Outcomes of hearing aid fitting for older people with hearing impairment and their significant others

Effectiveness of the active communication education program in improving the general quality of life of older adults who use hearing aids: a randomized clinical trial

BACKGROUND

Hearing loss in older adults affects general, generic health-related and disease-specific quality of life (QoL). The conventional strategy to address it is through hearing aids, which have been shown to improve disease-specific QoL. However, the long-term results regarding general quality of life are unknown, and communication problems and stigma associated with hearing loss may persist. An effective intervention strategy to address these problems is group communication programs, most notably Active Communication Education (ACE). This program has been shown to increase communication strategies and reduce communication activity limitations and participation restrictions. These precedents allow us to hypothesize that this program could improve general QoL.

METHODS

A randomized clinical trial was conducted on 114 older adult hearing aid users. Fifty-four subjects composed the intervention group that received the ACE program, while 60 subjects composed the control group that received an informational-lectures type intervention. The WHOQOL-BREF questionnaire was used to measure general QoL. Measurements were taken before and right after the intervention, with follow-ups at 6 and 12 months. Multilevel linear mixed models were estimated, considering the WHOQOL-BREF dimension scores and total score as the outcomes, and an interaction term between time since intervention and group as the predictor. Within- and between-group comparisons were made.

RESULTS

Compared to the baseline time-point, the ACE group showed significant improvements right after the intervention, and at the 6-month and 12-month follow-ups for the dimensions of psychological health, social relationships, environment, and total score. Compared to the control group, the ACE group exhibited significantly greater improvements in the social dimension at all postintervention assessments, as well as in the environment dimension and total score at the 12-month follow-up.

CONCLUSIONS

The ACE program improved general QoL in terms of social relationships and environment dimensions, which lasted up to 12 months after the intervention. Therefore, ACE is positioned as an effective complement for HA users, enhancing and delivering new benefits related to broader aspects of QoL not necessarily tied to health.

TRIAL REGISTRATION

ISRCTN54021189 (retrospectively registered on 18/07/2023).

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.

Impact of adult cochlear implantation on the partner relationship: a conceptual framework informed by cochlear implant recipient and partner perceptions

PURPOSE

(1) To understand the impact of adult cochlear implantation on the partner relationship, as perceived by adult cochlear implant (CI) recipients and their intimate partners. (2) To generate a conceptual framework for guiding future research and clinical adult cochlear implantation interventions.

METHOD

Concept mapping, a participatory, mixed-method approach, was used for data collection, analysis and interpretation. Participants attended sessions to generate, sort and rate statements describing the changes in their relationship due to cochlear implantation. Participants included 15 CI recipients (mean age: 51.6 years; SD: 8.2) and 12 partners (mean age: 50.9 years; SD: 8.2).

RESULTS

Five concepts emerged from the data, describing changes in the partner relationship following cochlear implantation: (1) Social Interactions, (2) Partner Involvement, (3) Communication, (4) Emotional Adjustment, and (5) Relationship Intimacy. The concept Relationship Intimacy was rated the highest in positivity and importance. Findings also underscored improved social interactions, communication dynamics, and emotional adjustment.

CONCLUSIONS

The Relationship Intimacy cluster emerged as pivotal, highlighting its essential role in improving post-implantation relationships. CI recipients experienced enhanced autonomy, while partners' roles evolved regarding assistance and support. The diverse effects of implantation on partner relationships highlight the importance of adopting a patient- and family-centered approach to audiological intervention.

Why Do Cochlear Implant Candidates Defer Surgery? A Retrospective Case-Control Study

OBJECTIVE(S)

Despite undergoing thorough cochlear implant (CI) candidacy evaluation and counseling, some patients ultimately elect against implantation. This study sought to identify patient-related and socioeconomic factors predicting CI deferral.

METHODS

A retrospective study of adult (≥18 years old) CI candidates presenting between 2007 and 2021 at a tertiary academic CI center was performed. The primary outcome was device implantation. Data collected included age, gender, hearing status, race, zip code of residence, median family income (MFI), distance traveled from the CI center, marital status, employment status, and insurance status. Multivariable binary logistic regression was performed to identify predictors of implantation.

RESULTS

A total of 200 patients qualifying for CI were included, encompassing 77 adults deferring surgery (CI-deferred) and 123 consecutive adults electing for surgery (CI-pursued). Age, gender, hearing status, insurance type, employment status, distance from the implant center, and MFI were comparable between the groups (p > 0.05). Compared to CI-pursued patients, CI-deferred patients were more likely to be non-Caucasian (24.7% vs. 9.8%, p = 0.015) and unmarried (55.8% vs. 38.2%, p = 0.015). On multivariable logistic regression, older age (OR 0.981, 0.964-0.998, p = 0.027), African American race (OR 0.227, 0.071-0.726, p = 0.012), and unmarried status (OR 0.505, 0.273-0.935, p = 0.030) were independent predictors of implant deferral.

CONCLUSION

This study demonstrates that increasing age at evaluation, African American race, and unmarried status are predictors for deferring CI surgery despite being implant candidates. These patients may benefit from increased outreach in the form of counseling, education, and social support prior to undergoing CI surgery.

LEVEL OF EVIDENCE

3 - retrospective study with internal control group Laryngoscope, 134:2857-2863, 2024.

Hear Me Out: A Meta-Analysis of Third-Party Disability Due to Presbycusis

OBJECTIVES

Hearing-related third-party disability is the transferrable impact of presbycusis on an affected individual's surrounding social network. Previous research suggests that interventions to overcome hearing-related communication challenges benefit both the individual with presbycusis and their communication partner. However, there have been no comparisons of the effects of different interventions on third-party disability. We conducted meta-analyses of hearing aid or communication-based longitudinal interventions to determine if: both kinds of interventions significantly benefit communication partners across three categories of third-party disability (communication, emotional health and lifestyle outcomes), hearing aid and communication interventions differ in the size of treatment effects, and demographic variables moderate intervention efficacy.

DESIGN

Four databases were systematically searched for studies published after 1990 that included preintervention and postintervention data for communication partners of individuals receiving a hearing aid or communication-based intervention. Studies were included if participants had presbycusis, were aged 45 or over, with no known physical or mental disorders, and had a willing study partner over 18 years old. Databases were last comprehensively and hand-searched in January 2023. One researcher applied the inclusion and exclusion criteria to select studies and complete data extraction. Depending on study design, risk of bias was assessed using the "Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group" or the "Risk of Bias 2." Random effects models were run for effect sizes for both intervention types (together and separately) for each third-party disability category. Meta-regressions were run to inspect the effect of demographic variables on intervention efficacy.

RESULTS

Six studies satisfied inclusion criteria and showed that for both hearing and communication interventions, communication partners experienced significant improvements in all three outcomes. Communication interventions showed greater benefits for lifestyle outcomes, but hearing aid and communication interventions did not differ for communication and emotional health outcomes. Meta-regressions revealed previously undetected relationships between demographic variables and intervention efficacy.

CONCLUSIONS

The results of this meta-analysis and meta-regressions may have clinical and real-world implications in terms of highlighting the widespread benefits of these interventions, and the need to build in greater consideration of an individual's wider network when designing and implementing interventions. Noted limitations included certain combinations of intervention type and third-party disability category that were underrepresented (in absolute and/or relative terms), a lack of combined intervention (hearing aids and communication training) studies, and variation in the types of questionnaires used between studies. The current study discusses possible ways to unite the current literature for more consistent research practices.

A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement

OBJECTIVES

The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no).

DESIGN

We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider.

RESULTS

All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups.

CONCLUSIONS

The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.

Dementia and Hearing Aid Use and Cessation: A National Study

PURPOSE

The current standard for management of hearing loss in the United States involves the use of a hearing aid. Anecdotal evidence suggests that the use of a hearing aid may be less effective in the context of dementia, though national data on use and cessation are not described.

METHOD

This longitudinal analysis of the National Health and Aging Trends Study followed participants who self-reported hearing aid use to estimate risk of hearing aid cessation over 9 years. We examine whether hearing aid cessation differs by dementia status using generalized estimating equations logistic regression accounting for loss to follow-up. Supplemental analyses were undertaken to examine the contribution of caregiving and environmental factors on hearing aid cessation.

RESULTS

Of 1,310 older adults who reported hearing loss (25% 80-84 years, 51% women, 74% White), 22% with dementia and 57% baseline hearing aid use. Dementia increased likelihood of ceasing hearing aid use during the first year after adoption (OR = 2.07, 95% CI [1.33, 3.23], p interaction = .11). In later years, older adults with either a previous or recent diagnosis of dementia had a 95% higher odds of hearing aid cessation (OR = 1.95, 95% CI [1.31, 2.90]), a decrease in odds with respect to the first year after adoption, when compared to participants without dementia, after adjusting for demographic, health, and economic factors. Economic and social factors that may influence care demands (more caregivers, income-to-poverty ratio, and additional insurance) increased likelihood for cessation for those with dementia.

CONCLUSIONS

Older adults with (vs. without) dementia are more likely to cease hearing aid use over time, most notably during the first year after adoption. Strategies to support hearing ability, such as self-management or care partner education, may improve communication for those living with co-occurring hearing loss and dementia.

Factors Associated With Hearing Aid Outcomes Including Social Networks, Self-Reported Mental Health, and Service Delivery Models

PURPOSE

This study aims to identify and describe factors that influence hearing aid outcomes including social networks, self-reported mental health, and service delivery models.

METHOD

A prospective cross-sectional online survey was sent to hearing aid users recruited through an online platform (http://www.hearingtracker.com) between October and November 2021. The survey contained questions on patient demographics, audiological variables, general health and social factors, and self-reported hearing aid outcomes using the International Outcome Inventory for Hearing Aids (IOI-HA). Regression models evaluated potential contributing factors of hearing aid outcomes on the IOI-HA.

RESULTS

Three hundred ninety-eight hearing aid users completed the survey with an average age of 66.6 (SD = 13.0) years, of which 59.3% were male. Positive contributing factors of hearing aid outcomes (IOI-HA total score) were social network of people with hearing loss with hearing aids (p < .010; Exp[B] = 0.03, 95% CI [0.01, 0.1]), self-reported mental health (p < .05; Exp[B] = 0.6, 95% CI [0.01, 1.2]), work situation (p < .001; Exp[B] = 1.9, 95% CI [0.7, 2.8]), quality of life (p < .005; Exp[B] = 1.2, 95% CI [0.3, 1.1]), and self-reported hearing difficulty (p < .02; Exp[B] = 0.8, 95% CI [0.2, 1.5]). Negative contributing factors of hearing aid outcomes included social networks of people with hearing loss without hearing aids (p < .001; Exp[B] = -0.1, 95% CI [-0.2, -0.2]) and service delivery model of private or university clinic compared to big-box retailers (p < .001; Exp[B] = -1.6, 95% CI [-2.7, -0.7]).

CONCLUSIONS

Novel factors including social network of persons with hearing loss who use hearing aids, self-reported mental health, service delivery model, and work situation are significant contributors to hearing aid outcomes. These newly identified factors can inform public hearing health promotion and individualized audiological care to optimize hearing aid outcomes.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24060486.

Hearing handicaps, communication difficulties and depression in the older adults: a comparison of hearing aid users and non-users

BACKGROUND AND AIM

Age-related hearing loss has potential effects on communication, cognitive, emotional, and social aspects of the older person's life. Evaluating the role of hearing aids in reducing these difficulties is important. This study aimed to evaluate communication difficulties, self-perceived handicaps, and depression in hearing-impaired older adults who are either hearing aid users or non-users.

METHODS

A total of 114 older adults in the age range of 55-85 years with moderate to moderately severe hearing loss (two hearing-matched groups; hearing aid users: n = 57; hearing aid non-users: n = 57) took part in this study during the COVID-19 pandemic. Self-perceived hearing handicaps and communication were evaluated using the Hearing Handicap Inventory in the Elderly-Screening (HHIE-S) and Self-Assessment Communication (SAC) questionnaires. Depression was assessed using the geriatric depression scale (GDS).

RESULTS

The average score of HHIE-S was significantly higher in the hearing aid users than the non-users (16.61 ± 10.39 vs. 12.49 ± 9.84; p = 0.01). Differences between groups were not significant for SAC or GDS scores (p ≥ 0.05). There were strong positive correlations between HHIE-S and SAC scores in both groups. Moderate correlations were found between SAC and GDS scores in the hearing aid users and between the duration of using hearing aid with SAC and HHIE-S scores.

CONCLUSION

It seems that self-perceived handicaps, communication difficulties and depression are affected by many factors, and only receiving hearing aids without subsequent support such as auditory rehabilitation and programming services cannot bring the expected output. The effect of these factors was clearly observed due to reduced access to services in the COVID-19 era.

Exploring Factors That Contribute to the Success of Rehabilitation With Hearing Aids

OBJECTIVES

Hearing aids are an essential and important part of hearing rehabilitation. The combination of technical data on hearing aids and individual rehabilitation needs can give insight into the factors that contribute to the success of rehabilitation. This study sets out to investigate if different subgroups of (comparable) hearing aids lead to differences in the success of rehabilitation, and whether these differences vary between different domains of auditory functioning.

DESIGN

This study explored the advantages of including patient-reported outcome measures (PROMs) in the process of purchasing new hearing aids in a large sample of successful hearing aid users. Subject data were obtained from 64 (commercial) hearing aid dispensers and 10 (noncommercial) audiological centers in the Netherlands. The PROM was a 32-item questionnaire and was used to determine the success of rehabilitation using hearing aids by measuring auditory disability over time. The items were mapped on six domains of auditory functioning: detection, discrimination, localization, speech in quiet, speech in noise, and noise tolerance, encompassing a variety of daily-life listening situations. Hearing aids were grouped by means of cluster analysis, resulting in nine subgroups. In total, 1149 subjects were included in this study. A general linear model was used to model the final PROM results. Model results were analyzed via a multifactor Analysis of Variance. Post hoc analyses provided detailed information on model variables.

RESULTS

Results showed a strong statistically significant effect of hearing aids on self-perceived auditory functioning in general. Clinically relevant differences were found for auditory domains including detection, speech in quiet, speech in noise, and localization. There was only a small, but significant, effect of the different subgroups of hearing aids on the final PROM results, where no differences were found between the auditory domains. Minor differences were found between results obtained in commercial and noncommercial settings, or between novice and experienced users. Severity of Hearing loss, age, gender, and hearing aid style (i.e., behind-the-ear versus receiver-in-canal type) did not have a clinically relevant effect on the final PROM results.

CONCLUSIONS

The use of hearing aids has a large positive effect on self-perceived auditory functioning. There was however no salient effect of the different subgroups of hearing aids on the final PROM results, indicating that technical properties of hearing aids only play a limited role in this respect. This study challenges the belief that premium devices outperform basic ones, highlighting the need for personalized rehabilitation strategies and the importance of evaluating factors contributing to successful rehabilitation for clinical practice.

A qualitative investigation of the hearing and hearing-aid related emotional states experienced by adults with hearing loss

OBJECTIVE

Despite previous research into the psychosocial impact of hearing loss, little detail is known regarding the hearing and hearing-aid-related emotional states experienced by adults with hearing loss in everyday life, and how they occur.

DESIGN

Individual remote semi-structured interviews were audio-recorded, transcribed verbatim and qualitatively analysed with reflexive and inductive thematic analysis.

STUDY SAMPLE

Seventeen participants (9 female) with hearing loss (age range 44-74 years) participated. Ten used bilateral hearing aids, four unilateral and three used no hearing aids at the time of interviews.

RESULTS

The four main themes which emerged from the data were: identity and self-image, autonomy and control, personality and dominant emotional states and situational cost/benefit analysis with respect to use of hearing aids.

CONCLUSIONS

This study goes beyond previous literature by providing a more detailed insight into emotions related to hearing and hearing-aids in adults. Hearing loss causes a multitude of negative emotions, while hearing aids generally reduce negative emotions and allow for more positive emotions. However, factors such as lifestyle, personality, situational control, the relationship with those in conversation and the attribution of blame are key to individual emotional experience. Clinical implications include the important role of social relationships in assessment and counselling.

Quality of Life Among Adults With Hearing Loss Who Were Prescribed Hearing Aids in Aseer Province, Saudi Arabia: A Cross-Sectional Tertiary Center-Based Study

Introduction Hearing loss affects people of all ages, and it may become a burden for patients as well as for those around them. It leads to social isolation and impacts the quality of life (QOL). Many studies aim to investigate the outcome of hearing aids as an intervention to treat hearing loss. Our study's objective is to assess the QOL in participants and investigate the possible factors that have an impact on the outcomes of hearing aid use. Methods The study adopted a cross-sectional design and was carried out in the Armed Forces Hospital South Region, a tertiary care center in Aseer Province, Saudi Arabia. Participants were patients who presented to the ENT clinic with a complaint of hearing loss from 2017 to 2019 and who were prescribed hearing aids as their treatment. The study uses the World Health Organization Quality of Life BREF (WHOQOL-BREF) questionnaire and the International Outcome Inventory for Hearing Aids (IOI-HA) to measure the QOL and its determinants in patients using hearing aids. Results A total of 210 patients were included in the study. Sensorineural hearing loss (SNHL) was found in 72.2%, and 20% of patients were found to have bilateral hearing loss. Moderate or severe hearing loss was found in 80% of the patients in the worst hearing ear. The overall QOL among the participants was satisfactory, with the highest domain score being the social relationship domain (85.9%). The QOL was significantly higher in participants who were in an intimate relationship (P = 0.02). A positive correlation was found between the IOI-HA scores and the WHOQOL-BREF scores in general health (R = 0.14, P = 0.034), psychological health (R = 0.16, P = 0.018), and the overall QOL score (R = 0.15, P = 0.035). Conclusion Hearing aids are a cost-effective intervention that improves QOL and prevents associated comorbidities. Compliance and adherence to hearing aids improve the QOL for patients, as well as for their spouses. Patients suffering from hearing loss while also in an intimate relationship had better QOL scores. A correlation was found in outcomes between the IOI-HA scores and the WHOQOL-BREF scores in general health, psychological health, and overall health.

A randomized controlled trial evaluating the effects of motivational interviewing in new hearing aid users (MI-HAT): study protocol for a randomized controlled trial

BACKGROUND

Hearing loss is the third leading global cause of disability and is associated with poorer quality of life. Hearing aids are often recommended for hearing loss; however, hearing aid uptake and use rates are perpetually low. Motivational interviewing (MI) is a patient-centered counseling aimed at addressing the desire in the patient to change their behavior. The aim of this study is to investigate the impact of one-on-one MI sessions on hearing aid use among new adult users.

METHODS

A multi-center, prospective, randomized patient-blind controlled trial with a pre- and post-tests design. New hearing aid users ≥ 18 years of age will be recruited from Vancouver, Canada. They will be randomly assigned to a treatment or control group. The treatment group will attend a one-on-one MI session hosted by a practicing MI therapist in addition to standard in-person audiological care. The control group will receive standard in-person audiological care. Data is collected at baseline and at 1, 3, 6, and 12 months' follow-ups. The primary outcomes are data-logged hearing aid use hours and patient-reported outcomes as measured by the International Outcome Inventory for Hearing Aids questionnaire. Associations between intervention and hearing aid use hours and self-reported outcome measures will be assessed.

DISCUSSION

This trial is designed to evaluate the efficacy of one-on-one MI in improving hearing aid use in new adult users in the short and long terms. Results will contribute to the evidence on whether MI counseling has an effect on hearing aid use and may guide future clinical practices.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04673565 . Registered on 17 December 2020.

From hearing aids to cochlear implants: The journey for private patients in New Zealand

OBJECTIVES

To understand adults' journey from hearing aids to cochlear implants (CIs).

METHODS

Qualitative, exploratory design using semi-structured interviews with twelve postlingually-deafened adults.

RESULTS AND DISCUSSION

All participants reported social isolation and/or depression. 'Not hearing well enough' was the most-common motivator to seek a CI. Due to the long wait for a public CI, they opted to pay for their implant privately. Funding was the most prominent barrier identified, with most participants using their own savings. The biggest struggle was in the period 3-months post switch-on. Many participants felt progress was slow and that they should have been doing better. After this period, benefits were most noted in quiet, with environmental sounds, and in helping them become more sociable. Music and telephone use were still areas many struggled with.

CONCLUSIONS

Participants reported the CI was worth the cost, that they would recommend it to others, and would do it again. Self-motivation was the biggest facilitator to success, with hearing professionals playing an integral role throughout the entire journey. There was a large variety of subthemes reflecting the diversity and individuality of the transition.

Patient-Reported Functional Impairment Due to Hearing Loss and Tinnitus After Cisplatin-Based Chemotherapy

PURPOSE

Cisplatin is widely used and highly ototoxic, but patient-reported functional impairment because of cisplatin-related hearing loss (HL) and tinnitus has not been comprehensively evaluated.

PATIENTS AND METHODS

Testicular cancer survivors (TCS) given first-line cisplatin-based chemotherapy completed validated questionnaires, including the Hearing Handicap Inventory for Adults (HHIA) and Tinnitus Primary Function Questionnaire (TPFQ), each of which quantifies toxicity-specific functional impairment. Spearman correlations evaluated associations between HL and tinnitus severity and level of functional handicap quantified with the HHIA and TPFQ, respectively. Associations between HL or tinnitus and five prespecified adverse health outcomes (cognitive dysfunction, fatigue, depression, anxiety, and overall health) were evaluated.

RESULTS

HL and tinnitus affected 137 (56.4%) and 147 (60.5%) of 243 TCS, respectively. Hearing aids were used by 10% TCS (14/137). Of TCS with HL, 35.8% reported clinically significant functional impairment. Severe HHIA-assessed functional impairment was associated with cognitive dysfunction (odds ratio [OR], 10.62; P < .001), fatigue (OR, 5.48; P = .003), and worse overall health (OR, 0.19; P = .012). Significant relationships existed between HL severity and HHIA score, and tinnitus severity and TPFQ score (P < .0001 each). TCS with either greater hearing difficulty or more severe tinnitus were more likely to report cognitive dysfunction (OR, 5.52; P = .002; and OR, 2.56; P = .05), fatigue (OR, 6.18; P < .001; and OR, 4.04; P < .001), depression (OR, 3.93; P < .01; and OR, 3.83; P < .01), and lower overall health (OR, 0.39; P = .03; and OR, 0.46; P = .02, respectively).

CONCLUSION

One in three TCS with HL report clinically significant functional impairment. Follow-up of cisplatin-treated survivors should include routine assessment for HL and tinnitus. Use of the HHIA and TPFQ permit risk stratification and referral to audiologists as needed, since HL adversely affects functional status and is the single largest modifiable risk factor for cognitive decline and dementia in the general population.

Prevalence and risk factors for ototoxicity after cisplatin-based chemotherapy

PURPOSE

Ototoxicity is a prominent side effect of cisplatin-based chemotherapy. There are few reports, however, estimating its prevalence in well-defined cohorts and associated risk factors.

METHODS

Testicular cancer (TC) survivors given first-line cisplatin-based chemotherapy completed validated questionnaires. Descriptive statistics evaluated the prevalence of ototoxicity, defined as self-reported hearing loss and/or tinnitus. We compared patients with and without tinnitus or hearing loss using Chi-square test, two-sided Fisher's exact test, or two-sided Wilcoxon rank sum test. To evaluate ototoxicity risk factors, a backward selection logistic regression procedure was performed.

RESULTS

Of 145 TC survivors, 74% reported ototoxicity: 68% tinnitus; 59% hearing loss; and 52% reported both. TC survivors with tinnitus were more likely to indicate hypercholesterolemia (P = 0.008), and difficulty hearing (P < .001). Tinnitus was also significantly related to age at survey completion (OR = 1.79; P = 0.003) and cumulative cisplatin dose (OR = 5.17; P < 0.001). TC survivors with hearing loss were more likely to report diabetes (P = 0.042), hypertension (P = 0.007), hypercholesterolemia (P < 0.001), and family history of hearing loss (P = 0.044). Risk factors for hearing loss included age at survey completion (OR = 1.57; P = 0.036), hypercholesterolemia (OR = 3.45; P = 0.007), cumulative cisplatin dose (OR = 1.94; P = 0.049), and family history of hearing loss (OR = 2.87; P = 0.071).

CONCLUSIONS

Ototoxicity risk factors included age, cisplatin dose, cardiovascular risk factors, and family history of hearing loss. Three of four TC survivors report some type of ototoxicity; thus, follow-up of cisplatin-treated survivors should include routine assessment for ototoxicity with provision of indicated treatments.

IMPLICATIONS FOR CANCER SURVIVORS

Survivors should be aware of risk factors associated with ototoxicity. Referrals to audiologists before, during, and after cisplatin treatment is recommended.

Effectiveness of Auditory Training in Experienced Hearing-Aid Users, and an Exploration of Their Health-Related Quality of Life and Coping Strategies

Hearing aids (HA) are a fundamental component in restoring auditory function; however, they cannot completely alleviate all problems encountered by adults with hearing impairment. The aim of this study is twofold. Firstly, we assess the health-related quality of life and coping strategies of experienced HA users. Secondly, we assess whether HA users can benefit from auditory training. To this end, 40 participants who had worn HAs for more than 6 months participated in this study. Half of the participants received auditory training, while the other half served as a passive control. The training consisted of a personalized training scheme, with outcome measures including speech in noise perception in free-field and via direct streaming to the HA, phoneme identification, cognitive control, and health-related quality of life. Results showed that experienced HA users reported a relatively good quality of life. Health-related quality of life was correlated with aided speech perception in noise, but not with aided pure tone audiometry. Coping strategies were adaptive, leading to improved communication. Participants showed improvements in trained tasks, consonant identification, and speech in noise perception. While both groups yielded improved speech in noise perception at the end, post hoc analysis following a three-way interaction showed a significantly larger pre-post difference for the trained group in the streaming condition. Although training showed some improvements, the study suggests that the training paradigm was not sufficiently challenging for HA users. To optimize daily life listening, we recommend that future training should incorporate more exercises in noise and focus on cognitive control.

Effects of Receiving Hearing Aids on Health-Related Quality of Life in Adults With Mild Hearing Loss

BACKGROUND AND OBJECTIVES

Hearing aid (HA) use is a common rehabilitation method for people with hearing loss. This study aimed to investigate whether the use of HA will advance the health-related quality of life (HRQoL). Subjects and.

METHODS

Patients referred to a public audiological department in Norway were invited to participate in this pre-post interventional study. The RAND-SF-36, a generic HRQoL questionnaire, was administered to the participants before and three months after HA fitting. Changes in HRQoL dimensions were analyzed for the whole group and for subgroups based on sex, age, and presence of tinnitus.

RESULTS

A total of 202 adults (109 men; mean age, 66.68 years [SD=10.92]) were included in the study. After a mean observation time of 91.63 days (SD=45.61), pain and general health significantly improved. Women aged ≥70 years without tinnitus improved in social functioning, while men aged <70 years with tinnitus improved in general health.

CONCLUSIONS

Adults with mild hearing loss reported better general health and less bodily pain three months after HA fitting than before. The patient subgroups reported improved general health and social functioning. However, causation remains uncertain because of methodological limitations. A randomized, controlled trial with a longer follow-up time could clarify such issues.

Older adults' neural tracking of interrupted speech is a function of task difficulty

Age-related hearing loss is a highly prevalent condition, which manifests at both the auditory periphery and the brain. It leads to degraded auditory input, which needs to be repaired in order to achieve understanding of spoken language. It is still unclear how older adults with this condition draw on their neural resources to optimally process speech. By presenting interrupted speech to 26 healthy older adults with normal-for-age audiograms, this study investigated neural tracking of degraded auditory input. The electroencephalograms of the participants were recorded while they first listened to and then verbally repeated sentences interrupted by silence in varying interruption rates. Speech tracking was measured by inter-trial phase coherence in response to the stimuli. In interruption rates that corresponded to the theta frequency band, speech tracking was highly specific to the interruption rate and positively related to the understanding of interrupted speech. These results suggest that older adults' brain activity optimizes through the tracking of stimulus characteristics, and that this tracking aids in processing an incomplete auditory stimulus. Further investigation of speech tracking as a candidate training mechanism to alleviate age-related hearing loss is thus encouraged.

Is There an Association Between Untreated Hearing Loss and Psychosocial Outcomes?

Objective

Age-related hearing loss is one of the leading causes of disability in older adults. This cross-sectional study investigated the association between untreated hearing loss, social (perception of quality and quantity of social network) and emotional loneliness (perception of limited emotional support), social isolation (size of the social network), social support (actual or perceived availability of resources from the social network) and psychological discomfort (depression, anxiety, and stress) in older adults.

Study Design

Cross-sectional study design.

Methods

A total of 202 community derived sample of volunteers, age range 40-89 years, mean age (M) = 65.3 ± 11.0 years were recruited. Of these 115 were females (M = 63.2 ± 12.0 years) and 87 were males (M = 68.2 ± 8.9 years). All participants completed a hearing assessment, social interaction and support questionnaire and a social and emotional loneliness questionnaire.

Results

Hearing loss significantly contributed to both moderate [P < 0.001, B (95% CI): 0.01 (0.99-1.02)] and intense levels [P < 0.001, 0.02 (1.00-1.04)] of emotional loneliness. Depression was significantly associated with satisfaction with social support [P < 0.001; -0.17 (-0.23 to -0.11), social interaction [P = 0.01; -0.07 (-0.12 to -0.01)], and moderate [P < 0.001; 0.31 (1.22-1.53)] and intense [P < 0.001; 0.29 (1.20-1.50)] levels of emotional loneliness and intense levels of social loneliness [P = 0.01; 0.12 (1.05-1.21)].

Conclusion

Untreated hearing loss significantly increases the odds of being emotionally lonely. Depression significantly contributes to social and emotional loneliness, satisfaction with social support and social loneliness. Given the higher prevalence of loneliness and psychological discomfort and their associations with untreated hearing loss, hearing-impaired older adults are at significant risk of developing loneliness and psychological discomfort. Therefore, hearing health professionals should be aware of the psychosocial burden that may accompany hearing loss, in order to provide appropriate advice and support.

Effects of providing free hearing aids on multiple health outcomes among middle-aged and older adults with hearing loss in rural China: a randomized controlled trial

BACKGROUND

Hearing loss has been associated with serious health problems around the globe. Previous studies have found the positive effects of fitting hearing aids on health, but few studies were conducted in developing countries. The aim of this study is to examine the effects of hearing aids on multiple health outcomes among middle-aged and older adults with hearing loss in rural China.

METHODS

In this randomized controlled trial (RCT), participants aged 45 and above were randomly assigned to the treatment group prescribing with hearing aids or to the control group with no intervention. Trial outcomes for 385 participants were collected during the 20-month follow-up study. Using the difference-in-difference approach, our primary outcomes were hearing-related quality of life (QoL) and generic QoL.

RESULTS

The intervention led to improvements in hearing-related QoL, presenting as the reduction in Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) scores (interaction coefficient = - 2.86, p = 0.005), HHIE-S-Emotional scores (interaction coefficient = - 1.42, p = 0.029), and HHIE-S-Situational scores (interaction coefficient = - 1.43, p = 0.007). The intervention was also effective in alleviating the increase in depressive symptoms (interaction coefficient = - 0.14, p = 0.042). Subgroup analysis revealed that the effects were only shown among people with social activities or active social networks.

CONCLUSIONS

Our study is the first RCT in China to measure the health effects and heterogeneity of hearing aid interventions. Wearing hearing aids can help improve hearing-related QoL and alleviate the increase in depressive symptoms. The intervention is expected to be applicable to similar settings in other developing countries to combat hearing-related health problems.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900024739 . Registered on 26 July 2019.

Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents

BACKGROUND

Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids.

METHODS

Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses.

RESULTS

Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline.

CONCLUSION

In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.

Accuracy of self- and proxy-rated hearing among older adults with and without cognitive impairment

BACKGROUND

Hearing loss is highly prevalent among older adults with cognitive impairment and may exacerbate neuropsychiatric symptoms and affect interactions with others. Although audiometry is the gold standard for measuring hearing, it is not always used in research or clinical settings focused on the care of individuals with cognitive impairment. Subjective assessments of hearing, both self- and proxy-rated, are widespread but may not adequately capture the presence of hearing loss as compared to audiometry. This study investigates the concordance between subjective and objective hearing assessments among older adults with and without cognitive impairment and evaluates factors associated with concordance.

METHODS

Participants were a subset of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), a prospective cohort study representing four US communities with adjudicated cognitive diagnoses and audiometric data, totaling 3326 self-rated and 520 proxy-rated hearing assessments. Sensitivity and specificity were calculated, and multivariable logistic regression estimated the magnitude of the association between the concordance of hearing assessments and variables of interest.

RESULTS

Sensitivity and specificity for self-rated hearing status were 71.2% and 85.9% among cognitively normal older adults, 61.1% and 84.9% among persons with MCI, and 52.6% and 81.2% among persons with dementia, respectively. For proxy-rated hearing, sensitivity and specificity were 65.7% and 83.3% for persons with MCI and 73.3% and 60.3% for persons with dementia, respectively. Female sex was positively associated with concordance for self-rated hearing assessments.

CONCLUSIONS

The low sensitivity of self- and proxy-rated hearing assessments compared to audiometry suggests that hearing loss among older adults with cognitive impairment may go underreported and unaddressed in subjective assessments. Clinicians and researchers should recognize the limitations of using self- and proxy-rated hearing assessments as measures of hearing status and incorporate objective audiometric evaluation whenever possible.

Towards Perceived Playfulness and Adoption of Hearables in Smart Cities of China

'Hearables' have become important in the aging population. This study investigates whether smart technologies help middle-aged and elderly people accept hearing aid devices in smart cities of China. The authors adopt the PLS-SEM framework to analyze the factors that affect behavioral intention towards adopting hearing aids in smart cities. In order to avoid common method bias, Harman's single factor method is also carried out to make sure the instrument does not introduce a bias. The findings suggest that perceived playfulness and perceived usefulness are principal determinants of hearing aids adoption. In contrast, perceived ease of use, a factor always stressed in literature, does not matter significantly. The results reveal that smart technologies enable patients to access professional services and instructions playfully, which reduces obstacles to adopt hearing aids. This study provides novel insights for policymakers and manufacturers to expand hearing aid adoption by facilitating smart infrastructure and technologies.

Effectiveness of a web-based SUpport PRogramme (SUPR) for communication partners of persons with hearing loss: results of a two-arm, cluster randomised controlled trial and process evaluation

OBJECTIVES

To examine the effects of web-based SUpport PRogram (SUPR) for communication partners (CPs) of persons with hearing loss (PHLs) in a HA dispensing setting.

DESIGN

Cluster randomised controlled trial (cRCT) with two arms (SUPR: Booklet, online videos; care as usual: no support) plus process evaluation. Measurements: baseline, and immediately-, six, and 12 months post-intervention. Outcomes: Significant Other Scale for Hearing Disability (SOS-HEAR), International Outcome Inventory for HAs/Alternative Interventions for Significant Others (IOI-HA/AI-SO). Process evaluation: dose-received, satisfaction, and benefit.

STUDY SAMPLE

The cRCT included 73 (SUPR) and 57 (care as usual) CPs. In the process evaluation study, 41 CPs (SUPR) participated.

RESULTS

There were no significant effects of SUPR for third-party disability (SOS-HEAR), the proxy report (IOI-HA-SO item "use"), and third-party disability (IOI-HA-SO items "satisfaction", and "quality of life"). SUPR-videos were watched by 15-22% of the CPs. SUPR materials were rated as moderately beneficial and useful.

CONCLUSIONS

Low baseline disability (floor effect) and low intervention dose-received may explain the findings. Directly targeting CPs rather than via their PHLs and providing intervention materials specifically for CPs may improve their engagement and contribute to SUPR's value supplementary to standard HA care.

Effects of text supplementation on speech intelligibility for listeners with normal and impaired hearing: a systematic review with implications for telecommunication

OBJECTIVE

Telecommunication can be difficult in the presence of noise or hearing loss. The purpose of this study was to systematically review evidence regarding the effects of text supplementation (e.g. captions, subtitles) of auditory or auditory-visual signals on speech intelligibility for listeners with normal or impaired hearing.

DESIGN

Three databases were searched. Articles were evaluated for inclusion based on the Population Intervention Comparison Outcome framework. The Effective Public Health Practice Project instrument was used to evaluate the quality of the identified articles.

STUDY SAMPLE

After duplicates were removed, the titles and abstracts of 2019 articles were screened. Forty-six full texts were reviewed; ten met inclusion criteria.

RESULTS

The quality of all ten articles was moderate or strong. The articles demonstrated that text added to auditory (or auditory-visual) signals improved speech intelligibility and that the benefits were largest when auditory signal integrity was low, accuracy of the text was high, and the auditory signal and text were synchronous. Age and hearing loss did not affect benefits from the addition of text.

CONCLUSIONS

Although only based on ten studies, these data support the use of text as a supplement during telecommunication, such as while watching television or during telehealth appointments.

Impact and cost-effectiveness evaluation of a community-based rehabilitation intervention on quality of life among Chinese adults with hearing loss: study protocol for a randomized controlled trial

Background

Hearing loss is quite prevalent and can be related to people’s quality of life. To our knowledge, there are limited studies assessing the efficacy of hearing interventions on quality of life in adults. Therefore, we aim to conduct a randomized controlled trial (RCT) to determine the impact and cost-effectiveness of community-based hearing rehabilitation on quality of life among Chinese adults with hearing loss.

Methods/design

In this two-arm feasibility study, participants aged 16 and above with some degree of hearing loss (n = 464) will be recruited from Linyi City, Shandong Province. They are randomly assigned to the treatment group or the control group. Those in the treatment group are prescribed with hearing aids, while those in the control group receive no intervention. Reinstruction in use of devices is provided for the treatment group during booster visits held 12 months post-randomization or unscheduled interim visits when necessary. Data are collected at baseline and the follow-up 20 months later. The primary outcome is changes in quality of life over a 20-month study period. Secondary outcomes include sub-dimensions in quality of life, physical functioning, chronic diseases, cognitive function, depression, social support, hospitalizations, falls, and healthcare costs. Finally, we will evaluate whether hearing aids intervention is cost-effective to apply in a large scale.

Discussion

The trial is designed to evaluate the impact and cost-effectiveness of a community-based rehabilitation intervention on quality of life among Chinese adults with hearing loss. We hope that it would help improve the well-being for Chinese adults and provide references in policy and practice for China and other countries.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900024739. Registered on 26 July 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05228-2.

Social representation of hearing aids among people with hearing loss: an exploratory study

OBJECTIVE

The aim of the current study was to examine the social representation (SR) of hearing aids in people with hearing loss (PHL) in India, the Republic of Korea (ROK), the United Kingdom (UK), and the United States of America (US).

DESIGN

The study used a cross-sectional survey design. The data collected by using a free association task were analysed qualitatively (i.e. content analysis) and quantitatively (i.e. chi-square analysis, similarities analysis, prototypical analysis).

STUDY SAMPLE

424 participants with hearing loss.

RESULTS

The most commonly reported categories across all countries were "beneficial," "cost and time," and "appearance and design." Approximately 50% of the associations reported were negative. There were variations in terms of the categories that were predominant in the SR of each country. "Others actions and attitude" category was predominantly reported by PHL in India. "Disturbance" and "dissatisfaction" of hearing aids and the "repairs and maintenance of hearing aids" categories were mainly reported from the ROK and the US, respectively.

CONCLUSIONS

The current results highlight the main aspects that PHL report spontaneously when they think about hearing aids. The findings will help to further inform public health campaigns and will contribute to develop culturally appropriate media materials regarding hearing aids.

Self-reported hearing handicap in adults aged 55 to 81 years is modulated by hearing abilities, frailty, mental health, and willingness to use hearing aids

OBJECTIVE

The aim of this study was to predict outcomes of the HHI questionnaire (Hearing Handicap Inventory) using individual variables beyond pure-tone hearing thresholds.

DESIGN

An extensive health-related test battery was applied including a general anamnesis, questionnaires, audiological measures, examination of visual acuity, balance, and cognition, as well as tactile- and motor skills. Based on the self-assessment of health variables and different sensory and cognitive performance measures, a frailty index was calculated to describe the health status of the participants. A stepwise linear regression analysis was conducted to predict HHI scores.

STUDY SAMPLE

A mixed sample (N = 212) of 55- to 81-year-old, participants with different hearing and aiding status completed the test battery.

RESULTS

The regression analysis showed statistically significant contributions of pure-tone hearing thresholds, speech recognition in noise, age, frailty, mental health, and the willingness to use hearing aids on HHIE outcomes.

CONCLUSIONS

Self-reported hearing handicap assessed with the HHI questionnaire reflects various individual variables additionally to pure-tone hearing loss and speech recognition in noise. It is necessary to be aware of the influences of age and health-related variables on HHI scores when using it in research as well as in clinical settings.

Clinical Application and Psychometric Properties of a Swedish Translation of the Abbreviated Profile of Hearing Aid Benefit

BACKGROUND

The impact of hearing loss on the individual and his/her everyday life can be assessed using questionnaires with the purpose to improve rehabilitation quality. The Abbreviated Profile of Hearing Aid Benefit (APHAB) can be used to evaluate disability in everyday life associated with hearing loss. Previous studies have examined APHAB outcomes in sensorineural hearing loss and we do not know whether the type of hearing loss influence questionnaire outcomes.

PURPOSE

The purpose was to evaluate the psychometric properties of a Swedish translation of the APHAB and the influence of demographic variables on the outcome in a clinical sample.

RESEARCH DESIGN

A descriptive, cross-sectional study in a clinical sample.

STUDY SAMPLE

Forty-eight participants with no hearing aid experience seeking audiological rehabilitation for the first time. These participants represented different degrees of hearing loss and three types of hearing loss: monaural mixed, binaural mixed, and binaural sensorineural hearing loss.

DATA COLLECTION AND ANALYSIS

Pure-tone audiometry was conducted and the participants completed the unaided APHAB during their first appointment at the clinic. Psychometric properties of the questionnaire were examined and the influence of age, gender, type of hearing loss, and degree of hearing loss on APHAB scores were studied.

RESULTS

The psychometric properties indicate high test-retest reliability but there seems to be some potential issues with the properties of the reverberation (RV) subscale. The items from the RV subscale failed to load as a separate component and the internal consistency of the subscale improved by removing four items (items 1, 9, 11, and 16). With few exceptions, APHAB scores were not influenced by age, gender, or type of hearing loss. APHAB scores were generally influenced by degree of hearing loss in both the best and the worst ear.

CONCLUSION

This Swedish version of the APHAB can be additionally improved by addressing the inconsistencies found in the RV subscale by rephrasing or removing some items. The degree of hearing loss has some influence on questionnaire outcomes but not age, gender, and type of hearing loss.

Ethical issues for large-scale hearing aid donation programmes to the Pacific Islands: a Samoan perspective

The Pacific Islands are estimated to have among the highest global burdens of hearing loss, however, hearing health services are limited throughout this region. The provision of hearing aid is desirable, but should be delivered in accordance with WHO recommendations of appropriate and locally sustainable services. Large-scale hearing aid donation programmes to the Pacific Islands raise ethical questions that challenge these recommendations.The aim of this paper is to consider the ethical implications of large-scale hearing aid donation programmes to Samoa, a nation of the Pacific Islands. Evaluation of both 'Western' and 'Pacific Island' perspectives reveals important cross-cultural differences regarding attitudes to donation programmes. We attempt to offer possible solutions that satisfy both ethical frameworks, and which should enable us to deliver an effective hearing health service for Samoa. These solutions may be translational and benefit other Pacific Island nations in a similar context.

Identifying the approaches used by audiologists to address the psychosocial needs of their adult clients

OBJECTIVE

To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss.

DESIGN

A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other.

STUDY SAMPLE

An international sample of 65 audiologists.

RESULTS

Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility.

CONCLUSIONS

Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice.

Quality of Life Outcomes Reported by Patients and Significant Others Following Cochlear Implantation

Purpose This study tested the hypotheses that both patients receiving cochlear implants (CIs) and their significant others (SOs) would demonstrate improvements in perceived hearing handicap over time following cochlear implantation and that the SOs would demonstrate delayed patterns of perceived improvement compared to the patients who directly experienced the changes in hearing function provided by the CI. Method A study sample of 19 pairs of postlingually deafened adult candidates with CIs and their SOs answered questions about the patients' hearing handicap. Patient- and SO-reported scores were obtained preoperatively and at 1, 3, and 6 months after CI activation. The study hypotheses were tested using linear mixed-effects models. Results Patients and SOs independently reported improvements on self-reported hearing handicap measures at 1, 3, and 6 months post CI activation compared to preoperatively. Correlations between patient- and SO-reported scores were significant at all intervals; however, the asynchrony between pairs at 1 month postactivation was greater in magnitude compared to the other intervals. Conclusions Findings support the hypotheses of the study. Results should inform future clinical practice and research to guide the expectations of patients and their SOs as they adjust to hearing with a CI and experience various benefits and challenges over time.

Evaluating a Theoretically Informed and Cocreated Mobile Health Educational Intervention for First-Time Hearing Aid Users: Qualitative Interview Study

BACKGROUND

Adults living with hearing loss have highly variable knowledge of hearing aids, resulting in suboptimal use or nonuse. This issue can be addressed by the provision of high-quality educational resources.

OBJECTIVE

This study aims to assess the everyday experiences of first-time hearing aid users when using a newly developed, theoretically informed cocreated mobile health (mHealth) educational intervention called m2Hear. This intervention aims to deliver greater opportunities for individualization and interactivity compared with our previously developed multimedia intervention, C2Hear.

METHODS

A total of 16 first-time hearing aid users trialed m2Hear for a period of 10-weeks in their everyday lives, after which individual semistructured interviews were completed. The data were analyzed using an established deductive thematic analysis procedure underpinned by the Capability, Opportunity, Motivation-Behavior model. The model stipulates that to engage in a target behavior, an individual must have physical and psychological capability, physical and social opportunity, and automatic and reflective motivation.

RESULTS

Capability-m2Hear was viewed as a concise and comprehensive resource, suitable for a range of digital literacy skills. It was stated that m2Hear could be conveniently reused to provide useful reminders that facilitate knowledge of hearing aids and communication. Opportunity-m2Hear was simple and straightforward to use, enabling greater individualization and independence. The availability of m2Hear via mobile technologies also improved accessibility. Motivation-m2Hear provided greater support and reassurance, improving confidence and empowering users to self-manage their hearing loss.

CONCLUSIONS

Overall, this qualitative study suggests that m2Hear supports first-time hearing aid users to successfully self-manage their hearing loss postfitting. Furthermore, this study demonstrates the utility of employing a combined theoretical and ecologically valid approach in the development of mHealth educational resources to meet the individual self-management needs of adults living with hearing loss.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03136718; https://clinicaltrials.gov/ct2/show/NCT03136718.

Hearing Aid Amplification Reduces Communication Effort of People With Hearing Impairment and Their Conversation Partners

Objectives This study investigates the hypothesis that hearing aid amplification reduces effort within conversation for both hearing aid wearers and their communication partners. Levels of effort, in the form of speech production modifications, required to maintain successful spoken communication in a range of acoustic environments are compared to earlier reported results measured in unaided conversation conditions. Design Fifteen young adult normal-hearing participants and 15 older adult hearing-impaired participants were tested in pairs. Each pair consisted of one young normal-hearing participant and one older hearing-impaired participant. Hearing-impaired participants received directional hearing aid amplification, according to their audiogram, via a master hearing aid with gain provided according to the NAL-NL2 fitting formula. Pairs of participants were required to take part in naturalistic conversations through the use of a referential communication task. Each pair took part in five conversations, each of 5-min duration. During each conversation, participants were exposed to one of five different realistic acoustic environments presented through highly open headphones. The ordering of acoustic environments across experimental blocks was pseudorandomized. Resulting recordings of conversational speech were analyzed to determine the magnitude of speech modifications, in terms of vocal level and spectrum, produced by normal-hearing talkers as a function of both acoustic environment and the degree of high-frequency average hearing impairment of their conversation partner. Results The magnitude of spectral modifications of speech produced by normal-hearing talkers during conversations with aided hearing-impaired interlocutors was smaller than the speech modifications observed during conversations between the same pairs of participants in the absence of hearing aid amplification. Conclusions The provision of hearing aid amplification reduces the effort required to maintain communication in adverse conditions. This reduction in effort provides benefit to hearing-impaired individuals and also to the conversation partners of hearing-impaired individuals. By considering the impact of amplification on both sides of dyadic conversations, this approach contributes to an increased understanding of the likely impact of hearing impairment on everyday communication.

Perception of One's Own Voice After Hearing-Aid Fitting for Naive Hearing-Aid Users and Hearing-Aid Refitting for Experienced Hearing-Aid Users

Dissatisfaction with the sound of one's own voice is common among hearing-aid users. Little is known regarding how hearing impairment and hearing aids separately affect own-voice perception. This study examined own-voice perception and associated issues before and after a hearing-aid fitting for new hearing-aid users and refitting for experienced users to investigate whether it was possible to differentiate between the effect of (unaided) hearing impairment and hearing aids. Further aims were to investigate whether First-Time and Experienced users as well as users with dome and mold inserts differed in the severity of own-voice problems. The study had a cohort design with three groups: First-Time hearing-aid users going from unaided to aided hearing (n = 70), Experienced hearing-aid users replacing their old hearing aids (n = 70), and an unaided control group (n = 70). The control group was surveyed once and the hearing-aid users twice; once before hearing-aid fitting/refitting and once after. The results demonstrated that own-voice problems are common among both First-Time and Experienced hearing-aid users with either dome- or mold-type fittings, while people with near-normal hearing and not using hearing aids report few problems. Hearing aids increased ratings of own-voice problems among First-Time users, particularly those with mold inserts. The results suggest that altered auditory feedback through unaided hearing impairment or through hearing aids is likely both to change own-voice perception and complicate regulation of vocal intensity, but hearing aids are the primary reason for poor perceived sound quality of one's own voice.

Improving Collaborative Behaviour Planning in Adult Auditory Rehabilitation: Development of the I-PLAN Intervention Using the Behaviour Change Wheel

Background

The consequences of poorly managed hearing loss can be ameliorated with hearing aid use but rates of use are sub-optimal. The impact of audiologist behaviour on subsequent use, particularly over the long term, is unknown.

Purpose

This study aimed to describe the role of the behaviour change wheel in developing an intervention to introduce and embed particular clinical behaviours into adult hearing aid fitting consultations, within the framework of the Medical Research Council guidance on complex interventions.

Methods

Following the steps of the behaviour change wheel, audiologist behaviours that might influence hearing aid use were identified based on a systematic review and qualitative work with audiologists. An analysis, using the COM-B model, identified potential drivers of the target behaviours. This was used to select intervention functions and behaviour change techniques likely to influence behaviour in this context.

Results

The target behaviours were as follows: giving information about the benefits of hearing aid use and the negative consequences of non-use, providing prompts for use and engaging in collaborative behavioural planning for use. The behavioural analysis suggested that psychological capability, opportunity and motivation were potential drivers of these behaviours. The intervention functions of education, coercion, training, environmental restructuring, modelling and enablement were selected and combined to develop a single complex intervention that seeks to address the target behaviours.

The Effects of Amplification on Listening Self-Efficacy in Adults With Sensorineural Hearing Loss

Objectives The aim of this study was to evaluate listening self-efficacy ratings between aided and unaided conditions in different communication environments and to determine what patient- and device-centered variables were associated with individual differences. Method An observational, cross-sectional study design was used to evaluate 165 older adults with mild to moderately severe sensorineural hearing loss who wore hearing aids at least 8 hr per week. Listening self-efficacy for both unaided and aided listening was measured using the Listening Self-Efficacy Questionnaire (LSEQ; Smith, Pichora-Fuller, Watts, & La More, 2011), consisting of a global score and subscales of Dialogue in Quiet, Directed Listening, and Complex Listening. Metrics to explain variability in the degree of improvement in LSEQ ratings with aided listening included patient-centered variables of age, pure-tone average, and personality and device-centered variables of hearing aid use, speech intelligibility index, directionality, and noise reduction. The NEO Five-Factor Inventory (Costa & McCrae, 1985) was used to measure 5 personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness). Associations were evaluated between LSEQ ratings and patient- and device-centered variables using a linear mixed-model analysis. Results Statistically significant improvements in LSEQ ratings were found for aided conditions (relative to unaided conditions), easier listening environments, lower pure-tone averages, and lower levels of neuroticism. Furthermore, the improvement in listening self-efficacy with hearing aids did not depend on the listening environment but did alter with severity of hearing loss, length of hearing aid use, and levels of conscientiousness. Conclusions Results of this study suggest that wearing hearing aids is associated with improved listening self-efficacy in a variety of communication environments. Aural rehabilitation and counseling may focus on improving listening self-efficacy to address the challenges of consistent hearing aid use and reduced quality of life related to hearing loss.

Quality of life in persons with hearing loss: a study of patients referred to an audiological service

Objective: To investigate the relationship between hearing loss (HL) and general quality of life (QoL) in adults seeking hearing aids (HAs). Design: The patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire's general part and a questionnaire measuring self-assessed communication ability (Abbreviated Profile of hearing Aid Benefit-APHAB). These responses were compared with EORTC scores from a general population and patients with former head and neck cancer. Study sample: One-hundred and fifty-eight adults with HL were recruited prior to hearing aid (HA) fitting with one half seeking renewal of their HA. Results: General QoL scores among patients with HL were similar to those in the general population, but higher than in many chronic serious diseases. Patients with unilateral HL reported slightly worse social function and more fatigue than patients with bilateral HL. Self-assessed communication ability correlated with general QoL scores. Also, we found that best ear pure tone average (PTA), cognitive and physical QoL function predicted APHAB scores. Conclusion: In the investigated HL group, general QoL scores seem to be relatively close to those seen in the general population.

Knowledge Is Power: Improving Outcomes for Patients, Partners, and Professionals in the Digital Age

Purpose

The aim of this research was to develop and evaluate methods to address poor knowledge of hearing aids, hearing loss, and communication in patients, partners, and nonaudiologic health and social care professionals.

Method

An interactive multimedia educational program (C2Hear) has been co-produced with hearing aid users and audiologists to provide high-quality information and demonstrate complex concepts relating to hearing aids and communication.

Results

A randomized controlled trial showed numerous benefits for first-time hearing aid users that included better knowledge and skill, and increased hearing aid use and satisfaction. Patients reported that C2Hear was highly useful, enjoyable, and preferable to written information. C2Hear Online is now freely available on YouTube and has global reach, well in excess of 150,000 views. Further developments include a version for communication partners, which showed that joint-working between hearing aid users and their communication partners resulted in joint responsibility for communication that facilitated communication behaviors. In addition, a behavior theory-driven version for use with mobile technologies (m2Hear) has been designed to be tailored to the needs of individual hearing aid users. m2Hear includes more activities/interaction to maximize user engagement and learning. Finally, C2Hear has been used to improve hearing-related knowledge in other health and social care professionals, such as carehome assistants.

Conclusion

This range of educational programs and tools aims to improve knowledge and skills, leading to better outcomes for patients, partners, and health care professionals.

A Data-Driven Synthesis of Research Evidence for Domains of Hearing Loss, as Reported by Adults With Hearing Loss and Their Communication Partners

A number of assessment tools exist to evaluate the impact of hearing loss, with little consensus among researchers as to either preference or psychometric adequacy. The item content of hearing loss assessment tools should seek to capture the impact of hearing loss on everyday life, but to date no one has synthesized the range of hearing loss complaints from the perspectives of the person with hearing loss and their communication partner. The current review aims to synthesize the evidence on person with hearing loss- and communication partner-reported complaints of hearing loss. Searches were conducted in Cos Conference Papers Index, the Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, PubMed, Web of Science, and Google Scholar to identify publications from May 1982 to August 2015. A manual search of four relevant journals updated the search to May 2017. Of the 9,516 titles identified, 78 records (comprising 20,306 participants) met inclusion criteria and were taken through to data collection. Data were analyzed using meta-ethnography to form domains representing the person with hearing loss- and communication partner-reported complaints of hearing loss as reported in research. Domains and subdomains mutual to both perspectives are related to “Auditory” (listening, communicating, and speaking), “Social” (relationships, isolation, social life, occupational, and interventions), and “Self” (effort and fatigue, emotions, identity, and stigma). Our framework contributes fundamental new knowledge and a unique resource that enables researchers and clinicians to consider the broader impacts of hearing loss. Our findings can also be used to guide questions during diagnostic assessment and to evaluate existing measures of hearing loss.

Generic Quality of Life in Persons With Hearing Loss: A Review of the Recent Literature

BACKGROUND

It is unknown whether persons with hearing loss (HL) have reduced generic quality of life (QoL) and to what extent a hearing aid (HA) might improve QoL. The main aim of the study was to review studies about the relationship between HL and QoL. A supporting aim was to study the association between distress and HL.

METHODS

Literature databases (CINAHL, Pub Med, and Web of Science) were searched for relevant articles published from January 2000 to March 17, 2016. A primary search was performed regarding the relationship between HL, HA, and QoL (search one) followed by a supporting search about the relationship between distress/mood/anxiety and HL (search two). After removing duplications and screening the titles of the articles, the abstracts of the remaining articles were read and those that met the inclusion criteria were included.

RESULTS

The two searches yielded a total of 4,188 journal articles. Twenty journal articles were included in the present review: 13 from search one, and 7 from search two. The literature shows distressed persons tend to have a lowered generic QoL. Some studies suggest an improved generic QoL following the use of HA. Other studies suggest that HA use is one of several possible factors that contribute to improved generic QoL.

CONCLUSION

Most of the studies suggest that HL is associated with reduced generic QoL. Using HA seems to improve general QoL. Further research is needed to explore the relationship between HL and generic QoL, in addition to the importance of influencing variables on this relationship.

Hearing and quality of life in older adults

OBJECTIVES

We assessed quality of life (QoL) in older adults with and without hearing loss (HL) and studied how hearing aids were associated with QoL. We hypothesized participants with normal hearing would have significantly better QoL than participants with HL and hearing aids, and participants with HL but no aids would have the worst QoL.

METHOD

At the University of Alabama and rural public health departments in surrounding counties, we tested 100 males and females aged 60-87 using pure-tone audiometry. They completed Short Form-36 and Medical Outcome Study assessments. We analyzed data with MANCOVA (covariate income).

RESULTS

Participants without hearing aids had significantly poorer QoL than participants with normal hearing, who did not significantly differ from participants with aids. General health drove the difference.

CONCLUSIONS

Hearing aids are associated with better QoL than having HL and going without aids. Clinical psychologists can improve coping among those with HL and motivate hearing aid use.

Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in Kampala, Uganda

Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12-5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17-6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.