PP112 - Influence of Speech Perception in Quiet and Noise, Degree of Hearing Loss, and Insurance on Hearing Aid Adoption, Use, and Retention

Abstract:
This study examines the impact of speech perception, degree of hearing loss, and insurance status on hearing aid (HA) adoption, use, and retention. Analysis of data from 26,816 adults reveals that billing type significantly influences HA procurement, with Medi-Cal users showing the highest adoption and retention rates. Further, modeling analysis indicates that speech perception scores in quiet and noise do not significantly affect HA adoption, use, or retention across varying degrees of hearing loss. Additionally, maximum retention rates are observed among Medi-Cal users, while return rates are influenced by patients who financed their devices or had insurance coverage.

Summary:
Rationale/Purpose
Hearing aids (HAs) are the most frequently recommended solution for individuals with hearing loss. However, many people either do not use them or return them during trial periods due to various factors, including the severity of hearing loss, perceived challenges in hearing, cost, and stigma. A common concern is the difficulty in understanding speech in noisy environments, which often results in dissatisfaction with HAs. However, the relationship between clinical speech perception measures (in quiet and noise) and HA use remains ambiguous. We aim to address this gap by investigating how speech perception in quiet and noise, degree of hearing loss, and insurance status affect HA adoption and retention with a large dataset from an academic medical center.

Methods
This preliminary study encompasses audiological and hearing aid data documented at the Stanford Ear Institute since 2006. Our study consisted of adults (≥18 years, N = 26816) and excluded individuals with normal hearing sensitivity based on high-frequency pure tone average (1000, 2000, 4000 Hz – HFPTA) of ≤25 dBHL, individuals with conductive hearing loss, and CI, CROS, and Bimodal hearing users. Our variables of interest contributing to the procurement and adoption of HA were degree of hearing loss, speech perception in quiet (Word Recognition in Quiet - WRQ) and noise (QuickSIN), and billing type - (1) private insurance, (2) Medi-Cal - healthcare provided by the California Government that always covers for hearing aids, and (3) self-pay by patients.

Results
Billing type significantly influenced hearing aid (HA) procurement (χ² = 643.71, df = 8, p < 2.2e-16), with Medi-Cal users showing the highest adoption rates. A Generalized Linear Model (GLM) analysis indicated that speech perception scores in quiet and noisy environments did not significantly impact HA procurement (p > 0.01) across degrees of hearing loss. Maximum retention rates were observed among Medi-Cal users, with speech perception and degree of hearing loss showing no significant effects on device retention (p > 0.01). To further explore factors affecting retention, we categorized the number of returns and exchanges and identified that return rates were influenced by "device cyclers," consisting of patients who financed their devices or had insurance. Device usage statistics revealed no significant patterns across degrees of hearing loss or speech perception performance. However, individuals with moderately severe hearing loss with better speech perception in noise tended to wear their hearing aids longer.

Conclusions and Future Directions
In conclusion, the billing source significantly affects the procurement, utilization, and retention of hearing aids, with Medi-Cal users exhibiting the highest retention rates. Contrary to our hypothesis, speech perception in noise (SPIN) scores were not a key determinant of HA adoption or return rates. These results suggest that personality traits and patient-specific non-auditory factors may also play a role in adopting and retaining hearing aids.

We are creating models to more effectively elucidate the relationships among speech perception, patient-specific factors, and hearing aid statistics, aiming to provide valuable insights for clinicians, researchers, and policymakers.

Brief Summary of Clinical Takeaways:
These results underscore the need for a more holistic approach when recommending hearing aids. Insurance coverage plays a vital role in adopting, retaining, and using hearing aids. This research also highlights the importance of a diagnostic test battery encompassing speech perception assessment in quiet and noise.

Assumptions
Attendees need to have prior knowledge regarding the test battery of audiometric and speech perception testing in the clinic.