Max Stanley Chartrand
DigiCare Behavioral Research, USA
Title: A quantitative view of the relationship between external ear canal keratin status and success in adaptation to hearing aids
Biography
Biography: Max Stanley Chartrand
Abstract
ABSTRACT Hearing care professionals and hearing aid manufacturers still report untenable levels of remakes, returns for credit, and cases of failure to fit for a variety of reasons. Hearing aid discomfort, own-voice artifacts, and cost/benefit perceptions top the list of reported reasons.1,2, 3,4In the present study, the status of the keratin or corneum stratum in the external auditory canal (EAC) has been found to negatively or positively affect hearing aid adaptation.5,6 These include keratin’s role in preventing oversensitivity in EAC mechanoreceptors (hair follicles, Meissner corpuscles and Pacinian corpuscles) and their subsequent neuroreflexes (Arnold’s Branch, Trigeminal, and Lymphatic Reflex), which affect own-voice perception, insertion and removal, wearing comfort, and coupler adaptation.1,7,8 STUDY PROFILE The Problem • Challenges due to missing or disrupted EAC keratin present obstacles to successful adaptation to wearing hearing aids • Because this is difficult to address adequately at the patient care level, too many new hearing aid users complain of discomfort, own-voice artifacts, and fail to accept their hearing aids • This perpetuates the problem of an unsustainable number of remakes and returns for credit (RFC), too many cases of failure to fit and subsequent delay in obtaining hearing correction Research Question: “How might clinicians identify keratin status and provide counsel relative to effects of hypersensitivity of the EAC neuroreflexes during hearing aid fitting and adaptation process?” Study Design: Bivariate correlational, retrospective file study, 45-day timeline, utilizing best practice standards Participants: 98 new hearing aid users, aged 29-95, 62 males, 36 females, selected randomly from 435 files at a hearing health/occupational therapy practice in Southern Colorado Materials: Patient files, Participant Data Sheet, Rating Scale for Keratin Status & Hearing Aid Adaptation, HIPAA Informed Consent Form, Notice of Privacy Policy, In-house Shipping & Logging Records Ethical Considerations: Observation of all federal, state, and local laws governing dispensing of hearing aids; Participants previously signed Informed Consent forms, HIPAA forms; IRB Review (Northcentral University) Hypotheses: • Ho: Keratin status of the EAC has no positive relationship with successful adaptation to wearing hearing aids. • Ha: Keratin status of the EAC is closely associated with success in physically adapting to wearing hearing aids. Measures Ratings of EAC Keratin Status (Likert-type scale 1-3): • Level 1: Absent/peeled keratin • Level 2: Thin or granulated keratin • Level 3: Moderate, thick keratin (w/ spaced desquamation lines) Ratings for hearing aid adaptation success (Likert-type scale 1-5): • Level 1: Failure to Fit/Complete RFC • Level 2: Exchange or one-sided RFC • Level 3: Remake/problems adapting • Level 4: In-office modifications • Level 5: Adaptation without difficulty