Hearing Aid Uptake, Benefit, and Use: The Impact of Hearing, Cognition, and Personal Factors

Exploring factors influencing hearing Aid uptake: insights from a Korean population with unilateral and bilateral hearing loss

OBJECTIVE

To evaluate audiological and nonaudiological predictors of hearing aid (HA) uptake in patients with unilateral hearing loss (UHL) and bilateral hearing loss (BHL).

DESIGN

Retrospective study.

STUDY SAMPLES

A total of 655 patients with UHL and 3,699 patients with BHL were retrospectively included over a 10-year period. The primary audiological measurements were 4-frequency average pure-tone audiometry, speech discrimination score, hearing loss type, and presence of tinnitus.

RESULTS

The HA uptake rates in patients with UHL and BHL were 28.4% and 45.0%, respectively. In the UHL group, no substantial differences were identified between the HA uptake and refusal groups, except for sex. In contrast, the BHL group showed significant differences based on age, sex, and hearing threshold.The significant associations between potential explanatory variables and HA uptake were observed for age, SDS, and tinnitus, with odd ratios of 1.015, 1.004, and 1.251, respectively. The predictive accuracy (discriminating power) was 52.0% for UHL and 55.9% for BHL.

CONCLUSIONS

The statistical analysis of this study indicates that audiological predictors accounted for approximately 50% of the impact on HA uptake. Our findings underscore the importance of considering nonaudiological factors during counselling to enhance HA uptake.

The Impact of Financial Coverage on Hearing Aid Utilization Rates Within the Military Health System

OBJECTIVES

To investigate hearing aid utilization rates among populations with varying hearing aid insurance benefits.

METHODS

A retrospective cohort study was performed. A total of 377 patients were included in the study after being identified through consecutive, hearing loss-related otology clinic visits. With respect to hearing aid benefits, patients were separated into full, partial, and no coverage populations. Chart reviews identified if a patient underwent hearing aid evaluation and fitting. Audiometric data were collected. Chi-square tests of independence and two-sided Z-tests were used for statistical analysis. ANOVA single-factor analysis testing was used to analyze pure tone averages (PTA) and word recognition scores (WRS) data.

RESULTS

The 377 patients who met criteria included: full insurance coverage (n = 210, mean age = 45 years), partial coverage (n = 82, mean age = 65 years), and no coverage (n = 85, mean age = 54 years). The full- and partial-coverage populations each had significantly higher hearing aid utilization rates (78% and 79%, respectively) than the no-coverage population (49%, p < 0.001). No statistical difference in mean PTA or WRS was noted among the three coverage categories.

CONCLUSION

Patients with at least partial financial coverage are more likely to acquire hearing aids than those without despite similar degrees of hearing loss. This implies that the out-of-pocket cost of hearing aids is a primary impediment to hearing aid adoption and provides a useful road map for public and private insurers considering hearing aid coverage.

LEVEL OF EVIDENCE

Level III (retrospective cohort study) Laryngoscope, 2025.

Reasons for the non-use of hearing aids: perspectives of non-users, past users, and family members

OBJECTIVE

Hearing loss in the older adult population is a significant global health issue. Hearing aids can provide an effective means to address hearing loss and improve quality of life. Despite this, the uptake and continued use of hearing aids is low, with non-use of hearing aids representing a significant problem for effective audiological rehabilitation. The aim of this study was to investigate the reasons for the non-use of hearing aids.

DESIGN AND STUDY SAMPLE

A cross-sectional survey was used to investigate the reasons given for the non-use of hearing aids by people with hearing loss (n = 332) and family members (n = 313) of people with hearing loss in Australia, the UK, and USA.

RESULTS

Survey results showed that hearing aid non-users generally cited external factors as reasons for non-use, whereas family members reported non-use due to attitudinal barriers. Past users of hearing aids and family members of past users both identified devices factors as barriers to use.

CONCLUSIONS

Differences in reasons for non-use may provide further insight for researchers and clinicians and help inform future clinical practice in addressing the low uptake and use of hearing aids by people with hearing loss and the role of family members in audiological rehabilitation.

Socioeconomic Deprivation Detrimentally Influences Language Outcomes in Toddlers With Cleft Palate

PURPOSE

The purpose of this study was to examine the influence of socioeconomic deprivation on language and developmental outcomes in toddlers with cleft palate with or without cleft lip (CP ± L). Other factors known to influence language outcomes were also considered, including home language history, history of hearing problems, syndromic diagnoses, and sex.

METHOD

A multicenter, cross-sectional study design was conducted. Data for 566 16-month-old toddlers with CP ± L were collected from 17 outpatient cleft palate clinics located throughout the United States. Outcome measures included the MacArthur-Bates Communicative Development Inventories, LENA Developmental Snapshot, age at first word as reported by the caregiver, and the Ages and Stages Questionnaires-Third Edition (ASQ-3). Multivariable linear or logistic regression was used to determine the influence of socioeconomic deprivation, as measured by the Area Deprivation Index, on language and developmental outcomes.

RESULTS

Greater socioeconomic deprivation significantly predicted poorer language outcomes in toddlers with CP ± L, including receptive vocabulary words (p = .02), expressive vocabulary words (p = .02), and late-developing gestures (p = .02). Additionally, toddlers from less affluent neighborhoods produced their first words significantly later than their counterparts living in more affluent areas (p < .01). Lower maternal education levels predicted significantly increased risk for problem solving delays (p < .01), and patients with subsidized insurance were at significantly increased risk for personal-social delays on the ASQ-3 (p < .01).

CONCLUSIONS

Children with CP ± L are susceptible to developmental delays associated with socioeconomic deprivation. These findings have implications for identifying a child's individual risk factors for developmental language disorders when conducting speech-language assessments. Future study should examine how inequities in care can be mitigated and addressed.

Factors influencing hearing aid use, benefit and satisfaction in adults: a systematic review of the past decade

OBJECTIVE

This systematic review examined the audiological and non-audiological factors that influence hearing aid use, benefit and satisfaction in adults based on studies published during the last decade (2010 and 2023).

DESIGN

Studies were identified by using PRISMA guidelines for systematic searches on five platforms (Web of Science, Scopus, PubMed, EBSCOhost including CINAHL and Academic Search Complete). The National Institute of Health Quality assessment tool and the Oxford Centre for Evidence Based Medicine tool were used for quality assessment and grading of level of evidence.

RESULTS

Forty-six articles were included in the review. A total of 101 significant factors influencing hearing aid use (n = 47), benefit (n = 17) and satisfaction (n = 37) were identified. Clear determinants of hearing aid use, benefit and satisfaction included hearing sensitivity, self-reported hearing difficulty, speech perception, attitude and beliefs. 34 cross-sectional studies in this review were graded level 4, 9 cohort studies rated level 3, and 3 randomised control trials rated level 2.

CONCLUSION

Factors associated with hearing aid outcomes identified in the past decade support previous evidence. New factors like social networks and service-delivery models, have also been identified. These factors require further investigations through high quality studies to further strengthen existing evidence.

Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment

BACKGROUND

Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest.

OBJECTIVE

This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions.

METHODS

In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naïve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis.

RESULTS

The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income.

CONCLUSIONS

This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps.

The leaky pipeline of hearing care: primary to secondary care evidence from the English Longitudinal Study of Ageing (ELSA)

OBJECTIVE

The proportions of older adults' transitions through acknowledging their hearing loss to getting access to treatment are unknown. This was examined using data from a nationally representative cohort in England.

DESIGN

Patient and healthcare factors associated with referrals were examined cross-sectionally, through primary to secondary care. Non-report predictors identified using multiple logistic regression models.

STUDY SAMPLE

8529 adults with hearing data in the English Longitudinal Study of Ageing Wave 7.

RESULTS

Nearly 40% of those with acknowledged hearing loss did not tell a doctor or nurse (n = 857/2249). Women (OR 2.68, 95% CI 2.14-2.98), retirees (OR 1.30, 95% CI 1.17-1.44), those with foreign education (OR 2.74, 95% CI 2.47-3.04), lower education (OR 2.86, 95% CI 2.58-3.18), smokers (OR 4.39, 95% CI 3.95-4.87), and heavy drinkers (OR 1.67, 95% CI 1.58-1.85) were more likely to not report hearing loss. Of those who acknowledged and reported hearing difficulties, willingness to try hearing aid(s) was high (78.9%).

CONCLUSIONS

Unacknowledged, or acknowledged but not reported hearing loss by individuals, and non-referrals by primary healthcare professionals, are barriers to accessing hearing healthcare. Future research should report hearing aid use as the proportion of individuals who acknowledge their hearing loss, to avoid an overestimation of the non-use of hearing aids within study samples.

Over-the-Counter Hearing Aids Challenge the Core Values of Traditional Audiology

PURPOSE

Regulatory changes in the United States introduced over-the-counter (OTC) hearing aids with the goal of increasing the accessibility and affordability of hearing health care. It is critical to understand the values inherent to hearing health care systems to evaluate their effectiveness in serving people with hearing difficulty. In this study, we evaluated the relative importance of values across service delivery models and the extent to which the introduction of OTC hearing aids represents a values shift relative to traditional audiology.

METHOD

We performed a qualitative content analysis of two document categories: critique documents that motivated the creation of OTC hearing aids and regulatory documents that defined OTC hearing aids. Team members coded portions of text for the values they expressed. In total, 29,235 words were coded across 72 pages in four documents. Rank-order analyses were performed to determine the prioritization of values within each category of documents and subsequently compare values between OTC and traditional audiology documents analyzed in a previous study.

RESULTS

Critique and regulatory documents both prioritized values related to reducing barriers to hearing aid access and use, but the lack of a significant correlation in the rank order of values in these documents was evidence of inconsistency between the motivation and implementation of OTC hearing aids. Differences in the rank order of values in the OTC documents compared to traditional audiology were consistent with a values shift.

CONCLUSIONS

The introduction of OTC as a solution to low hearing aid use represents a values shift, challenging the values of traditional audiology. This research demonstrates a need to establish the values of hearing health care service delivery through a consensus of stakeholders, including individuals from diverse backgrounds underserved by the traditional model.

Stress and Right Prefrontal Transcranial Direct Current Stimulation (tDCS) Interactive Effects on Visual Working Memory and Learning

Stress impacts prefrontal cortex (PFC) activity and modulates working memory performance. In a recent study, stimulating the dorsolateral PFC (dlPFC) using transcranial direct current stimulation (tDCS) interacted with social stress in modulating participants' working memory. More specifically, stress disrupted the enhancing effects of dlPFC tDCS on working memory performance. The current study aimed to further explore these initial findings by randomizing healthy females to four experimental conditions (N = 130); stimulation (right dlPFC tDCS vs. sham) and stress manipulation (social stress vs. control). Participants performed cognitive tasks (i.e., visual working memory task and a visual declarative memory task) at baseline and post-stimulation. They also completed self-report measures of stress and anxiety. A significant stimulation × stress interaction was evident in the declarative memory (One-Card Learning, OCL) task, while working memory performance was unaffected. Though tDCS stimulation and stress did not interact to affect working memory, further research is warranted as these initial findings suggest that immediate visual-memory learning may be affected by these factors. The limited number of earlier studies, as well as the variability in their designs, provides additional impetus for studying the interactive effects of stress and tDCS on human visual learning.

Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL): validation with hearing aid users

OBJECTIVE

Individuals who are deaf or hard of hearing (DHH) may find adherence to their hearing devices difficult due to internal experiences related to their hearing loss such as sadness or frustration. The Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) is the only measure available to assess psychological inflexibility as it relates to hearing loss. The purpose of this study was to confirm the single latent structure of the AAQ-AHL (through confirmatory factory analysis) and test convergent and discriminant validity.

DESIGN

Cross-sectional data was used to further validate the AAQ-AHL.

STUDY SAMPLE

Participants were 146 adults who had diagnosed hearing loss and used a hearing aid.

RESULTS

Results revealed the AAQ-AHL has a single latent structure, correlated to other similar constructs (psychological flexibility and hearing aid efficacy), and not correlated to unrelated constructs (hearing loss severity). These results suggest that the AAQ-AHL is a valid instrument to assess psychological flexibility as it relates to hearing aid use.

CONCLUSION

Together, the findings imply the AAQ-AHL has strong psychometric properties and justification to use in a clinical setting.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.

Behavior Change in Chronic Health: Reviewing What We Know, What Is Happening, and What Is Next for Hearing Loss

Untreated age-related sensorineural hearing loss is challenged by low adoption and adherence to hearing aids for treatment. Hearing care has evolved from traditional clinic-controlled treatment to online consumer-centered hearing care, supported by the increasingly person-centered design of hearing aid technology. Greater evidence and a more nuanced understanding of the personal need for adoption versus adherence to the use of consumer hearing care devices are required. Research considering consumer hearing aid acceptance behavior rests on behavior modification theories to guide clinical approaches to increasing hearing aid adoption and adherence. However, in the context of complex chronic health management, there may be a gap in how these theories effectively align with the needs of consumers. Similarly, market data indicates evolving consumer behavior patterns have implications for hearing care theory and implementation, particularly in terms of sustained behavior change. This essay proposes that evidence, including theory and application, be strengthened by revising basic theoretical premises of personal experience with complex chronic health, in addition to considering recent changes in commercial contexts.

Update on surgical and nonsurgical treatment options for age-related hearing loss

BACKGROUND

Age-related hearing loss (ARHL) is one of the most common chronic conditions that impacts on everyday life far beyonds speech understanding. Chronic hearing loss has been associated with social isolation, depression, and cognitive decline. Early diagnosis and appropriate treatment are recommended.

OBJECTIVE

To give an overview of surgical and non-surgical treatment options for ARHL and the gap between the high prevalence of ARHL and its inadequate treatment to date.

MATERIAL AND METHODS

A selective literature search was carried out in PubMed.

RESULTS

In case of mild to moderate hearing loss, provision of air conduction hearing aids is still the method of choice as it leads to a large benefit in speech understanding and hearing-specific quality of life, and to a slight improvement in overall quality of life. Implantable middle ear systems are used for the treatment of special types of hearing impairment. In case of severe to profound hearing loss, cochlear implantation should be considered; however, only a small number of older people with hearing loss are supplied with hearing aids or cochlear implants despite the well-known benefits of both. This also applies to high-income countries where the costs are covered by health insurance funds.

CONCLUSION

Considering the low rate of properly treated people with hearing loss, large-scale screening programs, including better counselling of older people, should be developed.

Factors Influencing Hearing Help-Seeking and Hearing Aid Uptake in Adults: A Systematic Review of the Past Decade

This systematic review examined the audiological and nonaudiological factors that influence hearing help-seeking and hearing aid uptake in adults with hearing loss based on the literature published during the last decade. Peer-reviewed articles published between January 2011 and February 2022 were identified through systematic searches in electronic databases CINAHL, PsycINFO, and MEDLINE. The review was conducted and reported according to the PRISMA protocol. Forty-two articles met the inclusion criteria. Seventy (42 audiological and 28 nonaudiological) hearing help-seeking factors and 159 (93 audiological and 66 nonaudiological) hearing aid uptake factors were investigated with many factors reported only once (10/70 and 62/159, respectively). Hearing aid uptake had some strong predictors (e.g., hearing sensitivity) with others showing conflicting results (e.g., self-reported health). Hearing help-seeking had clear nonpredictive factors (e.g., education) and conflicting factors (e.g., self-reported health). New factors included cognitive anxiety associated with increased help-seeking and hearing aid uptake and urban residency and access to financial support with hearing aid uptake. Most studies were rated as having a low level of evidence (67%) and fair quality (86%). Effective promotion of hearing help-seeking requires more research evidence. Investigating factors with conflicting results and limited evidence is important to clarify what factors support help-seeking and hearing aid uptake in adults with hearing loss. These findings can inform future research and hearing health promotion and rehabilitation practices.

Core Values in the Traditional Provision of Hearing Health Care

PURPOSE

Untreated hearing loss is a significant public health issue affecting the quality of life of millions of Americans. Barriers to treatment invite novel and innovation solutions, but as these solutions create new treatment delivery models, they also may-purposefully or accidentally-challenge the values of the field.

METHOD

Value-sensitive design methodology is used in this study to identify the values in current hearing health care service delivery. We performed qualitative content analysis of questionnaires, clinical practice guidelines, and professional ethics documents that represent the intended and enacted values in audiology.

RESULTS

The result is a comprehensive list of values that can be used as a structured codebook for systematic textual analysis of materials representing current best practices in the provision of hearing health care services. A secondary result is an analysis of the relative importance of values in audiology, inferred from the frequency of references to each value.

CONCLUSIONS

Subjective benefit, professional duties, and self-efficacy were the core values identified in the current provision of audiologic care, and these values should be central to considerations for new hearing health care models and technologies.