A variety of policies and regulations (Box 1) can influence the way different stakeholder groups work together in the hearing health sector (Box 2) to deliver information, services and interventions for consumers with hearing loss. Access to innovations should be promoted in parallel with strengthening existing systems and establishing new independent systems to assess and protect data integrity8.22as well as launching research and education transparency initiatives that can be used to inform clinical recommendations and allocate funding for hearing services and products.
Hearing aids are currently regulated primarily in terms of professional practices, product safety and efficacy, and in the context of competition law. Due to the data collection capabilities of new digital hearing products, regulation should also consider user data collection, integrity, access and privacy8.22. Device developers, providers and healthcare providers should focus on promoting health and healthcare equity, which will require attention to power imbalances and structural inequalities. Longitudinal studies will be needed to evaluate the effects of changes in the hearing health sector on consumer experience, job roles and the availability of clinical services in countries with different regulatory frameworks.
Consumer education and support for access to hearing services and products will be especially important for people who may be more vulnerable to misleading marketing claims15.23 due to limited digital, health or research literacy. More than 65% of adults over the age of 60 have hearing loss, with the prevalence increasing sharply with every decade of age1. Hearing loss is associated with increased risks of dementia and cognitive impairment1 and deaf and hard of hearing people are more likely to experience communication problems that limit their access to information24. Vulnerable groups, including the poorest populations, are less likely to access new technologies than less vulnerable groups, which can contribute to reduced health equity25. Hearing loss is also associated with common diseases such as high blood pressure and diabetes1and with an increased risk of hospitalization and mortality26. Adults with hearing loss are therefore overrepresented among patients receiving other health and disability services.
Professional training is required across all sectors of health and disability to support the communication and safety needs of hearing loss patients24. This will particularly benefit patients who are not receiving any hearing care and those who can access direct-to-consumer hearing aids without the services of a hearing health professional such as an audiologist or otologist. Enabling a broad range of professionals to better support the needs of people with hearing loss could improve overall health care engagement and satisfaction24. This could also increase opportunities for adults with hearing loss to receive information and advice independent of product sales.
All people with hearing loss should have access to reliable and comprehensive information and independent professional advice in selecting safe, evidence-based and affordable hearing and communication aids1. Tectonic shifts in the landscape of the hearing aid and hearing services industries may pose a fundamental threat to achieving this goal, as well as providing new opportunities. More research on conflicts of interest, regulatory gaps and the rapid expansion of emerging technologies is needed if everyone is to realize the benefits of these innovations.