What Exactly is an Over The Counter Hearing Aid?

One way or the other, it looks as if Over-the-Counter hearing aids will come on the market in the not too distant future.

In March, Senators Elizabeth Warren (D. Mass), Chuck Grassley (R. Iowa), Maggie Hassan (D-N.H.), and Johnny Isakson (R-Ga. reintroduced their bipartisan Over-the-Counter Hearing Aid bill.

On May 2, the House Energy & Commerce Subcommittee held a hearing on the proposed “Over-the-Counter Hearing Aid Act,” H.R. 1652, co-sponsored by Representative Marsha Blackburn, a conservative Republican from Tennessee, and Joseph Kennedy (D. Mass).

And now the Food and Drug Administration, which regulates the sale of hearing aids, looks like it may make legislation moot. The agency is expected to make an announcement in the near future about whether or not it will approve OTC hearing aids.

What exactly is an over the counter hearing aid?

We already have a device available over the counter that corrects hearing loss. What is it if not an OTC hearing aid?  It’s a PSAP,  a Personal Sound Amplification Product, which can cost anywhere from $50 to $500.  A PSAP can only be marketed as a sound amplifier for people with normal hearing..

So what’s an OTC hearing aid? Right now it’s a concept, not a product.

An OTC hearing would probably do pretty much what a good PSAP already does, but with FDA approval. It would be a digital device, possibly with directional microphones, Bluetooth and a telecoil, and presumably it would cost $1000 or less. An OTC hearing aid could be sold direct to the consumer, without an audiologist or hearing aid dispenser involved.

An OTC hearing aid would be subject to FDA safety and efficacy standards. Most consumer activists support this initiative, as a way of getting people to correct their hearing loss. OTC hearing aids are not for people with severe hearing loss, single sided hearing loss, or hearing loss caused by a number of medical conditions. So why do I, who can never benefit from an OTC aid, support it?

Four out of five older Americans with hearing loss decide to ignore it, so clearly something needs to change. Many of these people cannot afford hearing aids or worry about stigma. More widespread hearing devices of all kinds would help with both those issues.

Competition will bring prices down. Ubiquitous use will end stigma. Lower prices, end stigma. What’s not to like?

Addendum, 9:30 pm Weds May 10: It looks like a done deal.

From Hearing Health and Technology Matters:

WASHINGTON, D.C. — Members of the American Academy of Audiology (AAA) and International Hearing Society (IHS) learned yesterday afternoon that the Over-The-Counter Hearing Aid Act legislation has now been attached to the Medical Device User Fee and Modernization Act (MDUFA). According to AAA President Ian Windmill, the MDUFA bill is considered “must-pass” legislation and is scheduled to be voted on today in the assigned Senate committee.

Because the current OTC hearing aid legislation has sponsors from both political parties, and now that it has been attached to a must-pass bill, the likelihood of passage has increased significantly.

Turn Down the Noise!

A new national survey of adults shows that people in all age groups, from millennials to seniors, think that public spaces are too loud. Here’s a link to the study. And here’s a quick graphic version.

noise11

Forty-one percent of those polled said they were concerned that exposure to loud noise may have harmed their hearing. More than 50 percent said they worry that future noise exposure could be harmful to their hearing.

The survey, which was conducted by Crux Research for the American Speech-Language-Hearing Association, polled 1,007 people ages 18 to 70+. The largest percentage of participants were in the 18-24 and 70+ age groups.

Crotchety seniors who object to noise volume are the stereotype, but this new study found that dissatisfaction with the noise levels was highest in 18 to 29-year-olds. More than half of that group, however, said they found noisy environments more energetic or fun. Only 26 percent of the oldest participants agreed with that assessment..

The biggest culprits in terms of noise are live concerts (33 percent said they have not gone to concerts because of the noise level or have gone but the noise bothered them), bars or clubs (35 percent), sports events in a large stadium (27 percent), restaurants (25 percent) and movie theaters (21 percent).

The good news is that respondents across the board valued their hearing. More than 80 percent of those polled said their hearing status was extremely or very important. Almost three-quarters of 18 to 29 years olds answered that their hearing was important. A majority reported taking at least one step (moving away from speakers at a concert, using earplugs) to limit their noise exposure.

The survey did not ask about hearing aid use, but other studies show that despite this apparent awareness of hearing damage people are still not wearing hearing aids.

The survey was commissioned for Better Hearing and Speech Month, which is May.

What I Learned by Flunking Out of ASL

This past winter I decided to take a class in American Sign Language, ASL. It was a six-week course with a two-and-a-half hour class once a week. It was totally immersive – no spoken language allowed, even with the administrators.signlanguageabc

I took this challenge on for a couple of different reasons. The first was that I hoped to be able to exchange polite basics in ASL when I meet people who are Deaf. The second was to exercise my brain. Finally, ASL is a beautiful expressive language and in my work with the hard of hearing I often encounter someone signing. I wanted to see if I could pick up at least the most common signs.

We did learn some basics, but the class was geared more as an introductory level for people who intended to go on master ASL. In the first few classes we learned terms for discussing extended family. For instance, Is your cousin older than your brother? Who is her aunt? Are they divorced or separated? Is your youngest step-sister engaged? Clearly these are useful for conversation, especially as you get to know someone. But I couldn’t imagine myself ever asking about someone’s cousin. I found it hard enough to master father, mother, sister, brother, grandmother and grandfather to go on with other relatives.

Much of the class centered on student life. “May I borrow your slide rule?” In ASL (I think) this is “Slide rule me give?” Object subject verb, in that order. Online sources say you can use an alternate Subject Verb Object structure, which is more like spoken English, but not in my class. “Can you teach me English?” “English me teach? Help me need.” The tutor responds, “Yes. Me you pay?” (Don’t forget I flunked. This may not be correct.)

We did learn how to say Hello and Goodbye (just as you would in English, a hand signal of greeting and a little wave goodbye). “Thank you.” And “You’re Welcome” (which is “Thank You” back). “Deaf”, “hard of hearing,” and “hearing”. That was very useful. But “halter top”?

We learned how to finger spell. But we didn’t learn the alphabet from A to Z, we learned what seemed like random combinations of letters on different weeks.

The first few classes were fun. We played guessing games to increase eye-brain speed. About a third of each class was devoted to Deaf history (I did well in that) and Deaf Etiquette – some of which I was unable to comprehend. Repeatedly, in class and in quizzes, we were told that if two Deaf people are signing and you want to get past them, it is rude to walk around them. The proper etiquette is to walk right between them, without any acknowledgment that you are between them. I found this baffling but it was beyond my ability to ask about the logic of it.

My brain did feel more flexible, but only up to a certain point. We started out with six in the class, three women around my age, 50’s and 60’s, and three in their 20’s or early 30’s. One 60-year old dropped out after 20 minutes. The second made it through three classes. I made it to the end, my brain feeling ever more boggled.  Watching the teacher and then trying to repeat the signs is tricky. It’s a mirror image. It reminded me of what they always say about Ginger Rogers: She did everything Astaire did, but backwards, and in heels. Also, my aging fingers are just not as flexible as those of my 20-30-year-old fellow students.

When I spoke to the teacher about whether I should repeat Level 1 or go on to Level 2, he said I needed a private tutor. Whoa. I didn’t think I was that bad! I’ve never flunked anything. It’s humiliating!

My confidence immediately plummeted and I forgot everything I’d learned. But I didn’t want to give up so I started studying on line.

Here are some suggestions.

Print out a fingerspelling alphabet poster. Here are several to choose from. They are all free. Hang it above your desk. Teach yourself the alphabet. Then use  William Vicar’s Finger Spelling Practice. This is an increasingly difficult test-yourself site that is almost addictive. The words get longer, the fingerspelling gets faster. You can see your progress.

For those courtesy basics, go to Basic ASL: 100 Signs. The “student” in this video is a young woman who is competent but also charmingly modest and sometimes indecisive, and sometimes flat wrong. She makes you feel better about yourself. Want to learn how to count? Here’s a link.

There are many levels in this series, of increasing difficulty. You do it in your own time. I try to spend 20 minutes a day on practice, and I’m improving! My brain is also becoming more flexible. One unintended benefit is that my hand-eye coordination is improved, and it’s made a noticeable difference in my tennis game.

So I flunked ASL, but I learned a lot.

This column appeared in a slightly different form on AARP Health Essentials on May 4 2017

 

 

 

 

 

 

 

 

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.”

Update (May 9, 2017): For more on this, read the May issue of Hearing Journal: Noise-Induced Hearing Loss: What Your Patients Don’t Know Can Hurt Them. 

 

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