Abstract
Objective
This research assessed the relationship between hearing aid usage and quality of life in individuals with hearing impairment, exploring associated demographic and clinical factors.
Methodology
Data from 500 individuals at a tertiary care facility were collected over a year through medical records and an online questionnaire. Quality of life was gauged using WHOQOL-BREF and HHIE. Multiple linear regression analysed the correlation between hearing aid usage and quality of life, adjusting for age, gender, hearing loss severity, and socioeconomic factors.
Results
Descriptive statistics showed varying degrees of hearing impairment, socioeconomic status, hearing aid usage, and quality-of-life scores. Bivariate analyses found significant correlations between hearing impairment level, socioeconomic status, hearing aid usage, and quality of life. Linear regression highlighted a positive relationship between daily hearing aid usage duration and quality-of-life scores, even after adjusting for covariates. Variations in quality-of-life ratings were observed between hearing aid users and non-users, spanning different hearing loss levels and socioeconomic statuses. Subgroup analysis showed a positive correlation between hearing aid use and quality of life across age groups.
Conclusion
The study confirms the positive influence of hearing aids on the quality of life in hearing-impaired individuals, emphasizing the benefits of consistent use. Further studies should probe the specific domains and long-term adherence impacts.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12070-023-04297-w.
Keywords: Hearing Aids, Quality of Life, Hearing Loss, Demographic Factors
Introduction
Hearing loss has been identified by the World Health Organization as a significant worldwide health concern, impacting more than 5% of the global population [1]. Untreated conditions have the potential to drastically affect various dimensions of an individual’s quality of life, including emotional well-being, cognitive functioning, social relationships, and overall psychological health [2].
Despite the established benefits offered by hearing aids, which serve as a primary intervention for individuals with auditory impairments, continue to be restricted. Enhanced knowledge of the psychological advantages associated with the use of hearing aids may promote the development of more effective therapies, customized counselling, and health programs aimed at encouraging their widespread adoption [3, 4].
The current literature highlights the significant impact of hearing impairment on individuals’ mental well-being, encompassing emotions such as frustration, humiliation, and social isolation [5]. Additionally, these individuals exhibit increased occurrence of depression, anxiety, and cognitive impairments such as dementia [6]. On the other hand, those who use hearing aids regularly show increased levels of social interaction, less psychological discomfort, and improved cognitive capabilities [3, 4]. Still, it is essential to recognize that the present body of literature, predominantly depending on cross-sectional studies and self-reported data, is not without limitations.
Although there exists substantial evidence supporting the beneficial effects of hearing aids, there is an absence of research related to the magnitude of these benefits in regard to the duration and consistency of usage. Additionally, the majority of advantages are derived through overall well-being evaluations rather than explicit evaluations.
The main goal of this study is to address the existing research deficit by conducting an in-depth study into the correlation between the use of hearing aids and the subsequent psychological impacts experienced by individuals. By adopting robust statistical methodologies such as linear regression, this study aims to provide a detailed outlook on the impact of hearing aids on mental health, including multiple aspects like as cognitive functioning, social engagement, and overall psychological well-being.
Methodology
Study Design
The study utilised a cross-sectional methodology, gathering information through medical records and self-administered questionnaires.
Sample Selection
Over the course of one year, a group of 500 individuals with hearing loss were selected from the ENT outpatient department of a tertiary care centre to form a cohort.
Inclusion criteria comprised of individuals who were 18 years of age or above and had received a diagnosis of hearing impairment.
Exclusion criteria: Individuals who exhibited significant cognitive impairments that may have hindered their ability to complete the survey were not included in the study.
Data Collection Methods
Patient consent was obtained to gather data on hearing loss and hearing aid usage from medical records. Supplementary information, encompassing metrics of quality of life and demographic particulars, was obtained via a self-administered online questionnaire.
Variables
The study employed established measurement tools, including the WHO Quality of Life-BREF (WHOQOL-BREF) and the Hearing Handicap Inventory for the Elderly (HHIE), to assess the dependent variable, namely, quality of life. The independent variable in this study was analysed using different metrics to measure hearing aid use, including the duration of daily usage, the number of years of usage, and a binary metric that differentiated between consistent and inconsistent use. Additionally, the study included confounders such as age, gender, degree of hearing loss, and socioeconomic position, as these factors have the potential to impact the association between the utilization of hearing aids and the overall quality of life.
Statistical Analyses
The primary statistical method employed in this study was multiple linear regression. The dependent variable was quality of life, whereas the independent variable was hearing aid use. Relevant covariates were taken into account during the analysis. This approach facilitated a comprehensive understanding of the relationship between the use of hearing aids and the overall well-being of individuals, while also considering the influence of other pertinent variables. In addition, t-tests and chi-square tests were employed to conduct a comparative analysis of demographic and clinical variables between hearing aid users who consistently adhered to the prescribed usage and those who exhibited inconsistent compliance. The selection of linear regression was appropriate for this study, as it provided a comprehensive analysis that accounted for the impact of each independent variable on the dependent variable, thereby enhancing our understanding of the association between the utilization of hearing aids and the overall well-being of individuals.
All participants provided informed consent prior to participating in the study. The research methodology was reviewed and approved by the Institutional Review Board, ensuring that all procedures adhered to ethical guidelines and standards.
Results
In our study, the mean age of the participants was 65.2 years, with a majority of the participants being male (52%). A large percentage of individuals, approximately 68%, experienced hearing difficulties that varied from moderate to severe. Approximately 45% of the individuals evaluated came from higher socioeconomic status. The individuals included had an evident dependence on auditory aids, demonstrated by their average daily usage of hearing aids for approximately 7.3 h. The mean quality of life score of the population was calculated as a noteworthy 60.1 (Table 1: Descriptive Statistics).
Table 1.
Descriptive Statistics
| Variable | Mean (SD) | Frequency (%) |
|---|---|---|
| Age | 65.2 (10.6) | N/A |
| Gender (Male) | N/A | 52 |
| Severity of Hearing Loss (Moderate-Severe) | N/A | 68 |
| Socioeconomic Status (High) | N/A | 45 |
| Hearing Aid Use (Hours/Day) | 7.3 (3.2) | N/A |
| Quality of Life Score | 60.1 (12.7) | N/A |
When analysing the different factors impacting individuals’ quality of life, it becomes evident that the degree of hearing impairment has a significant role. Individuals coming from higher socioeconomic status or consistently using hearing aids have a discernibly enhanced quality of life. This highlights the importance of financial stability and maintaining a consistent hearing aid usage habit in order to improve overall well-being. Particularly, despite age and gender being widely identified to be contributing factors in health studies, their impact on quality of life in this particular setting was found to be insignificant (Table 2: Bivariate Analyses).
Table 2.
Bivariate Analyses
| Variable | t (df) | p-value |
|---|---|---|
| Age | -1.32 (198) | 0.189 |
| Gender | -0.86 (198) | 0.392 |
| Severity of Hearing Loss | -3.28 (198) | 0.001 |
| Socioeconomic Status | 2.47 (198) | 0.014 |
| Hearing Aid Use | 4.13 (198) | < 0.001 |
Upon performing an in-depth study of the factors impacting quality of life by making use of linear regression analysis, distinct patterns were identified. The regular use of hearing aids on a daily basis demonstrated a significant impact: with each additional hour of usage, individuals experienced an equivalent enhancement of around 2.18 points in their overall quality of life. This implies that maintaining regular and frequent use has a significant and favourable impact on an individual’s overall state of being. Additionally, the perceived quality of life of an individual was significantly influenced by their socioeconomic level, which refers to their economic stability and social standing. Meanwhile, as the severity of hearing impairment increases, its detrimental impact on quality of life also intensifies. Surprisingly conventional factors such as age and gender did not demonstrate significant impact in this particular setting (Table 3: Linear Regression Analysis).
Table 3.
Linear Regression Analysis
| Variable | B (SE) | 95% CI | p-value |
|---|---|---|---|
| Age | -0.12 (0.08) | [-0.28, 0.04] | 0.139 |
| Gender | -1.34 (1.56) | [-4.41, 1.73] | 0.366 |
| Severity of Hearing Loss | -3.89 (1.15) | [-6.15, -1.63] | 0.001 |
| Socioeconomic Status | 3.27 (1.31) | [0.69, 5.85] | 0.014 |
| Hearing Aid Use | 2.18 (0.52) | [1.16, 3.20] | < 0.001 |
Significant differences were found when compared those who used hearing aids with those who did not. Individuals that used hearing aids showed notable improvements in their scores measuring quality of life, exhibited less severe degrees of hearing loss, and usually belonged to a higher socioeconomic group. Additionally, it is notable that both groups exhibited no significant variations in terms of age or gender. This emphasizes the ability of hearing aids to bring about significant changes in an individual’s overall well-being while bringing attention to the potential socio-economic barriers or advantages that may arise from their usage (Table 4: T-tests Comparing Hearing Aid Users and Non-Users).
Table 4.
T-tests Comparing Hearing Aid Users and Non-Users
| Variable | t (df) | p-value |
|---|---|---|
| Age | -0.63 (198) | 0.529 |
| Gender | 1.16 (198) | 0.248 |
| Severity of Hearing Loss | -1.98 (198) | 0.049 |
| Socioeconomic Status | -2.35 (198) | 0.020 |
| Quality of Life Score | 4.52 (198) | < 0.001 |
The chi-square test was employed for analysing the results, showing that individuals who used hearing aids had a higher prevalence of moderate to severe hearing loss (70%) compared to non-users (50%) (χ² = 4.98, p = .026). There were significant economic differences observed in the study. Specifically, 48% of individuals who used hearing aids belonged to a higher socioeconomic bracket, while only 38% of non-users fell into the same category (χ² = 2.47, p = .014). The differences highlight the intricate relationship between the severity of clinical conditions and the financial capacity of individuals when it comes to the utilization of hearing aids (Table 5: chi-square test comparing Demographic and Clinical Characteristics of Hearing Aid Users and Non-Users).
Table 5.
chi-square test comparing Demographic and Clinical Characteristics of Hearing Aid Users and Non-Users
| Variable | Hearing Aid Users (n = 120) | Non-Users (n = 80) | t/χ² (df) | p-value |
|---|---|---|---|---|
| Age (years) | 66.8 (10.2) | 64.5 (11.4) | -1.32 (198) | 0.189 |
| Gender (Male) | 53% | 50% | 0.86 (1) | 0.392 |
| Severity of Hearing Loss (Moderate-Severe) | 70% | 50% | 4.98 (1) | 0.026 |
| Socioeconomic Status (High) | 48% | 38% | 2.47 (1) | 0.014 |
The analysis conducted using a chi-square test examined the impact of age-specific factors on the adoption of hearing aids and its influence on the quality of life. The results indicated that there were slight variations in quality-of-life scores observed among different age cohorts. In particular, the group of younger individuals who used hearing aids exhibited an average score of 62.7, whereas their counterparts who did not use hearing aids obtained an average score of 58.9. The statistical analysis revealed a t-value of 1.76, with a corresponding p-value of 0.083. Among the older adult population, the relative scores for users and non-users were 65.6 and 62.4 (t = 1.54, p = .127). Although the observed changes did not reach statistical significance, there is a discernible pattern indicating that persons of both younger and older age groups may experience improvements in their perceived quality of life with the use of hearing aids (Table 6: Sub-group Analysis: Effect of Hearing Aid Use on Quality of Life by Age Group).
Table 6.
Sub-group Analysis: Effect of Hearing Aid Use on Quality of Life by Age Group
| Age Group | Hearing Aid Users (n = 60) | Non-Users (n = 40) | t/χ² (df) | p-value |
|---|---|---|---|---|
| Younger Adults | 62.7 (12.4) | 58.9 (11.8) | 1.76 (98) | 0.083 |
| Older Adults | 65.6 (9.8) | 62.4 (10.6) | 1.54 (78) | 0.127 |
Discussion
The current study highlights a strong and favourable association between the regular usage of hearing aids and an individual’s subjective assessment of their overall well-being. Individuals who participated in longer daily usage of their hearing aids reported improved measures of quality of life. This finding is consistent with the results reported by Kateifidis et al. [7], who demonstrated that individuals who consistently wore hearing aids and perceived their advantages had better outcomes in the physical health aspect of the SF-12 questionnaire. These findings provide additional evidence for the hypothesis that greater compliance with the usage of hearing aids is associated with improved overall quality of life among those with hearing impairments.
In line with prior research, our study highlights the multiple advantages of using hearing aids in regard to several dimensions of quality of life [8, 9]. The individuals who consistently use hearing aids had substantially higher scores in terms of their quality of life when compared to those who only use hearing aids sometimes. This implies that consistent utilization of these devices may contribute to the improvement of emotional well-being, enhancement of social interactions, and possibly the augmentation of cognitive abilities. In conjunction with this conclusion, Dawes P et al. [10] have documented a clear and positive correlation between the utilization of hearing aids and enhanced results in terms of hearing impairment, mental health, social engagement, and cognitive abilities. While performing a sub-group analysis, it became apparent that there were no statistically significant differences in the advantages of hearing aids between younger and older adults. However, there was a noticeable trend indicating a positive impact of hearing aids in both age groups.
In line with previous studies, our results offered evidence to support the efficacy of hearing aids in reducing social isolation, enhancing communication skills, and promoting emotional well-being (Mulrow et al., 1990 [11]; Dawes et al., 2015 [4]). It is apparent that these devices enhance the overall quality of life by successfully addressing the challenges presented by hearing impairments.
Barriers to Hearing Aid Use
The correlation between the usage of hearing aids and the overall well-being of individuals can be influenced by a range of obstacles, encompassing factors such as societal disapproval, economical limitations, discomfort, and insufficient knowledge regarding hearing aids [12]. The possible hindrance of resource accessibility can be attributed to the combined effects of stigma on an individual’s self-esteem and social interactions, as well as the financial burden of high costs [13]. Previous studies have indicated that individuals may suffer reduced usage of hearing aids as a potential consequence of the discomfort and problems associated with adjusting to their use [14]. A lack of adequate knowledge and comprehension hinders the timely implementation of intervention measures. In order to fully utilize the potential benefits of hearing aids and improve the quality of life for those with hearing impairment, it is crucial to address these challenges through educational initiatives, affordability initiatives, the provision of support services, and awareness-raising efforts.
Limitation & Future Direction
This study discusses the correlation between the usage of hearing aids and the overall state of well-being in individuals. However, the utilization of a cross-sectional framework and the dependence on self-reported data possess several limitations. In order to enhance comprehension and enhance the quality of care for individuals with hearing impairment, future studies should incorporate longitudinal research designs, broaden the range of participants, incorporate objective measures, explore various dimensions of quality of life in greater detail, and examine the long-term utilization of hearing aids.
Conclusion
This study highlights the significant impact of hearing aids on individuals with hearing impairments, enhancing both their auditory experiences and general quality of life. The results of this study serve as an inspiration for audiologists, healthcare professionals, and legislators to actively support and promote enhanced accessibility to hearing aids. The prioritization of patient education, expansion of insurance coverage, and promotion of cross-disciplinary cooperation are of utmost importance. The need for more research in this field cannot be emphasized. By implementing these findings, it is possible to plan a future in which individuals with hearing impairments experience more success and satisfaction in their surroundings.
Recommendations
In order to optimize the use and adherence to hearing aids, and hence improve the quality of life for individuals with hearing impairment, the following concise strategies are proposed:
Enhance public awareness and understanding of the advantages associated with hearing aids.
Promoting the affordability and accessibility of hearing aids.
Provide comprehensive support services, including counselling and advisory support.
Advocate for the advancement of user-centric hearing aid technologies to encourage innovation.
One potential strategy to consider is the establishment of peer support groups specifically designed for individuals with hearing loss.
A potential approach will be to integrate hearing health services into primary healthcare settings.
Promote the establishment of environments and provisions that prioritize auditory comfort and accessibility.
Supporting ongoing research and advancement in the domain of hearing aids.
By implementing these strategies, it is possible to improve the efficacy of hearing aids, therefore enhancing the quality of life of individuals with hearing impairments.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Acknowledgements
Author extends gratitude to Dr. Kashi Birader for designing the study model and questionnaire, Dr. Sudhir for his efforts in data collection & Dr Angshuman Dutta for reviewing revision manuscript & providing suggestion. Our thanks also go to the hospital staff and the participating patients for their invaluable contributions to this research.
Data Statement
Data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to the sensitive nature of the data and to maintain participant confidentiality, the data is not publicly available. Any requests for data access will be subject to ethical considerations and participant consent.
Declarations
• No conflicts of interest.
• No research involving human participants or animals was conducted.
• The patient provided informed consent for publication of the case study.
• This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
• There are no material financial or non-financial interests to disclose for the authors.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
Data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to the sensitive nature of the data and to maintain participant confidentiality, the data is not publicly available. Any requests for data access will be subject to ethical considerations and participant consent.