Will over-the-counter hearing aids help with cognitive impairment?

In computer science, there's a saying: "Garbage in, garbage out." In other words, if the inputs are faulty, the outputs will be, too.

The same could be said of our brains, which are living computers. If information can't reach your brain effectively because of conditions like hearing loss, the result may be that the brain loses some of its ability to function.

Many studies show people with hearing loss are more likely to develop cognitive problems than people who do not have hearing loss, and I have seen this play out in my own practice as a private patient advocate. The National Institutes of Health estimates that approximately 1 in 3 people between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing.

That's a lot of lost information, isn't it?

Yet, because of cost or an unwillingness to "look old," only about one-fifth of Americans get help with their hearing, according to studies cited by the Food and Drug Administration, which has finally cleared the way for the sale of over-the-counter (OTC) hearing aids.

Its rules governing the sale of OTC hearing aids become effective in October, so you will be seeing them on your pharmacy shelf before the year is out. The devil will be in the details, so more on that a bit later.

Researchers have several theories as to why cognition suffers along with hearing loss. One has to do with cognitive load. When hearing loss goes untreated, the brain is constantly straining to understand speech and sound and, thus, doesn't work as well.

Some researchers theorize that brain cells can shrink because of a lack of stimulation, including the parts that receive and process sound. So brain structure may be another reason for cognitive decline.

And finally, there's social isolation. When a person has trouble hearing conversations and socializing, they may prefer staying home instead. However, the more isolated a person becomes, the less their brain is stimulated.

Whatever the reason, cognition and hearing go hand in hand. It's long been a frustration of mine that Congress hasn't agreed to have Medicare cover necessary health care of our ears, eyes or teeth. That hasn't changed with this new FDA approval for OTC hearing aids. But what it does mean is that people with mild to moderate hearing loss will be able to buy hearing aids without first seeing an audiologist, getting a prescription and paying anywhere from $2,000 to $7,000 for a pair.

The approval wasn't unexpected. In 2016, the National Academies of Science, Engineering and Medicine released a report proposing FDA approval of OTC hearing aids. Congress approved and the president signed legislation in 2017 to enable the FDA to do just that.

The price of hearing aids is expected to come down significantly. Though they still won't be covered by Medicare, people may be able to use a health savings account (HSA) or flexible spending account (FSA) funds to pay for them.

Companies will be competing to have the best hearing aids at the lowest costs. Dr. Robert Califf, the FDA commissioner, said the move is meant to "unleash the power of American industry." But even if the cost drops by thousands of dollars, as anticipated, they still won't be cheap.

There's also a concern that if a lot of cheap, ineffective hearing aids flood the market, people will still be driven to audiologists and expensive hearing aids. They are clearly not a one-size-fits-all solution. People with greater hearing loss will still need the professional services of audiologists and hearing aid specialists.

I'm hopeful, though, that there will be enough protections and requirements built in for this to be a net positive for those with mild to moderate hearing loss. For example, the FDA is requiring that maximum volume can't be so high it damages the ears and that there be a user-adjustable volume control. Crummy hearing aids should be driven out of the market by consumers.

OTC hearing aids will certainly transform the consumer market. Time - and additional research - will tell us if they're having a positive impact on cognition.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.