Over-the-Counter (OTC) Hearing Aid Availability across the Spectrum of Human Skin Colors

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to read and review this manuscript. I congratulate the authors on an important project that sheds light on an issue that could help improve the accessibility of OTC hearing aids particularly for individuals the devices were intended to increase access for initially. Overall the project was well-designed and the paper was very well written. I have only minor comments, mostly related to clarity and conciseness. I hope that the information in this paper will reach many people. My suggestions are below for the authors' consideration:

INTRO:

line 28: The FDA register does not seem like the right reference here. It works better for the previous sentence. This sentence may not need a reference as it is the premise/hypothesis of your study.

 

line 29: Consider changing to not covered by traditional medicare (they are covered in some part B medicare advantage plans).

 

line 35 - This sentence seems like it is already reporting the results of the current study. I recommend restructuring this paragraph to set up the motivation for the current study. 

 

line 52 - repetitive

 

line 91 - consider changing to "at least two"

 

line 106 - is hard to follow

 

lines 114 - 120 are repetitive

 

line 122 - due perhaps to 

 

line 123 - I’m not aware of any research that shows that remote microphones mitigate cognitive decline. Maybe the authors can say something like “other assistive listening devices that can help improve communication…”

 

line 147 - Knowledge gap section could be more concise. This statement about the lack of data on the number of people who have hearing loss - this is a knowledge gap but it's not clear from the writing how it relates to the current study so it takes away from the focus of the article. Maybe move to discussion or state something like “there are a number of knowledge gaps to address including: xyz. this paper aims to ….”

line 148 - again this seems like it is already stating the results of this paper.

OTC products are not offered in an equitable way - is this based on the present study? If so I recommend holding off on stating this until the results/discussion and instead stating something like, it is important to examine the extent to which they are offered in an equitalbe way.

line 151 - is this based on your research? Maybe state “we have noticed that there is…”. THis also seems better for the discussion. 

 

METHODS

when was the FDA search carried out? August 2023? Please state this. A specific date is preferable.

 

RESULTS

Figure 2, change axes titles to be more descriptive. Suggest to include the color of the palette relative to # of devices, either in figure 2 or as another figure. 

 

DISCUSSION

line 236 - Suggest removing the word significantly, consider "more OTC hearing aids were offered in relatively lighter skin tones compared to darker skin tones (82% vs. 18%)." 

line 254 - implications rather than consequences? 

line 256 - could have been  - consider using "have the potential to be"? 

line 259 -  however is not needed

line 264 - "this makes them" - consider replacing with more descriptive words - perhaps something like, "Mistrust can cause individuals…"

line 266 - became evident?

line 266 - 269 repetitive

 

line 270 - Consider mentioning here that the timeliness of this project offers an opportunity for manufacturers to address this problem. Also opens doors for research related to colorways in prescription hearing aids

 

line 281 - consider not starting the sentence with the word “It”

Author Response

INTRO

• line 28: The FDA register does not seem like the right reference here. It works better for the previous sentence. This sentence may not need a reference as it is the premise/hypothesis of your study.
  • Shifted citation to the prior sentence.
• line 29: Consider changing to not covered by traditional medicare (they are covered in some part B medicare advantage plans).
  • Clarified this.
• line 35 - This sentence seems like it is already reporting the results of the current study. I recommend restructuring this paragraph to set up the motivation for the current study.
  • Reworded to suggest the knowledge gap of interest.
• line 52 – repetitive
  • Deleted tor educe repetition.
• line 91 - consider changing to "at least two"
  • Clarified that other influences are also relevant to this issue.
• line 106 - is hard to follow
  • Edited for clarity.
• lines 114 - 120 are repetitive
  • Removed for parsimony.
• line 122 - due perhaps to
  • Clarified the current state of evidence on the link between hearing loss and cognitive decline.
• line 123 - I’m not aware of any research that shows that remote microphones mitigate cognitive decline. Maybe the authors can say something like “other assistive listening devices that can help improve communication…”
  • Removed this sentence to focus attention on the core argument in this section.
• line 147 - Knowledge gap section could be more concise. This statement about the lack of data on the number of people who have hearing loss - this is a knowledge gap but it's not clear from the writing how it relates to the current study so it takes away from the focus of the article. Maybe move to discussion or state something like “there are a number of knowledge gaps to address including: xyz. this paper aims to ….”
  • Reworked the knowledge gap section to clarify what exactly is being studied.
• line 148 - again this seems like it is already stating the results of this paper. OTC products are not offered in an equitable way - is this based on the present study? If so I recommend holding off on stating this until the results/discussion and instead stating something like, it is important to examine the extent to which they are offered in an equitalbe way.
  • Reworked the knowledge gap section to clarify what exactly is being studied.
• line 151 - is this based on your research? Maybe state “we have noticed that there is…”. THis also seems better for the discussion.
  • Reworded to clarify the knowledge gap in the literature and how it relates to this project.

METHODS

• when was the FDA search carried out? August 2023? Please state this. A specific date is preferable.
  • Added text discussing this to the first paragraph of the Materials and Methods section.

RESULTS

• Figure 2, change axes titles to be more descriptive.
  • Edited for clarity. Figure 2 is now figure 4 because of the addition of a new figure 1 and 2.
• Suggest to include the color of the palette relative to # of devices, either in figure 2 or as another figure.
  • Figure 2 now shows the palette colors, figure 2 is now figure 4, and the relative proportions of devices in each palette is shown in table 3.

DISCUSSION

• line 236 - Suggest removing the word significantly, consider "more OTC hearing aids were offered in relatively lighter skin tones compared to darker skin tones (82% vs. 18%)."
  • Reworded this section for clarity.
• line 254 - implications rather than consequences?
  • Wording changed.
• line 256 - could have been - consider using "have the potential to be"?
  • Reworded to clarify the intent of legislating the OTC market.
• line 259 - however is not needed
  • Removed for clarity.
• line 264 - "this makes them" - consider replacing with more descriptive words - perhaps something like, "Mistrust can cause individuals…"
  • Revised for clarity.
• line 266 - became evident?
  • Removed this section to address other points raised by this reviewer.
• line 266 - 269 repetitive
  • Removed some redundant content from this section.
• line 270 - Consider mentioning here that the timeliness of this project offers an opportunity for manufacturers to address this problem.
  • Clarified that these results can be used by manufacturers for this.
• Also opens doors for research related to colorways in prescription hearing aids.
  • Added a brief discussion on this as an avenue of future research.
• line 281 - consider not starting the sentence with the word “It”
  • Reworded for clarity.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

I hope this message finds you well. After a thorough review of your article titled "Over-the-Counter (OTC) Hearing Aid Availability Across the Spectrum of Human Skin Colors," I would like to express my appreciation for your efforts in addressing a significant and underexplored area of research. Your work adds valuable insights into the intersection of healthcare accessibility and racial equity, particularly in the context of OTC hearing aids. However, to further enhance the clarity and impact of your manuscript, I have identified a few areas that would benefit from revision:

The introduction section and subsequent subheadings present some redundancy that could be streamlined for conciseness and clarity. It would be beneficial to revise these sections to eliminate repetitive information and more clearly delineate the study's objectives and rationale.

The Materials and Methods section would benefit from additional subheadings to improve its organization and readability. Additionally, incorporating a diagram could significantly aid in visualizing the study design and methodology. This would not only enhance understanding but also facilitate a clearer connection between the study's objectives and the methodologies employed.

In Table 3, which presents the proportion of hearing aids by skin color, consider incorporating a specific color palette to improve visual interpretation. A carefully selected color palette could enhance the readability of the table and more effectively convey the disparities in hearing aid color availability across different skin tones.

The study acknowledges the limitation of relying on internet access for data collection. ideally, the HA's color should be derived from product characteristics. Future research should considers the product characteristics derived directly from manufacturers or physical retail assessments to mitigate this limitation and provide a more comprehensive overview of the market. 

Your contributions to this field are invaluable, and these suggested revisions aim to refine and highlight the importance of your findings further. Thank you for considering these suggestions. Should you have any questions or require further clarification, please do not hesitate to contact me.

 

Best regards,

Author Response

• The introduction section and subsequent subheadings present some redundancy that could be streamlined for conciseness and clarity. It would be beneficial to revise these sections to eliminate repetitive information and more clearly delineate the study's objectives and rationale.
  • These sections were reworked for clarity and parsimony, and to center the purpose of this study.
• The Materials and Methods section would benefit from additional subheadings to improve its organization and readability.
  • Added subheadings to clarify organization of this section.
• Additionally, incorporating a diagram could significantly aid in visualizing the study design and methodology. This would not only enhance understanding but also facilitate a clearer connection between the study's objectives and the methodologies employed.
  • Added as figure 1.
• In Table 3, which presents the proportion of hearing aids by skin color, consider incorporating a specific color palette to improve visual interpretation. A carefully selected color palette could enhance the readability of the table and more effectively convey the disparities in hearing aid color availability across different skin tones.
  • A palette was added as figure 2.