HEARING HANDICAP IN OLDER ADULTS: A MULTI-CENTER STUDY

Objective: To determine the level of hearing handicap and its age and gender association in older adults. Study Design: Cross sectional analytical study. Place and Duration of Study: Study conducted at Ear, Nose & Throat outpatients of Yusra General Hospital, National Institute of Rehabilitation Medicine Islamabad and Cantonment General Hospital Rawalpindi, from Jul to Sep 2017. Methodology: We recruited two hundred cases of self-reported hearing difficulty, using non-probability consecutive sampling, who fulfilled inclusion criteria. After recording demographic details including history, subjects were screened by the Screening Version of Hearing Handicap Inventory for the Elderly (HHIE-S). Followed by otoscopy and pure tone audiometry. Analysis was done using SPSS-24. Results: Study revealed 133 (65.5%) males and 67 (33.5%) females with mean age of 65.45 ± 7.50 years. Out of 179 (89.5%) had significantly high level of hearing handicap with HHIE-S score >43, while 21 (10.5%) revealed mild to moderate handicap with score of 17-42. Hearing handicap was significantly associated with aging (p<0.001), while no significant gender association was noted. Hearing loss was mainly of sensory-neural type 192 (96%). Conclusion: In older adults with self-reported hearing loss, high level of hearing handicap was present in majority (89.5%) and mild to moderate in 10.5%, with significant association with aging and hearing loss was predominantly sensory- neural type.

Diagnostic Validity of Self-Reported Hearing Loss in Elderly Taiwanese Individuals: Diagnostic Performance of a Hearing Self-Assessment Questionnaire on Audiometry

Key Points: Question: Can the traditional Chinese version of the hearing handicap inventory for elderly screening (HHIE-S) checklist screen for age-related hearing loss (ARHL) in elderly individuals? Findings: In this cross-sectional study of 1696 Taiwanese patients who underwent annual government-funded geriatric health checkups, the Chinese version of the HHIE-S had a sensitivity of 76.9% and a specificity of 79.8% with a cutoff score greater than 6 for identifying patients with disabled hearing loss (defined as a PTA > 40 dB). Meaning: The traditional Chinese version of the HHIE-S is an effective test to detect ARHL and can improve the feasibility of large-scale hearing screening among elderly individuals. Purpose: The traditional Chinese version of the hearing handicap inventory for elderly screening (TC-HHIE-S) was translated from English and is intended for use with people whose native language is traditional Chinese, but its effectiveness and diagnostic performance are still unclear. The purpose of this study was to evaluate the validity and reliability of the traditional Chinese version of the HHIE-S for screening for age-related hearing loss (ARHL). Methods: A total of 1696 elderly people underwent the government’s annual geriatric medical examination at community hospitals. In this cross-sectional study, we recorded average conducted pure-tone averages (PTA) (0.5 kHz, 1 kHz, 2 kHz, 4 kHz), age, sex, and HHIE-S data. Receiver operating characteristic (ROC) curve analysis was used to identify the best critical point for detecting hearing impairment, and the validity of the structure was verified by the agreement between the TC-HHIE-S and PTA results. Results: The HHIE-S scores were correlated with the better-ear pure-tone threshold averages (PTAs) at 0.5–4 kHz (correlation coefficient r = 0.45). The internal consistency of the total HHIE-S score was excellent (Cronbach’s alpha = 0.901), and the test-retest reliability was also excellent (Spearman’s correlation coefficient = 0.60, intraclass correlation coefficient = 0.75). In detecting disabled hearing loss (i.e., PTA at 0.5–4 kHz > 40 dB), the HHIE-S cutoff score of > 6 had a sensitivity of 76.9% and a specificity of 79.8%. Conclusions: The traditional Chinese version of the HHIE-S is a valid, reliable, and efficient tool for large-scale screening for ARHL.

The Effects of Hearing Handicaps and Instrumental Activities of Daily Living on Hearing-Handicap-Related Quality of Life in Community-Dwelling Older Adults

Purpose: The aim of this study was to investigate hearing handicaps, instrumental activities of daily living, and hearing-handicap-related quality of life among community-dwelling older adults and identify factors that influence hearing-handicap-related quality of life.Methods: A total of 129 older adults aged 65 and over participated in the study, and data collection was conducted from December 20th, 2020 to March 20th, 2021. Descriptive statistics, t-test, ANOVA, Pearson’s correlations, and multiple linear regression were used for data analysis.Results: Self-reported hearing handicaps positively associated with instrumental activities of daily living (r=.82, p<.001), and negatively associated with hearing-handicap-related quality of life (r=-.80, p<.001). Instrumental activities of daily living negatively associated with hearing-handicap-related quality of life (r=-.71, p<.001). Hearing handicaps influenced hearing-handicap-related quality of life (β=-.70, p<.001). A regression model explained 66% of the variance in hearing-handicap-related quality of life.Conclusion: Hearing handicaps affect hearing-handicap-related quality of life of older adults living in the community. Therefore, nursing interventions to prevent hearing handicaps are required to improve hearing-handicap-related quality of life of older adults.

Factors Affecting Hearing Aid Adoption by Adults With High-Frequency Hearing Loss: The Beaver Dam Offspring Study

Purpose Hearing loss (HL) is common among middle-age and older adults, but hearing aid adoption is low. The purpose of this study was to measure the 10-year incidence of hearing aid adoption in a sample of primarily middle-age adults with high-frequency HL and identify factors associated with hearing aid adoption. Method This study included 579 adults (ages 34–80 years) with high-frequency pure-tone average > 25 dB HL (3–8 kHz) enrolled in the Beaver Dam Offspring Study. Hearing aid adoption was measured at 5- and 10-year follow-up examinations. Cox discrete-time proportional hazards models were used to evaluate factors associated with hearing aid adoption (presented as hazards ratios [HRs] and 95% confidence intervals [95% CI]). Results The 10-year cumulative incidence of hearing aid adoption was 14 per 1,000 person years. Factors significantly associated with adoption in a multivariable model were higher education (vs. 16+ years; 0–12: HR: 0.36, 95% CI [0.19, 0.69]; 13–15: HR: 0.52, 95% CI [0.27, 0.98]), worse high-frequency pure-tone average (per +1 dB; HR: 1.04, 95% CI [1.02, 1.06]), self-reported hearing handicap (screening versions of the Hearing Handicap Inventory score > 8; HR: 1.85, 95% CI [1.02, 3.38]), answering yes to “Do friends and relatives think you have a hearing problem?” (HR: 3.18, 95% CI [1.60, 6.33]) and using closed captions (HR: 2.86, 95% CI [1.08, 7.57]). Effects of age and sex were not significant. Conclusions Hearing aid adoption rates were low. Hearing sensitivity, socioeconomic status, and measures of the impact of HL on daily life were associated with adoption. Provider awareness of associated factors can contribute to timely and appropriate intervention.

Evaluation of General Practitioners' awareness of hearing screening in the elderly

Objectives The aim of this study is to assess the awareness of community general practitioners on hearing screening for the elderly. Methods From January to February 2019, 367 general practitioners from 12 community health service centers, distributed in urban and suburban areas of Pudong District, Shanghai, were investigated with self-designed questionnaires. Results The general practitioners had poor understandings of the definition and onset of presbycusis. The accuracy of answers regarding the high-risk factors of presbycusis was zero. The top-three common hearing screening methods selected by general practitioners were screening version of the Hearing Handicap Inventory for the Elderly (HHIE-s) (94.55%), self-auditory assessment (83.65%), and pure-tone audiometry (77.66%). As for the attitudinal evaluation of hearing screening, 49.59% of the participants thought it was highly meaningful, 48.77% thought that early intervention would have clinical benefits. However, 52.59% of the participants believed it was necessary for specialists to complete the auditory screening in the community, and 13.62% thought hearing screening was impracticable in community. Conclusion Our questionnaire suggested that general practitioners were aware of the knowledge of hearing screening and agreed with its significance. But further training is highly demanded to promote the professional skills for general practitioners in community.

A Randomized Controlled Trial Using Automated Technology for Improving Ototoxicity Monitoring in VA Oncology Patients

Purpose Determine the efficacy of ototoxicity monitoring (OM) administered as automated protocols with the Oto-ID mobile audiometer (automated ototoxicity monitoring [A-OM]), compared with usual care (UC) OM in cancer patients receiving cisplatin. Method Participants were patients ( n = 46, mean age 64.7 years; range: 30–78 years) receiving cisplatin-based chemotherapy at the Department of Veterans Affairs Portland Health Care System. A randomized controlled trial contrasted A-OM and UC at up to three program evaluations (PEs) conducted by the study audiologist who was blinded to arm through PE1. PE1 occurred before randomization or oncology treatment; PE2 and PE3 occurred during and/or after treatment at 35 and 365 days postrandomization. The A-OM group ( n = 24) used Oto-ID to screen their hearing before each cisplatin dose. Oto-ID results were sent to the study audiologist for interpretation, follow-up, and care coordination. The UC group ( n = 22) received a consult for OM services through the audiology clinic. Outcomes included hearing shift near each patient's high-frequency hearing limit, revised hearing-handicap inventory score, and survival time from the start of treatment. Adherence to OM protocols, patients' use of aural rehabilitation services, and oncologists' treatment decisions were also examined. Results Ototoxicity was identified at a high overall rate (46% and 76% at 35 and 365 days, respectively, postrandomization). Adherence to monitoring prior to each cisplatin dose was 83.3% for those randomized to A-OM compared with 4.5% for UC. Randomization to A-OM was not associated with reduced ototoxic hearing shifts or self-reported hearing handicap relative to UC; neither did it compromise participants' survival. Half of participants in each arm accessed aural rehabilitation services. One in each arm had a documented ototoxicity-related cisplatin dose reduction. Conclusions Auditory impairment was an actionable concern for the participants and their oncology providers. A dedicated surveillance program using the Oto-ID's automated protocols improved adherence to OM recommendations over a traditional UC service delivery model. Supplemental Material https://doi.org/10.23641/asha.16649602