Dennis Van Vliet, AuD

The landscape for potential hearing aid users can sometimes look as bad as a Los Angeles traffic jam. Our job is to listen to concerns first, and then ask a lot of questions, and listen some more.

This fall, the main north-south artery running through west Los Angeles was closed over a full weekend for construction work. The news called it “Carmaggedon II” because of the traffic chaos that it could cause if everyone tried to drive around the area like they typically would. It was the second time that Interstate 405 had been closed for this project, and road signs as far north as Sacramento had warned everyone away from the area. The weekend passed without too much trouble, even though there was a triathlon scheduled that Sunday in the same area, closing some of the side streets.

Facing physical roadblocks that delay and reroute us can be frustrating; preparing for and avoiding them makes life easier. As a profession, we are interested in the apparent roadblocks that get in the way of people with admitted hearing loss who do not acquire hearing aids, and what we may do to change that behavior.

Using an economic model, Amlani and Taylor1 estimate that—once you rule out those people who do not want or need hearing aids due to their situations or degree of loss—the market penetration rate in our industry jumps from about 25% to 51%. They make the argument that price is a factor, but not the primary barrier for those who already have hearing aids. According to the article, hearing aid candidates with no experience with hearing aids have more reluctance to pay for professional fees than experienced users, but there is not much difference in their willingness to pay for features such as noise reduction, directional microphones, etc, when compared to experienced users.

So, like it or not, commodification influences to some degree the non-user’s attitude about the price of a hearing aid. Marketing sells features and benefits, but not what we are the most proud of: our ability to make technology work for that individual user.

What about the factors other than cost? Convenience, cosmetics, comfort, and stigma are factors that play into the decision process, each having an importance that varies by individual. Are we paying enough attention to these other factors that influence decisions about hearing aids? Good discovery questions in the needs-analysis portion of the history should yield information about the cosmetic and practical day-to-day factors of hearing aid use that are important to the individual user.

Comfort. Recently, I was wearing some prototype BTE hearing aids to learn more about how the aids performed in a variety of environments. In the process, I learned that, although the aids were comfortable, there was an issue when wearing my reading and sunglasses. There wasn’t enough room between my pinna and head to accommodate comfortably the glasses’ temple piece and the hearing aid. If I tried adjusting the aids or glasses, the fit of either was no longer secure. This wasn’t comfortable, cosmetically acceptable, or convenient. Here was a problem that could be determined only during a trial fitting, and not from any interview.

I learned something from the experience because I have usually been able to solve the eyeglass/BTE problem with careful fitting adjustments. This case was different, and I’ll approach future aid selection a little differently.

Stigma and cosmetics. Feeling stigmatized is a very personal reaction. I’m not sure that we can do much about affecting how someone feels about wearing hearing aids beyond education. What we can do is to listen to their concerns, and find out what steps we can take during the selection and fitting process that may lessen the feeling. My observation is that people worry most about visibility and not experiencing feedback. The underlying fear is that, if the hearing aids are detected by others, the wearer may be judged differently than they would without hearing aids.

This is a sometimes not-so-subtle point, and it goes well beyond cosmetics. We might be able to fit a product that has a nice, non-prosthetic look and satisfy cosmetic concerns for many people. However, those really concerned about stigma will need more heroic measures to make them comfortable. Fortunately, we do have much better cosmetic options and feedback reduction capabilities than we have had in the past, and have a better chance of avoiding that obstacle.

Convenience. Convenience can be a very big obstacle for some users. Difficulty inserting hearing aids in the ears—simply fumbling with the battery door or not remembering switch configuration—can be a deal-breaker for people whose hearing loss is mild to moderate, and who can get by without hearing aids, even if everyone around them is miserable as a result. Part of the value of face-to-face service is proper selection and configuration of hearing aids so that convenience is optimized for the individual.

The Final Word? The landscape for potential hearing aid users can sometimes look as bad as a Los Angeles traffic jam. Our job is to listen to concerns first, and then ask a lot of questions, and listen some more. From there, we can select alternate routes that match up with the preferences and needs of our patients. Just as with traffic, detours can be frustrating, but the right approach can avoid “earmageddon” and result in successful fittings.

Van Vliet photo Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network.  He currently serves as the senior director of professional relations for Starkey Technologies, Eden Prairie, Minn.

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1. Amlani AM, Taylor B. Three known factors that impede hearing aid adoption rates. Hearing Review. 2012;19(5):28-34.