Overall, 28 million Americans have hearing loss. Based on those numbers, some people aren’t getting diagnostic testing and likely aren’t getting treated. —Matthew L. Bush, MD, PhD, MBA
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May 2021
Patient education is an important part of getting help for hearing loss. A lack of education about identifying hearing loss and appropriate treatment options (e.g., otologic intervention, devices covered by insurance, devices available online or in ads, and over-the-counter devices) can result in patient dissatisfaction and poor adherence to recommendations (J Am Board Fam Med. 2016;29:394-403; JAMA Otolaryngol Head Neck Surg. 2020;146:13-19). “Direct-to-consumer interventions, such as those online and in advertisements, promise a false hope of a quick fix for hearing loss,” Dr. McGrath said. “When such readily available interventions fall short of patient expectations, they’re often deterred from seeking further options that may be more appropriate and managed by a trained medical professional.”
Furthermore, Medicaid and Medicare recipients are required to have a primary care physician (PCP) referral to see medical specialists like audiologists. “This is yet another obstacle keeping this population from accessing hearing healthcare,” Dr. McGrath said.
Along these lines, Chelsea Conrad, AuD, an audiologist in the division of audiology at Henry Ford Health System in Detroit, said that low-income individuals are more likely to be uninsured or be Medicaid recipients, and will seek healthcare less often. Patients frequently don’t seek care until it’s emergent, and although adults eligible for Medicaid may have hearing aid benefits, provider participation in this service provision remains low due to the administrative burden of preauthorization and low reimbursement. Some state and charitable organizations offer programs specific to hearing loss, but navigating these services for enrollment, care coordination, and follow-up is challenging for many patients. This difficulty can be amplified for individuals who have no internet access and who have low literacy levels.
Another challenge stems from the fact that if adults with chronic ear pathology aren’t treated promptly, erosion of ossicles may result, Dr. Kim said. This can cause conductive hearing loss, and in some cases irreversible sensorineural hearing loss, labyrinthine fistula resulting in balance dysfunction, cerebral spinal fluid leak, facial nerve paralysis, and meningitis, just to cite few examples.
At some point, severe to profound hearing loss may no longer be helped with conventional hearing aids. Even if hearing loss is treatable, most insurance provides nominal coverage for hearing aids at best, Dr. Kim said.
Pediatric hearing loss in socioeconomically depressed areas is even more challenging, especially for prelingual hearing loss. These children may present with concomitant behavioral or developmental issues due to late presentation. “Children from these areas are less likely to get the medical and social support necessary to achieve adequate hearing during a critical time of speech and language development,” Dr. Kim said. This may result in communication difficulties, learning impediments, dropping out of school, isolation, and employment challenges.