Starkey Research & Clinical Blog

Hearing Aid Use is Becoming more Accepted

Rauterkus, E. & Palmer, C. (2014). The hearing aid effect in 2013. Journal of the American Academy of Audiology 25, 893-903.

This editorial discusses the clinical implications of an independent research study and does not represent the opinions of the original authors.

Years ago, one of my patients quoted an aphorism, “Your hearing loss is more noticeable than your hearing aid”. At the time, it wasn’t always applicable. Hearing aids were larger and more visible in the ear and whistling feedback was harder to control, often resulting in embarrassment for the wearer. Today’s hearing aids are smaller, discreet, and comfortable, with effective feedback management. Still, there remains concern among many current and potential hearing aid users about a negative stigma associated with hearing aid use. Despite numerous potential benefits like improved communication ability and decreased stress, listening effort and fatigue, hearing impaired individuals quite frequently postpone or avoid amplification because they believe that wearing hearing aids will cause others to label them as old or less capable.

These negative associations have collectively been described as the hearing aid effect. Blood, Blood and Danhauer (1977) coined this term during a study in which 25 college students were shown photographs of 12 teenage males with and without hearing aids. The participants were asked to judge the boys in the photographs in terms of intelligence, achievement, personality, and appearance. On all attributes, the participants rated the boys in the photographs lower when they were wearing hearing aids versus when they were not.  Since their initial study, other reports showed a similar hearing aid effect (Blood, et al., 1978; Danhauer et al., 1980; Brimacombe & Danhauer, 1983).  Studies in which children rated other children showed strong and consistently negative judgments of individuals with hearing aids, on attributes such as intelligence and attractiveness (Dengerink & Porter, 1984; Silverman & Klees, 1989).  In contrast, some studies in which adults rated other adults did not find a hearing aid effect (Iler et al., 1982; Johnson & Danhauer, 1982; Mulac et al., 1983).

In general, a review of several reports from 1977 through 1985 indicates that hearing aid stigma at that time may have been changing slowly for the better.  A much more recent study (Clucas, et al., 2012) essentially reported the opposite of the typical hearing aid effect, in which 181 medical students rated photographs of a young male wearing a hearing aid as more worthy of respect than the photographs of the same young male without the hearing aid.

Through the years, hearing aids have become smaller and more discreet. Feedback reduction, automatic features and improved performance in noise have allowed hearing aid users to function better in everyday situations, calling less attention to their hearing loss. Ear level devices like earbuds for MP3 players and Bluetooth headsets have become widely used and visible. The Americans with Disabilities Act (ADA) has promoted equal participation of disabled individuals, including those with hearing loss. Public figures have openly discussed their hearing loss and hearing aid use, including Presidents Ronald Reagan and Bill Clinton and musicians like Pete Townsend and Neil Young. All of these factors have likely had a positive influence on public perception of hearing loss and hearing aids and may have reduced the negative stigma so prevalent in earlier reports.

The hearing aid effect, however, has not been re-examined in the same paradigm as the original report, so it is unknown how today’s perceptions might compare to the defining work. Rauterkus and Palmer’s study asked young adults to view and evaluate photographs of young men with and without hearing aids, in an effort to replicate the methods of earlier studies and derive an understanding of the hearing aid effect today.

Twenty-four graduate students in an MBA program were recruited to evaluate photographs of 5 young men, from age 15-17 years. The young men were photographed in 5 different configurations:

1. Wearing a standard BTE hearing aid coupled to a standard earmold and tubing

2. Wearing an open-fit BTE hearing aid coupled to a slim tube and dome

3. Wearing a CIC hearing aid that was not visible in the photo

4. Wearing earbud headphones as would be used with an MP3 device

5. Wearing a Bluetooth ear-level telephone headset

In the pictures, the young man was seated, reading a book. All photographs were taken from the rear left side of the young man, so that the left side and back of his head was visible and ear level devices could clearly be seen. All of the men in the pictures wore the same clothing so that differences would not affect the judgments of the participants.

No participant viewed the same man in more than one device configuration. Each photograph was shown on a page above a list of 8 attributes: attractive, young, successful, hard-working, trustworthy, intelligent, friendly, and educated. Participants were asked to rate the man in the picture on each attribute on a scale of 1-7.  These 8 attributes were selected because they were the most common attributes to have been rated in previous studies of the hearing aid effect.

The results showed no significant difference in ratings among the five young men in the photographs. Therefore, the data for all of the photographs were combined for data analysis.  There was a significant difference in the judgment of age between the photographs of the CIC user and the earbud user, with the CIC user being judged as significantly older than the earbud user.  Because the CIC instruments were not visible in the photographs, this difference is likely to be related to an association between younger people wearing earbuds to listen to music, as opposed to a negative judgment on the use of CIC instruments.  There was a significant difference in trustworthiness between the BTE user and Bluetooth device user, with the Bluetooth headset user deemed significantly less trustworthy. The authors’ findings clearly indicate that the participants did not have adverse reactions to the photographs of hearing aid users and did not demonstrate the hearing aid effect found in earlier studies.

The work of Rauterkus and Palmer suggests the hearing aid effect has diminished or even reversed. A welcome message for hearing care professionals, but we must also understand self-perception of hearing aid use. One could speculate that the commonality of ear-level devices and improvements in hearing aid size, design, performance and connectivity, have improved others perception of hearing aid use, resulting in the documented decrease of the hearing aid effect. It’s possible that the same social and technological factors are taking a similar toll on the negative self-perception of hearing aid use. Time will reveal the reality of these trends but smart research design helps us take a peak into the not-too-distant future.

 

References

Blood, G., Blood, I. & Danhauer, J. (1977). The hearing aid effect. Hearing Instruments 28, 12.

Blood, G., Blood, I. & Danhauer, J. (1978). Listeners’ impressions of normal-hearing and hearing-impaired children. Journal of Communication Disorders 11(6), 513-518.

Clucas, C., Karira, J. & Claire, L. (2012). Respect for a young male with and without a hearing aid: a reversal of the “hearing aid effect” in medical and non-medical students? International Journal of Audiology 51(10), 739-745.

Danhauer, J., Blood, G., Blood, I. & Gomez, N. (1980). Professional and lay observers’ impressions of preschoolers wearing hearing aids. Journal of Speech and Hearing Disorders 45(3), 415-422.

Dengerink, J. & Porter, J. (1984). Children’s attitudes towards peers wearing hearing aids. Language, Speech and Hearing Services in Schools 15, 205-209.

Iler, K., Danhauer, J. & Mulac, A. (1982).  Peer perceptions of geriatrics wearing hearing aids. Journal of Speech and Hearing Disorders 47(4), 433-438.

Johnson, C. & Danhauer, J. (1982). Attitudes towards severely hearing impaired geriatrics with and without hearing aids. Australian Journal of Audiology 4, 41-45.

Mulac, A., Danhauer, J. & Johnson, C. (1983). Young adults’ and peers’ attitudes towards elderly hearing aid wearers. Australian Journal of Audiology 5(2), 57-62.

Rauterkus, E. & Palmer, C. (2014). The hearing aid effect in 2013. Journal of the American Academy of Audiology 25, 893-903.

Silverman, F. & Klees, J. (1989).  Adolescents’ attitudes toward peers who wear visible hearing aids. Journal of Communication Disorders 22(2), 147-150.