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The Unintended Effects of OTC Hearing Aids

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By August, hearing aids will be sold without a prescription. They will benefit many people, but they also run the risk of stigmatisation, insufficient testing, and perhaps hearing loss.

I have hearing loss in boths ears that is almost 98 percent. I’ve had hearing aids for over 30 years, spending thousands of dollars in expenses that my insurance helped to cover in part. This week, the FDA approved the sale of over-the-counter (OTC) hearing aids to those with mild to moderate hearing loss without a prescription. OTC hearing aids will start to become accessible in October.

Author of Hearing Happiness: Deafness Cures in History, JAIPREET VIRDI is a historian of medicine, technology, and disability at the University of Delaware.

Analysts have been projecting for the past two years that when OTC hearing aids do finally become available, they will revolutionise the market in the US by making the devices less expensive and available without physician prescriptions or testing. It may have unforeseen implications for me or other deaf people who have hearing loss that is more severe than moderate, despite the fact that this new business model allows manufacturers to sell directly to consumers.

The National Institute on Deafness or Other Communication Disorders estimates that 30 million Americans aged 12 or older—roughly 13 percent of the country’s total population—have hearing loss. In the US, 28.8 million adults who could benefit from wearing hearing aids do not due to cost, accessibility, stigma, or personal preference.

This issue is not fresh. In the 1930s, doctors promoted routine hearing examinations and the prescription of hearing aids by framing deafness as a grave public health issue and working with groups for the deaf and hard of hearing. Hearing aid dealers employed direct marketing and storefront displays to win over sceptic consumers as the hearing aid industry improved the technical characteristics of their products. Consumers could select from a range of models and features and even get fitted for a particular kind of hearing loss. However, a lot of people were discouraged from buying a hearing aid due to escalating maintenance costs, the rising cost of new and powerful models, and insurance restrictions. Hearing aids are still not covered by Medicare as of right now.

However, the tendency has changed. A category of over the counter hearing aids for adults with a perceived mild or moderate hearing loss was established by the FDA Reauthorization Act (FDARA), which was passed by Congress in 2017. The recommendations made in October 2021 state that OTC hearing aids would be accessible from any retailer over the counter and sold at about $600 per pair, as opposed to the typical costs of $5000 to more than $14,000 for a pair (which includes fittings and follow-up services). OTC hearing aids will give consumers more affordable, convenient, and cutting-edge technical options for hearing improvement once they are available on the market. However, despite these advancements, the promotion and use of these over-the-counter (OTC) hearing aids may ultimately serve to reinforce prejudices that continue to stigmatise deaf people.

Consumers may become frustrated with their hearing aids without individualised fitting, which could lead to additional hearing loss deterioration. OTC hearing aids will likely experience this issue worse because they have preset or limited settings. By providing a smartphone app in conjunction with their OTC prototype, several firms are attempting to address this issue by simulating the audiology experience. However, as audiologists contend, consumers cannot accurately self-diagnose their own hearing assessment without a professional hearing test in a regulated setting, such as a soundproof booth.

How OTC hearing aids are marketed is the main issue. Press releases and advertisements stress how dangerous hearing loss may be if left untreated. In addition to physiological pressures, it is frequently linked to social isolation, depression, and dementia. These advertisements largely target senior people on fixed incomes, promoting the stereotype that hearing loss is a sign of age. Additionally, the “invisible” nature of these OTC hearing aids, according to their advertisements, will help to lessen the stigma or humiliation associated with deafness. Such marketing people force the deaf into a binary: They either belong to a Deaf culture and communicate mostly through sign language or they are “hearing passing.” However, it is projected that both groups will accept technical and medicinal “cures.” However, not many people who are deaf—including myself—want to be “fixed,” preferring to accept their deafness as an experience of auditory experiences and identities.

So, the first thing that need to change is how we view hearing aids. Instead of excessively emphasising the idea that wearing hearing aids is necessarily embarrassing, these devices could be marketed as instruments for showcasing the vibrancy and richness of the deaf experience, of which wearing hearing aids—whether they are OTC or not—is one method. The need for manufacturers to work with deaf users and designers to improve features that better benefit a wide range of customers is even more critical. These features include longer lifespans, better battery life, options for aesthetic features, and reasonably priced models for all degrees of hearing loss. For instance, the majority of prescription digital hearing aids have a life expectancy of three to seven years. This means that aids for profound to severe hearing loss will continue to be expensive and particularly difficult for people on fixed incomes due to the added costs of routine maintenance.

OTC hearing aids will undoubtedly revolutionise the consumer market, but they do not represent a one-size-fits-all solution or a substitute for the sophisticated services offered by licenced audiologists and hearing instrument specialists.


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