{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T18:10:23Z","timestamp":1790273423147,"version":"4.1.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation","award":["RS-2023-00210073"],"award-info":[{"award-number":["RS-2023-00210073"]}]},{"name":"Catholic Medical Center Research Foundation","award":["2022 Research Program"],"award-info":[{"award-number":["2022 Research Program"]}],"id":[{"id":"https:\/\/ror.org\/00ng7yn96","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Real-ear measurement (REM) is commonly used to verify hearing aid fittings; however, its added benefit over non-REM fitting in unilateral users and the influence of contralateral ear hearing remain unclear. In this retrospective study, we compared short-term audiometric and patient-reported outcomes between an REM-based fitting pathway and a manufacturer-first-fit pathway followed by routine clinical fine-tuning in unilateral hearing-aid users, and examined associations with contralateral-ear hearing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed data from 105 unilateral hearing aid users with 3 months of follow-up (REM: n\u2009=\u200960; non-REM: n\u2009=\u200945). Baseline measures included pure-tone averages (PTA4) of the aided ear (i.e., the ear fitted with the hearing aid) and contralateral ear (i.e., the opposite ear), as well as the Hearing Handicap Inventory for the Elderly (HHIE). Outcomes included sound-field functional gain (\u0394PTA4), achievement of \u226510 dB gain, change in HHIE (\u0394HHIE; responder \u226518-point reduction), and the International Outcome Inventory for Hearing Aids (IOI-HA) scores at 3 months. Group comparisons were performed using non-parametric tests, and multivariable linear and logistic regression models were used to adjust for demographic and audiometric covariates. Associations between contralateral ear hearing and outcomes were examined using correlation and subgroup analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline characteristics were generally comparable between groups, although fitted side differed. At 3 months, mean functional gain was 11.0\u2009\u00b1\u200910.6 dB HL in the REM group and 9.1\u2009\u00b1\u200910.1 dB HL in the non-REM group (p\u2009=\u20090.2145). Mean \u0394HHIE was 25.7\u2009\u00b1\u200930.3 and 32.9\u2009\u00b1\u200928.6 points (p\u2009=\u20090.1680), and mean IOI-HA scores were 24.4\u2009\u00b1\u20096.7 and 23.9\u2009\u00b1\u20095.9, respectively (p\u2009=\u20090.9492). In adjusted analyses, the REM-based fitting pathway was not associated with \u0394HHIE (\u03b2\u2009=\u20091.97; 95% CI, \u22123.12 to 7.06) or 3-month IOI-HA score (\u03b2\u2009=\u20090.32; 95% CI, \u22122.23 to 2.86). Worse contralateral-ear PTA4 was associated with greater HHIE improvement (r\u2009=\u20090.389, p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective cohort of unilateral hearing-aid users, an REM-based fitting pathway was not associated with statistically significant 3-month audiometric or patient-reported outcome differences compared with manufacturer first-fit followed by routine fine-tuning; this does not establish equivalence or isolate the effect of REM. Contralateral-ear hearing was associated with perceived handicap improvement and may be relevant to outcome interpretation and counseling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358875","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:35:51Z","timestamp":1790271351000},"page":"e0358875","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of real-ear measurement-based fitting in unilateral hearing aid users: Influence of contralateral hearing"],"prefix":"10.1371","volume":"21","author":[{"given":"Jeon Mi","family":"Lee","sequence":"first","affiliation":[{"name":"Ilsan Paik Hospital, Inje University College of Medicine","place":["Goyang, Korea"],"department":["Department of Otorhinolaryngology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae Hoon","family":"Kong","sequence":"additional","affiliation":[{"name":"Yonsei University Wonju College of Medicine","place":["Wonju, South Korea"],"department":["Department of Otorhinolaryngology-Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5991-2783","authenticated-orcid":true,"given":"Jeong-woo","family":"Lee","sequence":"additional","affiliation":[{"name":"Yonsei University Wonju College of Medicine","place":["Wonju, South Korea"],"department":["Department of Medical Informatics and Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3826-8830","authenticated-orcid":true,"given":"Hyun Jin","family":"Lee","sequence":"additional","affiliation":[{"name":"Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea","place":["Seoul, Korea"],"department":["Department of Otorhinolaryngology-Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"5","key":"pone.0358875.ref001","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2471\/BLT.13.128728","article-title":"The global burden of disabling hearing impairment: A call to action","volume":"92","author":"BO Olusanya","year":"2014","journal-title":"Bull World Health Organ"},{"key":"pone.0358875.ref002","doi-asserted-by":"crossref","first-page":"1526719","DOI":"10.3389\/fpubh.2025.1526719","article-title":"The global prevalence of complete hearing loss in 204 countries and territories from 1992 to 2021: A systematic analysis for the global burden of disease study 2021","volume":"13","author":"G-J Huang","year":"2025","journal-title":"Front Public Health"},{"issue":"3","key":"pone.0358875.ref003","doi-asserted-by":"crossref","DOI":"10.1001\/jamahealthforum.2021.0357","article-title":"WHO Report Predicts Hearing Loss for 1 in 4 People Worldwide by 2050","volume":"2","author":"J Stephenson","year":"2021","journal-title":"JAMA Health Forum"},{"key":"pone.0358875.ref004","doi-asserted-by":"crossref","first-page":"15333175241227318","DOI":"10.1177\/15333175241227318","article-title":"Hearing impairment and cognitive function: Mediating role of social isolation and depression","volume":"39","author":"F Wu","year":"2024","journal-title":"Am J Alzheimers Dis Other Demen"},{"issue":"5","key":"pone.0358875.ref005","doi-asserted-by":"crossref","first-page":"285","DOI":"10.3109\/14992027.2015.1120892","article-title":"Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL)","volume":"55","author":"Y-H Wu","year":"2016","journal-title":"Int J Audiol"},{"key":"pone.0358875.ref006","doi-asserted-by":"crossref","first-page":"1158272","DOI":"10.3389\/fragi.2023.1158272","article-title":"Impact of hearing aid technology level at first-fit on self-reported outcomes in patients with presbycusis: A randomized controlled trial","volume":"4","author":"SS Houm\u00f8ller","year":"2023","journal-title":"Front Aging"},{"issue":"4","key":"pone.0358875.ref007","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1177\/108471389600100402","article-title":"Real-ear measurement of hearing threshold and loudness","volume":"1","author":"LE Humes","year":"1996","journal-title":"Trends Amplif"},{"issue":"6","key":"pone.0358875.ref008","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1097\/AUD.0000000000001051","article-title":"Predicting hearing aid satisfaction in adults: A systematic review of speech-in-noise tests and other behavioral measures","volume":"42","author":"A Davidson","year":"2021","journal-title":"Ear Hear"},{"issue":"23","key":"pone.0358875.ref009","article-title":"A position statement on the treatment of hearing impairment, focused on hearing aids, from the Korean Otological Society Hearing Aid Study Group","volume":"40","author":"JM Lee","year":"2025","journal-title":"J Korean Med Sci"},{"issue":"7","key":"pone.0358875.ref010","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-038113","article-title":"Does probe-tube verification of real-ear hearing aid amplification characteristics improve outcomes in adult hearing aid users? A protocol for a systematic review","volume":"10","author":"I Almufarrij","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0358875.ref011","article-title":"Fitting a hearing aid on the better ear, worse ear, or both: Associations of hearing-aid fitting laterality with outcomes in a large sample of US veterans","volume":"27","author":"O Zobay","year":"2023","journal-title":"Trends Hear"},{"key":"pone.0358875.ref012","article-title":"Negative consequences of uncorrected hearing loss--A review","author":"S Arlinger","year":"2003","journal-title":"Int J Audiol"},{"issue":"2","key":"pone.0358875.ref013","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/00003446-198804000-00006","article-title":"The Hearing Handicap Inventory for the Elderly as a measure of hearing aid benefit","volume":"9","author":"CW Newman","year":"1988","journal-title":"Ear Hear"},{"issue":"1","key":"pone.0358875.ref014","doi-asserted-by":"crossref","first-page":"30","DOI":"10.3109\/14992020209101309","article-title":"The International Outcome Inventory for Hearing Aids (IOI-HA): Psychometric properties of the English version","volume":"41","author":"RM Cox","year":"2002","journal-title":"Int J Audiol"},{"issue":"3","key":"pone.0358875.ref015","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1080\/14992027.2022.2154281","article-title":"International Outcome Inventory for Hearing Aids (IOI-HA) translation into isiXhosa","volume":"63","author":"C Frisby","year":"2024","journal-title":"Int J Audiol"},{"key":"pone.0358875.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14992027.2025.2511218","article-title":"Some considerations in the use of the Hearing Handicap Inventory for the Elderly and its derivatives as hearing-aid outcome measures","author":"LE Humes","year":"2025","journal-title":"Int J Audiol"},{"key":"pone.0358875.ref017","doi-asserted-by":"crossref","first-page":"23312165231189596","DOI":"10.1177\/23312165231189596","article-title":"Listening preferences of new adult hearing aid users: A registered, double-blind, randomized, mixed-methods clinical trial of initial versus real-ear fit","volume":"27","author":"I Almufarrij","year":"2023","journal-title":"Trends Hear"},{"key":"pone.0358875.ref018","doi-asserted-by":"crossref","first-page":"2331216521999563","DOI":"10.1177\/2331216521999563","article-title":"Does probe-tube verification of real-ear hearing aid amplification characteristics improve outcomes in adults? A systematic review and meta-analysis","volume":"25","author":"I Almufarrij","year":"2021","journal-title":"Trends Hear"},{"issue":"6","key":"pone.0358875.ref019","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.3390\/jcm12062251","article-title":"Predictable factors of people with asymmetrical hearing loss wearing a hearing aid in the worse ear only","volume":"12","author":"H Noh","year":"2023","journal-title":"J Clin Med"},{"issue":"6","key":"pone.0358875.ref020","doi-asserted-by":"crossref","first-page":"69","DOI":"10.5935\/1808-8694.20120036","article-title":"Hearing aid fitting and unilateral auditory deprivation: Behavioral and electrophysiologic assessment","volume":"78","author":"MB Wieselberg","year":"2012","journal-title":"Braz J Otorhinolaryngol"},{"issue":"6","key":"pone.0358875.ref021","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1097\/AUD.0000000000001694","article-title":"Associations between pre-fitting factors and 2-year hearing aid use persistence, derived from health records and post-fitting battery order data of 284,175 US veterans","volume":"46","author":"G Naylor","year":"2025","journal-title":"Ear Hear"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358875","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:35:55Z","timestamp":1790271355000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358875"}},"subtitle":[],"editor":[{"given":"Gauri","family":"Mankekar","sequence":"first","affiliation":[{"name":"LSU Health Shreveport","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0358875","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}