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Development and Evolution of a Self-Report Measure of Hearing Handicap

The story of the creation, scaling up, and adaption of the Hearing Handicap Inventory for the Elderly (HHIE) for multiple purposes and populations.

Barbara E. Weinstein

DOI: 10.1044/cred-dsa-bts-003

I knew that the measured audiogram — the audiogram that we measure routinely — gave us information. But it didn’t give us enough information about the psychological and social effects of hearing loss, so I decided that we needed to measure and get a self-report of the psychological and social effects.

When I first did my dissertation in 1979, I was interested in exploring social isolation in the elderly. And I was interested in looking at all the different variables that correlate with social isolation in older adults that have hearing loss.

I found that hearing loss is associated with psychological and social isolation, and perceived isolation. It’s also associated with activity limitation, participation restrictions. And there’s an incomplete relationship between the audiogram and how people view the effects of the hearing loss.

So I said I needed to develop a questionnaire that would be appropriate for older adults.

Developing the Hearing Handicap Inventory for the Elderly

So my mentor for my dissertation and my doctoral studies was Dr. Ira Ventry. I joined the faculty of Columbia after I finished my dissertation, and I said, I think we should develop a questionnaire to assess hearing handicap.

Now hearing handicap — there were a couple of scales. Self-report was not an area that was as big as it is now. Speech recognition testing was always very popular. Self-report, not really so. But I felt it was very important because there’s a lot of variability in terms of what explains the individual differences in how people react to hearing loss.

We identified questions from the gerontologic literature and found over 50 items that were relevant. Then we did a psychometric analysis of the questions, so we came up with the full version of the Hearing Handicap Inventory for the Elderly.

Developing the Screening Tool

But audiologists are always anxious to get things done quickly. So, I was walking down the steps with Dr. Ventry in our cafeteria, and I said, I think we need a screening version of the Hearing Handicap Inventory for the Elderly.

He said, “Well, how will you do that?” I said I’ll figure it out. So I went to my office and I psychometrically developed the 10-item screening version of hearing handicap.

Validating Test/Re-Test Reliability and Outcome Measures

Then, at the time, audiologists were beginning to dispense hearing aids and I felt it was important for audiologists to measure the benefits of hearing aids. So I said, we need a reliable instrument to do that, to do test/re-test. So I said, let’s do a test/re-test reliability. So the next step was that, test/re-test reliability on the questionnaire.

Then I said, let’s see if we can use it to measure benefit from hearing aids. At that time, outcomes assessment was not a field, either. So, we used it for that purpose, and that was one of the first studies looking at the benefit of hearing aids from self-report.

So, we had done some screening studies and found this hearing handicap inventory could be used to identify people who had hearing problems along with pure tone testing. And I was on the ASHA Committee for Screening for the Elderly, so we developed a screening protocol using the hearing handicap scale and the pure tone.

And people started adopting and doing studies on the hearing handicap inventories outcome measures.

Adapting the Inventory for Additional Populations

One of my colleagues said, “Let’s develop this for adults.” So, then we developed a measure for adults, so it was used for adults.

I should step back and say, when we first developed the hearing handicap inventory, I said to Dr. Ventry, at the time it was Dr. Ventry to me, I said, I think we should copyright this. He said, “Barbara, we don’t have to copyright this.”

So, Dr. Ventry passed away in 1983, then it was for me to take this and run with it. Which is what I did.

People from countries around the world have adapted the HHIE. There’s a spousal version, it’s in almost every language. It’s in Persian, it’s in Turkish, it’s in Spanish, it’s in Chinese — Mandarin, Cantonese.

I think it’s been very useful. There’s been a lot of research on it. It’s used by physicians, it’s used by nurses, it’s used by physical therapists, and I think it’s been a contribution to the field. I think it’s helped people to realize how important it is to not only look at the audiogram, but to look at the person.

And what we know about the self-report is how much information you can get on self-report. It’s predictive of hearing aid uptake. It’s predictive of hearing aid outcomes, it’s associated with personality. It’s associated with health outcomes, mortality, morbidity. So, there’s a lot of information that can be extracted.

When I see people in Australia using it, and I see people in Brazil using it, and people here — I feel good about the fact that I have made a contribution.

Further Reading

Newman, C. W., Weinstein, B. E., Jacobson, G. P. & Hug, G. A. (1991). Test-retest reliability of the hearing handicap inventory for adults. Ear and Hearing, 12(5), 355–357 [Article] [PubMed]

Ventry, I. M. & Weinstein, B. E. (1982). The hearing handicap inventory for the elderly: A new tool. Ear and Hearing, 3(3), 128–134 [Article] [PubMed]

Weinstein, B. E. (1986). Validity of a screening protocol for identifying elderly people with hearing problems. Asha, 5, 41–45

Weinstein, B. E., Spitzer, J. B. & Ventry, I. M. (1986). Test-retest reliability of the hearing handicap inventory for the elderly. Ear and Hearing, 7(5), 295–299 [Article] [PubMed]

Barbara E. Weinstein
Graduate Center, City University of New York

The content of this page is based on selected clips from a video interview conducted at the ASHA Convention.
Copyright © 2015 American Speech-Language-Hearing Association