Indian Journal of Otology

: 2016  |  Volume : 22  |  Issue : 1  |  Page : 19--23

Reasons for nonacceptance of hearing aid in older adults

G Archana, Y Krishna, Ruth Shiny 
 Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India

Correspondence Address:
G Archana
Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka


Introduction: Hearing aids (HAs) are the electro acoustic device, developed for individuals with hearing loss. Aim: The present study was focused on analyzing the possible reasons for nonacceptance of the HAs in older adults.Methodology: A cross-sectional study was conducted in which 100 participants were enrolled in the study. Self-reported questionnaire was adapted to regional language Kannada in the first phase of the study. Adapted questionnaire was administered in individual with hearing loss in the second phase. Descriptive statistics was used for compiling the result of the study. Results: The result revealed that attitude-related factor had the highest mean score followed by device-related factor, personal, and financial-related factors. Conclusion: In developing countries such as India, still the stigma toward hearing loss and HAs are dominating these individuals and rejects them in procuring the HA.

How to cite this article:
Archana G, Krishna Y, Shiny R. Reasons for nonacceptance of hearing aid in older adults.Indian J Otol 2016;22:19-23

How to cite this URL:
Archana G, Krishna Y, Shiny R. Reasons for nonacceptance of hearing aid in older adults. Indian J Otol [serial online] 2016 [cited 2021 May 14 ];22:19-23
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Hearing is an important part of our lives. It is essential for normal speech and language development. Hearing loss refers to a diminished ability to hear sounds like other people. Hearing loss can be divided into conductive, sensorineural, and mixed hearing loss. According to the 2005 estimates of the WHO, 278 million people have disabling hearing impairment. The prevalence of deafness in Southeast Asia ranges from 4.6% to 8.8%. In India, 63 million people (6.3%) suffer from significant auditory loss. Hearing loss acquired in adult life can have a serious impact on the quality of life. This results in deficits of speech perception and communication breakdown. It also has a strong negative impact on social interaction of the individual. To overcome this deficit, individual with hearing loss should undergo aural rehabilitation (AR) as early as possible.

AR is the process of identifying and diagnosing a hearing loss, providing different types of therapies to clients who are hard of hearing and implementing different amplification devices to aid the client's hearing abilities.[1] AR includes specific procedures in which each therapy and amplification device has its goal in habilitation or rehabilitation of persons to overcome the Hearing difficulty (disability) caused by a hearing impairment or deafness. Providing a hearing aid (HA) is a basic step in AR. HA is an electro acoustic device which is designed to amplify sound for the wearer, usually with the aim of making speech more intelligible, and to correct impaired hearing as measured by audiometry.[2] The main function of the HA is to provide audibility of a wide range of sounds without making them uncomfortable loud to the HA user. HAs are of greatest benefit for those with moderate hearing loss. In cases of severe and profound hearing loss, HAs are necessary to be able to comprehend speech. However, studies are insufficient to show the benefits of HAs in individuals with profound hearing impairment. They have also suggested that bilateral fitting is superior to unilateral when both ears are impaired. Two HAs can provide better speech comprehension than single HA.

Candidacy criterion for HA depends on the degree, type, and nature of hearing loss. Individuals with hearing loss, who fits the candidacy criteria for HAs, still do not prefer to use amplification device. The literature reveals that cost and social stigma are major factors that hamper the use of amplification device. Currently, we are in the advanced era in the field of HA. Despite this, only 20–30% individuals with hearing loss use HAs in developed countries.[3] Even with the optimum fit of HAs, individuals are not satisfied with their HA performance, especially in difficult to hearing situation.

A survey conducted on geriatrics population aged 65 and above reported 35 possible reasons for rejection of HA use. The foremost reasons for nonuse of HAs included cost, calling attention to the handicap, dealer practices, concern about the nature of the amplified sound, difficulty in manipulating HA controls, and not knowing where to obtain HAs.[4]

Need of the study

In the advanced era of HA technology issues, limitations of the HA are being considered. Digital signal processing technology is being incorporated for improvisation of HA technology, especially to overcome noisy situations. Still the ratio between HA users and individual with hearing loss are not similar. On systematic review [3] on the reasons for nonusage of HAs suggests there is a lack of consistency and robustness in the way that usage of HA was assessed. Moreover, to the Indian scenario, there is limited literature available on the factors which obstruct the use of HAs. As India is a multicultural nation, the attitude toward hearing loss and HA vary significantly from another nation. Socioeconomic status also has a greater impact on procuring and maintenance of HA in developing country. Thus, the present study was considered with the aim of finding out the possible factors for nonacceptance of HA.


The present study incorporated cross-sectional study design. One hundred individuals participated in the study. Following inclusion and exclusion criteria were considered for recruiting the participants.

Inclusion criteria

Kannada as a primary language Age range - 41–65 years Degree of hearing loss – bilateral moderate hearing loss Monaural or binaural HA fitting.

Exclusion criteria

Participants having a history of middle ear infection Associated conditions.


The present study was carried out in two phases.

First phase: Adaptation of questionnaire to regional language Kannada

Internationally standardized questionnaire [3] was adopted to the regional language Kannada. As an initial step, the author's consent was taken to use the questionnaire in our study. The test constitutes of 51 reasons for nonadoption of HA in older adults under seven parameters. These parameters include person, device, appearance, financial, health care, attitude, and awareness-related factor.

For the adaptation of the above-mentioned questionnaire, initially, forward translation was carried out by an individual who was proficient in English and Kannada followed by backward translation was done from Kannada to English. Similarities and dissimilarities in the translation were considered along with the semantic and syntactic structure in Kannada with that of English. Translated questionnaire was presented to five audiologists and five HA users. For content validation, based on their input, further correction was carried out. Based on the inputs of audiologist, two were modified in the present study. These include questions related to dispenser practice and appearance of HA. One open-ended question was also included in the questionnaire to gather information on any other reasons which is not listed in the set of questionnaire.

Second phase: Administration of adopted questionnaire for clinical population

In the second phase of the study, adopted questionnaire was administered on hundred individuals with hearing loss, who use HAs. Before answering the questions, participants indicated their gender, age and geographical location, and details of hearing loss and HA were also collected from the patient report. Each participant was requested to complete the questionnaire by marking “yes” (score 2), “no” (score 0), and “sometimes” (score 1). These scores represent common reasons for nonacceptance of HAs. For open-ended questions, written/oral responses were considered.

Data analysis

Statistical Package for the Social Sciences version 20 (Armonk, NY: IBM Corp) was used for statistical analysis. For each parameter, the frequency was calculated using descriptive statistics and for comparison of mean between genders, independent t-test was used.


The reasons for nonusage of HA was divided into seven factors which include attitude and awareness, situational factors, psychosocial factors, personal factors, device factors, appearance, and health care professional factor. Each item of the questionnaire was analyzed using the descriptive statistics to find out the common reasons for nonacceptance of HA. The raw scores were converted to percentile scores and tabulated in [Table 1].{Table 1}

[Table 1] depicts the frequency of occurrence of reasons for rejecting the HA. On individual item analysis, items in the category of personal, device, and attitude- and awareness-related factor had a higher percentile scores. Especially in the personal factors, “I don't think aids are needed” had 64%. In device factor, “it's inconvenient to wear the HA had 57%. In financial factor, “HAs are expensive” had 53%. In attitude and awareness factor, “hearing impairment is common for elderly population” had 66% followed by “friends are ashamed of wearing a HA” had 55%, and “sign of aging” had 53%.

[Table 2] and [Figure 1] represents factor-based analyses. Mean and standard deviation (SD) were taken with respect to all seven parameters. According to factor-based analysis, attitude-related factor had the highest mean score (12.10, SD = 3.94), followed by device-related (9.48, SD = 3.58), personal factor (8.24, SD = 3.87), and financial-related factor (4.10, SD = 1.91).{Table 2}{Figure 1}

Comparison of mean scores with respect to gender

The independent test was used to compare between genders with respect to all seven parameters. The result shows that there was no significant difference between males and females in any of the factors considered [Table 3]. Even though there was no statistical difference, most of the female responders reported that appearance factor was the most common reason for rejection of the aid. For male responders, the attitude toward the HA like I don't think aids are needed was the common reason for nonaccepting the aid.{Table 3}

Few participants were responding to an open-ended question. One of the participants reported that “pain after wearing a HA” is also one of the reasons for nonusage of HA. Others mentioned that in a noisy situation, wearing a HA did not result in any improvement in speech perception.


The aim of the study was to highlight the potential reasons for nonusage of HAs among Indian adults. The result of the study revealed some interesting findings.

According to factor-based analysis, the reasons for nonusage of HA were from the attitude-related factor, followed by device-related, personal factor, and financial-related factor.

In a developing country such as India, stigma toward hearing loss and HAs is relatively high. Individual with hearing loss assume that wearing a HA is a sign of weakness/handicap. They also have a view that family members and friends do not accept them if they wear a HA. This is clearly depicted in the present study wherein responder of the present study reported that attitude-related factors are the reasons for nonusage of HA.[4] Literature also reported that stigma toward HA is the common reason for rejecting the HAs.

Followed by attitude-related factor, device-related factor had more reasons for nonacceptance of HA. This finding of the study supported by literature [3] where they reported that individuals who chose not to purchase HAs were more likely to report that HAs were inconvenient to wear. According to the literature,[5] the reasons for nonusage of HAs are mainly due to difficulties faced with a noisy situation with HA and poor comfort and sound quality of the aids. Even though there is an improvement in technology such as most of the cell phones are compatible with HAs, still there are some issues related to it, such as it creates an echo while talking and also individuals will not be able to use it in noisy situations.[6] Personal factors such as, “I don't think HA is needed” and awareness related to HA also had high percentile score. The individual considers that hearing loss is a normal aspect of aging, so procuring HA is not a benefit to them. Participants of the study also revealed that they are not aware of the different types of HA and they are worried of wrong selection of HA. This reason was supported by literature [3] that the most common reason for nonadoption of a HA was that these participants considered their hearing impairment not severe enough to warrant using a HA. Other common reasons included a belief that hearing loss is not a severe condition that can be managed without HA and better ear provided adequate audition.

Cost is one of the major factors in developing country such as India, so many participants of the study reported financial issue as a common factor for rejecting a HA; this finding was supported by literature [3] which reported that HAs were not affordable. The cost of HAs was reported as a barrier to use amplification device.[7] In the present study, factors such as health care, psychosocial, and appearance-related factor were not reported as common reasons for nonusage of HAs. However, literature supports that these factors are also one of the main predictors in the rejection of HAs. HAs are quite small and fiddly devices, so the individual tend to lose it.[8] Another study reported the most common reason for rejection was the insufficient information given by the dispenser and the cosmetic appearance.[9]

For the open-ended question, one of the participants reported that “pain after wearing a HA” is also one of the reasons for nonusage of HA. Others mentioned that in a noisy situation wearing a HA did not result in any improvement in speech perception. This finding was supported by literature [10] where they have reported individuals rejected the HA because of unbearable pain after wearing it.

Comparison of mean scores with respect to gender

The comparison of mean scores between genders revealed that there was no substantial difference between males and females in any of the components weighed. Even though there was no statistical difference, most of the female responders reported that appearance factor was the most usual cause for rejection of the aid. This finding was supported by literature;[3] they reported that younger women had more stigma toward HA due to its appearance. For male responders, the attitude toward the HA (I don't think HA is needed) was the common reason for nonaccepting the aid which was contraindicated by [11] wherein they reported males were more likely to report needing a HA than were the females. Overall gender was reported to be a modifying variable for all other factors, while prescribing the HA, audiologist has to look into this factor for a better prognosis.


To conclude, the common reasons for nonacceptance of HAs are attitude and awareness-related factor followed by device-related and personal factor. Misconceptions about HAs may also hinder potential HA users from gaining possible benefits. Audiologist has to overcome these factors to increase the rate of HA usage.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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