According to recent reports from multiple institutions pro swan The time of onset of hearing loss is an important determinant of patient confidence and self-reported sound localization ability (the ability to recognize and locate objects in the environment), even in people who use hearing aids or have received visual rehabilitation training, according to a study led by the Multisensory Laboratory at the Johns Hopkins Wilmer Eye Institute.
The research, supported by the National Institutes of Health, focuses on the factors that shape how people with dual sensory loss (combined loss of hearing and vision) interact with their environment and identifies opportunities for health care providers to improve patients’ quality of life.
Previous research from the CDC estimated that approximately 7 million adults in the United States have vision loss or blindness, and 30 million people ages 12 and older have hearing loss in both ears. The prevalence of dual sensory loss increases significantly with age, but little is known about how it affects patients’ confidence and skill development, two traits essential for independent living.
Although controlled laboratory studies exist, we do not fully understand how blind people with hearing loss navigate real-world environments and why they hesitate to enter certain complex spaces despite having measurable sound localization skills. Our study aimed to understand patients’ attitudes toward their own navigation skills and the compensatory strategies they use in daily life. ”
Yingzi Xiong, Ph.D., Barbara Simerl New Professor of Low Vision, Wilmer Eye Institute
In collaboration with the Minnesota Low Vision Research Institute and the Envision Low Vision Rehabilitation Center, Xiong’s research team recruited 58 blind or nearly blind adults for the study. Of the participants, 28 self-reported typical hearing and 30 self-reported hearing loss. Additionally, 94% of study participants received formal orientation and mobility training. This is a special type of visual rehabilitation training that teaches visually impaired people how to create a mental map of their environment and navigate safely.
Each participant completed the Dual Sensory Spatial Orientation Questionnaire (DS-SLQ). The DS-SLQ is a standardized tool previously developed by Xiong’s team to assess both the perceived and performed spatial orientation abilities of people with vision and hearing loss while performing daily tasks. In this study, responses were used to assess the onset of blindness, the onset of hearing loss, residual visual acuity, and how hearing aids shape perceived sound localization ability.
Researchers examined responses to the DS-SLQ and found that adults who experienced early blindness without hearing loss reported having the highest confidence in their skills. Adults who were blind and reported hearing loss had lower confidence levels, and adults who lost their hearing early in life reported the poorest sound localization abilities of all participants.
“People with dual sensory loss may feel less confident or less willing to employ new auditory strategies in daily tasks,” says Prachi Agrawal, MD, MPH, lead author of the study and a postdoctoral fellow in the Sion lab. “By identifying these barriers, healthcare providers can tailor rehabilitation strategies to build confidence and support targeted skill development.”
Although hearing loss is associated with difficulty localizing sounds, the researchers found that adults using hearing aids did not report greater confidence or navigation skills than other participants.
“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, similar to our previous study, we found that patients did not report that commercially available hearing aids helped with environmental navigation.”
Based on the study results, Xiong’s research team suggests that clinicians should consider hearing status during visual rehabilitation training and carefully identify areas of fear or hesitation that may be addressed through individualized care.
“About 40 percent of patients seeking vision rehabilitation in the United States, including at the Lions Vision Research and Rehabilitation Center at Wilmar Eye Institute, also have hearing loss,” Xiong says. “We believe that understanding how patients perceive their sound localization skills can help healthcare providers meet patients’ needs and establish skills to help them get on with life.”
This research was supported by the National Institutes of Health (K99/R00EY030145), an Envision Fellowship, and a Preventing Blindness Research Award.
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Reference magazines:
Agrawal, P.et al. (2026). Perceptual sound localization ability of visually impaired people. Pro Swan. DOI: 10.1371/journal.pone.0342118. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0342118
