Synopsis: Only about a fifth of people who could use hearing aids have them. Reasons include stigma, high cost, and poor training of people who actually get hearing aids. An audiologist, hearing aid manufacturer, and hearing aid user discuss solving these issues.

Host: Reed Pence. Guests: Dr. Mark Hammel, psychologist and hearing aid user; Dr. Cynthia Compton-Conley, Director, Consumer Technology Initiatives, Hearing Loss Association of America; Shawn Stahmer, Vice President of Business Development, Sound World Solutions

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Hurdles to Hearing Aids

Reed Pence: New Year’s Eve parties are full of people chatting with old friends and new acquaintances. But millions of others will sit on the sidelines and not take part. They have hearing loss that makes conversing in a noisy room just too difficult. And it’s far from uncommon. About a third of all people over age 60 have hearing loss that affects the quality of their lives. For many of them, hearing loss has been getting worse and worse each year, but so slowly they may not realize it.

Hammel:  I think that’s it’s really insidious, not just subtle, the way hearing loss works, because in effect we don’t know what we’re missing.

Pence: That’s Dr. Mark Hammel, a psychologist in Kingston, New York. Psychotherapists often have to deal with patients whose anxiety and social withdrawal is contributed to by their hearing loss.

Hammel:  They’re not fully involved in the social world around them. It causes them to withdraw and it also causes them to be ignored by the people who they are close to.

Compton-Conley:  People may not even notice what’s happening because it’s so gradual. As people get older anyway certain people may not be as social as they usually are.  

Pence: Dr. Cynthia Compton-Conley is director of consumer technology initiatives for the Hearing Loss Association of America.

Compton-Conley:  But if you’re starting to have trouble hearing you may start to isolate yourself from social situations, especially challenging ones, such as understanding your companion in a restaurant, that’s a classic difficult situation for people. In my work as a clinical audiologist I’ve met many many patients, you ask them about their lifestyle and they say, “Well, I don’t go to restaurants,” and then you have to probe further, “Well, why is it that you don’t go? You don’t like going out to eat? Or is it something else?” Usually they’ll admit, yes, it’s my hearing loss. I don’t want to be embarrassed. I don’t want to be frustrated. The same thing will happen; people might stop going to religious services, lectures, and town meetings, situations like that.

Pence: Hammel is more than familiar with those situations. He has noise-induced hearing loss from his military service years ago, and he wishes he’d gotten his hearing aids a lot sooner.

Hammel:  It’s made a tremendous difference, but it really took time. What’s really interesting to me is that it probably took two years to get back into the habit of listening. I realize that I had just given up. I would go to social events where there was a lot of background noise, people talking, people would be standing around at a party or a gathering and having conversation. I’d be standing there after a sentence or two not having any idea what they were talking about and I would just drift away. And then I began to avoid social situations. And after I got the hearing aids over time I realized that ‘d be sitting there doing the same thing just because I had learned to give up and I had to remind myself, stay in there…you can hear.

Pence: However, it’s not just social situations that are made worse by hearing loss. Many of Hammel’s patients are veterans suffering from PTSD.

Hammel: The two conditions — the impaired hearing and PTSD actually — work prodigiously against each other. Veterans with PTSD, really anyone with PTSD, not just veterans, but if they have a hearing impairment they’re trying to get information from the environment and if it’s impaired it means much more of their very very precious attention is being used up, and they are not getting what they need. So they become more anxious and more hyper vigilant as a result of that.

Pence: Studies show that people with moderate to severe hearing loss have more than a 50 percent higher risk of death compared to people who hear normally. And a Johns Hopkins study finds that a person’s risk of dementia is directly related to their degree of hearing loss. However, Compton-Conley says it works the other way around as well.

Compton-Conley: A lot of people sitting in assisted living centers and nursing homes can be diagnosed as having a cognitive problem, dementia or whatever, but in many cases it’s an undiagnosed hearing loss, or a hearing loss that even though it’s diagnosed it hasn’t been taken care of, it hasn’t been compensated for. It’s the third most prevalent chronic health condition facing older adults. Twenty percent of those who might benefit from treatment actually seek help and most people delay treatment until they can’t communicate even with the best of listening situations. I think the research says, if I recall this correctly, on the average, hearing aid users wait about ten years until after their initial diagnosis of hearing loss to be fit with first set of hearing aids.

 Pence: People don’t get hearing aids for a lot of reasons, but stigma is probably the biggest one. Many people who need hearing aids think they’d look old wearing them. But Hammel says that would dissipate quickly if the millions of people who need hearing aids all got them.  

Hammel:  Hearing aids should be every bit as common as eyeglasses. Sure, once upon a time eyeglasses were somewhat stigmatized. I know for children they are stigmatized. They’re more acceptable as one ages, but I think that hearing aids are really stigmatized.

Compton-Conley:  It’s not as much a stigma as before. There was an old study I can’t recall off the top of my head what it was, but years ago it showed people pictures of older adults and asked people to judge how smart they were. Some people had hearing aids on and some didn’t. They people with hearing aids were judged less competent and this study was repeated on my colleague. That’s not the case on any more because hearing aids are becoming a little more cool, like eyeglasses are.

Pence: Compton-Conley says many people have also been scared off by friends’ horror stories of how their hearing aids did them no good. And it’s true that a lot of people who get hearing aids end up not using them. But Hammel says that’s usually because the user didn’t get as much follow-up as they should have.

Hammel: It takes time to habituate to the hearing aids in a variety of ways. A lot of people just give up before they’ve actually given them a chance. They don’t go back to their audiologist as often as they need to have the adjustment tweaked every couple of weeks even for the first six month, and then every few months for the next year or two to keep having them tweaked so that they’re doing the optimal job. Unfortunately, that doesn’t happen as much as it should.

Pence: Hammel says many users have no idea what to expect when they get hearing aids. His experience shows that hearing aids take some getting used to.

Hammel: I had a linoleum kitchen floor and I remember walking across the kitchen floor when I’d just put the hearing aids in and it sounded like a stampede of horses. I kind of understood that in a fairly short order my brain would start to filter out the unnecessary sound of walking across a hard floor and that in fact is what happened after a week or two, that the sounds that were very very pronounced became much less pronounced and that’s part of the habituation that happens with hearing aids. At first they are very noisy and they can be uncomfortable.

Pence: But unless you’re well briefed by your audiologist and get some tweaks done to eliminate troublesome sounds as much as possible, Hammel says you’ll be dissatisfied, and you’ll probably tell your friends. It’s up to your audiologist to make sure that doesn’t happen.

Compton-Conley:  If you do a proper needs assessment and you do proper counseling and you serve as what I would call a hearing enhancement coach or guide, like a life coach for hearing loss, then people would be more willing to try technologies. When I started employing that approach, I found that my patients were much more happy. My waiting list for people to see me increased from two weeks to six months. It’s interesting, historically, the hearing aid return rate has hovereed around 20% to 23%, and in our clinic we had a return rate of zero because we didn’t focus on the hearing aids. Yes, we fitted them, but we focused on the person.      

Pence: Another reason many people don’t get hearing aids when they need them is that they’re expensive.

Stahmer:   In the U.S., the typical hearing aid will be somewhere around $2,000-$3,000 per ear.

Pence: That’s Shawn Stahmer, vice president of business development at hearing aid manufacturer Sound World Solutions.

Stahmer:   And it’s worth noting that price is what’s described as a bundled price. It means that you’re not just paying for the product itself, you’re also paying for the service of the medical professional. In many cases it is an audiologist, to see you and do the fitting and provide some after care follow up as well. So it’s a bundled comparison, the end result, though, is very expensive and it’s typically not covered by insurance. It’s not covered by Medicare, so it’s almost always an out of pocket expense for consumers.

Pence: However, Stahmer ‘s firm has developed hearing aids for emerging markets such as India, with a keen eye on keeping cost down. They cost as little as a tenth the usual price.

Stahmer:  Most of the traditional hearing aid companies do their own custom chips, which are the brains or intelligence inside the unit. They’ll design those from scratch, so that they do very specific things proprietary to that individual company. Of course, that’s really expensive to do. Lots of dollars, millions of dollars in research and development expense and you have to fabricate those chips yourself at relatively low volumes. In the grand scheme of things that leads to pretty high costs as a general rule. That contrasts with the approach we took, which was to say, let’s look at blue-tooth chips, which are widely available, there are something like 9 billion devices a year being put onto the market that use blue tooth chips. We took those off the shelf blue tooth chips and let those be the engine, the brain inside our unit and then took our signal processing knowledge and algorhythom development to wrap around that chip, so that we could let the market forces take that cost much much lower for us.   

Pence: Those hearing aids are now available in the United States and cost only $449, unbundled from assistance. Stahmer says the device’s specs are similar to those costing much more. But that’s not the ultimate in over-the-counter hearing help. Sound world sells another device with nearly identical technology for $50 less. But be sure not to call that a hearing aid. It’s a “personal sound amplification device.”

Stahmer:  The difference is really in the way that you’re allowed to market the devices. FDA provides guidance on what a personal sound amplification product is as compared to a hearing aid product. Even in their guidance they do not distinguish between the two from a technology perspective. What they do is they talk about what a personal sound amplifier is in terms of the way that it can be marketed to consumers. Personal sound amplifiers are for people who have “normal hearing” and who need occasional help in certain situations. A hearing aid is a medical device that’s intended to compensate for a medical condition, which is hearing loess.  

Compton-Conley: These PSADs are really hearing aids. They can be used by people. There’s research being done that shows that savvy adults with mild hearing loss, maybe even moderate hearing loss are perfectly capable of buying these products and trying them and deciding if they help them or not. Not everybody needs a hearing aid fitting, for example. So we’ll see. I mean HLAA we’d like to see over the counter hearing aids, we feel there’s a place for them. Not for kids. Not for certain people with more involved losses. And it’s always a good idea to have your hearing checked by a professional. You should always have an audiologist take a look at your hearing. You should always consult with your internist and ear doctor as well, and have a baseline test done at least. But we do feel that there’s a place for over the counter hearing aids, just as there’s a place for reading glasses.

Pence: Hearing aids can make an immense difference in people’s lives, but like any product, including medical care, consumers are wise to do their homework and shop around. You can find out more about all our guests on our website,  I’m Reed Pence. 


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