Counselling of hearing aid users is highly cost-effective

  • Arja VuorialhoEmail author
  • Petri Karinen
  • Martti Sorri


Hearing aids (HAs) are often left unused. Several investigations have shown that the use of HAs and the skills to use them can be significantly improved through counselling. Follow-up counselling is often restricted by increased cost. The objective of the study was to assess the cost and the effect of follow-up counselling on HA use. In a prospective pre-post design study, 98 first-time HA users were counselled 6 months after the fitting of a HA, and the use of and benefit from HAs were measured by means of an interview and the short form of the hearing handicap inventory for the elderly (HHIE-S) and the EuroQoL (EQ-5D) questionnaires. The results obtained before and 6 months after counselling were compared and the cost of counselling was calculated. After follow-up counselling, over half of the occasional users of a HA and as many as one third of the non-users became regular users. The number of regular users increased by 16 subjects, and non-users decreased from 29 subjects to 17. The HHIE-S results showed a significant positive change, but the EQ-5D results showed practically no change. The additional expense of follow-up counselling at home was approximately 8.8% (€83 per visit) of the calculated €942 cost of fitting a HA. Bringing one unused HA into regular use required €508. The results show that HA use and the consequent benefit can be significantly increased through counselling. The expense caused by follow-up counselling at home is highly acceptable in addition to the cost of fitting a HA.


Rehabilitation Hearing impairment Hearing aid fitting 


  1. 1.
    Abrams H, Hnath-Chisolm T, Guerreiro S, Ritterman S (1992) The effects of intervention strategy on self-perception of hearing handicap. Ear Hear 13:371–377PubMedCrossRefGoogle Scholar
  2. 2.
    Barton G, Bankart J, Davis A (2005) A comparison of the quality of life of hearing-impaired people as estimated by three different utility measures. Int J Audiol 44:157–163PubMedCrossRefGoogle Scholar
  3. 3.
    Benyon G, Thornton F, Poole C (1997) A randomized, controlled trial of the efficacy of a communication course for first time hearing aid users. Br J Audiol 31:345–351Google Scholar
  4. 4.
    Berlanger A, Berthelot J, Guimond E, Houle C (2000) A head-to-head comparison of two generic health status measures in the household population: McMaster Health Utilities Index (Mark 3) and the EQ-5D: Statistics Canada; Health analysis and modelling groupGoogle Scholar
  5. 5.
    Brickley G, Cleaver V, Bailey S (1996) An evaluation of a group follow-up scheme for new NHS hearing aid users. Br J Audiol 30:307–312PubMedCrossRefGoogle Scholar
  6. 6.
    Brooks D (1979) Counselling and its effect on hearing aid use. Scand Audiol 8:101–107PubMedGoogle Scholar
  7. 7.
    Brooks D (1981) Use of post-aural aids by National Health Service patients. Br J Audiol 15:79–86PubMedCrossRefGoogle Scholar
  8. 8.
    Brooks D (1985) Factors relating to the under-use of postaural hearing aids. Br J Audiol 19:211–217PubMedCrossRefGoogle Scholar
  9. 9.
    Brooks D, Hallam R (1998) Attitudes to hearing difficulty and hearing aids and the outcome of audiological rehabilitation, Br J Audiol 32:217–226PubMedGoogle Scholar
  10. 10.
    Chisolm T, Abrams H, McArdle R (2004) Short- and Long-term outcomes of adult audiological rehabilitation. Ear Hear 25:464–477PubMedCrossRefGoogle Scholar
  11. 11.
    DiSarno N (1997) Informing the older consumer—a model. Hear J 50:49–52Google Scholar
  12. 12.
    Drummond M (2001) The use of economic evidence by healthcare decision makers. HEPAC 2:2–3CrossRefGoogle Scholar
  13. 13.
    Drummond M, O’Brien B, Stoddard G, Torrance G (1997) Methods for the economic evaluation of health care programmes. Oxford University Press, New YorkGoogle Scholar
  14. 14.
    EuroQol Group (1990) EuroQol-a new facility for the measurement of health related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar
  15. 15.
    Gianopoulos O, Dafydd S, Davis A (2002) Follow up of people fitted with hearing aids after adult hearing screening: the need for support after fitting. BMJ 325:471PubMedCrossRefGoogle Scholar
  16. 16.
    Humes L, Wilson D, Barlow N, Garner C (2002) Changes in hearing-aid benefit following 1 or 2 years of hearing-aid use by older adults. J Speech Hear Res 45:772–782CrossRefGoogle Scholar
  17. 17.
    Joore M, Brunenberg D, Zank H, van der Stel H, Anteunis L, Boas Peters H (2002) Development of a questionnaire to measure hearing-related health state preferences framed in an overall health perspective. Int J Technol Assess Health Care 18:528–539PubMedGoogle Scholar
  18. 18.
    Joore M, Brunenberg D, Chenalt M, Anteunis L (2003a) Societal effects of hearing aid fitting among the moderately hearing impaired. Int J Audiol 42:152–160Google Scholar
  19. 19.
    Joore M, van der Stel H, Peters H, Boas G, Anteunis L (2003b) The cost-effectiveness of hearing-aid fitting in the Netherlands. Arch Otolaryngol Head Neck Surg 129:297–304CrossRefGoogle Scholar
  20. 20.
    Kapteyn T, Wijkel D, Hackenitz E (1997) The effects of involvement of the general practitioner and guidance of the hearing impaired on hearing-aid use. Br J Audiol 31:399–407PubMedGoogle Scholar
  21. 21.
    Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 316:736–741PubMedGoogle Scholar
  22. 22.
    Kochkin S (2002) 10-year customer satisfaction trends in the US hearing instrument market. Hear J 45:39–44Google Scholar
  23. 23.
    Langley P (1995) Therapy evaluation, patient distribution, and cost-outcomes ratios. Clin Ther 17:341–347PubMedCrossRefGoogle Scholar
  24. 24.
    Lichtenstein M, Bess F, Logan S (1988) Diagnostic performance of the hearing handicap inventory for the elderly (screening version) against differing definitions of hearing loss. Ear Hear 9:208–211PubMedCrossRefGoogle Scholar
  25. 25.
    McCandless G. Lyregaard P (1983) Prescription of gain and output (POGO) for hearing aids. Hear Instr 34:16–21Google Scholar
  26. 26.
    Meister H, Lausberg I, Kiessling J, Walger M, von Wedel H (2002) Determining the importance of fundamental hearing aid attributes. Otol Neurotol 23:457–462PubMedCrossRefGoogle Scholar
  27. 27.
    Mulrow C, Aguilar C, Endicott J, Tuley M, Velez R, Charlip W, Rhodes M, Hill J, DeNino L (1990) Quality-of-life changes and hearing impairment. Ann Intern Med 113:188–194PubMedGoogle Scholar
  28. 28.
    Mulrow C, Tuley M, Aguilar C (1992) Sustained benefits of hearing aids. J Speech Hear Res 35:1402–1405PubMedGoogle Scholar
  29. 29.
    Mäki-Torkko E, Sorri M, Laukli E (2001) Objective assessment of hearing aid use. Scand Audiol 52(suppl):81–82CrossRefGoogle Scholar
  30. 30.
    Northern J, Meadows-Beyer C (l999) Reducing hearing aid returns through patient education. Audiol Today 11:10–13Google Scholar
  31. 31.
    Oostenbrink R, Moll H, Essink-Bot M (2002) The EQ-5D and the Health Utilities Index for permanent sequelae after meningitis: a head-to-head comparison. J Clin Epidemiol 55:791–799PubMedCrossRefGoogle Scholar
  32. 32.
    Parving A, Philip B (1991) Use and benefit of hearing aids in the tenth decade—and beyond. Audiology 30:61–69PubMedCrossRefGoogle Scholar
  33. 33.
    Parving A (2003) The hearing aid revolution: fact or fiction? Acta Otolaryngol 123:245–248PubMedCrossRefGoogle Scholar
  34. 34.
    Schwartz D, Lyregaard P, Lundh P (1988) Hearing aid selection for severe-to-profound hearing loss. Hear J 41:13–17Google Scholar
  35. 35.
    Sorri M, Luotonen M, Laitakari K (1984) Use and non-use of hearing aids. Br J Audiol 18:169–172PubMedCrossRefGoogle Scholar
  36. 36.
    Sorri M, Jounio-Ervasti K, Uimonen S, Huttunen K (2001) Will hearing healthcare be affordable in the new millennium. Scand Audiol 30:203–204PubMedCrossRefGoogle Scholar
  37. 37.
    SPSS 11.5 for Windows/SPSS Tables 11.5, Copyright® 2003, SPSS IncGoogle Scholar
  38. 38.
    Surr R, Schuchman G, Montgomery A (1978) Factors influencing use of hearing aids. Arch Otolaryngol Head Neck Surg 104:732–736Google Scholar
  39. 39.
    Taubman L, Palmer C, Durrant J, Pratt S (1999) Accuracy of hearing aid use time as reported by experienced hearing aid wearers. Ear Hear 20:299–305PubMedCrossRefGoogle Scholar
  40. 40.
    Taylor K (1993) Self-perceived and audiometric evaluations of hearing aid benefit in the elderly. Ear Hear 14:390–394PubMedCrossRefGoogle Scholar
  41. 41.
    van Roijen L, Essink-Bot M, Koopmanschap M, Bonsel G, Rutten F (1996) Labor and health status in economic evaluation of health care. The Health and Labor Questionnaire. Int J Technol Assess Health Care 12:405–415PubMedCrossRefGoogle Scholar
  42. 42.
    Ventry I, Weinstein B (1982) The hearing handicap inventory for the elderly: a new tool. Ear Hear 3:128–134PubMedCrossRefGoogle Scholar
  43. 43.
    Vuorialho A, Sorri M, Nuojua I (2004) Costs of hearing aid rehabilitation in two finnish hearing centres. Audiol Med 2:1–5CrossRefGoogle Scholar
  44. 44.
    Vuorialho A, Sorri M, Nuojua I, Muhli A (2005) Changes in hearing aid use over the past twenty years. Eur Arch Otorhinolaryngol Nov 9 (Epub ahead of print)Google Scholar
  45. 45.
    Willan A, O’Brien B (1996) Confidence intervals for cost-effectiveness ratios: an application of Fieller’s theorem. Health Econ 5:297–305PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyUniversity of OuluOulun YliopistoFinland
  2. 2.Department of NeurosurgeryUniversity of OuluOulun YliopistoFinland
  3. 3.KajaaniFinland

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