Enablers and Barriers to Hearing aid Use in People Living With Dementia.

Hearing loss is highly prevalent in dementia; however, people with dementia are less likely to use hearing aids consistently than people with intact cognition are. This qualitative study is the first of its kind to explore factors that influence hearing aid use from the perspective of community-living people with mild to moderate dementia and their care partners. Eleven UK-based dyads from the European SENSE-Cog Randomized Controlled Trial of a sensory intervention for people with dementia completed semi-structured interviews based on the Theoretical Domains Framework (TDF). Our findings suggest that the TDF domains environmental context and resources, behavioral regulation, reinforcement, and social influences are of greatest relevance to hearing aid use in dementia. Within these domains, we identified a range of factors that may influence the target behavior of hearing aid use. The findings suggest that adoption of multifaceted, flexible intervention approaches may support hearing aid use in dementia.

Expressive vocabulary word categories of children who are deaf and hard-of-hearing.

This study investigated the acquisition of early expressive vocabulary among young children who are deaf and hard-of-hearing (DHH; n = 68) using auditory technology (hearing aids and cochlear implants). Parents completed a standardized vocabulary checklist, which allowed analyses of (i) the size of their child's spoken vocabulary; (ii) composition of the expressive lexicon (e.g., parts of speech such as nouns and verbs; semantic categories such as routines and body parts); and (iii) demographic and audiologic factors (e.g., chronologic age, degree of hearing access) potentially associated with these metrics. Young children who are DHH and use auditory technology acquired fewer spoken words than peers with typical hearing (TH) matched for chronologic age but more spoken words than peers with TH matched for listening experience. Action verbs-not nouns-significantly increased the odds of a child who is DHH achieving a vocabulary quotient within the normative range. These findings support the exploration of early expressive vocabulary size and composition-especially the number of active verbs-to guide clinical management and decision-making for young children who are DHH.

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

BACKGROUND AND AIM: Age-related hearing loss has potential effects on communication, cognitive, emotional, and social aspects of the older person's life. Evaluating the role of hearing aids in reducing these difficulties is important. This study aimed to evaluate communication difficulties, self-perceived handicaps, and depression in hearing-impaired older adults who are either hearing aid users or non-users. METHODS: A total of 114 older adults in the age range of 55-85 years with moderate to moderately severe hearing loss (two hearing-matched groups; hearing aid users: n = 57; hearing aid non-users: n = 57) took part in this study during the COVID-19 pandemic. Self-perceived hearing handicaps and communication were evaluated using the Hearing Handicap Inventory in the Elderly-Screening (HHIE-S) and Self-Assessment Communication (SAC) questionnaires. Depression was assessed using the geriatric depression scale (GDS). RESULTS: The average score of HHIE-S was significantly higher in the hearing aid users than the non-users (16.61 ± 10.39 vs. 12.49 ± 9.84; p = 0.01). Differences between groups were not significant for SAC or GDS scores (p ≥ 0.05). There were strong positive correlations between HHIE-S and SAC scores in both groups. Moderate correlations were found between SAC and GDS scores in the hearing aid users and between the duration of using hearing aid with SAC and HHIE-S scores. CONCLUSION: It seems that self-perceived handicaps, communication difficulties and depression are affected by many factors, and only receiving hearing aids without subsequent support such as auditory rehabilitation and programming services cannot bring the expected output. The effect of these factors was clearly observed due to reduced access to services in the COVID-19 era.

The future of hearing aid technology : Can technology turn us into superheroes?

BACKGROUND: Hearing aid technology has proven to be successful in the rehabilitation of hearing loss, but its performance is still limited in difficult everyday conditions characterized by noise and reverberation. OBJECTIVE: Introduction to the current state of hearing aid technology and presentation of the current state of research and future developments. METHODS: The current literature was analyzed and several specific new developments are presented. RESULTS: Both objective and subjective data from empirical studies show the limitations of the current technology. Examples of current research show the potential of machine learning-based algorithms and multimodal signal processing for improving speech processing and perception, of using virtual reality for improving hearing device fitting and of mobile health technology for improving hearing health services. CONCLUSION: Hearing device technology will remain a key factor in the rehabilitation of hearing impairments. New technology, such as machine learning and multimodal signal processing, virtual reality and mobile health technology, will improve speech enhancement, individual fitting and communication training, thus providing better support for all hearing-impaired patients, including older patients with disabilities or declining cognitive skills.

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

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

A randomised, controlled trial of clinically implementing online hearing support.

OBJECTIVE: The research-oriented objective of this study was to document the effectiveness of online support for hearing aid (HA) users compared with traditional support. DESIGN: This study is a randomised controlled trial with parallel group design. The research-oriented objectives were evaluated using the Hearing Handicap Inventory for the Elderly (HHIE) and the Communication Strategies Scale (CSS) at baseline and immediately postintervention. STUDY SAMPLE: Selected clients at five different clinics were randomised to an intervention group (n = 78) that took part in online hearing support and a control group (n = 58) that received standard care. RESULTS: The analyses (intention-to-treat) showed statistically significant improvements in the HHIE-total and Emotional subscale scores for the intervention group compared with the control group. The intervention group also showed significantly greater improvement in the CSS-total and Verbal and Nonverbal subscale scores. A subgroup analysis was performed including two groups: HA use <1 year and HA use >1 year. A statistically significant improvement was found for the HA users >1 year compared with HA use <1 year. CONCLUSIONS: It is effective to clinically include online hearing support for HA users when addressing self-perceived hearing difficulties and to sharpen communication strategy skills.

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.

Hearing impairment among workers and satisfaction with the use of hearing aids.

BACKGROUND: Hearing problems can have adverse effects on an individual's job performance, as well as on unemployment or underemployment and increased risk of stress-related sick leave. OBJECTIVE: To investigate hearing impairment among workers and satisfaction with the use of hearing aids. METHODS: Cross-sectional study with workers who are hearing aid users. Subjects underwent pure tone audiometry and answered the Hearing Handicap Inventory for Adults and the Satisfaction with Amplification in Daily Life questionnaires. RESULTS: Participants were 36 workers between 36 and 75 years old, with an average age of 53.47 years, 52.7% male and 47.3% female. There was a mild to moderate hearing handicap perception, with worse results for women in the emotional domain. As hearing loss increased, workers' frustration increased when talking to coworkers. Everyone was satisfied with the use of their hearing aids. Satisfaction increased with increasing age and decreased with increasing hearing loss. The greater the frustration when talking to co-workers, the lower the overall satisfaction with hearing aid use; the lower the satisfaction with the competence of the professional who assisted in adapting the hearing aid; the lower the satisfaction in environments with background noise and overall worse personal image. The worse the attitudes and emotional responses of workers regarding their hearing impairment, the lower the overall satisfaction with the hearing aid. CONCLUSIONS: Despite the use of hearing aids, workers perceive having a hearing impairment, especially women. As hearing loss and frustration in talking with co-workers increased, satisfaction decreased.

"Something is just not right with my hearing": early experiences of adults living with hearing loss.

OBJECTIVE: To understand the psychosocial process of how adults experience hearing loss; specifically, their readiness to accept that they may have hearing loss, and the challenges and coping strategies associated with it. DESIGN: A grounded theory methodology guided the research. A patient-orientated research approach informed the study. Thirty-nine individual interviews and six focus groups were completed. STUDY SAMPLE: Participants included 68 individuals aged 50 years and older with self-reported hearing loss living in Newfoundland and Labrador. RESULTS: The theoretical construct, 'Realising that something is just not quite right with my hearing' captured individuals' experiences as they gradually awakened to the fact that they had hearing loss. Three categories describe the process: (1) Rationalising suspicions, (2) Managing the invisible and (3) Reaching a turning point. CONCLUSIONS: Many individuals do not recognise hearing loss in its early stages, although they may be already experiencing its negative effects. It is important to identify motivators to engage individuals as early as possible in their hearing health. Taking a proactive approach to hearing health can help mitigate the potential negative outcomes of hearing loss.

The Effect of Music Genre and Music-Preference Dimension on Acceptable Noise Levels in Listeners with 'Normal' Hearing.

BACKGROUND: The acceptable noise level (ANL) is the maximum level of background noise that an individual is willing to accept while listening to speech. The type of background noise does not affect ANL results except for music. PURPOSE: The purpose of this study was to determine if ANL differed due to music genre or music genre preference. RESEARCH DESIGN: A repeated-measures experimental design was employed. STUDY SAMPLE: Thirty-three young adults with normal hearing served as listeners. DATA COLLECTION AND ANALYSIS: Most comfortable listening level and background noise level were measured to twelve-talker babble and five music samples from different genres: blues, classical, country, jazz, and rock. Additionally, music preference was evaluated via rank ordering of genre and by completion of the Short Test of Music Preference (STOMP) questionnaire. RESULTS: The ANL for music differed based on music genre; however, the difference was unrelated to music genre preference. Also, those with low ANLs tended to prefer the intense and rebellious music-preference dimension compared with those with high ANLs. CONCLUSIONS: For instrumental music, ANL was lower for blues and rock music compared with classical, country, and jazz. The differences identified were not related to music genre preference; however, this finding may be related to the music-preference dimension of intense and rebellious music. Future work should evaluate the psychological variables that make up music-preference dimension to determine if these relate to our ANL.

The role of the family doctor's language in modulating people's attitudes towards hearing loss and hearing aids.

Despite widespread hearing problems among older adults, only a minority of them use hearing aids. The decision to rely on hearing aids is influenced by several psychosocial factors, which may include attitudes influenced by significant others, particularly caregivers and health professionals. The language used by professionals when approaching this topic is particularly important. The purpose of this study was to deepen the role played by different communication styles in the area of hearing impairment by analysing the impact of language-medical versus everyday-used in the doctor-patient interaction on attitudes and behavioural intentions in a sample of potential caregivers of older adults. 209 Italian volunteers aged between 19 and 60 completed an online experimental study. The results suggested that, when interacting with doctors, exposure to a language that includes medical words promotes negative attitudes towards hearing loss. Nevertheless, medical language induces positive attitudes towards hearing aids and encourages people to adopt them when needed as well as recommending them to relatives and friends. Overall, the use of formal, medical language in doctor-patient communication, despite sounding less reassuring, is more effective in persuading people with hearing loss to rely on hearing aids.

Age-Related Hearing Loss, Neuropsychological Performance, and Incident Dementia in Older Adults.

BACKGROUND: Age-related hearing loss (HL) has been associated with dementia, though the neurocognitive profile of individuals with HL is poorly understood. OBJECTIVE: To characterize the neurocognitive profile of HL. METHODS: N = 8,529 participants from the National Alzheimer's Coordinating Center ≥60 years and free of cognitive impairment who were characterized as Untreated-, Treated-, or No HL. Outcomes included executive function (Trail Making Test [TMT] Part B), episodic memory (Immediate/Delayed Recall), language fluency (Vegetables, Boston Naming Test), and conversion to dementia. Regression models were fit to examine associations between HL and neurocognitive performance at baseline. Cox proportional hazards models examined the links between HL, neurocognitive scores, and development of dementia over follow-up. RESULTS: At baseline, those with Untreated HL (versus No HL) had worse neurocognitive performance per standardized difference on executive function (TMT Part B [mean difference = 0.05 (95% CI 0.00, 0.10)]) and language fluency (Vegetables [mean difference = -0.07 (95% CI -0.14, -0.01)], Boston Naming Test [mean difference = -0.07 (95% CI -0.13, -0.01)]). No differences in these neurocognitive performance scores were demonstrated between Treated HL and No HL groups other than MMSE [mean difference = -0.06 (95% CI -0.12, 0.00)]. Through follow-up, executive dysfunction differed by hearing group (χ2(2) = 46.08, p < 0.0001) and was present among 39.12% in No HL, 44.85% in Untreated HL, and 49.40% in Treated HL. Worse performance across all cognitive domains predicted incident dementia. CONCLUSION: The observed association between Untreated HL and lower cognitive ability that improved when hearing aids were worn may reflect an inability to hear the test instructions. Future studies using cognitive assessments validated for use in HL are needed to evaluate the neuropsychological profile of HL and identify individuals at risk for dementia.

Social Perceptions of Pediatric Hearing Aids.

OBJECTIVES: To determine whether hearing aid (HA) use affects social perceptions of general public adults and age-matched peers and if so, determine if effects are modulated by lack of societal representation of pediatric HAs. METHODS: A 10-year-old boy was presented in six photographic conditions with and without HAs and eyeglasses (a worn sensory aid with wider societal representation). HAs were presented in neutral skin tone and bright blue colors. Photographic conditions were embedded into web-based surveys with visual analog scales to capture social perceptions data and sourced to 206 adults (age 18-65) and 202 peers (age 10) with demographic characteristics representative of the general US population. Mean differences in scores for each condition compared to control images were computed using two-tailed t-tests. RESULTS: In both adult and child respondents, HAs were associated with decreased athleticism, confidence, health, leadership, and popularity. Glasses were associated with decreased athleticism and popularity but increased intelligence, overall success, and in the child respondents, friendliness. When worn in combination, the beneficial effects of glasses were mitigated by brightly colored but not neutrally colored HAs. CONCLUSION: Negative effects of pediatric HAs on social perceptions may be influenced by poor societal representation of HAs. These results suggest that greater representation of pediatric HAs is necessary to make society more inclusive for children with hearing loss. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2387-E2392, 2021.

Hearing Loss, Hearing Aid Use, and Depressive Symptoms in Older Adults-Findings from the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).

OBJECTIVES: Investigate the cross-sectional association between hearing loss (HL), hearing aid use, and depressive symptoms in community-dwelling older adults. METHOD: The analytic sample consisted of 3,188 participants (age range 71-94 years) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). Multivariable logistic regression was used to evaluate the association of audiometric hearing status and self-reported hearing aid use with depressive symptoms (11-item Center for Epidemiologic Studies Depression scale). RESULTS: 4.6% of participants had depressive symptoms. Forty percent had mild HL and 27% had moderate or greater HL. In multivariable-adjusted models, mild HL was associated with 1.90 times higher odds (95% confidence interval [CI] 1.20-3.01) and moderate or greater HL with 2.42 times higher odds (95% CI 1.44-4.07) of depressive symptoms compared to normal hearing. Each 10dB increase in HL was associated with 1.30 higher odds of depressive symptoms (95% CI 1.14-1.49). Hearing aid use was not associated with depressive symptoms among those with mild (odds ratio [OR] 0.94, 95% CI 0.35-2.54) or moderate or greater (OR 1.12, 95% CI 0.60-2.11) HL. DISCUSSION: Older adults with HL have higher odds of depressive symptoms compared to adults with normal hearing. Future studies are needed to assess whether hearing care is protective against depressive symptoms in older adults.

Covid-19 Lockdown Affects Hearing Disability and Handicap in Diverse Ways: A Rapid Online Survey Study.

OBJECTIVES: The aim of this study was to explore the perceived effects of coronavirus disease 2019 (Covid-19) social distancing restrictions and safety measures on people with hearing loss. DESIGN: Participants were 129 adults (48.1% female, mean age 64.4 years) with an audiometric hearing loss, living in Glasgow, Scotland. A rapidly deployed 24-item online questionnaire asked about the effects of certain aspects of lockdown, including face masks, social distancing, and video calling, on participants' behavior, emotions, hearing performance, practical issues, and tinnitus. Data were analyzed descriptively across the entire sample, and with Chi-squared tests for differences between subgroups self-reporting relatively good and relatively poor unaided hearing, respectively. Additional free-text responses provided further perspectives. RESULTS: Behavior: Video calls are used more frequently than prelockdown. The better-hearing group use their hearing aids less. Emotions: There is increased anxiety (especially among the worse hearing group) concerning verbal communication situations and access to audiology services, and greater rumination about one's own hearing loss. Enjoyment of group video calls is mixed. The worse hearing group shows substantial relief at not being obliged to attend challenging social gatherings. Across both groups, a majority would like to see all key workers equipped with transparent face masks. Hearing performance: A large majority finds it hard to converse with people in face masks due to muffled sound and lack of speechreading cues, but conversing at a safe distance is not universally problematic. In the worse hearing group, performance in video calls is generally inferior to face-to-face, but similar to telephone calls. Those who use live subtitling in video calls appreciate their value. TV and radio updates about Covid-19 are easy to follow for most respondents. There is only weak evidence of face mask fixtures interfering with hearing aids on the ear, and of tinnitus having worsened during lockdown. CONCLUSIONS: With due regard for the limitations of this rapid study, we find that there are many negative-and a few positive-effects of Covid-19 restrictions and safety measures on people with hearing loss. From a societal perspective, the widespread adoption of clear face masks may alleviate some of the difficulties and anxieties this population experience. From an individual perspective, one may consider using live subtitles on video calls. Manufacturers of hearing devices should consider developing processing modes and accessories specifically designed for video calls. Finally, repair and maintenance services should be resumed as soon as it is safe to do so.

Senescent Decline in Verbal-Emotion Identification by Older Hearing-Impaired Listeners - Do Hearing Aids Help?

PURPOSE: To assess the ability of older-adult hearing-impaired (OHI) listeners to identify verbal expressions of emotions, and to evaluate whether hearing-aid (HA) use improves identification performance in those listeners. METHODS: Twenty-nine OHI listeners, who were experienced bilateral-HA users, participated in the study. They listened to a 20-sentence-long speech passage rendered with six different emotional expressions ("happiness", "pleasant surprise", "sadness", "anger", "fear", and "neutral"). The task was to identify the emotion portrayed in each version of the passage. Listeners completed the task twice in random order, once unaided, and once wearing their own bilateral HAs. Seventeen young-adult normal-hearing (YNH) listeners were also tested unaided as controls. RESULTS: Most YNH listeners (89.2%) correctly identified emotions compared to just over half of the OHI listeners (58.7%). Within the OHI group, verbal emotion identification was significantly correlated with age, but not with audibility-related factors. The number of OHI listeners who were able to correctly identify the different emotions did not significantly change when HAs were worn (54.8%). CONCLUSION: In line with previous investigations using shorter speech stimuli, there were clear age differences in the recognition of verbal emotions, with OHI listeners showing a significant reduction in unaided verbal-emotion identification performance that progressively declined with age across older adulthood. Rehabilitation through HAs did not provide compensation for the impaired ability to perceive emotions carried by speech sounds.

Using attribution theory to explore the reasons adults with hearing loss do not use their hearing aids.

Hearing aids are an effective treatment for individuals with hearing loss that have been shown to dampen (and sometime ameliorate) the negative effects of hearing loss. Despite the devices' efficacy, many reject hearing aids as a form of treatment. In the present qualitative study, we explored the reasons for hearing aid non-use in the United States that emerged from the stories of adults with hearing loss who do not to utilize hearing aids. We specifically used thematic analysis in concert with an attribution theory framework to identify and analyze recurring themes and reasons throughout these individuals' narratives. A total of nine themes describing reasons of hearing aid non-use emerged. Four reasons were internally motivated: (1) non-necessity, (2) stigmatization, (3) lack of integration into daily living, and (4) unreadiness due to lack of education; five reasons were externally motivated: (5) discomfort, (6) financial setback, (7) burden, (8) professional distrust, and (9) priority setting. These findings contribute to the field of hearing healthcare by providing professionals with insight into reasons that people across the provided when recounting their experiences following the diagnosis of hearing loss, prescription for hearing aids, and their hearing aid non-use. These findings are an important step toward the development of more effective, person-centered hearing healthcare that can best address these individuals' concerns and expectations surrounding hearing loss and hearing aids.