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Hearing Aids

By Jack Hisley, M. D.

The Gadsden GAB is a monthly publication that’s written by BG residents, for BG residents. Every two weeks, we’ll feature an article from the GAB on the Bishop Gadsden website. To read more, you can read the entire February edition here.

It has been estimated that more than one-half of people 75 years and older have some hearing loss, yet only 20 percent of those who could benefit from hearing aids actually purchase them. The electronic hearing aid, developed early in the 1900s, relied on vacuum tubes and was the size of a standard cigar box. Not until innovations like transistors and digital data processing enabled hearing aids to be miniaturized and worn within the ear did they become practical. Today, the major drawback to greater public interest in the small auditory devices is price. Prior to October 17, 2022, hearing aids could not be sold without a prescription. One needed a medical doctor’s referral to an audiologist who provided testing and a device that was fitted to match the person’s particular hearing loss. Interestingly, only five companies owned the entire hearing aid market. Those five companies manufactured the devices, employed auditory specialists, and owned all the clinics and marketing firms. Medicare and most health insurance carriers did not cover the cost, which ranged from approximately $1400 at Costco up to $4700+ for a pair of aids from a private company. Most cells in the body regenerate as one ages. However, this is not true of the tiny hair cells housed in the inner ear. Sound waves first enter the ear canal where the eardrum is located. Vibrations are then transmitted over three interconnected bones in the middle ear to the cochlea, a structure located in the inner ear. The cochlea’s microscopic hair cells represent different frequencies, and when stimulated, the captured information is efficiently transmitted via the auditory nerve to the brain for interpretation. Unfortunately, aging takes its toll on the delicate hair cells, which do not regenerate. Damage to the hair cells responsible for detecting high frequencies causes people to lose the clarity of conversation. Those with high-frequency hearing loss can hear someone talking but they can’t quite make out what they are saying. Hearing aids fitted for specific frequency loss help but they tend to be imperfect since one is trying to hear using a device to assist an ear that is irreversibly damaged. It has been well documented that more desirable outcomes occur when hearing aids are initiated as soon as hearing loss is detected. In 2017, a bill passed in Congress authorized the Food and Drug Administration (FDA) to create a category of over-the-counter hearing aids for those with mild to moderate hearing loss. Although heavily lobbied by the hearing aid industry, the FDA on 17 October 2022 announced it was changing enforcement rules so that hearing aids could be sold without a prescription direct to the consumer. The FDA clearly stated they did not intend to enforce the previous requirement for medical evaluation prior to the sale of hearing aids to those over the age of eighteen. Since the year 2000 when hearing aids became digitalized, those with mild to moderate loss had the option of self-fitting a hearing aid using a smart phone, the innovative technology that has made over-the-counter (OTC) purchases feasible. Presently, OTC hearing aids must still meet the FDA’s medical device standards. Using a smart phone, a self-hearing test app such as SonicCloud Personalized Sound can illustrate one’s frequency loss and electronically program the OTC device, thereby saving the consumer hundreds of dollars. If one has severe hearing loss to the extent that conversation in a quiet room is not possible, a hearing professional should be consulted. In the coming years, competition should gradually lower prices, encourage increasingly innovative technology, and make hearing improvement available to more people. A good hearing aid only amplifies the sounds you cannot hear. It is wise to avoid personal sound amplification devices, which are less expensive but are not desirable for hearing loss. These devices indiscriminately amplify all frequencies, high and low, such that those with clinical hearing loss actually have more difficulty with conversations. According to Nicholas Reed, Director of the Cochlear Center for Hearing at The Johns Hopkins University School of Medicine, “The OTC market is a ‘wait and see’ market. Don’t wait too long to buy a hearing aid if you need one, for the longer one waits, the harder it is to adapt. In the long run, you’ll get used to hearing aids quicker if you don’t wait.” Meanwhile, it will be interesting to see what big companies like Samsung and Apple will do when they too enter the OTC hearing aid market.