Working-age first-time hearing aid users' self-reported outcomes.

OBJECTIVE: To study patient-reported hearing aid (HA) rehabilitation outcomes, social-communicative functioning, and expectations/experiences during eight months of HA use. DESIGN: Three self-reporting instruments, the International Outcome Inventory for Hearing Aids (IOI-HA), the Quantified Denver Scale of Communicative Function (QDS), and questionnaires tapping pre-rehabilitation expectations (HA-EXP-Q1) and post-rehabilitation experiences (HA-EXP-Q2) were administered. STUDY SAMPLE: 144 patients ages 23-66 with gradually acquired, adult-onset, mild-to-moderate sensorineural hearing loss affecting both ears who acquired their first HAs. RESULTS: According to self-reports, HA rehabilitation outcomes were good, and everyday social-communicative functioning improved after one month and after eight months of HA use. When the effects from demographic and audiological variables were analysed, younger age and positive expectations of HAs were associated with better outcomes and social-communicative functioning. The form or hearing loss severity, and the type or number of HAs did not affect outcomes. CONCLUSION: Working-age HA users reported better HA outcomes than older adults in previous studies. Coping in work life may be a strong motivator for active HA use. Considering that younger age and positive expectations resulted in better outcomes, early rehabilitation that supports positive and realistic expectations of HA performance is essential.

Studies on stigma regarding hearing impairment and hearing aid use among adults of working age: a scoping review.

PURPOSE: Research on stigma has been criticized for centering on the perceptions of individuals and their effect on social interactions rather than studying stigma as a dynamic and relational phenomenon as originally defined by Goffman. This review investigates whether and how stigma has been evaluated as a social process in the context of hearing impairment and hearing aid use. MATERIALS AND METHODS: Systematic literature searches were conducted within four major databases for peer-reviewed journal articles on hearing impairment and hearing aid rehabilitation. In these, 18 studies with stigma, shame or mental wellbeing as the primary research interest were identified. The reports were examined for their methodology, focus and results. RESULTS: The reviewed studies used both quantitative and qualitative methodologies, questionnaires and interviews being the most common methods. All studies concentrated on the participants' experiences or views concerning stigma. Studies examining the social process of stigmatization were lacking. Most studies pointed out the negative effect of stigma on the use of hearing aids. CONCLUSIONS: In order to understand the process of stigmatization, more studies using observational methods are needed. Moreover, additional research should also focus on how stigma as a social and relational phenomenon can be alleviated. IMPLICATIONS FOR REHABILITATION Low adherence in hearing aid use is connected to fear of stigma related to hearing impairment and hearing aids. Hearing health services should include counseling to deal with individual's experiences and fear of stigma. Stigmatization is a social process that concerns individuals with hearing impairment in contact with their social environment. Hearing health professionals should consider including close relatives and/or partners of hearing impaired individuals in discussions of starting hearing aid rehabilitation. In consulting patients with hearing impairment professionals should give advice about how to deal with questions of hearing aid, hearing impairment and fear of stigma at work.

Other-initiations of repair by children with developmental language disorder in speech-language therapy and non-institutional play.

This study explores the use of other-initiations of repair by children with developmental language disorder (DLD). The data are children's video-recorded language assessment sessions, speech-language therapy sessions and two kinds of non-institutional play sessions, parent-child and peer play. The videotapes were transcribed following CA conventions focusing on speech and relevant embodied actions. Other-initiations of repair were identified, collected and analyzed. The analysis focuses on open requests and candidate understandings which were the two most common types of other-initiation of repair in the data. The types of other-initiation of repair were similar to those found in adult interactions and by neurotypical children. Repair sequences were regularly short consisting only of three turns. Other-initiations of repair typically emerged in certain contexts: open requests were regularly used after sudden topical shifts, child's inattention, or long and complex setting of language tasks in assessment and therapy, whereas candidate understandings were mostly used for confirming the children's inferences of the meaning of unclear references or wider semantic content in free conversation. This indicates that the local sequential context influences the types of problems the children with DLD encounter, and the types of problems determine how the children other-initiate repair to solve these problems. Thus, the sequential context should be considered in a detailed manner when assessing children's communication skills and studying other-initiations of repair.

Discussing Hearing Aid Rehabilitation at the Hearing Clinic: Patient Involvement in Deciding upon the Need for a Hearing Aid.

The quality of interaction between hearing health professionals and patients is one prominent, yet under-studied explanation for the low adherence in acquiring and using a hearing aid. This study describes two different ways of introducing hearing aid to the patients at their first visits at the hearing clinic: an inquiry asking patients opinion followed by offer, and an expert evaluation of the necessity of a hearing aid; and shows two different trajectories ensuing from these introductions. The trajectories represent two extreme ends of a continuum of practices of starting a discussion about hearing aid rehabilitation, in terms of how these practices affect patient participation in decision-making. The analysis shows how granting different degrees of deontic and epistemic rights to professionals and patients has different consequences with regard to the activity of reaching shared understanding on the treatment. The data consist of 17 video-recorded encounters at the hearing clinic. The method used is conversation analysis.

Open-class repair initiations in conversations involving middle-aged hearing aid users with mild to moderate loss.

BACKGROUND: To manage conversational breakdowns, individuals with hearing loss (HL) often have to request their interlocutors to repeat or clarify. AIMS: To examine how middle-aged hearing aid (HA) users manage conversational breakdowns by using open-class repair initiations (e.g., questions such as sorry, what and huh), and whether their use of repair initiations differs from their normally hearing interlocutors. METHODS & PROCEDURES: Eighteen 45-64-year-old adults with acquired mild to moderate HL participated in the study. The participants were videotaped in everyday interactions at their homes and workplaces and in clinical encounters with hearing health professionals. Interactions were transcribed and open-class repair initiations of participants with HL and their interlocutors were identified using conversation analysis. The frequencies of initiations were analyzed statistically between the groups, and the contexts and structure of repair sequences dealing with communication breakdown were analyzed. OUTCOMES & RESULTS: Before acquiring HA the participants with HL reported intense use of open-class repair initiation. After HAs were acquired, there was no statistically significant difference in the frequency of open-class repair initiations between HA users and their interlocutors. The most common means for open-class repair initiation in the data was interrogative word mitä ('what'). Vocalization hä ('huh'), apologetic expression anteeksi ('sorry') and clausal initiations (e.g., 'what did you say'/'I didn't hear') occurred less often. Open-class repair initiations emerged in contexts where they typically occur in conversation, such as topical shifts, overlapping talk and action, background noise, and disagreements. When used, open-class repair initiations most often led to repetition by the interlocutor, which immediately repaired the conversational breakdown. Long clarification sequences with multiple repair initiations did not occur. CONCLUSIONS & IMPLICATIONS: Participants with mild to moderate HL using hearing amplification initiate open-class repair similarly to their normally hearing conversational partners when the frequency, types, contexts and structure of repair are considered. The findings diminish the stigma related to HL, HAs and the use of open-class repair. The findings suggest that HA amplifies hearing successfully in everyday conversation when the level of HL is mild to moderate. However, the evidence for the benefit of HAs remains indirect.