Noise Management Preferences During Long-Term Hearing Aid Usage and Their Relation to Audiologic Factors.
Marianna Vatti, Takanori Nishiyama, Daisuke Suzuki and 12 others
Hearing aid users mostly chose a modest noise-management level and 27.3% couldn't hear a difference between settings.
The strongest setting gave more speech-in-noise benefit than the one they picked, and no hearing measure predicted who preferred what.
Key findings
187% of participants preferred an adaptive directional-microphone plus noise-reduction setting (NP2–NP6), with a roughly symmetric distribution centred on modest strength; the strongest setting (NP6) produced a significantly higher speech-in-noise benefit (ΔSRT = 4.81 dB) than the preferred setting (ΔSRT = 3.39 dB).
2During directional-microphone and noise-reduction comparisons, 27.3% of participants reported hearing no difference between the two settings (rising from 15.4% in the first period to 34.2% in the fourth), compared with 5.26% during gain comparisons; preference strength was approximately 2.7 times higher for gain than for noise management.
3No audiologic measure (hearing loss, age, speech-in-noise threshold, modulation sensitivity, acoustic coupling) or environmental factor reliably predicted which noise-management setting a participant preferred; only subjective noisiness had a small significant effect (β = 0.087, p < 0.001).
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What it does not show
The hearing aid always defaulted to program 1 when switched off and back on, so one setting received 64–71% of use time versus 29–36% for the other, which could bias individual preferences toward the more-exposed setting. No objective noise-level measurements were taken, so the relationship between actual background noise and participants' subjective noisiness ratings is unclear. Part of the study overlapped with the COVID-19 pandemic, reducing participants' opportunities to experience complex listening situations. Participants submitted relatively few reports in noisy situations (noisiness rating above 5), which is precisely where noise reduction is most relevant. Reports were retrospective—participants could submit them at any time without a defined window after the listening event—introducing memory bias. Only one hearing aid model (Oticon More 1) was tested, so findings may not generalise to other brands or noise-management algorithms. German and Japanese participants were fitted with different methods (NAL-NL2 versus Utsunomiya), with the Japanese method prescribing 5–10 dB more gain and fully closed earmolds, which may have influenced preferences. 9 participants dropped out over the study (about 7%), and the number submitting at least one field report declined from 116 to 89 (about 23%), with the largest drop between periods 4 and 5.
Declared interests
Funded by the William Demant Foundation (grant 20-2461). Two authors (GJ and SL) own stocks in Demant, the parent company of Oticon (the hearing aid manufacturer used in the study), and in Iteracoustics, GSi, and MedRx (manufacturers of the ACT test equipment used in the study). The authors declared no other conflicts of interest.
The easy way to misread this
Do not read the finding that the strong setting gave a higher speech-in-noise benefit (4.81 dB versus 3.39 dB for the preferred setting) as a reason to set every patient to maximum noise reduction. The authors explicitly caution that strong settings should not be applied uniformly, and the effective real-world signal-to-noise difference is smaller than the laboratory measurement because of open fittings, diffuse background noise, and the signal-to-noise ratios users actually encounter in daily life.
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