A person’s hearing ability involves more than just detecting sounds. While a hearing impairment is the physiological loss of hearing function, a “hearing handicap” describes the personal and social consequences of that loss. It represents the perceived effect on an individual’s emotional well-being and ability to function in daily life. To measure this, clinicians use the Hearing Handicap Inventory (HHI), a self-assessment questionnaire designed to quantify these non-auditory challenges.
The Purpose and Versions of the Inventory
The primary purpose of the Hearing Handicap Inventory is not to test physical hearing ability, a function measured by an audiogram. Instead, its goal is to capture the subjective experience of living with hearing loss by quantifying its emotional and social difficulties. The results help a professional understand how much the hearing loss interferes with a person’s life, which can differ from what an audiogram suggests.
To accommodate different age groups, two main versions of the inventory were developed. The Hearing Handicap Inventory for the Elderly (HHIE) was created for individuals aged 65 and older. A subsequent version, the Hearing Handicap Inventory for Adults (HHIA), was adapted for younger adults. Both the HHIE and HHIA contain 25 questions for a detailed assessment.
For situations where a full assessment is not necessary, shorter screening versions are available. The HHIE-S and HHIA-S are 10-question surveys that allow for a quick evaluation of the perceived effects of hearing loss. These screening tools are often used to determine if a more comprehensive evaluation is needed, and a high score prompts a referral to an audiologist.
What the Inventory Measures
The questions on the full 25-item inventory explore two distinct domains of a person’s experience: the emotional and social/situational subscales. Analyzing these subscales separately allows a clinician to gain insight into the specific areas where an individual faces the most challenges. This understanding helps in forming a more targeted management plan.
The emotional subscale, containing 13 questions, focuses on the internal, psychological responses to hearing loss. Questions in this category probe feelings that can arise from communication difficulties. For instance, a person might be asked if their hearing problem causes them to feel frustrated with family, embarrassed when meeting new people, or left out in a group.
The social and situational subscale includes the remaining 12 questions and assesses how hearing loss affects a person’s ability to participate in various life activities. The items explore practical scenarios, with examples including whether a person has difficulty when visiting friends, attending religious services, or going to a restaurant.
Scoring and Interpreting the Results
The scoring system for the Hearing Handicap Inventory is straightforward. For each of the 25 questions, a person selects “Yes,” “Sometimes,” or “No.” Each response is assigned a point value: “Yes” receives 4 points, “Sometimes” receives 2 points, and “No” receives 0 points. The total score is calculated by summing the points, resulting in a number between 0 and 100.
This total score corresponds to a specific level of perceived handicap, providing a clear benchmark. A score from 0 to 16 indicates no significant self-perceived handicap. A score between 18 and 42 suggests a mild to moderate perceived handicap, and a score of 44 or higher indicates a significant or severe perceived handicap.
While the total score provides an overall measure, the scores for the emotional and social subscales can be examined individually for a more nuanced interpretation. For example, a person might have a low social score but a high emotional score. This indicates that while they still participate in activities, the effort to do so causes internal distress.
How the Results Guide Next Steps
The score from a Hearing Handicap Inventory complements clinical hearing tests. An audiologist uses the HHI score with an audiogram to develop a comprehensive understanding of the patient’s needs. A high handicap score, even when an audiogram shows only mild hearing loss, signals that the individual is experiencing daily struggles and would likely benefit from intervention.
The results directly inform the creation of a personalized management plan. For someone with a high score, recommendations may include hearing aids or assistive listening devices for specific situations. The challenges identified by the subscales can also be addressed. For example, a high emotional score might lead to counseling, while a high social score could prompt training in communication strategies.