Hearing Aid Evaluation/Rating Scales

Throughout the years numerous evaluation/rating scales have been conducted to determine patient/subject reaction to hearing aids – from comfort, cosmetics, handicap, self-evaluation of hearing difficulty, performance, satisfaction, cost, benefit, etc.  Some have been validated and others have been developed for specific purposes.  Regardless, all serve a purpose.

A partial list includes:

  • Feasibility Scale for Predicting Hearing Aid Use
  • Hearing Aid Needs Assessment
  • Communication Profile for the Hearing Impaired (CHI)
  • Communication Scale for Older Adults (CSOA)
  • Denver Scales
  • Hearing Handicap Inventory for the Elderly (HHIE)
  • Hearing Handicap Inventory for Adults (HHIA)
  • Hearing Handicap Scale (HHS)
  • Hearing Measurement Scale (HMS)
  • Hearing Performance Inventory (HPI)
  • McCarthy-Alpiner Scale of Hearing Handicap (M-A Scale)
  • Self-Assessment of Communication (SAC)
  • Significant Other Assessment of Communication (SOAC)
  • Abbreviated Profile of Hearing Aid Benefit (APHAB)
  • Client Oriented Scale of Improvement (COSI)
  • Glasgow Hearing Aid Benefit Profile (GHABP)
  • Hearing Aid Performance Inventory (HAPI)
  • Hearing Functioning Profile (HFP)
  • Profile of Aided Loudness (PAL)
  • Satisfaction with Amplification in Daily Life (SADL)
  • International Outcomes Inventory (IOI)
  • Hearing Aid Users’ questionnaire (HAUQ)
  • Speech, Spatial, and Qualities of Hearing Scale (SSQ)
  • MarkTrack

Essentially, all employ some kind of scale in which the patient/subject is asked to place reaction to the hearing loss or hearing aid on a 5, 7, 9, some other-point scale or some other descriptive scale – generally providing terms to describe the extremes of the scale or some kind of subjective impression to describe the patient/subject perception.  Some of these have been tested fairly extensively and provide descriptive statistics relative to the feature involved.

While each has its benefit, I kept thinking that something was missing with most scales – some kind of within scale description that would help the patient/subject respond better to the question, and also provide a better interpretation of the results for the evaluator to assist in counseling.

To this end, I have been involved with attempting to provide such a scale(s).

Comfort Scale

For example, as shown in figure 1, “Comfort” can easily by identified on a 9-point scale from unnoticeable to painful.  Reporting on the numbers alone is meaningful, but the “within scale description” provides additional help in answering the questions by the patient/subject, and also in interpreting the results by the evaluator.  As the chart shows, comfort ranges from no discomfort (green) to psychological discomfort (yellow), to physical pain (pink).

Figure 1. Comfort rating scale that includes a within scale description.










Comfort Frame of Reference Scale

Additional missing information is often a frame of reference with which to compare the hearing aid comfort to other products the patient has worn.  For example, how does the hearing aid compare to other in-dwelling products (another hearing aid, dental retainer, mouth guard, dentures, oral temperature probe, cell phone earpiece, contact lens), or non-adhesive products (i.e., belt, safety goggles, hat, eye glasses, swim goggles, wrist watch, ring, shoes)?  The comparison is to be made only to products the person has worn, and then to rate the results in overall comfort with 0 being poorest, and 8 being best (Figure 2).  Please note that the “n,” “avg,” and “std dev” numbers relate to another study and are inserted for demonstration purposes only.  Do NOT take these numbers as meaningful data! These data, however, do relate to the scale on the right side of the graph.  This format can be used for any number of features under investigation merely by changing the categories to desired entrees.

Figure 2. Comfort comparison to other products.

Comparing comfort impressions against other products is an interesting approach.  Of course, the sensitivity at different bodily locations will greatly affect the results.   Relative comparisons such as these can prove useful; however, the absolute approach gets at the question of whether the person will tolerate the hearing aid or not, and what it is about the device that makes it comfortable or not – therein the reason for the multi-attribute approach.



Visibility/cosmetics (Figure 3) is much easier to understand and then to apply appropriate rehabilitative procedures and counseling by knowing if the patient/subject sees this issue as primarily an internal (how they see themselves) or external (how they think others see them) issue.

Figure 3. Visibility scale that includes a within scale description.










Of course, just about any aspect of hearing handicap or hearing aid feature can be evaluated using modifications of this approach.  It seems, however, that the within scale descriptions provide additional useful information and counseling direction.


About Wayne Staab

Dr. Wayne Staab is an internationally recognized authority on hearing aids. As President of Dr. Wayne J. Staab and Associates, he is engaged in consulting, research, development, manufacturing, education, and marketing projects related to hearing. Interests away from business include fishing, hunting, hiking, mountain biking, golf, travel, tennis, softball, lecturing, sporting clays, 4-wheeling, archery, swimming, guitar, computers, and photography. Among other pursuits.

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