Listen Up: Hearing Aids 2022

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By Mary Carpenter

Since Mary Carpenter’s last post on this topic in 2016, hearing aids have evolved —with new FDA regulations poised to create an explosion of online purchase possibilities as soon as this fall—and companies like Bose and Apple jumping in. Not until Mary’s recent participation in a University of Maryland hearing-aid study, however, did she get useful explanations about hearing aids, as well as surprising advice.  

EARLY HEARING loss can be imperceptible: unlike diminishing vision, which makes it difficult to read street signs, people are often unaware of sounds they cannot hear. But even mild hearing loss can create the feeling, as some describe it, of slowly becoming untethered from the world. The largest study to date on over 100,000 people over age 66 associated hearing loss with increased risk of depression, falls and dementia—but also showed that hearing aids lowered risks for all three. With FDA approval expected by fall of 2022, the new regulations would cut costs for acquiring hearing aids that today can be as high as $5,000 to as low as $500, including the required audiologist appointments involved in obtaining and adjusting them. In addition, the new regulations will make way for consumers to directly purchase newer hearing aids on which people can make their own adjustments.

Concerns remain, however, about the purchase of hearing aids without input from an audiologist—not only because adjustments can require fine tuning but also because an audiologist (usually in an ENT practice) can help detect causes of hearing loss, such as infection or wax build-up. Audiologists can also advise those whose hearing loss is too severe to be alleviated by external devices, for example, in some cases recommending a cochlear implant.

Current high costs involved in purchasing hearing aids, generally not covered by private insurance or Medicare, are an important reason for their adoption by fewer than 20% of the estimated 37 million Americans with hearing loss —which affects up to 50% of U.S. baby boomers. Meanwhile, many “hearing aids” currently being marketed online are unapproved and unregulated by the FDA, with potential risks from over-amplification that can damage existing hearing.

In a recent innovation, big box stores— notably Costco—offer testing, hearing devices and check-ups—from a trained technician rather than an audiologist—at about half the typical price tag, with high ratings from most users.

Alternatively, a different kind of hearing device simply amplifies environmental sound—not for those with hearing loss, but helpful to people who struggle to hear in certain situations. These PSAPs or PSADs (personal sound amplification products or devices) don’t require FDA approval and can be purchased online, but the new regulations will cover these and help insure their quality and safety. Drawbacks include slight risk of over-amplification that can damage existing hearing and difficulties if hearing loss deteriorates enough to require hearing aids—at which point the entire process must be restarted and new devices purchased.

Domination of the hearing-aid market by a handful of companies may be the main reason for high costs. But another factor is the high rate of return for hearing aids of between 10 and 20% in the U.S.  Wearers complain that the devices do not help much in noisy environments, while those featuring an improved signal-to-noise ratio that reduces the volume of background noise (notably the Oticon More) do not rank high on the Forbes “Best of 2022” list.

And the newer digital hearing aids—which have advantages, such as smaller size and capabilities for finer tuning and better sound quality than older analog models—often create a several-second lag before digitized sound reaches the brain, during which time external noise seeps into the ear, creating a confusion of sounds.

Higher return rates also occur from people with milder loss, who might have trouble understanding why they need such a device.  But, according to Michele Michaels, a hearing health care program manager at the Arizona Commission for the Deaf and the Hard of Hearing in Phoenix, alternative OTC amplification devices, such as PSAPs, can help them “accept that they might benefit from hearing aids.”

Common signs of early hearing loss include missing syllables and high-frequency consonants such as F, S and SH; and confusing similar words—making it hard to distinguish, for example, between fifteen and sixteen. Another is trouble understanding whispered words and voices coming from another room—causing complaints that others are mumbling or requests that they repeat what they’ve said. Because making sense of sound depends on redundancy to allow the brain to fill in gaps, missing too much can create insurmountable barriers to comprehension.

Hearing loss occurs over time when tiny hairs in the inner ear responsible for most hearing are destroyed. “Presbycusis” (presby is defined as old or aging) starts with diminished clarity —as the inability to hear soft, high-pitched sounds makes it harder to distinguish words. Another kind of damage, discovered only recently with improved imaging, can occur deeper in the auditory system– in the fragile brain cells that the tiny hairs communicate with, which visibly shrivel after exposure to very loud noises like a rock concert.

With this “hidden hearing loss”—or difficulty with “disintegrated sound” —people may do well on traditional audiograms in the silence of an audiology booth but struggle more than most to discern voices in noisy restaurants or to hear well in the theater when sitting far from the stage.

Increased risk of depression, dementia and falls that can accompany hearing loss may occur because damaged hearing forces the brain to “expend more effort to decode the sound signals it takes in, possibly at the expense of other brain functions,” according to Consumer Reports. “Another hypothesis is that hearing loss changes the physical structure of the brain in a way that could harm memory —and some evidence from brain imaging studies supports this theory.”

Because hearing aids do not help with hidden hearing loss, audiologists recommend strategies such as asking speakers to repeat themselves more slowly instead of more loudly. Also, some PSAPs include directional microphones and frequency modulators that work with headphones like air pods, which can improve sound quality.

After a years-ago diagnosis of hidden hearing loss, I received an audiogram during my recent volunteer participation in a University of Maryland study. Although the resulting graph showed mild loss that didn’t automatically qualify me for hearing aids, the researchers who generously talked with me afterwards noted the graph’s flat line dropping off dramatically in the high frequencies, which led one researcher to say: “If it was me, I would get them.” With high hopes that the new regulations will bring costs way down, I will continue pondering how to proceed.

—Mary Carpenter regularly reports on need-to-know topics in health and medicine.