According to a leading Wall Street firm, Bernstein, low penetration rate and reimbursements for hearing aids are the key trends providing sufficient opportunity for further growth in the hearing aid industry. On the development front, the advent of wireless, Bluetooth and FM technology are among the recent major innovations in this industry. As audiologists know, the growth of this market is driven by the increasing population of the aging worldwide, growing demand for hearing aid devices, and the expanding worldwide economy, among other causes. However, the global hearing aid industry faces serious challenges from social stigma and rising price pressure.
While pricing of hearing aids has always been an issue in the world market, the size, shape, benefit, longevity, and utility of these products have all greatly increased over the past 5 years. Therefore, it seems reasonable to think that the stigma of hearing instruments and hearing loss would have greatly decreased in this new century. Stigma has been defined as “the possession of, or belief that one possesses, some attribute or characteristic that conveys a social identity that is devalued in a particular social context.” (Crocker, Major, & Steele, 1998).
No matter if it’s China, Latin America, Europe, North America, or other parts of the world, stigma remains a major factor that influences a patient’s motivation to treat their hearing impairment. This stigma toward hearing loss, fueled by cultural and religious values in many countries, affects people’s willingness to use hearing aids. A recent US study published in the Gerontologist (Wallhagen, 2010) sums up the world feelings on stigma. Wallhagen found that perceived stigma emerged as influencing decision-making processes for issues such as the initial acceptance of hearing loss, whether to obtain a hearing evaluation, the type and style of hearing aid selected, and when and where hearing aids are worn.
Stigma was related to three interrelated experiences: alterations in self-perception, ageism, and vanity and it was influenced by dyadic relationships and external societal forces, such as health, hearing professionals and the media. Wallhagen finds in her study that stigma and ageism are major factors, and she suggests the need to destigmatize hearing loss by promoting hearing assessment and treatment as well as by emphasizing the importance of remaining actively engaged to support positive physical and cognitive functioning.
While most long-time audiologists in the US will agree that stigma related to hearing aids and hearing loss (as well as other handicapping conditions) is not nearly as strong as it was 40 years ago, it is still very present in the US and, to one degree or another, in most cultures around the world.
Another recent study from the UK published Ear and Hearing, looked at the habits of 160,000 people aged 40 to 69 years. It found 10.7% of adults had significant hearing problems when listening to speech in the presence of background noise — but only 2.1% used a hearing aid. One in 10 middle-aged adults had substantial hearing problems, and they were more likely to be from a working class or ethnic minority background. Dr. Piers Dawes, from the University of Manchester’s Audiology and Deafness research group, said: “This is the first study to describe the prevalence of difficulties understanding speech in background noise in a large sample of the population, anywhere in the world. It shows hearing aids remain significantly under used despite significant improvements in both technology and their provision, and a high proportion of people who would benefit from treatment may not receive effective intervention.”
According to Dawes, “Reasons for the lack of uptake might be lack of awareness of treatment options, lack of recognition of their difficulties, finding hearing aids uncomfortable, or finding them of limited help. Professor Kevin Munro, Ewing Professor of Audiology at the University of Manchester who also worked on the study, said: “There still seems to be a stigma attached to wearing a hearing aid, where as there is little stigma now associated with vision loss and wearing spectacles.”
While it would be nice if the changes in amplification had changed patient perceptions of how hearing instruments look in the ear, stigma is still a factor. Dr. Au Bankaitis put it this way: “As an audiologist, I assumed that the introduction of thin tube and RIC/RITE BTEs would essentially eliminate any reluctance on the part of the patient to actually wear hearing instruments. To me, they are not noticeable at all unless you know what to look for and get really close to someone’s ear.”
This is a typical audiologist’s perspective worldwide. The truth is there is a new generation of patients who realize that products are smaller, less obvious in the ear, yet still find them unacceptable. Audiologists, on the other hand, feel as Bankaitis does, that today’s products are substantially different from those of years past and, thus, should be readily accepted by this new generation of consumers without question.
So, there is a perceptual difference between patients and the professionals as well as the manufacturers: Patients new to the market are still are having a hard time accepting the size and shape of the products that are used to address their hearing loss while professionals feel that they have the ultimate cosmetics in today’s hearing instruments. An example of this issue is summarized in an unsolicited letter to Dr. Bankaitis from a hearing aid user in San Jose, CA, who wrote:
“I recently had to get my first hearing aids and did so very reluctantly. My main issue was the stigma associated with wearing them. I was positive that everyone would be able to see the tubes (refer to the image at the right), know I am wearing hearing aids, and for some reason think less of me. I know this was wrong, but for the first three weeks I was so self-conscious about having the visible tubes running over and into my ear that I was continually looking in the mirror and trying to adjust them so they wouldn’t be so visible. “
You can bet this patient’s audiologist probably felt that the devices were as cosmetically appealing as possible. Meanwhile, the patient was extremely self-conscious about when and where to wear the devices, feeling that even these rather cosmetic instruments (to the audiologist) were still unsightly and very conspicuous to others (in his opinion).
The lesson for audiologists in this is that even though today’s hearing aids are much better looking than those in the past, we have still not overcome the stigma issue, especially in cultures where “different is less capable and makes people less valuable.” Study after study indicates that the stigma of amplification products and hearing loss is still with us and will continue to be for quite some time.
So…WHAT ELSE CAN WE DO ABOUT STIGMA?
Manufacturers offer many new products each year to reduce the stigma of hearing instruments. However, it was a consumer, dissatisfied with the cosmetics of a receiver wire cover on his hearing instrument, who developed a process called Vanish that won the new product showcase competition at the American Academy of Audiology Convention in April 2014.
About 5 years ago, Al Musser, a hearing aid wearer, came to me with a problem. He was using a very good set of relatively new, high-end, receiver-in-the-canal (RIC) hearing aids, but he was concerned that the receiver wire covers were too visible in his ear. To the audiologist, his RIC fitting was perceived as a very cosmetic solution; to Al, however, the RIC fitting remained stigmatizing.
Al spent 4 years studying plastics and dyes and developed a process for dyeing the receiver wire covers and thin tubes of hearing aids so they are almost invisible. In using this process, the audiologist actually becomes an agent of change in reducing the stigma by reducing reflectivity and blending the tube or RIC wire cover with the patient’s skin tones. Of course, even using with this process (outlined in a recent Hearing Review article), audiologists cannot get rid of stigma altogether. But they can offer a unique,
simple, and inexpensive cosmetic treatment that specifically addresses the concerns of any BTE patient. Offering patients a choice of color adds value, mitigates stigma, and creates a positive personal atmosphere about their hearing solution. The process and the results can be viewed at www.myvanish.com.
Dr. Robert Traynor, the author of this post and editor of Hearing International, has a small financial interest in Vanish. He states that his reason for writing about it on his blog is to make audiologists aware that there is a new method available to reduce the stigma of RIC and Thin Tube hearing instruments.