Greatly Heightened Public Interest in Hearing Aids in the Last 7 Years

Hearing aids remain highly underutilized in the United States with the majority of hearing-impaired adults not seeking treatment (1,2). With the recent recognition that hearing loss may be associated with other deleterious conditions of aging (3–8), legislation has been passed to create a category of hearing aids that may be purchased over-the-counter (OTC), as opposed to traditional prescription hearing aids. Food and Drug Administration (FDA) regulatory changes have allowed the sale of OTC hearing aids since October 2022. While the ruling and antecedent discussions have presumably increased public interest in hearing aids, this hypothesis remains poorly investigated. Given these recent, major scientific and political events, we studied whether public interest in hearing aids has correspondingly increased. Our objective was to explore public interest in hearing aids using Google Trends and SEMRush databases over a time period ending with sale of OTC hearing aids. METHODS We utilized 2 datasets, Google Trends and SEMRush, to track interest in “hearing aids.” Google Trends provides unitless normalized search volumes, with a maximum value of 100. These search volumes correspond to interest over time and were used to analyze user-specified search terms related to hearing aids. The Google Trends dataset spans from 2004 to the present day and tracks changes in public interest for virtually any search term (9). Queries were performed in September 2023 for “hearing aids” and control terms, including “hearing loss” (similar subject matter as hearing aids), “cochlear implant” (analogous hearing device without a change to OTC status), “laser eye surgery” (mature, similarly priced procedure that shouldn’t have fluctuating interest in 2022), and “Flonase” (fluticasone; product that became OTC a decade prior that should not have increased interest in 2022). We complemented this dataset with raw search numbers (searches per month) from SEMRush, a tool that aims to increase websites’ visibility through search engine marketing (SEM). SEMRush data are available from 2012 to the present and list a keyword’s mean monthly search volume in the United States over the last 12 months (10). Queries were performed in August 2022 for “hearing aids.” Both Google Trends and SEMRush contain anonymized, publicly available data. Thus, this study was deemed exempt from review by the Columbia University Institutional Review Board. RESULTS Google Trends interest over time for hearing aids remained unchanged during the 9 years between 2004 (normalized value of 34.8) and 2015 (value: 32.8). Since then, interest steadily increased 2.3 times between 2015 (value: 32.8) and 2022 (value: 74.8). Notably, between March and June of 2020, there was a transient drop from 60 to 41 with a nadir of 35 in March. This is presumably due to the COVID-19 pandemic and interest for the search term recovered toward the end of 2020 (Fig. 1).FIG. 1.: Google search interest for “hearing aids” compared to controls “hearing loss,” “cochlear implant,” “laser eye surgery,” and “Flonase.” Data were obtained from Google Trends. Interest is measured by a unitless, normalized volume value.To assess whether rising interest was unique to hearing aids or part of a general trend within health care, we queried control terms, that is, related terms within both otology and medicine. Google Trends searches for “hearing loss” and “cochlear implant” yielded flat trendlines (Fig. 1). Likewise, a search for “laser eye surgery,” which represents a qualitatively similar priced solution for another quality-of-life altering condition, produced a negative trendline. As a positive control, we included Flonase, which was approved for OTC use in July 2014 (11). After the Flonase OTC switch announcement date, there was a sharp increase in interest for the search term that was followed by a new, increased baseline level of interest. Additionally, there were cyclical peaks in interest for Flonase corresponding to an annual cycle, likely that of seasonal allergies. Analysis of raw search numbers in SEMRush data generally mirrors the trends for “hearing aids” seen with Google Trends (Fig. 2). Between 2012 and 2015, the average monthly searches for hearing aids increased 3.6 times, from 40,500 searches per month in 2012 to 74,000 searches per month in 2015. From 2016 to 2021 this number increased another 2.7 times to 201,000 searches per month before declining to 110,000 in 2022. We suspect this decline is in part an artifact due to the 12-month running average calculation done by SEMRush; 12-month running averages through 2022 will still capture data from 2021, while interest in hearing aids was recovering during the COVID pandemic.FIG. 2.: SEMRush average monthly search volume, updated annually, for the term “hearing aids” within the United States.Table 1 shows the top 5 query topics related to hearing aids in Google Trends. Topics centered around hearing aid brands. Table 2 shows the top 5 questions and searches containing the term “hearing aids” in SEMRush. Search questions related to cost and insurance coverage. TABLE 1. - Top related searches for “hearing aids” from Google Trends Google Trends related searches Top related queries Interest (volume value) Top related topics Interest (volume value) 1 Hearing aid 100 Hearing aid 100 2 Hearing aids Costco 48 Costco Wholesale – retail companies 6 3 Best hearing aids 45 Phonak 5 4 Phonak hearing aids 37 Ear 4 5 Phonak 36 Costco hearing aid store 4 Interest is measured by a unitless, normalized volume value. TABLE 2. - Most common questions and search terms including “hearing aids” from SEMRush SEMRush related searches Most common questions including “hearing aids” Most common search terms including “hearing aids” 1 Does Medicare cover hearing aids? Hearing aids 2 Does Medicare pay for hearing aids? Bose hearing aids 3 How much are hearing aids? Costco hearing aids 4 How much do hearing aids cost? Hearing aids near me 5 What are the best hearing aids? Hearing aid DISCUSSION Interest for hearing aids has more than doubled from 2015 through 2022 according to internet search databases. Negative control search terms during the same period did not increase, whereas Flonase, a positive control, increased after FDA announcement and then cyclically corresponded to allergy season. This supports our methodology to gauge public interest in products. Specific related searches demonstrate that individuals are curious about hearing aid pricing and insurance coverage. This increased interest has traveled in the same direction as hearing aid sales, which have steadily increased since the early 2000s with the exception of the 2008 recession and 2020 pandemic (12,13). Overall, sales have increased 1.4 times from 3.36 million units in 2015 to 4.73 million in 2021 (13–15), However, given that hearing aids are still largely underutilized (1,2), the need largely exceeds sales. Addressing public interest can help inform the gap that exists between needs and sales. Indeed, our data suggest that increased interest (2.3× since 2015) has outpaced increased sales (1.4× in a similar time period). Increased interest but persistently low use of hearing aids highlights the need to increase accessibility. OTC hearing aids are intended to address this gap through cost reduction and removing the requirement for a prescription. Further solutions may include guidance on purchasing and using OTC hearing aids to appropriate patients by audiologists and otolaryngologists, manufacturer competition to lower costs, and subsidies to patients who cannot afford OTC hearing aids. Finally, increased insurance coverage of prescription hearing aids or flexible spending account/health savings account eligibility for OTC hearing aids may also lower costs. Given the recent availability of OTC hearing aids, more research is required to track the sales, adoption, and effectiveness of these devices over prescription hearing aids. Consumer research has linked public interest in hearing aids to concerns about cost and insurance coverage. The top 4 search questions on SEMRush centered around cost, and surveys repeatedly cite price as a barrier to purchase (16,17). Prescription devices can cost $1000–$4000 per ear depending on features and place of sale (18). Unfortunately, Medicare Parts A and B do not cover hearing aids or fitting appointments; some Medicare Advantage Plans (Part C) may provide partial coverage (19). In contrast, Medicaid covers audiological services and hearing aids for children up to 21 years old and, in some states, for adults (20,21). Nonetheless, a significant portion of dual eligibles, those enrolled in both Medicare and Medicaid, report greater difficulties with hearing aid access and lower utilization of audiological services than wealthier Medicare-only counterparts (22). To increase accessibility and reduce cost, the FDA Reauthorization Act of 2017 proposed a new category of OTC hearing aids allowing people with perceived mild-to-moderate hearing loss to obtain aids without an audiology or medical visit (23). Proposed recommendations were published in October 2021, and the final guidelines became effective in October 2022, when sales of devices began (24). FDA guidelines include safety measures, such as output limits (111–117 dB SPL) and user-adjustable volume controls (24). Interestingly, the market response in the immediate aftermath has been lukewarm with the little data so far on OTC-specific sales suggesting limited adoption (25). This seemingly goes against the hypothesis that cost is a major barrier to hearing aid adoption. However, a typical pair of OTC hearing aids still ranges from $300 to $3000 (26), which may be too pricey for cost-conscious consumers, especially those living on fixed retirement incomes. Given the increased public interest in hearing aids over the prior 5–10 years and continued mention of price sensitivity in consumer searches and surveys, further price reductions for OTC hearing aids may increase adoption rates. Furthermore, the cost is just one of several reasons cited as barriers to hearing aid adoption; other reasons include hearing loss that is not perceived to be severe enough, lack of information on available options, and feelings of embarrassment (27). Research has consistently shown a mismatch between older patients’ awareness of their hearing loss and their audiogram findings, which presents a major barrier (28). Importantly, self-acknowledgement of hearing handicaps is correlated with pursuing hearing aids (28). A multifactorial approach targeting patient education, stigma reduction, and lower price points will be necessary to increase hearing aid purchases and utilization. One limitation of our study was the lack of highly granular search data. Data with monthly or weekly search numbers would allow for better comparisons between search terms and the correlation of search volume to real-time events. Furthermore, neither database provided demographic data (eg, age or hearing status) on who is searching. Additionally, the authors’ selection of controls may have confounded results; to mitigate this, we utilized both positive and negative controls within related categories. Finally, these results should not be generalized beyond hearing aids to other device categories. In conclusion, search engine interest in hearing aids was stable between 2004 and 2015 but has since more than doubled. The top questions concerning hearing aids were about cost and insurance coverage, emphasizing individuals’ price sensitivity and the need for greater hearing aid accessibility. The introduction of OTC hearing aids lowers the barrier to entry for hearing aid usage, leaving the future of the hearing aid market dynamic but also uncertain. A better understanding of the drivers of and barriers to hearing aid utilization is critical as the needs of the aging population continue to grow. FUNDING SOURCES None declared. CONFLICT OF INTEREST STATEMENT None declared. DATA AVAILABILITY STATEMENT Data used in this research are from publicly available databases Google Trends and SEMRush.