Lower cost, bet­ter hear­ing

Baltimore Sun - - FRONT PAGE - By An­drea K. McDaniels

WhenMar­i­lyn Witt was fit­ted for her first pair of hear­ing aids a few weeks ago, she was stunned by the nearly $7,000 price tag.

The sticker shock was so bad the 73-year-old re­tiree from Elkridge con­tem­plated just go­ing with­out the de­vices.

“It’s out­ra­geous,” she said. “When they told me the price I al­most passed out.”

Fed­eral leg­is­la­tion passed ear­lier this year aims to make hear­ing aids more af­ford­able for peo­ple like Witt, who are el­derly and have fixed in­comes, by al­low­ing some styles of the de­vices to be sold over-the-counter at drug­stores and other re­tail­ers. The new law al­lows hear­ing aids for peo­ple with mild to mod­er­ate hear­ing loss to be sold at re­tail­ers and not through an au­di­ol­o­gist — much like low-pre­scrip­tion “reader” eye­glasses are sold.

The leg­is­la­tion gives the U.S. Food and Drug Ad­min­is­tra­tion three years to de­velop stan­dards for the over-the-counter de­vices be­fore they can go on sale.

Sup­port­ers of over-the-counter hear­ing aids say it will in­crease com­pe­ti­tion and drive in­no­va­tion, re­sult­ing in lower prices. But med­i­cal ex­perts worry that peo­ple will self-di­ag­nose hear­ing con­di­tions in­stead of seek­ing the guid­ance of an au­di­ol­o­gist, who is trained to eval­u­ate hear­ing loss and help pa­tients get the right hear­ing aid.

“It’s a dou­ble-edged sword,” said Dr. David Eisen­man, an as­so­ci­ate pro­fes­sor at the Univer­sity of Mary­land School of Medicine who spe­cial­izes in oto­laryn­gol­ogy

— head and neck surgery. “I have no doubt that it will make it more ac­ces­si­ble, but I would be very con­cerned it would lead to a lot of scams, and poor health out­comes and the like.

Medi­care, the fed­eral health in­sur­ance pro­gram for peo­ple 65 or older and cer­tain younger peo­ple with dis­abil­i­ties, does not cover the cost of hear­ing aids for older adults be­cause of a 1960s era law pro­hibit­ing such cover­age. At the time, there was lit­tle known about var­i­ous health prob­lems hear­ing loss can lead to, in­clud­ing de­men­tia, de­pres­sion, and a propen­sity to fall. Most pri­vate in­sur­ance also doesn’t pay for the de­vices, and in Mary­land chil­dren en­rolled in the state health in­sur­ance pro­gram are only cov­ered un­til age 21. As re­sult, many peo­ple who need hear­ing aids are go­ing with­out the de­vices.

In the United States, 28.8 mil­lion adults could ben­e­fit from us­ing hear­ing aids, ac­cord­ing to the Na­tional In­sti­tute on Deaf­ness and other Com­mu­ni­ca­tion Dis­eases. Yet among adults age 70 and older, only about 30 per­cent have ever used the de­vices. About 16 per­cent of adults ages 20 to 69 who need a hear­ing aid have ever used one.

While costs are a sig­nif­i­cant fac­tor, some el­derly peo­ple don’t get hear­ing aids be­cause they’re in de­nial about hav­ing hear­ing prob­lems or have got­ten used to liv­ing with it and don’t re­al­ize their hear­ing has wors­ened. Oth­ers think di­min­ished hear­ing is part of the ag­ing process and are not aware that it can lead to other health prob­lems. Then there are those who just find the de­vices un­com­fort­able.

“Right now one of the bar­ri­ers is costs be­cause so many in­di­vid­u­als are get­ting their health­care through Medi­care,” said Erin Stauder, ex­ec­u­tive di­rec­tor of the Hear­ing and Speech Agency of Bal­ti­more, a non­profit that pro­vides hear­ing ser­vices on a slid­ing scale based on in­come.

The agency helped Witt pay for her de­vice. Her cost was $3,500, or about half the price she was orig­i­nally quoted.

“The price they gave me was a lot less, oth­er­wise, I don’t know what I would have done,” Witt said.

Sup­port­ers of over-the-counter de­vices say more peo­ple should use hear­ing aids be­cause un­treated hear­ing prob­lems can lead to more se­vere health is­sues.

Frank Lin, an as­so­ci­ate pro­fes­sor of oto­laryn­gol­ogy — head and neck surgery at Close-up view of a new blue­tooth-ca­pa­ble hear­ing aid worn by Mar­i­lyn Witt of Elkridge. Congress has re­cently au­tho­rized the Food and Drug Ad­min­is­tra­tion to study the reg­u­la­tion of over-the-counter hear­ing aids. the Johns Hop­kins Univer­sity School of Medicine, has con­ducted re­search that shows mild hear­ing loss dou­bles the risk of get­ting de­men­tia, while mod­er­ate loss triples the risk and­se­vere loss in­creases the risk by five times.

The ear may send gar­bled sig­nals to the brain, mak­ing it work harder to process sound, he said. Hear­ing loss also may lead to faster rates of at­ro­phy in parts of the brain.

“Now we have one model of hear­ing care and that is it,” Lin said. “Not ev­ery­one wants to go back and forth to an au­di­ol­o­gist and pay a lot of money. Some peo­ple with­out a doubt re­ally do need a lot of hand-hold­ing and guid­ance pro­vided by a pro­fes­sional. Other peo­ple do not need to see me about us­ing a hear­ing aid.”

Bar­bara Kel­ley, ex­ec­u­tive di­rec­tor of the Hear­ing Loss As­so­ci­a­tion of Amer­ica and a pro­po­nent of over-the-counter de­vices, said the bill is not meant to di­min­ish the role of au­di­ol­o­gists.

“I think there is al­ways go­ing to be a need for an au­di­ol­o­gist,” Kel­ley said. “There will be a need for fit­tings for peo­ple with more se­vere hear­ing loss.”

The new law re­quires the FDA to write reg­u­la­tions en­sur­ing that this new­cat­e­gory of over-the-counter hear­ing aids meets the same high stan­dards for safety, con­sumer la­bel­ing and man­u­fac­tur­ing pro­tec­tions as all med­i­cal de­vices. Hear­ing de­vices cur­rently sold over the counter are not al­lowed to be called hear­ing aids and are not reg­u­lated by the FDA.

Stauder at the Hear­ing and Speech Agency wel­comes more stan­dards.

“We are in support of the FDA reg­u­la­tions to make sure the de­vices are safe for the con­sumer,” Stauder said. “As ad­vo­cates for those with com­mu­ni­ca­tions chal­lenges of all kinds, we are en­cour­aged by greater di­a­logue around hear­ing health and the need for high safety stan­dards.”

Julie Norin, an au­di­ol­o­gist with the Hear­ing and Speech Agency, re­mains con­cerned about peo­ple self-diagnosing. She be­lieves even peo­ple with mild to mod­er­ate hear­ing loss should work with a spe­cial­ist to help with fit­tings and avoid get­ting hear­ing aids that ei­ther un­der am­plify or over am­plify sound.

“We con­sider hear­ing loss to be a health is­sue and you need the guid­ance of a spe­cial­ist or pro­fes­sional just as you would with any kind of a treat­ment of an ill­ness,” Norin said.

Some deaf and hard-of-hear­ing peo­ple aren’t com­pletely sold on over-the-counter hear­ing aids.

Brian McBride, a 21-year-old stu­dent who lives in Bal­ti­more and was born with se­vere hear­ing loss in both ears, said he would rather have a spe­cial­ist help him with the com­pli­cated process of find­ing the right hear­ing aids.

“There is test­ing and fit­ting ser­vices that I would rather get than go­ing through the hassle of do­ing it my­self,” he said.

But he ac­knowl­edged more ef­fort needed to re­duce the costs.

“I do be­lieve there should be some way to bring the costs down,” he said. “I am not sure how to do that out­side of govern­ment pro­grams, but some­thing should be done.” is

KEN­NETH K. LAM/BAL­TI­MORE SUN

Hear­ing and Speech Agency au­di­ol­o­gist Julie Norin, right, fits a new hear­ing aid for Mar­i­lyn Witt, 72, of Elkridge. Witt was able to buy the hear­ing aids at half the nor­mal price through the non­profit agency.

KEN­NETH K. LAM/BAL­TI­MORE SUN

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