Tuning in: how hearing loss and assistive devices reshape musical quality of life

Background/Objectives: Hearing loss, coupled with the configurations of hearing devices, adds to the complexity of understanding the subjective and personal implications of losing musical fidelity. Hearing music through assistive listening devices significantly impacts music perception and enjoyment, yet research examining music-related quality of life for late-deafened adults is limited. This study aimed to capture late-deafened adults' experiences related to music and quality of life.

Methods: The study administered a cross-sectional survey designed around three established questionnaires: Cochlear Implant Quality of Life, Goldsmiths Musical Sophistication Index, and Music Related Quality of Life. It was completed by 116 late-deafened adults (mean age 65.4 years, with an average of 23.1 years of hearing loss). It was hypothesised that the use of different hearing devices would impact music importance, engagement, enjoyment, and related quality of life in disparate ways. To determine if and how quality of life differed between hearing device users, statistical analyses were stratified across a subgroup of 75 participants with bilateral hearing aids (n = 33; musicians n = 18, and non-musicians n = 15), bilateral cochlear implants (n = 21; musicians n = 5, and non-musicians n = 16), and bimodal configurations (n = 21) musicians n = 8, and non-musicians n = 13).

Results: Music remained important for most participants (n = 55, 73%) despite hearing loss. However, regardless of music being valued, only 36 (48%) participants enjoyed music "Always" or "Most of the Time", while 17 (23%) "Rarely" or "Never" enjoyed it. Bilateral hearing aid users reported the highest, and bilateral cochlear implant users the lowest quality-of-life scores. These effects extended to participation in real-world musical activities: hearing aid users attended more live music events, while bilateral cochlear implant users experienced the greatest reduction in musical activities compared to other hearing device users.

Conclusions: Musical quality of life is fundamentally about music enjoyment and engagement and how late-deafened adults integrate music into their everyday life. Hearing loss and hearing devices create a profound disconnect between the capacity to enjoy and engage with music. Musicianship did not guarantee better musical enjoyment or engagement. However, musicians demonstrated greater perseverance when enjoyment was limited, in the hope of improvement. Understanding this allows clinicians to develop effective rehabilitation strategies tailored to different hearing devices and musicianship abilities and set realistic expectations.