Going Beyond Hearing Aids for Equal Care Access

As a physician who is hard of hearing, I was excited to learn about FDA’s authorization of Apple’s newest AirPods, which will come with the capability to convert into hearing aids. If the AirPods live up to their promise, individuals using them will have enhanced situational awareness and the ability to engage in conversations. This is more important than ever since the World Health Organization projects that 2.5 billion people will have some degree of hearing loss by 2050.

Hearing loss has grown, particularly among the 12-34 age group, largely related to listening to music at unsafe levels. Because this group is already a large market for AirPods, integrating hearing aids with the AirPods can help reduce the stigma associated with assistive devices.

While Apple’s move is a step in the right direction to address the issue of hearing loss, we can do more to make society more accessible and user-friendly for those who are deaf or hard of hearing.

Both of my parents are deaf. My dad taught at the oldest school for the deaf, located in Connecticut where we lived in a sizable deaf community. However, I still recall significant challenges with accessibility. I remember them emphasizing how intimidating and unwelcoming the doctor’s office was for a person who was deaf or hard of hearing. Often, interpreter services were not available (although medical offices became responsible for providing accessible communication under the Americans With Disabilities Act, many offices to this day do not provide effective communication access).

When it came time for my own hearing evaluation at the audiologist as a first grader, I sat in a cold, padded room, pressing a button every time I heard a tone at varying frequencies. I didn’t want to stick out amongst my peers, so despite my declining hearing, I refused to use an assistive listening device.

During the COVID-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients, and friends were saying muffled behind masks, I realized that I needed hearing aids. I was shocked by the expense. The cost of a pair of prescription hearing aids commonly climbs into the thousands. As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.

Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids. However, many insurance plans, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic for many, as on average, families with individuals who are deaf or hard of hearing make $15,000 a year less than other families with no disabilities.

Having more easily accessible assistive hearing devices is a huge step forward in access, but for those with more severe hearing loss who need more support, devices like the Apple AirPods and other over-the-counter devices may not be enough. We must ensure access to the latest technology and the proper tools to use hearing aids effectively.

We also must remember that individuals who are deaf or hard of hearing continue to face significant accessibility barriers, especially in the healthcare system. Video technologies used in lieu of in-person interpreters may be unreliable and difficult to operate. As a result, patients who are deaf or hard of hearing face prolonged wait times and the healthcare team is often unable to fully understand their medical needs. The communication barriers ultimately result in patients not fully comprehending what is happening with their medical care. When patients cannot adequately communicate their health needs due to inaccessibility, they are unable to get the care they need, exacerbating existing inequities.

When health systems and society do not accommodate individuals with hearing loss, they contribute to social isolation. This isolation can manifest in poorer long-term health outcomes such as dementia and premature mortality.

While I’m glad we have more affordable sophisticated hearing technology available, we need to continue to optimize the healthcare environment so that persons who are deaf or hard of hearing can get the best medical care possible.

This includes not only access to timely and appropriate sign language interpretation but also captioning options, ASL-translated videos, assistive devices that facilitate appointment scheduling, and quiet environments that allow patients to better communicate with the providers. We also need better training for all members of the healthcare team to understand the nuances involved in caring for deaf and hard-of-hearing patients. These steps are useful not only in the medical setting but also in all social settings so that the deaf and hard-of-hearing can be fully integrated into society.

Accessible hearing devices are a wonderful achievement that will significantly enhance the lives of those who are hard of hearing. But let’s not forget that we still have more challenges to overcome. We should normalize accessibility for the deaf and hard-of-hearing communities in our daily lives.

James Huang, MD, is a board-certified family physician and is fluent in ASL. He started the Comprehensive Medical Care for Deaf Adults and Children (CODA Clinic) at Unity Health Clinic in Washington, D.C., and is the director of student health services at Gallaudet University. He is a senior fellow with the Atlantic Fellows for Health Equity at George Washington University. The opinions expressed are his own.

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