Article by Sam Trychin

This article appeared in the March/April 2001 issue of "Hearing Loss: the Journal of Self Help for Hard of Hearing People." Reprinted with permission from Self Help for Hard of Hearing (SHHH).

One of our (SHHH) readers suggested that we have an article on how to get people to wear hearing aids. She asked, "How do those of us who have been 'saved' by hearing aids, get our friends and relatives to experience the same wonderful benefits that we do?"

We contacted Sam Trychin, who has years of experience conducting workshops on this very topic, to write an article. But, we also want to hear from you - "the saved" - about how you persuade your friends and relatives to get the hearing help they need.

Why Don't People Who Need Them Get Hearing Aids?
By Sam Trychin

The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that there are 28 million people in the United States who are deaf or hard of hearing. Probably, close to 27 million of them could benefit from using hearing aids. There are about six million of these people who have hearing aids. That leaves a very large group of people who need, but do not have, hearing aids. Professionals -- otologists, audiologists, hearing aid dispensers, and educators, are often perplexed by this problem. Family members, coworkers, and friends of those who need, but do not have, hearing aids also express concern about this issue and frequently ask what to do to get these folks to acquire and wear hearing aids

What are some possible solutions to approaching someone with hearing loss who obviously needs the help that hearing aids can provide? These seemingly simple and straightforward questions are actually more complex than they appear. This article discusses 20 possible reasons why people who need hearing aids don't acquire them. In any given instance, one or more of these reasons or factors may be operating.

Sometimes it's easy to determine the reason(s) why a person does not acquire (or wear) a hearing aid(s). Other times, it can be quite difficult to make that determination. Sometimes the barrier(s) that prevent the individual from acquiring hearing aids can be readily overcome. Other times, it can be quite difficult or impossible.

1. Don't Realize They Have a Hearing Loss
There are a number of people who don't know they have a hearing loss. One reason for this may be the insidious nature of some types of hearing loss, that is, that their hearing loss had a gradual onset, and they adapted to each slight reduction in hearing ability. They may have become habituated to each reduced level of ability to hear and become convinced that their hearing is normal or not an issue to be concerned about.

Usually, in such cases, there isn't a vehement, emotional denial when the issue of a possible hearing loss is raised by someone. When the possibility of hearing loss is made apparent, such people will often have their hearing checked out.

2. Denial A, B, and C

A. They probably know at some level, but will not admit to having a hearing loss.
There may be vehement, emotional denial when the issue of possible hearing loss is raised as in, "There's nothing wrong with my hearing; you mumble." Or, "This bloody TV sounds terrible."

This is a tough one. It is helpful to determine who it is that this person may listen to in regard to having their hearing checked out. It might be a grandchild or clergy person or close friend. Often, a parent, child, or spouse is the last person to whom we listen in such matters. Also keep in mind that the denial may have something to do with one or more of the items discussed below under 3 to 18.

B. Know they have a hearing loss, but do not realize it is a problem for them or for others.

"Yeah, I'm not hearing as well as I used to, but it's not a big deal." Or, "When I don't hear, Marge yells; she's used to it."

Sometimes, a physician or other professional gives erroneous and harmful information, such as, " It's only a mild hearing loss, don't worry about it unless it becomes severe."

It may be helpful to indicate, in a non-threatening way, how the hearing loss affects others--friends or family members. People who have hearing loss are often unaware of the effects of it on other people. One statement from a grandchild comes to mind that had an immediate positive effect on grandpa was, "Gramps, it would be so much more fun to talk to you if I didn't have to repeat everything."

C. Know they have a hearing loss, but don't think there's anything that can be done to help it.

Again, sometimes professionals give erroneous, harmful information, as in, "My doctor told me it's part of growing old, and I just have to get used to it." In both of these instances, a major barrier to overcome is the fact that a professional, e.g., "MY DOCTOR..." made the statement and it becomes cast in cement as an eternal verity. Who are we, mere mortals, to question the opinion of the family physician?

Providing information about the effects of hearing loss and steps that can be taken to compensate for it may help to counteract the misinformation. Going to SHHH Chapter meetings, reading this kind of Journal, and talking to a friend who is being helped by wearing hearing aids are examples of such steps.

3. Higher Priorities
Sometimes, the person is well aware that he or she has a hearing loss, but there are other things happening in their life that have a higher priority. It may be another physical condition; e.g., cancer, that takes precedence over hearing problems. It may be concerns over work-related problems.

The individual may intend to deal with the hearing loss later, after dealing with the more pressing issue. But, the person may not see that the hearing loss is, in fact, contributing to the other problems, whether health or work-related, and that dealing with the hearing loss now may help with the other concerns.

4. Cost
Cost is a very real issue for many, many people who do not have hearing aids. Older people on limited, fixed incomes, people in low paying jobs, and children from economically poor families are just a few examples of people who are often priced out of the hearing aid market.

The average family, too, will also have to do some financial juggling to be able to purchase hearing aids. This issue may be hard to detect because the person's pride may not permit him or her to own up to the cost factor. A Dad or Mom may not want to impose a financial burden on the family by buying a hearing aid for themselves. (HEAR NOW is an organization that provides hearing aids for people on low incomes. Anyone needing assistance can call 800/648-4327.)

5. Lack of Transportation
This may be related to cost, but, in some instances, it is not. Some people, in rural areas, older or physically infirm, may not have the means to get to a place to have an audiological assessment and hearing aid fitting. We have seen this with some frequency among residents living alone in residential settings for older people. Arranging for transportation for them or arranging for a hearing professional to come to their home are two solutions.

6. Lack of Motivation to Hear
This may result when people live alone and seldom interact with others. It may also result from situations in which communication with partners is aversive and the individual would prefer to hear nothing rather than something unpleasant.

Irritating environmental sounds are not conducive to getting and wearing hearing aids. A physician and his wife in one of our groups were concerned because his mother, who was bed-ridden in a skilled nursing facility, was not wearing her hearing aids. It turned out that one of the machines near her bed made a continuous irritating noise that bothered her. Moving the machine solved the problem.

Sometimes, as a result of longstanding, untreated hearing loss, the person has become so inward focused that he or she no longer want to interact with other people or hear what they have to say. Providing something of interest to listen to, a person to interact with on a regular basis, and eliminating unpleasant sounds or conversation may induce the person to acquire and wear hearing aids

7. Family Resistance
There are instances in which a family member or members resist the person's attempt to acquire hearing aids. Sometimes, this resistance is due to the family members wish to deny that their loved one has a problem, as in, "Oh honey, your hearing is really fine; let' s not worry about it, ok?" By denying the hearing loss, they avoid having to experience the pain of knowing that a loved one has a problem.

Sometimes the family member's motivation is more venal in nature. They may not want to spend the money on hearing aids that would otherwise go toward a new motorcycle, computer, or fur coat. Discussing the number of things that can be done to compensate for hearing loss and the positive effects of hearing aid use can be helpful. Also, it may help to indicate the benefits to the family member if the person had and wore a hearing aid

8. Fear of Being Seen as "Failing" or Incompetent
Some folks won't get hearing aids because they perceive hearing loss to be a sign of old age and a symbol of its attendant infirmities or failings. The reasoning seems to be, "If I don't have a hearing aid(s), I won't be seen as being old." Strange reasoning, especially so, when the misunderstandings related to hearing loss really make others wonder, "What the heck is wrong here?"

Some people still in the work force are concerned that supervisors or co-workers seeing a hearing aid(s) might question their competency to continue to perform at work. Unfortunately, there has been some justification for that fear. The bind is that not having hearing aids will probably result in misunderstanding and poor performance at work anyway. It can help to point out that without the hearing aid(s), when the person with hearing loss misunderstands or fails to understand, the other employees may come to view that person as being unfriendly, incompetent, slow witted, weird, etc.

9. Unwilling to Give Up the "Benefits" of Having the Hearing Loss
Believe it or not, there are some benefits to having hearing loss. For many people who are hard of hearing, the costs (negative effects) of the hearing loss obviously outweigh the benefits, so they, if they are able, acquire hearing aids and use them.

But, for some people, the benefits outweigh the costs, and they don't get the hearing aids. "Honey, would you call the Credit Union for me? I can't hear on the phone." "Sweetie, would you do the shopping at the grocery store? I can't understand the clerk." "I don't have to work, because I get good workman's comp."… Well, you get the idea.

Removing the benefits may provide more incentive to get the hearing aids, but whatever steps are taken should be carefully considered and humane. Many times, the person is not being manipulative and is not consciously aware of the benefits they are receiving by not hearing well.

10. Afraid of Doctors (professionals)
This is more likely to be true of older people who grew up when medicine was much more primitive than today, and visits to the doctor were often a harbinger of really distasteful medicines, painful treatments, or worse. My own mother had a phobic reaction to physicians and other professionals and wouldn't go near them for the last twenty years of her life (but she lived to be 92, hmmm!!).

Younger people may also have a phobic reaction to medical doctors and allied professionals, and it is something to consider when nothing else is apparent. Sometimes, when these reactions are severe, professional help is necessary to overcome them, such as, counseling or phobia clinic programs.

11. Motor Coordination Problems
I saw an elderly woman in a group I was conducting in Annapolis, Maryland, who had a mild palsy in her hands. She had purchased, at considerable cost, two in-the-ear hearing aids. The problem was that she couldn't remove or put in the batteries and couldn't adjust the volume control mechanism. Hearing aids are small and require good motor coordination or some way to compensate for lack of it. External controls that are large and easy to manipulate are available for some hearing aids. Providing help with batteries and controls will also solve the problem.

12. Bad Prior Experience with Hearing Aids or Vendors
Some people have had hearing aids in the past that either did not work well for them or that they failed to allow enough time to adjust to. There are really inexpensive (cheap), shoddy products one can get through magazine ads that produce poor quality sound and/or improper volume.

Bad experience with these products can turn a person off for future consideration of acquiring hearing aids. A hearing aid that is handed down by a friend or family member will not provide good sound quality unless they have the same type and degree of hearing loss.

Bad experience with a hearing aid vendor in the past can also color one's current views about hearing aids. On the other hand, adjustment to hearing aid(s), for some people, can take several weeks. Some folks just don't allow enough time to make the adjustment and become convinced that hearing aids are not for them.

It is very important to consider the person's previous experience in regard to hearing aids, because it colors the person's expectations about what a hearing aid will be able to do for them. Low expectations usually result in a "forget about it" attitude. Finding some way for such a person to experience the benefits of a hearing aid that is appropriate for their hearing loss is one solution for this kind of problem.

13. Friends' or Relatives' Bad Experiences
Sometimes, just hearing about another person's bad experience with hearing aid(s) or with the person selling the hearing aid(s) can have the effect of refusal to consider acquiring hearing aids for oneself. It is helpful to know if the person has friends or relatives who have had such experiences. Again, finding ways for the person to experience the benefits of a properly fitted hearing aid may result in changing their negative attitude toward hearing aids.

14. Overstimulation
Many people, upon wearing hearing aids, hear sounds that they hadn't heard in years or, perhaps, never heard before. I remember hearing instrumental sounds on my LP's that I hadn't heard for years; it was like getting a new record collection. For many people, hearing these new sounds is a blessing. But for some, it is jarring and uncomfortable -- they may suffer from auditory overstimulation. In such cases, wearing the hearing aid(s) for short periods each day and gradually increasing the time they are worn can help in adjusting to them.

Some people who haven't had such gradual adjustment may find the new sounds aversive and refuse to wear the aid(s), take them back to the vendor, and refuse to consider acquiring them in the future.

15. Emotional Status
Depression can result in the person not having enough energy to bother about getting and using hearing aids. They may feel, "What's the use anyway." Or, the person may be too anxious to deal with the whole process of locating an assessment site, having the testing and hearing aid fitting done, and hassling with batteries, volume, etc. In such cases, it may pay to deal with the emotional status of the person prior to or along with the acquisition of the hearing aid(s). Keep in mind, however, that the hearing loss itself may play a causative role in the depression or anxiety.

16. Ear Pain and Allergies
Some people experience ear pain or other uncomfortable sensations when they wear hearing aids. Others develop allergies to some types of ear mold material. In either case, it is necessary to return to the hearing professionals to find ways to alleviate the pain or to use non-allergenic earmold material.

17. Vanity
Some years ago, I did a workshop in the South and one of the participants was a woman in her early seventies who appeared to be quite wealthy. Anyway, we gave her an FM receiver, which allowed her to understand much more than she had in years. She kept raving about this "wonderful" device. At lunchtime, she left it in the room when we went out to a restaurant to eat. I asked her why she didn't take it along. Her response was, "Oh, it doesn't go with my outfit."

Some individuals may not want to wear hearing aids for some similar reason. However, in-the-ear and in-the-canal aids may be able to overcome some of this reluctance. Discussing how one appears to others when they frequently fail to hear or misunderstand what is being said may also help if done in a sympathetic and tactful way.

18 Fear of Ridicule
I've saved this for last because I feel it is so important, especially for young people who are hard of hearing. Kids who are hard of hearing in school and who have worn hearing aids in their earlier school career, often stop wearing them when they reach junior high or high school freshman status. The fear of being ridiculed or being seen as weird outweighs whatever benefits the hearing aid(s) had provided during the previous years.

It requires strong encouragement and support to get some young people to wear hearing aids. Others will still refuse to wear them; and alternative options, such as, sound field systems in their classrooms need to be used. Meetings for students who are hard of hearing focused on coping with hearing loss in classroom situations can be very beneficial. It is most important that the student, parents, teachers, and other school personnel;e.g., counselor, psychologist, audiologist, meet together to ensure they are all working together.

But, people are vulnerable to ridicule at any age, and it is wise to determine if fear of being made fun of is a factor. Openly discussing the effects of hearing loss and the consequences of ridicule with those who might be poking fun at the person can sometimes put it to an end.

Working with the person who is hard of hearing on how to handle ridicule is also important. Getting them to discuss, in a safe environment, their worst fears about being ridiculed is helpful; e.g., disclosing what they think people will actually say to them. Helping them to anticipate the things that people might say and role-play responses to these comments serves to alleviate some or much of the fear.

To find information about SHHH Chapters and to meet others who wear hearing aids, go to:
www.shhh.org

Sam Trychin, Ph.D., is the former director of training at the Mental Health Research and Training Center for Hard of Hearing and Late-Deafened Adults, California School of Professional Psychology, San Diego, California (1995-1997). Previous to that, he was professor of psychology and director of the Living With Hearing Loss Program, Gallaudet University, Washington, D.C. (1981-1995).

Dr. Trychin currently conducts training programs, classes, and workshops for people who are hard of hearing, their families, and professionals who provide services to them. He is also a consultant to the Sweetwater Union High School District in San Diego County. His specialty is the application of psychological concepts, principles, and procedures to problems and issues related to hearing loss.

Dr. Trychin has written 15 books, authored numerous professional books, chapters, and journal articles, and produced a variety of videotapes related to coping with hearing loss. He has conducted hundreds of workshops and training programs across the United States and in Canada. He and his wife Janet, an audiologist, frequently conduct workshops together.

Dr. Trychin is a member of the American Psychological Association, is listed in the National Register of Health Service Providers in Psychology, and is a licensed psychologist in the District of Columbia and in Maryland. He is also the mental health and rehabilitation advisor to SHHH. Dr. Trychin is hard of hearing himself and has been wearing hearing aids since 1953.