Experts on Camera

Dr. Nicholas Reed: Over-the-counter hearing aids

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May is Better Hearing Month—and after a recent federal rule change, hearing aids can now be purchased over the counter.

On Wednesday, May 17, 2023, SciLine interviewed: Dr. Nicholas Reed, an audiologist and assistant professor of epidemiology at Johns Hopkins University. He discussed topics including: risk factors for hearing loss; statistics on hearing loss, including the prevalence of hearing loss and hearing aid use; access and affordability barriers to hearing care; health (e.g., dementia, physical function, cognitive decline) and social (e.g., loneliness, social isolation, quality of life) problems associated with untreated hearing loss, particularly among older adults; the current science on the benefits of treating hearing loss; who can benefit from over-the-counter hearing aids—and what first-time buyers should consider before making a purchase; and recent policy initiatives to include coverage of hearing care under Medicare.

Declared interests:

Dr. Nicholas Reed receives grant funding from the NIH and is an advisory board member of Neosensory.

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NICHOLAS REED: I’m Nick Reed. I’m an assistant professor in the department of epidemiology at Johns Hopkins University Bloomberg School of Public Health and also an audiologist at the Johns Hopkins University School of Medicine. And I study hearing loss and aging.


Interview with SciLine

How does hearing loss occur in the ear?


NICHOLAS REED: When sound comes into your ear and goes down your ear canal and hits your eardrum and moves everything back and forth, that cochlea—there’s some fluid in there that starts to move. And when that starts to move back and forth, it creates these sort of waves. And when it reaches a peak, or hits any sort of strong point, those cells will start to fire off information. And that gives us information, right. That tells us we hear something. But hearing loss is when those cells start to get damaged over time—or just with age—unfortunately die off. They experience necrosis or apoptosis, which are the scientific terms for cellular death. And our ear it does not regenerate. It is one of the areas of the body where there’s no cellular regeneration whatsoever. So, once it’s gone, it’s gone. And so as those cells sort of go away, we lose the ability to encode accessed sound. Now, if things get louder, you may still be able to access what’s left of those cells. But it’s not as sharp as it is when you’re younger and all the cells are there.

Can you share any statistics on hearing loss, including the prevalence of hearing loss and hearing aid use?


NICHOLAS REED: Once we get over the age of 60, half of all adults have hearing loss. Once we get over the age of 70, two thirds of all adults have hearing loss. Using census numbers, roughly 44 to 45 million Americans have hearing loss in the United States—Americans over the age of 12 have hearing loss. But then among adults with hearing loss, approximately 20% or so actually own and use hearing aids—and that little term at the end there, use, is kind of key. If you if you look at sales numbers, it’s like 30% of people with hearing loss have hearing aids. But if you look at data from nationally representative surveys on use, it’s closer to around that 16 or 20%.

What are some of the health and social effects of hearing loss, particularly among older adults?


NICHOLAS REED: Among older adults who develop hearing loss, we see an association with cognitive decline, physical decline, including like gait speed, and how fast someone walks. My own research focuses on health care utilization, and so we see barriers to accessing care and spending more on health care and poorer health care outcomes—more likely to experience a 30 day readmission, more likely to experience an emergency department visit. We also see some fundamental work on loneliness and social isolation. And I think that work is sort of key to unlocking a lot of these other areas because hearing loss and cognitive decline, for example, gets a lot of the media attention, right. Particularly when it comes to dementia. But it’s likely that there’s sort of a pathway here where it’s hearing loss causing sort of social withdrawal and social isolation, that’s then leading to the cognitive decline and the dementia. So, there’s a lot of different outcomes that that are associated with hearing loss. But I think it’s important that we always remember it’s likely sort of a complex causal pathway, hitting from one to another, eventually.

What is known about the benefits of treating hearing loss?


NICHOLAS REED: We have a study published in JAMA that looks at the prevalence of dementia among people with hearing loss. And so they have a higher risk, if you will—prevalence of dementia. And then among people with hearing loss who use hearing aids, we do see a lower risk. But does that actually mean that hearing aids are the cure to some extent or they prevent dementia? And we can’t really make that assumption because hearing aids are also associated with higher socio-economic factors. Those people are wealthier, they have higher education levels, they have all these other sort of demographic variables that are descriptors that essentially are also protective and prevent dementia. So you know, it’s bad data in; it’s bad data out. And it’s really hard from a scientific standpoint to say that this treatment works in observational secondary data that just already exists.

Who should consider buying over-the-counter hearing aids?


NICHOLAS REED: Maybe you’re fine at home, at the dinner table when the TV’s off, but all of a sudden, at work, when you’re in that meeting where there’s a lot of people, you’re struggling a little bit more than you thought you would. Or if you sit in the back of an auditorium for some reason. And you’re like, “Oh, I can’t, I can’t hear like I used to.” Right? It’s worth thinking about maybe there’s some hearing loss going on. And the thing about these over-the-counter devices and hearing care in general is we think of this like you have hearing loss as a black box, right? You either have it or you don’t. But the truth is, it’s a continuum. And everybody’s sort of got their own hearing fingerprint. And the truth is you may not actually have the clinical definition of hearing loss. But your hearing has changed so much from when you were a child that for you it feels like hearing loss. And so, you could benefit without even having hearing loss. So, if you’re struggling at all, in any situation, it could be worth thinking about a simple over-the-counter device, a simple amplifier, or moving towards just, you know, strategies to address hearing loss.

What should first-time buyers consider before making an over-the-counter purchase?


NICHOLAS REED: I highly, highly recommend right now, looking for something that says “self-fitting” over-the-counter hearing aid. And that’s because, the way the FDA outlined this space—over-the-counter hearing aids—is that all a device has to do to be an over-the-counter hearing aid is register and say that they meet some basic technical standards. But if you want to call yourself a self-fitting over-the-counter hearing aid, that truly means that they had to do a clinical trial and prove to the FDA that somebody can take their device and use it and benefit from it. Usually the comparison group is as well as an audiologist. And so that’s really important. It means that those devices come with the backing of real clinical trials, which to be honest with you, we haven’t seen clinical trials on hearing aids in audiology in decades. We don’t see that very often—you see it from academics, but not from companies. And so if you’re gonna go this route and you don’t want to have a professional involved, I highly suggest self-fitting. If you’re willing, though, to think a little bit about the professional, it’s not the worst idea to contact somebody and have that initial visit. Maybe they get they get you a nice diagnostic hearing test, they tell you everything you want to know about your hearing, and they can offer you some counseling and guidance on where you might want to start.

Are there any common misconceptions about hearing loss?


NICHOLAS REED: Most of us, truth be told, don’t understand what hearing loss is. We don’t understand that it’s a clarity issue and not a volume issue. And what that means is, yeah, you’re likely to think other people are mumbling instead of actually thinking that you might have hearing loss because it’s really difficult to perceive clarity as hearing loss. We think of hearing loss, as you know, putting our hands over our ears, but that changes volume.

What are some risk factors for hearing loss?


NICHOLAS REED: At a population level there’s a lot of things we can’t really control. Age is a risk factor for hearing loss. Gender—male versus female—men are more likely to have hearing loss than women. And that is actually biological, there’s an estrogen factor, protective factor. And the same actually goes for ethnicity and race. Darker skin color is associated with less hearing loss. So, Caucasian individuals, white individuals, are more likely to have hearing loss. And it’s due to the protective nature of melanin, actually, in the ear. And that’s, that’s something we see in human and animal research, which is kind of fascinating. It doesn’t really change the course of if you have hearing loss, what you do about it, it’s just a general population level risk factor.

How much do hearing aids cost?


NICHOLAS REED: It’s costly. You know, the average set of hearing aids, according to the National Academies is $4,700. I think that’s a much wider range, though. It’s anywhere from $500 to $10,000. To be honest with you, it’s a there’s a big range. And that number, keep in mind, is not just the hearing aids. It’s also the services of an individual. It’s sort of a bundled model. So, it is expensive, though. That that could be a very, very costly figure for the majority of Americans. And it’s not a one and done thing, right? Hearing aids have a lifespan of 5 to 10 years. So, you’re looking at replacing that, you know—spending $5,000 every few years potentially.

How are reporters doing covering issues related to hearing loss?

[Posted May 17, 2023| Download video]