Aplicabilidade de protocolo de adaptação clínica de AASI com acomodação auditiva e acesso progressivo a sons de fala em adultos

Abstract

Hearing impairment is the second most chronic disease worldwide. The growing demand for a clinical therapeutic work in hearing impairments is an evidencebased fact, as is the need for studies on strategies that can be applied to these patients. Regarding the selection and adaptation of individual sound amplification devices (hearing aids), it is ideally recommended in clinical practice to verify whether they provide the desired and safe amplification, close to the target prescribed through electroacoustic tests with a probe microphone. Although prescriptive rules and their verification suggest a standard approximation range around the target to ensure sound access and audibility, the best fit is not always achieved in the first adaptation appointment. Therapeutic clinical follow-up is essential for progress in treatment, respecting the uniqueness of each patient. There is consensus on the need for an adaptation period and neural reorganization for new hearing aid users, and the patient should use it regularly to stimulate plasticity and auditory accommodation. The objective of this study was to investigate the applicability of a clinical adaptation protocol for hearing aids in adults, with auditory accommodation and progressive access to speech sounds, and its impact on the evolution of auditory perception. To this end, we conducted two studies. In Study 1, the results obtained from a group of well-adapted hearing aid users with good treatment adherence were analyzed. In Study 2, the proposed clinical protocol of adaptation to hearing aids with progressive access over time was applied to new users. The premise was to prioritize and maintain gain at the level of best comfort and progressively increase access to speech sounds towards the prescribed target. Our hypothesis is that a clinical management of progressive access favors plasticity and auditory accommodation, with built-on comfort, increasing the consistency of hearing aid use, treatment adherence, and audibility throughout the therapeutic clinical process towards the recommended range around the prescriptive target. The study observed adjustments close to the RMSE standard [+5; -5], validating results of well-adapted experienced users with expected SII values in this group. The study with new users showed good results with the applied protocol, which approached the expected outcomes after 4 months of adaptation, with better speech perception in noise and subject satisfaction. The research highlights the importance of initial consultations with an audiologist in the adaptation process, which can be a key instrument for device accommodation in adult patients. The SII measure and analysis of variations by RMSE can be tools for supporting progressive access as a fine-tuning strategy for hearing aids in adults