Adult patients with severe-to-profound hearing impairment : a clinical, register-based, and interview study

Sammanfattning: In Sweden, roughly 25,000 individuals in the adult population have severe-to-profound hearing impairment, a prevalence rate of 0.2-0.3%. This patient group often needs extended audiological rehabilitation. The general aim of the thesis was to explore and describe patients with severe-to-profound hearing loss and/or patients with dual sensory loss. The specific focus studied was dual sensory loss in Paper I and Paper V, audiological rehabilitation in Papers I-V, cochlear implants (CI) in Paper III, and mental fatigue Paper IV. The five papers are based on data from the quality register for severe-to-profound hearing loss (Papers I-III), a pilot clinical study (Paper IV), and an interview study (Paper V). Paper I compared patients with dual sensory loss to patients with severe-to-profound hearing loss only and found a significant negative effect on QoL parameters among the dual sensory loss group. In Paper II, data on 4,286 patients with severe-to-profound hearing loss were studied. The results revealed that only 40.5% received extended rehabilitation. Furthermore, significantly more women than men received audiological rehabilitation. Hearing loss seemed to have a significantly more negative impact on daily life of women than of men. In particular, group rehabilitation and visits to a pedagogue seemed to have an important role in the experience of benefits in rehabilitation. In Paper III comparisons with patients rehabilitated with or without CI were investigated. The study found that only 8.5% had CI, despite most fulfilled the criteria for CI. The various reasons were studied, and the most common were related to hearing (management with hearing aids) and unknown reasons for not receiving CI. Paper IV indicated that most patients in the study population with severe mental fatigue had normal hearing or mild-to-moderate hearing loss, and severe mental fatigue was associated with severe tinnitus. Paper V demonstrated experiences of disabilities in daily life in patients with dual sensory loss. The results revealed that patients did not think of their dual sensory loss as a combination, but rather as separate disabilities. Isolation and the ability to control one’s own daily life emerged as the main themes. In conclusion, patients with dual sensory loss seemed to have a higher risk of experiencing difficulties in health conditions than patients with severe-to-profound hearing loss only. Individuals with dual sensory loss experienced a lack of control and isolation. Hearing loss seemed to have a more negative impact on women’s daily lives. For patients with severe-to-profound hearing loss, it is of great importance to be able to participate in interdisciplinary rehabilitation program. There is a need to highlight mental fatigue to focus on implementing guidelines for intervention and treatment in patients with hearing loss and/or tinnitus.