Study Finds that Hearing Aids Work, but So Do Over-the-Counter-Type Hearing Devices. Both Work Better When an Audiologist Is Involved

Are OTC Devices Better?
Photo: ALAMY

A new study definitively found that hearing aids can help older adults with hearing loss. We’ve known this intuitively, of course, but this well-designed study provided the kind of proof that has not existed before.

The study team at the University of Indiana, Bloomington, was led by Larry E. Humes. “The research findings provide firm evidence that hearing aids do, in fact, provide significant benefit to older adults,” Dr. Humes said. “This is important because, even though millions of Americans have hearing loss, there has been an absence of rigorous clinical research that has demonstrated clear benefits provided by hearing aids to older adults.”

The study also found that an over-the-counter model of hearing aid (OTC hearing aids are not yet available) performed almost as well as an expensive hearing aid.

Those fitted with the real hearing aid, as well as a placebo group,  also received professional help with fit and instruction. The presence of best-practice audiology services greatly influenced the outcome, even in those receiving the placebo.

The six-week Indiana University study, published in the March issue of American Journal of Audiology, compared outcomes among three groups of patients: One that got a hearing aid that included the services of an audiologist. One that followed an over-the-counter process,  with the consumer choosing from among three pre-programmed devices — in actuality, the same high-end digital pair as the first group — but without a fitting. And a control group that got a professional fitting for a placebo hearing aid that had no amplification.

The subjects were 154 adults, ages 55 to 79, with mild to moderate hearing loss. The researchers compared benefits, including user satisfaction and usage of hearing aids after six weeks.

The researchers found that hearing devices helped both the audiologist group and the OTC group., although the OTC group was less satisfied with the hearing aids and less likely to purchase them after the trial. About 55 percent of the OTC participants said they were likely to purchase their hearing aids after the trial vs. 81 percent for the audiologist group.

Satisfaction significantly increased for patients in the OTC group who opted after the formal trial period to continue with an audiologist for a four-week follow-up. More of them also opted to purchase their hearing aids after receiving these audiology services.

Making OTC hearing aids available is the goal of a bill recently introduced by Sens. Elizabeth Warren (D-Mass.) and Chuck Grassley (R-Iowa) authorizing the sale of OTC hearing aids for mild to moderate loss. In an article in JAMA, they wrote: “Increasing access to innovative, low-cost hearing technologies must be part of the policy response to the untreated hearing loss now experienced by millions of Americans.”

The Hearing Loss Association of America (HLAA) also supports the Warren-Grassley bill and issued a call to action to its members to support it. Many members of HLAA have severe to profound hearing loss and would not be candidates for an OTC aid, but as the HLAA statement put it, improving service at the basic end encourages innovative technologies for all types of hearing loss. In addition, the introduction of lower-cost hearing aids and competitive pricing may help bring the cost of all hearing aids down.

Audiologists who are concerned that OTC hearing aids will put them out of business should take comfort in the study’s findings about the benefits of best practices in audiology. If audiologists get behind OTC hearing aids, it could mean hundreds of thousands more patients needing their services.

This would be good for people with hearing loss, and good for audiologists. And if hearing-aid manufactures get into the low-cost hearing business, it will be good for them as well. The study by Humes and colleagues shows that nobody really has anything to lose by encouraging innovation and competition in hearing aids.

For those who would like to read the study, here’s a link to the open-access publication: http://aja.pubs.asha.org/article.aspx?articleid=2608398.

For more information about living with hearing loss, my books  “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You” and “Living Better With Hearing Loss” are available at Amazon.com.

 

This post was first published in a slightly different form on AARP Health on April 7, 2017.

Advocacy Success!

Mayor 2017 billMayor Bill de Blasio was joined at the bill-signing ceremony at City Hall by, from left: Council Member Helen Rosenthal, HLAA-NYC Chapter President Katherine Bouton, MOPD Deputy Commissioner Kleo King, Chapter member and accessibility advocate Jerry Bergman, MOPD Deputy Commissioner Robert Piccolo, former City Council student intern Edward Friedman, and Council Member Elizabeth Crowley.

On March 21, 2017, Mayor Bill de Blasio signed a bill believed to make New York the nation’s first major municipality to require hearing loops in places of public assembly.

The new law applies to construction and renovation projects funded by the City at a cost of $950,000 or more. Council Member Helen Rosenthal of Manhattan, lead sponsor of the bill, estimates that, under the City’s current capital plans, loops will be installed in close to 300 new projects throughout the five boroughs.

“Hearing loop technology makes such a radical difference in the ability of so many to participate fully in public life,” said Council Member Rosenthal. “I’m proud that as a city we have moved to make it not just a priority but a requirement in our public investments.”

HLAA-NYC Chapter President Katherine Bouton added, “We look forward to the day when all who wear hearing devices can walk into City meeting halls and hear, understand, and communicate with others.”

The new law requires at least one assembly area and one adjacent security, information, or reception area to be looped. It also specifies that by July 2018 the Mayor’s office must post on its website a list of such facilities owned or operated by the city. For details about the new law, click here.

This is reprinted from the Hearing Loss Association of America-New York City Chapter website:

hearinglossnyc.org

CCAC Offers Grants for Captioning.

I”m reposting this here from CCAC’s blog, in case any organizations would like to apply for grants.CCAC is an organization that advocates for universal captioning. You can get to its blog by clicking on the link below.

CCAC offers three sorts of GRANTS to eligible associations and individuals for inclusion of LIVE EVENT CAPTIONING. And the newest thank you from a recipient makes our day! See below. All grant recipients are very grateful. It always helps to ensure an event is inclusive and accessible, and at the same time, it educates and […]

via Making Captions Happen: CCAC Grants — CCAC Blog

How’s Your Hearing? Maybe Not as Good as You Think.

Undetected Hearing Loss
Getty  Images/Canopy

If you think your hearing is fine, a new report from the Centers for Disease Control and Prevention (CDC) should make you think again. One in 4 people ages 20 to 69 who reported that their hearing was good to excellent were found to have hearing damage.

This kind of “hidden hearing loss” doesn’t show up on standard hearing tests but can make it difficult to impossible to hear conversation in a noisy setting.

The CDC analyzed more than 3,500 hearing tests conducted by the National Health and Nutrition Examination Survey (NNANES) in 2011 and 2012. It found that 20 percent of people who thought they could hear well and who said they didn’t work in a noisy environment nevertheless had hearing loss — some of them in their 20s. The type of loss they had, including a drop in the ability to hear high-pitched noise, indicated that noise damage may be to blame.

Even more surprising, more than half of the 40 million adults who have noise-related hearing damage developed it away from the workplace, from exposure to noisy rock concerts, sporting events, leaf blowers, traffic and other sources, the CDC reported.

Adding to the problem, 70 percent of people exposed to loud noise never or seldom wear hearing protection.

Although noise exposure in the workplace is well documented as a cause of hearing loss (the danger level is set at eight hours at more at 85 decibels, equivalent to the sound of heavy city traffic), the proportion of people with this kind of loss who don’t have a noisy workplace is an indication of how loud our everyday world is.

The understanding that some hearing loss is hidden and  doesn’t show up on standard hearing tests is relatively recent, the Associated Press recently reported. The loss, Harvard otolaryngology researcher M. Charles Liberman explained, may be caused by loud noise that damages the connections between hair cells in the inner ear and the nerves that carry the hearing signal to the brain.

You can test how well you understand speech in a noisy environment using a special online exercise prepared for the Associated Press in conjunction with the Mailman Center for Child Development at the University of Miami.

To take the test, click here. You will be asked to repeat a series of sentences. The exercise begins in quiet, but then slowly introduces background noise. The noise comes in six levels, faint at first but eventually louder than the words. People with hearing loss will start to have some trouble understanding the words at the second or third level, the AP reported.

What both the CDC report and the recent research into hidden hearing loss indicate is that people need to be aware of the noise they are exposing themselves to, and wear earplugs or noise-canceling headphones to protect their hearing. Keep the volume down, whether it’s while watching TV or listening to music or other programs through earbuds. The Hearing Loss Association of America offers more information on the CDC report, on its website. You can also go to the CDC website.

Hearing loss is no mere nuisance. As the CDC report noted, “Continual exposure to noise can cause stress, anxiety, depression, high blood pressure, heart disease, and many other health problems.”

 

This post first appeared on AARP Health on March 22, 2017.

Hearing Loss Won’t Kill You, or Will It?

I published this post on my Psychology Today blog, which is aimed at psychotherapists. But I thought the readers of this blog might also find it interesting.

If you are a therapist and have a patient with hearing loss, please read this to get a sense of what your patient may be experiencing.images

I lost much of my hearing gradually, over 30 years. And then, eight years ago, I lost almost all of the rest of it in a single day. Eventually I got a better hearing aid and a cochlear implant, but I never heard well again.

I was forced to leave a job I loved. Caring for my elderly parents was almost impossible because I couldn’t hear them, I couldn’t hear their health-care providers, and I couldn’t call 911 in an emergency. I flew there often, mostly for crises, because the only way I could begin to function was in person, reading lips, asking for written notes. The stress was overwhelming.

My marriage was disintegrating because of the depression and anger my hearing loss caused. My young-adult children were unable to comprehend how their mother had turned so difficult. I quit my book club. I avoided going out with friends. On election night 2008, the night of Obama’s election, I declined a friend’s invitation to watch together and stayed home alone with a bottle of wine and a box of Kleenex. I drank myself to sleep before the winner was declared.

Most nights I slept no more than two hours at a time, often dissolving into crying jags in the middle of the night. I lost 15 pounds. I thought about ways I might kill myself, assuring myself I wouldn’t actually do it. But I thought it about it too much.

Fortunately I found help. A psychotherapist provided medication and talked me through those dark months. When I developed vertigo, she worked with my ENT to help find the right drug combination to keep it under control.

Hearing loss is not a lifestyle problem, it’s not just a normal part of aging. It is a deeply disruptive loss that changes everything about the way a person lives. Isolation and depression are common responses. It contributes to cognitive decline. Society dismisses it, and this makes it even harder to cope with.

I survived my hearing loss and became an advocate for education and accessibility for the deaf and hard of hearing. I am a board member of the Hearing Loss Association of America. I wrote a memoir of my struggles with hearing loss, Shouting Won’t Help, and included my email address so people could contact me. And they do. Sometimes the emails are heartbreaking. Yesterday morning I got one from someone I had never corresponded with.

The subject line was: “Rage, Anger, Depression, Abusing Alcohol.” I responded, and as more email came in over the day, I realized the writer was in serious trouble. She was essentially alone in a distant state. After consulting with psychotherapist friends I urged her to contact a mental health professional immediately. I wish I had been able to provide a reference for her.

This person had been on medication for depression and anxiety. Her hearing loss was not new, although it was newly worse. Whoever prescribed the medication seems not to have recognized the severity of the impact of her loss, or not to have successfully dealt with it.

There’s nothing more I can do for this person, but I urge therapists to take hearing loss seriously. Acknowledge the significance of the loss. Understand that hearing aids and cochlear implants don’t always work very well. Try to understand what it’s like to lose your means of communication with others. Try to imagine what it’s like to doubt everything you think you hear. Imagine the embarrassment of repeatedly asking for clarification a third or fourth time. Many people just give up. They isolate themselves, they get depressed, they decline cognitively. Sometimes they even think about suicide. Sometimes, they even carry it out.

When I was writing my book, I included the experiences of many people who worked in jobs where hearing well is important. I interviewed psychotherapists, musicians, nurses. I wanted a teacher and finally found a high-school teacher who had been forced to leave his job because he could no longer hear his students. I heard he was depressed and drinking. Before I was able to interview him he was killed in a single-car accident. The cause was never discovered.

For more information about living with hearing loss, my books  “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You” and “Living Better With Hearing Loss” are available at Amazon.com.

Consumer Reports Rates PSAP’s

Bouton Blog - Consumer Reports
CR looked at hearing devices called PSAP’s – Istock

The February issue of Consumer Reports  magazine took an in-depth look at hearing loss and the hearing aid industry, as well as at the newest “hearing helpers” — less expensive, over-the-counter devices that may help some people with mild to moderate hearing problems.

Titled “No More Suffering in Silence?,” the report included the results of a fall 2015 survey of more than 131,000 of CR‘s subscribers. Nearly half reported they had trouble hearing in noisy environments, yet only 25 percent had had their hearing checked in the past year.

This isn’t surprising, as anyone who follows the hearing-healthcare business knows. The National Institute on Deafness and Other Communication Disorders (NIDCD) reports that among adults 20 to 69, only 16 percent of those who could benefit from a hearing aid has one.

Consumer Reports, however, with a subscription base of 7 million, reaches far more people than an NIDCD statistic does. When CR tells its readers about the dangers of untreated hearing loss, it is sending a message to millions who might not otherwise hear it.

The Consumer Reports article begins with an overview of hearing loss, noting the recent changes in understanding of the consequences of hearing loss. Once dismissed as “part of getting older” or a “nuisance,” we now know that untreated hearing loss is a “significant national health concern, one that’s associated with other serious health problems, including depression and a decline in memory and concentration. Several studies even suggest a link between hearing loss and dementia,” the article says.

Cost could be a big reason for this, the magazine notes. The National Academy of Sciences reports that hearing aids cost an average $4,700 per pair in 2013 and can climb to almost twice that price. Plus, hearing aids are usually not covered by health insurance or Medicare.

This is where OTC hearing helpers — also called PSAP’s, for personal sound amplification products — come in. They cost a fraction of the price of an average hearing aid. But do they really work?

The magazine had three of its employees with mild to moderate hearing loss try four devices priced from $20 to $350, wearing them for three to seven days to see how well they could help with hearing in a noisy environment. CR‘s audio labs also tested the devices for amplification, batteries, microphone function and sound distortion.

The most important finding: Pinching pennies can hurt you. The two lowest-priced devices — the Bell & Howell Silver Sonic XL ($20) and the MSA 30X ($30) – were found not only inadequate, but also potentially dangerous. Both overamplified sharp noises, like a siren, to the point where hearing damage could occur.

A hearing-aid researcher who assessed the devices recommended avoiding those under $50. “They don’t seem to help much, if at all, and could actually further diminish your ability to hear,” the magazine reported.

The two PSAPs that fared better were the SoundWorld Solutions C550+ ($350) and the Etymotic Bean ($214 each, $399 for a pair). CR reported on the pros and cons of each device, offering overall “device advice” for each one.

In general, The C55+ and the Bean seem useful for people with mild to moderate loss. The Bean was found to be especially helpful for those with hearing loss in the higher frequencies rather than the lower. For complete details, click here.

If your hearing loss is serious enough to warrant a hearing aid (and much hearing loss is, so have your hearing checked by an audiologist first), the article offered some suggestions for ways to pay less. I’ll write about these in my next post.

 

A version of this post first appeared on AARP Health on March 6, 2017.

Considering a Cochlear Implant? You’re Never Too Old.

Is there  an age limit for cochlear implant recipients? I asked this question of several cochlear implant surgeons around the country. Their answer? Never.

All have implanted patients in their 90s and, as Anil Lalwani, of New York-Presbyterian/Columbia University Irving Medical Center said, he “routinely” operates on patients over 80. His oldest patient is 93.

Surgeon Jay Rubinstein, at the University of Washington Medical Center, has performed cochlear implant surgery on a 96-year-old. Like the others, he thinks chronological age is -not the issue, it’s a person’s overall health.

In other words, it’s not so much how many years you’ve lived as how well your body has held up. In April 2014, Mollie Smith, 99, became the oldest cochlear implant recipient in Europe.

Cochlear implant surgery takes about two to three hours and requires general anesthesia or heavy sedation, so the ability to tolerate anesthesia is essential. Even so, a 2009 study by Dr. Lalwani and others, found that cochlear implantation in the elderly carries minimal risk from anesthesia.

One of the important preexisting conditions that may preclude surgery is moderate or severe heart and/or lung disease, which could make anesthesia potentially dangerous, said Rick Hodgson, a surgeon with Head and Neck Surgical Associates in Portland, Ore. The oldest patient he has implanted was 92 and he’s doing well, Dr. Hodgson said, noting that as a surgeon he looks more at “biologic age than chronological age.”

Darius Kohan, an otologist-otolaryngologist in New York (who was my cochlear implant surgeon at New York Eye and Ear Infirmary), told me he implanted a patient who was 95 years 6 months old. The patient is still using the implant 21/2 years after surgery.

Even dementia may not be a disqualifier, the surgeons said, assuming that the patient is not violent or likely to destroy the external parts of the implant. A study published last summer on implantees with dementia found a significant cognitive improvement a year later. The patients also received regular auditory rehabilitation. It was not clear from the study whether it was the implant itself or the aural rehab that made the difference in improved cognitive abilities.

Jack Wazen, a surgeon and  partner at the Silverstein Institute and director of research at the Ear Research Foundation in Sarasota, Fla. (and a fellow board of trustees member with me for the Hearing Loss Association of America), was the most conservative of those interviewed on the question of dementia, saying he routinely implants those with mild to moderate cognitive decline, but not those with severe decline.

All agree on the importance of auditory rehab for older patients. As Dr. Hodgson put it, “Auditory rehab helps get the most out of the process. This is amazing and life-changing technology, so why wouldn’t we want to maximize the impact on someone’s life?” He added that younger implant recipients might still be in the workforce and get stimulation from their everyday environment. The older recipients are less likely to get that stimulation. Also important, as all the surgeons agreed, is a social support system. This doesn’t necessarily mean a companion in the home, but a regular conversation partner is essential. Social interaction is important in general for quality of life.

The one issue on which the surgeons differed was which ear to implant: the worse or the better one. With younger implantees, the decision is usually to implant the worse ear, to preserve the natural hearing in the good ear, often using a hearing aid in the good ear. But an elderly person may have been deaf for some time in the bad ear, and thus less likely to benefit from the implant.

Although most said that they would consider implanting the deaf ear, they might not if the ear had been deaf for a long period of time. Dr. Wazen specified five years or more. Dr. Hodgson pointed out that “the longer the duration of hearing loss, the higher the chance of diminished benefit due to deterioration of sensory elements in the inner ear.”

Both Dr. Lalwani and Dr.  Kohan said they would implant the worse ear. Dr. Kohan’s reasoning is that if the patient is still able to hear with the hearing aid ear, there may still be enough plasticity in the brain, with crossover from the nonhearing ear, to make an implant in the deaf ear function. Dr. Lalwani went further: “I would always implant the deaf ear. One does not lose anything from doing so. If the outcome is less than satisfactory, the other ear could always be implanted down the road.”

As for outcomes, all the physicians agreed that older recipients do well with cochlear implants. Dr. Kohan mentioned benefits like delayed mental deterioration, better quality of life and more independence.

Dr. Wazen is completing a study comparing the results among patients over 80 with those under 80. The study found no differences in healing or complication rates. All patients did better with the cochlear implant than they had with a hearing aid. The study did find that speech recognition scores with implants were better in the younger group. This may be due to a number of factors, Dr. Wazen said, “including length of deafness, poorer cognitive function [in the older group] and aging changes in the brain.”

So if your doctor recommends an implant, go for it, no matter what your age. “When elderly patients tell me they are too old for a CI,” Dr. Rubinstein said, “I tell them age is not important unless they are a cheese.”

This post first appeared on AARP Health on February 22, 2016.