Comparison between self-reported hearing and measured hearing thresholds of the elderly in China

Despite the increasing prevalence of hearing loss among elderly people and its recognised severe consequences, routine audiometric examinations as well as systematic follow-ups and rehabilitation services are not readily available to those in need of hearing evaluation in China. In addition to a lack of competent audiologists and public awareness, the scarcity of well-calibrated audiologic equipment and appropriate sound-proof facilities is a major hurdle for the provision of regular hearing assessment in China, where resources are limited and audiology is emerging as a profession. Therefore, seeking alternatives has been of clinical importance. Since the early 1980s, the self-assessment of hearing sensitivity has been clinically validated as an effective approach in the English-language context and is widely used in a variety of clinical and community settings. Consequently, non-English self-report questionnaires are needed. This study aimed to evaluate the efficacy of the Mandarin Chinese version of the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) for elderly individuals in Beijing, China.

The authors recruited a total of 727 elderly subjects, 60 to 86 years of age, from Beijing to participate in the present study. The subjects completed the questionnaires and received audiometric testing. The HHIE-S scores were subsequently compared with audiometrically acquired hearing thresholds at >25dB HL, >40 dB HL and >60 dB HL to screen for mild, moderate and severe hearing impairment and for pure-tone averages at 0.5, 1, 2, and 4 kHz.

The HHIE-S scores correlate with age (correlation coefficient r = 0.475) and hearing impairment (correlation coefficient r = 0.745). To detect moderate or greater degrees of hearing loss (i.e., pure-tone average at 0.5-4 kHz >40 dB), the HHIE-S cut-off score >6 had a sensitivity of 100% and a specificity of 84.5%. The HHIE-S score >6 and pure-tone test hearing level >40 dB HL were in agreement with each other (kappa = 0.809).

The Mandarin Chinese version of the HHIE-S is considered to be a reliable and valid screening tool with greater sensitivity to identify moderate hearing loss in older adults in China. The application of this Mandarin Chinese version has the potential to be extended to a large number of under-tested older adults in a country where hearing impairment has become one of the top health care threats to the well-being of its citizens.