Debunking the Stigma of Age

Whenever I give talks, there’s one Power-Point slide I use that surprises people. That’s because it directly contradicts the notion that hearing loss is something for the elderly.

As this graph shows, hearing loss is for all of us, male or female, at any age.

Slide05

The majority of people first realize they have hearing loss between the ages of 20 and 59. That’s especially true for men: 64 percent. And it’s close to true for women: 50 percent. This survey was based on self-report, so we don’t know if they “developed” hearing loss at a certain age. More accurately, they first noticed it at a certain age. People are notoriously slow to recognize hearing loss. A study using audiologic metrics would probably find even higher numbers.

So, 64 percent of men with hearing loss first knew they had it between the ages of 20 and 59, and 50 percent of women did. Add those whose hearing loss was detected before the age of 20, and you’ll find that that 79 percent of men had hearing loss by age 60, as did 70 percent of women.

So why do we associate hearing loss with aging? Why is this stigma so powerful?

The elderly do develop hearing loss: But new hearing loss over the age of 60 constitutes a much smaller percentage of the total than those who knew they had a hearing problem when they were younger.  Where does this age=hearing loss idea come from?

Hearing tends to decline with age, so the loss among the elderly is on average more severe than it is in younger people. This prompts people who have had untreated hearing loss for decades to finally get hearing aids.Slide13

Those we notice wearing hearing aids are usually old. This 2012 graph shows that approximately 15 percent those over 80 who need hearing aids have them. It’s not a large number but it’s a whole lot larger than those wearing hearing aids who are younger than 70.

A huge majority of elderly people have hearing loss, and among them a fair number wear hearing aids. This leads to a natural association of hearing loss with aging. Look at the top graph again. The majority of those with hearing loss developed it before they turned 60.

Hearing loss isn’t just for the elderly. So let’s dispense with that stigma of age and take care of our hearing. Get hearing aids!

 

 

 

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.

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.

Good News About Hearing Loss, With Qualifications

Hearing loss is declining, according to a study published on December 15 by researchers at Johns Hopkins School of Medicine.

etna
At the top of Mt. Etna, April 2016, with Damian Croft of Esplora.co.uk. What does this have to do with hearing loss? Nothing! It’s a New Year’s treat.

This is good news.

But before you put back in those earbuds and conclude that all those reports of an “epidemic” of hearing loss were wildly exaggerated, read a little closer.

The study of almost 4000 adults 20 to 69 years old found that the overall prevalence of hearing loss (as measured in the speech frequencies) dropped from 16 to 14 percent in the years between 1999-2004 and 2011-12.  (Among adults 60 to 69, however, a whopping 39.3 percent still had hearing loss.)

The decline among working age adults was slight but statistically significant. Despite the fact that there was a greater number of older adults, “the estimated number of adults aged 20 to 69 years with hearing loss declined absolutely, from an estimate of 28.0 million in the 1999-2004 cycles to 27.7 million in the 2011-2012 cycle.”

“Our findings show a promising trend of better hearing among adults that spans more than half a century,” said Howard J. Hoffman, M.A., first author on the paper and director of the NIDCD’s Epidemiology and Statistics Program. “The decline in hearing loss rates among adults under age 70 suggests that age-related hearing loss may be delayed until later in life.”

The researchers attributed the decline to a decrease in noisy manufacturing jobs, to increased use of hearing protection (OSHA requirements for hearing protection have helped), to a drop in smoking and to better medical care.

A greater awareness of the dangers of noise may also have helped. It’s no longer unusual to see someone at a sporting event or loud concert wearing protective headphones. It’s the norm for people with ride-on lawn mowers or those doing other kinds of noisy yard work to wear headphones.

But before we celebrate and abandon advocacy for equal access for people with hearing loss, remember that the age group studied is getting older every day. In the coming years we can expect that normal age-related hearing loss will have its usual effects. “Despite the benefit of delayed onset of HI,” the paper concluded, “hearing health care needs will increase as the US population grows and ages.”

We’re still going to need cheaper and more accessible hearing aids. We’re still going to have to defeat the stigma of hearing loss so that people will wear those hearing aids – and help offset or prevent the negative health effects of untreated hearing loss.

We’re making progress against hearing loss, and that’s cause for celebration. But don’t give up the good habits that have allowed us to get to this point. The world is still noisy. We still need to protect our ears. There is still a lot of hearing loss. We need to treat it.

 

This post appeared in a slightly different form on AARP Health on Dec. 22, 2016.

What Do Consumers Want? Try Asking a Consumer.

If you asked consumers what is most important when buying a hearing aid, would they say price or sound quality?

Hearing Tracker, a respected independent online resource for consumers, and USB Evidence Labs recently surveyed more than 360 audiologists about what brands and features consumers ask for most when buying a hearing aid.

Not surprisingly, sound quality came in first by a long shot (56 percent), with reliability a distant second (17 percent) and value for money in third place (12 percent).

I don’t doubt that is exactly what the audiologists’ customers said they wanted. But I also wonder if the answers would have been different if consumers, especially those who never go to an audiologist, had been asked directly. I expect those consumers would say an affordable price was their top priority.

Currently, only 1 in 7 U.S. adults who can benefit from a hearing aid have one. Why don’t the other six?

The answer is cost. “Hearing aids are expensive,” Jan Blustein and Barbara Weinstein wrote in a June 2016 article in the American Journal of Public Health. Medicare and most insurance plans don’t cover them, and so consumers typically pay for aids and fittings out of pocket. And that can get costly. The average cost of a single hearing aid is $2,300, but because age-related hearing loss typically affects both ears, that’s a tidy $4,600 — a sum beyond the reach of many older people. Blustein and Weinstein note that “in a recent population-based prospective study, a majority of participants cited cost as a major deterrent to buying a hearing aid.”

Kim Cavitt, a past president of the Academy of Doctors of Audiology, says audiologists have turned a blind eye to consumer wants. In a recent article headlined “Have We Missed the Signs?” in Hearing Health and Technology Matters, she wrote that consumers “for the past decade have been clamoring for lower-cost amplification solutions,” meaning more affordable hearing aids or hearing aid–like devices.

The devices she refers to are lower-cost products that can effectively help with mild to moderate hearing loss. These won’t replace traditional hearing aids, she wrote but will expand the market by providing a gateway to more advanced traditional hearing aids.

She also noted that consumers want transparent pricing from audiologists — including detailed pricing of various goods and services — and access to assistive listening devices and aural rehabilitation. But mostly, consumers want hearing amplification they can afford.

This month, responding to that consumer demand, Senators Elizabeth Warren (D-Mass.) and Chuck Grassley (R-Iowa) introduced a bill to ease restrictions for getting hearing aids, including eliminating a required medical exam for many devices. The bill was supported by a number of organizations, including AARP and the Hearing Loss Association of America (HLAA), the nation’s largest consumer group representing people with hearing loss.

The legislation preceded an announcement from the Food and Drug Administration that it will no longer require adults to get a medical exam before purchasing certain hearing aids, clearing the way for a new category of over-the-counter devices.

Barbara Kelley, the executive director of the HLAA, endorses both developments.

“Each and every day,” she wrote, “our office receives letters, phone calls and emails from people with hearing loss inquiring about financial assistance to purchase hearing aids (up to 10 requests a day). The financial help page on hearingloss.org is the number one visited page on HLAA’s website. Sadly, there are few financial aid resources. Creating a category of over-the-counter hearing aids will go a long way toward making these essential devices affordable for the millions of Americans who need them.”

Cavitt agrees, although she isn’t by any means discounting the need for audiologists. People with serious hearing loss will always need audiologists and the services that only they can offer, she says.

For now, though, the goal should be finding an easier, financially feasible way to get the remaining 6 out of 7 Americans with hearing loss the devices they need.

 

This post was first published on AARP Heath on December 19, 2016.

For more on hearing loss and hearing health:

shoutingwonthelpLiving Better jpegKatherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.

Affordable Hearing Aids Just Got a Giant Step Closer

Decision Could Make Hearing Aids Available Over-the-Counter
– Getty Images

Buying hearing aids could soon become as easy as buying reading glasses.

In a surprise announcement yesterday, the Food and Drug Administration (FDA) said that, effective immediately, it would no longer require adults to get a medical evaluation before buying most hearing aids.

The agency  is also considering creating a category of over-the-counter hearing aids to encourage more “new, innovative, lower-cost products to millions of consumers,” the agency said in a prepared statement.

The announcement was made at a meeting of the National Academies of Sciences, Engineering and Medicine on hearing health care. Previous recommendations from this group, as well as from a White House advisory panel on science and technology, and consumer and some audiologist groups, had urged easing this restriction to make hearing aids more affordable and accessible.

The decision does not apply to those ages 18 and under, who still must have a medical evaluation before purchasing hearing aids. It also does not apply to bone-conduction hearing aids or to prescription-use hearing aids that are inserted deep in the ear canal.

Age-related hearing loss affects some 30 million Americans, affecting not only their work and social interactions but also their overall health and quality of life. For most, the hearing loss begins before the age of 60. The isolation and loneliness that can result from serious hearing loss have been linked to a higher risk of cognitive decline and dementia.

Despite the high prevalence and public health impact of hearing loss, only about one-fifth of people who could benefit from wearing a hearing aid actually use one, the FDA noted. The high price of the devices — about $4,600 a set — has been a major barrier. Medicare and many private insurance plans don’t cover the cost of hearing aids, so most consumers are stuck paying for them out of pocket.

In addition, six companies manufacture nearly all the hearing aids sold, and only one is based in the U.S., a White House blog post about the FDA decision said.

The impact of the FDA’s move could open the hearing aid market to new companies and more competition.

The ruling was one of several recommended by the Hearing Loss Association of America and other consumer groups. HLAA Executive Director Barbara Kelley commented, “We applaud the FDA’s decision to remove this requirement and believe it is a step forward to remove barriers and make hearing health care for consumers more affordable and accessible.”

“Today’s actions are an example of the FDA considering flexible approaches to regulation that encourage innovation in areas of rapid scientific progress,” said FDA Commissioner Robert Califf, M.D.

 

This post was first published on AARP Heath on December 8, 2016.

For more on hearing loss and hearing health:

shoutingwonthelpLiving Better jpegKatherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.

Charity Events Like HLAA’s Walk4Hearing Raise Awareness and Spirits — As Well as Money

Fall and spring are prime times for charity fundraiser walks and runs, events that raise a substantial part of yearly donations and help raise public awareness for important medical conditions, including hearing loss.

 

mr-ronnie-jay-and-jody-at-2016-w4h
Singer-Songwriter Jay Alan Zimmerman kicked off the New York Walk with the National Anthem. CART Captions and ASL interpretation allowed everyone to follow along.

 

Some charities raise hundreds of millions from their annual events, like the American Cancer Society’s Relay For Life, the Susan G. Komen Race for the Cure and the Alzheimer’s Association’s Walk to End Alzheimer’s.

Compared with those behemoths, the Hearing Loss Association of America (HLAA) received about $1.8 million in contributions in fiscal year 2014, according to Charity Navigator, a group that evaluates charity finances. This puts HLAA in the minuscule category, in terms of funds raised. In terms of people served, however, it’s up there with the major groups, considering there are 48 million Americans with hearing loss.

In September, about 1,500 New York area residents of all ages, ethnicities, boroughs and neighborhoods showed up for HLAA’s New York City Walk4Hearing, one of 22 walks around the country this spring and fall. I’m the president of our chapter and saw firsthand this year how much work goes into pulling off a walk. Kudos to HLAA staff and our tireless volunteers.

Our 64 teams were made up of adults and children with hearing loss, families and friends of those with hearing loss, audiology students from eight colleges, and representatives from the Hearing Health Foundation and the Center for Communication and Hearing. We also had walkers from hospital audiology departments and from schools for children with hearing loss. And, of course, walkers from HLAA’s New York City chapter.

We raised more than $125,000 to support HLAA’s education and advocacy efforts to help lower the cost of hearing aids, to get Medicare coverage for hearing aids, and to fund the continuing fight for equal access for those with hearing loss.

This year, the theme of the Walk4Hearing went beyond merely raising money and awareness and general camaraderie. This year’s walk was also a call to action: All walkers and supporters were encouraged to take personal steps to improve their own access to better communication.

These included such simple acts as asking for a captioned telephone at work, requesting assistive listening devices at the movies or theater, and asking your pharmacy to install a hearing loop so that you can understand the pharmacist’s directions. HLAA has an extensive list of the kinds of actions people can take every day to raise awareness of hearing loss and to better their own lives.

We also asked participants to come up with their own ways to speak up, to acknowledge their hearing loss, and to help raise awareness of a condition that affects Americans of all ages.

We also made sure that everyone enjoyed themselves. We walked, we cheered, we laughed, we ate — apples, cookies, even ice cream bars. But mostly we just enjoyed being in the company of so many others like us. By gathering publicly and prominently announcing our cause, we also raised awareness of hearing loss, a largely invisible condition that affects people of all ages, races, and economic and social backgrounds.

I would encourage everyone to consider participating in one of these charity walks or runs — for hearing loss and/or any other condition that has touched your life — for the camaraderie as well as knowing you’re helping a good cause. But before choosing to participate (or to donate), I would check out exactly how a charity uses the money it raises. It’s not uncommon for only 50 cents of every dollar to reach the cause it benefits, according to a 2011 MarketWatch article. The rest goes to expenses. You do have to spend money to make money in most charity events. There are fees for park permits, portable toilets and so on. Some push these expenses to unacceptable extremes. You can also check out Charity NavigatorGuidestar or the Better Business Bureau’s Wise Giving Alliance.

HLAA’s Walk4Hearing is a small event compared to fundraisers for cancer, Alzheimers and others. But that means that every dollar means all that much more. Our $125,000 will go a long way towards furthering awareness, accommodations, and aid for people with hearing loss.

 

This article first appeared on AARP Health on October 12, 2016.

Katherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.