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SALT LAKE CITY — Hearing aids are now available over the counter thanks to a new Food and Drug Administration rule making hearing aids, which are typically not included in health insurance, more affordable for many people.
In its announcement of the rule's approval, the FDA said it is expected to lower the cost of hearing aids and expand access. U.S. Health and Human Services Secretary Xavier Becerra said the action is a significant milestone in hearing aid accessibility.
"Reducing health care costs in America has been a priority of mine since day one and this rule is expected to help us achieve quality, affordable health care access for millions of Americans in need," Becerra said.
Close to 30 million adults in the United States could benefit from using hearing aids, the release said, but only about one-fifth of people with hearing loss are using them.
Kate Johnson, an audiologist in the department of otolaryngology at University of Utah Health, said she is excited about hearing aids becoming a little more affordable and having them on visible shelves, which will help bring more awareness to hearing loss. But she voiced some concerns.
Bringing hearing aids to a local pharmacy or retail store, Johnson said, could mean larger hearing issues will go unaddressed because people skip a hearing test or people will give up on hearing aids after failing to fit them properly themselves.
Hearing tests are still valuable
Johnson said hearing tests are covered by insurance, and she would still suggest people go get their hearing tested before buying an over-the-counter hearing aid. She said if anyone feels like they are struggling to hear, it's a good idea to have a hearing test, even if it ends up only setting a baseline for future tests. People over 60 or 65 should have their hearing checked yearly.
She explained that over-the-counter hearing aids are for "a perceived mild to moderate hearing loss," but said people who come to see an audiologist typically don't accurately perceive their hearing. She said a patient can have moderate or severe hearing loss but come in thinking they can hear fine, or come in thinking their hearing is gone when in reality they have very mild hearing loss.
"That 'perceived' part is what is really tricky. ... How can we expect someone to know what their hearing loss is without seeing a professional and having ... a diagnostic audiogram or hearing test?" Johnson said.
She also said there are multiple hearing disorders where a doctor would recommend surgery instead of a hearing aid. In some cases, the hearing can be fixed and a person who may use over-the-counter hearing aids to address their hearing loss could have instead had that hearing loss addressed directly.
In some of these issues, not treating the root cause can lead to more problems, like permanent hearing damage or facial paralysis.
"I don't ever want someone to go undiagnosed with a medical problem, and some of these problems can be pretty serious, that if untreated can cause more than hearing loss," Johnson said.
She said although there are online hearing tests available, results from those can be inaccurate based on speaker quality and the environment and they can't be trusted to give an accurate diagnosis.
However, Johnson said over-the-counter hearing aids should be completely safe for someone to try out and not cause any additional hearing damage, although she said it could be a waste of money if a person soon finds out they need surgery or a prescriptive hearing aid.
At an appointment at the University of Utah, Johnson said they won't push a prescriptive hearing aid when there is an over-the-counter option that could work. Although there are a lot of audiology practices that are trying to sell hearing aids, university hospitals and ear, nose and throat doctors' offices, along with many private practices, are more invested in making sure a patient has the right hearing aid and not making a sale.
I don't ever want someone to go undiagnosed with a medical problem, and some of these problems can be pretty serious, that if untreated can cause more than hearing loss.
–Kate Johnson, U. of U. Health audiologist
Difficulty fitting hearing aids
Johnson said hearing aids all have a corresponding phone app that is used to set them up and help them meet the right fit for a person. Although there are instructions in over-the-counter hearing aids for how to get them working correctly for you, fitting them can be tricky and is something that in the past has been done by a professional.
"We are expecting a lot of people to be pretty frustrated with the fitting process," she said, noting that many people who need hearing aids are older and may be less familiar with apps.
With the addition of an over-the-counter option, she said the University of Utah is considering having an option for people to bring in their over-the-counter hearing aids and pay out of pocket to have a professional help fit the device for them. So there will be some resources to help with this.
Hearing aid use is important
Johnson said there is a correlation between untreated hearing loss and dementia and cognitive decline. She said although hearing loss doesn't cause dementia, it makes sense that untreated hearing loss can lead to social isolation, which can cause areas of your brain to stop working as hard and eventually deteriorate. When hearing loss isn't treated, the brain resists hearing or is not able to deal with hearing, along with other demands.
She said hearing aids can be difficult to wear even when fitted by a professional. Often, patients don't like them or don't like the way they sound and don't wear them frequently.
Johnson said it's important to remember that hearing aids don't cure hearing loss and won't make hearing perfect. She said the most consistent reason they find patients report hearing aids don't work for them is they weren't wearing them throughout the day but only in complex environments.
"The way the brain works is that it needs consistency, it needs things to be the same in all settings. And so when you throw a pair of hearing aids on, even when they are perfectly fit and appropriately fit, if you're only wearing them when you're out to a restaurant, your brain doesn't know what to do with all of that information. It has to have that consistency of wearing them … during all waking hours. Otherwise your brain won't get used to it," she said.
If a brain doesn't have sound input when someone is moving around on their own, the noises can be very bothersome when hearing aids are in and they can hear all of the little noises they make.
"Our brain needs to hear all the time, not just in certain circumstances," Johnson said.
