After a long anticipated wait, over-the-counter hearing aids were released to the public in October 2022. This release created an entirely new category of hearing aids. The two common categories of hearing aids consumers will hear about now are over-the-counter hearing aids and prescription hearing aids. Prescription hearing aids are the hearing aids audiologists, and other hearing care professionals have always worked with.
With the introduction of a whole new category of hearing aids, consumers were left with many questions. What is the difference between an over-the-counter hearing aid and a prescription hearing aid obtained from an audiologist? Is a prescription needed for a hearing aid? Can I take a hearing prescription and use it with an over-the-counter device? What are the pros and cons to each type of hearing aid? The answers to these questions and more are compiled in the article below.
Do I Need a Prescription for a Hearing Aid?
Is a prescription needed for a hearing aid? In short, yes. Hearing aids are not a one-size-fits-all type of device. Hearing aids are measured and adjusted to account for a user’s specific hearing loss and ear anatomy. Hearing aids are also adjusted specifically for the user’s listening needs and listening environments.
When you visit an audiologist, they will begin by taking a thorough medical history and a lifestyle inventory. This information will help to highlight any medical concerns related to an individual’s hearing. This will also help the audiologist to guide the individual towards the most appropriate hearing aid style and technology for their needs.
A hearing test will then be completed. This is like an individual blueprint to each person’s ears. A hearing test will show how a person is hearing at individual pitches. An audiologist will then take this information to determine how much volume is needed from the hearing aid at each of these pitches. Hearing loss is typically not equal across all frequencies, and therefore it is not as easy as turning volume up across the board.
Next the audiologist will discuss hearing aid options with a patient, guiding them based on the results of the hearing test and the lifestyle information collected at the beginning of the appointment. There are many different styles and technologies available when it comes to hearing aids. An audiologist will help a patient to determine which options are appropriate for their best hearing outcomes.
The next step in the process is a test called Real Ear Measurements (REMs). In this test an audiologist will measure the hearing aids on a patient’s ear and adjust the settings according to the size, shape, and anatomy of their ear canal. Two hearing losses that are exactly the same on paper may need very different settings depending on the anatomy of that person’s ear.
The Dawn of Over-the-Counter Hearing Aids
Over-the-counter hearing aids were designed to make hearing aids more accessible to the general public. Many insurances do not cover hearing aids, even though they are necessary medical devices, and as such, it can be a financial burden for many individuals to obtain hearing aids. Over-the-counter hearing aids, while still an investment, can be less expensive than prescription hearing aids.
Over-the-counter hearing aids can also be attractive to individuals who may have limited mobility and therefore limited access to attend appointments out of the house at a doctor’s office.
For better or for worse, there are several options available for over-the-counter hearing aids. This means that consumers conduct their own research to select their devices.
Over-the-counter hearing aids are typically adjusted through the use of a smartphone app. For some this may offer appealing independence. For others who are not as comfortable being engaged with a cell phone all day, it may not be an appropriate option.
Over-the-counter hearing aids are designed as a one size fits all device. However, ears range greatly in size from individual to individual, so many consumers find that the one size fits all approach does not work well for their ears.
Over-the-counter hearing aids are also designed for a “self perceived” mild to moderate hearing loss, and as such will not be appropriate for all hearing losses or all listening environments.
The most significant disadvantage of over-the-counter hearing aids is that there is no inspection of the ear or evaluation of the individual’s hearing required. There is no way to be certain that the ear is not full of earwax, and there is no way to be sure that the volume set in the over-the-counter hearing aid is appropriate for that individual’s hearing loss.
Furthermore, if the over-the-counter hearing aid is to stop working, there is no person or office associated with the over-the-counter hearing aid that could help to troubleshoot and repair the device.
OTC Hearing Aids: Skipping the Middleman
To obtain an over-the-counter hearing aid, one would either visit a drug store, an electronics store, or shop online. Once purchasing the hearing aid, most of the set up for the device is completed in a smartphone app. The user will connect the devices to the smartphone and then follow the steps accordingly in the app.
As discussed previously, the traditional way of acquiring hearing aids involves visiting an audiologist. During this appointment a medical history and lifestyle history will be obtained. Next a hearing test will be completed. Then the audiologist will discuss the results with the patient and together they will determine how to proceed to help the patient best meet their listening goals. This next step is often hearing aids. At this point the audiologist will fit the physical components of the hearing aid to the patient’s ear, ensuring that each component fits well, and the hearing aid is comfortable and secure. Then the audiologist will program the hearing aid based on the results of the hearing test and the anatomy of the patient’s ear.
By bypassing the “middleman” or audiologist in this scenario, the patient is bypassing several important steps in the journey to better hearing.
The most significant concern is that there is no medical evaluation or hearing test completed with an over-the-counter hearing aid. Often the smartphone app used for programming of an over-the-counter device will have a hearing screening incorporated into it, however, this does not necessarily produce accurate results. By contrast, when an individual is evaluated for a prescription hearing aid the exam is completed in a sound booth which eliminates any outside sounds, background noise, or distractions. Additionally, the equipment used for testing by an audiologist is carefully calibrated for accuracy. A smartphone application is simply not able to offer the same accuracy.
Of further concern is the fact that hearing loss can often stem from or be related to other health conditions, if a medical evaluation is not completed, these conditions may not be detected or addressed.
As audiologists we know that patients often have many questions about how to use their hearing aids. They also need help maintaining and cleaning the devices. With an over-the-counter hearing aid, there is no person available to the patient in this type of support role.
Importance of Hearing Tests and Proper Diagnosis
There are many reasons why it is important for an individual to have their hearing evaluated and diagnosed properly.
The first, and most simplistic answer is that we want to be sure the hearing loss is a true hearing loss and not being caused by an obstruction in the ear canal, such as a build up of ear wax.
Secondly, there are many different types of hearing loss. Many of them can have medical causes. Is there an infection in the ear? Is there fluid in the ear? Is there something wrong with the ear drum? Is there something wrong with the bones in the middle ear space? Is there damage to the organ of hearing? Is there damage to the nerve of hearing? Only a medical professional, such as an audiologist, can determine the cause of a hearing loss.
Hearing loss can also be connected to many other medical conditions. These can include conditions such as diabetes, kidney disease, cognitive decline, vertigo, tinnitus, heart disease, and depression. Hearing loss can also put individuals at an increased risk for falls. Evaluating hearing loss and its impacts goes far beyond simply checking the ears. It is important to evaluate hearing as part of a larger medical picture to understand how it affects an individual as a whole.
Hearing tests are covered by most medical insurances. Even if prescription hearing aids are not the ultimate path forward for an individual, a proper hearing evaluation is always a recommended first step. The importance of a proper hearing evaluation and diagnosis can not be underrated.
Hearing is a vital sense. It is related to many other elements of a person’s social, emotional, and physical health. Hearing loss, and treatment of hearing loss, has been recently placed in the spotlight with the release of over-the-counter hearing aids. Hearing aids are now being described in two different categories: over-the-counter hearing aids and prescription hearing aids. This begs the questions, is a prescription required for hearing aids?
For best listening outcomes, a prescription is required for hearing aids. The foundational information for that prescription derives from a hearing test completed by an audiologist. This is an important step to determine the cause of an individual’s hearing loss and determine if there are any related medical conditions that may need to be addressed.
Over-the-counter hearing aids are designed for a self-perceived mild to moderate hearing loss. Similar to how an individual would use reading glasses from the drugstore to help with occasional difficulties, such as reading a menu at a restaurant. Over-the-counter hearing aids may be appropriate for the occasional difficulty with activities like hearing the television. As a hearing loss becomes observable in more situations than just the occasional challenge here and there, a prescription hearing aid is the next step.
When being assessed for a prescription hearing aid, individuals work together with an audiologist to craft a care plan and select hearing aids that are appropriate for all of their listening goals. Those hearing aids are then custom fit and measured to address the patient’s anatomy and specific listening needs.
As a consumer it can be difficult to know which option is the right option. It is recommended that everyone seeks out a proper hearing evaluation regardless of if their intent is to pursue over-the-counter hearing aids or prescription hearing aids. Then an individual can begin to navigate the many hearing aid options, if hearing aids are needed, with a good foundational knowledge.