Why do people fitted with hearing aids not wear them?

Figures & data

Figure 1. Flow diagram to illustrate the review process.

Table 1. Key characteristics of included articles (in date order).

Authors	Country	Total sample size	Age (years)	Gender	Reasons for not using the hearing aid	Number/percentage of people
1. Kochkin (2000)	USA	348 non-users	Unknown	Unknown	Poor benefit from HA Background noise Fit and comfort Negative side effects Price of repairs Don't need help HA broken Sound quality is poor Unspecified – do not wear Volume control adjustment Whistling and feedback Nuisance/hassle/annoying Poor service from dispenser High frequency loss not helped Stigma of wearing hearing aids Work in limited situations Profound hearing loss not helped Too loud Battery life too short Forget to use Does not work on phone Monaural aids inadequate Oversold expectations Have tinnitus Family pressure led to purchase Manual dexterity Rare social user Feel like ear plugs Poor directivity Gain is too low Cannot find them Ear wax problem	103 (29.6%) 88 (25.3%) 65 (18.7%) 38 (10.9%) 36 (10.3%) 28 (8%) 27 (7.8%) 22 (6.3%) 21 (6%) 17 (4.9%) 15 (4.3%) 14 (4%) 11 (3.2%) 10 (2.9%) 10 (2.9%) 9 (2.6%) 9 (2.6%) 8 (2.3%) 7 (2%) 4 (1.1%) 4 (1.1%) 3 (0.9%) 3 (0.9%) 3 (0.9%) 3 (0.9%) 2 (0.6%) 2 (0.6%) 1 (0.3%) 1 (0.3%) 1 (0.3%) 1 (0.3%) 1 (0.3%)
2. Tomita et al (2001)	USA	227 with hearing impairment (59 of those had a hearing aid)^1	Mean 76 (SD = 8.7)	71.4% Female	Does not help Makes a whistling or buzzing sound Picks up too much background noise Bothersome/nuisance Makes voice sound funny Uncomfortable Batteries too expensive Difficult to replace batteries/not sure when to replace Volume control adjustment difficult Difficult putting it in Do not like appearance Device lost Device needs repair Devise requires adjustment Devise is broken Can hear adequately without Embarrassed to use it	8 (13.6%) 4 (6.8%) 13 (22%) 3 (5.1%) 1 (1.7%) 5 (8.5%) 1 (1.7%) 4 (6.8%) 4 (6.8%) 5 (8.5%) 1 (1.7%) 2 (3.4%) 3 (5.1%) 3 (5.1%) 1 (1.7%) 3 (5.1%) 1 (1.7%)
3. Gianopoulos et al (2002)	UK	116 fitted with HA (66 not using HA at follow up, 47 gave reasons)	50–65 (mean unknown)	Unknown	HA did not improve their hearing Other (cosmetic concerns; handling difficulties; irritation in the ear; and feedback)	8 (17%) 39 (83%)
4. Cohen-Mansfield & Taylor (2004)	USA	279 (33 wear HA)^2	Unknown	Unknown	HA not working properly/ broken Device does not fit well Too hard to put in/ inconvenient to use Device requiring service Too expensive to fix/ replace Need help putting device on Need help taking device off Need help changing batteries	12 (36%) 7 (21%) 14 (42%) 2 (6%) 1 (3%) 14 (43%) 4 (13%) 20 (62%)
5. Lupsakko et al (2005)	Finland	601 (100 people had been fitted with HA; 24 (25%) were non-users).	Mean 81.3	74.1% Female	No need/or no benefit for a HA Too difficult to use HA broken Costs too much to replace batteries HA lost Cannot use due to external otitis media No reasons documented	10 (42%) 5 (21%) 4 (17%) 1 (4%) 1 (4%) 1 (4%) 2 (8%)
6. Vuorialho et al (2006)	Finland	76 (all fitted with a HA 6 months prior; 32 were rare / occasional use of which four were non-users).	Mean 73.8	51.3% Female	No opportunity for conversation Background noise amplified by HA Difficulties inserting ear mould Ear mould unsuitable Difficult to replace battery Acoustic feedback Difficulties in hearing despite the HA	20 (62.5%) 15 (46.9%) 9 (28.1%) 9 (28.1%) 3 (4.1%) 2 (9.4%) 5 (15.6%)
7. Bertoli et al (2009)	Switzerland	8707; (1086 occasional use or never)	18+	Unknown	Noisy/disturbing situations No perceived need No/poor perceived benefit Unpleasant side effects (e.g. rashes, itching, pain) Poor sound quality Only used for specific situations, e.g. concerts, church, family Difficulties with management Poor fit/comfort Other reasons	565 (52%) 257 (23.7%) 254 (23.4%) 201 (18.5%) 138 (12.7%) 126 (11.6%) 102 (9.4%) 97 (8.9%) 195 (18.0%)
8. Hartley et al (2010)	Australia	2956 (322 were HA owners; 78 (24%) were non-users)	49–99 Mean 67.4	Unknown	Does not help Too noisy Uncomfortable HA whistles Unable to put it in Batteries too expensive Not working	23 (30%) 22 (28%) 22 (28%) 7 (8.4%) 2 (2.8%) 1 (1.4%) 1 (1.4%)
9. Gopinath et al (2011)	Australia	2015 (no. of HA non-users unknown)	55+ (mean unknown)	Unknown	It does not help It was too uncomfortable They were unable to put it in	5.4%^3 5.1% 1.4%
10. Oberg et al (2012)	Sweden	346 responded to items relating to hearing difficulties. 124 had a HA; 13 (12%) were non-users.	85+	57% Female	Handling problems It is uncomfortable Disappointed with HA Hearing is not bad enough Hear well without HA	4 (30.8%) 2 (15.4%) 4 (30.8%) 1 (7.7%) 2 (15.4%)

¹Of the 59, it is not clear how many were non-users. All were included in the reasons for non-use. ²It is not clear how many were non-users but all 33 were asked for reasons for non-use. ³Only the percentage was reported.

Table 2. Reasons for non-use of hearing aids as identified in all studies.

Reasons for non-use of hearing aids	Total number of studies, and percentage of participants reporting yes	References
Hearing aid value/speech clarity	7
• Noisy situations/background noise	5 (52%; 46.9%; 28%; 25.3%; 22%)	7; 6; 8; 1; 2
• Does not help/poor benefit	7 (30%; 29.6%; 23.4%; 17%; 15.6%)	8; 1; 7; 3; 6; 2; 9
• Poor sound quality	2 (12.7%; 6.3%)	7;1
• Not suitable for type of hearing loss	1 (5.5%)	1
Fit and comfort of the hearing aid	9 papers
• Need help putting HA in	5 (42%; 28.1%; 8.5%; 2.8%; 1.4%)	4; 6; 2; 8; 9
• Need help taking HA off	1 (13%)	4
• Uncomfortable	8 (28.1%; 28%; 21%; 18.7%; 15.4%; 8.9%; 8.5%; 5.1%)	6; 8; 4; 1; 10; 7; 2; 9
• Side effects (rashes, itching)	3 (18.5%; 10.9%; unknown)	7; 1; 3
Care and maintenance of hearing aid	8
• Need help changing batteries	3 (62%; 6.8%; 4.1%)	4; 2; 6
• Handling problems/ manual dexterity	5 (30.8%; 21%; 9.4%; 0.6%; unknown)	10; 5; 7; 1; 3
• Volume control adjustment	2 (6.8%; 4.9%)	2; 1.
Attitude	4
• No need/hear well enough without HA	4 (42%; 23.7%; 23.1%; 8%)	5; 7; 10; 1
Device factors	8
• Not working properly/broken	4 (36%; 17%; 7.8%; 1.4%)	4; 5; 1; 8
• Disappointed with HA	1 (30.8%)	10
• Feedback/whistling	5 (9.4%; 8.4%; 6.8%; 4.3%; unknown)	6; 8; 2; 1; 3
• Device requires service	1 (6%)	4
• Battery life too short	1 (2%)	1
• Makes voice sound funny	1 (1.7%)	2
• Poor directivity	1 (0.3%)	1
Situational factors	3
• No opportunity/lack of situations necessary for HA	1 (62.5%)	6
• Only used for specific situations	1 (11.6%)	7
• Only works in limited situations	1 (2.6%)	1
• Does not work on the phone	1 (1.1%)	1
• Rare social user	1 (0.6%)	1
Financial factors	5
• Cost of repairs	2 (10.3%; 3%)	1; 4
• Cost of batteries	3 (1.7%; 1.4%; 0.4%)	2 ; 8 ; 5
Psycho-social factors	3
• Nuisance/hassle	2 (5.1%; 4%)	2;1
• Forget to use it	1 (1.1%)	1
• Lost it	2 (0.4%; 0.3%)	5; 1
Health care professionals	1
• Poor service from dispenser	1 (3.2%)	1
• Oversold expectations	1 (0.9%)	1
Appearance	3
• Stigma of wearing HA	1 (2.9%)	1
• Do not like the appearance	1 (1.7%)	2
• Cosmetic concerns	1 (unknown)	3
Infection/ear problems	2
• Have tinnitus	1 (0.9%)	1
• Cannot use due to external otitis	1 (0.4%)	5
• Ear wax problem	1 (0.3%)	1
Recommendations	1
• Family pressure to get HA	1 (0.9%)	1

Kochkin S. 2000. MarkeTrak V: ʽWhy my hearing aids are in the drawer': The consumers’ perspective. The Hearing Journal, 53, 34–41.

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Tomita M., Mann W.C. & Welch T.R. 2001. Use of assistive devices to address hearing impairment by older persons with disabilities. Int J Rehab Res, 24, 279–289.

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Gianopoulos I., Stephens D. & Davis A. 2002. Follow up of people fitted with hearing aids after adults hearing screening: The need for support after fitting. BMJ, 325, 471.

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Cohen-Mansfield J. & Taylor J.W. 2004. Hearing aid use in nursing homes, Part 2: Barriers to effective utilization of hearing aids. J Am Med Direct Assoc, 5, 289–296.

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Lupsakko T.A., Kautiainen H.J. & Sulkava R. 2005. The non-use of hearing aids in people aged 75 years and over in the city of Kuopio in Finland. Europ Arch Otorhinolaryngol, 262, 165–169.

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Vuorialho A., Karinen P. & Sorri M. 2006. Counselling of hearing-aid users is highly cost-effective. Euro Arch Otorhinolaryngol, 263, 988–995.

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Bertoli S., Staehelin K., Zemp E., Schindler C., Bodmer D. et al. 2009. Survey on hearing-aid use and satisfaction in Switzerland and their determinants. Int J Audiol, 48, 183–195.

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Hartley D., Rochtchina E., Newall P., Golding M. & Mitchell P. 2010. Use of hearing aids and assistive listening devices in an older Australian population. J Am Acad Audiol, 21, 642–653.

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Gopinath B., Schneider J., Hartley D., Teber E., McMahon C.M. et al. 2011. Incidence and predictors of hearing-aid use and ownership among older adults with hearing loss. Annals of Epidemiology, 21, 497–506.

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Oberg M., Marcusson J., Nagga K. & Wressle E. 2012. Hearing difficulties, uptake and outcomes of hearing aids in people 85 years of age. Int J Audiol, 51, 108–115.

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