#HLAA.

Hearing Aid Facts and Figures

Katherine Bouton #HLAA., FDA and hearing aids, Hearing Aids, OTC Hearing Aids

Almost a year after the passage of the Over-the-Counter Hearing Aid Act of 2017,  I was curious to know if the bill and the attendant publicity had affected the hearing aid marketplace. So I asked an expert: Abram Bailey of Hearing Tracker.save-money-image

OTC hearing aids won’t be on the market for months, if not years. But the one-year anniversary seemed like a good time to try to establish some kind of benchmark in terms of sales, prices, location where purchased, brands, cost and other issues that may begin to shift after OTC hearing aids become available.

The bipartisan OTC bill, sponsored in the Senate by Republican Chuck Grassley and Democrat Elizabeth Warren, was signed into law by President Trump in August 2017. The FDA, which regulates hearing aids, has three years from the time the bill was signed for comments and questions. The final regulations will reflect the views not only of consumer advocates but also of audiologists and other medical professionals as well as hearing aid companies and dispensers. Until that comment period is over, there will be no OTC hearing aids.

Abram Bailey constructed a survey that was filled out by over 2000 consumers. (Here is a link to the survey) The respondents were a self-selected group, already aware of their hearing loss and many already wearing hearing aids. The survey was sent to Hearing Tracker followers, HLAA members, and people who follow my blog.

Part 1 of the survey was published last week. Parts 2 and 3, focusing on hearing-aid preference and recommendations, insurance coverage, and purchase of accessories (assistive listening devices, for instance), will be published in the coming weeks.

The survey first established the demographics of the respondents: 54.7 were female and 44.2 male. More than three-quarters were over the age of 55, with pretax income that reflects that of the population at large. More than half were retired. Their self-reported levels of hearing loss ranged from mild to profound, with 18.2 percent reporting that their hearing loss was profound, and 31.4 percent reporting severe hearing loss. As would be expected from the respondents surveyed, many were experienced hearing aid users, over half with 10-plus years of use. This is a very different sample from those who are just now becoming aware of their loss and buying hearing aids, but the trends are interesting.

Almost all (84 percent) bought a pair of hearing aids, as opposed to a single aid. More than half bought what they understood to be top-end hearing aids and more than a third bought mid-range hearing aids. The average price paid was $2560 for a single aid, or $2,336 per aid when purchased as a pair. This is more or less in line with the reports from the President’s Commission on Hearing and Technology (October 2015), which recommended a “basic” hearing aid, and the National Academies of Sciences, Engineering and Medicine (June 2016), which found an average cost of approximately $4700 for a pair of hearing aids.

The top brand purchased by survey respondents was Phonak, with Oticon and ReSound second and third. Eleven other brands were purchased by at least 10 respondents. Not surprisingly, the share of the US market reflected sales figures, with Sonova (Phonak) accounting for 30 percent. William Demant (Oticon) and GN Resound third. All three also own other brands. (The market share statistics date from 2015, and may have changed.)

Did cost affect market share? Starkey (# 4 in market share at 16 percent) had the highest average price paid ($2,674), with Widex (with 3 percent of market share) being the second most expensive ($2,672). The least expensive were Kirkland Signature (Costco’s house brand) at $963.

I was interested to see that the vast majority were fitted by and bought through audiologists (75.18 percent) or hearing-instrument specialists (20.46 percent) Audiology training is far more rigorous than that of hearing instrument specialists. Hearing aids sold by audiologists (1056 responses) cost on average $2,499 per device, those sold by hearing instrument specialists (337 responses) $1944 averaged per device.

The data also revealed, however, that hearing instrument specialists and audiologists seemed to charge the same amount when in similar settings (a local office, for instance). The disparity may reflect the fact that at Costco hearing professionals are mostly hearing-instrument specialists (40 percent) with only 4 percent audiologists. Those who bought at Costco, the survey found, were more than twice as likely to have been fitted by a hearing aid specialist as by an audiologist. Costco’s current estimated market share is 11 percent of all US hearing aid sales.

Costco sells, in addition to its own brand, Phonak and Resound, at vastly reduced prices. How is this? Abram Bailey speculated that it may be due in part to the fact that the aids sold are not the brand’s latest model (usually one generation behind flagship stores) Costco also can purchase in volume, and has very little overhead for its hearing aid sales.

Most surprising to me was the response to a question about the length of time it took for respondents to buy hearing aids once they had learned about their hearing loss. It is commonly said that most people wait 7 to 10 years before buying hearing aids. Over half the survey  respondents reported buying their first hearing aids within two years of learning they had a loss. As Bailey noted, this discrepancy may be the result of sampling bias (the respondents were all already hearing-aid users) or erroneous self-reporting (a respondent might like to think she had bought hearing aids within two years when in fact it had taken her 4-5 to make that decision.)

As the survey says, Stay tuned for more.

 

 

Do Your Hearing Aids Sweat?

Katherine Bouton #hearingaids, #HLAA.

outdoor-thermometerhygrometer-picture-id153970895

It’s hot. And humid.

Perfect weather for ruining your hearing aids.

Moisture. Whether it’s humidity or sweat, getting caught in a downpour, or diving into the pool, moisture is terrible for your hearing aids. It’s damaging to the delicate inner workings (the microphone, flexible circuit board, disposable battery, receiver and antenna). And it can clog the tubing that connects your behind-the-ear processor to the in-the-ear component.

Wax: Hot weather seems to increase wax buildup, which can block your hearing and makes your hearing aid dirty. If you have a custom mold, waxy buildup may make the in-the-ear mold uncomfortable. If your hearing aid has wax guards, make sure you replace them regularly. If it doesn’t, a small brush and pick to clean wax out of the tubing and ear mold is helpful. Don’t forget to clean the battery compartment.

Full immersion? Accidentally dunked your hearing aids?  Don’t panic. Take the hearing aid out and remove the battery (discard it). Shake the hearing aid to remove any excess moisture. If the water is salt water or dirty, rinse the component with fresh water. Dry it off and then leave it on dry newspaper overnight. You can also use a hair dryer but only on a cool setting. Audicus suggests putting the aid into a jar of uncooked rice. Never expose the hearing aid to heat, and if you’re thinking maybe the microwave would be faster, don’t do it!

Many people routinely put their hearing aids in a hearing aid dehumidifier overnight. This would also be a good place for the wet hearing aids as well. Harris Communications offers a variety of these, as does Amazon.com and other retailers..

Do hearing aids sweat? No, it just feels like it.

For more about living with hearing loss, see my books at Amazon.com.

 

Where Hearing Loss is the Norm

Katherine Bouton #hearingaids, #HLAA., Healthy Hearing, hearing aid costs

There’s one event a year where my hearing loss is not afb_nyc_chapter FB profile factor in my ability to communicate.

That’s the Hearing Loss Association of America’s annual Convention.

This year’s convention was held in Minneapolis June 21st to June 24th. I don’t know how many attended but virtually everyone was deaf or hard of hearing – or accompanying someone deaf or hard of hearing. A few audiologists also attended – it’s great to see their interest in what people with hearing loss want and need.

Convention is a mix of lectures, workshops, parties, seeing old friends and making new ones.

GIRLS OF MINNEAPOLIS
At Convention, where hearing loss is the norm.

The larger events – the keynote address, the research forum, the awards brunch – offer three different forms of hearing accommodations: a hearing loop, CART captions, and ASL interpreters. The smaller workshop gatherings provide CART, some offer looping as well, and an ASL interpreter was available on request.  My hearing loss is severe enough that I need CART as well as the loop. The Deaf may use CART to elaborate on what they hear through the ASL interpretation. It’s actually thrilling to be in a place that offers so many different ways to hear

This year’s keynote speaker was Gary Shapiro, president and CEO of the Consumer Technology Association. Consumer electronics are playing an ever larger role in correcting hearing loss. Shapiro’s talk was a guide to this exciting new field of hearing instruments.

The three-hour Friday morning research symposium consisted of a panel of four experts discussing listening in noise. They explained why it is so difficult for hearing aids and cochlear implants to correct for background noise, and technological innovations that  may solve this problem.

As always, there was a large exhibit hall where you could try out new devices, find out how to get a hearing dog, how to add an app to your smartphone to make it easier to understand on a cell phone. My cochlear implant manufacturer, Advanced Bionics, even made a minor adjustment to my cochlear implant at the convention, adding a small magnet to my headpiece, which had been slipping.

The themed Get Acquainted Party is always popular with newcomers and old hands alike. This year’s theme was the 70’s, complete with Go-Go dancers and hilarious costumes. On Saturday evening, Mandy Harvey, a deaf singer-songwriter who was also an America’s Got Talent winner, gave a concert for a few hundred people, some of whom could not resist getting up to dance.

Saturday night, a group went to the famed Guthrie Center for a performance of “West Side Story.”

Workshops on four educational tracks occupied the daytime hours. These tracks included Advocacy, Hearing Assistive Technology, Living with Hearing Loss, and Hearing Loss in Health Care settings. The last category is a new one for HLAA, and it addressed how people with hearing loss can make sure an encounter with the health-care system includes clear communication from health-care professional to patient, and vice versa.

In between formal events, friends met for meals, or a walk in beautiful Minneapolis, or took a trip to the Walker Art Museum and the adjacent outdoor sculpture park. Big name tags with large print make it easy to strike up conversations with new people or those you may have met at other conventions. As a person with hearing loss, I find name tags one of the most gratifying aspects of convention. I am bad at hearing names and bad at remembering them, which makes it hard to initiate a conversation with someone new, and sometimes even with people I know quite well, when the mind balks at remembering. Name tags do the work for me.

Almost everyone at Convention is hard of hearing, and accommodations are provided as a matter of course.  It’s fun – and also something of a relief – to be the norm for a change. Next year’s Convention is in Rochester, N.Y., home to what may be HLAA’s largest chapter as well as the Rochester Institute of Technology and the National Technical Institute for the Deaf. If any city in America can be said to specialize in hearing loss, Rochester is it.

 

Not Much of a Joiner?

Katherine Bouton #HLAA., effect of #hearing loss on medical care, Healthy Hearing

NYnewyorkcitychapter

“I’ve never been much of a joiner.”

I was encouraging an acquaintance with hearing loss to come to one of our HLAA Chapter meetings. I told her about our informative programs and guest speakers. I also said the meetings were a chance to meet other people with hearing loss.

She agreed to give it a try, meanwhile explaining that she wasn’t much of a joiner and not to expect to see her often.

That’s what I always used to say too. “Thanks, but I’m not much of a joiner.”

Here are some groups I never joined: the PTA, a church, the co-op board, the block association, political action groups, yoga classes, meditation groups, group therapy, French classes, Al-anon, dog training.

I always thought I just wasn’t much of a joiner. But suddenly (how could I not have seen this before?) I realized that it had everything to do with my hearing. It’s not that I don’t like people. Or committees. Or volunteer work. Or meditation. Or a well-trained dog. I just can’t hear.

It took me a while to join HLAA. I first went to one of the annual conventions in the course of reporting for my first book. The research seminar that year was on advances in finding a cure for hearing loss, primarily through gene therapy and stem cell therapy. It was fascinating but, more important, I could “hear” it. I could hear it by virtue of the live captioning and the hearing loop that had been installed for the event.

Someone I met there invited me to come to a chapter meeting back in New York. I’m not really a joiner, I said, but come September I did show up at a chapter meeting. Captions! A hearing loop! A really interesting program, with a panel of audiologists talking about hearing strategies.

What I could not do then and still cannot do is join in the socializing before and after the formal program. Luckily we have name tags so I know who I’m talking to, which is a tremendous help. But a substantive conversation is out of the question. Just as I always did before I told people I had hearing loss, in the old days of denial, I nod and smile and ask encouraging questions. But if you’re reading this, and you’ve tried talking to me at a meeting, it’s possible I haven’t heard a word. Follow up with an email!

I’m open about my hearing loss. In fact, I joke that hearing loss has become my profession. But there are certain circumstances that just don’t work for me. One is social time at our chapter meetings. Another is exercise class, which I will write about in my next post.IMG_3613

The photo at left was taken at last year’s New York Walk4Hearing, an annual event that will be held this year on September 23. If you’re not sure you want to try a chapter meeting, come to the Walk. No need to register. Details on our website. 

For Better Care for Older Adults, Think Hearing Loss.

Katherine Bouton #HLAA, effect of #hearing loss on medical care, Healthy Hearing, hearing loss, Hearing Loss and dementia

Two scholarly papers published this month discussed the impact of hearing loss on patient communication in older adults. Both found that unrecognized hearing loss may have a serious negative impact on health care in the elderly.

In the first, published in the British Medical Journal (BMJ) on January 18, researchers Jan Blustein, a professor of health policy and medicine at NYU, Barbara E. Weinstein professor of audiology at the CUNY Graduate Center, and Joshua Chodosh, a geriatrician at NYU, found that the rate of hearing loss is underestimated in medical settings, and analyzed the effect of undetected hearing loss on doctor-patient communication.

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In the second, published in the Journal of the American Medical Directors Association (JAMDA)  on January 30, the same authors as well as Ellen M. McCreedy, at the Center for Gerontology and Health at Brown University, discussed why hearing loss may be especially disabling in nursing home settings, and provided an estimate of the prevalence of hearing loss in those settings.

Hearing loss in older adults is measured in various ways. One is a catchall number that includes everyone over a certain age:  two-thirds of those over 70 have hearing loss, four-fifths of those over 80 have hearing loss. Sometimes it’s measured by decades: half of those 70-79 have hearing loss; 80 percent of those over 80 do. These figures include everything from mild to profound loss.

Whatever way you count it, however, the elderly experience hearing loss in large numbers. So when the researchers found that federal data indicated that 68 percent of long-term nursing home residents over the age of 70 had “adequate” hearing, it seemed worth investigating.  Was hearing loss just not being recognized in nursing homes? And if so, was it affecting care?

The Federal Data was compiled from the Minimum Data Set (MDS) that all nursing homes are required to report to the federal government. In 2016, nursing homes reported that 68 percent of their residents had “no difficulty in normal conversation, social interaction, or listening to TV.”

That number seemed “implausibly low” to Dr. Blustein and her colleagues. The National Health and Nutrition Survey (NHANES), which is the authoritative source about the rate of hearing loss among adults who live outside of institutional settings, found that only 44% of those 80 and older said that they had “excellent or good” hearing. As the JAMDA paper notes, these two figures are at “striking odds” with each other.

It stands to reason that the rate of hearing loss in nursing home residents should be about the same as that of adults living outside of institutional settings, which would mean that many people in nursing homes and other health care settings are having trouble hearing. They may not be having trouble hearing all the time, but crucial hearing situations are often the noisiest.

Many of those who say they hear adequately probably have mild to moderate age-related hearing loss. Their speech comprehension may be fine in quiet conversation. But nursing homes are far from quiet – studies show that social settings are often very noisy, with televisions blaring, dishes clattering in cafeterias, and residents crying out. Moreover, “high stakes” medical-care situations – emergency rooms, intensive care units, ambulances — tend to be the noisiest. These are also stressful situations, and stress also impacts comprehension.

Hearing aids are one solution, but hearing aid use remains low even in this population. Even if they do have hearing aids, people may leave them at home or in a safe place, to prevent loss or damage.

In both articles, the authors propose easy low-tech solutions for making sure hearing loss doesn’t get in the way of good patient care.

The first is for clinicians to be aware that their elderly patients may have hearing loss, even if they don’t know it. They should also check for impacted cerumen, or ear wax, which can affect hearing.

Every facility should have on hand personal amplifiers that can be shared with patients. The PocketTalker is perhaps the best known. The researchers also mention the Mino and the Sonido Listener. These devices cost about $150.

Health care workers also need to be mindful of communication strategies: they should make sure they have the listener’s attention, face the listener, speak clearly but not too slowly, rephrase rather than repeat words the listener has not understood.

Dr. Blustein (who has hearing loss herself and who serves on the Board of Trustees of the Hearing Loss Association of America, as do I) believes that hearing loss profoundly affects communication with patients. “Those of us with hearing loss often smile and nod so that the world thinks that we understand. It’s much more convenient. It’s easier. A patient may nod and smile, but not really understand what she is being told,” she said in an interview with the BMJ. Busy clinicians, too, may just want to move on, get their work done. So both the patient and the clinician may be contributing to the detriment of good patient care.

Unrecognized hearing loss can also sometimes be misdiagnosed as a cognitive impairment. “I think… my intuition… is that this is one of the great issues,” Dr. Blustein told the BMJ. “It’s sort of low-hanging fruit in clinical medicine, the assumption that someone has cognitive impairment when they don’t respond appropriately.”

Asked why the effect of hearing loss on good communication has remained unrecognized by many doctors, Dr. Blustein replied: “I think disability, generally, is not something that medicine is attracted to. We tend to be attracted to really dramatic, acute illness. Disability is complicated, it takes time.” And, she added, it occurs primarily in older people. “This is dismissed as ‘normal aging’. It’s ageism.”

People with hearing loss share some of the responsibility. Both patients and providers will benefit from the Guide for Effective Communication in Health Care, created by Jody Prysock and Toni Iacolucci. It includes information specifically for patients and their families (including a form that can be filled out in advance of medical interactions and should be entered into patient charts) and for providers. It can be found on the New York City Chapter’s website under Resources, with a link to the national website.

For people with hearing loss, it’s important to be honest, to disclose our disability. For providers, it’s important to recognize that hearing loss may be a factor. It’s a two-way street.

 

For more information about living with hearing loss, read my book “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You. 

How I Learned to Love My Cochlear Implant.

Katherine Bouton #HLAA., Cochlear Implants, Hearing Health, Hearing Loss Association of America, Hearing Loss Humor

In 2013 in my first book, “Shouting Won’t Help,” I wrote about the difficult experience I had adjusting to a cochlear implant I received in 2009. That section was excerpted in Bloomberg View and it is still easily available online.shoutingwonthelp

I often get letters from people who have seen the article and are worried by the information in it. They write to ask if they should get a cochlear implant. (Needless to say, this is a question only they and their medical professionals can answer.) Part of the concern stems from the Bloomberg title, “Cochlear Implants Are Miraculous and Maddening.” If you read the article carefully, as I just did, you won’t see me damning cochlear implants. But you will see me raising some caveats.

I am 100 percent in favor of getting a cochlear implant if you qualify for one, and if your hearing aid no longer works for you. I am also 100 percent in favor of aural rehabilitation after the implant. If your implant center doesn’t offer aural training, look for it elsewhere. A speech language-pathologist is one possible provider. There are many online training programs, the best known of which is L.A.C.E. This is a graduated program that starts with speech at a decibel level you can hear (this is determined before you start the program) and gradually increases the noise level in the background. I have written about aural rehabilitation previously on this blog, and you can find other suggestions there.

So how did I come to love my cochlear implant after my initial tepid embrace?

The first answer is practice. I have taken formal and online aural rehabilitation courses. I’ve worked one on one with a speech language pathologist. I listen to recorded books and then read the text to make sure I’ve gotten it right.

The second answer is consistent use. I wear the implant all day every day.

The third answer is technology. The cochlear implant I got in 2009 was not nearly as sophisticated as the replacement implant I got in 2014. (Most implant companies upgrade the external processor every five years.)

The fourth answer is support. I am active member of the Hearing Loss Association of America. We meet regularly and we share tips and experiences. I am always learning new things about hearing.

The fifth is to have reasonable expectations. Is my hearing perfect? Far from it. I need assistive listening devices and captions to hear in a group. I use captions to watch TV. I use captions at movie theaters. I say “What?” a lot. But I live an active daily life in the hearing world, and rarely feel disabled.

But without my cochlear implant I would hear almost nothing. My hearing loss is progressive and the hearing in my hearing-aid ear continues to drop. I am already planning for a second cochlear implant. I qualify now (many times over) but my hearing aid is adequate and this is one area where I follow my own advice: If you can still hear with a hearing aid, hold off on a cochlear implant.

If your hearing aid is no longer adequate, start your research. I have written a great deal about cochlear implants and with every writing my optimism grows. The paperback version of “Shouting Won’t Help” is more upbeat on cochlear implants than the hardcover was. My 2015 book “Living Better with Hearing Loss” offers more updated information than the earlier books, and also reflects my comfort and satisfaction – and gratitude! – for having a cochlear implant.

 

For more information on living with hearing loss, see my books on Amazon.com.

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

Katherine Bouton #HLAA., Hearing Aids, OTC Hearing Aids
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.