The FDA Regulation: 1977 Final Rule
By 1977, the momentum driving hearing aids into the medical device arena was unstoppable. On Feb. 15, 1977, the FDA published its Final Rule, which made hearing aids restricted devices, promulgated regulations governing professional and patient labeling, and set forth conditions for the sale of hearing aids.1
The detail and scope of the Final Rule was astonishing, if not always logical.2 A section was included which defined hearing aids, hearing aid dispensers, otolaryngologists, and Audiologists. The logic of including Audiologists in the definitions was unclear because the Final Rule did not require an audiometric evaluation nor did it assign any special roles to Audiologists in the fitting of hearing aids.
The Final Rule had two other parts, components of which are condensed in Tables 1 and 2 to capture their comprehensive nature without going into pages of detail.Table 1. Section 801.420 of FDA Hearing Aid Final Rule (exact wording requirements shown in italics)
• WARNING TO HEARING AID DISPENSERS.
A hearing aid dispenser should advise a prospective hearing aid user to consult promptly with a licensed physician (preferably an ear specialist) before dispensing a hearing aid if the hearing aid dispenser determines through inquiry, actual observation, or review of any other available information concerning the prospective user, that the prospective user has any of the following conditions.
• NOTICE ABOUT THE MEDICAL EVALUATION REQUIREMENT.
“I have been advised by (Hearing aid dispenser’s name) that the Food and Drug Administration has determined that my best health interest would be served if I had a medical evaluation by a licensed physician (preferably a physician who specializes in diseases of the ear) before purchasing a hearing aid. I do not wish a medical evaluation before purchasing a hearing aid.”
• STATEMENTS THAT:
- the hearing aid will not restore normal hearing or improve a hearing impairment resulting from organic conditions;
- in most cases infrequent use of a hearing aid does not permit a user to attain full benefit from it;
- the use of a hearing aid is only part of hearing habilitation and may need to be supplemented by auditory training and instruction in lip-reading.
Finally, the Rule authorized FDA employees to “enter and inspect any facilities where restricted devices are manufactured, processed, packed, or held, and provides that the inspection shall extend to all things therein (including records, files, papers, processes, controls, and facilities).”
It is really and truly a wonder that any hearing aids were ever dispensed again in the USA after the Hearing Aid Rule went into effect. It is little wonder that hearing aid prices increased as Rule compliance drove up cost of sales. Did this help or hurt consumers? Tune in again for all the fun and excitement brought about by the Rule!
References and Footnotes
142 Fed. Reg. 9286
2Supporting Statement for Hearing Aid Devices, Professional and Patient Labeling and Conditions for Sale. 21 CFR 801.420 and 801.421. OMB No. 0910-0171.
Feature image courtesy of right pundits