Audiologist Decision-Making: Hearing Aid Technology Levels and Auditory Ecology.

Background: Audiologists are expected to use evidence-based practices to guide their decision-making practices and recommendations regarding specific hearing aid technology for each patient. However, guidance regarding how to make these decisions is limited and sometimes conflicting. Hearing aid manufacturers have promoted the idea that an individual's auditory ecology, which refers to their listening demands and environments, may contribute to interpatient differences in outcomes and benefits of specific technology. How the limited and conflicting evidence surrounding technology levels and auditory ecology impacts audiologists' decision-making is unknown. Purpose: We sought to understand audiologists' decision-making practices, including how they assess patients' auditory ecologies and apply the results of such assessments to their decisions. Research Design: An online survey was sent to audiologists across the United States. The 21 survey questions covered respondent demographics, the hearing aid selection process, use of auditory ecology, and patients' success with hearing aids. Study Sample: Survey respondents were clinical audiologists. A total of 185 completed surveys were included in the analysis. Data Collection and Analysis: The results of each topic area were summarized descriptively and investigated inferentially. Results: Most participants reported that a patient's listening demands and environments were the most important considerations when selecting the technology level. The most popular method of evaluating a patient's auditory ecology was a clinical interview. Most audiologists reported recommending higher-level technology for patients with more active lifestyles and lower-level technology for patients with calmer lifestyles. Conclusions: Audiologists reported prioritizing auditory ecology when selecting a technology level and using many different methods, sometimes in combination, to evaluate the auditory ecology of their patients. Clinician factors did not impact the use of auditory ecology or how they recommended technology levels. The use of auditory ecology did not impact return/exchange rates. Clinical Relevance Statement: Most audiologists have adopted a recommendation pattern of encouraging higher technology levels for patients who report more demanding listening environments and needs. More research is needed to gain a better understanding of the nuances of clinical interviews and unique practice approaches to evaluate auditory ecology.