Hearing Health is Finally Being Disrupted. So What Now?
Terry Mactaggart, President and CEO, Summus Hearing
We Need More Than Another Low Cost, Easy-to-Buy Hearing Aid
A recently published extensive analysis, conducted by Larry Humes, using the National Health and Nutrition Examination Survey (NHANES) data on hearing loss, self-reported hearing problems and hearing aid use reported that 85% of those who reported ”trouble hearing” were not currently wearing hearing aids.1 Providing further confirmation that an enormous swath of the adult U.S. population has an unmet hearing healthcare need.
Of course, it is too early to know how much of an impact over-the-counter hearing aids will have on this huge unmet need. Although OTC hearing aids have been available for about nine months, it has been reported in the press that they comprise a little over 1% of the total hearing aids sold in the U.S.
In addition to the usual suspects (cost, access, and stigma) it is becoming apparent that apathy and indifference drive a lot of this unmet need. Articles, both in the peer reviewed literature and trade publications, indicate that most adults – from unspeckled 30-somethings to weathered codgers – simply don’t prioritize their hearing health.2,3 This growing body of survey data shows that, compared to other common health conditions, Americans neglect their hearing. Perhaps even more unsettling, many primary care physicians and nurse practitioners, also failed to prioritize hearing health, according to a 2022 survey.4
Recently, a group of researchers, led by Sherri Smith at Duke University School of Medicine, showed that offering provider encouragement and screening facilities in the primary care clinic led to a significantly higher rate of adherence with hearing screening for middle-aged and older adults. In contrast, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.5 This is a great example of how direct interaction between an audiologist and primary care clinic can improve hearing screening uptake rates. The simple act of making hearing screening available in the clinic, combined with a caring primary care practitioner, gently pushing the patient to take a few minutes and have their hearing checked during a routine wellness visit makes a tremendous difference.
These findings also plainly demonstrate that we need more than just another low-cost, easy-to-buy hearing aid to move the meter on apathy and indifference surrounding hearing healthcare. It is an all-hands-on-deck problem that requires a variety of approaches.
Here to help us better understand the complexity of the challenge is Terry Mactaggart. He is the president and CEO of Summus Hearing. I’ve known Terry for about ten years. Maybe it’s because he is Canadian, but his forward-looking viewpoints are always worth a listen. Read further to see what he has to say about the persistent problem of unmet need plaguing our industry and our profession. All of us play a key role in improving hearing screening participation and hearing aid uptake rates.
Brian Taylor, Au.D.
Editor, Audiology Practices
It has been over two years since my last commentary about hearing health and the road ahead, as foreseen at that time. Since then, implementation of over-the-counter devices, the introduction of new players and channels, rapid evolution of technologies, and a growing body of relevant research all suggest that steady progress is being made.6
We still have a problem…
It was a recent editorial in The Lancet that provided the catalyst for another critical look.7 Well worth a read (or reread), it argues that “hearing is a growing public health issue affecting people of all ages,” a reality I’ve believed for some time. While ranked #3 after heart disease and cancer, evidence suggests that hearing loss is our #1 untreated chronic health problem! Another take on it is that apparently almost twice as many people report hearing loss than either diabetes or cancer. The facts are known if not widely appreciated. Highlights, again from that The Lancet editorial, include the World Health Organization’s (WHO) estimate that more than 1 billion people now experience some form of hearing loss, a number that could as much as quadruple by 2050. The article goes on to list some of the profound effects associated with hearing loss – employment and quality of life deficiencies, compromised learning (particularly among young people), and isolation and cognitive decline among older adults, all adding up to greater personal challenges and an enormous annual multi-billion-dollar cost.
Recognizing the breadth and sum of this problem is vital. The overarching question remains ‘What are we doing about it?’ And ‘Will such efforts be sufficient to stabilize, then demonstrate real improvements?’
One way of starting to address these questions is to break out the “hearing problem” into various components, examining the state of play with each. We did this exercise at Summus Hearing a couple of years ago and came up with this infographic highlighting seven common issues.
While simplified, the following comments still appear valid.
1. Only 2% are tested
This estimate for the United States is dated and may be different today. In any event, it’s a very low percentage of the relevant population and stands out when compared, say, to testing for eyesight or blood pressure.
Conclusion – Not anywhere good enough!
2. Testing, when done, is often inadequate
Screening tests abound, particularly online. But unless undertaken by an unbiased provider, these tend to be skewed towards acquiring hearing aids. Adequate interpretation of results is a problem as almost all lack that capability.
Conclusion – This bias needs to be rectified if an entry into one’s hearing journey or a check along the way is to be trusted.
3. Wait time between awareness and action is too long
Five years minimum, 10 years maximum defines the range between awareness of hearing loss and action to address it, with the median appearing to be 6-7 years; And that applies only to those who have been tested and ultimately decide to act!
Conclusion – Obviously a “Capital P” problem.
4. Relationships with other disease states require greater emphasis
Co-morbidities have multiplied and become more obvious.
Conclusion – In addition to further research, these relationships provide promising leverage. Much more could be done to insert a hearing test as part of the follow-up protocol when a disease state is detected or being managed.
5. Learning and behavioral issues need to be confronted
We know that undetected and untreated hearing loss compromises the learning and lifestyle trajectory of many children.
Conclusion – Testing of public-school age children should be mandated at regular intervals, and in many cases re-established.
6. Key healthcare providers are left out
This problem is enormous as family physicians and pharmacies (to name two prominent exclusions) are not connected sufficiently, if at all, with hearing health.
Conclusion – The imperative of mandating physicians to counsel and test appears to be gaining ground. And more pharmacy chains are adding hearing as a new revenue source. Engaging both fully would make a significant difference.
7. Productivity loss and social costs are too high
Billions of dollars are spent annually, often combined with other costs and therefore hidden.
Conclusion – Freeing up even a third of these costs represents a large amount that could be allocated to other pressing, underfunded public health problems.
Looking Ahead: What’s now needed…?
Adding up and combining this analysis suggests that, while progress is indeed underway, there is much more to do if “the growing aspect” of the public health issue is to be reduced and a broader and accelerating impact is to result. Typical of other “meta problems”, short of extremes like the pandemic, present approaches appear to be fragmented and underfunded with insufficient public-facing messaging being consistently sent from credible public and private sources.
Our basic assessment is that hearing health needs not “just more of the same” but an actual REBOOT if the substantial gains warranted are to be made during the next decade.
Our perspectives are drawn from actively participating in several of the above areas, reviewing our large data sets while working with channel partners towards extending a reliable and trusted hearing guidance process.
“Moving the meter” towards more impactful changes in hearing health requires a commitment to common cause and a coalition approach adopted by public, private and nonprofit parties. There are several moving parts that deserve greater commentary and cross-sectoral engagement.
In thinking about this, I’m reminded that significant change usually occurs when stimulated by crisis and/or opportunity. A persuasive argument can be made that both are now to some degree evident in hearing health.
A promising methodology could be to examine how other disease states have been confronted and managed. I looked, for example, at several contexts including colorectal cancer, multiple sclerosis (MS) and diabetes, each of which has a comprehensive ecosystem.
A multifaceted advance was critical with each involving various strategies and stakeholders. With the assistance of a chatbot, I came up with the following measures applicable to hearing.
1. Awareness and Education:
- Develop public health campaigns to raise awareness about hearing loss, its causes, prevention, and available treatments.
- Conduct educational programs in schools, workplaces, and communities to promote hearing health and safe listening practices.
2. Early Detection and Screening:
- Implement routine hearing screenings in healthcare settings, schools, and workplaces to identify hearing loss at an early stage.
- Provide accessible and affordable hearing tests and screenings in underserved areas or marginalized communities.
- Make sure these hearing screening are available in the clinic. An audiometer, a handheld screening device, even an app connected to a smartphone and high-quality earbuds are all options for in-clinic screenings.
3. Accessible and Affordable Hearing Care:
- Improve access to affordable hearing aids, assistive listening devices, and other hearing assistive technologies.
- Collaborate with manufacturers and policymakers to reduce the cost of hearing devices and promote insurance coverage for hearing-related services.
4. Professional Training and Capacity Building:
- Enhance training programs for healthcare professionals, audiologists, and hearing care specialists to ensure accurate diagnosis, appropriate treatment, and ongoing care for individuals with hearing loss.
- Encourage research and innovation in audiology to develop new treatments, technologies, and interventions.
5. Supportive Policies and Regulations:
- Advocate for the development and implementation of policies that prioritize hearing health, including noise regulations, occupational safety standards, and school based hearing health programs.
- Support legislative efforts to include hearing healthcare in public health initiatives and insurance coverage.
6. Collaborative Partnerships:
- Foster collaboration between government agencies, healthcare providers, educational institutions, non-profit organizations, and industry stakeholders to establish a comprehensive ecosystem for addressing hearing loss.
- Encourage partnerships to conduct research, share resources, and develop effective strategies for prevention, early intervention, and treatment.
7. Community Engagement and Empowerment:
- Engage local communities by organizing support groups, educational workshops, and awareness events.
- Involve individuals with hearing loss and their families in decision-making processes and empower them to advocate for their rights and access to quality care.
8. Data Collection and Surveillance:
- Establish a robust data collection system to monitor the prevalence, causes, and impact of hearing loss.
- Use data to identify at-risk populations, measure the effectiveness of interventions, and inform evidence based policies and programs.
9. Peer-to-Peer Networks:
- Match most other chronic conditions by developing and promoting an easily accessible platform for individuals to use to ask questions, share experiences and provide advice. Lack of such a peer-to-peer networks represent a current deficit in hearing health.
By combining these strategies, it should be possible to establish a comprehensive ecosystem that addresses the public health problem and promotes better hearing health for all individuals. A deeper dive, no doubt, would reorganize the list somewhat, ranking certain elements quite highly and well-advanced while others as barely evident.
Building out the Ecosystem: An imperative for hearing health
A systems approach will recognize that managing the process leading to better performance is tricky. It would involve a much greater degree of coordination and collaboration among stakeholders than at least I observe presently, to ensure the delivery of effective care, support, and research.
We must also be mindful that there is no centralized authority to take on and oversee such an enterprise.
Speculating further, one could foresee a need to rely on several mechanisms to facilitate its management including key aspects like…
- Intensifying research collaboration between researchers, academic institutions, and hearing-related companies collaborating on studies and clinical trials to advance knowledge and treatment options for hearing.
- Enhancing the roles of professional associations bringing together healthcare professionals and researchers with a sharp focus to establish guidelines, protocols, and standards of care, thus promoting consistent and evidence- based practices.
- Encouraging nonprofit organizations through greater funding to provide resources, and coordinate efforts to improve awareness, patient education, and access to care as well as advocate for policy changes.
- Engineering greater and targeted government involvement to oversee policies and regulations as well as allocate research funding, enforce quality standards, and collaborate with stakeholders to improve patient outcomes.
- Expanding the reach of healthcare providers and institutions to play a more crucial part in managing the hearing health ecosystem by diagnosing, treating, and monitoring individuals as well as collaborating with other stakeholders, such as rehabilitation services and nonprofit organizations, to provide comprehensive care. Family doctors and pharmacies are obvious candidates, along with other health related networks.
- Fostering and supporting technological innovations by adding incentives that encourage collaboration between technology companies and hearing care providers to develop and improve solutions including digital platforms, telemedicine, and remote monitoring tools tailored to the needs of hearing health patients.
- Increasing patient advocacy through facilitating patient advocacy groups working closely with healthcare providers, researchers, and policymakers to influence policies, raise awareness, and improve the quality of care.
- Improving education and training for healthcare professionals to stay updated with the latest advancements in hearing health management.
- Encouraging prominent social influencers to add their voices by stressing the importance of paying attention to one’s hearing health and taking action to protect and, when necessary, rehabilitate it.
- Empowering all members of the hearing health community to communicate with one another about personal experiences and needs as well as what resources are available and how the ecosystem is developing.
Improving the content and management of the hearing ecosystem will involve multiple stakeholders, collaboration, communication, and a person-centered approach to function effectively. Regular interactions, sharing of information, and alignment of efforts among stakeholders will contribute to improved care, support, and research outcomes for individuals living with hearing loss or prone to develop it.
One key metric should be increasing the proportion of the public who are aware of hearing health and acting proactively for their personal care.
That’s a tall order to accelerate and sustain and will require consistent application of joint leadership. But such a process is possible if well conceived, financed, and managed. It’s happened elsewhere. Those most involved will need to demonstrate a commitment not just to achieving the common milestones established but also to serving as leaders in some areas and followers in others.
Has not the time now come for such an initiative to take root? ■
- Humes LE. U.S. Population Data on Hearing Loss, Trouble Hearing, and Hearing-Device Use in Adults: National Health and Nutrition Examination Survey, 2011–12, 2015–16, and 2017–20. Trends in Hearing. 2023;27. doi:10.1177/23312165231160978
- Carlson ML, Nassiri AM, Marinelli JP, Lohse CM, Sydlowski SA; Hearing Health Collaborative. Awareness, Perceptions, and Literacy Surrounding Hearing Loss and Hearing Rehabilitation Among the Adult Population in the United States. Otol Neurotol. 2022 Mar 1;43(3):e323-e330. doi: 10.1097/MAO.0000000000003473. PMID: 35061637; PMCID: PMC8843398.
- Lexie Hearing. Study Shows Majority of Americans Neglect Hering Health Despite Accessibility of Over-the-Counter Hearing Aids. Hearing Review. March 7, 2023. https://hearingreview.com/hearing-loss/health-wellness/study-shows-majority-of-americans-neglect-hearinghealth- despite-accessibility-of-over-the-counter-hearing-aids.
- Sydlowski SA, Marinelli JP, Lohse CM, Carlson ML; Hearing Health Collaborative. Hearing Health Perceptions and Literacy Among Primary Healthcare Providers in the United States: A National Cross-Sectional Survey. Otol Neurotol. 2022 Sep 1;43(8):894-899. doi: 10.1097/ MAO.0000000000003616. Epub 2022 Jul 28. PMID: 35900911; PMCID: PMC9394502.
- Smith, Sherri L. Francis, Howard W.; Witsell, David L.; Dubno, Judy R.; Dolor, Rowena J.1,; Bettger, Janet Prvu; Silberberg, Mina; Pieper, Carl F.; Schulz, Kristine A.1; Majumder, Pranab9; Walker, Amy R.1; Eifert, Victoria; West, Jessica S.; Singh, Anisha; Tucci, Debara L. A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement. Ear and Hearing. Published ahead of print ():10.1097/AUD.0000000000001418, August 21, 2023. | DOI: 10.1097/AUD.0000000000001418
- McTaggart Terry. Evidence over Orthodoxy Part 3: Where Do We Go From Here? Hearing Health & Technology Matters. August 11, 2020. https://hearinghealthmatters.org/innovations-in-hearing/2020/audiology-evidence-uncertainty-3/
- Livingston Gill, Costafreda Sergi. Preventing dementia through correcting hearing; huge progress but more to do. The Lancet Public Health. Elsevier. April 13, 2023. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00058-0/fulltext
Terry Mactaggart is the president and CEO of Summus Hearing. He can be contacted at