Abstract
Background:
Hearing loss is a significant global issue. Individuals affected by this condition face numerous challenges in their daily lives, including difficulties in communication, social isolation, and a diminished quality of life. Thus, early diagnosis and prompt initiation of usage of hearing aids are crucial to mitigate the adverse effects of hearing loss.
Purpose:
This study aimed to examine the amount of time it takes for an individual to obtain hearing aids after a diagnosis of hearing loss. In addition, it attempted to identify factors that affect individuals in this process.
Research Design:
This was a cross-sectional survey study.
Study Sample:
The study comprised 150 individuals who were using hearing aids and were aged 18 years and over. There was an equal distribution of 75 females and 75 males.
Data Collection and Analysis:
A 23-item questionnaire was given to the participants in order to evaluate the factors that affected the participants with hearing loss in the process of obtaining hearing aids. In addition to this, the date of the hearing loss diagnosis and the date of the hearing aid purchase were calculated. Statistical analyses were made between calculated time and demographic information as well as the survey questions.
Results:
A significant association was observed between the time of purchasing hearing aids and the deterioration in social relations or fear of exclusion from society (p < 0.05). Furthermore, a significant correlation was found between the time of purchasing hearing aids and the individual’s educational level. Specifically, differences were noted in the purchase time for hearing aids between high school graduates and primary school graduates (p < 0.05). Additionally, the average duration between the diagnosis of hearing loss and the purchase of hearing aids was found to be 3 years.
Conclusions:
We observed that individuals with hearing loss tend to delay the purchase of hearing aids, and various factors influence this decision. These findings highlight the importance of implementing interventions aimed at facilitating earlier access to hearing aids, thus reducing the negative effects associated with untreated hearing loss.
Keywords: hearing, hearing loss, hearing aid, influencing factors
INTRODUCTION
Hearing is crucial for social interactions. Those with intact hearing are able to accurately locate the source of a sound in their environment. This enables them to engage in group conversations in a more seamless manner. Nevertheless, it has been demonstrated that individuals with low speech discrimination scores, that is, those experiencing auditory deprivation, may encounter difficulties in auditory information localization (Tubay et al, 2023). However, untreated hearing loss can lead to communication difficulties and negatively affect individuals’ daily functioning and psychological well-being. Recent research, including studies such as the ACHIEVE study by Lin et al, suggests an association between hearing loss and cognitive decline in older adults. Whereas the primary analysis showed that a hearing intervention slowed down the loss of thinking and memory abilities by 48 percent over 3 years in older adults at increased risk for cognitive decline, further research indicates potential benefits in broader populations. These findings highlight the importance of early intervention for hearing loss, particularly in older adults, in order to mitigate its negative impact on cognitive function and overall quality of life (Kaymakçı, 2021; Lin et al, 2023). Individuals with hearing loss seek treatment from health care institutions due to the challenges it poses in their social lives. Medical or surgical interventions may be recommended as part of their treatment (Dillon, 2012). Although medical or surgical treatments are available for individuals experiencing hearing loss, they may not always be effective in resolving the underlying cause. The negative effects of hearing loss can be reduced over time with the use of hearing aids. For this reason, hearing aids and assistive listening accessories are recommended for individuals to alleviate the effects of hearing loss.
The World Health Organization reports that more than 5 percent of the world’s population (432 million adults and 34 million children) need rehabilitation for “disabled” hearing losses (World Health Organization, 2024). In Turkey, there is no clear information about people with hearing loss and those using hearing aids. By 2050, nearly 2.5 billion people worldwide are projected to have some degree of hearing loss, and at least 700 million will require hearing rehabilitation (World Health Organization, 2024).
The objective of this study was to analyze the duration between the diagnosis and procurement of hearing aids among adults aged 18 years and above who use such aids. Furthermore, the study will investigate the environmental, physical, and psychological factors that influence this period.
MATERIALS AND METHODS
The study was conducted at the Department of Audiology, School of Health Sciences, Istanbul Medipol University (IMU). Ethical approval for the study was obtained from the IMU Non-Interventional Clinical Research Ethical Committee, and the study was conducted in accordance with the Principles of the Declaration of Helsinki.
Participants
The study included 150 participants, with 75 (50 percent) women and 75 (50 percent) men. The study included individuals aged 18 years or older who had been diagnosed with hearing loss, defined by the four-frequency pure-tone average of 500, 1000, 2000, and 4000 hertz (Hz) in the better ear, ranging from slight (25 dB hearing loss [HL]) to severe (greater than 70 dB HL). All participants were using hearing aids, had consented to participate in the study, and had been informed of the study details. Individuals aged 18 years and younger, those diagnosed with hearing loss but not using hearing aids, and those who demonstrated difficulty in cooperating, unreliable responses to the questionnaire, or a neurological, psychological, or mental illness were excluded from the study.
Procedure
The informed consent form, which outlined the study procedures and risks, was signed by all participants prior to their involvement in the study. The type and degree of hearing loss was determined based on the results of the hearing test that diagnosed the hearing loss. In addition, the date of hearing loss diagnosis and the date of hearing aid purchase were calculated and the questionnaire that we developed was administered to the participants. The questionnaire included 4 demographic questions and 19 questions to assess factors influencing the hearing aid purchase process. Demographic questions included the patient’s age, sex, educational status, and occupation. When evaluating the hearing aid purchase process, we take into account various factors such as the nature and progression of the hearing loss, the patient’s daily life challenges, coexisting health problems, economic considerations, family and social reactions, concerns about using hearing aids, aesthetic preferences, and awareness of the impact of hearing loss. The questionnaire was given to the participants as a face-to-face interview.
The age range of the participants was 21–90 years, and the mean age was 61.8 years (Table 1). The demographic characteristics of the participants included in the study are shown in Table 2.
Table 1.
Descriptive Statistics Results for Participants’ Age Data
| Mean | Median | Interquartile Range | Standard Deviation | |
|---|---|---|---|---|
| Age (years) | 61.8 | 66.5 | 27 | 17.85 |
Table 2.
Demographic Characteristics of Participants
| Participants | N | Percent |
|---|---|---|
| Sex | ||
| Female | 75 | 50 |
| Male | 75 | 50 |
| Degrees of hearing loss (HL) | ||
| Slight (16–25 dB HL) | 1 | 1 |
| Mild (26–40 dB HL) | 26 | 17 |
| Moderate (41–55 dB HL) | 70 | 47 |
| Moderately severe (56–70 dB HL) | 35 | 23 |
| Severe (71–90 dB HL) | 17 | 11 |
| Profound (91+ dB HL) | 1 | 1 |
| Type of hearing loss | ||
| Sensorineural | 132 | 88 |
| Mixed | 14 | 9 |
| Conductive | 4 | 3 |
| Education status | ||
| Illiterate | 15 | 10 |
| Primary education | 30 | 20 |
| Secondary education | 36 | 24 |
| High School | 36 | 24 |
| University | 31 | 21 |
| Postgraduate | 2 | 1 |
| Occupation | ||
| Retired | 57 | 38 |
| Not working | 43 | 29 |
| Other | 50 | 33 |
The degree of hearing loss of the participants is 1 (1 percent) slight, 26 (17 percent) mild, 70 (47 percent) moderate, 35 (23 percent) moderately severe, 17 (11 percent) severe, and 1 (1 percent) profound (Table 2).
Upon examination of the participants’ hearing loss types, it was found that 132 (88 percent) had sensorineural hearing loss, 14 (9 percent) had mixed hearing loss, and 4 (3 percent) had conductive hearing loss, as shown in Table 2.
Statistical Analysis
The interval between the dates of hearing aid purchase and hearing loss diagnosis was calculated. Statistical analyses were conducted to examine the associations between calculated time, demographic information, and survey responses. Statistical analysis of the data in the study was performed with the SPSS version 26. The initial step involved assessing the distribution of the data. Given its deviation from normality, analyses were conducted using the Mann–Whitney U and Kruskal–Wallis methods. The statistical significance level was accepted as p < 0.05.
RESULTS
In 2022, 150 individuals with hearing loss participated in our survey. Initially, based on the data gathered from participants, we calculated the duration between the diagnosis of hearing loss and the purchase of hearing aids. As shown in Table 3, the elapsed time is 3.03 years and the standard deviation is 5.57. The results of the analysis examining the relationship between this time obtained and the survey questions are shown in Table 4.
Table 3.
Hearing Aid Purchase Time After Diagnosis of Hearing Loss
| Mean | Median | Interquartile Range | Standard Deviation | |
|---|---|---|---|---|
| Elapsed time (years) | 3.03 | 0.1629 | 3.29 | 5.57 |
Table 4.
Mann–Whitney U and Kruskal–Wallis Test Analysis Results Between Purchase Time of Hearing Aid (Year) and Survey Questions
| Questions | Question Answers | Mean ± SD** | p |
|---|---|---|---|
| Level of education | Illiterate | 1.20 ± 4.37 | 0.02* |
| Primary Education | 0.73 ± 1.89 | ||
| Secondary Education | 3.42 ± 5.97 | ||
| High School | 4.31 ± 6.39 | ||
| University | 4.39 ± 6.40 | ||
| Postgraduate | 0.50 ± 0.70 | ||
| Have you thought if you use hearing aids you may experience deterioration in social relations or fear of exclusion from society? | Yes | 4.09 ± 5.49 | 0.03* |
| Sometimes | 4.33 ± 6.99 | ||
| No | 2.34 ± 4.94 | ||
| How did people around you react to the decision-making process of purchasing hearing aids? | Poor | 13.60 ± 2.30 | 0.00* |
| Average | 4.82 ± 6.87 | ||
| Good | 2.54 ± 4.69 | ||
| Excellent | 1.54 ± 4.42 | ||
| Did the hearing aid costs and maintenance affect your decision to purchase a hearing aid? | Yes | 3.41 ± 5.63 | 0.05 |
| No | 2.46 ± 5.46 | ||
| Have you ever had surgery on your ears and/or head-neck area before? | Yes | 8.29 ± 8.44 | 0.03* |
| No | 2.78 ± 5.30 |
*Significant p values (p < 0.05) are indicated with an asterisk.
**The mean value indicates that how many years after the hearing loss was diagnosed that participants purchased hearing aids. SD = standard deviation.
A statistically significant difference was found between the time of hearing aid purchase and the level of education. It was found that there were differences between high school graduates and primary school graduates in terms of purchase time for hearing aids (p < 0.05). High school graduates purchased hearing aids on average 4.31 years after they were diagnosed with hearing loss, whereas primary school graduates purchased hearing aids on average 0.73 years after they were diagnosed with hearing loss (Table 4). The mean purchase time of hearing aids for patients with hearing loss according to level of education is shown in Figure 1.
Figure 1.
Representation of the mean purchase time of hearing aid of patients with hearing loss according to level of education.
A statistically significant difference was found between the time of purchasing hearing aids and the concern regarding potential social repercussions or fear of exclusion from society due to hearing aid use (p = 0.03). The survey asked participants whether they believed they would face exclusion by their social environment or experience breakdowns in their relationships when using hearing aids. Those who answered “yes” to this question purchased hearing aids on average 4.09 years after they were diagnosed. Those who answered “no” to this question purchased hearing aids on average 2.34 years after they were diagnosed, and those who answered “sometimes” to this question purchased hearing aids on average 4.33 years after they were diagnosed (Table 4).
A statistically significant difference was found between the purchase time of hearing aids and the reaction of the social circle to the decision to use hearing aids (p < 0.01). Those who answered “poor” to this question purchased hearing aids on average 13.60 years after they were diagnosed. Those who answered “excellent” to this question purchased hearing aids on average 1.54 years after they were diagnosed (Table 4). The mean purchase time of hearing aids of patients with hearing loss according to the reaction of the social circle is shown in Figure 2.
Figure 2.
Representation of the mean purchase time of hearing aid of patients with hearing loss according to the reaction of the social circle.
There was no statistically significant difference between the purchasing time of hearing aids and the effect of hearing aid maintenance and costs of the purchasing process (p = 0.05). Those who answered “yes” to this question purchased hearing aids on average 3.41 years after they were diagnosed. Those who answered “no” to this question purchased hearing aids on average 2.46 years after they were diagnosed (Table 4).
A statistically significant difference was found between the purchase time of hearing aids and undergoing an operation from the ear or head–neck region (p = 0.03). The purchase time of hearing aids for those who answered “yes” to this question was 8.29 years after they were diagnosed, whereas the hearing aid purchase time for those who answered “no” was 2.78 years (Table 4).
In our study, the relationship between the degree of hearing loss and the duration of hearing aid purchase was analyzed. In our questionnaire, the degree of hearing loss was classified as normal, slight, mild, moderate, moderately severe, severe, or profound. No significant difference was found as a result of statistical analyses between the degree of hearing loss and the duration of hearing aid purchase (p > 0.05).
DISCUSSION
It has been determined in some studies that untreated and progressive hearing loss negatively affects the quality of life by causing cognitive, social, and emotional problems (Mulrow et al, 1990; Strawbridge et al, 2000). As a means to lower the occurrence of these problems, hearing loss should be treated with the appropriate method. Hearing aids are one of the most commonly used intervention methods in the treatment of hearing loss (Chisolm et al, 2007; Chao and Chen, 2008).
Although hearing aids can enhance auditory function in individuals with hearing loss, the rate of their adoption is still below the desired level (Moon et al, 2015). In studies, it has been determined that most individuals with hearing loss do not want to use hearing aids even though they are in the group that would benefit from hearing aids (Smeeth et al, 2002; Smits et al, 2006). Based on the literature review, some studies reveal the reasons individuals with hearing loss do not buy hearing aids. Moon et al pointed out that various factors affect the decision of individuals with hearing loss when it comes to acquiring hearing aids. These factors include the expense of hearing aids, maintenance costs, and social stigma. Additionally, misconceptions regarding hearing aids, inaccurate information about device usage and maintenance, and considerations influenced by the opinions of friends and family also play a significant role (Moon et al, 2015). Our study partially supports the results of this literature. Based on the results of our study, we found that the influence of friends’ and family’s opinions, fear of social exclusion, and the stigma associated with hearing loss influence the individual’s decision to purchase hearing aids. The reaction of the patients’ social environment to the decision to purchase hearing aids was assessed based on the patients’ personal perceptions. However, in some cases, this also included concrete reactions from the individuals’ social circles. For example, one patient’s relative openly told the patient that buying a hearing aid was a bad idea. The responses categorized as poor, average, good, and excellent in our survey reflect the concrete reactions patients received from their environment. As a result of the survey, it was found that people who reported receiving a “poor” reaction took significantly longer to purchase a hearing aid (p < 0.01). This indicates that the reaction of the environment can directly affect the hearing aid purchase process.
According to Cho et al (2022), the level of education significantly influences the acquisition of hearing aids, as found in their study. According to the results of their study, the rate of hearing aid adoption was 1.86 times higher among individuals with a secondary school education or below compared to those with a high school education. The reason is that individuals with low education levels usually have a low income level, and thus they receive 100 percent hearing aid subsidies (Cho et al, 2022). Our study also supports this result. In our study, we found a statistically significant difference between high school graduates and primary school graduates in terms of purchasing hearing aids. According to our study, high school graduates purchase hearing aids on average 4.31 years after diagnosis, whereas primary school graduates purchase hearing aids in 0.73 years. As the education level of individuals increases, their social status generally increases. Patients may have cosmetic concerns due to their social status. Due to the possibility that this situation may cause problems with the social environment of the patients, it is thought that individuals with a higher education level purchase hearing aids later than people with a lower education level. Because there were not an equal number of participants from each education group, a statistically significant difference was found only between primary and high school graduates.
According to MarkeTrak 2022 data, people have said that they felt embarrassed and disabled because of the appearance of the hearing aid, but now they are less embarrassed (Powers and Carr, 2022). In studies, it has been reported that people avoid using hearing aids due to cosmetic concerns; therefore, it has been observed that many individuals do not purchase hearing aids (Franks and Beckmann, 1985; Garstecki and Erler, 1998; Meister et al, 2008). Although our study found that factors such as the influence of friends’ and family’s opinions, fear of social exclusion, and the stigma associated with hearing loss influence individuals’ decisions to purchase hearing aids, interestingly we did not observe a significant impact of the appearance of hearing aids and cosmetic concerns on the purchase decision. This lack of significance may suggest a certain level of normalization of hearing aids within society, akin to the widespread acceptance of glasses.
To our knowledge, previous research has not investigated whether surgery in the ear or head–neck region affects the process of purchasing hearing aids. According to the results of our study, we determined that there was a statistically significant difference between ear or head–neck surgery and the duration of purchasing hearing aids. Individuals who have had surgery on their ear or head and neck region may worry that using electronic devices such as hearing aids could cause harm to the operated area. As a result, they may postpone using hearing aids. It is important to note that this analysis does not consider the duration of medical treatment received prior to obtaining hearing aids.
Jorgensen and Novak investigated the adoption rates of hearing aids by people. As a result of the study, they determined that the adoption rate of hearing aids differs according to age. They found that individuals aged 65 and over adopt hearing aids more easily than individuals aged 35–64 years, and individuals with moderate hearing loss purchase more hearing aids than individuals with mild or severe hearing loss (Jorgensen and Novak, 2020). Our study also supports the results of this literature. In our study, we observed that individuals aged 60–65 and over bought hearing aids more than the younger population. We also observed that individuals with moderate hearing loss tend to buy hearing aids more. The higher incidence of presbycusis in individuals over 65 years of age may cause this result. Because patients may also have neural involvement due to presbycusis, there may be problems in understanding speech. Therefore, it is thought that individuals over the age of 65 years tend to buy hearing aids more than those in other age groups.
MarkeTrak’s 2022 data show a gradual decrease in the time between noticing hearing loss and purchasing hearing aids for the first time over the past three years (2019–2022) (Powers and Carr, 2022). Previous studies have reported this period as 6 years, but MarkeTrak’s findings indicate a decrease to 4 years (Powers and Rogin, 2019).They suggested that the reasons for this decrease could be improvements in technology and increased insurance coverage (Powers and Carr, 2022). Additionally, they suggested that educational efforts and media coverage regarding the link between untreated hearing loss and comorbidities, such as social isolation, depression, cognitive decline, and dementia, might have contributed to this decrease (Abrams, 2017; Bray, 2019; Beck and Harvey, 2021). In our study, we found that the average time between the date of diagnosis and the date of purchasing hearing aids was 3 years. Furthermore, individuals typically seek hearing testing when hearing loss affects their daily communication, which may lead to additional testing and further extend the time to access hearing aids. However, it is important to note that our analysis did not include the time patients spent receiving medical treatment before acquiring hearing aids, which could potentially cause delays in obtaining hearing aids. This aspect is crucial for a comprehensive understanding of our results.
CONCLUSIONS
According to the results of our study, the factors affecting the hearing aid purchase process are level of education, the perspective of the social circle to the hearing aid, possibility of breakdown of social relationships, and fear of being excluded from society. In addition, we obtained an important result regarding an uninvestigated topic in previous studies: Ear or head and neck surgery also affect the purchase process of hearing aids.
In a recent study, the time between the date of diagnosis of individuals with hearing loss and the date of purchase of hearing aids was found to be 4 years (Powers and Carr, 2022). On the other hand, in our study we found the time between the date of diagnosis of hearing loss and the date of purchase of hearing aids to be 3 years.
In conclusion, it would be beneficial to try to eliminate the reasons for delaying the purchase of hearing aids by individuals with hearing loss, so they might suffer less damage from the negative effects of hearing loss.
Limitations of the Study
This study has several limitations. First, the small sample size may limit the generalizability of the findings. Second, certain factors examined in this study, such as participants’ education level and the reaction of their social environment, were found to influence their lived experiences and decision-making processes, particularly in relation to purchasing hearing aids. Because some of these factors may be age-related, the age range of participants could have affected the results. Third, this study focused on the time to purchase hearing aids after the diagnosis of hearing loss. However, no data were collected on the time taken for a hearing test before the diagnosis. Finally, the groups were not equally represented in terms of education level and type and degree of hearing loss, which may have affected the timing of hearing aid purchases.
Acknowledgments
The authors thank all participants and supporters of this research, as well as the esteemed academics and institutions that facilitated the distribution of the questionnaires. They extend special recognition to Rümeysa Yaşar, who contributed to the formulation of questions and the administration of the questionnaire.
Abbreviations
- HL
hearing loss
- Hz
hertz
- IMU
Istanbul Medipol University
- SD
standard deviation
Footnotes
Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.
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