Activity 8E: Measuring Hearing Handicap in Elders

The Hearing Handicap Inventory for the Elderly – Screening Version (HHIE–S) is a well studied ten item questionnaire that measures social and emotional problems related to hearing loss. The HHIE–S has been correlated with audiometric measures of hearing loss and overall functional status. Importantly, the HHIE–S also has been found responsive to changes when persons receive hearing aids. This means when an older person with hearing loss gets a hearing aid, their HHIE–S score tends to improve. Thus, the HHIE–S has become an important health related quality-of-life measure for assessing the effectiveness of hearing rehabilitation programs.

The HHIE–S takes about two minutes to administer. The answers to each question are in a ‘Yes', ‘No', and ‘Sometimes' format. A ‘Yes' scores a 4, a ‘Sometimes' scores a 2, and a ‘No' scores a 0. The individual question scores are simply summed to give a total score. Scores range from zero to 40. A score of zero to eight indicates little trouble with hearing. Scores of 10 or more are indicative of hearing loss that might benefit from an audiologic evaluation. The higher the score, the greater the degree of hearing handicap.

This is a class activity where the students will use the HHIE–S to survey elders and then pool and graph the results of their tests.

  1. Give each student five copies of the HHIE–S. Spanish and English language versions are provided with this lesson.
  2. Ask each student over a period of a week to interview five persons over the age of 65 about their hearing. Ask them to record the person‘s age and gender and give them the HHIE–S. Record each response for each question and calculate the total score for each person interviewed.
  3. As a class, the students should compile their data and plot it as a bar graph to give a frequency distribution. The HHIE–S scores may be grouped for convenience into the following categories:
    HHIE-S Scores
    Total HHIE–S Score  Interpretation 
    0-2  Little evidence for hearing impairment 
    4-8  Slight evidence for hearing impairment 
    10-20  Moderate evidence for hearing impairment 
    22-40  Strong evidence for hearing impairment 
  4. An example graph is given from a survey done with 100 Mexican American elders who took the HHIE–S in both Spanish and English (“Frequency Distribution of HHIE–S Scores”). The two language versions should give very similar results. The class survey should yield similar results:
    • About 1/2 of the elder respondents should have little evidence for hearing impairment.
    • About 1/5 of the elder respondents should have slight evidence for hearing impairment.
    • About 1/6 of the elder respondents should have moderate evidence for hearing impairment.
    • About 1/10 of the elder respondents should have strong evidence for hearing impairment.
  5. Have the students as a class discuss their frequency distribution and what they think it means. Compare and contrast the class survey with the example “Frequency Distribution of the HHIE–S Scores.” Discuss reasons why the class survey might be different from the example given. If any of the HHIE–S survey was given in Spanish, record how many surveys were done in Spanish. 

HHIE-S, survey, graph, hearing handicap inventory elderly


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Activity Code: 
Unit Reference: 
Challenges and Changes: Sensitivity to Vision & Hearing Compromises
Lesson Reference: 
Lesson 8: Hearing Handicap