Tinnitus & Hyperacusis Therapy Masterclass

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Specialist course for management of tinnitus and hyperacusis in children and adults


What are the costs and disadvantages of non-regular use of hearing aids?

Hickson et al. (2014)suggested that successful HA use requires a minimum of one hour of daily use in order to provide even moderate benefits. In the recent NHS survey, 27% of new patients failed to meet these criteria (Aazh et al. 2015). 500,000 new patients are fitted with HAs annually across the NHS (Davis et al. 2007). The average cost is £350 per person (Department of Health 2013). Therefore, there are approximately 135,000 unsuccessful users annually, corresponding to £47,250,000 waste of NHS funding per year.

This is a growing concern as it is estimated that there will be about 14.5 million people with hearing impairment by 2031 in the UK, and according to the World Health Organisation hearing loss will be in the top ten disease burdens in the UK by 2030 (Action on Hearing Loss 2011).

Non-use or infrequent use of HAs not only wastes resources but also has other implications: (1) non-use of HAs has been associated with increased risk of “loneliness” among hearing impaired individuals (Pronk et al. 2013); (2) failure to communicate adequately may adversely affect the non-user’s occupational, educational, leisure, and social activities (Hickson & Scarinci 2007); (3) partners and family of the non-user may experience activity limitation and participation restriction as a result of their partner’s communication difficulties (Scarinci et al. 2012); (4) non-users may not benefit from the learning and reorganization of the auditory cortex associated with consistent hearing-aid use (Hamilton & Munro 2010), and (5) non–users need to increase their attention, concentration and “listening effort” in order to compensate for their lack of hearing making them more susceptible to mental fatigue in demanding listening situations (Hornsby 2013).

Previous studies with regard to improving hearing aid use

Dr. Aazh’s pioneering studies published in the International Journal of Audiology and the Journal of Phonetics and Audiology were the first trials which offered scientific evidence on the impact of Motivational Interviewing (MI) on hearing aid use (Aazh 2016a; Aazh 2016b). Other researchers also published on this topic soon after (Zarenoe et al. 2016).    

Prior to these studies there were no proven intervention that can successfully improve hearing aid (HA) use in the sub-population of patients with hearing impairment who do not use their HAs consistently. Audiologists typically advise patients to use their HAs consistently throughout the day. This seems to work for majority of patients but not for this sub-population.

Barker et al. (2014) conducted a Cochrane review on interventions designed to improve HA use and outcome. They included 32 studies. The interventions were mainly focused on education and communication strategies and typically involved 4-6 sessions over a period of 2-3 months (total contact time of 6-10 hours) delivered either in group or distance learning.                   

Barker et al. (2014) did not find any evidence of statistically significant effect on HA use or on quality of life measures. Use of HAs often requires a change in behaviour which is a complex process. Simply advising people may not help them to change (Rollnick et al. 2005).

In a more recent systematic review on interventions designed to improve HA use and outcome., Aazh and Moore (2017)reported that there is limited evidence to support efficacy of educational rehabilitative audiology programmes with respect to HA use and quality of life. They suggested that there is a need for studies investigating the efficacy of interventions based on patient-centred counselling and empathetic listening as opposed to or in addition to educational interventions.   



Aazh, H. (2016a). Feasibility of conducting a randomised controlled trial to evaluate  the effect of motivational interviewing on hearing-aid use Int J Audiol, 55, 149-156.

Aazh, H. (2016b). Patients' experience of motivational interviewing for hearing aid use: A qualitative study embedded within a pilot randomised controlled trial. J Phonet and Audiol, 2, 1-13.

Aazh, H., & Moore, B. C. J. (2017). Audiological rehabilitation for facilitating hearing aid use: a review. J Am Acad Audiol, 28, 248-260.

Aazh, H., Prasher, D., Nanchahal, K., et al. (2015). Hearing-aid use and its determinants in the UK National Health Service: A cross-sectional study at the Royal Surrey County Hospital. Int J Audiol, 54, 152-161.

Action on Hearing Loss (2011). Facts and figures on deafness and tinnitus. London: 

Barker, F., Mackenzie, E., Elliott, L., et al. (2014). Interventions to improve hearing aid use in adult auditory rehabilitation. Cochrane Database Syst Rev, 7, Cd010342.

Davis, A., Smith, P., Ferguson, M., et al. (2007). Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models. Health Technol Assess, 11, 1-294.

Department of Health (2013). National tariff information workbook 2014/15. In London, UK:

Hamilton, A. M., & Munro, K. J. (2010). Uncomfortable loudness levels in experienced unilateral and bilateral hearing aid users: evidence of adaptive plasticity following asymmetrical sensory input? Int J Audiol, 49, 667-71.

Hickson, L., Meyer, C., Lovelock, K., et al. (2014). Factors associated with success with hearing aids in older adults. Int J Audiol, 53 Suppl 1, S18-27.

Hickson, L., & Scarinci, N. (2007). Older adults with acquired hearing impairment: applying the ICF in rehabilitation. Semin Speech Lang, 28, 283-90.

Hornsby, B. W. (2013). The effects of hearing aid use on listening effort and mental fatigue associated with sustained speech processing demands. Ear Hear, 34, 523-34.

Pronk, M., Deeg, D. J., & Kramer, S. E. (2013). Hearing status in older persons: A significant determinant of depression and loneliness? Results from the Longitudinal Aging Study Amsterdam. Am J Audiol, 22, 316-320.

Rollnick, S., Butler, C. C., McCambridge, J., et al. (2005). Consultations about changing behaviour. BMJ, 331, 961-3.

Scarinci, N., Worrall, L., & Hickson, L. (2012). Factors associated with third-party disability in spouses of older people with hearing impairment. Ear Hear, 33, 698-708.

Zarenoe, R., Soderlund, L. L., Andersson, G., et al. (2016). Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial. Journal of American Academy of Audiology, 27, 669-676.