“I think he just views hearing loss as a normal part of aging,” said Durgin about her 77-year-old father, who lives in New England. “For someone who never went to the doctor as a child and almost never as an adult, he just doesn’t view it as necessary.”
People who use prescription hearing aids or over-the-counter personal sound amplification products (PSAPs) often shy away from getting them adjusted when they don’t work well. They may struggle with the technology, hate the stigma of being old and hard of hearing or have trouble affording the extra cost, which is typically included with prescribed hearing aids but not PSAPs.
Hearing loss affects nearly a third of adults between 65 and 74 and half of those 75 and older, according to the National Institutes of Health. But only about 20 percent of those who could benefit from hearing aids have used them. Many people avoid buying hearing aids because of the $2,200 to $7,000 cost per set.
The Over-the-Counter Hearing Aid Act of 2017 will regulate PSAPs and is expected to make them more affordable by opening the market to competition and selling directly to consumers. The Food and Drug Administration is on track to complete regulations by August 2020 for these devices aimed at people 18 and older with mild-to-moderate hearing loss, FDA spokeswoman Alison Hunt said.
The devices are not meant for people with serious hearing problems, who need more expertise with testing, fitting and adjustment. The FDA has not yet revealed specifications for the devices, how complex or simple they might be or how much help will be included for customization.
Medicare doesn’t cover hearing aids, and neither does most private insurance. A recent research article, partly supported by funding from the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health and from the Commonwealth Fund, raises questions about how useful wider access to over-the-counter devices will be if buyers cannot afford to have them fitted.
The researchers’ analysis showed that people covered by Medicaid and Medicare were 41 percent less likely to use hearing-care services and twice as likely to have trouble hearing with their aids as their higher-income counterparts. They said even fewer people might use those services when they are separated from the cost of the devices.
Amber Willink, one of the authors, pointed out the study did not examine why that 41 percent didn’t get their devices adjusted. She said that some patients might have skipped adjustments after a simple fitting of an OTC device because of cost or because they weren’t told they might need to keep coming back for adjustments.
Medicaid coverage for hearing services varies by state, and some patients might not have had coverage and couldn’t afford to pay out of pocket.
Willink, assistant scientist at the Johns Hopkins Bloomberg School of Public Health, said the new law requires that the OTC devices be programmable but does not specify whether that means merely volume control or customization.
Research has shown hearing aid users are more likely to be satisfied if they receive hearing-care services, which may include tips on how to hear better in certain situations, gradually increasing wearing time and limiting use to the home at first.
Jaklin Naghdi Gabaee, an audiologist in Los Angeles, said her patients who have used OTC aids find them uncomfortable and harder to “filter speech from the rest of other sounds.”
“OTC hearing aids cannot be reprogrammed or calibrated to each individual audiogram,” Gabaee said.
The cost of hearing care services could be several hundred dollars for the first visit to customize the devices and less for follow-up visits, said Matthew Fitzgerald, chief of Audiology at Stanford Health Care, which is part of Stanford Medical Center.
“The OTC Act will certainly increase access to devices and lower costs, but it’s going to be like the Wild West the first few years because of how patients are going to handle and navigate that process,” he said.
“You have to sculpt your environment to you,” he said, “position yourself appropriately in a room, make sure you’re facing the people you speak with.”
And some consumers may have high expectations that may result in disappointment. “They’re not a panacea,” said Jay Miller, 69, of his high-quality hearing aids.
Miller, a retired tax lawyer who lives near Milwaukee, said that returning to an audiologist early on for adjustment was beneficial.
“If I’m in a restaurant in some sort of situation where I was having trouble before, I can more easily pick up the conversation from across the table,” Miller said. “But every once in a while, I still can’t hear clearly enough, so I have to ask somebody to repeat.”
While advances in PSAPs could improve their quality, some people may still shy away from getting more help.
Mark Alyn, the 67-year-old host of “Late Night Health Radio” in Thousand Oaks, Calif., has mastered his hearing aids, learning to adjust them to suit his needs. His 94-year-old father-in-law has worn a hearing aid for years with poor results but refuses to get it adjusted. Alyn attributes the refusal to a dislike for dealing with technology.
“They just don’t understand it,” he said.
Then there’s the stigma.
“I took my mom and she hated to go,” he said, telling him they were for old people.
Yet when hearing loss is left unchecked, the cost can be high emotionally, physically and financially. Hearing loss has been associated with cognitive decline, dementia, falls, higher health-care costs and worse health care when compared with those with good hearing.
My late mother loved chatting with her friends, doctors and other acquaintances until her hearing waned in her 80s. Then her social circle shrank and she became increasingly isolated, often hearing only parts of what was said. She would not buy a hearing aid because of the cost.
In her last few years, she began having trouble hearing what doctors said to her and misunderstood phone messages, leading to confusion and panic until I intervened.
During hospitalizations, when doctors spoke to her but she could not hear them, she often looked confused and failed to answer simple questions. Sometimes, physicians appeared to dismiss her concerns because of that confusion. But when I repeated what had been said slowly and loudly in a quiet setting, she understood.
Willink said Medicare should consider whether paying for hearing services would reduce other health-care costs.
“It’s not just a health issue, it’s also a social issue,” she said. “Once hearing loss is treated, people are more able to engage with other people.”