Effects of Economic Status on Changes in Social Networks and Mental Health after Using Hearing Aids

OBJECTIVES

Hearing impairment affects social networks and mental health. Hearing aids (HA) can improve these deficits. However, their effects might be affected by various factors such as economic status (ES). This study aimed to identify how ES could moderate the effects of HA on social networks, depressive mood, and cognition.

METHODS

A prospective cohort for new HA users was established and classified into two groups based on their ES: a low ES group (LES group) and a medium to high ES group (MHES group). Audiological examination, Lubben social network scale-18 (LSNS-18), Short form of Geriatric Depression Score, Mini-Mental State Examination in the Korean version of the CERAD Assessment Packet, and surveys for satisfaction with HA were conducted before and at six months after wearing HA.

RESULTS

Post-HA application LSNS-18 scores were not improved in the LES group whereas they revealed significant improvement in the MHES group (p = 0.003). The LES group showed lower LSNS-18 score (p = 0.020) and its change (p = 0.042) than the MHES group. Additionally, patients with depressive moods in the MHES group showed better improvements than those in the LES group (p = 0.048). The effects of wearing HA on cognition and satisfaction with HA were not significantly different between the two groups.

CONCLUSIONS

HA did not improve social relationships and depressive moods in the LES group. Comprehensive and multidirectional support as well as hearing rehabilitation may be important for patients with LES.

LEVEL OF EVIDENCE

3 (Nonrandomized controlled cohort/follow-up study) Laryngoscope, 134:2387-2394, 2024.

Hearing Loss and Dementia: Where to From Here?

Victorian era psychologists were the first to comment on associations between sensory and cognitive function. More recently, hearing loss has been shown as a marker of risk for dementia. However, it is not known whether this association represents a causal impact of hearing loss, nor whether treating hearing loss may help prevent dementia. Most studies on relationships between hearing loss and cognitive outcomes are observational, are at risk of confounding, and cannot reach conclusions about causation. A recent high quality randomized controlled trial, relatively uncommon in audiology, reported no impact of a comprehensive hearing intervention in mitigating cognitive decline in older adults. Although secondary analysis revealed potential benefits in a sub-sample of adults, this finding may be spurious. Encouraging policymakers, patients, and other health care practitioners to address hearing loss in terms of dementia prevention may be inappropriate on the grounds of both relevance at individual level and lack of clear evidence of benefit. In addition, advocating need to address hearing loss in terms of mitigating dementia risk may reduce the importance of addressing hearing loss in its own right. Linking hearing loss to dementia risk may also exacerbate the stigma of hearing loss, inadvertently discouraging people from seeking help for hearing. We suggest that treating hearing loss may have important benefits in preventing or delaying diagnosis of dementia via improving orientation and functioning in daily life, without changing the underlying pathology. Rather than linking hearing loss to dementia risk, we suggest a positive message focusing on the known benefits of addressing hearing loss in terms of improved communication, quality of life, and healthy aging.

Interactive effects of hearing aid use and cognitive function in patients with hearing loss

BACKGROUND

There has been a significant increase in scientific investigations of the hearing-dementia association among the research on potentially modifiable risk factors for cognitive impairment. We tested two clinical questions. Analysis 1: does persistent hearing aid (HA) use decrease the decline in cognitive function caused by ageing? Analysis 2: does cognitive function at the time of HA fitting predict future persistent HA use?

METHODS

This case-control study performed at two referral centres reported data obtained over a 4.5-year period. We recruited a group of patients with cognitive decline, aged 65 or older with or without hearing loss. The intervention consisted of the use of HAs. The primary outcome measures were adherence to continuous HA use and cognitive function measured using the Japanese version of the Mini-Mental State Examination Test and the Reading Cognitive Test Kyoto.

RESULTS

Eighteen HA users and 18 controls were included in the first analysis. HA use was associated with a deceleration of cognitive decline 12 months later. In the second analysis, 11 participants with good adherence to HA use were compared with 12 participants who showed poor adherence to HA use. Among the variables employed in this study, cognitive function measured using the Reading Cognitive Test Kyoto was significantly lower in participants with poor adherence to HA.

CONCLUSIONS

HA use in cognitively impaired individuals with hearing loss can slow age-related cognitive decline. Cognitively impaired people with hearing loss who fail to commit to HA use tend to have lower cognitive measurement scores before HA fitting. HA use is generally more challenging as people age and their cognitive abilities decline. Therefore, it is desirable that HAs be used when hearing loss and dementia are in their early stages.

Cause, severity, and efficacy of treatment for hearing loss in children with Trisomy 18: A single institution-based retrospective study

Trisomy 18 is a common chromosomal aberration syndrome, characterized by variable clinical manifestations, including cardiovascular, pulmonary, genitourinary, and musculoskeletal findings, leading to a shorter survival and severe developmental delay in survivors. However, recently, intensive therapeutic intervention has allowed for prolonging survival. In terms of otological complications, only a limited number of relevant reports have been published. To demonstrate the characteristic of hearing loss (HL) in children with Trisomy 18, we retrospectively evaluated 22 patients (44 ears) by comprehensive auditory evaluation with the auditory steady-state response (ASSR) test and temporal bone computed tomography (CT). ASSR revealed that 20 patients (91%) had bilateral moderate to profound HL, more frequent and severe than that in Trisomy 21; among 42 ears having HL, 12 ears (29%) had conductive HL, and 26 ears (62%) had mixed HL. CT scans of 38 ears revealed that 34 ears (89%) had an external and middle ear malformation. Hearing aids (HA) were fitted in 17 patients (air and bone-conduction HAs). The threshold hearing with HA was improved in all of them. Accurate otological evaluation using ASSR and CT and intervention by HAs could be a feasible choice for children with Trisomy 18.

Over-the-Counter (OTC) Hearing Aid Availability across the Spectrum of Human Skin Colors

BACKGROUND

Over-the-counter (OTC) hearing aids were recently approved for sale in the United States. Research has shown that consumers prefer hearing devices that match their skin color because these devices are less noticeable. Colorism is discrimination against individuals with relatively darker skin that manifests in "skin-color" product offerings as products being offered primarily in relatively lighter colors.

METHODS

This study compared images of U.S. Food and Drug Administration (FDA)-registered over-the-counter hearing aids to a range of human skin colors.

RESULTS

Most over-the-counter hearing aids are only offered in relatively lighter beige colors. Few over-the-counter hearing aids are available in darker skin colors.

CONCLUSIONS

These findings may represent structural bias, preventing equitable access to darker skin-color OTC hearing aids for individuals with darker skin.

An audibility model of the headband trial with a bone conduction device in single-sided deaf subjects

OBJECTIVE

Modelling the head-shadow effect compensation and speech recognition outcomes, we aimed to study the benefits of a bone conduction device (BCD) during the headband trial for single-sided deafened (SSD) subjects.

DESIGN

This study is based on a database of individual patient measurements, fitting parameters, and acoustic BCD properties retrospectively measured on a skull simulator or from existing literature. The sensation levels of the Bone-Conduction and Air-Conduction sound paths were compared, modelling three spatial conditions with speech in quiet. We calculated the phoneme score using the Speech Intelligibility Index for the three conditions in quiet and seven in noise.

STUDY SAMPLE

Eighty-five SSD adults fitted with BCD during headband trial.

RESULTS

According to our model, most subjects did not achieve a full head-shadow effect compensation with the signal at the BCD side and in front. The modelled speech recognition in the quiet conditions did not improve with the BCD on the headband. In noise, we found a slight improvement in some specific conditions and minimal worsening in others.

CONCLUSIONS

Based on an audibility model, this study challenges the fundamentals of a BCD headband trial in SSD subjects. Patients should be counselled regarding the potential outcome and alternative approaches.

Muddy, muddled, or muffled? Understanding the perception of audio quality in music by hearing aid users

Introduction

Previous work on audio quality evaluation has demonstrated a developing convergence of the key perceptual attributes underlying judgments of quality, such as timbral, spatial and technical attributes. However, across existing research there remains a limited understanding of the crucial perceptual attributes that inform audio quality evaluation for people with hearing loss, and those who use hearing aids. This is especially the case with music, given the unique problems it presents in contrast to human speech.

Method

This paper presents a sensory evaluation study utilising descriptive analysis methods, in which a panel of hearing aid users collaborated, through consensus, to identify the most important perceptual attributes of music audio quality and developed a series of rating scales for future listening tests. Participants (N = 12), with a hearing loss ranging from mild to severe, first completed an online elicitation task, providing single-word terms to describe the audio quality of original and processed music samples; this was completed twice by each participant, once with hearing aids, and once without. Participants were then guided in discussing these raw terms across three focus groups, in which they reduced the term space, identified important perceptual groupings of terms, and developed perceptual attributes from these groups (including rating scales and definitions for each).

Results

Findings show that there were seven key perceptual dimensions underlying music audio quality (clarity, harshness, distortion, spaciousness, treble strength, middle strength, and bass strength), alongside a music audio quality attribute and possible alternative frequency balance attributes.

Discussion

We outline how these perceptual attributes align with extant literature, how attribute rating instruments might be used in future work, and the importance of better understanding the music listening difficulties of people with varied profiles of hearing loss.

Determinants of Continuance Intention to Use Hearing Aids among Older Adults in Tehran (Iran)

The present study seeks to evaluate the factors determining the continuance intention to use hearing aids in older adults. This cross-sectional study was carried out in 2021. The technology post-acceptance model (PAM) framework was used to develop a model for the continuance intention to use hearing aids. In total, 300 hearing aid users aged ≥60 years, who were selected via a randomized stratified sampling method, completed the self-evaluation tools used in this study. With a mean age of 71.38 years (SD = 8), the participants comprised 50.7% and 49.3% females and males, respectively. The path analysis results showed that the continuance intention to use hearing aids was positively and significantly influenced by the actual use of hearing aids, the perceived benefits, satisfaction, confirmation, self-efficacy in using hearing aids, an extraverted personality trait, self-perceived hearing handicap, and perceived social support. The main results of the present study can help hearing care providers develop a better understanding of older users to design effective rehabilitation strategies and ensure their continuance intention to use hearing aids.

Cross-Modal Sensory Boosting to Improve High-Frequency Hearing Loss: Device Development and Validation

Background

High-frequency hearing loss is one of the most common problems in the aging population and with those who have a history of exposure to loud noises. This type of hearing loss can be frustrating and disabling, making it difficult to understand speech communication and interact effectively with the world.

Objective

This study aimed to examine the impact of spatially unique haptic vibrations representing high-frequency phonemes on the self-perceived ability to understand conversations in everyday situations.

Methods

To address high-frequency hearing loss, a multi-motor wristband was developed that uses machine learning to listen for specific high-frequency phonemes. The wristband vibrates in spatially unique locations to represent which phoneme was present in real time. A total of 16 participants with high-frequency hearing loss were recruited and asked to wear the wristband for 6 weeks. The degree of disability associated with hearing loss was measured weekly using the Abbreviated Profile of Hearing Aid Benefit (APHAB).

Results

By the end of the 6-week study, the average APHAB benefit score across all participants reached 12.39 points, from a baseline of 40.32 to a final score of 27.93 (SD 13.11; N=16; P=.002, 2-tailed dependent t test). Those without hearing aids showed a 10.78-point larger improvement in average APHAB benefit score at 6 weeks than those with hearing aids (t14=2.14; P=.10, 2-tailed independent t test). The average benefit score across all participants for ease of communication was 15.44 (SD 13.88; N=16; P<.001, 2-tailed dependent t test). The average benefit score across all participants for background noise was 10.88 (SD 17.54; N=16; P=.03, 2-tailed dependent t test). The average benefit score across all participants for reverberation was 10.84 (SD 16.95; N=16; P=.02, 2-tailed dependent t test).

Conclusions

These findings show that vibrotactile sensory substitution delivered by a wristband that produces spatially distinguishable vibrations in correspondence with high-frequency phonemes helps individuals with high-frequency hearing loss improve their perceived understanding of verbal communication. Vibrotactile feedback provides benefits whether or not a person wears hearing aids, albeit in slightly different ways. Finally, individuals with the greatest perceived difficulty understanding speech experienced the greatest amount of perceived benefit from vibrotactile feedback.

Hearing Rehabilitation With a Chat-Based Mobile Auditory Training Program in Experienced Hearing Aid Users: Prospective Randomized Controlled Study

Background

Hearing rehabilitation with auditory training (AT) is necessary to improve speech perception ability in patients with hearing loss. However, face-to-face AT has not been widely implemented due to its high cost and personnel requirements. Therefore, there is a need for the development of a patient-friendly, mobile-based AT program.

Objective

In this study, we evaluated the effectiveness of hearing rehabilitation with our chat-based mobile AT (CMAT) program for speech perception performance among experienced hearing aid (HA) users.

Methods

A total of 42 adult patients with hearing loss who had worn bilateral HAs for more than 3 months were enrolled and randomly allocated to the AT or control group. In the AT group, CMAT was performed for 30 minutes a day for 2 months, while no intervention was provided in the control group. During the study, 2 patients from the AT group and 1 patient from the control group dropped out. At 0-, 1- and 2-month visits, results of hearing tests and speech perception tests, compliance, and questionnaires were prospectively collected and compared in the 2 groups.

Results

The AT group (n=19) showed better improvement in word and sentence perception tests compared to the control group (n=20; P=.04 and P=.03, respectively), while no significant difference was observed in phoneme and consonant perception tests (both P>.05). All participants were able to use CMAT without any difficulties, and 85% (17/20) of the AT group completed required training sessions. There were no changes in time or completion rate between the first and the second month of AT. No significant difference was observed between the 2 groups in questionnaire surveys.

Conclusions

After using the CMAT program, word and sentence perception performance was significantly improved in experienced HA users. In addition, CMAT showed high compliance and adherence over the 2-month study period. Further investigations are needed to validate long-term efficacy in a larger population.

Auditory Profile-Based Hearing Aid Fitting: Self-Reported Benefit for First-Time Hearing Aid Users

Background: Although hearing aids (HAs) can compensate for reduced audibility, functional outcomes and benefits vary widely across individuals. As part of the Danish 'Better hEAring Rehabilitation' (BEAR) project, four distinct auditory profiles differing in terms of audiometric thresholds and supra-threshold hearing abilities were recently identified. Additionally, profile-specific HA-fitting strategies were proposed. The aim of the current study was to evaluate the self-reported benefit of these profile-based HA fittings in a group of new HA users. Methods: A total of 205 hearing-impaired older adults were recruited from two Danish university hospitals. Participants were randomly allocated to one of two treatment groups: (1) NAL-NL2 gain prescription combined with default advanced feature settings ('reference fitting') or (2) auditory profile-based fitting with tailored gain prescription and advanced feature settings ('BEAR fitting'). Two months after treatment, the participants completed the benefit version of the short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12-B) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire. Results: Overall, participants reported a clear benefit from HA treatment. However, no significant differences in the SSQ12-B or IOI-HA scores between the reference and BEAR fittings were found. Conclusion: First-time users experience clear benefits from HA treatment. Auditory profile-based HA fitting warrants further investigation.

Deaf signers and hearing aids: motivations, access, competency and service effectiveness

OBJECTIVES

This study concerns culturally Deaf signers in the UK who use hearing aids and (i) explores motivations for hearing aid use (ii) identifies barriers and facilitators to accessing NHS hearing aid services, (iii) examines cultural competency of hearing aid clinics and (iv) identifies factors influencing effective adult hearing aid service provision.

DESIGN

Online survey in British Sign Language and English that was informed by Deaf service users.

STUDY SAMPLE

75 Deaf adult BSL users who wear hearing aids and use NHS hearing aid clinics.

RESULTS

No specific reason emerged as outstandingly important for hearing aid use; however, assisting with lipreading (57%) and listening to music (52%) were rated as very/extremely important. Access issues reported were contacting clinics, poor communication with staff and lack of Deaf awareness. To be an effective and culturally competent hearing aid clinic for Deaf signers, a good understanding of Deaf culture and language was most rated as important (87%).

CONCLUSION

The study is the first that explores hearing aid use and experiences of accessing hearing aid clinics from Deaf signers' perspectives. Enhancements to clinical practice are required to consider culturally Deaf people's motivations for hearing aid use and make services more BSL-friendly.

Hearing Loss, Hearing Aids, and Satisfaction With Health Care in the National Health Interview Survey

OBJECTIVE

Hearing loss may negatively impact satisfaction with health care via patient-provider communication barriers and may be amenable to hearing care treatment.

STUDY DESIGN

Cross-sectional.

SETTING

National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles.

METHODS

Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self-report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use.

RESULTS

Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18-1.23), a little trouble (PRR = 1.27, 95% CI, 1.23-1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24-1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18-1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78-0.88) compared to nonusers.

CONCLUSION

Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient-provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.

Hearing aid utilization in Ontario - a population based study

BACKGROUND

Hearing loss is one of the most common sensory impairments and hearing aids are the most common unmet assistive device need among individuals with a disability. The benefits of hearing interventions are well-documented as they are known to deter the sequalae of hearing loss including social isolation, poor mental health, falls and cognitive decline. Identifying trends in hearing aid users can provide valuable information for improving access to hearing loss interventions.

METHODS

Data were retrieved from ICES databases that were used to generate a cohort of 372,448 individuals in Ontario, Canada, who first claimed hearing aids between April 2007 and March 2018 through the Assistive Devices Program.

RESULTS

The data indicated that the frequency distribution of hearing aids has steadily inclined since 2007. The mean age of hearing aid users was 70.25 ± 14.70 years and higher neighbourhood income quintile was associated with greater hearing aid use (p < 0.001). Most first claims occurred after visiting primary care physicians (70.60%) compared with otolaryngology (13.39%). An examination of clinical comorbidities revealed hypertension (63.41%), and diabetes (24.93%) to be the most common. Regression analysis demonstrated a positive associated between age and most comorbidities. Furthermore, higher neighbourhood income quintiles were associated with a reduced risk of having the examined comorbidities.

CONCLUSIONS

This study examines patient demographics and clinical comorbidities in a cohort of hearing aid users in Ontario. The results identify associations between demographics and comorbidities that provide information relevant for improving access to hearing interventions and clinical decision-making in primary care.Implications for RehabilitationScreening for hearing loss (using an audiogram) in elderly individuals that manage multiple comorbidities, and any patient with significant risk factors for hearing loss (e.g., noise exposure history, prior ototoxic medications, prior head injury, history of ear surgery, family history of hearing loss) will identify deficits and direct appropriate hearing interventions.Improving access to care in low-income communities should include community-based education around expectation management and communication strategies to reinforce proper use and care of hearing devices.Geographic proximity to hearing testing facilities and hearing aid dispensaries is a significant barrier to hearing rehabilitation strategies.

ENHANCE: a comparative prospective longitudinal study of cognitive outcomes after 3 years of hearing aid use in older adults

Background

With an aging population, the prevalence of hearing loss and dementia are increasing rapidly. Hearing loss is currently considered the largest potentially modifiable risk factor for dementia. The effect of hearing interventions on cognitive function should therefore be investigated, as if effective, these may be successfully implemented to modify cognitive outcomes for older adults with hearing loss.

Methods

This prospective longitudinal observational cohort study compared outcomes of a convenience sample of prospectively recruited first-time hearing aid users without dementia from an audiology center with those of community-living older adults participating in a large prospective longitudinal cohort study with/without hearing loss and/or hearing aids. All participants were assessed at baseline, 18 months, and 36 months using the same measures.

Results

Participants were 160 audiology clinic patients (48.8% female patient; mean age 73.5 years) with mild-severe hearing loss, fitted with hearing aids at baseline, and 102 participants of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Aging (AIBL) (55.9% female patient; mean age 74.5 years). 18- and 36-month outcomes of subsets of the first participants to reach these points and complete the cognition assessment to date are compared. Primary comparative analysis showed cognitive stability for the hearing aid group while the AIBL group declined on working memory, visual attention, and psychomotor function. There was a non-significant trend for decline in visual learning for the AIBL group versus no decline for the hearing aid group. The hearing aid group showed significant decline on only 1 subtest and at a significantly slower rate than for the AIBL participants (p < 0.05). When education effects on cognitive trajectory were controlled, the HA group still performed significantly better on visual attention and psychomotor function (lower educated participants only) compared to the AIBL group but not on working memory or visual learning. Physical activity had no effect on cognitive performance trajectory.

Conclusion

Hearing aid users demonstrated significantly better cognitive performance to 3 years post-fitting, suggesting that hearing intervention may delay cognitive decline/dementia onset in older adults. Further studies using appropriate measures of cognition, hearing, and device use, with longer follow-up, are required.

Evaluating Quality, Credibility, and Readability of Online Over-the-Counter Hearing Aid Information

OBJECTIVE

With over-the-counter hearing aids being recently approved by the United States Food and Drug Administration, the accuracy and usefulness of online information has not yet been examined. This study evaluates the quality, credibility, readability, and accessibility of online over-the-counter hearing aids education materials.

METHODS

Google was queried using the search term "over-the-counter hearing aids". The top 50 results were categorized into healthcare versus non-healthcare authored resources. The Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) tests were utilized to assess readability, whereas the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test and DISCERN instruments were used to assess quality and credibility. The number of clicks taken to access relevant information on each website was used to assess accessibility.

RESULTS

There was no significant difference in FRES or FKGL readability scores between healthcare and non-healthcare authored websites (p = 0.5548, p = 0.5981, respectively), but both readability scores were higher than that of the recommended reading level for patient education materials. There was no significant difference in CRAAP and DISCERN scores between both groups (p = 0.5746, p = 0.1699, respectively). The number of clicks did not significantly differ between healthcare and non-healthcare authored resources (p = 0.4932).

CONCLUSION

This study highlights poor readability and accessibility of virtual healthcare information regarding OTC hearing aids. Although credibility in articles authored by healthcare and non-healthcare professionals was adequate, readability was greatly compromised due to the written information exceeding the recommended United States reading level. Accessibility posed a similar issue, as many sites required multiple clicks to access product information.

LEVEL OF EVIDENCE

NA Laryngoscope, 2024.

Perceptions of older and younger adults who wear hearing aids

OBJECTIVE

To investigate older and younger adults' perceptions of older and younger adults who wear hearing aids.

DESIGN

Participants completed two Implicit Association Tests: One with images of older adults (OA-IAT) and one with images of younger adults (YA-IAT), either wearing or not wearing hearing aids. Participants also rated age, attractiveness, and intelligence of younger and older adults pictured with or without a hearing aid.

STUDY SAMPLE

Thirty older adults (M age = 70 years, SD = 4.38) and 30 younger adults (M age = 23 years, SD = 3.01) who reported not having hearing aids or a diagnosed hearing impairment.

RESULTS

For both IATs, older and younger participants responded faster and more accurately when images of individuals wearing hearing aids were paired with negative words in comparison to positive words. Photo ratings did not vary in relation to the presence or absence of hearing aids for either age group.

CONCLUSION

Although the photo rating tasks indicate neutral explicit attitudes towards individuals who wear hearing aids, our interpretation of the IAT results indicates that younger and older adults may hold negative implicit attitudes towards both older and younger hearing aid users.

Attitudes towards hearing difficulties, health-seeking behaviour, and hearing aid use among older adults in Thailand

Introduction

This qualitative study explores older adults' attitudes towards hearing difficulties, health-seeking behaviour and hearing aid use in Samutprakarn, Thailand.

Method

Three focus groups (n=25), with adults aged 60-88 years, were conducted within a residential complex for older adults. Qualitative data analysis, employing a phenomenological approach was completed.

Results

Four themes are presented: (1) Perception of hearing difficulties, (2) Experience of receiving care, (3) Attitudes towards wearing hearing aids, and (4) Raising awareness of hearing difficulties in older adults. Findings indicate that Thai older adults may not be aware or accepting of their hearing difficulties, due to the stigma associated hearing loss, older age, and disability. The consequential impact of these unacknowledged issues manifest in communication challenges and the adoption of avoidance behaviours across diverse situational contexts.

Conclusion

This study enhances our understanding of how Thai older adults perceive hearing problems and ear care. Findings underscore the potential pivotal role of familial and social networks in mitigating barriers associated with hearing difficulties among older adults in Thailand. These insights can raise awareness and inform effective management for older adults and their families. Additionally, the findings could guide healthcare providers, researchers, and policy makers, fostering improved care for this demographic.

Communicating Emotion: Vocal Expression of Linguistic and Emotional Prosody in Children With Mild to Profound Hearing Loss Compared With That of Normal Hearing Peers

OBJECTIVES

Emotional prosody is known to play an important role in social communication. Research has shown that children with cochlear implants (CCIs) may face challenges in their ability to express prosody, as their expressions may have less distinct acoustic contrasts and therefore may be judged less accurately. The prosody of children with milder degrees of hearing loss, wearing hearing aids, has sparsely been investigated. More understanding of the prosodic expression by children with hearing loss, hearing aid users in particular, could create more awareness among healthcare professionals and parents on limitations in social communication, which awareness may lead to more targeted rehabilitation. This study aimed to compare the prosodic expression potential of children wearing hearing aids (CHA) with that of CCIs and children with normal hearing (CNH).

DESIGN

In this prospective experimental study, utterances of pediatric hearing aid users, cochlear implant users, and CNH containing emotional expressions (happy, sad, and angry) were recorded during a reading task. Of the utterances, three acoustic properties were calculated: fundamental frequency (F0), variance in fundamental frequency (SD of F0), and intensity. Acoustic properties of the utterances were compared within subjects and between groups.

RESULTS

A total of 75 children were included (CHA: 26, CCI: 23, and CNH: 26). Participants were between 7 and 13 years of age. The 15 CCI with congenital hearing loss had received the cochlear implant at median age of 8 months. The acoustic patterns of emotions uttered by CHA were similar to those of CCI and CNH. Only in CCI, we found no difference in F0 variation between happiness and anger, although an intensity difference was present. In addition, CCI and CHA produced poorer happy-sad contrasts than did CNH.

CONCLUSIONS

The findings of this study suggest that on a fundamental, acoustic level, both CHA and CCI have a prosodic expression potential that is almost on par with normal hearing peers. However, there were some minor limitations observed in the prosodic expression of these children, it is important to determine whether these differences are perceptible to listeners and could affect social communication. This study sets the groundwork for more research that will help us fully understand the implications of these findings and how they may affect the communication abilities of these children. With a clearer understanding of these factors, we can develop effective ways to help improve their communication skills.

Amplitude Compression for Preventing Rollover at Above-Conversational Speech Levels

Hearing aids provide nonlinear amplification to improve speech audibility and loudness perception. While more audibility typically increases speech intelligibility at low levels, the same is not true for above-conversational levels, where decreases in intelligibility ("rollover") can occur. In a previous study, we found rollover in speech intelligibility measurements made in quiet for 35 out of 74 test ears with a hearing loss. Furthermore, we found rollover occurrence in quiet to be associated with poorer speech intelligibility in noise as measured with linear amplification. Here, we retested 16 participants with rollover with three amplitude-compression settings. Two were designed to prevent rollover by applying slow- or fast-acting compression with a 5:1 compression ratio around the "sweet spot," that is, the area in an individual performance-intensity function with high intelligibility and listening comfort. The third, reference setting used gains and compression ratios prescribed by the "National Acoustic Laboratories Non-Linear 1" rule. Speech intelligibility was assessed in quiet and in noise. Pairwise preference judgments were also collected. For speech levels of 70 dB SPL and above, slow-acting sweet-spot compression gave better intelligibility in quiet and noise than the reference setting. Additionally, the participants clearly preferred slow-acting sweet-spot compression over the other settings. At lower levels, the three settings gave comparable speech intelligibility, and the participants preferred the reference setting over both sweet-spot settings. Overall, these results suggest that, for listeners with rollover, slow-acting sweet-spot compression is beneficial at 70 dB SPL and above, while at lower levels clinically established gain targets are more suited.

Predictors of Susceptibility to Noise and Speech Masking Among School-Age Children With Hearing Loss or Typical Hearing

OBJECTIVES

The purpose of this study was to evaluate effects of masker type and hearing group on the relationship between school-age children's speech recognition and age, vocabulary, working memory, and selective attention. This study also explored effects of masker type and hearing group on the time course of maturation of masked speech recognition.

DESIGN

Participants included 31 children with normal hearing (CNH) and 41 children with mild to severe bilateral sensorineural hearing loss (CHL), between 6.7 and 13 years of age. Children with hearing aids used their personal hearing aids throughout testing. Audiometric thresholds and standardized measures of vocabulary, working memory, and selective attention were obtained from each child, along with masked sentence recognition thresholds in a steady state, speech-spectrum noise (SSN) and in a two-talker speech masker (TTS). Aided audibility through children's hearing aids was calculated based on the Speech Intelligibility Index (SII) for all children wearing hearing aids. Linear mixed effects models were used to examine the contribution of group, age, vocabulary, working memory, and attention to individual differences in speech recognition thresholds in each masker. Additional models were constructed to examine the role of aided audibility on masked speech recognition in CHL. Finally, to explore the time course of maturation of masked speech perception, linear mixed effects models were used to examine interactions between age, masker type, and hearing group as predictors of masked speech recognition.

RESULTS

Children's thresholds were higher in TTS than in SSN. There was no interaction of hearing group and masker type. CHL had higher thresholds than CNH in both maskers. In both hearing groups and masker types, children with better vocabularies had lower thresholds. An interaction of hearing group and attention was observed only in the TTS. Among CNH, attention predicted thresholds in TTS. Among CHL, vocabulary and aided audibility predicted thresholds in TTS. In both maskers, thresholds decreased as a function of age at a similar rate in CNH and CHL.

CONCLUSIONS

The factors contributing to individual differences in speech recognition differed as a function of masker type. In TTS, the factors contributing to individual difference in speech recognition further differed as a function of hearing group. Whereas attention predicted variance for CNH in TTS, vocabulary and aided audibility predicted variance in CHL. CHL required a more favorable signal to noise ratio (SNR) to recognize speech in TTS than in SSN (mean = +1 dB in TTS, -3 dB in SSN). We posit that failures in auditory stream segregation limit the extent to which CHL can recognize speech in a speech masker. Larger sample sizes or longitudinal data are needed to characterize the time course of maturation of masked speech perception in CHL.

Hearing Aid Amplification Improves Postural Control for Older Adults With Hearing Loss When Other Sensory Cues Are Impoverished

Recent studies suggest that sound amplification via hearing aids can improve postural control in adults with hearing impairments. Unfortunately, only a few studies used well-defined posturography measures to assess balance in adults with hearing loss with and without their hearing aids. Of these, only two examined postural control specifically in the elderly with hearing loss. The present study examined the impact of hearing aid use on postural control during various sensory perturbations in older adults with age-related hearing loss. Thirty individuals with age-related hearing impairments and using hearing aids bilaterally were tested. Participants were asked to perform a modified clinical sensory integration in balance test on a force platform with and without hearing aids. The experiment was conducted in the presence of a broadband noise ranging from 0.1 to 4 kHz presented through a loudspeaker. As expected, hearing aid use had a beneficial impact on postural control, but only when visual and somatosensory inputs were both reduced. Data also suggest that hearing aid use decreases the dependence on somatosensory input for maintaining postural control. This finding can be of particular importance in older adults considering the reduction of tactile and proprioceptive sensitivity and acuity often associated with aging. These results provide an additional argument for encouraging early hearing aid fitting for people with hearing loss.

Alpha-Band Dynamics of Hearing Aid Wearers Performing the Repeat-Recall Test (RRT)

This study measured electroencephalographic activity in the alpha band, often associated with task difficulty, to physiologically validate self-reported effort ratings from older hearing-impaired listeners performing the Repeat-Recall Test (RRT)-an integrative multipart assessment of speech-in-noise performance, context use, and auditory working memory. Following a single-blind within-subjects design, 16 older listeners (mean age = 71 years, SD = 13, 9 female) with a moderate-to-severe degree of bilateral sensorineural hearing loss performed the RRT while wearing hearing aids at four fixed signal-to-noise ratios (SNRs) of -5, 0, 5, and 10 dB. Performance and subjective ratings of listening effort were assessed for complementary versions of the RRT materials with high/low availability of semantic context. Listeners were also tested with a version of the RRT that omitted the memory (i.e., recall) component. As expected, results showed alpha power to decrease significantly with increasing SNR from 0 through 10 dB. When tested with high context sentences, alpha was significantly higher in conditions where listeners had to recall the sentence materials compared to conditions where the recall requirement was omitted. When tested with low context sentences, alpha power was relatively high irrespective of the memory component. Within-subjects, alpha power was related to listening effort ratings collected across the different RRT conditions. Overall, these results suggest that the multipart demands of the RRT modulate both neural and behavioral measures of listening effort in directions consistent with the expected/designed difficulty of the RRT conditions.

Hearing Loss Prevalence, Years Lived With Disability, and Hearing Aid Use in the United States From 1990 to 2019: Findings From the Global Burden of Disease Study

OBJECTIVES

This article describes key data sources and methods used to estimate hearing loss in the United States, in the Global Burden of Disease study. Then, trends in hearing loss are described for 2019, including temporal trends from 1990 to 2019, changing prevalence over age, severity patterns, and utilization of hearing aids.

DESIGN

We utilized population-representative surveys from the United States to estimate hearing loss prevalence for the Global Burden of Disease study. A key input data source in modeled estimates are the National Health and Nutrition Examination Surveys (NHANES), years 1988 to 2010. We ran hierarchical severity-specific models to estimate hearing loss prevalence. We then scaled severity-specific models to sum to total hearing impairment prevalence, adjusted estimates for hearing aid coverage, and split estimates by etiology and tinnitus status. We computed years lived with disability (YLDs), which quantifies the amount of health loss associated with a condition depending on severity and creates a common metric to compare the burden of disparate diseases. This was done by multiplying the prevalence of severity-specific hearing loss by corresponding disability weights, with additional weighting for tinnitus comorbidity.

RESULTS

An estimated 72.88 million (95% uncertainty interval (UI) 68.53 to 77.30) people in the United States had hearing loss in 2019, accounting for 22.2% (20.9 to 23.6) of the total population. Hearing loss was responsible for 2.24 million (1.56 to 3.11) YLDs (3.6% (2.8 to 4.7) of total US YLDs). Age-standardized prevalence was higher in males (17.7% [16.7 to 18.8]) compared with females (11.9%, [11.2 to 12.5]). While most cases of hearing loss were mild (64.3%, 95% UI 61.0 to 67.6), disability was concentrated in cases that were moderate or more severe. The all-age prevalence of hearing loss in the United States was 28.1% (25.7 to 30.8) higher in 2019 than in 1990, despite stable age-standardized prevalence. An estimated 9.7% (8.6 to 11.0) of individuals with mild to profound hearing loss utilized a hearing aid, while 32.5% (31.9 to 33.2) of individuals with hearing loss experienced tinnitus. Occupational noise exposure was responsible for 11.2% (10.2 to 12.4) of hearing loss YLDs.

CONCLUSIONS

Results indicate large burden of hearing loss in the United States, with an estimated 1 in 5 people experiencing this condition. While many cases of hearing loss in the United States were mild, growing prevalence, low usage of hearing aids, and aging populations indicate the rising impact of this condition in future years and the increasing importance of domestic access to hearing healthcare services. Large-scale audiometric surveys such as NHANES are needed to regularly assess hearing loss burden and access to healthcare, improving our understanding of who is impacted by hearing loss and what groups are most amenable to intervention.

Recruitment and baseline data of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study: A randomized trial of a hearing loss intervention for reducing cognitive decline

INTRODUCTION

Hearing loss is highly prevalent among older adults and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a multicenter randomized control trial (partially nested within the infrastructure of an observational cohort study, the Atherosclerosis Risk in Communities [ARIC] study) to determine the efficacy of best-practice hearing treatment to reduce cognitive decline over 3 years. The goal of this paper is to describe the recruitment process and baseline results.

METHODS

Multiple strategies were used to recruit community-dwelling 70-84-year-old participants with adult-onset hearing loss who were free of substantial cognitive impairment from the parent ARIC study and de novo from the surrounding communities into the trial. Participants completed telephone screening, an in-person hearing, vision, and cognitive screening, and a comprehensive hearing assessment to determine eligibility.

RESULTS

Over a 24-month period, 3004 telephone screenings resulted in 2344 in-person hearing, vision, and cognition screenings and 1294 comprehensive hearing screenings. Among 1102 eligible, 977 were randomized into the trial (median age = 76.4 years; 53.5% female; 87.8% White; 53.3% held a Bachelor's degree or higher). Participants recruited through the ARIC study were recruited much earlier and were less likely to report hearing loss interfered with their quality of life relative to participants recruited de novo from the community. Minor differences in baseline hearing or health characteristics were found by recruitment route (i.e., ARIC study or de novo) and by study site.

DISCUSSION

The ACHIEVE study successfully completed enrollment over 2 years that met originally projected rates of recruitment. Substantial operational and scientific efficiencies during study startup were achieved through embedding this trial within the infrastructure of a longstanding and well-established observational study.

Highlights

The ACHIEVE study tests the effect of hearing intervention on cognitive decline.The study is partially nested within an existing cohort study.Over 2 years, 977 participants recruited and enrolled.Eligibility assessed by telephone and in-person for hearing, vision, and cognitive screening.The ACHIEVE study findings will have significant public health implications.

To tell or not to tell? Exploring the social process of stigma for adults with hearing loss and their families: introduction to the special issue

OBJECTIVE

Stigma has long been implicated as a reason why adults with acquired hearing loss are slow to seek help and for sub-optimal uptake of hearing devices. However, the field has not developed a comprehensive understanding of why stigma occurs, nor has it related this comprehensive knowledge to a theoretical framework.

DESIGN

This special issue presents results from a two-phase, multi-method study to systematically investigate how stigma is experienced by adults with hearing loss and their families, how they manage it in everyday life, and how these experiences relate to the decision to wear hearing aids.

STUDY SAMPLE

Phase 1 of the study involved 20 dyads of adults with hearing loss and their family members. Phase 2 involved 331 adults with hearing loss and 313 family members.

RESULTS

Results of the study are presented in each of the subsequent papers that are part of this special issue. Results are mapped onto the Major and O'Brien model of stigma-induced identity threat in each paper.

CONCLUSIONS

This paper provides an introduction to the Special Issue and describes the methods for the overall study that is the focus of the papers within the issue.

Comparing criteria for deviation from hearing aid prescriptive targets in children

OBJECTIVE

To determine if a stricter criterion for paediatric hearing aid fitting for proximity of fit-to-target of <3 dB root-mean-square (RMS) error produces better audibility and outcomes compared to the current <5 dB criterion, and to examine the relationship between aided audibility and RMS error by degree of hearing loss.

DESIGN

We evaluated the influence of unaided hearing level on the relationship between RMS error and aided audibility. We assessed the effect of RMS error category (<3, 3-5, >5 dB) on aided audibility, speech recognition, expressive vocabulary, and morphosyntax.

STUDY SAMPLE

The study included 2314 hearing aid verification measurements from 307 children with hearing aids.

RESULTS

Children who met a <3 dB criterion had higher aided audibility than children who met no criterion (>5 dB error). Results showed no differences in speech recognition or vocabulary by error category, but children with <3 dB error demonstrated better morphosyntax than children with 3-5 and >5 dB RMS error.

CONCLUSIONS

Fittings that are close to prescriptive targets provide a more positive outcome for children with hearing aids. Using probe microphone measures to adjust hearing aids to within 3 dB may benefit language abilities in children.

Difference in SII provided by initial fit and NAL-NL2 and its relation to self-reported hearing aid outcomes

OBJECTIVE

The speech intelligibility index (SII) is used to quantify the audibility of the speech. This study examined the relationship between self-reported hearing aid (HA) outcomes and the difference in aided SII (SIIA) calculated from the initial fit (IF) gain and that prescribed as per the second generation of National Acoustic Laboratory Non-Linear (NAL-NL2).

DESIGN

A prospective observational study.

STUDY SAMPLE

The study included 718 first-time and 253 experienced HA users. All users had a valid real-ear measurement (REM) at three input levels (55, 65 and 80 dB SPL).

RESULTS

The gain provided by IF was lower than NAL-NL2 at 55 and 65 dB SPL. IF gain exhibited reduced compression than NAL-NL2 as input levels increased from 55 to 80 dB SPL. On average, the SIIA provided by IF was significantly lower than that for NAL-NL2 at all input levels. The difference in SIIA between IF and NAL-NL2 at 80 dB SPL input level with 0 dB signal-to-noise ratio (SNR) turned out to be a predictor for self-reported outcome for first-time HA users.

CONCLUSION

The study suggests that an SIIA close to that provided by NAL-NL2 at high input levels would be preferred to obtain a better self-reported outcome. .

Should Tinnitus Patients with Subclinical Hearing Impairment Be Offered Hearing Aids? A Comparison of Tinnitus Mitigation Following 3 Months Hearing Aid Use in Individuals with and without Clinical Hearing Impairment

There is a consensus among tinnitus experts to not recommend hearing aids for tinnitus patients with subclinical hearing impairment. However, this notion is arbitrary, as no previous study has compared the treatment effect of hearing aids on tinnitus distress in patients with and without clinical hearing impairment. In this article, we investigate whether tinnitus patients with clinical and subclinical hearing impairment differ in terms of tinnitus mitigation after hearing aid fitting. Twenty-seven tinnitus patients with either clinical (n = 13) or subclinical (n = 14) hearing impairment were fitted with hearing aids. All participants filled out the tinnitus functional index (TFI) before hearing aid fitting and after 3 months of hearing aid use. Clinically meaningful reductions in tinnitus distress (-13 TFI points or more) were seen in both groups, and the difference in tinnitus mitigation between tinnitus patients with clinical (mean TFI reduction = 17.0 points) and subclinical hearing impairment (mean TFI reduction = 16.9 points) was not statistically significant (p = 0.991). Group differences on the suspected confounding factors of age, sex, time since tinnitus debut, tinnitus distress (TFI score) at baseline, and treatment adherence were statistically insignificant. In light of this, we argue that clinical hearing impairment is not required to achieve meaningful tinnitus mitigation with hearing aids, and that hearing aids could be recommended for tinnitus patients with subclinical hearing impairment.

Development of an Internet-based system to guide and telemonitor hearing aid users

PURPOSE

To develop and verify the usability of an internet-based system for telemonitoring and guidance of the hearing aid user as well as monitoring the long-term performance in a pilot group.

METHODS

The system "I can hear, but I can't understand" was developed based on recommendations in the literature regarding layout, design, and content for guidance and advice. Three stages were followed: planning, design and content development, and pilot testing. The sample consisted of 43 adults and older adults with any type and degree of hearing loss, who had been regularly using a hearing aid for at least 30 days and at most 24 months, with reading skills and no evidence of cognitive impairments. The individuals were followed up for 8 to 12 months. The users' performance was monitored with the Speech, Spatial and Qualities of Hearing Scale. The usability of this material was assessed with the System Usability Scale.

RESULTS

Improved performance and increased self-reported daily use of the hearing aid were observed after the period of guidance and telemonitoring via the system for all research participants. In all analyzes of the SUS scale, it was possible to observe a performance superior to 70 points, demonstrating good usability of the system. In the analysis of the performance of the SSQ, in the three moments of the research, a positive response was observed in all domains, thus showing progress in the use of hearing aids, with significant data for the domain of Hearing Speech.

CONCLUSION

The system "I can hear, but I can't understand" proved to be an easy-to-use and effective tool to telemonitor hearing aid users.

The Association of Hearing Loss With Active Music Enjoyment in Hearing Aid Users

OBJECTIVE

Hearing aids (HAs) are designed for speech rather than music listening. The impact of HAs on music enjoyment is poorly studied. We examine the effect of HAs on active music enjoyment in individuals with varying levels of hearing loss (HL).

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary medical center and community.

METHODS

Adult (≥18 years) bilateral HA users and normal hearing (NH) controls actively listened to musical stimuli and rated their enjoyment across 3 measures (pleasantness, musicality, naturalness) with and without HAs using a visual analog scale. Multivariable linear regression was used to assess the association between HL (measured by a pure-tone average [PTA] and word recognition score [WRS] of the better ear) and music enjoyment with and without HAs, adjusting for covariates. Music enjoyment was compared between HA users and NH controls, and HA users with and without their HAs.

RESULTS

One hundred bilateral HA users (mean age 66.0 years, 52% female, better ear mean [SD] PTA 50.2 [13.5] dBHL, mean WRS 84.5 [16.5]%) completed the study. Increasing severity of HL (PTA) was independently associated with decreased music enjoyment (pleasantness, musicality, naturalness) with and without HAs (p < .05). HA usage increased music enjoyment (musicality) in those with moderate to moderately severe HL. Music enjoyment in NH controls (n = 20) was significantly greater across all measures compared to HA users.

CONCLUSION

Increased severity of HL is associated with decreased music enjoyment that can be enhanced with HA usage. Thus, HA usage can positively enhance both speech and music appreciation.

Cochlear Implantation in the Poorer-Hearing Ear Is a Reasonable Choice

Choosing the optimal side for cochlear implantation (CI) remains a major challenge because of the lack of evidence. We investigated the choice of the surgery side for CI (i.e., the better- or poorer-hearing ear) in patients with asymmetric hearing. Audiological records of 74 adults with a unilateral hearing aid who had undergone surgery at Okayama University Hospital were reviewed. The definition of 'better-hearing ear' was the aided ear, and the unaided ear was considered the poorer-hearing ear. We performed a multiple regression analysis to identify potential predictors of speech recognition performance after unilateral CI in the patients. Fifty-two patients underwent CI in the poorer-hearing ear. The post-Ci bimodal hearing rate was far higher in the poorer-ear group (77.8% vs. 22.2%). A multivariate analysis revealed that prelingual hearing loss and the patient's age at CI significantly affected the speech recognition outcome (beta coefficients: 24.6 and -0.33, 95% confidence intervals [11.75-37.45] and [-0.58 to -0.09], respectively), but the CI surgery side did not (-6.76, [-14.92-1.39]). Unilateral CI in the poorer-hearing ear may therefore be a reasonable choice for adult patients with postlingual severe hearing loss, providing a greater opportunity for postoperative bimodal hearing.

Does experience with hearing aid amplification influence electrophysiological measures of speech comprehension?

OBJECTIVE

To explore if experience with hearing aid (HA) amplification affects speech-evoked cortical potentials reflecting comprehension abilities.

DESIGN

N400 and late positive complex (LPC) responses as well as behavioural response times to congruent and incongruent digit triplets were measured. The digits were presented against stationary speech-shaped noise 10 dB above individually measured speech recognition thresholds. Stimulus presentation was either acoustic (digits 1-3) or first visual (digits 1-2) and then acoustic (digit 3).

STUDY SAMPLE

Three groups of older participants (N = 3 × 15) with (1) pure-tone average hearing thresholds <25 dB HL from 500-4000 Hz, (2) mild-to-moderate sensorineural hearing loss (SNHL) but no prior HA experience, and (3) mild-to-moderate SNHL and >2 years of HA experience. Groups 2-3 were fitted with test devices in accordance with clinical gain targets.

RESULTS

No group differences were found in the electrophysiological data. N400 amplitudes were larger and LPC latencies shorter with acoustic presentation. For group 1, behavioural response times were shorter with visual-then-acoustic presentation.

CONCLUSION

When speech audibility is ensured, comprehension-related electrophysiological responses appear intact in individuals with mild-to-moderate SNHL, regardless of prior experience with amplified sound. Further research into the effects of audibility versus acclimatisation-related neurophysiological changes is warranted.

Reasons for hearing aid uptake in the United States: a qualitative analysis of open-text responses from a large-scale survey of user-perspectives

OBJECTIVE

This study aimed to explore the main reasons for hearing aid uptake from a user perspective and recommendations to others with hearing difficulties.

DESIGN

A cross-sectional survey design was used. Responses to a single open-ended question were analysed using qualitative content analysis.

STUDY SAMPLE

Participants (n = 642) included adult hearing aid users sampled from the Hearing Tracker website community and Lexie Hearing user databases in the United States.

RESULTS

Participants had a mean age of 65.4 years (13.7 SD) and included 61.8% males, 37.7% females, 0.3% non-binary, and 0.2% preferred not to say. Reasons for hearing aid uptake were categorised into three domains (personal impact, social difficulties, and auditory difficulties), containing 11 main categories and 48 sub-categories. User recommendations to others with hearing difficulties constituted eight main categories (timely help, trial period, support, affordability, technology, direct-to-consumer hearing aids, adjustments, and advocacy) and 32 sub-categories.

CONCLUSIONS

The decision to take up hearing aids included intrinsic factors like readiness to change and extrinsic factors such as the availability of finances. The most frequent recommendation to others was not to delay seeking hearing help and to get hearing aids. Our findings may support strategies to facilitate behaviour change for improved hearing aid uptake.

Interviews with musicians with hearing aids

Objectives: Musicians who wear hearing aids are a unique subset of hearing-impaired individuals. There are a number of issues musicians experience with hearing aids, making effective hearing rehabilitation a challenge. Research suggests hearing aid satisfaction in musicians is lower partly due to their advanced listening skills, however, qualitative research addressing musicians who wear hearing aids for music is scarce. The current study aimed to record the barriers encountered by musicians who wear hearing aids when playing their instrument/singing, listening to recorded music and listening to live music.Design: Professional musicians who wear hearing aids were interviewed. Participants were questioned about their experiences with hearing loss and hearing aids, with particular emphasis on experiences listening to recorded and live music, and playing or performing music with the hearing aids.Study Sample: Eight professional musicians were interviewed, using a semi-structured interview style, with a question and prompt guide.Results: Thematic analysis revealed three main themes in the data: the musicians' journey, communication, and flexibility/adjustability.Conclusions: The results have implications for future research into specific fitting parameters for hearing aids for musicians (particularly for music performance), the need for evidence-based rehabilitation programs for musicians with hearing loss, and the need for a glossary of terms to assist communication between Audiologists and musicians.

High Levels of Satisfaction Among Hearing Aid Users in a Pilot Study for Sustainable Low-Cost Auditory Rehabilitation Services in Samoa

The provision of locally sustainable hearing aid device services is desirable in the Pacific Islands. The aim of the present study was (1) To assess the suitability of low-cost pre-programmable hearing aids in Samoa, a Polynesian nation of the Pacific Islands, and (2) To develop translations of established auditory rehabilitation questionnaires into the FaaSamoan language for clinical, public health, and research applications. A cross-over trial of 2 low-cost pre-programmable hearing aids among 20 adults in Samoa was conducted as part of a larger UN-funded global audiology study. The International Outcome Inventory for Hearing Aids, the International Outcome Inventory for Hearing Aids for Significant Others, and the Revised Hearing Handicap Inventory questionnaires were translated into the FaaSamoan language to assess the self-reported outcomes of study participants. Overall, high scores were measured for the self-reported outcome measures, suggesting good levels of use and satisfaction with the hearing aid devices. Overall, results found that once a hearing aid was fitted that 67.6% of participants reported no hearing handicap, 32.4% reported a mild to moderate hearing handicap, and no participant reported a significant hearing handicap.

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSION

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

Hearing Loss and Frailty among Older Adults: The Atherosclerosis Risk in Communities Study

OBJECTIVES

Hearing loss may contribute to frailty through cognitive and physical decline, but population-based evidence using validated measures remains scarce. We investigated the association of hearing loss with phenotypic frailty and its individual components and explored the potential protective role of hearing aid use.

DESIGN

Cross-sectional study of community-dwelling older adults at visit 6 (2016-2017) of the Atherosclerosis Risk in Communities (ARIC) study, a cohort study of older adults from 4 U.S. communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN).

SETTING AND PARTICIPANTS

Population-based study of 3179 participants (mean age = 79.2 years, 58.9% female).

METHODS

Pure-tone audiometry at 0.5-4 kHz was used to assess unaided hearing, and the better-hearing ear's pure-tone average was categorized as follows: no [≤25 dB hearing level (HL)], mild (26-40 dB HL), and moderate or greater (>40 dB HL) hearing loss. Hearing aid use was self-reported. The Fried/physical frailty phenotype was used to categorize frailty status (robust, pre-frail, or frail). Multivariable multinomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively.

RESULTS

In our sample, 40% had mild and 27% had moderate or greater hearing loss (12% and 55% reported hearing aid use, respectively). Moderate or greater hearing loss was associated with greater odds of being pre-frail [odds ratio (OR), 1.25; 95% CI, 1.01-1.57] and frail (OR, 1.62; 95% CI, 1.06-2.47) vs robust, and greater odds of having slow gait, low physical activity, and exhaustion, compared with no hearing loss. Among those with hearing loss (>25 dB HL), compared with hearing aid users, nonusers had greater odds of being frail vs robust, and having unintentional weight loss, slow gait, and low physical activity.

CONCLUSIONS AND IMPLICATIONS

Hearing loss is associated with pre-frailty and frailty. Longitudinal studies are warranted to establish if hearing aid use may prevent or delay frailty onset.

Promoting hearing and cognitive health in audiologic rehabilitation for the well-being of older adults

OBJECTIVE

With our aging population, an increasing number of older adults with hearing loss have cognitive decline. Hearing care practitioners have an important role in supporting healthy aging and should be knowledgeable about cognitive decline and associated management strategies to maximize successful hearing intervention.

METHODS

A review of current research and expert opinion.

RESULTS

This article outlines the association between hearing loss and cognitive decline/dementia, hypothesized mechanisms underlying this, and considers current research into the effects of hearing intervention on cognitive decline. Cognition into old age, cognitive impairment, dementia, and how to recognize cognitive decline that is not part of normal aging are described. Screening of older asymptomatic adults for cognitive decline and practical suggestions for the delivery of person-centered hearing care are discussed. Holistic management goals, personhood, and person-centered care in hearing care management are considered for older adults with normal cognitive aging through to dementia. A case study illustrates important skills and potential management methods. Prevention strategies for managing hearing and cognitive health and function through to older age, and strategies to maximize successful hearing aid use are provided.

CONCLUSION

This article provides evidence-based recommendations for hearing care professionals supporting older clients to maximize well-being through the cognitive trajectory.

Feasibility of a Smartphone-Based Hearing Aid App for Mild-to-Moderate Hearing Loss: Prospective Multicenter Randomized Controlled Trial

Background

Hearing loss is a growing health concern worldwide. Hearing aids (HAs) are the treatment of choice for hearing rehabilitation in most cases of mild-to-moderate hearing loss. However, many patients with hearing loss do not use HAs due to their high cost, stigma, and inaccessibility. Since smartphones are widely used, many apps that mimic the amplification function of HAs have been introduced. Smartphone-based HA apps (SHAAs) are affordable and easy to access. However, the audiological benefit of SHAAs has not been determined.

Objective

We compared the audiological performance between an SHAA and a conventional HA in a prospective, multicenter randomized controlled trial.

Methods

Patients with mild-to-moderate hearing loss were prospectively enrolled from 2 tertiary hospitals and randomly assigned to either an SHAA (Petralex; IT4YOU Corp LLC) or a conventional HA (Siya 1 miniRITE; Oticon A/S). For the cross-over study design, participants used the alternate device and repeated the same 2-month trial. Audiological measurements were obtained using hearing tests, real-ear measurements, and the hearing-in-noise test (HINT). Subjective satisfaction was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and International Outcome Inventory for Hearing Aids (IOI-HA).

Results

Overall, 63 participants were screened and 38 completed the study. In sound-field audiometry testing, the SHAA showed a 20- to 60-dB gain in the low-to-high frequencies of the hearing threshold level. The HA provided adequate gain in the middle-to-high frequencies (55, 65, and 75 dB in real-ear measurements), which is the sound level for most speaking volumes. However, the SHAA could not improve word recognition at 50 dB. The HA showed better audiological performance than the SHAA in both quiet and noisy conditions in the HINT. The IOI-HA scores were significantly improved by both the HA and SHAA versus unaided conditions. Among the SHAA users, 37% (14/38), 42% (16/38), 24% (9/38), and 32% (12/38) showed improvement in APHAB scores for ease of communication, reverberation, background noise, and aversiveness of sounds, respectively. There were no differences in adverse events between the 2 study groups.

Conclusions

The HA showed better performance than the SHAA in word recognition and the HINT. However, the SHAA was significantly better than unaided hearing in terms of amplification. The SHAA may be a useful hearing assistance device for patients with mild-to-moderate hearing loss when listening to soft sounds in quiet conditions. The SHAA demonstrated poorer performance than the HA in the mid- to high-frequency sounds that are important for word recognition, sound quality, and hearing in noisy conditions. Further development of the signal technology of SHAAs is needed to improve the sound quality of mid- to high-frequency sounds and overcome noisy environments.

Neurocognitive function in children with cochlear implants and hearing aids: a systematic review

Purpose

To systematically review the existing literature that examines the relationship between cognition, hearing, and language in children using cochlear implants and hearing aids.

Method

The review has been registered in Prospero (Registration: CRD 42020203974). The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and examined the scientific literature in VHL, MEDLINE, CINAHL, Scopus, WOS, and Embase. It included original observational studies in children using hearing aids and/or cochlear implants who underwent cognitive and auditory and/or language tests. Data were extracted from the studies and their level of evidence was graded with the Oxford Center for Evidence-Based Medicine: Levels of Evidence. Meta-analysis could not be performed due to data heterogeneity. Outcomes are described in narrative and tables synthesis.

Results

The systematic search and subsequent full-text evaluation identified 21 studies, conducted in 10 different countries. Altogether, their samples comprised 1,098 individuals, aged 0.16-12.6 years. The studies assessed the following cognitive domains: memory, nonverbal cognition, reasoning, attention, executive functions, language, perceptual-motor function, visuoconstructive ability, processing speed, and phonological processing/phonological memory. Children with hearing loss using cochlear implants and hearing aids scored significantly lower in many cognitive functions than normal hearing (NH) children. Neurocognitive functions were correlated with hearing and language outcomes.

Conclusion

Many cognitive tools were used to assess cognitive function in children with hearing devices. Results suggest that children with cochlear implants and hearing aids have cognitive deficits; these outcomes are mainly correlated with vocabulary. This study highlights the need to understand children's cognitive function and increase the knowledge of the relationship between cognition, language, and hearing in children using cochlear implants and hearing aids.

Consistent hearing aid use is associated with lower fall prevalence and risk in older adults with hearing loss

BACKGROUND

Falls and their sequelae cost more than $50 billion every year. Older adults with hearing loss are at 2.4 times greater risk of falls than their normal hearing peers. Current research is inconclusive about whether hearing aids can offset this increased fall risk, and no previous studies considered if outcomes differed based on the consistency of hearing aid use.

METHODS

Individuals 60 years and older with bilateral hearing loss completed a survey consisting of the Fall Risk Questionnaire (FRQ) and questions about hearing loss history, hearing aid use, and other common fall risk factors. In this cross-sectional study, fall prevalence, as well as fall risk (based on FRQ score), was compared between hearing aid users and non-users. A separate group of consistent hearing-aid users (at least 4 h daily use for more than 1 year) was also compared with inconsistent/non-users.

RESULTS

Responses from 299 surveys were analyzed. Bivariate analysis found 50% reduced odds of experiencing a fall for hearing aid users compared with non-users (OR = 0.50 [95% CI: 0.29-0.85], p = 0.01). After adjusting for age, sex, hearing loss severity, and medication usage, those who reported any hearing aid use still had lower odds of falls (OR = 0.48 [95% CI: 0.26-0.90], p = 0.02) and lower odds of being at risk for falls (OR = 0.36 [95% CI: 0.19-0.66] p < 0.001) than non-users. Results for consistent hearing aid users demonstrate an even stronger association of lowered odds of falling (OR = 0.35 [95% CI: 0.19-0.67], p < 0.001) and lower odds of being at risk for falls (OR = 0.32 [95% CI: 0.12-0.59], p < 0.001), suggesting a potential dose-response relationship.

CONCLUSIONS

These findings suggest that use of hearing aids-especially consistent hearing aid use-is associated with lower odds of experiencing a fall or being classified as at risk for falls in older individuals with hearing loss.

Benefits of Bimodal Stimulation to Speech Perception in Noise and Silence

Introduction  Understanding all the benefits of bimodality with self-assessment questionnaires on the effect of hearing on quality of life is still necessary. Objective  To present whether bimodality still offers hearing benefits to the population who uses acoustic stimulation associated with electrical stimulation. Methods  The present study included 13 participants aged between 16 and 80 years old who were users of cochlear implants from Cochlear Corporation and hearing aids. All patients underwent the Hearing in Noise Test, and their visual analog scale score was obtained. Four-tone means were collected, and the participants answered the Speech, Spatial and Hearing Qualities questionnaire. Results  Bimodal users had an average sentence recognition rate of 76.0% in silence and 67.6% in fixed noise, and the signal-to-noise ratio in adaptive noise was +2.89dB. In addition, a lower level of difficulty was observed in the test using the visual analog scale. The domain with the highest average was auditory qualities (6.50), followed by spatial hearing (6.26) and hearing for speech (5.81). Individuals with an average between 50 and 70 dB of hearing level showed better sentence recognition in silence and noise. Conclusion  Bimodal stimulation showed benefits for users with different degrees of hearing loss; however, individuals who presented greater hearing residue had better performance in speech recognition with noise and in silence in addition to a good perception of hearing quality.

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.

Social determinants of health associated with attitudes towards hearing loss and hearing aids in older adults fitted in a Latin American country: validation of the ALHQ questionnaire into Spanish

OBJECTIVE

This study aimed to evaluate the association between certain social determinants of health (i.e. educational level, income, and social support) and attitudes towards hearing loss and hearing aids among older adults with hearing loss fitted in a Latin American country.

DESIGN

Older adults were asked about their attitudes towards hearing loss and hearing aids, years of formal education, income, social support, perception of having a hearing disability, and social pressure when using the hearing aid. To do so, we adapted the Attitudes towards Loss of Hearing Questionnaire (S-ALHQ) into Spanish. All the questionnaires were conducted as structured interview.

STUDY SAMPLE

Two hundred fifty-two older hearing aids users were recruited from a public hospital in Chile.

RESULTS

The S-ALHQ showed adequate validity, along with good reliability. The multivariate models showed that educational level and social support were the social determinants of health negatively associated with the attitudes. Aided hearing disability and social pressure to use hearing aids were the co-variables associated with S-ALHQ scores.

CONCLUSIONS

The study showed a significant relationship between specific social determinants of health and attitudes towards hearing loss and hearing aids. These attitudes should be considered when implementing rehabilitation programs for older adults with hearing loss.

Hearing performance of individuals with minimal hearing loss in complex and realistic communication experiences

PURPOSE

To analyze hearing performance and expectations regarding the use of hearing aids (HA) by participants with minimal hearing loss.

METHODS

This research is a primary, observational, longitudinal and prospective study. Two questionnaires, the Speech Spatial Qualities Questionnaire (SSQ) and the Expected Consequences of Hearing Aid Ownership (ECHO), were used, respectively, to verify hearing performance in complex listening situations and expectations regarding the use of HA. The convenience sample consisted of adults aged 53 to 72.

RESULTS

SSQ showed that, for hearing performance, greater difficulties were observed in unfavorable situations such as speech and speech-in-noise, followed by greater ease in locating the sound source and in the quality and naturalness of the sound. ECHO showed that, for the expectations regarding the use of the HA, the variables with significant correlation values were age x general expectation with HA and age x HA's positive aspects. No statistically significant association existed between performance scores in complex listening situations and the analyzed variables.

CONCLUSION

Minimal hearing loss can negatively influence everyday communicative situations, and the expectation of individuals with minimal hearing loss regarding the use of HA was shown to be high. In addition, the hearing performance of individuals in this study did not show correlations with the age, gender and education level of the sample.

Validation of an integrated pressure level measured earmold wideband real-ear-to-coupler difference measurement

OBJECTIVE

To validate measurement of predicted earmold wideband real-ear-to-coupler difference (wRECD) using an integrated pressure level (IPL) calibrated transducer and the incorporation of an acoustically measured tubing length correction.

DESIGN

Unilateral earmold SPL wRECD using varied hearing aid tubing length and the proposed predicted earmold IPL wRECD measurement procedure were completed on all participants and compared.

STUDY SAMPLE

22 normal hearing adults with normal middle ear status were recruited.

RESULTS

There were no clinically significant differences between probe-microphone and predicted earmold IPL wRECD measurements between 500 and 2500 Hz. Above 5000 Hz, the predicted earmold IPL wRECD exceeded earmold SPL wRECDs due to lack of standing wave interference. Test-retest reliability of IPL wRECD measurement exceeded the reliability of earmold SPL wRECD measurement across all assessed frequencies, with the greatest improvements in the high frequencies. The acoustically measured tubing length correction largely accounted for acoustic effects of the participant's earmold.

CONCLUSIONS

IPL-based measurements provide a promising alternative to probe-microphone earmold wRECD procedures. Predicted earmold IPL wRECD is measured without probe-microphone placement, agrees well with earmold SPL wRECDs and is expected to extend the valid bandwidth of wRECD measurement.

Change in the Characteristics of Patients Qualified for Hearing Aids over the Last 25 Years in Poland

Hearing loss is one of the most common causes of disability worldwide. The aim of the study was to compare the demographic structure and the results of hearing tests in people qualified for hearing aids over the last 25 years. The material covered 1246 patients qualified for hearing aids in the years 1996-2001 and 2016-2021. Patients were divided into two groups according to the time of qualifying for hearing aids. Group 1 (G1) consisted of 759 people qualified in the years 1996-2001, and Group 2 (G2) comprised 487 people qualified in the years 2016-2021. Statistical analysis was performed on the results of pure tone threshold audiometry and the demographic structure in both groups. Patients in G1 had statistically significantly elevated hearing thresholds (HT) in the air conduction range at frequencies from 2000 to 8000 Hz in relation to G2 patients. The opposite situation was observed for the bone conduction threshold. G2 patients had significantly elevated bone conduction HT at frequencies from 250 to 1000 Hz compared to G1 patients. The age structure in both groups was similar; however, the gender distribution was statistically significantly different. In G1 women accounted for 40%, and in G2, they became the dominant gender (53%). Over the last twenty years, there has been a change in the structure of patients qualified for hearing aids. Although the age has remained similar, today, patients decide to use hearing aids at an earlier stage of hearing loss than 25 years ago. Modern women began to use hearing aids much more often.

Development and validation of BATUTA: a test to evaluate the musical perception of people with hearing impairment

PURPOSE

To describe the development and validation of a test, called BATUTA, that assesses the musical perception of people with hearing impairment that are hearing aid (HA) users. BATUTA is a computerized test with 35 subtests, divided into the rhythm, pitch, and timbre modules, and the participants must answer whether the sound samples and/or parts of the songs, presented in pairs, are the same or not.

METHODS

The BATUTA creation process consisted of four stages: test development, submission to the expert committee for content validation; pilot application with 51 normal hearing participants and retest to validate reliability. The process was based on several recommendations for the development and validation of musical assessment instruments. A deep investigation of the guidelines related to sound samples used, musical attributes evaluated, testing environment and the most appropriate response method was undertaken to ensure dependability.

RESULTS

The Content Validity Index (CVI) and expert agreement rates, when analyzed with the committee's recommendations, resulted in corrections and new audio recordings to ensure compliance to the test. The pilot test scores indicated internal consistency and the retest confirmed the reliability of BATUTA.

CONCLUSION

The results demonstrated the viability of BATUTA to assess the musical perception of people with hearing impairment that are HA users.

A Systematic Review of the Audiological Efficacy of Cartilage Conduction Hearing Aids and the Factors Influencing Their Clinical Application

This systematic review evaluates the efficacy and benefit of cartilage conduction hearing aids (CC-HAs) and that factors that influence purchasing decisions. The hearing thresholds and functional gain following CC-HA wear were synthesised. A one-way analysis of variance compared the differences in the hearing thresholds and functional gain at individual frequencies and in patients with a variety of pathological changes. The synchronised aided hearing threshold and functional gain at 2.0 kHz were significantly better than at 0.5, 1.0, and 4.0 kHz. There was no significant difference in the synchronised unaided hearing thresholds across individual frequencies between 0.5 and 4.0 kHz. The synchronised functional gain in patients with atresia was significantly greater than in patients with aural atresia or stenosis and middle ear pathologies with normal ear canals. The acceptability of CC-HAs in terms of purchase decision is influenced by the condition of the external auditory meatus and severity of hearing loss, with the highest purchase rate seen in patients with aural atresia or stenosis. CC-HAs' fitting procedure advantages and cosmetic considerations make these devices a viable and preferred choice for individuals with microtia and aural atresia. Additional research to evaluate the benefits towards emotional well-being is crucial to gain insights into the psychological impact of CC-HA use.