Hearing aids : wanting to understand

For decades, hearing care professionals and hearing aid companies have been surveying patients of hearing aid age and have come to the stark conclusion that approximately 13% of hearing impaired people wear a hearing aid. In other words, more than 80% of patients, in good times and bad, give up the comfort and quality of life that a hearing aid could bring them.

The discomfort invoked by the entourage of these patients or by the patient himself, particularly in a noisy environment, is however early (around sixty) and generally admitted. However, the average age of hearing aid fitting in France is 71 years old, i.e. almost 7 years after the first hearing problems appeared.

Why do so many patients give up on hearing aids?
Why do they get hearing aids so late in life?
What are the wishes of these patients, who prefer to make daily efforts to understand, rather than to be fitted with a hearing aid and thus benefit from real listening comfort?
Have their grievances, desires and wishes been listened to?

If we exclude young hearing impaired people, for whom wearing a hearing aid is unfortunately an obligation and not a choice to live better or to be better in company, presbycusians are necessarily demanding because they can do without a hearing aid, even if they are less comfortable without one.

Today, 95% of the indications for hearing aids from ENT doctors are due to presbycusis. This natural loss of hearing, linked to the aging of the auditory system, concerns 80% of hearing aids fitted.

The price and the low coverage of hearing aids

This is an important argument, which weighs considerably in the arbitration of choices and may explain why this expense is postponed until later (7 years on average, i.e. around 71 years of age), when the hearing discomfort becomes really embarrassing. According to the French Competition Authority :

In France, the price of hearing aids is freely set by the hearing aid specialist whose margin is not regulated (…). This price, which includes the supply of the device and the fitting and follow-up services, ranges from 900€ per ear for the entry-level to 2000€ for the top-of-the-line (…). All ranges taken together, the average bill amounts to 1500€ per ear, or 3000€ for a binaural fitting (80% of patients). (…) 80% of hearing aids sold are of medium or high range (…). Unlike the optical sector, where the reimbursement of complementary health insurance is on average 58% for simple glasses, the remaining cost is particularly high in the hearing sector.

Indeed, the Health Insurance participates in the financing up to 120€ per hearing aid and the complementary organizations between 80€ and 350€ on average. The remaining cost for the patient is therefore about 1000€ per ear, that is to say a private expense of 2000€ for a binaural equipment. This remaining cost corresponds to 66% of the price of the hearing aid.

Thus, the high level of prices and the very modest coverage of the Health Insurance as well as the mutual insurance companies appear as an obstacle to access to care.

Aesthetics

This is also an important argument that is often made by patients.

I don’t want to look old.
I am embarrassed to wear my hearing aids in public.

However, glasses have always been perfectly accepted and are very visible ! But it is true that a pair of glasses can give a personality to the face, which is rarely the case for a BTE and the idea of handicap remains anchored in the minds of patients. Patients who, at sixty years old, are still young and consider themselves young !

The results of the HUMANIS 2013 barometer confirm this :

While the actual average age is 57, respondents report having the same interests as 44-year-olds (on average) and behave like 46-year-olds. On the other hand, the physical appearance is closer to the real one (almost 52 years old).

In other words, a sixty year old person considers himself closer, in his interests, his behavior and physically – to a lesser extent, than a person 10 years younger.
Their aesthetic criteria concerning hearing aids are, therefore, perfectly legitimate, how can we not understand them ?

And how can we explain, then, that 80% of hearing aids fitted by hearing aid practitioners today are…BTEs?Several studies have highlighted the advantages of in-the-ear hearing aids and the greater satisfaction that these hearing aids generate for the patient, compared to BTE hearing aids. According to the Starkey laboratory, a leading specialist in hearing aids :

The CIC – Completely In the Canal – is the reference for near-invisible hearing instruments.

The following is a non-exhaustive list of the benefits of an ITE hearing aid :

• Increased patient satisfaction ;
• Decreased amplification of wind noise ;
• Improvement of the localization of sounds in space (the device uses the ear, contrary to the model contour of ear on which the microphone is located behind the pavilion of the ear) ;
• Immediate sound reproduction (tympanic proximity) ;
• The decision between the in-the-ear and the behind-the-ear hearing aids must be made by the patient in all cases. We talked about this in this article, which also details the major differences between these 2 types of hearing aids.

Non-satisfaction with hearing aids among relatives who have been fitted

When faced with a person who is reluctant to get a hearing aid, the non-satisfaction of a relative who has already been fitted with a hearing aid is an argument of choice for refusing to get a hearing aid or putting it off until later.
And, indeed, when a person spends 3000€ to “find their hearing” they seem entitled to expect a “miracle”.

It is worth remembering that there is a difference between the loss of vision linked to aging (presbyopia) and the loss of hearing also linked to aging (presbycusis).

In the case of presbyopia, the optic nerve is not affected: thus, with an adapted pair of glasses, the patient regains satisfactory vision. In the case of presbycusis, the hair cells of the ear, i.e. the auditory nerve, is destroyed. Unfortunately, these cells do not grow back. The hearing aids offered today, whatever their price, are sound amplifiers. It is important to explain this to the patient and to explain that a period of adaptation may be necessary in the face of certain “sometimes metallic” sounds or “a very unpleasant resonance”.

Other arguments

A lot of questions come up, if you bother to listen to them.

Do I need to change the batteries ? How long do the batteries last ?
Can I wear the device only when I need it ?

Technology is advancing. Some devices run on batteries and others are rechargeable.
Both have their advantages and disadvantages and the choice between one or the other should not be reduced to this technology. A battery lasts between 3 days and a week, depending on the use made of the device. A rechargeable device must be recharged every day. And the life of the battery decreases over time (loss of 10% to 20% of autonomy in the first 6 to 8 months). In addition, the cost of the charger is often equal to or greater than the cost of a year’s worth of batteries.

As for the wearing of the hearing aid, it must be done according to the needs of the person being fitted and it is better to wear the hearing aid early on – which contributes to getting the patient used to the hearing aid – than not to wear it at all.

There is one essential point that ENTs and hearing care professionals have completely bypassed: the age of the patient.

Unfortunately, ENTs often offer hearing aids to patients who come to them because they have poor hearing, referred by their family members (42% of cases), coming on their own or referred by hearing aid practitioners. The findings are often severe and the hearing aid is necessary, although not always accepted and the results are often disappointing.

When the hearing loss is discrete in a younger subject, around 30 to 35 dB on the high frequencies (presbycusis), the discomfort is nevertheless there, minimal, but often the ENT does not propose a hearing aid to these patients. These habits must change. It is at the very beginning of presbycusis that it is recommended to propose the wearing of one or two devices according to the financial possibilities of each person.

Why is this?
To meet the demands of these seniors who are still working, but who are sometimes embarrassed in meetings and who do not dare to admit it. The Sainte-Anne Hospital considers that 10% of working people suffer from hearing problems on a daily basis, which impacts their well-being in the workplace as well as their productivity.

Today’s increasingly noisy world is “manufacturing” these young, active and demanding seniors.
The current in-ear monitors, which are accessible in price, meet the requirements of cost, discretion and occasional wear.

This element is fundamental and yet totally ignored.

For example, a play, a meeting with friends in a noisy environment or a professional meeting are all places where they can, at that moment only, insert their discreet amplifier without the slightest discomfort, as if they were using, for example, theater binoculars to better appreciate the actors’ performance.

This early, occasional and invisible hearing aid will make the patient feel comfortable, will make him accept an aid that will not be seen as a handicap and will allow him to better apprehend, years later, if the need arises, a more powerful aid that can be worn permanently.

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