Hearing Health and Technology -- Workshop, Project No. P171200
The need for more people who need amplification to get it is very great, and a huge public health issue with our aging population. Particularly now that the relationship of hearing loss to cognitive decline is more widely accepted, the need for wider use of hearing aids is imperative. However the idea that hearing loss is similar enough to farsightedness that an OTC product will be a big help is uninformed by actual experience. I used "readers" for many years before I got prescription lenses. At the same time, I also had regular exams by an ophthalmologist since I am glaucoma suspect. I went to the readers' kiosk, tried on glasses, and saw how I saw small print, WHICH IS WHAT I WOULD USE THE GLASSES FOR! And I can see my own eyes in a mirror any old time! A typical hearing impairment is so much more complicated than a refractive problem. A hearing loss that would be analogous to farsightedness would be impacted wax in the ear canal. Both are essentially "mechanical" problems and the inverse of the problem solves the vision or hearing problem. Earwax is not a dangerous disease, and while wearing an amplifier to solve it is a stupid solution, it is usually safe. The hearing loss example, even this simple situation, is greatly complicated by the fact that the person cannot see into their own ears (and neither can a family member.) Most permanent hearing impairment involves the sensory cells AND the cranial nerve transmission AND the auditory and language parts of the brain. Each level affects different pitches, different intensities, different distortions, different processing interactions unpredictably and differently. An OTC product has many constraints: has to be loud enough so the effect is obvious, cannot be too loud to be annoying, can't whistle, can't plug up the ear too much, can't fall out-and probably be invisible. And then does all that assuming some "average" hearing loss and ear. From a public health point of view, there is enough evidence that the incidence of people dying from brain tumors or infective ear disease is so low that the risk of serious disease does not, in my opinion, outweigh the larger population risk from untreated hearing loss. The problem is the difficulty of reversing the effects of hearing loss with inadequate amplification. Many people are unhappy with hearing aids as it is now. Many of them recognize that it is better to wear them than not wear them. But many just stop wearing them. Often they don't even try because of problems they see relatives have with hearing aids. Successful use of hearing aids requires 1)a careful,accurate hearing evaluation, 2)selection of an appropriate aid, 3)validation of the fitting, and 4)counseling, counseling, follow-up, follow up. The last one, "aural rehabilitation," is not covered by Medicare. We don't want even more "amplification" failures walking around. "Why don't you get a hearing aid?" "I did and it wasn't any good." If an OTC doesn't work,they are in worse shape having wasted money on an OTC device. I see people every day who describe themselves as having only a mild hearing loss who turn out to have moderate to severe hearing losses. If you do nothing else, define the hearing loss to be remedied by an OTC product to be "Very Mild." To say "moderate" is dooming the idea that OTC devices will help avoid cognitive decline and increase independence and quality of life. What else to do? Help Medicare cover basic hearing aids as some states do now with Medicaid. For better hearing aids, have all the stakeholders design something more rational and cost effect than the methods used by insurance companies now. Have Medicare treat hearing loss as a disease process that requires periodic review. Reduce need for "bundling" of hearing aid services: (1) a follow-up hearing test for "Presbycusis" is now not paid, based on the invalid notion that hearing loss is like a refractive error. (2) Medicare and other payers should pay for aural rehabilitation.