>> LAURIE SCHALLER: Thank you for joining us today.
Over-the-counter hearing aids and what you need to know.
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Welcome.
This is the assistive technology loan program.
My name is Lori.
I'm a manager here and I work in the assistive technology loan program.
National disability Institute the society in which people who have a disability.
Financial stability and independence as people who do not have a disability.
Our mission is to collaborate and innovate to build a better financial future for people with disabilities and their families.
So.
Our services through the assistive technology loan program include outreach.
Providing these promotional webinars.
Providing financial education and guidance on spending plan development.
We provide referrals to financial counseling programs where other services that can help people get the assistive technology that they need.
We received a grant through the U.S. Department of Education's rehabilitation services for this presentation and our programs.
Today we welcome doctor Ed Bravo who will cover information about different kinds of hearing aids including over-the-counter hearing aids and services that are important to helping people select hearing aids and services that will best meet their needs.
This recording along with our assistive technology spotlight webinars are recorded and will be posted to our website probably within the next week for future viewing.
So.
I would like to welcome doctor Ed Bravo and yourself can tell us about your hearing services.

>> DR. ED BRAVO: Thank you so much for inviting me.
It is a pleasure to be here.
Based out of New York City was just in Connecticut.
So we have five locations.
Initially I started computer science but I was working with my uncle.
Hearing aid practice in the Bronx, New York.
I became so passionate about helping people especially at that time we were helping regain their hearing by fitting them with hearing devices.
That I felt that was my calling.
Being able to help people to improve their lives.
To improve communication.
I found that to be an excellent and great way for me to make a living.
And I'm so lucky that I have been surrounded by a great team of very professional people.
That we continue every day helping thousands of people in the area improve their lives.
For over 30 years.
I have been dispensing devices since 1986.
It has been a while.
We have seen dramatic changes in hearing aid technology.
And we have seen how every year new technology is making it.
Slightly better than the year before for people with serious hearing difficulties for my hearing difficulties.
We have been able to improve the way we fit them.
For us to understand the different difficult situations we have to give every day.
More and more patients at a younger age are looking at it as more of a stigma about getting help for hearing.
I am really looking forward to asking any questions people may have over hearing devices and hearing aids.
Different options for people who are hearing impaired.
So.
The objective of this presentation is to give potential patients or clients information about the recent introduction of over-the-counter hearing aids.
This will help you make informed decisions to purchase these products.
The over-the-counter hearing devices or prescription next slide.
Hearing loss has one of the highest incidences in the United States.
What we call significant hearing loss.
Ages 65 to 74.
Ages 75 and older have disabling hearing loss.
By disabling hearing loss we talk about hearing loss that is keeping patients from hearing important speech sounds and has an impact on their ability to comprehend speech.
It doesn't mean they don't hear anything.
There are significant numbers of speech sounds or absolutely not being heard.
In 2016 and the American Journal of Public health found two thirds of adults over seven years of age have hearing loss side effects communication that is a tremendous number.
The incident in seniors is extremely significant.
One of the main problems we found is that less than 20 percent of those with significant hearing loss are getting any help to address this problem.
Why is it that so little is done to treat hearing loss?
Historically, prescription hearing aids generally cost between $1000-$4000. Very few insurance companies provide significant reimbursement for the purchase of hearing aids.
We are finding that this is getting worse as time goes by.
As people are moving from some of these managed insurance programs.
We are finding that whatever little benefit they have has been cut dramatically and that they don't cover any of the services necessary to make sure the patient is successful with the hearing aid fitting.
Next slide.
Trying to address people and getting hearing devices.
On August 17 new category of hearing aids over-the-counter or OTC hearing aids.
The call was to improve access to safe, effective and affordable hearing aids. The objective of this 6052 must make hearing aids more accessible.
Affordable to most Americans.
And they recognize the over-the-counter hearing aids have a different type of device than prescription hearing aids.
Next slide.
The difference between prescription hearing aids and over-the-counter hearing aids.
Whenever you go to it, hearing health care providers, the instrument specialists, there would be a medical of some sort.
The first thing they will do is get a history.
With the patient to understand the communication difficulties they are having and also to understand the personal lifestyle.
Or the activities they enjoyed, what kind of obstacles they are experiencing in their daily life.
And also what are their preferences as far as what it is that they are looking to obtain to overcome the hearing devices.
Once we have the examination of the year.
We look inside the ear canal looking for any medical issues including wax.
Ear infections are any kind of sign of an issue that will require medical intervention.
After that,
We do the hearing tests in a soundproof room.
What are the hearing levels in each ear separate?
How do we have to make the sounds of each frequency for the patient to be able to hear that?
We compare that to what is a normal definition of hearing.
In addition to that level.
We are looking at clarity.
Comprehension.
We measure.
Once we make all of the sounds audible.
How clearly does the person understand speech?
These are two differences of hearing loss.
A big difference between the reality.
And a hearing instrument and a specialist.
Has to go through at least 6 to 8 years of training and understanding the anatomy of the psychology of hearing loss in addition to understanding technology and how hearing aids work.
Usually instrument specialists might perceive maybe a year of training.
And is mostly based on the selling of hearing aids.
Bring a different perspective.
To these services.
Next slide.
So.
On the right here.
If you could see we have an example over here.
The red circles are the test results with the right here.
Which would be perfect hearing.
The kind of hearing that you have.
Further down the graph.
More hearing loss in retrospect.
This would be a cause for the medical evaluation based on the results of the clinical by the realities.
In medical intervention, we will be recommending a solution that is best for the patient.
It could be hearing devices.
It could be hearing aids.
It could be in the canal hearing aids.
That goes inside the ear.
Different assistive listening devices such as a TV streamer or remote microphone that can be used with the patient.
We will have a program to make sure that the patient is successful.
So usually a patient with a hearing device.
One week or two weeks for adjusting the instruction.
The time of hearing devices.
For the year.
Repairs.
So if the hearing is damaged the hearing aid has to be sent to the manufacturer.
And our practices will come.
They will get a longer set of hearing devices.
The hearing aid was repaired and that is all included in the initial cost.
The expenses for the patient.
With all of our practices we see patients coming anywhere from 3 to 4.2 times per year.
There are patients that come a lot more often than not.
We encourage people to come in.
Many times we find that experienced users sometimes come to our office and they haven't noticed that one of their hearing devices has not stopped working.
And sometimes it is hard to tell whether it is the human that is getting worse or the hearing aids.
They don't know they can find out what it is.
It is a quick inspection of the ears.
A quick inspection of the hearing devices will tell us if we need to do further cleaning of the ear canals.
If we need to adjust the settings on the hearing device.
Many times we just need it to clean them.
Next slide.
What are over-the-counter hearing aids?
Or OTC hearing aids?
These are hearing devices that can be purchased without a description.
They can range in price from 250 or about 4000.
Most of the over-the-counter hearing devices come with different types of hearing models.
They are the over the ear models.
And they are the in the ear models.
Some go behind the ear others sit inside the ear canal.
You can find them typically in outlets.
Outlets such as drugstores.
Mass merchandise is like Costco, Walmart.
Best Buy.
So.
A lot more different points of self have entered in the last couple of years.
Offering different manufacturers in different types of hearing aids.
Next slide.
So.
I know that people wanted to know okay.
Can you tell me about the different brands and more information about batteries and hearing aids?
Rechargeable hearing aids?
As an example.
We have the retail price of 1995.
They have fruit returns for 100 days and a one year warranty.
The retail price is 799.
The 145 day trial.
And we have a one year warranty.
These two are over the year with a little wire that goes inside the ear canal.
These are either behind the ear or receiver in the canal if at the end of the wire the speaker is delivering the sound into the ear.
You also have an example of the canal hearing aids.
It retails for 2950.
It has a system so that you put that in the little recharges.
So the batteries are even though they are exchangeable.
They are rechargeable.
They have a 40 day trial.
And they can have up to a two year warranty.
These are some of the most popular devices out there as far as over-the-counter.
Next slide.
Number It retails for about 699, 98.
Comes with a 45 day trial.
Two year warranty and these are rechargeable.
Sony came up with the canal hearing aids.
They retail for about $1000.
They are rechargeable and they have a one year warranty.
Here they sell a set for about $110.
They are rechargeable and they have a one year warranty.
So.
As you can see from these examples.
They can range anywhere from $700 right there all the way to $2000 for the pair.
Next slide.
So.
Again every month they are coming out with new models.
And new points of sale.
So.
Price returns ability.
They all have to follow characteristics.
They are mostly indicated for patients with mild to moderate hearing loss.
So three of the losses are not that severe.
They all pretty much amplify most of the sounds.
Meaning they are not as selective in what kind of frequencies.
I will explain a little bit more about that in a second.
They are self fitting.
There is very little or no assistance from a hearing care professional or retail store personnel.
They can be purchased without a hearing test.
So the patient determines the level of hearing.
And again.
There are many different levels of technology and many different ways of getting there.
But one of the common factors is you regularly will see a face to face hearing health care provider helping you fine-tune and program the hearing devices.
It is specifically for your hearing loss.
They tend to be more amplifiers and make louder.
They are not specific for certain frequencies.
Hearing loss is different from person to person.
People have the same degree of hearing loss.
They may have a different perception of loudness.
So.
With the same.
Recall audio graphs.
Showing the degree of the laws.
Women find they need significantly more loudness at certain frequencies.
You have other people with the same type of loss and maybe find that the sounds are overpowering or extremely annoying.
So.
There is the need for personalizing the feeling according to the patient.
So.
Some of these over-the-counter hearing devices use the audio graph as a starting point.
But they cannot be fine-tuning specifically for the particular patient.
Now.
They don't have the same scrutiny as prescription hearing aids.
They just have to have some basic characteristics.
But they don't have the same detail and the same technology as the prescription hearing aids need to have to be certified properly by the FDA.
So.
One of the main tragedies of prescription hearing aids is that they are more focused on improving speech clarity.
Which is for the most part what people are looking for when they are looking for hearing devices.
They stay in a quiet room.
If I look at the person intensively,
I can do fine.
They don't have accents.
They complain about having difficulties.
Understanding speech.
When there are multiple talkers or when the risk background in a group setting in a restaurant.
Fine-tuning the hearing devices, specifically the situations, makes a huge difference amplifying all of the sounds.
That's when patients find that they were the hearing aids but everything sounds louder but not clear.
So for over-the-counter hearing aids,
Pretty much the patient has to figure out what the problem is.
And they have very little recourse as far as reaching out to getting help.
Many times they complain that they call and call and call back many times and many times they send the hearing devices back.
Talking to some of the manufacturers of over-the-counter hearing aids.
They're talking about more than half of the hearing aids that are being purchased are being returned for credit.
They are finding there is something missing in this delivery model.
The OTC hearing aids offer the lower level of technology which is the reason for the lower price compared to the prescription hearing aids.
Next,
So.
We visited some drugstores to see if they needed help for some of their patients who were hopefully buying hearing aids for them.
But we found that there are very few takers.
People don't find a drugstore a good place to buy items.
Sometimes it will be in the thousands of dollars.
So in drugstores.
Hearing devices are OTC hearing aids and would be the most expensive item.
People expect to get help from a pharmacist.
But the pharmacists are not trained to work with patients or assist them in selecting the hearing aids.
And there is no designated place in the pharmacy for people to try this hearing aid.
Next,
So.
What do we believe to be the future for over-the-counter hearing aids?
Well, I think we are in a trial.
Now.
Recently I had a conversation on Monday with one of the major manufacturers and they were very disturbed because they were hoping they would be doing better.
The number of hearing devices being returned for credit.
And the fact that the sales are not increasing as we were hoping for.
Is cause for concern.
Most over-the-counter hearing aids are not comfortable to wear.
Because they have not been properly customized for the ear canals.
They only provide help with people with my mild hearing losses.
The technology does not help for clarity correction.
Which is what most people are looking for.
Which is the main reason why prescription hearing aids have like 80 to 90 percent level of success.
Patients with prescription hearing aids over 90 percent of them keep them and are happy with them.
Having a consultation with a professional definitely makes a big difference in maximizing the benefits of over-the-counter hearing aids.
But we are not sure how to introduce that aspect in the current model of the distribution of over-the-counter hearing aids.
Many patients also complain that when they are outside the noise is so loud they are having difficulties carrying a conversation.
And earwax.
Earwax in the ear canal is always an issue.
We know those who have been dispensing hearing devices for many years.
That is the reason why we want patients to come three or four times a year.
So we are constantly cleaning the hearing devices.
Making sure they are working properly.
And helping patients with their ear canals to prevent this promise from recurring.
So.
Until this has been taken care of.
It requires face to face consultation.
I don't see how this is going to be something we are going to be able to take care of and be able to see the market.
And again.
Most insurances.
Use insurances to not cover over-the-counter hearing aids.
Our goal would be for insurance companies to provide more coverage.
A higher amount of benefit for people who need hearing aid so they can see a provider face to face.
Next slide.
So.
What Did they say?
There will be some people with hearing loss that would be helped with these hearing aids.
But also a large number of people who try them do not achieve their objectives.
A significant percentage of these people hopefully get a proper exam.
Effective counseling.
Earwax removal.
And ultimately get a set of hearing aids that would mean there is a specific personal need.
So.
We are open for questions.
We hope you found this presentation helpful.
We want to make sure that in this meeting or if you give us your information.
We reach out to you and provide you with specific answers to your questions.

>> LAURIE SCHALLER: We have a question in the Q&A.
When you express the retail price of the over-the-counter hearing aids.
Is that per year or five pairs?
For example for the job retail price of 1195.

>> DR. ED BRAVO: That is for the pair.
Most of these prices that I present are for 2 devices.

>> LAURIE SCHALLER: Great.
I want to again invite people to ask your questions in the Q&A.
I have another question that came in.
So.
You know, whenever I try something new.
It takes me a while to get accustomed to it.
And I think there is a lot of interaction between the brain and the actual hearing apparatus in our heads as well.
And we need to give time to learn how to use a hearing aid.
Can you provide some insight to that?

>> DR. ED BRAVO: Absolutely.
That is what we experience every day when we are sitting with our patients at our clinics.
The brain needs time to adjust.
Even better hearing takes some time getting used to.
Many times we start a lower prescription that ultimately we want to achieve.
To give the brain time to acclimate to new sounds.
It could be overpowering for you to start hearing the screeching of the chair.
The floor, footsteps.
Many people open the faucet and it is described as Niagara Falls.
It does take time to adjust to them.
Sometimes we get 45, 30, 45.
Some of them 800 days, 90 days to adjust.
But there is very little intervention.
The problem is that people are experiencing where the hearing devices are reviewed . That is one of the concerns.
And they tried to get help remotely.
It is very hard for the person who is trying to help these people.
To really identify with the problem is.

>> LAURIE SCHALLER: And then.
We have a question.
How long is the typical trial?
For over-the-counter hearing aids?

>> DR. ED BRAVO: Anywhere from about 30 to 45 days.
All the way up to 100 days.
Another question is is an audiologist better than seeing an instrument specialist?
Yes.
In my opinion absolutely.
Initially when I was going to school as a hearing instrument specialist.
Now I recognize I knew very little.
I thought I knew a lot.
Once you are studying audiology.
You see multiple dimensions involved in prescribing hearing devices.
He realized the more you know.
The better equipped you are to understand the patient's needs and to address them properly.
So.
I always find a doctorate profession.
Used to be with a Masters degree.
That has changed in the last 10+ years.
You need to be adoptable.
There is so much information.

>> DR. ED BRAVO: We are always ready to reach out to anyone who may have a question.
By all means go ahead.

>> LAURIE SCHALLER: Great, thank you so much.
I meet lots of people.
They are concerned about maybe their children.
Earbuds and listening to music all day long.
More hearing loss at a younger age do you have recommendations for how people can protect as important as their hearing.

>> DR. ED BRAVO: We have worked with manufacturers including Apple and Sony to create maximum limits on the sound that comes from the devices.
There was a time where they didn't want any interference as far as how loud their earbuds or earphone devices were.
We actively fought to create limits because we knew that some, especially young people, were listening to music.
Sometimes in a noisy space.
Such as a subway and the strip and there was a lot of noise.
They were cracking out the volume on their devices.
To a level that it was damaging.
One of my recommendations if you like music is loud.
Make sure that you take a break every 30 minutes and give your ears arrest.
It is very important that you do that.
There are some noise cancellation devices that help remove the outside noise.
When you are able to do that.
You don't have to raise the volume of your particular air pods to a level that is damaging to your ear.
Devices that go inside the air.
Some of them.
They create better insulation and isolation for outside noise.
Again if you're not competing so much with the outside noise.
You don't see the need to raise the volume very loud.
For people whose job it is to play music there are some specifically designed ear monitors like many of the ones being used by musicians that would allow you to keep track of the music being played without damaging your hearing.
So if this is what you do for a living or if you spend a significant amount of time in a place where there is very loud music.
I would absolutely encourage you to look for ear monitors to help you conserve your hearing.
Always consult with an audiologist.
If you ever go to a place where the volume of the noise or music is so loud that you come up with a place with a ringing in your ear.
You have exposed your ears to damaging levels of noise.
You need to use noise protection the next time that you are in a setting like this.
Even if it is the regular foam earplugs that you get in your ear.
Reaches this high level.
Think of the hair cells in the inner ear.
Processes and sound as grass.
Then they will recover.
Would die down and would not recover.
That is how you lose your hearing.
Those hair cells have reached a level where they cannot recover and they are permanently damaged.
At this point in time.
There is no cure for that.
That will reach the hair cells in the inner ear.
You should start by preventing this time to begin with.
By using noise protection.

>> LAURIE SCHALLER: Very good.
I see we have a question.
Is there a way to properly clean all of these ear devices that we are using now.
To help protect our ear canal?

>> DR. ED BRAVO: It depends on the device that we are using.
Some of the foam tips on some of these devices.
We recommend changing them periodically depending on how often you are using them.
This could be two or three times per year or one time per year.
But if you are using these devices all the time and touching them with your fingers.
It is likely to generate some bacteria and possibly some ear infections.
So you have to be careful with that.
If there is hard plastic.
Sometimes you can use a little bit of alcohol.
But don't do this too often.
It should not be done on a daily or weekly basis.
Maybe once a month.
There are different ways of caring for these pods.
Make sure your hands are clean before handling them.

>> LAURIE SCHALLER: Thank you so much for your time.
They gave today's presentation.
If people have questions you may give me a call at 202449 9521.
Everyone had a great day.
Thank you again.
>> DR. ED BRAVO: Thank you.
>> LAURIE SCHALLER: Thank you.
>> DR. ED BRAVO: Bye-bye.