FACTORS AFFECTING AMPLIFICATION USAGE IN YOUNG

ADULTS WITH CONGENITAL SEVERE TO PROFOUND

HEARING LOSS

By

Rekha G.M.

Dissertation submitted to the University of Kerala in partial

fulfillment of the requirements for the award of Degree of

Guided By:

Ms. Praveena Davis

NATIONAL INSTITUTE OF SPEECH AND HEARING

THIRUVANANTHAPURAM
NISH Library
2016
1111111111111111111111
0-71
 NATIONAL INSTITUTE OF SPEECH AND HEARING (NISH)

THIRUVANANTHAPURAM

CERTIFICATE

This is to certify that the dissertation entitled "Factors Affecting Amplification

Usage in Young Adults with Congenital Severe to Profound Hearing Loss" is a

bonafide record of independent research work done by Ms. Rekha G M under our

supervision duru 'T 2015-2016 as partial fulfilment for the award of the degree of

Master of Audiology and Speech Language Pathology (MASLP) of the University

of Kerala.

~
Ms.pr~ Ms.Sreebha Sreedhar

PRA(,~~'bAvIS (Co-Guide)
Head, ASLP
~ational Institute of Speech and Hearing
Kanmanal P.O., Thiruvananthapuram - 695 583
eRR No: A04980

Dr. Samuel N. Mathew

(Executive Director)
 DE CLARA TION

I hereby declare that this dissertation work entitled" Factors Affecting

AmplifICation Usage in Young Adults with Congenital Severe to

Profound Hearing Loss" is a bonafide record of the research work

done by me under the guidance of Ms. Praveena Davis (Guide) and

Ms. Sreebha Sreedhar (Co-Guide) that no part thereof has been

presented earlier for any Degree or Diploma or similar title of any

other universities.

C'iP
RekhaG. M.

Place: Thiruvananthapuram
 PfiDlCA 7 EiP TO

MYF55LOVfiD FAMILy
 ACKNOWLEDGEMENT

'WordS are not enougli to tlian{my £onfsliWa- my 'l(jTtfJand my Hero. J{is grace is sufficient for
me ana liis strenntli ma~s me perfect in my weaftness.

spent my 6 years of coffege life liere, tlie place tliat mad'e me wliat I am totfay. rz1i£
f}(ISJ{, I
experiences, ftnowfediJe ana memories tliat I haoe receivedfrom liere cannot 6e lJalued.

I express my gratitude to C])1{ 'l(:N Pa'Clitliransir -'Fonner executive director of :NISJ{. I also
express my sincere gratitude to ~ ~Iia-vtm Sir ana samuelSir for tlieir support atuf
encouragements ana prlYClid'iTtfJ sucli a nurturiTtfJenoironment to carry out our studies at :NISJf.

:No 'woras to express tlian~ to my guUfe... a'r4wena ma'am, a perfect guUfe and teaclierin a{{
senses. V really tried to sliape me a Cot... fJ1ian~ a Cotma 'amfor your patience, time, guUfance
ana motivation: it was a ~fediJea6Ce experience worfjTtfJ witli you ma 'am, you 6eiTtfJa{{
comforta6Ce ana approaclia6Cea{{ tlie times.

I woufi{ ~ to express my sincere tlian~ to Sree61ia ma'am, my c01JuUfefor Iierencouragement,

support ad fieCptlirougn.out tlie study. l'm grateful to lierfor a{{ the lieCpana guidance /pven to
compCetetliis wort slie lias 6een a source of tremendous inspiration and' IierinsifJlitfui comments
IialJeguid'etf me auriTtfJtlie course of my wort

I am exJremeCytfeEinlitea to extend. my lieartfe{t gratitud'e to lJ)r. ()Irlie (])riscofI for tlie wotufetjuf
questionnaire. I woufi{ also ~ to tlianftliim for gi'CliTtfJ me the permission. to adapt tlie
questionnaire to :Mafayafam.

I wouUf ~ to express my gratitud'e towards aff tlie participants ana tlieirparmts for tlieir RJna
co-operation ana encouragement wfticli IieCpeame in completion. of my wot{ana witliout them; I
wouUf not haoe compieted tliis wort

{am exJremeCytfeEinlitea to extend' my lieartfe& gratitud'e to a"rutmtfl sir, CIiitfa1'a mam, sUfi] mam,
SIiitCymam, fJ(pft mam, !J(eenamam, ~ft gopai man; Sapna mam aruf)f.nm fJopan sirfor IieCpiTtfJ
in tlie lJUfeorecordiTtfJana lJafufation.

I wouUf ~ to tlianftStI.flmY4 mam,Jeena mam, tfJinutlia!Mtnn, Swatliy mam,)f.rya CIiaruI mam,

Si:ta mam, Nama mam ana SrutUJ mam wlio supported me in the content validation. of tlie test.
fJ1ia~ to )f.1UU sit; 1Cunjamma mam, !Mura teaclier and ~ sirfor spendlTtfJtime to
moaify my material. fJ1ian~u foryour sUfJlJestionsana guidance.

}I note of tlian~ to staff of tJYF.1f.t at com, 1PEfJ'tP atuf msc sections in aOUwiTtfJme atuf IieCpiTtfJ
me
toJituf participants for my study.
I e~eruf my gratittuie to tDr. !Muralud1iaran wlio spent liis va{uaofe time for tlie statisticai
anafysis of my sttufy
I wouU also ~ to tlianftall tlie faculty mem6m of fNISJ{ for tlieir ctiticai advice and' guUfance
witliout wliicli tliis wort wouU not haoe been.possiofe and' to af{ myfacufties wlio taU{jlit me in
my graduation and' post graduation.

'Io my classmates, ~ .ftparrra, .ftnfra,)fJwatn.y, Jimi, Lameu cliiclii, !Monisli4 aruI srutli:y for
af{ your guUfance and for all tlie enjoyment, fun 'We fUu{ togetlierwliicli wi£[ remain as my S'WCet
memories. 71ianftyou for oeing ttiere witli me not onfy for tlie dissertation wo~ out for all tlie
gooa and' Oad tliings tliroU{jliout tliese years. flptWl, Lois,Lameu cIiedii, !Mom tliankyou soo
much: .

)l note of tlia~ to fl1Ule !Mtzmfor lier care, support and' advice wlienever needed aurin{j my
studies.

I wouU ~ tlianft our fi6rarian)l4tmra !Ma'am ana!MJmoj sirfor tier constant support ana liefp
in fi6rary tliroU{jliout my dissertation wo~

%itli rove I remember my (]3 L(j>classmates. I specially tlianft~ ~ ~ 1110' !Mm

aruI ~ for tlieir rove ana care.

5My sincere tlian~ to Sootty mofl11llI ana Satuffrya diecIiiiiii.for all tlie liefp ana support given to
me ana encouraging me a{ways. 71ia~ a rot to 6of/i.

I also sincerefy tlianftmy seniors)fmrit1i4 clieclii, !J{u61i4 clieclii ant! qeet/iu clieclii foryour
vafuaofe SUfJOestionsana liefp.

I wouU ~ to tlian/tall my dearest juniors from :NISJ{ wlio liave ta/ten part in tlie sttufy. 71ianft
you ~1i4, H41IUft4, fl~ tDcm4ana !l(9ny •....

I wouU ~ to e~eruf my tlian~ to !Mr.!Nmifrz!for liefping me in tlie video recording, editing ana
captioninlJ

5My sincere tlia~ to my favourite senior f(psmiyecliii for tlie prayers ana support .

.Jf/anuL .... 71iank..;you so mucli foryour Jrientfsliip, care, support, encouragement and' prayers. 'WiLT
aefinitefy miss all those oeautiJuf moments in class ... liostef. .... sliaring of {uncli, cliitcliats, jof<!s
tliat onfy we can understand. ...

Ji{Jy cMdiiiiiii .., No words to e~fain a60ut you.. ~y to liefp any time even in tlie midSt of your
aif.ficufties. 71iankyou sooo mucli cfiecliiiiii for tlie rove, care, prayer ana support you liave
retuferet{ to me.
}fnlia. ... Neoer I considered you as my junior; you are li/(f my Sis onfy. 'Woras won't 6e enoU{J1ito
ex:pressmy Iove ana gratituae to you. rzTianR..youso mucli dearfor your constant support,
inspiration; untiri11fJana unselfisli IieCpauri11fJiWerypliase of my stutfy.

*tli CoveJ remember myfamily for tlieir support, prayers ana care.jIlcli4 ana jIlmma .., 'WordS
just cannot convey tlie aeptli of my gratitu4e for a[[ tliat you liave donefor me, tfeepCyintfe6tetf to
youfor I am li'Cli11fJ, 6ut more because I am li'Cli11fJ wef{J It's myfortune tliat I am 6Cesseawitli tlie
6est parents in tlie wo~ honoured' to liave you as my parents. rzTian~u foryour uncorufitionaf
support witli my studies ana gi'Cli11fJ me a chance to prove ana improve myself tliroU{J1ia[[ tlie wa~
of my life. 1 'mgrateful ti£[tlie end.... Last 6ut not the feast i e~entf my sincere tlian~ to myaear
cliecli:iii,clietta ana my littCea11fJe(tfevu1.uuu.u. ... for 6ei11fJmy part of happiness.

fJ!J(MfJ( tYOV ..... 11

 TABLE OF CONTENTS

Page

LIST OF TABLES .i

LIST OF FIGURES ii

CHAPTER 1- WTRODUCTION 1

CHAPTER 2-REVIEW OF LITERATURE 5

Hearing 5

Hearing Loss 6

Types ofH acing Loss 6

Causes of Hearing loss 7

Classification of Hearing Impairment 8

Consequences of Hearing Loss 9

Early Identification and Intervention 13

Management of Children with Hearing Loss 14

Hearing Aids 16

CocWear Implants 16

Tactile Aids 17

Assistive Listening Device .17

Hearing Aid Usage .18

Outcome Measures 19
 Factors Affecting Hearing Aid Usage 21

Factors in Infants and Children 21

Factors in Adolescents .23

Factors in Young Adults .24

CHAPTER 3-METHOD 27

Aim 27

Objective 27

Participants 27

Inclusion Cri ria 27

Exclusion Criteria 27

Materials 28

Procedure 28

Phase 1: Cultural Adaptation and Validation of The Questionnaire .28

Phase 2: Data Collection and Data Analysis .29

CHAPTER 4- RESULT AND DISCUSSION .32

Background Information and Demographics '" .33

Hearing Aid Use .34

Hearing aid Service Experience 38

Opinions on Hearing Loss, Amplification and Hearing Services 39

 Factors Affecting Hearing Aid Use 43

CHAPTER 5- SUMMARY AND CONCLUSION .59

Limitation 60

Clinical Implication 60

Future Direction 61

REFERENCE 62

APPENDICES '" 76

Appendix A: Informed Consent Form - English 76

Appendix B: Informed Consent Form - Malayalam 78

Appendix C: FAHA Questionnaire 81

Appendix D: Video Record ofFAHA. in Sign Language 105

 LIST OF TABLES

Page

Table 2.1: Hearing Level Classification 9

Table 3.1: Distribution of the Samples According to the Age and Gender.. .31

Table 4.1: Participants Distribution in Group 1 and Group 2 .32

Table 4.2: Percentage, Mean, Median and Standard Deviation ofResponses .40
 LIST OF FIGURES

Page

Figure 4.1: Age of diagnosis and age of fitting in users and non-users .35

Figure 4.2: Responses Obtained for Statement 1.. .44

Figure 4.3: Responses Obtained for Statement 6 .45

Figure 4.4: Responses Obtained for Statement 7 46

Figure 4.5: Responses Obtained for Statement 12 .47

Figure 4.6: Responses Obtained for Statement 17 .49

Figure 4.7: Responses Obtained for Statement 22 50

Figure 4.8: Responses Obtained for Statement 27 51

Figure 4.9: Responses Obtained for Statement 34 .52

Figure 4.10: Responses Obtained for Statement 38 .53

ii
 CHAPTER!

INTRODUCTION

Hearing can be defmed as the capability to sense sound. The sense of hearing is

imperative for human beings. When the sense of hearing is impaired, the individual is at

a great disadvantage. The World health organisation (WHO), 2012defmes 'hearing

impairment' as the complete and partial loss of ability to hear, and "disabling hearing

loss" as, hearing loss greater than 40 dB in the better hearing ear in adults (15 years or

older) and greater than 30 dB in the better hearing ear in children (0 to 14 years)".

Hearing loss can vary depending upon the degree, type and age of onset of hearing loss.

Hearing loss varies from mild to profound based on the degree of hearing loss. It can be

conductive, sensory neural, or mixed hearing loss based on the anatomic location of the

problem and based on the age of onset, it can be congenital or acquired.

The World health organisation (WHO) 2012, estimates about 360 million

persons with disabling hearing loss, which accounts for 5.3% of the world's population.

Among the 360 million persons with disabling hearing loss, 328 million (91%) are

adults and 32 million (9%) are children. The National Sample Survey (NSS), 58th

round (2002) reveals hearing disability as the 2n<1nostcommon cause of disability and

top most cause of sensory deficit. According to the survey, it is also revealed that the

percentage of hearing loss is greater in rural areas (10% of all disability) than in urban

areas (9 % of all disability). There are also over 3.1 million persons with hearing

impairment affiicted with moderate or above severity in both the ears as revealed by the

survey. Among the persons with disabling hearing loss, about 32% had profound

hearing loss and 39% had severe hearing loss and about 7% of people were born with a

hearing loss. The incidence of hearing disability was reported to be 7 per 100000

populations as per the survey.

1
 The high prevalence rate indicates the need of early identification and

intervention of hearing loss. Neonatal hearing screening program is indented to detect

hearing loss at the earliest and thereby facilitate the early identification and

intervention. The main goal of early hearing detection and intervention (EI'ID!) is to

maximize linguistic and communicative competence and literacy development for

children who are hard of hearing. Children born with hearing loss can acquire and

develop spoken language if they are identified and fitted with appropriate hearing

technology early in their lives and receive quality intervention services (Clark, 2007).

Younger the age of diagnosis and intervention, better the development of spoken

language (White, 1997). Without appropriate opportunities to learn language through

appropriate rehabilitation, these children will fall behind their hearing peers in

communication, cogmtion, reading, and social-emotional development and such

delays may result in lower educational and employment levels in adulthood (Holden-

Pitt, 1998).

The consequences of hearing impairment also depend on the regular use of

hearing aids. But studies support the fact that many individuals with hearing

impairment are not regularly using their hearing aids as revealed by surveys

conducted in Germany, United Kingdom, Denmark, Australia, and United States on

hearing aid usage (Dillon et al., 1999; Lupsakko, 2005; Stark 2004).The success and

frequency of hearing aid use may be affected by several factors including discomfort,

motivation and financial factors (McCormack, 2013), which varies according to

different age groups.

The majority of research in this area has focused on the amplification use in

the neonates, infants, school age children and elderly population. When comparing

with primary school children, secondary school children are less likely to wear their

2
hearing aids (Clarke & Horvath, 1979). Factors like motivation, attitude play major

role in not using a hearing aid in higher age groups (McCormack, 2013). If a

secondary school aged student with severe to profound hearing impairment has

progressed to a stage where they consistently reject amplification, it seems plausible

that this pattern may continue into young adulthood, but there are only few or limited

studies that explore the factors that may affect whether young adults with hearing

impairment choose to use an amplification device. This is a particular group of

population that psychologist Jeffrey Arnett calls "emerging adults". Young adulthood

period is a more transitional period. That is moving from the education to job and

young hearing impaired adult faces various challenges in the field of education, job

and social living. Studies indicate that young persons with hearing loss in the United

States of America and Australia often find multiple challenges with tertiary education

and training, employment and career development, and independent living (Bullis,

Bull, Johnson & Peter 1995).

Most of the young adults with severe to profound hearing impairment show

lack of interest in wearing the hearing aid. The major reasons for the rejection of

amplification devices were psychosocial in nature and could be linked to the 'hearing

aid effect'. Specifically, these reasons related to cosmetic appearance, peer

acceptance, and low self-esteem (Cienkowski & Pimental, 2001; Johnson et al., 2005;

Kent & Smith, 2006).

With the presence of a large number of young adults with hearing impairment

in a developing country like India, it amounts to a severe loss of productivity both

physically and economically. Till date no studies have been reported regarding the

usage of amplification devices in young Indian adults. Thus there is a need to

investigate the factors affecting hearing aid usage in these young adults. Moreover a

3
comprehensive understanding of the factors affecting satisfaction and hearing aid

usage in young Indian adults with severe to profound hearing impairment is essential.

This will help us in increasing the awareness, ensuring optimal provision of

amplification, and improving the level of audiological support and counselling

provided to this population. Considering the major transitions that young adults face

from being dependent on and living with their parents to an independent life, and

from education to the work force, measuring their satisfaction with hearing device is

an important step in understanding and meeting the needs of this population.

Hence the study aims in investigating the factors affecting amplification use

in young adults with severe to profound hearing impairment.

4
 CHAPTER 2

REVIEW OF LITERATURE

Hearing

Hearing is one of the five senses. It is a complex process of picking up sound

and attaching meaning to it. The ability to hear is critical to understand the world

around us. Hearing is a complex sense involving both the ear's ability to detect sounds

and the brain's ability to interpret those sounds, including the sounds of speech.

The ear can be divided into three parts which are outer ear, middle ear and the

inner ear. The outer ear consists of the ear canal and tympanic membrane. Sound

travels down the ear canal, triking the tympanic membrane and causing it to move or

vibrate. The middle ear is a space behind the eardrum that contains three small bones

called ossicles. This chain of tiny bones is connected to the tympanic membrane at

one end and to an opening to the inner ear at the other end. Vibrations from the

tympanic membrane cause the ossicles to vibrate which, in turn, creates movement of

the fluid in the inner ear. Movement of the fluid in the inner ear, or cochlea, causes

changes in tiny structures called hair cells. This movement of the hair cells sends

electric signals from the inner ear up the auditory nerve to the brain. The brain then

interprets these electrical signals as sound.

The human ear is the only body part which is fully developed at the time of

birth. Even before birth infants respond to sounds.

5
Hearing Loss

Hearing loss, hearing impairment or deafness are similar terms used

interchangeably in literature. A handicapping hearing loss in a child is defined

as any degree of hearing that reduces the intelligibility of speech message to

degree inadequate for accurate interpretation of speech or as to interfere with

learning (Northern & Downs, 1984) Hearing impairment in children across the

world constitutes a particularly serious obstacle to their optimal development

and education, including language acquisition. It is approximated that 1.5 to 6

in every 1000 new-borns suffer from permanent congenital hearing

impairment (Fortnum, Summerfield, Marshall & Davis, 2001; Vohr, Simon &

Letourneau, 2000).

Types of Hearing Loss

There are mainly 3 types of hearing loss. Conductive hearing loss,

Sensorineural hearing loss, Mixed hearing loss.

Conductive hearing loss occurs when sound is not conducted efficiently

through the outer ear canal to the tympanic membrane and the tiny bones (ossicles) of

the middle ear. Conductive hearing loss usually involves a reduction in sound level or

the ability to hear faint sounds. This type of hearing loss can often be corrected

medically or surgically.

Sensorineural hearing loss (SNHL) occurs when there is damage to the inner

ear (cochlea), or to the nerve pathways from the inner ear to the brain. Most of the

time, SNHL cannot be medically or surgically corrected. This is the most common

type of permanent hearing loss.

6
 Mixed hearing loss is when, a conductive hearing loss occurs in combination

with a sensorineural hearing loss (SNHL). In other words, there may be damage in the

outer or middle ear and in the inner ear (cochlea) or auditory nerve.

Causes of Hearing Loss

Billings and Kenna (1999), in his study examined the causes of paediatric

sensorineural hearing loss, by reviewing the medical records of 301 children and

revealed that, of the 301 children, 68.1% had a definite or probable cause of their

SNHL identified. In 18.9% of children, one or more possible causes were reported

and in 31.9% no obvious causes were reported.

Hearing loss can be congenital or acquired and congenital hearing loss is

caused by genetic factors, maternal infections, prematurity, low birth weight, birth

injuries, toxins including drugs and alcohol consumed by the mother during

pregnancy, Rh incompatibility, maternal diabetes, lack of oxygen (anoxia) etc.

The common causes may include hypoxia, hyperbilirubinemia, very low birth

weight and ototoxic medications as reported by Roizen in 2003. Although meningitis

has decreased in frequency, it is still a risk factor for hearing loss. Cytomegalovirus

remains the most common congenital infection and a relatively common etiology of

hearing loss, which can be progressive. Preventable causes of hearing loss include

those caused by head trauma, noise, and ototoxic medications. Identification of the

etiology of hearing loss can facilitate the development of a treatment and management

plan.

According to Kochhar, A. J.,Hildebrand & Smith (2007), 60% of congenital

deafness has a primary genetic aetiology and the genetic causes of congenital hearing

7
loss include 75% are autosomal recessive, 20% are autosomal dominant, 4% are X-

linked, 1% are mitochondrial, 70% of genetic deafness is non-syndromic, 30% is

syndromic. In his study, he also reported that, Connexin 26 (GJB2) mutations are

found in 40% of infants with congenital hearing loss and congenital hearing loss due

to CMV accounts for another 40% of early identified hearing abnormalities. Also, he

reported that a variety of genetic syndromes such as, Branchio-oto-renal syndrome,

Pendred syndrome, Jervell and Lange-Nielsen syndrome, Waardenburg syndrome,

Usher syndrome, Mitochondrial based hearing loss may be associated with hearing

loss.

Grosse and Rosse (2007) reported that, approximately 14% of children with

congenital CMV infection develop SNHL of some type, and 3-5% develop bilateral

moderate to profound SNHL.

Classification of Hearing Impairment

The most commonly used classification system was given by Clark, in 1981 .

.The different grades of hearing impairment by Clarke, is presented in Table 2.1

8
Table 2.1

Hearing level classification by Clarke1981.

Degree of hearing loss Hearing loss range (dB Hl.)

Normal 10 to 15

Slight 16 to 25

Mild 26- 40

Moderate 41 to 55

Moderately severe 56-70

Severe 71 to 90

Profound 91+

Consequences of Hearing Loss

The consequences of hearing loss in children can be mainly classified into 2

broad categories as primary and secondary consequences. The primary consequences

mainly include the speech and language impairments and the secondary consequences

mainly include the Educational, Social, Psychological and Vocational consequences.

Congenital hearing loss will lead to lack of access to sounds during the critical

period which affects the child's ability to communicate and learn language. As a

result, their later development will also get affected. When a child is diagnosed as

having hearing loss, it places lots of pressure on the families. The quality of life of

these children will also get affected with its effect in literacy development, social

isolation and mental health issues. Together, all these difficulties will result in

reduced employment opportunities and limited vocational choice. The effects of

hearing impairment in each domain have been discussed below.

9
 Effect on speech: Children with atypical hearing often miss out auditory

information presented, thus they show delay in the development of speech skills .The

acquisition of speech skills follows, developmental pattern as the typical hearing

children but at a very slow rate. Hearing loss results in greater difficulty to perceive

consonants. It was also documented that highly visible, audible front vowels are more

likely to be articulated correctly than less audible and visible consonants. In addition

to this they also exhibit problems with vowel perception and production where they

will make only slight variation in vowel across all vowels .As vowel production

generates tactile resonance cues, the children with severe hearing impairment attempts

to prolong the vowel in order to monitor the output (Davis & Hardick, 1981) .Because

of this their vowel production will sound as diphthongs.

Besides the segmental errors, atypically hearing children also exhibit supra-

segmental errors. As there is an in coordination of phonation and consonant

production, they may cause inappropriate voicing (Ling, 1989).The voice quality of

atypically hearing children is mainly found to be harsh, breathy, strident and strained.

Inappropriate rhythm, monotonous speech, loud and hyper nasal speech is often

observed.

Effect on language: Communication through verbal mode occurs when the

sender formulate ideas, requests, comments and selects, arranges and delivers the

message to the receiver. When a receiver hears the words or sentences properly and

interprets it, effective communication takes place. But when hearing loss exists, the

transmission of spoken message from sender to receiver doesn't take place due to the

audibility issues. Children with hearing impairment doesn't get access to auditory

feedback, so there is a reduction in vocal play which in turn will cause less

reinforcement of the parent's attempt to communicate with the child. The impact of

10
hearing loss on language and learning is dependent on factors like age of

identification of hearing loss, degree of hearing loss, amplification device used,

intellectual capabilities, style of communication. The development of language skill is

likely to be delayed and different from that of the typical hearing children.

Effect on literacy skills: Literacy skills have a marked importance in reading

and writing prior to receiving formal education (Most, Aram & Andorn, 2006). These

skills are primary determinants which will influence educational achievements and

academic success (McDonald & Thomley, 2009). It has been well researched that

children with atypical hearing perform poorly on literacy measures (Mayer, 2007) and

fall below their typical hearing peer groups. Phonological awareness (James, Rajput,

Brinton & Goswami, 2009), print knowledge «Kyle & Harris, 2011) and definitional

vocabulary (Johnson Goswami, 2010) are found to be the early predictors of

literacy development. children with hearing impairment have shown significant gaps

in literacy development (Wauters & van on, 2006) and this is mainly attributed to

the fact of late identification of hearing loss.

Effect on personal development: As any individuals, atypically hearing

individuals also show same range of emotions as typically hearing individuals.

Individuals with hearing impairment are described as impulsive, passive, dependent,

egocentric, inflexible, and immature. The behavioural problems exhibited by these

individuals are not only because of their of hearing problem, rather the impact of

hearing loss which is pronounced on communication, language, reactions to hearing

loss, peer relation, home and learning environment which in turn affects their psycho

social development. In spite of all the technologies available, individuals with hearing

impairment still experience difficulty in functioning like their peer groups.

11
 Children with hearing impairment are shown to experience affected

socialization skills. The other factors which are responsible are age, gender, degree of

hearing loss, communication skills, educational or occupational settings. A child who

is attending mainstream education will feel, as if the child is less popular and will find

it difficult to engage in interactions with others. If a child is diagnosed as having

hearing loss late, it will not only lead to poor language and academic skills but also

leads to lack of motivation, feelings of frustration, inadequate social skills through

poor social competence.

Effect on cognitive development: The primary consequence of childhood

deafness is that it blocks the development of spoken language, both the acts of

speaking and comprehending. This fact leads us to ask what spoken language

contributes to the child's cognitr e development. Because deafuess impedes the

development of spoken language, we must ask whether complex and logical thought

can develop in the absence of spoken language. Co ition has been referred to ability

to acquire and organize knowledge and using this knowledge through acts like

thinking, recalling, and reasoning. It is found that development of cognitive skills

follows the same developmental pattern as in typically hearing children but at a

slower rate. When short term memory is considered, it is found that it is dependent on

factors such as degree of hearing loss, intelligence, communication system used by

the individual, and the speech skills of the person.

Auditory experience is not found to influence short term memory directly.

Audition affects short term memory because it has a principal role in spoken language

acquisition.

Language familiarity determines how well words can be recalled. Children

with hearing impairment are found to show reduced attention span for written words

12
as compared to typical hearing children. The short term memory of children with

congenital hearing loss is predicted by factors such as degree of hearing loss and

degree oflanguage development (Conrad, 1970). But when asked to recall nonsense

figures they performed on par with typical hearing children.

Early Identification and Intervention

Hence in order to minimize the consequences of hearing loss in the diverse

areas arises the importance of early identification and early intervention. Early

intervention is effective in preventing or minimizing the negative impact of hearing

loss on speech and language development (Calderon & Naidu, 1999; Kennedy et al.,

2006). However, it is likely that early identification will result in developmental

advantages for children only if the process is linked to timely and effective

interventions. The American Academy of Paediatrics (AAP, 2010) and the Joint

Committee on Infant Hearing (JCIH, 2007) have recommended the following "1-3-

6" benchmarks for follow-up: (a) provide com lete newborn hearing screening (NHS)

before 1 month of age, (b) diagnose hearing loss before 3 months of age, and (c) enrol

those identified with hearing loss in early intervention before 6 months of age.

There are several studies in the literature which supports that early

identification and intervention results in better overall development in children. White

and White (1987) reported significantly better oral language outcomes ofEID (early

identified group) children in a group of 46 deaf infants up to 36 months of age; 14 of

the 46 infants were EID (prior to 12 months). The EID group began intervention

services by 12 months of age, but the average age of obtaining hearing aids in this

EID group was 20.5 months for those with deaf parents and 28 months for those with

hearing parents.

13
 Apuzzo and Yoshinaga-Itano, (1995) ; Robinshaw (1997) reported that

significantly better language outcomes of infants identified with hearing loss

the first 6 months oflife. The sample sizes ofEID children (n = 14; Apuzzo &

Yoshinaga-Itano, 1995) and (n = 5; Robinshaw, 1997) were small.

Yoshinaga-Itano et al., 1998 compared the language abilities of earlier-

and later-identified hearing impaired children. They compared the receptive

and expressive language abilities of 72 deaf or hard-of-hearing children whose

hearing losses were identified by 6 months of age with 78 children whose

hearing losses were identified after the age of 6 months. All of the children

received early intervention services within an average of 2 months after

identification. The participants' receptive and expressive language abilities

were measured using the Minnesota Child Development Inventory. The results

indicate that children whose hearing losses were identified by 6 months of age

demonstrated significantly better language scores than children identified after

6 months of age. For children with normal cognitive abilities, this language

advantage was found across all test ages, communication modes, degrees of

hearing loss, and socioeconomic strata. It also was independent of gender,

minority status, and the presence or absence of additional disabilities.

Management of Children with Hearing Loss

Early identification and intervention of the hearing loss will diminish the delay

in the speech and language skills. According to ASHA (1997), children identified

with hearing loss and who begins services before 6 months develop language on par

with their hearing peers. Reduced or decreased hearing in infancy is thought to

interfere with the child's developmental period! critical period as they don't receive

14
adequate auditory, linguistic, social stimulation which is required for language

development, social and emotional development.

The use of amplification devices during the critical period helps them to assist

to get the auditory information. The critical period refers to a time when the brain is

particularly plastic for learning new information early in life (McDonald-Connor et

al., 2006). It is assumed that the brain is particularly sensitive to sounds from birth to

three years. This is the time when new neural connections are formed with stimulation

and the input from the external environment will also lead to the foundation for

speech and language development (McDonald-Connor et al., 2006).

New neural connections are constantly being generated and children

experience a large burst in neural connections that helps to lay the foundations for the

development of speech and language skills. When auditory input is interrupted during

the early development, the morphology and functional properties of the neurons in

central nervous system break down. Hence auditory deprivation occurs and it is

referred to as significant decrease in ear's ability to understand speech and decrease in

hearing ability caused due to limited auditory input. It occurs when the brain no

longer receives enough auditory input which makes it harder for the individuals to

recognize sounds even after providing amplification device. If the brain is deprived of

auditory stimulation for long, the brain gradually lose the ability of auditory

processing.

When a child is being diagnosed as having hearing loss, the immediate step to

follow is the fitting of appropriate amplification device. The technologies which are

available for a child diagnosed with profound sensorineural hearing loss include the

use of hearing aids, cochlear implants, and assistive listening devices.

15
Hearing Aids

Hearing aids are electronic devices that collect sound, amplify it, and direct

the amplified sound into the ear. Hearing aids are provided for almost all types of

hearing loss. There were six types of hearing aids which were named according to,

where it was worn. They are namely Body worn, behind the ear, in the ear, in the

canal, completely in the canal and eye glass aids (Mueller, Johnson & Carter, 2007).

The most commonly used type of hearing aid for infants and children is the behind the

ear type which consists of the components housed in a small crescent shaped case that

is worn behind the ear. The hearing aid is worn with an ear mould which is fitted into

the ear canal and it is an acoustic coupling device which is meant to deliver sound to

the hearing aid. The main purpose of any hearing aid is to amplify the sounds so that

the listener can dete it. The hearing aid mainly consists of microphone, amplifier,

receiver and battery. Modem technologies in hearing aid offers sophisticated signal

processing strategies to fine tune and to make adjustments according to listener's

requirement.

Cochlear Implants

In the modem medicine cochlear implant is considered as a successful story.

In the past, that is before thirty years cochlear implant were devices which provides

little more than a sensation of sound and were useful as an aid to lip read. Later on

with technological advancement, devices were designed with multiple channels which

aid in more speech understanding.

It's not necessary that all individuals will benefit from hearing aid. Some

individuals have only little residual hearing and will fail to recognize the auditory

signals presented how much ever it is ampiified. So cochlear implant is the latest

16
technology which is found to provide better development of speech and language

skills and persons who doesn't benefit much from a hearing aid.

A cochlear implant is a device which replaces the hair cell transducer system

by stimulating the auditory nerve directly bypassing the damaged hair cells. The nerve

impulses are then delivered to the brain via the auditory pathway.

Tactile Aids

Tactile aids are mainly used with children who are having higher degree of

hearing loss and used when the child doesn't benefit from conventional hearing aid. It

consists of two types namely the vibrotactile and the electro tactile aids (Osberger,

1993). Vibrotactile devices enable the child to feel the vibration of sounds under the

skin .Electro tactile device on the other hand provides electrical pulses to the skin. It is

worn in the wrist, abd men, and fingers.

Tactile devices are mainly found to enhance the reception and the production

of supra segmental of speech. The skin i mostly sensitive to low frequency signals,

so in order to identify a high frequency affricate, they rely on the cue provided with

the position of fmgers. As with any amplification device, tactile device also require an

intensive training which has to be undergone by the user (Osberger, 1993).

Assistive Listening Device

An assistive listening device is any type of device that can help you function

better in your day to day communication situations. An ALD can be used with or

without a hearing aids to overcome negative effects of distance, background noise,

poor room acoustics(ASHA).There are many types of assistive listening device like

FM systems, hardwire systems, induction loop systems, infrared systems, visual

alerting devices, telephone devices.

17
 An ALD is not a hearing aid. It consists of components like microphone,

amplifier, and loudspeaker as in the hearing aid. The microphone of the ALD can be

placed near the source of sound.

Hearing Aid Usage

Hearing aids are the primary therapeutic options available for hearing

loss. It is estimated that in developing countries, about 20% of people who

have hearing loss require hearing aids, suggesting 72 million potential hearing

aid users worldwide. However, current production of hearing aids meets less

than 10% of the global need (World health organization, 2011).

In the 1980s, (pre-digital hearing aid era) in a follow up study of 150

people fitted with a hearing aid in Finland, 23% reported never wearing their

hearing aid two years after they had been fitted (Sorri et al, 1984). The reasons

given included trouble handling the aid and little opportunity to converse with

others. hearing aid ownership and regular use of hearing aids has been found

to be low (popelka et al, 1998) and the numbers of people given a hearing aid

who do not wear it/them ranges from 4.7% (Hougaard & Ruf, 2011) t024%

(Hartley et al, 2010).

Brooks (1985) also found that reasons given for non-use of hearing

aids included difficulty inserting the ear mould, difficulty coping with signals

in noise, lack of recognition of hearing loss, advanced age and poor health,

and less than ideal matching of the aid to the loss of hearing. It might be

expected that nearly three decades later, reasons for non-use of hearing aids

might be quite different, especially given the improvements in hearing aids

typically available. Digital hearing aids now offer a number of advantages

over analogue hearing aids including increased comfort; digital feedback

18
reduction; digital noise reduction; digital speech enhancement, automatically

switching listening programmes, directional microphones, and remote controls, as

controls, as well as smaller size and open fit design. Benefits of digital hearing aids

also include improved sound quality, multiple listening programs for different

listening environments, compatibility with remote control options, and flexibility in

manipulation of the frequency, compression, and gain (Davis, 2001). As such,

audiologists now have greater flexibility in choosing appropriate technology for the

needs of older adults. But surveys conducted in Germany, the United Kingdom,

Denmark, Australia, and the United States have reported that between 1 and 40% of

hearing aids dispensed are never or scarcely used (Lupsakko & Kautiainen, 2005;

Stark & Hickson, 2004).

It indicates that everal factors may be affecting the frequency of hearing aid

use and its success. Like discomfort, motivation, fmancial factors etc. (McCormack,

2013). Those factors affecting hearing aid u age is not similar to different age groups.

As age increases there are several factors like motivation, attitude etc. which affects

the usage of hearing aids. The majority of research in this area has focused on the

amplification use in the neonates, infants, school age children and elderly population.

But there are only few or limited studies that exploring the factors that may affect

whether young adults with hearing impairment choose to use an amplification device.

Outcome Measures

Hearing aid benefit refers to the difference between a patient's status with and

without a hearing aid. The challenge for the audiologist who fits hearing aids is to

demonstrate that observed changes in the patient's status, are due to hearing aid

treatment effects. It is up to the patient to decide whether in fact the benefit is

significant enough to warrant the substantial fmancial outlay currently associated with

19
available technology. Monitoring the hearing-related outcomes in individuals with

hearing loss can be accomplished both objectively and subjectively.

One example of an objective measure is the use of aided sound field

thresholds (ASFT). ASFT can be conducted in the sound field with the individual

wearing his or her hearing aids. This measures the individuals' aided ability to detect

low-level sounds, and is considered an objective measure. Limitations of ASFT

include the impact of room and hearing aid circuit noise, off-frequency listening with

steeply sloping hearing losses, and patient responses to low-level sounds do not

provide an indication of performance to moderate levels (Hawkins, 2004).

Questionnaires, diaries, and structured interviews are examples of subjecti ve

ways to assess the individual's auditory behaviours in real world environments.

Subjective measures focus on the person's responses to various sounds in real-life

situations. Questionnaires are more appropriately administered in the native language

of the family and there may be challenges for caregivers who have literacy issues

(Johnson & Danhauer, 2002). These barriers can be overcome through the use of

questionnaires in various languages or administering the tool interview style. Overall

this type of outcome measurement provides rich and important information that can

support the more objective tests that clinicians perform as well as being more

applicable to individuals with complex needs.

Some of the subjective outcome measures:

The Hearing Performance Inventory for Children (HPIC): It is developed by

Kessler et al (1990), is a self-assessment instrument for children (ages 8-14 years) that

samples a child's perceived communication difficulties in a variety of academic

environments. The primary goal of this test is to develop a personal profile of difficult

academic communication situations to aid in the design of an individualized

20
management program. The test consists of 31 test items depicting a variety of typical

classroom listening situations (e .g. hearing the teacher when his/her face is not

visible).

Abbreviated Profile of Hearing Aid Benefit (APHAB): Kopun and

Stelmachowicz (1998) adapted the APHAB, developed by Cox and Alexander (1995),

to be appropriate for children in the 10- to IS-year age range. Parents also were given

the test in order to assess the parent's perception of the child's communication

problems.

Satisfaction with Amplification in Daily Life (SADL): SADL, a self-report

measure developed by Cox and Alexander (1999), fulfils the need for a clinically

viable tool, which assesses the multidimensional nature of satisfaction. The scale

consists of 15 questions elated to aspects of hearing aid use. SADL items were

determined based on key satisfaction issues raised during interviews with hearing aid

users (Cox & Alexander, 1999).

Client Satisfaction Survey (CSS): CSS features ten items relating to hearing

aid use, and hearing aid difficulties and benefits, which are measures of hearing aid

success that are considered independent of, but related to, satisfaction (Hosford-Dunn

& Halpern, 2001).

Factors Affecting Hearing Aid Usage

The majority of research in this area has focused on the amplification use in

the neonates, infants, school age children and elderly population.

Factors Affecting Hearing Aid Usage in Infants and Children

Hearing aid use can be more difficult to establish at earlier ages, infants wear

their hearing aids for fewer hours per day and have more variable use than older

children (Walker et al., 2013).

21
 Moeller and colleagues (2009) completed one of the first studies of device use

in children. Seven children who were identified with hearing loss prior to 6 months of

age and received hearing aids by 7 months of age and their mothers participated. A

parent questionnaire was used to assess hearing aid use at four different age intervals

during early childhood between 10.5 and 28.5months of age. The questionnaire asked

mothers to rate their child's hearing aid use in different listening situations (play time,

book reading, in the car, etc.). The data showed several important trends. First,

hearing aid use increased as the children grew older. Second, hearing aid use was

highly variable across the seven children, depending on the listening situation. The

mothers in the study responded to open-ended questions about challenges in

establishing hearing aid use; many reported challenges related to different listening

situations and their chi's temperament.

Data reported by Jones and Launer (2011) also suggested that hearing aid use

was not consistent for many children. Hearing aid use increased as a function of age,

but 40% of children in their study used their hearing aids for 4 hours or less each day

based on a centralized data base of data logging measures collected by a hearing aid

manufacturer. Similarly, Munoz and colleagues (2014) reported that the median

number of hours of hearing aid use for a group of young children to be approximately

5 hours per day. Hearing aid use varies as a function of the child's age with the

amount of hearing aid use generally increasing as children increase in age (Jones &

Launer, 2011; Moeller et al., 2009; Mufioz et al., 2014; Walker et al., 2013). The

birth-to-two age group is particularly challenging in terms of consistent hearing aid

use. Infants have a limited number of waking hours each day, as they sleep 14.2 hours

per day on average (Iglowstein, Jenni, Molinari, & Largo, 2003).Thus, children fit

with hearing aids before 6 months of age would be expected to have limited hearing

22
aid use. Additionally, Walker and colleagues (2013) reported a decline in hearing aid

use between 6 and 12 months, which could potentially be related to the development

of the pincer grasp that allows infants to remove their own hearing aids.

Understanding and anticipating age-related developmental challenges toward

consistent hearing aid use can help providers create practical and realistic goals for the

family (Moeller et al., 2009).

Children with greater degrees of hearing loss tend to wear their hearing aids

for a greater number of hours per day than children with lesser degrees of hearing

loss. Specifically, previous research by Walker et al. (2013) and Munoz et al. (2014)

both indicate a greater number of hours of hearing aid use per day in children with

moderate or severe hearing loss than in children with mild hearing loss.

Children from economically disadvantaged backgrounds face challenges in

tenus of access to services and their overall development (Boyle et al., 2006).Beyond

potentially being identified and fit with hearing aids at later ages, children from lower

socioeconomic status households may also experience limited hearing aid use (Walker

et al., 2013). The number of hours of hearing aid use decreases as the family's

socioeconomic status decreases (Walker et al., 2013).

Factors Affecting Hearing Aid Usage in Adolescents

Wh n comparing with primary school children, secondary school children are

less likely to wear their hearing aids (Clarke & Horvath, 1979). Factors like

motivation, attitude play major role in not using a hearing aid in higher age groups

(Cormack, 2013). If a secondary school aged student with a severe to profound

hearing impairment has progressed to a stage where they consistently reject

amplification, it seems plausible that this pattern may continue into young adulthood,

23
but there are only few or limited studies that explore the factors that may affect

whether young adults with hearing impairment choose to use an amplification device.

Factors Affecting Hearing Aid Usage in Young Adults

The definitions of young adults are poorly defined. Adolescents and young

adulthood is the combined cohort of 10 to 24 years old (WHO). At the upper end of

the young adulthood age range are "older young adults" age ranges 18 to 24 years.

This is a particular group of population that psychologist Jeffrey Arnett calls

"emerging adults". Young adulthood period is a more transitional period. That is

moving from the education to job. And young hearing impaired adult faces various

challenges in the field of education, job and social living.

Technology has improved dramatically in recent years; there is little

information available about young persons' use of and satisfaction with hearing aids.

There are only limited studies in this area and the limited studies related to hearing aid

usage in young adult are conducted in foreign countries. At present there is no

research related to this area conducted in India.

Of the approximately 34.5 million persons in the United States with hearing

loss, nearly 2.5 million are young adults between 18 and 35 years of age (Fabry, 2011;

Kochkin, 2001, 2005, 2009; Kochkin et al., 2010). Roughly 25o/00fthe U.S.

population uses hearing aids (Fabry, 2011; Kochkin et al., 2010), but only 11% of

those between 18 and 35 years of age have adopted hearing instruments, indicating

that young adults may be reticent toward using amplification (Kochkin, 2005).

Carlie Driscoll (2007) conducted a preliminary study in this area. This

preliminary study was aimed to investigate satisfaction with amplification and hearing

services experienced by young Australian adults (with profound hearing impairment)

through self-administration of the Factors Affecting Hearing Aid Use in Adults

24
(FARA) questionnaire. Opinions were gathered from 25 subjects (15 male and 10

female), with a mean age of22.73 years (SD = 2.03, median = 22.25). Overall, it was

revealed that a considerable proportion of respondents (83%) were satisfied with their

amplification devices, yet only 48% agreed that their hearing centre provided an

excellent level of service. Additionally, several significant differences n opinion

regarding certain domains of satisfaction were found between hearing aid users and

nonusers. Findings from this investigation suggest there are several areas that health

care professionals could target for improvement in service provision and related

policy development. Specifically, these include: (1) sound quality of aids, (2) tinnitus

retraining therapy and education, (3) aid cosmetics, (4) public perception of

dispensers' motivation, and (5) listening stress-management techniques.

Cameron et al. (2 8) administered the 79-item Factors Affecting Hearing Aid

Use in Adults (FAHA) questionnaire (Driscoll & Chenoweth, 2007) to 57 participants

in Australia between 20 and 26 years of age. Items on the FAHA were rated from

Strongly Disagree to Strongly Agree using a Likert-scale. The participants were a

combination of previously collected data from a statistically underpowered,

preliminary study, and a new group that was solicited with the help of Australian

hearing loss support networks. They found that 35% of their respondents discontinued

hearing aid use between the ages of 12 to 15 years, but 49%said that they "would like

to wear their hearing aids more often." They found that hearing aid users' and non-

users' responses were significantly different on seven items on the survey, which

suggested that non-users were more likely to believe that: (a) they did not hear better

with their hearing aids on (63 %), (b) they did not like the sound quality of hearing

aids (50%), (c) hearing aids gave them headaches (58%), (d) hearing aids made

background noise too loud (50%), (e)hearing aids were too much hassle (53%), (f)

25
hearing aids were out of their control (55%), and (g) their parents made them go see

an audiologist (46%).

Cameron et al. (2008) found differences between users and non-users

regarding their opinions about sound quality with and control over hearing aids.

Cabernet al. (2008) only assessed persons with severe to profound hearing losses and

their reasons for discontinuing or refusing amplification, which may differ for those

having less severe hearing losses.

Danhauer, 2012 had administered the SADL questionnaire to 114 participants

in young adults (18 to 35 years of age). Cox and Alexander (1999) developed the

Satisfaction of Amplification in Daily Life (SADL), which users can complete after

sufficient acclimatization with amplification. Subscale scores are useful in helping to

determine, on an individual basis, areas in which hearing aid users would like to see

improvements made in their devices. The purpose of his study was to survey young

adults' hearing aid to compare them to existing norms based mainly on middle-aged

to elderly patients. An Internet questionnaire was administered to potential

participants. Although they rated their hearing aid satisfaction significantly poorer

than norms on the Service and Cost and Personal Image subscale and Global scores,

these young adults were generally satisfied with their hearing aids. Based on their

findings Danhauer suggest that, separate norms on the SADL may need to be

developed for young adults.

26
 CHAPTER 3

METHOD

Aim

The present study aims in investigating the factors affecting amplification use

in young adults with severe to profound hearing impairment.

Objective

The objective of this study is to explore the factors affecting amplification use

in young adults.

Participants

The participants included in the study were 94 young adults within the age

range of 18 to 24 years (with mean age of 21.04) diagnosed as having bilateral severe

to profound hearing impairment, which include 23 females and 71 males.

Inclusion Criteria

Participants for the present study were individuals within the age range of 18

to 24 years having congenital severe to profound hearing loss (PTA >70dBHL). All

participants should have a "A' type tympanogram and absent reflexes. All the

participants must have used their hearing aid continuously at least in one ear for a

minimum period of 2 years at some point in their life time.

Exclusion Criteria

Individuals with any kind of associated conditions such as intellectual

disabilities, motor problem, visual impairment, any neurological conditions and

acquired hearing loss were excluded from the study.

27
Materials

FAHA (Factors Affecting Hearingaid use in Adults) questionnaire prepared

by Driscoll C in 2007 examines the factors that affect hearing aid use in young adults

with profound hearing impairment was adapted with permission. The tool consists of

79 items in eight separate sections: general information, hearing history, about the

individual, individual's opinion about hearing aids, educational & family history,

changes required, other issues, and about the questionnaire.

Culturally adapted FAHA questionnaire was used for the present study. The

prepared Sign Language video of the questionnaire was also used as material for those

individuals who communicate through sign language to elicit the responses.

Procedure

The study was carried out in two phases:

Phase 1

Cultural adaptation and validation of the questionnaire: The forward

translation of the FAHA questionnaire (into Malayalam) was done by a linguist.

Minimal cultural adaptation was done. The backward translation was done by another

linguist.

Linguistic validity and content validity was done. Linguistic validity of the

adapted questionnaire was done by a linguist whose mother tongue is Malayalam, and

also provisioned in English. Content validity of the questions were evaluated by

getting it rated from 5 audiologists, who are experienced in the assessment and

management of individuals with hearing loss. Each statement in the questionnaire was

rated based on relevance, language appropriateness, grammatical structure,

28
appropriateness of rating and comprehension in a 5 point Likert scale (0% relevance,

25% relevance, 50% relevance, 75% relevance, 100% relevance). The statements

rated as 50% relevant by 70% of the professionals were considered for the study and

other statements were avoided from the questionnaire.

The adapted FAHA Questionnaire (Appendix C) consisted of 25 questions and

46 statements, which is branched under seven domains as general information,

Information related to hearing skill, about yourself, opinion about hearing aid,

education and family history, expecting changes, and other problems.

The adaptation and validation of the FAHA questionnaire into Indian Sign

Language was done. The each statement and questions in the questionnaire in Indian

Sign Language (ISL) w video recorded by three A level sign language interpreters.

The three video recorded versions were assessed by five, A- level sign language

interpreters and two sign language users (individuals with hearing impairment), for

the reliability. Each section in the questionnaire was rated for the validation by the

above experts in the field of sign language. Each section in the questionnaire was

evaluated based on easy to comprehend, appropriates of signs, grammatical structure,

concept delivery and clarity of signs. Scoring was done and the video recordings

scoring a minimum of 65% score from all the experts were selected as the fmal

material for the study.

Phase 2

Phase 2 was consisted of data collection and data analysis.

Data collection: A total of94 participants were selected for the present study.

The informed consent was obtained from each participant prior to the administration

of the questionnaire (Appendix AI B). Pure tone audiometry and immittance

29
audiometry was administered in all the participants except those who had their

audiological evaluations within six months period. Each participant had to mark their

perceptions in the hard copy of the adapted questionnaire that was handed over to

them. Both forward and backward materials (Malayalam and English) were provided

to all the participants for better comprehension of the questionnaire. The video

recorded sign language version of FAHA questionnaire (Appendix D) was projected

to elicit the responses from the participants who communicate through sign language.

The participants who were relying on sign language as their mode of communication

were divided into smaller groups and were seated in a common room for data

collection. Sign Language interpreter was available to clarify doubts during

administration of the questionnaire. Parents of all the participants were interviewed

for collecting identific ions and intervention details.

Data analysis: The responses to questionnaire items were either discrete yes!

no questions, or need to select answers from a choice. The section on 'opinions on

hearing loss, amplification and hearing services' participants were required to rate

their responses on a 5 point Likert scale ranging from strong disagreement to strong

agreement (strongly disagree, disagree, not sure, agree, strongly agree) for better

quantification of data.

The data obtained from each participant were recorded and percentages of the

factors affecting hearing aid usage in the participants were obtained. The whole

participants were divided into two groups, group 1 and group 2 for the purpose of

better analysis. Group 1 is hearing aid users, included those individuals use their

hearing aids regularly (25 participants in which 18 were males and 7 were females)

and group 2 is composed of Non-users, it include individuals who were stopped their

hearing aid usage at some point of their life time due to any reason, at present they are

30
not using any type of amplification device. (69 participants in which 53 were males

and 16 were females). The distribution of the participants according to the age and

gender is given in the table 3.1.

Table 3.1

Distribution of the Samples According to the Age and Gender

No. of Gender Groups No. of Age Mean Standard Gender

Participants subjects range age distribution
(years)

18
males
23 Group 25 18-24 21.08 1.73
females 1 7
females
94
53
males
71 Group 6 18-24 21.1 1.90
males 2 16
females

The relationship between daily use of hearing aids (hearing aid wearers vs.

Non-wearers) and opinions on hearing loss, amplification, and hearing services was

explored using Modified t test.

31
 CHAPTER 4

RESULTS & DISCUSSION

The present study aimed in investigating the factors affecting amplification

use in young adults with severe to profound hearing impairment. The objective of this

study was to explore the factors affecting amplification use in young adults. A total of

94 participants were randomly selected, which include 23 females and 71 males. The

age of the participants varied from 18- 24 years (mean=21.04, and SD= 1.85).

In order to identify the factors affecting hearing aid usage in young adults the

whole participants were divided in to two groups as shown in table 4.1. Group 1

included 25 participants who are regular users of hearing aid (18 males and i females)

and group 2 having 69 participants who are not using hearing aids (53 males and 16

females).

Table 4.1.

Participant distribution in group 1 and group 2

Group Number of Age range Mean age SD Gender

subjects
(years)

18 males

Group 1 25 18-24 21.08 1.73 7 females

53 males

Group 2 69 18-24 21.1 1.90 16 females

32
 The following statistical procedures were carried out to fulfil the objectives:

foreach FAHA questionnaire, descriptive statistics was used in order to investigate

thebackground demographics of participants, hearing aid use and hearing aid service

experience.The relationship between daily use of hearing aids (hearing aid wearers

vs.Non-wearers) and opinions on hearing loss, amplification, and hearing services

wasexplored using Modified t test.

Thefindings of the present study are discussed below in the following headings,

4.1 Background Information and Demographics

4.2 Hearing Aid Use

4.3Hearing aid Service Experience

4.4 Opinions on Hearing Loss, Amplification and Hearing Services

4.5 Factors Affecting Hean g Aid Use

4.1 Background Information and Demogra ics

All the 94 participants in the present study were diagnosed as having bilateral

severe to profound hearing impairment. It was revealed from the FAHA questionnaire

that the majority of participants (78.7%) were living in their hostels, 19.1 % of

participants were living with their parents. A small percentage of participants lived

with other relatives (2.1 %). It was revealed that majority (77.7 %) of participants were

currently receiving a disability pension from the government. However, 21

participants (22.3 %) were not receiving a disability pension from the government.

The most commonly cited reason for not receiving the pension was because they were

not aware about the disability pension (33.33%) and some of them have applied but

not yet received (33.3%).19.04% of population believes that disability pension is not

33
necessary for them. 14.2% of population not receiving the pension due to other

reasons.

All the individuals who participated in the present study were degree students

.With regard to the personal income, 52.1 % of participants reported of earning less

than Rs. 10000, 25.5 % earned between 10000 - 20000 Rs per annum and the

remaining 22.3% has no income. The income reported are mainly from the disability

pension that they receive from the government.

All participants have completed their higher secondary education and are

pursuing their graduate studies. None of them are married and only 8.5% reported a

family history of hearing loss, with either one or both parents. When asked about their

notion on their hearing impairment, 67% considered themselves having complete

hearing impairment, hile 30.9 % considered themselves partially-impaired. Two

participants (2.1 % of the total participants) did not feel either term was appropriate.

A large proportion of respondents (62.8%) reported that they are a part of the Deaf

community. 52.1 % of participants preferred using a combined mode of

communication that is using both speech and Indian sign language. Additionally,

27.7% identified sign language as their preferred communication mode and 22.8%

indicated Indian sign language as their preferred choice and the remaining 3.2 % cited

speech as the primary choice.

4.2 Hearing Aid Use

The mean age at which participants were diagnosed with hearing impairment

was 1.55 years (SD = 0.819, median = 1.6 years, range = birth to 7 years), with

hearing aid fitting occurring at a mean age of 3.36 years (SD = 2.19, median = 2.8

years, range = 1 year to 13 years). The mean age of identification is almost same in

the both groups, in hearing aid users the mean age of identification is 1.53 years with

34
hearing aid fitting occurring at a mean age of 3 .36 years. The mean age of

identification is 1.56 and hearing aid fitting occurs at 3.36 years for hearing aid non

users. Showed in figure 4.1

14 -r-r-r-r-r'-t-r-r-r-r-r-r- __ --,-,------,-----,---,----;---,

10 +-:----r- -t-r-' ---HII~---r--+-+--+----1

12 +-+~-'-~--~-+---+-+--,---.--~
~ 8 +-:---r---t-----HII~,-----+--,---.____c---1
till 10 +-+--j-+-+--+-+----i---1-+-+--:-+---~ E
c ~ 6 +----''---'-H-~---i--j----'-+---~
.f! 8
-
+-+----j-+-+--+-+----'---1---r--...,....-'--~ o
0;:::
~ 4 --.---r--~---+~-----1
o
CIJ
6 +-+-'---'~~+----'---1-~~>--'---t--~ «
till
« 4 ~-'---+--+-""*----HII~__ -:-+----'---'-~ 2 +-~~~~~--~-+~--~

2
o +-----r---~--~-+~--~
o 1 2 3 4
o +---~~~~~~-+----~
Age of identification
o 1 2 3 4
Age of identification

(a) (b)

Figure 4.1

Responses obtained for age of diagnosis of hearing loss and age offitting from

hearing aid non-users (a) and users (b).

Even though the age of identification and intervention are similar, a major

group that is 69 out of 94 (73.4%) participants reported of not wearing the hearing

aids regularly. Majority of the participants (33.3%) reported discontinued aid use

between the ages of 16 years to 17 years. 31.8% of participants discontinued the use

of hearing aids between the ages of 12- 15 years. 23.1 % of population between the

age of 18-21 years, with the remainder occurring between the ages of 6-11 years and

21 to 24 years (5.7% each).

The most frequently reported reason for not using hearing aid daily was the

belief that hearing aid is not needed. 20.3% of participants discontinued regular use of

35
hearing aids due to poor sound quality whereas other 18.8% discontinued due to poor

benefit. Noisy disturbance was reported by 13%, and 10.1 % discontinued due to

disturbances like itching, pain etc. 4.3% discontinued due to other reasons. Out of

total 94 participants, 44.7% of participants (n= 42) desire to wear their hearing aids

more often than they currently did, whereas half of the 55.3% of participants did not

wish to increase hours of aid use. Nearly half of participants wish to use their hearing

aid more often than they currently do.

Although the mean age of identification and age of fitting is almost same in

both groups, majority of the participants are not using their amplification device.

Exact justifications for this observation have never been clearly provided. This result

indicates that even if they are fitted with the appropriate amplification device they

may fail in appropriate ity intervention services in oral rehabilitation. Clark, 2007

reports that children with congenital hearing loss can develop spoken and language if

they are identified and fitted with appropriate hearing technology early in their lives

and receive quality intervention services. Younger the age of diagnosis and

intervention, better the development of spoken language (White, 2006). Robinshaw,

1995 reported significantly better language outcomes of infants identified with

hearing loss within the first 6 months of life. Without appropriate opportunities to

learn language through appropriate rehabilitation, these children will fall behind their

hearing peers in communication, cognition, reading, and social-emotional

development and such delays may result in lower educational and employment levels

in adulthood (Holden-Pitt, 1998).

A major group that is 69 out of 94 (73.4%) participants reported of not

wearing the hearing aids regularly. Early studies indicate that secondary school

students with hearing impairment are less likely to wear hearing aids than those of

36
primary school age (Clarke & Horvath, 1979). Precise explanations for this

observation have never been clearly provided, but could feasibly be associated with

factors such as educational setting, level and competency of audiologic support, mode

of communication, benefit of amplification for speech perception and/or sound

awareness, attitudes of family, peers, and associates, hearing status of parents, and age

at fitting (Gillies, 1997). Degree of hearing impairment (i.e., mild, moderate, severe,

profound) may also exert influence; students with a greater degree of loss are less

likely to be hearing-aid users (Clarke &Horvath, 1979).

Study by Driscoll and Chenoweth (2007) from 25 subjects reported that 83%

of young Australian adults with profound hearing impairment were satisfied with their

amplification devices. However in the follow up study, they found that, out of 57

participants 29.8% were t wearing their hearing aids daily (Cameron et al., 2008).

The non-wearers felt that their hearing aids were a visible sign of their disability

(Danhauer,2012).

The present study reveals that the majority of the participants (33.3%) were

discontinued aid use between the ages of 16 years to 17 years. This is supported by

the findings of Clarke and Horvath (1979) and Winn (2006) who reported that the

rejection of hearing aids most commonly occur during the early high school years.

Cameron et al. in 2008 also reported of young adults discontinuing hearing aid use

between the ages of 12 to 15 years (33.35). However, Gillies (1997) believes that the

use of amplification is independent of age and that it is the environment that

influences use or non-use of amplification devices. In the present study it revealed

that 28.8% of participants discontinued their use of hearing aids during the age of

young adulthood that means between the ages of 18 to 24 years. The educational

37
setting and communicative environments of these participants could be the reason for

rejection of hearing aid usage.

Cameron et al (2008) suggested that there are a number of factors that impact

on amplification use in young Australian adults with severe to profound hearing

impairment. These related to self-perceived aided benefit, services and costs, hearing

aid performance, locus of control, and the 'hearing aid effect'. Similar results were

obtained for Driscoll in the year 2007. Even if majority of the participants are not

using their amplification device nearly half of participants wish to use their hearing

aid than they currently do. Therefore, the factors that are preventing an individual

from extending hearing aid usage should be carefully considered.

4.3 Hearing Aid Service Experience

Numerous sug tions were put forth by participants to improve satisfaction

with their amplification devices and the audiological services provided. Among 94

participants, half of them (50%) suggested for the provision to supply hearing aids

and batteries free of cost. 16.7% of population recommended to provide better access

to information about hearing aids, in turn would improve their satisfaction from

hearing aid use. Reminder notice for regular check-ups and provision for free

audiological evaluation were other important suggestions put forth to improve hearing

aid use by 7.1% and 11.9% of the participants respectively. 14.3% of population

suggested of having modifications other than those illustrated in the questionnaire.

Apart from the service provider related suggestions, recommendations related to

hearing aid features and technology would also improve the hearing aid usage and

their satisfaction related to it. Those suggestions include to provide better sound

quality of the hearing aids (38.1 %), waterproofmg of aids (22.8%), improvement in

mould comfort (14.3%) and quick repair services of hearing aids (14.3%).

38
 Driscoll and Chenoweth (2007), Cameron et al (2008) identified the provision

of providing free hearing aids/batteries/hearing tests, quicker repair services, reminder

notices for regular check-ups would improve the hearing aid use considerably, which

is in agreement with the results obtained in the present study. Also improving

amplification related features such as water resistance of amplification devices and

mould comfort resulted better hearing aid use among Australian adults (Driscoll &

Chenoweth,2007).

4.4 Opinions on Hearing Loss, Amplification and Hearing Services

For the analysis purpose, response scoring of each statement in the

questionnaire was collated as follows: 0 (90%) and 1(75%) categorised based on the

negative influence of the fa r in hearing aid usage. 3(75%) and 4(90%) categorised

based on the positive influence of the factor in hearing aid usage. Score of 2 was

given when they are uncertain about those statements. The mean, median, standard

deviations and percentage of participant's responses to the 49 statements concerning

hearing loss, amplification and hearing services are displayed in Table 4.2.

39
Table 4.2.

Percentage, mean, median and standard deviation (SD) of responses obtained of each

46 statement concerning Hearing Loss, Amplification and Hearing Services. 0, 1,2,3,

4 refer to the ratings of agreements.

Sl. No Statement(s) Mean SD Median 0(%) 1(%) 2(%) 3(%) 4(%)

1. SI 2.20 1.0 2.00 3.2 25.5 34.0 22.3 14.9

2. S2 2.20 .0.9 2.00 1.1 22.3 43.6 21.3 11.7

3. S3 2.03 1.24 2.00 11.7 23.4 35.1 9.6 20.2

4. S4 1.81 1.13 2.00 7.4 39.4 30.9 9.6 12.8

5. S5 1.56 1.27 1.00 22.3 33.0 22.3 10.6 11.7

6. S6 1.46 1.17 1.00 22.3 37.2 19.1 14.9 6.4

7. S7 1.37 1.08 1.00 28.7 22.3 33.0 14.9 1.1

8. S8 2.48 1.28 3.00 4.3 26.6 16.0 23.4 29.8

9. S9 1.86 1.19 2.00 10.6 35.1 23.4 19.1 11.7

10. S10 1.23 1.11 1.00 31.9 29.8 24.5 10.6 3.2

11. Sl1 2.21 1.21 2.00 7.4 26.6 19.1 30.9 16.0

12. S12 1.95 1.29 2.00 14.9 26.6 22.3 21.3 14.9

13. S13 1.57 1.13 1.00 16.0 38.3 25.5 12.8 7.4

40
S1.No Statement(s) Mean SD Median 0(%) 1(%) 2(%) 3(%) 4(%)

14. £14 1.73 1.17 2,00 12.8 35.1 29.8 10.6 11.7

15. S15 1.87 1.07 2.00 9.6 25.5 42.6 12.8 9.6

16. S16 2.00 1.11 2.00 9.6 24.5 30.9 26.6 8.5

17. S17 1.56 1.18 1.00 18.1 39.4 18.1 17.0 7.4

18. S18 1.91 1.11 2.00 11.7 21.3 40.4 17.0 9.6

19. S19 2.06 1.18 2.00 10.6 22.3 28.7 26.6 11.7

20. S20 2.00 1.20 2.00 5.3 39.4 21.3 18.1 16.0

21. S21 2.64 1.16 3.00 4.3 11.7 30.9 22.3 30.9

22. ~22 1.64 1.23 1.00 17.0 38.3 19.1 14.9 10.6

23. S23 1.65 1.14 1.00 16.0 35.1 22.3 21.3 5.3

24. S24 1-.J3 J.]) 1.99 J9.~ J.3..4 J.3..4 J7..7 J4.9

25. S25 1.98 1.05 2.00 7.4 28.7 27.7 30.9 5.3

26. S26 1.88 1.09 2.00 5.3 40.4 24.5 20.2 9.6

27. S27 1.69 1.20 2.00 21.3 22.3 27.7 23.4 5.3

28. S28 1.86 1.16 2.00 13.8 25.5 28.7 24.5 7.4

29. S29 1.94 1.13 2.00 7.4 34.0 26.6 21.3 10.6

30. ~30 J ..JJ J.04 J-.OO 4.3 J5.5 .35.1 24.5 10.6

41
Sl. No Statement(s) Mean SD Median 0(%) 1(%) 2(%) 3(%) 4(%)

31. S31 1.51 l.1g 2.00 25.5 22.3 3-5.1 9".6" 7.4

32. S32 2.03 1.09 2.00 3.2 36.2 26.6 22.3 11.7

33. S33 1.99 1.12 2.00 8.5 30.9 20.2 34.0 6.4

34. S34 1.59 1.12 1.50 18.1 31.9 28.7 16.0 5.3

35. S35 1.93 .997 2.00 5.3 30.9 36.2 21.3 6.4

36. S36 1.91 .947 2.00 4.3 28.7 45.7 13.8 7.4

37. S37 2.05 .943 2.00 1.1 29.8 40.4 20.2 8.5

38. S38 1.71 1.30 1.00 19.1 34.0 14.9 20.2 11.7

39. S39 2.06 .925 2.00 4.3 17.0 56.4 12.8 9.6

40. S40 2.05 1.06 2.00 6.4 24.5 36.2 23.4 9.6

41. S4J .1.OJ J.Q3 1.00 7..4 J.3..4 }5.J J7..7 p.4

42. S42 1.65 1.00 1.00 6.4 48.9 23.4 16.0 5.3

43. S43 2.17 1.01 2.00 3.2 21.3 43.6 19.1 12.8

44. S44 2.06 1.18 2.00 5.3 35.1 22.3 22.3 14.9

45. S45 2.41 1.26 3.00 6.4 24.5 13.8 31.9 23.4

46. S46 2.02 .867 2.00 2.1 23.4 51.1 17.0 6.4

42
4.5 Factors Affecting Hearing Aid Use

In order to delineate the factors affecting hearing aid use among young adults,

the total 94 participants were categorized into two groups, 25 daily hearing aid users

and 69 nonusers and the responses obtained for each statement from those two groups

were statistically analysed using modified t test at 95% confidence level.

On analysis of the data obtained, statistically significant difference among

users and non-users exist only for 9 out of the 46 statements given in the

questionnaire related to opinions on hearing loss, amplification and hearing services.

For the purpose of this analysis, opinion response categories were collated as

follows: strongly disagreed and disagreed combined to form the 'disagreement'

category, agreed and strongly agreed combined to form the 'agreement' category.

Statement 1: Hearing aids are very costly

The responses obtained for the statement 1 was statistically analysed (p value

.001) and a significant difference was obtained among users and non-users. 40% non-

users agreed that hearing aids are too much expensive compared with 24.6% users.

Graphical representation of the responses are shown in figure 4.2

43
 50.00% l
45.00% ..,

40.00%

35.00%
j
~ 30.00%
c:::
sc- 25.00% ~ • Non users
CII
~ 20.00% ~
• Users
15.00%
~
10.00% l
5.00%

0.00%
j
Agree Not sure Disagree
Response

Figure 4.2

Responses obtained for statement I (Hearing aids are very costly) from hearing aid

users (n = 25) and non-users (n =69).

Several studies reported that external factors (cost of the hearing aid,

counselling), personal factors (e.g., source of motivation, expectation, attitude,

hearing sensitivity) and demographic factors (e.g., age, gender) plays a major role in

hearing aid use and satisfaction. (Mansfield& Taylor, 2004). Certain others found that

cost appears to be a significant factor influencing amplification use (Fino et aI., 1992;

Franks & Beckmann, 1985; Winn, 2006). These findings highlight the importance of

providing the amplification devices at subsidized rate which agrees with the findings

of the present study.

Statement 6: I used to check my hearing efficacy every year

The responses obtained for the statement 6 was statistically analysed (p value

.000) and a significant difference was obtained among users and non-users. 48%

44
hearing aid users agreed that they are undergoing for a regular audiological

evaluation. While only 11.5 % of hearing aid non-users were agreed this. Graphical

representation of the responses are given shown in Figure 4.3

80.00%

70.00%

60.00%

50.00%
...>
c
~ 40.00%
r:r
•..
Qj • Non users
u.. 30.00%
• Users

20.00% -j

10.00%

0.00%
Agree Not sure Disagree
Response

Figure 4.3.

Responses obtainedfor statement 6(1 used to check my hearing efficacy every year)

from hearing aid- users (n = 25) and non-users (n =69).

Majority of the hearing aid users periodically undergo audiological evaluation

reflecting their knowledge regarding hearing loss progression and need for fine tuning

their amplification devices depending on the current hearing status compared with the

non-users. This indicates that the regular audiological evaluation and continuum of

care is an important factor determining the satisfaction from hearing aid use which

can be facilitated by providing annual reminders to clients regarding hearing

assessment (Cameron, 2008).

45
Statement 7: I service my hearing aid every year

The responses obtained for the statement 7 was statistically analysed (p value

.037) and a significant difference was obtained among users and non-users. 36%

hearing aid users agreed that they are servicing their amplification device every year

compared with 8.69% of non-users. Graphical representation of the responses are

given below in Figure 4.4

60.00%

50.00%

40.00%
>-
u
C

~ 30.00% -
cr
•..
<II
u..
• Non users

20.00% • Users

10.00%

0.00%
Agree Not sure Disagree
Response

Figure 4.4.

Responses obtained/or statement 7(1 service my hearing aid every year) from

hearing aid users (n = 25) and non-users (n =69).

There exist a statistically significant difference in the above statement when

comparing with hearing aid users and non-users. Several studies pointed a tendency

towards reduction in hearing aid use over time due to hearing aid not working

properly, feedback problem, whistling noise and limited life time of batteries

46
(Kochkin, 2000; Hartley et aI., 2010). Most of problems related to reduction in

hearing aid use can be solved to an extent by implementing a long-term follow-up

program after the initial fitting process (Cameron, 2008). Gianopoulos, 2002 stated

that follow up appointments and other efficacy measures did not occur for hearing

aids distributed through publicly-funded services. So regular follow ups in servicing

the hearing aids increases the durability of hearing aid and thereby increases the

satisfaction from hearing aid use.

Statement 12: use of hearing aid gives me head ache

The responses obtained for the statement 12 was statistically analysed (p value

.001) and a significant difference was obtained among users and non-users. Statement

showed that 47.82% of non- ers agreed that, 'hearing aids give them a headache',

whereas only 24 % of hearing aid users agreed. Graphical representation of the

responses are given in Figure 4.5

60.00%
1

50.00%

40.00%
>
u
C

~ 30.00%
CT 1
•..
Qj
•....
• Non users
20.00% • Users

10.00%

0.00%
Agree Not sure Disagree
Response

Figure 4.5

Responses obtainedfor statement 12 (use of hearing aid gives me head ache) from

hearing aid users (n = 25) and non- users (n =69).

47
 Results of the present study goes hand in hand with another study by

Cameron, 2008 using FAHA questionnaire, revealed that 58.3% of non-wearers

agrees hearing aids give them a headache compared with the hearing aid users

(11.1 %). These findings suggest the need for the Audiologists to pay more attention

while setting hearing aid parameters, such as compression and maximum power

output (MPO) characteristics for high intensity sounds, and also should consider

providing clients with training in listening, stress management and communication

training in noisy situations. This also suggests the need for fine adjustment of the

hearing aid settings repeatedly after initial fit to tailor the exact need of the patient

(Cameron 2008).

Statement 17: I do not like the und quality of my 'aids

The responses obtained for the statement 17 was statistically analysed (p value

.000) and a significant difference was obtained among users and non-users. 71% non-

users agreed that sound quality of their hearing aids not good compared with 20 %

hearing aid users. Graphical representation ofthe responses are given in Figure 4.6

48
 80.00% -

70.00%

60.00% -<

> 50.00%

1 4000%

u.. 30.00%
j
~
• Non users

• Users

20.00% -1

10.00%

0.00%
Agree Not sure Disagree
Response

Figure 4.6.

Responses obtained/or statement 17 (I do not like the sound quality of my aids)from

hearing aid users (n = 2)) and non-users (n =69).

Current study revealed that poor sound quality of the hearing aid is a major factor

hindering the hearing aid use. As the sound quality is not good, young adults finds it

difficult to adjust with the aid and so rejects it. Poor sound quality of hearing aids is

noted as one of the reason for rejection of hearing aid among older adults (Archana,

2016 & Romer1997). Kochkin (1992) determined that the most important factor

determining hearing aid use are clarity, improved sound quality and usefulness in

multiple environments.

Statement 22: I don't believe or think that hearing aids can help me

The responses obtained for the statement 22 was statistically analysed (p value

< .005) and a significant difference was obtained among users and non-users. 57.9 %

49
non- users agreed that hearing aids can't help them, compared with 48% users.

Graphical representation of the responses are given in Figure 4.7

70.00% -,

60.00% ~

50.00% -<

>
~ 40.00% -1

<II

j 30.00% ~
• Non users

• Users
20.00% -<

10.00% I
0.00%
Agree Not sure Disagree
Response

Figure 4.7

Responses obtained for statement 22(1 don't believe or think that hearing aids can

help me) from hearing aid users (n = 25) and non-users (n =69).

This is one of the important factors that may lead to strong dissatisfaction with

amplification or even discontinuation of hearing aid use identified by Cameron et ai,

2008. Most nonusers indicated a self-perceived lack of belief in the ability of aids to

assist them in their daily lives. Amplification may provide only limited advantages for

some with profound hearing impairment, to the extent that its use cannot be justified

(Driscoll, 2007). However, for others, there may exist at least some tangible benefits,

such as increased environmental sound awareness. This particular benefit is unlikely

to be apparent to the client, if only routine aided audiograms or speech tests are used

50
to demonstrate aided performance. Hence the audiologists should be cautious while

investigating functional hearing aid benefit out of amplification with this population.

Statement 27: The centre for the checking hearing efficacy offers a good service

The responses obtained for the statement 27 was statistically analysed (p

valueO.037) and a significant difference was obtained among users and non-users.

44% hearing aid users agreed that their audiology clinic provide an excellent service,

compared with 23 % non-users. Graphical representation of the responses are given in

Figure 4.8

60.00%

50.00%

40.00%
>-
u
C

~ 30.00%
0-
w • Non users
~
LL.

20.00% • Users

10.00%

0.00%
Agree Not sure Disagree

Response

Figure 4.8

Responses obtained/or statement 27(I/eel that the centre/or checking hearing

efficiency offers me a good service.) from hearing aid users (n = 25) and nonusers (n

=69).

Kochkin, 1992 has discovered that post purchase service has also a role in the

regular hearing aid usage. Regular hearing aid users are happy with their hearing care

centres because all their needs relating to audition and amplification are full filled.

Statement 34: I do not give much importance to hearing

51
 The responses obtained for the statement 34 was statistically analysed (p

valueO.OOO) and a significant difference was obtained among users and non-users.

Majority 62.3% hearing aid non users agreed that they are not giving much

importance to their hearing, compared with 16 % users. Graphical representation of

the responses are given in Figure 4.9

70.00%
l
60.00%

50.00% 1
>
~ 40.00%
QJ
::l
0-
l • Non users
...~ 30.00%
• Users
20.00%
1
10.00%

0.00%
Agree Not sure Disagree
Response

Figure 4.9

Responses obtained for statement 34 (l do not give much importance to hearing) from

hearing aid users (n = 25) and non- users (n =69).

Normal hearing is important for effective communication and responsiveness

to environmental sounds. Hearing impairment may hinder one's effective

communication. As their primary mode of communication majority of the hearing aid

non- users are sign language they were not giving importance to their hearing.

Hearing aid wearers depending on aural mode reported that improved everyday

communication is their primary requirement from a hearing aid (Bareham &

Stephens, 1980).

52
Statement 38: I am happy with the use of my hearing aids

The responses obtained for the statement 38 was statistically analysed (p

valueO.OOO) and a significant difference was obtained among users and non-users.

64 % hearing aid users agreed that they are happy with their amplification device. In

contrast, only 20.2 % of users agreed with this statement. Graphical representation of

the responses are given in Figure 4.10

80.00% ...,

70.00% ~
60.00%
~
> 50.00%
u
c:
~ 40.00%
0"
•..
CIJ
u..
30.00%
j • Non users

• Users

20.00%

10.00%
1
0.00%
Agree Not sure Disagree
Response

Figure 4.10.

Responses obtainedfor statement 38 (1 am happy with the use of my hearing aids)

from hearing aid users (n = 25) and non- users (n =69).

Satisfaction has been described as a pleasurable emotional experience

resulting from the evaluation of product performance relative to expectations or a

sense that one's needs have been met (Abrams, 2000; Cox & Alexander, 1999).

Regular hearing aid users are happy and satisfied with their hearing aid, but vice versa

in the case of non-users. Satisfaction may be one of main reason why persons

53
irrespective of their age with hearing loss do take advantage of amplification

(Hickson2004). Satisfaction is crucial to the whole hearing aid fitting process and its

importance in audiology is evidenced by the fact that it is frequently included as a

measure of outcome (Cox & Alexander, 1999). Danhauer, 2012 found that young

hearing impaired adults rated their hearing aid satisfaction significantly poorer than

norms on the Service and Cost but in personal image subscale and Global scores these

young adults were generally satisfied with their hearing aids.

Questions showing statistically significant difference when compared between

user and non-users using modified t test were discussed earlier. Even though rest of

the statements did not show a statistically significant difference, majority question

were clinically relevant. The results of the other statements were discussed under

broad headings such as adverse ffects of hearing loss, cosmetic appeal of hearing

aids, sound quality from hearing aids, self-perceived hearing aid benefit, other's

attitude towards hearing aid usage and audiological service related factors.

Hearing loss related factors reflected form statement 35 concerned with public

attitude towards individual with hearing impairment. 36.2% of participants reported a

negative attitude wherein 27.7% showed positive attitude and rest 36.2% were not

sure about the attitude of public towards hearing impairment. The statement focussing

on the need for reminders for routine audiological evaluation indicated that 30.9% of

participants require frequent reminders while other 33% do not require and rest 36.2%

were uncertain about the statement.

Several research findings suggest that attitudes of individuals without

disability towards people with disability has found that very young children did not

exhibit negative attitude towards their classmates with hearing impairments (Hall,

McCarthy, & Peach 1989). However, negative attitudes have been documented for

54
older children and adults. (Brimacombe, Danhauer & Mulac, 1983). Dengerink and

Porter (1984) reported that school aged children also exhibit negative attitudes

towards the appearance, personality and intelligence of children with hearing

impairment. Stein, Gill and Gans, 2000 reveals in adolescents with normal hearing

there exist some sort of negative attitude towards individuals with hearing loss. But

the degree of negativity appears to have decreased compared to studies conducted in

the 1980's.

Statement 4 and 5were concerned with cosmetic appeal and hearing aid usage,

showed that nearly half (46.8%) of the total population were concerned with

cosmetic appearance of the hearing aid while a minority (22.3%) were not concerned

about the appearance of the amplification device.

Young adults were mor embarrassed and concerned to wear hearing aid

(Cienkowski & Pimentel, 2001). Garstecki, 2002 found that cosmetic issue is one of

the reasons in persons with hearing impairment leading to hearing aid reluctance .
.
Driscoll and Chenoweth 2007 suggested cosmetics to be one of the important target

factor to be considered to improve hearing aid usage.

Statements 9, 11, 13 and 14 in the questionnaire focus on sound quality.

Statement 9 deals difficulty while using hearing aid, majority (45.7 %) reported a

negative impact with hearing aid. Next important issue focussed through question 11

was hearing difficulty despite using hearing aid. Only 34% agreed with the statement

showing a positive influence on hearing aid usage even though they reported a

difficulty while using it. Statement 13 has addressed difficulties in presence of

increased background noise; a major chunk (54%) reported a difficulty which could

be attributed to amplification of environmental sounds. Only 20% were satisfied with

the hearing aid performance in presence of noise. Discomfort from loud sounds was

55
focussed in statement 14 and 47.9% of participants agreed with this. Responses of

13th& 14thstatement reflect the need for fine tuning and frequent follow ups after

initial fit.

Several literatures have mentioned 'difficulty in noisy situationslbackground

noise as a reason for deduced hearing aid use (Bertoli et al2009; Hartley et al201O;

Kochkin et al., 2000).Majority of the individuals with hearing impairment reported

they don't need a hearing aid, they can hear well enough without hearing aid (Bertoli

et al., 2009; Kochkin, 2000; Lupsakko et al., 2005).

Statements 20 and 21 deals with the attitude of other's towards hearing aid

usage. Even though statement 20 and 21 addressed attitude of others, peer group

showed a negative influence on hearing aid usage (44.7%) wherein family members

(53.2%) showed a positive a . de towards hearing aid usage.

Early studies indicate that as age grows children are less likely to wear hearing

aids. (Clarke & Horvath, 1979). Precise explanations for this observation have never

been clearly provided, but negative attitudes of family 'and peers could feasibly one of

the reason. Research found that hearing aid users were perceived as older and less

communicative by their peers (Franks & Beckman, 1985, Kricose et. al., 1991)

Statement 24 related to self-perceived hearing aid benefit. Statement 24 is

participant's preference to use one hearing aid at a time. 42% of them disagree to this

concept, while 34% prefer to use one hearing aid.

Erdman and Sedge (1981) reported that most of the individuals with hearing

loss preference for two hearing aids. In a similar study, Schreurs and Olsen (1985)

found that most subjects preferred the bilateral fitting for listening in quiet and the

unilateral fitting for listening in noise.

56
 Those statements (2, 15, 16,18,28,32,33,39, 43and 44) dealing with cost of

the battery and care and maintenance of hearing aid, most of the participants were

unsure about the statements as they have discontinued the hearing aid usage at an

early age and could not be able to exactly recollect the information needed.

Audiological service related factors were addressed in statements 8, 10, 19,23,

26,29 and 3. Statement 8 reflected 53.2% undergoing regular audiological evaluation

without any compulsion while 30.9 % would only visit audiologists on parents'

request. Statement 10 shows individual preferences in consulting same audiologist

again, only 13.8% participants agreed with that. Majority (51.l %) do not have a clear

idea regarding where to go in order to meet a good audiologist. Certain other

statements dealing with the cost of hearing evaluation, dissatisfaction in the service

provided by the audiologist and a essibility to hearing centres, most of the

participants were uncertain and these could be attributed to less dependency of aural

mode by proficient sign language users.

Competency of audiologic support is one of the factor that influencing hearing

aid usage (Gillies, 1997). Quality audiological services is imperative to resolve why

people fail to use their hearing aids (Goulios & Patuzzi, 2008).

In summary, the present research investigated factors affecting amplification

use and satisfaction in young adults with severe to profound hearing impairment.

Some potential factors that may lead to strong dissatisfaction with amplification or

even discontinuation of aid use were identified by the current study. Most nonusers

indicated a self-perceived, lack of belief in the ability of aids to assist them in their

daily lives. The fmdings have allowed identification of potential areas for

improvement in audiological and social service provision for this population.

57
 CHAPTERS

SUMMARY & CONCLUSION

Hearing can be defined as the capability to sense sound. The sense of hearing

is imperative for human beings. When the sense of hearing is impaired, the individual

is at a great disadvantage. As literature says, hearing aids dispensed are never or

scarcely used (Kirkwood, 2005). This indicates the effect of several factors on the

frequency and duration of hearing aid use and its success. Majority of research in this

area has focused on the amplification use in the neonates, infants, school age children

and elderly population. The present study focused on hearing aid usage in young

adults. The study aimed at investigating the factors affecting hearing aid usage in

young adults with severe to profound hearing impairment through the administration

of adapted version of FAHA (Factors Affecting Hearing Aid Use in Adults)

questionnaire. FAHA questionnaire was translated and validated into Indian Sign

Language. Questionnaires were administered in 94 subjects (71 male and 23 female)

within the age range of 18- 24 years (mean=21.04yrs). The data obtained from each

participant were documented and percentages of the factors affecting hearing aid

usage in the young adults were obtained. The relationship between daily use of

hearing aids (hearing aid wearers vs. Non-wearers) and opinions on hearing loss,

amplification, and hearing services was explored using Modified t test.

It was revealed that a considerable proportion of respondents (73.4%) were not

satisfied with their amplification devices and are not currently using their hearing

aids.28.8% of participants discontinued using their hearing aids between 18 to 24

years. 44.7 (Yooftheparticipants reported that they "would like to wear their hearing

aids more often". Statistically Significant differences between users and nonusers of

hearing aids were obtained on nine areas on-like (a) hearing aids are costly, (b) they

58
did not like the sound quality of hearing aids, (c) only regular hearing aid user go for a

routine audiological evaluation, (d) regular servicing of the hearing aid, (e)hearing

aids gave them headaches, (f) non-wearers agreed that they don't believe or think that

hearing aids can help them (g)hearing aid users agreed that their hearing centre

provided an excellent level of service, (h) hearing aid non users have not given much

importance to hearing, ( i) regular hearing aid users are happy with their hearing aids.

Findings from this investigation suggest there are several areas that health care

professionals could target for improvement in service provision and related policy

development. Specifically, (1) hearing aid sound quality, (2) provision for free

hearing aids and batteries (3) remainder notice for regular check-ups etc.

There is a statistically significant difference between users and non-users in

the questionnaire administer and it occurs for 9 out of the 46 statements. But there

are also other statements which have indicated clinically significant data. Those

statements are related to adverse effects of hearing loss, cosmetic appeal of hearing

aids, sound quality from hearing aids, self-perceived hearing aid benefit, other's

attitude towards hearing aid usage and audiological service related factors.

59
Limitations

Limitations of the study includes: there were unequal proportions of

participants in terms of hearing aid wearers versus non-wearers, males versus females,

and test retest reliability of the adapted questionnaire was not done.

The study participants comprised oflarger sample size and the data was

collected using a questionnaire and video recorded version of sign language, thus the

data collection was done within a group. So it would have resulted in minimal

interaction among the participants, which would have an effect on the result obtained.

Majority of the participants in the study were students from the same institute, so it

can result in poor generalization of result.

GJiD.icaI- ~"T_nlications
________ I•.•.• . _

In the present study It is revealed that even after an early identification, there

exist a delay in providing timely management of hearing loss. Hence the parents need

to be counselled regarding the importance ofp oviding early intervention once

hearing loss is conformed.

The parents also need to be counselled regarding the critical period for language

development and also the role of audition in speech and language development.

Parents need to be emphasised on intensive auditory training in order to enhance

auditory skills which is the primary modality in acquiring speech and language skills.

Educ .on placement of children with hearing loss in integrated schools should

be promoted.

Need for routine audiological evaluation and hearing aid performance to be

evaluated every 6 months.

60
 Young adults need to be made aware of the need for wearing amplification

device even for minimal awareness of sound purpose and promote the hearing aid

usage among them.

Audiologist must give due attention in satisfying the requirements of the

hearing aid users while programming.

Future Direction

Indi viduals with hearing impairment from different institutions and work

places should be included in future studies to get the factors affecting hearing aid

usage from a broader perspective.

Comparative study of hearing aid usage among children provided with and

without early intervention and the same study can be conducted in school going

children.

61
 REFERENCE

Af.upsakko, T. N., J.Kautiainen, H., & Sulkava, R ..(2004). The non-use of hearing

aids in people aged 75 years and over in the city of Kuopio in Finland. Eur

Arch Otorhinolaryngol, 262(3), 165-169. doi: 10.1007 Is00405-004-0789-x.

Ahmed, A., & Tsiga-Ahmed, F. (January 10,2015). Demographic and Hearing

Related Variables Important for Prediction of Disabling Hearing Impairment:

A Community Based Survey. International Journal of Tropical Disease &

Health, 7,3,94-101. doi:l0.9734/ijtdhl2015116822.

American Academy.ofPediatrics ..(2007). Year 2Q07position statement: Principles

and guidelines for early hearing detection and intervention programs. Elk

Grove Village, IL: American Academy of Pediatrics.

Apuzzo, M. L., & Yoshinaga-Itano, C. (May 01, 1995). Early Identification of Infants

with Significant Hearing Loss and the Minnesota Child Development

Inventory. Seminars in Hearing, 16, 2, 124-135. doi:l0.1055/s-0028-1083710.

Aram, D., Most, T., & Simon, A. B. (January 01,2008). Early Literacy of

Kindergartners with Hearing Impairment: The Role of Mother-Child

Collaborative Writing. Topics in Early Childhood Special Education, 28, 1,

31-41. doi:l0.9734/ijtdhl2015/16822

Arehana, G., Krishna, Y.,Rajashekhar,B.,.&Bhargavi,P. G. (January.Ol, 2016).

Adult auditory training is it part of aural rehabilitation? Focused group

discussion. Indian Journal of Otology, 22, 1,24. doi: 10.4103/0971-

7749.176514.

62
Bareham, L. J., & Stephens, S. D. (January 01, 1980). The use of an open-ended

problems questionnaire in auditory rehabilitation. British Journal of

Audiology, 14,2,49-54. doi:l0.3109/03005,368009078900.

Billings, K. R., & Kenna, M. A. (January 01, 1999). Causes of pediatric sensorineural

hearing loss: yesterday and today. Archives of Otolaryngology-Head & Neck

Surgery,125, 5, 517-2l. doi:l0.l001larchoto1.125.5.517.

Boyle, M. H., Racine, Y., Georgiades, K., Snelling, D., Hong, S., Omariba, W.,

Hurley, P., Rao-Melacini, P. (January 01,2006). The influence of economic

development level, household wealth and maternal education on child health

in the developing world.Social Science & Medicine (1982), 63, 8,2242-54.

doi:10. 1016/j.socscimed 2006.04.034.

Brooks, D. N. (January 01, 1985). Factors relating to the under-use of posta ural

hearing aids. British Journal of Audiology, j 9, 3, 211-7.

doi: 10.3109/03005368509078975.

Bullis, M. (December 01, 1995). Transition Achievement among Young Adults with

Deafness: What Variables Relate to Success? Rehabilitation Counseling

Bulletin, 39, 2, 130-50.Retrived from http://eric.ed.gov/?id=EJ525638

Calderon, R., & Naidu, S. (November 01, 1999). Further Support for the Benefits of

Early Identification and Intervention for Children with Hearing Loss. Volta

Review, 100,5,53-84

http://connection.ebscohost.com/c/articles/3274899/further-support-benefits-

early-identification-intervention-children-hearing-Ioss

63
Cameron, B., Cunningham, E., Lindner, A., Nicol, L., Chenoweth, L., & Driscoll, C.

(2008). Hearing Aid Use and Satisfaction in Young Australian Adults With

Severe to Profound Hearing Loss. Australian and New Zealand Journal of

Audiology, 30,1,59-72. doi:l0.1375/audi.30.l.59.

Cienkowski, K. M., & Pimentel, V. (2001). The hearing-aid "effect'trevisitedin

young adults. British Journal of Audiology, 35(5), 289-295.

Clark, G. J. (n.d.). Degree of Hearing Loss. Degree of Hearing Loss. Retrieved from

http://www.asha.org/public/hearing/Degree-of-Hearing-Loss/

Clark, M (2007). A Practical Guide to Quality Interaction With Children Who Have a

Hearing Loss, Plural Publishing, ISBN 1-597556-112-6, San Diego, Oxford,

Brisbane. Retrieved from http://cdn.intechopen.com/pdfs/33866.pdf

.Clarke, B. R., & Horvath, A ..(January 01,1979). Children who wear individual

hearing aids in British Columbia, Canada. Scandinavian Audiology, 8, 3, 131-

6. doi: 10.3109/01050397909076313.

Cohen-Mansfield, J. L., & Taylor, J. W. (2004). Hearing Aid Use in Nursing Homes,

Part 1: Prevalence Rates of Hearing Impairment and Hearing Aid Use. Journal

of the American Medical Directors Association, 5(5), 283-288.

doi: 10.1016/s1525-8610(04)70017-1.

Connor, C. M., Craig, H. K., Raudenbush, S. W., Heavner, K., & Zwolan, T. A.

(January 01,2006). The age at which young deaf children receive cochlear

implants and their vocabulary and speech-production growth: is there an added

64
 value for early implantation? Ear and Hearing, 27, 6,628-44.

doi: 10.1097/01.aud.0000240640.59205.42.

Conrad, R (1972). Short-term memory in the deaf A test for speech coding. New

York: Cambridge University Press doi:1O.111I1j.2044-8295.l970.tbOI236.x

Cox, R M., & Alexander, G. C. (January 01,2000). Expectations about hearing aids

and their relationship to fitting outcome. Journal of the American Academy of

Audiology, II,7'.

Cox, R, & Alexander, G. (1995). The abbreviated profile of hearing aid benefit. Ear

and Hearing, 16(2), 176-186.

Danhauer, J. L., & Johnso C. E. Survey of Hearing Aid Use and Satisfaction by

Young Adults. Retrieved from

http://www.audrebab.org/jaral2012IDanhauer%20et%20al.%202012.pdf.

Davis, J. M., Hardick, E. J., & Van, T. D. J. (1981). Rehabilitative audiology for

children and adults.

Davis, W. E. (January 01,2001). Proportional Frequency Compression in Hearing

Instruments. Hearing Review, 8, 34-43.

Dengerink, J. E., & Porter, J. B. (1984). Children's Attitudes toward Peers Wearing

Hearing Aids. Language Speech and Hearing Services in Schools,15(3), 205.

doi: 10.1044/0 161-1461.l503 .105.

Dillon, H., Birtles, G., & Lovegrove, R (January 01, 1999). Measuring the Outcomes

of a National Rehabilitation Program: Normative Data for the Client Oriented

65
 Scale of Improvement (CaS!) and the Hearing Aid User's Questionnaire

(HAUQ). Journal- American Academy of Audiology, 10, 2, 67-79. Retrieved

from

http://studentacademyofaudiology.com/sites/ defaul t/mes/journal/] AAA 10 02

02.pdf

Driscoll, C., Bruce, M., Bruce Murdoch, Driscoll, Carlie, & Chenoweth, Lesley Irene.

(2007). Amplification use in young Australian adults with profound hearing

impairment. San Diego: Plural Pub. & Asia Pacific Society for the Study of

Speech Language & Hearing. doi:10.1179/136132807805297657.

Brdman, S. A, & Sedge, R.K. (January 01, 198t). Subjective comparisons of

binaural versus monaural mplification. Ear and Hearing, 2, 5.)

doi: 10.1097/00003446-198109000-00009.

Fabry, D. (2011). Will implantable devices become hearing health care's Lasik

procedure? Audiology Today, 23(3), 20-28.

Fino, M.S., Bess, F.H., Lichenstein, M.J., & Logan, S.A (1992). Factors

differentiating elderly hearing aidwearers vs. non-wearers. Hearing

Instruments, 43(2), 6-10.

Fortnum, H. M., Summerfield, A Q., Marshall, D. H., Davis, A c., & Bamford, J. M.

(January 01,2001). Prevalence of permanent childhood hearing impairment in

the United Kingdom and implications for universal neonatal hearing

screening: questionnaire based ascertainment study. Bmj (clinical Research

Ed.), 323, 7312,536-40. doi: 10.1136/bmj.323.7312.536.

66
 Garstecki, D.C. (1990). Hearing health knowledge in aging adults. Journal of the

Academy of Rehabilitative Audiology, 23, 79-88.

Gillies, K. (1997). Hearing aid use by students at a school for the deaf. Australian

Journal of Audiology, 19,2,91-98.

Goulios, H., & Patuzzi, R. (2008). Audiology education and practice from an

international perspective. International Journal of Audiology, 47(10), 647-

b64. doi:1O.l080/14992020802203322.

Grosse, S. D., Ross, D. S., & Dollard, S. C. (February 01, 2008). Congenital

cytomegalovirus (CMV) infection as a cause of permanent bilateral hearing

loss: A quantitative assessment. Journal of Clinical Virology, 41, 2,57-62.

doi: 10.1016/j .jcv.2007 .09.004

.Hartley, D., Rochtchina, E., Newall, P., .Golding, M., & Mitchell, P. (January 01,

2010). Use of hearing AIDS and assistive listening devices in an older

Australian population.Journal of the American Academy of Audiology, 21, 10.)

doi: 1O.3766/jaaa.21.1 0.4.

Hawkins, D. B. (January 01, 2004). Limitations and Uses of the Aided

Audiogram.Seminars in Hearing, 25, 51-62. doi:10.1055/s-2004-823047.

Holden-Pitt, L., & Diaz, J. A. (January 01, 1998). Thirty Years of the Annual Survey

of Deaf and Hard-of-Hearing Children & Youth: A Glance Over the

Decades. American Annals of the Deaf 143, 2,71-76. doi:

10.1353/aad.2012.0630.

67
Hougaard S., Ruf S. EuroTrak 1: A consumer survey about hearing aids in Germany,

France, and the UK. Hearing Review. 20.11;18:12-28.

http://www.hearingreview.com/20.11/0.2/eurotrak-i-a-consumer-survey-about-

hearing-aids-in-germany- france-and-the-ukl.

tgtowstein', J., Jenni, ·0: ·G.,M0tiIl"ari;-L.,& Largo, R. 1I. {January ·01, 2003) Sleep

duration from infancy to adolescence: reference values and generational

trends. Pediatrics, 111,2,30.2-7. doi:10..1542/peds.111.2.30.2.

James, D., Rajput, K., Brinton, J., & Goswami, U. (October 0.1,20.0.9).Orthographic

Influences, Vocabulary Development, and Phonological Awareness in Deaf

Children Who Use Cochlear Implants. Applied Psycholinguistics, 30, 4, 659-

684 doi:10. 1017/s0.14271 40.9990.0.63

J.ClH. Year 20.0.7Position Statement: Principles.and.Guidehnesfor Early Hearing

etection and Intervention Programs. Pediatrics. 20.0.7;120.(4):898-921.

http://pediatrics.aappublications.org/contentl120./4/898.

Johnson, C. E., & Danhauer, J. L. (20.0.2).Outcomes measurement and the

audiologist. In C. E. Johnson & J. L. Danhauer (Eds.), Handbook of outcomes

measurement in audiology (pp.1-14). Clifton 'Park, NY: Thomson Delmar

Learning, Singular. Retrieved from

http://www.ncbi.n1m.nih.gov/pmc/artic1esIPMC40.40.8351.

Johnson, C. E., Danhauer, 1. L., Gavin, R. B., Karns, S. R., Reith, A. C., & Lopez, I.

P. (January 0.1,20.0.5). The "hearing aid effect" 20.0.5:a rigorous test of the

visibility of new hearing aid styles. American Journal of Audiology, 14, 2,

169-75. doi: 10..10.44110.59-0.889(20.0.5/0.19).

68
Johnson, C., & Goswami, U. (January 01, 2010). Phonological awareness,

vocabulary, and reading in deaf children with cochlear implants. Journal of

Speech, Language, and Hearing Research: Jslhr, 53, 2,237-61

doi: 10.1044/1059-0889(2005/019)

Johnson, J. A., Cox.R. M.,.& Alexander, G. C. (January 01, 2010). Development.of

APHAB norms for WDRC hearing aids and comparisons with original

norms. Ear and Hearing, 31, 1,47-55. doi:lO.l097/aud.Ob013e3181b8397c.

Jones, C., & Launer, S. (2011). Pediatric fittings in 2010: The Sound Foundations

Cuper project. In R C. Seewald, J. M. Bamford (Eds.), A sound foundation

through early amplification: Proceedings of the 2"010international conference

(pp. 187-192). Chi ago, IL: Phonak AG.

Jones, .C.,.& Launer, S..(2011). Pediatric fittings in 2010: The Sound Foundations-

Cuper project. In R C. Seewald, J. M. Bamford (Eds.), A sound foundation

through early amplification: Proceedings of the 2010 international conference

(pp. 187-192). Chicago, IL: PhonakAG.

Kennedy, C. R, McCann, D. C., Campbell, M. J., Law, C. M., Mullee, M., Petrou, S.,

Watkin, P., ... Stevenson, J. (January 01,2006). Language ability after early

detection of permanent childhood hearing impairment. The New England

Journal of Medicine, 354,20, 2131-4l.

Kent, It,& Smith, S. (JaauaryOl , 2006). They-Only SeeIt when the Sun Shinesin

My Ears: Exploring Perceptions of Adolescent Hearing Aid Users. Journal of

Deaf Studies and Deaf Education, 11,4,461-476. doi:10.l093/deafedienj044.

69
Kessler AR, Giolas TG, Maxon AB. (1990). The Hearing Performance Inventory for

Children (HPIC): Reliability and Validity. Poster presented at American

SpeecbLanguage-Hearing Association Convention, November 1990, Seattle,

WA. Retrieved from:

http://studentacademyofaudiology.com/sites/default/files/journallJAAA18 03

03.pdf

Kirkwood D. H. (2005). Dispenser surveyed on what leads to patient

satisfaction. Hearing Journal, 58(4), 19-26

Kochhar, A. J.,Hildebrand, M. S., & Smith, R. J. (2007). Clinical aspects of

hereditary hearing loss. Genetics in Medicine, 9(7), 393-408. doi:

10.1097/gim.Ob013e_ 80980bdO.

Kochkin, S. (2001). The VA and direct mail sales spark growth in hearing aid market.

Hearing Review, 8(12), 16-24, 63-65.Retrieved from

http://www .betterhearing. org/hearingpedialmarketrak -publ ications/marketrak-

vi-va-and-direct-mail-sales-spark-growth-hearing-aid.

Koohkin, S. (200S). Marke'Irak VIr: ltearili"g .loss ·population -tops Bl million ·people.

Hearing Review, 12(7), 16-29. Retrieved from.

http://www.betterhearing.org/hearingpedialmarketrak-publications/marketrak-

vii-hearing-loss-population-tops-31-million-people.

Kochkin, S. (2009). MarkeTrak VITI: 25-year trends in the hearing health market.

Hearing Review, 16(11), 12-31. Retrieved from

http://hearingloss.org/sites/ default/files/ docslKochkin MarkeTrak8 OctHR09.

oM·
70
Kochkin, S. (2010). MarkeTrak Vlll: Consumer satisfaction with hearing aids is

slowly increasing. Hearing Journal, 63(1), 19-32.Retrieved from

http://journals.1ww.com/thehearingjournallPages/articleviewer.aspx?year=201

O&issue=O1000&article=O0004&type=Fulltext.

Lupsakko.T. A,Kaufiainen,lI. J., & Sulkava,R. (January-Ol , 2005). The non-use of

hearing aids in people aged 75 years and over in the city of Kuopio in

Finland.European Archives ofOto-Rhino-Laryngology: Official Journal of

the European Federation ofOto-Rhino-Laryngological Societies (eufos) :

Affiliated with the German Society for Oto-Rhino-Laryngology - Head and

Neck Surgery, 262, 3, 165-9. doi:l0.1007/s00405-004-0789-x

Mayer, C. (January 01, 2007 What really matters in the early literacy development

of deaf children. Journal of Deaf Studies and Deaf Education, 12, 4, 411-31

doi:1O.1093/deafed/enm020

McCarthy, P. (1985). Peer Perceptions of Kindergarten and First-Grade Hearing Aid

Wearers.

McCormack, Abby, & Fortnum, Heather. (n.d.). Why do peopiejittedwith hearing

aids not wear them? (McCormack, Abby and Fortnum, Heather (2013) Why

do people fitted with hearing aids not wear them? International Journal of

Audiology, 52 (5). pp. 360-368. ISSN 1499-2027.) Informa Healthcare. doi:

10.3109/14992027.2013.769066.

McDonald, T., & Thomley, C. (n.d.). Critical literacy for academic success in

secondary school: Examining students? Use of disciplinary knowledge.

Critical Literacy: Theories and Practices.

71
Moeller, M. P., Hoover, B., Peterson, B., & Stelmachowicz, P. (January 01,2009).

Consistency of hearing aid use in infants with early-identified hearing

loss. American Journal of Audiology, 18, 1, 14-23. doi:l0.l044/1059-

0889(2008/08-0010).

Mueller-Johnson.K, Toglia~ M. P., Sweeney.C. D., & Ceci, S. J. (January 01, 2007).

The perceived credibility of older adults as witnesses and its relation to

ageism.Behavioral Sciences & the Law, 25, 3,355-75. doi:l0.l002lbs1.765.

Muiioz, K., Blaiser, K., & Barwick, K. (January 01, 2013). Parent hearing aid

experiences in the United States. Journal of the American Academy of

Audiology, 24, 1,5-16. doi:l0.3766/jaaa.24.1.2.

National Sample Survey Organization (2003). Report # 485. Disabled Persons in

India.Ministry of Statistics and programme implementation, Government of

India. Retrieved from http://mospi.nic.in/rept%20 %20pubn/485 final.pdf

Northern, J. L., & Downs, M. P. (1984). Hearing in children. Baltimore: Williams &

Wilkins.

Osberger, M. J., Maso, M., & Sam, L. K. (1993). Speech Intelligibility of Children

With Cochlear Implants, Tactile Aids, or Hearing Aids. Journal of Speech

Language and Hearing Research, 36(1),186. doi:1O.1044/jshr.3601.186.

Popelka, M. M., Cruickshanks, K. J., Wiley, T. L., Tweed, T. S., Klein, B. E., &

Klein, R. (1998). Low Prevalence of Hearing Aid Use Among Older Adults

with Hearing Loss: The Epidemiology of Hearing Loss Study. Journal of the

72
 American Geriatrics Society, 46, 9, 1075-1078. doi:l0.l111/j.1532-

5415 .1998.tb06643.

Robinshaw, H. M. (1995). Early intervention for hearing impairment: Differences in

the timing of communicative and linguistic development.British Journal of

Audiology, 29(6), 315-334. doi:1O.3109/03005369509076750.

Roizen, N. J. (January 01,2003). Nongenetic causes of hearing loss. Mental

Retardation and Developmental Disabilities Research Reviews, 9,2, 120-127.

doi: 10. 1002/mrdd. 10068.

Schreurs, K. K., & Olsen, W. O. (January 01, 1985). Comparison of monaural and

binaural hearing aid use on a trial period basis. Ear and Hearing, 6, 4.

doi: 10.1097/00003446-198507000-00005.

Stark, P., & Hickson, L. (January 01, 2004). Outcomes of hearing aid fitting for older

people with hearing impairment and their significant others. International

Journal of Audiology, 43, 7,390-398. doi:l0.1080/14992020400050050.

Stark, P., & Hickson, L. (January 01, 2004). Outcomes of hearing aid fitting for older

people with hearing impairment and their significant others. International

Journal of Audiology, 43, 7,390-398. doi:l0.1080/14992020400050050.

Vohr, B.R., Wright, L. L., Dusick, A. M., Mele, L., Verter, J.,Steichen, J. J., Kaplan,

M. D. (2000). Neurodevelopmental and functional Outcomes of Extremely

Low Birth Weight Infants in the National Institute of Child Health and Human

Development Neonatal Research Network, 1993-1994. PEDIATRICS, 105,6,

12161226.

73
Walker, E. A., Spratford, M., Moeller, M. P., Oleson, J., Ou, H., Roush, P., & Jacobs,

S. (January 01,2013). Predictors of hearing aid use time in children with mild-

to-severe hearing loss. Language, Speech, and Hearing Services in

Schools, 44, 1, 73-88. doi:1O.1044/0161-1461(2012/12-0005).

Wauters, L. N., Van, B. W. n. J., & TeUings, A. J!. J. M. (February·01, 2006).

Reading Comprehension of Dutch Deaf Children. Reading and Writing: an

Interdisciplinary Journal, 19, 1,49-76 doi:10.1007/s11145-004-5894-0

White, K. R. (March 08, 2006). Early Intervention for Children with Permanent

Hearing Loss: Finishing the EHDI Revolution. Volta Review, 106, 3,237-258.

White, S. J., & White, R. E. (January 01, 1987). The effects of hearing status of the

family and age of intervention on receptive and expressive oral language skills

in hearing-impaired infants. Asha Monographs, 26,9-24. Retrieved from

https:/ /www.researchgate.netlpublicationl196 51590 The effects of hearing

status of the family and age of intervention on receptive and expressive

oral language skills in hearing-impaired infants

WHO global estimates on prevalence of hearing loss. (2012). WHO.

Winn, S. (January 01, 2006). Is there a link between hearing aid use, employment, and

income? American Annals of the Deaf, 151, 4,434-40.

doi:10.1353/aad.2006.0048.

World Health .Organization. (20:12). Grades -of.hearing .impairment. Retrieved from

http://www .who.intlpbd/ deafness/hearing_ impairment_grades/enlindex.html.

74
Yoshinaga-ltano, C. (January 01, 2003). Early intervention after universal neonatal

hearing screening: Impact on outcomes. Mental Retardation and

Developmental Disabilities Research Reviews, 9, 4, 252-266.

doi: 10.1002/mrdd.1 0088.

75
 APPENDIX-A

NATIONAL INSTITUTE OF SPEECH AND HEARING

TRIVANDRUM

Informed Consent Form

Title: Factors Affecting Amplification Usage in Young Adults with Congenital

Severe to Profound Hearing Loss

Guide: Ms. Praveena Davis, Head of the Department, NISH, Trivandrum

Co-Guide: Ms. Sreebha Sreedhar

Candidate: Rekha G.M.

Guidelines for the participant

J9 p.~~ip.~J~ in Jh~ r~_s~~~h_sJ.u~yentitled "Factors Af(~ting-

y9Jl .arer~.qu~_SJ~9

Amplification Usage in Young Adults with Congenital Severe to Profound

Hearing Loss" by Rekha GM, under the guidance of Ms. Praveena Davis (Head of

the Department, Department of Audiology and Speech Language Pathology, NISH).

This study has no medication involved and is non-invasive. The information will be

provided in the language understandable to you.

Your consent to participate in this study is sought. You have the right to refuse

consent or withdraw the same durin any part of the study without giving any reason.

If you have any doubts about the study please feel free to clarify the same.

76
 Consent

I have been informed about the procedure of the study. I have understood that I have

the right to refuse my consent or withdraw it any time during the study. I am aware

that by subjecting to this investigation Iwill have to give more time for assessments

by the investigator and that these assessments do not interfere with the benefits (if

any). All the information has been provided in the language understandable to me.

_~IJ.tll&s~J~plg.-,J.
-'~'ft~F 1l.!l9Y-F.$1aildin-g- v.Q.~U.!lj~Fj9 ~m.Q.l.m y_sy-If in .tbis study.

Ialso give my consent in using my quotes and extracts for publications.

Signature of the participant Signature of the investigator

Name and Designation Name and Designation

Place:

Dat~:

77
 APPENDIX-B

NATIONAL INSTITUTE OF SPEECH AND HEARING

TRIVANDRUM

Informed Consent Form

Title: Factors Affecting Amplification Usage in Young Adults with Congenital

Severe to Profound Hearing Loss

Guide: Ms. Praveena Davis, Head of the Department, NISH, Trivandrum

Co-Guide: Ms. Sreebha Sreedhar

Candidate: Rekha G.M.

"Factors affecting amplification usage in congenitally deaf hearing impaired

adults with severe to profound hearing loss"
n(j)CTnru1~CIDroYm1<m63mJ(f)<:ru~6mn...lomom1~1<m mSroYmJCTnJ. Ms.
Praveena Davis- CIDJQS .(Head.of the Department, Department of Audiology and

Speech-Language Pathology, NISH) cfh"lY'1am Ms. Rekha G.M.

<:..!lJJC3J Jru9..J1 m, n...IroYm1<m<G@>CID1m1cB6>Jo

<G@>6Y11n...10momSroYmJCTncID.
flJ1rum<:WQjm€fflo.~ru~€fflmYm1~Qtm:)«TJru1w(l)«TJfff>"Jcfh~~J
waU l<mlcfh"lCIDcfh<:~J ~cmQ?dSJroYmJCTn<m~. m16t3'Bcmcfi6) Cllmcw19JJcfhJCTn
(5J~CID19JJCID1m1cB6>Jo ooru<mm6mo.

78
~(J)arudH6lT)mYm1am m16t3Y3~JQsn.JebJ~1mYmo tGYgru(f()J Q?i:/SJCTnJ.

IZlJobcf:hJm6lT)6t3Y3~1i:JJQcm ~(J)arudH6lT)mYm1am ~ QcmJmJne.J3mYm19.JJO

m16t3Y3ubcBE5n.J1obruJ6t3Y3JruJCTncmJ6'(l). ~

n.JomQmYmcruo6Yl.l(TU.n~ m16t3Y3ubcB6)J~ ~QcmJmJcruo(f()<IDruJo

ru J cBa»1ZlJcB6)JruJCTncm J6'(l). C(f()QJm1cB6)JCTnru1ru m6t3Y3ub cm1cf:h~Jo

cruJcf:hJm J IZlJ<ID1cru" c&.ai1cB6)JCTncm

J6'(l)

ru9.J1cB6)lCTncm1mlon.J" ~~IZlJ<IDlon.JommYm1m1CTnlon.J1obruJ6t3Y31CTncm1

mJIZlJ~«rn)rucf:hJ(f()on.Q)crnem cB6)JQG'(lgm) bfIDJoblZlmcm19.JJcB6)J CTnJ .

~(J)arudH6lT)mYm1obQ()@J(J)IZlJcf:hJCTncm19.l" QSbfIDJrm

cf:h~SJcmamcrulZl<IDo(J)arudHcf:hdbQ()m1(f)lZlm6t3Y3ubcOOJaruG'(lg1IZlJg1ru

em cB6)JQIZlCTnJo~ cm19.J~QScf:hQG'(lgmYmJCTnm1(J)lZlm6t3Y3ub

IZlQgJmJcruJcf:hJmJ9.JJ@mYm1mJaruG'(lg1<IDJo~n.Ja<IDJ(J)1cB6)Jcf:h<ID1Qi:J

CTnJon.Q)m1cBE5a6Yl.lJW J IZlJ6'(l) .n.Q)~pru1rum6t3Y3~J on.Q)m1cBE5IZlmcm19.JJ

cf:hJCTn(gJdH<ID19.JJ6'(l)mamcf:h1<IDcm.

79
GYmJrrb ~nJommYm1rrbQ0(5J(J)CllJc£bJCTncm1

mJ<IDJQcmJ<nJn(j)cm1d>~c£b~JCll1Q~cm ~cm1mJ~CTUJ~d Q';tjSJmYmJCTnJ

. ~cm19.J'QsGYmJob~nJ

OmQmYmCTUo6llJml.n~J~~n{D~Jc£bJ<nJ6tffi~JoCllmcw19.JJcB6)JCTnJQru

CTnJoCTUJ<IDo~nJommYm1rrbQo(5J(J)CllJc£bJCTnJQruCTnJon(j)rrbQoruJc£bJ

CTUD9.Jo

80
 APPENDIX-C

FACTORS AFFECTING HEARING AID USE IN YOUNG ADULTS (FAHA

QUESTIONNAIRE)

INSTRUCTIONS (m1dlcC3Ul>6lff3cib)

• Please answer the following questions (Bouru:>ou1..!lJJruQsouJ~

• There is no correct or wrong answer. Please tell us what you think (~ru1QS

Ul>m1OUlamnmclZl:>Qan~lamnmclZl:> ~ij; cmaan1m:>~ m16lff3cib

..!lJ1mn1cB6)JcmcmQO)6lff3C~:>S n.J ()OUJdb)

.• No one else -will read this questionnaire other than the -person eoneemed

(..!l.IJfZlcm~Q'kJ3OJdl63~1Qdb fZlg:>mJo grJ C..!lJ:>BJ:>ru~1

OJ:>ou1cB6)Jcmani!)

SECTION 1. General information (Qn.J:>anJru1rum6lff3cib)

u
1. Name(Cn.Jm):

2_ Date of birth (fimman"louan1):

81
SECTION 2. Information related to Hearing skill / Hearing history (l<fCJru6m

aCJl)cat1~Jt2lJCID16Tl1ffil)Q.?d~ ru1ru«l6a'BuO)

1. At which age were you identified as having a hearing problem (CIDJEfbuOceQ

acfbuOru1cB6)J()ruJQQ1g em cfbQ1gJn ...nS1cB6)JCTncm n.Q}lm>JI2.lQantn

ru CIDCTU19..JJ6m')?

2. At which ·agedid -you·getyour first hearing -aid-(n(j)lCIDJt2lQamJ)

ruCIDCTU19..JJb(J) «3'@SJt2lJCID1lCJl)OJ6mCTUnDJCID1

CTUJ<Ymt2lJcB6?JCTncm)?

3. Do you regularly use h . g aids (CIDJEfbuO n.(j)i:P S1ruCTUruJo

.lCJl)OJGmCTUnD JCID1 ~aCIDJ(f)1cB6)J() JaQ1gJ)?

a. Yes (GO TO SECTION 3)

b. Np (90 T9 Q!JESTI9N 4)

4. If you are not a regular user of hearing aid, please explain the reason

((o)JEfbuO n.(j)~P S1ruCTU ruJo lCJl)ruGmCTUnD JCID1

~n.JaCIDJ(f)1cB6)J CTn1i:j n.(j) CTnJQQ1g Efb1~ cfbJ«l6mo

ru J c:fffi))12.l
JcB6)J cfb)?

a. Noisy situations are disturbing (CJl)6Yl,jt2lJQJ«l1cmt2lJCID

«rtaruCTU «l6a'BuO 6TlIJfW1t2lJ3JQ1g JcB6)JCTnJ).

b. No need (<<3'@OJCJl)Jt2l1i:j).

82
 u
c. No/poor benefit (tn.JC<IDJf2mo ~@:j/ln.JC<IDJ!imo cfbJOOJJ6m).

d. Leads to other disturbances (itching, pain etc.); fll~?J

~p~, COJC3m
6'f1JJ1ID1fllJ3Jcfbcib~6'(lgJcB6)JcmJ (Q..!lJJ01 ..
I

e. Poor sound quality ((f()Q)Jmvm1mQo OJJc6<O)an

f. Other reasons (fllg J cfbJm6m6tm~Jam).

5. If you are not using hearing aid.at which age did you stop using hearing aids

(anJffbcib l(f()OJ6m 1.)n.DJ<ID1~n.J C<IDJ(J)1c:.66)Jcm1@:j

n.g)~JQ6'(lgffb 1am, l(f()OJ6mCTUn.DJ<ID1m1anJ~Jo

~n.J C<IDJ(J)1cB6)Jcmanm1rnmvm1cwan n.(j)lan JfllQmvm OJCWCTU19.JJbffi)?

$. 9-_5

b. 6-11

~. J]-J:5

d. 16-17

~. J~:7J

f. 21-24

83
SECTION 3. About yourself (CIDJEfhQ~c66)J()1~ )

1. With whom do you stay now (CIDJEfhCib~<:~Jun <GY9mJQS cfb,QSCIDJ6YTl

a. Along with parents (IZlJCIDJn.JlCIDJc66)~JQS cfb,QS).

b. Along with relatives (IZl~U 6Yl.ICTWJc66)~JQS cfbJQS).

2. Are you receiving pen ton for the physically challenged category from the

a. Yes

b. No

If no, why?

.a. Ldon '.1know .about the-disability pension (~.(T>~

b. I don't-think it is necessary (iQm) cG'r9"ruooJIZlJWl n{j)mlcB())

84
 c. I have applied, but have not yet received it (<<3YaCnJcBfM

QdhJ~Jamn1~Jm§' , nJQcBfMdhJe.JCO))(2)CTUo
cmm1csbY151

OJmJ(JnJ.)

3. Please note down your job details (co)JEfb~JQS !QCt~:p~Qamn Qco)J~1am

OJ1OJ<p~~ ~<P~~~$J~J.~)?

a. Permanent job (ffil1l1mc!TlJe.J1).

b. Temporary job (CO)JeldhJeJ1'dh C!TlJeJ1).

c. Studying (nJo1cOOJ(JnJ).

d. Not employed at present (Qco)J~1ammn111CO)cTb).

4. What is your annual income (co)JEfb~JQS OJJrodM1dh OJmJ(2)Jmo

n.Q){CO)
(ll)Jb(T)?

a. Less than Rs-10000 (10000 am co)JQ~).

·b. "1()000-20000

c. 20000-30000

.d~ .MQr~than .3.00.0.0.(3.0.0.0.0

.@ ~~J.@.@)

e. No income (OJmJ(2)Jm(2)1~p.

85
5. What is your highest qualification (emJBh<il>n.J~d>mYm1<IDJcB6)1<ID

~<IDd>CTnru1BJ-J(5J-JCTU a<IDJ(f)J"emn.(DcrmJ6Y'O)?

a. Primary school (QQtn.Jtll()1 crUdb,<il».

b. High school (QQnD mrdb,ub).

c. Higher secondary (nD<IDd>QCTUcB6)m()()1).

d. Degree (CTU~<)ddb9.JJUl)J9.J6O:J1mJBo).

e. Post-graduation and above (60nmJBJmcrmmro.J1mJBruJo

<maem1m)n.Jm1<ID)o).

6. What is your marital status (emJBh~JQS QQruruJnD1db m19.J

r4DcrmJ6Y'O)?

a. Married (ru1ruJnD1emoo/ru1ruJnD1em).

b. Unmarried (<maru1·ruJn.cffemob/<maru1-ruJn1i1"em).

c. Separated!Divorcee (arud>n.J1m1GYOYmJ

emJmCTU1cB6))CTn)lru1ruJnD am J_!l.nemJOO/amJ_!l.J1em).

7. Do you think that you are a person with complete hearing impairment or

partial hearing impairment (emJBh<il>63mJ n.J,d>~tllJ<IDJo

adb<il>ru1cB6)J()ruJ~ ruJcB<O)1<maQiiBh1am (5J(f)1dbtllJ<ID1

adb<il>ru1cB6)J()ruJ~ ruJcB<O)1«Jf9<ID1CTUJ<IDodbmJemJCTnJamsJ)?

86
 a. Complete hearing impairment (n.J,d>~(l}JCIDJo

b. Partial hearing impairment «(5Joo1cfb(l}JCID1 ecfbuOru1cB6)J()ruJ~

ru J-cB<ID1).

c. None of these (iQQ(O)JCTnJ(l}ij ).

,8. If you are a person with complete .hearing impairment, win you -be a part of

ru J cB<ID1«J'@Q6lT)ffb1~ (0) JffbuO n.Q).wJCID1e'6~p~ Jo 63COJ6llJW1CO

<TU(l}J nO COYm
100 Q() (5 JOO(l}Jcfb J() J ems J )?

u
a. Yes (~6ll5 )

b. No (iQij).

9-. -What-kind of communication do you use mainly (n.{f?,a»-J tID«>tmin1e:tJ~~

«J'@CJl)CIDru1m1(l) OU (l}Jd>~(l} J6Y'O (0) JffbuO cfb, SJ (0) 9.JJOU1

~eouJoo1cB6)JCTncID)?

a. Indian Sign language (iQ<YmJ 00 «J'@oOOJ (5Jc6£M ).

b. Sign language (<<J'@oOOJlSJc6£M)

c. Speech (<TU0<TUJCOo).

87
 10. Do you have any other disabilities or health problems (CO>JEfbubcB6'l

~a6YlSJ)?

u
a. Yes (~Gn5).

b. No (iQ~).

·SECTION 4. Your opinions about hearing aid (tOOf)J€ff)

Please give your opinion by tick on your choice (CO>JQY'n.J()CIDJcmruCID1am m1cm

A- Strongly Disagree (co>immYll'lJo aCIDJSl1c:OOJcm1~) .

B- Disagree (aCIDJ!i1c:OOJcm1~ ).

D- Agree (aCIDJ!i1c:OOJcmJ ).

E- Strongly agree (co>immYll'lJo aCIDJ~1c:B6)JcmJ).

88
Sl.no Statement A B C D E

-1 . Hearing -aids-arevery costly (lW(lJGm

CTUn.nJCllndbcmcB()) ru~Qmrue..n<ID

rule.J<IDJ6m).
-

2 Lack of money to buy the hearing aid

(J..OOru6mCTUn.n J<ID1.~n.JC:<IDJ(J)1cB6) Job

cGrgruoo J /Z)J<ID n.J6mo J

e.J(5 tZl~ ).

3 It.is.not.comfortableto.usem.y.ear.moulds

(n.(j)obQOO Q..DJru1<IDJQS <Gm~Jdb<ib

~n.JC:<IDJ(J)1cB6)Job CTUJQJln.J(3tZl~ ).

4 My use of hearing aids draws a lot of

attention from others (n.Q)obQ(:()

l(f()ru6mCTUn.nJ<IDl tZlg J~rumJQS

l(f()flU n.Q)CTnlc:e.JcB())db J SJ em e.JJ<ID1

rumJmYmJCTnJ).

5 Idon't like the structure/ appearance of my

hearing aid (n.Q)obQO()

l(f()ru6mCTUn.n J<ID1<IDJQS mJ n.J 0

n.Q)m1cBt)) ~~tZlJdbJCTn1~).

89
6 I used to check my hearing efficacy every

year (bYmJOOnm~p ructca:truJo

nmOO6>GO <:dhuDru1

n.J(01<:cmJw1cB6)JoJ~).

7 I service my hearing aid every year (nm~p

ructca:truJo QIDJOO

lcmru6mCTUn.DJCID1dhuDCTUctQJlaU'

u
6>~~.POJbl1'S ).

8 I approach an audiologist only because of my

family's compulsion (QIDJOO

63J(U)1<:CIDJ~2r,n~16>m

CTU21In.J1cB6)JCTncm
ruI3JdhJ(OJ6>S

m1ctmJCTU>o6>dhJ~ 2lJl«n21J6rO).

9 The hearing aid creates difficulties or

problems for me (lcmru6mCTUn.DJCID1dhuD

nmm1cf}6) mJJfID121J3Jbl1'SJcB6)JCTnJ).

10 I always prefer to approach the same

audiologist (QIDJOOnm~JCID1<:tkPY>Jo

63<:(0 63J(U)1<:<IDJ~1!il1~1Qm

90
 O'Ual1nJ lcB6)J (1JJOO

.(ID)~.nd~ J.f?l.?E/$J<!OJ)

11 Even though I use a hearing aid, I cannot

. hear properly (l(f()(1J6mO'UnDJC2>1CU?JQS

O'UnD JC2>roYmJetmbfmJrm mcmJC2>1

CcfbuDcB6)Jcm1iij ).

12 Use of hearing aid gives me a headache

(lOO(1J6mO'UnD JC2>1cfbuD ~ m1cBE))

COle.JC(1JBm ~6Yl5JcB6)JcmJ).

13 My hearing aid makes the surrounding noise

louder (~OOQO() l(f()(1J6mO'UnDJC2>1

.!lJJg JalJ~ (f()b'OJQroYm cfh, sJCOle.JJC2>1

CcfhuD?d1cB6)JcmJ).

14 Those louder sounds I hear while using my

hearing aid are unbearable for me (6YIDJOO

l(f()(1J6mO'UnD JC2>1

i2nJCC2>J(J)1cB6)JCcruJuD CcfhuDcB6)Jcm

(1J e.J1C2>(f()Gn,j6a"Bub ~m1cBE))

«3'faO'UnDm"lODalJODl can JcmJ()JbYl~').

91
15 I don't know which hearing aid to buy

( n..ID (O)Jlemru srrxru n.f) J em1

ru J6tmbffiQf2)crO nmm1cOO' «3'tao1em1~

).

16 I don't know how to use a hearing aid

(lemrubffiffi)n.f) Jem1 nm 6tmQm

~n.JaemJcn1c:B6)bffiQf2)cm nmm1cOO'

«3'tao1em1~).

17 I don't like the sound quality of my hearing

aid (nmdbQ(iO

lCJl) ru srrxru n.!1J em1emJQS CJl)6Yl,J af2)<lll

nmm1cOO' ~~f2)~).

18 If I am a person with tinnitus, I strongly feel

that my tinnitus worsen with hearing aid

usage (6YIDJdbs100msaU ~~ 63(OJ

ruJ &0)1 «J@Qbffi8h1am,

lemrubffiffi)n.f) Jem1

~n.JaemJcn1cOOJa<TlJJuD nmdbQoo

Q..!lJru1em1Q2.I f2)~~am cfh,SJCTn(o)Jem1

nmm1cOO' a(O)JCTnJCTnJ).

92
19 I have to travel a long distance in order to

meet an audiologist (63mJ

63JctU1ccmJ~m1cru()16)m

cruczlin.J1c:66)Jcmcm1mJcm1 Bldlne.J B, mo

cmJlcm 6)~C~6Yl5cmJcm1 rumJcmJ).

20 My classmates prefer me not using a hearing

u
cmJEiffi).

21 My relatives prefer me not using a hearing

aid (n.(D CTb6)~)()G'flJ0'U) J c:66)UOcOO

db, sJcmata ~~o btmJob

,

22 I don't think or believe that hearing aids can

93
 CTU
nD JOlilcB6)Jdb cfbyi 1<ID
JQ(llcm

. £(ID~® cfb.~J.(IDJo:n~).

23 I don't know where to go in order to meet a

good audiologist (63~J mil

63Jcw1c<IDJ~m19;'H1Qm

CTU(lllnJ1cB6)JruJdb nij)ru1QS

CnJJcfb6YT>Q(llcm n.Q)m1cOO'

«3Y'a0 1 <ID1~).

24 I feel much better when I use only one

hearing aid at a time ( 63mJ

l(f()ru6YT>CTUnD
J<ID1 (llJl cmo

~nJ C<IDJ(J)1cB6)JcmJJeib nij)m1cOO'

cfbJSJCO)(l0m~cmJ<ID1 ccmJcmJOJbTT~').

25 Audiologists do not always give importance

to my hearing (63Jcw1C<IDJ~~1~

nij)dbQGO ccfbeibru1cOO'

nij)~J<ID1CtkPY>Jo oom1<IDJ<ID

nJm1(J)6YT>m mc10cfbJo1~).

94
26 I feel that the audiologist's only aim is to

earn money (n.J6mo crumJ)B1cB6)Jcfb

n.(j)(IT)co)'CZ)lcmCZ)6rJ)

g)ru..nc(ID)~m19;H1ob6lo() e.Jcf)BjJ0

n.(j)6l(IT)m1cOO'ccm)(IT»()J6m\

27 I feel that the centre for checking hearing

efficiency offers me a good

service( n.(j)m1cOO' ccm)(IT)J(IT)J,

n.(j)crb6lo() ccfbubru'l n_J(~1CUD)Bm

Ccfbl<l30 CZ)1cfb~ crro rumCZ)6rJ)

.. m~I'ibJ<:m6l<mm)\

28 It takes a lot of time to select a good hearing

aid.(-63(OJ.~ {UllruGmCTU.n.n)CSl)1

cm1C'06lQ'OYO)sJcB6)J(IT)cm1m
gC'OJn.J)S

. cfb)e.J~~ru cmC'01csQ151ru~J(IT)J).

29 It takes a long period to get an appointment

to see an audiologist

(g)(U)1c(ID)~m19;H16lm

rro CZ)1n.J1cB6)Jru)mJ~ «rf()rucru C'Oo

95
 eJ(5]cB6)Jru:>em nmQr> m:>oo

-~$J~J<mJ).

30 I don't get enough time to spend with an

audiologist (n4)m1c:aQ

63:><w1cCID:>~m1~JIll:>CID1

° rruIIICID°
..!l.J1eJ ru Y'1cB6):>em <C3YaW1db

eJ(51cB6):>r>1~ ).

31 Every year I feel the need to visit audiologist

more than once (63:>Cm:> ruc7JcatruJo

63(ffi1~ db, sJem~ emru6m

63:><w1cCID:>~m1~1Qm

rru1ll1~.n Ccf)6)6'(lgem:>CID1
u
cem:>(ffi:>r>J6'(lg ).

32 The hearing aid batteries are too expensive

(lOOru6mml n!) :>CID1CID

JQS

m.J:>gr>1CIDJQS ru1eJ ru~Qm

<C3YaW1-dblll
:>bT11').

33 People consider me as a less intelligent

person only-because of my use of a hearing

aid (bYO):>emlOOru6mmln!) :>CID1

96
 ~n.Ja<IDJ(J) lcB6)JcmcmJQdbJ~ (2)Jlcmo

. cnrg~JdbvJ>.~~.c:m ~J@1dhJ.o~

63mJ~J<ID1 dbbmcB6)JcB6)JcmJ).

34 I do-not .give-mueh -importanee to -hearing

(bfIDJrmadbc.ibru1cB65'ru~1<ID

In.JJWJmJo m<tmdbJcm1~p.

35 People have a negative attitude towards

persons with hearing impairment

(adbc.ibru1cB6)J()ruJ~ ru J cB<O>1a<IDJs

«ng~Jdbc.ibcOO'Qn.JJcmJQru

a (2)J(f()(2)J<ID...!l.l1mn
J(J)cm1 <IDJ6m\

36 It needs a lot of money for a hearing test

(adbc.ibrul n.Jm1a(f()Jema» cB6)J

db, SJcm<tmn.Jbmo «ngru(f() J (2)J<ID1

ruCOJcmJ).

37 The audiologist does not provide the service I

need (n:IDffilcBt5 <GY9(')j(f() J ~J~

acrurumo 63Jcw1a<IDJ~~1~

m.~.dbJ.cm1~p.

97
38 I am happy with the use of my hearing aids

(n.{DrnHi)(:() l(Ii)ru 6mCTU

n..n JCIDl

~nJ <:CIDJ(I)(O)1))la06YmJOO

u u
emjnJ emmJ6m).

39 Hearing aid is not my responsibility. It is the

job of an audiologist (l(li)ru6mCTUn..nJCIDl

n.{Dcmcm n.{DOO6)O()

~(O)1))mruJal(O)1))al~, cmacm 63mJ

63J<tUl<:CIDJ~~l~lOO6)O()

<:~J9..J1CID
J b'(T)

40 Unless reminded every year, I won't check

my hearing efficacy

(~Jd>al ~l.~~f1g)~ffb 1~ .63J<:(o:;)

rud!~ruJo n.{DOO6)O()<:dbcibrul

nJml<:(Ii)Jam mS(O)1))J()l.i:P,

41 Due to an error on the part of my audiologist,

I am not using a hearing aid

(63J<tUl<:CIDJ~~l~lOO6)O() (5J (1)6)(0)1))

nJ1Y>ruJalJ 9..JalJb'(T) 6YmJOO

98
 t(f()ru sm CTU 1
n.n J CID

&l~gl)~(J)1~J~)...

42 Hearing aid is beyond my control (like

·volume control, programme switch, on off

switch etc.); t(f()rumlCTUn.nJCID1

~clbQG() m1CIDtClIDmlamn1mJo

«3Ya~J()amnJQ1) ( CruJ~1CIDo

cfbCt6Yl'5Jcib ,Ctn..JJt(l)Jo CTUJ1~, 6'3JbYTb-

6'3Jnn CTUJ1~ CIDJS6ID'31CIDru)

43 The use of hearing aids during working hours

creates difficulty (C~Je.n CTUtZlCID6ID'3~1am

t(f()ru mlCTUn.n JCID1CID

J QS ~n..J CCIDJ(I)o

· Q1JJIllHtZlJ3J6Yl'5JcOOJcmJ).

44 People behave badly towards me when they

see me with hearing aids (n..{j)"rmQO()

t(f()rumlCTUn.n JCID1 cfbJmlJCCTlJJcib

·~J'CfbOO' em:::>(Jael3ov1·

Qn..JmJtZlJ()JcmJ).

45- r use hearing aids only when r am inside the

home (bYmJclb ru131eJJ~

99
 CTUt2lem 6m3 811~ t2l:>lant2l:>brO

_~_QJ6'fT)<n>~3<RH

~nJ~em:>(J)1cOOJ<man').

46 I don't get-tlie-time-to approaeh an

audiologist (n.(j)m1cB())

63:>cw1~em:>~m1~1Qm

CTUt2llnJ1cOOJ ru:>mJ ~ CTUt2lOVo

9J8Jt2l~)-

SECTION 5. Education and family history (ru1C3J:>@J:>CTUo&cfbJSJo6TlJ

1l.cID0 )
_!l..J(O

1. Are your parents completely hearing impaired (m16m3u'bcB())

nJJ dl~t2l:>ov Jo ~cfbu'bru1cOOJ()ruJ~

(ocBfMcfhdla:rrm:>cOO8l:>~6'fT):>~~ro))?

b. No (<GYCl~)

100
2. Do your mother/ father have hearing problems (m16lm~JQs

tmal2l2laV<:cB6)Jtma7A<:mJ <:cfbubru1cB6)J()ruJ<:6l1SD)?

a. Yes (tmaQCID)

b. No (<<rragp

3. Did you study at a primary/secondary school for the hearing impaired

(<:cfbubru1cB6)J()ruJ~rurncB6)JCIDJ~ QQtn.JCZl()1/

QCTU
cB6)OO()()1 mr cfb~~1 am «JY9<:6YT>J
n.J o1~ro»)?

a. Yes (tmaQCID)

4. Did you study in a primary / secondary school that had a hearing impaired

unit! resource class room ((wru6YT>n.Jm1wl9.Jm ru1l5J(J)o/

()1C:CTUJy)'mr~Jmr (),o ~~ ~tn.JCZl()1/QCTUcB6)OO()()1

mr cfb,~1am «JY9<:6YT>J
n.Jo1~ro»)?

a. Yes (tmaQCID)

101
SECTIONS 6. Expecting changes (rumJ<:mYm6Tr5 elJc;?6aY3ub)

i. Do you wish to use hearing aids always

(n.(j)<:~JY> J 0 lCfl)ruQ1)<ru n.O JCID1idn.J<:CIDJ(J)1c:86)Q1)QelcrO <IDJEfbub

<GY9l(J)n.O 1c:86)J <mJ <:6Tr5J )?

u
a. Yes (id6Tr5)

b. No(~~)

2. If yes, what are the changes you expect from the service of your

audiologist

a. To provide the provision for free hearing aids and batteries

(<ru'nSlm J elJCID1<:cfbubru1<run.OJCID1,
GnJJgo1<IDJs 6aY31CIDrug.Jt~ J elJc:86)Jcfh ).

b. To provide the provision for free hearing test

102
 c. Reminder notice for regular check-ups

(db jan J (2)JCID~S(:CtJ~db~19..1J~<:dbuOru1n.Jm1<:cmJwm

dbuOcOOJCIDl63Jc1>CZlZlQ~SJ COYmJ
db).

d. Provide better access to information about hearing aids

(ru1ru1wlcmru6mcrunDJCID1dbQ~~glCIDJ~ru1rum6tfB

uOQ(2)-:9dQ~3ml(O)lCID1~9..ItSJ(2)JcOOJdb).

e. Any other (IZlQgQO'OHfb19..1Jo).

3. If you want to use the hearing aids always, what are the changes that are

required

(n(j) <:~ JY>J lcmru6mcru nD JCID1~n.J <:CIDJ(J)lcOO6mQ(2)crO Qm5ffi> 1

~~Qcrm~:)o(O)mCOYm19..1J~(2)J~~~:;>~ «Jrc)(Q)lmJIZlJCTbn.JJru

mJ <:COYmm5an JCID1ml6'tffiuO«Jr9l(J)nD 1cOOJcman)?

a. Improvement in mould comfort

(Q..!l..Iru1CIDJ QS «J'«) ~JdbQ~dbJ SJ (O)~ffi)JQJ ln.JBIZlJc66)Jdb ).

h. Improve the durability of hearing aids against water

(~9..ICOYm1Qmln.Jan1<:mJw1cOOJcmru1wCOYm1~l(f{)ru6mffi)

nDJCID1CIDJQS~S Q(2)-:9dQ~SJCOYmJdb).

103
 d. Quicker repair services

(l UllrubffiCTU n.D J<ID1<IDJQS <:cfbSJ n.JJsJcfbcibmlcB6)1<:ruCf)

(O"(O)1arnln.J ruaHUYmmCTU ~fZl JcB6)1(O"(O)(OJcfb).

Section 7. Other problems (fZlgJln.JWm6t3Y3cib)

1. Please write down your other opinions/ comments

(m16t3Y3cibcB6)J ~fZlg Joo@1ln.JJ<ID6t3Y3cib<:(o6lIQ';tjSJ(O"(O)Jcfb).

104
 APPENDIX-D

Video record of FAHA in sign language (CD included).

105