HIPPOKRATIA 2007, 11, 4: 183-186 HIPPOKRATIA 2007, 11, 4 183

ORIGINAL ARTICLE

Hearing aids: Quality of life and socio-economic aspects

Tsakiropoulou E1, Konstantinidis I1, Vital I1, Konstantinidou S², Kotsani A1
1. Otorhinolaryngology Department, Veria District General Hospital, Veria, Greece
2. Health Sciences Department, Glenfield Hospital, Leicester University, UK

Abstract
Objective: Hearing loss can significantly impair patient’s quality of life, affecting communicative behavior, emotional
and social function. This study assesses the impact of hearing aids on the quality of life of patients in a rural area and its
correlation with socio-economic factors.
Materials – methods: Thirty patients (18 male, 12 female), with bilateral sensorineural hearing loss of variable etiology,
using hearing aid for at least five years, were enrolled in this study. Mean age of subjects was 74 years. This study used
the Glasgow Benefit Inventory (GBI) to quantify the changes in quality of life. Patients were divided in above and below
criterion group. The criterion used was the median of the air contaction threshold improvement. The binaural use and the
type of hearing aids were recorded and correlated with the type of social security service of patients.
Results: Eighty per cent of patients reported significant benefit from the hearing aid use. The majority of patients (90%)
used one hearing aid (mean GBI total score 35) and only 10% had binaural hearing aid (mean GBI total score 45). The
majority of patients used analog hearing aid (56.5%) while 43.5% used digital hearing aid. Interestingly, it was found
that patients did not attend appointments for hearing aids maintenance with a mean follow up of 2.5 years.
Conclusion: This study demonstrates a trend of better quality of life for patients with bilateral hearing loss and binaural
hearing aid use. The type of hearing aid is related to the funding from their social security service. Therefore more pa-
tients are using analog hearing aids, as they are less expensive than the digital hearing aids. Hippokratia 2007; 11 (4):
183-186

Key words: hearing aid, quality of life, socioeconomic aspects

Corresponding author: Konstantinidis I, 3 P.Tsaldari Str, Neapoli, Thessaloniki, PoBox: 56727, tel: 0030-6973229525, e-mail: jokons57@
hotmail.com

Hearing loss is a common and potentially disabling female patients. Mean age of patients was 74 years (male
problem in elderly individuals. Even though over than 73 years old, female 76 years old, range 57-79 years).
one-quarter of elderly individuals complain of hearing This study uses the Glasgow Benefit Inventory
problems, only one-third of them have significant hear- (GBI) to quantify the changes in quality of life. The
ing impairment on audiological testing1. Hearing loss GBI is a generic quality of life questionnaire designed
may impair physical and social function, and is associ- for measuring outcomes after otorhinolaryngological
ated with cognitive deficits, mood disturbances and be- procedures4. It has been validated over a wide range of
havioral disorders1,2. Hearing aids improve the quality of procedures and is patient oriented5. It measures quality
life; however the benefit from their use is strongly related of life in three domains, social, general, and physical.
to the patients’ social and economic status3. Differences Specifically out of the 18 questions included in GBI, 12
in cost among analog and digital devices and the vari- are related to general improvement of quality of life, 3
ous funding among social security services are signifi- to social improvement, and 3 to physical improvement.
cant factors that affect the choice of hearing aid type. This Each of the questions has five possible responses; a
study assesses the effectiveness of hearing aid interven- response of 5 denotes the most favorable outcome, while
tion assessing the quality of life of patients in relation to a response of 1, the poorest result. A response of 3 denotes
the hearing aid type and social security services in a rural no change. The scores are averaged and plotted as a graph
area of Northern Greece. with a final range of GBI score from – 100 to +100.
GBI uses a criterion to be a measure of technical success
Materials and Methods based on pure-tone thresholds. The change in average air
In this study 30 consecutive patients were enrolled with conduction threshold calculated over 0.5, 1, 2 and 4 kHz.
bilateral sensorineural hearing loss of variable etiology, Pre-intervention data derived from the last audiometric
who had been using hearing aids. Inculsion criteria were measurement before the use of the hearing aids. As post-
moderate hearing loss (air conduction threshold between intervention audiogram was considered the most recently
40-70 db4) and use of hearing aids for at least five years performed. A four-frequency average air conduction
(mean time of use 7.4 years). There were 18 male and 12 threshold was measured pre- and post-intervention for
184 TSAKIROPOULOU E

every patient. The differences between the above average

numbers were recorded. The median of these differences
was considered as the criterion to divide patients in two
groups, above and below criterion respectively.
The binaural and monaural use and the type of hear-
ing aids (digital / analog) were recorded and mean total
GBI scores were compared for the above parameters.
The type of social security service was also recorded
dividing patients in three groups as follows: Patients with
funding from the Social Insurance Institute (SII), patients
with funding from the Organism of Agricultural Security
Services (OASS), and patients with funding from other
type of social security service.
Analyses were conducted in SPSS 12.0 (SPSS, Inc.,
Chicago, IL). Differences between groups with respect
to GBI scores were tested using Mann-Whitney U test.
All reported p-values are two-tailed with a significance
level of 0.05. Figure 1. Distribution of patients according to their type of
social security service
Results
All patients reported benefit from the use of hearing can not be performed regarding quality of life outcome.
aids (positive GBI score). Using as a criterion the However this difference shows a trend especially if we
median of air conduction threshold improvements we consider that all patients with two hearing aids had the
divided patients in two groups above and below criterion same type of social security service (SII).
respectively. The vast majority of patients (80%) were The distribution of patients regarding their type of
included to the above criterion group (mean GBI score social security service is shown in figure 1. The number
38.5 ± 2) and only 20% of them to the below criterion of patients having social security service SII and OASS
group (mean GBI score 22 ± 4). This difference between was similar (11 vs 13 patients respectively) allowing
GBI means for the two groups was statistically significant subgroup comparison. In total seventeen patients (56.5%)
(p<0.001). No intersexual differences were found between used analog hearing aids and thirteen patients (43.5%)
GBI scores (males: mean GBI score 35.9 ± 3 / females: of used digital hearing aids. The distribution of patients
mean GBI score 36.2 ± 4). according to their type of social insurance (SII or OASS)
The vast majority of patients used one hearing aid and the type of hearing aid is shown in figure 2, where
(27 patients, 90%) and only 3 patients had binaural use of it is obvious that patients with SII security service use
hearing aids. Patients with one hearing aid had a mean GBI digital hearing aids in a greater percentage compared
total score 35 ± 3, and patients with two hearing aids had with OASS patients (55% vs 32%).
a mean GBI total score 45 ± 10. Due to small number of Comparison of mean GBI scores between digital
patients with binaural hearing aid use, a statistical analysis and analog hearind aid users showed a trend towards

Figure 2. Comparison of digital/analog hearing aid use between SII and OASS social security services
 HIPPOKRATIA 2007, 11, 4 185

ence their positive impact on patients across their lifes-

pan. Our results showed benefit for all patients from the
use of hearing aids. However the scores from the quality
of life questionnaires were lower than results recorded in
other similar studies7.
Patients with symmetric hearing loss need binaural
(ie, both ears) hearing aids1. It has been demonstrated in
clinical and laboratory studies that binaural hearing aid
wearers may benefit from the ability of the central audi-
tory system to integrate binaural information and enjoy
benefits such as binaural loudness summation, masking
level difference, localization, and elimination of head-
shadow8. Globally about 80% of patients with bilateral
severe hearing loss wear hearing aids binaurally9. This
Figure 3. Comparison of GBI scores between patients using fact is not in agreement with our results although we as-
analog and digital hearing aids sess patients with moderate hearing loss, and probably
affects negatively the quality of life results. If patients
significance for the use of digital hearing aids (analog with bilateral hearing loss wear only one hearing aid,
34.4± 3, digital 37.2± 2, p=0.061), (Figure 3). they cannot identify where a sound is coming from, and
Interestingly, all patients did not attend their regular in noisy environments, they cannot hear speech clearly.
appointment for hearing aid maintenance every year. The More amplification is usually required with a monaural
mean period of time between service appointments was unit than with binaural units10. Based on these limitations
2,5 years. There was no difference between patients with we can speculate that the considerably low quality of life
different social security services regarding the hearing results in our study group are partially due to monaural
aid maintenance appointments. use of hearing aids. Although the sample of binaural us-
ers in our study is small, all of them had the same type of
Discussion social security and this shows a trend indicating the role
Hearing loss is the most frequently recorded com- of funding differences between social security services
munication handicap in the world and restricts sever- for hearing aids.
al aspects in the quality of life of patients2. It impairs Hearing aids cost ranges from cheap devices to very
communication, emotional and social function and can expensive devices. Factors that affect the cost are size,
isolate affected people from their family and friends. circuitry options, circuitry sophistication and add-on op-
Hearing impairment has been shown to interfere with tions. Analog hearing aids are the most common and least
patients’ ability to live independently and safely hav- expensive type (range 200-500 euros). Digital hearing
ing a negative impact on communicative behavior2. Fur- aids (digital signal processing units) are the most tech-
thermore, it can cause or aggravate depression, anxiety, nologically advanced. They are usually more expensive
and feelings of inadequacy, contributing to functional (range 600-3000 euros) than analog units (2-5 times more
impairment 2. expensive). Thus, patients who need basic amplification
Elderly individuals who experience hearing impaire- at the lowest possible price may prefer the analog hear-
ment seek for expert opinion when they realise that their ing aids. Our hospital serves an area mainly agricultural.
hearing has deteriorated to an extend that limits their so- These people usually do not have occupational need of
cial activity. Another significant factor is the social pres- hearing and their social security service does not provide
sure from family members who are negatively impacted funding for hearing aid expenses. This can explain to
by the individual’s hearing loss. Hearing loss usually a certain point the extended use of analog hearing aids
occurs gradually. By the time the need for hearing aids among them.
is recognized, the quality of life may have been signifi- There is a need for regular follow – up appointments
cantly impaired. to make sure that the hearing aid is functioning and that
The average first-time hearing aid wearer is close to the patient is benefiting from its use.The fitting of an aid
65 years of age1,2 as seen also in our study. Social isola- is not an one-off event. It is therefore essential that there
tion and inability to follow conversations are much more should be a good line of continuing communication be-
common among hearing-impaired adults aged 50 years tween the dispenser and the hearing aid user. In our study
and over, than among non-hearing impaired people in the all patients had a prolonged period of time between regu-
same age group1. lar follow-up appointments for hearing aid maintenance.
The impact of hearing impairment on the quality of This fact may affect negatively the overall impression of
life can be minimized with the help of hearing aids. The the benefit from the hearing aid use. However the cost of
rapid improvement when hearing aids are introduced is hearing aid maintenance has to be met by the patient and
well documented6. What is not clearly documented is this is probably the reason why patients usually do not
their long-term effectiveness as many factors may influ- attend these appointments.
186 TSAKIROPOULOU E

Hearing aid fitting is a cost-effective intervention. In 4. Robinson K, Gatehouse S, Browning GG. Measuring patient
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5. Arunachalam P, Kilby D, Meikle D, Davison t, Johnson I. Bone-
work together to fundamentally change the state’s health anchored hearing aid quality of life assessed by Glasgow Benefit
policy and social security strategy in treating hearing Inventory. Laryngoscope 2001; 111: 1260-1263
loss. 6. Kochkin S. On the issue of value: Hearing aid benefit, price,
satisfaction, and brand repurchase rates. The Hearing Review
2003; 10:12-25
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