Benefit of a Clinically Streamlined and Structured Aural Rehabilitation (CSSAR) Program in Adults

Primary outcomes

1. Self-Perceived Hearing Aid Benefit

   Time frame: Baseline, 3 Months Post Phase I CSSAR Intervention, 3 Months Post Phase II CSSAR Intervention

   Change in self-perceived hearing aid benefit will be measured using The Abbreviated Profile of Hearing Aid Benefit (APHAB). The APHAB is a 24-item questionnaire consisting of listening experiences across a range of situations with and without hearing aids. Participants indicate on a 7-item scale the percentage of time in which the statement is true from Always (99% of the time) to Never (1% of the time) when unaided and when aided with their devices. The APHAB is a well-used and -accepted clinical questionnaire of perceived hearing aid benefit. Each item loads onto one of four subscales (Ease of Communication, Background Noise, Reverberation, and Aversiveness). Benefit is calculated by subtracting the aided average from the unaided average. The APHAB Benefit score (excluding the Aversiveness subscale) score will be used for analyses, with higher scores suggesting greater benefit.

2. Self-Perceived Hearing Handicap

   Time frame: Baseline, 3 Months Post Phase I CSSAR Intervention, 3 Months Post Phase II CSSAR Intervention

   Change in self-perceived hearing handicap will be measured using the Revised Hearing Handicap Inventory (R-HHI). Based on the original Hearing Handicap Inventory for Adults (HHIA) and for the elderly (HHIE), the R-HHI consists of 18 items related to hearing-related aspects of psychosocial health including "Does a hearing problem cause you to feel left out when you are with a group of people." The respondent is asked to rate each item with "Yes", "Sometimes", and "No", which correspond to scores of 4, 2, and 0 respectively. Because the R-HHI contains common items across both HHIA and HHIE, it can be used for adults across all ages. The total score will be used for analyses, with higher scores corresponding to greater perceived hearing handicap.

3. Word Recognition in Noise

   Time frame: Baseline, 3 Months Post Phase I CSSAR Intervention, 3 Months Post Phase II CSSAR Intervention

   Change in word recognition performance will be measured using the Words in Noise (WIN) Test. The WIN consists of Northwestern University Auditory Test No. 6 (NU-6) monosyllabic words, a standardized set of phonetically balanced words commonly used to assess speech-recognition ability, presented in the presence of 6-talker babble that is fixed at 80 dB SPL. There are 35 target words spoken by a female talker within a single list for the WIN, with the signal-to-noise ratio (SNR) decreasing from +24 dB (easiest) to 0 (most difficult) by 4 dB every 5 words. Following practice, two word lists will be administered and averaged to obtain a total score reflected as percent correct. WIN Lists 1 and 2 will be counterbalanced across participants and alternated across the follow-up visits to minimize systematic list-order and repeated-exposure. This total percent of words scored as correct across the two lists will be used for analyses with a higher percentage suggesting better performance.