摘要：Hearing loss is a leading cause of disability among older people. Yet only one in seven US adults who could benefit from a hearing aid uses one. This fraction has not increased over the past 30 years, nor have hearing aid prices dropped, despite trends of steady improvements and price reductions in the consumer electronics industry. The President’s Council on Science and Technology has proposed changes in the regulation of hearing aids, including the creation of a “basic” low-cost over-the-counter category of devices. We discuss the potential to reduce disability as well as to improve public health, stakeholder responses to the president’s council’s proposal, and public health efforts to further mitigate the burden of disability stemming from age-related hearing loss. Hearing loss impairs communication, an essential human function. 1 The most common cause is age-related hearing loss (ARHL), characterized by progressive hearing loss and degraded speech comprehension in both ears. In the United States, one quarter of adults aged 60 to 69 years have a bilateral disabling hearing loss; this climbs to nearly 80% among those aged 80 years and older. 2 ARHL reduces quality of life 3 and is associated with social isolation 4 and depression 5 —problems that are important in their own right and are risks for medical conditions such as cardiovascular disease. Hearing loss is also associated with falls, fractures, and faster cognitive decline. Hearing loss disrupts health care. Compared with adults with normal hearing, those with hearing loss report worse communication with their physicians. 6 They also report overall poorer health care quality. 6 Because many older people have complex medical problems, these disruptions pose a serious challenge. In this commentary, we contrast the high population burden of disability with the low prevalence of hearing aid ownership among older Americans. We describe cost as a barrier to ownership and discuss a recent high-profile call for regulatory change that could substantially lower costs. We note factors beyond cost that need to be addressed to improve hearing health and functioning.
