Is There Benefit for Auditory Training with Hearing Aid Users

This literature review has been created to look at and understand if auditory training should be used in a clinical environment to help underpin hearing aid user’s rehabilitation process. To see if it will increase their understanding of speech in noise, and if the hearing aid user felt that their ability to hear and understand had been improved, through the training.

Through the literature, different approaches have been used to apply auditory training principles to their participants. This has led to a variety of different results between the papers. However, looking at the articles it can be broken into face to face training and computer-based training methods. With the improvement in technology and computer savvy adults, the ability for the participants to conduct their training at home has positive and negative implications. As noted in the study by Abrams, Bock and Irey (2015), the participants ability to navigate the website and technology required for the study could have had a negative impact on the results. All of the computer-based studies did provide over the phone technical support and testing of hardware and software; however, this may not have been enough for some of the participants, and it was not explored as a factor of negative results in the studies (Chisolm, et al., 2013; Henshaw & Ferguson, 2013).  Another limitation to computer based at home auditory training is the amount of time dedicated to learning. It was seen in two of the studies that not all participants met the required at home learning targets, the studies do not specify why the participants did not complete the training programs or did not meet the study objectives. This being stated, 2 out of the 3 studies indicated positive results from their auditory training programs in the outcome measures, when the training is completed in full.

The outcome measures with computer based auditory training programs in the literature reviewed were all based off different program lengths and used a variety of different outcome measures. In the studies that did see improvements, they were in different stages of the training cycle, in the study by Chisolm, et al., (2013), the main improvements were seen in sessions 5 & 10 out of the 20 sessions in the program. The study by Henshaw & Ferguson (2013), also showed improvements; however, theirs were noted over the progression of the training program. The result observed in these studies support findings found in historical literature on auditory training. The Abrams, Bock and Irey (2015) study did not indicate any improvement from the internet based auditory training program provided; however, the researchers felt this could have been due to the compliance from the participants, noting that the auditory training group only indicated 4.5 hours of training per week instead of the required 7.5 hours per week. This could have had a direct correlation to the results from the trial. This being stated, the overall results were positive from the literature showing improvement by the participants when hearing aids were fitted and auditory training was provided as a rehabilitation process.

Face to face auditory training was used in two of the studies reviewed, this does require a more hands on delivery process compared to computer-based learning and could have a financial implication on a clinic long term. However, it is important to understand if there is an added benefit from this approach. Both programs were delivered face to face to new hearing aid users, the delivery of the auditory training was different, and the outcome measures were also different. The study by de Miranda, Gil, & Iorio (2008), showed positive results from auditory trianing and hearing aid wearing for elderly adults. There was a significant improvement in the outcome measures and self-reported questionaires showed that the people who participated in the auditory training programed noticed an improvement in their auditory perception compaired to the control group, who did not notice any significant change after 12 weeks of hearing aid useage. This indicated that the participants did not feel that their hearing loss was an issue when socialising. This led the researchers to the development that hearing aid fitting alone is not the only way to help a person hear but formal hearing training is the best way to achieve positive results (de Miranda, Gil, & Iorio, 2008). This result is not necessarily the same result observed in the study by Nkyekyer, Meyer, Pipingas, & Reed (2019).  They did note that the use of hearing aids contributed to a decrease in depression and also improved speech perception; however, there was no evidence to indicate that the partipants were able to track speech better with or without hearing aids. The study also indicated that there was no significant difference between hearing aid users before or after the auditory training program. The researchers indicated that this could have been due to the fact that all partipants were new hearing aid users and the researchers were unable to track the amount of hearing aid usage time per day.

The literature reviewed was from a variety of different study designs, this included, cross-over pilot, controlled trails, repeated measures. Three of the studies used randomised controlled trials, providing a high level of evidence. Of all the studies used, only one used a double blinded test (de Miranda, Gil, & Iorio, 2008), which provides a strong amount of evidence. The participation numbers in the study did vary from 14 to 50 adults. With a variety of program intervention, timeframes from 6 weeks to 7 months, long term result follow ups of the studies were not reported to see if any improvements were seen during period after the training program was discontinued. Self-motivation of the participants using at home computer based training program could also be a contributing factor on how the group performed overall (Abrams, Bock, & Irey, 2015).

Consistency across all the literature reviewed is a weakness of the current review. With the varied study approaches taken; study design, participation numbers and requirements, outcome measures, auditory training delivery and reporting protocols, by the studies it is difficult to understand if significant improvements were made by the participants or if there is a level of bias in the results. As the biggest study only had 50 participants (Chisolm, et al., 2013), it is difficult to see if the processes implemented for the papers could be applied over a larger number of participants and still achieve the desired results. Further research with larger trials would be beneficial to see if results can be replicated, whilst also trying to determine the best timeframe for the training programs, so they are not too long to keep engagement, but not too short and miss out on achieving the desired results.

The future direction for auditory training appears to be computer-based. With the increase in technology, affordability and the average person’s technical ability to use them effectively, a self-paced, user-friendly auditory training program could be beneficial for clinics, to increase hearing aid satisfaction, and incorporate auditory training into their current rehabilitation processes. This would help overcome the current issues facing clinics of the cost-time benefit of auditory training programs (Brouns, El Refaie, & Pryce, 2011). That being stated, the evidence of current literature shows that compliance is key for good results. When programs are completed at home, there is always the potential that the training is not completed properly or is not completed at all. This could mean a more inclusive approach may be needed with regular communication between clinics and participants; however, more research would be needed in this area.