Hearing Handicap Research Articles

Psychometric appraisal of the Kurdish version of the Revised Hearing Handicap Inventory-Screening

Psychometric appraisal of the Kurdish version of the Revised Hearing Handicap Inventory-Screening

Toward a better understanding of barriers to wayfinding technology use for people with disabilities

ABSTRACT Wayfinding is the process of navigating from one’s present location to their desired location. While wayfinding technologies are increasingly used by people with disabilities, there is little understanding of the barriers specific to wayfinding technology. The objective of this study was to understand the wayfinding technology barriers experienced by Canadians with disabilities. A total of 213 participants with varying disabilities (i.e. mobility, visual, hearing, memory and learning disabilities) completed a survey of open-ended questions about their personal experiences with different types of technologies. Technologies were categorized into public (i.e. digital and tactile interfaces) and personalized (i.e. mobile/website applications, wearable devices, smart assistive devices), and qualitative content analysis was used. Main themes were identified and either common across both groups (i.e. compatibility, demands on personal resources, information provision, interactability) or specific to one technology type (i.e. stigma, specific to personalized technology). Detailed subthemes provided greater specificity on the types of barriers encountered. For example, infection risk was noted as a barrier to public technology and high costs was a barrier for personalized technology. Results support the inclusion of wayfinding technology within accessibility standards and provide insights to clinicians on how to best support people with disabilities and their use of technology.

PTSD Is Associated with Self-Perceived Hearing Handicap: An Evaluation of Comorbidities in Veterans Without Measured Hearing Loss.

Cases of self-reported hearing difficulty despite no traditionally measured hearing loss (pure tone audiometric thresholds ≤ 25 dB HL from 250 Hz through 8000 Hz) have risen with the return of Veterans from recent conflicts in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Auditory outcomes improved despite low compliance among those receiving treatment. Medical chart data appeared more comprehensive for Veterans with, rather than without, auditory complaints. One possibility is that self-reported hearing problems are associated with a subset of these comorbidities, the treatment of which improved auditory outcomes. This study examined the relationships between Veterans' self-reported auditory problems and other diagnosed medical conditions. A retrospective chart review was used. Participants were 286 Veterans, aged 21 to 52 years with pure-tone audiometric thresholds ≤ 25 dB HL at all measured frequencies in both ears. Veterans were dichotomized into a group with either self-reported hearing complaints (n = 143) or an age-matched control group with no auditory complaints (n = 143). A query of the Computerized Patient Record System was performed with the date range restricted to 2009 to 2018. Metrics of self-perceived hearing handicap, auditory processing disorder testing, and hearing aid use were collected. All diagnoses and related symptoms were recorded. A best subsets regression with principled model selection was performed to investigate the role of these comorbidities on self-perceived hearing loss. The self-report group had 16 comorbidities that were classified as prevalent, having occurred in ≥33.3% of the group, compared with the age-matched control group, which had 2 comorbidities. The number of diagnosed medical conditions was associated with self-perceived hearing impairment. Specifically, posttraumatic stress disorder (PTSD) and related symptom clusters constituted the largest group of comorbidities that were significantly associated with self-reported hearing problems. The significant association between PTSD and self-perceived hearing impairment warrants investigations on whether treatment of PTSD would reduce perceived hearing handicap severity. Further, PTSD assessments could be useful for audiologists to identify potential candidates for auditory complaints without measured hearing loss.

Effects of speech tracking method using hearing aids for hearing disorder in older people.

Speech tracking is defined as a complex act or task of listening in which the learner tracks the speech heard and repeats it as accurately as possible while paying attention to incoming contextual information. This ability involves auditory input, speech output, repetition, and divided attention. In this small-scale study, we aimed to use a speech-tracking method to train older adults with hearing loss and examine its effects on hearing loss from multiple perspectives, including hearing handicap, frailty, and neuropsychological testing. Auditory rehabilitation was provided to older patients who purchased hearing aids at the clinic and wanted to engage in rehabilitation. The Hearing Handicap Inventory for the Elderly, Nursing Home Hearing Handicap Index, speech-tracking rate, Token Test, Communication Activities of Daily Living, Kihon Checklist, Mini-Mental State Examination, Digit Symbol Substitution Test, symbol search, and word recall were used for assessments before and after rehabilitation using the speech-tracking method. Changes in scores of each assessment item and sub-item were examined using Wilcoxon's signed-rank test, and changes per question were examined using the sign test. The speech tracking rate (p<0.001), Token Test score (p<0.001), and Mini-Mental State Examination score (p=0.035) improved significantly after the training. Notably, the speech-tracking rate improved for 31 of the 33 participants, with a maximum increase of 19.6 phrases per minute. The combination of a hearing aid and the speech-tracking method improved auditory comprehension.

American Sign Language Recognition System: Enhancing Communication Accessibility for Individuals with Hearing Disabilities

American Sign Language Recognition System: Enhancing Communication Accessibility for Individuals with Hearing Disabilities

Universal Design for Learning as a pathway to accessibility in the linguistics classroom

This paper offers suggestions on enhancing accessibility in our introductory linguistics courses, with a particular focus on teaching phonetics and phonology to students with hearing and visual disabilities. After reviewing some existing resources designed to make linguistics content more accessible, we address some of the practical constraints we experienced in trying to adopt these resources for our own courses. In light of such challenges, we offer practical strategies for improving accessibility both in the physical classroom as well as for online or hybrid courses. We suggest that implementing such strategies, which are in line with the principles of Universal Design for Learning, can prove beneficial for all students, with or without the need for accommodation. Finally, we encourage instructors to take proactive steps to make their course content more accessible, both in their current and future classes.

Workshops: Enhancing communication for nursing students with patients with hearing disabilities

Abstract Background Nursing students need guidance on effective communication strategies for interacting with patients with hearing disabilities, emphasizing the importance of addressing this gap in their education as future healthcare professionals. Methods A cross-sectional survey was conducted among nursing students at seven institutions before and after workshops led by guides with hearing disabilities from a non-profit organization Ma’agalei Shema and funded by the National Insurance Institute. Data was collected from 2023 to March 2024 and analyzed using SPSS software. Results 279 participants completed the survey before the workshops. and 136 responding afterward. Almost 80% were female. Before the workshops, 68.46% of students expected to gain communication tools for patients with hearing disabilities. About one-third believed the healthcare system offers accessible treatment to these patients, while only 22.22% foresaw no barriers. One-third reported no clinical contact with such patients. Among those who did, lip-reading (25.53%), writing (17.73%), assistance from family members (15.6%), and sign language (9.22%) were commonly used. Only 2.84% used professional sign language interpreters, and 20.57% reported never meeting a patient with hearing disabilities (8% reported “other”). Post-workshop surveys showed that around 82.48% of participants felt the workshops would significantly enhance their communication skills with such patients, with only 5.11% reporting a lack of practical tools received. Conclusions Practical workshops can significantly enhance communication skills and improve patient care. This study underscores the potential impact of minor adjustments in communication strategies on patient care, such as increasing the use of professional interpreters. Main messages: Providing training to nursing students in effective communication with these patients can streamline interactions, diminish reliance on family intermediaries, and enhance medical care. Key messages • Nursing students need guidance on communicating with patients with hearing disabilities to improve future healthcare interactions. • Practical workshops enhance communication skills, stressing the importance of minor adjustments for better patient care.

Sensorineural hearing loss in post-COVID-19 patients

&lt;b&gt;Background: &lt;/b&gt;Hearing loss (HL) is one of the most common chronic conditions after hypertension and arthritis. Mounting indices suggest that sensorineural hearing loss (SNHL) may be one of the adverse effects of severe acute respiratory syndrome coronavirus 2.&lt;br /&gt; &lt;b&gt;Objective: &lt;/b&gt;This work aimed at studying SNHL in post-COVID-19 patients, alongside with exploring the relationship between severity of the disease and degree of hearing disability.&lt;br /&gt; &lt;b&gt;Materials and methods: &lt;/b&gt;This prospective cross-sectional study was conducted at Al-Azhar University Hospitals, Cairo, Egypt. It included 100 post-COVID-19 patients selected according to the study inclusion and exclusion criteria. Pure tone audiometry was done to confirm the presence of HL and to determine its degree.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Hundred patients with recent oncent hearing symptoms after documented COVID-19 infection were included. Males (71%) were more affected than females (29%). The most of our cases had bilateral moderate HL (45%). Tinnitus was the most frequently associated otological symptom (96.96%). The time of HL onset varied from days to weeks (55% had time onset between 11-30 days post-confirmed infection). Higher thresholds were detected in all frequencies of affected ears with more deterioration of hearing as frequencies increase. All degrees of HL were detected; mild, moderate, severe and profound. There was no significant correlation between severity of COVID-19 infection and severity of HL.&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;SNHL is one of the extrapulmonary complications of COVID-19. COVID-19 patients may develop hearing affection regardless the severity of the infection. It is recommended to assess hearing functions in patients after COVID-19 for early detection and proper management.

Performance of the Washington Group questions in measuring blindness and deafness.

The Washington Group Short Set (WGSS) questions are intended to measure the severity of disability and disability status in US federal surveys. We used data from the 2010-2018 National Health Interview Survey to examine the performance of the WGSS visual disability and hearing disability questions in capturing blindness and deafness. We found that the WGSS questions failed to capture 35.7% of blind adults and 43.7% of deaf respondents as having a severe disability, or, per their recommended cut point, as being disabled. Coupled with evidence demonstrating the poor performance of the WGSS questions in estimating the size of the overall disability population, we contend that results from this study necessitate a halt in the use of the WGSS questions to measure disability in US federal surveys.

Auditory and vestibular function in mitochondrial patients harbouring the m.3243A>G variant.

Hearing impairment is a frequent clinical feature in patients with mitochondrial disease harbouring the pathogenic variant, m.3243A>G. However, auditory neural dysfunction, its perceptual consequences and implications for patient management are not established. Similarly, the association with vestibular impairment has not yet been explored. This case-control study investigated in 12 adults with genetically confirmed m.3243A>G adults [9 females; 45.5 ± 16.3 years (range 18-66); 47.1 ± 21.5 hearing level, dB] compared with 12 age, sex and hearing level-matched controls with sensory (cochlear level) hearing loss [9 females; 46.6 ± 11.8 years (range 23-59); 47.7 ± 25.4 hearing level, dB]. Participants underwent a battery of electroacoustic, electrophysiologic and perceptual tests, which included pure tone audiometry, otoacoustic emissions, auditory brainstem responses, auditory temporal processing measures, monaural/binaural speech perception, balance and vestibular testing and self-reported questionnaires (dizziness and hearing disability). Our findings showed evidence of auditory neural abnormality and perceptual deficits greater than expected for cochlear pathology. Compared with matched controls with sensory hearing loss, adults with mitochondrial disease harbouring m.3243A>G had abnormal electrophysiologic responses from the VIII nerve and auditory brainstem (P = 0.005), an impaired capacity to encode rapidly occurring acoustic signal changes (P = 0.005), a reduced ability to localize sound sources (P = 0.028) and impaired speech perception in background noise (P = 0.008). Additionally, vestibular dysfunction (P = 0.011), greater perceived dizziness (P = 0.001) and reduced stance time (balance, P = 0.009) were also seen in participants with m.3243A>G mitochondrial disease when compared with matched counterparts. This pilot study revealed that auditory evaluation including evoked potential responses from the auditory nerve/brainstem and speech perception in noise tests should form an important part of the management for individuals with m.3243A>G-related mitochondrial disease. Those presenting with hearing impairment and symptoms concerning balance and dizziness should undergo vestibular testing and appropriate management.

A Non-Surgical Wearable Option for Bone Conduction Hearing Implants: A Comparative Study with Conventional Bone Conduction Hearing Aids Mounted on Eyeglasses.

This study aimed to compare the audiological benefits of a non-implantable wearable option for a bone conduction (BC) implant mounted on an arch (SoundArc) to those of traditional BC hearing aids (HAs) mounted on eyeglasses (BCHAs) in patients with moderate to severe conductive or mixed hearing loss. A preliminary cross-sectional observational prospective cohort study was conducted in the Tertiary Audiological Department, University Hospital. Fourteen adults with conductive or mixed hearing loss (PTA at 0.5-1-2-4 KHz = 67 ± 15 dB HL) who had been wearing conventional BCHAs mounted on eyeglasses for at least 3 years and had declined surgical implantation of a bone conduction hearing implant (BCHI) were included in the study. Unaided and aided pure-tone air conduction (AC) and bone conduction (BC) thresholds, as well as speech tests in quiet and noise, were recorded at baseline and in two different settings: with a BCHI mounted on SoundArc® and with their own BCHAs mounted on eyeglasses using two couplers. Participants completed questionnaires in both conditions, including the International Inventory for Hearing Aids (IOI-HA), the Hearing Handicap Inventory for Adults/Elderly (HHIA/E), the Speech, Spatial, and Qualities of Hearing Scale (SSQ), a 10-point visual analog scale (VAS), and the Fatigue Impact Scale (FIS). A significant functional gain was observed in both settings (p = 0.0001). Better speech perception in quiet and noise was observed with SoundArc compared to conventional BCHAs on eyeglasses (improvements in word repetition scores in noise: +19.3 at SNR +10 dB, p = 0.002; +12.1 at SNR 0 dB, p = 0.006; and +11.4 at SNR -10 dB, p = 0.002). No significant differences were found in IOI-HA, FIS, and HHIA/E scores. However, significantly better SSQ scores were reported for SoundArc in all domains (p = 0.0038). Although patients were accustomed to using BCHAs mounted on eyeglasses, the bone conduction wearable option of the BCHI (SoundArc) proved to be a viable alternative for adult patients with conductive or mixed hearing loss who are unable or unwilling to undergo BCHI surgery.

The Role of Hearing Difficulty: Cognitive-Communication and Speech-in-Noise Deficits in Adults Following Mild Traumatic Brain Injury

Purpose: Mild traumatic brain injury (TBI) has a high rate of occurrence across the lifespan. Following mild TBI (mTBI), perceived deficits in cognitive communication and hearing may be noted. This study aimed to determine if adults with a history of mTBI and hearing difficulty perceived greater degrees of cognitive-communication difficulty and performed poorer on a speech-in-noise task when compared to participants with mTBI and controls without reported hearing difficulty. Method: Adults aged 19–77 years with and without a history of mTBI were analyzed. Participants were divided into three groups: control ( n = 49), mTBI ( n = 22), and mTBI with hearing difficulty (mTBI-HD, n = 26). Perception of hearing difficulty was based on a score of ≥ 20 on the Hearing Handicap Inventory or a score ≥ 2 on the Adult Auditory Performance Scale. Self-perceived cognitive communication was measured using the Cognitive Difficulties Scale (CDS) and the La Trobe Communication Questionnaire (LCQ). Speech-in-noise performance was measured using the low-cue speech recognition threshold (SRT) from the Listening in Spatialized Noise–Sentences (LiSN-S) test. Results: Adults in the mTBI-HD group reported significantly greater degrees of cognitive-communication difficulties (higher CDS and LCQ scores) and exhibited significantly poorer speech-in-noise performance on the low-cue LiSN-S condition when compared to the control and mTBI groups. Results also revealed significant correlations between the LiSN-S low-cue SRT and perceived cognitive communication on the CDS. Conclusions: Results of the current study indicate that adults with a history of mTBI and hearing difficulty experience greater subjective cognitive-communication difficulties and perform more poorly on difficult speech-in-noise tasks than adults who do not experience self-perceived hearing difficulties. The results of this study support the consideration of hearing and cognitive-communication difficulties when determining appropriate speech, language, and hearing assessment, treatment, and intervention strategies for individuals following mTBI.

Modifiable dementia risk factors associated with objective and subjective cognition.

Early detection of both objective and subjective cognitive impairment is important. Subjective complaints in healthy individuals can precede objective deficits. However, the differential associations of objective and subjective cognition with modifiable dementia risk factors are unclear. We gathered a large cross-sectional sample (N=3327, age 18 to 84) via a smartphone app and quantified the associations of 13 risk factors with subjective memory problems and three objective measures of executive function (visual working memory, cognitive flexibility, model-based planning). Depression, socioeconomic status, hearing handicap, loneliness, education, smoking, tinnitus, little exercise, small social network, stroke, diabetes, and hypertension were all associated with impairments in at least one cognitive measure. Subjective memory had the strongest link to most factors; these associations persisted after controlling for depression. Age mostly did not moderate these associations. Subjective cognition was more sensitive to self-report risk factors than objective cognition. Smartphones could facilitate detecting the earliest cognitive impairments. Smartphone assessments of cognition were sensitive to dementia risk factors. Subjective cognition had stronger links to most factors than did objective cognition. These associations were not fully explained by depression. These associations were largely consistent across the lifespan.

Addressing Postpartum Care Challenges and Information Accessibility for Mothers With Hearing Disability: A Systematic Review.

Access to healthcare significantly impacts the health outcomes of individuals with hearing disability, underscoring the necessity for enhanced accessibility to health services. Despite this situation, there is a paucity of data regarding the provision of postpartum care for women with hearing disability. Understanding the unique experiences and needs of womenwith hearing disability is crucial for improving not only the health system but also the overall health of their families and, by extension, the broader community. In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 methodology was employed. Comprehensive searches were conducted across several databases, including PubMed/Medline, Scopus, BioMed Central, Cochrane Library, and Google Scholar. A total of 331 article titles and abstracts were screened based on Population/Intervention/Control/Outcome/Study/Time(PICOST) criteria, resulting in 12 articles being included in the final review. Among these, nine were qualitative studiesand three were quantitative, which were reviewed using the Caldwell framework. The findings from this systematic review indicate that motherswith hearing disability often face significant inadequacies and misunderstandings concerning the information and care they receive. These inadequacies lead to a tendency to avoid or delay seeking care, or to rely heavily on self-care practices. Additionally, it was found that healthcare professionals generally lack awareness and understanding of the specific needs of mothers with hearing disability.Future research should prioritize examining both the experiences of healthcare providers and motherswith hearing disability to develop interventions that can adequately address the needs of families with mothers with hearing disability. By doing so, the healthcare system can be better equipped to provide appropriate and effective care, ultimately improving health outcomes for these families.

Continuity of care and hospitalization frequency for ambulatory care-sensitive conditions after hearing-disability onset: a retrospective cohort study

We assessed the effect of continuity of care (COC) on the frequency of hospitalization for Ambulatory care-sensitive conditions (ACSCs) to estimate the impact of COC and hearing disability relative to the controls. This retrospective cohort study used claim data of Korean National Health Insurance Service – National Sample Cohort 2.0 DB. We used propensity score matching to determine a control group for the hearing disability group by age, sex, and the Charlson Comorbidity Index. The hearing-impaired group included 720 participants, and the non-disabled control group, consisting of individuals without any form of disability, had 1,423 individuals. We used the frequency of hospitalization for ACSCs during one-year follow-up as the dependent variable for Poisson regression. We measured COC with the Bice–Boxerman Continuity of Care Index (COCI); higher COCI values represent better continuity of care, with COCI values ranging from 0 to 1. Poisson regression showed that disability status modifies the effect of COCI on the incidence of hospitalization. COCI = 1 reduced hospitalizations in people with hearing disabilities (adjusted Incidence Rate Ratio [aIRR]: 0.30, 95% CI: 0.20–0.44) but was not statistically significant for controls. In the COCI = 1 group, the effect of disability was not significant(aIRR: 1.10, 95% CI: 0.83–1.44). Compared to people without disabilities, enhanced COC for people with hearing disabilities was more effective in preventing hospitalizations for ACSCs.

Students’ Specific Needs Frequently Presented in English Language Class in Ecuador: Attention Deficit Hyperactivity Disorder and Hearing Disability

Students’ Specific Needs Frequently Presented in English Language Class in Ecuador: Attention Deficit Hyperactivity Disorder and Hearing Disability

The relationship between Hearing Handicap Inventory for The Elderly – Screening Version (HHIE-S) Questionnaire Scores and Hearing Loss in The Elderly in Sukawati Village, Gianyar Regency

Background: Age-related hearing loss, or presbycusis, significantly impacts communication, social interaction, and cognitive function. This study examined the relationship between Hearing Handicap Inventory for the Elderly – Screening Version (HHIE-S) scores and hearing loss severity among the elderly in Sukawati Village, Gianyar. Methods: A cross-sectional study of 50 elderly participants aged 60 years and older was conducted. Data were collected using the HHIE-S questionnaire and pure-tone audiometry, and analyzed using Pearson’s correlation. Results: A strong positive correlation was found between HHIE-S scores and hearing loss severity (r = 0.896, p &lt; 0.001), indicating that higher scores correspond to more severe hearing impairment. Conclusion: The HHIE-S questionnaire is an effective tool for early detection of hearing loss in the elderly and is recommended for use in primary healthcare settings to enhance timely management and improve quality of life.

Sign Language Interpreting System Using Recursive Neural Networks

According to the World Health Organization (WHO), 5% of people around the world have hearing disabilities, which limits their capacity to communicate with others. Recently, scientists have proposed systems based on deep learning techniques to create a sign language-to-text translator, expecting this to help deaf people communicate; however, the performance of such systems is still low for practical scenarios. Furthermore, the proposed systems are language-oriented, which leads to particular problems related to the signs for each language. For this reason, to address this problem, in this paper, we propose a system based on a Recursive Neural Network (RNN) focused on Mexican Sign Language (MSL) that uses the spatial tracking of hands and facial expressions to predict the word that a person intends to communicate. To achieve this, we trained four RNN-based models using a dataset of 600 clips that were 30 s long; each word included 30 clips. We conducted two experiments; we tailored the first experiment to determine the most well-suited model for the target application and measure the accuracy of the resulting system in offline mode; in the second experiment, we measured the accuracy of the system in online mode. We assessed the system’s performance using the following metrics: the precision, recall, F1-score, and the number of errors during online scenarios, and the results computed indicate an accuracy of 0.93 in the offline mode and a higher performance for the online operating mode compared to previously proposed approaches. These results underscore the potential of the proposed scheme in scenarios such as teaching, learning, commercial transactions, and daily communications among deaf and non-deaf people.

Derived Amharic alphabet sign language recognition using machine learning methods

Hearing-impaired people use sign language as a means of communication with those with no hearing disability. It is therefore difficult to communicate with hearing impaired people without the expertise of a signer or knowledge of sign language. As a result, technologies that understands sign language are required to bridge the communication gap between those that have hearing impairments and those that dont. Ethiopian Amharic alphabets sign language (EAMASL) is different from other countries sign languages because Amharic Language is spoken in Ethiopia and has a number of complex alphabets. Presently in Ethiopia, just a few studies on AMASL have been conducted. Previous works, on the other hand, only worked on basic and a few derived Amharic alphabet signs. To solve this challenge, in this paper, we propose Machine Learning techniques such as Support Vector Machine (SVM) with Convolutional Neural Network (CNN), Histogram of Oriented Gradients (HOG), and their hybrid features to recognize the remaining derived Amharic alphabet signs. Because CNN is good for rotation and translation of signs, and HOG works well for low quality data under strong illumination variation and a small quantity of training data, the two have been combined for feature extraction. CNN (Softmax) was utilized as a classifier for normalized hybrid features in addition to SVM. SVM model using CNN, HOG, normalized, and non-normalized hybrid feature vectors achieved an accuracy of 89.02%, 95.42%, 97.40%, and 93.61% using 10-fold cross validation, respectively. With the normalized hybrid features, the other classifier, CNN (sofmax), produced a 93.55% accuracy.

Randomised Controlled Trial for the Evaluation of the Efficacy of the IDA's "Living Well" Online Counselling Tool in First-Time Adult Users with Hearing Loss.

Effective management of hearing loss through the use of modern hearing aids significantly improves communication and the quality of life for individuals experiencing auditory impairment. Complementary counselling of patients with hearing loss who will be fitted with hearing aids for the first time should be evidence-based and adapted to their individual needs. To date, several counselling protocols and tools have been developed. The aim of this randomised controlled trial study was to investigate the efficacy of the application of the IDA's "Living Well" counselling tool in first-time hearing aid users in terms of the degree of their hearing related handicap (using the Hearing Handicap Inventory (HHI)), their communication coping strategies (using the Communication Profile for the Hearing Impaired (CPHI)) and their overall satisfaction of the hearing aids (using a Likert scale). Both groups (the IDA and the control group) were fitted with hearing aids and received counselling for their hearing aids by the same audiologist. The IDA group attended an additional counselling session about communication coping strategies with the use of the "Living Well" tool. Both groups' participants were seen for their hearing aid fittings 4-6 weeks, 3 and 6 months after their fitting when the HHI and the CPHI were measured. Although there was not a statistically significant difference between the two groups for the primary and secondary outcomes, the IDA group did show a more consistent improvement of their HHI score and less frequent use of maladaptive strategies. The "Living Well" counselling tool proved to be a favourably received and helpful counselling tool in first-time hearing aid users.