Topic Date: Approved Not Approved Signature: Date: TABLE



Name of Academic Supervisor

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Name of Principal/Director
Dr.  Muhammad Naveed Babur



      Not Approved







1.    INTRODUCTION————————————————————– 03

1.1.        Rationale for Proposed Study————————————- 03

1.2.        Objectives————————————————————– 04

1.3.        Operational Definitions———————————————- 04

2.        HYPOTHESIS—————————————————————- 04

2.1.        Research Hypothesis———————————————— 04

2.2.        Null Hypothesis——————————————————- 04

3.        METHODS & MATERIALS———————————————— 05-06

3.1.        Setting——————————————————————- 05

3.2.        Study Design———————————————————- 05

3.3.        Sample Size———————————————————– 05

3.4.        Sampling Technique———————————————— 05

3.5.        Duration of Study—————————————————- 05

3.6.        Ethical issues——————————————————— 05

3.7.        Selection Criteria:————————————————— 05

3.7.1.           Inclusion criteria—————————————- 05

3.7.2.           Exclusion Criteria————————————– 05

3.8.        Data collection —————————————————— 06

3.9.        Data Analysis———————————————————06

3.10.     Data presentation—————————————————06

4.        LIMITATION OF PROPOSED STUDY—————————— 10

5.        PLAN OF WORK———————————————————- 11







 Hearing loss (HL) is one of the most common health problems for people aged 65 years and above1, the growing number of hearing-impaired older adults is a natural result of our growing elderly population2.  The prevalence of hearing impairment rapidly increases with increasing age. It is estimated that it affects  48% of individuals in their 60s, 60% in their 70s3,4, and 90% of people aged 80 years and above.5,6   .  The degree of hearing aid use has increased in the past decades, but the level of usage remains insufficient. Over the last 20 years, hearing aid adoption has remained stubbornly at about one in five adults with an admitted hearing loss. Even among those who possess a hearing aid, a substantial proportion never or scarcely uses their hearing aid. In addition, not all adults provided with hearing aids use them, wear them regularly, or are satisfied with them. Surveys conducted in the United Kingdom, Australia, Finland, Denmark, and the United States revealed that between 1% and 40% of hearing aids dispensed are never or rarely used. Primary clinical management intervention for people with hearing loss is hearing aids. The majority of people who would benefit from hearing aid do not use it. Although there is large prevalence of hearing impairment in human population, the uptake and use of hearing aid is still poor. Over the last 20 years, hearing aid adoption has remained at 20% with an admitted hearing loss.


 It is necessary to identify the factors that affect compliance with this treatment recommendation. Some investigators have explored the barriers that may prevent those with hearing loss from choosing to purchase and use hearing aids to assess with their communication needs. Among some of the barriers to hearing aid adoption are that they can hear well most situations without hearing aid, hearing not severe enough can’t afford and need medicines. Many of the reasons why older adults with hearing impairment choose not to wear their hearing aids according to advice represent root causes of vision and handling problems, ringing sensations, disappointment with hearing aids, un natural sound and too embarrassed to wear their hearing aid in public.

Rationale For Proposed Study

The aim of the study was to find out obstacles regarding hearing aid adoption and not using hearing aid according to advice and to collate the available evidence as to the potential barriers for non-use of hearing aids.


1.1.      Objectives

To seek the obstacles regarding hearing aid adoption and use in older adults of age equal to and greater than fifty years coming to audiology department Chiniot.

1.2.    Operational Definitions

An obstacle is something, material or non-material, that blocks one’s way or prevents or hinders progress. Obstacles which prevent progress to better hearing by using hearing aids in older adults are cost and quality of hearing aids, expectations, physical and cognitive restrictions, stigmatization, wax accumulation, poor amplification and some medicals conditions etc. Older adults who were reluctant to purchase and use hearing aid most often in their everyday lives were studied. We couldn’t operationalize each obstacle so we accepted them on subjective basis as patient told us.




2.1.        Research Hypothesis:


·         There are many obstacles regarding hearing aid adoption and use in older adults of age greater than and equal to fifty years.


2.2.        Null Hypothesis:


·         There are no obstacles regarding hearing aid adoption and use in older adults of age greater than and equal to fifty years.



3.1.        Setting: This study will be conducted in audiology department of district headquarter hospital Chiniot.

3.2.        Study Design: Cross sectional descriptive study

3.3.        Sample Size: Due to limited availability of time and resources sample size will be 40 older adults of age ? 50 years.

3.4.        Sampling Technique: Non probability Convenience Sampling

3.5.        Duration of Study: The duration of study will be nine months after approval of synopsis.

3.6.        Ethical issues:. Ethical approval will be taken from Hospital ethical committee DHQH, Chiniot.

3.7.        Selection Criteria:

Inclusion criteria:

Hearing impaired older adults of age ? 50 years.

   Older adults who were prescribed hearing aid from one month but have not              adopted yet and those who were not using according to the advice of audiologist.


Exclusion criteria:                                                                                           Labeled psychiatric patients and those who were not willing to participate were excluded.

  3.8. Data Collection:

         Data was collected with the help of pre-tested questionnaire which consists        of two parts. The first part was demographic variables (name, age, gender, residence, socioeconomic status, monthly income and occupation). Study variables (hearing not severe enough, hear well in most situations without hearing aid, vision and handling problems, ringing sensations and disappointment with hearing aids).

3.9.  Data Analysis:

Data was analyzed through manually.

3.10  Data Presentation:

o   Frequency and percentages were calculated and data was presented in the form of graphs, tables and charts.


Hearing Aid Obstacles Questionnaire

 Name _________         Date _______        Age    __________                                     Gender_________       Occupation_______   Residence _________

Marital status __________   Education __________

Question 1.From how much duration hearing aid is prescribed to you?

a)     I don’t remember exactly

b)    Greater than one month

c)     Less than one month

Question 2:- Do you have purchased hearing aid?

Yes ?

No ?                                                                                                                     

Question 3:-If no then what are the reasons for not purchasing the hearing aid?

1.     Can’t afford

2.     I need medicines

3.     I need surgery rather than hearing aids

4.     Do not know where to get hearing aids

5.     Hearing not severe enough

6.     Hear well enough in most situations without hearing aid

7.     Do not admit hearing loss in public

8.     Make me look disabled

9.     Noticeable

10.               Do not trust audiologists

11.               Family resistance

12.               Friends or family bad experiences

13.               Any other


If yes then are you currently using hearing aid according to the advice?



Question 4:- If not, then what are the reasons for not using hearing aid according to the advice?

1.      Do not work in humid climates

2.      Require too many adjustments

3.      Uncomfortable

4.     Disappointment with hearing aids

5.      Unnatural sound

6.      They break down

7.     Hear well enough in most situations without hearing aid

8.     Vision and  handling problems

9.     Too embarrassed to wear

10.                Make you look disabled and noticeable

11.                Do not trust Audiologists

12.                Friends or family bad experiences

13.                Ear wax problems

14.                Draining ear

15.                Itching/rashes

16.                Irritation and Feedback

17.                Too expensive to maintain




·         Frequency: Qestionnaire will be filled out whenever a patient meeting inclusion criteria visits audiology department of DHQH,Chiniot.

·         Duration for questionnaire will be 5-10 minutes.

4.  Limitation Of Proposed Study

Limitation of the proposed  study is this that we will cater only those patients coming to Audiology department but not all of hearing impaired older adults of district Chiniot.




Data Collection & analysis

Will be completed in 6 months after approval synopsis

Thesis writing 

Will be completed in 03 months

First draft

Will be submitted after 9 months after the approval of synopsis






1.      Davis AC. Epidemiology of hearing disorder. In: Kerr AG, editor.Scott Brown’s Otolaryngology. Boston: Butterworth-Heineman;1997:2/3/1–2/3/38.

2.      Ries PW. Prevalence and characteristics of persons with hearing trouble:United States, 1990–91. Vital Health Stat 10. 1994;188:1–75.

3.      Davis AC. The prevalence of hearing impairment and reported hearingdisability among adults in Great Britain. Int J Epidemiol. 1989;18(4):911–917.

4.      Wilson DH, Walsh PG, Sanchez L, et al. The epidemiology of hearingimpairment in an Australian adult population. Int J Epidemiol.1999;28(2):247–252.

5.      Cruickshanks KJ, Wiley TL, Tweed TS, et al. Prevalence of hearingloss in older adults in Beaver Dam, Wisconsin. The Epidemiology ofHearing Loss Study. Am J Epidemiol. 1998;148(9):879–886.

6.      Tambs K. Utbredelse av hørselstap. Prevalence of hearing impairmentin Norway. Nytt fra Miljø og Samfunnsmedisin. 1998;2:1.









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