Key Takeaways:
- Hearing changes are normal and expected to occur gradually over the course of a person's lifetime.
- Checking your hearing every 1-2 years is a good way to monitor your hearing and track changes.
- The Hearing Number is a method of self-testing that checks important frequencies needed for speech understanding.
- The ACHIEVE study showed that treating hearing loss helped lessen risk of dementia and supported memory and thinking abilities.
- Dr. Lin was integral to the FDA approval of OTC hearing aids to help improve affordability and accessibility to hearing healthcare.
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The following is a conversation with Dr. Frank Lin, the foremost expert on hearing and public health from Johns Hopkins University.
He talks about why hearing should be checked regularly, technological advances to help you communicate, the link between hearing treatment and reducing risks of dementia, and at what age everyone’s hearing starts to decline (it’s earlier than you think.)
Dr. Lin, you have said that everyone over the age of 20 has some level of hearing loss, yet the average age for people to treat their hearing is over 70. Why do you think that is?
Everyone’s hearing gradually declines over their entire lifetimes, but our brains are pretty adept at compensating for the declines in hearing that come with getting older. At the same time, accessing interventions to assist hearing (i.e., hearing aids) until recently had some pretty incredible barriers—for example, a $4000+ price tag, multiple trips to a clinician needed, etc.
No surprise, then, that the only people who would be willing and interested to get hearing aids would be people who have more advanced levels of hearing loss and who have time and the means to get these devices.
Fortunately, that’s all beginning to change now with OTC (Over the Counter) hearing aid regulations driving innovation and competition in this space. At the same time, there’s a push now toward re-educating the public that hearing changes gradually for everyone and that incrementally adopting technologies and strategies to augment hearing along this continuum is what’s important.
When we talk about hearing health and protection, there is often a stigma associated with treatment. What can we do to reduce that stigma to get people the help they need?
A big part of reducing stigma is normalizing something with language, discussion, and widespread adoption. There are many examples of how normalizing a shared experience or condition has changed the stigma around something - think of how we regard eyeglasses as ubiquitous and fashionable accessories, or how comfortable we are discussing medical conditions we never would have discussed publicly before. This strategy has also helped us shed outdated social stigmas that just don’t serve us anymore.
Hearing is ready for a rebranding! Changes to our hearing are normal. Hearing is not a binary where someone either has hearing or they have hearing loss.
Everyone’s hearing changes as we get older, starting from much earlier than we probably expect, because parts of the inner ear wear out over time and don’t regenerate. If people of all ages understand their hearing and how it changes over time, they can know when to be proactive about protecting their hearing, and when to use communication strategies or technologies to help them hear better.
You were integral to the FDA’s approval allowing for the sale of hearing aids “over the counter,” meaning people can buy at a retail store or online without a medical prescription for those with mild to moderate hearing loss. This opens accessibility to hearing treatment to a much broader range of people at a much more affordable price point. Can you talk about why you, as a medical professional, advocated for this?
My support for over-the-counter hearing aids is rooted in my work as a public health researcher: while 2/3 of Americans over 60 have hearing loss, less than 20% of adults in the U.S. with hearing loss report hearing aid use. This, despite all that we’ve learned about the effect hearing loss has on the health of adults, including increasing loneliness, fatigue, and its adverse impact on thinking and memory abilities. Recently, in a large, randomized trial that I lead funded by the NIH, we also learned that treating hearing loss reduces loss of thinking and memory abilities by 48% over 3 years in older adults at increased risk of cognitive decline—that’s a huge impact!
A big reason for under treatment of this common and very treatable condition is that the average cost for a pair of prescription hearing aids is $4,700, and before the OTC hearing aid market opened, they could only be obtained through a hearing care provider. Many people put off considering hearing aids because of the outrageous costs and hassle involved.
It goes back to the original FDA regulations for hearing aids, which were written in 1977 and required hearing aid sales to go through a licensed provider because hearing aids back then were only safe and effective if programmed by a licensed provider. That made sense then. But technological advances in the intervening 45+ years allow properly designed hearing aids to be safely and effectively used by adults with hearing loss without the need for a licensed provider.
The new regulatory category for over-the-counter hearing aids will spur innovation and increase the accessibility and affordability of hearing aids for millions of Americans with hearing loss.
What would you tell me or anyone else is the most important thing we can do to maintain our hearing health?
One of the most important things you can do to protect your hearing is to avoid exposure to loud noises. If you can’t move away from loud noises, ear protection (such as earplugs or noise protection earmuffs) can help. There are also ways to reduce noise exposure from headphones, like adjusting the settings of the headphones to automatically keep the volume at a safe level,using over-the-ear headphones rather than in-the-ear earbuds, and limiting theuse of headphones to no more than 60 minutes at a time.
About Frank Lin, MD, PhD
Frank R. Lin, MD, PhD is a Professor and the Director of the Cochlear Center for Hearing and Public Health at Johns Hopkins University. As an otologic surgeon & epidemiologist, Dr. Lin has translated his clinical experiences caring for patients with hearing loss into foundational public health research and federal policy in the U.S. His epidemiological research from 2010-2014 established the association of hearing loss with cognitive decline & dementia, and his research served as the direct basis for the Lancet Commission on Dementia conclusion that hearing loss is the leading modifiable risk factor for dementia. Based on this early research, he initiated the ACHIEVE study in 2014, and the results of this landmark randomized trial that were released in 2023 established that treating hearing loss reduces loss of thinking and memory abilities by 48% among older adults at increased risk for cognitive decline.
In parallel, Dr. Lin has collaborated with the National Academies, White House, and Congress to develop policies to ensure hearing loss can be effectively and sustainably addressed in society. These efforts directly resulted in bipartisan passage of the Over-the-Counter Hearing Aid Act of 2017 which Dr. Lin testified on before Congress and final enactment of federal regulations for OTC hearing aids in the U.S. on October 17, 2022. Dr. Lin has subsequently collaborated with the Consumer Technology Association to develop the standard for a consumer-facing hearing metric based on the PTA4 (Hearing Number) to empower consumers to track, monitor, and act on their own hearing. As the director of a public health research center, Dr. Lin’s academic efforts are focused on reshaping the rules and assumptions underlying the global hearing care market in order to ensure the market is optimized to advance public health.
About the Cochlear Center
The Johns Hopkins Cochlear Center for Hearing and Public Health is the only global research institution focused exclusively on issues related to hearing loss and public health in older adults. Founded in 2018 and based in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Cochlear Center researchers are interested in understanding the impact of hearing loss on public health. We focus on what can be done now across five core areas - population health evidence, public awareness, policy & legislation, technology, and healthcare delivery - to address hearing loss in older adults at scale.
