{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:11:40Z","timestamp":1789452700120,"version":"build-2803163510"},"reference-count":56,"publisher":"American Academy of Audiology","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["j am acad audiol"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"\n Background:<\/jats:bold>\n 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\n conflicting. Hearing aid manufacturers have promoted the idea that an individual\u2019s 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\n surrounding technology levels and auditory ecology impacts audiologists\u2019 decision-making is unknown.\n Purpose:<\/jats:bold>\n We sought to understand audiologists\u2019 decision-making practices, including how they assess patients\u2019 auditory ecologies and apply the results\n of such assessments to their decisions.\n Research Design:<\/jats:bold>\n 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\u2019 success\n with hearing aids.\n Study Sample:<\/jats:bold>\n Survey respondents were clinical audiologists. A total of 185 completed surveys were included in the analysis.\n Data Collection and Analysis:<\/jats:bold>\n The results of each topic area were summarized descriptively and investigated\n inferentially.\n Results:<\/jats:bold>\n Most participants reported that a patient\u2019s listening demands and environments were the most important considerations when selecting the technology level. The most popular method of evaluating a patient\u2019s auditory ecology was a clinical\n interview. Most audiologists reported recommending higher-level technology for patients with more active lifestyles and lower-level technology for patients with calmer lifestyles.\n Conclusions:<\/jats:bold>\n Audiologists reported prioritizing auditory ecology when selecting a technology\n 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.\n Clinical Relevance Statement:<\/jats:bold>\n 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\n interviews and unique practice approaches to evaluate auditory ecology.\n <\/jats:p>","DOI":"10.3766\/jaaa.250077","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T16:32:45Z","timestamp":1769185965000},"page":"280-297","source":"Crossref","is-referenced-by-count":1,"title":["Audiologist Decision-Making: Hearing Aid Technology Levels and Auditory Ecology"],"prefix":"10.3766","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2066-7715","authenticated-orcid":false,"given":"Rachael","family":"Pennock","sequence":"first","affiliation":[{"name":"*Northwestern University, Evanston, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0928-3479","authenticated-orcid":false,"given":"Pamela","family":"Souza","sequence":"additional","affiliation":[{"name":"*Northwestern University, Evanston, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2087","reference":[{"key":"c1","article-title":"Standards of practice for audiology","year":"2023"},{"key":"c2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1044\/leader.AAG.24082019.32","article-title":"A demographic snapshot of audiologists","volume":"24","year":"2019","journal-title":"ASHA Lead"},{"key":"c3","year":"2024","journal-title":"2023 Audiology survey: Survey summary report: Number and type of responses"},{"issue":"(11)","key":"c4","first-page":"809","article-title":"The use of self-report measures to examine changes in perception in response to fittings using different signal processing parameters","volume":"57","year":"2018","journal-title":"International Journal of Audiology"},{"key":"c5","first-page":"1","article-title":"Decision-making in audiology: Balance evidence-based practice and patient-centered care","volume":"21","year":"2017","journal-title":"Trends in Hearing"},{"issue":"(1)","key":"c6","first-page":"175","article-title":"Evidence-based public health: a fundamental concept for public health practice","volume":"30","year":"2009","journal-title":"Annual Review of Public Health"},{"issue":"(1)","key":"c7","first-page":"95","article-title":"The revised hearing handicap inventory and screening tool based on psychometric reevaluation of the hearing handicap inventories for the elderly and adults","volume":"41","year":"2020","journal-title":"Ear & Hearing"},{"issue":"(5)","key":"c8","first-page":"1313","article-title":"Predicting individual hearing-aid preference from self-reported listening experiences in daily life","volume":"45","year":"2024","journal-title":"Ear & Hearing"},{"key":"c9","first-page":"16","article-title":"Another tool for assessment of communication needs? Try the TRACA: their reported assessment of communication abilities","volume":"7","year":"2015","journal-title":"Audiology Practices"},{"issue":"(8)","key":"c10","first-page":"403","article-title":"Norms for the international outcome inventory for hearing aids","volume":"14","year":"2003","journal-title":"Journal of the American Academy of Audiology"},{"issue":"(2)","key":"c11","first-page":"176","article-title":"The abbreviated profile of hearing aid benefit","volume":"16","year":"1995","journal-title":"Ear and Hearing"},{"issue":"(4)","key":"c12","first-page":"306","article-title":"Measuring satisfaction and amplification in daily life: the SADL scale","volume":"20","year":"1999","journal-title":"Ear and Hearing"},{"issue":"(6)","key":"c13","first-page":"557","article-title":"Impact of advanced hearing aid technology on speech understanding for older listeners with mild to moderate, adult-onset, sensorineural hearing loss","volume":"60","year":"2014","journal-title":"Gerontology"},{"issue":"(4)","key":"c14","first-page":"e224","article-title":"Impact of hearing aid technology on outcomes in daily life I: the patients\u2019 perspective","volume":"37","year":"2016","journal-title":"Ear & Hearing"},{"key":"c15","article-title":"5 key needs assessment","year":"2019"},{"issue":"(1)","key":"c16","first-page":"27","article-title":"Client oriented scale of improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids","volume":"8","year":"1997","journal-title":"Journal of the American Academy of Audiology"},{"key":"c17","volume-title":"Hearing Aids","year":"2012"},{"issue":"(1)","key":"c18","first-page":"20","article-title":"The influence of forced social isolation on the auditory ecology and psychosocial functions of listeners with cochlear implants during COVID-19 mitigation efforts","volume":"42","year":"2021","journal-title":"Ear & Hearing"},{"issue":"(3)","key":"c19","first-page":"185","article-title":"Note on the \u201ccorrection for continuity\u201d in testing the significance of the difference between correlated proportions","volume":"13","year":"1948","journal-title":"Psychometrika"},{"issue":"(4)","key":"c20","first-page":"1010","article-title":"Occupational stress in US audiologists","volume":"30","year":"2021","journal-title":"American Journal of Audiology"},{"key":"c21","first-page":"221","year":"1999"},{"issue":"(3)","key":"c22","first-page":"130","article-title":"Linear and nonlinear hearing aid fittings \u2013 1. Patterns of benefit","volume":"45","year":"2006","journal-title":"International Journal of Audiology"},{"issue":"(3)","key":"c23","first-page":"153","article-title":"Linear and nonlinear hearing aid fittings\u20132. Patterns of candidature","volume":"45","year":"2006","journal-title":"International Journal of Audiology"},{"issue":"(2)","key":"c24","first-page":"85","article-title":"The speech, spatial and qualities of hearing scale (SSQ)","volume":"43","year":"2004","journal-title":"International Journal of Audiology"},{"issue":"(3)","key":"c25","first-page":"229","article-title":"Case factors affecting recommendations by hearing care professionals","volume":"26","year":"2015","journal-title":"Journal of the American Academy of Audiology"},{"issue":"(2)","key":"c26","first-page":"191","article-title":"Communication patterns in audiologic rehabilitation history-taking: Audiologists, patients, and their companions","volume":"36","year":"2015","journal-title":"Ear & Hearing"},{"issue":"(10278)","key":"c27","first-page":"996","article-title":"Hearing loss prevalence and years lived with disability, 1990 \u2013 2019: findings from the global burden of disease study 2019","volume":"397","year":"2021","journal-title":"The Lancet"},{"issue":"(3)","key":"c28","first-page":"149","article-title":"Effect of hearing aid technology level on new hearing aid users","volume":"33","year":"2022","journal-title":"Journal of the American Academy of Audiology"},{"key":"c29","first-page":"235","article-title":"Auditory ecology in a group of experienced hearing-aid users: Can knowledge about hearing-aid users\u2019 auditory ecology improve their rehabilitation","year":"2005"},{"issue":"(5)","key":"c30","first-page":"529","article-title":"Impact of hearing aid technology on outcomes in daily life II: Speech understanding and listening effort","volume":"37","year":"2016","journal-title":"Ear & Hearing"},{"issue":"(6)","key":"c31","first-page":"746","article-title":"Impact of hearing aid technology on outcomes in daily life III: Localization","volume":"38","year":"2017","journal-title":"Ear & Hearing"},{"issue":"(3)","key":"c32","first-page":"603","article-title":"Auditory environments and hearing aid feature activation among younger and older listeners in an urban and rural area","volume":"44","year":"2023","journal-title":"Ear & Hearing"},{"issue":"(4)","key":"c33","first-page":"2395","article-title":"Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal-hearing and hearing-impaired listeners","volume":"116","year":"2004","journal-title":"The Journal of the Acoustical Society of America"},{"issue":"(4)","key":"c34","first-page":"1299","article-title":"Assessment of hearing-related lifestyle based on the common sound scenarios framework","volume":"31","year":"2022","journal-title":"American Journal of Audiology"},{"issue":"(2)","key":"c35","first-page":"153","article-title":"Note on the sampling error of the difference between correlated proportions or percentages","volume":"12","year":"1947","journal-title":"Psychometrika"},{"issue":"(9)","key":"c36","first-page":"626","article-title":"Acceptable noise level as a predictor of hearing-aid use","volume":"17","year":"2006","journal-title":"Journal of the American Academy of Audiology"},{"issue":"(2)","key":"c37","first-page":"143","article-title":"Development of the tinnitus handicap inventory","volume":"122","year":"1996","journal-title":"Archives of Otolaryngology - 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