RP303 - Audiologist Practices for Low-Gain Hearing Aids in Adults with Normal Hearing Thresholds

Abstract: Adults with normal pure-tone thresholds reporting auditory difficulties represent a growing clinical population. Limited evidence exists on how audiologists approach amplification decisions for these patients. This study examined current practices for fitting low-gain hearing aids, including identification of patient complaints, clinical criteria, and diagnostic tools. Results suggest audiologists across clinical settings are successfully fitting amplification for adults with normal thresholds. Patients report high daily use and positive outcomes. Disclaimer: The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy of the DOD or the U.S. Government.

Summary: Rationale. Adults presenting with normal or near-normal pure-tone hearing thresholds yet reporting auditory difficulties represent a growing clinical population. Despite increasing interest, limited evidence exists regarding how audiologists approach amplification decisions for these patients. This study aimed to: 1) determine how frequently audiologists recommend and fit amplification for adults with normal or near-normal audiometric thresholds; 2) identify the primary patient complaints, clinical criteria, and diagnostic tools used to support amplification decisions; 3) evaluate device types, fitting approaches, and outcome measures employed; 4) assess audiologists' perceptions of treatment benefit, usage patterns, and hearing aid return rates; and 5) explore clinician-identified barriers and facilitators to care, along with desired resources for improved decision-making.

Design: An online survey was developed and distributed to practicing audiologists across diverse clinical settings. Data were captured from over 150 audiologists working in hospitals, ENT clinics, military facilities, private practices, university settings, and Veterans Affairs medical centers. The survey assessed clinicians' experiences with and approaches to amplification for adults with normal hearing thresholds, including case frequency, clinical decision-making processes, fitting protocols, and outcome assessment strategies.

Results: Audiologists across all practice settings reported fitting amplification for adults with normal or near-normal hearing thresholds. The primary patient complaints driving consideration for amplification were listening effort and history of traumatic brain injury or concussion. Additional factors influencing fitting decisions included patient-reported functional hearing difficulties, poor performance on speech-in-noise testing, and presence of tinnitus. The majority of prescriptive gain applied ranged from 5-10 dB across frequencies from 1000-8000 Hz. Subjective feedback and device data logging were the most commonly used outcome measures. Usage patterns indicated that the majority of patients wore their devices more than six hours per day. Nearly all responding audiologists reported that patients' self-reported benefit was generally positive or very positive. The most commonly cited barriers to providing amplification for this population included lack of clinical practice guidelines and patient stigma associated with hearing aid use.

Conclusions: These findings demonstrate that amplification for adults with normal or near-normal hearing thresholds is an emerging area of clinical practice across diverse audiology settings. Audiologists are successfully fitting this population with low-gain hearing aids, with high daily usage and positive patient-reported outcomes. Listening effort, cognitive factors such as traumatic brain injury history, speech-in-noise difficulties, and tinnitus appear to be key clinical indicators guiding amplification decisions beyond traditional audiometric thresholds. The positive usage patterns and subjective benefit reported suggest that low-gain hearing aids represent a viable intervention for appropriately selected patients. However, the lack of standardized clinical guidelines and persistent stigma present significant barriers to care. Future research should focus on developing evidence-based protocols and outcome measures specific to this population to support clinical decision-making and optimize patient outcomes.

Brief Summary of Clinical Takeaways: The clinical takeaway for this session is that audiologists are increasingly fitting low-gain hearing aids for adults with normal pure-tone thresholds who report hearing difficulties. These fittings show high daily use and positive patient-reported outcomes, suggesting amplification can be a beneficial option even without traditional hearing loss.

Assumptions: Knowledge of functional hearing difficulties and the use of low-gain hearing aids will be helpful to attendees.