Here’s to Your Hearing Health!
April 27, 2023
Here’s to Your Hearing Health!
Government is slow, but policies can eventually change.
On April 21, 2016, the Food and Drug Administration (FDA) hosted a workshop to gather perspectives on how to remedy untreated hearing loss, which the President's Council of Advisors on Science and Technology (PCAST) had identified as a serious national problem. I was invited to speak, and in my allotted 15 minutes I argued in favor of PCAST’s recommendations, which sought ways to “open up the market for innovative hearing technologies.”
At the time, there were only six companies worldwide that manufactured hearing aids, and they kept a tight grip on the products they made and the prices they charged. The PCAST report pointed out that despite the increases in features and reductions in price that are evident in other consumer electronics, the cost of hearing aids had only gone up. I personally recalled purchasing a clunky 1200 gigabyte hard drive in the early ‘90s for roughly $1200. In 2016, that amount of data, and more, easily fit on the freebie flash drive I used to transfer my presentation. Meanwhile, I had recently spent five times that amount for a pair of hearing aids.
Distribution of hearing aids was tightly controlled through networks of audiologists and hearing aid dispensers, all of whom in effect functioned as salespeople on behalf of the manufacturers. Audiologists will no doubt bristle at being identified as salespeople, but while ‘sales’ may not be their primary motivation or focus, the structure of the industry put them in that position.
Prompted by PCAST, Congress had charged the FDA and FTC to frame rules that would remove the requirement for a medical exam and make hearing aids available over the counter for those with mild-to-moderate hearing loss. Industry representatives for manufacturers and hearing health practitioners lobbied against this, declaring that by maintaining control, they protected unwitting individuals from themselves. I argued that by increasing availability and affordability of hearing aids, the number of people that could try them would increase, the audiology patient base would remain stable or, more likely, broaden, and manufacturers could expand what they brought to market as that market itself expands. It is too early to say whether these predictions will be borne out.
By 2019, the “Big 6” had become the “Big 5” when two of the companies merged. Hearing aid prices continued to rise while the FDA plodded along. Eventually Congress introduced new legislation requiring that the FDA issue a final rule regarding over-the-counter hearing aids. After years of fits and starts and stasis, the FDA established the rule to make over-the-counter hearing aids available as of October 17, 2022.
The advent of over-the-counter hearing aids is prompting innovation. You are entitled to a copy of your audiogram, whether it is generated online or by a hearing health professional. It is now possible to purchase a hearing aid without a medical exam or a professional fitting. Price points are coming down. Those with mild-moderate hearing loss can shop around. All of this is the good news and the bad news. It is up to you to wade through the morass of information for better and worse. For tips on successfully navigating this new world, see my article “Over the Counter and Through the Woods.”
Realities that prompted action in 2016 remain troubling:
“Hearing loss affects an estimated 30 million people in the United States and can have a significant impact on communication, social participation, and overall health and quality of life. Despite the high prevalence and public health impact of hearing loss, only about one-fifth of people who could benefit from a hearing aid seek intervention.”
If your hearing loss is gradual you may not recognize how much hearing you have lost, so it is not uncommon for us to put off identifying and dealing with it. Maybe you suspect something is off, maybe you don’t. Either way, take a hearing test!
If you need to address anything more than “mild-moderate” hearing loss, you can still only access high-end help through the incumbent system of audiologists and high-end manufacturers. And there’s no way around it: that is expensive.
Still, there can be even more costly ramifications for not dealing with your hearing loss. Untreated hearing loss can lead to social isolation, making you vulnerable to depression, and unengaged brain activity can lead to cognitive decline. The sooner you deal with changes in your hearing, the easier it is to stay connected and engaged, even with hearing loss.
So… take a hearing test. There are some free tests listed here. Let me know where you land and how you want to proceed.
Here’s to your hearing health!
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photo: Darleen Wilson