Development of a Visual Faces Scale for Adults with Hearing Loss: The Facial Scale of Hearing Difficulty

Background: In busy clinics, audiologists can benefit from brief, patient-centered tools to identify those with hearing difficulties. Pure-tone and speech audiometry measures, as well as self-report measures, require time and significant patient engagement. Visual analog scales have been used in health care as an accessible and simple way to understand patients’ multifaceted experiences. Purpose: To develop and test a brief, facial-based visual instrument, the Facial Scale for Hearing Difficulty (FSHD), that could provide a clinically useful complement to traditional diagnostic testing. Research Design: Correlational. Study Sample: Twenty-three adults with hearing profiles ranging from normal hearing (defined as −10 to <25 dB HL) to profound hearing loss. Intervention: The FSHD is a single-item, face-based visual analog scale that features five expressive faces ranging from 1 (no difficulty) to 5 (extreme difficulty). Data Collection and Analysis: Participants were asked to select the face from the FSHD that best represents their difficulty hearing. Participants also completed pure-tone audiometry, the Quick Speech-in-Noise test (QuickSIN), and a hearing handicap measure. Results: The FSHD had very strong, positive correlations with hearing handicap scores (ρ = 0.803, p < 0.001), pure-tone averages (ρ = 0.753, p < 0.001 for the better ear; ρ = 0.635, p = 0.001 for the worse ear), and QuickSIN (ρ = 0.567, p = 0.005). Conclusions: The FSHD is a quick instrument that can be administered in less than 1 minute and provides insight into patient difficulties with hearing. Given the strong associations with established clinical measures, the scale could be used as a point-of-entry tool for patient-centered care. Clinical Relevance Statement: The FSHD can help support clinical decision-making by helping to quickly identify patients who could benefit from further assessment, counseling, or aural rehabilitation. Because the instrument does not rely on technical language, literacy, or lengthy questionnaires, it could be well suited for inclusive service delivery in private or public practice, across diverse populations, or in under-resourced or fast-paced clinical settings.