This study aimed to explore the quality-of-life post-onset of SOHL whilst investigating effects on social, emotional and situational subscales to gain a multi-faceted understanding of this complex diagnosis.

The study objectives were: (1) to explore the lived experiences of adults diagnosed with SOHL and (2) to investigate the impact of SOHL on the QoL of individuals diagnosed with the hearing impairment and to establish facilitators of emotional and social aspects of counselling provided by audiologists post-SOHL diagnosis.

This was a convergent parallel research study (Creswell & Plano Clark, 2011; Demir & Pismek, 2018). The researchers adopted the use of a convergent parallel design whereby a quantitative survey and qualitative interviews were concurrently conducted to gain a more in-depth insight and multifaceted understanding of the experiences of a small number of individuals diagnosed with SOHL, which is considered rare, and the impact on their QoL (Creswell & Plano Clark, 2011; Demir & Pismek, 2018).

Purposive non-probability sampling was used to identify participants who met the study inclusion criteria (Table 1). Participants included in the study were recruited from the Wits University Speech and Hearing Clinic (USHC). There were only two participants who were identified as individuals diagnosed with SOHL in the audiology files accessed from the study site. These participants were labelled and anonymised as primary participants 1 and 2 (P1 and P2). In addition, there were three secondary participants (S1, S2 and S3), S1 (P1’s nephew), S2 (P1’s colleague) and S3 (P2’s wife); these individuals were nominated by the primary participants as their significant others in their microsystem (Granberg et al., 2014). Secondary participants S1 and S2 were related to P1, and S3 was related to P2. Table 1 illustrates the inclusion criteria used for both the primary and secondary participants.

Our study site is the audiology clinic that offers hearing healthcare services and is also intended for students’ clinical training. Prior to conducting the study, official permission was granted by the site’s Head of Department to have access to the audiology clinic patients’ records from January 2014 to June 2022 to identify patients diagnosed with SOHL. The selected period was based on the availability of records at the study site. The researchers identified five potential primary participants from the audiology clinic patients’ records, and these potential participants were contacted, by the audiology clinic administrator, either telephonically or via email to briefly inform them of the research study and what it entails. Individuals who had agreed to participate in the research gave consent to participate in the study.

The data collection process included a convergent parallel method. The researchers concurrently conducted a quantitative survey and qualitative interviews as part of the data collection process whereby: (1) Primary participants 1 and 2 completed the Hearing Handicap Inventory Screening Questionnaire for Adults (HHIA) (Newman et al., 1990), where quantitative data were collected. (2) Semi-structured interviews were conducted face-to-face with the P1 and P2, and telephonically with S1, S2 and S3, where qualitative data were collected. The HHIA is a 25-item hearing handicap survey questionnaire adapted from Ventry and Weinstein (1983) by Newman et al. (1990) and was a modified version of the HHIE (Ventry & Weinstein, 1983). For the purpose of the study, a 10-item hearing handicap screening tool was used (Newman et al., 1990). It was deemed as a suitable tool to determine the self-perceived hearing handicap of individual study participants (P1 and P2) who were actively involved in their workspaces. Quantitative scores for individual participants were calculated from the HHIA screening tools.

Next, the semi-structured self-designed interviews (Appendix 1) were designed using various literature sources that focused on the impact of SOHL on the QoL. The qualitative interviews were administered virtually via video-recorded calls on MS Teams and Zoom to collect data from the recruited participants (P1, P2, S1, S2 and S3) to determine the impact on the QoL for individuals diagnosed with SOHL. Previous researchers reported that hearing handicap screening tools such as the HHIA may not be used alone as they tend to provide inconsistent patient-to-patient results and their validity was questioned; thus, the designed interview schedule was guided by the HHIA screening tool. These data collection methods in our study were weighed equally but analysed as two independent components to inform an integrated interpretation of the study findings (Creswell & Plano Clark, 2011; Demir & Pismek, 2018). In addition, to improve the scientific rigour of the study, member checking was performed following the interviews.

For data analysis, the HHIA quantitative scoring was used to show handicap levels obtained, and thereafter, a deductive thematic analysis that followed Braun and Clarke’s (2012) six steps was used to analyse data from interviews. The convergent mixed methods design was used in this study to determine whether HHIA scores and data collected from the semi-structured interview were in agreement (Crowe et al., 2011). Thus, quantitative scores obtained from the HHIA screening tool were analysed separately from the qualitative data obtained from the thematic analysis; thereafter, the HHIA scores were obtained, and the deducted themes were checked for confirmability regarding the impact of SOHL on the QoL (Braun & Clarke, 2012; Korstjens & Moser, 2017).

Prior to the study being conducted, it was obligatory that the researcher attained ethical clearance. Ethical clearance was obtained from the University of the Witwatersrand Human Research Ethics Committee (HREC) (Medical), Protocol Number: M220348. All participants consented to take part in the research study; their identities were protected and raw data obtained from interviews were confidentially kept and protected. Participants’ responses were autonomous and respected by researchers.

The individual’s age and age of SOHL diagnosis as indicated by the HHIA scores estimate the hearing handicap and impact on communication. Our study’s primary participants obtained 84% (P1) and 50% (P2), respectively, and reported that they struggled mostly with communicating with family members at home and peers at work, who formed part of their microsystem. A study by Härkönen et al. (2017) agrees with our findings that high HHIA scores may be linked to secondary factors such as tinnitus, vertigo and otalgia, which were reported by our primary participants. While a study by Kuhn et al. (2011) reported that treatment and prognosis for hearing recovery were dependent on one’s age, severity of SOHL, vertigo and the audiogram configuration, these factors seemed to increase the primary participants’ perception of their hearing handicap. These risks were also indicated in our findings (Table 2) and were in agreement with the findings previously reported by Kuhn et al. (2011). Although the age of P1 (93) may be associated with age-related hearing loss, the perceived severity of the HI was associated with tinnitus, pain, vertigo and the SOHL diagnosis. Recent studies have attributed SOHL to medical conditions such as HIV and coronavirus disease 2019 (COVID-19) (Elmoursy et al., 2023; Frosolini et al., 2022) but these were not reported by our study participants. Thus, successful informational counselling and aural rehabilitation intended to improve the communication abilities of adults diagnosed with SOHL should be informed by patient-specific audiological data on the age of onset and associated risk factors such as tinnitus, vertigo, medical conditions and type of hearing loss. Furthermore, future studies should consider probing patients about their history of COVID-19 infections as part of the case history interview.

Individuals diagnosed with SOHL experience life differently following the SOHL diagnosis; however, factors such as anxiety and depression were associated with hearing loss and affected the individuals’ QoL (Arslan et al., 2018). In our study, although P1 aged 93 years may seem old, he was still actively working, and thus, the SOHL diagnosis may have possibly triggered job insecurity and subsequent experiences of anxiety and depression. In addition, the secondary participants further emphasised the primary participants’ impact on their well-being that following SOHL diagnosis, the primary participants were withdrawn and avoided various communication spaces, which reduced their social interactions and affected their relationships with those within their microsystems. Our findings were similar to those reported by Arslan et al. (2018), who confirmed their participants’ anxiety and depression high scores calculated from the Beck Anxiety Scale (BAS) and the Beck Depression Inventory (BDI) that were conducted following their participants’ initial audiology visit. Therefore, participants’ information about their mental health and well-being deducted from interviews and scores obtained from the hearing handicap scales may be useful intervention measurements when integrated into counselling and used to guide the appropriate referrals.

The HHIA as a quantitative measure should be augmented with a qualitative interview schedule that is context specific for a successful intervention of SOHL. The score of 84% obtained from P1’s HHIA indicated a severe impact on the participant’s QoL. This score is linked with a significant negative impact on one’s QoL, coupled with his age, age of onset of SOHL and reported symptoms of tinnitus, otalgia and vertigo, and the perceived hearing handicap may be severe. The impact on the participants’ QoL affected their communication abilities. Thus, audiologists’ role pre- and post-SOHL diagnosis should integrate patient-and-family-centred counselling as support for those diagnosed with SOHL.

The responses obtained from the individuals who represent the microsystem of the individual diagnosed with SOHL are crucial and inform the external perspective on the QoL and impact the interrelationships of those diagnosed with SOHL. Data obtained from the secondary participants consequently provided in-depth insight into the primary participants’ communication struggles that were not so much reported by the primary participants themselves. Insight knowledge was specifically with regard to the impact of hearing loss on social behaviour, mental wellness and emotional instability, which were more visible to secondary participants. Thus, involving a holistic microsystem type of aural rehabilitation should be reinforced to improve patient-specific hearing healthcare support.

Literature has clearly defined the difference between informational counselling and patient-and-family needs counselling (Meibos, 2018). Meibos (2018) further reported that audiologists were more inclined to focus on informational counselling and paid less attention to the patient-and-family needs (Meibos, 2018). The participants in our study reported that audiologists provided inadequate informational counselling following the SOHL diagnosis, and there was a lack of guidance and follow-up support. These were the clinical competency gaps for audiologists that were also reported by Meibos (2018) which were essential for PCC and FCC practices (ASHA, 2020). Thus, the lack of patient-and-family-centred counselling was a barrier that impacted the participants’ QoL following SOHL diagnosis. Thus, effective interventions offered by audiologists should have PCC and FCC aspects of counselling.

It has been established through a review of literature that SOHL is rare in nature when compared to other types of hearing impairment, hence our small study sample; this was noted as a trend reported in previous studies yet may be seen as a limitation. Nevertheless, the convergent parallel methods of data collection used in our study favour scientific rigour, especially when studying a known rare medical condition (Demir & Pismek, 2018). Although transferability and generalisability of the study findings may not be possible (Smith, 2018), lessons from our methodology may have potential relevance and value in the case management of other rare audiology cases. We accessed our data from the university audiology clinic only; however, we acknowledge that this type of clinic site was not necessarily contextually representative, and hence, our findings may not be generalised. Using the HHIA tool and qualitative interviews allowed for triangulation during data analysis, and this was our study strength that showed scientific rigour.

Counselling aids an individual not only to accept and understand their hearing loss but also to navigate their daily functions. Daily functioning activities encompass functioning in physical spaces and are inclusive of one’s social behaviours, mental wellness and emotional stability and maintaining functional relationships. Therefore, informational counselling that integrated PCC and FCC may benefit those diagnosed with SOHL and individuals in their microsystems.

The intentional and combined use of the HHIA and qualitative interviews by audiologists during aural rehabilitation post-SOHL diagnosis could be facilitators used to improve the efficiency of patient-centred interventions and add value to their QoL instruments.