History
Total Hearing Care
Debbie F. Schirico
Dr. Jill E. Copley
Erika Porter |
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Based on an article written
by Sam Trychin for the journal
Hearing Loss, May/June 2001
The National Institute on Deafness and Other Communicative
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, co-workers, 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?
Sometimes it’s easy to determine the reason(s) why a person does not acquire (or
wear) a hearing aid(s). 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, C
A. They probably know at some level, but will not admit to having
a hearing loss.
There may be a 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 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 wants 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 member’s 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 worn a hearing aid before.
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 misunderstanding
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 costs, 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 LPs
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 over-stimulation. 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 earmold material. In either case, it’s 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 the last because 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 serve to
alleviate some or much of the fear.
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