New NASEM Report Recommends Core Outcome Measures for Hearing Health Interventions

On May 14, 2025, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a consensus report, Measuring Meaningful Outcomes for Adult Hearing Health Interventions. The report and its recommendations are needed because current methods for measuring and reporting clinical outcomes in hearing healthcare are highly inconsistent, creating an “apples-to-oranges” situation when comparing interventions or assessing their real-world effectiveness. This lack of standardization not only limits the ability to pool data across studies but also risks overlooking the outcomes that are most meaningful to adults with hearing difficulties, as well as researchers, audiologists, and other healthcare providers.

The committee ultimately recommended three objective and self-report tools: the Words in Noise (WIN) test¹ and the Abbreviated Profile of Hearing Aid Benefit questionnaire (APHAB-Global Score)² for understanding speech in complex situations, and the Revised Hearing Handicap Inventory (RHHI)³ for measuring the perceived social and emotional impact of hearing-related issues.

Developed by a 13-member expert committee led by Dr. Theodore (Ted) Ganiats of the University of California, San Diego, the report provides recommendations for standardizing outcome measurement in adult hearing care, with the goal of ensuring that interventions are evaluated based on what matters most to both patients and clinicians. The committee was comprised of experts in audiology, primary care, rehabilitation, epidemiology, and quality of life research.

A NASEM webcast from Monday, May 12, hosted by Dr. Ganiats summarizes the committee's findings.

How Core Outcomes Were Identified

The committee focused on outcomes related to the effectiveness of adult-onset hearing health interventions, particularly common amplification devices such as hearing aids. The evaluation emphasized meaningful distal outcomes—such as improved speech understanding in noise or enhanced social and emotional well-being—rather than more proximal ones like audibility, which are intervention-specific and difficult to generalize.

While outcome measurement practices vary widely across research and clinical settings, the committee operated under the assumption that such measurement is both essential and ongoing. Their task was to recommend which outcomes to prioritize and how to measure them across a broad range of interventions and populations.

To define a “core outcome set,” the committee undertook a comprehensive literature review, hosted public webinars with adults experiencing hearing difficulties, and invited commentary from clinicians and professional groups. Three main criteria guided outcome selection:

1. The outcome had to be clearly defined and strongly associated with hearing difficulties;
2. It had to be universally meaningful to adults with hearing difficulties and their clinicians;
3. It had to be important to measure across diverse intervention types and contexts.

Outcomes were categorized as either proximal (e.g., audibility) or distal (e.g., functional communication). The committee concluded that while verifying audibility is essential (e.g., an audiogram), it is too context-dependent to be included in the core outcome set.

NASEM Committee's Recommended Outcome Measurement Tools

Individuals and organizations engaged in hearing health interventions should adopt the following outcomes as a core outcome set in both research and clinical settings:

• Understanding speech in complex listening situations
• Hearing-related psychosocial health

To assess these, the committee recommends a combination of objective and self-report tools:

• For understanding speech:
  • Words in Noise (WIN) test – chosen for its psychometric robustness and test–retest reliability.
  • Abbreviated Profile of Hearing Aid Benefit (APHAB – Global Score) – a self-report measure emphasizing complex listening scenarios.
• For psychosocial health:
  • Revised Hearing Handicap Inventory (RHHI) – a streamlined version of the widely used Hearing Handicap Inventory for the Elderly (HHIE), offering a reliable yet practical tool for capturing perceived hearing-related social and emotional impact.

The report stresses that these represent a minimum standard for outcome measurement and that other outcomes may still be valuable in specific contexts.

Their mission was to identify core outcome measures that reflect the lived experiences of adults with hearing difficulties while enhancing the scientific rigor, consistency, and comparability of research and clinical practice in hearing health.

Recommendations and Future Directions

The committee also made several recommendations, including:

• Research Expansion: More direct research is needed to identify outcomes that matter most to patients, beyond the usual satisfaction surveys. This includes developing new or revised measures that better reflect individual lived experience.
• Psychometric Refinement: Further validation is needed to improve the sensitivity, reliability, and cross-language utility of existing tools. The committee specifically called for continued development of the WIN test, exploration of the QuickSIN and digits-in-noise tests, and use of item response theory.
• Implementation Strategies: To promote adoption, the committee recommends embedding the core outcome measures in electronic health records (EHRs), incentivizing their use in research and clinical reimbursement models, and ensuring broad dissemination through professional training and public awareness.

The report also urges national health agencies like NIH, and the Department of Defense and VA to establish a centralized data repository. This would allow researchers and clinicians to benchmark outcomes, support big-data analysis, and adapt core measures over time based on emerging evidence.

A Step Toward More Consistency in Outcomes Measurement

In a webinar presentation on Monday, May 12 that summarized the report, Chair Dr. Ganiats emphasized that outcome measures must do more than validate treatment; they must reflect the real-world impact of hearing interventions on people’s lives. The committee hopes this work will pave the way for more patient-centered care, enable more rigorous comparisons between treatments, and ultimately improve hearing-related quality of life for millions of older adults.

As such, the NASEM report appears to be a step forward for helping align hearing healthcare with outcomes that matter—not just for researchers, but for individuals living with hearing loss every day.