Hearing aids, Cochlear implants and Extended audiological rehabilitation

Factors associated with patients’ use and participation

Hjaldahl J, Widén S, Carlsson P-I

University Health Care Research Centre, Region Örebro County, Sweden
School of Health and Medical Sciences, Örebro University, Swedish Institute for Disability Research, Örebro, Sweden

Audiological Research Center, Örebro University Hospital, Sweden
Department of Otorhinolaryngology, Central Hospital, Karlstad, Sweden

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A severe to profound hearing loss can be defined trough average pure tone audiometry at the frequencies 0.5, 1, 2 and 4 kHz (PTA4) ≥ 70 dB HL in the better ear (1). Many with a severe to profound hearing loss require audiological rehabilitation in order to function in daily life. Rehabilitation may include technical rehabilitation such as Hearing Aids (HA) or Cochlear Implants (CI). Extended audiological rehabilitation requires involvement from different professions from within the audiological department (2). There is little knowledge about factors that could influence the rehabilitation that individuals with a severe to profound hearing loss use.


The aim was to determine whether demographic variables and variables from the quality register are associated to HA and CI use, and participation in extended audiological rehabilitation among individuals with severe to profound hearing loss. The aim was also to compare the use of unilateral and bilateral HA use.


  • A selection from the clinical quality register The Swedish Quality Register of Otorhinolaryngology was conducted.
  • Inclusion criterion were PTA4 ≥ 70 dB HL in the better ear and being at least 19 years old.
  • The material was analysed with multiple logistic regression.
  • 1703 individuals were included in the analysis of use of HA, CI and extended audiological rehabilitation.
  • 1466 individuals were included in the comparison analysis of the unilateral and bilateral HA use.
  • Comparison of binaural CI was not possible since only 3 individuals had binaural CIs.
  • Demographic variables (sex, age, education level, onset age and sick leave) and the self-rated PIRS (Problem Impact rating scale) were collected from the quality register among with information about audiological rehabilitation (HA, CI and extended audiological rehabilitation).
  • The PIRS is a self-rated instrument were the participant is asked to rate, on a thermometer scale ranging from 0- 100, the impact the hearing loss has on the daily life. 100 indicates the most extensive impact and 0 indicates no impact on daily life. The cut frequency were set at 70 and were dichotomized to <70 and ≥70.

Results & Conclusions

  • Degree of hearing loss was the strongest factor associated with the use of HAs, CI or participation in extended audiological rehabilitation. The lower PTA4 the individuals had, the more likely they were to use at least one HA and the higher PTA4 they had, the more likely they were to use CI.
  • The sex distribution was evenly divided, but the women indicated a higher level of participation in extended audiological rehabilitation. Previous research (3) have shown that women are more likely to adhere to recommended medical treatment than men, which could also be a possible explanation.
  • Individuals with higher education level were more likely to have at least one HA, CI or participate in extended audiological rehabilitation. Individuals with a higher education level might be better at expressing their needs, which could be an explanation for this results.


  1. Martini, A. (2001). Definitions, protocols and guidelines in genetic hearing impairment. London: Whurr.
  2. The National Board of Health and Welfare. Rehabilitering för vuxna med syneller hörselnedsättning. Landstingets habiliterings- och rehabiliteringsinsatser. [Rehabilitation for adults with sigh and hearing loss. Rehabiliation interventions of Regions in Sweden]. 2012. [5 September 2016].
  3. Manteuffel M, Williams S, Chen W, et al. Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt). 2014;23: 112–119.
Contact information

Relaterad personal: Jennie Hjaldahl, Per-Inge Carlsson, Stephen Widén