Why do people reject using hearing aids?

Age related hearing loss is the most commmon form of sensori-neural hearing loss. By the age of 70 years about 30% of men and 20% of women need hearing aids. It has been clearly established that having untreated hearing loss can cost money and advancement in the work place. Untreated hearing loss is also associated with poor quality of life and may lead to depression, anxiety and dementia. With all of these negative consequences known, it is still true that only one in five patients adopts a hearing aid when they learn that they need to do so. Why?

Abby McCormack and Heather Fortnum did a scoping study of the literature about hearing aid rejection that was published in the International Journal of Audiology. In that study they found 155 articles, of which 80 seemed most relevant to the question of why people do not use hearing aids. Of those 80 studies, only 23 articles were suitable for review. Of those 23 articles only 10 actually reported REASONS for non-use. The other studies were pointed at rates of use, benefit and reasons for not buying hearing aids. Clearly, we know as an audiology community that people reject hearing aids, but we have not really bothered to try and find out why. We have assumed that stigma and cosmetic issues drive most individuals away from hearing aids. Strangely, that is not what our researchers discovered.

There have been improvements in hearing aid technology from traditional analogue hearing aids to more flexible and sophisticated digital hearing aids. One could expect that this would have improved the rate of adoption. Our researchers did not find that to be true. So, cosmetic concerns were found in these ten studies to be a small concern and not that much of a barrier to adult users. New and improved technology has not proved to be the solution either, despite the fact that the improvements have been substantial. The most significant reasons for people to reject or refuse to use devices they have purchased seems to center around “hearing aid value/speech clarity, and fit and comfort of the hearing aid.”

McCormack and Fortnum indicate they found “A major reason why people do not wear their hearing aids when presecribed them seems to be because of discomfort or they do not know how to put them in correctly. These reasons should be relatively straightforward for clinicians to deal with by insuring the hearing aid fitting process is accompanied by counseling and support from the audiologist in case of problems…” The emphasis is my own. “It would seem that, in terms of increasing hearing aid usage, support and counseling may be more important than expensive modern technology.”

Just imagine how well a patient would do with excellent technology and good counseling and after care! This scoping study of the literature revealed exactly what is wrong with current trends in hearing aids sales being pushed by manufacturers and insurance companies. Patients don’t need just a hearing aid. Hearing help is more than buying a gadget. They need the professional rehabilitative services that go with it. An online hearing test and a hearing aid programmed in another state will not provide a caring professional and personal assessment of how the patient is doing with the small things. Can they change the battery? Can they put the hearing aid on the correct ear? Can they manipulate the controls? Has there been a sudden decline is capability over a few weeks that their family doctor needs to know about?

When patients try to save money by purchasing a device at a big box store or online, they are putting their precious dollars into a sink hole. The research that has been done, and it is not enough, shows that the most important part of successfully using a hearing aid takes place in a therapy setting with a professional that cares about you and knows how to maximize your chances of actually getting your money’s worth.

McCormack and Fortnum discovered some really interesting things. People choose not to use hearing aids or put them in a drawer because they may have been “over-promised” how much they will help. Some individuals simply have a very difficult time with word clarity. Patients reject hearing aids because adequate support and counseling is lacking. We don’t know if there is a difference between men and women and the rate at which they adopt hearing aids because the questions have not been asked often enough. We do not know how long people use hearing aids before they give up. We haven’t asked that either.

There is so much left to learn, and I will start asking much more of my patients who do not choose to use a hearing instrument.

Abby McCormack and Heather Fortnum, Why do people fitted with hearing aids not wear them? Int J Audiol. May 2013; 52(5): 360-368