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Abstract

Objectives:

This scoping review aims to summarize and synthesize research findings on the disparities between audiometrically diagnosed and aided hearing loss versus the individual’s own experience of hearing loss.

Methods:

A systematic search strategy was employed across multiple databases to identify studies published between 1990 and October 2023 focusing on the experiences of hearing problems among individuals with aided hearing loss. The selected studies underwent screening based on predetermined inclusion and exclusion criteria. These criteria revolved around including papers featuring a population of adult (+18) individuals with audiometrically measured hearing loss who had undergone technological rehabilitation. Data charting was employed to provide an overview of the studies and was additionally utilized to identify key themes. Narrative analysis was used to identify subthemes within the data set.

Results:

A total of 11 articles met the inclusion criteria. The analysis identified five themes: “disability experience and discrepancy between measured and self-perceived hearing loss”; “listening effort”; “mental burden/psychological consequences”; “factors that alleviate the consequences of HL”; and “sociodemographic factors.”

Conclusions:

The scoping review shows that, despite the proliferation of technological options, there is a pressing need for a more concentrated effort to identify and scrutinize the supplementary facets of hearing loss that remain inadequately addressed by current hearing technology. This includes subjective experiences associated with hearing loss that may not be effectively treated solely with hearing aids.

Keywords

hearing aids audiometry listening effort self-report disability quality of life narrative analysis

Introduction

Hearing loss (HL) is a prevalent sensory impairment that can significantly impact an individual’s communication and overall quality of life. HL is typically categorized into different grades based on severity, including slight, mild, moderately severe, severe, and profound HL. These categories are determined by the decibel (dB) level at which an individual’s hearing thresholds fall. Mild HL refers to difficulties in hearing softer sounds, typically within the range of 26–40 dB. Moderate HL involves further impairment, affecting the understanding of speech, particularly in noisy environments (41–55 dB). Severe HL (71–90 dB) results in significant difficulties in understanding speech without amplification, whereas profound HL (91+ dB) indicates a near-total or complete inability to hear sounds without significant amplification or assistive devices.¹ The diagnosis relies on an audiological definition of HL, and an individual is deemed to have hearing impairment when their hearing thresholds exceed 20 dB, as measured via pure-tone audiometry across the frequency range of 250–8000 Hz.² The majority of HL cases are irreversible, and rehabilitation is crucial to improve function, activity, participation, and ultimately offer a better quality of life for those affected by HL.² Rehabilitation methods can broadly be categorized into technological interventions, communication strategies, and auditory training.³

Technological interventions comprise hearing aids (HAs) and bone-anchored hearing aids. These devices amplify sounds and improve the perception of speech and environmental sounds. Cochlear implants (CIs) are surgical implants that directly stimulate the auditory nerve, bypassing the damaged or non-functioning parts of the inner ear. This helps individuals perceive sound signals and restore some level of hearing ability. Other technological interventions comprise assistive listening devices. These are devices (e.g., FM systems or captioning services) that enhance the clarity of speech under specific situations. The eligibility criteria for HAs versus CIs vary depending on factors such as the severity and type of HL.⁴ HAs are generally recommended for individuals with mild-to-severe HL who can benefit from amplification. These devices are designed to enhance sound perception and speech understanding by amplifying the incoming sounds. Conversely, CIs are considered for individuals with severe-to-profound HL who do not experience significant benefit from HAs alone. However, criteria for CI selection exhibit substantial variation at the international level.⁵

Communication strategies are comprised of lip reading. This is a skill that involves interpreting speech by watching the movements of the lips and facial expressions and is an extension to auditory-only (A), visual-only (V), and audiovisual (AV) speech recognition.^6,7 Another strategy to improve communication is sign language; a visual-gestural language typically used by the deaf community for communication.⁸ Speechreading and communication training are programs also designed to improve communication skills in challenging listening environments.

Finally, auditory training involves exercises and activities to enhance the brain’s ability to process auditory information, improving speech perception and understanding.⁹

Objective outcome measures for rehabilitation efficacy include aided audiological tests such as pure-tone audiometry and speech audiometry conducted with the use of HAs or CIs. Furthermore, electrophysiological tests such as auditory brainstem response or otoacoustic emissions are used to assess the functioning of the auditory system.¹⁰

When it comes to subjective measures, a frequently used method is self-reported assessments. Based on questionnaires or surveys, the idea is to capture the individual’s perception of their hearing abilities, communication challenges, and the impact of rehabilitation. One example of this is the “Hearing Disability and Handicap Scale” (HDHS).¹¹ Furthermore, quality of life measures are often used. These are assessments that consider the broader impact of HL and rehabilitation on an individual’s overall well-being.^12,13

When the need for rehabilitation is determined and remedial interventions are recommended, the audiological measurement and the nature of the hearing problem are often regarded as equal.¹⁴ The argument is that a person withsevere HL has a more significant hearing problem than someone with a mild HL. However, this functional definition of HL may conceal other understandings of when HL becomes a problem that requires further rehabilitation. Discrepancies between aided tests and self-report assessments in the context of HL rehabilitation outcomes can be attributed to a variety of factors, reflecting the complexity of the hearing experience and the limitations of current assessment methodologies.¹⁵ Key factors contributing to these discrepancies relate to the subjective nature of self-report assessments. For example, studies have shown that individuals’ subjective experiences and perceptions are influenced by factors such as cognitive skills, emotional states, and personal expectations.^3,16

Contextual factors are also an issue. Aided tests often take place in controlled and quiet environments, whereas individuals experience real-world listening challenges in various acoustically complex situations.¹⁷ A discrepancy may therefore arise from the mismatch between the controlled conditions of the tests and the dynamic nature of everyday communication. It is established that self-perceived hearing disability has little correlation with measurable hearing thresholds.^11,18–21 HL is often accompanied by other issues, such as tinnitus (ringing in the ears without an apparent external cause) and hyperacusis (sound hypersensitivity).²² This has led to a greater awareness that HL must be seen in a broader context and cannot be equated solely with audiologically measurable HL.

For instance, a common complaint among individuals with HL is fatigue associated with the higher levels of effort required to comprehend speech in everyday listening environments. Listening effort (LE), which refers to the cognitive resources needed to process an auditory message,^23–25 is reported to negatively impact occupational performance, causing more frequent instances of stress-related sick leave from work.²⁶ Further, HL and speech recognition both correlate with self-reported LE and fatigue.²³ The existence and prevalence of these HL-related challenges point to the argument that adults provided with hearing technology also require instructions, auditory training, and counseling to restore function, activity, participation, and quality of life.¹⁵

Shields et al.²⁵ concluded in their systematic review on measures of LE that all the included measures of LE are poorly correlated and suggested that it is more important to capture the consequences of LE rather than focusing on measuring LE directly. Their findings underscore the complexity of the listening process and implies that traditional approaches focusing solely on quantifying effort may not provide a comprehensive understanding of the impact on individuals. The issue at hand revolves around the fact that aided thresholds alone do not provide an accurate representation of the challenges patients continue to face. This discrepancy is attributed to the influence of various factors beyond hearing sensitivity alone.

The aim of this scoping review is (1) to identify knowledge and gaps in the current literature regarding the disparities between severity in audiometrically diagnosed and aided HL versus the individual’s own experience of severity in aided HL and (2) to examine why some people experience challenges despite accurate diagnosis and rehabilitation.

Methods

Literature search

A scoping review (No review protocol exists for this study.) was conducted by searching five databases (PubMed, Scopus, Ovid, PsycInfo, and Web of Science), using the methodology proposed by Arksey and O’Malley.²⁷ In addition to the databases, the authors conducted a manual search of references in pertinent studies. Relevant studies were initially pinpointed in a literature search, followed by screening of titles and abstracts, as well as full-text screening. The closing search took place on August 1, 2023 (see flow diagram shown in Figure 1). Table 1 shows the terms used in the search, and the full search profile can be found in Supplemental material Appendix A. Equivalent codes to PubMed’s Mesh terms were used for the other databases. The PICO framework (Population, Intervention, Comparison, and Outcome), as introduced by Richardson et al.,²⁸ served as the inspiration for constructing the search profile. Breaking down the research question into these four components proved instrumental in facilitating the identification of pertinent information. Studies considered eligible for consideration had to be published after 1990 for relevancy and be written in English or a Nordic language for accessibility.

Figure 1.

Flow diagram with results of the literature review.

Table 1.

Key search words.

Keywords	Synonyms
Adult	OR middle aged
Hearing loss	OR hard of hearing OR hearing handicap OR hearing disorder OR hearing impaired
Hearing aids	OR CIs OR bone-anchored hearing implants
Audiometry	OR diagnosis OR screening
Self-report	OR self-evaluation OR self-assessment OR subjective wellbeing
Emotions	OR strain OR stress OR fatigue OR anxiety OR depression
Discrepancy	OR difference OR variation OR deviation OR comparison

A total of 1060 articles were identified (PubMed 211 articles, Scopus 669 articles, Ovid 54 articles, PsycInfo 136 articles, and Web of Science 273 articles) (Figure 1, flow chart). All results were exported to the reference manager Endnote and then exported to the review tool, Covidence. After the removal of duplicates, 1045 articles were screened for inclusion based on defined inclusion and exclusion criteria (see below) at the title-abstract level, followed by full-text screening.

Screening process

Drawing from Arksey and O’Malley’s framework for scoping studies, the screening process aligns closely with that of systematic reviews, entailing the establishment and application of inclusion and exclusion criteria²⁷ (p. 14). However, the scoping study’s screening process allows for a dynamic refinement of these criteria, evolving in tandem with an enhanced understanding of the material.²⁷ Adhering to this framework, the definitive inclusion criteria (see below) and exclusion criteria (see Table 2) emerged progressively during the screening process. Consequently, the authors subjected all the full-text screening articles to these final criteria, culminating in the determination of articles to include.

Table 2.

Exclusion criteria.

Wrong study design	Published before 1990 (to ensure the relevance of the hearing amplification)
Wrong study design	A review or meta-analysis
Wrong publication type	Other language than English or Nordic
Wrong setting	Empirical data or analytical points only relevant to a specific setting (non-transferrable).
Wrong patient population	Did not involve a population of 18+ patients
Wrong patient population	Did not involve a population of patients with diagnosed, and treated HL, with conclusions pertinent to this population.
Wrong outcomes	Did not deal with discrepancy between audiometrically measured and treated HL and subjective experience of HL, or with difficulties arising from a treated HL.

To mitigate selection bias, data charting and screening was conducted in duplicate. Two authors independently assessed the outcomes from each database to ascertain articles meeting the inclusion criteria. Any discrepancy was discussed with a third reviewer and was resolved by the majority opinion.

Inclusion criteria:

• Published from 1990 onwards. This restriction was imposed to ensure that all articles reflected current rehabilitation provision.

• Research articles, not reviews.

• Peer-reviewed journal articles.

• Target population aged 18 years or older with diagnosed and aided HL.

• The intervention centered on the self-reported experience of aided HL, with comparison against audiometric tests or screenings.

• The outcome focused on the discrepancy between audiometrically diagnosed and aided HL and patients’ experiential accounts.

Exclusion criteria: See table 2

Data charting

The authors undertook data charting based on the framework and conception of data charting put forth by Arksey and O’Malley²⁷ (p. 15). Data charting involves the extraction of comparable data from articles. This approach is advantageous in categorizing articles under key themes, facilitating the synthesis and interpretation of the data²⁷ (pp. 15–16). All authors participated in this process.

The subsequent details were recorded, where feasible, from the included studies (see Table 3 in Results):

Table 3.

Overview of included articles.

Study	Country of study	Number of participants	Age of participants (years)	Degree of hearing loss	Study method	Outcomes
Alhanbali et al.²³	United Kingdom	50	55–85	Mixed	Questionnaire	People with HL experience higher levels of fatigue and LE
Andersson et al.³¹	Sweden	151	19–85	Unknown (Likely mixed)	Questionnaire	The presence of tinnitus increases experienced hearing handicap
Bigelow et al.³⁹	United States	25665	18+	Mixed	Questionnaire answered via interview	People with HL have a greater risk of developing moderate and serious psychological distress
Christensen and Gupta⁴⁰	Denmark	2407	50–64	Mixed	Questionnaire and interviews	HL gives a higher likelihood of an early exit from the workforce
Dunn et al.¹⁷	United States	48	27–78	Mixed	Ecological Momentary Assessment (EMA) and retrospective questionnaires	Auditory ecology has a strong influence on the well-being of people with HL
Gopinath et al.³²	Australia	829	55+	Mixed	Data extraction from the Blue Mountains study (audiometry test, SF-36)	Lower quality of life among people with HL, who experience having a hearing handicap. This was improved by the use of HA
Kim et al.³³	Korea	19642	20–97	Mixed	Questionnaire and audiometry test	Discrepancy between audiometrically measured and experienced HL for approx. 20% of the study population
Manchaiah et al.³⁴	United Kingdom	32	48–90	Mixed	Qualitative workshop	Discrepancy between what audiologists focus on, and what people with HL focus on in HL rehabilitation
Tavanai et al.³⁵	Iran	114	55–85	Mixed	Questionnaires	Greater levels of experienced hearing handicap among people with HL who use HAs
Von Gablenz et al.³⁶	Germany	24	50–75	Mild to moderate	EMA	HA improves speech comprehension and LEs, but people with HA still experience difficulties in loud environments
Wang et al.³⁷	China	80	30–69	Mixed	Audiometry test and questionnaire	Discrepancy between audiometric measures of HL, and the individual’s own experience of the HL

• Author, year of publication, country of study

• Population characteristics and/or participant details (sociodemographic variables, degree, and type of HL)

• Study methodology (questionnaire, interview, etc.)

• Key findings encompassing the experiences of individuals with HL, specifically addressing: (1) discrepancies between audiometrically diagnosed and aided HL versus the individual’s own experience of HL and/or (2) factors contributing to challenges experienced despite diagnosis and rehabilitation, encompassing the nature of these challenges.

The data presented in Table 3 provides an overview of issues found in the selected articles.

Narrative synthesis

Due to the variety of themes, research designs, and data outcomes in the selected articles, the conceptual framework of a narrative synthesis was chosen. The three stages outlined by Popay et al.²⁹ and Leamy et al.³⁰ were used:

Developing a preliminary synthesis

Comparing themes within and between studies

Thematic classification.

To identify the themes present in the selected articles, the authors started with initial observations of potential themes that arose during the readings, as well as by reviewing the data chart to find common themes. The authors thoroughly reviewed each article to establish the themes. During this, additional themes emerged, and one of the previous themes was eliminated. Finally, some of the themes were merged to create overarching categories.

Results

This review is comprised of 11 articles (see Figure 1). An overview of the included articles can be found in Table 3. Employing narrative synthesis, five overarching categories have been discerned, and they will be explored here: (1) Disability experience and discrepancy between measured and self-perceived HL; (2) LE; (3) Mental burden/psychological consequences; (4) Factors that alleviate the consequences of HL; and (5) Sociodemographic factors.

Disability experience and discrepancy between measured and self-perceived HL

This category encompasses the experienced discrepancy between audiometrically measured and self-perceived aided HL, alongside the concept of disability experience. Disability experience refers to the individual’s experience of HL disability, as opposed to what can be measured audiometrically. Despite differences in terminology, the authors view disability experience and self-perceived aided HL as part of the same area of interest, as both terms denote a self-assessment of a functional impairment. Seven articles provide insights in this category.^31–37

Four of the studies found that although participants have been treated with HAs or CIs, they still experience significant hearing problems,^31,35–37 Von Gablenz et al.³⁶ conducted an EMA among 20 patients fitted with a HA. EMA is defined as “monitoring or sampling strategies to assess phenomena at the moment they occur in natural settings, thus maximizing ecological validity while avoiding retrospective recall”³⁸ (p. 3). Von Gablenz et al.³⁶ found patients, despite the HA, experience varying degrees of hearing disability across the full range of daily listening tasks. Wang et al.³⁷ conducted a clinical study measuring patients’ pure tone average threshold and word recognition score in both unaided and aided conditions. Their findings indicated the use of a HA did not significantly enhance patients’ word and speech recognition. The study concluded that correlations between objective audiologic tests, acoustic gain, and subjective patient-reported outcomes were weak or nonexistent³⁷ (pp. 171–172). Tavanai et al.³⁵ conducted a comparison between individuals with HL who use HA and those who do not. Their study shows the HA user group experiences a more significant hearing handicap than those without HA.

Gopinath et al.³² investigated the impact of hearing problems on Quality of Life (QoL) among older adults. They concluded that self-perceived hearing handicap has a greater impact on QoL than audiometrically measured impairment, indicating that experiencing hearing problems can negatively impact QoL. However, they also found that using a HA for over 10 years can positively affect QoL³² (pp. 148, 150). Tavanai et al.³⁵ identified a positive correlation in their study cohort between the duration of HA usage and the intensity of self-perceived handicaps and communication challenges. This suggests that delaying referrals for HA fine-tuning and neglecting auditory rehabilitation can exacerbate handicaps and communication difficulties, even in the presence of HAs³⁵ (pp. 4, 8). In a qualitative study conducted by Manchaiah et al.,³⁴ 32 patients with HL were interviewed to identify aspects of their hearing rehabilitation process the professionals may not be aware of. The patients experienced difficulties despite the diagnosis and aid with HA. They felt they had to do a lot of self-evaluation³⁴ (p. 231). This suggests that there are problems only the patients themselves experience, which cannot be remedied by HA alone.

Listening effort

Three studies found that hearing-impaired adults report high levels of LE and fatigue in daily life.^17,23,36 This finding was consistent despite the utilization of different methods and populations.

Alhanbali et al.²³ examined whether there is a measurable difference between users of HA or CI, as well as people with single-sided deafness (SSD) and could not identify a difference in the level of effort required for different devices. Both HA and CI users experienced high levels of LE²³ (p. 47). This shows some of the limits of hearing technology and indicates that people with hearing impairments will still experience difficulty in hearing-related tasks in their everyday lives.

In contrast, a study by von Gablenz et al.³⁶ concluded that HA can make it easier for hearing-impaired people to listen and understand, significantly diminishing their experience of disability, although this effect varies across participants³⁶ (p. 16). While the von Gablenz et al. study provides evidence that HAs can have a substantial effect, Alhanbali et al. suggest that people with HL still must do more work to understand communication despite the use of HAs.

Dunn et al.¹⁷ investigated the effects of Covid-19 lockdown on people with hearing impairments. Participants reported that their listening environments were quieter, they had fewer social engagements, and they encountered fewer unknown listening environments. As a result, they experienced lower levels of LE, better speech understanding, and less activity limitation, social isolation, or anxiety due to HL¹⁷ (pp. 10, 11). These conclusions provide insights into the circumstances in which people with hearing impairments might experience higher levels of LE and difficulty understanding speech, such as in situations with background noises, unknown listening environments, and with more social engagements.

Mental burden/psychological consequences [of HL]

In a context where the functional perspective posits that the severity of objectively measured HL equates to the severity of hearing-related difficulties and challenges in individuals’ lives, the authors find it pertinent to incorporate the theme of mental burdens and psychological consequences associated with HL. This theme contributes to an enhanced understanding of how hearing loss, even when aided, can impact individuals and, consequently, influence their subjective perception of HL.

Five studies investigated the psychological consequences and mental burdens experienced by people with aided HL.^{17,23,31,39,35} Two studies investigated anxiety among people with aided HL.^17,31 Dunn et al.¹⁷ (p. 12) concluded that people with HL experienced less HL-related anxiety during the Covid-19 isolation period as they navigated in quieter and more controlled listening environments. This put forward the notion that HL-related anxiety is more prevalent in loud, unpredictable environments and when surrounded by more people. In their investigation of the relationship between HL and tinnitus distress, Andersson et al.³¹ (p. 318) concluded that individuals with HL who also experience tinnitus have a higher risk of experiencing symptoms of anxiety. Andersson et al.³¹ (p. 318) reported findings related to experiences of depression associated with HL. Additionally, Tavanai et al.³⁵ (p. 9) identified a correlation between the use of HAs and difficulties in communication, as well as an elevated risk of increased depression severity.

Two studies reported higher levels of distress among people with HL. Andersson et al.³¹ (p. 318) found approximately a quarter of their study population experienced moderate-to-severe tinnitus, which was significantly correlated with higher levels of distress. Bigelow et al.³⁹ (pp. 5–6), studying general psychological distress, reported that people with varying degrees of HL, “(. . .) had increased odds of both moderate psychological distress (. . .) and serious psychological distress.”

Alhanbali et al.²³ (p. 43) found extreme levels (Extreme levels were defined as scores above the 95th percentile of the control group²³ (p. 43).) of fatigue among 22% of all participants with HA, 10% of all participants with CI, and 22% of all participants with SSD. They concluded there was no significant difference in fatigue between the three groups, indicating that a significant proportion of people with aided HL still experience extreme fatigue.

Factors that mitigate perceived difficulties despite the use of HA

Six studies had a focus on factors that could alleviate consequences of HL.^{32–34,36,37,39} Bigelow et al.³⁹ (pp. 6–7) found that HA users had lower odds of moderate psychological distress compared to nonusers. Gopinath et al.³² (p. 148) showed HA use is associated with significant improvement in overall well-being compared to non-HA users. This is in line with the findings of Kim et al.,³³ (p. 10) as they concluded HA users exhibited significantly less overestimation of HL compared to non-HA users.

Manchaiah et al.³⁴ (p. 232) identified several aspects of hearing rehabilitation that were only visible from the patients’ experience and not noticed by professionals. This included work with self-evaluation and getting used to the HL and to the HA. The authors pointed out that if professionals explore patients’ perspective via the patient journey method, it can help patients to cope with their challenges.³⁴ (p. 233) Wang et al.³⁷ (p. 173) analyzed HA outcomes and found that both objective audiologic tests and subjective questionnaires were useful when conducting HA fitting.

Sociodemographic factors and HL experience

Four studies in our scoping review had a focus on sociodemographic variables, such as gender, work, or educational level in relation to aided HL.^33,35,39,40

In their study, Tavanai et al.³⁵ observed elevated rates of depression among older women with both HL and HAs, as compared to men. However, beyond this observation, they did not identify any other significant correlations related to age or gender³⁵ (p. 7).

Examining psychological distress among individuals with varying degrees of HL, Bigelow et al.³⁹ found individuals aged 65 or older with mild HL to experience lower levels of psychological distress compared to those younger than 65 years. Consequently, they concluded that age plays a role in the extent of psychological distress, even among those with mild HL³⁹ (p. 7).

While the three other studies focused primarily on factors that affect mental outcomes such as depression, overestimation, or distress, Christensen and Gupta⁴⁰ investigated the granting of disability benefits to adults with HL in Denmark and analyzed sociodemographic factors related to gender. They found objectively measured HL did not affect men’s likelihood of receiving disability benefits, while for women, it decreased their likelihood⁴⁰ (pp. 86, 87). However, the use of HAs, indicating a functional hearing problem, increased the likelihood of both men and women receiving disability benefits.⁴⁰ Moreover, women who disclosed their HL to their employers were more likely to have an early labor market exit⁴⁰ (p. 88).

Discussion

The synthesized results point to several topics of discussion. First, it is important to draw attention to the variety of difficulties a person with diagnosed and aided HL might experience. One of the problems highlighted by several of the selected articles is the experience of disability by people with HL in daily situations, particularly in social contexts, which can be quite debilitating. Several of the selected studies highlight the gravity and importance of mental challenges associated with HL, encompassing distress, anxiety, depression, fatigue, and heightened LE.

While a portion of the included studies advocate for the effectiveness of HAs, others concentrate on the patient’s experience and the persistent difficulties they endure despite hearing rehabilitation. This aligns with the discoveries of Lund et al.,⁴¹ who investigated the value propositions perceived by adults undergoing hearing rehabilitation with HAs. Among the twenty-one identified value propositions, the one considered most significant by HA users was: “To solve the hearing problem you have.”

Secondly, the selected studies point to some sociodemographic factors, such as gender, age, work, and education, which may influence how people experience difficulties and struggles related to aided HL in their daily lives. In their systematic review evaluating factors involved in access and the utilization of adult hearing healthcare, Barnett et al.⁴² found that utilization is primarily affected by factors such as self-efficacy, educational level, and engagement in the rehabilitation process. In this review, some of the studies show correlations between some sociodemographic factors and some difficulties, but no causal effect has been documented. The low number of studies found, and the focus the studies have, limit the ability to make steadfast conclusions. However, some of the tendencies that have been accounted for, in relation to sociodemographic factors, reveal differences in age and gender among people with diagnosed and treated HL. This area seems in other words under-researched. Given the search parameters, there seems to be very little research, which link demographic factors, life with a diagnosed and aided HL, with other conditions (such as tinnitus and/or hyperacusis), the use of other technological interventions, knowledge of communicative strategies, and auditory training.

A third point of discussion is the issue of perspective. As shown by Manchaiah et al.³⁴ in particular, patients with HL and HA have experiences and reflections about the difficulties which come with a HL that differ from the hearing healthcare professionals. Some challenging aspects are not necessarily visible to professionals due to their perspective and focus. Other aspects are not accessible, as some experiences of difficulties happen away from the context of the clinic, such as when individuals with HL engage in social activities with multiple conversational partners and poor listening environments. This means that the individual patient with HL can experience difficulties, which cannot be accounted for, or adjusted to, during clinical sessions with professionals. Both the patient perspective examined by Manchaiah et al.,³⁴ and the mental burdens examined in several articles in this review point to the existence of invisible work and invisible difficulties because of HL. These difficulties are experienced by people who have HL only and indicate a possible benefit by incorporating the patients’ perspective into the treatment process to improve rehabilitation.

The fourth and final point refers to the difficulty of finding and selecting articles for this review. While sorting articles, it became clear that one of the primary reasons for exclusion was population. Most articles did not concern themselves with determining whether its population had a diagnosed HL, much less an aided one. Sometimes, this was addressed as a potential pitfall, but often it was never presented in the study design. Thus, some otherwise relevant articles have been excluded as they draw conclusions about hearing aid usage based on the entire study, even though some of the participants in the study do not use HAs, for example, Alhanbali et al.⁴³ Furthermore, we have only been able to draw conclusions from the study by Kim et al.,³³ where they explicitly concluded on the parts of their study that relate to HA users. Most studies did not distinguish between populations with an aided HL or an unaided one, resulting in studies with a mixed population that could potentially affect the study results. This had the consequence of making it challenging to find relevant articles for this review.

In a broader context, the synthesized results of this review reveal several tendencies regarding the research in this area. Firstly, the search for relevant articles and the result of only 11 included articles have highlighted a surprising knowledge gap in this problem field as HL is a widespread issue within national populations, and a considerable number of public and private resources are allocated to it annually.^44,45 Therefore, the authors advocate for more knowledge in this field to improve rehabilitation and patient satisfaction. However, the review has identified some factors that can affect the experience of difficulties with HL, such as LE, fatigue, tinnitus, patient involvement, and listening environment. These factors should be the basis for actions to improve rehabilitation and more targeted research to understand their impact.

Finally, using narrative synthesis, this review has attempted to categorize some aspects of life with HL that can affect one’s experience of its severity, despite hearing rehabilitation. These categories have allowed the researchers to find interesting and relevant indications. However, since all the studies differ in terms of focus, method, design, and number of participants, it has been challenging to synthesize and create very specific categories. Therefore, the results presented here are more indicative than definitive.

Despite the indicative nature of the results, some recommendations can still be made based on the individual articles and the synthesis. One recommendation for improving rehabilitation is to involve patients in the process, for example by having individuals with HL maintain a logbook or respond to a questionnaire regarding when their HL is most pronounced before engaging in a conversation with a professional. This information could then be used to adjust or program the conversation accordingly. Two articles, Manchaiah et al.³⁴ and von Gablenz et al.,³⁶ which had a focus on patient involvement, indicated a need for patients to be involved in the process of receiving HA. Involving the patient in the rehabilitation process can provide professionals with insight into the common difficulties experienced outside the clinic, which could aid the fitting and counseling process going forward.

Another recommendation related to patient involvement is to pay attention to the significance of the listening environment. This is something that primarily affects patients, but it can also be measured technologically. As evidenced in Dunn et al.’s¹⁷ study of listening environments and mental burdens during the Covid-19 lockdown, people with HL experienced less HL-related distress in quieter and more structured listening environments. If people with HL experience more HL-related distress in louder listening environments, this should be recognized and addressed, especially in counseling with professionals.

A final recommendation, based on the included articles, is to increase the focus on the context of the workplace and the realities of working with HL. As Kim et al.³³ have shown, overestimation of one’s HL (i.e., experiencing a greater HL than what can be measured) is tied to working in the service industry. Additionally, Christensen and Gupta⁴⁰ have demonstrated that differences in gender and how one handles HL at the workplace can lead to an early work life exit due to disability. More research is needed in this area to gain insight into the factors that may induce inequality and experiences of difficulty with HL in the workplace.

The synthesized findings shed light on the following aspects that have implications for shaping health policies and organizational practices in order to enhance the support and services provided for individuals with HL:

Mental health support: Health policies should address the mental health challenges associated with HL, including distress, anxiety, and depression. Organizations should provide resources for counseling to support individuals with HL.

Equitable access to hearing healthcare: Policies should ensure that individuals with HL have equal access to hearing healthcare services. This includes access to HAs, CIs, and other necessary interventions regardless of sociodemographic factors such as gender, age, education, and work.

Incorporating the patient’s perspective: The patient’s perspective is crucial in understanding the challenges and experiences of HL. Health policies should encourage patient involvement in decision-making and treatment processes. Organizations should adopt patient-centered care models that prioritize the individual needs and preferences of patients and their relatives.

By addressing these key points, policymakers and organizations can work toward ensuring improved outcomes and better QoL for individuals with HL.

Conclusion

In conclusion, the benefits and effectiveness of hearing technology in addressing the quantifiable aspects of HL as assessed by audiometry are well established and there is a need to go beyond these quantifiable measures. As highlighted by several of the articles included in the scoping review, the scope of HL extends beyond what can be captured solely through audiometric measures. We have little knowledge of life with a diagnosed and aided HL, how demographic factors, other hearing issues as tinnitus or hyperacusis, use of other technological interventions, and communicative strategies affect the experience of HL and QoL. A more complete understanding of this should help give a more comprehensive basis for improving services for those who need it most. By expanding our knowledge in these areas, we can develop more holistic and effective approaches to support individuals with HL, ensuring their overall well-being, improved QoL, and improved communication experiences. This calls for further research, funding, and collaboration between healthcare professionals, researchers, and patient communities to bridge the existing knowledge gaps and provide comprehensive services for individuals dealing with HL.

Supplemental Material

sj-docx-1-smo-10.1177_20503121241279230 – Supplemental material for Disparities between objectively measured hearing loss and subjectively perceived aided hearing loss: A scoping review

Supplemental material, sj-docx-1-smo-10.1177_20503121241279230 for Disparities between objectively measured hearing loss and subjectively perceived aided hearing loss: A scoping review by Anette Lykke Hindhede, Natascha Sofie Soendergaard, Eva Juul Toldam and Niels-Henrik Møller Hansen in SAGE Open Medicine

Supplemental Material

sj-docx-2-smo-10.1177_20503121241279230 – Supplemental material for Disparities between objectively measured hearing loss and subjectively perceived aided hearing loss: A scoping review

Supplemental material, sj-docx-2-smo-10.1177_20503121241279230 for Disparities between objectively measured hearing loss and subjectively perceived aided hearing loss: A scoping review by Anette Lykke Hindhede, Natascha Sofie Soendergaard, Eva Juul Toldam and Niels-Henrik Møller Hansen in SAGE Open Medicine

Footnotes

Acknowledgements

None.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research received a grant from Jascha Foundation.

This project received partial funding from Jascha Fonden. The funding organization was not involved in the study design, data collection, analysis, and interpretation of the data; decision to submit the article for publication, or preparation, review, and approval.

Ethics and consent statement

The paper is a scoping review; thus, no individual patient information is included.

ORCID iDs

Anette Lykke Hindhede

Niels-Henrik Møller Hansen

Supplemental material

Supplemental material for this article is available online.

References

American Speech-Language-Hearing Association (ASHA), https://www.asha.org/public/hearing/degree-of-hearing-loss/ (accessed 7 August 2024).

World Health Organization (WHO). Report on hearing: executive summary. Geneva: World Health Organization, 2021.

Stropahl

Besser

Launer

Auditory training supports auditory rehabilitation: a state-of-the-art review. Ear Hear 2020; 41(4): 697–704.

Haumann

Hohmann

Meis

, et al. Indication criteria for cochlear implants and hearing aids: impact of audiological and non-audiological findings. Audiol Res 2012; 2(1): e12.

van der Straaten

TFK

Briaire

Vickers

, et al. Selection criteria for cochlear implantation in the United Kingdom and Flanders: toward a less restrictive standard. Ear Hear 2021; 42(1): 68–75.

Bernstein

Jordan

Auer

, et al. Lipreading: a review of its continuing importance for speech recognition with an acquired hearing loss and possibilities for effective training. Am J Audiol 2022; 31(2): 453–469.

Tye-Murray

Sommers

Spehar

Audiovisual integration and lipreading abilities of older adults with normal and impaired hearing. Ear Hear 2007; 28(5): 656–668.

Vermeerbergen

Past and current trends in sign language research. Language Commun 2006; 26(2): 168–192.

Percy-Smith

Tønning

Josvassen

, et al. Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants Int 2018; 19(1): 38–45.

10.

Bakhos

Marx

Villeneuve

, et al. Electrophysiological exploration of hearing. Eur Ann Otorhinolaryngol Head Neck Dis 2017, 134(5), 325–331.

11.

Helvik

A-S

Jacobsen

Hallberg

LRM

. Psychological well-being of adults with acquired hearing impairment. Disabil Rehabil 2006; 28(9): 535–545.

12.

Bess

FH.

The role of generic health-related quality of life measures in establishing audiological rehabilitation outcomes. Ear Hear 2000; 21(4 Suppl): 74S–79S.

13.

Punch

Hitt

Smith

SW.

Hearing loss and quality of life. J Commun Disord 2019; 78: 33–45.

14.

Tremblay

Pinto

Fischer

, et al. Self-reported hearing difficulties among adults with normal audiograms: the Beaver Dam Offspring Study. Ear Hear 2015; 36(6): e290.

15.

Boothroyd

Adult aural rehabilitation: what is it and does it work?

Trends Amplif 2007; 11(2): 63–71.

16.

Holman

Ali

YHK

Naylor

A qualitative investigation of the hearing and hearing-aid related emotional states experienced by adults with hearing loss. Int J Audiol 2023; 62(10): 973–982.

17.

Dunn

Stangl

Oleson

, et al. The influence of forced social isolation on the auditory ecology and psychosocial functions of listeners with cochlear implants during COVID-19 mitigation efforts. Ear Hear 2020; 42(1): 20.

18.

Bentler

Kramer

SE.

Guidelines for choosing a self-report outcome. Ear Hear 2000; 21: 37S–49S.

19.

Hindhede

AL.

Everyday trajectories of hearing correction. Health Sociol Rev 2010; 19(3): 382–394.

20.

Hindhede

AL.

Negotiating hearing disability and hearing disabled identities. Health (London) 2012; 16(2): 169–185.

21.

Hindhede

AL.

Situations of choice: configuring the empowered consumer of hearing technologies. Health Care Anal 2013; 23(3), 221–237.

22.

Hébert

Fournier

Noreña

The auditory sensitivity is increased in tinnitus ears. J Neurosci 2013; 33(6): 2356–2364.

23.

Alhanbali

Dawes

Lloyd

, et al. Self-reported listening-related effort and fatigue in hearing-impaired adults. Ear Hear 2017; 38(1): e39–e48.

24.

McGarrigle

Munro

Dawes

, et al. Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group “white paper”. Int J Audiol 2014; 53(7): 433–445.

25.

Shields

Sladen

Bruce

, et al. Exploring the correlations between measures of listening effort in adults and children: a systematic review with narrative synthesis. Trends Hear 2023; 27: 23312165221137116.

26.

Kramer

Kapteyn

Houtgast

Occupational performance: comparing normally-hearing and hearing-impaired employees using the Amsterdam Checklist for Hearing and Work: Desempeño laboral: Comparación de empleados con audición normal o alterada usando el Listado Amsterdam para Audición y Trabajo. Int J Audiol 2006; 45(9): 503–512.

27.

Arksey

O’Malley

Scoping studies: towards a methodological framework. Int J Social Res Methodol 2005; 8(1): 19–32.

28.

Richardson

Wilson

Nishikawa

, et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club 1995; 123(3): A12–A13.

29.

Popay

Roberts

Sowden

, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version 2006; 1(1): b92.

30.

Leamy

Bird

Le Boutillier

, et al. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Brit J Psychiatry 2011; 199(6): 445–452.

31.

Andersson

Freijd

Baguley

, et al. Tinnitus distress, anxiety, depression, and hearing problems among cochlear implant patients with tinnitus. J Am Acad Audiol 2009; 20(5): 315–319.

32.

Gopinath

Schneider

Hickson

, et al. Hearing handicap, rather than measured hearing impairment, predicts poorer quality of life over 10 years in older adults. Maturitas 2012; 72(2): 146–151.

33.

Kim

H-J

Kim

M-S

, et al. Discrepancy between self-assessed hearing status and measured audiometric evaluation. PLoS One 2017; 12(8): e0182718.

34.

Manchaiah

Stephens

Meredith

The patient journey of adults with hearing impairment: the patients’ views. Clin Otolaryngol 2011; 36(3): 227–234.

35.

Tavanai

Khalili

Shahidipour

, et al. Hearing handicaps, communication difficulties and depression in the older adults: a comparison of hearing aid users and non-users. Eur Arch Otorhinolaryngol 2023; 280(12): 5229–5240.

36.

von Gablenz

Kowalk

Bitzer

, et al. Individual hearing aid benefit in real life evaluated using ecological momentary assessment. Trends Hear 2021; 25: 2331216521990288.

37.

Wang

Zheng

, et al. Objective and subjective outcomes in patients with hearing aids: a cross-sectional, comparative, associational study. Audiol Neurotol 2022; 27(2): 166–174.

38.

Shiffman

Stone

Hufford

MR.

Ecological momentary assessment. Annu Rev Clin Psychol 2008; 4: 1–32.

39.

Bigelow

Reed

Brewster

, et al. Association of hearing loss with psychological distress and utilization of mental health services among adults in the United States. JAMA Network Open 2020; 3(7): e2010986–e2010986.

40.

Christensen

Gupta

ND.

Hearing loss and disability exit: measurement issues and coping strategies. Econ Hum Biol 2017; 24: 80–91.

41.

Lund

Ordoñez

Nielsen

, et al. Value propositions of public adult hearing rehabilitation in Denmark. Audiol Res 2023; 13(2): 254–270.

42.

Barnett

Hixon

Okwiri

, et al. Factors involved in access and utilization of adult hearing healthcare: a systematic review. Laryngoscope 2017; 127(5): 1187–1194.

43.

Alhanbali

Dawes

Lloyd

, et al. Hearing handicap and speech recognition correlate with self-reported listening effort and fatigue. Ear Hear 2018; 39(3): 470–474.

44.

Gordon

Abram . (2023). How much do hearing aids cost in 2023?. Forbes Health, https://www.forbes.com/health/hearing-aids/actual-cost-of-hearing-aids/#how_much_do_hearing_aids_cost_in_2023_section (accessed 16 December).

45.

Danish Health Authority (Sundhedsstyrelsen). 2021—Godkendelse af private leverandører af høreapparater. Sundhedsstyrelsen, 2022.

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