Thomas Lunner

Research Area Manager / Adj. Professor

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Exploring narrative effects

The clinical meeting is a narrative (‘story’) in itself. To be able to study narrative effects in isolation, the narrative must be separated from the outcome of the hearing-aid fitting. In this study the test persons were given two hearing aids. These were accompanied by different narratives, but had identical amplification/acoustic signal processing.

Testing narrative effects

The purpose of this study was to demonstrate the power of the narrative in affecting the client’s perception of the dispensing process. The experimental approach was to implement alternative dispensing processes with divergent narratives but identical acoustical results. Then, in a balanced crossover design, to carry out fittings with these processes on a group of hearing-aid clients. The two carefully rehearsed dispensing processes were: a ‘Diagnostic’ process and an ‘Interactive’ process.

Exploring narrative effects 1 diagnostic process
Narrative 1: ‘Diagnostic’ process. The client is inactive and the dispenser makes a number of adjustments based on hearing assessments, during which the client is passive. Fitting is based on hearing thresholds only.
Exploring narrative effects 2 interactive process
Narrative 2: ‘Interactive’ process. The client is led to believe that they have adjusted the HA settings to their own preferences. Fitting is based on hearing thresholds only (hearing-aid settings identical for Narratives 1 and 2.)


20 of the 24 subjects had a clear fitting preference. This is surprising, since the two fittings were acoustically identical. We must suppose that it is the subjects’ perception of the fitting process which determined their preferences. However, all subjects except one gave exclusively sound-related reasons for their preferences (“Sounds more clear” etc.). Thus it seems that clinicians may not always hear the ‘true’ reasons for preferences from their clients.

Further reading

Bentler R, Niebuhr DP, Johnson TA, Flamme GA (2003). Impact of digital labeling on outcome measures. Ear and Hearing, 24(3), p. 215-224.

Dawes P, Powell S, Munro KJ (2011). The placebo effect and the influence of participant expectation on hearing aid trials. Ear and Hearing, 32(6), p. 767-774.

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