OTC hearing aids and risk of dementia

Will OTC hearing aids reduce cost of untreated hearing loss and lower risk of dementia?

World hearing aid market is growing at a steady pace, year after year financial reports are cheerfully announcing new sales highs.

But there is a shadow on the sunny image: the hearing aid product of today is continuously failing to reach large parts of the population.

The result is the high social and economic cost of hearing impairment. A Study in 2006 [hear-it 2006] calculated the cost of unaided hearing impairment at 213 Billion Euro a year in Europe only. While this number is huge, it describes something intangible and is hard to put into relation to individual experience.

A much more tangible cost of untreated hearing loss becomes apparent if you look at related decline of cognitive abilities. It is heartbreaking to imagine a life prematurely deteriorating due to curable but neglected health issue.


Use it – or loose it!

A devastating result from several scientific studies states that adults with mild hearing loss are two times more likely to develop dementia [Sanches 2016]. Higher level of hearing loss increases the risk up to fivefold. Such cognitive decline could effectively be avoided by timely use of hearing aids. However, due to its delayed onset, dementia is ignored as a reason for use of hearing aids.

Mild-hearing-loss trap

While the mild hearing loss is annoying, it is not necessarily seen as a critical indication for use of hearing aids. The population with mild hearing loss is not fully respected in the design of new hearing aid products, the product portfolios and the distribution model are heavily concentrated on the moderate, profound and severe hearing losses. In those cases the cumbersome distribution and fitting procedure is justified with the severity of hearing difficulties – a trade-off that seldom counts for mild hearing loss. The outcome is low penetration in the mild hearing loss market (see the figure below). But this harmless fact rings a real urgency if we remember that this neglected populationis loaded with a double risk of dementia.

Figure 1. Hearing loss types and estimated market penetration of hearing aids (in b

lue). The mild hearing loss is aided in only 10% of cases. Source: Sonova

While it would be easy to blame the manufacturers who are not providing products that address the problems of availability and accessibility of hearing aids, that would not be fair: the manufacturers are very successful in serving their existing customer base (and their shareholders). In a way, they are too successful in serving the profound hearing loss. And obviously, current hearing aid concept cannot serve both populations well.

More of the same – just cheaper?

Future market for OTC hearing aids could change this by providing breeding ground for innovation and more suitable products. There is the opportunity, but also the responsibility, waiting for the newcomers to the OTC market. One critical quality of the OTC devices will be the comfort of use. Only those products that can fully support rehabilitation will tackle cognitive decline. That means the devices which can be worn for 8 hours a day – without embarrassing form factor, high weight and annoying sound quality. Devices used only situationally – such as hearables, cannot support rehabilitation and reduce the risk of dementia.

The continuous involvement of user in tuning of hearing instrument through a patient-facing app and the underlying AI learning methods can additionally improove ownership of the device – and support rehabilitation.

Design of good OTC hearing devices will therefore be a technological challenge – not a business opportunity for quick profits. It is important to undertand this before “OTC hearing healthcare” becomes a synonym for “gold-rush mentality”. Otherwise, future OTC hearing devices might end up in a drawer even sooner than the clinically prescribed hearing aids.


[hear-it 2006] https://www.hear-it.org/sites/default/files/multimedia/documents/Hear_It_Report_October_2006.pdf

[sanches 2016] https://starkeypro.com/pdfs/technical-papers/The_Relationship_Between_Hearing_Ability_and_Congnition_Dimentia.pdf