Ecological Momentary Assessment (EMA) is a method that can be used to evaluate hearing problems and hearing aids in everyday life. In the past EMA studies, hearing aid satisfaction ratings have often been close to ceiling. This poses the question if hearing aid performance really is perfect for all the situations EMA respondents experience in real life or if there are other reasons for this. Possibly, participants are reluctant to give negative ratings even when dissatisfied, do not have the resources to answer a survey in difficult situations or are avoiding, leaving, or modifying dissatisfactory hearing situations before answering a survey. All those biases could lead to an overestimation of hearing aid performance and a lower contrast between e.g. two different hearing programs that are being evaluated.

To analyze the reason for the very positive ratings, we conducted a study with eleven experienced hearing aid wearers (mean age 72 years, SD: 5.6 years, pure tone average 37.7 dB HL, SD: 12.2 dB HL) who were fitted with study hearing aids. The acceptable noise level (ANL) of participants was measured, and they rated hearing aid satisfaction, speech understanding and listening effort for defined SNRs between -10 and +20 dB in the laboratory. These ratings were then compared to ratings of a two-week EMA trial. Also, estimates of SNRs during the wearing time were collected via the hearing aids.

Initial results show that for hearing aid satisfaction and speech understanding, the full rating scale was used in the laboratory, while results in real life are strongly skewed towards positive ratings. Hence reluctance to give negative feedback is likely not the underlying reason for the positive ratings in real life.

In the laboratory, the SNRs closest to the ANL were generally rated in the range of “satisfied” to “very satisfied” and participants indicated “some effort” at these SNRs. SNRs experienced during speech situations in real life span the whole range of SNRs tested in the laboratory, but SNRs which were rated negatively in the laboratory make up less than 15 % of the speech situations experienced in real life.

Hence, people do not seem to frequently experience listening situations at SNRs where they are dissatisfied with their hearing aids and this could be the reason for the overly positive hearing aid satisfaction ratings in EMA studies. It remains unclear whether the scarcity of such situations is due lack of encounters or intentional avoidance.