Treating hearing loss shouldn’t be a pricey hassle, panel says

WASHINGTON – Treating hearing loss shouldn’t be such a pricey hassle. That’s the message from a prestigious government advisory group that’s calling on Medicare and other agencies to find ways to make better hearing more affordable and accessible for millions of older Americans.

One proposal: Allow over-the-counter sales of simple devices for mild hearing problems as an alternative to full hearing aids – much like consumers with vision problems today choose between drugstore reading glasses or prescription bifocals.

Thursday’s report says action is important because hearing loss isn’t just a struggle for individuals but a growing public health problem, putting untreated seniors at extra risk of social isolation, depression, even dementia.

“This is not something to be ignored,” said Dr. Dan Blazer of Duke University, who chaired the National Academies of Sciences, Engineering and Medicine committee that studied the problem.

Yet only a fraction of people who might benefit from hearing aids use them and one reason is the price – averaging about $4,700 a pair including all the fitting services – the report found. Insurance coverage is very limited, and Medicare doesn’t pay for hearing aids, only diagnostic hearing tests.

Thursday, the panel urged Medicare to evaluate options to provide coverage of hearing aids and other care, while acknowledging that Congress has long refused to lift that restriction.

“We know this is a reach,” Blazer said. But, “Medicare needs to have this on their radar screen.”

Hence the panel’s bigger focus on other recommendations:

–The Food and Drug Administration should allow over-the-counter sales of simple wearable devices to ease mild hearing problems, offering a first-step option for people who can’t afford or aren’t ready to make the leap to hearing aids. There are consumer electronic products that can amplify sound in various ways – costing from $50 to $500 – but the FDA hasn’t considered them hearing treatments.

–Hearing tests aren’t part of routine check-ups but they should be, including the Medicare annual wellness visit.

–Many providers charge fixed prices for hearing aids that include both the devices and all the professional services to fit and adjust them, but itemizing those prices would better allow consumers to choose the treatments that best fit their needs.

–Consumers should be told before purchasing that some hearing aids can be programmed only by certain providers, limiting their ability to switch care.

–And consumers should have access to their hearing tests so they can shop around, much like people can go to one optometrist for a glasses or contacts prescription but buy elsewhere.

About 30 million Americans have hearing loss, a problem that increases as people pass middle age – and the population is graying rapidly. Thursday’s report urges more research about the effects of untreated hearing loss on people’s physical health, including links to cognitive dysfunction and dementia, saying a better understanding is critical both to insurance decisions and to families’ decisions to seek care.

How could hearing loss be related to dementia?

“Your brain constantly has to deal with more garbled sound,” explained Dr. Frank Lin, an otolaryngologist at Johns Hopkins University, a co-author of Thursday’s report.

That extra work by the brain “comes at the expense of our thinking skills,” and the reduced auditory input even may lead some parts of the brain to shrink, said Lin, who has long studied the link and is preparing to study the bigger question – whether treating hearing loss reverses that risk.

It’s not clear whether the recommendations will be adopted. University of Miami audiologist Robert Fifer, who wasn’t involved with Thursday’s report, criticized the assumption that self-treating hearing problems could be done as easily as choosing reading glasses. It takes precision to tune sound-amplifying devices to target just the frequency someone needs to hear speech rather than merely making background noise louder.

But Fifer welcomed calls for providers to be reimbursed for what’s called rehabilitation, training people to make the most of what hearing remains whether they’re using a hearing aid or not.

Indeed, the National Academies posted some of those rehabilitation tips Thursday for talking with someone who has hearing loss: Speak face-to-face, and more slowly rather than loudly – shouting distorts speech. Reduce background noise such as TVs or music. And don’t just repeat a missed statement, rephrase it, which gives listeners more opportunity to figure out the words they miss through context.