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Hearing loss is a direct link to dementia. Easier access to hearing aids could help

AYESHA RASCOE, HOST:

Over-the-counter hearing aids - no prescription necessary - could be at a store near you this fall. That's because the Food and Drug Administration decided last week to create a category of OTC devices for adults with mild to moderate hearing loss. It's expected to drive down the cost - good news for millions of Americans who need the devices but can't afford them. And it's not just the ability to hear that's important. Dr. Frank Lin has been researching the effects and risks of hearing loss for years. He's the director of the Cochlear Center for Hearing and Public Health at Johns Hopkins in Baltimore, and he joins us now. Welcome.

FRANK LIN: Thank you so much, Ayesha.

RASCOE: So first, do you have any idea how many Americans with hearing loss actually have hearing aids?

LIN: It's roughly about 15 to 20% of Americans with hearing loss actually report using a hearing aid. It's phenomenally low, and it really hasn't changed in many, many years.

RASCOE: Medicare doesn't cover the cost, which can average about $4,700 for a pair of hearing aids. And most insurance plans don't cover it, either. I would think that that would be a barrier for some people - that amount of money.

LIN: Forty-seven hundred dollars - to put that in perspective - for the average American, that could be your third-largest material purchase in life after a house and a car. But I'll say, in the same breath, though, it's not only cost - issues of access, the only way to get a hearing aid per se now is to make multiple trips to see an audiologist or an ENT like me and, you know, multiple trips thereafter to get fit and adjusted. And then beyond that, there's issues where people don't think hearing is important. They think it's just a - you know, it's a usual process of aging, and hence, it's inconsequential. And there are issues with obviously just the technology themselves. Why - if you spend so much money on a hearing aid, why doesn't it work seamlessly with my - let's say my phone and my computer and my TV, for instance? But without a doubt, cost is - and access are probably the biggest issues.

RASCOE: So you and your colleagues have studied other health risks associated with hearing loss. What has your research found?

LIN: About a decade ago, we began a series of research studies. And we increasingly found that hearing loss was strongly linked with your risk of dementia. And to this day now, based on all the studies over the last 10 years showing that hearing loss is arguably the single largest potentially treatable or potentially modifiable risk factor for dementia.

RASCOE: Do we have any sense of why that might be the case? Because some people may be listening and be like, well, what does hearing have to do with dementia?

LIN: (Laughter). You know, you're absolutely right. I mean, like, you know, hearing loss affects, like, the inner ear - your cochlea. And dementia is about your brain. How could they be related? But it comes down to probably arguably three major mechanisms. So the first mechanism is basically that hearing loss likely imposes a load on the brain. And what I mean by that is when you can't hear well, when you have had some aging of your inner ear, it basically means your brain's constantly getting a much more garbled sound from your ear. And in turn, what the brain has to do to consciously decode that sound is the brain has to sort of throw more brainpower at it. And when the brain has to do that, those brain resources may come at the expense of other systems, like our thinking and memory abilities.

The second idea is related but actually is very different. And it's the idea that hearing loss actually does directly affects the brain's structural integrity. Parts of the brain that are used to receiving sound begin to atrophy faster. And we actually see this now not only in animal studies but in human studies. And finally, the third idea - and again, the thing I need to emphasize is these ideas aren't mutually exclusive - not that one's right; other ones are wrong. It's likely a combination of all three. The last ones the most intuitive. And it's the idea that, you know, for some people, if you can't hear very well, you might be more isolated and hence lonely. And in turn, for many, many years now, we've understood that social isolation and loneliness likely directly affects our risk of cognitive decline dementia, mainly through loss of cognitively stimulating activities but also just a loss of engagement with the world around us as we become sort of more pigeonholed at home sometimes.

RASCOE: Will the over-the counter devices - will they be good enough to actually address Americans', like, hearing loss issues?

LIN: Absolutely. And I've been working on the over-the-counter hearing aid legislation regulations literally for eight years. And the regulations, fortunately, are such that they can benefit people up to a moderate hearing loss, which basically means among American adults with hearing loss, fully about 90% of people, if not a bit more, could be served by OTC hearing aids in terms of the sound output levels, which just makes it incredibly exciting because all of a sudden, in one fell swoop, you're going to see innovation. You're going to see competition. You're going to see increased access. And you're going to see lower costs. So it's really a win, win win all around.

RASCOE: Are there any concerns about buying hearing aids at the store the way someone might get some reading glasses? Is there any risk to this?

LIN: Yes, and you're talking to a surgeon here. So everything from a surgeon's point of view is, you know, benefit versus risk. So are there risks, you know, risk of someone underamplifying their hearing loss or overamplifying their hearing loss or maybe missing, like, some type of weird hearing condition? Yes, that's always theoretically a risk. The question is, is it outweighed several orders of magnitude by the benefits? And, you know, I think the best line about all of this comes from Stephanie Czuhajewski, who is my friend and colleague. She said, you know, the only way an over-the-counter hearing aid is going to kill you is if you swallow it. And I think it's absolutely true. It's just a hearing aid. It's not going to kill you.

RASCOE: That's Dr. Frank Lin, director of the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health. Thank you for talking with us today.

LIN: Absolutely. Thanks so much, Ayesha. Transcript provided by NPR, Copyright NPR.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.