What to consider before buying a hearing aid over the counter

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. The Food and Drug Administration has made hearing aids available without a prescription or medical exam, so soon, people with hearing loss will see hearing aids in stores. Before making a purchase, there are some important things to consider and I'm going over them with audiologist, Dr. Erin Bagley from Upstate Medical University. Welcome to "The Informed Patient" Dr. Bagley.

Erin Bagley: Thank you for having me.

Host Amber Smith: First of all, let's talk about the scope of the issue of hearing loss. How many Americans are having trouble hearing?

Erin Bagley: About one in eight Americans, age 12 and up. So it's about 30 million people have some degree of hearing loss. As we age, can we expect that our hearing is not going to be as sharp as it was?

Yes. As we age, I think statistics are just about one in three people between the ages of 65 to 74 have some degree of hearing loss. And that number goes up after 75 to about half of Americans have some degree of hearing loss. So it is more common as we age.

Host Amber Smith: Does it always affect both ears equally? Or might people lose hearing in only one ear?

Erin Bagley: So typically, if we're talking about age-related hearing loss, we expect that that's going to be affecting both ears pretty equally. Anytime a person has hearing loss in just one ear, that does raise some red flags for us. And we actually do want to do a workup with that patient and find out what the underlying cause might be and what might be causing that hearing loss to affect one ear and not the other.

Host Amber Smith: When a person starts having trouble hearing the television or understanding what's said in a conversation at the dinner table and they think they may have some hearing loss, do you advise them to see a primary care provider first?

Erin Bagley: I do. I always think it's a good idea to discuss any concerns with your primary care provider. It's always really important to make sure that there's not some other underlying cause. And often that primary care doctor will refer that patient for a hearing test to go see an audiologist, just so that we know what's going on with their ears.

Host Amber Smith: So a primary care doctor might be able to rule out some other things, and then if....

Erin Bagley: Yeah.

Host Amber Smith: ...necessary, they could send them to someone like yourself to have their hearing tested?

Erin Bagley: Exactly. So we want to make sure that it's not something like wax in their ears, or fluid, things like that that could be treated differently.

Host Amber Smith: Well, what would typically happen at a visit with an audiologist?

Erin Bagley: The first thing we always do is we take a thorough history to find out whether the person has any pain in their ears, whether they have ringing or tinnitus in their ears, if they have any balance concerns because hearing and balance are related in many cases. We also want to know have they worked around loud noises and things like that that might have had an impact on their hearing. Then, we of course look in their ears to make sure there's no wax or debris in their ear canals. We check their eardrums to see how their eardrums are moving and make sure that there's not fluid or some sort of stiffness of their eardrums that could be impacting their hearing. And then we do a hearing test, kind of like what you think about back when you were in elementary school, where you put on headphones, and let the audiologist know when you hear the beeps. We also measure word understanding as well, so some recordings of speech and have the patient repeat the words to see how clear speech is for them too.

Host Amber Smith: So, are you able, at the end of the exam to quantify how much hearing loss there is?

Erin Bagley: Yes. And also what type of hearing loss it is. Because there are different causes of hearing loss. So we just wanna make sure that we know where it's coming from as well.

We're gonna be talking a lot about hearing aids, but are there other things that people may be recommended to try?

Erin Bagley: That would really be dependent upon what the audiologist finds. There are definitely some medical conditions that could be treated in other ways, either through surgery, perhaps the person needs some sort of medical intervention. And an audiologist is a great first person to look at that and decide if they, perhaps, need to follow up with a specialist, an ear, nose and throat specialist to have that medical concern addressed, or if it's a matter of more of an age-related type of hearing loss that would be best suited by getting hearing aids.

Host Amber Smith: Is there a hearing aid out there for everyone, or are there some types of hearing loss that won't be helped by a hearing aid?

Erin Bagley: So in my practice, I see quite a range. There are patients for whom their hearing loss is so significant that hearing aids are no longer the best course of action for them. And the good news is, there is a continuum of care. We have cochlear implants for patients whose hearing loss is beyond what a hearing aid can provide for them. And I work with those patients as well, to help them on that journey and be able to hear better that way.

Host Amber Smith: That's good to know. So, how long have hearing aids been on the market available with a prescription?

Erin Bagley: The very first hearing aids with the invention of the vacuum tube, go way back to the early 1900s, like around the 1930s. And those weren't necessarily worn on the ear. They were something that was like a box that someone would put in their pocket that had wires to run up to their ear. After World War II, a lot of veterans came home with hearing loss, and that's when the field of audiology really came into its own, to help all those veterans returning. And also the technology used in World War II helped lead to smaller and smaller electronic devices, which help lead us to where we are now, where hearing aids can be very small, and some aren't even very noticeable anymore.

Host Amber Smith: So how does a hearing aid work?

Erin Bagley: There are microphones on the outside of the device that pick up sounds in the person's environment. Then there's a little tiny computer chip inside, a microchip, that processes those sounds. It might give more emphasis to certain sounds at certain pitches where that individual needs more help. It may help filter out sudden loud sounds or other types of noises, like fan noises or wind noise. And then there's a speaker, and that filtered sound gets played through the speaker, into the person's ear.

Host Amber Smith: What is the price range for hearing aids?

Erin Bagley: Hearing aids, I want to separate a little bit prescription hearing aids versus over the counter hearing aids that will be coming out soon. So for prescription hearing aids, like you would get from an audiologist typically, they typically start around $1,000 apiece and up from there, depending on the technology involved.

Host Amber Smith: And when you say $1,000 apiece, do you need two of them, one for each ear? Or do they come in a set?

Erin Bagley: It depends on the person's needs and their hearing loss. So typically most people, again, we typically expect hearing loss to affect both ears pretty equally. So the majority of people do benefit the most from two hearing aids, but there are cases where that may not be the most appropriate treatment.

Host Amber Smith: In your experience, have you seen health insurance plans that cover the cost of hearing aids?

Erin Bagley: There are some health insurances that do cover the cost of hearing aids, or at least pay a portion of the cost. Unfortunately, a lot of them don't, unfortunately, including Medicare, which is obviously a big insurance carrier for a large majority of the population we're talking about, 65 and older. So unfortunately they don't, but there may be supplemental plans or secondary insurances that may offer some assistance.

Host Amber Smith: Do they generally pay for a hearing exam with an audiologist? Is that usually covered?

Erin Bagley: Yes. Usually the exam is covered.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, talking with audiologist, Erin Bagley from Upstate Medical University about what's important to know about hearing aids, now that they will be available over the counter without a prescription.

Now I've heard that it's sometimes tricky to find a hearing aid that works, that's comfortable because everyone's ears and their hearing abilities are all different. So how would you guide people who might be purchasing from store shelves or online? How can they pick something that's going to work?

Erin Bagley: Currently we don't know exactly how the labeling is going to work on over-the-counter hearing aids. Our professional organizations, the American Speech Hearing Association, and the American Academy of Audiology have been working with the FDA, to give suggestions on labeling. Hearing aids purchased through an audiologist in New York state, have a 45-day trial period. So the patient can return the hearing aids within 45 days to get a refund. We don't know yet exactly how return policies will work with over-the-counter hearing aids, so one thing I would caution people about is to make sure anything you do buy over the counter does have some sort of clearly stated return policy in case it doesn't work out for you.

Also, I'm a big believer in things like online reviews. Get as much information as you can about the product you're buying because we don't know yet which manufacturers or which companies may be starting to produce their own devices and enter the market. So even audiologists, we're not sure yet what kind of devices we might be seeing in the stores.

Host Amber Smith: Do hearing aids feel like you're wearing earbuds?

Erin Bagley: Not necessarily. So it does depend. There are different styles of hearing aids, depending on the person's hearing loss, depending on their shape of their ears, depending on the degree of hearing loss. So, for many people, many of my patients have said once they get used to them, they kind of forget that they're there, once they're comfortable and appropriately fit.

Host Amber Smith: Because I know some of the earbuds that people use to listen to music, for instance, they have a tendency to fall out pretty easily. Do you ever see that with hearing aids?

Erin Bagley: Not if they're appropriately fit. So I agree. Ears come in all different shapes and sizes. And that's where, as a professional, it's important to make sure that our patients' hearing aids fit well. So that is a concern that we have with over-the-counter hearing aids, is just making sure people are able to get something that fits well for them. You know, I'm anticipating they're going to come with some different size tips that go on the part that goes into the ear, and finding a size that is a good fit for the ear so that it stays in place well is going to be important.

Host Amber Smith: Are there standardized sizes among all of the different hearing aid styles?

Erin Bagley: There are not. So there can be quite a wide range. Even among the prescription hearing aids that are on the market currently through audiologists there is quite a wide range. It kind of depends: what types of features are in the hearing aids? What size battery? If they're rechargeable? Things like that can all impact the size and shapes of devices. And some devices are custom made, so they'll fit the person's ear. And I'm anticipating that over the counter hearing aids will be the same. You know, I'm anticipating some will look kind of more like a Bluetooth headset kind of device, and some are going to look more like a traditional hearing aid, so I think we're going to see a range of sizes and styles.

Host Amber Smith: So they're all powered by some type of battery, is that right?

Erin Bagley: Yes. Some are rechargeable and I'm anticipating over the counter will be the same, that some will be rechargeable and some will take small disposable batteries.

Host Amber Smith: And are all of the hearing aids adjustable? If you get them, do you have to do some adjusting to get the volume comfortable?

Erin Bagley: Prescription hearing aids through an audiologist are fit, like a prescription. So they are fit to the person's hearing loss. There's measurements that can be taken with a small microphone in the ear while the patient's wearing the hearing aid to make sure that the output of the hearing aid is doing what we think it's doing and meeting their needs.

With over-the-counter hearing aids, I think there's going to be a range of the recommendations from our professional organizations. Of course we want there to be a volume control so that the person can adjust the hearing aids and have some control. Some of them, I think, are, it sounds like, are going to have some adjustments you can make perhaps through an app on your phone. So for the over-the-counter hearing aids, I do think that the adjustments will be more limited. But I think that there will be some degree of adaptability.

Host Amber Smith: Can people swim or shower with their hearing aids in? Or what about running or strenuous sports?

Erin Bagley: The first part, absolutely not. I always tell patients, treat your devices just like you would your cell phone. So you wouldn't take your cell phone in the pool or the shower. You don't want to do that with your hearing aids either. They are electronic devices, so they are susceptible to damage from water. As far as running or doing activities, I've had plenty of patients that are athletes who are runners, or who do yoga. If a hearing aid is fit appropriately for that person's ear, then they should be able to do most things without difficulty.

Host Amber Smith: Are they generally Bluetooth compatible so that someone can answer their phone with the hearing aid in place?

Erin Bagley: The large majority of the prescription hearing aids on the market are. I don't know yet about over the counter. I'm anticipating that some of them will have that function as well. But a lot of prescription hearing aids have the ability to answer the phone, to stream music. Most of them have an app where you can make some adjustments to settings or volume.

Host Amber Smith: About how long should hearing aids last?

Erin Bagley: Hearing aids on average last about six years. Because they're little electronic devices, they do wear out. And they are exposed to sweat and ear wax and things like that. So they do wear out over time.

Host Amber Smith: In your experience with patients, how long does it take someone to get used to using hearing aids? Once they find something that works, does it take time to get used to it?

Erin Bagley: It can. I think in my experience, the longer someone has been struggling with their hearing, sometimes the longer it takes for them to get used to hearing differently through the hearing aids and hearing sounds around them again, and kind of relearn what all those different little noises in their home environment are. But every person is different and has a different experience. I find people that are really motivated and wear their hearing aids consistently do adapt more quickly than people who are not quite ready to wear them all the time.

Now, if these hearing aids are available over the counter, even if they are rather expensive, anyone could buy them and use them. Will a hearing aid help someone who doesn't have a hearing loss? Would it help them be able to hear better than they already do? It's not really recommended. If you have normal hearing, it's not necessarily recommended to wear something like this. We don't want to make anything too loud for a person either because we don't want to risk any further damage to their ears. It is important to consider that. And as far as distance, hearing aids are really meant to work within a conversational space. We call it a person's listening bubble. So any hearing aids are really meant to work within about a 6-foot radius. We don't want to spy on the neighbors. We want to have conversations around the dinner table, is what I always tell people. So, it's not really necessarily going to help you hear at a distance.

Host Amber Smith: Well, as an audiologist who, your career has been spent with prescription hearing aids, do you have any concerns about them becoming available over the counter?

Erin Bagley: My biggest concerns are some of the marketing has been, "now available without needing a hearing test." I do think it's still really important if you have concerns about your hearing to get a hearing test. Hearing loss is one of those things that can come on very gradually over time. So, it's not always clear what degree of hearing loss you may have. Over-the-counter hearing aids are really intended for people with a mild to moderate hearing loss. But if you haven't had a hearing test, you may not know if you fall in that category. Also, I think it's very important to make sure that we're ruling out other causes of hearing loss that might be treatable in another way. So, I still think it's really important to at least get a baseline hearing test so that we can make sure that we're seeing the big picture and treating a medical issue before it becomes more problematic.

Host Amber Smith: So if someone gets a hearing aid over the counter, what are some things they need to be aware of? Are there any warning signs that they need to have checked out?

Erin Bagley: If a person has any drainage coming from their ears, that's definitely something you want to go see a physician about. Or if a person has a sudden drop in hearing or a sudden change in hearing, especially if it's only in one ear, it's very important to get that checked out and make sure that there's not another underlying medical condition. Also, if a person has dizziness or if they have any pain in their ears, it's really important to see a physician about that, just to check on the health of your ears.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Bagley.

Erin Bagley: Thank you.

Host Amber Smith: My guest has been Dr. Erin Bagley. She's an audiologist at Upstate Medical University. "The Informed Patient" is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.