Over-the-counter (OTC) hearing aids are finally here.
As of Oct. 17, you are be able to officially purchase over-the-counter hearing aids in stores and online, without needing to see a doctor, an audiologist, or a licensed hearing aid specialist. For the millions of people with hearing loss who don’t yet use the devices, the new product category is intended to increase access and lower costs.
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Over-the-counter hearing aids are only meant for people with self-perceived mild-to-moderate hearing loss, so they’re not right for everybody. Still, if you seem to be having trouble hearing, you may wonder if these devices could be right for you.
Some tools are already available that can help you figure that out. 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 estimated that about 36.1 million U.S. residents age 12 or older have either 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 intended for adults; children still need to 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 figure out if an over-the-counter hearing aid might be right for you.
Start With Simple Questions
The Food and Drug Administration requires that over-the-counter hearing aids 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 a hard time hearing when talking on the phone, or finding that you have to turn up the TV volume to hear it and other people tell you it’s too loud. Another sign: Listening makes you tired. If any of these apply to you, you might want to try an over-the-counter hearing aid.
The agency also provides information about the signs that might suggest that 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 engines, power tools, or loud music). If that’s the case for you, then visiting a doctor or an audiologist is a better bet.
You should also think carefully about your hearing needs. Some people—even with milder hearing loss—may want to visit an audiologist simply because they have unusually complex or specific hearing needs, says Sumit Dhar, PhD, a professor in the department of communication sciences and disorders at Northwestern University. This might include someone like an air traffic controller, a litigator who frequently works in a large and echoey courtroom, or a teacher in a large classroom filled with children in all directions.
Rule Out 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 those cases, you’ll need to see a doctor to resolve the problem rather than jumping right to a hearing aid.
The FDA also requires hearing aids to be labeled with a list of “red flags” that indicate you need to see a doctor to get your ears checked out. These include symptoms such as blood, pus, or fluid coming out of your ears recently, ear pain or discomfort, feelings of dizziness or vertigo, and sudden changes in your hearing.
You can also use an online tool called the Consumer Ear Disease Risk Assessment (CEDRA), developed at Northwestern University, to help rule out any ear problems that warrant a trip to the doctor.
Consider Testing Options
If you think you’re a likely candidate for an over-the-counter hearing aid, you can still decide to get an in-person hearing exam. There’s no need to go it alone.
“For consumers, the gold standard would be go get your hearing tested from a licensed provider, get a copy of that test, and then come home and do your own research on what the best options for you are,” says Kim Cavitt, AuD, a hearing healthcare consultant.
Increasingly, providers are unbundling hearing assessments or consultations from the cost of hearing aids themselves, so you should be able to find a provider who’ll test you even if you don’t want to buy hearing aids from their office. Call ahead to find out how much a test would cost, whether it would be covered by your insurance, and whether you need a referral. Medicare, for example, only covers a hearing test if your doctor refers you for one.
Still, if you’d rather go the DIY route, a number of valid remote or self-test hearing screening options are available that can help you gauge your level of hearing loss without even leaving your house.
Tone-based testing apps. Typically, in-person hearing examinations include what’s called pure-tone audiometry. This is done with audio tones played in decreasing volumes to determine your specific level of hearing loss. An app-based version can’t totally replicate the in-office experience. Still, certain well-designed apps can produce a measurement called a “pure-tone average” (PTA), or, as some public health experts call it, your “hearing humber.”
The hearing number reflects how loud speech must be for you to be able to hear it, and provides a simple shorthand for your level of hearing loss. A hearing number of about 25 to 40 means you have mild hearing loss, while 41 to 60 means moderate hearing loss.
One benefit of the hearing number is that it provides a simple measurement of hearing loss that’s also more concrete than the imprecise labels of “mild” and “moderate,” says Nicholas Reed, AuD, an assistant professor of epidemiology and audiology with the Johns Hopkins Cochlear Center. “For OTCs to succeed, we actually need common language around hearing loss,” Reed says. “We can’t use this vague language.”
The limitation of remote or app-based pure-tone audiometry is that it requires specifically calibrated equipment to work—to ensure the tones are played at the proper volume. This tends to be more achievable within the Apple ecosystem, since the specs for both the devices and the Apple-made headphones are controlled by the same company.
Two iPhone apps will reliably produce a hearing number: Mimi or SonicCloud, according to a group of scientists advocating for more widespread use of the hearing number. Find instructions on how to get the hearing number from these apps here.
If you do get an in-person hearing test, you can also ask the provider who gives you the test for this number.
Digits-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 plays. These tests have their own advantages, including that they don’t require any special equipment, which makes them more accessible. And they provide a more real-world test of hearing, says Dewet Swanepoel, DPhil, a professor of audiology at the University of Pretoria in South Africa. “That’s actually what people have difficulty with when they have hearing loss—speech in background noise,” he says. “So this test really gets to the heart of what people have difficulty with.”
The downside: Speech-in-noise tests don’t provide as precise a measure of hearing loss as pure-tone audiometry. Still, they can be a useful screening tool to help you figure out whether you might have at least some degree of hearing loss.
The World Health Organization’s hearing test app, hearWHO, employs such a testing method, as does an online hearing screening offered by Best Buy. Many other websites also offer to screen your hearing with a digits or speech-in-noise test. Keep in mind, Cavitt advises, that online tests may also be accompanied by marketing pitches from various companies offering hearing aids or hearing care services.
An evidence-based self-assessment. Another approach for figuring out if an over-the-counter hearing aid is right for you involves assessing how much hearing difficulty you experience in daily life. After all, the FDA’s rules about OTC hearing aids say the devices are meant to address self-perceived hearing loss.
“The FDA is sending this signal that you can self-determine if you have mild to moderate hearing difficulty,” says Dhar. “Inherent in that claim is that your perception of mild-to-moderate hearing difficulty will be well-correlated” to a professional measurement 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 that self-assessment.
They involve either 10 or 25 questions that are designed to evaluate how much a hearing problem affects your life. The simple questionnaires, developed and validated by audiologists in the 1980s and 1990s, have been used for decades to assess the extent to which hearing loss affects people emotionally and socially. Questions include, “Does a hearing problem cause you to feel embarrassed when meeting new people?” and “Does a hearing problem cause you to have arguments with family members?” This approach can be a good way to figure out if you might get use out of an over-the-counter hearing aid.
“The factor that most likely determines whether somebody will seek hearing aids and use them and benefit from them, is their perceived hearing disability, 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 graph that shows the results of a hearing test.)
There aren’t a lot of user-friendly online versions of these tests just yet, but you can download a printable copy of the shorter version of the HHIA and the HHIE. If you score in the mild-to-moderate range, that means an over-the-counter hearing aid could be a good fit.