I was born with severe hearing loss in my right ear and was first fitted with a hearing aid in 1997, at 18 months old. At the time, hearing aids weren’t as high-tech as they are now, and you had to sit at the audiologist for five long minutes with putty hardening in your ear, which would become a new mold connected to an amplifier — the mold was similar to getting a retainer fitted at the orthodontist. Throughout grade school, I wore a pink and purple hearing aid with a wire that clipped to my shirt, ensuring I wouldn’t lose it.
I was lucky to have proactive parents who sent me to audiologists, assigned me speech therapists and paid for my hearing aid and its subsequent updates. Not everyone is so lucky. Many people are stunned to learn that hearing aids, which typically cost between $1,000 and $4,000 each, are not covered by most health insurance plans or Medicare.
National Institutes of Health data shows that 38 million Americans have some trouble hearing, but only one in five use hearing aids. A hefty price tag and stigma around wearing hearing aids are main reasons people report not seeking care. And even if someone wants to get a hearing aid, the process can be lengthy: a 2020 survey on hearing loss found that it takes an average of 6.2 years from when a patient recognizes hearing loss to when they get their first hearing aid.
On Aug. 16, the Food and Drug Administration approved the sale of over-the-counter (OTC) hearing aids at local pharmacies and other outlets. This is expected to help bridge a gap in hearing care by allowing people with perceived mild to moderate hearing loss to purchase hearing aids more affordably, without having to see an audiologist.
Advocates of OTC hearing aids have heralded their approval as a win for those who had trouble accessing hearing care previously. Here’s what you need to know about them.
How are OTC hearing aids and traditional models different?
To appeal to a wide range of consumers, over-the-counter hearing aids are not self-fitted for each individual. However, the FDA requires them to have some level of customization, involving adjustable volume and frequency settings.
Companies creating OTC aids use much of the same technology as traditional models. Hearing aids work by using a microphone to capture sound from the environment and converting it into electrical signals using a computer chip inside the device.
Those electrical signals then get sent to the speaker — usually inside the ear — and converted back into sound waves for our brain to process. They rely on what is called air-conduction technology, which means that sounds from the air are amplified and sent into the ear canal, in contrast to bone-conduction, which requires an implant.
But hearing loss runs the gamut, both in severity and in flavor. For example, like many people with hearing loss, I have high-frequency hearing loss, which means I can’t hear high-pitched sounds like s-, f- and c- consonants.
Sometimes my hearing aid battery will die while I am in public, and environments with loud background noise prove frustrating. Having high-frequency hearing loss means that in this situation, I can’t discern between words like “fan” and “sand.” I can hear the -an fine, but my understanding of the words themselves is diminished, so everyone sounds garbled, like I am underwater.
My hearing aid, made by the brand Widex, has a specialized amplifier that only increases certain sounds and dampens the background noise so I can discern individual voices. In a raucous bar, it allows me to hear nuanced sounds, like those s- and f- consonants, with more clarity, instead of having the entire soundscape cranked toward deafening.
Because you don’t visit an audiologist to have an over-the-counter aid custom-fitted to your hearing experience, they may not have the technology specific enough to amplify the right sounds. But it may be just enough of a boost for someone with mild hearing loss.
While audiologists can provide more precise hearing aids, they’re out of reach for many people, both financially and geographically. A 2019 study found that more audiologists practiced in urban areas compared to rural ones, which means not everyone lives near an audiologist.
Most people, however, live close to a pharmacy.
Lucas Berenbrok, an associate professor at Pitt’s school of pharmacy, realized the potential advantage of this when he heard Elaine Mormer, director of audiology clinical education in the department of communication science, give a lecture to pharmacy students about hearing loss.
The two teamed up and created an online program, called C.H.A.M.P., to prepare pharmacy students to inform patients about the new over-the-counter products. If a customer’s hearing loss is more severe, the pharmacist could suggest visiting an audiologist.
Where can I get a hearing aid?
There are a few places other than an audiologist’s office where you can get a traditional hearing aid. Mission of Mercy, a nonprofit in Pittsburgh, gave out 229 Starkey hearing aids free earlier this month at its annual clinic. Starkey is one of the “big five” traditional hearing aid manufacturers — their aids are high-tech and usually cost thousands of dollars.
John Randal, an employee at the Robinson Costco who works in the store's hearing center, said that store sells three audiologist-approved hearing aid brands: Philips, Rexton and its Kirkland Signature house brand.
The Philips is the most popular and costs $1,799 per pair. Randal said a benefit of getting hearing aids at Costco is that they are custom-made: the appointment includes the fitting, the servicing, the hearing test, and the follow-up, and any Costco member is eligible. And because these hearing aids are the high-tech traditional models, they work for severe hearing loss, too.
Audition Technology is a start-up born out of Carnegie Mellon University. They are developing an over-the-counter aid with sophisticated technology and expecting their product to cost around $300 to $500.
Elora Gupta, regulatory and operations lead of Audition Tech, stressed that patient control is an important aspect to their approach to hearing care. “We want our OTC users to feel confident in using their aid and being armed with the most up-to-date information,” said Gupta. She said that the reduced cost does not mean reduced quality: the product uses the same air-conduction technology as the “big five” hearing aids.
An over-the-counter aid from Audition Technology will come with access to the company’s e-learning portal and the paid version of its public app, SafeListen. These resources will help customers understand what hearing loss is, how it can come about, and how to protect against noise-induced hearing loss, Gupta said.
What will the future hold for hearing aid technology?
Companies planning to sell OTC aids must adjust their products to comply with the FDA’s revised guidelines, which will take time. In a White House news release about the hearing aid approval, President Joe Biden said that over-the-counter aids should be available in stores and pharmacies by October.
As OTC hearing aids hit the market, more companies will probably join in, driving prices down and giving customers more options.
At the very least, opening the hearing aid market to over-the-counter products could encourage conversation about accessibility, equity and stigma.
Jaipreet Virdi-Dhesi, a writer and historian of technology and medicine, published an essay in the Atlantic in 2016 about how hearing aid companies boasting about the inconspicuousness of their product contribute more toward stigma because users still feel they must either hide their experience and “pass as hearing,” or appear disabled and be categorized as such.
“That the hard of hearing should feel compelled to disguise their impairment with an invisible technology says a lot about how hearing loss is stigmatized,” she wrote in the essay.
Are there other ways I can assist my hearing?
There are other devices besides hearing aids that can give you a boost if you have trouble hearing. Personal sound amplification products, or PSAPs, provide general amplification and can be purchased at pharmacies like CVS and Walgreens for $30 to $65.
Catherine Palmer, the director of audiology for the UPMC Integrated Health System and a Pitt professor, said not to forget about simpler solutions like getting a person’s attention, keeping good eye contact and turning off other sounds like the television or running water.
There’s also speech-to-text. Mary Jane Kuffner Hirt, a retired teacher who lives in Harmar Township, was watching TV one evening when she looked down at her phone and noticed that it was capturing the audio from the screen and transcribing it live. She had recently gotten a new Android phone, on which Google live transcription is a built-in feature.
She ran to show her partner, Bruce Betty, who had mucosal melanoma, a rare form of cancer that robbed him of his hearing. It was diagnosed in September 2020, at a time when so many were already feeling isolated from the pandemic.
Live transcription put Betty back in control of his own care, said Hirt. Before then, the couple would use a notepad or whiteboard to communicate with doctors, nurses and with each other. But he’d often grow frustrated and eventually stopped wanting to have visitors.
“Because he was terminally ill, I couldn’t take him out in the world due to COVID-19. His whole world was his apartment. So this was a tool of major magnitude,” said Hirt.
Hirt was surprised to find that many of Betty’s caretakers did not know about the feature, and she hopes they’ll know to use it for other patients with hearing impairments in the future.
Betty passed away last May, and Hirt buried him with his phone — that’s how much the live transcription service meant to him. “It was a hidden gem,” she said.
OTC hearing aids could help many people, but they’re not the only option.
Growing up, I never felt as if I had to hide my hearing loss, because I started wearing an aid so young, and it just felt like a part of me. But I know well the relief of putting in my hearing aid while in a crowded room: the senses elevate, the noises shape themselves into language. I’m hopeful that the arrival of these new aids can help other people with hearing loss find that relief, too.
Hanna Webster: hwebster@post-gazette.com
First Published: August 27, 2022, 10:00 a.m.
Updated: August 28, 2022, 2:22 p.m.
