While most people don’t correlate hearing with health, hearing loss affects 48 million Americans and is associated with an increased risk of depression, dementia and falls. And that number is expected to increase to 73 million by 2060, yet only one in five people who might benefit from hearing aids wears them.
“The majority of people with untreated hearing loss are people who don’t actually recognize they have a problem and therefore are not seeking help,” explained Catherine Palmer, PhD, president of the American Academy of Audiology and Director of Audiology and Hearing Aids at the University of Pittsburgh Medical Center. “The rest of the untreated group realize they have hearing loss but don’t pursue hearing aids for various reasons, including stigma and cost.”
But change is underway. The Food and Drug Administration (FDA) has been working on creating a new regulatory class to make over-the-counter hearing aids available without a prescription or fitting by an audiologist. The new class of device will be sold online and at retail stores. When the guidelines go into effect, the U.S. will be the first country to have a regulated market for OTC hearing aids.
Until the FDA’s determination of final rules on OTCs expected this year, those considering hearing aids have the option of personal sound-amplification products (PSAPs), devices that increase the volume of all sounds in the environment and are best used for mild hearing loss.
When is it time to consider hearing aids or PSAPs?
More than half of adults over 65 have some form of hearing loss but according to the American Speech-Language-Hearing Association, hearing aid users wait an average of 10 years after initial diagnosis to be fit with their first set.
More than just an inconvenience, hearing loss has been linked to an increase in social isolation, depression, anxiety, cognitive decline, and more.
Hearing loss has been linked to an increase in social isolation, depression, anxiety, cognitive decline, and more.
Regardless of the cause, if you’re experiencing hearing loss, schedule an appointment with an audiologist.
“An evaluation is important to understand how severe the hearing loss is before providing treatment,” said Amit Gosalia, AuD an audiologist with the West Valley Hearing Center in Los Angeles. “Hearing loss could indicate an underlying medical issue that needs intervention, and a professional assessment is the first step in providing a treatment plan.”
It’s important to note that a baseline evaluation is advised whether recommendations might include use of either hearing aids or PSAPs.
Common hearing loss symptoms include:
- Muffled speech and other sounds
- Difficulty understanding words, especially against background noise or in a crowd
- Trouble hearing consonants
- Frequently asking others to speak more slowly, clearly and loudly
- Turning up the TV and radio volume
- Withdrawing from conversations
- Avoiding social settings
Specialists use a number of different tests, and an evaluation takes about 30 minutes (and is painless). Test results are plotted on a chart called an audiogram used to recommend the best course of treatment, which may include either hearing aids or PSAPs.
Hearing aids vs. PSAPs
PSAPs boost all sounds (or frequencies) without any differentiation and are recommended for those who have hearing thresholds of 20 dB or better in both ears. Unlike hearing aids, PSAPs are not customized or clinically prescribed but offer a number of settings, including mobile app integration in some models.
PSAPs don’t crystallize nearby sounds or isolate specific frequencies and are a good first step to hearing aids for people with mild hearing loss. They are helpful in quiet settings but aren’t well-suited for environments like restaurants and conferences, where many sounds are coming in at different volumes.
PSAPs require some initial work to learn how to insert and remove the device, adjust settings to maximize performance, change the battery, clean and maintain them.
For someone experiencing gradual to extensive hearing loss, hearing aids are the better choice over PSAPs. Unlike hearing amplifiers, hearing aids are categorized as a class 1 medical device by the FDA and require an audiological evaluation and a personalized prescription like eyeglasses. Aids are programmed to simulate the biology of the inner ear, picking out the exact sounds and frequencies one has trouble hearing and amplifying only those sounds so background sounds stay in the background.
Specifically, they’re designed to help users better understand speech, even in environments with a lot of ambient noise. The signal processing of hearing aids is designed to mimic some of the features in an ear missing sensory cells (known as sensorineural hearing loss). The aids detect and recognize high-frequency sounds compensating for those missing cells. Hearing aids can last anywhere from three to seven years, depending on how well they’re made and maintained, and general wear and tear on the device.
Hearing aids can last anywhere from three to seven years, depending on how well they’re made and maintained, and general wear and tear on the device.
It takes most people about four months to acclimate to hearing aids with required adjustments by the audiologist.
Hearing aid pros
- FDA-regulated class 1 medical device
- Produce natural sound
- Feature settings for varying hearing environments, such as wind noise reduction
- Provide personalized hearing correction based on a prescription
- Include inputs from hearing professionals
- Restore hearing ability during use, which can alleviate isolation and symptoms of depression
- Can be adjusted by the wearer or by a hearing aid professional
- Connect to smart devices to stream music, television and phone calls
- Alleviate tinnitus
Hearing aid cons
- Higher cost
- Rarely covered by health insurance
- Models using non-rechargeable batteries can be challenging to handle manually
Hearing amplifier pros
- No prescription or visit to hearing aid professionals required
- Less expensive
- Make distant sounds audible
- Good first step toward hearing aids
Hearing amplifier cons
- Not regulated by the FDA
- Not meant to improve hearing loss or help with medical conditions that can affect hearing, such as impacted earwax or a perforated eardrum
- Don’t crystallize nearby sounds
- Can’t distinguish between sound frequencies or pitch
- Make all sounds louder
- Can damage ears and further reduce hearing
- Not serviceable by all audiologists
Cost considerations of hearing aids and PSAPs
Historically, hearing aids have rarely been covered by private health insurance, Medicare or Medicaid—keeping them financially out of reach for many who could benefit.
“Medicare does help with the diagnostic evaluation. In fact, most plans cover 100% of the fee. Medicaid also covers hearing evaluations at 100%,” said Gosalia. “Certain states provide a hearing aid benefit as well. Some coverage includes both ears (if needed), but some only cover one ear. Usually there are audiological requirements that need to be met prior to Medicaid covering hearing aids, such as severity of hearing loss.”
Medicare does help with the diagnostic evaluation. In fact, most plans cover 100% of the fee. Medicaid also covers hearing evaluations at 100%.
The cost of prescription hearing aids can range from $1,600 to $8,000, depending on the model, technology and options, and the overall cost can include services like fitting and dispensing fees, after care, adjustments, warranties and customization. (If you purchase hearing aids online through a direct-to-consumer site, the price may only include the device.)
PSAPs are much more affordable and come in a wide range of prices—from $10 to $500 per device. Certain parts can be small and hard to manipulate, and some higher-end PSAPs may require an app for making adjustments. If you aren’t able to perform these tasks, you may need to pay an audiologist to do it for you (which could drastically increase the overall cost).
Pending OTC options could be priced as low as $200, but experts believe they are likely to range from $600 to $1,000 per set.
Don’t wait to schedule an appointment
Treating hearing loss is one of the best health decisions older adults can pursue to improve quality of life and prevent conditions like dementia, Gosalia said.
Treating hearing loss is one of the best health decisions older adults can pursue to improve quality of life and prevent conditions like dementia.
“Studies are showing untreated hearing loss is the most modifiable risk factor for dementia, but use of hearing aids helps patients have normal conversations, improve relationships and enjoy social activity again. The positive feedback I’ve received from the thousands of patients who have been helped with appropriate amplification continues to be very rewarding. I can’t stress enough that seeing a professional for hearing care is really the key to start enjoying a greater quality of life.”
Seeing a professional for hearing care is really the key to start enjoying a greater quality of life.