What's in a Number? Establishing a Consumer-friendly Metric for Hearing Loss
If your doctor told you your blood pressure was 140/95 or that your cholesterol was 220, would you be concerned? For most of you, the answer is “yes” since 85% of adults know the normal values for blood pressure and 52% know the values for normal levels of cholesterol, according to a recent study by Carlson et al (2022).
This level of public awareness is extraordinary. It reflects alignment between the American College of Cardiology (representing professionals) and the American Heart Association (representing consumers), as well as significant investment in public awareness campaigns regarding heart disease. A critical success factor of their “know your numbers” campaigns is the messaging: normal blood pressure is 120/80; cholesterol should be less than 200. There is one number for consumers to pay attention to.
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In my experience as a practicing clinician, a Chief Medical Officer in the insurance industry, and as a healthcare reporter, I have seen, firsthand, the power of simplicity. Give consumers:
- An objective measure,
- A number value that reflects normal (or abnormal),
- An explanation for why this number matters for their health status,
and they begin to care and take responsibility for their health. Vision may be the best example: 92% of adults know that normal acuity is 20/20 and 66% are very likely to have an annual eye exam.
Compare this to hearing: 9% of adults are aware of a normal value and only 27% are very likely to have their hearing evaluated. According to MarkeTrak 2022, people wait an average of 5 years from the time they notice a hearing loss to the time they decide to get treatment, and only 34% of people with hearing loss are treated with hearing aids.
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A pivotal time for providing consumers with clear, easy-to-understand information
We are at a critical point in time for hearing healthcare. Baby boomers are aging, creating the largest number of people in need of hearing healthcare in the history of the world. There is a growing body of evidence showing the strong correlation between hearing loss and dementia, with hearing aids suggested as a treatment that may prevent or modify the risk of cognitive impairment. In addition, hearing aids will soon be available over-the-counter (OTC) which expands access and simultaneously increases the importance that anyone contemplating use of a hearing aid has an objective measure of their hearing status.
So, how do we get more people to care and ultimately, take responsibility for their hearing? Establish a single “hearing number” that is routinely communicated to patients to describe their hearing status/loss—instead of using the normal, mild, moderate, severe, and profound scheme.
If you are a hearing care professional, let’s pause before you say, “Hearing is much more complicated than a single number.” Of course it is, but a hearing number is not meant to dictate treatment; rather, it is designed to educate and engage patients. To deliver high quality care, hearing care professionals should always use an array of tests and considerations to design a patient’s treatment plan.
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How do we get a single number that objectively describes hearing status?
Establishing a “hearing number” is not a new concept, as several hearing healthcare professionals, as well as consumer advocates like Shari Eberts, have endorsed the idea through the years. Many prominent hearing scientists publicly support the development of a universal metric, including Drs. Barbara Weinstein and Larry Humes who suggest using the Hearing Handicap Inventory Screen (HHI-S) score. Drs. Frank Lin and Nicholas Reed from Johns Hopkins propose using a 4-frequency pure-tone-average (PTA4). Interestingly, in October 2020, Cochlear Limited (the implant manufacturer providing financial support to Dr. Lin’s Cochlear Center for Hearing and Public Health) launched Hearing 20/20, a public awareness campaign stating:
“…a hearing level from 0 to 20 dB PTA in each ear is considered normal. Numbers exceeding 20 dB could benefit from amplification, such as hearing aids, while levels above 60 dB suggest a referral for a cochlear implant evaluation. Cochlear is proposing hearing health professionals use the PTA as a simple, easy to remember metric for consumers to track their hearing levels.”
The Hearing 20/20 website lists the American Academy of Audiology (AAA), Academy of Doctors of Audiology (ADA), Hearing Loss Association of America (HLAA), and other professional and advocacy organizations as partners in the campaign. Ironically, during 2021, there was not a single presentation at these organizations’ national meetings focused on educating professionals on the rationale or value of a single metric; there was no training on how to best explain this metric to patients. Even more importantly, there were no sessions to debate the science on whether a PTA4 is the best metric or whether it's the HHI-S.
Maybe it’s even possible that a QuickSIN or some other score would be even better. I don’t know the answer; that’s the job of good researchers. What I do know is that to drive real change, the national hearing organizations—representing consumers and professionals rather than a single academic center and device manufacturer—should align to lead and own the establishment of a universal hearing metric.
There is an opportunity to (finally) make hearing health a priority. Let’s make it as important and simple for consumers as their heart and their vision because hearing is essential.
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Yesterday, while testing a new patient, I thought of this same thing. I have been in touch with Cochlear in the past about the 20/20 thing, but as I was testing this man yesterday, I had the thought of likening it to lab values. It worked in his case as he had somewhat of a flat hearing loss and it helped his family understand. "If you knew normal was 0-20 for your xx result and found out today, yours is 70--would you do something about it?"
In NZ, I often compare PTA with a richter scale number. It takes into account the logarithmic nature of decibles and especially in NZ, they just get it.
1-2 get them all the time and unless you are standing on top of the epicenter and in the hearing world, the epicenter is something so important you need to hear every word, All is good but three-we are up to what was that and 5- time to hide under the desk. But if your house is on firm ground or you do not have high communication needs, 4-5 may not affect you.
Only works for audiograms and not functional hearing loss or APD.
A couple of years ago I made a concrete proposal for a new metric to express in a single number the degree hearing loss: it is based on loss in critical signal to noise ratio as measured by the LiSN-S PGA test. A loss in SNR is closer to the problems patients experience in their daily lives. A metric based on the pure tone audiogram will never be successful, as it is industry centric, with fitting of hearing aids in mind, and anything meaningful needs to be patient centric. You can read my proposal here: New way of classifying and describing hearing loss Phonak Audiology (phonakpro.com)