Because they are relatively basic, over-the-counter hearing aids may end up pushing features like directional hearing and telecoils into prescription hearing aids for more severe types of hearing loss.    

By Stephen O. Frazier and Hansapani Rodrigo, Ph.D. 

The intent for the over-the-counter (OTC) hearing aids that made their debut in October 2022 was to serve the needs of adults with a mild to moderate hearing loss. The models range from the very basic to those having a variety of advanced features such as Bluetooth capability, directional mics, rechargeability, smartphone apps, and even telecoils. Consumer sales will make the final determination as to what attributes in hearing aids and their accessories are important to this subgroup of the nation’s nearly 29 million people the National Institute on Deafness and Other Communication Disorders says could benefit from being fitted (if they are not already) with hearing aids.

The Survey

Adults with a hearing loss greater than mild to moderate will still need to be fitted with prescription hearing aids to adequately address their condition. A 2021 survey holds insights into what features this group wishes to have in their hearing aids. 

Nearly 15,000 hard of hearing participants who have varying degrees of hearing loss and all age groups participated in a 21-question survey, conducted by Vinaya Manchaiah, Ph.D., and colleagues, with the results published in the Journal of the American Academy of Audiology. 

The responses to the survey were also used online in a different report by Abram Bailey, Au.D., and team on Hearing Tracker. Hansapani Rodrigo, Ph.D., an assistant professor in the School of Mathematical and Statistical Sciences at the University of Texas Rio Grande Valley, collaborated on the original study. She provided the statistics on the 4,027 survey participants who had a severe to profound hearing loss—that is, those who don’t qualify for OTC hearing aids—for this article.  

The Results

According to the report in the Journal of the American Academy of Audiology, the four most common attributes identified as “extremely” or “very” important for the overall group—those with hearing loss that ranges from mild to moderate to severe to profound—were:  

• improved ability to hear friends and family in noisy settings (88.3 percent)

• reliability (85.1 percent)

• improve ability to hear friends and family in quiet (75.3 percent)

• physical comfort (74.3 percent)

For the severe to profound (S/P) group, the top four were:

• improved ability to hear friends and family in noisy settings (88.9 percent)

• reliability (85.8 percent)

• improved ability to hear friends and family in quiet (84.1 percent)

• improved hearing on mobile telephones (71.2 percent)

Not surprisingly, both the overall group and the S/P group rated ability to hear well in noisy settings as the most important attribute desired in hearing aids. But the S/P group seems to have more difficulty hearing even in quiet settings compared with the overall group. Reliability was more important to the S/P group, as was being able to hear well on cell phones. 

Streaming audio, whether it be from a mobile phone or TV, ranked higher in the minds of the S/P group than the full group and stood at 54.3 percent for mobile phone streaming (versus 48.5 percent for the full group) and 51.6 percent for TV streaming (versus 45.5 percent for the full group).

The S/P group was less concerned about the visibility of their hearing aids (33 percent) than was the full group at 44 percent.  

As for the ability to recharge the devices, it was less important to the S/P group at 32 percent than to the full group who rated it at 39 percent. Surprisingly, in this increasingly technological and digital world, the ability to control hearing aid volume and settings using a smartwatch was almost equally unimportant to the two groups, with the S/P group at less than 12 percent and full group at 15 percent.

Of Loops and Microphones

Being an advocate for hearing loop technology, I was disappointed that just 27.9 percent of all respondents felt that the ability to receive audio broadcast by a hearing loop through their hearing aids was important. Among the S/P group, 35 percent indicated this often ignored technology is still an important capability—and I consider this group, because of their greater hearing loss, to be more hearing impacted and therefore more experienced hearing aid consumers.  

It is also worth mentioning that telecoil-equipped hearing aids and a cell phone with a jack for a neck loop would help those who wish for the ability to better converse on cell phones.

Even my audiologist was not aware that many remote microphones now, in addition to streaming sound they “hear,” contain a telecoil. This means they have the capability to stream the sound from a hearing loop directly to hearing aids that don’t have telecoils using Bluetooth. Among the S/P group, 26 percent felt the availability of this kind of remote microphone was extremely or very important, versus 21 percent of the overall group.    

Another thing to point out is that since the ability to stream sound to hearing aids from a variety of sources was rated very important by so many respondents, streaming is almost a “must have” for hearing aid buyers. For the many hearing aid wearers whose devices do not contain telecoils, the advent of remote microphones such as Starkey’s Remote Microphone Plus can ensure improved communication access since these remote microphones can connect to hearing loops. The Oticon EduMic not only has a telecoil, it can also connect to the signal from an FM assistive listening system. 

Questions Remain

OTC hearing aids may shrink the overall size of the client pool for prescription devices but have little or no impact on the group whose hearing loss is severe to profound, who will continue to need to purchase prescription hearing aids. 

Will the price of prescription hearing aids go up to make up for income lost to OTC competition? Will other hearing aid makers join Starkey in developing an OTC hearing aid? Will the features the S/P group both want and need be discontinued in order to lower the price to compete with the new OTC kid on the block? 

Will the burgeoning online sale of all types of hearing aids (OTC and prescription) result in less availability of in-person care from a local audiologist or hearing instrument specialist? Will more hearing care offices unbundle their services to treat online and OTC hearing aid buyers?

We’ll continue to monitor the hearing aid market and optimistically hope that the greater accessibility and affordability will benefit  all.

Hearing Health magazine staff writer Stephen Frazier is trained as a hearing loss support specialist by the Hearing Loss Association of America. For more, see sofnabq.com.

Hansapani Rodrigo, Ph.D., is an associate professor at the School of Mathematical and Statistical Sciences, University of Texas Rio Grande Valley, in Edinburg, Texas.

Special thanks to Vinaya Manchaiah, Ph.D., and team as well as to Abram Bailey, Au.D., who provides commentary about the study on the Audiology Practices website.

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