As we look ahead to the new year, what challenges and opportunities will hearing care professionals experience? In this roundtable discussion, members of The Hearing Review editorial advisory board share their perspectives and predictions and what hopes they have for the future of hearing healthcare in 2024, and beyond. Participants include David Akbari, AuD, senior medical science, regulatory, and clinical affairs liaison at Intricon; Douglas L. Beck, AuD, audiologist and consultant; Marshall Chasin, AuD, owner of Musicians Clinics of Canada; and Shari Eberts, hearing health advocate and author and founder of the Living With Hearing Loss blog.
The Hearing Review: What do you plan to focus on in hearing healthcare in the coming year? And what do you hope this will help you accomplish?
David Akbari: The main thing I plan to do going into 2024 is to leverage my role as chairperson of the American National Standards Institute accredited Acoustical Society of America Sound-focused Working Group 48 (ANSI/ASA S3/WG48) to facilitate the release of a new version of the ANSI/ASA S3.22 test standard. This is the standard that is used for outgoing quality control of prescription hearing aids (and over-the-counter hearing aids by reference). This standard is very important to hearing healthcare as a whole because it provides a method by which manufacturers can ensure that hearing aids that are shipped from manufacturers to their final destination meet a relevant set of quality measures to ensure they function correctly.
We are moving expeditiously toward the balloting and release process, and I would expect the new version of the standard to be released sometime in late Q1 2024.
In releasing a new version of the ANSI/ASA S3.22 standard I hope that outgoing quality control inspection will be aligned with the new post-OTC reality we find ourselves in. ANSI/ASA S3.22 is a key standard for both prescription and OTC hearing aids and was last substantively updated in 2014 with a reaffirmation in 2020. Many things have changed since 2020, and it is my sincere hope that we continue to drive the profession forward through developing a robust standard process for testing hearing aids.
Douglas Beck: I think the two most important aspects which I will focus on in 2024 are to always follow nationally recognized best practices (such as AAA, ASHA, IHS) and to always perform comprehensive audiometric evaluations. I have written quite a few times about why we need to stop doing hearing screenings (except newborn-infant screenings, which are very worthwhile!) as licensed professionals. Rather, it is apparent to me we must practice at the top of our license with Best Practice functional and measured outcomes driving our decisions. Basically, it boils down to treating the patient as we would like to be treated: with compassion, empathy, expertise, and a full clinical profile to guide our outcomes-based counseling and technology recommendations.
Marshall Chasin: Of the various people answering these questions, I am the only Canadian. While there are many differences between how hearing healthcare is delivered in Canada and the United States, there are some similarities as well. Like in the United States, hearing healthcare professionals in Canada do not have direct access to adequate funding for their services. As a result, clinical programs and services tend to be more geared toward those that are “cost efficient.” Aural rehabilitation is one such service that comes to mind.
While it can be argued that aural rehabilitation is part of the cost of hearing aids, this is not an easy “sell” to the prospective client. Nevertheless, aural rehabilitation is included for all that chose to avail themselves of this program. Having improved access to funding will result in both the quality and the quantity of services and programs being delivered.
Shari Eberts: 2024 should be an exciting year for hearing healthcare. The industry must continue to expand treatments to extend beyond the hearing device and to adapt to a more educated consumer—one who wants to be a partner in their treatment plan. In 2024, I hope to continue to share the patient perspective with those in the hearing care industry. My goal is that over time providers will reach beyond the hearing device in their practices to include the many other strategies people with hearing loss must use to communicate and live well. When practitioners share these skills, not only do their patients live more effectively with their hearing loss, but it also strengthens the client-provider relationship.
HR: What challenges and opportunities do you see on the horizon?
Akbari: While there are many challenges on the horizon, the biggest challenge I see going into 2024 is also the biggest opportunity; improving public health literacy around hearing aids while chipping away at the lingering stigma surrounding the daily wear of hearing aids. I have been very energized throughout 2023 to see some of the exciting research linking cognitive outcomes to the use of hearing aids. I hope that this great work continues, as it serves as an important area of leverage to get people to care about their hearing as a sensory modality that contributes to a whole person, rather than something that can be ignored because “it isn’t too bad” or “I don’t need help yet.”
I am very optimistic that as the new regulatory framework around hearing aids has solidified and new examples are emergent, patients and consumers will start to see the care and maintenance of the hearing sense as a lifelong journey toward better health and wellness of a whole person, which will lead to a long and flourishing life filled with joy and social connectedness.
There are many other practical challenges that exist going into 2024, and one that is worth pointing out is that many industry players are lacking good tracking data with regard to OTC hearing aids—whether this means sales, use, returns, or something else. This represents a tremendous challenge to the industry because the incentive structures will all need to be realigned to reflect the current reality. Perhaps one of the opportunities coming out of the regulatory reclassification of all hearing aids in the aftermath of the OTC final rule is the opportunity to re-establish and re-define the incentive structures around tracking hearing aid key performance indicators in a general sense. I am optimistic that the top minds in the field are going to try to figure this out.
You might see new methods of tracking embedded within the hearing aid itself commensurate with increasing levels of connectivity to be able to leverage hearing assistive technology in new and exciting ways. Think of images of digital therapeutics, health and fitness tracking, or other adjacent consumer electronics in ways that even a short time ago may have been untenable in prescription hearing aids. There are programs, for example, that do not just track what you eat but what triggers your feelings to need to eat. Ideas like this could easily translate to hearing, and the opportunities to leverage this type of thinking for the benefit of the hearing healthcare industry are just beginning to take shape, which is very exciting.
Beck: The challenges we face are the same as they were in the last century; hearing care professionals (HCPs) are often not taken seriously by other healthcare professionals nor the public. Of course, a lot of that has to do with HCPs and hearing instrument sales. As such, we are often viewed as salespeople. Further, when we take clinical shortcuts, when we don’t follow best practices, when we don’t use a hearing aid test box to assure the instrument is within manufacturer’s specifications, when we don’t obtain real ear measures, when we don’t assess speech-in-noise and listening and communication ability, we shoot ourselves in the foot as we reinforce the sales image while attenuating the professional image. The opportunity to provide clinical services professionally and within BP models is there. It’s a choice, and each of us has to choose what’s in the patient’s best interest and how we practice.
Chasin: Most hearing healthcare professionals tend to be amazing clinicians and bring quality services and programs to their patients, day in and day out. But just because a person is a great clinician, doesn’t mean that they also have the ability, or time, to lobby their politicians who are responsible for making policy decisions. Hearing healthcare in Canada is primarily delivered publicly with partial hearing aid funding being available on a province-by-province basis. Private insurance tends to be rather rare in Canada as compared with the United States. It is not in the Canadian psyche to hire professional lobbyists who can ensure that the concerns of front-line hearing healthcare professionals are being heard and considered, but that is something that we need to do. A change in perspective will be required.
Eberts: Hearing devices remain stigmatized and expensive, but there are glimmers of change on the horizon. Over-the-counter hearing aids are now a reality, and while the uptake has been slow, new products and listening features from the likes of Apple and other consumer-tech companies should help provide more attractive and cost-conscious choices for many over time. Hearing aids have also been showing up on television in a more positive light. For example, the vibrant and attractive Golden Bachelor makes a point of displaying his devices with pride. Over time, these positive trends will help break through the cost and attitudinal barriers that often hold people back from treating their hearing loss.
Further reading: Building a Better Model for Hearing Healthcare
HR: What challenges do you feel the field has overcome, and how has this created a better future for hearing healthcare?
Akbari: The biggest challenge the field has overcome I see almost everywhere is the uncertainty leading up to the release of the final OTC hearing aid rule. Through legislative action and a robust public policy debate, we have arrived at the final OTC rule, and critically also the final rule for the reclassification of prescription hearing aids. In the years from 2017 to 2022 when the OTC hearing aid rule was being debated, there was much passion on display from many corners of our industry. So many interests and motivations all colliding to try and engineer the best public policy outcomes for their unique position. Surviving through all of that and arriving on the precipice of 2024 with the dust settled is a huge challenge that the field has overcome. No matter where any group or individual landed on the debate surrounding OTC hearing aids, the FDA has made their determination. Now is the time to embrace the incredible possibilities to shape the future for all whom we can benefit. We have a rare opportunity now, and into the foreseeable future to reimagine what a hearing aid is and looks like, what effective care means, and how we can benefit those we serve. There is tremendous potential that we are just beginning to see and will continue to evolve going into 2024.
Beck: HCPs have overcome some major hurdles. For example, for more than 20 years doctoral education has been the entry level to the profession of audiology. Patients and clinicians have benefited from Scope of Practice clarifications from AAA and ASHA while IHS has done a remarkable job publishing their comprehensive Best Practice guidelines. HCPs were very active in helping the FDA establish some reasonable OTC guidelines and cautions. Many of these changes have improved our clinical skills and services and, most importantly, patient outcomes. Some of the 2024 challenges which will help create a better future for HCPs and patients include the provision of clinical services directly to Medicare patients, new CPT codes for each of our clinical services, reasonable reimbursements for those CPT codes, and more. These changes occur slowly over time, yet—they eventually facilitate quicker and improved access and outcomes for patients.
Chasin: I feel that diversification is not only good for the hearing healthcare professional, but also for the clinic bottom line. The more varied the services and programs there are, the broader will be the care that can be provided. In my own clinic, I not only offer the full range of hearing assessment services, but also a substantial part of my time (and therefore income) is dedicated to hearing loss prevention for those in the performing arts. While counseling and the provision of environmental strategies to minimize the potential of hearing loss in the performing arts is not specifically funded, the provision of specially tuned and filtered forms of hearing protection is.
Eberts: The field has remained strong despite the launch of over-the-counter devices. Unlike some feared, audiologists have not lost customers to these lower-cost/lower-service devices and may even gain new clients over time. For example, as people become used to hearing better situationally, they may desire better hearing at all times, leading them to the audiologist’s door ahead of the 5-or-more-year delay to seeking treatment of years past. The more people who take their hearing health seriously—in whatever form factor they choose—the better it will be for both consumers and hearing care professionals alike.
HR: Is there anything else you’d like to add about your hopes for hearing healthcare in 2024 and/or further in the future?
Akbari: The best way to predict the future is to invent it. Where there is a willingness to serve, there will be a way. Through our shared determination, our field will continue to create and innovate. The human imagination is one of the most powerful forces in the universe, and it has led us from humble beginnings to landing on the moon, and beyond. The opportunities available to those involved in hearing healthcare will continue to grow and flourish. The thing I sincerely hope going into 2024 and beyond, is that we are courageous enough to dream of a better future, wise enough to leverage our evidence-based care approach, and powerful enough to convert the figments of our imagination into reality. If the last year is anything to go by, we are well on our way.
Beck: My hopes for the future are that HCPs continue to evolve, just as all other healthcare professionals do. We must strive for continual improvement by assessing and improving the status quo. We need to continue to create our own future. I hope that HCPs will take it upon themselves to find a better position if/when someone prevents them from practicing in accordance with nationally recognized models. We are only as strong as the weakest link. I’d love to see 100% professionalism among HCPs and that is within our grasp, if we choose to grab it. Professionalism is ours for the taking, or it’s ours so lose.
Chasin: Although this is being done to a small extent, it would be nice to see more public funding of programs that are aimed to educate the public about the prevention of hearing loss, and other programs that underscore the importance of how hearing healthcare professionals are important cogs in health education in general.
Eberts: The future of hearing healthcare is bright. Hearing health is increasingly linked to overall physical and cognitive health, raising its importance for both consumers and mainstream medical professionals. Increased focus will benefit us all.