How to address stigma in patient counseling

Hearing care professionals are no stranger to stigma in their daily clinical practice. Researcher Dr. Kevin Seitz-Paquette shares results of a recent literature review highlighting what needs to change during conversations with patients.

In the United States, roughly 38% of individuals who could benefit from a hearing aid actually own one. Even in countries where hearing aids are fully covered by insurance, the rate only improves to about 44%.1

Although there are numerous factors that could explain the low rate of adoption (access to services, patient awareness/education, etc.), it is hard to construct a believable list of those factors that does not include stigma.

What does stigma mean in this context? 

Because our professional world is so deeply connected to a device, it is easy to attach 100% of the stigma patients experience to the hearing aid itself.  Research on stigma among people with hearing loss, however, paints a different picture. 

While research has shown that patients do have some level of stigma associated with hearing aids, the same work has also shown that the stigma associated with the hearing loss itself is stronger.2

Stigma may not be the end of the story, though.  You’ve probably heard about FOMO, or the fear of missing out.  When your friend invites you to dinner at the end of a long day when you’d rather rest, FOMO is the voice in the back of your mind telling you to go anyway. 

You may not have heard about FOGO—the fear of getting old—but research says most of us experience it, even when we are young adults. 

A 2014 survey commissioned by Pfizer of adults 18 years and older found that 87% of respondents had at least one fear related to aging.  Another study analyzed 4.2 million Tweets on the topic of aging and found that 62% were negative!3 Given the well-known association between hearing loss and age, it is likely that FOGO adds to the anxiety and stigma patients experience in a hearing care appointment.

Less talking, more listening

As hearing care professionals (HCPs), we play a critical role in rehabilitating our patients.  The hearing aid is one important tool in that process, but an HCP’s empathetic ear and expert advice are not to be discounted. 

When working with your patients, taking the time to have a broader conversation about hearing aids, hearing loss, and aging can help guide your approach to counseling the patient over time.  It shouldn’t be viewed simply as a way to plan for objection handling to close a sale, but as the foundation for a long-term, trusting relationship.

A recently published literature review concluded that HCP’s dominate the conversation with a typical patient; the review found that roughly 51% of utterances in an appointment were from the HCP, while only 37% from the patient themselves.4  

Such little speaking time leaves little room for the patient to voice their own perspective; what’s left unsaid won’t ever be addressed during counseling and aural rehabilitation. 

Patients should be invited to state own goals and anxieties surrounding treatment; this invitation is an important component of person-centered care and can only take place when the HCP is sensitive to the complex web of emotions patients often experience.  When the patient voices their own fears and concerns, the HCP can use their clinical expertise to address them in the best possible way, be it through technology, rehabilitation, counselling, or a combination. 

To learn more about stigma and hearing loss, see the previous blog post by Dr. Gurjit Singh.


1. Ricketts, T. and Picou, E. (2023). Over-the-Counter Hearing Aids Are Only Partly the Answer. Audiology Today, March/April 2023.

2. Erler, S and Garstecki, D. (2003). Hearing Loss- and Hearing Aid-Related Stigma: Perceptions of Women with Age-Normal Hearing. American Journal of Audiology, 11:83-91

3. Pfizer. (2014). New Survey Reveals 87% of Americans Have a Fear of Getting Old (FOGO) – Results Show Top Fear is Decline in Physical Ability. Accessed on March 16, 2023 from

4. Manchaiah, V., Bellon-Harn, M., Dockens, A., Azios, J., and Harn, W. (2019). Communication Between Audiologist, Patient, and Patient’s Family Members During Initial Audiology Consultation and Rehabilitation Planning Sessions: A Descriptive Review. Journal of the American Academy of Audiology, 30(9)