HEARING IS LIVING by Hear the World

HEARING IS LIVING

EN 037-0154-02

ABOUT HEAR THE WORLD Hear the World is a global initiative, launched in 2006, by leading hearing instrument manufacturer Phonak created to raise awareness about the importance of hearing. The initiative calls attention to the social and emotional impact of hearing loss and addresses prevention of and solutions to a problem that affects more than 16% of the worldâ&#x20AC;&#x2122;s population. Bryan Adams, Annie Lennox, Lenny Kravitz, PlĂĄcido Domingo and other renowned personalities support the Hear the World Initiative as ambassadors. In the context of the Hear the World Initiative, Phonak has established the non-profit Hear the World Foundation to improve the quality of life of people with hearing loss through financial and technical assistance. The foundation is committed to the prevention of hearing loss as well as the support of people with hearing loss and their families.

Hear the World on the internet: www.hear-the-world.com Follow Hear the World at: http://twitter.com/Hear_The_World Become a fan at: www.facebook.com/CanYouHearTheWorld

A STUDY BY HEAR THE WORLD

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HEARING IS LIVING A STUDY BY HEAR THE WORLD

List of contents

Editorial 2 Methodology 4 The survey participants 6 Hearing loss and hearing aids 8 The significance of hearing in various aspects of life 12 The relativesâ&#x20AC;&#x2122; perspective 14 Looking for partners and partnership 16 Family and friends 22 Sports and leisure 24 Travel and everyday mobility 26 Health and wellbeing 28 Publication details 30 Glossary, legal notice

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EDITORIAL

A STUDY BY HEAR THE WORLD

Hearing accompanies us throughout our lives; it shapes and influences every part of our world. Hearing enables us to communicate with others. Sounds are there with us in our daily life â&#x20AC;&#x201C; some relax us, others cause stress. Much of what we hear we enjoy. There are everyday sounds we no longer even notice, and other noises we would rather just avoid. We need our ears to communicate with other people, and when we want to listen to music or make music ourselves. But these are only the better-known facets of the subject. On the occasion of the fifth anniversary of the founding of the Hear the World initiative, we commissioned a large study to shed light on the lesser known aspects of hearing. In all, we surveyed over 4,000 people in five countries, on diverse topics related to hearing in all areas of life. In addition, we asked experts from relevant specialist areas for their assessment of the study results, and once again reached the conclusion: Hearing is Living! For example, did you know that our hearing is partly responsible for how well we sleep at night, how often we exercise, where we go on vacation or

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how attractive we think we are? Or would you have thought that the quality of our hearing also affects our personal relationships? Or how happy we are in partnerships? Our study shows that more than one in three hearing aid users believe that their love lives have improved since having their hearing loss treated with a hearing aid, and 81 percent of partners and spouses also say: “I am glad that my partner wears a hearing aid.” I am pleased to be able to present some of the exciting results of our study in this brochure and we hope that reading it will lead you too to conclude: Hearing is Living!” I hope you will find it enjoyable and stimulating to read.

Yours, Maarten Barmentlo Group Vice President Marketing, Sonova Holding AG

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4.335 people from 5 countries were surveyed in this study

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METHODOLOGY A STUDY BY HEAR THE WORLD

FIGURE 1: METHODOLOGY • online survey

• time frame: Sept 23rd – Oct 11th, 2011 • LOI approx. 25 minutes • 4,335 respondents ages 45 and up

• number of respondents (weighted): 867

862 UK

866

Germany

854

4.335 Total What signiﬁcance does hearing have on various aspects of life? How important is hearing for relationships with partners, with friends and family, or at work? What bearing does it have on how we spend our leisure time, and how does it affect our health and well-being? We focused on questions such as these in the design of this study. In terms of methodology, the present study, “Hearing is Living”, consists of two parts. The starting point was an international online study involving large numbers of participants. A total of 4,335 people in ﬁve countries, aged 45 years and upwards, were surveyed: 867 people (weighted) per country in Germany, Switzerland, France, the UK and the USA (see Figure 1). In a second stage, renowned experts from relevant specialist areas were asked to comment on the study results.

USA

897

France

856

Switzerland

(“owners” and “non-owners” of hearing aids). A group of people with normal hearing served as a comparison group (“control group”). And in order to find out something about the significance of hearing within families and partnerships, a fourth group was surveyed: close relatives of people with hearing loss. For the purposes of the study, “close relatives” were defined as partners, children, parents or siblings. All four groups were asked some of the same questions, and some questions that covered the same ground. From the different responses given by the four groups, we can assess the relative significance of hearing. What is especially interesting here is the comparison of the two groups “with a hearing aid” and “without a hearing aid” – this is the area which highlights the difference between cases of corrected and untreated hearing loss.

The aim of the survey was to explore the importance of hearing in different areas of life. In order to ﬁnd out what effect hearing has in various contexts, one group of respondents were people who were especially involved with the topic of “hearing” because they themselves are affected by hearing loss. A further distinction was made here between respondents with and without hearing aids HEARING IS LIVING 5

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THE SURVEY PARTICIPANTS A STUDY BY HEAR THE WORLD

68 % wear their hearing aid “every day” or “almost every day” n = 985 surveyed hearing aid owners

50 % of respondents with hearing loss but without a hearing aid had not yet seen a doctor about it n = 1,137 respondents with hearing loss but without a hearing aid Let us look more closely at the four sub-groups in the “Hearing is Living” study (see Figure 2).

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Group 1 consisted initially of 985 people who stated that they are affected by hearing loss and have a hearing aid. For the subsequent evaluations, however, a total of 70 were excluded who admitted that while they owned a hearing aid, they “virtually never” wore it. This leaves a total of 915 people in group 1 (“owners”). Of these, 15 % have had their hearing aid for only a few months, 38 % have worn one for two to five years, and around half the respondents in this group have had their hearing aid for more than five years. More than two thirds of the respondents (68 %) wear their hearing aids every day or almost every day, if not always for the whole day. A further 11% wear their hearing aids “several times a week”. In terms of the type of hearing aids used, the overall finding across all the countries in the survey was that around two thirds of respondents wear behind-the-ear devices (67 %), just under a third wear in-the-ear devices (30 %), and 2 % have opted for implants. Considerable differences can however be observed between the various countries – the incidence of in-the-ear devices ranges from 17 % in Germany to 50 % in the USA, and the proportion of implants varies between 4 % in France and 0.3 % in the USA.

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FIGURE 2: DEFINITION OF SUBGROUPS Group 1: HI OWNERS

Group 2: HI NON-OWNERS

Group 3: RELATIVES

Group 4: CONTROL GROUP

• hearing loss • owner of a hearing aid

• hearing loss, self noticed

• no hearing loss • have someone close to

• no hearing loss • no close relative with

they wear at least occasionally • n (HI) = 915

or diagnosed • do not own a hearing aid (n = 1,137) or own a hearing aid, but wear it “virtually never” (n = 70) • n (no HI) = 1,207

The second group (“non-owners”) consisted of a total of 1,137 participants. In response to the question of how they would assess their own hearing, just under one ﬁfth of respondents (18 %) reported that they had not themselves noticed any change in their ability to hear, but other people would occasionally remark that they no longer seemed able to hear very well. 50 % had noticed that their hearing was no longer as good as it had been, but had not yet seen a doctor or hearing care professional about it. 22 % stated that they had seen a doctor or hearing care professional, who advised them that a hearing aid was not yet necessary. And ﬁnally, 15 % of the respondents in group 2 actually had been advised to wear a hearing aid to compensate for their failing hearing, but for various reasons had not yet taken the decision to do so.

them who suffers from hearing loss, e.g. a spouse, parent, sibling or own child • n (relative) = 1,104

hearing loss • no special connection to

the topic of hearing loss • n (control) = 1,109

In group 3, “relatives”, a total of 1,104 people were surveyed. This group could hear well themselves but had a particular interest in the subject of hearing and hearing loss because they had family members affected by hearing loss. In most cases the person affected by declining hearing was a parent (56 %), for 10 % it was a brother or sister who was affected. In 5 % of cases it was their own child, while for just over one third of respondents it was the partner or spouse who was affected (36 %). Slightly less than half the affected family members had a hearing aid (46 %). To place the responses of the three groups in context, a control group was also included in the survey. The 1,109 participants in this sub-sample match the age and sex proﬁle of internet populations aged 45+ in the countries covered. They are not affected by impaired hearing and do not have a relative with hearing loss – so their answers represent the views of the general population over the age of 45 in these countries.

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49% “I should have started using a hearing aid much earlier.” 237 hearing aid owners in the age group 45-64 years, percentage of top 2 boxes

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HEARING LOSS AND HEARING AIDS A STUDY BY HEAR THE WORLD

FIGURE 3: STATEMENTS OF HI OWNERS (GROUP 1)

FIGURE 4: REASONS FOR NOT WEARING A HEARING AID (GROUP 2, NON-OWNERS)

n (HI) = 915 Percent of top 2 boxes (strongly agree, agree)

n (no HI) = 1,207 Percent of top 2 boxes (strongly agree, agree)

17.4%

76.5 %

81.2%

“I wear my hearing aid quite openly, it’s nothing to be ashamed of.”

“I don’t think a hearing aid helps very much.”

“Other peoples’ reactions to my hearing aid are generally positive.”

67.6%

“I can’t imagine being without my hearing aids again.”

19.9%

“I would be embarrassed to wear a hearing aid.”

61.3 % “Hearing aids are too expensive.” 11.1%

“I want to avoid negative reactions of other people.”

FIGURE 5: FACTORS TO OPT FOR A HEARING AID (GROUP 2, NON-OWNERS) “WHICH FACTORS WOULD MAKE YOU OPT FOR A HEARING AID?” HL becomes worse Hearing care professional / doctor recommends HI 66.1 HI fully reimbursed or free 47.3 Partner / close relative asks me to 41.3 HI become cheaper 29.1 Financial situation improves 11.4 Recommendation of acquaintance 9.6 Press / TV/ internet 7.8 Employer asks me to 4.7 Advertising 2.9 n (no HI) = 1,207 Testimonial / celebrity 1.1 Percent top 2 boxes (strongly agree, agree) What is it like to live with a hearing aid? Why do some people use them – and why do other people decide against a hearing aid, even if they clearly notice that their hearing is no longer perfect?

Most of the hearing aid users surveyed in the study feel very comfortable with their hearing aid. A total of just under two thirds (63 %) of all respondents in group 1 agree or strongly agree with the statement “My hearing aid(s) have become an essential aspect of my life. I even forget that I am wearing them.” In Switzerland the ﬁgure is as high as 69 %, and in Germany 73 %. Eight out of ten hearing aid owners state that they wear their hearing aid quite openly – after all, a hearing loss is nothing to be ashamed of. A good three quarters of hearing aid owners report generally positive reactions to their hearing aid (77 %) and over two thirds (68 %) say that they would not want to do without their hearing aids (see Figure 3).

78.6

In all, 40 % of respondents regret in retrospect that they did not opt for a hearing aid much earlier – in the 45 – 64 age group, as many as half the sample say they should have started using one much earlier. So why do so many people hesitate when it comes to restoring their own hearing? It is interesting that ﬁnancial reasons appear to play the biggest role in the decision against a hearing aid. The view that a hearing aid “does not help very much” is held by only 17 % of respondents with hearing loss but without a hearing aid – implying that 83 % believe that a hearing aid would certainly help them. Only about a tenth of respondents in this group (11%) say that they want to avoid negative reactions from other people. 20 % state that they would ﬁnd it embarrassing to wear a hearing aid – they would not want everyone to know that they could not hear very well. By far the greatest level of agreement is expressed, by 61%, with the statement “hearing aids are too expensive” (see Figure 4).

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56 % “My hearing aids were a worthwhile purchase.” 915 hearing aid owners, percentage of top 2 boxes

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HEARING LOSS AND HEARING AIDS A STUDY BY HEAR THE WORLD

“My wife and I have had lengthy discussions about why I waited so long to buy a hearing aid. Was it vanity? Probably most of all I was unaware of how much quality of life a hearing aid would give back to me.” Dr. Ulf Berg, president of the board of directors of several international companies (Switzerland)

“My husband even says that my hearing aids are one of the best purchases we have ever made.” Tanja Buelter, journalist and TV presenter (Germany)

“As a global community, we happily use iPods, mobile phones or Bluetooth headsets all the time because we are told that these are aspirational and desirable items to own. Even though we embrace this technology, hearing aids – which are smaller, more technologically advanced and in some cases invisible – are not used to the same degree. Why? It can’t be stigma because we are so used to seeing people wear things on their ears. Could it be that we have an old fashioned, subconscious view of how someone with hearing loss is viewed by others?” Robert Beiny, Audiologist (UK)

Another possible reason is identiﬁed by Professor Dr. Martin Ohlmeier, specialist in neurology, psychiatry and psychotherapy, and Director of the Ludwig Noll hospital in Kassel (Germany): “Getting used to change, in this case the loss of hearing, is almost always accompanied by a certain resistance. For adults in particular, it is very difﬁcult to get used to new situations and to adjust one’s life. Even positively anticipated changes, such as the prospect of improved hearing, can cause stress. This may explain why many affected people often wait far too long to acquire a hearing aid.” Against this background, it would be interesting to know what would persuade the respondents from group 2 to opt for a hearing aid after all. Figure 5 (page 9) shows that around two thirds (66 %) could accept the idea of a hearing aid if their doctor or hearing care professional recommended it. 41% could imagine using a hearing aid if their partner or a close relative asked them to. As many as 79 % of respondents in group 2 say that they would wear a hearing aid if their hearing loss got worse – and here they may well be underestimating how much a hearing aid could improve their quality of life, even in a case of mild hearing loss.

And of course financial factors play their part: almost one in two people (47 %) might opt for a hearing aid if their health insurance paid for it in full, or if it were free of charge for some other reason. Cost was a major factor for respondents in the USA and France especially. In all, 29 % of respondents state that cheaper hearing aids overall would be attractive to them. 11% are waiting for their financial situation to improve. By contrast, hearing aid owners do not regret opting for a hearing aid, even taking the financial side into account: across all countries, 56 % of hearing aid owners are of the view that getting a hearing aid was definitely worth it. In the USA, as many of 72 % of respondents agree with this statement, as do 66 % in Switzerland and 63 % in Germany.

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36 % of hearing aid users state that their love life has changed for the better since they have been wearing a hearing aid 915 respondents with a hearing aid, percentage of top 3 boxes

78 % of hearing aid users enjoy shared activities with friends more since they have been wearing a hearing aid 915 respondents with a hearing aid, percentage of top 3 boxes Hearing is an important part of our lives – so it is obvious that any worsening in hearing has very direct effects on the most diverse areas of life. That people with declining hearing find it increasingly difficult to follow dialogues on TV, radio or in the theater, that outings to restaurants suddenly become a challenge because they can no longer make out what their companion is saying in the hubbub of voices, that hearing loss can also lead to problems at work – all this is known. But hearing loss has other consequences over and above these, including in areas of life that might not be immediately apparent.

Figure 6 shows the parts of their lives in which respondents without a hearing aid perceive some worsening since their hearing has declined (top 3 boxes). It can be clearly seen in the graphic that the greater the perceived deterioration, the more serious the (untreated) hearing loss is. But even people who rate their hearing loss as “mild” sometimes notice clear negative changes. Around a quarter of all respondents (26 %) state that they have noticed a reduction in their general quality of life. Of those respondents who assess their hearing loss as “moderate” or “severe”, as many as one in two conﬁrm that their general quality of life has 12 HEARING IS LIVING

been impaired. But hearing loss also has negative effects on receptiveness and mental fitness (mentioned by 25 %), on friendships and activities with friends (22%), on the sense of self esteem (21%), feeling of security, or the relationship with one’s partner (each 20 %). And last but not least: 14 % of respondents without hearing aids report that hearing loss has negative effects on their love life – amongst respondents with more than just mild hearing loss it is as high as 23 %, so almost one person in four. The solution to the problem is close at hand, as the study clearly shows – 36 % of hearing aid users report that their love life has improved since they have had a hearing aid. 64 % report that the hearing aid has a positive influence on their self-confidence. Around 70 % state that their mental fitness, their general mood and their relationship with their partner have improved. 78% have had more fun in shared activities with their friends since they have been wearing a hearing aid, 73% have better relationships with their family, and 83 % believe that their hearing aid has a positive influence on their overall quality of life (top 3 boxes for all statements, see Figure 7).

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THE SIGNIFICANCE OF HEARING IN VARIOUS ASPECTS OF LIFE A STUDY BY HEAR THE WORLD

FIGURE 6: ASPECTS OF LIFE (GROUP 2, NON-OWNERS)

mild hearing loss moderate / severe hearing loss total, group 2

“WOULD YOU SAY THAT YOUR LIFE HAS CHANGED FOR THE WORSE IN THESE AREAS SINCE YOU HAVE BEEN UNABLE TO HEAR SO WELL?” 22.4 Events 29.4% 52.3 18.5 General quality of life 26.0% 50.5 19.7 Receptiveness, concentration, mental fitness 25.4% 44.4 16.7 Going out (e.g. restaurants) 22.9% 43.2 14.3 Friendships, activities with friends 22.0% 47.2 16.6 General mood, frame of mind 21.9% 39.2 14.9 Self-esteem 21.3% 42.3 15.7 Feeling of security 20.1% 34.6 14.8 Relationship with partner 20.0% 37.2 11.8 17.9% Relationships with family members 38.0 14.6 17.7% Physical health (e.g. heart and circulation, weight) 27.9 12.0 17.4% Career 35.4 13.1 17.1% Sporting activities 30.6 10.1 Traveling (e.g. holiday travel, business trips) 14.6% 29.3 10.0 Sense of independence 14.3% 28.2 11.5 Love life 14.2% 23.0 9.7 Everyday mobility (e.g. road transport, public transport) 13.9% 27.6 n (no HI) = 1,207. Percent top 3 boxes (a little / significantly / very much so)

FIGURE 7: ASPECTS OF LIFE (GROUP 1, HI OWNERS) “HOW MUCH OF A POSITIVE IMPACT HAVE HEARING AID(S) HAD IN VARIOUS ASPECTS OF YOUR LIFE?”

General quality of life Friendships, activities with friends Events (movie theater, theater, concerts, etc.) Relationships with family members Going out (e.g. restaurants) Feeling of security Relationship with partner General mood, frame of mind Receptiveness, concentration, mental fitness Sense of independence Traveling (e.g. holiday travel, business trips) Everyday mobility (e.g. road transport, public transport) Self-esteem Sporting activities Career Physical health (e.g. heart and circulation, weight) Love life

83.1 77.7 73.4 72.5 71.2 70.6 69.7 69.3 69.3 66.9 65.6 64.5 64.2 44.4 43.9 38.3 35.5

n (HI) = 915. Percent top 3 boxes (a little / significantly / very much so) HEARING IS LIVING 13

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58 %

“My relative has been having a better life since he has been wearing a hearing aid.” 432 respondents whose relative wears a hearing aid, percentage of top 2 boxes

41% “My own life is easier now that my relative wears a hearing aid.” 432 respondents whose relative wears a hearing aid, percentage of top 2 boxes

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THE RELATIVES’ PERSPECTIVE A STUDY BY HEAR THE WORLD

“In the end, it was my husband who asked me to ﬁnally do something about my hearing loss. He was after all the one who bore the brunt of it. He was constantly having to repeat things he had said, and time and again there were misunderstandings. When we had arranged to meet, sometimes I would be standing at the wrong place at the right time, and sometimes at the right place at the wrong time.” Caroline Roth, former domestic science teacher, now housewife and mother of two children (Switzerland)

“I have two lovely girls aged 4 and 23 months old. I’d never hear them cry during the night and as a result my wife would end up seeing to them. The sleep deprivation for my wife did not help our relationship.” Allen Reid, employee in the credit division of an automotive manufacturer (UK)

I have been wearing hearing instruments for 20 years and I have to say that my life has changed. My wife, Anne, no longer has to serve as my hearing assistant. I can hear people at social outings and at business meetings. I also hear our grandchildren when they call, “Grampie”. Jim Ryun, founder and president of a public relations company and former congressman (USA)

Hearing loss generally affects not only the sufferers themselves, but also their families. We asked family members: “Would you say that your own life has changed for the worse since your relative has been unable to hear so well?” And indeed in each case, 29 % of relatives report negative effects on their own activities with friends, and on their general mood.

A quarter of the relatives surveyed (26 %) noticed a decline in their own overall quality of life, 18 % a worsening in their own self-conﬁdence and their own health (top 3 boxes for all statements). Hearing loss in one’s partner has a more severe effect on wellbeing than if a parent or sibling have the problem. If we look only at those respondents in group 3 whose spouse is affected by hearing loss, we notice that especially the relationship is put under strain: around 42 % of the respondents reported that their partner’s hearing loss had negatively affected their relationship. But also their own activities with friends, their own ability to concentrate, and their general mood suffered as an effect of their partner’s hearing loss (around 34 % of responses, top 3 boxes).

Professor Dr. Martin Ohlmeier, specialist in neurology, psychiatry and psychotherapy in Kassel (Germany), conﬁrms these results: “Relatives rightly have a claim to be able, and be allowed, to communicate with their partner or family member. In practice, it is not uncommon for conflict to arise when the relatives can no longer put into practice what is necessary to maintain the relationship they have been used to sharing. To put it another way: the partner has a right to an acceptable level of communication in the relationship.” No wonder that amongst those respondents whose relative does not yet wear a hearing aid, one in three believes that their own lives would be easier if the affected family member could make up their mind to get one (29 %). That they are probably right to think so is demonstrated by looking at those respondents whose relatives already have a hearing aid: they conﬁrm that getting the hearing aid not only had a positive effect on their relative’s life (58 %), but also directly improved their own life (41%).

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52 %

of hearing aid users state that they find it easy to make new acquaintances â&#x20AC;&#x201C; just as many as in the general population

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LOOKING FOR PARTNERS, AND PARTNERSHIP A STUDY BY HEAR THE WORLD

81%

of partners and spouses say: “I am glad that my partner wears a hearing aid.”

Respondents whose spouse or partner wears a hearing aid, percentage of top 2 boxes

It is probably one of the most common prejudices about hearing aids: they are a hindrance if you want to get to know someone.

Amongst those with hearing loss who have not yet opted for a hearing aid (group 2), across all the countries 19 % of respondents hold this view. The vote is particularly clear in the USA – here, one in three fear that it may be difficult to make new acquaintances. In the UK, the ﬁgure is just under one in four (24 %), in France 15 %, in Germany 12 % and in Switzerland 11% of respondents worry that wearing a hearing aid will make it harder to meet someone (top 2 boxes for all statements, see Figure 8, page 18). What is the real truth about this prejudice? In the “Hearing is Living” study we wanted to get to the bottom of it. First, we were interested in the experiences of hearing aid wearers themselves. The result: more than half (52 %, top 2 boxes) of hearing aid owners report that they ﬁnd it easy to make new acquaintances. Since 52 % of respondents in the control group also said they had no problems getting to know people, there is no difference between hearing aid owners and the general population.

We wanted to ﬁnd out more, and asked: “Have you had a relationship break down because of the hearing aid?” Only 3 % of hearing aid users answered “yes” to this question. In comparison, in the group of non-users also 3 % of respondents state that a previous relationship had broken down – albeit not because of a hearing aid, but because of their hearing loss. To cover the subject of getting to know people and partnerships from all angles, we couldn’t ignore the partners in the relationship – after all, they have their own opinions on the question “hearing aid: yes or no”? And their opinion is clear: 41% of those respondents whose partner or spouse is affected by hearing loss, but does not yet wear a hearing aid would be glad if their partner would get one. Just under one in ﬁve (19 %) even believe that getting a hearing aid would improve their relationship.

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LOOKING FOR PARTNERS, AND PARTNERSHIP A STUDY BY HEAR THE WORLD

FIGURE 8: PREJUDICE (GROUP 2, NON-OWNERS) “HEARING AIDS ARE A HINDRANCE WHEN YOU WANT TO GET TO KNOW SOMEONE.”

24.2 % UK

Germany

19.1% Total

33.2%

15.0% France

USA

10.6%

Switzerland

n (no HI) = 1,207. Percent top 2 boxes (strongly agree / agree)

FIGURE 9: STATEMENTS (GROUP 3, PARTNER)

40.0%

“I receive more attention from my partner since he has been wearing a hearing aid.”

81.0% “I am glad that my partner wears a hearing aid.”

37.9%

“Our relationship has improved since my partner has been wearing a hearing aid.”

n = 100 (relative = partner, wears HI). Percent top 2 boxes (strongly agree / agree)

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12.3%

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94 %

“In principle, I think glasses are a positive thing – if wearing glasses means you can see better, you should definitely wear them.” 1,109 respondents from the control group, percent top 2 boxes (strongly agree / agree)

92 %

“In principle, I think hearing aids are a positive thing – if wearing hearing aids means you can hear better, you should definitely wear them.” 1,109 respondents from the control group, percent top 2 boxes (strongly agree / agree)

FIGURE 10: STATEMENTS

29.1%

15.7%

27.9%

22.1%

HI-ms (n = 695)

no HI-ms (n = 282)

“I FEEL ATTRACTIVE AND DESIRABLE.” Percent top 2 boxes (strongly agree / agree) Control group: 27 %

“I OFTEN RECEIVE COMPLIMENTS.” Percent top 2 boxes (strongly agree / agree) Control group: 35 %

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LOOKING FOR PARTNERS, AND PARTNERSHIP A STUDY BY HEAR THE WORLD

FIGURE 11: STATEMENTS (GROUP 3, PARTNER) RELATIVE = SPOUSE, NOT WEARING HEARING INSTRUMENT n = 278 (relative = partner wears no HI) Percent top 2 boxes (strongly agree / agree)

70.0%

“I would not find my partner less attractive if he wore a hearing aid.”

RELATIVE = SPOUSE, WEARING HEARING INSTRUMENT

FIGURE 12: THOUGHT EXPERIMENT (CONTROL GROUP)

78%

of the control group say it would not be a deterrent to start a relationship with a person wearing a hearing aid n = 1,109 (control) Percent bottom 2 boxes (would not bother me / would not bother me at all)

n = 101 (relative = partner, wears HI) Percent top 2 boxes (strongly agree / agree)

71.3%

“My partner is not less attractive to me because he wears a hearing aid.”

And what about those respondents whose partner or spouse has already opted for a hearing aid? For them, things are even clearer. A resounding 81 % conﬁrm: “I am glad that my partner wears a hearing aid.” 40 % report that they received more attention from their partner since he or she has had a hearing aid. And 38 % think that they now have a better relationship (see Figure 9, page 18). The study also shows that there is no need to worry about being attractive: almost a third of hearing aid owners with moderate to severe hearing loss say that they feel attractive and desirable (29 % agreement in the top 2 boxes), whilst in the comparison group without hearing aids only half as many respondents (16 %) agree with this statement. And the hearing aid owners feel just as attractive and desirable as the control group (27 %). Such a positive inner attitude is bound to show on the outside, and 28 % of respondents with hearing aids report that they often receive compliments. Of the group who have not yet opted for a hearing aid, the ﬁgure for those who state they often receive compliments is only 22 % (in each case, respondents with moderate to severe hearing loss, top 2 boxes. See Figure 10, page 18).

20 HEARING IS LIVING

Spouses and partners also believe that a hearing aid does not detract from their partner’s attractiveness: seven out of ten respondents (70 %) whose spouse or partner has hearing loss but has so far done without a hearing aid would not ﬁnd their partner any less attractive if he or she were to wear one. This is echoed by the partners of the hearing aid owners, of whom 71% agree that: “My partner is not less attractive to me because he wears a hearing aid” (see Figure 11). It is not just those study participants confronted with the subject of hearing loss because their partner is affected who are completely open to hearing aids. Those respondents who have no close connection with the topic of “hearing and hearing loss” – the control group – also have much less anxiety about contact than affected people seem to fear. (See Figure 12).

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“My ten-year career as a model was very positive. I have gained self-conﬁdence, I talk quite normally to everyone, and I ﬁnd it easy to make friends.” Yoya Vallée, model and mother (France)

Within the framework of the “Hearing is Living” study, we carried out a small thought experiment with the respondents from the control group. We asked them: “If you were single and wanted to get to know someone, what would be a deterrent to starting a relationship with this person?” The result: if the person in question wore glasses, that would be a hindrance to a relationship for 2 % of the control group. If they wore a hearing aid, that would be a deterrent for 9 %. However, if the person in question did not wear a hearing aid but definitely could not hear well, that would definitely deter 24 %, or one in four respondents. Female respondents in particular show a firm opinion here: entering into a relationship with a man who does not hear well but does not wear a hearing aid would be completely out of the question for 28 % of the women.

And for the sake of completeness, the other side of the coin: 78 % of respondents in the control group would not have a problem with starting a relationship with someone who wears a hearing aid (see Figure 12). What does all this mean for our previous theory that: “Hearing aids are a hindrance when you want to get to know someone”? The study results allow only one conclusion: in the search for a partner, quite evidently neither hearing loss nor hearing aids themselves represent a hindrance – it is much more likely just to be your own feeling of insecurity that stands in the way. These days, a hearing aid is just as natural as glasses, the study clearly shows. A total of 94 % of the control group agree or strongly agree with the statement “In principle, I think glasses are a positive thing – if wearing glasses means you can see better, you should deﬁnitely wear them”. Almost as many, namely 92 % of respondents, believe: “In principle, I think hearing aids are a positive thing – if wearing hearing aids means you can hear better, you should deﬁnitely wear them.”

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86%

of hearing aid users feel that their friends accept them as they are 915 hearing aid users, percentage of top 2 boxes

“No man is an island”, said the English poet John Donne back in 1624 – people are not meant to make their way through life alone. We need other people to interact with, share our thoughts, and do things with. Family and friends undoubtedly play a particular role here. It is in the family and the circle of close friends that we feel particularly at ease and secure, and in which we can be ourselves. And here it is all the more important that we understand one another – in the truest sense of the word – and that there are no unnecessary misunderstandings.

It is no wonder therefore that hearing loss in a family member is a subject that can concern a family greatly: 23 % of relatives of people with hearing loss but without a hearing aid report that the hearing loss is a frequent subject of conversation in their family. 29 % try often or very often to persuade their relative to wear a hearing aid. Sometimes no great persuasion is necessary; sometimes the family itself provides the necessary nudge. Tanja Buelter, a well-known German journalist and TV presenter, describes the moment when she decided to do something about her hearing loss: “I generally have difﬁculties in busy places 22 HEARING IS LIVING

with a lot of people, where I often cannot tell the direction a voice or a noise is coming from. One day, my three-yearold son called for me from the crowd, I turned in the wrong direction, and lost sight of him. At that moment I knew that things could not go on like this.” Once the hearing loss has been corrected, not only does normality quickly return, but also enjoyment of shared activities. 62 % of hearing aid owners report that their hearing loss is no longer an issue among family and friends since they have been wearing a hearing aid. 86 % feel they are accepted by their friends just as they are. 74 % keep close contact with their family and 73 % enjoy doing things with their friends (see Figure 13). Even severe hearing loss need not be a reason to do without activities with friends, as is shown by the following ﬁgure: around 41% of hearing aid users with moderate to severe hearing loss say that they have a large circle of friends. Of the respondents with moderate to severe hearing loss but without hearing aids, only 27 % agreed with this statement.

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FAMILY AND FRIENDS A STUDY BY HEAR THE WORLD

“My relationships with my friends and family have become better because I can be more involved in noisy evenings – previously, I would simply withdraw. That is no doubt a subtle area, but maybe the most important. Today I enjoy being in company again.” Dr. Ulf Berg, president of the board of directors of several international companies (Switzerland)

“My hearing aids make me better company. I used to really talk over people. Because I couldn’t hear what they were saying I’d do all the talking and I’d interrupt them without knowing. I’m far less irritating now!” Sarah Reygate, Celebrity Make-Up Artist (UK)

FIGURE 13: STATEMENTS “FAMILY AND FRIENDS” (GROUP 1, HI OWNERS)

74.1 % “I keep in close contact with my family.”

85.5% “Friends accept me as I am.”

73.3% 41.6%

“I have a large circle of friends.”

“I enjoy doing things with my friends.”

n (HI) = 915. Percent top 2 boxes (strongly agree / agree) HEARING IS LIVING 23

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70%

“Wearing a hearing aid during sporting activities is no problem at all.” 915 respondents with hearing aid, percentage of top 3 boxes

37%

“Since I have been wearing my hearing aid, I have enjoyed sports more.” 915 respondents with hearing aid, percentage of top 3 boxes

24 HEARING IS LIVING

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LEISURE AND SPORTS A STUDY BY HEAR THE WORLD

FIGURE 14: STATEMENTS “LEISURE” (GROUPS 1 AND 2)

FIGURE 15: STATEMENT “SPORTS” (GROUP 2, NON-OWNERS) “YOU CAN’T WEAR A HEARING AID WHEN YOU ARE EXERCISING.”

26.0% UK

27.5%

66.2%

“Thanks to my hearing aid, I can finally truly appreciate nature in full.”

22.8 %

35.7% Germany

France

USA

25.3%

Switzerland

54.9%

“Thanks to my hearing aid, I can (once again) do what I like in my free time.”

27.6 %

“Not being able to hear the sounds of nature can be very stressful in daily life.”*

27.5% Total

n (HI) = 915 Percent top 2 boxes (agree / strongly agree) *n (no HI) = 1,207 Percent top 2 boxes (agree / strongly agree)

n (no HI) = 1,207 Percent top 3 boxes (partly agree / agree / strongly agree)

Often it is the little things – you only notice how much you missed them when they suddenly come back. “When I went for a walk in the woods, I often thought that maybe there just happened to be no birds that day”, says one affected woman, for example. “These days, I am just happy when I hear birds singing.”

the opposite is the case. In fact many modern hearing aids are resistant to water and sweat, and even top athletes think nothing of wearing a hearing aid during training or competitions. So it’s no surprise that seven out of ten hearing aid users (70 %) conﬁrm that wearing a hearing aid during exercise is no problem for them at all. More than a third of respondents also enjoy sports more since they have been wearing a hearing aid (37 %).

Not being able to hear nature properly, not being able to hear birdsong, the drumming of rain and the sounds of the sea, is perceived by three in ten respondents with uncorrected hearing loss (28 %) as stressful or very stressful. By contrast, two thirds of respondents with hearing aids (66 %) report that, thanks to their hearing aids, they can truly appreciate nature in full once more. More than half of respondents with hearing aids (55 %) are happy that thanks to the hearing aid, they can once again do whatever they like in their free time (see Figure 14). Choosing how to use your spare time often means being able to play sports. While a surprisingly high proportion of nonwearers think that you cannot exercise with a hearing aid (see Figure 15) – across all the countries surveyed, more than a quarter hold this view and in Germany it is even a third –

And along with enjoyment, they also evidently gain endurance: amongst respondents with moderate and severe hearing loss, those with a hearing aid take part in sport or exercise more frequently than those without one: one in three hearing aid users (33 %) say that they actively take part in sports at least once a week, but the ﬁgure is only one in four (25 %) for non-wearers. Regardless of the severity of the hearing loss, respondents with hearing aids also play sports with other people more frequently (e.g. with friends, family or other training partners) than respondents without hearing aids (50 % vs. 43 %)

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84%

“Thanks to my hearing aid, I can travel in whatever way I like.” 915 respondents with hearing aid, percentage of top 3 boxes

26 HEARING IS LIVING

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TRAVEL AND EVERYDAY MOBILITY A STUDY BY HEAR THE WORLD

“What I did not know for a long time is that hearing aids are an enormous advantage when travelling. When I set the device to flight mode, it is very relaxing. All the background noises in the plane, such as air conditioning etc., are almost completely screened out.” Tanja Buelter, journalist and TV presenter (Germany)

Whether we like to travel, discover foreign countries, languages and cultures, or whether we view leaving our familiar surroundings as a stressful experience, is no doubt largely down to our individual own personality. What is certain is that hearing loss can make travelling more complicated.

It’s true that few of the respondents without hearing aids feel constrained by their hearing loss when travelling – but only if their hearing loss is very mild. More severe hearing impairments can, if they remain untreated, cloud one’s enjoyment of travel considerably. This is shown by a comparison of respondents with and without hearing aids, with moderate to severe hearing loss respectively. The differences start as early as the planning of the trip: 61% of respondents with a hearing aid state that they are able to plan their travels with complete flexibility. Respondents without a hearing aid, on the other hand, have to take their hearing loss into account more often when planning the trip: only 53 % feel they are completely flexible here. And on the trip itself, there is more enjoyment with a hearing aid: of the hearing aid wearers, 69 % state that they are able to enjoy their travels with all their

senses, whereas the figure is only 57 % for respondents without a hearing aid. A similar picture emerges for the experiences gained during the trip. 71% of hearing aid users report mainly positive experiences when travelling, but only 62 % of those who do not yet wear a hearing aid do so. Apart from the correction of hearing loss, travelling with a hearing aid often also has practical benefits, which those who travel a great deal appreciate. Tanja Buelter, who travels a lot for her work as a journalist, says: “What I did not know for a long time is that hearing aids are an enormous advantage when travelling. When I set the device to flight mode, it is very relaxing. All the background noises in the plane, such as air conditioning etc., are almost completely screened out.” Hearing aids offer benefits not just for travel, but also in terms of everyday mobility. Of the owners in the survey, 79 % confirmed that thanks to their hearing aid, they can get their bearings even in unfamiliar surroundings (top 3 boxes). Just as many, 79 %, say that finding their way around in traffic does not present a challenge to them since they have been able to rely on their hearing aid (bottom 2 boxes). HEARING IS LIVING 27

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69%

“I believe that my hearing aid has had a positive effect on my general state of health.” 915 respondents with hearing aids, percentage of the top 3 boxes

“When we read we don’t see every letter of every word in every sentence, but the brain takes what it wants to and relies on its ability to make sense of the sentence. With sound, the same thing occurs in someone who is partially hearing: part of the sound is heard and the brain interprets the rest. With sound however, it takes more effort and is therefore exhausting.” Robert Beiny, Audiologist (UK)

Asked about their physical fitness, 45 % of hearing aid owners and 44 % of non-owners say that: “I am as physically fit as my friends and acquaintances.” By comparison, 43 % of respondents in the control group agree with this statement (top 2 boxes in each case). It appears that hearing loss has no influence on health and physical fitness. Or does it? If we look just at those respondents whose hearing loss is more than “mild”, clear differences suddenly emerge. In the group of hearing aid users, there are still 44 % who feel just as fit as their friends and acquaintances. However, in the group of those who have not yet done anything about their hearing loss, the figure is only 34 %. Wearing or not wearing a hearing aid affects not only physical fitness, but also other aspects of wellbeing. The “Hearing is Living” study shows that those respondents (moderate to severe hearing loss) who do not wear a hearing aid feel sad or depressed much more frequently than the equivalent group of hearing aid owners; they are more likely to feel insecure or angry for no reason, have more often lost interest in areas of their lives that used to be important to them, feel more isolated and frustrated, and above all they suffer more frequently from insomnia (see Figure 16). The symptoms mentioned 28 HEARING IS LIVING

here are generally regarded as possible ﬁrst indicators of depressive disorders. Dr. Annette Menzel, a doctor specializing in psychiatry, psychotherapy, neurology and psychoanalysis in Kassel (Germany), had these comments on the results: “The relatively high agreement levels for individual aspects of depression in people with hearing loss but without a hearing aid do not surprise me. One can clearly see that people who do not have a higher-grade hearing loss corrected are more likely to suffer depressive symptoms.” A possible consequence of the faulty communication that arises through the hearing disorder, Dr. Menzel explains, is isolation of the affected person. People with hearing loss lack the usual opportunities for human contact – the consequences of this isolation can be the development of depression and increased anxiety, but also increasing mistrust of others. It is obvious that a hearing aid can quickly provide relief here. In connection with the slight differences in the tendency to depression between the control group and the hearing aid users, the expert points out: “Hearing loss does not by any means automatically lead to depression – it is much more a matter of how one deals with it.”

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HEALTH AND WELLBEING A STUDY BY HEAR THE WORLD

HI owners, moderate / severe hearing loss

FIGURE 16: FIRST SIGNS OF DEPRESSION

HI non-owners, moderate / severe hearing loss

15.2

I often feel sad or depressed

13.4

I often feel insecure or anxious I am often very angry for no reason I have lost interest in areas of my life which used to be important to me I often feel isolated, as if I were shut off from the world I often feel frustrated

7.4

12.2 13.0 12.0

21.9 21.0

17.5

16.7 15.4

19.4 24.1

I frequently suffer from insomnia

31.0

n (HI-ms) = 695 / n (no HI-ms) = 282 Percent top 2 boxes (agree / strongly agree)

FIGURE 17: CONCENTRATION “I LOSE TRACK WHEN TELLING A STORY.“

4.7 %

14.6%

10.7%

20.9 %

HI-ms (n = 695)

no HI-ms (n = 282)

Another area within health and wellbeing is “concentration and relaxation”. Here the study clearly shows that hearing aid owners have an easier time with both of these aspects than non-users do. They can concentrate better, and are less likely to lose the thread when telling a story (see Figure 17). And the respondents with hearing aids also seem better at relaxation. 59 % of them state that they are good at relaxing, while for non-users the figure is only 49 % (moderate to severe hearing loss in each case). Dr. Inge Richter, consultant in the department for hearing damage in the Klinikum am Europakanal in Erlangen (Germany), comments: “Especially when the hearing loss occurs for the first time when the person is already an adult, communication problems tend to be glossed over and concealed. But this becomes increasingly difficult with increasing hearing loss. The stress associated with this can lead to a growing impairment of one’s quality of life.” In her everyday clinical practice, Dr. Richter often finds that patients who can no longer compensate their hearing loss adequately complain of diverse physical and mental problems as an expression of the situation of permanent stress. Dr. Richter goes on to explain that treatment with a hearing

Top 2 boxes (often / very often)

“I FIND IT DIFFICULT TO LISTEN AND CONCENTRATE DURING CONVERSATIONS.“ Top 2 boxes (often / very often)

aid enables the restoration of an acoustic link with the world around us, and contributes to an improvement in the communication situation. “Speech is heard more clearly, and one no longer needs to concentrate so hard all the time. Hearing aid users can thus relax better, experience less stress, and regain their quality of life.” Despite all the relaxation, boredom is not a problem for the hearing aid users who were surveyed. Just under three quarters of the wearers (74 %) agree with the statement: “I like to keep myself occupied in my free time – I’m never bored”, which is just as many as in the control group (73 %). In the group of those who do not yet have a hearing aid, only 61% agree with this statement (top 2 boxes, moderate / severe hearing loss). If one takes all these results together, it is not surprising at all that seven out of ten respondents believe that their hearing aid has had a positive effect on their health.

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CONCLUSION A STUDY BY HEAR THE WORLD

With its large number of participants and its comprehensive study design “Hearing is Living” provides many fascinating insights. Not only the overall results, but also the international comparison between responses is interesting, as there are distinct differences between the different countries. When consolidating the numerous results on a higher level we can distinguish three important findings: Firstly, hearing influences so many areas of our everyday life that improved hearing has one benefit above all others: enhanced quality of life. Better hearing means better communication – in our relationships with our partners, as well as toward friends and family. Good hearing is not merely of benefit to yourself: its positive effects are also directly measurable among family, relatives and partners – this is the first significant insight gained from this study.

30 HEARING IS LIVING

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The second important insight of the study is that better hearing enables us to experience life in a more active, healthier way, and with fewer restrictions. Stress is reduced, or may be avoided in the first place, concentration is improved, and relaxation is easier. In this way, good hearing also contributes to enhanced personal wellbeing and general health. And thirdly, looking at the way people perceive the hearing capability of others, the study shows very clearly that wearing a hearing aid does not have any negative effect on attractiveness. On the contrary: not only relatives and partners, but also the unaffected people in the control group have a very open and positive attitude to the subject of “hearing loss and hearing aids”. That is the final, and very welcome, insight to come out of the “Hearing is Living” research study.

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GLOSSARY

A STUDY BY HEAR THE WORLD

Explanatory notes about hearing loss Untreated hearing loss Hearing loss that is not being treated, i.e. no hearing aid, implant, etc. Mild hearing loss Soft noises are not heard. Understanding speech is difﬁcult in a loud environment Moderate hearing loss Soft and moderately loud noises are not heard. Understanding speech becomes very difﬁcult if background noise is present Severe hearing loss Conversations have to be conducted loudly. Group conversations are possible only with a lot of effort Explanatory notes about the survey groups view Figure 2, page 7 Explanatory notes about the statistics Weighting Measure used to adjust the structure of the sample to that of the population to be investigated in the statistical data analysis. In this study, Groups 1, 2 and 4 were weighted with respect to the factors of “age” and “gender” to match the populations in the countries concerned. In addition, the interrelationships between the individual countries were weighted for each group so that all the countries studied were entered with the same weight into the total values for each group

n (HI) Number of respondents in Group 1 “HI owners” n (no HI) Number of respondents in Group 2 “HI non-owners” n (relatives) Number of respondents in Group 3 “Relatives” n (control) Number of respondents in the “control group” (Group 4) n (HI-ms) Number of respondents with hearing instrument and moderate to severe hearing loss. This is a subgroup of Group 1 – only those hearingaid owners suffering from moderate or severe hearing loss are considered n (no HI-ms) Number of respondents affected by moderate or severe hearing loss but who do not own a hearing aid. This is a sub-group of Group 2 – only those people who do not own a hearing aid and are suffering from moderate or severe hearing loss are considered Top boxes Combination of several agreement levels on a scale to form one aggregated agreement level. For example, in the ﬁve-step scale used in the study (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree) the two highest categories of agreement, – i.e. “agree” and “strongly agree” – are combined to form the statement “(strongly) agree” (= top two boxes)

HI Hearing instrument Internet population That part of the total population of a country that is accessible via the Internet (e.g. via PC, laptop, smartphone or any other Internet-compatible terminal) mild /ms Describes the degree of hearing loss as assessed by the respondent him / herself: mild or moderate / severe n Number of people who answered the relevant question

32 HEARING IS LIVING

Bottom boxes Similarly, with the bottom boxes, several disagreement levels are combined to form one aggregated disagreement level. For example, in the ﬁve-step scale used in the study, the percentages for the categories “disagree” and “strongly disagree” can be combined to form an aggregated level of disagreement: “(strongly) disagree” (= bottom two boxes)

Study design and survey: zehnvier research & strategy, Zurich, Switzerland www.zehnvier.ch Project management: Olivier Richard, Elena Torresani (Hear the World) Dr. Kerstin Bolliger, Felix Steinhauer (zehnvier research & strategy) Text: Dr. Kerstin Bolliger, Prof. Dr. Clemens Koob (zehnvier research & strategy) Art Direction: Antonia Henschel, Sign Kommunikation GmbH, Frankfurt am Main, Germany www.sign.de Publisher: Hear the World, an initiative by Phonak Copyright: The use or distribution of the content of this study is only permitted when the source is accurately referenced. A sample of the intended use must be provided. Date of publication: January 2012 Contact: Phonak AG, Corporate Marketing, Laubisruetistrasse 28, CH 8712 Staefa www.hear-the-world.com info@hear-the-world.com

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