hearing loss
Advancing Access to Hearing Health Care
Posted on by Debara L. Tucci, M.D., M.S., M.B.A., National Institute on Deafness and Other Communication Disorders
By 2050, the World Health Organization estimates that more than 700 million people—or one in every 10 people around the globe—will have disabling hearing loss. In the United States alone, hearing loss affects an estimated 30 million people [1]. Hearing loss can be frustrating, isolating, and even dangerous. It is also associated with dementia, depression, anxiety, reduced mobility, and falls.
Although hearing technologies, such as hearing aids, have improved, not everyone has equal access to these advancements. In fact, though hearing aids and other assistive devices can significantly improve quality of life, only one in four U.S. adults who could benefit from these devices has ever used one. Why? People commonly report encountering economic barriers, such as the high cost of hearing aids and limited access to hearing health care. For some, the reasons are more personal. They may not believe that hearing aids are effective, or they may worry about a perceived negative association with aging. [2].
As the lead federal agency supporting research initiatives to prevent, detect, and treat hearing loss, NIH’s National Institute on Deafness and Other Communication Disorders (NIDCD) conducts and funds research that identifies ways to break down barriers to hearing health care. Decades of NIDCD research informed a recent landmark announcement by the Food and Drug Administration (FDA) creating a new category of over-the-counter (OTC) hearing aids. When the regulation takes effect (expected in 2022), millions of people who have trouble hearing will be able to purchase less expensive hearing aids without a medical exam, prescription, or fitting by an audiologist.
This exciting development has been on the horizon at NIDCD for some time. Back in 2009, NIDCD’s Working Group on Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss created a blueprint for research priorities.
The working group’s blueprint led to NIDCD funding of more than 60 research projects spanning the landscape of accessible and affordable hearing health care issues. One study showed that people with hearing loss can independently adjust the settings [3] on their hearing devices in response to changing acoustic environments and, when given the ability to control their own hearing aid settings, they were generally more satisfied with the sound of the devices than with the audiologist fit [4].
In 2017, the first randomized, double-blind, placebo-controlled clinical trial comparing an over-the-counter delivery model [5] of hearing aids with traditional fitting by an audiologist also found that hearing aid users in both groups reported similar benefits. A 2019 follow-up study [6] confirmed these results, supporting the viability of a direct-to-consumer service delivery model. A small-business research grant funded by NIDCD led to the first FDA-approved self-fitting hearing aid.
Meanwhile, in 2016, NIDCD co-sponsored a consensus report from the National Academies of Sciences, Engineering, and Medicine (NASEM). The report, Hearing Health Care for Adults: Priorities for Improving Access and Affordability, which was developed by an independent expert panel, recommended that the FDA create and regulate a new category of over-the-counter hearing devices to improve access to affordable hearing aids for adults with perceived mild-to-moderate hearing loss. These devices will not be intended for children or for adults with more severe hearing loss.
In sum, this targeted portfolio of NIDCD-funded research—together with the research blueprint and the NASEM consensus report—provided a critical foundation for the 2021 FDA rule creating the new class of OTC hearing aids. As a result of these research and policy efforts, this FDA rule will make some types of hearing aids less expensive and easier to obtain, potentially improving the health, safety, and well-being of millions of Americans.
Transforming hearing health care for adults in the U.S. remains a public health priority. The NIH applauds the scientists who provided critical evidence leading to the new category of hearing aids, and NIDCD encourages them to redouble their efforts. Gaps in hearing health care access remain to be closed.
The NIDCD actively solicits applications for research projects to fill these gaps and continue identifying barriers to care and ways to improve access. The NIDCD will also continue to help the public understand the importance of hearing health care with resources on its website, such as Hearing: A Gateway to Our World video and the Adult Hearing Health Care webpage.
References:
[1] Hearing loss prevalence in the United States. Lin F, Niparko J, Ferrucci L. Arch Intern Med. 2011 Nov 14;171(20):1851-1852.
[2] Research drives more accessible, affordable hearing care. Tucci DL, King K. The Hearing Journal. May 2020.
[3] A “Goldilocks” approach to hearing aid self-fitting: Ear-canal output and speech intelligibility index. Mackersie C, Boothroyd A, Lithgow, A. Ear and Hearing. Jan 2019.
[4] Self-adjusted amplification parameters produce large between-subject variability and preserve speech intelligibility. Nelson PB, Perry TT, Gregan M, VanTasell, D. Trends in Hearing. 7 Sep 2018.
[5] The effects of service-delivery model and purchase price on hearing-aid outcomes in older adults: A randomized double-blind placebo-controlled clinical trial. Humes LE, Rogers SE, Quigley TM, Main AK, Kinney DL, Herring C. American Journal of Audiology. 1 Mar 2017.
[6] A follow-up clinical trial evaluating the consumer-decides service delivery model. Humes LE, Kinney DL, Main AK, Rogers SE. American Journal of Audiology. 15 Mar 2019.
Links:
National Institute on Deafness and Other Communication Disorders (NIDCD) (NIH)
Funded Research Projects on Accessible and Affordable Hearing Health Care (NIDCD)
Adult Hearing Health Care (NIDCD)
[Note: Acting NIH Director Lawrence Tabak has asked the heads of NIH’s Institutes and Centers (ICs) to contribute occasional guest posts to the blog to highlight some of the interesting science that they support and conduct. This is the ninth in the series of NIH IC guest posts that will run until a new permanent NIH director is in place.]
LabTV: Curious About Genetics of Deafness
Posted on by Dr. Francis Collins
What do Miami, music, and genetic research have in common? They are all central to the life of Joseph Foster, the young researcher who’s in the spotlight for our next installment of LabTV.
Foster, a research associate in Mustafa Tekin’s lab at the University of Miami’s Hussman Institute for Human Genomics, is involved in the hunt for the remaining genes responsible for congenital forms of deafness.This area of research is a good fit for Foster. Not only does he have a keen interest in genetic diseases (a close family member was born with cystic fibrosis), he’s a musician with a deep appreciation of the gift of hearing—loving to play the saxophone in his free time.
Snapshots of Life: The Biological Basis of Hearing
Posted on by Dr. Francis Collins
Credit: Peter Barr-Gillespie and Kateri Spinelli, Oregon Health & Science University, Portland
Did you know that chickens have ears? Well, here’s the evidence—you’re looking at a micrograph of sensory hair cells that make up the inner ear of Gallus gallus domesticus, otherwise known as the domestic chicken. Protruding from each hair cell is a tall bundle of stiff appendages, called stereocilia, that capture vibrations and enable the chicken to hear everything from grain being poured into a feeder to the footsteps of a wily fox. The flatter area is occupied by supporting cells, which have recently been shown to have the capacity to regenerate damaged or destroyed hair cells.
Peter Barr-Gillespie and Kateri Spinelli of Oregon Health & Science University, Portland used a scanning electron microscope to capture this image—one of the winners of the Federation of American Societies for Experimental Biology’s 2014 BioArt competition—while studying how these cells convert sound waves into brain waves. It is generally known that sound waves cause the stereocilia on each hair cell to oscillate in concert. These vibrating stereocilia trigger electrical changes in the hair cells, which then send signals to the brain. Barr-Gillespie’s group focuses on the actual molecules that build the stereocilia and translate the vibrations into brain signals.
Vision Loss Boosts Auditory Perception
Posted on by Dr. Francis Collins
Caption: A neuron (red) in the auditory cortex of a mouse brain receives input from axons projecting from the thalamus (green). Also shown are the nuclei (blue) of other cells.
Credit: Emily Petrus, Johns Hopkins University, Baltimore
Many people with vision loss—including such gifted musicians as the late Doc Watson (my favorite guitar picker), Stevie Wonder, Andrea Bocelli, and the Blind Boys of Alabama—are thought to have supersensitive hearing. They are often much better at discriminating pitch, locating the origin of sounds, and hearing softer tones than people who can see. Now, a new animal study suggests that even a relatively brief period of simulated blindness may have the power to enhance hearing among those with normal vision.
In the study, NIH-funded researchers at the University of Maryland in College Park, and Johns Hopkins University in Baltimore, found that when they kept adult mice in complete darkness for one week, the animals’ ability to hear significantly improved [1]. What’s more, when they examined the animals’ brains, the researchers detected changes in the connections among neurons in the part of the brain where sound is processed, the auditory cortex.
Meet Alex—Before and After NIH Clinical Trial
Posted on by Dr. Francis Collins
Caption: Alex, then and now, with Dr. Goldbach-Mansky
Credit: Kate Barton and Susan Bettendorf (NIH)
Alex Barton recently turned 17. That’s incredible because Alex was born with a rare, often fatal genetic disease and wasn’t expected to reach his teenage years.
When Alex was born, he looked like he’d been dipped in boiling water: his skin was bright red and blistered. He spent most of his time sleeping. When awake, he screamed in agony from headaches, joint pain, and rashes. After a torturous 14 months, a rheumatologist told his mother that Alex suffered from Neonatal-Onset Multisystem Inflammatory Disease (NOMID). The doctor showed her a brief and scary paragraph in a medical text. Kate Barton, Alex’s mother, admitted that it “knocked her over like a freight train.”
