December 2016

Patient Expectations & Realities of Hearing Loss Treatments

Approximately 20% of Americans (48 million) have some degree of hearing loss and the prevalence increases with age: 30% of those aged 65 and 50% over 75 experience disabling hearing loss. Medical, psychosocial conditions and overall quality of life (QoL) are negatively linked to untreated hearing loss. The majority of people without hearing loss (68%) report having an excellent QoL or very good physical health while only 39% of people with hearing loss agree. Addressing treatments for each patient’s unique hearing needs and preparing the patient for a successful aural rehabilitation process greatly impact medical health and overall life satisfaction.

Results from the MarkeTrak IX industry survey show that although hearing aid adoption rates are on the rise and satisfaction with hearing devices is high, the majority of patients with a known hearing loss still wait an average of 13 years to purchase hearing devices. Patients cite the following reasons for their decisions:

  • Purchasing and using hearing devices: having a compelling hearing test result and increased insurance coverage.
  • Taking no action/not buying hearing devices: financial constraints and lack of a perceived need.
  • Discontinuing use/returning hearing devices: physical discomfort or performance below expectations (too much background noise, too much feedback and/or poor sound quality).

Unrealistic expectations along with the common misconception that hearing devices instantly “cure” hearing loss can stymie patients’ success with treatment. Hearing Care Providers (HCP) work collaboratively with patients to establish realistic goals and learn new skills to enhance communication. Recommended components of a successful program include:

  • Education: Understanding the type and degree of hearing loss, implications for communication, preventative and rehabilitative recommendations, need for referrals to other professionals including physicians and any recommended amplification options is critical for making rehabilitative decisions.
  • Realistic Expectations and Goals: Gauging individual needs, goals and expectations determine the successfulness of patients using any prescribed amplification or complying with rehabilitation. No device will restore hearing to “normal” but increasing ease of communication is a realistic expectation. Each patient’s perception of sound is unique and requires a personalized communication needs assessment for the environments he participates in. It is important to note that both patients with hearing devices and those without rate trying to follow a conversation in the presence of noise as the most difficult and least satisfying listening situation. Speech in noise is a universal problem but one that can be addressed well with properly prescribed hearing treatment.
  • Hearing Device Follow Up: Expect several follow up appointments for counseling and rehabilitation. Objective and subjective tests performed by the HCP evaluate perceived benefits from hearing devices and identify areas where fine-tuning may be needed, as well as to learn strategies to maximize sound processing.
  • Adjustment Counseling: Amplification involves adjusting to the process of learning to hear again. It may take time for the brain to begin responding to certain noises after a lack of stimulation. Different environments present unique and highly subjective listening challenges that may require multiple fitting and adjustments to program devices at comfortable and usable settings.
  • Communication Strategies: Hearing is a dynamic process that involves utilizing input from multiple sensory sources beyond just receiving sounds through the ear. Listening skills often decline with hearing loss, so conversations can be improved just by relearning how to increase attention, concentration and interest. Using visual cues and environmental manipulation (where to position in different listening situations like at a restaurant, at a party, in a car) are combined strategies that can also improve communication proficiency.
  • Family Support: Involving family members and/or significant others in the patient’s aural rehabilitation is strongly advised. Learning good communication practices like using appropriate speed and volume of speech, limiting background noise, getting the attention of the listener and avoiding communicating from another room support improved interactions.

More PCP’s are discussing hearing issues at appointments and including hearing screening in annual physicals. Primary care physicians (PCP) play a major role in supporting patients’ decision making and follow up with an HCP: “many consider a positive recommendation from their physician to be a key motivator.”

However, because people are averse to the perception of loss and the threat of a medical issue (a perceived loss of health), some tend to avoid the discovery of a condition (refuse the test, or deny the need for testing), especially if they feel powerless to prevent that loss. A simple reframing of the discussion from loss, tests, disability and hearing aids to prevention, evaluation/assessment, maintaining and/or improving listening and communication and using hearing technology can empower patients to take action.

Hearingwellallowspatientstoparticipatemorefullyintheirhealthcareand positively impacts their health status. Primary Care Providers hold a strong influence with patients by presenting hearing assessments as part of maintaining “maximal hearing and listening” throughout life, similar to routine dental, vision or physical exams normalizes hearing healthcare and erases the social stigma of hearing loss.