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Objectives: To determine population-based risks of adverse effects on hearing and well-being outcomes associated with unilateral hearing impairment.Design: A group of 40-69-year-old adults (n = 861) who reported being able to hear only in one ear and having speech reception thresholds (SRTs) in noise indicating normal hearing in that ear (SRT_N/?) was selected from the UK Biobank cohort. The UK Biobank participants with SRTs indicating either normal (SRT_N/N, n = 95,514) or symmetrically impaired hearing in both ears (SRT_I/I, n = 17,429) were selected as comparison groups. Self-reported difficulty following conversations in noise, tinnitus presence, feelings depressed, lonely, unhappy, and being in poor health or dissatisfied with health were selected as hearing and well-being outcomes. Logistic regression models were used to evaluate the risks of reporting adverse outcomes associated with SRT_N/? compared to SRT_N/N and SRT_I/I whilst controlling for numerous factors linked to hearing and general health. Results: People with SRT_N/? were significantly more likely to report difficulties following conversations in noise (Odds Ratio = 10.61, 95% Confidence Interval = 8.83 to 12.75), tinnitus (4.04, 3.51 to 4.66), poor health (1.35, 1.15 to 1.58), health dissatisfaction (1.22, 1.00 to 1.47), and loneliness (1.28, 1.08 to 1.51) compared to people with SRT_N/N. Well-being outcomes were similar in the SRT_N/? and SRT_I/I groups. However, difficulties following conversations in noise (5.35, 4.44 to 6.44) and tinnitus presence (2.66, 2.31 to 3.08) were significantly more likely with SRT_N/? than with SRT_I/I. The SRT_N/? was associated with increased risk of self-reported poor health by 18% (Relative Risk = 1.18, 95% Confidence Interval = 1.06 to 1.32) and loneliness by 24% (1.24, 1.07 to 1.43) compared with SRT_N/N. The risk of reporting difficulties following conversations in noise increased by 64% (1.64, 1.58 to 1.71) and tinnitus presence by 84% (1.84, 1.69 to 2.01) compared to SRT_I/I. The effect of SRT_N/? on reporting poor health was similar to that from having other health problems such as hypertension or high cholesterol.Conclusions: The large increases in the risks of reporting adverse hearing-related outcomes associated with unilateral hearing impairment suggest its specific impact on hearing function in everyday situations. The increased risk of loneliness and poor health indicates that one normally functioning ear is also insufficient to protect against the adverse psychosocial impacts of unilateral hearing impairment. This impact was still significant after controlling for various health-related factors and can lead to perception of poor health comparable to that with having medical problems contributing to life-threatening conditions such as heart disease. The findings suggest the need for effective interventions to address the hearing-related problems and their impact on well-being in people with unilateral hearing impairment.

BackgroundThe main clinical intervention for mild to moderate hearing loss is the provision of hearing aids. These are routinely offered and fitted to those who seek help for hearing difficulties. By amplifying and improving access to sounds, and speech sounds in particular, the aim of hearing aid use is to reduce the negative consequences of hearing loss and improve participation in everyday life.ObjectivesTo evaluate the effects of hearing aids for mild to moderate hearing loss in adults.Search methodsThe Cochrane ENT Information Specialist searched the ENT Trials Register; the Cochrane Register of Studies Online; MEDLINE; PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 March 2017.Selection criteriaRandomised controlled trials (RCTs) of hearing aids compared to a passive or active control in adults with mild to moderate hearing loss.Data collection and analysisWe used the standard methodological procedures expected by Cochrane. The primary outcomes in this review were hearing-specific health-related quality of life and the adverse effect pain. Secondary outcomes were health-related quality of life, listening ability and the adverse effect noise-induced hearing loss. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.Main resultsWe included five RCTs involving 825 participants. The studies were carried out in the USA and Europe, and were published between 1987 and 2017. Risk of bias across the studies varied. Most had low risk for selection, reporting and attrition bias, and a high risk for performance and detection bias because blinding was inadequate or absent.All participants had mild to moderate hearing loss. The average age across all five studies was between 69 and 83 years. The duration of the studies ranged between six weeks and six months.There was a large beneficial effect of hearing aids on hearing-specific health-related quality of life associated with participation in daily life as measured using the Hearing Handicap Inventory for the Elderly (HHIE, scale range 1 to 100) compared to the unaided/placebo condition (mean difference (MD) -26.47, 95% confidence interval (CI) -42.16 to -10.77; 722 participants; three studies) (moderate-quality evidence).There was a small beneficial effect of hearing aids on general health-related quality of life (standardised mean difference (SMD) -0.38, 95% CI -0.55 to -0.21; 568 participants; two studies) (moderate-quality evidence). There was a large beneficial effect of hearing aids on listening ability (SMD -1.88, 95% CI -3.24 to -0.52; 534 participants; two studies) (moderate-quality evidence).Adverse effects were measured in only one study (48 participants) and none were reported (very low-quality evidence).Authors' conclusionsThe available evidence concurs that hearing aids are effective at improving hearing-specific health-related quality of life, general health-related quality of life and listening ability in adults with mild to moderate hearing loss. The evidence is compatible with the widespread provision of hearing aids as the first-line clinical management in those who seek help for hearing difficulties. Greater consistency is needed in the choice of outcome measures used to assess benefits from hearing aids. Further placebo-controlled studies would increase our confidence in the estimates of these effects and ascertain whether they vary according to age, gender, degree of hearing loss and type of hearing aid.

BackgroundIndividuals with a unilateral severe-to-profound hearing loss, or single-sided deafness, report difficulty with listening in many everyday situations despite having access to well-preserved acoustic hearing in one ear. The standard of care for single-sided deafness available on the UK National Health Service is a contra-lateral routing of signals hearing aid which transfers sounds from the impaired ear to the non-impaired ear. This hearing aid has been found to improve speech understanding in noise when the signal-to-noise ratio is more favourable at the impaired ear than the non-impaired ear. However, the indiscriminate routing of signals to a single ear can have detrimental effects when interfering sounds are located on the side of the impaired ear. Recent published evidence has suggested that cochlear implantation in individuals with a single-sided deafness can restore access to the binaural cues which underpin the ability to localise sounds and segregate speech from other interfering sounds.Methods/DesignThe current trial was designed to assess the efficacy of cochlear implantation compared to a contra-lateral routing of signals hearing aid in restoring binaural hearing in adults with acquired single-sided deafness. Patients are assessed at baseline and after receiving a contra-lateral routing of signals hearing aid. A cochlear implant is then provided to those patients who do not receive sufficient benefit from the hearing aid. This within-subject longitudinal design reflects the expected care pathway should cochlear implantation be provided for single-sided deafness on the UK National Health Service. The primary endpoints are measures of binaural hearing at baseline, after provision of a contra-lateral routing of signals hearing aid, and after cochlear implantation. Binaural hearing is assessed in terms of the accuracy with which sounds are localised and speech is perceived in background noise. The trial is also designed to measure the impact of the interventions on hearing- and health-related quality of life.DiscussionThis multi-centre trial was designed to provide evidence for the efficacy of cochlear implantation compared to the contra-lateral routing of signals. A purpose-built sound presentation system and established measurement techniques will provide reliable and precise measures of binaural hearing.Trial registrationCurrent Controlled Trials http://www.controlled-trials.com/ISRCTN33301739 (05/JUL/2013)

OBJECTIVES:To estimate and compare the prevalence of and associations between tinnitus and sleep difficulties in a sample of UK adult cochlear implant users and those identified as potential candidates for cochlear implantation.DESIGN:The study was conducted using the UK Biobank resource, a population-based cohort of 40- to 69-year olds. Self-report data on hearing, tinnitus, sleep difficulties, and demographic variables were collected from cochlear implant users (n = 194) and individuals identified as potential candidates for cochlear implantation (n = 211). These "candidates" were selected based on (i) impaired hearing sensitivity, inferred from self-reported hearing aid use and (ii) impaired hearing function, inferred from an inability to report words accurately at negative signal to noise ratios on an unaided closed-set test of speech perception. Data on tinnitus (presence, persistence, and related distress) and on sleep difficulties were analyzed using logistic regression models controlling for gender, age, deprivation, and neuroticism.RESULTS:The prevalence of tinnitus was similar among implant users (50%) and candidates (52%; p = 0.39). However, implant users were less likely to report that their tinnitus was distressing at its worst (41%) compared with candidates (63%; p = 0.02). The logistic regression model suggested that this difference between the two groups could be explained by the fact that tinnitus was less persistent in implant users (46%) compared with candidates (72%; p < 0.001). Self-reported difficulties with sleep were similar among implant users (75%) and candidates (82%; p = 0.28), but participants with tinnitus were more likely to report sleep difficulties than those without (p < 0.001). The prevalence of sleep difficulties was not related to tinnitus persistence (p = 0.28) or the extent to which tinnitus was distressing (p = 0.55).CONCLUSIONS:The lack of association between tinnitus persistence and sleep difficulties is compatible with the notion that tinnitus is suppressed in implant users primarily during active electrical stimulation and may return when the implant is switched off at night time. This explanation is supported by the similar prevalence of sleep problems among implant users and potential candidates for cochlear implantation, despite differences between the groups in tinnitus persistence and related emotional distress. Cochlear implantation may therefore not be an appropriate intervention where the primary aim is to alleviate sleep difficulties.