Thursday, January 14, 2016

The Mechanics of HearingMost of us have a relative or friend who could benefit from hearing aids. About 10 years ago, I began to notice a significant shift in my father’s ability to participate in our family’s conversations.

Once he was the center of social interaction, asking pointed questions and conjuring healthy debate at the dinner table. He now sat quietly in his chair, unable to follow the lively banter of his children and grandchildren.

Hearing 1

It took a while, but finally my dad agreed to get hearing aids. It has made an enormous difference. He has been able to rejoin the noisy flock and take an active part in conversation again. But my father is fortunate: He can afford hearing aids.

Hearing loss in adults and children

Hearing 2Approximately 15% of American adults report some difficulty hearing.1 As adults age, the rate of debilitating hearing loss increases; approximately 2% of 45- to 54-year-olds, 8.5% of 55- to 64-year-olds, nearly 25% of 65- to 74-year-olds, and half of individuals age 75 and older experience loss of hearing.2 The majority of these individuals would benefit from the use of hearing aids.

Two to 3 children per 1,000 are born with congenital, permanent hearing loss.5,6 These children comprise approximately 50% of all children and adolescents with hearing loss7; the remaining deaf and hard-of-hearing young people experienced hearing loss at some time after birth. Many hard-of-hearing children can gain meaningful access to spoken language through amplification offered by good-quality hearing aids.

Advances in screening

Early hearing detection and intervention programs for infants were nationally mandated and funded between 1999 and 2002.8 Current legislation (scheduled for U.S. Senate vote for reauthorization in early 2016) aims to ensure “prompt evaluation and diagnosis of children referred from screening programs [and]…appropriate education, audiological, and medical interventions for children identified with hearing loss.”9 However, nowhere in this legislation is language specifically addressing access to affordable hearing aids.

The high cost of hearing aids

High-quality hearing aids fitted by an audiologist cost between $2,200 and $7,000 per pair. Prices vary by region, but the average cost of a mid-level pair of hearing aids is about $4,500.10 Most private insurance does not cover hearing aids. Only 3 states—Arkansas, New Hampshire, and Rhode Island—mandate coverage for adults, and just 20 states require that children’s hearing aids be covered by health insurance.11 Insurance companies say that they do not cover hearing aids because hearing aids are “elective” or because, unlike cochlear implants, hearing aids do not require a medical doctor’s prescription or surgical intervention. It is likely, however, that the underlying reason that the vast majority of insurance plans do not cover hearing aids is financial.11 Because hearing loss is so prevalent, the potential cost to insurers and their customers is high. Unless mandated to do so, insurance companies are unlikely to cover hearing aids, because this would result in a significant increase in premiums passed along to the consumer.

Fewer than 25% of individuals who could benefit from hearing aids actually get them.12 While there are many reasons for this, including fear of appearing old, stigma, lack of information about screening, and cultural choice, it is likely that the high cost of hearing aids plays a large part.

Why it matters

We learned that our own daughter was profoundly deaf in 2002, when she was 4 months old. We were fortunate to be in Washington, DC, where there are many resources, including the DC Hears Loaner Aid Bank, which would provide our daughter with hearing aids up to the age of 3 years. This spared us a huge expense during a very stressful time. It was critical that we see whether hearing aids could provide her with access to spoken language (they could not; her impairment was too profound), in order to determine whether she was eligible for cochlear implants (she was).

Without Universal Newborn Hearing Screening (UNHS), it is likely that we would not have known our alert, engaged daughter was deaf until she was much older. Before the bill’s initial passing, the average age at which a child born deaf was identified was 2.5 years.13 Often, children with less severe but still significant hearing loss were not identified until they reached school age.14 This meant that the critical language-learning window had closed for many children by the time their hearing loss was identified. UNHS has enabled deaf and hard-of-hearing children to gain access to early intervention services and auditory tools that have a profound impact upon their linguistic, cognitive, and social development. For parents who hope to provide their children with access to spoken language, cochlear implants (for severely to profoundly deaf children) and hearing aids (for hard-of-hearing children) are critical tools needed in order to open the door to the world of sound. In order to maximize the impact of UNHS, families must have access to hearing aids for their children.

Hearing 3The cost of untreated hearing loss in adults is also high. Hearing loss can have a dramatic impact on work performance, family and social relationships, and mental health. Studies have found that hearing impairment is significantly associated with depression and social isolation, particularly among women.16,17 A national survey found that hearing loss also has a negative impact on household income, with a loss of earnings up to an average of $12,000 per year, with the severity of hearing loss directly correlated with the amount of lost income. The use of hearing devices was found to mitigate this effect by 50%.18

How do we address the fact that only a small percentage of individuals who could benefit from hearing aids actually use them? Efforts aimed at increasing awareness of the costs associated with hearing loss could lead to higher rates of screening. An increase in local and state-based programs (such as the DC Hears Loaner Aid Bank) would provide access to hearing aids. This could be especially beneficial for adults and for children who live in states in which insurance coverage is not mandated. Most important, lobbying efforts that support policy for universal insurance coverage of hearing aids is needed. Hearing loss is a highly prevalent health problem, but up until now, it has not been a high profile cause. It is time to turn up the volume.

Citations

1. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. Vital Health Statistics. 2014;10(260):1–161.

2. Hoffman HJ, Ko C-W, Themann CL, Dillon CF, Franks JR. Reducing noise-induced hearing loss (NIHL) in adults to achieve U.S. Healthy People 2010 goals. Abstract. American Journal of Epidemiology. June 2006(Suppl S);163(11):S122.

3. Lin FR, Niparko, JK, Ferrucci L. (2011). Hearing loss prevalence in the United States. [Letter]. Archives of Internal Medicine; 171(20): 1851-1852.

4. Hearing Health Foundation. Hearing Loss & Tinnitus Statistics. Available at: http://hearinghealthfoundation.org/index.php?pg=statistics&gclid=Cj0KEQiAno60BRDt89rAh7qt-4wBEiQASes2taJE2mYJ24s0JCgr7mGHdZILy--gmOoJ8HFeo0ktTt4aAtRo8P8HAQ. Accessed December 30, 2015.

5. Hyde ML. Newborn hearing screening programs: Overview. Journal of Otolaryngology. 2005;34(Suppl 2):S70–S78.

6. Newlson HD, Bougastos C, Nygren P. Universal newborn hearing screening: Systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pedatrics. 2008;122:e266–e276.

7. California Ear Institute. Common causes of hearing impairment in children. Available at: http://www.californiaearinstitute.com/hearing-device-center-common-causes-hearing-impairment.php. Accessed December 30, 2015.

8. National Association of the Deaf. Early hearing detection and intervention. Available at: https://nad.org/issues/civil-rights/early-hearing-detection-and-intervention. Accessed December 30, 2015.

9. Govtrack.us. Available at: https://www.govtrack.us/congress/bills/111/s3199. Accessed December 30, 2015.

10. Cropp I. Why do hearing aids cost so much? Available at: http://www.aarp.org/health/conditions-treatments/info-05-2011/hearing-aids-cost.html. Accessed December 30, 2015.

11. Packer L. Why aren’t hearing aids covered by insurance? Available at: http://www.healthyhearing.com/report/52484-Why-aren-t-hearing-aids-covered-by-insurance. Accessed December 30, 2015.

12. American Speech-Language-Hearing Association. Overview of hearing aids. Available at: http://www.asha.org/public/hearing/Hearing-Aids-Overview/. Accessed December 30, 2015.

13. Commission on Education of the Deaf. Toward equality: Education of the deaf. Washington, DC: U.S. Government Printing Office; 1988.

14. Durieux-Smith A, Fitzpatrick E, Whittingham J. Universal newborn hearing screening: A question of evidence. International Journal of Audiology. 2008;47:1–10.

15. Patel H, Feldman M. Universal newborn hearing screening. Paediatrics & Child Health. 2011;16(5):301–305.

16. Li CM, Zhang X, Hoffman HJ, Cotch MF, Themann CL, Wilson MR. (2014). Hearing impairment associated with depression in U.S. adults, National Health and Nutrition Examination Survey 2005–2010. JAMA Otolaryngology—Head & Neck Surgery. 2014;140(4):293–302.

17. Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. JAMA Otolaryngology—Head and Neck Surgery. 2014;150(3):378–384.

18. Kochkin S. MarkeTrak VII: Hearing loss population tops 31 million people. The Hearing Review. 2005;12(7):16–29.


All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.