Core Outcome Set Implementation Toolkit
This toolkit supports clinical adoption of the core outcome set established by the 2025 NASEM Meaningful Outcome Measures report. Use these tools—alongside any others that you deem clinically appropriate—when assessing hearing health interventions in adults.
Unlike during diagnostic use, you should administer these measures before and after intervention to track progress over time and enable comparison across settings.
Outcome Set At A Glance
| Outcome Domain | Measure | Type |
|---|---|---|
| Understanding speech in complex listening situations |
Abbreviated Profile of Hearing Aid Benefit (APHAB)—Global score |
Subjective |
| Understanding speech in complex listening situations |
Words-in-Noise Test (WIN) |
Objective |
| Hearing-related psychosocial health |
Revised Hearing Handicap Inventory (RHHI) |
Subjective |
Measures
APHAB—Abbreviated Profile of Hearing Aid Benefit
Minimal Detectable Difference
A change of ≥17% between unaided and aided Global Scores indicates meaningful benefit.
Outcome domain
Speech-in-Noise
What it measures
Patient-reported difficulty with communication and environmental noises across a range of listening situations (24 items, 18 scored).
Note: Designed for hearing aids but applicable across hearing health interventions.
Access materials
- APHAB webpage (includes PDF versions of the tool in several languages)
- Download APHAB Form A [PDF]
| Patient Instructions | “Please circle the answers that come closest to your everyday experience. Notice that each includes a percentage. You can use this to help you decide on your answer. For example, if a statement is true about 75% of the time, circle “C” for that item. If you have not experienced the situation we describe, try to think of a similar situation that you have been in and respond for that situation. If you have no idea, leave that item blank." (Cox & Alexander, 1995) |
|---|---|
| Pre-test | Administer at time of hearing evaluation or during hearing aid discussion (“Unaided” column). |
| Post-test | Administer at hearing aid follow-up, consider after the trial period or once patient has acclimated (“Aided” column). |
| Time to complete | Approximately 5–15 minutes (18 items) |
| Format options |
|
Global Score Calculation
Calculate the average of the Ease of Communication, Background Noise, and Reverberation subscales (18 items).
Note: Manual scoring is lengthy—NOAH and Windows calculate automatically.
Benefit calculation
Compare “Unaided” vs. “Aided” scores. A ≥ 17% change indicates meaningful benefit.5
Scoring Guide—Manual Scoring Guide [PDF]
WIN—Words-in-Noise Test
Minimal Detectable Difference
A change of ±3.5 dB in signal-to-babble threshold indicates a meaningful difference in speech-in-noise performance.
Outcome domain
Speech-in-Noise
What it measures
Speech-in-noise performance. Patients repeat monosyllabic words presented against multi-talker babble. Yields a dB signal-to-babble ratio threshold based on percent correct.
Note: Commonly used as a diagnostic tool. Within the core outcome set, administer before and after intervention to capture change.
Access materials
- NIH Toolbox (iPad only; subscription required to score/save)—Instructions for how to download–request the “B-level access form” for the WIN
- VA CD download—WIN tracks on CD 4
- Pre-loaded on some audiometers
| Patient Instructions | “You will hear a woman asking you to repeat various words. Repeat the words she asks out loud so that I can hear you. For example, if you hear her say, ‘Say the word dog,’ you would say, ‘dog.’ If you are not sure what she said, just say what you think you heard. You will also hear people talking in the background. Do your best to ignore them and to focus on the woman’s voice asking you to repeat the words. Do you have any questions?” (Hook & Giella, 2023) |
|---|---|
| Test parameters |
|
| Pre-test | Administer at time of hearing evaluation or hearing aid discussion—or prior to hearing health intervention. To administer the WIN unaided:
|
| Post-test | Administer at hearing aid follow-up, at end of trial period, or once patient has acclimated—or following another hearing health intervention. To administer the WIN aided:
|
| Time to complete | 2:20 (min:sec) per list (5 items per SNR): 4–6 minutes total |
Scoring guide
Mark each word correct or incorrect. Using the WIN Score Sheets (pages 9–12) [PDF], match number correct to the corresponding threshold.
Word lists
Two 35-word lists (5 words per SNR). Multiple word order variants. A third list is available as practice.
Benefit calculation
Compare aided vs. unaided scores. A change of ±3.5 dB is a significant change in speech-in-noise listening abilities.
RHHI—Revised Hearing Handicap Inventory
Significant Change Threshold
A change of ±6 points on the total score indicates a meaningful difference in hearing-related psychosocial health.
Outcome domain
Psychosocial health
What it measures
Emotional consequences and social/situational effects of hearing loss (18 items). Derived from the Hearing Handicap Inventory for the Elderly (HHIE) and the Hearing Handicap Inventory for Adults (HHIA).
Note: Commonly used as a diagnostic tool, but within the NASEM core outcome set, it is administered pre- and post-intervention to capture change following hearing health intervention.
Access materials—Download RHHI Form [PDF]
| Patient Instructions | “The purpose of this scale is to identify the problems your hearing loss may be causing you. Answer YES, SOMETIMES, or NO for each question. Do not skip a question if you avoid a situation because of your hearing problem.” (Cassarly, Matthews, Simpson, & Dubno, 2020) |
|---|---|
| Pre-test | Administer at time of hearing evaluation or during hearing aid discussion—or prior to hearing health intervention. If the patient uses amplification, ask them to respond as they hear WITHOUT the device. |
| Post-test | Administer at hearing aid follow-up, at end of trial period, or once patient has acclimated—or following another hearing health intervention. Ask the patient to respond as they hear with the device. |
| Time to complete | Approximately 2–5 minutes (18 items) |
| Format options | Paper and pen (RHHI) [PDF] |
Scoring guide
“Yes” = 4 pts. “Sometimes” = 2 pts. “No = 0 pts.
Total score calculated at the bottom of the form.
Benefit calculation
Compare aided vs. unaided scores. A change of ±6 points is a significant change in hearing-related psychosocial health.8
References
Cassarly, C., Matthews, L. J., Simpson, A. N., & Dubno, J. R. (2020). The Revised Hearing Handicap Inventory and Screening Tool based on psychometric reevaluation of the Hearing Handicap Inventories for the Elderly and Adults. Ear and Hearing, 41(1), 95–105. https://doi.org/10.1097/AUD.0000000000000746
Chisolm, T. H., Abrams, H. B., McArdle, R., Wilson, R. H., & Doyle, P. J. (2005). The WHO-DAS II: Psychometric properties in the measurement of functional health status in adults with acquired hearing loss. Trends in Amplification, 9(3), 111–126. https://doi.org/10.1177/108471380500900303
Cox, R. M., & Alexander, G. C. (1995). The Abbreviated Profile of Hearing Aid Benefit. Ear and Hearing, 16(2), 176–186.
Dillard, L. K., Matthews, L. J., & Dubno, J. R. (2025). Change on the Revised Hearing Handicap Inventory and associated factors: Results from a longitudinal cohort study. International Journal of Audiology, 64(5), 460–470. https://doi.org/10.1080/14992027.2024.2364197
Hook, J. N. (ed), & Giella, A. K. (ed). (2023). National Institutes of Health (NIH) Toolbox® V3 Administration Manual. Toolbox Assessments, Inc.
National Academies of Sciences, Engineering, and Medicine. "Measuring meaningful outcomes for adult hearing health interventions." (2025). https://doi.org/10.17226/29104
Newman, C. W., Weinstein, B. E., Jacobson, G. P., & Hug, G. A. (1990). The Hearing Handicap Inventory for Adults: Psychometric adequacy and audiometric correlates. Ear and Hearing, 11(6), 430–433.
Wilson, R. H. (2003). Development of a speech-in-multitalker-babble paradigm to assess word-recognition performance. Journal of the American Academy of Audiology, 14(9), 453–470.
Wilson, R. H., & McArdle, R. (2007). Intra- and inter-session test, retest reliability of the Words-in-Noise (WIN) Test. Journal of the American Academy of Audiology, 18, 813–825. https://doi.org/10.3766/jaaa.18.10.2
Ventry, I. M., & Weinstein, B. E. (1982). The Hearing Handicap Inventory for the Elderly: A new tool. Ear and Hearing, 3(3), 128–134.
