Bill Dickinson, AuD, assistant professor in the department of hearing and speech sciences at Vanderbilt University School of Medicine in Nashville, Tenn., pointed to data showing that only about 40 percent of Americans reporting moderate to severe hearing loss wear hearing aids, a number that drops to only 9 percent in people with mild hearing loss (Hear Rev. 2009;16(11):12–31).
Explore This IssueJanuary 2011
For Dr. Dickinson, compliance is dependent upon ensuring that the chosen device is appropriate and efficacious, producing the needed benefit for the patient. Thus, he emphasized, the focus needs to be on the efficacy of the device and not on the effectiveness of the device, which is defined by whether the device is capable of doing what it was designed to do.
“If a hearing aid is incorrectly chosen or inappropriately programmed, then the result will be a device that has high effectiveness and very low efficacy,” Dr. Dickinson said. Given this fact, he emphasized that only audiologists with experience in hearing aids and related technologies should select and fit hearing aids.
Another factor that may influence compliance, one that is often cited as the main reason for noncompliance, is their cost, because most people will have to pay for them out of pocket. However, the effect of cost on usage, said Dr. Lin, is diminished when looking at data from Europe, where national health insurance does cover hearing aids, and usage is similar to the U.S.
Another issue is simply the lack of recognition on the part of patients of the benefits they could derive from hearing aids. In addition, otolaryngologists and other physicians who see patients with hearing loss may not understand the detrimental consequences of untreated hearing loss.
“Hearing loss is a slow, insidious process, so people get used to it but not necessarily in a good, adaptive way,” said Dr. Lin, adding that when people do finally try a hearing aid, and it does not immediately work perfectly, they stop using it.
What is needed, he said, is improved counseling on the time, patience and training it takes to adapt to a hearing aid in order to gain its benefit. “Audiology studies show that the rate of hearing aid use skyrockets by just expending a bit more energy on counseling,” he said.
Otolaryngologists, he said, can learn from ophthalmologists who have developed approaches to vision rehabilitation for people with macular degeneration that could be a model for hearing loss rehabilitation. Citing a program at Johns Hopkins that uses occupational therapists dedicated to vision rehabilitation, he emphasized that otolaryngologists lack anything equivalent for hearing loss.