By Sarah Sydlowski, AuD, PhD
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy
It is not yet legal to sell over-the-counter hearing aids (OTC HAs), but we expect FDA labeling for these devices later this year. One of the driving forces behind the development of OTC HAs is the desire to improve access to—and affordability of—hearing aids for individuals with mild to moderate hearing loss.
As an audiologist, making sure that everyone who needs to use a hearing device is able to obtain one is a high priority. The creation of OTC HAs will introduce a convenient new way to access hearing technology, but there could be significant consequences for individuals with hearing loss who opt to skip a comprehensive hearing evaluation by a licensed audiologist.
Only up to 30% of Americans over age 50 who might benefit from hearing aids use them, according to the National Institute on Deafness and Other Communication Disorders. Cost, stigma, and underestimating hearing loss have all been cited as reasons for this. But there is more to audiology than hearing aids.
Beyond the cost of the hearing aid devices themselves, one modifiable barrier to this lack of hearing aid use is the Medicare rule, which requires patients to obtain a referral in order to see an audiologist. This requirement adds time and additional cost to the process of improving hearing for Medicare beneficiaries, while most other commercial and government insurance plans allow individuals to go directly to an audiologist.
Understanding the type and degree of hearing loss that is making conversations difficult to follow is very important for being successful in managing the hearing loss, even with OTC HAs. You have to know what you’re trying to improve in order to be able to do so. For that reason, it is essential that patients receive a comprehensive hearing test before deciding to use any hearing device.
Significant room for error when relying on individuals to self-identify hearing loss and self-fit devices
It is important to note that individuals may overestimate or underestimate their level of hearing loss. One study found that nearly 20% of individuals were unable to appropriately self-identify the extent of their hearing loss. This inability was related to age, stress and anxiety levels, middle ear infections and tinnitus.
According to the American Academy of Audiology, “No studies suggest that consumers can differentiate degree, type or etiology of hearing loss, or to discriminate those hearing losses that require audiologic or medical intervention.”
In addition to the challenge of self-identification, OTC HAs purchased without consulting audiology would need to be self-fitted. Research indicates that only 55% of patients with mild to moderate hearing loss were able to perform the self-test and self-fitting procedures as instructed. Improperly fitted hearing aids will not provide optimum hearing amplification.
Consumers who self-identify may miss underlying medical conditions (suspicion for which can be identified by an audiologist), or under-treat or over-treat their hearing loss, which can exacerbate hearing impairment. Additionally, without consulting audiology, it may be difficult for consumers to determine the extent of their hearing loss (i.e., is it mild, moderate or severe?) or the devices that would provide the greatest benefit.
For those of us concerned about the health—including hearing health—of our patients, there are many potential red flags to skipping a comprehensive hearing test before using OTC HAs. Although OTC HAs do not require screening and consultation, fitting and education with an audiologist, they may be appropriate options for some individuals with hearing loss. But if they selected and used OTC HAs incorrectly, limited benefit may be achieved and frustration may follow.
Hearing as a primary health concern
Hearing is a primary health concern that calls for prevention efforts, screening and treatment. Despite this, only a very small percentage of primary care providers ask about hearing loss. When they do ask, they are usually doing so in the context of a quiet office visit that does not involve the baseline noise that may make hearing more difficult for some people in real-life situations.
Hearing should be ranked high in the priorities of primary care providers, as hearing loss has been linked to cognitive decline and dementia. Many health issues that primary care providers routinely address, such as diabetes, hypertension and circulatory problems, can negatively impact hearing. If providers are monitoring a patient for any of those health concerns, they should be monitoring the patient for hearing loss, regardless of age.
Hearing is the sense that allows us to connect with people. It is among the top ranking factors that keep people in the workforce. Hearing is measurable, but in our current health environment, hearing is often an afterthought. For example, a primary care provider may monitor (with precise measurements) and treat a patient’s high blood pressure for decades. The physician is having specific, likely repeated, conversations about diet and exercise, but may never ask about that patient’s hearing or refer to an audiologist. Fast-forward 20 years, and that patient may walk in with a significant hearing loss that could have been prevented. We have to change the conversation about how people think about and manage hearing loss.
Anyone remotely suspicious of hearing loss should consult an audiologist and have their hearing tested to determine the specific type of hearing loss, and what hearing devices are available to meet their needs and fit their budget.
Several of the Healthy People 2020 goals are related to identifying more people with hearing loss and obtaining appropriate devices for these individuals. The 2020 goals include increasing the proportion of people who have hearing exams on schedule, and increasing the use of hearing aids or assistive listening devices among those with hearing impairments. Perhaps OTC HAs will help us reach some of those goals, but I do not think we will move the needle on the issue until individuals—physicians included—begin to recognize hearing as a primary health issue.