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LESSON 36

The psychosocial impact of hearing loss

Year 1
Fall semester
Communication and Psychology in Healthcare
Psychosocial aspects
Duration: 9:17

Hearing loss affects not only thresholds but also communication, emotions, family and work life. In this lesson we cover communication difficulty and social isolation, listening effort and listening fatigue, stigma, the impact on family members, and the scales that measure these effects.

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Hello, and welcome to the AIHEAR Audiology Academy.
In this lesson we will learn how hearing loss affects communication, emotions, family life and work.
We will also look at listening effort and fatigue, stigma, and how these effects are measured.
Hearing loss affects not only the ear but also a person's communication, emotions and relationships.
The sum of these effects is called the psychosocial impact.
This example audiogram shows a loss in both ears that increases toward the high frequencies, from mild to moderately severe.
Of two people with the same audiogram, one may struggle very little while the other has to change their work and social life.
This difference depends on the person's job, environment, age at onset of the loss, and personality.
In children, even mild or one-sided losses can affect language development, school success and friendships.
The World Health Organization's World Report on Hearing, published in 2021, clearly shows the scale of the issue.
According to the report, more than one and a half billion people worldwide live with some degree of hearing loss.
For about four hundred thirty million of them, the loss is at a level that calls for rehabilitation.
By 2050, this number is expected to reach about two and a half billion, with more than seven hundred million people needing rehabilitation.
For such a common condition, the psychosocial effects also matter at the level of society.
People with hearing loss struggle most in noisy places and at busy tables where several people talk at once.
With high-frequency loss, a person hears speech but misses consonants such as s, sh and f; they hear but cannot understand.
Phone calls, television, and someone talking from a distance or with their back turned create extra difficulties.
Many people hesitate to keep asking for repetition and pretend to understand, which leads to misunderstandings.
On the speech banana, the example audiogram shows high-frequency consonants falling above the threshold line, out of hearing.
A person who struggles constantly may gradually start to avoid crowded gatherings, meetings and activities they enjoy.
Not answering the phone or leaving conversations to others are common avoidance behaviors.
This withdrawal can lead to social isolation and feelings of loneliness.
Especially in older adults, a strong link has been reported between hearing loss and loneliness and social isolation.
In later life, hearing loss is also recognized as one of the modifiable risk factors linked to cognitive decline.
We will cover this link in detail in the lesson on hearing loss and dementia.
With hearing loss, the signal reaching the brain from the ear may be incomplete and distorted.
The brain tries to fill in the missing parts from context and lipreading; this extra work is called listening effort.
The attention and memory spent on listening leave fewer resources for understanding and remembering what was said.
So even if a person repeats a sentence correctly, they may struggle to follow the rest of the conversation.
This all-day effort can lead to marked listening fatigue toward the evening.
Listening effort is studied with physiological methods such as pupil measurement, with dual-task tests and with questionnaires.
Hearing loss often brings embarrassment; the person fears the awkwardness of misunderstanding.
Worry about missing something in an important conversation raises anxiety.
Others speaking fast or with their back turned can cause anger and frustration.
Research shows a significant link between unsupported hearing loss and depressive symptoms.
The person may feel less capable than before, and their self-confidence may drop.
These are understandable reactions; the audiologist should notice them and refer to appropriate support when needed.
In many societies, a hearing aid may still be seen as a sign of old age or weakness; this is called stigma.
Fear of stigma makes it harder for people to accept their loss and tell others about it.
Studies show that years often pass between noticing a hearing loss and seeking help.
Small, in-the-ear devices can ease this worry somewhat, but real change comes from accurate information.
Yet many Deaf people who use a sign language, such as Turkish Sign Language, see deafness as a language and culture, not a deficit.
Respecting this view is also part of a psychosocial approach.
Hearing loss affects not only the person but also the people who talk with them every day.
Family members often have to repeat themselves, raise their voice and relay what was said.
Small issues such as the television volume can turn into tension at home.
Over time, family members may take on a go-between role for phone calls and appointments.
The difficulties experienced by family members are called third-party disability.
So whenever possible, it helps to include a family member in the assessment and counseling.
For working people, meetings, phone calls and open-plan office noise are the most common sources of difficulty.
Listening effort throughout the day can lead to marked fatigue at the end of the workday.
Some studies have reported more stress-related sick leave among employees with hearing loss.
In noisy jobs where warning signals must be heard, workplace safety is also an important issue.
Simple adjustments such as hearing technology, seating arrangements and communication strategies can make a big difference at work.
The audiogram does not measure psychosocial impact; for this we use scales based on the person's own rating.
The Hearing Handicap Inventory for the Elderly, or HHIE, and its adult version, HHIA, ask about the emotional and social impact of the loss.
The short ten-item version, HHIE-S, is widely used for quick screening.
The Speech, Spatial and Qualities of Hearing Scale, or SSQ, assesses speech understanding, localization and sound quality in daily life.
The Client Oriented Scale of Improvement, or COSI, focuses on the person's own communication goals; we will see it in later lessons.
Some of these scales have validated Turkish versions; before using any translation, check that the version has been validated.
A tip from practice: start the interview with an open question about the situations the person finds hardest.
Instead of yes-or-no questions, you can ask them to describe a recent moment when they struggled.
These answers reveal psychosocial effects that the audiogram does not show.
The difficulties a person describes in their own words are also the basis for setting shared goals.
The impact of hearing loss is not limited to the audiogram; the same audiogram can describe different lives.
Communication difficulty can lead to withdrawal, social isolation and loneliness.
The listening effort spent understanding an incomplete signal causes fatigue by the end of the day.
Family members and work life are affected too; scales and open questions help in the assessment.
Test yourself: What does listening effort describe?
The correct answer is B: the mental effort spent on understanding.
The attention and memory spent filling in an incomplete signal can lead to listening fatigue by the end of the day.
In the next lesson, with these effects in mind, we will see how to talk with patients: an introduction to counseling in audiology.
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Prerequisites

LESSON 04 Conductive, Sensorineural and Mixed Hearing Loss

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