Staff Standpoint | January 2020 Hearing Review By Karl E. Strom Is time spent using a hearing aid a good indication of satisfaction, benefit, and value of the device? Well, in a nutshell, probably. But as we move into the over-the-counter (OTC) hearing aid era—and what some consumers might view as situational hearing devices—maybe it’s time to start re-examining some of our hardline orthodox views on this topic. A good audiologist or hearing aid specialist is proud of the work they do—and rightly so. Logically, the time your patients spend using their hearing aids is a proxy for hearing aid benefit and customer satisfaction. After all, why would a person wear hearing aids if they didn’t benefit from them? But is customer satisfaction correlated with the number of hours a person uses a hearing aid? A good analysis of this question (among others) was published in Trends in Amplification by Wong, Hickson, and McPherson in 2003. They show that numerous studies do correlate hearing aid use with satisfaction. For example, hearing aid users who wear their devices more than 2 hours per day are more likely to be satisfied compared to low-level users. However, plenty of studies indicate that people wearing their hearing aids for what might be considered ridiculously short periods of time (eg, 1 hour/day)—a fitting failure?!—also report being satisfied with their devices. (Note: An important topic to acknowledge is the complicated relationship between benefit, satisfaction, and value, but space limitations don’t allow for an adequate discussion of this subject here. We also know there are more robust validation measures of hearing aid satisfaction, like COSI, SADL, HHIE, etc, that should be used routinely.) One way to look at this question is through Sergei Kochkin’s idea of multiple environment listening utility (MELU) in MarkeTrak. The basic idea of MELU is the more listening situations a person can hear well in—particularly those situations involving speech in noise, which is the number-one reason people seek hearing help—the better satisfaction score they’ll have with their hearing aid. Makes sense, right? But for years I have been guilty of having a rather radical or over-simplistic view of MELU. My view has been that a good hearing aid should allow you to hear well in as many environments as possible, and logically, that suggests the best hearing aids (and fittings) will prompt people to wear their hearing aids all or most of their waking hours. But this doesn’t necessarily apply to all amplification. For example, I have a progressive mild hearing loss that will some day morph into a moderate hearing loss (like every older adult in my family). Because I’ve been experimenting with PSAPs (ie, future OTC aids) and trying to learn more about them, I’ve found a couple that do an exemplary job solving my situational hearing difficulties, like hearing the TV at the same volume my wife prefers. Since then, I’ve worn PSAPs as an experiment in other places and for other purposes (including the car and in noise) with mixed results. However, if you asked me, I’d say I’m generally satisfied with several of the devices. So, as our field moves into the era of OTC, we may need to stop gauging a successful fitting by the amount of time a wearer uses his/her amplification. Rather, it will depend on the particular device and the stated objectives of the wearer. As greater numbers of people with borderline/mild hearing losses seek help from your practice, maybe it’s time to see situational hearing—and the OTC and/or “basic” hearing aids it calls for—as an entry-point or threshold for people to learn about hearing loss and experience amplification. It’s also a good time for education on protecting their residual hearing and the possibility of better situational hearing with a device/app you’re comfortable recommending (see Larry Medwetsky’s article on p 20 of this issue). On the other hand, we’re seeing so much data emerging on the negative effects of hearing loss—and its links to loneliness, depression, cognitive deficits, and other comorbidities—that suggest people with hearing impairment should consider full-time amplification. Where do we draw the line, and how should professionals view and counsel these mild losses? Citation for this article: Strom KE. Situational hearing loss. Hearing Review.2020;27(1):6.