Introduction
earing
is one of the most desirous divine gifts for humans. Hearing is the basis of
language development. Growth and development of our knowledge and thoughts depend
on hearing. Language and speech are the only natural methods for communication.
Aging can cause presbycusis, so communication may become compromised.
The population of elderly people and therefore
presbycusis is increasing worldwide due to improvements
in public health conditions, and control of new birth and infectious diseases. Therefore,
attention to their health has become a part of governmental policies.
In this century, hearing loss is becoming one of the
most prevalent chronic diseases in the elderly as in the USA; hearing loss is the third most prevalent chronic disease in the elderly.1 WHO
has anticipated an increase in the number of elderly people in the world. In Poland, for example, the elderly people constituted 15.32% of the population in 2005 while the
expected figure would be 16% in 2020.2
The prevalence of presbycusis is not the same in
different parts of the world. The prevalence of sensorineural hearing loss in the
Egyptian elderly (>65 years) is reported to be 44.3%3 while in
Taiwan, its prevalence is reported to be 1.7% between 65 and 69; 3.2% in 70 to 74;
7.5% between 75 and 79; and 14.9% in those who are 80 years old or more.4
In addition to presbycusis, old people, like others, may
suffer from conductive hearing loss or a combination of conductive and
sensorineural hearing loss called a "mixed hearing loss". Since presbycusis
is a sensorineural type of hearing loss which cannot be medically or surgically
treated, the only appropriate help is to amplify sounds through a hearing aid.
The benefits and satisfaction from using a hearing aid
among hearing-impaired elderly people have been studied in different countries.
According to Cox et al., 23% of hearing-impaired elderly people actually seek
and use hearing aids.5 The effect of different types of hearing aids
on the quality of life of the hearing-impaired elderly people has been
investigated and some results show that programmable hearing aids have positive
and efficient effects on hearing and the quality of life of the hearing-impaired
elderly peoples.6
Hearing loss can cause loneliness, decrease of social
activities, and communication disorders; therefore, it is difficult to manage
them in elderly houses. Using a hearing aid and returning them to an ordinary
lifestyle is cost-effective according to Manula's report.7
In another study, Chao and Chen concluded that for the
hearing-impaired elderly people, use of hearing aids was a cost-effective
strategy for rehabilitation.8
To assess whether hearing aids improve the quality of
life of Iranian elderly people with a hearing loss, we studied the effect of using
a hearing aid in the hearing-impaired elderly people who referred to the rehabilitation
centers of Tehran Welfare Organization (Molavi and Shemiranat) for having a
hearing aid.
Patients and Methods
The participants in this research were elderly hearing-impaired
people who referred to hearing rehabilitation centers of Tehran Welfare
Organization from May 2005 through June 2007 with a complaint about hearing
loss.
After a complete ENT examination and ruling out all
causes but presbycusis, all patients were examined by an audiologist and pure tone
audiometry, tympanometry, speech reception threshold, and speech detection threshold
tests were carried out for all of them.
None of the subjects had used a hearing aid before. In
this study, we recommended a hearing aid for those whose average hearing loss
was more than 40 dB hearing loss in frequencies: 0.5, 1, 2, and 4 KHz in the better
ear.
An informed consent was obtained from each participant
in this research and Medical Ethics Committee of the university approved the
study.
All of the participants were over the age of 60, all
were otherwise healthy and were counseled by the same audiologist, and all were
provided with similar hearing aids and most of them had a moderate to severe
sensorineural hearing loss.
The patients were asked to complete the Hearing
Handicap Inventory for the Elderly (HHIE) questionnaire to determine the
severity of the perceived hearing loss and specific communication problems and
quality of life. HHIE consists of a series of 25 standardized questions
developed to assess hearing loss and quality of life in elderly individuals. It
consists of 13 social or situational items (S) and 12 emotional (E) response
items. A response of "yes" is given four points, "sometimes"
is given two points, and "no" is given zero points. HHIE scores range
from zero to 100. A change of nine scores indicates improvement in the quality
of life. The questionnaire was completed before a hearing aid was prescribed and
also three months after using the hearing aid and the scores were compared
(HHIE Questionnaire, Page 368).
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The Hearing Handicap
Inventory for the Elderly (HHIE) questionnaire
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Instruction:
The purpose of
this scale is to identify the problems your hearing loss may be causing you.
Answer YES, SOMETIMES, or NO for each question. Do not skip a question if you
avoid a situation because of your hearing problem. If you use a hearing aid,
please answer the way you hear without the aid.
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Yes
(4)
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Some- times (2)
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No
(0)
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S-1
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Does a hearing problem cause you to use the
phone less often than you would like?
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E-2
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Does a hearing problem cause you to feel
embarrassed when meeting new people?
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S-3
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Does a hearing problem cause you to avoid
groups of people?
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E-4
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Does a hearing problem make you irritable?
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E-5
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Does a hearing problem cause you to feel
frustrated when talking to members of your family?
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S-6
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Does a hearing problem cause you difficulty
when attending a party?
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E-7
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Does a hearing problem cause you to feel
"stupid" or "dumb"?
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S-8
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Do you have difficulty hearing when someone
speaks in a whisper?
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E- 9
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Do you feel handicapped by a hearing
problem?
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S-10
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Does a hearing problem cause you difficulty
when visiting friends, relatives, or neighbors?
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S-11
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Does a hearing problem cause you to attend
religious services less often than you would like?
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E-12
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Does a hearing problem cause you to be
nervous?
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S-13
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Does a hearing problem cause you to visit
friends, relatives, or neighbors less often than you would like?
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E-14
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Does a hearing problem cause you to have
arguments with family members?
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S-15
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Does a hearing problem cause you difficulty
when listening to TV or radio?
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S-16
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Does a hearing problem cause you to go
shopping less often than you would like?
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E-17
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Does any problem or difficulty with your
hearing upset you at all?
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E-18
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Does a hearing problem cause you to want to
be by yourself?
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S-19
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Does a hearing problem cause you to talk to
family members less often than you would like?
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E-20
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Do you feel that any difficulty with your
hearing limits or hampers your personal or social life?
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S-21
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Does a hearing problem cause you difficulty
when in a restaurant with relatives or friends?
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E-22
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Does a hearing problem cause you to feel
depressed?
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S-23
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Does a hearing problem cause you to listen
to TV or radio less often than you would like?
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E-24
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Does a hearing problem cause you to feel
uncomfortable when talking to friends?
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E-25
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Does a hearing problem cause you to feel
left out when you are with a group of people?
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FOR CLINICIAN'S USE ONLY: Total score?
Subtotal
E:
....
Subtotal
S:
Reprinted by permission
from Ventry L, Weinstein B. The Hearing Handicap Inventory for the Elderly: a
new tool. Ear Hear. 1982; 3: 128 134.
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Those who did not complete the informed consent or the
questionnaire were excluded from the research. After three months, the score of
each questionnaire and each item of it was compared with the prior scores and
categorized according to the severity of the hearing loss and the results were
then analyzed.
The mean and standard deviation of the frequency distributions
of answers were calculated using SPSS software. Statistical significance of
differences between the mean scores was tested with Man-Whitney U-test.
The Chi-square test was applied for comparing the
severity of hearing loss and the mean scores before and after using a hearing
aid.
Results
From 350 primary participants in our study, 207 (59%)
completed the questionnaires in two stages while 143
(41%) were excluded from study. One hundred and forty-seven (69.56%) were males
and 63 (30.43%) were females with a mean age of 73.01 years (SD=8.43). One
hundred and seventy- one (82.6%) had a sensorineural hearing loss, 24 had
(11.69%) a mixed, and 12 (5.8%) had a conductive hearing loss.
One hundred and ninety-six (95.55%) of them had a moderate
to severe (56 70dB) sensorineural hearing loss while nine (4.45%) had a profound
(71 90 dB) hearing loss.
The HHIE questionnaire scores before and after wearing
a hearing aid in males and females are listed in Table 1. The results showed
that the difference in the quality of life was statistically significant before
and three months after using a hearing aid in all subjects (P<0.000).
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Table 1. Mean score (of HHIE
questionnaire) before and after hearing aid use.
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HHIE score
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Mean score
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Before hearing aid use
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After hearing aid use
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Total
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(65.88±23.14)
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(22.1±28.13)
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Female
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(67.20 ±20.86)
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(27.00±29.70)
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Male
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(65.33±24.21)
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(21.00±29.37)
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Social question
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Total
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(35.41±11.25)
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(10.50±13.96)
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Female
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(36.50±12.19)
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(10.60±13.96)
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Male
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(34.95±10.95)
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(10.10±14.60)
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Emotional question
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Total
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(30.47±13.04)
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(11.50±14.95)
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Female
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(32.50±12.70)
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(11.90±14.23)
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Male
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(29.62 ±13.22)
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(9.80±14.50)
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The social, emotional, and total scores of the HHIE
questionnaire before and after using a hearing aid were compared between males
and females. The results in Table 2 show that there was no significant
difference between them (P>0.05).
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Table 2. Comparing social,
emotional, and total scores between males and females before and after use of
hearing aid.
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Variable
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Male
(mean±SD)
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Female
(mean±SD)
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Man-Whitney U-test
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P value
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Before use of hearing aid
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Social
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35.0±11.56
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36.25±10.23
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4369.5
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0.674
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Emotional
Total
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30.65±13.64
65.65±24.06
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30.16±11.34
66.41±20.45
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4307.5
4479.0
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0.564
0.886
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After use of hearing aid
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Social
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11.104±13.45
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9.61±10.46
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4478.5
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0.946
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Emotional
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11.694±14.23
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11.341±12.86
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4358.5
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0.674
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Total
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22.68±22.86
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20.603±22.35
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4298.0
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0.597
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The effect of the severity of the hearing loss before
and after using a hearing aid in social and emotional scores in Table 3 showed
that the severity of the hearing loss did not have any effects on social and
emotional scores (P>0.05).
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Table 3. Comparing social, emotional, and
total scores between hearing loss levels and after use of hearing aid.
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Hearing loss level
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Moderate
n=57
PAT
(55.1±4.95)
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Moderate to severe
n=87
PAT
(65.19±2.89)
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Severe
n=60
PAT
(73.56±6.56)
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Chi-square
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df
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P value
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Mean rank
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Before use of hearing aid
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Social
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91.71
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101
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141.93
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4.64
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2
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0.098
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Emotional
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93.28
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98.71
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116.76
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274.5
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2
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0.072
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Total
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92.72
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98.76
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117.22
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5.654
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2
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0.05
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After use of hearing aid
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Social
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100.86
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100.44
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105.33
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0.284
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2
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0.868
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Emotional
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108.37
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102.96
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96.26
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1.293
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2
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0.524
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Total
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103.66
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100.73
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102.25
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0.089
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2
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0.957
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PAT=pure tone audiometry;
df=degree of freedom.
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We obtained the average score of each question in all
participants before and after using a hearing aid. The maximum average (3.797)
before using a hearing aid belonged to the question S8 (Do you have difficulty
hearing when someone speaks in a whisper?) and the minimum average (2.183) belonged
to S13 (Does a hearing problem cause you to visit friends, relatives, or
neighbors less often than you would like?). After using a hearing aid, the
maximum difference between average scores (2.763) was seen in S15 (Does a
hearing problem cause you difficulty when listening to TV or radio?) and the minimum
difference (0.840) belonged to S13.
Question 21, (Does a hearing problem cause you
difficulty when in a restaurant with relatives or friends?), was excluded from
analysis because most of the participants (85%) did not answer this question.
Discussion
The effect of using a hearing aid in changing the quality
of life of the hearing-impaired elderly people has been investigated in many studies.
Theoretical consideration of communication and social
interaction is emphasized by Tesch-Romer 9 and Antonucci.10 The
effect of an appropriate hearing aid on communicative efficiency11
and quality of life12 is obvious and for this reason, hearing difficulty
may reduce communicative relationships and social and emotional interactions.
The impact of hearing loss on the quality of life has
been assessed by Dayana.13 Data analyses of this study as measured
by the SF-36 and activity of daily life (ADL) show a reduction in the quality
of life.
The satisfaction from using hearing aids in adults
investigated with reviewing many articles by a task force and the final report
says that hearing aids improve adults health-related quality of life.14
Magni et al.15 discussed that analog and
digital hearing aid users have different levels of satisfaction, but all of
them can benefit from a hearing aid.
Vuorialho et al. concluded that the total HHIE score
changed from 28.7 (before wearing a hearing aid) to 12.7 (six months after a hearing
aid was fitted).16 In our study, these scores were 65 before and 22
three months after using a hearing aid. In another study in Brazil, Veras and Mattos concluded that a hearing aid and hearing re-education could enhance
the quality of life of the elderly people.17
Hearing loss in the elderly can reduce ADL and quality
of life which were assessed and reported by Nishinaga et al.18
In our study, (Table 1), the social and emotional
scores of HHIE questionnaire changed in males and females before and after
using a hearing aid; however, the comparison between the scores of males and
females before and after using a hearing aid showed no significant difference (P>0.05).
In this study, the highest variation of average scores
after using a hearing aid was related to question 15 or listening to TV and radio.
This means that the participants had a better hearing after using a hearing aid
and could listen to radio or TV which could prevent them from feeling lonely.
The least variation was related to question 13.
Perhaps this is related to our Iranian culture i.e., our relationship is not
mainly affected by disabilities.
Question 21, about dining out, was also excluded
because our participants who referred to Tehran Welfare Organization almost always
ate their meals at home and for this reason did not answer that question.
Table 3 shows that the severity of the hearing loss had
no significant effects on communication and quality of life in males and
females and a hearing aid also had a similar effect on improving the quality of
life in both genders.
In conclusion, with respect to the beneficial effects
of hearing aids in presbycusis and due to the significant improvement in the quality
of life, hearing aids are recommended for this group of population.
Acknowledgment
We offer our thanks to all participants, and Dr. Mahdi
Rahgozar, Assistant Professor of Biostatistical Sciences, University of Social
Welfare and Rehabilitation Sciences, Tehran.
References
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Betlejewski
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Chang HP,
Chou P. Presbycusis among older Chinese people in Taipei, Taiwan: a
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Chen TH. Cost-effectiveness of hearing
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Harless EL,
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Mulrow CD,
Aguilar C, Endicott JE, Tuley MR, Velez R, Charlip WS, et al. Quality-of-life
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Dalton DS,
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Chisolm
TH, Johnson CE, Danhauer JL, Portz LJ, Abrams HB, Lesner S, et al. A systematic
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Magni C,
Freiberger F, Tonn K. Evaluation of satisfaction
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Veras RP,
Mattos LC. Audiology and aging: literature
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AIM
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