***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This paper addresses the development and effectiveness of a home education program . The program , design ed for hearing-impaired elders and their significant others ( SO ) , deals with communication strategies and speech reading . Participants were r and omly assigned to a training group ( hearing aid fitting + home education program ) or a control group ( hearing aid fitting ) . The training group included 24 hearing-impaired subjects and 24 SO 's . Controls were 24 affected individuals and 22 SO 's . Question naires addressing emotional response , communication strategies and the IOI-HA , IOI-AI and IOI-SO were used . A repeated measures analysis of variance was applied to test group differences between pre , post , and 6-months follow-up measures . Increased awareness of benefits of speech reading and improved interaction with the SO were observed in the training group only ( p < 0.05 ) . No group difference on ‘ emotional response ’ was found . IOI-AI and IOI-SO demonstrated favorable attitudes towards the program . Follow-up measures showed improved quality of life and satisfaction in the training group , while a decrease was observed among the controls ( p < 0.05 ) . Some effects differed between first-time and experienced hearing aid users . Addition of services to amplification and involvement of the SO are relevant in aural rehabilitation OBJECTIVES To show that hearing loss has such a high prevalence in the older population to justify screening , if effective and acceptable methods are available ; and that population take-up and benefit can make a measurable outcome difference in quality of life . DESIGN A population study of people aged 55 - 74 years was undertaken . A clinical effectiveness study of differently organised screening programmes was carried out using a controlled trial to identify those who might benefit from intervention ( and the extent of the benefit ) . A retrospective case-control study examined the very long-term ( more than 10 years ) compliance of patients in using their hearing aids after early identification and determined the extent to which early-identified hearing-impaired people have better outcomes than equivalent people identified later . An examination of the costs and cost-effectiveness of different potential screening programmes was also undertaken . SETTING A population study was design ed in the UK , with specific stages being conducted in more depth on a sample of people from Nottingham and Southampton . The clinical effectiveness study was conducted in general practice s in Nottingham and Bath using a systematic or opportunistic screen . The retrospective case-control study compared a group of early-identified hearing aid users , with control matched for age , gender and occupation , in Cardiff , Glasgow and Manchester . PARTICIPANTS In Great Britain responses were obtained for 34,362 individuals from the postal question naire as part of a population study , 506 were interviewed , 351 were assessed for benefit from amplification and 87 were fitted with a hearing aid . The clinical effectiveness study received 1461 replies from the first-stage question naire screen , with 306 people assessed in the clinic , of whom 156 were fitted with hearing aids . The retrospective case-control study traced 116 previously fitted hearing aid users , who had been identified by a screen , and then conducted a case-control using 50 of these for whom complete data were available , matching with two control groups of 50 people . INTERVENTIONS The major prospect i ve interventions were to introduce amplification through offering people , with minimal hearing impairment , hearing aid(s ) in a rehabilitative setting . In the population study , aids were offered as a monaural in-the-ear ( ITE ) hearing aid and in the clinical effectiveness study people who met the criteria were r and omised to be offered two different ITE hearing aids to be fitted bilaterally . The retrospective case-control study used unilateral and bilateral hearing aids . MAIN OUTCOME MEASURES Prevalence of hearing problems and degree to which services meet need in 55 - 74-year age group .  Public acceptability and individual benefits of hearing screening and intervention as a function of demographic and hearing domain-specific characteristics . Improvement in quality of life . Screening costs and cost-effectiveness as a function of proposed programmes . RESULTS It was found that 12 % of people aged 55 - 74 years have a hearing problem that causes moderate or severe worry , annoyance or upset , 14 % have a bilateral hearing impairment of at least 35 dB hearing level ( HL ) and only 3 % currently receive intervention , through the use of hearing aids .  Good amplification was shown to benefit about one in four of this 55 - 74-year-old population and the degree of hearing loss predicted benefit well . Overall , there was a strong correlation between benefit from amplification and from using hearing aids . Question naires and audiometric screens gave good screening operating characteristics . The systematic screening programme was more acceptable and gave a better response than the opportunistic . About 70 % of those who were offered an aid accepted a bilateral fitting . This increased to 95 % for those with > or = 35 dB HL ( averaged over 0.5 , 1 , 2 and 4 kHz in the better ear ) . The retrospective case-control study showed that long-term hearing aid use was low , unless hearing impairment was quite high ( e.g. > 35 dB HL ) . Those identified early had greater benefit through additional years of use/better adaptation to use than those of the same age and hearing impairment who were fitted with hearing aids later . Different screening programmes were modelled . The 35 dB HL better ear average hearing impairment level was found to be a good , robust and justifiable target group for screening and here the most efficient and practicable method was to use two questions in primary care concerning hearing problems and a hearing screen using a pure tone at 3 kHz 35 dB HL . The average cost of the screening programme was 13 pounds per person screened or about 100 pounds if treatment costs were included . Making the conservative assumption that identification gives an extra 9 years using hearing aids , the costs of screening and intervention were in the range of 800 - 1000 pounds per quality -adjusted life-year when using the Health Utilities Index and about 2500 pounds using the Short Form 6 Dimensions metric . CONCLUSIONS A simple systematic screen , using an audiometric screening instrument , has been shown to be acceptable to people in the age range 55 - 74 years , is likely to provide substantial benefit and may be cost-effective to those in that target group . Hearing screening appears to meet the National Screening Committee 's criteria in most respects , provided screening is targeted at those with at least 35 dB HL better ear average . Based on the research carried out here there is sufficient evidence to support a larger and more definitive study of hearing screening . Further research into who should be referred for and benefit from audiological assessment and provision of hearing aid in a primary care trust setting is needed as is investigation into screening devices and the various aspects of introducing such a programme Abstract Objective : To investigate the benefits in reported outcomes after providing bluetooth accessories for established hearing aid users . Design : Prospect i ve observational study using vali date d quantitative outcome measures and detailed patient narrative before and two months after patients were provided with bluetooth accessories . Study sample : Twelve patients with bilateral NHS hearing aids participated . They had a wide range of ages and hearing loss . Results : After two months , 10 patients reported substantial additional benefit and kept the accessories ; two returned them for various reasons . Statistically significant changes were seen in two vali date d outcome measures : the Glasgow Hearing Aid Benefit Profile and the International Outcome Inventory – Hearing Aids , but not in the Speech , Spatial and Qualities of Hearing Scale . Two notable benefits were reported : some described hearing the emotion and mood in a voice for the first time ; others were amazed to report an improved ability to hear film or to hold conversations over the telephone . Conclusions : The provision of bluetooth accessories can give additional reported benefit for some patients – we need better knowledge about who benefits , and whether further support/training to individuals would make a difference Hearing impairment has been associated with decline in psychosocial function . Previous investigations have reported that the utilization of hearing aids can ameliorate these reductions in psychosocial function . To date , few investigations have examined the effects of frequency modulation technology on hearing h and icap , adjustment to hearing loss , and communicative strategies . The purpose of this investigation was to examine these effects and to compare them to the benefits obtained when using hearing aids alone .  Subjects ranged in age from 34 to 81 years and had mean pure-tone thresholds consistent with a bilateral moderate to severe sloping sensorineural hearing loss . All subjects wore hearing aids only and hearing aids plus FM system in a r and omized fashion . The Communication Profile for the Hearing Impaired ( CPHI ) was administered prior to fitting the study devices and once a month for three months in each of the two conditions . A statistically significant difference between device conditions was obtained for the Importance of Communication in Work Situations subscale . Additionally , statistically significant differences over time were noted in several CPHI subscales . Despite statistical significance , none of these results were clinical ly significant . The implication s of these results will be discussed Introduction Hearing loss is a major public health concern , affecting over 11 million people in the UK . While hearing aids are the most common clinical intervention for hearing loss , the majority of people that would benefit from using hearing aids do not take them up . Recent technological advances have led to a rapid increase of alternative listening devices to conventional hearing aids . These include hearing aids that can be customised using a smartphone , smartphone-based ‘ hearing aid ’ apps , personal sound amplification products and wireless hearing products . However , no systematic review has been published evaluating whether alternative listening devices are an effective management strategy for people with hearing loss . Methods and analysis The objective of this systematic review is to assess whether alternative listening devices are an effective intervention for adults with hearing loss . Methods are reported according to the Preferred Reporting Items for Systematic review s and Meta-analyses Protocol s ( PRISMA -P ) 2015 checklist . Retrospective or prospect i ve studies , r and omised controlled trials , non-r and omised controlled trials , and before-after comparison studies will be eligible for inclusion . We will include studies with adult participants ( ≥18 years ) with a mild or moderate hearing loss . The intervention should be an alternative listening device to a conventional hearing aid ( comparison ) . Studies will be restricted to outcomes associated with the consequences of hearing loss . We will search relevant data bases to identify published , completed but unpublished and ongoing trials . The overall quality of included evidence will be evaluated using the GRADE system , and meta- analysis performed if appropriate . Ethics and dissemination No ethical issues are foreseen . The findings will be reported at national and international conferences , primarily audiology , and ear , nose and throat , and in a peer- review ed journal using the PRISMA guidelines . Review registration number PROSPERO CRD4201502958 Objectives The objectives of this study were to determine efficacy of hearing aids in older adults using audiology best practice s , to evaluate the efficacy of an alternative over-the-counter ( OTC ) intervention , and to examine the influence of purchase price on outcomes for both service-delivery models . Design The design of this study was a single-site , prospect i ve , double-blind placebo-controlled r and omized trial with three parallel branches : ( a ) audiology best practice s ( AB ) , ( b ) consumer decides OTC model ( CD ) , and ( c ) placebo devices ( P ) . Outcome measures were obtained after a typical 6-week trial period with follow-up 4-week AB-based trial for those initially assigned to CD and P groups . Setting Older adults from the general community were recruited via newspaper and community flyers to participate at a university research clinic . Participants Participants were adults , ages 55–79 years , with mild-to-moderate hearing loss . There were 188 eligible participants : 163 enrolled as a volunteer sample , and 154 completed the intervention . Intervention(s ) All participants received the same high-end digital mini-behind-the-ear hearing aids fitted bilaterally . AB and P groups received best- practice services from audiologists ; differing mainly in use of appropriate ( AB ) or placebo ( P ) hearing aid setting s. CD participants self-selected their own pre-programmed hearing aids via an OTC model . Primary and Secondary Outcome Measures Primary outcome measure was a 66-item self-report , Profile of Hearing Aid Benefit ( Cox & Gilmore , 1990 ) . Secondary outcome measure was the Connected Speech Test ( Cox , Alex and er , & Gilmore , 1987 ) benefit . Additional measures of hearing-aid benefit , satisfaction , and usage were also obtained . Results Per- protocol analyses were performed . AB service-delivery model was found to be efficacious for most of the outcome measures , with moderate or large effect sizes ( Cohen 's d ) . CD service-delivery model was efficacious , with similar effect sizes . However , CD group had a significantly ( p < .05 ) lower satisfaction and percentage ( CD : 55 % ; AB : 81 % ; P : 36 % ) likely to purchase hearing aids after the trial . Conclusions Hearing aids are efficacious in older adults for both AB and CD service-delivery models . CD model of OTC service delivery yielded only slightly poorer outcomes than the AB model . Efficacious OTC models may increase accessibility and affordability of hearing aids for millions of older adults . Purchase price had no effect on outcomes , but a high percentage of those who rejected hearing aids paid the typical price ( 85 % ) . Trial Registration Clinical trials.gov : NCT01788432 ; https:// clinical trials.gov/ct2/show/NCT01788423 Supplemental Material s Background Presbycusis has a direct influence on autonomy of the elderly but hearing aids lack of affordability . Moreover a recent review demonstrate that electroacoustic characteristics of OTC hearing aids were generally not suitable for the elderly people . In our study , we assessed the clinical value of a new over-the-counter ( OTC ) hearing aid device ( TEO First ® ) in the elderly . Method This prospect i ve monocentric open label study included patients over 60 years of age with a mild to moderate presbycusis . Patients were assessed with acceptable noise level test ( ANL ) , pure tone ( PTA 
    Output:
    
The evidence in this review suggests that alternative listening devices improve behavioural measures of speech intelligibility relative to unaided and /or aided conditions .