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Benchtop Hearing Aids: Disability Professionals Weigh Benefits and Concerns

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The U.S. Food and Drug Administration finalized a decision Monday to make hearing aids available over the counter without a prescription or appointment.

It’s a game changer for many with disabilities, who say the decision will benefit millions of Americans with hearing loss. At the same time, the decision sheds light on barriers to accessing hearing aids, which community members with disabilities say still need to be addressed. HuffPost spoke to experts in the field who outlined the benefits of over-the-counter hearing aids and raised some concerns about their rollout.

“I’m excited about this step forward,” Glenda Sims, head of information accessibility at digital accessibility firm Deque, told HuffPost. “People who have mild or moderate hearing loss who want to improve their hearing or return to their current level of hearing, [and] Those who couldn’t afford it in the past will really have a lot more at their disposal when there are some items on sale for $200 versus thousands of dollars.”

According to the National Institute on Deafness and Other Communication Disorders, tens of millions of Americans suffer from hearing loss, but only 16% of them wear hearing aids. Cost is a major factor preventing access to these devices. The average cost of a prescription hearing aid is about $2,000, excluding the cost of audiology visits for equipment and other services.

Over-the-counter hearing aids are now available at major retailers such as Walgreens and CVS at a significantly lower cost and are estimated to save consumers $3,000 per pair of hearing aids. Sims said his best friend had a hearing loss in one of his ears but struggled to get a hearing aid as a single parent on a primary school teacher’s salary. He paid $2,000 out of pocket for prescription hearing aids.

“He can’t pay for this,” Sims said. “He gets into credit card debt because he needs it. He can’t hear the end of the words the kids are saying to him in the classroom.”

OTC hearing aids can also be beneficial for people with mild to moderate hearing loss who have no previous access to prescriptions. Laura Pratesi, who is also an audiologist who is hard of hearing, said many patients fall into this category and that having some technology would benefit, but they could not afford or need prescription hearing aids.

An important point, according to Pratesi, is that OTC hearing aids can enable early adoption of hearing technology. The longer a person lives with hearing loss, the more difficult it can be for them to successfully transition to hearing aids if they want to. And research has shown that adults will wait more than a decade after experiencing hearing loss for the first time to wear hearing aids, which Pratesi believes is linked in part to stigma.

Sims believes that the commercialization of OTC hearing aids and further innovation can free the devices from stigma. Pratesi states that the emergence of Bluetooth technology and AirPods has breathed new life into the field of hearing care.

“I’ve had patients who don’t like the idea of ​​buying hearing aids, but when I say, ‘This can connect to your iPhone, this can connect to your Android,’ they’re like, ‘Oh, that’s it. very cool,” he said.

One issue that professionals see with regard to OTC hearing aids is that consumers do not have the technological knowledge to choose the right products. Jaipreet Virdi, professor of history at the University of Delaware, said he believes the FDA’s decision on OTC hearing aids is a good thing, especially given the cost-saving benefits. But he worries that not everyone will have the technological know-how to take full advantage.

“It would be great for people to go and buy the right hearing aid for themselves, which is more affordable, but they may not be able to take full advantage of the products they need,” Virdi told HuffPost.

Audiologists can calibrate hearing aids and program them into the individual’s audiological range, as well as provide services such as auditory rehabilitation, auditory training, cleaning and software updates to ensure the wearer gets the most out of the device. However, with the cost of prescription hearing aids, these services can be difficult to afford. Sims notes that this is one reason why some people may want to buy OTC hearing aids instead of prescription ones.

“If I needed [hearing aids] I would go to an audiologist right now,” Sims said, “who will guide me step-by-step, learning all sorts of things about sound, ears and tunings.”

“I only spoke of privilege,” he added. “I could afford to do it instead of doing the research myself. I can also do the research myself and be patient and do some more trial and error. So I think audiologists and doctors are still an important piece of the puzzle. It’s just nice not to force it.”

Pratesi said OTC hearing aids are limited in some ways as they don’t help children or people with severe hearing loss. For example, Maria Page, 53, said her hearing loss was too great to benefit from OTC hearing aids.

“Due to my inner ear hearing loss, my very small, in-ear canal hearing aids are a custom fit so I can wear them all day, every day,” Page told HuffPost. “Will there be a custom fit for over-the-counter hearing aids? I don’t think so, because that would mean additional expense.”

Virdi said hearing aids are not a one-size-fits-all model. He uses the analogy of buying glasses: Depending on their vision needs, some people may go to the store and try different glasses to figure out which ones help them see more clearly. But other people need to have their eyes examined and evaluated by an ophthalmologist to determine which prescription lens will work best for them.

Page worries that the FDA’s decision on OTC hearing aids and the one-size-fits-all mentality might lead some people to draw the wrong conclusions.

“If anything, this FDA decision will have a negative impact on me because everyone else will regularly expect that I can get hearing aids easily and somehow cheaper,” he said. “I’m going to have to explain even harder how that didn’t happen.”

Pratesi said her practice can help people who bring OTC hearing aids, as they’re segregated as a cheaper alternative to takeaways. However, costs can still be high out-of-pocket, as audiological services are not covered as well as actual hearing aids.

“I want audiological care to be affordable and accessible to everyone,” Pratesi said. “If someone is working over the counter for what they need, that’s great. If the over-the-counter doesn’t work for what someone needs, no one should have to go without audiological care because of the cost.”

This barrier to access could be addressed if insurance companies categorize audiologists as limited licensed practitioners rather than equipment suppliers, and hearing aids as medical devices rather than cosmetic or consumer products, Pratesi said. Virdi said this issue has been heavily debated since the development of the first electric hearing aid 100 years ago, and especially during congressional hearings that began in the 1960s.

“As long as consumers decide which hearing aid suits their needs, and they are promoted as a consumer product, not as a medical device, which means it is covered by insurance … we will always be limited,” he said.

According to the American Speech-Language-Hearing Association, some states have passed their insurance mandates to hear health care coverage. But Pratesi notes that federal legislation will help. The Medicare Audiologist Access and Services Act is a federal bill that requires insurance coverage of hearing aids and audiological services. It will also improve access to licensed providers for people who suspect they have hearing loss, by eliminating medical doctor referrals required to get hearing testing.

“If we think about where we’re going in the future, I think we need to push harder to have devices covered—not just devices, but all the associated costs that come with that,” Virdi said. “I think that’s something that I really hope will change.”

Some experts predict that OTC hearing aids will eventually lead to more innovation and lower costs. Pratesi believes there will be a change in practices that offer more differentiated services, resulting in lower costs.

Pratesi said OTC hearing aids are also starting important conversations about inaccessibility and how hearing aids, American Sign Language and cochlear implants are tools to help people with a variety of communication goals. He doesn’t want change to stop here, though.

“I am excited about what this law has done. But I don’t want people to think, ‘OK, great, we passed OTC and now we’re there. We’re not there,” he said. “There are still more people to help, more changes we need to make to make audiological care affordable and accessible for everyone.”

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