When adjusted for gender and age to the European Standard Population, the prevalence of hearing impairment observed both in HÖRSTAT and the Aalen sample is considerably lower than reported for international studies. Since the analysis refers to cross-sectional data only, possible cohort effects are not considered in the prevalence projection.

Common methods to assess hearing deficits and the benefit of hearing devices include retrospective questionnaires and speech tests under controlled conditions. As typically applied, both approaches suffer from serious limitations regarding their ecological validity. An alternative approach rapidly gaining widespread use is ecological momentary assessment (EMA), which employs repeated assessments of individual everyday situations. Smartphones facilitate the implementation of questionnaires and rating schemes to be administered in the real life of study participants or customers, during or shortly after an experience. In addition, objective acoustical parameters extracted from head- or body-worn microphones and/or settings from the hearing aid’s signal processing unit can be stored alongside the questionnaire data. The advantages of using EMA include participant-specific, context-sensitive information on activities, experienced challenges, and preferences. However, to preserve the privacy of all communication partners and bystanders, the law in many countries does not allow audio recordings, limiting the information about environmental acoustics to statistical data such as, for example, levels and averaged spectra. Other challenges for EMA are, for example, the unsupervised handling of the equipment, the trade-off between the accuracy of description and the number of similar listening situations when performing comparisons (e.g., with and without hearing aids), the trade-off between the duration of recording intervals and the amount of data collected and analyzed, the random or target-oriented reminder for subjective responses, as well as the willingness and ability of the participants to respond while doing specific tasks. This contribution reviews EMA in hearing research, its purpose, current applications, and possible future directions.

Ecological momentary assessment (EMA) was used in 24 adults with mild-to-moderate hearing loss who were seeking first hearing-aid (HA) fitting or HA renewal. At two stages in the aural rehabilitation process, just before HA fitting and after an average 3-month HA adjustment period, the participants used a smartphone-based EMA system for 3 to 4 days. A questionnaire app allowed for the description of the environmental context as well as assessments of various hearing-related dimensions and of well-being. In total, 2,042 surveys were collected. The main objectives of the analysis were threefold: First, describing the “auditory reality” of future and experienced HA users; second, examining the effects of HA fitting for individual participants, as well as for the subgroup of first-time HA-users; and third, reviewing whether the EMA data collected in the unaided condition predicted who ultimately decided for or against permanent HA use. The participants reported hearing-related disabilities across the full range of daily listening tasks, but communication events took the largest share. The effect of the HA intervention was small in experienced HA users. Generally, much larger changes and larger interindividual differences were observed in first-time compared with experienced HA users in all hearing-related dimensions. Changes were not correlated with hearing loss or with the duration of the HA adjustment period. EMA data collected in the unaided condition did not predict the cancelation of HA fitting. The study showed that EMA is feasible in a general population of HA candidates for establishing individual and multidimensional profiles of real-life hearing experiences.