Justin A. Zakis

NAL-NL2 (National Acoustic Laboratories Non-Linear 2) is an empirically grounded and clinically validated algorithm for hearing aid fitting. It was developed as the successor to NAL-NL1 to balance ...

To describe the development and evaluation of the NAL-NL3 Comfort in Noise Module; a new algorithm for determining hearing-aid gain that is part of the NAL-NL3 fitting system. Single-site multi-study design with each study and subsequent perceptual modelling informing refinements to module gain targets. Participants completed laboratory studies to investigate gain preferences and to evaluate the effect of the module on speech understanding in noise. Participants also completed real-world evaluations using a smartphone-based Ecological Momentary Assessment app with different brands of hearing aids. 83 adult hearing aid users with mild to severe hearing loss. The new module selectively reduced gain (compared with the NAL-NL3 Prescription) by imposing a limit on the total loudness. Iterative refinements led to progressive increases in user preferences favouring the new module over the NAL-NL3 Prescription in noise with respect to listening comfort. Laboratory-based testing identified no detrimental impact on speech perception in noise. Reducing the level of prescribed gain for hearing aid users in noise compared to in quiet improves comfort without significantly degrading speech understanding. This work supports the broader philosophy of the NAL-NL3 fitting system to provide specialised targets for different populations, situations and device technologies.

To describe and discuss the evolution of hearing aid prescriptions for gain and compression from the National Acoustic Laboratories (NAL). Narrative review of the philosophies and scientific approaches underlying the derivation of the NAL prescriptions, from the first linear NAL 'rule' to the latest advancements in the NAL-NL3 Fitting System. Published studies on the development of the various NAL hearing aid prescription formulas. From the first linear formulas (NAL, NAL-R, NAL-RP) to the subsequent non-linear formulas (NAL-NL1 and NAL-NL2), the NAL philosophy has been grounded in the importance of maximising speech understanding while ensuring loudness remains within normal levels. The NAL-NL3 Fitting System represents both a continuation of this philosophy in the design of the NAL-NL3 Prescription, but also the introduction of alternative philosophies in the NAL-NL3 Modules that address a broader set of needs and characteristics in today's hearing aid recipients. The NAL prescriptions have evolved to address the needs of hearing aid users and advances in hearing aid technology. Independent evidence-based manufacturer-agnostic hearing aid prescription formulas still represent a key aspect of audiological practice, enabling hearing professionals to provide evidence-based individualized amplification strategies to optimize auditory outcomes.

Background/Objectives: Sensorineural hearing loss (HL) is a highly prevalent chronic health condition. It can be managed through hearing care, including the use of hearing aids (HAs). Still, a majority of individuals with HL remain undiagnosed or untreated. Virtual care delivery may support uptake and adherence to interventions. In blended care, individuals can choose interchangeably between in-person and virtual services. This study aimed to investigate how real-world individuals accessed blended hearing care (through in-person, virtual, or hybrid services), the amount of support they received, and their satisfaction with services and products. Methods: An exploratory, retrospective analysis was performed on longitudinal observational data collected through Australia’s longest-running blended hearing care model. A total of 25,058 appointment records were available, matched to HA purchase records and clinical notes where possible, as well as 916 satisfaction ratings. Results: The majority of individuals attended in-person appointments (75%); 25% were virtual or hybrid appointments. The number of appointments attended depended on how HAs were purchased (in-person, virtually, or hybrid), but all modalities were complemented by ample unscheduled email and telephone support. Of those who purchased HAs repeatedly, 49% changed preferred sales channel (in-person versus virtual) over time. Satisfaction ratings were highest for virtual services. Conclusions: This first report of real-world, longitudinal evidence on blended hearing care showed strong attendance of in-person appointments, while hybrid services—including informal; unscheduled support—may have responded to individuals’ changing needs and preferences over time. The findings offer practice-based evidence for blended care models and recommendations for further research.

Healthcare systems are traditionally a clinician-led and reactive structure that does not promote clients managing their health issues or concerns from an early stage. However, when clients are proactive in starting their healthcare earlier than later, they can achieve better outcomes and quality of life. Hearing healthcare and the rehabilitation journey currently fit into this reactive and traditional model of care. With the development of service delivery models evolving to offer services to the consumer online and where they are predominately getting their healthcare information from the internet and the advancement of digital applications and hearing devices beyond traditional hearing aid structures, we are seeing a change in how consumers engage in hearing care. Similarly, as the range of hearing devices evolves with increasingly blended and standard levels of technology across consumer earbuds/headphones and medical grade hearing aids, we are seeing a convergence of consumers engaging earlier and becoming increasingly aware of hearing health needs. This article will discuss how the channels, service, and technology are coming together to reform traditionally clinician-led healthcare models to an earlier consumer-led model and the benefits and limitations associated with it. Additionally, we look to explore advances in hearing technologies and services, and if these will or can contribute to a behavioral change in the hearing healthcare journey of consumers.