Scott Webb (Host): There was a time when you had to have a prescription for hearing aids, but today, thanks to FDA approval, you can walk into the store and buy them off the shelf, so to speak. And joining me today to talk about the effects of hearing loss and whether or not OTC hearing aids are the right choice, is Dr. Thomas Glenn Pait. He's a Neurosurgeon and Professor of Neurosurgery and Orthopedic Surgery with UAMS.

Scott Webb (Host): This is UAMS Health Talk, the podcast from University of Arkansas for Medical Sciences. I'm Scott Webb. Doctor, it's so great to have your time today. I was just mentioning that I have a little bit of familiarity with hearing aids in that both of my folks have hearing aids and they've spent thousands upon thousands over the years and tried this and tried that.

And so what we're going to do today is just try to give folks some idea, especially when it comes to over-the-counter hearing aids when they walk into their local pharmacy or Costco or wherever they're going, you know, what they can expect. How we got here in terms of FDA approval. So maybe let's start there. Why did the FDA decide to approve the sale of OTC hearing aids? It seemed like it was always kind of a specialized thing before, and now you can, you know, walk into the store and get yourself some hearing aids. So let's start there. Why did they approve OTC hearing aids?

Thomas Glenn Pait, MD: The bottom line here is it's the number of people who are now having hearing problems in the United States. And you think about this, 30 million Americans are now having problems hearing, and only about 20% of those have any hearing aids at all. And this number, young, older people, that number is growing and it's causing some unknown harmful effects for individuals, particularly on brain health. And I can tell you the physicians, myself included, and nurses and physical therapists and chiropractic doctors, we're not talking about hearing loss and the problems that are now coming about with hearing loss. And I know every week I go in to see a patient and I, I start talking and there's a loved one, a husband, wife, or others, and they go doctor, doctor, doctor, you, you got to talk up a little bit, because they just can't hear you.

 And so I go through the whole consultation and then I sit down later as the patient's gone. I go, you know, I forgot to talk to him about hearing and hearing loss impacts the quality of our lives. And two things that are very difficult to do in life is, one, the ability to communicate, and two, to understand that which has been communicated.

So if you can't communicate and understand, you find yourself isolated. And this leads to communicating and difficult times with friends and families and colleagues. And you get lonely and you get isolated, and then depression, and then anxiety comes about and you're embarrassed and frustrated. And then safety concerns.

I, I don't think you can walk down the street without seeing somebody with a cell phone. And what are they doing? They're relying upon their ears to keep harm away. So safety concerns. And then there are growing concerns nowadays that there is a cognitive problem going on, a decline in memory and reasoning. Here's the thing. This is the big crux of this thing to get to the question is dementia. And for our early adulthood and middle life, if you have hearing loss, you have a greater chance of having a dementia later on. And some 55 million people will be challenged with dementia and hearing loss is a top modifiable risk factor for dementia prevention. What do you think about that? If we prevent hearing loss from people, we can help prevent dementia.

Host: That's amazing. That's,

Thomas Glenn Pait, MD: It is, it's,

Host: One of the things I love. Yeah. I love about having experts on. It's what I love about this job so much is learning from experts, and I'm sort of shaking my head. I'm thinking, well, I didn't know that.

Thomas Glenn Pait, MD: Yeah. You never thought how important hearing was and it contributes to about 8% of all the new cases of dementia. So I don't think there's anybody out there who would say, well, gosh, if there's a way for me to prevent getting dementia, I'm going to do it. And preserving hearing and doing something about hearing loss is incredibly important. The hearing impairment causes serious consequences, and that's why experts decided we're going to put some pressure here and there to find cheaper devices. And devices that are easier to get. And, those are over-the-counter hearing aids. Now, these over-the-counter hearing aids are not for everybody.

It's for mild to moderate hearing loss. So you got to put that. And this is a new category, a total new category. You can, you can go to a store now. And you can buy them directly. You don't need an audiologist or an otolaryngologist or any prescriptions. And you can get them over the counter.

Now, if you call your pharmacist up and I, I've called several pharmacy folks and said, Hey, do you have some of those over the counter hearing aids? And they don't.

Host: Hmm.

Thomas Glenn Pait, MD: And I've also asked, do you plan to sell the over-the-counter hearing aids? And they say, no. We're not planning to do it. I have found two places and I have no interest financially, but Sam's and Costcos, are now selling these things. But you got to be very careful. The FDA requires that there is an over-the-counter label. And that's because, you may find yourself looking in one category and say, oh my gosh, this is one third the price of this other thing over here. And that's because it's nothing more than a hearing amplifier.

And you see these hearing amplifiers advertised particularly on television, people watching TV, and now they can hear better with them, but it's just an amplifier. So that's...

Host: yeah, it's just making, uh, yeah, just making things louder. So how does someone then know, if it's the right time to even explore, you know, to head to their local pharmacy to see if they're selling them. How do we know when our hearing is bad enough to need something? And in this case, the over-the-counter options.

Thomas Glenn Pait, MD: What'd you say? What'd you say there? No, wait. What'd you say? Uh, can you talk a little louder for me?

Host: Can you speak up a little bit there, sonny?

Thomas Glenn Pait, MD: Yeah. Can, yeah, can you just talk a little louder just for me? I, I, I didn't know you were selling toothpaste today. See, that's that the problem we have where you, you turn the TV up or the radio up higher, you're traveling down the road and you don't hear the noises the way you used to. I think you, you've got to say, well, something's going on. And then when you find yourself with friends out eating, particularly in a noisy, crowded place, and you miss half of the conversation. You got to do something about that cause you're going to lead yourself down the road to being isolated and depression.

Now these hearing aids, they're for individuals who have loss due to damage to the small sensory cells in the inner ear. And we know these as the hair cells and we lose these hair cells sadly as we get older. And then loud noises. A lot my generation, the boomer generation, my gosh, we couldn't go anyplace without maxing out on the speakers, you know, and you couldn't go into a room or a dance or a stadium without the noises.

And then medications can also cause hearing loss. Uh, the most common medications we see that will damage the ear, aspirin, that's a very common one, non-steroidal anti-inflammatory medications like ibuprofen. That can do it and antibiotics can cause some loss. And of course, some of the chemotherapy agents that are used can cause loss.

So when you lose these small sensory cells in the inner ear, you don't hear as well. And the surviving hair cells, they need to detect sounds. So the sounds have to be larger and then the sounds are converted into neural signals. And those are sent along to the brain. The more hair cell damage you have, the more amplification you're going to need.

And so it's going to be somewhat limited with what these things can do.

Host: So I'm assuming then that the nicer ones, the more expensive ones, the ones you can't just walk into your pharmacy and buy; I'm assuming that there's more to them, that they're more sophisticated, that they're more customizable for people than the over-the-counter versions. So if folks, you know, try the OTC versions and they don't work, then what are their options? What's your best advice about what they should do next to get what they need?

Thomas Glenn Pait, MD: I think you're absolutely right. Before you buy an over-the-counter hearing aid, you've got to do some of your homework. I found at least a dozen different manufacturers are in the market now. And the most expensive doesn't always mean the best one for you. So you got to do your homework and find out what's going to be good for you.

Some of these stores, I think, again, Sam's and Costcos, I'm told, will have someone there to, to help you out. But remember, over the counter means out of pocket. And so you ...

Host: No prescription, no insurance, right.

Thomas Glenn Pait, MD: No, no, no. Scott. The insurance is not going to pick up any of this regardless of what type you have. But, you've got to check the warranty. You've got to check to see what updates are going to be provided down the road. Now let's say, you buy one of these devices and you go, oh my Grace, this is wonderful. I can hear and jumping up and down, and two weeks later it's not working. What are you going to do? I just spent several hundred dollars for this thing.

And, you go back to the store and they go, well, you got to send it to the manufacturer. Well, you can actually go to an audiologist and they can evaluate this for you. But again, remember it's, it is out of pocket that, that you're going to be dealing with the examination you will need. And also looking at the device. There's no insurance for this.

When you go see an audiologist or an otolaryngologist, some of these hearing aids will be picked up by insurance. And, you got to remember also, Medicaid only pays for children. So if you are 47 years old and you have some hearing loss and using Medicaid, you're kind of out of luck with that.

You've got to check your own insurance policy to make sure you're going to be covered. Just to remember, I want to emphasize over the counter means out of pocket. So you've, you've got to do homework before you go in and just buy it.

Host: Yeah. And we hope that podcasts like this will help folks to, you know, do some of the educating, you know, for them. Because, you know, if you're just taking it upon yourself to say, well, I'm having some trouble hearing. Let me go see what they have at Costco. Okay, fine. And those may or may not work, but as you say, they're out of pocket.

And the likelihood of having insurance pay, especially for the more expensive, more sensitive, whatever, more technologically advanced ones. You got a better shot if you've been to an audiologist, if you've been to a doctor, if you've, you know, gotten a prescription, if you will. It's a lot to take in here and a lot to accomplish in one podcast, but just want to give you an opportunity as we wrap up here, when you think about hearing loss, globally, but here in America for sure. And the options for over-the-counter hearing aids versus maybe the better, more expensive ones; what would be your best advice? Final thoughts and takeaways, Doctor?

Thomas Glenn Pait, MD: One, I think you have to determine what type of hearing loss you have, whether it's a problem with the ear itself, hearing aids are a worn inside the ear. And then there are devices that otolaryngologists, will place outside the ear. And some of those things, a fancy term is an osseointegrated system.

So you need to see somebody for that. And just remember not all hearing aids are going to be good for you, so you need to see a professional about this. Also discuss any type of hearing changes with your doctor. There are newer technologies coming about. There are smaller hearing aids. I have patients who come to see me and they have hearing aids, but they don't want me to see them, because they're ashamed of them.

Hearing aids are an important part of one's life, particularly with hearing loss. If there's a, an individual that can't hear well, I encourage family or friends to speak to them about it and to get the help they need. Because here it is, dementia. Nobody wants, 55 million Americans will have this. And now we have a way to help prevent some of that dementia, and that's by maintaining our hearing.

Host: That's the most important takeaway for me today. Doctor, your expertise here in understanding the connection between hearing loss and dementia and how we could slow the progression, or prevent it perhaps. Maybe OTC hearing aids are the option for some folks.

Maybe worth a shot because of their low cost. But in the end, you know, folks really probably should see a specialist, to figure out what's going on, how best to address it. So appreciate your time, your expertise today. Really educational. Thanks so much. You stay well.

Thomas Glenn Pait, MD: Well, nice to be with you and take care and, and keep on hearing.

Host: And visit uamshealth.com for more information. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest.

This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Scott Webb. Stay well.