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Why four out of five people do not wear a hearing aid

13 min read
Ruhiges Schlafzimmer-Stillleben mit einer Brille auf einem Nachttisch im warmen Morgenlicht

Few of the people who would benefit from a hearing aid actually wear one – and this is no new phenomenon. According to the US National Institute on Deafness and Other Communication Disorders (NIDCD), fewer than one in three people over 70 with significant hearing loss have ever used a hearing aid, and for those aged 20 to 69, the figure is only around 16 percent. Why so many people do not wear hearing aids cannot be explained by cost or convenience alone. Part of the answer lies in something that initially seems secondary: how these devices look and what they reveal about the people wearing them.

Why so many people do not wear hearing aids: the figures at a glance

Hearing loss is widespread in old age. According to the NIDCD, about 5 percent of 45- to 54-year-olds have hearing loss that impacts their daily life; for 55- to 64-year-olds, the figure is 10 percent; for 65- to 74-year-olds, 22 percent; and for those over 75, it is already 55 percent. Thus, with age, not only does the need grow, but so does the number of people who have to make a decision about a hearing aid – and who, in the majority of cases, decide against it.

One of the most frequently cited papers on this subject comes from Abby McCormack and Heather Fortnum, published in 2013 in the International Journal of Audiology. The two evaluated ten studies on the non-use of hearing aids and reached a clear conclusion: around 40 percent of 55- to 74-year-olds have age-related hearing loss, yet about 80 percent of adults in this group who would benefit from a hearing aid do not use one. Even among those who have already been prescribed a device, many do not wear it in everyday life.

The reasons McCormack and Fortnum extracted from the literature are multifaceted: perceived benefit, fit and comfort, maintenance, cost, psychosocial and situational factors, the attitude of professionals, ear-related problems – and appearance. The reasons cited most frequently were low perceived benefit and lack of comfort. Appearance was not at the top of the list, but it appeared as a relevant factor in the vast majority of the studies evaluated.

Stigma as an underestimated reason

What "appearance" specifically means in research can be pinned down to several individual studies compiled in a 2024 review by Edward Madara and Achintya Bhowmik in the journal Audiology Research. It cites a 2007 survey by Sergei Kochkin (MarkeTrak VII, published in the Hearing Journal), according to which 48 percent of potential users stated that stigma contributes to their reluctance toward hearing aids.

A 2023 survey by Sindi et al. in the journal Cureus (517 participants) found that 40.3 percent subconsciously perceive hearing aid wearers as "disabled" or "reliant on extra support" – an attribution that has nothing to do with the person's actual capabilities but influences the decision to use a visible device. An evaluation of several studies by David and Werner from 2016 in the journal Stigma and Health concluded that in about a third of the papers reviewed (33.3 percent), stigma was cited as a primary reason for non-use.

Gerontologist Margaret Wallhagen describes this particularly vividly in her frequently cited essay "The Stigma of Hearing Loss," published in 2009/2010 in the journal The Gerontologist. She cites three closely linked factors: a changed self-image, ageism, and simple vanity. In doing so, Wallhagen also cites a much-discussed figure – around 65 percent of people with hearing loss would refuse a free, government-provided hearing aid. However, this figure originates from a secondary source (Amlani, 2009) for which no published methodology exists. It is repeatedly cited in professional literature but should be read as a widely circulated estimate rather than an independently verified finding.

A detail cited by the Madara and Bhowmik review from a Forbes Health survey (Alcido, 2024) is noteworthy: the belief in hearing aid stigma is not most pronounced among older generations, but rather among younger ones. Among Millennials, 63 percent agreed with the statement that hearing aids are stigmatized; for Generation X, the figure was 47 percent, and for Baby Boomers, it was 41 percent. In the same survey, respondents identified the biggest social hurdle as understanding what is being said clearly in noisy public situations, such as at the airport. This suggests that stigma is not a phenomenon that automatically disappears with age, but rather a cultural perception that persists across generations.

Two objects, two opposing paths

What the numbers do not automatically show becomes clearer by looking at design history. Two everyday objects, both of which support sensory performance, took almost opposite paths in the 20th century.

The hearing aid: designed for camouflage for decades

The "Deafness in Disguise" exhibition at the Becker Medical Library at Washington University School of Medicine documents this development in detail. In 1947, the Acousticon A-100 entered the market as a one-piece vacuum tube device. When the transistor became available – hearing aids were the first commercial product ever to use it in 1952, two years before the first transistor radio – a veritable race for invisibility began.

  • Eyeglass hearing aids entered the US market in 1954 and had already achieved about half the market share by 1959 – models like the Beltone "Hear-N-See" (1955) or Danavox "Lunettes" (1955) hid the technology in the temple arms of glasses.
  • Behind-the-ear (BTE) devices followed at the end of the 1950s and were deliberately worn under the hair. The Zenith "Diplomat" from 1956 weighed less than an ounce and had overtaken eyeglass models by the early 1960s.
  • In-the-ear (ITE) devices like the Dahlberg D-10 "Miracle Ear" (1955) and later models that vanished completely into the ear canal (e.g., Oticon I-21, 1987–1991) drove miniaturization even further.

By 1996, around 80 percent of all hearing aids sold in the USA were worn completely in the ear – invisibility was the declared development goal for decades. It was not until the 1990s that some manufacturers attempted the reverse approach and designed devices that were deliberately conspicuous: with gemstones, flower or leaf motifs, or in colorful housings. The attempt remained a marginal phenomenon compared to the fundamental principle of "the smaller, the better," which still characterizes the industry today.

Glasses: the opposite path

During the same period, glasses took an almost mirror-image development. The Austrian company Silhouette, founded in 1964 by Arnold and Anneliese Schmied, formulated a goal early on that, in retrospect, seems programmatic: to turn glasses into an "accessory for better vision and appearance." The rimless "Futura" model of 1974 is often considered the turning point; worn by Elton John among others, it contributed significantly to glasses being perceived as a fashion accessory rather than just a necessary medical aid.

Today, people buy glasses in boutiques, choose frames based on face shape and style, and change them like an item of clothing. Hearing aids, by contrast, are still predominantly fitted in medical supply stores and audiology studios – a context that immediately positions the product closer to a diagnosis than a design object. The technology differs very little, but the framework in which it is sold and perceived differs significantly.

What happens when hearing technology suddenly looks commonplace

A recent experiment provides an interesting test case for how closely design and perception are linked. In 2022, a team led by Yen-Fu Cheng of the Taipei Veterans General Hospital and Ying-Hui Lai of the National Yang Ming Chiao Tung University compared how well various devices functioned for 21 people with mild to moderate hearing loss in the journal iScience: no device, a basic hearing aid, a premium hearing aid, and Apple's AirPods 2 and AirPods Pro, connected via the "Live Listen" function.

In a quiet environment, the AirPods Pro performed about as well as the basic hearing aid and only slightly worse than the premium device; they met four out of five electroacoustic criteria of the ANSI/CTA-2051 standard. In a loud environment, they kept up with the premium devices, provided that the noise was coming from the side. In terms of price, the AirPods cost 129 to 249 US dollars at the time of the study, basic hearing aids about 1,500, and premium devices up to 10,000 US dollars.

What is interesting is not so much the technical performance itself as the researchers' classification: because AirPods are not recognizable as medical devices and are, on the contrary, considered fashionable everyday objects, the barrier to using them at all decreases for many people. A few months before the study, the US Food and Drug Administration (FDA) had also created a separate category for over-the-counter hearing aids in August 2022 – a regulatory step that, in addition to falling costs, is likely to change the appearance of the devices, as consumer electronics manufacturers are now entering the market.

A growing need

The question of how hearing aids are designed and perceived will become more, not less, important in the coming decades. The World Health Organization's "World Report on Hearing" from 2021 assumes that by 2050, nearly 2.5 billion people worldwide – about one in four – will have some degree of hearing loss. At least 700 million people will then need access to ear and hearing care and rehabilitation services, provided the current supply situation does not change.

Since hearing loss is so closely linked to age, as the NIDCD figures above show, an aging world population automatically means more people facing the same decision as today: wear a device that stands out, or go without hearing. According to all available research, how this decision is made depends not only on the device's hearing performance but significantly on how it feels to wear it in one's own life.

Where the state of research remains cautious

When dealing with a topic that fits so well into a catchy narrative, restraint is advisable. Stigma is an important factor, but it is not the only one, nor is it consistently the most important. In the evaluation by McCormack and Fortnum, perceived benefit and comfort were ranked ahead of appearance. Cost and access to professionals remain—especially outside wealthy countries—an independent, often greater obstacle, as the WHO report highlights with regard to the supply gap in low-income regions.

The much-discussed 65-percent figure regarding the refusal of free hearing aids should also be cited with the necessary caution, as mentioned above, because its original methodology is not publicly verifiable. And even where studies find a connection between design or stigma and non-use, these are mostly correlations from surveys, not experiments showing that a redesign alone would increase usage rates. The AirPods experiment is a hint in this direction, but a single study with 21 participants cannot replace a large-scale long-term investigation.

What this means for everyday objects

Taken together, the figures paint a picture that extends beyond hearing aids: whether an object related to health is actually used in everyday life does not depend solely on its technical performance, but also on whether it feels like something that fits into one's life, rather than like a label one would rather not wear. Glasses took this path early and consistently. With the hearing aid, a similar development is only now emerging, fueled by consumer electronics from outside the industry.

It is precisely at this point that our approach at Oxionix toward everyday objects begins: we believe that objects related to health deserve the same design care as any other well-made item in the home – not as a substitute for professional advice, but as a fundamental attitude toward design in everyday life.

Frequently Asked Questions

How many people with hearing loss actually wear a hearing aid?

According to the NIDCD, only about 16 percent of people aged 20 to 69 with significant hearing loss have ever used a hearing aid; among those over 70, the figure is less than 30 percent. The study by McCormack and Fortnum (2013) found a non-use rate of around 80 percent among those who would benefit from a device in the 55- to 74-year-old age group.

Is stigma the only reason hearing aids remain unused?

No. Several studies, including the evaluation by McCormack and Fortnum, cite perceived benefit and comfort as the most frequent reasons. Stigma and appearance play a documented role, but not an exclusive one – just like costs and access to professionals.

Why were hearing aids historically designed to be so small and inconspicuous?

With the availability of the transistor starting in the 1950s, the industry pursued the goal for decades of making devices as invisible as possible – from eyeglass hearing aids and BTE models to variants that disappeared completely into the ear canal. According to the "Deafness in Disguise" exhibition, about 80 percent of all hearing aids sold in the USA by 1996 were worn completely in the ear.

Can AirPods replace a hearing aid?

A study in the journal iScience (2022) showed that AirPods Pro performed similarly well to a basic hearing aid in a quiet environment for mild to moderate hearing loss. This is a research finding, not a medical recommendation: if you suspect hearing loss, an audiological examination remains the correct first step.

How did glasses develop into a fashion accessory?

According to industry classifications, an important turning point was 1964, when the Austrian company Silhouette was founded with the stated goal of making glasses an accessory for "better vision and appearance." This was followed in 1974 by the rimless "Futura" model, a design that contributed significantly – also due to prominent wearers like Elton John – to the perception of glasses as a fashion object.

How many people will be affected by hearing loss in 2050?

In 2021, the World Health Organization estimated that by 2050, nearly 2.5 billion people worldwide – about one in four – will have some degree of hearing loss and at least 700 million people will need access to hearing care.

Sources