Hearing loss and auditory processing ability in people with aphasia

Abstract

Background: Hearing loss can add to the linguistic deficits present in aphasia to make comprehension of speech difficult. Although some studies document a relatively high prevalence of hearing loss in adults with aphasia, many people with aphasia do not have their hearing tested. Self-reported disability measures offer a possible alternative to pure-tone audiometry when this service is not readily available.

Aims: This study aims to investigate the prevalence of hearing loss in a group of people with aphasia and to determine the usefulness of self-reported measures to screen for hearing impairment.

Methods & Procedures: Hearing ability was measured using pure-tone audiometry and five measures of auditory processing, which looked at speech perception in quiet and noise, for 21 individuals with aphasia recruited from a community clinic and 21 age-matched individuals without aphasia. The Speech, Spatial and Qualities of Hearing Scale (SSQ) and a brief questionnaire exploring whether they had experienced hearing difficulties were used to measure self-perception of hearing acuity. Differences in scores between the groups were analysed. Correlations and regressions were used to establish the relationship between self-perception of hearing and measures of hearing ability.

Outcomes & Results: Despite minimal impairment and a non-significant difference between performance on pure-tone audiometry for participants with and without aphasia, participants with aphasia performed significantly worse on measures of speech perception in noise than participants without aphasia. They also had a significantly greater degree of perceived hearing disability. Although SSQ scores were correlated with some behavioural measures for the participants with aphasia, the SSQ only predicted the hearing status and speech in noise performance of control participants.

Conclusions: The results suggest that the prevalence of hearing loss for people with aphasia (at least for this group) is no greater than the general population. However, they are significantly more affected in their recognition of speech in noise and experience greater disability in listening situations than people without aphasia. The latter problems were not predicted by pure-tone audiograms or sound-in-noise performance. The brief questionnaire was not effective in identifying hearing impairment, indicating the need for a regular hearing screen to ensure provision of the most effective rehabilitation. Ideally, the screen should include disability and behavioural measures, as our results suggest they cannot replace each other. These findings should assist clinicians in setting realistic goals and delivering interventions in the most effective way for people with aphasia.

Keywords:

• Aphasia
• Hearing loss
• Speech-in-noise
• Hearing disability
• SSQ

The authors thank those who gave up their time to participate in the study, and two anonymous reviewers for their comments on previous versions of this manuscript.

Notes

¹ In this paper, the term “hearing disability” is used to refer to any difficulties experienced by individuals in hearing sounds in everyday life, in line with the definition of the International Classification of Impairments, Disabilities and Handicaps (WHO, 1980). “Hearing loss” and “hearing impairment” are used to refer to a reduction in hearing sensitivity as measured by pure-tone audiometry.