By Stephen O. Frazier

The Hearing Loss Association of America (HLAA) reports that 80 percent of those who could benefit from them do not own hearing aids. Some will admit that vanity, stigma, or priorities play a role in that decision and some will simply say, “I don't need them. I hear well enough.” HLAA also reports that a major reason is that hearing aids are too expensive and folks who would benefit from them can't afford them. For those who claim cost as their reason, it may soon become apparent whether that is really a reason or just an excuse for not addressing hearing loss.

This month the Food and Drug Administration (FDA) turned the hearing care profession upside down with the approval of over-the-counter (OTC) hearing aids. Intended for adults with mild to moderate hearing loss, these devices will be in stores in time for the holidays, as early as October. They're not the $19.99 personal sound amplification products (PSAPs) advertised in supermarket tabloids, they're FDA-approved medical devices.   

Walmart, Walgreens, and other chains will carry them. Best Buy has already announced plans for a “hearing solutions” area in many of their 1,000 stores featuring up to 10 different devices. Amazon already sells PSAPs and will no doubt offer an assortment of FDA-approved OTC hearing aids. Some OTC hearing aids may feature Bluetooth or telecoil wireless connectivity, may be rechargeable, and may differ from lower end prescription hearing aids only by an even lower price and the amount of volume they can produce. People will not need to take a hearing test or see a hearing care professional to buy these medical grade devices.

Adults will be able to buy a pair for the partner who refuses to admit to a hearing loss. Though not intended for children it seems likely that parents could buy them for a hard of hearing child, particularly teens. The American Academy of Audiology says OTC hearing aids are very risky and not approved for use in children, warning: “They may be self-programmed by the child or a parent to be too loud, risking damage to the child’s remaining hearing or too quiet to provide adequate help.” It would seem these same programming errors would apply to adults too.

Will the sale of these devices cannibalize the sale of their prescription counterparts? The answer might be found in Europe where hearing aids are often free or subsidized under various national health plans. Among European nations in 2014–2015, Statista.com reports the adoption rate for hearing aids by the hard of hearing varies. Switzerland (where they're heavily subsidized) and the U.K. (where they're free) are at 41 percent and 42 percent respectively. However, in both France and Germany (where they are also though less generously subsidized at the time of the study) the figure is just 34 percent. The latest figure for the U.S., according to MarkeTrak 10 released in 2019, was 32 percent.

Hearing loss is usually a progressive disability with the young more apt to have a mild to moderate hearing loss than their seniors. Those degrees of loss are the target for OTC hearing aids, yet MarkeTrak 9 found that for people in the 18 to 34 year old age the adoption rate for hearing aids is actually higher in the U.S. (30 percent) than in the U.K. (25 percent). In the U.K., 75 percent of those hearing aids were provided free by the national health service while young Americans shelled out an average of $2,400 for theirs.

Figures for other groups also bear scrutiny. For those 35 to 44 years of age MarkeTrak 9 reported the U.S. led the U.K. by 1 percent. Reversing that pattern, in the 45 to 54 year old bracket (those possibly in their peak earning years) 26 percent of those with a hearing loss opted for hearing aids in the U.K. while only 21 percent of Americans did. By ages 65 to 74, where more severe hearing loss manifests itself, though, the difference is only 1 percent. 

It's in the over 75 age group—a contingent where many may be living on social security and the kindness of others—that a substantial difference is found. Here the adoption rate for the U.K. is 56 percent compared with America's 41 percent. 

“Too expensive” may actually apply for many in this group but their loss may be too severe. Theirs has the highest instance of severe or profound hearing loss that OTC hearing aids can't effectively treat. One additional hindrance to hearing aid ownership in this age group is the actual availability of audiology services. There are communities where there is no local hearing care provider, or at least not one that's conveniently located.

There could very well be a local resource, though, for OTC hearing aids that could be purchased by the senior or by someone else on behalf of the senior. The pharmacy may be such a resource, according to a new paper in Senior Care Pharmacist. 

So, what does the pending introduction of OTC hearing aids portend for hard of hearing Americans? Logic would seem to say they, especially the young and seniors, will opt for OTC devices. On the other hand, logic does not seem to apply when comparing current adoption statistics so, as King Mongkut says in “The King and I,” “is a puzzlement.”

Trained by the HLAA as a hearing loss support specialist, Hearing Health magazine staff writer and New Mexico resident Stephen O. Frazier has served HLAA and others at the local, state, and national levels as a volunteer in their efforts to improve communication access for people with hearing loss. For more, see loopnm.com or email him at hlaanm@juno.com.

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