Are they right for me?

In October 2022, the Food and Drug Administration (FDA) approved over-the-counter hearing aid sales in the US. The law was passed after lobbying efforts by electronics manufacturers, despite protests by many medical and professional organizations. The reasoning for the law was mainly rooted in the cost savings to the consumer.  However, the first over-the counter hearing aids (often called OTCs) have mostly proven to be either cheaply made unproven amplifiers, or instruments that still cost over $1000 each. Depending on the product, they may have no adjustments at all, or require you to program the aid yourself via a smartphone app which many people find difficult to use.

There are many reasons why professionally fit hearing instruments are superior to OTC hearing aids.

How do you know if the OTC aid is right for you? OTC aids have no way to determine if they fit in the ear properly, if they provide the amplification you need, or if they are over-amplifying background noise. Professionally fit hearing instruments by licensed professionals should always be both electronically verified to be appropriate for your individual hearing needs, and validated with gold-standard tools to ensure that you will be hearing as well as possible.

How do you know if your hearing problem would be addressed with an OTC aid? The FDA rule states that OTC aids are intended only for “mild to moderate” hearing loss. However, OTC aids are made to be sold and worn without even a basic hearing test to determine if your hearing falls into that category. We are concerned that patients will try an OTC aid that is inappropriate, then reject the notion that they can be helped with prescription hearing instruments. Medical and audiological evaluation is key to proper hearing instrument fitting, which is not part of an OTC hearing aid purchase.

How do you know if there is a simple, or dangerous, medical condition, with hearing loss as a symptom? In a recent editorial by an ENT physician, “research has unquestioningly linked hearing loss to progression of neurologic disease.” Other research, including from Johns Hopkins University, has shown correlation between untreated hearing loss and cognitive decline, depression, and even falling. ENT physicians will ensure that hearing problems are not something as simple as clogging earwax, or as complex as a tumor on the hearing nerve. Using OTC hearing aids without a proper hearing evaluation and medical clearance can delay care and treatment of problems which can seem like simple hearing loss.

What about ringing in the ears? Any phantom sound (ringing, hissing, buzzing, humming, “crickets,” etc.) is called tinnitus and is a symptom of a variety of medical conditions. However, tinnitus is very common in people with hearing loss. Again, a medical ENT evaluation with a professional hearing /tinnitus evaluation is always your best starting point for diagnosis.

Professionally fit hearing instruments are available with circuitry specifically to address tinnitus that can provide tailored amplification and signals to reduce the stress that comes with tinnitus. OTC hearing aids have no such circuitry. And, like hearing loss, tinnitus is a symptom which could mean something simple and harmless, or it could be an indicator of a serious medical condition. Your physician in conjunction with your audiologist will provide you with your best health options.

It is our position that there is no substitute for a well-made, quality hearing instrument which is professionally fit by a licensed, experienced hearing professional after receiving medical clearance for hearing instrument use. In a 2022 editorial on OTC hearing aids, James Donnelly, MD the CEO of the American Academy of Otolaryngology, stated, “there is no disagreement that the best hearing result comes from (a) personalized individual fitting.” He also noted, “we must overcome the current transition that is moving patient care away from highest quality care first to ‘what can we get by with’ scope-of-practice changes, which are pervasive in medicine.”

We believe that a “better than nothing” approach to hearing care is a disservice to our patients. Instead, our practice provides recommendations to gold-standard hearing instrument services with professionalism and care, while still being as affordable as cell phone or internet service.

We are dedicated to providing comprehensive, high-level hearing healthcare to all of our patients. If you have concerns about your hearing, and wonder if hearing instruments would be right for you, we will be happy to discuss your concerns and address your problems.

Bibliography October 2022