Social Outcomes Among Adults With Hearing Aids and Cochlear Implants: A Systematic Review and Meta-Analysis.

Importance: Hearing loss is associated with social isolation and loneliness, which are known to negatively impact mental and cognitive health. However, high-quality evidence on the impact of hearing rehabilitation devices on social outcomes remains limited.

Objective: To assess the impact of hearing rehabilitation device use on social outcomes in adults with hearing loss.

Data sources: Embase, MEDLINE, Linguistics and Language Behavior Abstracts, CINAHL, and PsycINFO were searched from database inception to March 13, 2024.

Study selection: Included studies used a hearing rehabilitation device and compared a validated social outcome score to a baseline or control. Studies with baseline and follow-up scores, including variability measures, were eligible for meta-analysis. Risk of bias was assessed using the Newcastle-Ottawa Scale.

Data extraction and synthesis: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Two independent reviewers screened studies and extracted data using a standardized template. The meta-analysis used restricted maximum likelihood-based random-effects models to estimate effect sizes.

Main outcomes and measures: Hearing rehabilitation devices included hearing aids, cochlear implants, bone conduction hearing aids, and personal sound amplification. The main outcomes included quality of life, isolation, loneliness, and social engagement using the following validated measures: the UCLA Loneliness Scale, Short Form 36, Nijmegen Cochlear Implant Questionnaire, Hearing Handicap Index for the Elderly, Hearing Handicap Index for Adults-Short, Cochlear Implant Quality of Life-35 Profile, Glasgow Benefit Inventory, and World Health Organization Quality of Life.

Results: Of 5847 studies screened, 295 underwent full-text review, 65 were included in the systematic review, and 35 in meta-analysis. A total of 5911 participants (weighted mean [SD] age, 64.1 [6.3] years; weighted mean [SD] percentage female, 49.4% [13.9%]) were included among the studies in the systematic review, and 2664 participants (mean age [SD] age, 65.9 [8.3] years; weighted mean [SD] percentage female, 46.3% [13.6%] female) among the studies in the meta-analysis. Hearing rehabilitation with hearing aids or cochlear implants was generally associated with improved social outcomes, including higher social quality of life (QoL) and decreased perceived social handicap and loneliness. The meta-analysis revealed that both hearing aid and cochlear implant use were associated with higher social QoL scores compared to baseline or control groups (SMD, 1.22; 95% CI, 0.88-1.57). Hearing aid use was linked to a moderate improvement in social QoL (SMD, 0.62; 95% CI, 0.13-1.10). Cochlear implant use, for those with moderate to profound hearing loss and limited benefits from hearing aids, was associated with a larger improvement in social QoL (SMD, 1.37; 95% CI, 1.01-1.74). Hearing rehabilitation was associated with decreased perceived social handicap (SMD, -3.41; 95% CI, -5.16 to -1.65). The findings from the meta-analysis on loneliness were inconclusive due to the limited number of studies.

Conclusions and relevance: In this systematic review and meta-analysis, hearing rehabilitative devices were associated with improved social outcomes for adults with hearing loss. Their use should be encouraged for those with hearing loss to potentially enhance social engagement and functional outcomes.