hearing disturbance is the third most common chronic disease in elderly individuals , following arthritis and high blood pressure.1 ) hearing disturbance also occurs in younger individuals , due to their frequent exposure to noise.2 ) hearing aids improve hearing by amplifying sound , thus promoting the ability of patients to communicate with other people . the korea centers for disease control and prevention recently announced that the prevalence of bilateral hearing disturbance in individuals over age 12 years was 4.5% , increasing to 25.9% in individuals over age 65 years . after age 50 years , the rate of bilateral hearing disturbance triples every 10 years , being 2.9% for persons in their 50 s , 12.1% for persons in their 60 s , and 31.7% for persons aged 70 years and over . however , only 11.3% of individuals aged 65 years with unilateral or bilateral hearing disturbance use hearing aids , with the rate being much lower in females than in males ( 7.2% vs. 17.0%).3 ) the national statistics service of korea has estimated that 11.8% of the total population in 2012 were aged 65 years and that this percentage will increase to about 24.3% in 2030.4 ) thus , interest in and demand for hearing aids for recovery from hearing disturbance are expected to increase . nevertheless , despite improvements in hearing aid performance , design , and adaptation , the current hearing aid usage rate is still quite low , with an estimated 20% of patients prescribed hearing aids returning or declining the devices.5 ) to elucidate the reasons that patients refuse and/or return properly prescribed hearing aids , we analyzed hearing aid usage and the reasons for return in younger ( < 65 years ) and elderly ( 65 years ) adults . of the 1318 patients who visited the department of otolaryngology , kyunghee university school of medicine hearing aid clinic and were prescribed hearing aids from january 2000 to november 2012 , 81 ( 6.14% ) returned their hearing aids within 3 months , including 36 patients aged < 65 years and 45 aged 65 years . using retrospective chart analysis and phone surveys , we compared reasons for returning hearing aids in the two groups . the characteristics of patients with returning hearing aid were subdivided into patient related , hearing related , and hearing aid related factors . patient related factors included patient age , gender , period of hearing disturbance , and main symptom at the time of hospital visit ( hearing disturbance , ringing , or fullness in the ears ) . hearing related factors included the results of pure tone audiometry at the time of hearing aid prescription , speech discrimination test , dynamic range , and degree of hearing disturbance , defined as mild ( 26 - 40 db ) , moderate ( 41 - 55 db ) , moderately severe ( 56 - 70 db ) , severe ( 71 - 90 db ) , and profound ( > 90 db ) . hearing aid related factors included hearing aid location : completely in the canal ( cic ) , in the canal ( itc ) , in the ear ( ite ) , behind the ear ( bte ) , and open type bte . for analysis , reasons for hearing aid return were subdivided into 2 groups , hearing aid problems and patient problems . hearing aid problems included ineffective hearing aids , noise ( noisiness , vibration ) , discomfort , and bad sound quality , whereas patient problems included uselessness ( e.g. hearing recovery , ill health , death ) , financial situation , and difficulties managing the hearing aids . all statistical analyses were performed using the statistical package for social science 18.0 ( spss inc . , parameters were compared using the chi - square test and student 's t - test , as warranted . of 1318 hearing aid users , 81 ( 6.14% ) , of mean age 65.314.5 years , returned their hearing aids . mean ages in the younger and elderly adults were 52.611.4 years and 75.46.5 years , respectively . of the 81 patients , 33 were male and 48 were female , including 17 males and 19 females in the younger adult group and 16 males and 29 females in the elderly group . although females over age 65 years returned more hearing aids than females under age 65 years , this difference was not statistically significant ( p=0.288 ) . the overall duration of hearing disturbance was 7.412.2 years , 8.814.5 years in younger adults and 6.310.1 years in elderly patients ( p=0.373 ) . the main symptom at first appearance at the hospital was hearing disturbance , observed in 72 of the 81 patients ( 88.8% ) , including 32 of 36 ( 88.8% ) younger and 40 of 45 ( 88.8% ) elderly adults . thirty - five patients ( 43.2% ) , 19 younger ( 52.7% ) and 16 elderly ( 35.5% ) individuals , reported ringing in the ears , whereas 17 ( 20.9% ) , 9 younger ( 25% ) and 8 elderly adults ( 17.7% ) , reported ear fullness ( table 1 ) . we found that the overall spondee recognition threshold in all 81 patients was 59.014.9 db , 63.314.0 db in younger and 55.614.7 db in elderly adults ( p=0.019 ) . mean overall speech discrimination ability was 74.413.8% , 75.612.1% for younger and 73.316.1% for older adults , mean overall most comfortable loudness ( mcl ) was 82.2814.9 , 85.2219.1 for younger and 79.339.3 for older adults ( p=0.419 ) , mean overall uncomfortable loudness ( ucl ) was 102.399.2 , 104.1111.2 for younger and 100.677.0 for older adults ( p=0.443 ) ; and mean overall dynamic range was 49.317.4 db , 49.121.0 db for younger and 49.614.2 db for older patients ( p=0.948)(table 2 ) . assessment of the degree of hearing disturbance in the 81 patients who returned their hearing aids found mild , moderate , moderately severe , severe , and profound deafness in 8 ( 9.8% ) , 30 ( 37% ) , 25 ( 30.8% ) , 17 ( 20.9% ) , and 1 ( 1.2% ) patients , respectively . these degrees of hearing disturbance were observed in 0 ( 0% ) , 14 ( 38.8% ) , 12 ( 33.3% ) , 9 ( 25% ) , and 1 ( 2.8% ) , respectively , of the younger group , and in 8 ( 17.7% ) , 17 ( 35.5% ) , 13 ( 28.8% ) , 8 ( 17.7% ) , and 0 ( 0% ) , respectively , of the older group ( table 3 ) . types of hearing aids returned included 22 cic type , 41 itc type , 3 ite type , 6 bte type , and 9 open type . in the younger group , these types were returned by 10 , 19 , 0 , 3 , and 4 patients , respectively , whereas , in the older group , these types were returned by 12 , 22 , 3 , 3 , and 5 patients , respectively ( table 4 ) . the most frequent hearing aid problem was ineffectiveness , reported by 26 patients ( 32.0% ) , 10 in the younger and 16 in the elderly group . other hearing aid problems included noise , reported by 19 patients ( 23.4% ) , 7 in the younger adult and 12 in the elderly group ; wearing discomfort , cited by 14 patients ( 17.2% ) , 9 in the younger and 5 in the elderly group ; and poor sound quality , mentioned by 3 patients ( 3.7% ) , 1 in the younger and 2 in the elderly group . patient problems included management difficulty in 8 patients ( 9.8% ) , 1 in the younger and 7 in the elderly group ( 2 male and 5 female patients ) ; financial difficulty in 6 patients ( 8.6% ) , 5 in the younger and 1 in the elderly group ; and uselessness ( e.g. hearing recovery , poor health , death ) in 5 patients ( 6.1% ) , 3 in the younger and 2 in the elderly group ( table 5 ) . hearing loss results in partial severance of communication via speaking and language and information exchange , resulting in considerable inconvenience in daily life and negative mental and/or emotional effects . patients who experience hearing loss can therefore benefit substantially from hearing aids . the degree of noise in modern society has increased the number of hearing - impaired individuals . moreover , people are living to an older age , increasing the population of elderly individuals . thus , the demand for hearing aids is expected to increase dramatically in the future . in korea , 7.2% of the total population in 2000 was over 65 years of age , and this percentage is expected to increase to 14.5% by 2018.6 ) in 2011 , it was estimated that only 13% of individuals with hearing disorders who required hearing aids had been prescribed hearing aids , fewer than the 25% in countries such as the usa and other european countries.7,8,9 ) nevertheless , the market for hearing aids has grown continuously , due to increases in the population of elderly individuals and their income level , as well as to the development of medical devices , and this market is expected to increase in the next few decades . despite advances in hearing aid development and technology , 3% to 16% of patients prescribed hearing aids return the devices.10 ) factors associated with adaptation to hearing aids include younger age , strong desire for rehabilitation,11 ) and mild deafness . regular visits to the hospital for hearing aid adaptation and adjustment have been associated with good hearing rehabilitation.12 ) adaptation to and benefits from hearing aids have been associated with degree of education , hearing aid type and price , battery price , wearing hearing aids daily for a certain period of time , and horizontal shape of the hearing aid.13,14,15,16,17 ) we found , however , that , despite hearing aid prescription , consultation , and fitting processes by experts , 81 of 1318 ( 6.14% ) patients prescribed hearing aids returned their devices within 3 months . females were more likely to return hearing aids than males ( 59.2% vs. 40.8% ) , especially when females and males over age 65 years were compared . elderly women may be less familiar with the operation of their devices and be less involved in social life than men with hearing aids , making elderly women less sure about the necessity of wearing hearing aids . these findings suggest that attention should be paid to hearing aid prescription and management in women , especially elderly women . in general age has been found to correlate with the severity of deafness , making the threshold higher in elderly patients due to hearing aid failure . in contrast , we found that the spondee recognition threshold was higher in the younger than in the elderly group . this may have been due to our selection of itc type rather than bte or ite type hearing aids for patients with severe deafness , due to the better appearance of the itc type . other characteristics of the 2 groups were similar , including speech discrimination ability , ucl , mcl , and dynamic range . the return rate by both groups was highest for individuals with moderate hearing loss , followed by individuals with moderately severe and severe hearing loss . when we assessed hearing aid related factors , we found that the rates of return of each hearing aid type were similar in the two groups . this may have resulted from our consideration of patient preference , including allowing the patient to make the decision on hearing aid type . in evaluating the reasons for return of hearing aids , we found that ineffectiveness of the device was the most frequent reason , accounting for 32.0% of returns , the highest percentage in both groups . noises , including acoustic feedback , occlusion effect , over - amplification , surrounding noise , and sound transformation , accounted for 23.4% of returns . our finding , that hearing aid return was due in large part to hearing aid ineffectiveness and hearing aid noises , indicates that hearing recovery in patients with hearing disturbance is limited and that hearing aid technology is not sufficiently developed to result in a normal hearing level . these patients usually do not adapt easily to new technology , have less sensitive sensations in their hands , find handling small hearing aids difficult , delay repairing their hearing aids , and are unfamiliar with handling hearing aids , despite repeated consultations and education . whereas 52.4% of patients hesitated to purchase hearing aids due to inconvenience , 51.2% were reluctant for financial reasons . we found , however , that few elderly individuals returned their hearing aids for financial reasons , since many of their healthcare expenses were paid by their children . in contrast , most of the younger adults likely had to pay these expenses themselves . hearing aid return ratios may be reduced by adequate medical consultation , including a diagnosis of the reason for deafness , proper hearing tests to determine the type and degree of deafness , and to choose the optimal hearing aid for hearing improvement . follow - up measures after hearing aid prescription should include a continuous hearing rehabilitation service . periodic consultations and education may help solve problems and minimize any inconvenience , allowing patients to adapt to hearing aids . although hearing aid return rates were similar in younger and elderly adults , but the reasons showed different tendency . financial considerations were cited more by younger adults , while difficulties in managing hearing aids were cited more frequently by elderly adults . patients in both groups , however , reported that the most frequent reasons for return were inadequate hearing improvement and inconvenience wearing the hearing aid due to noise amplification .