Are Over-the-Counter Hearing Aids Right for you?

Welcome, Dr. Cliff, from HearingUp. It's so nice to see you again and thank you for taking some time to spend with us at Ask the Hearing Doctors. So, everybody's talking about OTC. Let's talk about it.

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Welcome, Dr. Cliff, from HearingUp. It’s so nice to see you again and thank you for taking some time to spend with us at Ask the Hearing Doctors. So, everybody’s talking about OTC. Let’s talk about it. Let’s just dive into it. And everybody knows a little bit about OTC from other products but not the hearing aid world, right? And not hearing devices for the first time. Direct to consumer, that’s another acronym. We have many out there, but OTC is important reading. Those are easy ones. It’s an easy transition before you actually get the real help, the professional help, the diagnosis. But we’ve never thought about hearing aids. We’ve had some augmentation devices out there in the past, but let’s really talk about what does it mean to the consumer and what’s beneficial and maybe what’s not.

Yeah, absolutely. I mean, if we kind of just go back in time a little bit, back to 2017, when the Over the Counter Hearing Aid Act is what we like to call it was passed or signed into law. And from that point in time, the FDA was tasked with creating guidelines for what is an OTC hearing aid. Prior to that, we’ve always had some form of direct to consumer hearing aids. It was just never regulated in any way, shape, or form. And then here, as of recent, which was October 17 of 2022, was the first official day that individuals with hearing loss could just go online or go into a big box store or what have you and purchase an official over-the-counter hearing aid. And they had to meet certain criteria to be considered over the counter. But what I will say is that you had alluded to direct to consumer products earlier as well, is that all of those direct to consumer hearing aids that have been available for decades, they have just naturally transitioned into the over-the-counter hearing aid category. And really, when you look at it, it was designed to create a more affordable and accessible option for individuals with hearing loss.

Yeah. Affordability, right? I love it. I think it’s great. I think it’s an option for some but maybe not for many out there. And I think that it gives them a starting point, but ultimately they’re going to need something much more appropriate. What makes me a little crazy is that it’s a perceived mild hearing loss. So, I have patients that, as you know, you see many of your patients that come in, they have a much more significant hearing loss. Do you perceive it? No. It’s like, what, you’re going to leave it up to the patients to perceive it? No. The patients almost are always the last one to know. You ask the family, oh yeah, they’ve had hearing loss for a very long time. And so what is perceived is not a really good place to be. It’s not the reality. We need data, we need our information so we can better educate and then transmit that into better care for their hearing healthcare, right?

Yeah. And I’ve tested a lot of these products on my channel and a lot of the ones that are out right now, and I’ve started getting in some of these over-the-counter, the official over-the-counter version of these hearing aids. And a lot of them do have either online screeners that can be done, a lot of them have in situ audiograms that you can take while you’re wearing the hearing aids through the remote control app that you have. And there’s a varying degree of accuracy that comes out with those particular tests. But you’re right. And for the FDA to make it perceived mild to moderate, they really just wanted to do away with the necessity of having a hearing test because they felt like that was a barrier to people adopting hearing treatment or being able to afford hearing treatment. So, I can totally understand where the FDA was coming from with that particular recommendation. They’re trying to increase hearing aid adoption. And when you look at the United States, our hearing aid adoption rates at around 34% to 38% or so as of right now for individuals who have treatable hearing loss and who are actually utilizing hearing aids. And when you look at some of these other countries that are out there, that prescription hearing aids are given free to their members of their country, members to the citizens of their country, they have hearing aid adoption rates that are anywhere between like 10% and 15% at the most, higher than what ours is in the United States. So the FDA is hoping that by opening up a lower cost option for some of these individuals, even though some people will fall through the cracks, you’re going to get someone who has a severe to profound hearing loss, thinking, “Oh, my hearing loss is just mild,” and they’ll try to use it and they won’t have success with it. It’s just very important that they understand that there is something else to go to that you could have success with if you try OTC and it doesn’t work, and I think that you’re probably the same as me. The biggest thing I’m worried about is people trying OTC and saying, “See, hearing aids didn’t work for me,” and then they just give up forever.

Not only that, the worst thing is delaying their treatment. Because it didn’t work, it’s going to further delay their treatment. And say, if it was, we used to say seven to ten years, I think it’s dropped down to about four years, it doesn’t matter. You’re still going to then have that individual, it did not work, so therefore nothing’s going to work. Right? And then delay it for another seven years.

You’re going to have people who fall through the cracks. You’re going to have people that OTC turned out to be a very bad thing for them. It’s going to turn into something where, just like you said, they’re going to say, “See, it didn’t work for me. Now I’m going to kick the can down the road a while longer,” or you’re going to have someone who goes undiagnosed for an acoustic neuroma that grows into their brain stem and kills them. I’m talking worst case scenario there, but that is a possibility. However, I’ve been a big supporter of OTC and I know a lot of people are like shocked, like, “Wait, hold on, you’re the best practices guy. How could you possibly be okay with OTC?” Well, here’s the thing. We need to get people taking the first step in treating their hearing loss. And I don’t care if that’s with an amplifier, I don’t care if it’s with an OTC hearing aid, and I don’t care if it’s with a prescriptive level hearing aid with professional care. You have to start the journey at some point. And if we can get the amount of years that people wait to shorten, that is going to be beneficial for them and society as a whole. And I think it’s going to be a lot like what happened with readers. When readers became available over the counter and you didn’t have to go in to see an optometrist to get a prescription for a pair of reading glasses. The entire optometry industry was against it, for the most part. There was probably some people for it. But the same kind of thing I think is going to happen with over-the-counter hearing aids. I think that people, once they have the ability to just test them out and try them and see what it’s all about, that’s going to make them more comfortable with it. And then they’re going to ultimately decide, “Hey, I’m going to go in and get some professional care if it doesn’t work.”

Right, I’m hoping, I’m really hopeful that the consumer is going to think like we’re thinking. We have a starting place and then you have the audiologist. I just don’t want the audiologist or the hearing care professional to be completely out of the equation. I think that for those that are really serious about their hearing healthcare, we’ve been forever, right? The eyes, you get an examination, your teeth, you’re always there every six months for everything else except our hearing. And I just want the consumer to really know and our listeners to really understand the differences between what’s an OTC, what’s a prescriptive medical device, but never to take away a starting point because you need a diagnosis and then a treatment plan. And we have them here. If I can offer that over the counter, I’d rather be the one that they’re coming to so I can better educate them and say, “This could be fine for you if this is what you want for yourself. It’s a product. Now, it may be very limited and I’m going to show you why, but let’s start the journey and eventually move on to something a little bit more efficient and effective for you.”

And it’s like you say all the time, and the reason that we’re even having this conversation right now is that individuals with hearing loss have to be better educated at what their options are and what the ramifications of their own decisions are. And so as long as someone’s understanding that if you do not get a hearing test before trying to treat your own hearing loss, you have to be understanding that there’s potential things that could fall through the cracks. That could be detrimental to you over the course of time or even immediately when it comes to undiagnosed types of hearing losses that require medical attention. But if they’re listening to this right now or if you’re listening to this right now and you have hearing loss and you know it, you’re essentially making your own risk assessment in your own head of is it worth the risk to go over the counter, not get a hearing test, not get an evaluation from a hearing care professional? Or are you like, “Yeah, you know what? Even if I do chose to go OTC route, it probably makes sense to at least get a hearing test so I know if an OTC could effectively treat my hearing loss.” And you’ll probably end up saving time and money if you go that route.

Yeah. What if it was wax? Simple as that.


It drives me nuts. Oh my God! Does somebody look into your ears? I mean, one thing is go into a little kiosk putting headphones or doing an online or something else, but did anybody look in your ears? How do we know? How do we rule that out?

You’re not kidding. That’s the one thing I’m like, yeah, that’s going to be weird when someone gets an over-the-counter hearing aid and within one day it stops working. They’re like, “Why did it stop working?” Well, it got plugged up with wax. Did you ever have anyone check to see if there’s wax inside of your ears? So, we’re going to learn a lot here in the next year. I mean, we’re having this conversation two weeks after OTC hearing aids hit the market, and right now, none of us really knows how this is all going to play out. It could be a total disaster, or it could be something that truly improves the hearing healthcare of millions of Americans across the country.

And I hope that’s going to be the case. I think that most people that are serious about their hearing, I think they’re going to continue to go to an audiologist, continue to go to the ENT route, and then eventually be really educated about hearing devices out there. And I will be so glad to have those people coming through my door saying, “Teach me about that.” Or, if they did buy it, come into my office, let me do a real ear, let me verify it, and then educate you the differences. This is what it’s doing. And the lack of audibility or even comfort. We talked a little earlier about maybe ill-fitting ear domes. Right? And the comfort. It doesn’t matter if it’s something that’s valued a dollar or a few thousand dollars. It doesn’t matter. If it’s not comfortable, it just never going to work.

It’s funny, I actually published a video on my YouTube channel where I said that this 50 cent piece of rubber controls your $7,000 set of hearing aids, potentially, right? And if you get that part wrong, you actually don’t get the full benefit of the device that you use. The thing that I’m most nervous about, though, is that I think that a lot of hearing care professionals are going to be really dogmatic about, oh no, OTC is never the proper option. And I don’t agree with that. I think that people deserve the right to make an educated decision on what’s right for themselves. And if they feel like OTC is the proper starting point for them, I’m in full support of people being able to make their own decisions. But like we talked about before, they just need to understand what the pros and cons are of going one route versus the other.

So, we talked a little bit about the candidacy, right? But let’s talk about the anatomy of the ear. As you know, the anatomy of anybody’s ear, even between ears, is not the same. So, what’s to say that that over-the-counter hearing aid will fit or not fit that anatomy?

Yeah, when you’re talking about physical fit and acoustic fit, and I talk about fit in two different contexts, right? So, the physical fit, is it going to physically fit inside of the ear canal? Is it going to stay put? Is it going to allow us to control the acoustics of the hearing aids and how we program them inside of your ears? Because like I said before, a 15 cent or a 50 cent piece of rubber that is attaching that hearing aid to your ear canal, is that going to allow us to do what we needed to do? And if your hearing aid is constantly migrating outside of your ear all day long and you constantly have to keep pushing it back in, it’s going to create a situation where for whatever amount of minutes or seconds that it stays into your ear, you might be hearing well. But then if it migrates out because you’re chewing on food or you’re talking or you’re doing whatever, you’re not going to get the full benefit out of that hearing aid anyway. And then you had talked about the differences between the two ears. One ear might need a certain type of dome or custom earmold or whatever on one side, and then on the other side, you need something completely different. And then you start looking at the acoustics inside of the ear. So, you could have an identical level of hearing loss in both ears. And if you program them both of those hearing aids in the same way, they’re going to be off because everybody has different variations of how their ear canal controls how sound hits the eardrum. And so if you don’t take that into account, you could be having maybe even success with a hearing aid in your left ear but no success with that hearing aid in your right ear. And the sad thing is that you wouldn’t even know it unless you went to a hearing care professional and got those over-the-counter hearing aids verified for you.

Yeah, not only that, I think about when we’re talking about the disparities of discrepancies between the right ear and the left ear. What if you have really good abilities to interpret sound and words in one ear and not the other? Well, if you’re going to augment the ear that it’s not quite eligible to receive any type of corrective device. We fit those, as you know, very differently and address them very differently. But without a data, you may be entitled to wear something that we call cros or bicros, and then you’re augmenting something that it’s really not appropriate for.

Sure. And I’ll share an example of this. Had a patient come into my clinic with a pair of over-the-counter hearing aids and they’re wondering, “Why am I not getting benefit with these devices?” And so we do a full hearing evaluation on this individual, and we identify that in one of their ears, they had 30% word recognition, which means that, yeah, you can amplify sound until the cows come home. You can amplify it perfectly for the level of hearing loss that you have. But if you can only understand 30% of the information, like actually comprehend 30% of the information in that ear, guess what? A hearing aid is not going to help very much, whether it’s a prescriptive level hearing aid or an over-the-counter hearing aid. So, you had mentioned this idea of doing cros transmission. That’s where you would take sound from the bad ear, send it over into the better ear, and that’s the most appropriate treatment option because it gives you better speech understanding all the way around you, so you’re not constantly having to turn only your good ear towards the person that you want to hear.

Yeah. And you treat that very differently. It’s not just augmenting one ear and thinking, “Oh, this is great, and then it should be the same on this side, but it’s not. So, I’m just going to give up.”

Yeah. And that’s the biggest thing, is that, whoever is listening to this, just know that if you do not have success with over-the-counter hearing aids, don’t give up. Go to see a hearing care professional who’s following best practices and make sure that you’re being treated in the right way. If you really want to get benefit, the only way to guarantee that you optimize your hearing treatment outcome is to go to a hearing care professional who follows best practices because every single variable that can possibly be taken into account with hearing treatment is going to be taken into account.

Yeah, absolutely. But look at us. It’s like we’re coaches, right? As professionals, we’re coaches. So, we take our time to really educate our patients as to what works, what doesn’t work in the reason for this or that. So, imagine if I’m just a consumer trying to make a decision. There’s a lot of information out there, but without professional care, understanding, expertise, and really just educating them and counseling them about what’s expected, what’s realistic, what’s not. I think it’s so important that anybody who has the opportunity to improve their hearing through, even if it’s just an over-the-counter hearing device, I highly recommend to come in and just get it validated, verified it. Even if you skip the hearing test part, I think it’s never too late to try to figure out where the mishap might have happened.

And that’s the thing, I think that a lot of people don’t realize unless they’re listening to this right now, that you could take the OTC hearing aid and you could make it work better by going and seeing a hearing care professional. It doesn’t mean that you have to get prescriptive level hearing aids if you can’t afford it or if you don’t want it or whatever that your own personal reasons are. But if you could get an additional 50% of benefit out of an over-the-counter hearing aid just by going into a professional and having them work with you to optimize that particular device, why would you not want to do that?

Exactly. So, let’s talk a little bit about we talk about depression and isolation as a result of untreated hearing loss. So, I love the fact that we’re talking about treating it even with the over-the-counter solution, but let’s talk about the real possibility of even early cognitive decline.

Yeah, so there is a lot of research that’s coming out about the relationship between hearing loss and cognitive decline and dementia. If you go back to around 2011, there was data coming out that if you have a mild untreated hearing loss, you are two times more likely to develop dementia later in life. If you are a moderate untreated hearing loss, you are three times more likely, and a severe untreated hearing loss, you are five times more likely to develop dementia later in life. And then you have the Lancet Commission that recently came out with data that was showing approximately 8% or so of hearing loss, or hearing loss is 8% of your risk factor for developing dementia later in life as well. So, there’s a lot of different studies that have come out kind of showing that. And it’s really kind of I don’t want to be a fear monger, but if simply treating your hearing loss prevented or removed that risk factor related to cognitive decline in dementia, it seems like a no brainer to me that you would want to do something about your hearing loss for the future self or for your future self. And I know that we all don’t like to. We think of all of ourselves in the now, like, what do we want right now? And a lot of us have a hard time thinking about us in the future. But if you really want to do yourself a favor, treating your hearing loss could be one of the biggest favors that you ever do to yourself if, in fact, you were one of the individuals who is going to develop dementia because of an untreated hearing loss.

And so as audiologists, what should we be? I know we talked a little bit encouraging our patients or our listeners. What else should we be talking about?

Oh, man. So, I know that you talked about a couple of the other aspects of our lives that are affected by untreated hearing loss. Depression is a big one. If you were to treat your hearing loss so you can stay engaged with family and friends. And I think that there’s a piece of data out there that not a lot of people understand and that’s that longevity is determined by social interaction for a lot of people. I mean, if you start to withdraw from social activity and interacting with other human beings, your life expectancy drops down significantly. And so if you want to live a longer and happier life, staying engaged with people through communication is extremely important. And I know you see this all the time in your clinic. The individuals who come in because of their hearing loss, most often it’s because they’re noticing that their social lives are being negatively impacted from the hearing loss. It’s not because they can’t hear the TV. It’s not because they can’t hear birds chirping outside, at least most of them, right? It’s not because they can’t hear that. It’s because they literally are starting to lose their relationships with family members and friends to the point where they go and they talk to someone and they have to ask them to repeat so many times that their loved one says, “Oh, forget it,” and they don’t continue on with the conversation. It’s much easier just to not communicate with someone than it is to fight through that communication difficulty that’s caused by hearing loss. So, the thing that I encourage everyone to do is I don’t care what your starting point is. Getting a hearing evaluation, of course is a great idea to find out, at least baseline wise, where the heck you’re at from a hearing perspective. And if they identify that you’re a mild to moderate hearing loss, that requires a potentially different way of treating than a severe to profound level of hearing loss. But you have to at least identify what the hearing loss is so you can do something about it.

And Cliff, let’s talk to our listeners about how exciting it is that we now have applications in new technology, in medical grade technology, medical grade hearing aids that would record and give us an idea of how engaged you might be. Things that you’re just not going to have available in an OTC product.

Yeah, at least for now we won’t. I think that the OTC products will eventually get better. But when you start looking at…we talk about gold standards with best practices. When you look at gold standards of hearing aids, there is prescriptive level hearing aids out there that are so advanced to the point where I don’t understand how they can possibly make them more advanced than what they are right now. And yet these major hearing aid manufacturers keep coming out with products that I’m like, “Holy cow, how did they do this?” And so, being able to track different metrics of different lifestyles that people have in different situations they find themselves in, how active they’re being physically, which is a component of living a longer and happier life. These are all important things to understand as a hearing care professional. As long as we utilize that to help educate our patients and make sure that they understand what’s going on with this professional level treatment.

Yeah. Let me talk a little bit about tinnitus. I think it’s an important subject or even fall risk. Right? So, let’s spend a few minutes talking about it. Are OTC devices out there good for tinnitus?

No. If you have tinnitus, you should not be going with an OTC hearing aid. You should definitely be going with a prescriptive level hearing aid. And here – time out. You might not even need a prescriptive level hearing aid. You might just need other types of treatment outside of hearing aids if you have tinnitus. So, hands down, you got to go and get a hearing evaluation, especially if that tinnitus is only in one ear because that could indicate that you have a tumor growing on your auditory nerve.

Yeah. And what if you’re falling or tripping over yourself and also maybe not hearing as well?

You got to get a hearing evaluation. When you start looking at how close… In fact, they’re attached organs, when you look at the vestibular organ and the hearing organ, they are literally contained inside of the same bony structure. And so what affects one can oftentime affect the other. And so if you go into your doctor and you’re like, “Hey, I’m having balance and dizziness issues,” guess where they’re going to send you? They’re going to send you to an audiologist to get a hearing evaluation.

Exactly. Great. This is awesome. Is there anything else that you want to leave as parting thoughts?

Yeah, I would say if you want more information on this, checking out your additional channels to get more information. If you want to go on to YouTube and check out Dr. Cliff AUD. That’s my YouTube channel. There’s over 700 videos on there now that are completely educationally focused to help you become a better informed consumer.

Well, that’s fantastic. Thank you so much for spending so much time with us and educating us and all audiology things. So, thank you so much. I appreciate it.

Thank you.

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