PUMPING IRONY: Hopeful Signs for Troubled Ears?

You might call it ironic that hearing-impaired seniors are finally gaining access to (more) affordable hearing aids just as research is heating up to address hearing loss in a way that renders the devices unnecessary. I’d call it, well . . . aspirational.

Five years after Congress charged the Food and Drug Administration with the task of developing standards for manufacturers to offer hearing aids over the counter without a prescription, people with mild to moderate hearing loss can now shop for devices priced as low as $200 — or as high as $3,000.

“Ninety-plus percent of adults with hearing loss have needs that can be served by over-the-counter hearing aids,” Frank Lin, MD, PhD, director of the Johns Hopkins Cochlear Center for Hearing and Public Health, tells the New York Times. But the wide range of models and prices, along with the vagaries of self-diagnosis and the inevitable blitz of deceptive marketing, will pose multiple challenges to consumers. “It may be the Wild West for the next few years,” he admits.

It’s not like correcting your vision by upgrading the prescription for your eyeglasses, Lin notes. New glasses will typically restore your eyesight to previous levels, but hearing aids — even when prescribed and fitted by an audiologist after a hearing test — cannot completely address hearing loss. And adjusting the device to amplify the necessary frequencies without the assistance of a trained professional will no doubt lead to some frustration along the way.

There’s also the matter of maintenance and lifespan: These devices typically wear out after three to five years. The hearing aid in my left ear is still operating after five years (I lost the one for my right ear and had to buy another), but every year or so it will suddenly stop working. That requires a trip to the clinic, where a technician will repair it for $100 — a small price to pay when compared with the $2,500 I shelled out for the device, but it’s no small expense for someone on a fixed income. You’ll be wise to read the fine print when buying one of these over the counter.

Whether any of these obstacles will dampen the demand for these devices is anyone’s guess. “It’s a new frontier, and it is confusing,” Barbara Kelley, executive director of the Hearing Loss Association of America, tells the Times. “We need time to see how the market settles out.”

While we wait, however, science marches on.

Two recent studies suggest that, rather than sticking a device into your ear to improve your hearing, you may be better served by tweaking your genes. Which genes to tweak, however, remains a point of contention.

For Jaime Garcia-Anoveros, PhD, and his team at Northwestern University, it’s all about the ear’s inner and outer hair cells and how they function together. The outer hair cells respond to sound waves by expanding and contracting, thus amplifying the waves that the inner cells then transmit to the neurons in the brain that we interpret as sounds.

“The outers crouch and jump and lift the inners further into the ear,” Garcia-Anoveros explains. “The ear is a beautiful organ. There is no other organ in a mammal where the cells are so precisely positioned. Otherwise, hearing does not occur.”

So, when the outer hair cells die off — which they often do as we age — they do not regenerate, and our hearing suffers. But Garcia-Anoveros and his team were able to identify and manipulate a master gene switch (TBX2) that governs these two types of hair cells: Express the gene and the cell becomes an inner hair cell; block it, and it becomes an outer hair cell. All they need to do is combine a couple of other genes to create a cochlear hair cell from a non-hair cell, and put the TBX switch to work.

“We can now figure out how to make specifically inner or outer hair cells and identify why the latter are more prone to dying and cause deafness,” Garcia-Anoveros says. The study, which he acknowledges was “experimental,” was published in the journal Nature.

Genes are certainly the key to restoring hearing, according to a research team from King’s College London, Karolinska Institute, and Erasmus University, but they’re not located in the hair cells. Reviewing a meta-analysis of 17 studies involving genetic samples from more than 700,000 people, the researchers identified 48 genes — including 10 new variants — linked to hearing loss and concluded that any effective genetic manipulation would need to focus on a part of the cochlea known as the stria vascularis. Their findings were published in the American Journal of Human Genetics.

“This study points to genes we could target for screening purposes, drug development, and even gene therapy in the future,” says co-lead study author Frances Williams, PhD. “[It] provides a solid foundation for ultimately improving therapies against hearing loss.”

I’m going to assume that it’ll be a while before we’ll be scheduling sessions of gene therapy at our local audiology clinic, so here’s hoping those over-the-counter hearing aids prove as effective as their proponents suggest — and that my hearing-impaired counterparts remember to read the fine print before plugging them into their hopeful ears.

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