Helping Patients Decide on OTC Hearing Aids

Jennifer Middleton, MD, MPH
Posted on June 5, 2023

The U.S. Food and Drug Administration (FDA) ruled last fall that hearing aids to treat “mild to moderate” hearing loss in adults may now be purchased over the counter (OTC). These OTC hearing aids are available at a lower price than the hearing aids traditionally prescribed in an audiology or physician office, and there are now an overwhelming number of options for our patients to choose from. OTC hearing aids aren’t appropriate for everyone who might benefit from a hearing aid, though, and they also can encourage skipping the history and examination for hearing loss that might point to less common but more worrying causes.

Hearing loss in adults remains widely prevalent in the United States, with a recent survey showing that approximately 15% of adults report difficulty with hearing, with 25% of adults aged 65-74 years, and 50% of those over the age of 75, experiencing disabling hearing loss:

• Mild to moderate loss: You have trouble hearing a conversation in a noisy restaurant, ask people frequently to repeat what they said or turn up shows or music to levels that are uncomfortable for others in the room. Or you may have difficulty understanding what people say if you can’t see their lips moving.

• Severe loss: You can’t hear a conversation in a quiet room or loud sounds such as power equipment or trucks. (source)

Most afflicted adults, however, do not use hearing aids (only 30% of persons older than 70 who would benefit have ever used a hearing aid), and cost is a big reason why. Until last year’s FDA ruling, hearing aids were available only with a prescription at a cost of between $2,000 and $7,000, with most insurance plans not covering any of that cost. The new OTC options are either simple sound amplifiers or more complex self-fitting digital devices. Patients who purchase a sound amplifier can just wear and go; patients who opt for a self-fitting device are usually directed to a website or app that provides a hearing test to customize the device’s settings. Sound amplifiers are less expensive, with options under $200 (and some under $100), whereas self-fitting devices can be found for as low as $600-$900, with some models approaching $2,000-$3,000.

    A significant portion of the cost of traditional, prescription hearing aids is the professional expertise of having a comprehensive examination and device fitting. Although presbycusis and repeated exposure to loud sounds are the most common causes of hearing loss, a thorough history and exam can assess for more worrisome causes (this AFP article on “Hearing Loss in Adults: Differential and Treatment” provides a detailed overview). After performing the appropriate history and examination on patients who ask about OTC hearing aids, in-office testing can confirm that they have only mild to moderate loss. Directing appropriate patients to consumer advocate websites, such as the American Association of Retired Persons (AARP) or the New York Times Wirecutter, may help decrease the intimidation factor in choosing among the many OTC hearing aid options. We can also direct patients who aren’t good candidates for OTC hearing aids to an audiologist or otolaryngologist; the American Academy of Audiology advises that patients who “need a more customized solution, have complex medical needs (e.g., difficulty using hands or problems with thought processes), or have an increasing degree of hearing loss...need to involve an audiologist to create a comprehensive plan of care.”

If you’d like to read more, check out the AFP By Topic on Ear and Hearing Disorders, which includes this Curbside Consultation on “Making Recommendations to Reduce Noise Exposure” to help our patients prevent hearing loss when possible.