{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:27:52Z","timestamp":1790044072539,"version":"4.0.1"},"reference-count":36,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Sensorineural hearing loss represents a significant global health burden affecting over 1.5 billion individuals worldwide. Modern hearing aids, equipped with digital signal processing and smart connectivity features, constitute a cornerstone of neuro-sensory rehabilitation. However, the psychosocial impact of these assistive smart technologies on patient self-esteem remains incompletely characterized. Methods: A cross-sectional multivariate study was conducted with 245 participants, divided into three groups: normal-hearing controls (NH, n = 73), hearing-impaired patients using smart hearing aid technology (HA users, n = 86), and hearing-impaired patients not using hearing aid technology (HA non-users, n = 86). Self-esteem was measured using the Rosenberg Self-Esteem Scale (SES). Hearing disability and tinnitus severity were assessed with the Hearing Handicap Inventory for Adults (HHIA) and Tinnitus Handicap Inventory (THI), respectively. Data analysis included one-way ANOVA, Tukey\u2019s HSD post hoc tests, Pearson correlations, and multivariate regression. Results: Hearing aid users showed significantly higher SES scores (35.41 \u00b1 5.32) compared to non-users (22.99 \u00b1 4.53; p &lt; 0.001, Cohen\u2019s d = 2.515). One-way ANOVA indicated highly significant differences among groups (F = 299.00, p &lt; 0.001, \u03b72 = 0.712). SES was negatively correlated with HHIA (r = \u22120.573, p &lt; 0.001) and THI (r = \u22120.443, p &lt; 0.001), while HHIA and THI were strongly positively correlated (r = 0.729, p &lt; 0.001). In multivariate analysis, HA use remained a strong independent predictor of self-esteem (\u03b2 \u2248 11.9, p &lt; 0.001), even after adjustment for age, sex, HHIA, and THI. Perceived hearing handicap was independently associated with lower self-esteem, whereas tinnitus severity was not a significant predictor in the fully adjusted model. The model explained approximately 65% of the variance in self-esteem scores. Conclusions: Smart hearing-aid use is strongly and independently associated with higher self-esteem in patients with sensorineural hearing loss. These results support the inclusion of modern audiological rehabilitation devices in comprehensive management strategies for long-term conditions and highlight psychosocial benefits that extend beyond hearing restoration.<\/jats:p>","DOI":"10.3390\/healthcare14101336","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T16:26:37Z","timestamp":1778689597000},"page":"1336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Smart Hearing Aid Technology on Self-Esteem in Patients with Sensorineural Hearing Loss: A Cross-Sectional Multivariate Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Liviu Lucian","family":"Padurean","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Department of Otorhinolaryngology, Municipal Clinical Hospital, 335700 Or\u0103\u0219tie, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5249-6859","authenticated-orcid":false,"given":"Mirela","family":"Frandes","sequence":"additional","affiliation":[{"name":"Department of Functional Sciences\u2014Medical Informatics and Biostatistics, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Center for Modeling Biological Systems and Data Analysis, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6669-7715","authenticated-orcid":false,"given":"Horatiu Eugen","family":"Stefanescu","sequence":"additional","affiliation":[{"name":"Department IX, Discipline of Otorhinolaryngology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0497-0405","authenticated-orcid":false,"given":"Calin","family":"Muntean","sequence":"additional","affiliation":[{"name":"Department of Functional Sciences\u2014Medical Informatics and Biostatistics, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7210-1263","authenticated-orcid":false,"given":"Ioana Delia","family":"Horhat","sequence":"additional","affiliation":[{"name":"Department IX, Discipline of Otorhinolaryngology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021). World Report on Hearing, WHO."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2147\/CIA.S26059","article-title":"The impact of hearing loss on the quality of life of elderly adults","volume":"7","author":"Ciorba","year":"2012","journal-title":"Clin. Interv. Aging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/S0140-6736(21)00516-X","article-title":"Hearing loss prevalence and years lived with disability, 1990\u20132019: Findings from the Global Burden of Disease Study 2019","volume":"397","author":"Haile","year":"2021","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Rosenberg, M. (1965). Society and the Adolescent Self-Image, Princeton University Press.","DOI":"10.1515\/9781400876136"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1037\/a0028931","article-title":"Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies","volume":"139","author":"Sowislo","year":"2013","journal-title":"Psychol. Bull."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/geronb\/gbw005","article-title":"Association of hearing impairment and emotional vitality in older adults","volume":"71","author":"Contrera","year":"2016","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"887","DOI":"10.3109\/14992027.2011.599871","article-title":"Prospective effects of hearing status on loneliness and depression in older persons: Identification of subgroups","volume":"50","author":"Pronk","year":"2011","journal-title":"Int. J. Audiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S0140-6736(23)01406-X","article-title":"Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): A multicentre, randomised controlled trial","volume":"402","author":"Lin","year":"2023","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission","volume":"404","author":"Livingston","year":"2024","journal-title":"Lancet"},{"key":"ref_10","first-page":"19","article-title":"MarkeTrak VIII: Consumer satisfaction with hearing aids is slowly increasing","volume":"63","author":"Kochkin","year":"2010","journal-title":"Hear. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1001\/jama.2014.14781","article-title":"Wearable devices as facilitators, not drivers, of health behavior change","volume":"313","author":"Patel","year":"2015","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1055\/s-0040-1718711","article-title":"Argumentum ad Ignorantiam: Smartphone-Connected Listening Devices","volume":"41","author":"Maidment","year":"2020","journal-title":"Semin. Hear."},{"key":"ref_13","first-page":"CD012023","article-title":"Hearing aids for mild to moderate hearing loss in adults","volume":"9","author":"Ferguson","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1044\/jshr.3506.1402","article-title":"Sustained benefits of hearing aids","volume":"35","author":"Mulrow","year":"1992","journal-title":"J. Speech Hear. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"580","DOI":"10.3109\/14992021003753508","article-title":"The ten-year incidence of tinnitus among older adults","volume":"49","author":"Nondahl","year":"2010","journal-title":"Int. J. Audiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Rosenberg, M. (1965). Rosenberg Self-Esteem Scale (RSE). Acceptance and Commitment Therapy. Measures Package, University of Wollongong.","DOI":"10.1037\/t01038-000"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1037\/0022-3514.89.4.623","article-title":"Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: Exploring the universal and culture-specific features of global self-esteem","volume":"89","author":"Schmitt","year":"2005","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/00003446-198205000-00006","article-title":"The Hearing Handicap Inventory for the Elderly: A new tool","volume":"3","author":"Ventry","year":"1982","journal-title":"Ear Hear."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/00003446-199110000-00009","article-title":"Test-retest reliability of the Hearing Handicap Inventory for Adults","volume":"12","author":"Newman","year":"1991","journal-title":"Ear Hear."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1001\/archotol.1996.01890140029007","article-title":"Development of the Tinnitus Handicap Inventory","volume":"122","author":"Newman","year":"1996","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1046\/j.1365-2273.2001.00490.x","article-title":"Guidelines for the grading of tinnitus severity: The results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999","volume":"26","author":"McCombe","year":"2001","journal-title":"Clin. Otolaryngol. Allied Sci."},{"key":"ref_22","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3766\/jaaa.18.2.7","article-title":"A systematic review of health-related quality of life and hearing aids: Final report of the American Academy of Audiology Task Force on the Health-Related Quality of Life Benefits of Amplification in Adults","volume":"18","author":"Chisolm","year":"2007","journal-title":"J. Am. Acad. Audiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.archger.2010.04.013","article-title":"Effects of hearing aids on cognitive functions and depressive signs in elderly people","volume":"52","author":"Acar","year":"2011","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1093\/geront\/gnp107","article-title":"The stigma of hearing loss","volume":"50","author":"Wallhagen","year":"2010","journal-title":"Gerontologist"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Dawes, P., Emsley, R., Cruickshanks, K.J., Moore, D.R., Fortnum, H., Edmondson-Jones, M., McCormack, A., and Munro, K.J. (2015). Hearing loss and cognition: The role of hearing aids, social isolation, and depression. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0119616"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2331216517734088","DOI":"10.1177\/2331216517734088","article-title":"A data-driven synthesis of research evidence for domains of hearing loss, as reported by adults with hearing loss and their communication partners","volume":"21","author":"Vas","year":"2017","journal-title":"Trends Hear."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1044\/2017_AJA-16-0111","article-title":"The effects of service-delivery model and purchase price on hearing-aid outcomes in older adults: A randomized double-blind placebo-controlled clinical trial","volume":"26","author":"Humes","year":"2017","journal-title":"Am. J. Audiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1001\/jama.2017.6905","article-title":"Personal sound amplification products vs a conventional hearing aid for speech understanding in noise","volume":"318","author":"Reed","year":"2017","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/01.HJ.0000389925.64797.e5","article-title":"A new method for wireless connectivity in hearing aids","volume":"63","author":"Galster","year":"2010","journal-title":"Hear. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1055\/s-0040-1701243","article-title":"MarkeTrak 10 (MT10) survey results demonstrate high satisfaction with and benefits from hearing aids","volume":"41","author":"Picou","year":"2020","journal-title":"Semin. Hear."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/S0140-6736(13)60142-7","article-title":"Tinnitus","volume":"382","author":"Baguley","year":"2013","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/AUD.0000000000000093","article-title":"Validation of a novel combination hearing aid and tinnitus therapy device","volume":"36","author":"Henry","year":"2015","journal-title":"Ear Hear."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1080\/13607863.2014.915924","article-title":"Hearing loss and dementia\u2014Who is listening?","volume":"18","author":"Lin","year":"2014","journal-title":"Aging Ment. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e137","DOI":"10.1093\/geront\/gnz009","article-title":"Hearing loss and depression in older adults: A systematic review and meta-analysis","volume":"60","author":"Lawrence","year":"2020","journal-title":"Gerontologist"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1177\/0194599820910377","article-title":"Hearing Loss, Loneliness, and Social Isolation: A Systematic Review","volume":"162","author":"Shukla","year":"2020","journal-title":"Otolaryngol. Head Neck Surg."}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/14\/10\/1336\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T04:21:11Z","timestamp":1779510071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/14\/10\/1336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["healthcare14101336"],"URL":"https:\/\/doi.org\/10.3390\/healthcare14101336","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]}}}