Your Health | Mount Sinai Today

Why a Colonoscopy Is the Best Way to Detect and Prevent Colon Cancer

Oct 19, 2022 | Featured, Your Health

Colonoscopy is one of those important, routine medical procedures that most people would rather avoid. But experts say the test is a highly effective tool for both preventing colorectal cancer and diagnosing it at an early stage. Colonoscopy is also helpful in diagnosing and treating a variety of gastrointestinal (GI) disorders.

The American Cancer Society recommends that people with an average risk for colorectal cancer start regular screening for that cancer at age 45. There are several choices for colorectal cancer screening; colonoscopy is one of those options and has the advantage of being a one-step test, where precancerous polyps can be identified and removed if they are there at the same time.

For those in good health who have a colonoscopy—a procedure that enables a physician (usually a gastroenterologist) to directly image and examine the entire colon—it does not need to be repeated for ten years.

Those looking for an excuse to put off a colonoscopy might now point to a large study conducted in Europe and published in September 2022 in the New England Journal of Medicine (NEJM) that appeared to question the benefits of colonoscopies.

But many experts caution that the results of the NordICC study are being misinterpreted. They say colonoscopies remain “the gold standard” to detect and prevent colon cancer, and that this study should not cause you to change your behavior, no matter how much patients might wish otherwise.

“People should continue to rely on high-quality colonoscopy for polyp detection and removal, which will lead to prevention in most cases of colorectal cancer,” says David Greenwald, MD, Director of Clinical Gastroenterology and Endoscopy at The Mount Sinai Hospital.

David Greenwald, MD

In this Q&A, Dr. Greenwald, Immediate Past-President of the American College of Gastroenterology, and Co-Chair of New York’s Citywide Colorectal Cancer Control Coalition (C5), discusses the recent study and why the value of colonoscopies remains unchanged.

He adds, “The bottom line: This study, along with prior studies, shows that colonoscopy decreases your chances of getting and dying from colorectal cancer. Getting sick and dying from colorectal cancer—especially due to delayed screening—is real. Screening with colonoscopy saves lives.”

Why is a colonoscopy important?

Colonoscopy is effective in the diagnosis and/or evaluation of various GI disorders, such as colon polyps, colon cancer, diverticulosis, inflammatory bowel disease, bleeding, change in bowel habits, abdominal pain, obstruction and abnormal X-rays or CT scans. It is also used for therapy, such as the removal of polyps or control of bleeding. A colonoscopy is also used for screening for colon cancer. A key advantage of this technique is that it allows both identification of abnormal findings and also therapy or removal of these lesions during the same examination. This procedure is particularly helpful for identification and removal of precancerous polyps.

Does this recent study change how we view colonoscopies and how doctors in the United States will recommend colonoscopy screening?

No. The results of this study must be understood in context, and the accompanying editorial in the same issue of the NEJM spelled out significant details about the strengths and limitations of this study. The bottom line is that colonoscopy is still the gold standard to detect and prevent colorectal cancer, especially for high-risk individuals. Most importantly, in the section of the study that analyzed people who actually had a colonoscopy, the risk of developing colorectal cancer decreased by 31 percent and the risk of dying from colorectal cancer decreased by 50 percent, which is huge.

What is one of the most significant issues with this study?

One drawback of the study is that participants were randomly invited to have a colonoscopy, and many people who should have gotten a colonoscopy chose not to. In fact, less than half (42 percent) of those invited to have a colonoscopy actually had one. This remains an issue in the United States as well. Screening for colorectal cancer remains an enormous public health goal. Colorectal cancer is the second leading cause of cancer death, but fully one-third of the eligible U.S. population remains unscreened.

Are there other issues with the study?

The benefits of colonoscopies take time to be realized. Colon polyps typically take many years (ten or more in most cases) to advance from small polyps to large polyps to cancer, and so the benefits of taking out small polyps or even large precancerous polyps is not seen as leading to a reduction in colorectal cancer for many years, maybe even decades. Other studies that have looked at the effect of removing polyps have shown greater reductions in colorectal cancer incidence and mortality when they looked at outcomes over a longer period of time than was reported in the NordICC study. The NordICC study, short for Northern-European Initiative on Colon Cancer, included more 84,000 men and women ages 55 to 64 from Poland, Norway and Sweden, and covered a period of 10 years, which included a period before these countries began widespread screenings.

Should people still rely on their routine colonoscopy screenings to prevent colorectal cancer?

Yes. People should rely on high-quality colonoscopy for polyp detection and removal, which in most situations will lead to prevention of colorectal cancer. The National Polyp Study demonstrated a substantial decrease in expected colon cancer incidence and mortality related to removing colorectal polyps, and was published in the NEJM years ago. High-quality colonoscopy is key. Nearly 30 percent of the endoscopists who were included in the NordICC trial did not meet a key quality measure. The adenoma detection rate (ADR) measures the percentage of patients who have one or more precancerous polyps detected. The NordICC study did not meet the 25 percent rate that is recommended in the United States; the ADR average in the United States is rising and now approaches approximately 40 percent in many studies.

Learn more about Gastroenterology at Mount Sinai

Seven Common Misconceptions About Breast Cancer

Updated on Oct 12, 2022 | Your Health

One of the most common cancers in the United States, breast cancer will affect about 1 in 8 women in their lifetimes, according to the Centers for Disease Control and Prevention.

Yet there are many misconceptions about breast cancer—and improving your knowledge of the disease is one way you can fight it.

Here are seven common misconceptions, and the facts from some of Mount Sinai’s leading breast cancer specialists.

Misconception: More than 50 percent of breast cancer patients have a family history of breast cancer.

The Facts: Many women think you can only get breast cancer if there is a genetic factor and, as a result, are not getting screened. In fact, 80 to 90 percent of all breast cancer patients have no family history. There are women who have genetic predispositions to breast cancer and genetic mutations that cause breast cancer. However, only 5 to 10 percent of all breast cancer patients actually have one of these genes, and a majority have no genetic predisposition or family history. In reality, your biggest risk factors are gender and age. If you are a woman who is 40 or older, even if you don’t have a close relative with breast or ovarian cancer, you should still follow the CDC’s recommended guidelines to begin getting screened annually.

Misconception: Screening recommendations are the same for everyone, regardless of a family history of breast cancer.

The Facts: The guidance for the general population is to start mammography screening at age 40 and continue on an annual basis thereafter. Those who may be at a higher risk, such as those with a family history or other personal factors, may need to be screened earlier. If you have a first-degree relative, such as a mother or sister, who was diagnosed at a certain age, you should start screening 10 years before that relative’s age at diagnosis. So, for example, if you were diagnosed at 45, your daughter should start screening at age 35. If you have a genetic predisposition, such as the breast cancer (BRCA) gene, you may need to begin screening as early as age 25.

Misconception: Only women get breast cancer.

The Facts: For most men, the risk of getting breast cancer is extremely low, approximately 1 percent. However, for men with the BRCA1 gene, the risk is about 1 to 2 percent, and for those with the BRCA2 mutation, the risk is 7 to 10 percent, about the same as the general female population. These men should be followed at a high-risk surveillance center.

Misconception: Consuming too much sugar directly increases your risk for breast cancer, and non-natural sugar is riskier than natural.

The Facts: There are no human studies that can absolutely defend or corroborate that theory. Your body maintains a more or less constant sugar level, and even if you consume a lot of sugar, it does not directly affect cancer cells. However, adopting healthy eating habits can reduce your risk for developing cancer and other chronic health conditions, especially if you have diabetes and are prone to have high blood sugars. You need to have a certain amount of fiber. You need to have foods that are natural whole foods, and minimize the amount of processed foods.

The U.S. government dietary guidelines recommend five to seven servings a day of fresh fruits and vegetables. We recommend increasing that to 7 to 10 servings a day. One serving is an amount that fits in the palm of your hand. Stay away from saturated fats, eat healthy oils, such as extra virgin olive oil, and lean meats that don’t have a lot of fat. You should eat a mostly plant-based diet. That doesn’t mean vegetarian or vegan. It means the majority of the foods you consume should be plants. Legumes, a type of vegetable that includes peas, beans, and lentils should be an essential part of it. Two servings a day of legumes are associated with decreased chronic disease, including cancer. You can still enjoy some sweets in moderation.

Concerning whether there are better types of sugar: Fruit, even though it is high in fructose, also contains fiber, which blunts the absorption of the fructose, so you don’t really get those peaks of high blood sugar. Honey and agave nectar don’t raise blood sugar as much as other sugars, because they are thicker, and they have some health benefits. Though artificial sweeteners are referred to as “sugar-free,” they contain ingredients that drive appetite and cause people to consume more calories throughout the day, and should be limited or avoided.

Misconception: Limiting alcohol consumption to several drinks per week can reduce your risk for developing breast cancer.

The Facts: Studies show there is no amount of alcohol that a human being can safely consume without any future risk for chronic disease. When people increase their alcohol intake, they also tend to eat less fruits and vegetables, which is linked to a number of cancers. This is because, unlike food, your body cannot burn off alcohol for energy. Instead, it converts alcohol to fatty acids in certain parts of the body that become fat depots and can lead to insulin resistance. This is how unhealthy diets can lead to cancer.

Misconception: If you tested negative for the BRCA gene 10 years ago, you do not need to get tested again because the test today is not much more advanced.

The Facts: If you haven’t been tested since 2013, you should get re-tested, because the testing today is based on much more comprehensive data. Aside from BRCA genes, we now test for a whole other panel of genes that predispose for developing breast cancer, including PALB2, CHEK2, and the ATM gene. The risk these carry is affected by family history. If there’s a lot of family history of breast or ovarian cancer, and you also have that gene, then you are in the highest range of the risk model of that gene.

Misconception: It is not necessary for everyone to get tested for the BRCA gene because only some ethnicities are affected.

The Facts: Genetic testing is vastly underutilized. The American Society of Breast Surgeons recently changed its guidelines and recommended testing every woman diagnosed with breast cancer regardless of family history or background. However, there are certain ethnic groups that are at higher risk for having a BRCA gene. For example, in the general population, about 1 in 500 to 1 in 1,000 will have a BRCA gene—far less than one percent. Among the Ashkenazi Jewish population (Jewish people of European descent), the rate is 1 in 40, or 2 percent of the Ashkenazi Jewish population. Many clinicians feel that population-based testing should be done in these selected groups where the yield is higher. But no ethnic group is without risk. For example, there’s an Icelandic version of BRCA. There’s a Hispanic version of BRCA. We see BRCA in Black women. There is a version of BRCA across all ethnic backgrounds, and it’s just a question of picking populations where the yield is the highest. We implemented a program so every woman can get genetic testing regardless of ability to pay. The maximum out-of-pocket expense is $99, which will be waived if you can prove financial need.

This Q&A is based on questions and answers from the annual Dubin Breast Center Fact vs. Fiction Luncheon and Symposium held in June. The panel discussion was moderated by Elisa Port, MD, FACS, and featured a panel of experts, including David Anderson, MD, FACS; Anna Barbieri, MD; Jeffrey Mechanick, MD; Cardinale Smith, MD, PhD; and Joseph Sparano, MD, FACP. Watch the video here.

Learn more about the Dubin Breast Center at Mount Sinai

Learn more about the Center of Excellence for Breast Cancer at Mount Sinai

Here’s Why You Should Get a Flu Shot Now

Oct 9, 2022 | Vaccines, Your Health

With the arrival of fall, the weather is getting cooler, the days are getting short, and it’s time for your annual flu shot.

Since the outbreak of the COIVD -19 pandemic, the presence of seasonal flu, caused by the influenza virus, has been lower than normal, as people did not go out as much, wore masks, and practiced social distancing.

But as life returns to normal, so does the flu season, and so health experts are recommending you get the shot, the sooner the better. The Centers for Disease Control and Prevention (CDC) recommends influenza vaccination of all individuals six months of age and older, preferably by the end of October.

Here are five things to keep in mind about the flu vaccine from Waleed Javaid, MD, Professor of Medicine at the Icahn School of Medicine at Mount Sinai and an expert on infectious disease.

Getting the flu shot is especially important this year.

For the last two years, the COVID-19 pandemic has tended to overshadow the flu, and the incidence of flu was lower than normal. But that’s expected to change. Experts have been tracking the flu season in the Southern Hemisphere, where winter in places like South America and Australia officially ends in September, and there has been a significant increase in flu activity back to normal levels. They expect the same pattern to occur in the United States and the rest of the Northern Hemisphere. Health care providers understand that some may have become wary of another vaccine when the pandemic appears to be winding down. But now is not the time to let down your guard.

You can get the flu vaccine at the same time you get a COVID-19 vaccine.

The CDC says you can get both of these shots at the same time, which is especially convenient. Of course, it’s always best to discuss your personal circumstances with your primary care provider. And you may decide to space them out by a few weeks, which may help reduced potential side effects, such as fatigue, headache, and muscle ache. It’s also okay for children to get both shots at the same time.

The seasonal flu is serious business.

Some may dismiss the seasonal flu as little different from the common cold. In fact, it is much more severe and it is actually more like COVID-19 in severity than the common cold. In addition, many are at higher risk of developing serious flu-related complications, including those 65 and older; those with chronic medical conditions such as asthma, diabetes or heart disease; those who are pregnant; and children younger than five. So you may expose others you are in contact with. You can still get the flu even if you are vaccinated. But the vaccine is very effective at reducing hospitalizations and deaths due to the seasonal flu.

Earlier is best, but any time is good.

Experts recommend getting vaccinated by the end of October. This will provide protection during peak of flu season in December and January. Vaccination later can still provide protection, but it takes about two weeks after vaccination for the vaccine to be effective. Something new this year: The CDC recommends that those over age 65 get a higher dose version of the vaccine.

The symptoms for the flu and for COVID-19 are very similar.

It’s very hard to distinguish between the two conditions without an actual test. The symptoms for both are very similar, including fever, chills, and difficulty breathing. Bottom line: If you are feeling these symptoms, stay home. If they worsen, call your health care provider.

Six Things You May Not Know About Hair Loss From Alopecia Areata. For Starters: It’s More Common Than You Think

Updated on Sep 28, 2022 | Your Health

Alopecia areata is a common autoimmune skin disease that causes hair loss, and the emotional toll can be devastating. Currently there is no cure, but the condition can be managed well, especially if treated early.

Emma Guttman-Yassky, MD, PhD, Waldman Professor and System Chair, the Kimberly and Eric J. Waldman Department of Dermatology, and Director of the Alopecia Center of Excellence at Mount Sinai, shares six things you may not know about alopecia areata.

1. It’s an autoimmune disease

Alopecia Areata is an autoimmune skin disease that causes hair loss on your scalp, face, and sometimes other areas of the body. Your body’s immune system attacks the hair follicles, resulting in increased hair loss. The onset is often sudden, with clumps of hair being shed, and circular bald spots may form.

2. It’s common

About 7 million people in the United States— and 147 million people worldwide—are affected by alopecia areata.

3. It affects all kinds of people

People of all ages, both sexes, and all ethnic groups can develop alopecia areata. It often first appears during childhood and can be different for everyone who has it.

4. It’s complex

Alopecia areata is very complex, and may run in families. However, multiple factors, both genetic and environmental, are thought to trigger the disease. It is not just a matter of heredity.

5. There are three types of alopecia areata

alopecia areata (patchy)—one or more coin-sized patches on the skin or body
alopecia areata totalis—complete hair loss on the scalp
alopecia areata universalis—total hair loss on the scalp and body

6. Other forms of alopecia include:

Scarring alopecia: This includes frontal fibrosing alopecia (FFA), which is hair loss on the front and sides of the scalp and may also affect the eyebrows; lichen planopilaris (LPP), an uncommon condition producing smooth white patches of hair loss on the scalp that is slowly progressive; and central cicatricial centrifugal alopecia (CCCA), a unique form of scarring alopecia affecting mostly black women on the crown of the scalp
Male Pattern Baldness: Hair loss usually follows a pattern of receding hairline and hair thinning on the crown. It is related to your genes and male sex hormones.

There is no cure for alopecia areata, but it now is emerging as a manageable condition that doctors can treat effectively, which can allow you to grow back hair. Mount Sinai is also conducting studies in scarring alopecia conditions that induce hair regrowth.

“At the Alopecia Center of Excellence at Mount Sinai, we are conducting clinical trials offering our patients access to new therapies such as novel JAK inhibitors and other new treatments, many of which are not available anywhere else,” says Dr. Guttman.

To make an appointment to see one of our team of Alopecia Areata experts, call 212-241-HAIR or email alopecia@mountsinai.org

Learn more about the Alopecia Center of Excellence

Suicide Prevention: We Can Make a Difference

Updated on Sep 30, 2022 | Psychiatry, Your Health

Suicide is a serious public health problem, one that affects a broad segment of the population, according to the Centers for Disease Control and Prevention. But it can be hard to talk about.

In fact, there is one suicide death every 11 minutes, and that does not reflect the number of attempts. The suicide rate had been rising dramatically prior to the pandemic, which is one reason why the federal government in July launched the 988 National Suicide & Crisis Lifeline, an upgraded hotline for those in crisis.

At the same time, it’s important to remember there are ways to mitigate the risk of suicide and specific things you can do if you are concerned about a friend of family member. In this Q&A, Marianne Goodman, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, offers some guidance on this sensitive topic.

“If we can help people identify suicide risks, limit access to ways that they could die by suicide, and use the crisis services that are now much more available, including the national 988 hotline, we can make a big difference,” says Dr. Goodman, acting director of the Mental Illness Research, Education and Clinical Centers at the James J. Peters VA Medical Center in the Bronx, who also co-leads a new initiative to help concerned family members speak to veterans about safely storing firearms and reducing the risk of self-harm.

How serious is the problem of suicide in the United States?

Suicide is the 12th leading cause of death. There are about 130 suicide deaths every day, and that’s one about every 11 minutes. In 2020, almost 46,000 Americans died by suicide, and this is twice as many as those who die in homicides. There were also 1.2 million suicide attempts. White males account for about 70 percent of the suicide deaths, and firearms are involved in more than half of these deaths. Unfortunately, in the past 20 years, the age adjusted suicide rate has increased 30 percent. This is a national crisis prompting a tremendous amount of research and clinical programming developed to target this elevating rate of suicide.

Who is most at risk, and why?

Certain populations have a particularly heightened risk. These include those encountering chronic stressors such as the elderly, veterans, lesbian, gay, bisexual, transgender, and queer populations, those with debilitating physical and mental illness, and especially those with a previous suicide attempt. Other risk groups include people with acute stressors such as a recent job loss, having been stigmatized, victimized, or traumatized, or who have experienced financial or relationship problems. But there’s not an equal risk at all times. It turns out that the rate of suicide is higher on Mondays and lower on the weekends; rates are higher during the spring and summer and after midnight.

What are some of the most common causes of suicide and suicidal thinking?

Suicide and suicidal thinking is prompted by many factors. In addition to the known risk factors, suicidal symptoms can be triggered by intense feelings of failure, shame, and being a burden to others. A deep sense of isolation, helplessness, and hopelessness leads to the belief that taking one’s life is the only answer to the misery they are feeling. However, there are also protective factors that actually lower the risk of suicide. These include bolstering coping abilities, having a purpose and reason for living; possessing a strong cultural identity; and a connection to others. If we can increase our protective factors, it actually mitigates some of the risks.

There are growing concerns about suicide among younger people. Why is that?

There is a tremendous and growing concern about suicide in younger people. Suicide is now the second leading cause of death among people aged 15 to 24. The highest rate of suicide death in youth are American Indians and Alaska Natives, with about 23 deaths per 100,000 people. White youth are second with about six suicide deaths per 100,000 people. While these numbers are certainly concerning, there’s a lot of recent evidence that suggests that youth suicide is a growing problem. A recent study that looked at just the past year found that 20 percent of high school students reported serious thoughts of suicide, and 9 percent made an attempt. Those are astronomical numbers. It’s not just high school students at risk; other concerning emergency room data of pre-adolescent children 10 to 12 years old document an increase in suicidal ingestion of substances, up four and a half fold in the past two decades. Also, reports of firearm use in youth is the highest in the past 20 years. During the pandemic, there was an increase in firearm suicide deaths of about 2 percent in adults, but 15 percent in young people. So clearly life stressors are affecting youth, and it’s being expressed through suicidal expression.

What has been the impact of the pandemic?

Suicide rates peaked in 2018. During the pandemic, suicide rates actually declined 3 percent in 2020. Pandemic related decreases could be explained by the notion that people pull together during a crisis. Some stressors were lessened during the pandemic, such as no longer needing to endure long commutes to work. The pandemic did draw attention to the importance of mental health. So while the pandemic was stressful, some of those forces were mitigated with the suicide rate coming down since 2020.

Has the new 988 National Suicide Prevention Hotline helped?

The 988 hotline is the 911 for mental health crises. The national hotline, accessed through calling 988, now connects people to the National Suicide Prevention Lifeline. This lifeline then connects individuals to various resources, including the Veteran’s Crisis Line, and a network of more than 200 state and local call centers services through the U.S. Department of Health and Human Services. The Biden administration invested a tremendous amount of money into this infrastructure. In fact, funding increased from $24 million to $432 million to address our mental health and suicide crises. In the year before the hotline, there were about three million calls, chats, and text to these centers. That’s expected to double within the first year of the national hotline.

What are some signs that someone may be in need of help?

Suicide prevention is everybody’s responsibility. There are warning signs that signal that someone is struggling. These include a preoccupation with death, comments about feeling trapped or a burden to others, or suggesting that people would be better off without them. Look for reckless behavior and impulsivity, such as driving at high speeds or enhanced use of alcohol and mind-altering substances. Mood swings, irritability, and worsening anger are concerning signs, as are changes in behavior including pushing people away, turning off phones, excessive sleep, or inability to sleep.

What should you do if you are concerned about a loved one or friend?

If you are concerned about a loved one or a friend, it’s important to reach out to that person. Talk to them and listen carefully. Encourage them to tell you what’s going on. Ask some difficult questions, such as: Are they feeling so bad that they want to think about ending their life? Do they have a plan to end their life? Don’t pass judgment about what they’re saying. Just be there to hear what they have to say. It’s important to empathize with the pain that they are going through. Help them to connect to either friends or support. If they are in crisis, use the 988 hotline, or seek professional help in a local emergency room. It’s very important to reassure the person that that they will not feel this bad forever and that negative feelings do get better over time.

What resources are available?

There are tremendous resources available. You can call the 988 hotline line 24/7. There are many organizations that offer assistance, including the American Foundation for Suicide Prevention, which has a website with lots of information. Another website, Means Matter, offers information about the importance of restricting access to a means to die by suicide, such as firearms. The Suicide Prevention Resource Center is another valuable resource.

Why is the issue of firearms so important?

When firearms are used, more than 85 percent of suicide attempts end in death. All other methods average about a 2 percent likelihood of death. More than 50 percent of people who die by suicide use firearms. If we can limit access to firearms, especially for those who are vulnerable, during high-risk times, we can meaningfully bring down suicide death rates. Promoting safe storage of firearms, and involving family in these decisions, is key. Pulling a trigger can happen so quickly with firearms—that urge, that impulse, once it is acted upon, you can’t take it back.

Learn more about the 988 Suicide & Crisis Lifeline

What to Expect With New Over-the-Counter Hearing Aids

Sep 9, 2022 | Your Health

The Food and Drug Administration (FDA) recently issued a rule that allows hearing aids to be available over-the-counter (OTC). This rule enables consumers who perceive themselves to have mild to moderate hearing loss to buy hearing aids from stores or online retailers without a medical exam or prescription.

This rule, which took effect October 17, is expected to make hearing aids more accessible to the public, but many questions remain unanswered: what does it mean to have perceived mild to moderate hearing loss; what can we expect from this new category of hearing aids; and how can audiologists and hearing specialists help even when there isn’t a need for a hearing exam to obtain these devices? Enrique Perez, MD, Assistant Professor of Otolaryngology at the New York Eye and Ear Infirmary of Mount Sinai, shares his thoughts on the FDA rule and the benefit OTC hearing aids can bring to consumers.

Who might benefit most from this new rule?

Older adults who have noticed they are struggling somewhat with hearing in their day-to-day activities would likely benefit the most. The rule applies to people age 18 and older with perceived mild to moderate hearing loss, which can be subjective to quantify without an exam. The OTC devices would likely be suitable for people without serious otologic (ear) disease, frequent discomfort in the ear, or ear infections.

What devices are covered under the rule?

The rule covers air conduction hearing aids, which mimic the way we naturally hear but deliver amplified sound to the inner ear. This is opposed to bone-anchored hearing aids, which require surgical implantation, or personal sound amplification products, which are not mean for impaired hearing but are intended for people with normal hearing to amplify sounds in certain situations.

It remains to be seen how OTC hearing aids will eventually be labeled, but it is important that the labels are comprehensive, to ensure that individuals are not misled. For example, an OTC label could point out that the product is different from a prescription hearing aid and that if you are not seeing a benefit, you should be evaluated by a specialist.

How might an audiologist help?

Hearing aids becoming available over the counter doesn’t necessarily mean there is no longer any need for an audiologist. As more people have access to hearing aids, we might start to see a big chunk of these people we might not ordinarily see in clinic.

Enrique Perez, MD

How can I tell if I might have mild to moderate hearing loss?

There are clearly defined levels of hearing loss, which are determined through hearing exams, known as audiograms, on the decibels individuals are able to hear. But without an actual audiogram, you would have to rely on subjective cues, Dr. Perez said.

Someone with mild hearing loss might be struggling to hear low rumbling sounds or people whispering or speaking in another room.

Moderate hearing loss could look like someone with difficulty hearing people talking at a low tone, or struggling to understand conversation in a quiet office.

People with mild or moderate hearing loss might also struggle to hear conversations in a noisy environment, like a busy restaurant.

A key takeaway: If you’re struggling to hear in your daily activities, you might have some form of hearing loss, and hearing aids could be suitable for you.

For example, someone might try an OTC hearing aid and notice it is not amplifying sounds the way it needs to. An audiologist in this situation might be able to classify the degree of hearing loss and point the patient to the right kind of device they need.

Audiologists specialize in managing prescription devices, adjusting to each patient’s condition. Hearing loss can be complex: some people have very good hearing in the low frequencies but poor hearing in high frequencies, and a specialist can account for those nuances.

A possible limiting factor of an OTC hearing aid could be comfort. Everyone’s opening of the ear canal can be quite different. Audiologists work with making ear molds to make the fit more secure and comfortable. However, it is not clear how billing would work for mold services at this point, especially regarding OTC devices.

What might the future of hearing aid access look like?

In the long term, I hope to see that as more OTC hearing devices enter the market, competition will drive down the price of the technology in general. Perhaps it could even reduce the prices of prescription hearing aids.

It’s sad to tell a patient that they could benefit from hearing aids, but because most insurances do not cover these devices, they are shut out. These devices are pretty expensive, even at wholesale prices. The cheapest ones could run around $800, and expensive ones could easily run north of $5,000. This is not pocket change for a retiree on fixed income.

There also has to be a system for consumers to try out and return OTC hearing aids, just as they can try on reading glasses at the pharmacy. Some dispensers of prescription hearing aids do 30- to 90-day trials; perhaps there’s some way OTC devices can have a similar return policy. Finally, as a physician, I want to see OTC hearing aids rolled out in a safe manner, with adequate patient education and labeling to ensure people don’t end up getting hurt. There needs to be proper education of when these devices are suitable and for what kind of patient.

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