For the first time, you can now buy OTC hearing aids as easily as you can buy reading glasses. Here’s how to determine if they might work for you.
By Catherine Roberts
Over-the-counter (OTC) hearing aids are finally here.
Starting October 17, you will be able to officially buy over-the-counter hearing aids in stores and online, without needing to see a doctor, audiologist or licensed hearing care professional. For the millions of people with hearing loss who are not yet using the devices, the new product category aims to increase access and reduce costs.
Over-the-counter hearing aids are only intended for people with mild to moderate hearing loss, so they are not suitable for everyone. Still, if you seem to have trouble hearing, you might be wondering if these devices might be right for you.
Some tools are already available to help you understand this. And keep in mind: the vast majority of people with hearing loss have a mild or moderate amount, according to a 2016 study in the American Journal of Public Health. Researchers have estimated that about 36.1 million US residents age 12 or older have mild or moderate hearing loss, while only about 2.2 million have severe or profound hearing loss. (Note that over-the-counter hearing aids are only for adults; children should always see an audiologist or other hearing specialist for a hearing evaluation.)
Here we explain some of the existing tools and strategies you can use to determine if an over-the-counter hearing aid might be right for you.
An Eargo OTC hearing aid
Start with simple questions
The Food and Drug Administration requires over-the-counter hearing aids to be labeled with some of the common signs of mild to moderate hearing loss. These include having trouble hearing speech in noisy places or in groups, having trouble hearing when talking on the phone, or finding that you have to turn up the TV volume to hear it and that other people tell you it’s too strong. Another sign: listen fatigue. If any of these situations apply to you, you may want to try an over-the-counter hearing aid.
The agency also provides information on signs that might suggest your hearing loss may be too severe for an over-the-counter hearing aid to be of much use. These include not being able to hear speech even if the room is quiet and not being able to hear loud sounds well (such as motors, power tools, or loud music). If this is your case, it is best to consult a doctor or an audiologist.
You should also think carefully about your hearing needs. Some people, even with milder hearing loss, may want to see an audiologist simply because they have unusually complex or specific hearing needs, says Sumit Dhar, PhD, professor in the Department of Communication Sciences and Disorders at Northwestern University. This may include someone like an air traffic controller, a litigant who frequently works in a large, noisy courtroom, or a teacher in a large classroom filled with children from all directions.
Eliminate other problems
Most hearing loss is irreversible. Still, sometimes changes in hearing can be caused by medical issues such as infections, earwax buildup, or certain types of injuries. In these cases, you will need to see a doctor to fix the problem rather than going straight to a hearing aid.
The FDA also requires hearing aids to be labeled with a list of “red flags” indicating that you need to see a doctor to have your ears checked. These include symptoms such as blood, pus, or fluid recently coming out of your ears, ear pain or discomfort, feelings of lightheadedness or lightheadedness, and sudden changes in your hearing.
You can also use an online tool called Consumer Ear Disease Risk Assessment (CEDRA), developed at Northwestern University, to help rule out any ear problems that warrant a trip to the doctor.
A Bose OTC hearing aid
Consider testing options
If you think you’re a likely candidate for an over-the-counter hearing aid, you can always decide to take an in-person hearing test. It is not necessary to go there alone.
“For consumers, the gold standard would be to have your hearing tested by an approved provider, get a copy of that test, and then go home and do your own research on the best options for you” , says Kim Cavitt, AuD , hearing health consultant.
Increasingly, providers are decoupling hearing assessments or consultations from the cost of the hearing aids themselves, so you should be able to find a provider who will test you even if you don’t want to purchase hearing aids from their office. Call ahead to find out how much a test would cost, if it would be covered by your insurance, and if you need a referral. Medicare, for example, only covers a hearing test if your doctor recommends one.
Nevertheless, if you prefer to go DIY, a number of valid remote hearing screening or self-testing options are available to help you assess your level of hearing loss without even leaving your home.
Tone-based test applications. Typically, in-person hearing exams include what’s called pure-tone audiometry. This is done with audio tones played at decreasing volumes to determine your specific level of hearing loss. An app-based version cannot fully replicate the desktop experience. Still, some well-designed apps can produce a measurement called “pure tone average” (PTA), or as some public health experts call it, your “hearing humber.”
The hearing count reflects the volume of speech so you can hear it and provides a simple shortcut for your level of hearing loss. A hearing number of around 25 to 40 means you have mild hearing loss, while 41 to 60 means moderate hearing loss.
One of the benefits of the hearing number is that it provides a simple measure of hearing loss that’s also more concrete than the imprecise labels of “mild” and “moderate,” says Nicholas Reed, AuD, assistant professor of epidemiology and of audiology at Johns Hopkins. Cochlear center. “For OTC to be successful, we actually need a common language around hearing loss,” says Reed. “We cannot use this vague language.”
The limitation of remote or app-based pure-tone audiometry is that it requires specifically calibrated equipment to operate, to ensure tones are played at the appropriate volume. This tends to be more achievable within the Apple ecosystem, as the specifications of Apple-made devices and headphones are controlled by the same company.
Two iPhone apps will reliably produce an audience number: Mimi or SonicCloud, according to a group of scientists advocating for more widespread use of the audience number. Find instructions on how to get the audience number from these apps here.
If you take a hearing test in person, you can also ask the provider who gives you the test for this number.
Digit-in-noise or speech-in-noise tests. In this type of test, your task is to identify spoken numbers or other words while background noise is playing. These tests have their own advantages, including the fact that they do not require any special equipment, which makes them more accessible. And they provide a more real hearing test, says Dewet Swanepoel, DPhil, professor of audiology at the University of Pretoria in South Africa. “That’s actually what people struggle with when they have hearing loss: speaking in background noise,” he says. “So this test really gets to the heart of what people are struggling with.”
The downside: Speech-in-noise testing doesn’t provide as accurate a measure of hearing loss as pure-tone audiometry. Still, they can be a useful screening tool to help you determine if you might have at least some degree of hearing loss.
The World Health Organization’s hearing-testing app, hearWHO, uses such a testing method, as does an online hearing screening offered by Best Buy. Many other websites also offer to test your hearing with a numbers or speech-in-noise test. Keep in mind, Cavitt advises, that online testing may also come with marketing pitches from various companies offering hearing aids or hearing care services.
An evidence-based self-assessment. Another approach to determining if an over-the-counter hearing aid is right for you is to assess the degree of hearing difficulty you experience in daily life. After all, FDA rules for over-the-counter hearing aids state that the devices are intended to treat self-perceived hearing loss.
“The FDA sends this signal that you can determine for yourself if you have mild to moderate hearing difficulties,” says Dhar. “Inherent in this statement is that your perception of mild to moderate hearing difficulty will correlate well” with a professional measure of hearing loss.
The Hearing Handicap Inventory for the Elderly (HHIE) and its variant, the Hearing Handicap Inventory for Adults (HIAA) are tools that can help you with this self-assessment.
They have 10 or 25 questions designed to assess how much a hearing problem is affecting your life. Simple questionnaires, developed and validated by audiologists in the 1980s and 1990s, have been used for decades to assess how hearing loss affects people emotionally and socially. Questions include: “Does a hearing problem make you uncomfortable when meeting new people?” and “Does a hearing problem cause you to argue with family members?” This approach can be a good way to determine if you could use an over-the-counter hearing aid.
“The factor that most likely determines whether someone will seek out hearing aids and use and benefit from them is their perceived hearing loss, not what the audiogram says,” says Larry Humes, PhD, a distinguished professor emeritus of speech, language, and hearing sciences at Indiana University. (An audiogram is a chart that shows the results of a hearing test.)
There aren’t many user-friendly online versions of these tests yet, but you can download a printable copy of the shorter version of the HHIA and HHIE. If your score is in the mild to moderate range, that means an over-the-counter hearing aid might be a good choice.
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