A scoping review of studies investigating hearing loss, social isolation and/or loneliness in adults

Figures & data

Figure 1. Flow chart of studies included in scoping review.

Table 1. Summary of key findings of comparison studies (n = 9).

		Aims associated with hearing loss/hearing interventions, loneliness and isolation	Measures				Relationship between hearing loss and:
ID	Authors		Social isolation	Loneliness	Comparison groups	Outcomes	Social isolation	Loneliness
1	Bosdriesz et al. (2017)	To examine psychosocial health of people with and without HL who use or do not use interventions	Not measured	Loneliness Scale^a	37 CI users 418 HA users 247 with untreated HL 553 with NH Age range 18–70 years (CI users ∼5 years older than other groups)	CI users and NH were less emotionally lonely than HA users and people with untreated HL. CI users and NH did not differ in emotional loneliness. Social loneliness did not differ across HL groups	NA	Mixed
2	Hay-McCutcheon et al. (2019)	To examine the impact of HL on social interactions using MOS data	Positive Social Interaction Scale, MOS Social Support survey^b	Not measured	13 rural-dwelling NH 18 rural-dwelling HL 24 urban-dwelling NH 25 urban-dwelling HL Mean age: 60+ years (NH individuals ∼4 years younger than those with HL)	Urban dwellers with HL were less socially isolated than rural dwellers with HL. HL was a predictor of social isolation	Yes	NA
3	King and Stephens (1992)	To examine factors associated with auditory disability with normal hearing	Not measured	R-UCLA Loneliness scale^c	20 NH with report HL 20 NH with no reported HL Age matched groups. Mean age 30 years	Participants reporting hearing problems were significantly more lonely than those not reporting hearing problems	NA	Yes
4	Knutson and Lansing (1990)	To examine the relationship between reported communication function from CPHI and general measures of loneliness, social isolation and other outcomes	MMPI Social introversion scale 0^d	Revised UCLA Loneliness Scale^e	27 CI candidates Mean age = 49.1 year Revised UCLA published norms	Sample was more socially isolated than norms. Most participants would be described as being “somewhat” to “extremely” lonely	Yes	Yes
5	Murphy and Newlon (1987)	To investigate loneliness in mainstreamed hearing impaired college students	Not measured	Revised UCLA Loneliness Scale^e Self-report: loneliness in prior week	94 mainstreamed college students identifying as “deaf”, 76 mainstreamed college students identifying as “hearing impaired”, NH students, Norms from Russell, Peplau, and Cutrona (1980) UCLA scale, and NH students	Mainstreamed students were lonelier than NH students. Association between loneliness and adjustment to HL and comfort using speech/sign. No difference in loneliness of self-defined deaf and self-defined hearing-impaired students. No differences in loneliness by college year or gender	NA	Mixed
6	Øhre et al. (2017)	To investigate whether communication mode (sign vs. spoken language) impact mental health	Not reported	Not measured	40 users of Norwegian sign language (NSL) 36 hearing impaired users of spoken language Mean age 36.7 years	No difference in social isolation between NSL and users of spoken language	No	NA
7	Ringdhal and Grimby (2000)	To describe hearing and other factors in relation to subjective health and compare them with age-matched community sample	Swedish version of the Nottingham Health Profile^f	Not measured	311 HA users with profound deafness Mean age = 66.0 years 2356 age-matched norms	HA users more socially isolated than age matched norms. Working people with HL had lower isolation scores than non-working individuals. Degree of HL did not predict social isolation within the HL group	Mixed	NA
8	Stevens (1982)	To examine the main problems of people who are deaf	Scale developed for study	Not measured	50 HA users 49 people with untreated HL Age range 45–82 years	HA users were less socially isolated than people with untreated HL	Yes – benefit of HA reported	NA
9	Thomas and Herbst (1989)	To examine social and psychological effects of acquired deafness in working age adults provided with NHS HAs	Questions developed for study	Questions developed for study	211 HA users fitted between 1970 and 1976, 418 matched non-HA user controls Age range 16–64	HA users were more lonely and more socially and emotionally isolated than the control group. No relationship between degree of HL and loneliness	Yes	Mixed

CI: cochlear implant; CPHI: Communication Profile for Hearing Impaired; HA: hearing aid; HL: hearing loss; MMPI: The Minnesota Multiphasic Personality Inventory; MOS: Medical Outcomes Study; NA: not applicable; NH: normal hearing; NHS: National Health Service (UK); NSL: Norwegian Sign Language; UCLA: University of California Los Angeles.

^aDe Jong-Gierveld and Kamphuls (1985).

^bSherbourne and Stewart (1991).

^cHays and Dimatteo (1987).

^dHathaway and McKinley (1943).

^eRussell, Peplau, and Cutrona (1980).

^fWiklund (1992).

Table 2. Summary of key findings of experiential studies (n = 5).

		Aims associated with hearing loss, social isolation and/or loneliness	Measures			Sample n = age other		Relationship between hearing loss and:
ID	Authors		Social isolation	Loneliness	Hearing		Results	Social isolation	Loneliness
1	Canton and Williams (2012)	To examine social, psychological and economic impacts of NIHL among dairy farmers in NZ	Open-ended questionnaire		Self-report or ‘confirmed’ HL	74 Range: 16–30 31 reported HL	HL resulted in social isolation in general (22%) and at work (39%)	Yes	Not reported
2	Chen (1994)	To examine relations between hearing handicap, loneliness and low self-esteem in an elderly population	Not measured	UCLA Loneliness Scale	Self-report	88 Range: 65–90 (mean = 74.9)	HHIE correlated with loneliness in whole population and in women, but not in men. HHIE-emotional scale showed stronger associations with loneliness than did the HHIE-social scale	NA	Mixed
3	Christian et al. (1989)	To explore hearing loss and loneliness among an older population	Not measured	UCLA Loneliness Scale^a	Four-frequency screening	63 65–74 years: n = 30 75–94 years: n = 33	Loneliness scores did not differ between normal/mild HL versus serious/severe HL	NA	No
4	Picou and Buono (2018)	To evaluate the relationship between emotional responses, isolation and hearing	Social Disconnectedness and Perceived Isolation scales^b		Audiometry	83 Range: 22–80 23 HA users	Degree HL not associated with degree of social isolation or loneliness	No	No
5	Simpson et al. (2018)	To examine whether internet usage by adult HA users lowers perceptions of loneliness	Not measured	UCLA Loneliness Scale V3^c	Self-report: Do you own HAs?	65 Range: 65-81+ All HA users	Higher internet use was associated with lower loneliness scores among HA users	NA	Yes
6	Sung et al. (2016)	To investigate factors associated with loneliness among older individuals presenting to clinic for hearing assessment	Not measured	Revised UCLA Loneliness Scale^a	Audiometry	145 Range: 50-80+ yr. 81 HA candidates, 64 CI candidates	Degree of HL was associated with degree of loneliness. People with severe/profound HL were lonelier than those with NH	NA	Yes
7	Weinstein and Ventry (1982)	To determine the relationship between social isolation and auditory performance	Comprehensive Assessment and Referral Evaluation^d	Not measured	Audiometry Hearing Measurement Scale^e	80 Range: 65-88 (mean = 74) All with reported HL	Isolation scores were similar to norms. Degree of isolation was associated with degree of HL. Reported HL was a predictor of social isolation	Yes	NA

CI: cochlear implant; HA: hearing aid; HL: hearing loss; NA: not applicable; NIHL: noise-induced hearing loss; NH: normal hearing; NZ: New Zealand; UCLA: University of California Los Angeles.

^aRussell, Peplau, and Cutrona (1980).

^bCornwell and Waite (2009).

^cRussell (1996).

^dGurland et al. (1977–1978).

^eNoble and Atherley (1970).

Table 3. Summary of key findings of population-based studies (n = 21).

		Aims associated with hearing loss, social isolation and/or loneliness		Measures					Relationship between hearing loss and:
ID	Authors		Dataset	Social isolation	Loneliness	Hearing	n = Age	Results	Social isolation	Loneliness
1	Cheung et al. (2019)	To investigate sociodemographic, physical, functional and psychological predictors of loneliness	Individuals who completed InterRAI from 2014 to 2016^a	None	InterRAI loneliness item^a	Self-report: single item	51,239 mean: 82.3 years	Reported hearing difficulty was a predictor of loneliness	NA	Yes
2	Cimarolli et al. (2018)	To explore effects of sensory impairment among the oldest old	Fordham Centenarian study data	None	UCLA Loneliness Scale V3^b	Self-report single item	119 Range: 95–107	Reported hearing difficulty correlated with loneliness	NA	Yes
3	Dawes et al. (2015)	To model statistical associations between hearing and cognition accounting for the mediating role of social isolation and depression	UK Biobank	Single item: Do you often feel lonely?	None	Digit Triplet test^c	64,770 Not reported	Poorer hearing and HA use were associated with social isolation. Effect of HA use on cognition was partly mediated by social isolation	Yes^d	NA
4	Dugan and Kivett (1994)	Examine impact of emotional and social isolation on loneliness in very old rural adults	Longitudinal study of rural persons in North Carolina	Quantified based on social interactions	Single item: Do you find yourself feeling lonely	Self-report single item	119 Mean: 83 years	Reported hearing difficulty was a predictor of loneliness	Not analysed	Yes
5	Guthrie et al. (2018)	To understand how a sensory impairment adds to impact of cognitive impairment on health-related outcomes	Canadian Institute for Health Information for people with interRAI data	None	InterRAI loneliness item^a	Subjective ratings by interviewer^e	26,495 with HL, 59,360 with NH range: 65–85+	More people with HL than with NH were lonely	NA	Yes
6	Harithasan et al. (2019)	To determine whether sensory impairment is independently associated with loneliness and more	Long Term Research Grant Scheme study	None	R-UCLA^f	Audiometry	137 No sensory loss, 46 HL, 27 VL, 19 DSI 60+ years	No differences in loneliness across the four groups. HL was not a predictor of loneliness	NA	No
7	Hawthorne (2006)	To examine prevalence and correlates of perceived social isolation in a community	South Australian Health Omnibus Survey	Friendship scale^g	None	Self-report: single item	3015 Mean: 45.3 years	Reported hearing difficulty was associated with social isolation	Yes	NA
8	Kramer et al. (2002)	To examine the association between HL, chronic conditions and psychosocial status	Longitudinal Aging Study Amsterdam	Not measured	Loneliness Scale^h	Self-report: three items	3017 Range: 55–85	People with HL were more lonely than people with NH. HL was a predictor of loneliness	NA	Yes
9	Maharani et al. (2019)	To test the hypothesis that higher rate of cognitive decline with poor hearing is mediated by loneliness	English Longitudinal Study of Ageing	Index of social isolation^i	R-UCLA^f	Self-report: single item	8199 Mean: 62.8 years	Reported hearing difficulty was associated with isolation and loneliness. HL and episodic memory scores were mediated by social isolation and loneliness	Yes	Yes
10	Mick et al. (2018)	To examine the association between sensory impairment, social engagement and loneliness	Canadian Longitudinal Study on Aging	None	Single item: In the past week how often did you feel lonely?	Self-report: single item^j	19,325 Range: 45–89 years	HL was associated with loneliness	NA	Yes
11	Mick and Pichora-Fuller (2016)	To determine whether HL is associated with social isolation, and more among people that might benefit from hearing screening	National Health and Nutrition Examination Survey	NHANES SSQ^k	None	Audiometry and self-report single item	Varied by measure and cohort from 465 to 1845 Varied by measure and cohort Range 40–70+ years	HL was associated with social isolation in people age 60–69 years only	Mixed	NA
12	Mick et al. (2014)	To determine whether age-related HL is associated with social isolation, and how age, gender, income, race and/or HA use moderate it	National Health and Nutrition Examination Survey	NHANES SSQ^k	None	Audiometry	1453 Range: 60–84 years	More HL associated with social isolation in women aged 60–69 years only	Mixed	NA
13	Nachtegaal et al. (2009)	To examine relationship between hearing and self-reported psychosocial functioning	Netherlands Longitudinal Study on Hearing	None	Loneliness Scale^h	National Hearing Test^l	1588 Mean: 46.3 years	HL was associated with loneliness. Use of HAs did not impact loneliness	NA	Yes for HL No for HA use
14	Pronk et al. (2014)	To examine the relationship between rate of hearing decline and rate of decrease in psychosocial health	Longitudinal Aging Study Amsterdam	None	Loneliness Scale^h	National Hearing Test^l	Varied by cohort and measure Range across all cohorts: 57–97 years	Rate of change in hearing was associated with rate of change in loneliness for subcategories of participants	NA	Mixed
15	Pronk et al. (2011)	To examine longitudinal relationships between hearing status, loneliness and more	Longitudinal Aging Study Amsterdam	None	Loneliness Scale^h	National Hearing Test and self-report: three items^l	Varied by participant type and measure	HL (reported and measured) was associated with loneliness in subcategories of participants	NA	Mixed
16	Ramage-Morin (2016)	To examine the association between HL and social solation	Canadian Community Health Survey—Health Aging	Two items from R-UCLA combined with single sense of community belonging item^f	None	HUI Mark 3^m^,n	30,176 Mean: 60.4 years	HL was associated with social isolation in women but not men. Male HA users were more socially isolated than NH males	Mixed	NA
17	Ray et al. (2018)	To determine whether untreated HL and social isolation explain the link between age related HL and cognitive decline	English Longitudinal Study of Ageing	Index of social isolation^i	None	Two-frequency hearing screening	7385 Mean: 67.4 years	HL was associated with higher odds of social isolation among non-HA users but not among HA users. Social isolation was a mediating factor between cognition and HL	Mixed	NA
18	Savikko et al. (2005)	To examine prevalence of loneliness in the Finnish older population and its association with health-related factors	Community dwelling sample recruited from The Finnish National Population register	None	Single item: Do you suffer from loneliness?	Self-report: single item	3915 Mean: 81.1 years	HL was not a predictor of loneliness. People with good hearing were less lonely than those with poorer hearing. HA use did not impact loneliness. Loneliness was rarely attributed to HL	NA	Mixed
19	Stam et al. (2016)	To understand longitudinal relationship between decline in hearing and psychosocial health	Netherlands Longitudinal Study on Hearing	None	Loneliness Scale^h	National Hearing Test^k	508 Range: 18–69 (mean = 47)	HL was associated longitudinally with loneliness. Changes in loneliness and hearing were associated in some subcategories of participants	NA	Mixed
20	Strawbridge et al. (2000)	To examine relationship between degree of HL and functioning over time	Alameda County Study	Self-report: two items	Self-report: Do you feel lonely or remote?	Self-report: three items	2461 Range: 50–102	Degree of HL was associated with loneliness and isolation	Yes	Yes
21	Tomioka et al. (2013)	To evaluate relation between self-reported hearing and quality of life	Community-dwelling adults recruited through neighbourhood associations	None	Revised UCLA Loneliness Scale^o	Self-report: single item and Japanese HHIE-S	731 Males: mean = 71.0 yr. Females: mean = 70.0 years	Odds of loneliness increased with increased HHIE-S score, but not with single item self-report	NA	Mixed
22	Van der Werf et al. (2010)	To examine the association between HL and psychosis	Maastricht Aging Study	Quantified based on single item	Loneliness Scale^h	Thresholds at .5, 1, 2 and 4 kHz	1823 Range: 24–86	HL was associated with social isolation but not loneliness	Yes	No

DSI: Dual Sensory Impairment; HA: hearing aid; HHIE-S: Hearing Handicap Inventory for the Elderly – screening version; HL: hearing loss; NH: normal hearing; NA: not applicable; UCLA: University of California Los Angeles; SIS: Social Isolation Score; VL: vision loss.

^aInterRAI: International Resident Assessment Instrument.

^bRussell (1996).

^cHall (2006).

^dAssociation between loneliness and hearing aid use in unexpected direction.

^eRated using RAI-HC and MDS 2.0 instruments (www.interrai.org).

^fHughes et al. (2004).

^gHawthorne (2006).

^hDe Jong-Gierveld and Kamphuls (1985).

ⁱSteptoe et al (2013).

^jAnswered for aided hearing if applicable.

^kSeeman and Berkman (1988).

^lSmits et al. (2004).

^mFeng et al. (2009).

ⁿFeeny et al. (2002).

^oRussell, Peplau, and Cutrona (1980).

Table 4. Summary of key findings of interventional studies (n = 8).

		Aims associated with hearing loss, social isolation and/or loneliness	Measures				Sample		Relationship between hearing loss and:
ID	Authors		Social Isolation	Loneliness	Hearing	Design	n = Age	Results	Social isolation	Loneliness
1	Applebaum et al. (2019)	To examine impact of HAs and CIs on loneliness	Not measured	UCLA Loneliness Scale V3^a	Audiometry	Intervention: HAs and CIs. Assessment: pre-intervention, and 6 month, 12 and 60 months post-intervention	81 Range 63.5 − 78.5 years	HAs did not change loneliness. CIs decreased loneliness initially, but loneliness returned to near baseline by 5 years	NA	Mixed
2	Bai and Stephens (2005)	To examine impact of CI on quality of life using an open-ended questionnaire	Open-ended problems questionnaire^b		Self-report: Single item	Intervention: CIs. Assessment: pre-implantation and at approx. 6, 12, 24 and 36-month post-implantation	47 Range: 21–78 years (mean = 52.4)	CIs decreased social isolation. HL and social isolation only associated at 12 and 24-month post-implantation	Yes, for intervention Mixed for HL	Not revealed
3	Cooper (1995)	To examine how CIs change quality of life and whether it is maintained over time	Questions developed for study	Not measured	Not measured	Intervention: CIs. Assessment: 1-mth pre-CI switch on, 1 and 6-month post switch on	18 Range: 55–64 years	Pre-implantation participants were more socially isolated than norms. CI decreased social isolation to normative level by 1 month. No change thereafter	Yes	NA
4	Jones et al. (2019)	To examine feasibility and impact of a group exercise/social program supplementing GAR program	Not measured	Loneliness Scale^c	Self-report: Hearing Handicap Inventory for the Elderly-25^d	Intervention: GAR vs. no GAR. Assessment: Pre- and post-intervention period	66 Mean: 74.5 years	Emotional loneliness decreased following GAR attendance. Social loneliness did not change	NA	Mixed
5	Knutson et al. (1998)	To assess the psychological state of experienced CI users	Minnesota Multiphasic Personality Inventory Scale 0^e	Revised UCLA Loneliness Scale^f	Audiometry	Intervention: CIs. Assessment: pre-implantation and at 9, 18, 30, 42 and 54-month post-implantation	37 Range: 24–70 years mean =51.8)	Pre-implantation participants were more socially isolated than norms. CI decreased social isolation and loneliness at each time point. Measured CI benefit correlated with change in loneliness	Yes	Yes
6	Sarant et al. (2019)	To investigate how CIs impact quality of life	Lubben Social Network Scale^g	Loneliness Scale^c	Audiometry	Intervention: CIs. Assessment: pre-implantation and at 18 months post-implant switch on	59 Range: 61–89 years, (mean = 72.3)	CI did not change loneliness or social isolation	No	No
7	Weinstein, Sirow, and Moser (2016)	To determine whether HAs impact loneliness	Not measured	Loneliness Scale^c	Audiometry	Intervention: HAs. Assessment: pre-fitting and 4–6 weeks post-fitting	40 Range: 62–92 years (mean =80.4)	HAs decreased emotional loneliness but not social loneliness. Change greatest for people with more HL. Degree of HL was not associated with degree of loneliness	NA	Yes for HAs. No for degree of HL
8	Zhao et al. (2008)	To determine how CIs change reported quality of life	Open ended problems questionnaire^b		Not Audiometry	Intervention: CIs. Assessment: pre-implantation and at 9, 12, 18, 24, 36 and 48 weeks post-implantation	24 Range: 32–78 years (mean =53.8 years)	CI decreased social isolation. Scores plateaued by 18–24 months	Yes	Not revealed

CI: cochlear implant; GAR: group audiological rehabilitation; HA: hearing aid; HL: hearing loss; NA: not applicable; UCLA: University of California Los Angeles.

^aRussell (1996).

^bBarcham and Stephens (1980).

^cDe Jong-Gierveld and Kamphuls (1985).

^eHathaway and McKinley (1943).

^fRussell, Peplau, and Cutrona (1980).

^gLubben (1988).

Table 5. Summary of key findings of qualitative studies (n = 11).

		Aims associated with hearing loss, social isolation and loneliness				Relationship between hearing loss and:
ID	Authors		Qualitative method	Study sample	Results	Social isolation	Loneliness
	Experiential studies
1	Aguayo and Coady (2001)	To examine psychological and sociological effects resulting from deafness	Thematic analysis of interviews	Eight deaf individuals Age range: 31–68 years (mean = 49 years) Users of HAs, CIs, and neither	Problems communicating with family lead to feelings of being isolated within the family, that family members overlooked their needs and minimised the situation. All felt socially isolated in general, and inadequate in social situations. Withdrawal/avoidance lead to more isolation	Yes	Not reported
2	Barlow et al. (2007)	To examine the experience of living with acquired deafness	Framework analysis of interviews	Nine adults with acquired deafness Age range: 33–60 years	Deafness caused physical and emotional isolation and loneliness	Yes	Yes
3	Bennion and Forshaw (2013)	To explore and understand experience of living with HL	Descriptive thematic analysis of interviews	9 HA users Age range: 61–93 years	Inability to hear household sounds (e.g. phone, doorbell) resulted in missing visitors and phone calls, and thus to social isolation	Yes	Not reported
4	Heffernan et al. (2016)	To explore psychological experiences of adults with HL	Thematic analysis of interviews	15 HA users with mild to moderate HL Age range: 20–91 years (mean = 68.8; SD =16.5)	Communication difficulties and participation restrictions from HL led to sensations of loneliness and isolation	Yes	Yes
5	Hétu et al. (1988)	To understand handicap associated with occupational noise exposure	Combination of phenomenological and content analysis of interviews	n = 61 workers plus their spouses Age: mean = 39.5 years Presence/absence and degree of HL varied among workers	In groups, persons with HL felt isolated, less communicative, and less participatory than others	Yes	Not reported
6	Hughes et al. (2018)	To explore how listening effort impacts relationships and shared activities	Grounded theory methodology applied to focus group data	11 CI users 4 HA users waiting for CI 2 NH spouses Age range 20–70+	As HL progressed individuals began to disconnect, which resulted in increasing isolation. HL threatened social connectedness, leading to feeling invisible, lonely, like an outsider. Following implantation, reconnection was sought, resulting in increased social connectedness	Yes. CI decreased isolation	Yes
7	Ingram et al. (2016)	To understand the perspectives of people with HL, their family and their friends towards hearing loss	Content analysis using socio-ecological model of interviews with adults with HL. Focus group data from family members/friends	20 adults with HL 27 family members/ friends Adults with HL age> 50 years	Adults with HL reported HL negatively impacted social engagement. Family said HL caused the person with HL to feel isolated and lonely	Yes	Yes
8	Smith (2012)	To explore the meaning of loneliness in community-dwelling older adults	Interpretive phenomenological analysis of interviews	12 community-dwelling adults reporting loneliness Age: 74–98 years	Participants attributed loneliness to declining health, including hearing—not being able to engage meaningfully, lead to feelings of isolation and being left out	Yes	Yes
	Interventional studies
9	Barlow et al. (2007)^a	To examine impact of LINK rehabilitation course	Framework analysis of interviews	Nine adults with acquired deafness Age not reported	LINK program^b participants said the program gave them a sense of belonging, and made them realise they were not alone	Not reported	Yes. LINK program decreased loneliness
10	Ross and Lyon (2007)	To examine effects of HL pre-and post-cochlear implantation	Thematic analysis of interviews	Six CI users and their normal hearing partners Age range: 46–71 years (Mean = 67 years)	Pre-implantation, participants reported a downward spiral of withdrawal and reduced social contact. Post-implantation they engaged in wider social interaction	Yes. CI decreased isolation	Not reported
11	Maki-torkko et al. (2015)	To examine pre-operative expectations and post-operative impacts of CIs on users and family/friends	Inductive content analysis of open-ended questionnaire responses	101 CI users; 87 family members/friends: Age range: 27.1–91.7 years (Mean = 66.0 years)	All described experiences of isolation prior to CI. Family members considered CI decreased isolation and worried that if CI malfunctioned the person with HL would become isolated	Yes. Family said CI decreased isolation	Not reported
12	Smith et al (2016)	To evaluate the impact of attending a sensory support centre support (WISC)	Thematic analysis of interviews	12 adults with self-reported HL, 7 of whom had measured HL Age range: 61–85	Individual attended WISC because HL had caused feelings of isolation. Individuals given HAs said the HAs positively impacted social interaction	Yes. WISC program decreased isolation	Not reported

CI: cochlear implant; HA: hearing aid; HL: hearing loss; NH: normal hearing; WISC: WESTERN Isles Sensory Centre.

^aStudy included as both experiential and intervention.

^bAn intensive two-week rehabilitation program for people with hearing loss.

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