When to Fit Hearing Aids for Hearing Loss and Tinnitus?
Sereda et al (2015) report the results of their three-round Dephi Review, which explored “clinical consensus” (agreement of 70 percent or greater) of 28 hearing professional panelists in the United Kingdom. One hundred and fifteen (115) statements were evaluated and 58 statements achieved consensus.
Sample of factors that achieved consensus for fitting hearing aids with mild loss and without bothersome tinnitus:
- Patient reported hearing difficulties.
- Motivation of patients to wear hearing aids.
- Patient self-reported impact of hearing loss on quality of life.
- Degree of hearing loss.
- Realistic patient’s expectations.
- Health of ears.
- Shape of the audiogram.
- Speech discrimination and comprehension in quiet and background noise.
- General ability to hear in quiet and background noise.
- Hyperacusis/reduced sound level tolerance.
- Manual dexterity/manipulation difficulties.
Sample of level of agreement regarding uni-vs-bilateral hearing aids for people with mild loss with and without bothersome tinnitus:
- When fitting a patient with mild loss who does not have bothersome tinnitus, I offer uni-or-bilateral amplification based on patient’s preference. (86 percent agree)
- When fitting a patient with mild bilateral hearing loss and bothersome tinnitus, I always fit bilateral amplification. (75 percent agree).
All panelists agree “they would always provide information about the potential benefit of hearing aids for tinnitus management” and there was consensus that “hearing aids should be offered for patients with a mild loss and bothersome tinnitus even if they did not report hearing difficulties (82 percent agreed).
Consensus was reached regarding fitting mild hearing losses with open fit (100 percent), BTE on the ear (100% percent), multiple programs (93 percent), directional microphones (96 percent), and slim/thin tubing (93 percent); and given a patient who also has bothersome tinnitus, 100 percent agreed they would focus on as open a fitting as possible.
Consensus was reached and panelists agreed hearing aids improve tinnitus through the following: the provision of environmental sound enrichment, recalibrating auditory gain/central gain, reduced concentration/listening effort, reduce stress (due to hearing difficulties), and provide distraction from tinnitus. Additionally, 79 percent agreed that hearing aids reduce tinnitus for patients with mild hearing loss—even “if there is no benefit for hearing” and 75 percent agreed that unilateral amplification can shift the perception of tinnitus to the other ear.
Sereda et al report “the most common audiological management strategy in the United Kingdom is education and reassurance, combined with sound therapy with hearing aids being the most popular choice for patients with tinnitus and a co-morbid hearing loss. Where needed, it is supplemented with an intervention to reduce stress (such as cognitive behavioral therapy or relaxation therapy),” and they report that “our panelists considered the presence of bothersome tinnitus alone, without reported hearing difficulties, a sufficient criterion for fitting hearing aids….”
For More Information, Reference and Recommendations
Sereda M, Hoare DJ, Nicholson R, Smith S, Hall DA. (2015) Consensus on Hearing Aid Candidature and Fitting for Mild Hearing Loss With and Without Tinnitus – Delphi Review. Ear & Hearing 36(4):417-429.