Bilateral hearing aids gave more benefit than one, though the gap may be small for patients

Design

Single-blinded randomised clinical trial

Population

275 adults aged 50 or over with age-related hearing loss and less than 3 months of hearing aid use

Primary outcome

APHAB benefit score at 3 months

Effect

19.7 (bilateral) vs 14.4 (unilateral); difference 5.3 points (95% CI 1.8 to 8.8)

This single-blinded randomised trial at two US audiology clinics enrolled 275 adults aged 50 or over (mean age 71) with age-related hearing loss who had little or no previous hearing aid use. They were fitted with prescription receiver-in-the-canal aids in one ear or both, and self-reported benefit was measured with the Abbreviated Profile of Hearing Aid Benefit at three months.

Both groups improved. Mean benefit was 14.4 points with one aid and 19.7 with two, a difference of 5.3 points (95% CI 1.8 to 8.8). The authors say this difference is statistically clear but may not reach the threshold patients would notice, and that it informs but does not establish bilateral fitting as the standard.

Cost is the deciding factor for many Indian patients, where hearing aids are usually paid for out of pocket. This trial supports telling patients honestly that one aid gives substantial benefit and two give somewhat more, and letting them choose, rather than offering two or nothing.

• Offer bilateral hearing aids for symmetrical age-related hearing loss where affordable.
• Tell patients that a single aid still gives substantial benefit if two are not affordable.
• Avoid presenting the choice as two aids or none; untreated hearing loss carries its own harms.
• Review benefit at about three months and consider adding a second aid if the patient is still struggling.

Why it matters

It gives randomised evidence for a choice that, in practice, is often made on cost alone.

Don't overread it

A 5-point difference on the benefit scale may be below what patients notice; the trial does not establish bilateral fitting as essential.

The statistics, in plain English

A mean difference of 5.3 points (95% CI 1.8 to 8.8) on the APHAB benefit score is unlikely to be chance. Whether it matters depends on the minimum change patients notice, which the authors say may not have been reached.

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