Cross-cultural adaptation and psychometric determining of the Arabic version of the Hearing Handicap Inventory forAdults-Screening version (AHHIA-S)

Hearing loss is often thought of as a simple matter of volume, a physical inability to hear a whisper or a shout. Yet, the experience of losing one's hearing stretches far beyond the ear itself. It reshapes how a person connects with the world, often leading to feelings of isolation, frustration, and a quiet withdrawal from social life. Because the physical act of hearing is only part of the story, doctors and researchers need a way to understand how much a person's daily life is actually affected by their condition. While machines can measure the softest sounds a person can detect, they cannot measure the emotional weight of missing a conversation at a family dinner or the anxiety of not hearing a doorbell. To capture this human side of the condition, experts use self-report questionnaires. These are sets of questions that ask people to describe their own struggles, offering a window into the personal impact of hearing loss that a machine cannot see.

In a recent study, researchers set out to ensure that one such tool, the Hearing Handicap Inventory for Adults—Screening Version, works just as well for Arabic speakers as it does for English speakers. This specific questionnaire is a short, ten-item list designed to be a quick check for hearing difficulties. It asks about two main areas of life: emotional feelings, such as embarrassment or frustration, and social situations, like the trouble of following a group conversation. Each question offers three simple answers: "yes," "sometimes," or "no." By adding up the points from these answers, the tool produces a single number that indicates how severe a person's hearing handicap feels to them. A score of zero means no trouble at all, while a high score suggests a significant struggle. The researchers wanted to know if this tool, originally written in English, could be translated into Arabic without losing its meaning, and if it could accurately distinguish between people with normal hearing and those with hearing loss in an Arabic-speaking community.

The team, based at Tehran University of Medical Sciences, began by carefully translating the questionnaire into Arabic. They did not simply ask one person to translate the words; instead, they followed a rigorous process used by international health organizations. Two translators, who were fluent in both English and Arabic but had never seen this specific questionnaire before, created their own versions. The team then combined these into a single draft. This draft was sent to two other translators to convert it back into English, allowing the researchers to check if the original meaning had survived the journey. Finally, a committee of eight experts, including audiologists and ear, nose, and throat doctors, reviewed the Arabic version to ensure every question made sense and was culturally appropriate for the people they intended to study. They confirmed that the questions were clear, necessary, and relevant to the lives of Arabic speakers.

To test the new Arabic version, the researchers gathered sixty adults in Wasit Province, Iraq, between September and October of 2023. They divided these participants into two equal groups. The first group consisted of thirty people who had normal hearing in both ears. The second group included thirty people who had sensorineural hearing loss, a type of permanent hearing loss caused by damage to the inner ear or the nerve connecting the ear to the brain. None of the participants wore hearing aids, and all had healthy middle ears, ensuring that their hearing issues were not caused by temporary blockages or infections. The two groups were carefully matched in terms of age, gender, and education levels to ensure a fair comparison. Before filling out the questionnaire, every participant underwent a standard hearing test using a machine that measures the softest sounds they can hear at different pitches. This provided an objective, scientific measurement of their hearing ability.

Once the hearing tests were complete, the participants filled out the Arabic questionnaire. The researchers then analyzed the results to see if the tool worked as intended. They first checked if the questions were consistent with one another. They found that the answers were highly reliable; when a person answered one question, their response to the others followed a predictable pattern, suggesting the tool was measuring a single, clear concept. They also asked a smaller group of twenty-five people to take the test again two weeks later. The scores remained almost identical, proving that the questionnaire yields stable results over time and is not just a snapshot of a person's mood on a single day.

The most critical test, however, was whether the questionnaire could actually tell the difference between someone with hearing loss and someone with normal hearing. The researchers compared the questionnaire scores with the objective hearing test results. They found a strong link: as the hearing loss measured by the machine got worse, the scores on the questionnaire went up. People with normal hearing gave themselves very low scores, indicating they felt no handicap, while those with hearing loss gave themselves much higher scores, reflecting the difficulties they faced in daily life. The tool successfully separated the two groups, with the people who had hearing loss scoring significantly higher than those with normal hearing. This confirmed that the Arabic version is not just a translation, but a valid and accurate instrument that captures the real-world impact of hearing loss.

The study concludes that this Arabic version of the screening tool is ready for use in clinics and research. It offers a reliable way for doctors to understand how hearing loss affects the emotional and social lives of Arabic speakers, filling a gap where such a tool was previously unavailable. By providing a clear, culturally adapted way to measure these challenges, the study helps ensure that people with hearing loss in Arabic-speaking communities can be identified and supported more effectively, addressing not just the physical loss of sound, but the human experience of living with it.