OTC Hearing Aid Survey: The 2% Conundrum. Key Insights and Implications of ASHA’s Survey Findings with Dr. Janice Trent

Hello, everyone and welcome to this weekend hearing. In September, the American Speech Language Hearing Association or ASHA, published the results of their OTC hearing aid survey taken mid year. several interesting results jumped out at me along with several questions. Therefore, it’s a pleasure to have Janice Trent an audiologist by trade and ASHA’s Vice President for audiology practice join me to discuss the findings. Janice thanks for coming on the program. Please, let’s begin with you telling everyone a bit about yourself and your background.

Thank you, Andrew so nice for you and job, it’s so nice to be here to invite us on. Well, I am an audiologist of about 35 years, I presently have a private practice in Bowie Maryland, had that for about 17 or 18 years now. But prior to that, I was the director of the speech and hearing clinic at Howard University in Washington, DC. And then I was on faculty at Temple University in Philadelphia, before we moved in a year and done, you know, some hospital working with physicians doing audiology clinical work. So I come with a breadth of experience from different perspectives of the practice.

And I’m sure that breadth of experience really comes in handy in your role in ASHA, although many of the audience already know what ASHA is, I think would be beneficial. If you’d say a few words about what the organization is all about.

Well, ASHA, I met the American Speech Language Hearing Association is a profession representing speech language pathologists, audiologists, hearing scientists, we are over 227,000 Strong, we represent the most audiologists of any of the associations in the country. And you know, our purpose and focus is to make sure that communication is valued as accessible for everyone. And that’s, that’s our major goal. We are patient centered practice, meet association. So we want to make sure that all of our professionals well trained, certified, hadn’t take gone through extensive examination had been gone through clinical practicums, that all of them are focused, if they’re working clinically, they’re all focused on providing current needs of their patients. And those who are in research are doing dynamic work, and research to make sure that the services that are needed by now our clients are, are being researched appropriately, so that they are getting the best quality services possible.

Okay, and although audiology is your focus, I suppose it’s worth mentioning at least, in my thinking, is that ASHA is also the largest organization for speech language pathologists as well, correct? Absolutely. Absolutely. So very much a focus on communications accessibility, more broadly than even hearing although hearing is what we’re going to discuss today. Yes. Okay. So let’s get on with the survey, then. Which by the way, we’ll post a link to it in the show notes. And if looking at top level, what would you say are the key findings?

Wow. Well, looking at top level in a nutshell, I will tell you that the key the key findings are that only 2% of individuals interested in over the counter hearing aids purchased them in the past year. What what makes that stick out is the fact that this time last year, I was doing media tours with the American – The Hearing Loss Association of America, we must have done 20 interviews across the country for news media’s several my other colleagues and other associations. We were all across the country promoting the over the counter hearing aids. And I’m sure if you remember, you probably saw it on the news. And lots and lots of it. Lots and lots of it. Yeah. And then you had the Congress, politicians were talking about the President was talking about it. So I think in our mind, we were certain that this – with this kind of media coverage, there was going to be a big uptake of the over the counter hearing aids our Association put forth a tool toolkit so that our professions and even working with, people who we thought might interact i.e. the pharmacist because these over the counter hearing aids were supposed to be available in pharmacy. And so we did this toolkit so that the change, to train them so that they will be ready for this onslaught of over the counter hearing. So people are going to be coming in to get some And so the surprise in the poll was: it didn’t come. And we were, we’re a little puzzled by that. And our major thinking, is that, okay, we need to do more education. We certainly welcome the introduction of the over the counter hearing aids. Frankly, if you know what’s going on in the industry, we know that only about 20 to 25% of people who need hearing aids get them. And this has been a long standing problem for many, many years. And so we always tried to figure out ways to bring more patients into our offices so that we can introduce hearing aids. And so we welcome any opportunity to do this. And we thought that this was going to be the groundswell that we thought that this was not a real opportunity, affordable, and accessible. And we really thought that we were going to see people coming through the door. Yeah, so

clearly, with that 2% must be disappointing. And I guess I just want to thinking through the actual survey was taken mid-year correct. So you’re really talking about nine months rather than the full year, but even still 2% of the people actually purchased over the counter hearing aids and an another 4%, are thinking about it according to the results, and not very high, when you come right down to it. And you you had in the executive summary said, or the survey said that a low likelihood of purchase is likely driven by a number of things. But one is a lack of confidence that a device could address the issue. And that people could choose the correct device themselves. Now, why did you actually call that out amongst all of the different possibilities that when was called out in particular,

we thought that making them available and goodness knows, the label on these things are quite extensive. While the outside label in the inside label in terms of instructions. So we really thought that we were making it as easy as possible for patients to go ahead and try their devices. So that you know, all the reason- And I will tell you that prior to the FDA approval, we spent a lot of time reading the instructions, tried to make sure that the way they were worded was appropriate, so that patients wouldn’t know what to do.

And so then what in the end, why do you believe that consumer confidence is low in both cases that that the device will actually address their hearing loss? And also that they can pick one? Why do you think the confidence level is so low?

Well, part of it you know, I think we talked about this, it’s not so much of a fear. But number one, as you know that people don’t feel that their hearing is ‘that bad’. Okay, so they’re not going to jump necessarily on the opportunity to get these devices. But, you know, I have a slightly different take on this. Now, I went back and I was, I was looking at the PCAST guidelines, and that was the President’s Council for Advisories for Science and Technology. And, you know, their, their reasoning for this was to make an amplification accessible for individuals who could not afford, okay. And they specifically outlined the fact that individuals low income would not have had not purchased hearing aids. So the idea was that these devices, were going to make it accessible for for those individuals. And I this is just a thought that I have had, that if you look at the demographics that are in the study, you’ll see that a large portion of them were high, less than high school education, or just high school education, right. That would speak to a reading level I think, okay, and the way that the instructions that are written, I sometimes wonder whether that wasn’t also a deterrent, that individuals may have been challenged by reading all of those instructions that did that. That’s just another dynamic that we really haven’t considered that we were looking at making it accessible. But you had lawyers, doctors, researchers writing all of this material. Now these are all well educated folks, yet you’re writing it thinking that the people you’re writing for will be able to pick this up and read it and I do think that that might have been a deterrent, also.

Okay, that’s a really interesting finding. And I’ll ask another, because, as you said, there was a lot of effort to educate pharmacists and other allied health care providers, and yet, even up to the present day, and there’s been a lot written about this. If you walk into a pharmacy, you might find one hanging on In the rack and yet, same thing with a big box store until very recently, even on a small level, could you find anybody actually well versed in talking about over the counter hearing aids, their applicability and their function? Do you think that’s a part of it as well

We had gone out to talk to several pharmaceutical associations, and what we can, you know they’re interested, but what we, you know, what I do get them on the side, at a coffee break is, you know, from the pharmacist that is, you know, my schedule is really busy. I’m just trying to deal with medications that I have to get out. Did anyone ask us if we would really be able or willing to manage over the counter hearing aids? I think that that’s a real con. We, they’re interested, they’re concerned. But they were just in real language saying, you know, my schedule is really busy. So I think you’ll just as you said, they’re not meeting over the counter, often many people are not feeling comfortable to answer the question. So it is, it’s an issue that we may have to do more education.

Okay. Okay. And yeah, so and there may be some things outside of your control, for example, I’ve read and somebody can tell me how true this is perhaps, but I’ve read that there’s actually a shortage of pharmacists right now. And so that doesn’t make it any easier even if they’re willing. Yeah, and we’ll have to see what the next year brings as we started to see some of the big box stores put dedicated areas of their stores to address hearing like Best Buy for examples deployed some hundreds of Hearing Centers today wants to see what effect that has in the second year of OTC. Exactly. And there was in that statement in the executive summary you know, it said there are many things are other things but confidence was one you called out but what are some of the other things that you would know it that impeded the progress of OTC

I don’t think that people really well, I think it gets back to the reading I think when you when you look at it, you find out that they really don’t know much about the OTC so even though we were advertising even though we were putting that information out, they really did not do any additional research. In my private practice, I will tell you that I do have people coming in. And they the comments to me are, you know, I’ve heard something about OTC hearing aids, what can you tell me? And then that opens the door for me to have the dialogue. But to think that people number one, they don’t think they have that much of a problem. So are they going to go do the research? That’s going to get them to the point back so they can go and purchase the devices.

Okay, and an interesting side comment on all that is is I saw the latest published figures based on HIA data, quarterly hearing aid sales, prescription hearing aid sales, and they included OTC although very few OTC companies are reporting into the HIA. So that numbers going to be artificially low, but the prescription hearing aid numbers are very valid. And they showed the last reporting quarter was q1 of 2023, the first full quarter of OTC while they showed an 8% jump and prescription hearing aid sales from the same period a year ago. And it’s more like 10% from q4 2022. So do you think there’s the possibility that all of the publicity and discussion around hearing, hearing comorbidities, the available OTC are bringing people into professional practices and perhaps responsible for the uptick in prescription hearing aid sales? Do you think that’s possibility?

So, absolutely. And the things that we haven’t talked about, not necessarily than in the poll, as I said, the PCAST had started this back in 2015.

And they it seems like a million years ago.

And they were doing that focus groups even before that, because they presented their findings in 2015, to the FDA. And one of the things that we don’t think about is, what were some of the other players in this process doing along the way? Who were the other players, you have a hearing instrument, the hearing aid companies, you also have insurance companies. You know, prior to there were a handful of insurance companies that provided a benefit for amplification. Okay, and so that was a problem because so many individuals had to purchase their hearing aids outright. Well, since 2015, there has been a huge increase in hearing aid benefits by most of the insurance now they’re not always paying for the full hearing aid, but they are now giving a substantial discount or they’re getting the paying for them but you can get the entry level hearing aids and and other I don’t think we thought, like, you know, we even, we think about either the OTC hearing aids or, or the private or the prescription is not recognizing that there were other people. There were other players in the field that were responding to the introduction of the over the counter hearing aids, and how did they respond? They responded, and the insurance companies responded by making hearing aids available to many more as a benefit in many more insurance programs. Okay, you also have many more, and this is probably a good thing, many more hearing aid companies that are now providing lower end hearing aids that are more affordable, and frankly, many of them are, are more affordable as or as affordable as the over the counter hearing aids. So you’ve gotten many more players in the market? That I don’t think we thought about in the past, we didn’t realize they were coming in

what which may be a collateral benefit all this discussion about the prevalence of hearing loss to comorbidities and so on that you see a lot of different responses. I mean, I’m happy to say that my home state of Illinois published a law requiring that insurance companies provide a hearing aid benefit. I haven’t, I haven’t looked at the details of it. So I don’t know exactly what’s included. When it’s time to refresh mine, I’m going to find out.

But I’m sorry, you know, to get back to your original comment. Yes, even I have seen a tremendous in interest of people coming through the door. And so I have to tell you that my sales are probably going up in the past year, because people are coming in asking the question, not necessarily coming in to purchase over the counter hearing aids. But certainly coming in to ask the questions about what is my hearing aid look like? What does my hearing loss look like? Do I qualify those kinds of questions,

which is wonderful, because ultimately that the goal of the OTC legislation was to get hearing treatment for more people, right. And so all the different market responses are making that happen and your points very valid, I can get a professionally fitted rechargeable, good quality hearing aid at Costco for 1500 US dollars, which is the upper end of the OTC space. And so the gap has closed a lot. And of course, there are lots of examples of that. That’s the one I’ll use. Now, in in the, in the survey, it shared the average cost of the OTC hearing aids that people purchase and people were looking at they were around 200 or $250, which implies that people looking at OTC are looking less at the upper end of the range where you’re bumping into prescription devices, but more at the lower end of the price range. And which speaks to the affordability. We’ll get to the effectiveness in a little bit. But I do have a question for you. ASHA actually estimated the average cost not what people bought, but the average cost overall of OTC hearing aids is $240. And considering you can get them as low as 100, and as high as 1500 or more. How did you arrive at the figure of 240 as being the average?

I don’t think that was an ASHA decision. I think that that was done by the pollers. So you.gov Okay. They were doing that based on what their what the polls were telling them.

Okay, got it. Yeah, because pinning down an average price is really hard, in the sense. So do do it per model, you know, anyway. Okay, so that’s

why, yeah, so I’m okay. We know that over the counter hearing aids run from about $199, frankly, a pair, up to maybe almost $3,000 A pair. So yeah, so that there is a huge range, but in this old, this was the average price that they were talking

about. Okay, got it. Got it in. One of the things I found that was really interesting to me in this came off of page nine of the survey was that stigma, including fear of aging, or fear of looking old, was really low on the list of reasons for not seeking professional help. Why do you think that is in I guess, related? I’ll ask if you saw any correlation with demographic factors such as age, for example, are younger people less likely to feel stigma than older ones, or vice versa? Like break that down for me a bit?

Well, I think the key ones were cost, right with the key, right? So weighing that out, stigma is is going to come out low of we’ve we’ve been able to educate away from that a little bit. It would be socially inappropriate for anyone to talk about a stigma related to hearing loss. Everybody knows that’s inappropriate. You know, and I think that that’s what you’re getting to what is the socially acceptable norms at this time? 30 years ago when I got into that profession. Yeah, it was definitely a stigma to have to wear hearing aids. Now, people know, I think that that’s socially inappropriate. And I think that that’s a main reason that you see that low, that low score. But what prevalent and three things that you pointed out on the survey, those are the three major things that people were concerned about.

Okay, which I think will be music to a lot of people’s ears because the stigma factor distresses a lot of people that are even been articles written, can we start talking about stigma already? And the fact is, is if your survey respondents answered accordingly. That’s really good news in that respect. So it gives you the option to tackle the quote, unquote, real issues, if you will, like cost is a real issue, for example. And another one is actually, I would say people’s poor ability to actually predict what their hearing loss level is. And I can testify to that personally, because I went the mandatory five years waiting time before I did something about my own. Well, because it’s so very, very gradual. And it’s very easy to tell yourself, it’s not that bad until fire it is. And in so in that that was actually the top two reasons. And your survey was that people said they’re hearing loss was not bad enough, or it’s not a priority. So how do you educate people around those issues, and get them thinking about their hearing loss sooner or recognizing it sooner? And all the ill effects that come with it?

Well, I’m gonna go- the education is so key. But you know, as I read this, one of the things I thought about was the interpretation that individuals have about what a hearing aid looks like. And what I see hearing aid can and cannot do,

don’t get me started are all the pictures you still see with the 1970s big banana in people’sears

And it’s real. Okay.

Oh, it is it drives me crazy, right

that is real. And so what happens? So this is where the education comes up, because we’re still seeing those pictures being thrown up into the media of these old hearing aids. And, you know, when I take out a digital hearing aid, and present it to the patient that, you know, they say, once this, this doesn’t look like my grandmother’s hearing aids, right? They don’t know, now, let me tell you what, what what your hearing aids can do. And, but people are coming through the door with their own impression of it, their own interpretation of what a hearing aid actually looks like. And so we still have those doors, those barriers to knock down. Education, education, education, we’ve got to get people through the door so that we can introduce them to new technology, what can new technology do for you, you know, when I tell them, you know, I’m gonna flood this, these connect greens, hearing aids, to your cell phone, and you’re gonna be able to, you know, the talk on the phone, no wires. And that really, I mean, what I’m getting a hearing aid, I’m always amazed at the shock of many patients that they had no idea that the technology was out there was technology has been out there for a while, but we have a lot to do to change the public’s interpretation of what kind of services technic technological services are available in hearing aids? They just don’t know.

Yeah, and that makes perfect sense. Because the to reach the general public is very difficult, right? It’s very noisy out there. Right. And it takes a very concerted effort to reach the general public, which goes to your you know, what you’re saying is that if people get some exposure, at least, to you know, all the discussion about the prevalence of hearing loss and all the rest of it, at least to get them in your door, so audiologist and you have the chance to educate them.

Right? Because, and that’s it. I want to stop by the I’m a certified audiologist. And yes, in my office, I sell hearing aids, but I do a lot more than that. So when a patient comes to the door, I’m meeting the patient, where they are, when they come in hearing loss is really a very personal thing. And what people have the take the nerve to come through the door, they have they come through the door with a lot of anxieties, a lot of concerns, a lot of concerns about the image, how is this gonna make me look, but sometimes they come through the door with family issues where, you know, they’re arguing with their spouses, or they have concerns about their job, because they have misunderstood what their you know, their bosses have said to them, and so they come in, oftentimes, with a lot of issues that do not meet that, does that mean that I’m going to immediately take out a pair of hearing aids, put it on them and send them out the door. Because that’s not meeting their needs. Their needs are that we have to sit down and talk to them. To find out who they are, what is going on in their lives, in their communication needs, so that we are aware of where they are, sometimes it’s just a matter of counselling. Other times, it is a matter of fitting hearing aid, sometimes it’s help, and I gotta send them to, you know, physician. But there’s a bigger picture to hearing loss – not just fit, you got to come in and do the test, I hang hearing aids on you, and I send you out the door. Now there’s a whole person that we were looking with looking at, and that’s what an audiologist will do. We’re not just trying to sell hearing aids, but a certified audiologist is going to be patient centered, is going to look at where the person is, in their journey, before they try to just put a hearing aids on, you know, you know, I can’t tell you the number of people who come in my office, and they’re almost mad, because my wife said they have a hearing loss, but I don’t want it you know, I don’t want to be here with you. And it’s I try to talk them through that I got to kind of get them off the ceiling, more or less, find out where you are, what’s going on. What are your personal anxieties, you know, now we’re in the sound booth, nobody can hear you what’s really going on with you. And then as we talk, and this is key, we first have to talk, we have to find out where folks are first. And then we can take them somewhere. It is not uncommon for me to counsel and send folks out the door and say, when you’re ready, come back and see me. And what they leave saying is Wow, well, thank you very much. I didn’t know this. I’m educated. And that is the whole purpose of what we need to do. We’ve got to educate my standing policy is it hearing is three, I do three screening anybody for anyone who comes through the door, if you come in, it’s out and read what’s going on, I’d like put you in the booth it just to a quick screen. Either you pass or you fail. If you fail, I’ve certainly got to recommend you back. But it could pass you have this is one area maybe we don’t have to worry about. And I think that that’s really critical to understand that we are looking at the entire health, hearing health of the individual, and that’s what we’re seeking to serve.

Okay. And that causes me to ask a related question which for your own practice, you describe, but more generally, I would I would ask this question in framing in terms of your own practice to and that is on page 14. It said the survey said that just over half of people who spoken to an audiologist, audiologist are not prescribed hearing aid. Now, in a broader sense, I mean, are those people getting what ever appropriate treatment is so in other words, are there people walking in with a different auditory processing issue and being told, I can help you you don’t have hearing loss? And you’re just sent out the door? How is that working with a half of people who are not getting a hearing aid? In your view more generally, right? Even outside your practice?

Okay, well, we are all trained to do counseling, I mean, that’s 101. But we also know that everybody who comes in with a hearing loss is not a candidate for hearing aids. The basic hearing test process, we’re going to look at pure tones, you’re going to see how soft you can hear a beat, we’re going to look at how soft you can hear words – baseball, cowboy toothbrush – then we’re going to make sounds louder, and we want to see whether you can process that information, say the word bass, say the word gun, you know it at a comfortable listening level. Now, if you can’t repeat those words, when we put them at a comfortable listening level, that’s a flag for us. And that says that we need to send you out to an ear, nose and throat doctor for assessment, because you ought to be able to hear when sounds are made loud enough. Now, there are some situations, you know, people will come in, they have had a stroke. Well, I gotta know what I’m going to see when I know they’ve had a stroke. But everybody who comes into us brings different types of hearing loss. And that’s probably my biggest concern when we’re talking about the over the counter hearing aids, because every hearing loss is not just, you know, hearing loss. There are other issues that play into what’s going on. So as I said before, you know, some people come in with a with a mild hearing loss. And the World Health Organization years ago came out with some guidelines. So one of the things they said is that people can have an impairment, mild, moderate, severe hearing loss, which could also have a handicap. So how does your impairment impact your daily functioning? I have had individuals who have mild to moderate hearing loss or mild hearing loss in quite devastate who just I can’t hear you need to do something. And even, I’m thinking really, but when I put a hearing aid on their faces light up and they’re like, Yes, I need this. And then I have other people who had put hearing aid on and they say, you know I don’t really notice a difference. Sometimes I’ll send them out for a trial, you know, go use this for a week see that it does make a difference. And many times they come back and they say, No, it doesn’t make a difference. They have different coping strategies. So they are not handicapped by their hearing loss. They had one, but they’re not handicapped. And that’s fine. I’m going to give them some strategies to use it, say, Come back and see me if you notice that you’re having a problem. But those are some of the variables that we have to look at when a patient comes through the door.

Okay, and so in the survey, then this really speaks to the survey results that showed a little over half of respondents were not satisfied with the performance of the over the counter hearing aid. And how much of that do think is related to the actual performance of the hearing aid and how much is related to the fact that their auditory issues are not your classic pure tone hearing loss that an over the counter hearing aid is meant to address,

while there’s another factor and how much of that is related to the fact that they have not received appropriate counseling and adapting to the hearing loss. Okay. And that that, I think, is the bigger problem. Hearing aids are not eyeglass, they’re just not they don’t, they’re not the same. And so when you get a hearing loss, you and you get hearing aids, you can counsel, you know, my folks are coming back to see me two or three times, before I let them out before I say, Okay, I’ll see you in six months. Because we need to figure out what’s going on the first time I set the mic, I’ll own it. This is what I think you should like. But I need to see you in two weeks, so we can talk about it. And oh, by the way, I didn’t turn these all the way up. Because I think for me to turn them up to the target for you may be a little overwhelming. So I’m not I’m going to turn the maybe 80 percent, I want to see you in two weeks. And maybe in two weeks, when you come back, you can critique it for me, you can let me know what you liked, what sounds you didn’t like, what noise was to what for you, or what speech was not clear enough for you, then you come back and we sit down with on the computer, I take their critiques their observations, and now I’m going to try to fine tune the hearing aid so that it’s comfortable for that. And I may turn it up 100 to 100%. But you know, I might go from 80 to 85%. And they say, oh, that’s enough, fine, go out with it at 80%. And I’ll see you in two weeks. And maybe in two weeks, I’ll be able to turn it up to 90%. And maybe it’s gonna take me four or five weeks to get them up to 100%. And maybe some people I will never get up to 100% of the target. That is okay. But the issue is communication. This as I said hearing loss is not like any other disorder. You can either when you go to an eye doctor, you know, go to the eye doctor, he tweaks it, and he sends you out the door very seldom do you have to go back for a follow up visit. But with an audiologist, even with the best technology, and there’s some great technology, you’re still many times going to have to come back, if not for a fitting to be desensitized or to be sensitized to your experience. What I mean by that is, several years ago, I had this big military guy come in, and he had this huge big booming voice funny is all good. We had a ball. And but his wife said he can’t hear. And so I put hearing aids on him. And he started talking to his big booming voice. And the first thing he said to me, these hearing aids are too loud. So I laughed, and I said, well, I need you to turn your voice down. He was like, I’m really. And I said, Yeah, so when he turned his voice down, he was like, oh, okay, so we had a lot of fun. And I sent him out for two weeks. And, you know, he came back and he was contemplative when he came in. And I said, Well, what’s going on? And he said, You know, I’m high level exec, and I look big man. And I saw my subordinates recoiling. When I spoke to them, I saw them backing up. And in my mind, I was I was rolling them. His I didn’t realize that I was yelling at them. And I wish I could find them. Because I’d apologize. Because I did. He was retired at this point. He said I didn’t, I didn’t intend to a part to yell at them. And I didn’t know that my hearing loss was impacting me in such a way that I was having an impact on people that I was communicating with. Now, that was a great introspective observation that he made, but he made it on his second or third appointment with me. And we were able then to have a discussion about the impact of hearing, and how do you talk to people? And how do you listen to your voice. So these are some of the things that we do as audiologists, beyond just putting a hearing aid on budgeting. We are the ones who take time to talk about what’s going on. So not only are we educating, but we are counseling and we are equipping them in individual to go out of our continent in a short hearing into the hearing world and that’s what’s really important.

Well, and I’m actually the poster child for everything you said. I, I would say I was first fitted five years ago. And I didn’t even make it out of the office at 100%. Like, I got fitted and then the audiologist sent off her printer to print out my receipt, and I jumped out of the chair, it almost hurt. And so she turned it down. And then some weeks later, I came back and I said, you know, here’s your here are my observations of Well, first thing, let’s get you back to 100%. And then I came back describing some situations that because I’ve been an audio person, my whole career, I could give it to her pretty straight. My, my message to her was actually that it almost hurts and sounds a little bit distorted when the altos in our church choir get going, she’s got, Okay, gotcha covered, and then adjusted to compression settings there and all that. So it actually took three or four visits, to make it all happen. And I would say if I had, say, 10 years ago for OTC had been available, I probably would have been flying. But by the time I perceived my hearing loss to be bad enough where I needed to address it, I was at 2kHz and 4kHz in severe territory. So it was kind of too late even though the pure tone average said moderate, I’ve got the big hole in the middle that comes with noise induced. And so it would have been too late for me. And so I think that’s really just everything you’ve said resonates with me personally. And then. So that’s, that seems to be part of the not satisfied, I guess, then my question is, people according to your suit survey are generally buying at the lower end of the price range, and half the people aren’t satisfied. But from what I’m hearing, you’re, you’re saying it may not be price performance, so much, or some mix of price performance, because they’re buying lower end devices, and some mix of they’re just not appropriate for where they’re at. Right that what their needs are beyond what OTC can supply? Is that a correct way of stating it, then how would you kind of see that mix? What percentage

now the over the counter ignoring needs, you’re kind of a do it yourself, device, you go to the store, you read the instructions, find out whether you can return your device, you open up the package, and you fit yourself- Okay? You just heard me say how many times I patients come back to my office, you just told me how many times you went back to your audiologist. Hearing aids, whether they’re over the counter or prescriptive, need follow up care. So the frustration that we see in this poll relates to the fact that many times these individuals purchasing over the counter hearing aids are out there by themselves. And they don’t have the education and the support to help them adapt. Once again, on hitting on this mantra education, education, education, and that’s what a certified audiologist will help the individual do.

Okay. Okay, thank you. Now, I’m going to ask a slightly different question. Because you had some interesting demographic data in the survey as well. Again, one of the things that jumped out at me was that people who identified as having hearing difficulty, nothing to do with what they purchase, but people identified as having your health difficulty was correlated with lower income and education level. Okay. So why do you think that people with lower incomes and lower educational lovers had a higher prevalence of hearing difficulty as self assessed?

Well, that’s not really the case. Hearing loss effects, everyone, regardless of your socio economic level. But if you go back to the research, starting with PCAST, the purpose of the over the counter hearing aids was to serve individuals who could not afford to purchase the prescriptive hearing aids, those 6000 whatever that number is, that people always talk about when they think about purchasing a hearing aid. I can’t afford that it’s too much money. And so that’s why that is what’s in their head. Okay. What you also notice in the study was that the education that showed in the poll for educated individuals in was very low. Well, the whole design for the over the counter hearing aids was to serve individuals with lower education and low financial status. Okay, that doesn’t mean that on the other side of the spectrum individuals with with the wherewithal, are going to go to the audiologist and get their hearing taken care of So that that I think is in distinction? I don’t I don’t really think that necessarily. There are health issues that that certainly do arise. But across the spectrum, I think what you’re going to see is that the issue is that health care is more accessible to individuals who’ve got health care, who have education, and they’re able to manage it. People who are looking at over the counter hearing aids don’t have health insurance, not education and that’s are not too uncertain. But they don’t have a high level of education. So now you see them coming in, because they’re looking for something. They they need something, but they know they can’t afford the high end. And I think that that’s more what we’re looking at the end, that’s really what OTCs are about. They tried to reach those individuals who can’t afford that high in hearing. But at a cat as a cat. Yeah, I just want to mention that there are a plethora of hearing aids between the over the counter and the high end hearing aids that many people could be fitting in. And oftentimes we don’t talk about that when you when you hear in the media, it’s always hearing aids are super expensive, and I can’t afford it yet. There are many, many more generic prescriptive hearing aids that are much more affordable that individuals can purchase.

Okay, now, I think all that makes perfect sense. But I did, I did notice into demographic data there actually was and so I’m looking at it here now, demographic profile those with hearing difficulties, 43% with incomes below 50k 27%, from 50 to 100k and 21% from 100k. Plus, which, which is just what you said, I mean, hearing loss is everywhere, but people who self reported were a little bit more skewed towards lower incomes. I mean, when I saw that, I wondered if that was occupation related that people with lower incomes are, are more often in the sort of loud occupations that can cause more noise induced hearing loss. And, and that’s what I was wondering if you had any idea behind that finding in the survey

Yeah I think there’s some of that. But, you know, dentists are there are many people who are truck drivers who are exposed to noise, but they make a really good check and when they need hearing aids, they go purchase them. Okay, so So I think that that’s the difference. Now we’re talking about people who do not have either the financial wherewithal or they don’t have the health benefits that will allow them to correct

okay, okay, so that makes perfect sense that is so there, there might have been people who have no insurance. Right. And up until the advent of OTC and even perhaps, in the advent of OTC you see disproportion amount of people complaining about hearing loss because they haven’t been able to get a treated, that’s what you’re saying in part, okay? Yes. Okay, that makes pretty, that makes that makes a lot of sense. And really, the the probably the last thing that jumped out at me was, by the nature of the survey, and a low percentage of people actually purchased OTC hearing aids, when you get to those parts about the attitudes of people who actually bought OTC hearing aids, the end is pretty low. So it implies that when you do this, again, you either have to widen out the number of people surveyed in the first place, or if the percentage is higher, you’ll get a higher and I mean, is that on your mind as you think about repeat versions of the survey?

Well I don’t know, I don’t know. From my perspective, a lot of this information is very consistent with the perspective of many, many surveys that have gone out over the years, to individuals about why they don’t purchase hearing aids and these reasons are consistent across the board. And I think that it’s not, it’s not just enough to double the number of n, we don’t, I don’t know the doubling the n is going to make the data, any any different. I think what we really need to look at is our strategies that will help individuals overcome whatever roadblocks they have. So it’s not fear, they said it was cost – OTCs are affordable. So it wasn’t cost, because they didn’t go and get them. Okay. It’s not that bad. But in reality, many of them now that we talk to them, many of them will have to acknowledge that maybe they are having trouble. You know, one of the things that I do oftentimes is when I have patients come in, I always have this third party, the third party is the adult child or the spouse. So while one person is telling me I really don’t have a problem with that, you know, the doctor sent me here, but there’s nothing wrong. Then I have the parent or the or the child or the spouse behind them going, ‘That’s not true’. And so that’s the other dynamic and so that’s why So you have to ask someone, there are very, very few people that I meet in my office that come and say, I really have a problem I can’t hear when they’re coming in their office, there is something that has happened that has made them decide that they have to do so. You know, my running joke is that 90% of the men who sit in my chair will say my wife said, I have to admit something is wrong with my hearing. So So now something is going on to that relationship that he he has finally said, If I don’t do something, I’m going to be in big trouble. There is an emphasis, there’s something that gets them in the door. But it is very seldom that somebody just comes in and sits down as hey, you know, I think I got to hearing it. And I’m not saying they don’t do it. But I’m saying that usually when you talk to them, something has happened. Something’s going on in the job, something’s going on at home. The adult children feel guilty, yelling at their elderly parents. Now, they’re not yelling to be mean, they’re yelling, because their parents can’t hear them. But there’s a lot of guilt that comes in from yelling at your parents. And they’re saying, Yep, do something. Number one, my voice is getting horse. But number two, I’m in and out in the stores. And I’m yelling at my mother so that she can hear me, people look at me and think I’m being disrespectful. And not, I’m just trying to help my mother here. So oftentimes, it is the reason that it is the frustration that gets people in my door, not somebody just coming in and saying I don’t think I have much of a hearing loss. That doesn’t happen. I get a lot of referrals from physicians. And oftentimes it is the physician who will say, you know, medically I need you to go have a hearing test, I’ll just, you know, I need to go for you to go check this out. And they will come in. And what they will say to me is, well, the doctor says I have a hearing wants to be something wrong. And yeah, I’ll test that hearing. And also, yeah, the doctor was right, you do and then they’re completely shocked. So you know, I think that that’s what we’re looking at is not really expecting that at this point. I’m really expecting that people are going to be self aware, in many times to say, Oh, I’ve got a hearing was often times it is the circumstances in their lives, that gets them into my doula. And so we want to have opportunities where they can get through the door of an audiologist through the door of an ear, nose and throat doctor if it was more medically related, so that they can then get on their path, or better hearing healthcare.

Okay, okay. And I think the takeaway from that is that hearing loss is about relationships more than anything else, with your family, with your friends, with the people in your workplace, that that, for me, is the key takeaway, that if you want to have the most satisfying relationships, in all phases of your life, you’re doing yourself a disservice not to treat your hearing loss

Absolutely, absolutely.

So we’ve covered a lot of ground today, and I appreciate you taking the time to discuss the survey in such detail. Before we under Do you have anything else to add?

Well, you know, just that over the counter hearing aids are certainly the entry level. And we, as I said, we want to get people just aware of it, and coming on through the door, doing something about it. Because we think that that’s so important. Education is critical. We are there as certified professionals, we are there well willing to talk to you to counsel, we’ve got plenty of surveys that we can we can give you to talk about what’s going on in your life. And what how does the hearing loss making feel, I mean, we have lots of that, that we can talk about. And we want people to feel comfortable coming in, we’re non judgmental, we want to find out what’s going on in your lives. And we also want to help you where you are, we are not trying to make people do something that they don’t want to do. But we do want to educate because as they said, some people think that the hearing aids that are available are their grandmother’s hearing aids – not the case. And so we want to make sure that people are aware of that.

Okay, all thanks. Really, thanks. It was a very enjoyable conversation. Now, if people want to reach out to you, how would they do that?

They can through the American Speech Language Hearing Association. They can just reached out to Dr. Janice Trent, Vice President of audiology practice at ASHA and they will get all the information you need.

Okay. Okay, great. Thanks a lot. And really, thanks for joining me and thanks to everyone who watched or listened to this episode.

Thank you so much.

Transcribed by https://otter.ai