Impact of Probe-Microphone Measurements and NOAH Quick-Fit on Patient Satisfaction and Loyalty

Amyn Amlani, PhD

Amyn Amlani, PhD, returns to Hearing Economics after a long absence, having written on “Efficacy of Smartphone-Based Technology in Improving Hearing Aid Adoption Rates” last July.  

Dr. Amlani’s sustained interest in economic principles related to efficacy and consumer satisfaction are evident in these posts as well as several he wrote for the Hearing Health disruptions section several months ago.    

Probe-microphone measures were first introduced into clinical practice in the early 1980s .¹

This procedure affords clinicians the opportunity to verify that the amplified signal delivered by a hearing aid in an individual ear canal does, indeed, maximize speech audibility without exceeding uncomfortable listening levels.

An Underused Verification Tool

Surveys on the clinical use of probe-microphone measurements are abysmal.  Only 20% to 40% of clinicians who dispense hearing aids use the procedure as part of their practices’ standard of care,^2,3 despite evidence-based recommendations from professional organizations, such as the American Academy of Audiology⁴ and the American Speech-Language Hearing Association.⁵

Rationales for not employing probe-microphone measurements cover a wide range of clinician responses:

• cost of equipment
• the procedure is time intensive
• lack of reimbursement
• lack of knowledge to perform the task

We are Hindering Our Own Growth

Continued efforts are ongoing, on a global basis, to understand why hearing aid adoption rates are relatively unchanged over the past four decades, despite advances in technology.

One aspect that has hindered the growth of the profession are the services, or lack thereof, provided by practitioners.

This statement is supported, in part, by evidence that first-time users tend to experience greater emotional distress than their experienced counterparts during the hearing aid adoption process,⁶ and that 50% of experienced hearing aid users do not return to their previous provider when seeking new hearing aids and audiology services.^7,8

In this blog, we assess the positive impact that providing probe-microphone measures can have on patient satisfaction and loyalty.

Quantifying Satisfaction and Loyalty 

A collaborative study between Audioscan and the University of North Texas is currently underway. To date, we have collected data on three groups of 12 (n = 36) adult listeners with mild to moderately-severe sensorineural hearing loss.

• Group 1:  experienced users of amplification (> 1 year of use, devices are used > 8 hours/daily),
• Group 2:  users of amplification who did not use their devices on a frequent basis (i.e., hearing aids are in the proverbial “drawer”)
• Group 3: non-adopters of amplification that experienced hearing difficulties and who are interested in amplification

Six listeners in each group were fit with an experimental hearing aid programmed to a NOAH quick-fit only, while the remaining 6 listeners in each group were fit using a real-ear measurement protocol that included real-ear aided responses (REAR) at multiple input levels.

Post-fitting survey responses were obtained for the two fitting procedures (NOAH quick-fit, real-ear measurement protocol) assessed in this study. The surveys included:

• A modified version of the Perceived Value Measurement – Service Scale (SERVAL) which measures a respondent’s attitude and behavior toward perceived value assessed in five dimensions: perceived quality, perceived value, behavioral intent, emotion, and price;⁹
• the RAPID Loyalty Survey¹⁰  which quantifies three transactional components:
  • retention:  the degree to which consumers remain consumers to the same business
  • advocacy:  the degree of positive perceptions that lead to advocacy of the business
  • purchasing: degree to which consumers will increase purchase behavior
• Willingness-to-pay (WTP) for professional services anchored at $250 for the single verification session

Real Ear Fit Protocol Improves Satisfaction and Loyalty

Findings from the SERVAL, Loyalty, and WTP scales (Table 1) showed significantly (p < .05) improved responses across surveys when the real-ear measurement protocol was administered compared to the NOAH quick-fit condition in all three groups.

Our data suggests that the real-ear measurement protocol improves patients’ satisfaction and loyalty towards audiology professional services in experienced listeners, while lessening emotional distress in first-time adopters of amplification.

Collectively, our findings indicate that real-ear measurements, and not the NOAH quick-fit protocol, should be implemented as a standard practice in the clinic practice.

Note: In-depth results of this study entitled, “Improving Patient Satisfaction and Loyalty through Real-Ear Measurements,” including results not reported in this blog, will be presented at AudiologyNow! 2016, on Friday, April 15, 2016, from 7.30 to 8.30 am PST.

References

1. Mueller HG. (2001). Probe microphone measurements: 20 years of progress. Trends in Amplification, 5, 35-68.
2. Beck D. (2008, December 18). Hearing aids, real-ear measures, FM technology, and more: An interview with Michael Valente, PhD, American Academy of Audiology Web-based Interview. https://www.audiology.org/news/hearing-aids-real-ear-measures-fm-technology-and-more-interview-michael-valente-phd
3. Mueller HG, Picou EM. (2010). Survey examines popularity of real-ear probe-microphone measres. Hearing Journal, 63(5), 27-28, 30, 32.
4. American Academy of Audiology (2006). Guidelines for the Audiological Management of Adult Hearing Impairment. Audiology Today, Vol 18 (5), 32-37.
5. American Speech-Language-Hearing Association. (2015). Guidelines for Hearing Aid Fitting for Adults. https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935381&section=Key_Issues
6. Amlani AM. (2013). Influence of perceived value on hearing aid adoption and re-adoption intent. Hearing Review Products, 20(3), 8-12.
7. Kochkin S. (2009). MarkeTrak VIII: 25-year trends in the hearing health market. Hearing Review, 16(11), 12-31.
8. Kochkin S. (2014). A comparison of consumer satisfaction, subjective benefit, and quality of life changes associated with traditional and direct-mail hearing aid use. Hearing Review, 21(1), 16.
9. Amlani AM. (unpublished).
10. Hayes BE. (2011). www.qualityprogress.com

Amyn M. Amlani, Ph.D., is an Associate Professor on the faculty of the Department of Speech and Hearing Sciences, University of North Texas. Dr. Amlani holds the B.A. degree in Communication Disorders from the University of the Pacific, the M.S. degree in Audiology from Purdue University, and the Ph.D. degree in Audiology/Psychoacoustics (minor in Marketing and Supply Chain Management) from Michigan State University. His research interests include the influence of hearing aid technology on speech and music; economic and marketing trends within the hearing aid industry; and playing bass guitar with The Moonlighters, a heavy metal cover band.   E-mail: [email protected]

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