The hearing aid effect: challenges for counseling

Journal of Rehabilitation,  Oct-Dec, 1997  by Ingrid M. Blood

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Over 22 million Americans are diagnosed with hearing losses. Approximately 1.4 million hearing aids are sold annually (Shimon, 1992) in an effort to deal with this communication disability. The stigma associated with the wearing of hearing aids may preclude the necessary commitment of clients to wear their hearing aids. The tradeoff between social acceptance, vanity, personal appraisal about aging, and other issues may play a pivotal role in improving the quality of lives for millions of Americans with hearing losses.

Hearing loss affects communication in a number of ways but primarily by decreasing the intensity of the speech signal and the clarity of the words and message. According to Hull (1997), "feelings of embarrassment, frustration, anger, defeat and ultimate withdrawal from situations that require communication are very real among older persons who are hearing impaired" (p. 326). LaFerle and LaFerle (1988) indicated that hearing loss in the presence of other limitations, especially in the elderly, may result in depression and self-isolation. The effects of hearing loss vary from speaker to speaker and the adjustment to hearing loss is a unique experience for each person. For some people conversations may sound muffled or unclear, while another person may barely hear any sound even when amplified with a hearing aid. Hearing aid wearers must be prepared to wear hearing aids, become active and informed consumers, understand the benefits of the aids, and learn to adjust to the experience of wearing these mechanical devices.

Typically, individuals needing hearing aids have little or inaccurate information that may be misunderstood from television, magazine advertisements, or anecdotes from family and friends. Therefore, the need for informational and supportive counseling for first time wearers is critical. According to Warren and Daily (1984), even when individuals are provided with appropriate informational counseling they may not wear hearing aids because of the strong desire to pass for "socially normal" or younger. Rupp, Higgins, and Maurer (1977) considered motivation the most important factor in the successful adaptation and use of hearing aids. Kasten (1992) indicated that there were nine important factors that should be considered when determining the appropriateness of dispensing hearing aids including: motivation, adaptability, personal appraisal, money, social context, personal influence, mobility, vanity, and manual dexterity. According to Hull (1997) clients who can see the benefits of acoustic amplification over other issues such as vanity, negative personal appraisals, or unrealistic expectation for hearing aids appear to successfully adapt to wearing hearing aids. The awareness of the existence of a hearing loss and the acceptance of the need for an assistive device are critical steps in adjUstment to hearing aids.

Unfortunately, hearing aids have not gained the same popular acceptance as eyeglasses or contact lenses. Himber (1989) in discussing her own "surviving" of hearing loss described that she "was gripped by resentment that this widespread impairment remained underground, whereas millions of people with poor vision could display their problem openly ......Why should I have come to expect a harmless unit tucked behind my ear to prompt such uneasiness in everyone who caught sight of it?" (p. 90).

Over a decade before Himber's personal account, Blood, Blood, and Danhauer (1977) reported that the mere presence of a hearing aid prompted raters to evaluate individuals more negatively on the dimensions of intelligence, achievement, personality, and appearance. The authors labeled the stigma associated with wearing a hearing aid the "Hearing Aid Effect." Continued research showed that the "Hearing Aid Effect" was found in hearing impaired and deaf school-age children when evaluated by college students, school age peers, classroom teachers, or speech language pathologists and audiologists (Blood, Blood, & Danhauer, 1978; Blood & Blood, 1982; Blood & Blood, 1983; Danhauer, Blood, Blood, & Gomez, 1980; Dengerink & Porter, 1984). The stigma was also reported in elderly individuals evaluated by their elderly peers (Johnson & Danhauer, 1982) and college students (Mulac, Danhauer, & Johnson, 1983). Since the results of those first studies were published, hearing aid manufacturers have addressed the cosmetic satisfaction issues of consumers and significantly reduced the size and visibility of the hearing aid. However, many clients still have amplification needs which necessitate a highly visible hearing aid. Clients need to learn about the technology and maintenance of these assistive listening devices and also how to deal with communication problems encountered with significant others in work and social environments. Informational counseling plays an integral role in helping fist time wearers adjust to their hearing aids. Issues involving the cosmetics of the hearing aid (size and visibility), keeping background noise to a minimum (talking in smaller groups, moving away from noise interference), or reducing the distance from the speaker are a few of the tactics for improving communication and assisting with overall adjustment to the hearing aid.