The effect of background sounds on hearing aid usage- focus groups

Chief investigator

Dr Brian Gygi

Study team

Dr Paul Leighton


NIHR Nottingham Hearing BRU programme

Study period


Difficulty with background sounds is consistently listed as one of the major problems hearing aid users have. For example, in surveys of reasons for non-use of hearing aids respondents consistently list ‘annoyance from background sounds’ as a major factor.  However, the exact nature of the problems listeners have with backgrounds is rarely elaborated upon. Survey listeners often report ‘they don’t work in noisy settings’ without details of what that means.  A more precise understanding of the problems hearing aid users have with noisy backgrounds is necessary. If the nature of background sounds and the effects on new hearing aid users is more precisely understood, that will lead the way to diagnostics and interventions for those users for whom background sounds are a major impediment to optimal use of their hearing aids.

The goal of these focus groups was to gather both quantitative and qualitative data on new hearing aid users’ experiences with background sounds.  The quantitative data will be lists of sounds that new hearing aid users find pleasant and unpleasant.  The qualitative data will be transcripts of discussions relating to the sounds new hearing aid users find unpleasant, and why they find them so.  The transcripts were be subjected to thematic analysis to determine the underlying common elements in the user’s experiences which will lead to a greater understanding of role of background noise in new users’ dissatisfaction with hearing aids.

Three focus groups were conducted with recent hearing aid users and service volunteers centering on discussions around the effects of background noise on recent hearing aid users.  Two focus groups (n = 7; n=4)  were held at the NIHR Nottingham Hearing Biomedical Research Unit. The third group (n=9) consisted of hearing aid volunteers for the Hard of Hearing Groups, part of the Sensory Resource & Development Service of the Shropshire Rural Community Council, and was held at the Shrewsbury Shropshire Vounteer center. All the participants in these groups had been fitted less than one year ago.  These participants were treated as one group for analysis purposes.

The sessions were transcribed by a professional transcription service.  The responses were coded according to a set of codes developed by the investigators.  The responses were compiled according to the codes and analyzed thematically.

Summary of findings

Some of the findings which emerged from the qualitative data reinforce the challenges that background noise poses for recent hearing aid users.  Although some of these problems might be alleviated by technological solutions within the hearing aid devices, most participants reported simply taking the hearing aids out or turning them down in difficult situations.

Interference from background noise:
Participants made comments such as:
• “Noise is very, very prominent and it is difficult to get used to.”
• “It has taken me a good six months before I start to be able to cope in restaurants and things with all the different background noise.”

Difficulty inhibiting unwanted sounds:
Participants made comments such as:
• “It can be unpleasant if you are in the cinema because you notice much more somebody rattling
sweet papers”
• “...these just magnify sound more so everything is louder.”

Hearing sounds in a way one has not heard for a long time:
Participants made comments such as:  
• “Obviously things sounded very very tinny and suddenly I was kind of really aware of my
hearing again ... your life suddenly starts centering around hearing.”
• “I am thinking that every lorry, bus, car cyclist was making straight for me because suddenly I
got hearing.”

The quality, clarity and loudness of the sounds:
Participants made comments such as:
• “The pots and pans in the kitchen which really are incredibly noisy.”
• “I think the first time I wore my hearing aids and turned a tap on.  It is like Niagara Falls.”

The problems of background affect hearing aid users' quality of life.  Participants reported changing the times they would go to the market, so that there was less background noise.  Several people reported taking out their hearing aids in situations such as the cinema, which of course diminished their enjoyment of the experience.

Preliminary conclusions

The findings suggest that greater attention should be given to what kinds of challenges they will face in adapting to background noise with hearing aids and making sure users are aware of the range of options available.  In addition, future clinical work which considers background noise should take into account the non-unitary nature of backgrounds sounds, and the varied responses individual present to these sounds.