Hearing Aids: Who Needs ’em?

By David H. Kirkwood

Don’t get me wrong. The title of this post doesn’t mean I think hearing aids aren’t necessary. Quite the contrary. I strongly believe that there are hundreds of millions of people around the world who need hearing aids. But, the fact is, what I believe—or you believe–about what other people need doesn’t matter very much. I’ll explain why a little later on.

Numbers Don’t Measure Need

Recently, several of us at HHTM were casually discussing the issue of what percentage of people who “need” hearing aids actually have them.

Probably the leading source of statistics about the U.S. market for hearing care is the Better Hearing Institute (BHI). Every few years, it conducts the MarkeTrak survey, which collects data from 80,000 people identified as having a hearing loss.

In a 2009 article in The Hearing Review on the latest MarkeTrak findings, Dr. Sergei Kochkin, the executive director of BHI, reported that about 34.2 million Americans, approximately 10% of the total population, had hearing loss. Of these, a little over 8 million–about 24%–had hearing aids.

Since then, there have been reports that hearing loss may be much more prevalent. As discussed at Hearing News Watch, researchers at Johns Hopkins University School of Medicine recently analyzed data from the National Health and Nutritional Examination Surveys (NHANES). From these, they concluded that about 20% of all Americans age 12 and over, some 48 million people, suffer from hearing impairment, if one includes individuals with hearing loss in only one ear. If this figure is used, then only about 15% of those with hearing loss have hearing aids.

So, as you can see, there’s lots of information out there about how many people have hearing loss and how few of them get help for that loss.

However, what all these data don’t tell us—and, I would add, can’t tell us–is how many people need hearing aids. That’s because need is an inherently subjective matter. In the end, the only person–at least the only adult–who gets to determine if her or she needs hearing help is the person with the hearing loss.

That can be very frustrating for everyone who deals with someone with unaided hearing loss. The woman who can no longer converse with her husband without shouting at him is certain he needs hearing aids. The man whose aging mother no longer enjoys her weekly lunch with her friends has no doubt that it’s time for her to get her hearing tested. And every audiologist and hearing instrument specialist has a file full of people whose audiograms provide incontrovertible proof that they need hearing aids now. But their opinions count for little unless the person in question shares them.

Why Don’t People Perceive the Need?

There are myriad reasons why people with hearing loss see no need to address it. It’s easy to assign their reasons to some standard category, such as denial (“He refuses to admit that he can’t hear well any more”), vanity (“She thinks hearing aids would make her look old.”), or plain old stubbornness (“That old coot hasn’t listened to anything I told him since the day we got married!”). Sometimes, a simple label seems to fit the situation.

But in fairness to those with hearing loss, often their reluctance to get help is much more reasoned—and reasonable. To explain what I mean, I’d like to share a perspective that my colleague Wayne Staab, editor of Wayne’s World, brought to the discussion I mentioned earlier.

Dr. Staab, who’s been practicing audiology since the 1960’s, points out that a person’s decision to get hearing aids is “never based on the degree of hearing loss, but only on the degree of ‘hurt.’  If the hurt is not great enough psychologically, emotionally, economically, or socially, there is no justification for hearing aid use.”

Elaborating, Wayne says that in the farming and ranching country where he comes from, older people often have treatable hearing losses as defined by their audiometric thresholds. However, they but don’t hurt enough to feel the need for hearing help. Why is that? It’s often a matter of lifestyle, he explains. For example, he says, “Many farmers live with their spouses, they speak with them from fairly close distances, and they use their television volume controls as their hearing aids.” In other words, they hear well enough for the way they live.

Sometimes, it works the other way, Wayne adds. He has fitted people with “normal” hearing thresholds because they weren’t satisfied with their unaided hearing.

Weighing Priorities

If hearing aids were products that people wanted, we wouldn’t be having this discussion. But, unlike cars, clothes, or electronics, no one thinks, “Wouldn’t it be great to have a pair of hearing aids!” The only reason people ever buy them is because they decide they need them. Reaching that decision usually takes many years from the time that their hearing loss first becomes noticeable.

For a long time, all the reasons not to get hearing aids outweigh the desire to hear better. These include the cost of hearing aids, the hassle of getting, using, and maintaining them, the concerns about what other people will think, the reluctance to admit that their powers are in decline, the suspicion that the hearing aids won’t help them very much, and plain old inertia.

For most people, such factors build up a pretty powerful case for putting off action until later. And as long as they still believe it when they tell themselves, “My hearing isn’t that bad,” they don’t need hearing aids—no matter what anyone else may think.

Perceptions Change

The good news for all of us who share the HHTM credo that “Hearing Health Matters” is that, over time, perceptions change. People find that their reasons for not getting hearing aids no longer outweigh what they are losing by being unable to hear what they want to hear. And as the balance shifts, some people who are certain today that they don’t need hearing aids will decide next month or next year that they do.

Editor’s Note: This article originally appeared at Hearing Views on Feb 1, 2012. Last updated August 31, 2016. Image courtesy Laurie Graham site