Moving the Meter for Hearing Health Across the Population: How Big Data Can Nudge People into Action…Faster
Terry Mactaggart
According to the World Health Organization (WHO), approximately 5% of the entire world’s population – or 430 million people – require rehabilitation to address their disabling hearing loss (including 34 million children). It is estimated that by 2050 over 700 million people – or 1 in every 10 people – will have disabling hearing loss. When unaddressed, hearing loss impacts many aspects of life at individual level: communication and speech, cognition, social isolation, loneliness and stigma, and effects on years lived with disability (YDLs) and disability adjusted life years (DALYs). The WHO estimates that unaddressed hearing loss poses an annual global cost of US$ 980 billion. This includes health sector costs (excluding the cost of hearing devices), costs of educational support, loss of productivity and societal costs. Of these costs, 57% are attributed to low- and middle-income countries.
Early identification of hearing loss and ear diseases is key to effective management. This requires systematic screening for detection of hearing loss and related ear diseases in those who are most at risk. This includes newborn babies and infants, pre-school and school-age children, people exposed to noise or chemicals at work, people receiving ototoxic medicines and older adults.
Hearing assessment and ear examination can be conducted in clinical and community settings. Tools such as the hear- WHO app and other technology-based solutions make it possible to screen for ear diseases and hearing loss with limited training and resources. Once hearing loss is identified, it is essential that it is addressed as early as possible and in an appropriate manner, to mitigate any adverse impact. The WHO has done yeomen work raising awareness of the global need for hearing loss awareness and treatment. Closer to home, others are trying to further the cause.
What is happening in the private sector?
Hearing aid innovation continues with the advent of multitasker- type devices such as the Airpod Pro with its new “hearing aid mode” that will be found in the new iOS 18. Results for the first year of over-the-counter (OTC) device availability in the United States have been tabulated. They show that the current OTC market is dominated by the existing hearing aid manufacturers without much disruption from consumer electronic and other start-up companies. Although uptake of OTC hearing aids remains low at this time, it is possible that lower OTC price points and rising awareness of the availability of these devices will drive demand. Additionally, behind prosthetic devices, a possible “cure” for certain types of hearing loss is being explored by several well-funded start-up companies.
Individually and together, these developments are progressive. But are they really making a difference if the goal is to stimulate many thousands more to understand their hearing status and take account of the actions indicated to preserve and/or rehabilitate it? Before these burgeoning treatments can be fully realized, all sectors of the hearing health care industry must work together to build awareness of the harmful effects of untreated hearing loss across the life span.
It is possible that as more extensive analysis of the deleterious effects of hearing loss is undertaken, shortcomings in hearing health awareness and action will continue to grow among all age cohorts. We are gaining a better understanding of the reasons why those who know their hearing status tend to delay. And we understand from emerging research that the stakes of maintaining the status quo have become more severe.
Reducing this dilemma to its bare essentials may shake out in some unforeseen ways. For example, hearing loss is unlike other chronic conditions for the following reasons.
- Hearing is a “tricky” sense as problems (particularly permanent losses) usually develop over time – they tend to “sneak up” on people.
- Unlike sight, early decline can often be managed by finding new ways to get by - learning to “re-hear just good enough” allows many people to cope in challenging listening situations.
- Research indicating the perils of delay, albeit still nuanced, is under communicated – not nearly enough people know about it.
- The industry continues to focus primarily on selling hearing aids, retaining most of its expensive business model.
Summus Hearing Solutions, a Canada-based company, pioneered one of the world’s first tablet-based, AI-enabled self-guided hearing health test platforms for use in trusted healthcare settings. Based on more than a decade of data collection, we know that structured and interpreted hearing test results across a wide demographic indicate those who should be considering some form of hearing instrumentation represent only about 30% of the total of those tested. The majority (more than 65%) of those tested are either “normal” or have a “conductive” component that requires some type of medical intervention.
Yet most of the self-guided testing platforms being used today are seeking or confirming hearing aid candidates. That is to say, well over 50% of those conducting a self guided test are essentially being ignored when it comes to hearing health and maintenance, which is perhaps the most important conundrum of all. Not nearly enough people are tested and, when tested, are not evaluated rigorously, without bias.
One way of starting to address these questions is to break out the “hearing problem” into various components examining the state of play with each. Recently at Summus we created the following infographic highlighting seven common issues.
"The Hearing Problem"
Only 2% are tested
This estimate for the United States is dated and may be different today. In any event, it’s an exceptionally low percentage of the relevant population and stands out when compared, say, to testing for eyesight or blood pressure.
CONCLUSION – More people need to obtain a baseline hearing test.
Testing, when done, is often inadequate
Screening tests abound, particularly online. But unless undertaken by an unbiased provider, these tend to be skewed towards acquiring hearing aids. Adequate interpretation of results is a problem as almost all lack that capability.
CONCLUSION – This bias needs to be rectified if an entry into one’s hearing journey or a check along the way is to be trusted. Most people who get a hearing test today, do not need hearing aids. The test is the beginning of the journey toward greater self-awareness of your own hearing, not the start of wearing hearing aids.
Wait time between awareness and action is too long
5 years minimum, 10-plus years maximum defines the range, the median appearing to be 6 to 7 years; and that applies only to those who have been assessed and ultimately decide to act.
CONCLUSION – Encourage people to self-test to monitor any changes in their hearing over time. Encourage people to see an audiologist when they have questions about their hearing or the results of their self-guided hearing test.
Relationships with other disease states require greater emphasis
Co-morbidities have multiplied and become more obvious.
CONCLUSION – In addition to further research, these relationships provide promising leverage. Much more could be done to insert a hearing test as part of the follow-up protocol when a relevant disease state is detected or being managed. At a minimum, physicians and nurses who specialize in geriatrics must be educated on these co-morbidities.
Learning and behavioral issues need to be confronted
We know that undetected and untreated hearing loss compromises the learning and lifestyle trajectory of many children.
CONCLUSION – Testing of public-school age children should be mandated, and in many cases re-established.
Key healthcare providers are left out
This problem is enormous as family physicians and pharmacies (to name two prominent exclusions) are not connected sufficiently, if at all, with hearing health.
CONCLUSION – The imperative of mandating physicians to counsel and test appears to be gaining ground. More pharmacy chains are adding hearing as a new revenue source. Engaging both fully would make a significant difference.
Productivity loss and social costs that result from untreated hearing loss are too high
More than $900 billion dollars per year in the global economy are lost due to lost work hours and poor productivity that result from untreated hearing loss.
CONCLUSION – Freeing up even a third of this monetary value represents a large amount that could be allocated to other pressing, underfunded public health problems.
We encourage audiologists to print this infographic and share it with all members of your medical community. It is imperative for all of us to educate key stakeholders in our communities. Further, Summus is embarking on a significant project aimed at addressing aspects of the problems related to poor awareness. For some time, we have referred to our mission as providing “hearing health guidance” rather than simply “hearing testing.”
Providing a competent screening test on an internet-connected device at any time is an obvious entry point. The more important aspect in the application of “Hearing Triage”, a term we set when our proprietary pattern recognition algorithms allowed pure-tone thresholds to be sorted into four standard audiological categories. From there we can produce and send a medical grade report as well as coach the user about what next steps make most sense given his or her classification.
While this technology is available in English, French, and Spanish and has been widely applied, it’s impact in “Moving the Meter” is still limited. Most who are deemed to have a sensorineural hearing loss, for example, when consideration of hearing aids often represents an effective response, balk at taking that next step. Frequently, this delay continues for some time, three to seven years being commonplace. Likewise with other classifications, when used within the medical environment tend to be followed to a greater extent.
The issue we’re grappling with involves providing guidance that takes account of age, gender, lifestyle, and other health conditions. Messaging to a 42-year-old male in a high-paced job who plays in a band, for example, should be quite different than to a 72-year-old female encountering problems playing bridge with her friends. When combining classification, age (in cohorts), comorbidities and “lifestyle”, a complex array of messages results – 100’s in fact. And if somehow, user response to the original message can be captured, follow-up messaging can be created thus moving the user further along in “their journey” while compounding the technical challenge of continuing the follow up even more.
What’s sought is a process that “nudges” the person by taking account of attitudes and behavioral differences – an innovation that is beginning to be talked about with little evidence of becoming mainstream in healthcare to date. The recent isolation of consumer archetypes for different individuals with hearing difficulties is one early example in the hearing space, as Brian Taylor discusses in his editorial in this issue of Audiology Practices.
Our “hearing health guidance” prototype provides a roadmap for how nudging people into action could be accomplished by using a combination of big data (large pools of information), previous knowhow, and an added dose of AI. We anticipate experimentation with and acceptance of this enhanced form of guidance can ultimately make a difference with several of the issues cited above. Success will depend on timely financing, and interplay with a variety of partners including audiologists on the forefront of technological innovations that can be used to raise awareness in their communities about the harmful effects of untreated hearing loss. ■
Terry Mactaggart is the founder and CEO of Summus Hearing Solutions, Inc. He can be contacted at