Living in Silence: A Learning Guide for a Deaf and Autistic Student

The present study examined the effect of hearing aid use on cognitive test performance using a single-subject treatment design. Six participants 54 to 64 years old with sensorineural hearing loss were fitted with hearing aids. Participants used the hearing aids for approximately 8 hr each day for the duration of the study. A battery of cognitive tests was administered to participants during baseline (pre-hearing aid fitting), treatment (hearing aid use), and withdrawal (post-hearing aid use) study phases over a period of 6 months of hearing aid use. All participants showed significant improvements in performance on the cognitive test measures with hearing aid use. The most significant treatment effects were evidenced at 2 to 4 weeks of hearing aid use on the Listening Span Test and an auditory selective attention task. In many cases, cognitive performance scores returned to baseline levels after the participant stopped using the hearing aids. The findings from this study are consistent with the hypothesis that hearing aid use may improve cognitive performance by improving audibility and decreasing the cognitive load of the listening task.

How Theory Can Influence Hearing Aid Use

Exploring older adults hearing and vision and driving – The Swedish study

Consistency of hearing aid and remote microphone system use declines as school-age children with hearing loss age. One indicator of hearing aid use time is data logging, another is parent report. Recent data suggest that parents overestimate their children's hearing aid use time relative to data logging. The potential reasons for this disparity remain unclear. Because school-age children spend the majority of their day away from their parents and with their teachers, reports from teachers might serve as a valuable and additional tool for estimating hearing aid use time and management. This study expands previous research on factors influencing hearing aid use time in school-age children using data logging records. Discrepancies between data logging records and parent reports were explored using custom surveys designed for parents and teachers. Responses from parents and teachers were used to examine hearing aid use, remote microphone system use, and hearing aid management in school-age children. Thirteen children with mild-to-moderate hearing loss between the ages of 7 and 10 yr and their parents participated in this study. Teachers of ten of these children also participated. Parents and teachers of children completed written surveys about each child's hearing aid use, remote microphone system use, and hearing aid management skills. Data logs were read from hearing aids using manufacturer's software. Multiple linear regression analysis and an intraclass correlation coefficient were used to examine factors influencing hearing aid use time and parent agreement with data logs. Parent report of hearing aid use time was compared across various activities and school and nonschool days. Survey responses from parents and teachers were compared to explore areas requiring potential improvement in audiological counseling. Average daily hearing aid use time was ∼6 hr per day as recorded with data logging technology. Children exhibiting greater degrees of hearing loss and those with poorer vocabulary were more likely to use hearing aids consistently than children with less hearing loss and better vocabulary. Parents overestimated hearing aid use by ∼1 hr per day relative to data logging records. Parent-reported use of hearing aids varied across activities but not across school and nonschool days. Overall, parents and teachers showed excellent agreement on hearing aid and remote microphone system use during school instruction but poor agreement when asked about the child's ability to manage their hearing devices independently. Parental reports of hearing aid use in young school-age children are largely consistent with data logging records and with teacher reports of hearing aid use in the classroom. Audiologists might find teacher reports helpful in learning more about children's hearing aid management and remote microphone system use during their time at school. This supplementary information can serve as an additional counseling tool to facilitate discussion about remote microphone system use and hearing aid management in school-age children with hearing loss.

The World Health Organization recognizes acquired hearing impairment as the third leading cause of disability worldwide, with a mild hearing impairment the most prevalent. Between 1 in 3 and 1 in 5 adults have a mild hearing impairment, with prevalence rising with age. Studies of other age-related changes, for example in cognition and physical activities, suggest that declines in these functions may be exacerbated if hearing impairment is not addressed at an early stage.Few studies, however, have focused specifically on the implications of the early stages of hearing impairment in older adults. The research program in this thesis investigated the impact that a mild hearing impairment may have on an individual’s daily listening situations and if the most common intervention strategy – the provision of hearing aids – is beneficial. An initial systematized review found the limited research literature available indicated large variation amongst adults with mild hearing impairment in many aspects and in the weak correlations between current common audiological assessments and self-reported hearing difficulties. It also found some evidence that hearing aids could be beneficial for this clinical population but reports of hearing aid use, benefit and satisfaction were variable.The first empirical study in this research program utilized an international database to investigate hearing aid use amongst adults with mild hearing impairment. Retrospective fitting and data logging hearing aid use information was extracted from a total of 8,489 participants with bilateral fittings. Analysis of average hearing aid use showed that the participants with mild hearing impairment used their hearing aids as much as those with a moderate degree, on average 8.5 hours per day. These findings support the recommendation of hearing aids for adults with mild hearing impairment.A further need identified in the initial review was for evaluation of the real-world listening experiences and performance of people with mild hearing impairment. Such information has commonly been evaluated using self-report questionnaires. However, these require individuals to give global reports based on their memory of specific listening situations which may date back a number of weeks or months. To reduce the recall bias inherent in retrospective questionnaires, a methodology called ecological momentary assessment was applied in the subsequent studies in this thesis. Ecological momentary assessment captures data, via surveys, about participants’ experiences in real-time, in their natural environment. To date, ecological momentary assessment had been used in a small number of audiology studies. Therefore, the initial phase of the research in this thesis explored the feasibility and construct validity of ecological momentary assessment. Twenty-nine adults with mild hearing impairment (mean age = 69 years) answered daily surveys, over 2 weeks, about their hearing experiences in their everyday listening situations. The results showed good participant compliance, little participant burden and good feasibility. A comparison of subjective data (224 daily surveys of listening events) with objective data (environmental sound classifier data) indicated good construct validity.A total of 1128 individual listening event surveys were collected. The most common listening situations were conversation with three or fewer people or listening to television or radio, most often in the home with a speaker familiar to the participant. Participants reported, on average, very good speech understanding and low impact from their hearing difficulties during the listening events. However, while participants reported 100% speech understanding in just over half the listening situations, more than two-thirds of listening situations required effort, indicating that participants were performing well but expending effort. The study highlighted the wide range of variation of listening experiences amongst participants.The final study of the thesis focused on the differences that a short trial with hearing aids could make to listening experiences, using a single-subject design. Ten participants (mean age = 70 years) answered surveys about their hearing for a total of 4 weeks; 1 week without hearing aids, 2 weeks with and 1 last week without hearing aids. The surveys asked about the characteristics of the listening situations as well as the participants’ hearing performance. Comparison between the mean baseline and intervention phase hearing performance scores showed significant hearing aid benefit for speech understanding, listening effort, hearing difficulties hampering communication and enjoyment of listening events. Individual variation was again evident with nine participants showing small to large benefit from hearing aids and one not demonstrating benefit. This research program has given deep insight into the hearing performance of adults with mild hearing impairment and the potential benefits that hearing aids could bring to this clinical group. It also utilized a methodology still new to the hearing research field and showed how ecological momentary assessment can be a valuable tool for research and clinical practice in the future. The research program highlighted the value of collecting real-world data, be it from data-logging in hearings aids or real-time, in-situ surveys to fully explore the individual implications of mild hearing impairment.

Previous research, mostly reliant on self-reports, has indicated that hearing aid (HA) use is related to the degree of hearing impairment (HI). No large-scale investigation of the relationship between data-logged HA use and HI has been conducted to date. This study aimed to investigate if objective measures of overall daily HA use and HA use in various listening environments are different for adults with mild HI compared to adults with moderate HI. This retrospective study used data extracted from a database of fitting appointments from an international group of HA providers. Only data from the participants' most recent fitting appointment were included in the final dataset. A total of 8,489 bilateral HA fittings of adults over the age of 18 yr, conducted between January 2013 and June 2014, were included. Participants were subsequently allocated to HI groups, based on British Society of Audiology and American Speech-Language-Hearing Association audiometric descriptors. Fitting data from participating HA providers were regularly transferred to a central server. The data, with all personal information except age and gender removed, contained participants' four-frequency average (at 500, 1000, 2000, and 4000 Hz) as well as information on HA characteristics and usage. Following data cleaning, bivariate and post hoc statistical analyses were conducted. The total sample of adults' average daily HA use was 8.52 hr (interquartile range [IQR] = 5.49-11.77) in the left ear and 8.51 hr (IQR = 5.49-11.72) in the right ear. With a few exceptions, there were no statistical differences between hours of HA use for participants with mild HI compared to those with moderate impairment. Across all mild and moderate HI groups, the most common overall HA usage was between 8 and 12 hr per day. Other factors such as age, gender, and HA style also showed no relationship to hours of use. HAs were used, on average, for 7 hr (IQR = 4.27-9.96) per day in quiet and 1 hr (IQR = 0.33-1.41) per day in noisy listening situations. Clinical populations with mild HI use HAs as frequently as those with a moderate HI. These findings support the recommendation of HAs for adults with milder degrees of HI.

How to Improve Audiology Services: The Patient Perspective

The Benefits of Social Support for Listeners with Impaired Hearing

Childhood hearing loss is a significant risk factor for language and academic delays.1–5 At the same time, the current generation of children with hearing loss show enormous variability in outcomes, with some children with hearing loss performing at the level of children with normal hearing, while others fall significantly behind.5 There has been a notable interest in recent years to determine the locus of variability in outcomes in children with hearing loss, including children with mild-to-severe hearing loss (i.e., children who are hard of hearing) who wear hearing aids. Researchers have pinpointed various factors that account for individual differences in children who are hard of hearing, including the quality and quantity of hearing intervention (e.g., amount of hearing aid use, amount that the hearing aid adequately restores access to speech),3–6 as well as cognitive factors such as working memory and attention.7,8 However, a comprehensive understanding of how these factors interact is still in its infancy, and the neural mechanisms underlying these interactions is unknown.www.shutterstock.com, audiology, hearing impaired, neural dynamics.Figure 1: Differences in brain activity between children with and without hearing loss. There was an increase in activity in the rightfrontal and parietal cortices in children who are hard of hearing (CHH) relative to children with normal hearing (CNH). Activity inthese regions correlated with verbal intelligence across groups. Audiology, hearing impaired, neural dynamics.Figure 2: Impact of hearing aid use on neural activity. Increased hearing aid (HA) use, especially more than ~8.5 hours of use,was correlated with more typical patterns of brain activity serving working memory processing. Audiology, hearing impaired, neural dynamics.On the heels of recent work using electroencephalography (EEG) and functional magnetic resonance imaging in people with severe-to-profound hearing loss,9–12 our lab is taking a new approach to understanding the impact of auditory experience on cognitive development by quantifying the real-time neural dynamics underlying these language and cognitive processes using magnetoencephalography (MEG). MEG is a noninvasive neuroimaging technique that records the small magnetic fields that naturally emanate from active neuronal populations in real time while a participant performs a task. MEG has a good combination of spatial accuracy (4-5 mm) and temporal precision (1 ms), which allows us to investigate the complex neural dynamics underlying cognitive and language processes as they evolve. In other words, these data provide a quantitative measure of neural activity throughout the brain during each stage of a behavioral process. This tool holds significant promise in determining the brain mechanisms and cognitive subprocesses that underlie differences in behavioral performance between children with normal hearing (CNH) and children who are hard of hearing (CHH), as well as between individual CHH. CURRENT STUDIES We had two goals in the current studies.13,14 The first goal was to identify the impact of hearing loss on the neural dynamics underlying verbal working memory processing groupwise between CHH and CNH, and the second was to determine the impact of the amount of hearing aid use on individual variability in brain activity within the hard-of-hearing group only. We analyzed data from a total of 30 children ages 7-15 years old, including 14 children with mild-to-severe hearing loss (9 females) and 16 children with normal hearing (8 females), who underwent neuroimaging with MEG while they performed a letter-based version of the Sternberg working memory task, as well as neuropsychological testing. During the verbal working memory task, participants were initially presented visually with six consonants for 2.0s (encoding period). The letters disappeared for 3.0s (maintenance period), then a probe letter appeared (retrieval period). Participants were asked to respond with a button press whether the probe letter was one of the previous six letters. The two groups did not significantly differ in reaction time or accuracy on this task. Finally, participants completed the Weschler Abbreviated Scale of Intelligence (WASI-II). Scores from the WASI-II were used to determine each participant’s verbal intelligence, nonverbal intelligence, and overall IQ. Parents also filled out questionnaires regarding the child’s hearing aid use that included questions such as, “How many hours per day does your child wear their hearing aids during the school year Mon-Fri? What about Sat-Sun?” Finally, degree of hearing loss was calculated in the children who are hard of hearing using their most recent audiogram. We used the MEG data to create whole-brain images of encoding- and maintenance-related neural responses separately, then compared the images groupwise to probe whether children who are hard of hearing showed differences in the neural patterns underlying each phase of verbal working memory compared to their normal hearing peers.13 We found that children who are hard of hearing exhibited significant elevations in right frontal activity during encoding, as well as elevations in maintenance-related right parietal activity relative to children with normal hearing. For context, the right prefrontal cortex is homologous to one of the most important regions for encoding verbal stimuli into memory storage,15,16 while the right parietal cortex is critical for working memory maintenance.17 Thus, increases in activity in these regions in the hard-of-hearing group was likely compensatory, which enabled the children to perform the task as well as their normal hearing peers. Crucially, we also found that activity in these two regions significantly correlated with verbal intelligence across groups, suggesting a tight link between working memory-related neural activity and language ability, in line with previous work (Figure 1).7,13,18,19 Our second goal was to determine whether working memory--related neural activity was sensitive to amount of hearing aid use in the children who are hard of hearing only.14 To this end, we performed whole-brain correlations between hours of hearing aid use and encoding-related and maintenance-related brain images separately, controlling for degree of hearing loss. We found significant correlations between hearing aid use and bilateral occipital and right precentral encoding-related activity, as well as maintenance-related activity in the right frontal cortex, above and beyond any effects of degree of hearing loss. In all these regions, more hearing aid use was correlated with a “normalization” of neural activity. Specifically, occipital encoding-related activity is known to be important for effective working memory encoding, and greater hearing aid use was associated with an increase in occipital responses. On the contrary, precentral and right prefrontal responses are generally considered atypical or compensatory in these types of tasks, and increased hearing aid use was associated with a decrease in activity in these regions (Figure 2). Critically, the “break even” point in these data, or the amount of hearing aid use that was related to more typical neural patterns, was at least 8.5 hours per day.14 CLINICAL IMPLICATIONS These data provide striking evidence that children with mild-to-severe hearing loss exhibit compensatory alterations in brain physiology during the performance of cognitive tasks. More consistent hearing aid use was associated with normalized neural patterns in children who are hard of hearing. It is important to note that brain differences were found despite there being no differences in behavioral performance between groups. These tasks were performed in a controlled laboratory setting, so it is possible that real-life environments, where there are multiple cognitive demands or distractions, may lead to an exhaustion of these compensatory resources and eventual behavioral decrements in children who are hard of hearing. Expanding on this idea, variability in the neural patterns that serve language and cognitive processes, especially relative to the difficulty of a given task, may explain why some studies find behavioral differences between those with and without hearing loss, while others find no such differences. Even more remarkable is the relationship between hearing aid use and neural activity in children with hearing loss. We found significant relationships between the neural patterns serving each phase of working memory and hearing aid use, such that consistent hearing aid use was related to more prototypical neural dynamics. These data suggest that the amount of quality auditory experience has substantial effects on their underlying brain physiology, and that at least 8.5 hours of hearing aid use seems to be beneficial, at least from a neural perspective. This aligns well with previous work suggesting that at least 8-10 hours of hearing aid use relates to better behavioral outcomes in these children.5,8 More broadly, our studies provide preliminary evidence that neuroimaging may hold promise in uncovering the mechanisms underlying differences in language and cognitive development between children with and without hearing loss, and may help explain the variability in outcomes between individuals with hearing loss.

The 2014-2016 National Health Interview Survey found that 15.9 percent of U.S. adults reported having hearing loss.1 Self-reports invariably underestimate the true prevalence of hearing loss possibly because of the insidious onset of the most prevalent type of acquired hearing loss: presbyacusis.2 This is confirmed by a recent national audiometric test-based study of a North American population that identified hearing loss prevalence rates as high as 65 percent in adults aged 70 to 79 years old.3iStock/sanjeri, audiology, primary care, hearing aids.Hearing aids are effective4 and common treatment options for hearing loss. However, hearing aid use is low, with only 3.7 percent of U.S. adults with hearing loss reporting owning a hearing aid.5 The reasons for this are uncertain, though subjects have reported being less satisfied with hearing aids than with similar sensory assistive devices such as eyeglasses.6In a literature review, Knudsen, et al.,7 concluded that perceived hearing disability was the only factor that affected both hearing aid use and satisfaction—an important finding illustrating adult hearing loss as a chronic condition that is amenable to management within the chronic care model advocated by Bodenheimer, et al.8 This model highlights that support for self-management and/or delivery system design-focused interventions can yield improved hearing health outcomes, thereby offering an alternative avenue for intervention to the more traditional audiological focus on hearing aid gain, amplification, and fit. The effects of self-management support and delivery system design on hearing aid use were studied in the Cochrane review by Baker, et al.9 Among the 32 studies reviewed, only two studies looked at the effect of self-support management on hearing aid use; however, these were not suitable for meta-analysis. Also, the researchers didn't find any statistically significant evidence that intervention combinations in the self-management and system design domains affected hearing aid use, though they found a reduction in hearing handicap.9 In a systematic review of the literature on hearing aid use and satisfaction, Mousavei, et al.,10searched a combination of keywords in the PubMed, Medline, and Embase databases and included studies published from January 1990 to January 2015 that focused on interventions aimed at improving hearing aid satisfaction and use and determinants of hearing aid use and satisfaction. Peer-reviewed articles that reported quantitative outcomes on a minimum of 20 older adult subjects were included in the review. Twenty-four studies were judged suitable for further study by two independent investigators. The subjects’ perceived severity of hearing loss and expectations of hearing aid benefit were positively correlated with hearing aid use. No specific factors conclusively affected hearing aid satisfaction. Hearing aid use and satisfaction were not affected by the patient's age or sex. No evidence showed that counseling, provided as a delivery system design intervention, improved hearing aid use or satisfaction. STUDY PREVIEW Based on existing literature, a multicenter randomized control trial was undertaken to investigate if a delivery system design intervention that includes a visit to a physician (family doctor or otolaryngologist/head and neck surgeon) during the hearing aid fitting process alter a patient's reported satisfaction with hearing aids.11 The trial was approved by the University of British Columbia's Clinical Research Ethics Board. Study participants were recruited from five audiology clinics in the Vancouver metropolitan area. Participants were adults 55 years of age or older who had hearing aid fitting for a sensorineural hearing loss greater than 25 dB, averaged over pure-tone audiometric measures of four frequencies in one or both ears. They were randomized to undergo standard-of-care hearing aid fitting alone or standard-of-care hearing aid fitting and a visit to their family doctor or an otolaryngologist/head and neck surgeon. At the visit, the physician conducted a Client Oriented Scale of Improvement (COSI)12 interview to see if the patient's hearing had changed following the hearing aid fitting. Participants completed the validated Satisfaction with Amplification in Daily Life (SADL) questionnaire13 three to four months after their initial fitting. At the time of interval analysis of the trial data, 94 patients had been recruited, with 57 and 37 randomized to the control and physician intervention groups, respectively. Eight patients in the control and three in the physician group didn't report for follow-up. SADL questionnaires were pending on nine control and 10 physician intervention patients. Therefore, data of 40 control and 24 physician intervention group patients were analyzed. The two groups were similar in age (72.8 and 70.3 years); sex (50% and 44% male); and PTA (43.1 and 49.2 dBHL). No statistically significant inter-group difference was found in the global SADL scores at three to four months follow-up (5.3 and 5.4; students’ t-test, p = 0.6). A chronic care system design intervention consisting of a single physician visit did not significantly change the level of satisfaction with hearing aids in a group of older adult hearing aid users. This finding is not definitive since a minimum of 40 patients is required in each arm of the study to show a standardized difference of 0.625 (0.5/0.8) at a five percent significance level, with a power of 80 percent based on the sample size nomogram by Altman.14 The physician group data set analyzed includes 24 patients and is thus short of the minimum sample size. The COVID-19 pandemic restrictions have delayed the final data accrual. However, it is anticipated that the shortfall will be filled as the data from patients who have been recruited after the interval analysis become available. The definitive results will then be reported.

Hearing impairment is ranked fifth globally for years lived with disability, yet hearing aid use is low among individuals with a hearing impairment. Identifying correlates of hearing aid use would be helpful in developing interventions to promote use. To date, however, no studies have investigated a wide range of variables, this has limited intervention development. The aim of the present study was to identify correlates of hearing aid use in adults in the United Kingdom with a hearing impairment. To address limitations in previous studies, we used a cross-sectional analysis to model a wide range of potential correlates simultaneously to provide better evidence to aid intervention development. The research was conducted using the UK Biobank Resource. A cross-sectional analysis of hearing aid use was conducted on 18,730 participants aged 40 to 69 years old with poor hearing, based on performance on the Digit Triplet test. Nine percent of adults with poor hearing in the cross-sectional sample reported using a hearing aid. The strongest correlate of hearing aid use was self-reported hearing difficulties (odds ratio [OR] = 110.69 [95% confidence interval {CI} = 65.12 to 188.16]). Individuals who were older were more likely to use a hearing aid: for each additional year of age, individuals were 5% more likely to use a hearing aid (95% CI = 1.04 to 1.06). People with tinnitus (OR = 1.43 [95% CI = 1.26 to 1.63]) and people with a chronic illness (OR = 1.97 [95% CI = 1.71 to 2.28]) were more likely to use a hearing aid. Those who reported an ethnic minority background (OR = 0.53 [95% CI = 0.39 to 0.72]) and those who lived alone (OR = 0.80 [95% CI = 0.68 to 0.94]) were less likely to use a hearing aid. Interventions to promote hearing aid use need to focus on addressing reasons for the perception of hearing difficulties and how to promote hearing aid use. Interventions to promote hearing aid use may need to target demographic groups that are particularly unlikely to use hearing aids, including younger adults, those who live alone and those from ethnic minority backgrounds.

Previous studies found that, on average, users overreport their daily amount of hearing aid use compared to objective measures such as data logging. However, the reasons for this are unclear. This study assessed data-logged and self-reported amount of hearing aid use in a clinical sample of hearing aid users. It identified predictors of data-logged hearing aid use, self-reported hearing aid use, and hearing aid use overreport. This observational study recruited adult hearing aid users from 22 private dispensers in the Netherlands and in Denmark. The sample consisted of 228 hearing aid users. Typical participants were over the age of 65 and retired, were fitted binaurally, and had financially contributed to the cost of their hearing aids. Participants had on average a mild-to-severe sloping bilateral hearing impairment. Participants completed a purposefully designed questionnaire regarding hearing aid usage and the International Outcome Inventory-Hearing Aids. Dispensers collected audiometric results and data logging. Multiple linear regression identified predictors of data-logged hearing aid use, self-reported hearing aid use, and hearing aid use overreport when controlling for covariates. Data logging showed on average 10.5 hr of hearing aid use (n = 184), while participants reported on average 11.8 hr of daily hearing aid use (n = 206). In participants for which both data-logged and self-reported hearing aid use data were available (n = 166), the average absolute overreport of daily hearing aid use was 1.2 (1 hr and 11 min). Relative overreport was expressed as a rate of absolute overreport divided by data-logged hearing aid use. A positive rate denotes hearing aid use overreport: the average overreport rate was .38. Cluster analysis identified two data-logged patterns: "Regular," where hearing aids are typically switched on for between 12 and 20 hr before their user powers them off (57% of the sample), and "On-off," where hearing aids are typically switched on for shorter periods of time before being powered off (43% of the sample). In terms of self-report, 77% of the sample described their hearing aid use to be the same every day, while 23% of the sample described their hearing aid use to be different from day to day. Participants for whom data logging showed an On-off pattern or who reported their hearing aid use to be different from day to day had significantly fewer data-logged and self-reported hours of hearing aid use. Having an On-off data-logging pattern or describing hearing aid use as the same every day was associated with a significantly greater hearing aid use overreport. Data-logged and self-reported usage patterns significantly predicted data-logged hearing aid use, self-reported hearing aid use, and overreport when controlling for covariates. The results point to patterns of hearing aid usage as being at least as important a concept as amount of hearing aid use. Dispensers should discuss not only the "how much", but also the "how" of hearing aid usage with their clients.

Association between self-reported hearing impairment, use of a hearing aid and performance of instrumental activities of daily living

Hearing impairment has been linked to low self-esteem in children. Many teachers have noted that a growing number of students are unwilling to wear hearing aids, even though non-governmental groups such as the Starkey Ear Foundation provide them free of charge. The study aimed to discover how learners with hearing impairment in integrated units in Nairobi City County, Kenya, felt about hearing aid use and how it affected their self-esteem. Peter Burke's Identity Control Theory directed the research. The study was conducted using a descriptive survey design. Headteachers, teachers in charge of learners with hearing impairment, parents, and learners with and without hearing impairment were the target population. A total of 90 participants were surveyed, including 8 headteachers, 15 parents, 8 teachers, 51 learners with hearing impairment who used hearing aids, and 8 learners who did not have hearing problems. Data was gathered by the distribution of questionnaires to learners, parents, and instructors, as well as a complementing interview with the headteachers. Pilot research was undertaken in a Nairobi primary school. Descriptive statistics were used to analyze the quantitative data. The computer programme SPSS version 22.0 was used to do inferential statistics. Thematic analysis was done on qualitative data. The study discovered that learners with hearing loss had generally positive attitudes concerning hearing aid use. Hearing aid use had a weak positive influence on the self-esteem of learners with hearing impairment as per the study's overall findings. The study recommends that the government provide schools with speech therapists/audiologists to follow up on language intervention of learners with hearing impairment who are wearing hearing aids, as well as encourage collaboration of a multi-disciplinary team that includes teachers, parents, headteachers, audiologists/speech therapists to ensure that they benefit from hearing aid use and improve their self-esteem.

Objective: To examine the epidemiological and audiological profile, pattern of hearing aid (HA) fitting and usage among HA users in Singapore. Design: Retrospective cross-sectional study. Study sample: Cohort of 1068 subjects issued with HAs at a tertiary hospital between 2001 and 2013. Results: Mean age was 70 years with 50.8% male. Mean hearing loss (HL) was 63.1 dB and 69.5% had at least moderate-severe HL. Sensorineural HL was present in 66.4% and 69.8% had symmetrical HL. “Behind-the-Ear” HAs were cheaper than “In-Ear” HAs. Standard “Behind-The-Ear” HAs were also cheaper than “Receiver-in-Canal” HAs. Among In-Ear HAs, “In-the-Canal” and “Completely-in-Canal” were more popular than “In-the-Ear” HAs despite costing more. HA was used ≥4 days/week by 85.6% but >7 h per day by only 35.7%. Only 18% received bilateral first HA fitting. In multivariate analysis, younger age and symmetrical HL were predictors of bilateral HA uptake while better Pure-Tone-Audiometry of aided ear and >7 h of daily HA usage were predictors of successive HA fitting. Conclusions: HA users in Singapore were elderly and presented with advanced HL. Bilateral HA adoption and average daily use were low compared to other developed countries. Future research on understanding the suboptimal HA usage should explore patients' motivation, hearing disability, and HA effectiveness.