NIHR DC Discover

NIHR Signal Hearing aids make communication easier for people with mild hearing loss

Published on 19 December 2017

doi: 10.3310/signal-000523

Hearing aids for people with mild-to-moderate hearing loss make communication easier and improve listening ability. Quality of life improved alongside the improvements in hearing. There were no reports of adverse effects for hearing aids.

Hearing loss can have a far-reaching impact on people’s mental and physical health, taking a toll on their quality of life. It can be simply viewed as a natural part of ageing, but this review highlights the positive impact that hearing aids can have on conversation and socialisation before people’s hearing loss becomes more severe. Despite hearing loss being common, it can take on average ten years to get appropriate treatment.

These findings suggest that raising public awareness of the value of hearing aids for mild-to-moderate hearing loss may encourage people to seek help earlier to maximise the benefit.

Commissioners could also consider these broader benefits in people with mild-to-moderate hearing loss when deciding on eligibility criteria.

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Why was this study needed?

In the UK over 11 million adults and 45,000 children are affected by hearing loss. Hearing loss can impact people’s ability and confidence to carry out everyday tasks, which can reduce their employment and education prospects. Communication difficulties caused by hearing loss can also leave people socially isolated as they struggle to listen and take part in conversations. This all means that hearing loss that is not identified and managed properly can have a negative impact on people’s quality of life.

Hearing loss is measured on a sliding scale using tests of the softest sounds that are audible. It is classified from mild to profound, the most severe. It can be difficult to notice gradual change, and often people seek help only when their hearing deteriorates beyond a mild loss.

Until now there has not been much high-quality evidence to test the assumption that hearing aids would help people with the wider impacts of hearing loss. This review looked at the improvements in emotional and social quality of life related to giving people with mild to moderate hearing loss hearing aids.

What did this study do?

This systematic review included five randomised controlled trials of a total of 825 people, average age 69 to 83. Trials were published after 1987 in the US and Europe. Most were after 2000 and included a range of newer analogue and digital hearing aids.

The included trials were mainly at low risk of bias. The three older trials either gave people hearing aids or they stayed on a waiting list for one. The visibility of hearing aids means that the people assessing outcomes and participants were aware of whether or not they had a hearing aid, which could introduce bias.

The two 2017 trials used hearing aids programmed to not transmit sound as a placebo to conceal this from participants and assessors.

A range of general and hearing specific quality of life scores was used to determine the presence of perceived emotional and situational hearing restrictions, such as whether a hearing problem led people to use the phone less often or feel embarrassed when meeting new people.

What did it find?

  • Wearing hearing aids for 6 to 16 weeks led to an average 26 point reduction on a 100 point scale measuring hearing-specific quality of life with lower scores indicating better quality (95% confidence interval [CI] ‑42 to ‑10; 722 participants, three studies).
  • Overall generic health-related quality of life was moderately improved by wearing hearing aids compared to none or a placebo (standard mean difference [SMD] ‑0.38, 95% CI ‑0.55 to ‑0.21; 568 participants, two studies).
  • Using hearing aids also greatly improved listening ability (SMD ‑1.88, 95% CI ‑3.24 to ‑0.52; 534 participants, two studies).
  • Only one study measured adverse effects and reported none.

What does current guidance say on this issue?

The key objectives of NHS England’s 2015 Action Plan on Hearing Loss are to improve prevention, early diagnosis and patient-centred care, prevent social isolation and improve people’s involvement in everyday activities.

NHS England’s 2016 commissioning framework for hearing services does not specify thresholds for referrals. Referral and management pathways can vary locally with different models of care emerging in a drive to develop more integrated services for out of hospital and community settings. Most assessments and hearing aid fittings are provided under an NHS standard contract. This recent framework provides key outcome indicators to support commissioners and includes the recommendation to include in contracts measurement of an individual’s disability and communication difficulties using validated tools.

NICE is currently developing a guideline on hearing loss. This is due to be published in May 2018.

What are the implications?

Although the finding that hearing aids improve hearing-related quality of life may seem obvious, it is an important quantification of the social benefits of hearing aids that were largely assumed before.

Given the high cost of the potential negative impact of hearing loss on mental and physical health, NHS England considers hearing loss services, including the provision of hearing aids, as good value for money.

The review highlights the improvements to communication and socialisation of wearing hearing aids for managing mild-to-moderate hearing loss. This suggests that national level awareness campaigns may be useful in reducing the stigma of hearing loss, raising awareness of services and encouraging people to seek intervention sooner so that they can maintain conversations and feel less isolated.

Citation and Funding

Ferguson MA, Kitterick PT, Chong LY, et al. Hearing aids for mild to moderate hearing loss in adults. Cochrane Database Syst Rev. 2017;9:CD012023.

Cochrane UK and the ENT Cochrane Review Group are supported by NIHR infrastructure funding.
In addition, four of the authors received support from the NIHR Biomedical Research Unit Programme.

Bibliography

Action on Hearing Loss. Hearing aids. London: Action on Hearing Loss; undated.

Hill S and Regan C. Action Plan on Hearing Loss. London: NHS England and Department of Health; 2015.

NHS Choices. Hearing aids. London: Department of Health; updated 2017.

NHS England. Commissioning services for people with hearing loss: a framework for clinical commissioning groups. London: NHS England; 2016.

Why was this study needed?

In the UK over 11 million adults and 45,000 children are affected by hearing loss. Hearing loss can impact people’s ability and confidence to carry out everyday tasks, which can reduce their employment and education prospects. Communication difficulties caused by hearing loss can also leave people socially isolated as they struggle to listen and take part in conversations. This all means that hearing loss that is not identified and managed properly can have a negative impact on people’s quality of life.

Hearing loss is measured on a sliding scale using tests of the softest sounds that are audible. It is classified from mild to profound, the most severe. It can be difficult to notice gradual change, and often people seek help only when their hearing deteriorates beyond a mild loss.

Until now there has not been much high-quality evidence to test the assumption that hearing aids would help people with the wider impacts of hearing loss. This review looked at the improvements in emotional and social quality of life related to giving people with mild to moderate hearing loss hearing aids.

What did this study do?

This systematic review included five randomised controlled trials of a total of 825 people, average age 69 to 83. Trials were published after 1987 in the US and Europe. Most were after 2000 and included a range of newer analogue and digital hearing aids.

The included trials were mainly at low risk of bias. The three older trials either gave people hearing aids or they stayed on a waiting list for one. The visibility of hearing aids means that the people assessing outcomes and participants were aware of whether or not they had a hearing aid, which could introduce bias.

The two 2017 trials used hearing aids programmed to not transmit sound as a placebo to conceal this from participants and assessors.

A range of general and hearing specific quality of life scores was used to determine the presence of perceived emotional and situational hearing restrictions, such as whether a hearing problem led people to use the phone less often or feel embarrassed when meeting new people.

What did it find?

  • Wearing hearing aids for 6 to 16 weeks led to an average 26 point reduction on a 100 point scale measuring hearing-specific quality of life with lower scores indicating better quality (95% confidence interval [CI] ‑42 to ‑10; 722 participants, three studies).
  • Overall generic health-related quality of life was moderately improved by wearing hearing aids compared to none or a placebo (standard mean difference [SMD] ‑0.38, 95% CI ‑0.55 to ‑0.21; 568 participants, two studies).
  • Using hearing aids also greatly improved listening ability (SMD ‑1.88, 95% CI ‑3.24 to ‑0.52; 534 participants, two studies).
  • Only one study measured adverse effects and reported none.

What does current guidance say on this issue?

The key objectives of NHS England’s 2015 Action Plan on Hearing Loss are to improve prevention, early diagnosis and patient-centred care, prevent social isolation and improve people’s involvement in everyday activities.

NHS England’s 2016 commissioning framework for hearing services does not specify thresholds for referrals. Referral and management pathways can vary locally with different models of care emerging in a drive to develop more integrated services for out of hospital and community settings. Most assessments and hearing aid fittings are provided under an NHS standard contract. This recent framework provides key outcome indicators to support commissioners and includes the recommendation to include in contracts measurement of an individual’s disability and communication difficulties using validated tools.

NICE is currently developing a guideline on hearing loss. This is due to be published in May 2018.

What are the implications?

Although the finding that hearing aids improve hearing-related quality of life may seem obvious, it is an important quantification of the social benefits of hearing aids that were largely assumed before.

Given the high cost of the potential negative impact of hearing loss on mental and physical health, NHS England considers hearing loss services, including the provision of hearing aids, as good value for money.

The review highlights the improvements to communication and socialisation of wearing hearing aids for managing mild-to-moderate hearing loss. This suggests that national level awareness campaigns may be useful in reducing the stigma of hearing loss, raising awareness of services and encouraging people to seek intervention sooner so that they can maintain conversations and feel less isolated.

Citation and Funding

Ferguson MA, Kitterick PT, Chong LY, et al. Hearing aids for mild to moderate hearing loss in adults. Cochrane Database Syst Rev. 2017;9:CD012023.

Cochrane UK and the ENT Cochrane Review Group are supported by NIHR infrastructure funding.
In addition, four of the authors received support from the NIHR Biomedical Research Unit Programme.

Bibliography

Action on Hearing Loss. Hearing aids. London: Action on Hearing Loss; undated.

Hill S and Regan C. Action Plan on Hearing Loss. London: NHS England and Department of Health; 2015.

NHS Choices. Hearing aids. London: Department of Health; updated 2017.

NHS England. Commissioning services for people with hearing loss: a framework for clinical commissioning groups. London: NHS England; 2016.

Hearing aids for mild to moderate hearing loss in adults

Published on 26 September 2017

Ferguson, M. A.,Kitterick, P. T.,Chong, L. Y.,Edmondson-Jones, M.,Barker, F.,Hoare, D. J.

Cochrane Database Syst Rev Volume 9 , 2017

BACKGROUND: The main clinical intervention for mild to moderate hearing loss is the provision of hearing aids. These are routinely offered and fitted to those who seek help for hearing difficulties. By amplifying and improving access to sounds, and speech sounds in particular, the aim of hearing aid use is to reduce the negative consequences of hearing loss and improve participation in everyday life. OBJECTIVES: To evaluate the effects of hearing aids for mild to moderate hearing loss in adults. SEARCH METHODS: The Cochrane ENT Information Specialist searched the ENT Trials Register; the Cochrane Register of Studies Online; MEDLINE; PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 March 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs) of hearing aids compared to a passive or active control in adults with mild to moderate hearing loss. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes in this review were hearing-specific health-related quality of life and the adverse effect pain. Secondary outcomes were health-related quality of life, listening ability and the adverse effect noise-induced hearing loss. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS: We included five RCTs involving 825 participants. The studies were carried out in the USA and Europe, and were published between 1987 and 2017. Risk of bias across the studies varied. Most had low risk for selection, reporting and attrition bias, and a high risk for performance and detection bias because blinding was inadequate or absent.All participants had mild to moderate hearing loss. The average age across all five studies was between 69 and 83 years. The duration of the studies ranged between six weeks and six months.There was a large beneficial effect of hearing aids on hearing-specific health-related quality of life associated with participation in daily life as measured using the Hearing Handicap Inventory for the Elderly (HHIE, scale range 1 to 100) compared to the unaided/placebo condition (mean difference (MD) -26.47, 95% confidence interval (CI) -42.16 to -10.77; 722 participants; three studies) (moderate-quality evidence).There was a small beneficial effect of hearing aids on general health-related quality of life (standardised mean difference (SMD) -0.38, 95% CI -0.55 to -0.21; 568 participants; two studies) (moderate-quality evidence). There was a large beneficial effect of hearing aids on listening ability (SMD -1.88, 95% CI -3.24 to -0.52; 534 participants; two studies) (moderate-quality evidence).Adverse effects were measured in only one study (48 participants) and none were reported (very low-quality evidence). AUTHORS' CONCLUSIONS: The available evidence concurs that hearing aids are effective at improving hearing-specific health-related quality of life, general health-related quality of life and listening ability in adults with mild to moderate hearing loss. The evidence is compatible with the widespread provision of hearing aids as the first-line clinical management in those who seek help for hearing difficulties. Greater consistency is needed in the choice of outcome measures used to assess benefits from hearing aids. Further placebo-controlled studies would increase our confidence in the estimates of these effects and ascertain whether they vary according to age, gender, degree of hearing loss and type of hearing aid.

One commonly used hearing-related quality of life score used in the included studies lists 25 questions across emotional and situational 'participation restrictions' due to hearing loss. It asks things such as:

  • Does a hearing problem cause you to use the phone less often than you would like?
  • Does a hearing problem cause you to feel embarrassed when meeting new people?
  • Does a hearing problem cause you to avoid groups of people?
  • Does a hearing problem make you irritable?

In this score, a maximum of four for each question is possible, with a total score of more than 43 out of 100 indicating significant handicap.

Expert commentary

Hearing loss will affect us all as we inevitably get older. Not only will hearing loss affect our ability to engage in conversations with families and friends, but experiencing hearing loss can have negative effects on how we feel emotionally and physically. 

It is reassuring for both clinicians and people with hearing loss to know that hearing aids are effective in improving the social participation and physical and emotional well-being of people with mild-moderate hearing loss.

It is important that hearing aids are available for all individuals with hearing loss, regardless of severity.

Dr Ted Killan, Audiology Lead, University of Leeds; Vice-Chair, British Society of Audiology