Having a hearing aid is great! But wearing it is even better…

Hearing aids end up packed away in a drawer for one in seven individuals with hearing loss aged 50 years or more, according to a 2012 study by American researchers Wade Chien and Frank R. Lin.
How can we stop these hearing aids from ending up in a drawer and improve their use? There is no shortage of studies that show how few people with hearing loss are actually equipped with hearing aids. The number of unused hearing aids is however more difficult to determine but this is definitely a real problem. A British study has listed a certain number of reasons why this happens, and highlights the importance of follow-up and guidance.

Many older people who could benefit from hearing aids are not equipped with them. According to World Health Organization data from 2006, only one hearing-impaired person in five has a hearing aid. On the basis of studies carried out in the United States between 1999 and 2006, the American researchers Wade Chien and Frank R. Lin (2012) reported that six in seven people over 50 years of age with hearing loss do not have a hearing aid. But beyond these figures, there is a significant number of hearing-impaired individuals who do not wear their hearing aids, even though they have been fitted with them.

What are the factors that stop people with hearing impairment from wearing their hearing aids, which are after all intended to make their day-to-day lives easier and to improve their quality of life? To answer this question, a team from the UK analyzed data from ten previously published studies reporting reasons why hearing aids are not used. Analysis of the data shows a wide range of reasons cited by patients. Some are related to the devices themselves, such as their quality, comfort and fit, or even maintenance. Others are more personal and include psychosocial factors, how patients feel about the technology, appearance issues, or the attitude of healthcare professionals.

The authors, Abby McCormack and Heather Fortnum from the Hearing Biomedical Research Unit at the University of Nottingham, found that the most important factors are those that concern the devices themselves, and above all their quality. Also, many people stow their hearing aids away in a drawer simply because they feel that the device does not bring them the expected benefit, particularly in noisy conditions. Improving sound quality in noisy environments is the main challenge in the Research and Development departments of hearing aid manufacturers.

“Follow-up by the audiologist can have an impact on the immediate and long term success of hearing aid usage.”

Another important factor for those who do not use their hearing aids is whether they find them comfortable to wear, the second most critical issue after quality. Many potential users say that they find it difficult to insert or remove the device, or even to change the batteries. Most people with hearing aids are elderly and often have trouble handling the device, and even more so as they get older. If users encounter this type of problem, the chances are good that they will soon become frustrated and set their hearing aid aside. Other people say they do not really know how to use their hearing aids properly. It is therefore important for audiologists to test whether their patients effectively know how to use their hearing aids. The PHAST test (see inset) developed by Jamie Desjardins and Karen Doherty in 2009, and its revised version of 2012, provides an objective way of assessing whether people with hearing aids know how to use them properly.

Moral of the study

To increase hearing aid usage, ensuring follow-up and providing support to patients may be more important than rolling out various new technologies, which the patients will probably never use. Follow-up by the audiologist can help to significantly increase the benefit of hearing aids, and to improve immediate and long term success of hearing aid usage. It is also important not to neglect the hearing experience: counseling and guidance are key, and ensuring that the patient is adapting to use of the device, and not only that the device is suitably adapted to the patient! Checking that a patient’s expectations are in line with what the hearing aid can offer, or that they have a hearing aid able to meet their expectations, is another essential factor to ensure that hearing aids are a success.

One of the reasons hearing aids are not used is the difficulty users have in changing the batteries. Is appearance of the hearing aid a deciding factor? Surprisingly, appearance is mentioned in only three studies and, each time, the findings are not highly representative in terms of percentages. This is remarkable given how the "stigma" of wearing a hearing aid was once considered by professionals as one of the major reasons why patients end up putting their hearing aids in the nearest drawer… Of course the energy manufacturers have put into design these last few years has paid off, and the issue of appearance is becoming less and less a concern.

It is clear that audiology professionals can do a lot by providing support to hearing impaired people beyond the purchase of a hearing aid. Discussing problems with patients can help to pinpoint the “real” reasons why they are not using a hearing aid, despite getting a prescription and buying the device. It is essential to identify factors that hamper correct use of hearing aids so that suitable solutions can be found and implemented. This is the best way to ensure greater use of hearing aids, and ultimately to better treat hearing impairment.

Objectively evaluating patients’ ability to use hearing aids

The study carried out in 2009 by the American researchers Jamie L. Desjardins and Karen A. Doherty was intended to evaluate the abilities of experienced hearing aid wearers to use their devices. To do this, they developed the PHAST test (Practical Hearing Aids Skills Test) to measure the performance of users when carrying out eight basic tasks, usually taught to new clients when they are first fitted with a hearing aid: insertion of the hearing aid, removal, opening the battery compartment, changing batteries, cleaning the device, volume control, using the telephone, and using the noise program.

The test was given to 50 experienced users who were also asked to complete a satisfaction questionnaire. The study showed a wide range of scores on the PHAST test, 48 % to 100 %. The revised version (2012) shows that although 89 % of patients claim that they know how to use their device, only 18 % managed to correctly perform the tasks in the test. In addition, 100 % of new users, 73 % of experienced users wearing a new hearing aid, and 66 % of experienced users with their usual hearing aid, needed explanations for one or more of the test tasks. Maintenance and using the telephone were the two most problematic tasks. The authors conclude that these findings highlight the importance of directly evaluating the ability of users to handle and operate their hearing aids.

Sources : Desjardins JL, Doherty KA. Do experienced hearing aid users know how to use their hearing AIDS correctly? Am J Audiol. 2009 Jun;18(1):69-76.
Doherty KA, Desjardins JL. The Practical Hearing Aids Skills Test-Revised. Am J Audiol. 2012 Jun;21(1):100-5.

Facts & Figures: Reasons why patients give up on their hearing aids

According to a study carried out in the USA (Sergei Kochkin, 2000) including 348 people with hearing aids who do not use them.

According to a study conducted in Switzerland (Bertoli et al, 2009) including 8,707 people.

Ludivine Aubin-Karpinski and Arielle Le Masne,
Audio infos / Audiology infos France

Photos: Guillaume Bureau

Sources: McCormack A, Fortnum H. Why do people fitted with hearing aids not wear them? Int J Audiol. 2013 May;52(5):360-8.
Chien W, Lin FR. Prevalence of hearing aid use among older adults in the United States. Arch Intern Med. 2012 Feb 13;172(3):292-3.