On Hearing Loss, Fighting Stigma and New Models of Care

Sharon Sandridge, PhD, has over 35 years of experience in areas of amplification, including hearing aids and assistive technology, the evaluation and treatment of tinnitus and auditory electrophysiologic assessment. She was recently named Section Head, Allied Hearing, Speech, and Balance Services and is current Vice President of Audiology Practice with the American Speech-Language-Hearing Association.

What are some of the clinical challenges to improve hearing loss?

There isn’t a “corrective” solution: A loss of hearing is complicated. Hearing is complicated! It is unlike vision loss which typically can be corrected by placing the visual image on the proper place on the retina through corrective lens. For hearing loss, we not only lose our ability to hear softer sounds but also our ability to understand speech, which makes it more than just an issue of volume.

Filtering speech from noise: In quieter environments, our brain can fill in the gaps and allow us to understand what is being said. However, when there are sounds in the background, our ears and brain now have to filter the signal of interest – meaningful speech from background noise. Compounded with aging, our ability to process and understand speech may be severely compromised.

Devices have limitations: Even though hearing-assisted devices are better than ever, they are not as sophisticated as our brains. The challenge is working with individuals who have hearing loss to identify the best solution to meet their unique situation. Devices cannot “fix” the problem, but they can help manage the issue.

How can providers fight the stigma of hearing-assisted devices?

Part of the resistance, or denial, may be because patients believe they can hear fine in one-on-one settings. The truth is, most people are still working hard to fill in the gaps, but they just don’t realize it. As clinicians, we must communicate that hearing devices allow patients to expend less cognitive energy. Studies also show that hearing loss is linked to higher rates of depression and cognitive decline in older adults. This patient population is more likely to withdraw socially, as a result, which can lead to new or worsening health conditions. In the meantime, education, active listening and empathy play key roles in guiding patients to the right device at the right time.

What is the value of patient counseling?

Motivation is our best metric to predict success in patient outcomes, and counseling allows us to educate patients and assess their readiness. We determine patient motivation through a standardized questionnaire. Our goal is always to arm patients with information, provide clinical guidance and have them return when they are ready. I have been managing care for one patient with bilateral hearing loss for a number of years. Finally, when the time – and the device – were both right for her, she exclaimed, “Oh, My Gosh, you gave me my life back!” We hear so many stories like this from spouses, adult children and other family members who have profoundly benefited from this intervention.
What changes or conversations are happening in the industry?

Third-party administrators (TPAs) serve as contractors for insurance companies and have become major competitors in the hearing device marketplace. TPAs typically offer lower-quality and/or limited selections of product and care. It might be the only option for some patients based on their insurance provider. There is an active discussion about how we can work around TPAs to improve patients’ access to low-cost, high-quality devices.

Another change in the hearing healthcare domain is the deregulation of hearing devices, allowing over-the-counter hearing aids to be purchased at retail establishments. While this promotes access to hearing devices, there are significant concerns of inappropriate use leading to negative experiences or failing to identify conditions that need medical attention. Finally, telepractice continues to be a growing initiative for our hearing program at Cleveland Clinic. Interstate licensing issues currently prohibit clinicians from practicing outside of the state, but new movements aim to accommodate this growing demand. I should mention, counter to that, there is a movement in the industry to deregulate licensing altogether, which I think could have a detrimental effect on patients and the industry as a whole. It’s a balance and we must be careful about how we proceed.

Why is advocacy important to patients and, more broadly, the field of audiology?

We continue to see professional societies advocate for change. Recently, the American Academy of Audiology, the Academy of Doctors Audiology and ASHA introduced a bill to Congress to allow direct access to audiologists for hearing and balance concerns, rather than require the patient to see a medical provider first to obtain a referral. This legislation would also reclassify audiologists as practitioners, which would be consistent with how Medicare recognizes other non-physician providers such as clinical psychologists, clinical social workers and advanced practice nurses.
From a growing number of baby boomers with hearing loss, new threats and opportunities to access care and greater activism with the industry, we are on the precipice of big changes in the hearing health community. It is essential that we leverage this momentum to motivate our patients and support greater access to care.