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Over-the-counter (OTC) hearing aids are FDA-regulated devices for adults who believe they have mild to moderate hearing loss. They typically come in two setup types: self-fitting, adjusted
through a smartphone app and preset, which allows manual volume changes but no customization. They are also commonly available in two styles -- in-the-ear and behind-the-ear.
OTC aids can be purchased online, in big-box stores such as Walmart, Sam's Club and Costco,
and sometimes at local pharmacies. When Congress authorized OTC hearing aids, some hearing professionals feared they would threaten traditional practices. I did not share that concern.
Experience has shown that better hearing requires more than a gadget; it also requires expert
guidance and carefully nuanced sound adjustments. I have always viewed OTC aids as a "better than nothing" step toward improved hearing. Each month, people bring OTC devices to me hoping I can help them hear better. Unfortunately, because these devices are not programmable in the same way prescription instruments are, I cannot access or adjust their internal electronics.
Traditional prescription-grade hearing aids are medical devices customized by a hearing
professional--an audiologist or hearing instrument specialist--after a comprehensive hearing
evaluation. As technology has evolved from transistors to digital processing, prescription hearing aids have become easily programmable. Today's devices contain computer chips that work with fitting software, allowing professionals to fine-tune performance for each patient. Common styles include Receiver-in-Canal (RIC), which sits behind the ear with a small wire into the ear canal and is popular for mild to severe loss; Completely-in-the-Canal (CIC) or Invisible-in-Canal (IIC), which are tiny devices designed for discretion; In-the-Ear (ITE) or full-shell aids, which fill the outer ear and may be easier to handle; and Behind-the-Ear (BTE) aids, which attach to a custom earmold and are often used for severe to profound loss.
Many prescription aids also connect through Bluetooth to smartphone apps for remote control, streaming music, audiobooks, conversations and phone calls directly to the ears. Most prescription hearing aids are mass produced and fitted by a hearing professional, while some are custom made from an ear impression and built by the manufacturer to fit the individual patient. Custom models are often chosen for cosmetic reasons, especially when patients want the devices to be as discreet as possible. However, about 78% of hearing aids sold worldwide are now non-custom models.
Custom aids can sometimes create a plugged feeling or sound, known as occlusion; non-custom aids generally reduce this sensation and help the patient's own voice sound more natural. Although custom and non-custom devices at the same technology level may use identical internal circuits, their acoustics can sound different.
Price has always been a major factor in the OTC hearing aid discussion. OTC devices cost much less than prescription-grade hearing aids. If you have hearing loss and choose the traditional route instead of OTC aids, shop carefully and make sure you understand exactly what is included in the price, including the hearing evaluation, fitting, follow-up adjustments and all customer service.
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Jeff Bayliff is owner of Hear the Birds Hearing Aid Center in Lock Haven.