Vishakha Rawool 1, A-G  
More details
Hide details
Department of Communication Sciences and Disorders University of Mississippi University, USA
A - Research concept and design; B - Collection and/or assembly of data; C - Data analysis and interpretation; D - Writing the article; E - Critical revision of the article; F - Final approval of article;
Vishakha Rawool   

Vishakha Rawool, Ph.D., CCC-A, FRSM, FAAA Department of Communication Sciences and Disorders University of Mississippi University, MS 38677 USA,
Publication date: 2020-04-09
J Hear Sci 2018;8(3):9–23
Some patients deny that they have a hearing impairment, which can lead to unmanaged hearing impairment. The purpose of this review is to provide insights into why some individuals deny they have a hearing loss and do not want any hearing health care. This paper suggests strategies for promoting acceptance among such patients.

Material and Methods:
The article is based on a synthesis of the clinical and scientific literature, as well as clinical experience related to the various aspects of why patients deny that they have a hearing loss and reject hearing health care. The cited literature was collected by using the PubMed database and the Google Scholar search engine using the terms ‘denial’, ‘hearing loss’, and ‘hearing aids’

In addition to denying they have a hearing loss, some patients deny there is any impact of hearing loss and that they don’t need hearing aids. Denial can present in a variety of forms, including implicit or explicit denial, and can range in severity from partial to complete denial. Reasons for denial include the stigma related to hearing loss and hearing aids, lack of trust in hearing health care providers, uncertainty of the benefits of hearing aids, and lack of confidence in making the required adaptations.

Patients with denial of hearing loss are unlikely to seek assistance from hearing health professionals or participate in studies related to their condition. Thus, outreach efforts are necessary to reach such individuals. To address denial, enrolment in aural rehabilitation support groups, guidance to significant communication partners, and several other strategies can be used. Additional studies will be beneficial in further exploring denial.

Freud S. The Ego and the Id: Standard edition of the complete psychological works of Freud, Vol. XIX. London, Hogarth Press, 1961.
Kubler-Ross E. On Death and Dying. New York, Springer. 1969.
Vos MS, De Haes JC. Denial in cancer patients, an explorative review. Psycho‐Oncol, 2007;16:12-25.
Rawool VW, Kiehl JM. Effectiveness of informational counseling on acceptance of hearing loss among older adults. Hear Rev, 2009;16:14-24.
American National Standards Institute (ANSI). ANSI S3.6-1989 (ASA 81-1989). Revision of ANSI S3.6-1969. Specification for Audiometers. New York: ANSI.
American Speech-Language-Hearing Association (ASHA) (1978). Committee on audiometric evaluation. Guidelines for manual pure-tone threshold audiometry. ASHA, 1978;20:297-301.
Chisolm TH, Johnson CE, Danhauer JL, Portz LJ, Abrams HB, Lesner S, McCarthy PA, Newman CW. A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force on the HealthRelated Quality of Life Benefits of Amplification in Adults. J Am Acad Audiol, 2007;18(2):151-83.
Yueh B, Collins MP, Souza PE, Boyko EJ, Loovis CF, Heagerty PJ, ... & Hedrick SC. Long‐term effectiveness of screening for hearing loss: the Screening for Auditory Impairment Which Hearing Assessment Test (SAI‐WHAT) randomized trial. J Am Geriatr Soc, 2010;58(3):427-34.
Dye CJ, Peak MP. Influence of amplification on the psychological functioning of older adults with neurosensory hearing loss. J Acad Rehab Audiol, 1983;16: 210-20.
National Institute on Deafness and other Communication Disorders (NIDCD, 2016). Quick Statistics About Hearing. https:www.nidcd.nih.govhealthstatist....
World Health Organization (WHO). Global Costs of Unaddressed Hearing Loss and Cost-effectiveness of Interventions. Geneva: 2017.
Rogin C, Abrams HB. MarkeTrak 9 points the way in a time of change. AudiologyOnline 2016; Article 16512.
Southall K, Gagné J-P, Leroux T. Factors that influence the use of assistance technologies by older adults who have a hearing loss. Int J Audiol, 2006;45(4):252-9.
Southall K, Gagné JP, Jennings MB. Stigma: a negative and a positive influence on help-seeking for adults with acquired hearing loss. Int J Audiol, 2010;49(11):804-14.
Hetu R. The stigma attached to hearing impairment. Scand Audiol, 1996;25:Suppl 43, 12-24.
Hallberg LR-M. Occupational hearing loss: coping and family life. Scand Audiol, 1996;25,25-33.
Lavizzo-Mourey R, Smith V, Sims R, Taylor L. Hearing loss: an educational and screening program for African-American and Latino elderly. J Nat Med Assoc, 1994;86(1):53.
Barker AB, Leighton P, Ferguson MA. Coping together with hearing loss: a qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners. Int J Audiol, 2017; 56(5):297-305.
Gilhome Herbst KR, Meredith R, Stephens SDG. (1991). Implications of hearing impairment for elderly people in London and in Wales. Acta Otolaryngol (Stockh), 1991;Suppl 476:209-14.
Von der Lieth, L. Hearing tactics. Scand Audiol, 1972;1:155-160.
Hetu R, Riverin L, Getty L, Latande NM, St-Cyr C. The reluctance to acknowledge hearing difficulties among hearing impaired workers. Br J Audiol, 1990;24:265-76.
Yorgason JB. Acquired hearing impairment in older couple relationships: an exploration of couple resilience process. PhD Dissertation. Virginia Polytechnic Institute and State University, Blacksburg, Virginia, 2003.
Kyle JG, Jones LG, Wood PL. Adjustment to acquired hearing loss: a working model. In H. Orlas (Ed.) Adjustment to Adult Hearing Loss. San Diego: College Hill Press, 1985.
Smith SL, Kricos PB. Acknowledgement of hearing loss by older adults. J Acad Rehab Audiol, 2003;36:23-35.
Dancer J, Jackson L. Value of self-identification of hearing loss in a screening program for older adults. Percep Motor Skills, 1996;83:114.
Scherer MJ, Frisina DR. Characteristics associated with marginal hearing loss and subjective well-being among a sample of older adults. J Rehab Res Devel, 1998;35(4):420.
Rawool VW, Kiehl JM. Perception of hearing status, communication and hearing aids among socially active older individuals. J Otolaryngol, 2008;37:27-42.
Humphrey C, Herbst KG, Faurqi S. Some characteristics of the hearing-impaired elderly who do not present themselves for rehabilitation. Br J Audiol, 1981;15(1):25-30.
Martin F, Bass M, Bernstein M. Professional attitudes regarding counseling of hearing impaired adults. Am J Otol, 1992;13:279-87.
Erler S. Brief counseling in audiologic practice (Abstract). American Speech-Language-Hearing Association annual convention, Orlando FL, December, 1995.
Grenness C, Hickson L, Laplante-Lévesque A, Meyer C, Davidson B. The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations. J Am Acad Audiol, 2015;26(1):36-50.
Rawool VW. A survey to help older clients accept hearing loss and hearing aids, Part 1. Hear Rev, 2000;7:34, 36, 40, 41.
Getty L, Hetu R. Development of a rehabilitation program for people affected with occupational hearing loss. 2. Results from group intervention with 48 workers and their spouse. Audiology, 1991;30:317-29.
Wolf KE, Hewitt EC. Hearing impairment in elderly minorities. Clin Geriatr, 1999;7:56-66.
Harrison RV, Nagasawa A, Smith DW, Stanton S, Mount RJ. Reorganization of auditory cortex after neonatal high frequency hearing loss. Hear Res, 1991;54:11-9.
Mulrow CD, Aguilar C, Endicott JE, Tuley MR, Velez R, Charlip WS, Rhodes MC, Hill JA, DeNino LA. Quality-of-life changes and hearing impairment. A randomized trial. Ann Intern Med, 1990;113(3):188-94.
Hetu R. Jones L, Getty L. The impact of acquired hearing impairment on intimate relationships: implication for rehabilitation. Audiology, 1993;32:363-81.
Hallberg LR-M, Barrenas M-L. Living with a male with noiseinduced hearing loss: experiences from the perspective of spouses. Br J Audiol, 1993;27:255-61.
Hétu R, Lalonde M, Getty L. Psychosocial disadvantages associated with occupational hearing loss as experienced in the family. Audiology, 1987;26:141-52.
Hétu R, Riverin L, Lalande N, Getty L, St-Cyr C. Qualitative analysis of the handicap associated with occupational hearing loss. Br J Audiol, 1988;22:251-64.
Wallhagen MI, Strawbridge WJ, Shema SJ, Kaplan GA. Impact of self-assessed hearing loss on a spouse: a longitudinal analysis of couples. J Gerontol B Psychol Sci Social Sci, 2004;59:S190-S196.
Corbin S, Reed M, Nobbs H, Eastwood K, Eastwood MR. Hearing assessment in homes for the aged: a comparison of audiometric and self-report methods. J Am Ger Soc, 1984;32:396-400.
Hallberg LR-M, Barrenas M-L. Coping with noise-induced hearing loss: experiences from the perspective of middle-aged male victims. Br J Audiol, 1995;29:219-30.
McDavis KC. The effects of severity of hearing impairment and locus of control in the denial of hearing impairment in the aged. Int J Aging Hum Devel,1983-84;18:47-60.
David D, Werner P (2016). Stigma regarding hearing loss and hearing aids: a scoping review. Stigma Health 2016;1(2):59.
Goffman E. Stigma: The Management of Spoiled Identity. Harmondsworth: Penguin, 1963.
Knapp PH. Emotional aspects of hearing loss. Psychosomatic Med, 1948;10:203-22.
Tye-Murray N, Spry JL, Mauzé, E. Professionals with hearing loss: maintaining that competitive edge. Ear Hear, 2009;30(4):475-84.
Johnson CE, Stein RL, Lyons R, Lass NJ. Study surveys views of nurses on hearing aids, hearing aid wearers. Hear J, 1995;48:29-31.
Jones L, Kyle JG, Wood PL. Words Apart: Losing your hearing as an adult. London, Tavistock. 1987.
Stephens D. Hearing rehabilitation in a psychosocial framework. Scand Audiol, 1996;25(Suppl 43), 57-66.
Laplante-Lévesque A, Hickson L, Worrall L. Factors influencing rehabilitation decisions of adults with acquired hearing impairment. Int J Audiol, 2010;49(7):497-507.
Wallhagen MI. The stigma of hearing loss. Gerontologist, 2010; 50: 66-75.
Scambler G. Epilepsy. London: Tavistock, 1989.
David M, Trehub SE. Perspectives on deafened adults. Am Annals Deaf, 1989; 134: 200-204.
Heffernan E, Coulson NS, Henshaw H, Barry JG, Ferguson MA. Understanding the psychosocial experiences of adults with mild– moderate hearing loss: an application of Leventhal’s self-regulatory model. Int J Audiol, 2016;55(Supp3):S3-S12.
Kelly-Campbell R, Plexico L. Couples’ experiences of living with hearing impairment. Asia Pacific J Speech, Lang Hear, 2012;15(2):145-61.
Hallam RS, Books DN. Development of the hearing attitudes in rehabilitation questionnaire (HARQ). Br J Audiol, 1996;30:199-213.
Chang NC, Dai CY, Lin WY, Chien CY, Hsieh MH, Ho KY. Perception of hearing impairment and the willingness to use hearing aids in an elderly population in southern Taiwan: a community-based study. Int J Audiol, 2016;55(9):491-8.
Valente M, Amlani AM. Cost as a barrier for hearing aid adoption. JAMA Otolaryngol Head Neck Surg, 2017; May 18.
Kochkin S. MarkeTrak III: why 20 million in U.S. don’t use hearing aids for their hearing loss. Hear J, 1993;46(1):20-27; 46(2), 26-31; 46(4), 36-37.
Gilliver M, Hickson L. Medical practitioners’ attitudes to hearing rehabilitation for older adults. Int J Audiol, 2011;50(12):850-6.
Ekberg K, Grenness C. Hickson L. Addressing patients’ psychosocial concerns regarding hearing aids within audiology appointments for older adults. Am J Audiol, 2014;23(3):337-50.
National Council on Aging. The consequences of untreated hearing loss in older persons: summary report from the National Council on Aging. Head Neck Nurs, 2000;18:12-6.
Davis M, Jackson R, Smith T, Cooper W. The hearing aid effect in African American and Caucasian males as perceived by female judges of the same race. Lang Speech Hear Serv Schools, 1999;30:165-72.
Löckenhoff CE, De Fruyt F, Terracciano A, McCrae RR, De Bolle M, Costa Jr, PT, ... Allik J. Perceptions of aging across 26 cultures and their culture-level associates. Psychol Aging 2009;24(4):941-54.
Assawavichairoj S, Taghian M. Cross-cultural comparison of consumer pre-purchase decision-making: anti-aging products. Asia Pacific J Marketing Logistics, 2017;29(1):27-46.
Maestripieri D, Henry A, Nickels N. Explaining financial and prosocial biases in favor of attractive people: interdisciplinary perspectives from economics, social psychology, and evolutionary psychology. Behav Brain Sci, 2017;40:e19.
Hamermesh DS, Parker A. Beauty in the classroom: instructors’ pulchritude and putative pedagogical productivity. Economics Ed Rev, 2005;24:369-76.
van den Brink RH, Wit HP, Kempen GI, van Heuvelen MJ. Attitude and help seeking for hearing impairment. Br J Audiol, 1996;30:313-24.
Garstecki DC, Erler SF. Hearing loss, control and demographic factors influencing hearing aid use among older adults. J Speech Lang Hear Res, 1998;41:527-37.
Strange A, Johnson A, Brigitte-Jane R. The stigma of wearing hearing aids in an adolescent aboriginal population. Aust N Z J Audiol, 2008;30:19-37.
Plath P. Problems in fitting hearing aids in the elderly. Acta Otolaryngol (Stockh), 1991;Suppl 476:278-80.
Doggett S, Stein RL, Gans D. Hearing aid effect in older females. J Am Acad Audiol, 1998;9:361-6.
Anderson JM. Immigrant women speak of chronic illness: the social construction of the devalued self. J Advanced Nursing, 1991;16(6):710-7.
Johnson CC, Danhauer JL, Koch LL, Celani KE, Lopez IP, Williams VA. Hearing and balance screening and referrals for Medicare patients: a national survey of primary care physicians. J Am Acad Audiol, 2008;19:171-90.
Michie S. Talking to primary care patients about weight: a study of GPs and practice nurses in the UK. Psychol Health Med, 2007;12:521-5.
The GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med 2017.
Finset A. One size does not fit all: how to talk to patients about obesity. Patient Education Counseling, 2009;76:147-8.
Rabinowitz P, Taiwo O, Sircar K, Aliyu O, Slade M. Physician hearing loss. Am J Otolaryngol, 2006;27:18-23.
Luterman D. Counseling families of children with hearing loss and special needs. Volta Rev, 2004;104:215-20.
Kaplan HB. Self-attitudes and Deviant Behavior. Pacific Palisades, California Goodyear, 1975.
Rawool VW. Overcoming obstacles in the purchase and use of hearing aids. Hear Rev, 2000;7:46-50.
Noble, W. Hearing, hearing impairment, and the audible world: a theoretical essay. Audiology, 1983;22:325-38.
Lazarus RS, Folkman S. Coping and adaptation. In: Gentry WD, ed. Handbook of Behavioral Medicine. Guilford Press: New York, pp 282-325, 1984.
Weiner B. On sin versus sickness: a theory of perceived responsibility and social motivation. Am Psychol, 1993;48:957-65.
Desjardins JL, Doherty KA. Changes in psychosocial measures after a 6-week field trial. Am J Audiol, 2017; 26(2):119-28.
Erler SF, Garstecki DC. Hearing loss- and hearing aid-related stigma: perceptions of women with age-normal hearing. Am J Audiol, 2002;11:83-91.
Brooks DN. The effect of attitudes on benefit obtained from hearing aids. Br J Audiol, 1989;23:3-11.
90 Barker F, Atkins L, de Lusignan S. Applying the COM-B behaviour model and behaviour change wheel to develop an intervention to improve hearing-aid use in adult auditory rehabilitation. Int J Audiol, 2016;55(Suppl 3): S90-8.
Van der Horst H, Hoogsteyns M. Disability, family and technical aids: a study of how disabling/enabling experiences come about in hybrid family relations. Disabil Society, 2014;29(5):821-33.
Meyer C, Hickson L, Lovelock K, Lampert M, Khan A. An investigation of factors that influence help-seeking for hearing impairment in older adults. Int J Audiol, 2014;53:S3–S17.
Mahoney CF, Stephens SDG, Cadge BA. Who prompts patients to consult about hearing loss? Br J Audiol, 1996;20:153-8.
Koerber R, Jennings MB, Shaw L, Cheesman M. Representations of workers with hearing loss in Canadian newspapers: a thematic analysis. Int J Audiol, 2017;56(4):260-6.
An SK, Paine LE, McNiel JN, Rask A, Holder JT, Varan D. Prominent messages in television drama Switched at Birth promote attitude change toward deafness. Mass Commun Soc, 2014;17(2):195-216.
Hyde ML, Riko KA. Decision analytic approach to audiologic rehabilitation. J Acad Rehabilitative Audiol, 1994;27:337-74.
Goldstein DP, Stephens SDG. Audiological rehabilitation: management model 1. Audiology, 1980;20:432-52.