MM105 - Health-Related Quality of Life Benefits of Hearing Aids: What is the Evidence?

Abstract: A systematic review with meta-analysis found that hearing aids improve health-related quality of life in adults with sensorineural hearing loss. A random effects meta-analysis of disease-specific HRQoL measures used in eight RCTs found a mean effect size of 1.245 with a total of 2,350 participants. For generic measures, seven RCTs with 1,568 participants showed a mean effect size of 0.307. This benefit merits an A grade from the Oxford Centre for Evidence-based Medicine (2009). Providers should inform patients, and these results may support insurance coverage for those unable to afford hearing aids.

Background: Hearing loss is projected to affect over 2.5 billion people by 2050, with approximately 700 million requiring rehabilitation. Sensorineural hearing loss (SNHL) is typically managed with hearing aids or amplification devices, which improve health-related quality of life (HRQoL). A 2007 systematic review by the American Academy of Audiology found positive HRQoL effects for adults using hearing aids but highlighted the need for more randomized controlled trials (RCTs). Recent research growth and evolving HRQoL definitions justify updating the 2007 review. The purpose of this systematic review with meta-analysis is to determine a grade for the recommendation that hearing aid use enhances the HRQoL of adults with SNHL.

Method: The study design was a systematic review with meta-analysis. The RCTs enrolled community-dwelling adults with mild to profound SNHL. Excluded were individuals in acute care, nursing facilities, or who were incarcerated. The intervention was options included various hearing aid styles (e.g., behind the ear, in the ear, or completely in the ear), power source (e.g., battery, rechargeable, or solar powered), signal processing circuitry (e.g., analog or digital), microphone technology (e.g., omnidirectional or directional), fitting arrangement (e.g., monaural or. binaural), service-delivery method (audiologist fit. direct to consumers [e.g., over the counter]), or payment type (e.g., self-pay or free). Articles up to December 31, 2024 were obtained from major medical databases: CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Scopus, Web of Science Citation Indexes, ISRCTN Registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. Covidence was used for study selection, quality assessment (Revised Cochrane Risk-of-Bias Tool for Randomized Trials: RoB 2), and data extraction. Random effects meta-analyses estimated effect sizes for disease-specific and generic HRQoL measures.

Results: The database search found 9,620 articles and one additional record through handsearching. After removing 5,383 duplicates, 4,238 articles were screened by title and abstract, resulting in 76 articles for full-text review; from these, eight study protocols, 13 RCTs, and one systematic review of RCTs were identified. A random effects meta-analyses found a mean effect size of 1.245 (95% CI: 0.877 to 1.613 (Z = 6.635; p < 0.001) for disease-specific HRQoL measures used in eight RCTs with a total of 2,350 participants. For generic measures, seven RCTs with 1,568 participants showed a mean effect size of 0.307 (95% CI: 0.133 to 0.481; Z = 3.463; p = 0.001) using the SF-12 mental subscale for three of the studies. Using the SF-12 physical subscale, a second meta-analysis found similar effect sizes for generic measures.

Conclusions: The systematic review with meta-analyses of RCTs found a large effect size for disease-specific HRQoL measures and a small effect size for generic outcomes. The recommendation that hearing aid use compared to nonuse improves the HRQoL of adults with SNHL deserves a grade of A (Oxford Center for Evidence-based Medicine, 2009).

Clinical Relevance: Strong evidence indicates that hearing aids improve HRQoL for adults with SNHL. Providers can inform patients of these benefits, and these results may encourage third-party payers to cover hearing aid costs for those unable to pay themselves.

Clinical Takeaways: The clinical takeaway for this session is that audiologists can counsel patients with a great level of certainty that hearing aids improve health-related quality of life of adults with SNHL. These findings also have implications for health policy, supporting the adoption and use of hearing aids and underscoring the importance of evidence-based rehabilitative strategies in conjunction with device use.