Think about this question for a moment… Would it be useful for you to know if your newly fit hearing aid patient has a realistic or unrealistic view of how well they can hear?
You know who I’m talking about! It is the patient with pretty good hearing who complains of all kinds of difficulty, and when they get hearing aids the complaints continue, despite good evidence that they are receiving appropriate gain and output. “He’s a complainer!” “She just has unrealistic expectations!” It’s them! They are the problem!
Or it is the patient with a pretty significant hearing loss who claims he or she hears “just fine”, despite plenty of clinical evidence to the contrary. They won’t consider hearing aids because, heaven knows, they don’t need them. “He’s in denial!” “She’s resistant to change!”
Wouldn’t it be nice to know in advance what the situation is with these patients? Then you would be able to craft your counseling to correspond and have clinical evidence of the mismatch between their hearing performance and their hearing perception.
For the under-estimator we could focus our counseling on the improvement they are receiving by using such techniques as unaided vs. aided comparisons while wearing their new hearing aids. For the over-estimator, perhaps unlikely to be ready to purchase “un-needed” hearing instruments, the same kind of unaided vs. aided comparison, this time in the context of a hearing aid demonstration, could be helpful in providing a more realistic view of the patient’s hearing status.
Some years ago, Gabrielle Saunders (Saunders et al 2004) and her colleagues developed a Performance Perceptual Test (PPT) that was able to identify those who underestimate and those who overestimate their hearing abilities. They also showed that under-estimators were less likely to be satisfied with their hearing aids. In their study they used the Hearing in Noise Test (HINT) and the technique for its use is not particularly user-friendly. In a recent issue of The Hearing Journal, Ou and Wetmore (2020) describe a much simpler technique using QuickSIN that yielded similar results to the Saunders study.
If you already are using QuickSIN, to determine whether the patient before you has a realistic perception of the extent of their hearing loss or underestimates / over-estimates their hearing loss, requires only that you administer a few extra QuickSIN sets.
Here is the Procedure:
Set up as usual – i.e. under headphones – intensity a little louder than MCL. The lists used will be selected from lists 1, 2, 6, 8, 10, 11, 12, 15, and 17 (these score very consistently with each other according to McArdle and Wilson ).
First we determine the patient’s own perception of their ability to understand speech in noise.
Here are the patient instructions:
‘‘Imagine that you are at a party. There will be a woman talking and several other talkers in the background. The woman’s voice is easy to hear at ﬁrst because her voice is louder than the others. The background talkers will gradually become louder, making it difﬁcult to understand the woman’s voice. Listen closely to each sentence and let us know how much you are able to understand based on a scale from 0 to 5. Zero means that you understand nothing from the sentence. Five means that you can understand every word for the whole sentence. Two-and-a-half means that you can only understand half of the sentence. Please use any number between 0 and 5 to indicate how much you understood the sentence. The noise will start ﬁrst, and then you will hear the woman’s voice.’’
- Record for each sentence the score the patient declares as you would counting correct words in the regular QuickSIN test.
- Administer at least 2 (preferably 4) lists in this fashion.
- Score as usual (25.5 minus the score declared by the patient for each list).
- Total the scores for all lists and divide by the number of lists administered.
Next we determine the patient’s actual performance:
- Instruct the patient and administer QuickSIN as usual, administering the same number of lists as you did in the perception condition (using different lists from those used in the Perception condition)
- Score as usual (25.5 minus the number of words repeated correctly by the patient for each list).
- Total the scores for all lists using this condition and divide by the number of lists administered.
To determine whether the patient has a realistic view of their hearing, or are an over- or under-estimator, subtract the Perception condition average score from the Performance condition average score.
- If the result is between -1.65 and 0.0 –
- The patient has an accurate assessment of their ability to understand speech in noise.
- If the result is < -1.65 –
- The patient under-estimates their ability to understand speech in noise. They have an unrealistically poor perception of their hearing ability. This is likely to carry over to their perception of the benefit they receive from hearing instruments. Counseling in this regard, as well as demonstrations of benefit (unaided vs. aided) will be helpful.
- If the result is > 0.0 –
- The patient over-estimates their ability to understand speech in noise. They have an unrealistically good perception of their hearing ability. They may not be motivated to pursue the hearing help they truly need due to this misperception. Demonstration of the benefit they would receive from hearing instruments prior to purchase would be particularly compelling for these patients, again using an unaided vs. aided comparison.
This is an excellent way of helping you to focus the kind of counseling required for the sometimes subtle and hard-to-identify issues some patients bring to the table.
If this procedure will even incrementally help you to change more lives through better hearing, by encouraging some to keep their hearing aids, and others to pursue them in the first place, it will be worthwhile. Give it a shot!
McArdle RA, Wilson RH (2006) Homogeneity of the 18 QuickSIN Lists. JAAA 17: 157-167
Ou H, Wetmore M (2020) Development of a revised performance-perceptual test using Quick Speech in Noise test material and its norms. JAAA 31: 176-184.
Saunders G, Forsline A (2006) The performance-perceptual test and its relationship to aided reported handicap and hearing aid satisfaction. Ear Hear 27:229-242