Impact of Hearing Aid Technology on Outcomes in Daily Life II: Speech Understanding and Listening Effort.

The participants had uncomplicated mild-to-moderate hearing loss, so the study does not answer what happens for people with more complicated hearing losses. Researchers were not blinded to which hearing aids were fitted and assessed, although participants were blinded to technology differences and study purpose. Device features were set according to manufacturer recommendations rather than individually adjusted beyond fitting targets, so premium devices may not have been optimized for each participant. Laboratory stimuli were brief, and test-box measures may not have fully engaged premium directional and noise-management features. Listening effort was measured by self-report, which some clinicians may prefer to supplement with dual-task measures. Diary findings may have been influenced by participants' prior questionnaires, localization and sound acceptability tasks, and training about device programs. The significant premium advantage was limited to one brand in the loud laboratory condition, and the authors note findings might differ for other brands. Eleven of 1575 data points were adjusted as outliers, and one participant received 60 rather than 80 loud test utterances with brand B premium aids, but the authors included these data. The study treated a medium effect as the minimum interesting difference, and the authors note that at least a moderate effect would be needed for differences to be clinically meaningful.

Do not conclude that premium hearing aids are clinically better than basic hearing aids. Premium and basic devices were not significantly different across most laboratory and daily-life outcomes. The only significant premium advantage was a small laboratory listening-effort difference for one brand in loud noise, and it was not significant in daily life.