How can we change the stigma surrounding hearing loss?
By Allison MacEacheron
Cultural and societal stereotypes are often held against people with hearing loss, such as that they are less intelligent, that they listen selectively, or that they are disabled, frail or of advanced age (Southall et al. 2010). These can have a very detrimental effect on individuals’ help-seeking behavior, adherence to treatment and rehabilitation, feelings of self-worth, and subsequently, their social interactions. Stereotypes may be reinforced when individuals alter their treatment course because of stigma. For example, if it is believed that only the elderly wear hearing aids, then middle-aged people with hearing loss may delay treatment until they are older to avoid this stigma. Similarly, individuals with untreated hearing loss might mishear instructions at work or respond inappropriately in social situations, reinforcing the stereotype that people with hearing loss are less intelligent antabuse tablets. By succumbing to the stigma surrounding hearing loss, therefore, individuals could be making decisions that hinder their social and emotional wellbeing and put further social pressure on others to maintain the stereotypes. The stigma surrounding hearing loss must change for the benefit of those with undiagnosed or untreated hearing loss as well as those who will be diagnosed in the future.
Though advocacy campaigns are important to reach the general public, they are not the most effective long-term way to change stereotypes. I would argue that self-advocacy on the part of individuals with hearing loss is far more effective. As hearing health professionals, it is our job to make sure that those people we are serving do not buy into negative stereotypes, and if they do, to manage them (Southall et al. 2010). We cannot reach everyone in the community but if we instill a sense of confidence and self-empowerment in those who seek our help, they may in turn demonstrate behaviours contrary to some of the stereotypes, changing attitudes in those around them and empowering others to seek assistance. Change is only effected when ideas are put into practice so I have focused the following paragraphs on practical ways an audiologist can change patient interaction to address some of the common stereotypes.
One way to reduce stigma is to avoid age-related language when discussing hearing loss. Unfortunately, audiologists can inadvertently perpetuate the stereotypes they work so hard to fight against with the language they use with their patients. I have so often heard audiologists explain a sensorineural hearing loss in individuals in their 50s by stating that they do not know what caused the loss but it is common for people’s hearing abilities to decrease as they age. Though it is true that significantly more people over 70 have hearing loss, it is still only ≈63% of the population, and some of those losses may have been caused by processes other than ageing (Lin et al. 2011; Southall et al. 2010). If the individual had been in their 30s with the same loss, most audiologists in my experience would have explained that we do not always know the cause of a given hearing loss and left it at that. Is it right that ageing is brought into the mix for someone in their 50s even though the cause is idiopathic? Is it helpful? On one hand, it may comfort the individual because ageing is something they recognize, but on the other, when explaining their hearing troubles to others it is likely that ‘you know, I’m getting older’ will be used, further perpetuating the stigma that it is mainly older adults who have hearing loss.
Audiologists can also counter certain stereotypes in the way they present options during a hearing aid or cochlear implant fitting. Individuals should not be ashamed to wear hearing aids so why are neutral colours always presented on posters and in display cases? If an audiologist starts by presenting colour choices that match the hair or skin or styles that are ‘practically hidden behind the ear’ from the start, a patient will think that discreteness is what they are supposed to be shopping for. As an alternative, a professional could ask the patient what their favourite colour is, what colours they wear a lot, or present a colour that matches their glasses. This introduces the idea that a hearing aid can be worn as an element of style as well as sensory assistance, just as glasses are. There will always be patients who wish to be discreet, whether because of their personality or level of acceptance of their hearing loss, and that is perfectly alright, but we should not present this as the default. Colourful hearing aids, or at least ones chosen with style in mind, will be more confidently worn and will encourage others to view the wearer as naturally intelligent/young/or able, and to view hearing aids differently as well.
Finally, audiologists may be able to reduce stigma by encouraging their patients to wear their hearing aids and to be more assertive in communicative situations. Communication partners, work colleagues, cashiers, etc. may become frustrated with individuals with hearing loss and label them as less intelligent or capable because of communication breakdowns. Being open with these people about hearing difficulties is a start but breakdowns in communication will still occur. The audiologist must educate his or her patients on communication repair and assistance strategies and emphasize that individuals who actively engage in a conversation, even when there are breaks, will likely appear to be more intelligent and able than those who are passive. Every time an individual with hearing loss presents themselves in this way, the stigma will be reduced in one person’s mind.
I firmly believe that the stigma surrounding hearing loss is changing, but it is changing slowly. As hearing health professionals it is our duty not only to ensure that as many of our patients as possible have successful and fulfilling communication (e.g., with assistive devices and communication strategies), but that our interaction with them does not inadvertently reinforce social stigma. Hearing loss presents many inherent challenges to everyday life; stigma does not have to be one of them.
Lin,F.R., Thorpe, R., Gordon-Salant, S., and Ferrucci, L. (2011). Hearing loss prevalence and risk factors among older adults in the United States. J Gerontol A Biol Sci Med Sci, 66(5):582-590.
Southall, K., Gagne, J.P., and Jennings, M.B. (2010). Stigma: A negative and a positive influence on help-seeking for adults with acquired hearing loss. International Journal of Audiology, 49: 804–814.