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Year : 2019  |  Volume : 25  |  Issue : 3  |  Page : 151-154

Translation and validation of hearing handicap inventory in adults in Hindi language

Department of Otolaryngology-Head and Neck Surgery, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission26-Mar-2019
Date of Acceptance03-Apr-2019
Date of Web Publication18-Oct-2019

Correspondence Address:
Dr. Amit Kumar
Department of Otolaryngology-Head and Neck Surgery, AIIMS, Rishikesh - 249 201, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.INDIANJOTOL_41_19

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Context: At present, various questionnaires are being used to assess the effect of hearing loss on quality of life. Majority of questionnaires assessing hearing handicap in adults are in English language, whereas Indian population is predominantly Hindi speaking. Hence, the study is aimed at developing a questionnaire in Hindi language, assessing the impact of unilateral sensorineural hearing loss (USNHL) on quality of life. Aim: The aim of the study is to translate Hearing Handicap Inventory for Adults (HHIA) into Hindi language and to validate it for evaluating the impact of USNHL on quality of life. Settings and Design: This is a cross-sectional study of 15 patients at ENT outpatient department of a tertiary care center. Materials and Methods: A previously validated questionnaire – HHIA – was translated into Hindi. Fifteen patients of USNHL were evaluated using this translated questionnaire – HHIA-Hindi (HHIA-H). The responses were analyzed, and Cronbach's alpha was calculated to measure the internal consistency of the questionnaire. Results: The Cronbach's alpha score for HHIA-H was found to be 0.895 (0.829 for emotional subscale and 0.848 for social subscale), which is significant, and hence it shows good internal consistency. Conclusion: HHIA-H showed good internal consistency, and it can be recommended to be used for assessing the impact of USNHL on the quality of life.

Keywords: Hearing handicap, hearing loss, questionnaire

How to cite this article:
Sood R, Kumar A, Tyagi AK, Varshney S, Malhotra M, Priya M. Translation and validation of hearing handicap inventory in adults in Hindi language. Indian J Otol 2019;25:151-4

How to cite this URL:
Sood R, Kumar A, Tyagi AK, Varshney S, Malhotra M, Priya M. Translation and validation of hearing handicap inventory in adults in Hindi language. Indian J Otol [serial online] 2019 [cited 2022 Jan 26];25:151-4. Available from: https://www.indianjotol.org/text.asp?2019/25/3/151/269555

  Introduction Top

Language is the soul of communication. Not only it has a vital role in day-to-day activities of a person but it also plays a key role in establishing social relationships. Thus, inability to effectively communicate can lead to a distressing condition which can ultimately have an adverse effect on the quality of life of an individual.

A wide variety of validated questionnaires for assessing the quality of life in patients with hearing loss are available in English language, but none exists in Hindi. Since the majority of Indian population is Hindi speaking, the true burden of disease cannot be assessed effectively. It is known fact that language acts as barrier in delivery of health care. Through this questionnaire, we are aiming at bridging those gaps.

  Materials and Methods Top

The study protocol was approved by the Institutional Ethics Committee, and written informed consent was taken from the participants in their native language (Hindi) before data collection. The trial is registered with the Clinical Trials Registry – India. This analysis is a part of ongoing thesis project on the impact of USNHL on the quality of life. All patients aged between 18 and 50 years with unilateral sensorineural hearing loss (USNHL) based on PTA were included in the study. On PTA, bone conduction threshold of more than 25 dB was taken as a criterion for sensorineural hearing loss, with the other ear being normal. Exclusion criteria were either conductive or mixed hearing loss in either ear or any other significant comorbidities, which may affect hearing or quality of life. Other exclusion criteria were history of ear discharge and nonconsenting individuals.

The study was an observational cross-sectional study. It was done on a sample size of 15 patients of pure USNHL coming to the ENT outpatient department of a tertiary care center. The previously validated questionnaire, Hearing Handicap Inventory for Adults (HHIA), was translated into Hindi by a graduate in Hindi language. Fifteen patients of USNHL were evaluated using this questionnaire.

Personal information was collected from the patients which included name, age, sex, occupation, education, and family income. A brief history was taken to account for hearing loss, tinnitus, and/or vertigo, which was followed by a general, systemic, and local examination of ear, nose, throat, and of vestibular function as and when indicated. The severity of hearing was assessed based on the pure-tone audiometry findings. The patient was then interviewed by the investigator using translated questionnaire. The questions were read out to the patients by the investigator, and a response was sought from the patient as “yes” (4 points), “sometimes” (2 points), or “no” (0 points). The scores were then calculated for HHIA-Hindi (HHIA-H), emotional subscale, and social subscale separately. Degree of handicap was evaluated using these scores. Statistical analysis was done using “SPSS Statistics for Windows, Version 21.0. IBM Corp., Armonk, NY”. A Cronbach's alpha value was calculated to test the reliability and the internal consistency of the Hindi-translated questionnaire.

  Results Top

The study population was 15 (93% males and 1% females). Age of the study population was between 18 and 50 years with a mean age of 33.2 years [Table 1]. After data analysis, it was found that 2 patients had no handicap, 2 patients had mild-to-moderate handicap, and 11 patients had significant handicap [Figure 1] and [Figure 2]. The HHIA scores varied from 4 to 82, with a mean of 49. Five out of 15 patients in the current study sample suffer from profound hearing loss.
Table 1: Demographic profile (n=15)

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Figure 1: Hearing Handicap Inventory for Adults - Hindi - Degree of handicap

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Figure 2: Hearing Handicap Inventory for Adults – Hindi - Individual degree of handicap

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The mean total HHIA-H scores of all patients of USNHL were 49.07 and the variance was 506.78, with a standard deviation of 22.51. The Cronbach's alpha value for internal consistency was 0.895 for HHIA-H, 0.829 for emotional subscale, and 0.848 for social subscale [Table 2]. The interitem correlation was also calculated [Figure 3].
Table 2: Hearing Handicap Inventory for Adults-Hindi - statistical analysis

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Figure 3: Interitem relationship

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  Discussion Top

WHO defines that any person with more than 25 dB suffers from hearing loss. Any amount of hearing loss more than 40 dB in adults is defined as disabling hearing loss. The degree of hearing loss as defined by WHO is mild (25–40 dB), moderate (40–60 dB), severe (60–80 dB), or profound (>80 dB).[1],[2]

About 5% of the world's population (nearly 360 million) is suffering from disabling hearing loss, which is similar to people suffering from diabetes mellitus, and it is believed to reach 10% of world's population by 2050.[1] According to a National Sample Survey 58th round (2002), 6.3% of Indian population (nearly 63 million) is suffering from significant hearing loss.[3]

Many questionnaires have been developed for assessing the impact of USNHL on quality of life. Akeroyd et al., in 2015, did a survey of such questionnaires that were developed in the past five decades and found a total of 139 hearing-specific questionnaires. The item number per questionnaire varied from a median of 20 to a maximum of 158 items.[4] Each item measured a specific subscale. One of the first such questionnaires was developed in the year 1982 by Ventry et al., which was HHIE. It is a 25-item questionnaire.[5] This questionnaire measured two subscales, i.e., emotional (12 items) and social (13 items). The questionnaire was in Likert scale, with the total score varying from 0 to 100. The hearing handicap was classified accordingly. A variety of modifications and translations of HHIE have been done since then. Newman et al. (1990) developed a similar questionnaire for the adults (age <65 years), namely Hearing Handicap Inventory for the Adults.[6] The HHIA has also been translated into a variety of languages including Italian, Portuguese, and Kannada.[7],[8],[9]

Hearing loss can silently disable the person and make him/her handicap. This study is intended to provide a standard, validated, easy, and freely available questionnaire, which can be used to assess the hearing handicap in Hindi-speaking population. The study concluded that the Hindi-translated version of HHIA showed high internal consistency with a Cronbach's alpha value of 0.895. High internal consistency values were also found for emotional (Cronbach's alpha – 0.829) and social subscales (Cronbach's alpha – 0.848) of the HHIAH. A Cronbach's alpha (α) score between 0.70 and 0.95 was given positive rating for internal consistency.[10] The interitem correlation is shown in [Figure 3]. The acceptable limit of interitem correlation is >0.3. A correlation value of <0.2 or 0.3 indicates that the question does not correlate very well with the scale overall, and thus, it may be dropped.[11] [Figure 4] shows the Cronbach's alpha value if a particular question is dropped out. Q5, Q6, Q8, and Q10 have low interitem correlation, but the removal of these questions would result in only a small improvement in Cronbach's alpha value, and hence, these items are retained. Moreover, these questions and responses depend on the occupation of the person and are relevant for people who have more social interaction as a part of their occupation. This fact is also evident in our study since two of the patients in the current sample had to change their profession due to the handicap. Although this analysis was not part of the current paper, the findings have been mentioned just to put emphasis on the fact that some questionnaires might be more meaningful for one person and less for others.
Figure 4: Change in Cronbach's alpha value if particular item is deleted

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With the statistical analysis of the HHIA-H, it can be concluded that it can be used as an effective tool in evaluating the Hindi-speaking patients with USNHL.

  Conclusion Top

The HHIA-H is a reliable and validated tool that can be used effectively in Hindi-speaking population to evaluate the handicap caused by hearing loss and it can also grade the handicap objectively. Thus, it could be useful in the assessment of the burden of disease and also in the monitoring of management of hearing loss.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Deafness and Hearing Loss. World Health Organization. Available from: http://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. [Last accessed on 2018 Jul 08].  Back to cited text no. 1
World Health Organization | Grades of Hearing Impairment. World Health Organization. Available from: http://www.who.int/deafness/hearing_impairment_grades/en/. [Last accessed on 2018 Jul 08].  Back to cited text no. 2
Varshney S. Deafness in India. Indian J Otol 2016;22:73.  Back to cited text no. 3
  [Full text]  
Akeroyd MA, Wright-Whyte K, Holman JA, Whitmer WM. A comprehensive survey of hearing questionnaires: How many are there, what do they measure, and how have they been validated? Trials 2015;16 Suppl 1:26.  Back to cited text no. 4
Ventry IM, Weinstein BE. The hearing handicap inventory for the elderly: A new tool. Ear Hear 1982;3:128-34.  Back to cited text no. 5
Newman CW, Weinstein BE, Jacobson GP, Hug GA. The hearing handicap inventory for adults: Psychometric adequacy and audiometric correlates. Ear Hear 1990;11:430-3.  Back to cited text no. 6
Monzani D, Genovese E, Palma S, Rovatti V, Borgonzoni M, Martini A, et al. Measuring the psychosocial consequences of hearing loss in a working adult population: Focus on validity and reliability of the Italian translation of the hearing handicap inventory. Acta Otorhinolaryngol Ital 2007;27:186-91.  Back to cited text no. 7
Araújo PG, Mondelli MF, Lauris JR, Richiéri-Costa A, Feniman MR. Assessment of the auditory handicap in adults with unilateral hearing loss. Braz J Otorhinolaryngol 2010;76:378-83.  Back to cited text no. 8
Thammaiah S, Manchaiah V, Easwar V, Krishna R, McPherson B. Psychometric properties of the hearing handicap questionnaire: A Kannada (South-Indian) translation. Int J Audiol 2017;56:194-201.  Back to cited text no. 9
Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007;60:34-42.  Back to cited text no. 10
Khilnani AK. Translation and validation of tinnitus handicap inventory into Gujarati language. Int J Otorhinolaryngol Head Neck Surg 2018;4:730.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2]

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