Research, Translation And Preliminary Application Of Chinese Version Of Hearing Handicap Inventory For The Elderly-screening

Objective: The study aimed to translate and study the content ofthe scale based on the English version of the hearing handicap inventory for theelderly-screening version (HHIE-S), to debug it in combination with thecharacteristics of Chinese traditional culture, and to apply it to the Chinesecultural context. We preliminarily applied the Chinese version of HHIE-S to theelderly, verified the reliability and validity of the scale through statisticalanalysis, and investigated whether the Chinese version of HHIE-S could beused in screening Chinese presbycusis. Methods: The source scale, translatedand back-translated by our researchers, was obtained from English literature.Referring to the Chinese scale reported by domestic literatures, our scale wascompared, checked and revised to form the initial version of the scale.30elderly people were randomly selected to carry on the preliminary survey,specific revisions concerning the content of the scale were solicited, and thusthe scale could be preliminarily finalized after modification. Another30elderlypeople were randomly selected to do the survey for the modified version, andthe finalization came into being and used for making a survey if there would beno completely unexplained question or phenomenon on the scale.170cases ofelderly people who didn’t live alone and were over65years were selected viathe methods of direct interview and these subjects as well as their close familymembers were required to complete the Chinese version of HHIE-S. One totwo weeks later, they were resurveyed to evaluate the reliability and validity ofthe scale and the final scores of the scale were compared with the pure toneaverage of the better ear (0.5kHz,1kHz,2kHz and4kHz) under quietconditions (the background noise was controlled within40dB) to realize thevalue of the screening. Results: After translation, back translation, revision andfinalizing of the scale, it retained all the items of the scale in a total of10and adjusted some of these items considering Chinese culture so as to be moresuitable for elderly people to accept. SPSS15.0software package was used forstatistical analysis to find out that the Chinese version of HHIE-S had betterperformances in various inspections. The two subscales (emotional andsituational) in the scale included10entries which were completely retained fortheir strong correlations. The average completion time of the scale was about5minutes with the completion rate of100%. Reliability test: the HHIE-S had twosubscales: emotional and situational. The total Cronbach’s α coefficient of thescale was0.935, the total split-half reliability0.836and the test-retest reliability0.963. Validity test: The content validity was assessed by calculating thecorrelation among various entries and the two subscales and the total scale,between0.659and0.927. Sphericity tests of Kaiser-Meyer-Olkin and Bartlett’swere carried out. The value of KMO test was0.907and the approximatechi-square value of Bartlett’s was1351.357. There was a significant difference(P<0.001). There were common factors among the related matrixes, suitable forfactor analysis. According to principal component analysis and orthogonalrotation method for analyzing the scale, the eigenvalues of emotional andsituational subscales were both greater than1and the total explained rate ofvariance was73.874%. The factor loadings of10entries in the scale were allbetween0.684and0.871and the factor loadings of all entries on thecorresponding factors were greater than0.60. The average hearing thresholdwas considered as the "gold standard" and the two subscales and the total scalewere positively correlated to the pure-tone average. The results ofquestionnaires completed by the agents were compared to the pure-tone average,and discovered to be similar to the results of self-assessment questionnaires,thus showing a positive correlation. The specificity value and the overallsensitivity for the HHIE-S scale to assess prebysusis was95.24%and59.06%respectively, the latter of which increased with the increase of hearing thresholdvalues. The pure tone average of149(accounting for87.65%of the total) increased. Among the patients with mild to moderate hearing loss by pure-toneaudiometry, there were50cases with greater than8points of HHIE-S score,suggestive of having hearing impairment,39cases with10~22points ofHHIE-S score, of having mild to moderate hearing loss,11cases with24~40points of HHIE-S score, of severe hearing impairment. Among the patients withsevere and more severe hearing loss by pure-tone audiometry, there were38cases with greater than8points of HHIE-S score, suggestive of having hearingimpairment, among whom9cases with10~22points of HHIE-S score, ofhaving mild to moderate hearing loss,29cases with24~40points of HHIE-Sscore, of having severe hearing impairment. With an increase of the scale scoresand the auditory threshold, the matching proportion of hearing aids alsosignificantly increased; when the scores of the scale was between24and40, thematching proportion of hearing aids was42.5%. Conclusions: Our Chineseversion of HHIE-S conformed to the characteristics of Chinese culture withstable structures, rather high reliability and validity. The HHIE-S showed highsensitivity and specificity in presbycusis screening so it was tentativelysuggested that the scale could be employed as a stable screening tool forChinese presbycusis and also preliminarily for screening presbycusis.Meanwhile, the agent scale like the self-assessment scale also could be used inscreening presbycusis. HHIE-S could preliminarily reflect not only the hearingloss in the elderly, but also the impact of hearing loss on the social lives andpersonal feelings of them. In combination with the pure tone test, it can morecomprehensively assess presbycusis of the patients with the purpose ofpromoting them to receive early positive treatment and rehabilitation.