Hearing-aid use and long-term health outcomes: Hearing handicap,mental health,social engagement,cognitive function,physical health,and mortality

Objective: To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. Design: We assessed hearing handicap (hearing handicap inventory for the elderly; HHIE-S), cognition (mini mental state exam, trail making, auditory verbal learning, digit-symbol substitution, verbal fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities), and mental health (SF-12 mental component) at baseline, five years prior to baseline, and five and 11 years after baseline. Study sample: Community-dwelling older adults with hearing impairment (N = 666) from the epidemiology of hearing loss study cohort. Results: There were no significant differences between hearing-aid users and non-users in cognitive, social engagement, or mental health outcomes at any time point. Aided HHIE-S was significantly better than unaided HHIE-S. At 11 years hearing-aid users had significantly better SF-12 physical health scores (46.2 versus 41.2; p = 0.03). There was no difference in incidence of cognitive impairment or mortality. Conclusion: There was no evidence that hearing aids promote cognitive function, mental health, or social engagement. Hearing aids may reduce hearing handicap and promote better physical health.     

An investigation of the audiologic handicap associated with unilateral sudden sensorineural hearing loss

OBJECTIVE: To determine the incidence of tinnitus and associated handicap after unilateral sudden sensorineural hearing loss (SSNHL); in addition, to determine the hearing handicap experienced as a consequence of such a loss. STUDY DESIGN: Identification of patients and determination of demographic and audiologic data by retrospective case review; determination of handicap and distress by postal questionnaire. SETTING: Teaching hospital department of otolaryngology. PATIENTS: Thirty-eight patients were identified as having been treated for a unilateral sudden sensorineural hearing loss in the period 1988 through 1997. Of those, 21 (55.3%) replied to the questionnaire. MAIN OUTCOME MEASURES: Audiometric data at admission and at 4-week follow-up, Tinnitus Handicap Inventory (THI), visual analogue scales of tinnitus loudness and distress, Hearing Handicap Inventory in Adults (HHIA). RESULTS: The questionnaire responder group did not significantly differ from the questionnaire nonresponder group on demographic nor audiometric variables, and hence were considered to be a representative sample. Tinnitus was present in 14 patients (67%). Hearing handicap was found in 86% of patients (of the 21 questionnaire responders) and tinnitus handicap in 57% (of the 14 with tinnitus). Correlations were found between tinnitus loudness, distress, and handicap. There was no correlation between time elapsed since SSNHL and tinnitus or hearing handicap, nor was there a correlation between the extent of audiometric loss and hearing or tinnitus handicap. A strong negative correlation was, however, found between recovery in audiometry in the first 4 weeks after onset and tinnitus and hearing handicap. The audiometric status of the contralateral ear correlated with hearing handicap. CONCLUSIONS: A majority of patients after unilateral SSNHL have a perceived handicap associated with tinnitus and hearing. Although this condition is an otologic emergency, careful thought should be given to the audiologic rehabilitation of this patient group.     

An evaluation of the English language version of the social hearing handicap index

It is widely acknowledged that standard clinical measures of hearing assessment can provide no more than a relative measure of social efficiency. A Danish language scale for self-assessment of hearing handicap has been reported both in terms of initial assessment, and of assessing response to rehabilitatory intervention. The English language version of this scale was included in a study on hearing handicap in a sample of adult native English speakers. The results essentially supported the claims of the authors but some reservations are noted.     

The Hearing Handicap Inventory for the Elderly as a measure of hearing aid benefit

Hearing impairment in older adults is associated with psychological and social difficulties. The goal of hearing aid fitting is to reduce the perceived handicap resulting from the hearing loss. Measures of self-perceived handicap are being increasingly incorporated into the clinicians armamentarium as an objective measure of the outcome of intervention. Eighteen elderly hearing-impaired males and their spouses responded to the Hearing Handicap Inventory for the Elderly (HHIE) prior to and following 1 year of hearing aid provision. Our findings revealed a significant reduction in the perceived emotional and social effects of hearing impairment following 1 year of hearing aid use. The reduction in perceived handicap, as measured using the HHIE, was greater for the hearing aid users than for their spouses. The findings attest to the construct validity of the HHIE as a measure of hearing aid benefit.     

Hearing handicap in Asian patients with dementia

BackgroundHearing loss and hearing handicap may contribute to cognitive impairment and dementia. The purpose of this study was to analyze the association between hearing loss and hearing handicap with dementia in an Asian memory clinic parents.MethodsThis study includes the data obtained from patients with mild dementia who attended the National University hospital memory clinic and non-demented healthy subjects among spouses and caregivers who are non-genetically related to our patients. All participants underwent comprehensive physical, medical, neuropsychological and audiological assessments (i.e. pure tone audiometry - PTA). Disabling hearing loss was defined as a hearing loss of >40 dB in the better ear on PTA. Amsterdam Inventory for Auditory Disability and Handicap (AIADH) questionnaire was administered through the verbal interview to measure their hearing handicap score. Linear regression models were used to investigate the association between hearing loss and hearing handicap with dementia. Mean differences (β) with 95% confidence intervals (CI) were calculated.Results91 participants (65–90 years old) were recruited for this study; 39 of them were patients with dementia and 52 were non-demented healthy controls. 48.7% of the patients with dementia had disabling hearing loss, which is higher than the non-demented controls (25.0%) (p = 0.019). The significant association between hearing handicap (as measured by AIADH) and dementia was observed, which was independent of demographic factors and audiology related history and PTA average (β = −6.40; 95% CI =0.11.99, −0.81, p = 0.025). There was no independent association between hearing loss and dementia (p > 0.05).ConclusionA significant association between hearing handicap and dementia was found. The mechanism of this association requires further research and may involve higher order central processing disorder.     

Occupational hearing loss--an otologist's view of a long-term study

Seven hundred nineteen consecutive patients referred by The Workmen's Compensation Board for adjudication of hearing loss of presumed occupational etiology, have had an otological and audiological evaluation. Significant ear disease was found in 7 percent of ears, and in >3 percent it was considered the major cause of hearing loss. Routinely evoked response audiometry was undertaken in a consecutive sub-series of 258 patients and the results compared with conventional tests. Approximately one in five showed an exaggerated hearing loss, which was well predicted by the audiologist on the basis of the patient's attitude during conventional tests. It is argued that compensation awards based upon pure-tone averages ignore a major aspect of the patient's handicap — the loss of ability to discriminate sound in background noise. Comparison between speech discrimination results and pure-tone threshold responses showed a statistically significant inverse relationship with the low frequency response and a positive relationship with high frequency response, which is contrary to the present method of evaluating handicap awards. It is suggested that 500 Hz should be eliminated from the frequencies used in handicap evaluation of sensori-neural hearing loss and/or that at least one extra higher frequency (3,000 or 4,000 Hz) be included.     

Speech perception in medico-legal assessment of hearing disabilities

Objective: Examination of Danish data for medico-legal compensations regarding hearing disabilities. The study purposes are: (1) to investigate whether discrimination scores (DSs) relate to patients’ subjective experience of their hearing and communication ability (the latter referring to audio-visual perception), (2) to compare DSs from different discrimination tests (auditory/audio-visual perception and without/with noise), and (3) to relate different handicap measures in the scaling used for compensation purposes in Denmark. Design: Data from a 15 year period (1999–2014) were collected and analysed. Study sample: The data set includes 466 patients, from which 50 were omitted due to suspicion of having exaggerated their hearing disabilities. Results: The DSs relate well to the patients’ subjective experience of their speech perception ability. By comparing DSs for different test setups it was found that adding noise entails a relatively more difficult listening condition than removing visual cues. The hearing and communication handicap degrees were found to agree, whereas the measured handicap degrees tended to be higher than the self-assessed handicap degrees. Conclusions: The DSs can be used to assess patients’ hearing and communication abilities. The difference in the obtained handicap degrees emphasizes the importance of collecting self-assessed as well as measured handicap degrees.     

Hearing loss in over-65s: is routine questionnaire screening worthwhile?

It has been suggested that there is considerable unmet need in respect of hearing loss amongst the elderly population, but no routine screening test is currently used in general practice to identify these patients. The aim of this study was to determine whether routine questionnaire screening of the over-65s is a feasible way to identify elderly patients with hearing loss in primary care and whether patients so identified would benefit from hearing aid fitting. A cohort of patients consisting of a sample of 234 individuals aged between 65 and 74, attending a doctor's surgery over a specified period, received a scored questionnaire to complete based on the Hearing Handicap Inventory for the Elderly Screening test. Hearing aid owners and those with a hearing handicap were identified, and non-aid wearers with handicap offered examination and referral. Those patients who were fitted with aids were assessed after six months for aid usage and persisting handicap. Twenty-five per cent of the patient sample reported a previously undiagnosed hearing handicap. Six months after aid fitting, a reduction in hearing handicap was reported in 79 per cent of these cases and overall aid usage in the population sample had increased from nine per cent to 20 per cent. Routine questionnaire screening in general practice may be worthwhile since it is easy to carry out and the resulting intervention significantly reduces reported hearing handicap.     

Audiologic and nonaudiologic correlates of hearing handicap in black elderly

The purpose of this study was to explore the contributions of audiologic and nonaudiologic factors, including medical, social, economic, and psychological, towards understanding hearing handicap in black elderly. One hundred hearing-impaired black elderly subjects from Harlem Hospital were given audiologic evaluations, including speech recognition tests under varied conditions. Audiologic factors were significantly related to hearing handicap, measured by the Hearing Handicap Scale (HHS) and the Hearing Handicap Inventory for the Elderly (HHIE), with stronger correlations for speech recognition measured at 50 dB HL in a sound field than at 40 dB SL under earphones. Once hearing loss was taken into consideration, nonaudiologic factors (measured on the Multidimensional Functional Assessment Questionnaire), particularly the dependability dimension of social support and the lethargy and paranoid dimensions of mental health, emerged as contributing predictor variables for HHS and HHIE scores. These findings suggest that a multidimensional approach is key to understanding and remediating hearing handicap in black elderly.     

Age-related hearing difficulties. II. Psychological and sociological consequences of hearing problems--a controlled study

71 individuals aged 70-75 years, whose audiological profile has been described in part I' of the study, were subjected to an extensive psychological questionnaire to evaluate the influence of hearing impairment on the psychological and sociological profile and general behaviour. The subjects consisted of three groups: first-time applicants for hearing-aids, re-applicants, and a control group not complaining of hearing problems. Neither hearing deterioration in general, as measured by hearing handicap and communication handicap, nor noise-induced hearing impairment was correlated to social class. The general activity level and the intellectual capacity were independent of hearing level, but a significant correlation was found between activity level and intellectual capacity. Also social class was correlated to activity level and intellectual level. Thus, a highly active life was correlated to preserved intellect and higher social class. Most of the elderly regarded themselves as being active, but this did not correlate with the objective activity score. Decreased activity was not correlated to hearing problems, but rather to physical limitations, decreased number of interests, tiredness. Self-perception was not influenced by the degree of hearing handicap and a stable mood and an optimistic attitude predominated. Only 14% experienced a depressed mood, and this state seemed to be linked to deteriorated hearing.     

Audiometric and subjective assessment of hearing handicap

This study compares self-perceived assessment of hearing handicap with audiometrically derived measures of hearing handicap in a sample of elderly persons. Subjects were evaluated by traditional audiometric tests, the Speech Perception in Noise test, and the Hearing Handicap Inventory for the Elderly, a self-assessment questionnaire. Hearing handicap was also calculated by the audiometrically derived American Academy of Otolaryngology (1979) method. Our results are consistent with other studies that indicate a low correspondence between audiometric measures of hearing handicap and self-assessment of hearing handicap. Furthermore, if the Hearing Handicap Inventory for the Elderly is considered the true measure of hearing handicap, our data indicate that the American Academy of Otolaryngology method tends to overestimate handicap among persons with no self-perceived hearing handicap and underestimates handicap among persons with significant self-perceived hearing handicap.     

Results of the bone-anchored hearing aid in unilateral hearing loss

OBJECTIVES: The advantages of binaural hearing are well established and universally accepted. However, a tendency remains to withhold the benefits of binaural hearing to adults and children with one normal ear. The purpose of this study is to demonstrate the benefit of the bone-anchored hearing aid (BAHA) in a group of patients with unilateral conductive or mixed hearing loss. STUDY DESIGN: This is a prospective study of nine patients (five males and four female patients) with conductive or mixed hearing loss who met the criteria for BAHA except for having normal hearing in the other ear. They had congenital aural atresia or mastoidectomies secondary to chronic ear infections with or without cholesteatoma or had a temporal bone tumor excised METHODS: Patients had evaluations before and after implantation, including audiological testing and responses to a standardized hearing handicap questionnaire. Statistical analyses of the data were made using the Wilcoxon signed rank test and the paired Student t test for repeated measures. RESULTS: All patients had tonal and spondee threshold improvement with BAHA when compared with thresholds before treatment. Speech recognition performance in BAHA-aided conditions was comparable to the patient's best score in unaided condition. Patients reported a significant improvement in their hearing handicap scores with the BAHA. CONCLUSIONS: The use of BAHA has significantly improved the hearing handicap scores in patients with unilateral conductive or mixed hearing loss. The proven safety and efficacy of the device promote its use in unilateral cases that traditionally had been left unaided.     

Subjective magnitude of auditory impairment: A Pilot Study

A study of two samples (one in London, the other in Cairo) of patients who were suffering from an impairment of hearing showed that the subjective magnitude of auditory handicap was significantly correlated to the average hearing level at 2 000 Hz for the two ears. For both samples, the subjective magnitude of the auditory handicap was shown to be a power function of the hearing loss expressed in terms of the sound pressure corresponding to the threshold of hearing. The exponents in the power function applying to the two samples were similar. Age, sex and pain threshold did not influence the estimation of the subjective magnitude of auditory handicap in this study.     

The evidence base for the application of contralateral bone anchored hearing aids in acquired unilateral sensorineural hearing loss in adults

? Acquired unilateral sensorineural hearing loss reduces the ability to localize sounds and to discriminate in background noise. ? Four controlled trials attempt to determine the benefit of contralateral bone anchored hearing aids over contralateral routing of signal (CROS) hearing aids and over the unaided condition. All found no significant improvement in auditory localization with either aid. Speech discrimination in noise and subjective questionnaire measures of auditory abilities showed an advantage for bone anchored hearing aid (BAHA) > CROS > unaided conditions. ? All four studies have material shortfalls: (i) the BAHA was always trialled after the CROS aid; (ii) CROS aids were only trialled for 4 weeks; (iii) none used any measure of hearing handicap when selecting subjects; (iv) two studies have a bias in terms of patient selection; (v) all studies were underpowered (vi) double reporting of patients occurred. ? There is a paucity of evidence to support the efficacy of BAHA in the treatment of acquired unilateral sensorineural hearing loss. Clinicians should proceed with caution and perhaps await a larger randomized trial. ? It is perhaps only appropriate to insert a BAHA peg at the time of vestibular schwanoma tumour excision in patients with good preoperative hearing, as their hearing handicap increases most.     

Hearing in patients operated unilaterally for otosclerosis. Self-assessment of hearing and audiometric results.

The objective of this study was to examine the outcome of unilateral stapes surgery in one patient group with bilateral hearing loss and one group with unilateral hearing loss. The patients' own estimations of improvement in hearing ability and the occurrence of other ear-related symptoms were examined retrospectively and in a follow-up study. Ninety-five of 123 patients operated for otosclerosis in only one ear between 1987 and 1992 responded to a follow-up examination. Observed audiometric findings and changes thereof, along with the patients' own estimations of their hearing handicap pre- and postoperatively, and the occurrence of other ear-related symptoms were studied. Despite good surgical results (closure of air-bone gap within 20 dB in 94%), 33% of the patients had severe hearing disabilities postoperatively, and many of these patients needed further amplification with a hearing aid. Mild dizziness occurred in 33% of the patients postoperatively and did not decrease over time. Discomfort in the operated ear due to strong sounds was reported in 20%. Change in sound quality occurred in 80% of the operated ears, but tended to disappear over time. From the results of this study it may be concluded that surgery in one ear only, leaving the other ear with poor hearing, is not an optimal hearing rehabilitation of patients with otosclerosis. It is important endevour to achieve bilateral hearing in order to give the patient good social hearing. Postoperative dizziness and unpleasant hearing quality do occur frequently, and the patients need to be informed about these problems preoperatively.     

Articulation index and hearing handicap

This investigation examined the relationship between perceived hearing handicap and the Articulation Index (AI) and the extent to which this relationship was influenced by the variables age, gender, degree of hearing loss, and audiometric slope. Subject age, gender, pure-tone thresholds, and scores for the Self-Assessment of Communication (SAC) and the Significant Other Assessment of Communication (SOAC) were extracted retrospectively from 373 patient files (194 males, 179 females). Correlation analysis revealed a significant (p < .01) negative relationship between AI values and both measures of hearing handicap, and also indicated that SAC/SOAC total scores correlated significantly (p < .01) with each other. Partial correlation analyses revealed that degree of hearing loss was the only variable under study that had substantial influence on the strength of AI/hearing handicap correlations.     

Change in hearing handicap after translabyrinthine vestibular schwannoma excision.

OBJECTIVE: To evaluate the change in hearing handicap after translabyrinthine vestibular schwannoma excision. STUDY DESIGN: Prospective administration of the Hearing Handicap Inventory preoperatively and at 3 and 12 months postoperatively. SETTING: A tertiary referral neurootology clinic. PATIENTS: A total of 119 consecutive patients who had vestibular schwannomas excised between May 1998 and July 2002 and who had completed Hearing Handicap Inventories preoperatively and at 3 and 12 months postoperatively. INTERVENTIONS: Translabyrinthine excision of a unilateral sporadic vestibular schwannoma; pre- and postoperative hearing therapy and rehabilitation. MAIN OUTCOME MEASURES: Hearing Handicap Inventory scores. RESULTS: Sixty-one percent of patients showed no change in their hearing handicap between preoperative and 3-month postoperative measures. Fifty-eight percent showed no change between preoperative and 12-month postoperative measures. Twenty-five percent of patients had a worsening in their hearing handicap when comparing preoperative and 12-month postoperative scores, and these patients were those with a better hearing class preoperatively. Seventeen percent of patients showed an improvement in their hearing handicap over this same time period, and the reasons for this remain unclear. Neither age nor tumor size had an effect on change in hearing handicap. CONCLUSIONS: The findings of the current study can be used during preoperative patient counseling. In particular, the clinician is now able to take an informed and positive stance about the hearing handicap to be expected postoperatively.     

Considerations in selecting and validating an adult/elderly hearing screening protocol.

This article presents important factors related to hearing impairment, medical concerns related to hearing, hearing handicap, and epidemiological principles as considerations in selection of a protocol in adult/elderly hearing screening (18 yr and older). I encourage protocol validation which incorporates a series of criteria: medical conditions, rates of failure for handicap and impairment, handicap perspectives, hearing aid use and satisfaction, and follow-up data when referred. Three different pure-tone fence levels (20 dB, 25 dB, and 40 dB at 1000, 2000, and 4000 Hz) are proposed for further study by virtue of their utility for different settings and populations. Finally, a possible protocol is proposed for use with the different pure-tone fences.     

The Surgical Rehabilitation of Total Deafness with the Multichannel Cochlear Implant: Indications and Results

By using a modified stepwise regression analysis technique, the structure of self-perceived handicap and tinnitus annoyance in 89 males with noise-induced hearing loss was described. Handicap was related to three clusters of variables, reflecting individual, environmental, and socioeconomic aspects, and 60% of the variance in self-perceived handicap was explained by the representatives of these clusters: i.e. ‘acceptance of hearing problems’, ‘social support related to tinnitus’ and ‘years of education’. Tinnitus had no impact of its own on self-perceived handicap and only a modest portion (36%) of the variance in tinnitus annoyance was explained by ‘sleep disturbance’ and ‘auditory perceptual difficulties’.