Written by Karen Hovav, MD, FAAP | Reviewed by Sophie Vergnaud, MD
Key takeaways:
You can buy over-the-counter (OTC) hearing aids without a prescription or hearing test.
OTC hearing aids are good for people who are older than 18 years with self-perceived mild to moderate hearing loss. This means you don’t need to have your hearing loss confirmed by a diagnostic test.
Signs of mild to moderate hearing loss include trouble hearing speech in noisy places or on the telephone, difficulty following conversation in group settings, or needing to turn up the volume on the TV or radio beyond what others find acceptable.
If you’re new to using a hearing aid, it can take some time to get used to it. An appointment with an audiologist can help.
A woman fits a hearing aid in her ear. Over-the-counter hearing aids work for people with mild to moderate hearing loss.Ines Fraile/E+ via Getty Images
Hearing loss affects almost 30 million adults in the United States. But only about 1 in 6 people with hearing loss actually uses a hearing aid. So why aren’t more people getting help for this common condition?
For some, it’s because of the high cost, trouble with access, or poor quality of available hearing aids. To try to get around some of these barriers, the FDA authorized over-the-counter (OTC) hearing aids in October 2022.
Now it’s easier than ever to get a hearing aid. But who benefits the most and who should consider buying OTC hearing aids? Here we’ll review what to consider when thinking about purchasing an OTC hearing aid, and how to know if it’s right for you.
How can you benefit from OTC hearing aids?
Just like prescription hearing aids, OTC hearing aids make sounds louder so that you can hear them better. They can help you:
Hear speech over the telephone more clearly
Hear sounds you couldn’t hear before
Communicate better with friends and family
Have an easier time participating in a conversation with large groups
Have an easier time talking with someone when there’s a lot of background noise, like a restaurant or party
Hearing aids also improve your health, by preventing some of the problems that come with hearing loss. After all, even mild hearing loss can have a serious impact on your life beyond hearing.
Hearing loss can affect your quality of life in many ways. And untreated hearing loss is linked with:
Depression
Anxiety
Low self-esteem
Dementia
Increased risk of falls
What’s the difference between prescription and OTC hearing aids?
OTC hearing aids are relatively new on the market. They’re similar to prescription hearing aids, but there are some important differences.
OTC hearing aids are:
Sold directly to consumers, without the need for a prescription or hearing test
Lower-cost than prescription hearing aids
Only for people with mild to moderate hearing loss
Only authorized for people 18 years and older
Self-adjusting, which means you can change the settings using software or a smartphone app
On the other hand, prescription hearing aids are:
Available for any type of hearing loss, including severe hearing loss
Appropriate for people of all ages, including children
Able to be made specifically for your ear rather than a “one-size-fits-all” approach
Better for people who were born with an abnormal shape to their ear
Adjusted by a hearing specialist to fit your unique hearing needs
Is an OTC hearing aid of lower quality than a prescription option?
Not necessarily. OTC hearing aids are similar to lower-cost prescription options. In practice that means that they may have fewer bells and whistles than prescription hearing aids. For example, prescription hearing aids might offer more features and more individualized fine-tuning.
That said, the FDA regulates OTC hearing aids to ensure that they’re safe and effective.
And, while a hearing specialist, known as an audiologist, can help make sure a hearing aid is set properly and fitted to your ear, OTC hearing aids that are self-fitted may be equally effective as hearing aids fitted by a trained audiologist.
In one small study, adults with mild to moderate hearing loss were randomly assigned to either have a trained audiologist adjust their hearing aid settings, or use self-fitting hearing aids with some support. After 6 weeks, the two groups reported having the same quality level of hearing.
Types of hearing aids
Not all hearing aids are created equal. You can buy different types of OTC hearing aids:
Behind-the-ear (BTE) models: These tend to be a little larger than other models. So they have more power. They’re also the easiest to handle for anyone with arthritis.
In-the-ear (ITE) models: These are smaller and may have fewer features. So they can be less powerful. But they’re less noticeable than the BTE models. These may be best for those with mild hearing loss.
Completely-in-the-canal (CIC) models: These models are practically invisible. If you want your hearing aid to go unnoticed by others, this is your best bet. These ones may also have fewer features and less power than the BTE models. And if you have trouble with fine motor skills, it can be harder to get in or out of your ears, or to recharge the batteries.
Rechargeable earbuds: These aren’t meant to be worn 24 hours a day. They’re intended for a few hours at a time, for example at a restaurant or party. They look like regular Bluetooth wireless earbuds.
Do you need a hearing test to get OTC hearing aids?
No. You don’t need to get a hearing test to get OTC hearing aids. The hearing aids are meant to be used by anyone with “perceived mild to moderate hearing loss.” You don’t need to have a medical exam or a prescription. And you don’t need to have a fitting with an audiologist. OTC hearing aids are designed to be self-fitting, which means you can adjust the settings yourself.
Having said that, seeing a hearing specialist isn’t a bad idea. If you buy an OTC hearing aid, you can still choose to visit an audiologist to make sure that you’re using it the right way and the settings are optimized for your type of hearing loss.
What are the signs of mild to moderate hearing loss?
According to the FDA, you may have mild to moderate hearing loss if you:
Have trouble hearing speech in noisy places
Find it hard to follow people’s speech in group settings
Have trouble hearing on the phone
Need to turn up the volume on the TV or radio (even when others complain it’s too loud)
Feel tired after listening for a while
The most common causes of mild to moderate hearing loss are aging and damage from repeated loud noises. Less commonly, hearing loss can be caused by drug side effects, smoking, or other chronic diseases.
When to schedule a hearing exam
If you think you have hearing loss that’s more than just mild to moderate, you should schedule a hearing exam with an audiologist. You may have severe hearing loss if:
You can’t hear speech even if the room is quiet.
You have trouble hearing loud sounds like power tools, loud music, or car engines.
You tried an OTC hearing aid, but it isn’t helping.
In some cases, hearing loss may be caused by more than just age or previous harmful noise exposure. In these cases — or your audiologist recommends it — it’s best to see an ear, nose and throat (ENT) specialist.
You should see an ENT if you:
Have had blood, pus, or fluid coming out of your ear in the past 6 months
Have ear pain
Have a lot of earwax
Had a sudden change in your hearing in the past 6 months
Feel like your hearing loss comes and goes
Your hearing is worse in one ear
Hear ringing or buzzing in one ear only
Have either a birth defect or physical trauma to the ear
How much do OTC hearing aids cost?
OTC hearing aids are designed to be more affordable than most prescription hearing aids. Some models start as low as $99 for a pair, while others can be as high as $3,000. Many OTC hearing aids seem to be in the price range of $500-$1,000. This may change as more and more models come onto the market.
Keep in mind that hearing aids may not be covered by insurance. Some Medicare advantage plans will provide partial or full coverage, but original Medicare (parts A and B) don’t cover the cost. Some Medicaid plans provide coverage, but this depends on what state you live in. Medicaid plans in Alaska, California, Connecticut, Florida, and Hawaii do provide coverage for hearing aids.
Where can you buy OTC hearing aids?
You can buy OTC hearing aids in a variety of settings. OTC hearing aids can be purchased in:
Pharmacies
Retail stores like Walmart, Costco, and Best Buy
Online retailers like Amazon
Hearing clinics
Are there disadvantages to OTC hearing aids?
Disadvantages of OTC hearing aids include:
Even though they’re more affordable than prescription hearing aids, they can still be too expensive for some budgets.
Users may need to learn new technology to adjust the settings.
Sometimes the background noise becomes louder, and people can find this distracting.
Some people are self-conscious about using a hearing aid that other people can see.
Using an OTC hearing aid is relatively low-risk. But you should still be aware of possible risks, including:
Irritation to the skin on your outer ear
Injury from the device (like cuts, scratches, or burns from an overheated battery)
Headaches, while you’re getting used to hearing so many new sounds. Sometimes headaches can be a sign that your settings need to be adjusted.
Do hearing aids work right away?
OTC hearing aids will work to increase sounds right away, but getting used to wearing hearing aids can take some time. It can take a few months to get used to what things sound like with a hearing aid. So be patient. You may also need to adjust your settings and spend some time figuring out what settings feel most comfortable for you.
Even though you don’t need to see an audiologist to buy an OTC hearing aid, a hearing specialist can help. So if you find yourself having trouble feeling comfortable with a new OTC hearing aid, you may consider visiting an audiologist for support. They can help you figure out how to make your hearing aid work for you, by checking or adjusting the settings and troubleshooting any concerns you have.
The bottom line
OTC hearing aids are a convenient, more affordable option than traditional prescription hearing aids. OTC hearing aids are helpful for people with mild to moderate hearing loss. But you should see a hearing specialist if you think you might have more severe hearing loss. Signs of severe hearing loss include trouble hearing loud sounds or trouble hearing someone’s speech even if you’re in a quiet room.
If you think OTC hearing aids are for you, check your insurance coverage first. And, expect to be patient as you get used to your new hearing aids. It’s normal to experiment with different settings. If you buy an OTC hearing aid and still feel that it’s hard to hear after a few months, consider scheduling an appointment with an audiologist for an evaluation.
References
Crouch, M. (2022). 5 ways over-the-counter hearing aids are different from prescription ones. American Association of Retired Persons.
Cunningham, L. L., et al. (2017). Hearing loss in adults. The New England Journal of Medicine.
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