“Volume Control” Entertains, Educates and Will Probably Make You Mad at the Big Six

One of the great things about being a writer is that it lets you pursue your passions and still call it work. Like many people who encounter hearing loss when they don’t expect it, David Owen, author of more than a dozen books, wanted to know what had happened to his hearing and why. So he wrote a book. (So did I.)

9780593147009In “Volume Control: Hearing in a Deafening World,” Owen starts with the basics – how hearing works and what can go wrong – and allows himself an entertaining and informative meander into a world that many of us veterans of hearing loss will recognize. But what a story he tells along the way.

Some of it you may have learned in high-school physics: there’s no sound in space because sound waves need “stuff” to travel through and if there’s no stuff, there’s “nothing to vibrate, nothing to push and pull.” Of the cochlea, usually described as a spiraling shell, Owen offers the amusing comparison to a “Barbie-size serving of frozen custard.” A newborn’s inner ears are fully developed and the same size as an adult’s. The National Institutes of Health maintains a cadaver registry for ears, which provides specimens to hearing researchers all over the world. “If you don’t mind the thought of pathologists and medical students using a band saw to remove parts of your skull after you’re dead, you should consider donating yours.” Here’s a link to the registry if you want to donate.

Occasionally he left me scratching my head:  “Turn an ear trumpet around and you have a megaphone, not a silencer; how can that be?” That’s because an ear trumpet IS a megaphone, right? It amplifies sounds that go into your ear.

And really, don’t take as gospel Rush Limbaugh’s opinion about what things sound like with a cochlear implant: “It’s totally artificial,” Limbaugh says, “because in my memory of hearing there isn’t anything I ever remember hearing that sounds like the way I hear sounds now.” The closest he can get, Limbaugh says, is that it’s like “scratchy, static AM radio.” That’s not my cochlear-implant experience. I don’t hear perfectly with the implant, but what I do hear is very much like what I heard with my original ears. But never mind.

Many of the paths Owen goes down have to do with specific individuals with hearing loss. Their stories are varied and informative. Just as no two ears are alike – your hearing aid probably won’t work with my hearing – no two people’s experiences with hearing loss are alike.

Among his detours is the history of Chilmark, on Martha’s Vineyard, where so many people were Deaf that the hearing people also learned to sign. Alexander Graham Bell is revealed as an anti-signing, eugenicist crank. A 19th-century Portuguese king sat on a throne that acted as a hearing amplifier. “Supplicants knelt before the king and spoke into the open mouths of lion heads carved into the ends of the throne’s arms.” Sound was funneled through the chair arms and eventually to the king’s ears.

More serious, and quite damning, is his discussion of pricing by hearing-aid companies. In 2016, Starkey executives were indicted for what the U.S. attorney called “a massive and long running fraud scheme.” One executive settled before the trial began. Another was convicted on eight counts of fraud and sentenced to seven years in prison. A third was convicted on three counts and got two years. Appointed successor was the founder’s fourth wife’s son, who — among other indiscretions — used company funds to build a chicken coop and a skating rink. The scandal was confined to Starkey, but as Owen notes, all the hearing aid companies will suffer “if potential customers conclude that, no matter whose products they decide to buy, they’re being ripped off. ”

One disillusioned Starkey employee, Diane Van Tasell, had long since left the company, in 2002, and went on to work with Andy Stabin, who as a graduate student developed a method that would allow consumers to program their own hearing aids. They were later joined by Kevin Franck, an audiologist with an MBA. (Franck is now a member of the board of the Hearing Loss Association of America, HLAA.) The result was Ear Machine, which later became the Bose product called “Hearphones,” self-adjustable high-quality headphones that are hearing aids in everything but FDA-approved name. Owen describes his tryout with Hearphones, in the noisiest restaurant he could find, and although they’re not for people with severe hearing loss, they do sound excellent.

Why didn’t the hearing aid companies embrace Stabin and Van Tasell’s self-adjusting technology? Kevin Franck was their ambassador to the Big Six. His first contact was always with the engineers at the companies, who seemed excited about the technology. Then he’d visit with the business side. “We like this, but we don’t want to anger our customers,” they would tell Franck. It took him a while to figure out that the hearing aid companies’ “customers” were not those who wear hearing aids. “They were talking about audiologists.” When asked if they weren’t interested in the new markets a self-adjusting hearing aid would create, Van Tasell says, they would answer no. “Frankly,” they told her, “they were making enough money as it was.”

And that’s one reason the average cost of a hearing aid in the United States is $2400.

2020 is the year that FDA-approved hearing aids come on the market, which may help bring the cost of all hearing aids down. As Owen says, “There is no better time in all of human history to be a person with hearing loss.”

That’s good, because, as he also writes, “Our ability to deafen ourselves with ordinary daily activities has never been greater than it is now.”

For more about living with hearing loss, read my books, available at Amazon.com and maybe at your favorite bookstore or library. If it’s not there, ask for it!

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“Affordable” Hearing Aids

There’s a lot of talk about “affordable” hearing aids, much of it in anticipation of the Food and Drug Administration’s final approval of an over-the- counter hearing aid. We don’t know the specifics of the future OTC hearing aid but some have speculated that the cost will probably be around $1000.

Comparatively speaking, that is affordable. The cost of high-end hearing aids is approaching $4000 (for one). $3000 is not unusual. Costco’s least expensive hearing aid is $999.  There are less expensive devices, many available online, some of which use the term “hearing aid”, but buyer beware. For some people, they may work well out of the box. Others may end up with hearing aids that aren’t really right for them. As for hearing-aid like devices, PSAP’s or hearables, for some they will be adequate but for others not so good. And if they are too cheap, a 2016 Consumer Reports survey found, they can actually damage your hearing.

But these low-cost alternatives are still a major expense for many Americans, especially older Americans.  Earlier this year a Federal Reserve Board survey found that 40 percent of Americans could not cover a $400 emergency expense without selling something or borrowing.  A $1000 affordable hearing aid is not “affordable” for 40 percent of our population.

Medicare does not cover hearing aids. Some Medicare supplement programs do, as do some other insurance policies. But that 40 percent who can’t find a quick $400 for an emergency probably do not have this level of insurance. The V.A. also provides hearing aids to veterans with service-related hearing loss.

For many, Medicaid is the only solution. Medicaid covers hearing aids for adults in 28 states, including New York State where I live. For a complete list of states and of eligibility requirements for hearing aids, based on the severity of the loss, see this recent article in Health Affairs. Coverage varies widely from state to state, as does coverage for associated services like hearing-aid batteries.

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In this map, the dark red states have the best Medicaid hearing aid coverage. The pink states have no hearing aid coverage. The other states fall in between.

As the Health Affairs article concludes: older Americans “in states lacking comprehensive hearing health care coverage have few ways to access hearing aids or the professional services associated with hearing loss and hearing aid use.” As we know, untreated hearing loss is significantly related to other adverse health outcomes, especially in the elderly.

The Health Affairs study also found that over one-fourth of adults skipped necessary medical care in 2017 because they were unable to afford the cost.

So when we talk about “affordable” hearing aids, let’s remember that that is a relative term.

 

For more about hearing health, read my new book, which will tell you everything I know about hearing loss, hearing aids, and hearing health!Smart Hearing Cover final

You can get it online at Amazon or Barnes & Noble, in paperback or ebook for Kindle or Nook. You can also ask your library or favorite independent bookstore to order it.