Bonetti Luka, Bonetti Ana, Krišto Tea
Department of Hearing Impairments, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Borongajska cesta 83f, 10000 Zagreb, Croatia.
Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Borongajska cesta 83f, 10000 Zagreb, Croatia.
Audiol Res. 2025 Sep 12;15(5):116. doi: 10.3390/audiolres15050116.
This study aimed to: (1) evaluate the effectiveness of the Croatian version of the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S-CRO) in screening for hearing loss greater than 20 dB HL in the better-hearing ear among adults aged ≥ 60 years; (2) assess its utility in identifying individuals with hearing loss ≥ 40 dB HL in the better-hearing ear, meeting current Croatian eligibility criteria for state-funded hearing aid rehabilitation; and (3) determine whether the emotional and social components of perceived hearing handicap can be meaningfully distinguished. Validity of the HHIE-S-CRO was analyzed using Spearman's correlation coefficient, the Mann-Whitney test and the factor analysis, while reliability was assessed via Cronbach's alpha and the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curve analysis was calculated to determine sensitivity, specificity, and positive and negative predictive values (PPV and NPV) at various cut-off scores of the HHIE-S-CRO total for specified audiometric criteria (better ear pure-tone average > 20 dB HL and ≥40 dB HL). The nonparametric Wilcoxon Matched Pairs Test was used to compare scores on the emotional and social subscales of the HHIE-S-CRO. The HHIE-S-CRO demonstrated excellent internal consistency (Cronbach's alpha = 0.92) and high repeatability of the results (ICC = 0.92). Discriminant, convergent, construct and predictive validity were confirmed. The area under the curve (AUC) for detecting hearing loss > 20 dB HL in the better ear was 0.95, with a sensitivity of 90.67% and specificity of 94.65% at a cut-off score of 6. For the Croatian threshold for state-supported hearing aid rehabilitation (≥40 dB HL in the better-hearing ear), similarly favorable screening characteristics were found at a cut-off score of 10. Based on these findings, the HHIE-S-CRO appears to offer sufficient sensitivity and specificity to support two key clinical applications: (1) screening for hearing loss > 20 dB HL in individuals aged 60 and older, and (2) identifying individuals within this age group who may be eligible for state-supported hearing aid-based rehabilitation.
（1）评估克罗地亚语版老年人听力障碍筛查量表（HHIE-S-CRO）在筛查60岁及以上成年人较好耳听力损失大于20 dB HL方面的有效性；（2）评估其在识别较好耳听力损失≥40 dB HL、符合克罗地亚当前国家资助听力辅助设备康复资格标准的个体中的效用；（3）确定感知听力障碍的情感和社会成分是否能被有意义地区分。使用斯皮尔曼相关系数、曼-惠特尼检验和因子分析来分析HHIE-S-CRO的效度，通过克朗巴哈系数和组内相关系数（ICC）评估信度。计算受试者工作特征（ROC）曲线分析，以确定在HHIE-S-CRO总分的不同截断分数下，针对特定听力测定标准（较好耳纯音平均听阈>20 dB HL和≥40 dB HL）的敏感性、特异性以及阳性和阴性预测值（PPV和NPV）。采用非参数威尔科克森配对检验来比较HHIE-S-CRO情感和社会子量表的得分。HHIE-S-CRO表现出出色的内部一致性（克朗巴哈系数=0.92）和结果的高重复性（ICC=0.92）。判别效度、收敛效度、结构效度和预测效度均得到证实。检测较好耳听力损失>20 dB HL时的曲线下面积（AUC）为0.95，截断分数为6时敏感性为90.67%，特异性为94.65%。对于克罗地亚国家支持的听力辅助设备康复阈值（较好耳≥40 dB HL），截断分数为10时也发现了类似良好的筛查特征。基于这些发现，HHIE-S-CRO似乎具有足够的敏感性和特异性，可支持两项关键临床应用：（1）筛查60岁及以上个体的听力损失>20 dB HL，以及（2）识别该年龄组中可能有资格接受国家支持的基于听力辅助设备的康复治疗的个体。
