The term the hearing aid ‘effect’ was coined in 1977 by Blood et al. to describe the stigma associated with wearing hearing aids (Hear Inst 1977;28:12). Using a bipolar semantic differential scale probing intelligence, achievement, personality, and appearance, the investigators asked 50 college students to rate 24 male Caucasian children (ages 12-15 years), of which 12 wore hearing aids and 12 did not. The children who wore hearing aids were rated more negatively than those who did not, on all parameters except one—cruel versus kind. Since then, numerous studies, primarily showing pictures of Caucasian males, have investigated the hearing aid effect. Most recently, Rauterkus and Palmer had 24 participants rate photographs of five different Caucasian males between the ages of 15-17 years wearing five different types of amplification or hearing devices, specifically a standard behind-the-ear (BTE) type hearing aid, a smaller and slimmer BTE type hearing aid, a completely-in-the-canal type hearing aid, an earbud, and a Bluetooth receiver (J Am Acad Audiol 2014;25:893 http://bit.ly/29kYMg8). They found that the hearing aid effect had virtually disappeared. They attributed their finding to greater acceptability of seeing people wearing personal listening devices with insert or supra-aural headphones, and to a greater public awareness of hearing loss.
Disability occurs regardless of gender, race, religious affiliation, or socio economic status. However, it has been suggested that racial and ethnic minorities with disabilities might find it even more difficult to overcome stigmas and stereotyping than those belonging to the majority (McDonald. Am J Community Pyschol 2007;39:145 http://bit.ly/29kYExr; Rohmer. Rehabil Pyschol 2009;54:76 http://bit.ly/29kYqWX). Category-based processing occurs when individuals view and assess others based on race/ethnicity, gender, physical appearance, and occupation, among others (Rohmer, 2009). These categories can be organized by salience, with gender and race being the most apparent. It can be argued that disability can be compared to the categories above, and is thus a potential target for category-based processing (Rohmer, 2009). This categorization may be exacerbated when an individual has a disability such as hearing loss, which requires the use of a visible device. Also, the fewer the members in these categories, the more apparent they will be to others (Rohmer, 2009). About 15 percent of children and 3.3 percent of those over 18 years old have been diagnosed with hearing loss; 49 percent of children with hearing loss are non-white (Niskar. JAMA 1998;279:1071 http://bit.ly/29kYG8m; Rhoades. Volta Review 2004;104:285).
This investigation aims to, first, determine if race and gender were factors affecting the hearing aid effect. Specifically, would African American male and/or female children be rated differently than Caucasian male and/or female children? Second, it aims to determine if the diminished hearing aid effect found by Rauterkus and Palmer extended to individuals wearing cochlear implants (CIs).
This study was approved by the Pace University Institutional Review Board. A total of 286 college students were presented with a photograph of a male or female, African American or Caucasian child, and asked to rate them across seven attributes on a 7-point Likert scale (Table 1). Each of the four children between ages 8 and 15 years were photographed in the profile wearing three device configurations: (1) no hearing device; (2) a BTE hearing aid coupled to an ear mold; and (3) a CI. Following the Rauterkus and Palmer study, a positive or negative descriptor could be on the left or right for any given attribute to deter participants from responding to one side or the other of the scale receiver.
A two (gender: male x female) by two (race: African American x Caucasian) by three (hearing device: no hearing device x hearing aid x CI) between subject multivariate analyses of variance (MANOVA) was used; the seven attributes served as dependent variables. Post hoc comparisons were made using the Tukey Honest Significant Difference (HSD) test.
A hearing aid effect was found. Photographs of children showed that race and gender individually, and in combination, influenced ratings (ps <.05). Although the type of device depicted did influence rating, neither race nor gender moderated this influence. Post hoc comparisons between the three devices revealed that children wearing CIs were rated more intelligent, attractive, and tidy than children without a device; children wearing no device were rated more outgoing than those wearing a hearing device (Tukey HSD, p <.05; Table 2).
Participants rated children wearing no device as more “outgoing” than children wearing a hearing aid or CI. It is possible they believed that the “ashamed” or insecure feelings a child with a hearing aid or CI may have caused others to perceive them as less outgoing (Green. Soc Sci Med 2003;57:1361 http://bit.ly/29kZhHl; McDonald, 2007; Rohmer, 2009). Another possible explanation is that participants surveyed may have felt that the hearing aid and/or CI was cumbersome and could potentially restrict participation in activities (e.g., fear of losing or dislodging the device during an activity).
Also of interest is the finding that children wearing CIs were rated more intelligent, neat, and attractive than children wearing no device or a hearing aid. These results are consistent with Brimacombe et al. who had teachers rate adolescent students with no hearing aid, a BTE type hearing aid, or a body type hearing aid using a semantic differential scale with 16 bipolar pairs (Lang Speech Hear Serv Sch 1983;14:128). The teachers rated students wearing the body type hearing aid as being more personable than the students in the two other categories. In the present study, the CI is the most visible aid, and photographs of the children in this condition were rated as being higher in intelligence, neatness, and attractiveness. These results can be compared to the body type hearing aid, the most visible device in the Brimacombe et al. study. The participants in the present study may have felt similarly to the teachers in the Brimacombe et al. study; both may have been uncomfortable giving lower ratings to children with visible disabilities.
In the current study, all children wearing a hearing aid and CI were rated similarly regardless of race and gender. Differences in racial and gender ratings were independent of the hearing device. Although a significant gender by race interaction was found, interactions where gender and race served as moderator for hearing devices were not. That is, neither race nor gender was found to interact with a hearing device.
There are several possible explanations for this finding. First, mainstreaming of students with disabilities became prevalent in the 1970s and 1980s with the passage of the Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act in 1973. In 1975, the Education for All Handicapped Children Act PL 94-142 was passed, giving every child the right to an education in the least restrictive environment. Second, the use of earbuds and headphones has become widely common. Today, seeing a person with a hearing aid or CI may not be very unusual, which may have reduced the perceived stigma. These results are indeed encouraging in promoting greater acceptability of people with hearing impairment.