301222 The Self for Hearing Screening of the Elderly-Revised (SHSE-R) Components Loadings from the EFA for the 20 Items of the SHSE-R

Prior to the main article here is a brief screen test for hearing loss from the Spokane ear, nose, and throat practice in Spokane, WA.

1. When you are in a group or in a crowded restaurant, is it difficult for you to follow the conversation?

2. Do you often need to turn up the volume on your TV?

3 .Is talking on the phone difficult?

4. Do you have trouble understanding others in a car?

5. Has someone close to you mentioned you might have a problem with your hearing?

If you answered yes to any of them, you may want to see a professional hearing specialist.

If you are a Veteran, go the VA for your free health care including a hearing test. The hearing aids, if needed, are free and they are the best in the world!

The Self for Hearing Screening of the Elderly-Revised (SHSE-R) Components Loadings from the EFA for the 20 Items of the SHSE-R

Information from and the full report: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974408/

Test component abbreviation definition:

  1. D-Distracting conditions
  2. G General issues
  3. W-Working memory

Factor 1. General issues

D         10        Do you have difficulty understanding speech in a reverberating location (e.g., cathedral, indoor swimming pool)?           0.87

D         9          Do you find it difficult to talk to people in noisy places (e.g., restaurants, subway)?            0.86

G         1          Do you have difficulty understanding when someone talks too quietly?        0.83

G         11        Do you have difficulty understanding the conversation when several people talk at the same time?   0.82

G         3          Do you have difficulty understanding mumbled or unclear voices?    0.82

G         6          Do you wish to increase the TV’s volume when watching it with family because the sound is not clear?  0.81

D         8          Do you have difficulty hearing the announcements on public transport (e.g., bus, subway)?       0.80

G         5          Have you ever misunderstood or responded inappropriately to what someone said?            0.79

D         2          Do you have difficulty hearing sounds such as birds and crickets singing or water flowing?         0.78

D         13        Do you find it difficult to understand what others are saying on the phone? 0.74

G         4          Do you find it difficult to understand an unfamiliar voice (e.g., stranger) compared to a familiar voice (e.g., friend, family)?           0.70

D         12        Have you missed hearing a doorbell when a guest has visited your house (if there is no doorbell, a knock, or a voice calling to you)? 0.69

Factor 2. Distracting condition

D         15        Have you ever felt that the TV or radio sound is too fast?        0.83

D         16        Have you ever asked a communication partner to speak slowly because you feel his or her speech is too fast?   0.79

D         14        Do you have difficulty communicating in a dark environment where the face is not clearly visible (expression and mouth shape)?   0.66

G         7          Have you ever heard that your voice is too loud when you speak?    0.60

Factor 3. Working memory

W        20        Have you ever asked someone to repeat what you just said because you did not remember?    0.78

W        19        Have you ever wandered the store aisles because you could not remember after hearing the location of the item you were looking for?  0.71

W        17        Have you ever found it difficult to remember the first half while listening to a rather long story?                 0.61

D         18        Have you ever asked someone to repeat what was said during a conversation?   0.56


The purpose of the present study was to develop and verify the SHSE-R questionnaire that was designed to assess the degree of hearing loss and its difficulty in the elderly. The developed SHSE-R had high internal consistency with three subcategories to measure homogeneous content and high reliability of test–retest scores while being significantly differentiated in the four groups for both test and retest results.

By revising the questionnaire, the total scores were decreased more than SHSE and more significantly differentiated among the group. Specifically, the SHSE total score for each group decreased under test conditions, 18.31, 18.88, 5.92, and 3.85, in the normal hearing and mild, moderate, and moderate-to-severe hearing loss groups, respectively. In other words, subjects with hearing closer to normal scored lower, while those with moderate or severe hearing loss scored higher. These results suggest that the SHSE-R more distinctly differentiated the degree of hearing loss.

Content, convergent, construct, and criterion validations of the SHSE-R were performed by statistical evidence. When considering that the proportion of all items can exceed 0.75, the SHSE-R had high content validity. Unfortunately, although it showed a relatively weak correlation between objective test and SHSE-R score, the convergent validity showed that the SHSE-R scores can reflect the degree of hearing loss. In addition, the construct validity for moderate correlation with subcategories and the hearing tests indicates that higher SHSE-R scores mean greater difficulty in perceiving speech under a noisy environment and poor ability in fast rate of speech

Regardless, the category of the working memory and the working memory test did not show a strong enough relation. We assume any limitation of digit tests applied in the present study, although we changed the general digit test measured in the original version8 into the adaptive digit ordering test in the revised version6 due to no significant correlation between them. The criterion validity showed that the SHSE-R subcategory scores and total score with KHHIE and KESHH have a significant and high correlation in normal hearing to moderate hearing loss, but the severe hearing loss group showed a lower correlation that was not significant. These results may be due to the relatively small number of subjects in the severe group.

For the results of EFA, based on eigenvalue and variance, three factors were extracted in the SHSE-R: general issues, distracting conditions, and working memory. These three factors are the same as in SHSE, but the composition items of each factor are shifted (see the first row of Table 3). For instance, the SHSE’s subcategories consisted of 10, 7, and 3 items in general issues, distracting condition, and working memory, respectively. However, SHSE-R consisted 12, 4, and 4 items in the same subcategories. In more detail, questions 2, 8–10, 12, and 13 represented the distracting condition in SHSE, but these questions were shifted to general issues in SHSE-R. Also, question 7, general issues in SHSE, shifted the distracting condition in SHSE-R, and question 18 in the distracting condition in SHSE shifted working memory in SHSE-R. The movement in factors of these items may be caused by the following reasons; general issues and distracting conditions are classified according to distinct factors that are statistically distinguished, but the two factors cannot be clearly distinguished. That is, the movement between the two factors is considered a feature of the general presbycusis that can coexist with two subcategories.4,5

Although most validation evaluations of the SHSE-R showed a strong correlation with various subject and object tests, four groups failed to include the same number of subjects as the limitation of the study. In the real world, considering the relatively small number of normal or severe hearing loss patients visited in clinics or hospital, the current results are realistic but should be considered in future studies. If constructing a Web or application device, we expect that the SHSE-R will be more convenient and highly accessible for the elderly so that many older adults can use it.9 Also, improved awareness of presbycusis, which is often misunderstood and underestimated, can increase accessibility in terms of diagnosis. Therefore, the SHSE-R needs to be translated and standardized into the languages of many countries of the world to become an international hearing screening tool.

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