input/output internet connection,– local area (human communication) wireless networks, – ……… all voice controlled, of course

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What do we mean by hearing loss?

• 2 to 3% of children are estimated to have some form of central auditory processing disorder.

• CAPD reduces speech intelligibility in noise, just like sensorineural hearing loss.

• CAPD includes a group of different deficits, which can be present singly or mutiply.

• CAPD can be compensated for, and can probably be remediated as well.

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Messages so far• Hearing loss is on the increase due (at least) to aging

• Motivation is the major determinant of benefit

• Hearing aid penetration is:– low, but …

– highest in world, and

– rapidly increasing.

• Fitting hearing aids to people who don’t want them spreads negative, self-fulfilling stories

• Technology advances have been:– worthwhile, but …

– oversold, and

– will continue, or even accelerate

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Aim

To increase penetration rate of hearing aids

and

Increase usage and benefit

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The solution is in the hands of:

• Clinicians

• Provider owners

• Government

• Manufacturers

• Researchers

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Clinicians

Don’t fit people who don’t seem to want them

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Provider owners

Provide incentives to clinicians for superior outcomes, not just superior sales

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Government

Pay for outcomes, not for processes

• Current system specifies process• Payment is made for process• Quality control inspects the process

Result:• No control over outcomes• No financial motivation for providers to improve outcomes • Financial benefit if clients don’t wear hearing aids• Financial motivation for providers to maximise number of

fittingsDillon, NAL

Government (cont)Alternative scheme

• Pay same for assessment• Pay less for fitting• Pay for outcomes

Result:• Providers with worse than current average outcomes earn

less• Providers with better than current average outcomes earn

more • Most providers will have better than current average

outcmes• Huge saving by government on people who won’t be fitted

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Government (cont)Outcomes measurement

Just measure:– Use– Benefit– Satisfaction– Quality of life improvement

Need to allow for:– New versus return clients– Response rate– Degree of hearing loss

International Outcomes Inventory for Hearing Aids

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Manufacturers

• Continue technology improvements• Change marketing:

– don’t oversell; – don’t confuse

• Pursue convergence– hearing aid– communication device– hearing protector– better than normal hearing

hearing aids normalised and desired

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Hearing device of the future

• Pathway to many systems:

Communication

Information

Entertainment

• Speech enhancer in noise

• Active hearing protector

• (Hearing aid)

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Noise suppression

Adaptive directionality

Feedback cancelling

Bernafon

Oticon

Phonak

Siemens

Starkey

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Researchers

• What makes a hearing aid candidate ?– What other than motivation ?– How do you measure motivation ?– How do you change motivation ?

• How beneficial are hearing aid features ?– For different people– For different situations

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Future behavioural research

• Why don’t some people seek help?

• Why do some people seeking help not get hearing aids?

• Why do some who get hearing aids not get benefit?

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60.7%

38.7%

27.7%

22.9%24.8%

Results from Telscreen Testing (n=4058)Golding, 2008

N=36N=124

N=230

N=485

N=1001

N=1270

N=850

(N= 3996)(age range 16-100 years only)

>25 dB 4FAHL Worse ear (Wilson et al)

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The life quality of people with hearing loss - in the hands of:

• Clinicians

• Provider owners

• Government

• Manufacturers

• Researchers

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Thanks for your attention

Slides will be on the NAL web site

www.nal.gov.au

From May 28

Dillon, NAL