A study published in PLOS One reports that the timing of hearing loss onset influences confidence and self-reported sound localisation abilities in adults with blindness, including those who use hearing aids or have completed vision rehabilitation training.
The research was led by the Multisensory Research Lab at the Wilmer Eye Institute at Johns Hopkins Medicine with support from the National Institutes of Health. The findings examine how combined hearing and vision impairment affects how people interact with their surroundings and suggest ways clinicians could improve quality of life through targeted rehabilitation strategies.
According to estimates from the Centers for Disease Control and Prevention, about 7 million adults in the US live with vision loss or blindness. Approximately 30 million people aged 12 or older have hearing loss in both ears. The likelihood of experiencing both conditions increases with age, yet little research has explored how dual sensory loss affects confidence and skill development that support independent living.
“Controlled lab studies exist, but they do not fully capture how blind individuals with hearing loss navigate real-world environments, or why they may hesitate to enter certain complex spaces despite having measurable sound localization skills,” says Yingzi Xiong, Ph.D., Barbara Simerl rising professor of low vision at the Wilmer Eye Institute. “With our study, we aimed to capture patient attitudes on their own navigational skills and the compensatory strategies they use in their daily lives.”
Researchers collaborated with the Minnesota Laboratory for Low Vision Research and the Envision Low Vision Rehabilitation Center to recruit 58 adults with total or near-total blindness. Among them, 28 reported typical hearing and 30 reported hearing loss.
Most participants had received orientation and mobility training, a specialised form of vision rehabilitation that helps blind or visually impaired individuals develop mental maps of their surroundings and travel safely. In total, 94% of participants had completed this training.
Participants completed the Dual Sensory Spatial Localization Questionnaire, or DS-SLQ, a standardised tool created by Xiong’s team to evaluate perceived and performed sound localisation during everyday activities. Researchers analysed responses to examine how blindness onset, hearing loss onset, residual vision, and hearing aid use influenced participants’ perceptions of their abilities.
Analysis showed that adults with early-onset blindness and typical hearing reported the highest confidence in their ability to locate sounds. Confidence declined among participants who were blind and also had hearing loss. Those who experienced early hearing loss reported the lowest sound localisation abilities overall.
“People with dual sensory loss may feel less confident or less motivated to adopt new hearing strategies for everyday tasks,” says Prachi Agrawal, M.D., M.P.H., the study’s first author and a postdoctoral research fellow in the Xiong lab. “By identifying these barriers, providers can tailor rehabilitation strategies to build confidence and support targeted skill development.”
The study also found that hearing loss was linked to greater difficulty locating sounds. However, participants who used hearing aids did not report higher confidence or improved navigation skills compared with others.
“Hearing aids are a common intervention used for patients with hearing loss, but currently available devices primarily focus on improving speech perception,” says Xiong. “Here, we saw that patients did not report on the market hearing aids were helpful for environment navigation, similar to our previous research.”
The findings suggest that clinicians should consider hearing status when designing vision rehabilitation programs and identify specific situations that cause fear or hesitation.
“About 40 percent of patients who seek vision rehabilitation in the U.S., including at the Wilmer Eye Institute’s Lions Vision Research and Rehabilitation Center, also have hearing loss,” says Xiong. “We believe understanding how patients perceive their own sound localisation skills will help providers meet their needs and establish skills to live their lives.”