Editor’s note: Ear to the Ground is a monthly column from Dr. Brian Taylor, offering timely reflections on research, technology, clinical practice, and emerging trends in hearing care. You can read last month’s column here.
How One Word Can Change Everything: Don’t Underestimate the Power of the Labeling Effect
Our profession is awash in social media influencers. They can be entertaining and influential, especially during product launches, but don’t let their presence fool you into thinking they are all impartial interpreters of the latest peer-reviewed hearing aid research — many of them are paid to say the things they say.
Next time you watch one of them on YouTube, TikTok, or Reddit proclaiming the latest new hearing device as “revolutionary,” “groundbreaking,” or “game-changing,” remember the power of the labeling effect, a phenomenon that has been studied by researchers in our field for several years.
The labeling effect is one of three types of expectation effects that shape decision-making. The other two are the halo effect and the placebo effect.
The most germane to hearing aid product launches is probably the labeling effect, which has been used to describe when a diagnostic or technological term changes how a person interprets or engages with their own experience.
What Hearing Aid Research Tells Us About Labeling
To understand how labeling shapes patient expectations, we can look back 30 years to the late 1990s, when digital hearing aids first hit the market.
A University of Iowa study (Bentler et al., 2003) was the first to systematically assess the labeling effect associated with digital hearing aids. Although speech understanding measures did not show meaningful differences between the “digital” and “conventional” labeling conditions in their study, participants generally rated the hearing aid more favorably when they believed it was digital.
Two additional studies suggest that the labeling effect is not necessarily tied to the word digital itself.
Dawes and colleagues conducted two controlled experiments in which experienced hearing aid wearers compared two hearing aids that were acoustically identical but were described differently: one was presented as “new” technology and the other as “conventional” technology.
In the first study, Dawes, Powell & Munro (2011) asked 20 participants to complete speech testing with the Four Alternative Auditory Feature (FAAF) test (65 dB SPL, +2 dB SNR), sound quality ratings, and overall preference.
Speech-in-noise performance was slightly better with the “new” device, although this effect was marginal. Participants, however, rated the hearing aid labeled “new” as having significantly better sound quality, and 75% (15 of 20) preferred the device described as new, with the other five expressing no preference.
In their second study, Dawes, Hopkins, and Munro (2013) replicated the 2011 study with 16 hearing aid wearers. The results were similar — although the speech-in-noise labeling effect was stronger.
Participants performed significantly better with the device labeled “new” (a score of 71% vs. 67%), rated its sound quality higher (8.1 vs. 7.4 on a 10-point scale), and again, 75% preferred the device labeled “new.”
“The expectations created by how hearing technology is labeled (‘new’ vs. ‘conventional’) can influence both subjective judgments and clinically measured performance.”
Because the devices used in these two studies were acoustically identical, their findings provide evidence that the expectations created by how hearing technology is labeled (“new” vs. “conventional”) can influence both subjective judgments and clinically measured performance.
Something to consider today when we read white papers comparing the “new technology” to the patient’s “old” hearing aids.
Can the Fitting Process Shape Expectations?
One additional, more recent study evaluated the effects of narrative on hearing aid outcomes. Narrative is most aptly described as the clinician’s monologue with the patient during an appointment.
Wu et al. (2024) included 30 adults with hearing loss in a crossover design. Participants were told the study was comparing two different hearing aid fitting processes.
Each participant underwent an initial “actual” fitting in which the investigators programmed the hearing aid settings that would be used during both subsequent field trials. Then, participants experienced a lengthy, comprehensive fitting process designed to resemble a best-practice fitting approach.
It included multiple assessments: COSI, Acceptable Noise Level, Loudness Discomfort Levels, QuickSIN, probe-microphone prescriptive target verification, and hearing aid fine-tuning based on participant feedback.
That was followed by a streamlined fitting condition where the participants experienced a much simpler process involving essentially a hearing test without any additional assessments. Each condition was followed by a three-week real-world field trial.
The outcomes from both experimental fitting sessions were never used to program the devices. Instead, participants wore the same hearing aids with the same amplification settings during both three-week trials; they were led to believe that the settings resulted from whichever fitting process they had just experienced.
This allowed the investigators to ask whether the perceived effort, thoroughness, and professionalism of the fitting process would itself create an expectation effect.
The primary outcome was the International Outcome Inventory for Hearing Aids (IOI-HA), measured in two ways: conventional retrospective questionnaires and ecological momentary assessment (EMA), which asked participants in real time about their hearing aid experience in everyday life. The researchers also collected hearing aid preference using the NEO Five-Factor Inventory.
The researchers found no significant difference between the comprehensive and streamlined conditions on either retrospective IOI-HA scores or EMA-based IOI-HA scores.
“Although the hearing aids and their settings were the same, 73% of participants believed the two fitting processes produced different outcomes.”
However, they found that 73% of participants believed the processes produced different outcomes. Although the hearing aids and their settings were the same, 22 of 30 participants expressed a preference for one of the two fitting processes: 14 preferred the comprehensive process, eight preferred the streamlined process, and eight had no preference.
Although these preference differences did not reach statistical significance, most participants believed that the two processes produced different outcomes, despite the absence of any actual difference in the hearing aid settings.
Further, when participants explained why they preferred one fitting over another, their explanations were primarily about how the hearing aids sounded. For example, several reported that one fitting sounded clearer or was better at managing noise.
Applying These Findings to Clinical Decision-Making
In 2026, anything with “AI” in its name conjures the same images of technological superiority that “digital” once did in 1996.
Consequently, the most powerful part of the hearing aid fitting may not be the AI-based noise reduction or the Bluetooth streaming at all; it may be the words the audiologist chooses to describe the hearing aids.
The labeling effect, along with its halo and placebo cousins, provides evidence that clinical outcomes aren’t purely a function of the technology or the treatment.
Instead, outcomes are a function of the technology or intervention plus the patient’s expectations that accompany it, and how those expectations can be shaped by the narrative of the clinician.
These “effects” seldom function in isolation; rather, they compound and reinforce one another.
In clinical practice, for example, a “premium” or “AI-based” label triggers assumptions about quality (labeling effect), and when that message is delivered by an audiologist who looks and acts like a caring expert (halo effect), this primes the patient to have expectations of improved outcomes, which can result in measurable changes in outcomes, such as better speech understanding in background noise or improved satisfaction scores on a self-assessment inventory.
The Bottom Line for Audiologists
How hearing technology is labeled can shape patient expectations — and perceived outcomes — independent of measurable performance. Terms such as “AI,” “revolutionary,” or “game-changing” can create positive expectations before the patient ever wears the device.
To keep those expectations grounded, clinicians should:
- Describe hearing technology in accurate, balanced language.
- Emphasize individualized outcomes rather than marketing-driven claims.
Social media influencers may help consumers sort through their hearing device options, but clinicians should look past the hype and let the published research guide their recommendations.
In the end, what you say to the patient may matter more than what the computer inside their hearing aid is doing.
References
Bentler, R. A., Niebuhr, D. P., Johnson, T. A., & Flamme, G. A. (2003). Impact of digital labeling on outcome measures. Ear and Hearing, 24(3), 215–224.
Dawes, P., Powell, S., & Munro, K. J. (2011). The placebo effect and the influence of participant expectation on hearing aid trials. Ear and Hearing, 32(6), 767–774.
Dawes, P., Hopkins, R., & Munro, K. J. (2013). Placebo effects in hearing-aid trials are reliable. International Journal of Audiology, 52(7), 472–477.
Wu, Y.-H., Dorfler, M., Stangl, E., & Oleson, J. (2024). Would a comprehensive hearing aid fitting process lead to placebo effects compared to a simple process? Frontiers in Audiology and Otology, 2, 1411397.
About the Author
Brian Taylor, AuD, has served as the editor of Audiology Practices since 2009 and is an adjunct instructor at the University of Wisconsin. He brings more than three decades of experience as an audiologist, educator, clinical researcher, and author across a wide range of professional topics. He received ADA’s prestigious Joel Wernick Award for outstanding educational contribution within the fields of audiology and hearing science in 2024.
