P-CHAT OTC Trial (Humes et al., 2025)

<b>Trial Design:</b> This is a randomized multisite noninferiority comparative-effectiveness clinical trial with three parallel branches comparing a best-practices audiologist-fit method to two experimental self-fit (person-fit) methods. Outcomes were measured at 6 weeks and 6 months post-fit.<b>Method:</b> Participants: Five hundred eighty-four participants met the following inclusion criteria and enrolled: (a) age between 50 and 79 years; (b) never used or tried hearing aids previously; (c) can speak, read, and understand English well; (d) willing to purchase the study hearing aids for $650/pair; (e) no diagnosis of a memory or cognitive impairment; (f) 25-item Hearing Handicap Inventory for the Elderly (HHIE) score &gt; 4; (g) Montreal Cognitive Assessment score ≥ 23; and (h) not excluded due to specific audiometric criteria. The audiometric exclusion criteria, based on air-conduction pure-tone thresholds, were as follows: (a) thresholds at all frequencies (250–8000 Hz) &lt; 20 dB HL, for both ears (no hearing loss); (b) pure-tone average for 500, 1000, 2000, and 4000 Hz (PTA4) in the better ear &gt; 50 dB HL (greater than moderate hearing loss); and (c) interaural difference &gt; 20 dB at three or more frequencies or ≥ 40 dB at 500 or 1000 Hz. Interventions: Three groups received the same hearing aids fitted either by an audiologist using best practices (Group AB) or by themselves using one of two efficacious self-fit methods (Groups CD and EF). Objectives: The effectiveness of each of the self-fit methods, CD and EF, was hypothesized to be noninferior to the professional-fit method, AB. Outcomes: The primary outcome measure was the global score from the Profile of Hearing Aid Benefit (PHAB), and the secondary outcome measure was the benefit score (unaided – aided) for the 25-item HHIE. Randomization: Participants were stratified into one of three hearing loss categories based on better-ear PTA4: normal (≤ 20 dB HL), mild (20.1–35 dB HL), or moderate (35.1–50 dB HL). The random assignment of sequential enrollees within each hearing loss category to the three treatment groups made use of a site-specific pregenerated randomization list produced from a random-numbers table. Blinding: It was not possible to blind the participants as to the fitting method used, but the research personnel assessing the outcomes were blinded to the treatment group.<b>Results:</b> Numbers randomized: The 584 enrollees were randomized to one of the three treatment groups: AB (n = 190), CD (n = 193), and EF (n = 201).Trial status: The trial began on November 1, 2020, and 6-month outcomes were obtained from the last participant on March 29, 2024. Numbers analyzed: At the 6-week measurement interval, outcome measures were completed for 182 AB, 172 CD, and 178 EF participants, representing 91.1% of the 584 individuals who enrolled. At the 6-month interval, completed outcomes were available for 166 AB, 148 CD, and 151 participants, representing 79.6% of the 584 original enrollees. Outcome: Bootstrapped (N = 1,000) means and 95% confidence intervals (CIs) at 6 weeks were 16.4 (95% CI [14.3, 18.7]), 16.8 (95% CI [14.9, 18.6]), and 15.2 (95% CI [13.5, 17.1]) for the AB, CD, and EF treatment groups on the primary outcome measure (PHAB global). At 6 months, primary outcome scores were 15.5 (95% CI [13.4, 17.8]), 16.3 (95% CI [14.4, 18.2]), and 15.3 (95% CI [13.5, 17.3]) for the AB, CD, and EF treatment groups, respectively. At both measurement intervals, there were no significant effects of treatment group (p &gt; .05) for the primary or secondary outcome measures. Harms: No significant adverse events or side effects were observed.<b>Conclusions: </b>At both the 6-week and 6-month postfit intervals, each of the two self-fit methods (CD, EF) yielded outcomes (primary and secondary) that were noninferior to the professional-fit best-practices (AB) fitting method. In addition, on average, clinically meaningful benefit was provided regardless of the fitting method.<b>Supplemental Material S1. </b>Outcome measures recorded at three sessions for each group separately presented for each site.<b>Supplemental Material S2.</b> Results from the physical and mental subscales of the PROMIS10 for sessions 1 and 3 separately presented for each site.<b>Supplemental Material S3.</b>Results of GLM analysis of outcome measures performed for separate hearing-loss subgroups.Humes, L., Dhar, S., Meskan, M., Pitman, A., &amp; Singh, J. (2025). A multisite randomized controlled trial comparing the effectiveness of two self-fit methods to the best-practices method of hearing aid fitting. <i>Journal of Speech, Language, and Hearing Research,</i><i> </i><i>68</i>(4), 2080–2103. https://doi.org/10.1044/2024_JSLHR-24-00423

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