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This activity was supported by contracts between the National Academy of Sciences and the Centers for Disease Control and Prevention, the Defense Health Agency (contract no. HT942524P0098), the Department of Veterans Affairs, the National Institute on Aging and the National Institute on Deafness and Other Communication Disorders under a contract with the National Institutes of Health (contract no. HHSN263201800029I and task order no. 75N98023F00011), and NAS Endowment.

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Digital Object Identifier: https://doi.org/10.17226/29104
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Measuring meaningful outcomes for adult hearing health interventions. Washington, DC: National Academies Press. https://doi.org/10.17226/29104.

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COMMITTEE ON MEANINGFUL OUTCOME MEASURES IN ADULT HEARING HEALTH CARE

THEODORE G. GANIATS (Chair), University of California, San Diego

KENDALL M. CAMPBELL, University of Texas Medical Branch

TAMALA DAVID, State University of New York at Brockport

LARRY E. HUMES, Indiana University Bloomington

ALAN M. JETTE, Boston University

COLLEEN G. LE PRELL, University of Texas at Dallas

UCHECHUKWU MEGWALU, Stanford University

CATHERINE V. PALMER, University of Pittsburgh and University of Pittsburgh Medical Center

CARLA PERISSINOTTO, University of California, San Francisco

THOMAS A. POWERS, Powers Consulting, LLC

NICHOLAS REED, NYU Grossman School of Medicine

SHERRI SMITH, Duke University School of Medicine

FAN-GANG ZENG, University of California, Irvine

National Academy of Medicine (NAM) Fellows

CAMERON GETTEL, Yale School of Medicine

PAULE JOSEPH, National Institutes of Health

Study Staff

TRACY A. LUSTIG, Senior Program Officer/Study Director

ELLA MORSE, Research Associate

ABIAN HAILU, Senior Program Assistant

TAYLOR KING, Associate Program Officer (from November 2024)

CRYSTAL J. BELL, Program Officer (from July 2024 through December 2024)

JULIE WILTSHIRE, Senior Finance Business Partner

SHARYL J. NASS, Senior Board Director, Board on Health Care Services

Consultant

ROBERT POOL, Science Writer, Digital Pens, LLC

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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

RICHARD ALBA, City University of New York

KATHERINE BOUTON, Hearing Loss Association of America

CHRIS GREAME, Health Care Executive

RONALD HAYS, University of California, Los Angeles

ROBERT KAPLAN, Stanford University

RYAN MCCREERY, Boys Town National Research Hospital

TODD RICKETTS, Vanderbilt University Medical Center

HINRICH STAECKER, University of Kansas Medical Center

ANDREW VERMIGLIO, East Carolina University

BLAKE WILSON, Duke University

SARAH WINGFIELD, University of Texas Southwestern Medical Center

YU-HSIANG WU, The University of Iowa

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by DAVID B. REUBEN, University of California, Los Angeles, and DAN G. BLAZER, II, Duke University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Acknowledgments

The study committee and the Health and Medicine Division project staff take this opportunity to recognize and thank the many individuals who shared their time and expertise to support the committee’s work and to inform deliberations. The committee appreciates the sponsors of this study for their generous financial support: the Centers for Disease Control and Prevention, the Defense Health Agency, the Department of Veterans Affairs, the National Institute on Aging, the National Institute on Deafness and Other Communication Disorders, and NAS Endowment. The contents provided do not necessarily represent the official views of the sponsors.

Over the course of its meetings, the committee heard from many people who shared their stories about their hearing difficulties, particularly regarding what outcomes are most meaningful to them. The committee thanks the participants from its public sessions: Katherine Bouton, Chris Greame, Suzanne Johnston, Eric Matson, Russell Misheloff, Elizabeth Pentin, Kerry Sullivan, and Wynne Whyman. The committee is also grateful for the many submissions to this committee by adults with hearing difficulties as well as their clinicians and care partners.

Additionally, the committee benefited greatly from discussions with representatives of the project’s sponsors, hearing health care clinicians, and representatives from professional groups who participated during the committee’s open sessions:

Yulia Carroll, Centers for Disease Control and Prevention

Lee Cottrell, Balance and Hearing Institute at Farragut ENT & Allergy

Patricia Gaffney, American Academy of Audiologists

Kelly King, National Institute on Deafness and Other Communication Disorders, National Institutes of Health

Rachel McArdle, Veterans Health Administration

Erica Person, Flex Audiology

Sierra Sharpe, International Hearing Society

Donna Smiley, American Speech-Language-Hearing Association

Alicia Spoor, Academy of Doctors of Audiology

Tim Steele, Associated Audiologists, Inc.

The committee is grateful to Erin Giovannetti and Bryan Luce for their early contributions to this project. Deep appreciation goes to the many staff within the National Academies who provided support at various times throughout this project, especially to Violet Bishop, Lori Brenig, Sam Gerard, Megan Lowry, Amber McLaughlin, Rebecca Morgan, Leslie Sim, and Taryn Young. The committee and project staff are grateful to Robert Pool for his drafting and editorial assistance to prepare this report.

Contents

ACRONYMS AND ABBREVIATIONS

SUMMARY

1 INTRODUCTION

Study Origin and Statement of Task

Previous Work of The National Academies

Study Approach

Organization of Report

References

2 CONTEXTUAL BACKGROUND OF ADULT HEARING HEALTH CARE

Prevalence and Severity of Hearing Loss and Hearing Difficulties

Etiology of Hearing Loss

Disparities in Hearing Loss

Classes of Nonsurgical Interventions

Settings for Outcome Measurement

Findings

References

3 GENERAL PRINCIPLES FOR CORE OUTCOME SETS AND OUTCOME MEASUREMENT

Overview of Outcomes and Outcome Measures

Core Outcome Sets

Measurement of Core Outcomes

Assessment of Outcome Measures

Core Outcome Sets and Measurement for Hearing Health Interventions

Findings

References

4 MEANINGFULNESS AND IMPORTANCE TO MEASURE

Overview of Meaningfulness

Peer-Reviewed Literature on Meaningfulness

Other Sources of Evidence on Meaningfulness

Importance to Measure

Findings

Recommendation

References

5 OUTCOMES FOR HEARING HEALTH INTERVENTIONS

Proximal Outcomes of Hearing Health Interventions

Hearing and Communication Outcomes

Outcomes Beyond Hearing and Communication

Findings

Recommendations

References

6 MEASUREMENT OF THE CORE OUTCOME SET

The History of Assessing Hearing Health Outcomes

Committee Process and Criteria

Understanding Speech in Complex Listening Situations

Hearing-Related Psychosocial Health

Statistical Approaches for Future Research

Findings

Recommendations

References

7 DISSEMINATION AND IMPLEMENTATION

Dissemination and Implementation Basics

Dissemination and Implementation for Core Outcome Set Uptake

Strategies to Increasing the Uptake of a Core Outcome Set for Hearing Health Outcomes

Findings

Recommendations

References

APPENDIXES

A Glossary

B Measure Inventory

C Measure Evaluation Worksheet

D WIN vs. QuickSIN Table

E Biographical Sketches of Committee Members and Staff

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Boxes, Figures, and Tables

BOXES

1-1 Statement of Task

4-1 Hearing Health Goals

4-2 Effects of Hearing Loss in the Workplace

4-3 Listening Effort and Listening Fatigue

4-4 Clinician Perspectives on Patient Goals

4-5 What Matters to Adults with Hearing Difficulties

4-6 What Clinicians Hear from Their Patients About What Is Most Meaningful

7-1 Approaches to Dissemination and Implementation of New Information in Hearing Health

FIGURES

S-1 Overview of the committee’s process

S-2 Proximal and distal outcomes of hearing health interventions

1-1 Overview of the committee’s process

2-1 Prevalence and severity of hearing loss by age

2-2 Prevalence of self-reported trouble hearing among U.S. adults aged 20 and older

Acronyms and Abbreviations