Over-the-counter Hearing Aids Experts Discussion


Listen to the interview instead

In this discussion between Barbara L. Kurman, AuD, e3 Diagnostics Sales Representative and Consultant, and Laura Prigge, AuD, GSI Clinical Application Specialist, you’ll hear about the conversation that is taking place about OTC Hearing Aids. This alternative to buying hearing aids is going to change the face of Audiology and potentially open up new opportunities as more people want to be evaluated before purchasing any hearing aid. Listen to the rest of the conversation.

Laura Prigge, AuD

Laura graduated with a Doctorate of Audiology from AT Still University. Her 15 years experience include providing manufacturing support as well as managing educational audiology training for an international audiologic equipment company. She has also worked as a clinician in both ENT offices and a retail hearing center conducting audiologic evaluations and hearing aid fittings on all patient populations including infants, adults, geriatric, and special needs patients. Laura spends her time at GSI focused on training and education. In addition to webinars and phone training, Laura speaks at audiology congresses and conferences around the world.

Barbara L. Kurman, AuD

Barbara received her MS in Audiology from Syracuse University in 1979, and her AuD in 2002 from what is now Salus University. During her long professional career as an audiologist, she worked clinically as Clinical Supervisor of Audiology at a major NY metropolitan hospital center, and at a national renowned center of Audiology and Rehabilitation. She co-founded Northeastern Technologies Group in 1991, and Midlantic Technologies Group in 2001, and both were acquired by Demant in 2011, becoming part of the e3 Diagnostic organization. Barbara served as the Regional Sales Manager for e3 Northeastern Technologies Group for many years. She has been active professionally, serving on the Board of the American Board of Audiology of AAA, the Board of the New York State Speech Language and Hearing Association, President of the Metropolitan Audiology Group, and President of the National Association of Special Equipment Distributors (NASED). She has remained active in her state, local and national organizations, chairing committees for conventions and special programs and has lectured and presented there as well. Barbara has also been a regular guest lecturer at local AuD programs in New York and New Jersey and has co-authored peer reviewed articles. Barbara currently works part time in a sales representative capacity for e3 Diagnostics, mentors new hires, and provides consultative guidance to customers.

Laura: Barbara, I just saw the OTC announcement. Can we talk about it for a little bit? What do you think this means?

Barbara: Well, that's not too loaded a question.

Laura: I know.

Barbara: So here's the deal. There has been a ton of stuff out there. Everybody and their brother are talking about the new OTC laws and different folks are taking credit for it. Senator Grassley posted about how the hearing aid companies were nefarious and other people are talking about this is the greatest thing since sliced bread. From my perspective, there is a lot of positives to take away.

From our perspective, the visibility of hearing health care has never been more shining or bright. Everybody is aware. Everybody is talking about hearing loss in a way that has never happened before. It is no longer the hidden disability. There is nothing hidden about it. Everybody understands that sooner or later, it is going to affect a lot of us. The degree it affects us and the time that it affects us, it is not a question of if, It's a question of when. And that increases the need for hearing health care in our country significantly.

Laura: We're already having a crisis in audiology. The research shows there's not enough audiologists to provide health care for hearing aids, and care for the people who already need it with all this increased awareness. What does that mean?

Barbara: Well it means a lot of things. It means more opportunities for equipment that we sell for situations where audiologists are not necessarily required. There are screening pieces of equipment that non audiologists can utilize. It also means people are going to have to figure out where they fit in the hearing loss spectrum. The big take away from the OTC law, which we will know exactly when is published in October, (OTC hearing aids) are for the self-diagnosed levels of disorders, and it's designed from mild to moderate. Who knows what that is on an individual?

Laura: Remember when we were in clinic and you would have someone come in and say, "I can't hear anything", and they would have basically normal hearing. And then someone who's like, "every once in a while I struggle a little bit at church" and they're basically profound. I mean, this self-diagnosis is crazy.

Barbara: 100%, yes. The degree to which people think they have a hearing loss is all over the place. And the only people who really can assess the degree of impairment and the impact on communicative abilities are audiologists. Having said that, in the beginning audiologists may or may not be the point of entry because this whole thing is designed to be self-identified and self-corrected.

But I am not sure how many people are going to go into a big box store or someplace pay $800 or $1,000 for something or some level of amplification that they think they might need, or they think that could help them. As opposed to finding out what they really might need. So perhaps in the short term, I think the interest on good screening, good hearing identification, use of equipment that maybe doesn't need an audiologist or use of audiological services, I think will increase dramatically.

How that will transcend to where people buy the end-product, I don't know. Will they go back to the big box store? I do not know. Will they have their health care professional help them choose? I don't know. But the point of entry, I think, is going to definitely increase the need for hearing health care professionals to provide screening and diagnostic services.

Laura: So when you talk about assessment equipment that doesn't require an audiologist, does that mean that we're trying to cut the audiologist out of the loop? That's a loaded question too.

Barbara: Really, no. We should never think about cutting the audiologist out of the loop, because audiologists, by definition, are those who can identify the communication implications of the hearing loss and best determine what technology or what methodology would be best suited to that patient. That's not going to happen with a screening product. That's not going to happen with somebody that's going to buy something off the shelf.

However, the benefit of hearing health awareness, I think, is going to put a spotlight on audiologists. The opportunities that they can provide, whether it's an oral rehabilitative, whether it's in counseling, whether in other application type devices, whether it's a combination of products and services that are available. A lot of what audiologists do is sort of not always known. I think the fact that the visibility of hearing health care issues are going to be more prominent, it will shine a spotlight on what services audiologists can provide.

Laura: So, if I'm an audiologist and I want to help these new self-identified people who have some level of hearing loss that they consider to be mild or moderate, what do I do in my office? What am I going to put in there? What kind of equipment are you? Tell me the equipment type you think would be best suited.

Barbara: There is a lot of things you could do. Number one, if somebody wants to come in and schedule a full diagnostic evaluation, that's a no brainer, they (audiologists) have the equipment, fine. Patients come in and the audiologist can counsel them and assess the degree and the nature of the hearing impairment. That is one possibility.

The number two possibility is to buy equipment such as, the GSI Pello or the Audiostar Pro. You could use that equipment coupled with the Amtas. The patient could self-administer a test during the time the audiologist is working with other patients. So, the patient is getting high quality diagnostic testing that gives a very, very specific indication of the degree of hearing loss with equipment that has been shown to be highly accurate because of the quality indicators and the way that the whole Amtas program was developed.

With this option, you're utilizing the equipment and are maximizing the time in your office for both your patients and your time with other patients. You're able to use that time and counsel the patients the best next steps. If the patient only wants to have a better definitive idea of the hearing and says "thank you goodbye", you provided the service, but you have the opportunity to further counsel the patients. You as the audiologist could say, I could counsel you, maybe you need this product, or maybe you need to come back because there are other questions that need to be answered. But without that initial self-diagnosis of capability of Amtas Pro or even Amtas Flex or something along those lines, that patient does not have definitive and accurate information.

Laura: I think those are all such good points. It's really interesting when I talk to other audiologists, they're already overwhelmed. They already have this, this huge backlog just for basic audiometric evaluations. And this impasse would be would be perfect. Do they have to set the patient up or can the patient set themselves up?

Barbara: I do not know. I would have to think, based on the quality of the test, the placement of the headphones, the placement of the forehead oscillator, the set-up should be done by someone who's been trained, it could be the office person. I do not think it's necessary. I do not think we want to do the patient setting it up because, the oscillator must be a certain pressure on the forehead, etc...

Even though there is a self-check in terms of the placement, I think someone who's been trained how the position of transducers should do it, but that's all it's required. It certainly doesn't require an audiologist to position the transducers and if you’re using the Amtas Flex, pretty much anybody could put headphones on a patient. It is a no brainer.

And the Flex would give you an air conduction threshold evaluation. I know the screen up might be the entry point for some patients so they can get an idea of if they are normal or mild or moderate. It would help patients answer "what's my story?" and for other patients if they might need the whole bone and speech components of diagnostic testing along with the audiometric air conduction.

As audiologists we know there are many testing opportunities, and there is more information that we can obtain with middle ear analysis and other conditions and processing and binaural versus monaural and a whole host of other specialized testing. That, in my opinion, becomes very important when trying to assess a hearing loss and that's communicative impact.

I don't think we even have enough tests yet to fully evaluate the impact of what a hearing loss can do on communicative impairment. I think research will only help us do a better job in the coming years.

Laura: It's really interesting because initially when we talked the OTC law and making the OTCs for self-diagnosis, I think that myself and maybe some other audiologists were a little bit nervous at first. We were worried that this was going to hurt audiology in some way. But I think that after this discussion, I think it is actually going to be really helpful.

I think the audiologists are going to want to find those less time-consuming ways to evaluate a patient who is curious about their hearing. And honestly, I also thought when I first heard it, I do not want to say I'm like this dooms guy or something, but I thought, "oh my gosh, they're going to be able to buy these hearing aids for $22 and it's going to ruin them for audiology forever!"

And the more that I read and the more that I hear, and the more that I learn from you and the governing bodies and just articles, I do not think that's the case at all. I think, just like you said, this is kind of a cool opportunity for audiology. An educated patient base is going to really enhance their experience and give us an opportunity to help them more too .

Barbara: Well, I think you nailed it with that. The term educated patients is especially interesting. But what are they educated in and who is educating them? That is us. We are the ones certainly that can be a very big part of the education, but the more information every patient has about his or her own hearing capabilities or condition will make a better case for them to get the proper treatments.

The treatments are going to be self-identified and the treatments will be professionally identified. Again and again, these old OTCs are limited to those who are moderately impaired. Anyone beyond that and of course, anyone under the age of 18 are still required to see a hearing health care professional, specifically one with an audiologist. However, I think with the advent of all this new information and awareness, I think audiologists can be very, very busy and so busy that something like self-administered testing like that's available in the Amtas and Amtas pro. Utilizing existing clinical equipment is a no brainer because you can do two things at one time and your initial investment essentially gets utilized twice as quickly and twice as much, twice as often. And it becomes, in my opinion, an essential component of a clinical practice.

Laura: Yeah, I couldn't agree more. And you know, the other thing that I wanted to point out is I have seen on social media and just talking to audiologists how creative everyone is getting in the education. It's not just education in their offices, but education outreach. I think, like you said, this too is going to increase our patient load significantly.

I'm very impressed with the way that audiologists are taking this information that we have limited right now. We’ll have the full ruling coming out later, but they're taking this initial information and they're like, let's make some lemonade with our lemons and see who we can reach. General practice, physicians, pharmacists, where are these over-the-counter hearing aids going to be sold? We're really able to be super creative to get patient education on the forefront.

Barbara: Well, and you bring up a good point, because these alternative pathways, I would bet that they will be opportunities to sell screening equipment to those places. Oh, you do not know if you have a hearing loss. Oh, you do not know the degree. Well, they can screen you and you could do whether it's a Flex or a portable air conduction audiometric test.

There are places that would sell these things where a patient might want to have some idea of what they're walking into. Again, as you pointed out, these items are not inexpensive. They're not $29. I saw one a box of products, coming in at $800 a box, next to aspirin. I mean, really? Yes. But that's the way it's going to be rolled out, at least, I think.

But the biggest part is the awareness. This is a spotlight on the part of the world that we live in which many people are not aware of. It (hearing aids) were to be avoided and it mean you were too old. Now everybody is out in the sunshine and everybody knows we need to be more aware of the impact of hearing loss. It's very positive, in my opinion, in so many ways.

Laura: I agree 100%. I know that as we continue to learn more and more, I'm feeling better and better about the whole OTC thing. And I think that, we're doing what we set out to do when we went to college, and that is help people live their lives to the fullest with the best communication possible.


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