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*298. Randomized Trial of Hearing Amplification Strategies

B Yueh, VA Puget Sound; PE Souza, University of Washington; JE McDowell, VA Puget Sound; MB Sarubbi, VA Puget Sound; CF Loovis, VA Puget Sound; SC Hedrick, VA Puget Sound; SD Ramsey, University of Washington; RA Deyo, University of Washington

Objectives: Hearing loss is one of the most common service-connected diseases in veterans. Advances in hearing aid technologies have resulted in an array of amplification products, but little is known about whether the effectiveness of technologies such as programmable circuits and directional microphones are worth the added expense. Our goals were to compare the effectiveness of a variety of hearing amplification strategies. The primary comparison of interest was between the standard hearing aid dispensed by VA Puget Sound and a programmable hearing aid with a directional microphone.

Methods: A randomized pilot trial at the audiology clinic at VA Puget Sound enrolled 64 veterans with bilateral moderate to severe sensorineural hearing loss into one of four treatment arms: no amplification, an assistive listening device (ALD), a standard non-programmable hearing aid that is routinely issued, and a programmable aid with a directional microphone. Non service-connected patients were assigned to either no amplification (control arm) or the ALD. Service-connected patients were assigned to either the standard or programmable aid. Of 64 patients enrolled, 60 completed the trial. Our primary outcomes were hearing-related quality of life, self-rated communication ability, adherence to use, and willingness-to-pay for the amplification devices (measured 3 months after fitting).

Results: Clear distinctions were observed between all four arms. The mean improvement in hearing-related quality of life (Hearing Handicap Inventory for Elderly) scores was small for control (2.2 points) and ALD (4.4 points) patients, excellent for conventional patients (17.4 points), and substantial for programmable patients (31.1 points, P<.001 by ANOVA test). Qualitative analyses of free text diary entries, self-reported communication ability (Abbreviated Profile of Hearing Aid Benefit) scores, and adherence to hearing aid use showed similar trends as well. Patients in each hearing amplification arm were willing to pay very different amounts to have their devices replaced if they lost them. ALD users offered $40, standard aid users $800, and programmable users over $2,200.

Conclusions: In this randomized trial of hearing amplification strategies, quality of life, communication ability, and preference outcomes were substantially improved in veterans receiving hearing aids, and in particular, the programmable model.

Impact: The programmable aid with the directional microphone, which is not typically dispensed, was strongly preferred by veterans in this study. Because these aids are more expensive, cost-effectiveness studies are now underway to determine the potential impact for the 300,000 veterans with service-connected hearing loss.