This fall, a much-anticipated assistive technology hit virtual and physical shelves nationwide.
Over-the-counter hearing aids are a more affordable alternative to the traditional prescription-only version, which users could only purchase after an appointment with a licensed audiologist. The U.S. Food and Drug Administration announced its decision to support OTC hearing aids in an August press release, and the FDA's final rule confirmed that adults with mild to moderate hearing impairment can now purchase OTC hearing aids directly from brick-and-mortar and online retailers.
Fatima Husain is an associate professor of speech and hearing science at the University of Illinois Urbana-Champaign and an expert in the physical, social, and emotional aspects of hearing loss. She's also a researcher at the Beckman Institute for Advanced Science and Technology, where she uses magnetic resonance imaging to understand how hearing loss and tinnitus impact the brain.
In this Q&A, Husain explains how access to affordable hearing aids could offer unique opportunities for individuals with tinnitus, turn the tide on social stigma, and contribute to a competitive industry and a collaborative research frontier.
As a scientist studying hearing loss, what was your initial response to this news?
I have been looking forward to this for a long time! I would have been happy to see OTC hearing aids in stores 10 years ago, and I am delighted they’re available now.
According to the FDA's final rule on OTC hearing aids, “only about one-fifth of people who could benefit from a hearing aid seek intervention.” Will OTC hearing aids help users overcome barriers to access?
Cost is a significant barrier to hearing aid access in the U.S. and globally. OTC hearing aids are meeting a pressing need for assistive technology that’s inexpensive while also remaining safe and reliable. If we have close to 1 billion people with hearing loss around the world, it’s just not feasible for everyone to purchase $6,000 hearing aids. Even individuals who own prescription hearing aids are hesitant to use them because of how expensive they are to replace or repair. I hope that access to OTC hearing aids will make it more feasible and more doable for people to get the assistance they need.
Audiologists don't just write prescriptions. They can help people who use hearing aids find the best fit for their ears — and their brain signals. Are there challenges associated with skipping that consult prior to purchasing an OTC device?
To answer this one, I like to use the metaphor of vision. When I buy a pair of glasses, I go to an optometrist first to receive a clinical exam and determine not only my prescription, but if I have any associated conditions like astigmatism, glaucoma, or diabetes. With OTC hearing aids, I worry that if individuals are self-evaluating their degree of hearing loss and purchasing hearing aids based solely on that evaluation, they might not account for other conditions. For example, some people experience hyperacusis, which is an increased sensitivity to loud sounds. For someone with this condition, the wrong hearing aid might amplify sounds to a level that would cause distress. Another example is tinnitus. For an individual with tinnitus, the fitting for their hearing aid might be slightly different than it would be for someone with a stereotypical mild to moderate degree of hearing loss.
Tinnitus is one of your research specialties. How should individuals with tinnitus approach the process of purchasing an OTC hearing aid?
For anyone across the board, including individuals who have tinnitus, I would recommend making at least one appointment with a licensed audiologist. This will help determine the specific degree and extent of someone’s hearing loss and help characterize their specific way of hearing. Tinnitus is a very specific hearing disorder that is the perception of a sound, like ringing or noise, when there is no source. Chronic tinnitus can impact mental health, sleep cycles, and even communication with others. Hearing aids can certainly be helpful to people with tinnitus, because if someone has difficulty hearing the environment around them, they might focus more on the subjective distressing sounds. Hearing aids can help by amplifying ambient sounds like rain falling or background chatter to effectively mask the tinnitus.
I do like to recommend hearing aids with sound generators, which produce modulated noise or low-level white noise, to help distract from the tinnitus. Typically, OTC hearing aids will not have these. If that’s the case, what someone with tinnitus might do is mix and match with smartphone apps that provide sound generators. It’s all about being aware of your situation and making the best choice for you. Once you have the correct information about yourself and your hearing, go for it! Purchase OTC hearing aids, absolutely.
As OTC options become more widely adopted, where is the future of hearing aid technology headed?
I hope that OTC hearing aids will create a disruption in the industry and an opening for inexpensive, innovative hearing aid technologies. And not just in the U.S.; this one notch of progress from a single country could have a global impact. Imagine the world just five years from now, when about 2 million people have adopted OTC hearing aids. So, we’ll have data from 2 million people in the U.S. alone to figure out what’s working, what’s not working, and how we can keep improving the technology. OTC technology can be incredible, but it can also be inflexible and not adaptive. In some ways, we are trained to believe that if we improve the technology, then everything will follow. But technology does not exist in a vacuum. It’s not a linear correlation between the technology and our adoption; everyone is different, and everyone’s brains are different, and even top-of-the-line technology might work only for a few.
What should researchers prioritize to innovate better hearing aid technologies?
Collaboration, definitely. I think we’ll need to bring in neuroscientists, aging and cognition experts, designers, and brain imaging experts to help us understand how the brain changes in individuals across the lifespan, and how hearing aids can be inexpensively designed to fit their specific needs. A hearing aid might fit a 20-year-old brain much differently than an 8-year-old brain, for example. And the engineering labs who are developing the technology can be working with neuroscientists, consumers, and communities of end users. The opportunities for interdisciplinary, collaborative research are endless.
Your own research considers the social and behavioral aspects of hearing loss alongside the physical and medical. What are the social implications of OTC hearing aids?
There is, unfortunately, a great deal of stigma attached to wearing hearing aids. People might be hesitant to wear their hearing aids in public, or to reluctant request accommodations when they are having difficulty hearing. In many cases, it becomes the norm to accept hearing loss instead of advocating for oneself and one’s needs. Separately, we also know that hearing loss can increase the risk for social isolation, especially in older adults, and older adult populations are not exempt from feeling stigmatized for wearing hearing aids. My hope is that a widespread adoption of OTC hearing aids will make them more ubiquitous, normalize them, and that will help extinguish social stigma and enhance users’ social connectedness all at the same time. And a big part of that — possibly the biggest part — is simply access.
How can people help combat stigma in their day-to-day interactions with people who use hearing aids?
Hearing aids are the same as glasses and we only attach a negative label to one of them. Communication is a shared responsibility. If you cannot hear me, it’s my responsibility as well to take actions like turning on the closed captioning, facing you when I’m speaking, speaking more slowly, and things like that. Taking the time to do this additional work is extremely important.