by Katherine Bouton
People with hearing loss got a bit of a break last week when the US Food and Drug Administration announced that it is considering creating a new category of over-the-counter hearing aids. The aim, it said, would be to encourage “new, innovative, lower-cost products to millions of consumers.”
Thirty million Americans suffer age-related hearing loss. Only about 14 percent of them currently use hearing aids. The primary reason for this is the high cost.
Americans usually pay out of pocket for hearing aids, and those pockets must be deep indeed.
The average price of a hearing aid is now $2,300 but people pay as much as $6000 per aid. A good hearing aid bought through an audiologist will cost around $3000. Most people need two, and there is no volume discount for the pair – so that’s $6000.
Moreover, hearing aids are often not a one-time purchase. They don’t last forever, and as the technology becomes outmoded people want to upgrade. If the hearing loss is progressive, they need to be replaced, sometimes as often as every four or five years.
None of this affects me personally. I have a cochlear implant in one ear and severe to profound loss in the other. I will never be buying an OTC hearing aid. But as an advocate for people with hearing loss, I know that untreated hearing loss has both serious personal and public health consequences.
Untreated hearing loss is associated with depression and isolation, with a greater risk of falls, and with cognitive decline including dementia.
The cost of hearing aids is a major deterrent. Barbara Kelley, the executive director of the nonprofit Hearing Loss Association of America, says her group receives requests every day for information about financial assistance for hearing aids. “Sadly, there are few financial aid resources,” she wrote in a letter to the Senate sponsors of recent bill that would make OTC hearing aids legal.
Americans are often surprised to find that hearing aids are not covered by Medicare. They are also not covered by most state Medicaid programs or by the Affordable Care Act or most private insurance. The V.A., some state vocational bureaus, and a few private insurers cover hearing aids. But essentially, you’re on your own.
The fact is that at $6000 a pair, insurance companies can’t afford to cover them any more than individuals can afford to buy them. Permitting the sale of over the counter hearing aids would open up the market to competitive pricing. The big six hearing aid manufacturers would face competition from consumer electronics. As prices come down, covering hearing aids would no longer be prohibitively expensive to insurance companies.
The FDA announcement was part of a ruling that, effective immediately, consumers are no longer required to have doctor’s clearance before buying a hearing aid. Most people waive that requirement anyway.
In waiving the physician requirement, the FDA was following the recommendations of two important scientific groups: the President’s Council on Science and Technology and the National Academies of Sciences, Engineering and Medicine. Consumer groups like the Hearing Loss Association of America also endorsed these recommendations.
Some people worry that waiving the physician requirement and allowing OTC hearing aids means that serious medical conditions will be missed. All such hearing aids will include labeling that warns the consumer to see a doctor immediately if the hearing loss is accompanied by certain red flag conditions — sudden hearing loss, single-sided or asymmetric hearing loss, drainage from the ear, pain, dizziness.
The Academy of Doctors of Audiology supports the bill with the caveat that the over-the-counter products “be very specifically labelled and include a strong recommendation that a patient seek a comprehensive audiological evaluation from an audiologist or physician.” The Academy added, “There is a preponderance of data available today which demonstrates that when it comes to hearing loss, the risk of non-treatment may be greater than the risk of self-treatment.”
The Hearing Industries Association, while supporting “efforts to increase the accessibility and affordability of hearing aids,” expressed concern about the self-diagnosis of hearing loss. In a comment on the proposed Senate bill it noted “no studies have indicated that people can accurately self-diagnose either the cause or the extent of their hearing loss.” If the American Doctors of Audiology think the can, then so do I.
There’s a secondary benefit to making hearing aids affordable and accessible, which I wrote about on Bloomberg View: The high cost contributes to another reason people don’t use hearing aids: stigma. Most people put off getting hearing aids until their hearing has deteriorated substantially, usually as they age. This means that in the popular mind hearing aids are for the elderly. This is a false perception. More than half of those with hearing loss are under the age of 60.
If all the people of all ages who could benefit from hearing aids used them, they would be as common as glasses. As use increases, stigma decreases. This is good for us as individuals, and it is good for our public-health dollars.
Katherine Bouton is the author of “Shouting Won’t Help,” a memoir of her adult-onset hearing loss, and “Living Better with Hearing Loss,” a guide for consumers. She is a member of the Board of Trustees of the Hearing Loss Association of America.