When the average person develops vision trouble, they might just pick up a pair of reasonably priced reading glasses at a neighborhood pharmacy. If they require a more customized solution, they could stop by an eyewear retailer to book a professional eye exam and walk away with prescription glasses that same day. But what if they notice problems with their hearing?
Hearing health care is apparently a low priority for our society, even though conservative estimates put the number of Americans living with hearing loss at 30 million. Most insurance plans (including the majority of Medicare plans) won’t touch it. Unlike eye care, oral care, and even foot care, it hasn’t spawned its own retail industry—perhaps because hearing health care has a harder time driving the consumer market with a cosmetic angle. That’s left people in the early stages of hearing loss with few choices outside of doctors’ visits (which can be inconvenient and expensive) and hearing aids (which cost hundreds or even thousands of dollars per pair). Plus there’s the social stigma associated with hearing loss, which discourages many from seeking help. Eighty-six percent of adults over 50 living with hearing loss don’t wear hearing aids at all.
Jasleen Singh aims to change that. She’s a clinical audiologist and postdoctoral fellow at Northwestern University’s Auditory Research Laboratory, and she was recently awarded the $75,000 Birtman Grant from the American Hearing Research Foundation. Over-the-counter hearing aids are on the horizon, and this grant will allow her to study the way attitudes about hearing loss and hearing health care change when patients consider an over-the-counter model of hearing-aid distribution, as compared to the current doctor-driven model.
While gearing up to launch her research project, a Chicago-area study that will focus especially on underserved and marginalized populations, Singh took the time to speak to the Reader about her work.
Jamie Ludwig: Can you please share a little bit about your background and what drew you to audiology?
Jasleen Singh: I got my AuD from Syracuse University. During my clinical rotations I saw that there was this fundamental need of improving access to hearing health care, specifically in populations that typically are underrepresented. This inspired me into looking into how I could contribute to that type of literature or evidence-based best practice. I decided to pursue my PhD as well at SU, specifically with Dr. Karen Doherty, who has done a lot of work with hearing aids, and I did my dissertation with respect to over-the-counter hearing aids.
To give you some background as to what’s happening in our field: in 2017, the President’s Council of Advisors on Science and Technology recognized that there was this huge limitation, or lack of uptake, in hearing aids, which is super concerning. There was a paper in the Lancet, which talked about hearing loss being the largest modifiable risk against dementia. What that essentially means is, of all the factors that we have control of in our environmental space, unaided hearing loss is neglected, even though it’s the third most common chronic health condition in the U.S.
So there was this very deep discussion as to, “Why do adults with specifically age-related hearing loss choose to forgo treatment?” To drop another statistic, among people who could benefit from a hearing aid, only about 15 to 20 percent uptake them, and one of the biggest barriers to access is cost. So there was this huge push to see if we could create a new model of health-care deliveries, specifically with over-the-counter hearing aids.
That’s where my dissertation came into play, looking at the feasibility of this model in terms of whether or not we’re actually targeting the issue at hand. And that’s where [this idea] came about in terms of my general interest in audiology, and what led me to pursue it a little bit further at Northwestern, which is where I’m currently doing my postdoc.
Is the Auditory Research Lab at Northwestern known specifically for its work on hearing aids?
Dr. Sumit Dhar is the principal investigator of the Auditory Research Lab at Northwestern University. They’re doing a lot of work looking at how we can optimize hearing health care. There’s currently a multisite study that’s looking at the feasibility of the over-the-counter hearing-aid model, specifically when it pertains to actually self-fitting your own hearing aid—the actual process of having the devices in your hand and manipulating them yourself to see whether or not you can get sustainable outcomes.
Why is it that hearing aids are not currently covered by most insurance companies? You can find visual aids in any drugstore, but in terms of the retail market, hearing devices have been so far behind.
In the recent Medicare revamping under Joe Biden, there was a discussion of getting hearing aids covered under Medicare. Unfortunately that hasn’t come to fruition, although I agree that they should be covered by insurance, at least to some degree. It’s unfortunate that our health-care system hasn’t caught up to speed with other analogous fields. I think a lot of it comes down to just the sheer number of people who would require it.
What holds people back from dealing with their hearing loss?
The literature has shown that the number one predictor of hearing-aid uptake is someone’s perceived handicap from their hearing loss. Hearing loss is so invisible that it takes almost ten years for somebody to notice a change in their hearing. So even though there are gradual age-related changes that might begin in your 40s or 50s, it’s not until later in life when you actually say, “There’s something going on with my hearing, and I would like to do something about it.” At first it’s not being able to recognize it, and then it’s whether or not your hearing loss is causing enough of an issue in your day-to-day activities where you feel like you need to address it.
Outside of that, there are also general stigmas related to hearing aids. I think a lot of people associate having a hearing aid with being old. Unfortunately, the perception that hearing loss is a part of the natural aging process feeds into the idea of pushing off getting hearing aids. Now there’s considerable research that suggests that people who get hearing aids earlier on in their progression tend to do better with them. It’s interesting that there’s all this push for starting earlier in your life, while there are multiple barriers that are preventing people from getting them.
Do you think movies like CODA or Sound of Metal, or American Girl releasing a doll with a cochlear implant, are helping to change the stigma? Have younger generations started to change their minds about hearing loss compared to older generations, or are they at least talking about it more?
I think the discussion around hearing loss—in terms of a lot of the culture platforms—is at least bringing some sort of awareness to the idea of taking care of your hearing. There still needs to be a lot more research to determine whether or not they are making measurable strides as to what people perceive about hearing aids in general, but I’m optimistic that it’s encouraging people to think about their hearing in a more targeted and calculated way.
More and more, our smartphones are actually able to give us much more information about the levels of what we’re setting our headphones to. There are sound-level-meter apps. There are a lot more tangible tools for the individual that can allow them to start thinking about their hearing more seriously.
You start to think about how many people in our city spend so much time playing music or going to concerts, or who work in a field like construction or aviation where there’s a lot of noise. Are younger people just not conscious of the risks of losing your hearing and the associated potential health consequences over time?
Unfortunately, hearing health care does not get a lot of advertising attention. In general, my guess would be that most people are not aware of what they’re doing and how that can cause issues to the integrity of their auditory system. I’m just happy to keep pushing out that message as much as I can.
You mentioned that preventative care can do a lot to prevent this degradation over time. What are some positive steps that people can take?
Genetics play a big role in whether or not hearing loss is going to be something that you experience at some point in your life. But hearing protection is the number one way to prevent noise-induced hearing loss. Noise-induced hearing loss is super challenging, because of the way that it affects our auditory system. It specifically impacts the frequencies that are related to speech, specifically consonants, and how we’re able to have intelligibility when it comes to conversations.
So noise exposure specifically impacts our ability to understand conversations over time. You talked about wearing hearing protection regularly, and specifically in situations like concerts, but even going to a restaurant or a bar that’s noisy can cause potential damage in the long run. So just be more cognizant of the areas that you’re going to be, and whether or not you need to bring your plugs along with you.
With this grant, do you have a specific plan in mind for conducting your research, or what the scope is going to look like?
A very important part of my research is looking at the psychology behind using hearing aids as a potential treatment. The plan is currently to use an already FDA-approved self-fitted hearing aid. There are companies which have already started the process of developing technology that is completely consumer driven, so it’s all controlled through a smartphone app—you’re able to do a hearing test, which then provides a prescription. Typically when you purchase hearing aids, you go to a professional who then fits the hearing aid using a specific hearing test, so it’s much more involved.
I’m basically trying to see whether or not this new model of hearing health-care delivery reduces some of the barriers, in terms of being able to actually physically handle the device yourself and program the device yourself. More importantly, are you able to reduce your level of hearing handicap if you have concerns with your hearing? So that’s kinda more the general scope or objective, and one of the major things that we’re also trying to do is to target communities that are typically underserved.
Right. If you don’t have a smartphone, how can you use these new technologies?
Exactly. There is considerable research to suggest that individuals in lower SES [socioeconomic status] populations uptake hearing aids at a lower rate. So we’re also trying to figure out information related to what cost is actually appropriate for somebody who is living paycheck to paycheck. We don’t want to be providing these solutions and have them be sold at a thousand dollars, or any price point that may not actually be attainable for somebody who doesn’t have a lot of disposable income. Plus the smartphone.
We’re trying to work with more community partners and see what their feedback is on this specific model of health care, and see if it’s something that’s actually going to address what it intended.
Is the study limited to people in the Chicagoland area, or is it a national study?
This is seed funding, so we’re limited to the Chicago area just primarily because of dollars—we can only go so far when it comes to the implementation. We’re still in the process of trying to partner with specific community centers to see whether or not this is something that can be integrated into specific community health centers. So that’s TBD at this point, but I’m really hoping for some more exposure, to see if people would like to get involved. We are hoping for about 90 participants, so it’s a pretty decent-size group. Typically when we do hearing-aid studies, the populations tend to be very small, but we’re hoping to get a pretty sufficient sample size.
The specific AHRF grant is intended to kinda wrap out in about a year’s time. Like I mentioned before, it’s seed funding, so the idea is to get you started with an idea and see whether or not it can be scalable. The other study that I mentioned that our lab is doing runs until the end of next year, so, OK. We do have several projects people can absolutely get involved in with respect to OTC hearing aids.
What’s the clincher that really gets people from saying “I should do something about my hearing” to actively pursuing it?
I think the bare minimum that somebody should do is just get a baseline hearing test. When you think about vision, everyone’s had an eye test at some point, just to ensure that things are working the way they should. That way, if anything does change, you have a reference of what your baseline is. So if somebody is trying to be more proactive about their hearing, that is a great first step.
Then based on the results—of course there’s never any pressure to consider a hearing aid—we typically recommend following up with a hearing test every three to five years. That’s a very low investment. And typically Medicare does cover the cost of a hearing test. So I think that’s a really good first step: being able to know about what your hearing system is doing, and whether or not there’s anything you could do presently to help you.
If you’re a musician, definitely get your hearing checked as soon as you start playing your instruments. But if you’re concerned more about age-related hearing loss, I think your early 50s is a good time to get started on that.
It’s exciting to think about how this research could really change lives. In a generation it might just be common sense that if you need to get a hearing aid, you just stop at the Walgreens on your way home.
Hopefully that will be the norm. For a lot of clinicians, OTC hearing aids are thought of as your entryway into hearing health care. So let’s say you’re not ready for a full-fledged hearing aid, where you have to go into specific appointments—this could be a great primer to get you to think about your hearing. And it’s a low-investment primer, which is super important. Then if your problems continue and you need much more involved health care, you can go to an audiologist or a hearing health-care professional who can guide you through the process with much more pointed advice. It’s better to start early, so I do see a lot of potential for this market. We just have to make sure that people are set up for success.
