Optimizing work performance and engagement in adults with hearing loss: the role of hearing devices

Abstract

Hearing loss is a common but under-recognized condition among older adults, linked to fatigue, reduced productivity, social isolation, and early workforce exit. As developed countries face aging workforces, there is a critical need to understand how hearing device usage influences occupational outcomes. This study analyzed cross-sectional data from the Hearing Impairment in Adults: A Longitudinal Outcomes Study, involving 227 Australian adults aged 40 + using hearing aids, cochlear implants, or both (bimodal). We examined whether work functioning and performance differed between the three hearing device groups. After multivariate adjustment, total individual work performance scores were significantly higher (indicating a better outcome) among cochlear implant (2.26) and bimodal users (2.31) than hearing aid users (2.08, p < 0.05). Similarly, multivariate-adjusted mean total Utrecht Work Engagement Scale scores were significantly higher (better outcome) in cochlear implant (4.16) and bimodal users (4.50) than hearing aid users (3.97, p < 0.05). This novel study highlights that adult cochlear implant and bimodal users exhibit significantly better work performance and engagement compared to hearing aid users, ever after multivariate adjustment. These findings emphasize the importance of optimizing hearing care strategies, particularly in countries with rapidly aging workforces, to better support older adults’ occupational functioning and productivity.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-32530-9.

Introduction

Continued employment in midlife and later in life is associated with a range of benefits, including sustained income, social connection, and a sense of purpose—all of which are linked to better psychological and physical well-being¹. Employment in this life stage supports identity continuity, self-efficacy, and engagement with broader societal roles. It can act as a buffer against isolation, depression, and loss of agency, especially in the context of age-related health changes such as hearing impairment². Conversely, barriers to meaningful work, whether structural such as accessibility or employer attitudes or personal such as fatigue or stigma, may contribute to reduced wellbeing, early retirement and underutilization of experienced workers³.

In Australia, in the 20 years leading up to April 2021, the workforce participation rate of older Australians more than doubled (from 6.1% in 2001 to 15% in 2021)⁴. This trend reflects a global pattern, where the proportion of adults aged 55 and older in the global labor force increased from approximately 10.9% in 1995 to 16.3% by 2020⁵. Hence, it is integral to understand the work experiences and performance of older adults who live with chronic conditions, including hearing impairment.

Hearing impairment affects millions of working-age adults worldwide and poses significant, often overlooked challenges in the workplace, impacting not only communication but also job performance, engagement, and career progression. For example, studies have shown that employees with hearing impairment experience increased listening effort, communication barriers, and reduced job control, which can negatively impact work engagement and performance^6,7. Further, our prior population-based study found that the presence of moderate to severe hearing loss versus normal hearing, was associated with 96% greater odds of being retired⁸. Notably, workers with hearing loss may face greater psychosocial distress⁹ and workplace barriers due to a lack of awareness among colleagues and employers¹⁰.

Addressing the above challenges through timely diagnosis and the use of appropriate hearing devices is essential to ensuring workforce participation. However, few studies have examined whether hearing device usage such as hearing aids^11,12 or cochlear implants¹³ improve work engagement and performance in employees with hearing impairment. For example, Ruusuvuori et al. (2019) conducted a review on the stigma surrounding hearing impairment and hearing aid usage at work, highlighting that such stigma can deter individuals from seeking or consistently using hearing aids at working environments¹².

While prior research has examined hearing loss and employment barriers, limited studies explore how different hearing devices act as job resources to mitigate workplace challenges and enhance occupational engagement and performance. To guide this investigation, we draw on the job demands–resources (JD–R) model¹⁴, a widely used occupational health framework that explains how job demands, including workload, stressors and job resources, such as tools and social support, interact to shape employee well-being and performance. According to the JD–R model, job resources can buffer the negative effects of demand and promote engagement, motivation, and performance. In the context of hearing impairment, hearing devices may serve as compensatory resources, helping workers manage communication barriers, reduce listening effort, and improve their ability to participate effectively at work. Given the rising number of working-older age adults, it is critical to explore the roles of hearing device usage in mitigating occupational difficulties and enhancing workplace participation.

This study aims to compare work engagement and performance, conceptualized within the JD–R framework, among adults aged 40 years and older who use hearing aids, cochlear implants, or bimodal devices, while adjusting for a range of demographic characteristics, hearing function, and health-related quality of life predictors. Given that older workers are more likely to experience both hearing loss and its work-related consequences^15,16, the role of hearing devices as occupational enablers is particularly critical in aging workforces. However, research directly comparing the occupational experiences of different hearing device users remains scarce. Identifying whether certain devices more effectively support work engagement and performance is essential for understanding how specific job resources can promote sustainable employment and well-being among older adults.

Methods

Design

The Hearing Impairment in Adults: A Longitudinal Outcomes Study (HALOS) is an ongoing prospective, longitudinal cohort study designed to assess the influence of hearing device usage on a comprehensive range of health and social outcome measures. The methodology for this study has been published¹⁷. Briefly, this study presents cross-sectional analysis of baseline data from HALOS, specifically focusing on observed differences in individual work performance and work engagement outcomes among the three hearing device user groups. The study was approved by the Macquarie University Human Research Ethics Committee (ID: 11262) and Southern Adelaide Local Health Network (ID: LNR/22/SAC/88). All methods were carried out in accordance with relevant guidelines and regulations.

Participant recruitment

Inclusion criteria were adults aged 40 years and over who were currently using either a cochlear implant, hearing aid, or both (bimodal), and with English proficiency. Exclusion criteria were individuals with cognitive impairment or untreated hearing loss. To be included in the present analysis, participants needed to be engaged in paid or voluntary work at the time of the survey and to have completed the relevant sections on work function. Recruitment was conducted through flyers distributed by hearing service providers across the country and social media (e.g., Facebook). Interested individuals contacted the research team by phone or email to express their interest in participating in the study.

Data collection

Participants self-completed an online survey via Research Electronic Data Capture (REDCap) or a paper-based survey via post or email within a two-week period. Participants took 60–75 min on average to complete the survey. Written informed consent was obtained from all participants prior to survey commencement.

Study factors

Demographic data that was collected and included in the present study included age, sex, and education (e.g., tertiary or lower than tertiary level education). Hearing-related data that was considered included hearing device type (e.g., hearing aid, cochlear implant, bimodal), duration of device use (number of years), and average daily usage hours. Objectively measured hearing loss was determined from the most recent audiometric assessments (within the past two years), including air and bone conduction thresholds in both ears at octave frequencies at 0.25 to 8.0 kHz or four-frequency average hearing loss (4FAHL) data measured at 0.5, 1, 2 and 4 kHz. The data were accessed with authorized participant consent from their hearing service provider. Hearing functioning was evaluated using the Speech, Spatial, and Qualities of Hearing Scale¹⁸ (SSQ), a validated self-report measure designed to capture self-perceived hearing abilities such as speech understanding, spatial hearing, and qualities of hearing across everyday listening situations. Overall health status was measured using the Health Utilities Index Mark¹⁹ (HUI3), a widely used multi-attribute system that evaluates eight health dimensions, including hearing, vision, ambulation, dexterity, cognition, pain, emotion, and general well-being. Higher scores indicate better health-related quality of life.

Study outcomes

Work Engagement was measured using the Utrecht Work Engagement Scale²⁰ (UWES-9), a 9-item validated self-report instrument assessing three dimensions: vigor, dedication, and absorption. Participants rated items on a 7-point Likert scale ranging from 0 (never) to 6 (always), with higher total scores indicating greater overall work engagement. All nine items are summed and averaged to calculate a total score ranging from 0 to 6, with higher scores indicating greater work engagement. Subscale scores were calculated by averaging the relevant items: Vigor (items 1–3), Dedication (items 4–6), and Absorption (items 7–9) (See Appendix – UWES-9 questionnaire).

The Individual Work Performance Questionnaire²¹ (IWPQ) measured self-reported work functioning over the past three months. The IWPQ is an 18-item validated self-report instrument capturing three domains: task performance, contextual performance, and counterproductive behavior. Items are rated on a 5-point Likert scale (0, seldom to 4, always). Subscale scores were calculated as the mean of the items within each domain: Task Performance (items 1–5), Contextual Performance (items 6–13), and Counterproductive Work Behavior (items 14–18). Counterproductive work behavior scores were reversed before computing the total score. The total IWP score was calculated as the mean of the three domain scores, ranging from 0 to 4. Higher scores indicate stronger individual work performance across domains.

Statistical analysis

There are three groups (hearing aids, bimodal devices, and cochlear implants) in our study. General Linear Models (proc GLM, SAS 9.4) was used. GLM provided analysis of variance (ANOVA) and analysis of covariance (ANCOVA) for our study. To determine whether there is a significant difference between the mean outcome scores across these three groups, we used ANOVA for models without covariates (Table 1). This was done using the F-test. The same approach was used for ANCOVA.

Table 1.

Descriptive characteristics of study participants stratified by hearing device groups for individual work performance and work engagement scores. Data are presented as mean ± SD, ^a for significant p < 0.05. Abbreviations: HUI3, health utilities index mark 3; IWP, individual work Performance; UWES, Utrecht work engagement Scale; SSQ, Speech, Spatial and qualities of hearing Scale. For the IWP total score, the Eta-Squared is 0.038 (95%, confidence level: 0.002, 0.093), and for the UWES total score, the Eta-Squared is 0.037 (95%, confidence level: 0.001, 0.091).

Device user groups
Characteristic	HA (n = 107)	Bimodal (n = 43)	CI (n = 77)	Total (n = 227)	P value
Age (years), Mean (SD)	63.7 (10.1)	57.6 (10.4)	55.6 (10.1)	59.8 (10.8)	< 0.0001a
Females, n (%)	66 (29.1)	24 (10.6)	47 (20.7)	137 (60.4)	0.7928
Tertiary education, n (%)	93 (41.0)	35 (15.4)	73 (32.2)	201 (88.5)	0.0664
SSQ, Mean (SD)	4.5 (1.8)	3.8 (1.6)	4.6 (2.1)	4.4 (1.9)	0.0692
HUI-3, Mean (SD)	0.62 (0.22)	0.61 (0.21)	0.69 (0.17)	0.64 (0.21)	0.0302a
IWP Task Performance Score Mean (SD)	3.0 (0.9)	3.2 (0.8)	3.1 (0.8)	3.1 (0.8)	0.1563
IWP Context Performance Score Mean (SD)	2.3 (1.0)	2.6 (1.0)	2.7 (0.9)	2.5 (1.0)	0.0228a
IWP Counter Behaviour Score Mean (SD)	1.0 (0.7)	1.0 (0.6)	1.0 (0.7)	1.0 (0.7)	0.8158
IWP Total Score Mean (SD)	2.1 (0.5)	2.3 (0.5)	2.3 (0.5)	2.2 (0.5)	0.010.2 30a
UWES Vigor Score Mean (SD)	3.7 (1.5)	4.3 (1.4)	4.2 (1.4)	4.0 (1.5)	0.0171a
UWES Dedication Score Mean (SD)	4.5 (1.3)	4.9 (1.0)	4.7 (1.3)	4.7 (1.2)	0.1932
UWES Absorption Score Mean (SD)	5.8 (1.6)	6.4 (1.4)	6.2 (1.2)	6.0 (1.5)	0.0141
UWES Total Score Mean (SD)	4.1 (1.3)	4.6 (1.0)	4.5 (1.0)	4.3 (1.2)	0.0147a

Analysis of covariance (ANCOVA) were used to examine associations between hearing device type (hearing aids, cochlear implants, bimodal devices) and the primary outcome of work engagement (UWES-9 total and subscale score) and individual work performance (IWPQ total and subscale scores). Covariates included age, sex, education, number of years of device use, SSQ, and HUI3. Objectively measured hearing loss was not a significant covariate in the multivariate models and therefore was not adjusted for in the final analysis. Least squares means were calculated to compare adjusted group means, and post hoc pairwise comparisons were conducted with p values presented. To estimate effect size across the three hearing device groups, Eta-Squared (ANOVA) and Partial Eta-Squared (ANCOVA) were used. According to Cohen’s (1988) definition, effect sizes are categorized as small (η² = 0.01), medium (η² = 0.06), and large (η² = 0.14). Statistical significance was set at p < 0.05. All analyses were performed using SAS Version 9.

Results

Participant characteristics

A total of 227 participants with complete data on work performance and engagement were included in the analysis: 107 hearing aid users, 43 bimodal device users, and 77 cochlear implant users. Both the hearing aid and cochlear implant groups included unilateral and bilateral device users. A flowchart of participant inclusion is presented in Fig. 1. The mean age was 59.8 years (SD = 10.8), and 60.4% were female. Most participants (88.5%) reported receiving tertiary education. Table 1 presents the demographic, hearing, and psychosocial characteristics of the sample stratified by device group.

Fig. 1.

Flowchart of participant recruitment and inclusion.

Work engagement (UWES) scores

In age- and sex-adjusted analyses, cochlear implant and bimodal devices users had significantly higher adjusted-mean total UWES work engagement scores compared to hearing aid users (4.54 and 4.68 vs. 4.03; p = 0.004 and p = 0.002, respectively; Table 2). No significant differences were observed between cochlear implants and bimodal users.

Table 2.

Comparison of adjusted mean Utrecht work engagement (UWES) scores among hearing device users (n = 227). Model 1 includes adjusted mean total scores for age and sex. Model 2 includes further adjusted mean total scores for education, device usage period, HUI3 and SSQ. N.S. Signifies not significant p value and ^a indicates significant p values presented when compared to hearing aid users.

Device user groups
Adjusted mean total scores (standard error)	Hearing aid	Cochlear implant	Bimodal	Effect size (confidence level)
Total
Model 1	4.03 (0.11)	4.54 (0.13)	4.68 (0.17)	0.038 (0.002, 0.092)
p valuea		0.004	0.002
Model 2	3.97 (0.11)	4.16 (0.15)	4.50 (0.19)	0.047 (0.004, 0.103)
p valuea		N.S.	0.010
Vigor subscale
Model 1	3.58 (0.14)	4.25 (0.17)	4.34 (0.22)	0.036 (0.001, 0.090)
p valuea		0.004	0.005
Model 2	3.51 (0.13)	3.70 (0.18)	4.06 (0.23)	0.049 (0.005, 0.106)
p valuea		N.S.	0.032
Dedication subscale
Model 1	4.45 (0.12)	4.78 (0.14)	4.96 (0.19)	0.015 (0.000, 0.054)
p valuea		N.S.	0.024
Model 2	4.40 (0.13)	4.49 (0.17)	4.85 (0.22)	0.016 (0.000, 0.0560)
p valuea		N.S.	N.S.
Absorption subscale
Model 1	5.68 (0.14)	6.31 (0.17)	6.49 (0.22)	0.038 (0.002, 0.0930)
p valuea		0.006	0.003
Model 2	5.61 (0.15)	5.96 (0.20)	6.36 (0.25)	0.043(0.003, 0.0980)
p valuea		N.S.	0.007

After further adjustment for education, device usage period, HUI3 and SSQ, bimodal users continued to show significantly higher UWES scores compared to hearing aid users (4.68 vs. 4.16; p = 0.01). No significant differences were observed between cochlear implant and hearing aid users in this final model or after adjusting for all potential covariates.

Significant group differences were also observed for the vigor and dedication subscales. Specifically, after adjusting for age and sex, cochlear implant and bimodal users performed significantly better than hearing aid users, p = 0.004 and p = 0.005, respectively for vigor scores; and p = 0.0061 and p = 0.0027, respectively for dedication scores (Table 2). After multivariate adjustment, significant differences in these subscale scores still persisted between bimodal and hearing aid users (Table 2). No significant differences in dedication subscale scores were observed across the different device user groups.

Individual work performance (IWP) scores

After adjusting for age and sex, cochlear implant and bimodal users had significantly higher adjusted-mean total IWP scores compared to hearing aid users (2.28 and 2.26 vs. 2.04; p = 0.005 and p = 0.032, respectively; Table 3). In the final multivariate model, cochlear implant and bimodal users maintained significantly higher total IWP scores than hearing aid users (2.25 and 2.28 vs. 2.04; p = 0.02 and p = 0.03, respectively; Table 3).

Table 3.

Comparison of adjusted mean individual work performance (IWP) scores between hearing device users (n = 227). Model 1 includes adjusted mean total scores for age and sex. Model 2 includes further adjusted mean total scores for HUI3 and device usage period. N.S. signifies not significant p value and ^a indicates significant p value when compared to hearing aid users.

Adjusted mean scores (standard error)	Device user groups
	Hearing aid	Cochlear implant	Bimodal	Effect size (confidence level)
Total
Model 1	2.06 (0.05)	2.29 (0.06)	2.29 (0.08)	0.039 (0.002,0.093)
p value a		0.006	0.019
Model 2	2.08 (0.05)	2.26 (0.06)	2.31 (0.08)	0.041 (0.002,0.096)
p valuea		0.027	0.022
Task performance subscale
Model 1	2.92 (0.08)	3.19 (0.09)	3.28 (0.13)	0.017 (0.000,0.059)
p valuea		0.030	0.016
Model 2	2.96 (0.08)	3.14 (0.10)	3.25 (0.14)	0.018 (0.000,0.056)
p valuea		N.S.	0.043
Contextual performance subscale
Model 1	2.27 (0.10)	2.67 (0.12)	2.58 (0.15)	0.034 (0.000,0.086)
p valuea		0.006	N.S.
Model 2	2.30 (0.10)	2.58 (0.11)	2.61 (0.15)	0.036 (0.001,0.086)
p valuea		0.037	N.S.
Counterproductive behavior subscale
Model 1	1.01 (0.07)	1.00 (0.08)	1.00 (0.11)	0.002 (0.000,0.019)
p valuea		N.S.	N.S.
Model 2	1.02 (0.08)	1.10 (0.09)	1.06 (0.12)	0.002 (0.000,0.019)
p valuea		N.S.	N.S.

Significant group differences were also observed for the task performance subscale. Specifically, after adjusting for age and sex, cochlear implant and bimodal users performed significantly better than hearing aid users (3.17 and 3.26 vs. 2.86; p = 0.02 and p = 0.01, respectively). These differences remained in bimodal users after multivariate adjustment (Table 3). For the contextual performance subscale, cochlear implant users scored significantly higher than hearing aid users in the age-sex adjusted (p = 0.01) and multivariate-adjusted models (p = 0.04) (Table 3). No significant differences in counterproductive behavior subscale scores were observed across the different hearing device user groups.

Effect sizes

To assess clinical significance, effect sizes were calculated for total UWES and IWP scores. The effect size for IWP total score was 0.038, and for UWES total score was 0.037. According to Cohen (1988), these values represent small-to-medium effects, indicating meaningful clinical differences between device user groups.

Discussion

These results highlight the nuanced ways hearing devices can shape occupational outcomes, namely, we show that bimodal device users maintained significantly higher work engagement compared to hearing aid users, particularly regarding vigor and absorption in the workplace. Additionally, both cochlear implant and bimodal users reported significantly higher individual work performance, particularly in the task or contextual performance domains, compared to hearing aid users. In addition to statistically significant, small-to-moderate clinical differences were observed in work performance and engagement measures between the different groups of hearing device users. For IWP, this suggests that cochlear implants and bimodal users, on average, report slightly greater productivity, reliability, and fewer difficulties at work than hearing aid users, potentially encountering fewer barriers in daily job performance. For UWES, small mean differences indicate that cochlear implant and bimodal users feel slightly more energized, committed, and absorbed in their work than hearing aid users, suggesting that even modest improvements in engagement may foster sustained workforce participation.

While prior research has focused on the broader occupational impacts of hearing loss⁸, few studies have directly compared workplace engagement or performance between hearing device users. For example, Mutić and colleagues investigated work engagement among deaf and hard of hearing employees in Serbia, finding that higher perceived organizational support was associated with greater work engagement, as measured by the UWES and framed within JD–R model²². Similarly, the ongoing study by Philips et al. (2023) evaluated the effect of severe hearing loss and cochlear implantation on work productivity and social-wellbeing, highlighting the potential occupational benefits of cochlear implants²³. However, to our knowledge, this is the first study to directly compare work engagement and performance outcomes across these three hearing device groups, providing important new evidence on the occupational impacts of hearing rehabilitation.

Our findings extend prior work by demonstrating that hearing solutions, such as bimodal and cochlear implants, are associated not only with improved auditory function but also with significantly higher workplace engagement (particularly vigor and absorption), and higher task and contextual performance. The finding that bimodal hearing device users scored highest on the UWES, and that both bimodal and cochlear implant users outperformed hearing aid users on the IWP, highlights the broader occupational benefits of hearing solutions. These results suggest that beyond improving hearing thresholds, bimodal and cochlear implant devices may significantly enhance users’ psychosocial functioning in the workplace. High scores on the UWES among bimodal users imply they experience greater vigor and absorption in their work, factors strongly associated with increased job satisfaction, resilience, and reduced risk of burnout. Similarly, elevated IWP scores indicate these users are more productive, adaptable, and collaborative, contributing more effectively to team and organizational outcomes.

Conversely, hearing aid users scoring lower on both the UWES and the IWP scales suggests they may face hidden barriers to fully engaging and thriving in the workplace, despite having access to amplification. These lower scores point to potential struggles with communication, fatigue, and confidence that can undermine both productivity and emotional connection to work. The findings highlight a critical gap in support: hearing aids alone may not sufficiently address the complex challenges of workplace functioning.

One explanation may be that bimodal and cochlear implant users, who often engage in more intensive rehabilitation and receive structured support, are better equipped to navigate complex auditory environments typical of many workplaces. This may lead to increased communication ease, lower cognitive load, and greater confidence in professional settings. In contrast, hearing aid users may receive less comprehensive follow-up care or counseling, which could contribute to challenges in workplace communication and interpersonal dynamics. These findings present the importance of not only providing access to advanced hearing technologies but also ensuring that hearing healthcare for working-age adults incorporates occupationally relevant goals, personalized rehabilitation, and strategies to sustain engagement and performance at work.

The JDR framework offers a powerful and nuanced lens through which to interpret these findings. In this model, when job demands, such as sustained listening effort, frequent communication breakdowns, and the psychological toll of workplace exclusion, are not counterbalanced by adequate resources, workers are at heightened risk for disengagement, reduced productivity, and even premature withdrawal from the workforce (Fig. 2). For individuals with hearing loss, these demands are often invisible yet relentless, undermining both cognitive capacity and emotional resilience on a daily basis. Our findings indicate that cochlear implants and bimodal devices serve as more robust compensatory resources compared to hearing aids. These devices are typically accompanied by structured aural rehabilitation, communication training, and access to professional support networks, all of which amplify their effectiveness in mitigating hearing-related job demands. In contrast, users of standard hearing aids often lack access to these wraparound supports, limiting the devices’ potential to fully restore workplace function and engagement.

Fig. 2.

The Job Demands-Resources (JDR) for work engagement and performance among adults with hearing loss, adapted from Bakker and Demerouti (2018).

This differentiation is critical: it is not just the device itself, but the ecosystem of support surrounding its use that determines its effectiveness as a job resource. Cochlear implants and bimodal solutions appear to offer a more comprehensive response to the multifaceted demands of hearing loss in the workplace, facilitating better speech understanding, reducing listening fatigue, enhancing confidence, and supporting sustained participation in cognitively demanding work.

This study has notable strengths, including a large and diverse group of adult hearing device users across Australia and the use of validated instruments, such as the UWES-9 and IWPQ, to assess workplace engagement and performance; and analysis that accounted for a range of demographic, health, and hearing-related measures. However, there were limitations. First, our sample primarily reflects a Western, educated, industrialized, rich, and democratic (WEIRD) population, which are common in hearing health research, we recognize that this limits generalizability to other culturally and linguistically diverse populations. Second, our study uses self-reported outcomes which could introduce potential recall bias. Finally, while we adjusted for key covariates, residual confounding from unmeasured factors such as job type, workplace support, or environmental context cannot be ruled out.

Conclusion

This novel study shows that adult cochlear implant and bimodal hearing device users exhibit significantly better work performance and engagement compared to hearing aid users. These findings reinforce the value of viewing hearing healthcare not just through a clinical lens, but as a workplace intervention that enhances the resources employees need to thrive, supporting the JD–R model’s emphasis on resource optimization to maintain well-being and productivity. For example, device users may benefit from additional workplace-focused supports, including communication coaching, accommodations, and supervisor or coworker engagement, to bridge the performance and engagement gap identified.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

S.L., D.T., K.S., K.S., P.G., R.M., and B.G. conceived and designed the study. S.L., D.T., K.S., K.S., P.G., R.M., and B.G. developed the methodology. Formal analysis, validation and visualization were conducted by S.L., J.T., G.B., and B.G. Data were curated by J.T. The investigation was performed by S.L., J.T., D.T., S.C., and A.S.C. The original draft was written by S.L. and B.G. All authors contributed to reviewing and editing the manuscript. Funding was acquired by D.T., K.S., K.S., P.G., R.M., and B.G.

Funding

This research was funded by the Cochlear-Macquarie University Joint fund and Martin Lee Centre of Hearing Health Innovation. The funders had no role in the design, conduct or reporting of the study. Macquarie University, through the involvement of the author team, contributed to the study design, data collection, data analysis, interpretation, and preparation of the manuscript, as well as the decision to publish manuscript.

Data availability

Due to ethical restrictions regarding participant confidentiality, the dataset generated and analyzed during the current study is not publicly available. However, the study protocol and associated materials are publicly accessible¹⁷ and requests to access data can be made to the corresponding author. Please contact Shermin Lim at shermin.lim@mq.edu.au.

Declarations

Competing interests

The authors declare no competing interests.