Marc Lacroix decided he needed to do something about his hearing loss. The Concord resident started having trouble following conversations and, during Sunday services, he couldn’t understand what his priest was saying.
But, as a retiree on a fixed income, he was daunted by the cost of hearing aids, which can exceed $6,000 per pair.
That’s why he welcomed the Food and Drug Administration’s ruling last month to allow the sale of over-the-counter hearing aids for people 18 and older with mild to moderate hearing loss, a move the federal agency says could save consumers an average of $2,800 per pair.
The FDA action, effective in mid-October, is meant to improve access for the estimated 30 million Americans who could benefit from using hearing aids, as only 20 percent of that population actually wears them, according to the National Institutes of Health. Stigma and embarrassment prevent some people from wearing the devices, but for many, the real prohibition is cost.
“When you’re on a fixed income, inflation becomes much more real to you,” Lacroix, 68, said. “I’m not crying poverty and I can afford to get what I need, but if I can save three or four or five thousand dollars, that could be used for gas or heating oil this winter.”
The FDA ruling has won the endorsement of many medical professionals and advocates for seniors — but with provisos.
Currently, those interested in getting hearing aids have to visit an audiologist or hearing professional first. Health experts who are critical of the change fear that over-the-counter hearing aids might not be appropriate for someone whose hearing loss is caused by a medical condition or whose impairment is more severe than the person realizes.
“One of my big fears is, if people aren’t required to get a hearing test, you might not even know what your hearing loss is,” said Noelle Paradis, lead audiologist at Cheshire Medical Center in Keene. “If you get an over-the-counter one that’s not appropriate for you, you might not get the support you need.”
Paradis said she spends a minimum of two hours advising clients on how to use and take care of their hearing aids and how to pair them to phones. Over several appointments, she’ll also adjust the hearing aids as needed.
Though the FDA’s ruling requires that over-the-counter hearing aids have a user-adjustable volume control, that is different from having a professional make the adjustments, according to Paradis.
Still, she said, “if you have a mild hearing loss, it might be the perfect solution.”
Audiologist Laura Robertson, immediate past president of the N.H. Academy of Audiology, echoed Paradis’ concern.
“I would have to state very clearly that the average individual is not able to judge the severity of their hearing loss,” she said. “I see people on a regular basis who don’t think it’s that bad.”
Roberston, who works in Laconia, added that people need a professional hearing test to determine what their hearing level is.
“You can’t just walk into a store and say, ‘That’s a pretty box. I’ll take that one, ’ ” she said.
Consumers also may not realize their hearing devices require maintenance to remove things like wax, dust and debris, Robertson said, and may not be aware that medical issues like viruses, injury or chemotherapy may be the cause of their hearing condition.
State Rep. Mark Pearson, chair of the House Health, Human Services and Elderly Affairs Committee, compared the over-the-counter hearing aids to over-the-counter reading glasses.
“They are inexpensive, and they can be helpful if the need is to address a simple problem — make hard-to-hear things louder and hard-to-see things clearer,” he said. “The problem comes when there’s an underlying medical problem. So over-the-counter hearing aids could be useful, but if you’re going to buy one, don’t forget to have that periodic visit with your audiologist.”
Whether the over-the-counter versions of hearing aids will be as sophisticated as the ones now available through health professionals is another unknown, according to Paradis. But, they will certainly be a far cry from the earliest versions of hearing instruments.
From the cartoonish “ear trumpets” of the late 1600s to today’s high-tech hearing devices, the technology to help people with hearing loss has improved dramatically over time.
That’s good news for a state like New Hampshire, with an aging population that includes some 150,000 older adults with some form of hearing loss, according to Christina FitzPatrick, director of the state’s chapter of AARP.
More than 20 percent of Cheshire County’s residents are 65 or older, the most recent data available from the U.S. Census Bureau show.
“I think it’s absolutely a good thing and that’s because hearing loss can have such a profound ability in people being able to engage with their community,” she said of the new FDA ruling.
Hearing loss has been associated with health issues like depression, falls, loneliness, cognitive problems, dementia and social isolation. Studies have found that social isolation “is the equivalent of smoking 15 cigarettes a day,” in terms of negative health consequences, FitzPatrick said.
“That’s why making hearing aids more affordable and easier to get is so important to health,” she said.
AARP volunteer Jill Martin, of Dover — who got hearing aids at the age of 63 — salutes the FDA ruling, saying it offers a less expensive solution for those with mild to moderate hearing loss.
“I feel very strongly that embracing something that allows you to continue with a high quality of life is very important,” she said. “[Without hearing aids] you only get one layer of experience. But with the hearing aids, you get it all.”
The ruling is also meant to introduce competition into a field that has been dominated by five major hearing-aid manufacturers, some of whom also own audiology clinics and marketing companies that pitch their own devices.
In addition, some “proprietary brands” of hearing aids, like those sold at Costco or Miracle-Ear, can be programmed or serviced only by the company from which they were purchased. And for hearing professionals, services are typically bundled, so the cost of the hearing aid, adjustments and follow-up is rolled into one price tag.
So what if a consumer wants help from a hearing professional to decide which over-the-counter hearing aid to buy or to adjust them after purchase?
Some experts predict the ruling will lead to audiologists offering a la carte services for such work.
“I think when you introduce more competition into the market, the market will change,” FitzPatrick said. “I wouldn’t be surprised if audiologists changed the way they do business.”
Some assistance is already available to help individuals with the cost of hearing aids. In New Hampshire, state law requires private insurance companies to pay up to $1,500 toward the cost of hearing aids for clients.
Michelle McConaghy, executive director of the Concord-based nonprofit Northeast Deaf and Hard of Hearing Services, said her agency helps clients contact Medicaid and Medicare to see what coverage might be available and also refers them to organizations like the Lions Club for assistance. The N.H. Bureau of Vocational Rehabilitation is another resource.
“We get calls every week from people who say, ‘I need hearing aids and they’re so expensive,’ ” McConaghy said. “One lady in her late 70s or early 80s came in and she got a quote for hearing aids that was over $8,000.”
Many say they would like to see medical insurance pay for the full cost of hearing-aid services provided by medical professionals.
“I personally wish our insurance companies would provide more coverage for hearing aids so you could go to a professional who at least has some knowledge on fitting and programming hearing aids …,” Paradis, of Cheshire Medical, said. “We’re actually trying to set up a cost-effective, entry-level hearing aid so people that can’t afford the $2,000-per-pair hearing aids can possibly choose to see an audiologist and have the entire package, with services, at a cheaper price point.”
If someone is considering purchasing an over-the-counter hearing aid, Robertson recommends getting a hearing test beforehand, and to be sure of the seller’s right-to-return and refund policies.
“Reliability, ease of use and quality of sound are tremendously important,” she said.