Author: Nicholas S. Reed, AuD
"Blindness cuts us off from things, but deafness cuts us off from people" -- Helen Keller
The onset of hearing loss can impact the quality of life in older adults. Helping others with their hearing needs to improve overall quality of life is why I became a clinical audiologist. In 2015, I decided to change my path from a full-time clinician career to a clinician-scientist track. In this capacity, I can still enjoy helping patients individually with their hearing care needs but I can also leverage public health research to help bring change to address the public’s needs. The reason for my career track change can be summed up in this sentence:
Nearly 38 million Americans have hearing loss, but less than 20-30 percent of these individuals actually use a hearing aid.
During my clinical training. I can recall instances of adults who made it all the way to my office. They had navigated the healthcare system, including seeing other specialists for medical clearance, to find an audiologist for a full evaluation only to walk away without care. Some might chalk this up to the patient simply not being ready or not acknowledging their hearing loss. However, I had some great mentors who gave me their insight that if a person had come all the way to the clinic to see us, hearing loss was clearly impacting their life (even if they didn’t want to admit it in front of the clinician) and it was likely something about the process creating a barrier to care. These encounters always bothered me and made me wonder how many other adults who needed help weren’t even making it to the audiologist’s office.
"The National Academies estimate hearing aids cost, on average, $4700 per a set--a figure that includes the services provided by professionals to customize and support hearing aid use. While $4700 is the estimated average, the figure could range from approximately $1000-8000."
While stigma may play a role in limiting hearing aid adoption, awareness, access, and affordability are likely the more important barriers. Hearing loss onset is slow and the consequences, need, and options for hearing care suffer from a severe lack of public awareness. In addition, hearing aids are currently dispensed via licensed individuals in a model that may not suit the needs of many Americans. The simple barrier of navigating the healthcare system may prevent many from accessing hearing care. Lastly, the National Academies estimate hearing aids cost, on average, $4700 per a set--a figure that includes the services provided by professionals to customize and support hearing aid use. While $4700 is the estimated average, the figure could range from approximately $1000-8000. Even on the lower end of the spectrum, this could be an unaffordable one time figure for some.
It is unlikely that any one factor is the main culprit. In fact, despite all of the attention it gets, cost is likely not the main factor. However, the combination of these factors could result in a cost-benefit calculus that is not enough to push one to obtain or pursue hearing care. These may include Americans with more mild hearing losses who only have trouble in limited situations and simply are not ready for comprehensive hearing care and hearing aids but who could still benefit from hearing technologies.
Last August, the federal government passed legislation, The Over-the-Counter Hearing Aid Act of 2017, mandating that the Food and Drug Administration (FDA) create an over-the-counter category of hearing aids for adults with mild to moderate hearing loss by the year 2020. Over-the-counter hearing aids may provide a quick and simple solution for those not ready or unable to pursue traditional hearing care. Moreover, it may increase entry into the hearing aid market by new and established consumer tech companies which could drive down prices and increase innovation. Some of these companies may leverage marketing, advertising, and public relations departments to increase awareness of hearing loss and hearing care options for the public.
"Over-the-counter hearing aids may provide a quick and simple solution for those not ready or unable to pursue traditional hearing care."
Aside from addressing access issues that bring more persons with hearing loss into hearing care, I’m extremely excited about the innovation that may explode as more devices and companies enter the market. Already, companies are leveraging smartphone connectivity to provide innovative ways to customize hearing devices to the user’s needs and desires. For persons who need devices for a select few specific situations, these customization settings could suit their needs. For more complicated cases or for those whose hearing loss progresses to more severe levels, the services of a profession and a traditional care model can serve as a next step. It’s exciting to consider a future with multiple steps of hearing care to suit the needs of as many as possible.
At the current time, we don’t know exactly what the over-the-counter hearing aid market will look like or even what the specific FDA technologic regulations will be. Importantly, over-the-counter hearing aids do not mean the services of an audiologist are unavailable – audiologists could still offer their services on a la carte basis (pricing will vary by audiologist). And, quite frankly, the services of an audiologist would very much help maximize the benefit of an over-the-counter product.