Daily-Life Fatigue Among Adolescents Who Are Hard of Hearing: An Ecological Momentary Assessment Study

Studies using retrospective questionnaires have suggested that children, adolescents, and adults who are hard of hearing may be more fatigued than their peers with typical hearing, though the effects of hearing loss severity and hearing loss interventions on fatigue are unclear. The purpose of this preliminary study was to closely examine the relationship among hearing loss, hearing aid use, and fatigue in a small sample of adolescents using ecological momentary assessment.

Ten adolescents with typical hearing and 10 adolescents who are hard of hearing completed ecological momentary assessments on a smartphone across a 1-week sampling period. Most participants completed two sessions, one in the summer and one in the school year. Participants were asked to take eight assessments a day, 2 hours apart. The assessments asked participants to report on their momentary fatigue as well as their hearing aid use, listening environment, and listening activity. Last, hearing loss severity among participants who are hard of hearing was quantified using unaided Speech Intelligibility Indices.

Compliance on the ecological momentary assessments was high. Participants completed, on average, 47 and 54 of the requested 56 ecological momentary assessments in the summer and school year, respectively. Overall, there were no differences in fatigue between our samples of adolescents with typical hearing and adolescents who are hard of hearing. Adolescents with typical hearing reported greater fatigue in the school year than they did in the summer, while adolescents who are hard of hearing reported greater fatigue in the summer than in the school year. However, among adolescents who are hard of hearing, session, hearing loss severity, and hearing aid use moderated fatigue, with a complex relationship observed between hearing aid use, unaided Speech Intelligibility Index, and session. Hearing aid use results in lower ratings of fatigue for adolescents with less hearing loss, with larger effects in the summer. All adolescents showed increasing but nonlinear trajectories of fatigue across the day, with lowest fatigue in the middle of the day. The increase in fatigue across the day was less steep in the summer and for adolescents who are hard of hearing. All adolescents reported greater fatigue when listening in background noise, but the size of this effect did not differ between groups. Fatigue did not differ depending on listening activity.

In contrast to expectations, mean fatigue in our sample of adolescents who are hard of hearing was not greater than that reported by our sample of adolescents with typical hearing. This may simply reflect our limited sample size and the wide variability of fatigue in those with hearing loss. In addition, within our sample, fatigue effects may have been moderated by hearing aid use, particularly for those adolescents with less hearing loss. The findings from this study support the idea that hearing aid use may reduce fatigue in adolescents; however, important questions remain regarding the degree to which fatigue is listening-related or whether hearing aid use is simply more likely during fatiguing activities. This study also demonstrates that ecological momentary assessment can quantify the effects of hearing loss and hearing aid use on fatigue in daily life among adolescents.