- Hey guys, welcome back to the DrCliffAuD vlog.
This is vlog number 107
and today I wanna do a little bit of a clarification
on my stance on over the counter hearing aids.
I have a colleague and friend
inside of the audiology profession, Dr. Scott Frank.
Who practices up in Salem, Oregon.
He owns a couple of clinics up there in the Salem area
but he kind of posed a question to me about, you know,
kind of my stance and how over the counter hearing aids
fits into best practices.
And it was actually a really, really good question
that I kinda wanna clarify my standpoint of it
but before I into that, if you guys could do me a favor
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And I will go ahead and get into the video.
So Dr. Frank, basically posed this question this week
about my stance on over the counter hearing aids
with how they're related to best practices,
because if you've been following my channel for a while,
you know that I talk about best practices a lot.
And I think the best practices
are the key foundational things that you need to be doing
to make sure that you have the most amount of success
with hearing treatment based on research.
So I'm gonna get into of that part of it here a little bit,
but let me kind of, there's pros and cons to everything.
So let me just kinda break down a couple of what I can see
as being potential negatives
of over the counter hearing aids.
First and foremost, you know,
when these over the counter companies
and really over the counter hearing aids
don't technically exist yet but you know,
there are some in, you know, companies out there
that are talking about over the counter hearing aids
they have devices ready to go.
There's companies that have been selling
hearing aids direct online.
So we, I consider them DTC for direct to consumer
rather than OTC, since that's not a real category yet
but one thing that kind of, you know,
bothers me a little bit about it,
is that a lot of these companies
say that the hearing aids that they are selling
direct to consumers are just as good
as some of the major hearing aid brands that are out there
and they just cost, you know, a 10th of the price
or a fifth of the price or whatever the case may be.
And I've probably tested more over the, sorry
I've probably tested more direct to consumer hearing aids
than probably anybody and you know,
this basically is my entire life.
Is evaluating different hearing aid technologies
determining which technologies are better than others.
So I can recommend the most appropriate technologies
to my patients and to potentially viewers of this channel
and I can tell you this, that there is no hearing aid
that is direct to consumer hearing aid
out on the market right now
that is as good as the least good prescription hearing aid,
in my opinion.
Now there are of course individuals out there
who they have personal preferences with certain devices.
You know, I know that they both hear phones
when hear phones were available.
There are some individuals who are like,
I like my hear phones better than these, you know,
$6,000 pair of premium level hearing aids
and, you know, I get it because there are different nuances
for everybody when it comes to what they prefer
in amplification.
The other issue that I have
or my concern rather going forward is the idea
that over the counter hearing aid companies
will control the entire dialogue
with the individuals who initially try their products.
And what I mean by this is that
if you go online and you identify that, hey, you know
this product seems right for me
I'm gonna go ahead and order it and then you get it
and you're like I think I'm having like moderate benefit
with this but, you know, I don't know
if this is really working for me
and so you reach back out to the company
and you say, hey, I'm not sure if this product's great.
And they're like, oh, well
we've got a new product coming out in six months,
you know, do you want us to send you that one instead?
You know, or whatever.
I mean, they're gonna be, you know,
constantly marketing to you, you know,
making you think that the next latest
and greatest technology is just right around the corner.
So hold on and wait for that hearing aid
if you're having limited success
with these current devices that you're using.
I just, I don't like the idea
that if someone's not having success
with a particular product that the only answer
to that is the next product in the pipeline
for that particular company
when the correct answer might be, you know,
the needs of you might exceed
the capabilities of our devices
so we recommend that you go see a hearing care professional.
So maybe that's the selfish side of me talking,
but I just think that if there are certain technologies
that aren't meeting your needs,
I don't think that the correct answer is,
oh well try this one or this product that we have
or this one that we have.
I just don't think that that's gonna be the true solution
to the problem.
The third issue really is this aspect of,
there are gonna be some individuals
who get taken advantage of
with over the counter hearing aids.
I mean, it's just the way that it is,
just like individuals are taken advantage of
in dispensing hearing aid clinics.
There's be individuals who get taken advantage of
but like I said, you can get taken advantage of
in any form of hearing aid dispensing,
whether it's over the counter
or whether it's direct to consumer, you know
you just have to make sure
that you're doing your due diligence
and I talk about this a lot on my channel.
Now to get to the topic of how best practices fit in
with over the counter hearing aids,
like my friend Dr. Scott Frank posed.
And I can see how there is somewhat of a conflict
of interest here, because technically speaking
you cannot have best practices followed
with an over the counter hearing aid.
I mean, like you can't get real measurement.
A lot of these devices are not even going to require
a hearing test of any sort.
Some of them will develop these hearing tests
inside of their apps, some will be better than others.
A lot of the ones that I've personally tested thus far
have not been accurate when compared
to a a clinic audiogram.
So, you know, I think that there is some concern there
that best practices won't be followed
and so does this contradict my belief
that best practices should always be followed?
And to some degree, yes it does
but let me kind of explain why I think it's okay.
From the aspect of best practices,
I think that everyone should get best practices
but there are some individuals
who don't have access to best practices
or who cannot afford best practices
and we have to consider this idea that accessibility
and affordability is something that's important
for certain individuals
and I would rather have someone forego best practices
in a order to get something in their ears
rather than just to not do anything at all.
Now, of course, if you had the choice
and you could afford it, I would say absolutely hands down.
It would be dumb of you not to have best practices followed
when getting hearing aids,
whether they're prescription hearing aids
that you get from an audiology clinic
or hearing aids that you purchase over the counter
and which leads me to my next point here which is,
you could technically take those
over the counter hearing aids
into a hearing care professional who follows best practices
and pay whatever the cost is of that clinic
to have best practices followed.
Now that could be an expensive endeavor
or it could be not that expensive of an endeavor
depending on where you live
and how much a particular clinic charges
and how good they are at actually providing best practices.
Now, the other side of this is not just best practices
but it's also this concept of person-centered care.
So is it really possible for a direct to consumer
over the counter hearing aid company
to provide person centered care
and technically speaking at least initially,
I'm gonna say the answer to that is no.
Now if you're not familiar with what that actually is,
person-centered care.
I have made a video
about that particular topic
that I have linked in the description of this video.
You can see the thumbnail right here
but it's the whole concept
of taking a person's specific wants, needs
and values into consideration when selecting technology
and then actually ultimately going through
the treatment process.
A lot of the direct to consumer over the counter,
they're gonna have some aspect of like online support
I believe some companies will not, but some will
and some will be able to have like a support person there
to help guide you through different things.
Bose is a good example of this.
They have support, you know, if you've seen my review video
on the Bose sound control hearing aids
you can see that they have built into their program
some amount of audiologic support.
I shouldn't say audiologic support, I should say support
because they are not audiologists
that are providing that support
and they are limited when it comes down
to the knowledge about, you know,
hearing loss and hearing treatment in that sense.
So, you know, it just depends
on who you're gonna get with that.
On top of that, it is not a person centered care approach
to have a one size fits all option
which is what a lot of these direct to consumer companies
are going to actually have.
So, you know,
can you really follow a person-centered care model
as a direct to consumer company.
Potentially at some point when there are multiple options
that could suit different needs of individuals
and if there was an actual, full comprehensive testing
and consultation process to actually evaluate
and determine what product would be best
for a particular individual.
So I think initially it won't be,
but eventually down the road,
there is some potential for that.
Now, like I said before,
I think that OTC ultimately is going to be a good thing.
If you just kind of look at the global influence
or maybe nationwide influence inside the United States
of over the counter reading glasses
and how that had a positive impact
on individuals actually treating vision loss.
So there was a large unmet need
for individuals needing help with, you know,
reading glasses that you can now buy over the counter easily
that are relatively cheap.
And what we saw when that happen,
is that individuals would go in
they would get these cheap little readers
and be like, hey I can actually see what I'm reading
a lot better or a little better,
or whatever the case may be.
And eventually it led to the, you know,
if I'm getting some benefit with these
maybe I should actually go see an optometrist
to have them do an evaluation on my eyes
and then eventually get a legitimate pair
of prescription strength eyeglasses
whether it's for reading, whether it's for far distance
whatever the case may be
and so it actually had a positive impact
on people's overall vision health
which I think that was amazing.
And to be honest with you,
there were probably other eye related conditions,
medical conditions that were identified
by individuals starting out with readers
determining that, hey, this either doesn't work
or I'm only getting limited benefit or I want more benefit
and then they go to see their optometrist
and the optometrist is like, oh yeah
actually you have a serious vision condition
or eye condition that you need to get addressed.
So I think that that's a really a positive thing
that could come out of the counter hearing aids
but again, as long as that dialogue
between the individual who's using the devices
and the company who sold them the devices
is kind of open and honest about like,
hey, if you're not getting benefit it could be
because there's an actual underlying medical condition
that is giving you difficulty here
and you should go see a hearing care professional
as soon as possible.
So really it comes down to this whole cost
versus benefit, right?
You know, here's the thing.
If you end up saving a ton of money
going with over the counter
versus going into a hearing aid dispensing clinic
and you are okay
with getting potentially a significant reduction
in performance with your hearing,
then that's I think potentially
a worthwhile trade off right?
Now, if you're the type of person who's like, no
I really want to hear my absolute best,
do not fall for the marketing gimmicks
that are out there with, you know,
you're gonna hear just as good as if you go see
a hearing care professional.
The likelihood of that happening is likely very low
and could it happen?
Potentially, it could potentially happen
to when you self-treat with a direct to consumer,
over the counter hearing aid
that you get as good of performance outcomes
as prescription hearing aids.
I don't think we have enough data to fully support that,
that thesis at this point, but who knows?
The one thing I am a little bit nervous about.
So this is kind of like a really odd way to look at it
but up until the point, like even right now
before OTC is officially available, you know
with this whole access
and cost affordability situation
that we're dealing with right now.
Up until now,
it has been the successful hearing aid companies,
the successful private practice clinics
who have been the ones who've been providing, you know,
low cost hearing treatment options
to individuals with hearing loss
and when I say low cost, I mean and often times it's free.
I mean, I'm going down here in a month
to grace hearing centers down in Tucson, Arizona.
To do a fitting day where for free low income individuals
are going to be getting fit with hearing aids
and this type of thing happens in states all across America.
You just have to find out who's actually doing them
and if you are watching this video right now
then you have the ability to do an internet search
to actually find one of these non-for-profit clinics
who can actually fit you with free hearing aids.
Now here's the scary part when you start to look at,
okay if these successful manufacturers
and successful clinics
are going to start losing business
because of direct to consumer,
they're gonna have less money
which means that they're gonna not be able to provide
as many free services
and free hearing aids to really low income individuals.
So could this have an overall extremely negative impact
on really low income individuals?
The answer to that is possibly.
I think that individuals who just either don't want
to buy hearing aids
or who have very little money to buy hearing aids
but can still, you know, scrape up, you know
500 to a $1000 for what I think is gonna be the cost
of a lot of these over the counter devices.
I think that that group's gonna be okay.
I think it's gonna be the really low income individuals
who can't even afford over the counter hearing aids
that are gonna be the ones who are in trouble.
Because let's face it, you know,
I don't know if you know of this company named Doppler Labs
that went out of business.
They sold, they were basically the first company
who came out
and sold these wireless earbuds that could amplify sound.
I think they were called the Hear Ones
or something like that
but that company was never profitable.
Obviously they went out of business
and I can tell you they weren't, you know,
doing charity events where they were giving away
their products for free
because they had no money to give away.
So what does this all really come down to
from a moral standpoint if you ask me,
I think it would be immoral to say
that individuals should not have accessibility
and affordability of hearing treatment, okay?
I think it is also to some degree immoral to tell someone
that you don't need to have best practices followed
when treating your hearing loss, right?
Like it, for me that seems like I struggle with it, right?
'Cause I think it is very important
if you want to optimize your ability to hear better
with no matter what hearing treatment you use.
The best practices are not followed,
there is no guarantee that you'll even get any benefit
with hearing treatment but I can't let my in that,
obstruct my belief of people deserve to hear better.
So Scott Frank, if you are watching this video,
just know like I totally get it.
Like, you know, I preach all the time about best practices
and how important they are
and why you should never go to a hearing care professional
who doesn't follow best practices
and now here I am saying, I support OTC.
So like, I can totally see how this makes me seem
like a hypocrite, but hopefully this has provided
some kind of clarity as to my thought process behind this
and at the end of the day, I could totally be wrong.
All of my viewpoints could be wrong
and I've had incorrect viewpoints before
and I would be surprised if I don't have another one again.
Obviously I'm gonna have incorrect viewpoints
at some point in the future again
and this could be totally one of them.
So I'd be interested to hear what you guys think
about over the counter hearing aids.
Is it gonna ultimately be a net positive
for individuals with hearing loss?
A net negative for individuals with hearing loss?
Let me know what you think
and then maybe we'll kind of continue
this discussion down the road
but that is really all that I wanted to talk about
today guys, I hope you enjoyed the video.
If you did again, go ahead
and give it that thumbs up button
and as always, I'll see you next week.
(upbeat music)