Are Over-the-Counter Hearing Aids Suitable for Adults With Tinnitus?
By Gail M. Whitelaw, PhD, Theodora Bowman, BS, Kelly Schroeder, BA, Kim Siegel, BA, Abigail Simon, BA, and Alison Reynolds, BA
Over-the-counter (OTC) hearing aids have been a hot topic in the news, on social media, and in consultations with audiologists and other healthcare providers since 2017 when Congress passed the Over-the-Counter Hearing Aid Act, which set the stage for the development of a new category of hearing aid devices that would be available directly to consumers without an audiological consultation. The legislation was partly informed by recent research that indicated hearing loss may contribute to cognitive decline, dementia risk, and social withdrawal.1 The Food and Drug Administration, which oversees hearing aids, was tasked with establishing rules to create this new category. It finished its work in 2021, paving the way for OTC devices, which debuted on store shelves and online on October 17, 2022. It’s critical to clarify that OTC hearing aid options are aimed at adults 18 years or older with self-perceived mild to moderate hearing loss.
Today, consumers are exploring what is available and how exactly “self-fit” works. For individuals with tinnitus, there are considerations that haven’t been readily explained. This article considers current information on OTC options, their benefits and limitations, and their potential role in the treatment and management of tinnitus. OTC devices were intended to create greater price competition, thereby providing options for adults shut out by higher-priced prescription hearing aids that are professionally fitted. A frequently cited statistic is that the average person with hearing loss waits between seven and 10 years before seeking help. That delay has been attributed to the insidious nature of hearing loss, which most often is gradual, the cost of prescription hearing aids, and the stigma associated with hearing loss and aging. It remains to be seen whether OTC devices will help break down hearing loss denial and stigma associated with hearing loss among consumers.
Prior to the release of OTC hearing aids, hearing aids were prescription devices available through licensed audiologists, who are healthcare professionals trained to identify, assess, and manage disorders of hearing and balance, or through a licensed hearing aid dispenser trained in fitting hearing aids, which includes conducting audiograms (hearing tests).
Now that adults are no longer required to have an audiological evaluation or medical examination, it has been suggested that more people with hearing loss will purchase OTC hearing aids. These devices have been touted as being analogous to nonprescription reading glasses that are available in stores and are often thought of as a bridge to prescription glasses. And though it may be the case that OTC hearing aids will serve as a bridge for seeking more in-depth hearing care and/or prescription hearing aids, they are more complicated than nonprescription eyeglasses.
When a consumer purchases OTC hearing aids, the individual is responsible for fitting and adjusting the devices. These products generally have settings that can control volume (e.g., make the device louder or quieter) and pitch (e.g., the bass or treble sound). The consumer changes the settings using either an accessory that comes with the device or an app that can help guide the self-fitting process. If a consumer needs help fitting it, the OTC hearing aid manufacturer may have a customer support line; however, manufacturers are not required to do so. For a fee, some audiologists may help fit OTC devices in person or via telehealth services.2
For the adult with tinnitus who is experiencing distress, an OTC device has pros and cons. Many people who have sought medical help for their tinnitus have been told that “there is nothing that can be done” or “you’ll have to learn to live with it,” leaving an incorrect perception that there are no management tools or interventions to lessen tinnitus distress. Adults with tinnitus may welcome the opportunity to have a wider range of devices that may address their tinnitus distress and may see OTC hearing devices as part of a potential treatment plan. Indeed, prior to the release of OTC hearing aids, some people with tinnitus were using personal sound amplification products (PSAPs), or hearables, which are classified as consumer electronics and aren’t regulated by the FDA, to manage hearing loss and tinnitus. Because tinnitus can be associated with an underlying medical condition, it is important to rule that out by seeing a physician and audiologist, depending on the evaluation. In some cases, tinnitus will clear up following an ear or sinus infection or removal of earwax. It may also be related to high blood pressure or hormonal changes. And there are countless other medical conditions that may be behind the onset of tinnitus.
If your tinnitus doesn’t have an underlying medical cause and is bothersome, you should see someone trained in tinnitus management to explore ways to alleviate the distress. Approximately 90 percent of adults with tinnitus have some degree of hearing loss, which means a certain percentage will be eligible for OTC hearing aids. Why not skip the audiology office and go straight to a store to find cheaper self-fit devices? It is generally difficult for individuals to estimate their degree of hearing loss, and hearing loss categories are generally arbitrary. We see this in audiology clinics every day. People with mild hearing loss may report significant communication issues and tinnitus distress, whereas people with severe hearing loss may perceive little functional communication deficit. Many people with tinnitus have noise-induced hearing loss, which should be addressed audiologically. There are also individuals with normal audiograms, that is, no apparent hearing loss, whose major complaint is tinnitus and/or sound tolerance issues.
It is unclear how OTC devices can address these scenarios, which means the best advice is to have an audiologic evaluation prior to obtaining OTC hearing aids to ensure that they’re appropriate and to discuss the potential benefits and limitations. Additionally, evaluating loudness discomfort and a person’s ability to hear speech in noise should be done routinely when evaluating people with tinnitus because it can help direct management. It is estimated that approximately 38 million adults have hearing loss and 10–15 percent of the population experiences tinnitus in the United States. There is a significant overlap between people who report hearing loss and those who report tinnitus. Decades of research and anecdotal evidence demonstrate that if people with hearing loss and tinnitus are properly fit with hearing aids, the amplification alone—a form of acoustic therapy—may reduce tinnitus perception among 70–90 percent of people.3,4 Hearing aids provide auditory stimulation that addresses the auditory deprivation inherent in hearing loss as described by the neurophysiologic model of tinnitus.5
To maximize hearing aid benefit and satisfaction, the definition of “well-fit” hearing aids should include verification measures, such as “real ear” or “probe microphone” measures that match hearing aid performance to the hearing aid prescription that is based on a person’s hearing loss and personal ear acoustics.6 A primary advantage of a prescription hearing aid over OTC products is the ability to customize the fit to the listener’s need.
Another critical point for the adult with tinnitus is understanding that OTC hearing aids are currently not equipped with tinnitus masking or habituation features. Most prescription hearing aids have programs that can be activated to address tinnitus perception that are based on research conducted by the manufacturer and/ or independently. These programs can provide a significant benefit in tinnitus relief and, again, can be adjusted by the audiologist to best meet the needs of the individual with tinnitus and hearing loss.
Although purchasing a self-fit device in a store or online may work for some people with tinnitus, for others, the limited ability to customize the OTC device may limit success. Another key consideration is building a relationship with a healthcare provider who can support tinnitus care. One of the mantras in audiology is that it is not the product but the process that creates success in addressing patient concerns. Hearing loss is very individualized and complex, and when tinnitus is added to the equation, a partnership with an audiologist knowledgeable in tinnitus evaluation and treatment is likely to provide superior outcomes. Additionally, audiologists who work with people with tinnitus generally have a network of appropriate allied health partners to support patients in their tinnitus journey. For someone struggling with tinnitus, an OTC device may do little to decrease tinnitus distress and a sense of isolation. Skilled tinnitus-trained audiologists also can track patient progress through questionnaires, which guides treatment and modification of interventions.
All of this is to say that tinnitus is not simply a hearing loss issue for many people, and OTC hearing aids may not be the best option for someone bothered by tinnitus or someone unsure of their degree of hearing loss. Hearing and tinnitus needs are very individualized, and tinnitus is a complex condition that can be managed in a variety of ways, including the possible use of OTC hearing aid options, which will continue to expand in the months and years ahead. Because it’s a dynamic market and the needs of an individual with tinnitus can be varied, we hope you’ll partner with an audiologist who provides tinnitus services. Not all audiologists provide tinnitus assessment and management services therefore you may need to verify that the provider has knowledge, skill, and interest in working with patients experiencing tinnitus and tinnitus distress. If in doubt, call or email the clinic to inquire about the experience of the audiologist. You are also encouraged to reach out to a local tinnitus support group, a counselor with training in CBT and tinnitus, or a local ENT/otologist for recommendations on audiologists in your area who work with tinnitus patients. Some audiologists have earned a voluntary credential in tinnitus, such as the Certificate in Tinnitus Management (CH-TM) from the American Board of Audiology, or the Advanced Study in Tinnitus and Hyperacusis Certificate Program from Salus University. Although these certificates cannot guarantee that an audiologist is competent in tinnitus management, they do indicate that the audiologist had sufficient interest in the topic to obtain a certificate. An audiologist who is proficient in providing tinnitus services can create a roadmap for treatment and management, as well as offer additional resources and valuable advice, including the suitability of using OTC hearing devices to address your hearing and tinnitus needs.
Gail M. Whitelaw, PhD, is a clinical associate professor and the Director of the Speech-Language- Hearing Clinic at The Ohio State University in Columbus, OH. Dr. Whitelaw is a clinical preceptor in the Doctor of Audiology (AuD) program and also provides direct clinical care. Her clinical interests are in tinnitus and related sound tolerance disorders, auditory processing disorders, traumatic brain injury, and professional leadership development. She is a Certificate Holder in Tinnitus Management (CH–TM) from the American Board of Audiology. Dr. Whitelaw is a frequently invited presenter on the topic of tinnitus management, particularly as it relates to children and teens.
The contributing student authors are all third-year Doctor of Audiology students at The Ohio State University in Columbus, OH.
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2: American Academy of Audiology. (2022). https:// www.audiology.org/advocacy/legislative-andregulatory-activities/federal-affairs/over-the-counterhearing-aids/
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