What are the costs and
disadvantages of non-regular use of hearing aids?
Hickson et al.
(2014)suggested that successful HA use requires a minimum of one hour of daily use in
order to provide even moderate benefits. In the recent NHS survey, 27% of new
patients failed to meet these criteria (Aazh et al. 2015). 500,000 new patients are fitted with HAs annually
across the NHS (Davis et al. 2007).
The average cost is £350 per person (Department of
Therefore, there are approximately 135,000 unsuccessful users annually,
corresponding to £47,250,000 waste of NHS funding per year.
This is a
growing concern as it is estimated that there will be about 14.5 million people
with hearing impairment by 2031 in the UK, and according to the World Health
Organisation hearing loss will be in the top ten disease burdens in the UK by
2030 (Action on Hearing Loss 2011).
Non-use or infrequent use of HAs not
only wastes resources but also has other implications: (1) non-use of HAs has
been associated with increased risk of “loneliness” among hearing impaired
individuals (Pronk et al. 2013); (2) failure to communicate adequately may
adversely affect the non-user’s occupational, educational, leisure, and social
activities (Hickson &
(3) partners and family of the non-user may experience activity limitation and
participation restriction as a result of their partner’s communication
difficulties (Scarinci et al.
(4) non-users may not benefit from the learning and reorganization of the
auditory cortex associated with consistent hearing-aid use (Hamilton &
and (5) non–users need to increase their attention, concentration and
“listening effort” in order to compensate for their lack of hearing making them
more susceptible to mental fatigue in demanding listening situations (Hornsby 2013).
Previous studies with regard to improving hearing
Dr. Aazh’s pioneering studies published
in the International Journal of Audiology and the Journal of Phonetics and
Audiology were the first trials which offered scientific evidence on the impact
of Motivational Interviewing (MI) on hearing aid use (Aazh 2016a; Aazh
researchers also published on this topic soon after (Zarenoe et al.
Prior to these studies there were no
proven intervention that can successfully improve hearing aid (HA) use in the
sub-population of patients with hearing impairment who do not use their HAs
consistently. Audiologists typically advise patients to use their HAs
consistently throughout the day. This seems to work for majority of patients
but not for this sub-population.
Barker et al. (2014) conducted a Cochrane review on interventions
designed to improve HA use and outcome. They included 32 studies. The
interventions were mainly focused on education and communication strategies and
typically involved 4-6 sessions over a period of 2-3 months (total contact time
of 6-10 hours) delivered either in group or distance learning.
Barker et al. (2014) did not find any evidence of statistically
significant effect on HA use or on quality of life measures. Use of HAs often
requires a change in behaviour which is a complex process. Simply advising
people may not help them to change (Rollnick et al.
In a more recent systematic review on
interventions designed to improve HA use and outcome., Aazh and Moore
(2017)reported that there is limited evidence to support efficacy of educational
rehabilitative audiology programmes with respect to HA use and quality of life.
They suggested that there is a need for studies investigating the efficacy of
interventions based on patient-centred counselling and empathetic listening as
opposed to or in addition to educational interventions.
Aazh, H. (2016a).
Feasibility of conducting a randomised controlled trial to evaluate the effect of motivational interviewing on
hearing-aid use Int J Audiol, 55, 149-156.
Aazh, H. (2016b). Patients' experience of motivational interviewing
for hearing aid use: A qualitative study embedded within a pilot randomised
controlled trial. J Phonet and Audiol,
Aazh, H., & Moore, B. C. J. (2017). Audiological rehabilitation
for facilitating hearing aid use: a review. J
Am Acad Audiol, 28, 248-260.
Aazh, H., Prasher, D., Nanchahal, K., et al. (2015). Hearing-aid use
and its determinants in the UK National Health Service: A cross-sectional study
at the Royal Surrey County Hospital. Int
J Audiol, 54, 152-161.
Action on Hearing Loss (2011). Facts
and figures on deafness and tinnitus. London:
Barker, F., Mackenzie, E., Elliott, L., et al. (2014). Interventions
to improve hearing aid use in adult auditory rehabilitation. Cochrane Database Syst Rev, 7, Cd010342.
Davis, A., Smith, P., Ferguson, M., et al. (2007). Acceptability,
benefit and costs of early screening for hearing disability: a study of
potential screening tests and models. Health
Technol Assess, 11, 1-294.
Department of Health (2013). National tariff information workbook
2014/15. In London, UK:
Hamilton, A. M., & Munro, K. J. (2010). Uncomfortable loudness
levels in experienced unilateral and bilateral hearing aid users: evidence of
adaptive plasticity following asymmetrical sensory input? Int J Audiol, 49, 667-71.
Hickson, L., Meyer, C., Lovelock, K., et al. (2014). Factors
associated with success with hearing aids in older adults. Int J Audiol, 53 Suppl 1,
Hickson, L., & Scarinci, N. (2007). Older adults with acquired
hearing impairment: applying the ICF in rehabilitation. Semin Speech Lang, 28,
Hornsby, B. W. (2013). The effects of hearing aid use on listening
effort and mental fatigue associated with sustained speech processing demands. Ear Hear, 34, 523-34.
Pronk, M., Deeg, D. J., & Kramer, S. E. (2013). Hearing status
in older persons: A significant determinant of depression and loneliness?
Results from the Longitudinal Aging Study Amsterdam. Am J Audiol, 22, 316-320.
Rollnick, S., Butler, C. C., McCambridge, J., et al. (2005).
Consultations about changing behaviour. BMJ,
Scarinci, N., Worrall, L., & Hickson, L. (2012). Factors
associated with third-party disability in spouses of older people with hearing
impairment. Ear Hear, 33, 698-708.
Zarenoe, R., Soderlund, L. L., Andersson, G., et al. (2016).
Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients
with Tinnitus: A Randomized Controlled Pilot Trial. Journal of American Academy of Audiology, 27, 669-676.