Hearing Aids Aren’t Invisible and They Shouldn’t Be

"Don’t worry, hearing devices are so small, no one will see them.” “Big, ugly hearing aids are long gone.” “They are small and beautiful now.” Those and similar phrases can be heard, whenever hearing aids come up in conversation as well as in marketing. Apparently, a lot of emphasis is placed on hearing devices being invisible, barely noticeable, and generally unassuming. If someone questions their need for hearing aids, the first reassurance that comes to mind is, “No one will notice.” If we look at the history of hearing aids, the change in size and conspicuity is indeed apparent. Hearing loss treatment has come a long way from various contraptions to the sophisticated devices that are available now. I have been wearing hearing aids since 2005 and know that my first and my current set of hearing aids are inherently different.A photo of the author’s first and most recent hearing aids for side-by-side comparison.The way we, as a society, see hearing loss did not seem to change as much, at least judging from the shame around hearing aids that is noticeable in multiple aspects even now. People are still reluctant to admit any kind of (hearing) deficit. Dr. Megan Knoetze, Dr. Vinaya Manchaiah, and Dr. De Wet Swanepoel wrote a compelling article about promoting hearing aids in The Hearing Journal.1 This article mentions that hearing loss is still often undertreated. Many hard-of-hearing people resist taking up hearing aids due to various reasons; presumably social stigma and prejudices. To put it simply: People are afraid of what others might think if they are seen with hearing aids. At this point, it should also be mentioned that hearing loss has become more common. The World Health Organization claims that by 2050, 1 in 10 people will have some form of hearing loss.2 This leads to two potential conclusions: The need for hearing devices is increasing. The reluctance towards hearing aids is not decreasing (as much). These are only assumptions. However, a lot of people in the audiology community seem to agree that something should be done about the shame around hearing loss and the prevalent stigma around wearing hearing aids. Many manufacturers and audiologists seem to agree, but only a few act on it. Perceived invisibility is still a desired attribute, at least when it comes to marketing hearing aids. This hypothesis is supported by the study performed by Scarinci, N, Waite, M, Nickbakht, M, Ekberg, K, Timmer, B, Meyer, C, & Hickson, L. This also becomes apparent if you look at two examples of “truly invisible” hearing aid devices; namely the Phonak Lyrics and the Hearing Glasses by Nuance.3,4 Both claim to be revolutionary constructs made to amplify hearing and remedy (in the case of Phonak Lyric, light to moderate) hearing loss. Based on a first look and their description, they differ from classical hearing aids. For many people, this might be a sensible solution. Both the Hearing Glasses and the Phonak Lyric devices also promise a specific level of comfort – one of Phonak’s main selling arguments is that “you can live like you don’t wear a hearing aid”.3 Both take a fundamentally different approach on providing support for hard of hearing people. The headlines on both websites involve the word “invisible“. The impact of hearing loss is first and foremost reduced to the fact, that someone might recognize something different about you. The exhaustion of keeping up with a conversation in a loud situation is secondary. The enjoyment of music, birdsong and the human need to communicate with each other are not a priority. At the very least, not when it comes to marketing hearing aids and other solutions for hard-of-hearing people. As proficient as those new devices may be, this is a fact we should not ignore. The next question is: Are classical hearing aids actually invisible? By personal experience, I have to answer with no. I remember asking about those invisible hearing aids I‘d seen in ads, wondering why mine had to look different. As a matter of fact, the types of hearing aids that are actually (nearly) invisible did not fit my degree of hearing loss. “Behind-The-Ears” was the way to go for me. On people with longer hairstyles, BTE-type hearing aids are still mostly unnoticeable. Personally, I never had much of an issue, even when others did notice my hearing aids. Having hearing loss since childhood does make a difference in that regard. On one hand, I was never afraid my hearing aids would make me look old. On the other hand, as a child, you are quite used to adults not taking you seriously. Now, however, as a businesswoman, being seen as capable is important. I can understand why someone would worry that hearing aids would change the impression people have of them. While glasses are rarely a reason to doubt someone‘s competence, not being able to hear properly can lead to difficult situations, namely, during business meetings or video calls. This is especially true if you work in a field that requires a rather large amount of extraversion. If you are first confronted with your hearing loss, you find yourself at a crossroads. You either openly discuss your options with friends, family, and co-workers, or you try to continue with your usual modi operandi, like nothing changed at all. If, for whatever reason, you choose to make as few changes as possible, then you might want a hearing aid that is, in fact, invisible. No need to explain anything, since you assume that with your new devices, you can perform your daily life as usual. That‘s what hearing aids are for, after all. Right? Sorry to say, but not entirely. Wearing a hearing aid does not make your hearing loss go away. But they are useful tools. The promise of an invisible hearing aid does not mean a quick fix for your ears and it does not reduce the impact your hearing loss already had on your life. If your social setting was affected, for example, it won‘t go back to normal instantly. In that situation, reintegrating yourself into the hearing community is a process that you must be willing to endure. Still, not having to disclose your hearing loss to the people around you could potentially make things easier. Being wary of change is human, and therefore it is quite tempting to believe: “If my hearing aids are not noticeable, my life won‘t change as much.” The promise of invisibility provides both comfort for the customers and more potential sales for the manufacturers and audiology businesses. The previously mentioned study supports this claim and elaborates: “Interestingly, the HCPs [hearing care practitioners] in the study reported reinforcing this focus on concealment of HAs [hearing aids] by highlighting the discrete appearance of modern HAs in their clinic/at demonstrations. HCPs should consider how they may be potentially adding to the stigma of HAs by highlighting the size of HAs and making clinical recommendations based around concealing HAs.”4 Following the trend, even BTE-models will become increasingly invisible: easier on the eye, with a sleeker and more modern look. No wonder that they are frequently marketed as “high-tech”, to appear efficient and cool. Ideally, they are something you will be proud to use. This will likely also affect the design and style possibilities. The demand of the market will influence the design in both ways, towards being invisible and towards being boldly futuristic. Add empowerment to the mix and you‘ve got a decent marketing strategy. That may even lead to more people who can benefit from hearing aids to take the leap of faith, by making an appointment with a chosen audiologist. Nothing bad to say about that. Truth be told, though, not everyone‘s hearing aids will fit the description. Not everyone‘s hearing aids are going to be invisible. And some hard-of-hearing people will be disappointed, because they still won‘t quite fit in. Most people never noticed mine, but the difference between me and normal hearing people still exists. The claim “hearing aids are invisible” can and in some cases likely does lead to the assumption that once you have them, you will be “normal” again. Just like any other hearing person. But you are not. Others may not be able to tie it to your hearing and think you are just distracted, exhausted, or otherwise unsociable when you keep repeating a question, but eventually, they will notice a difference. Being open about your hearing aids can clear up a lot of difficult situations, whether your hearing aids are easily visible or not. Not everyone will be comfortable with that approach or with visible hearing aids. Not wanting someone to know you are wearing them is a valid choice. Ideally, hard-of-hearing people are not only equipped with hearing aids but also with a clear strategy on how to handle social situations with them. At this point, the support of their audiologist is key. “What exactly should an audiologist do?” is the follow-up question, which I will answer by personal experience. It should start with discussing social situations and developing a clear plan for communicating hearing loss. Audiologists can shape a local community and provide resources about living with hearing loss, weighing in on the pros and cons of visible hearing aids. That way, the choice of how visible hearing aids should be is not forced (as much). There is a delicate balance between the comfort of belonging to the hearing community again and empowerment through visible hearing aids. Defying societal stigma feels great, but it is not easy. Audiology is not only a market for high-tech devices and hearing aids are more than just a gadget to be advertised and sold. We have to keep that in mind. Supporting people during the process of getting hearing aids and actively helping them as they find a way to fit their hearing loss into their lives is important. The visibility of hearing aids should be dictated by the choice of the wearer, not by what is most convenient to others around them. Some things should not be automated. Handling hearing loss is one of them. It is our responsibility to pave a way forward, at least to the point where there is no more societal pressure to make hearing aids invisible. It will be a long way to go, but small steps should still be made. By reflecting on our views and by acting accordingly, we shape our future. That shows even in little changes. Like concluding “Hearing aids can be invisible,” with “but they don‘t have to be”.