Outcomes of Direct-to-Consumer Hearing Devices for People with Hearing Loss: A Review

Comparing Direct-to-Consumer Devices to Hearing Aids: Amplification Accuracy for Three Types of Hearing Loss

PURPOSE

The U.S. Food and Drug Administration finalized regulations for over-the-counter hearing aids (OTC-HAs) on August 17, 2022. Little is known about the comparative performance of OTC-HAs and prescription HAs. This study compared amplification accuracy of prescription HAs and direct-to-consumer devices (DTCDs, including personal sound amplification products [PSAPs] and OTC-HAs).

METHOD

Eleven devices were programmed to meet prescriptive targets in an acoustic manikin for three degrees of hearing loss. Devices consisted of high- and low-end HAs, PSAPS, and OTC-HAs. Each was tested, and deviations from target measured with an HA analyzer at every combination of 10 frequencies and low-, average-, and high-level inputs. Accuracy was compared using a multilevel Poisson model with device-specific intercepts controlling for input level, frequency, and device type.

RESULTS

For mild-moderate hearing loss, deviations from targets were not statistically different between high- and low-end HAs, but PSAPs (5.50 dB, SE = 0.92 dB) and OTC-HAs (8.83 dB, SE = 1.10 dB) had larger differentials. For flat moderate hearing loss, compared to high-end HAs, average differentials were larger for all device types at all input levels and frequencies (Low HA: 3.82 dB, SE = 1.10 dB; PSAP: 9.24 dB, SE = 1.22 dB; OTC-HA: 8.61 dB, SE = 1.19 dB). For mild sloping to severe hearing loss, compared to high-end HAs, OTC-HAs (9.72 dB, SE = 1.20 dB) and PSAPs (7.34 dB, SE = 1.07 dB) had larger differentials and significant variability at the highest and lowest frequencies. Half (three) of the PSAPs and OTC-HAs met most targets within ±5 dB.

CONCLUSIONS

DTCDs were unable to meet prescriptive targets for severe types of hearing loss but could meet them for mild hearing loss. This study provides an examination of current hearing devices. More research is needed to determine whether meeting prescriptive targets provides any benefit in the outcomes and performance with DTCD devices.

Prioritizing research on over-the-counter (OTC) hearing aids for age-related hearing loss

Hearing aids are the most commonly used treatment for people with age-related hearing loss, however, hearing aid uptake is low, primarily due to high cost of the device, stigma, and a lack of perceived need. To address accessibility and affordability issues, the U.S. Food and Drug Administration created a new over-the-counter (OTC) hearing aid category. Various types of hearing devices are available for both individuals with hearing loss and for those with normal hearing, as hearing enhancement devices. Hearing aids (i.e., prescription hearing aids, self-fitting OTC hearing aids, and pre-set OTC hearing aids) are regulated by the FDA. The purpose of this article is to (a) provide a summary of existing research on direct-to-consumer (DTC) hearing devices such as Personal Sound Amplification Products (PSAPs) that informs OTC service delivery models; (b) provide an update on existing and ongoing randomized controlled trials on currently marketed OTC hearing aids; and (c) highlight the need for immediate research on OTC hearing aids and service delivery models to inform policy and clinical care. It remains to be seen what effect OTC hearing aids have on improving the uptake of hearing aids by individuals with mild-to-moderate hearing loss. However, there is scant research on all aspects of OTC hearing aids that are currently on the market. We conclude that high quality independent research must be prioritized to supplement evidence provided by the OTC hearing aid manufacturers for regulatory approval purposes.

Hearing Healthcare Professionals' Views about Over-The-Counter (OTC) Hearing Aids: Analysis of Retrospective Survey Data

Over-the-counter hearing aids have been available to consumers in the US since 17 October 2022 following a ruling by the Food and Drug Administration. However, their reception by hearing healthcare professionals (HHP) has been mixed, and concerns have been expressed by many HHPs. The aim of this study was to examine the concerns that HHPs have towards over-the-counter (OTC) hearing aids. The study used a retrospective survey design. The survey data of HHPs (n = 730) was obtained from Hearing Tracker. A 22-item structured questionnaire was administered using a Question Scout platform. Descriptive analyses examined reported areas of concern and a Fisher's exact test examined the relationship between demographics and responses. A cluster analysis with partitioning around medoids (PAM) was used to identify a sub-group of participants based on responses. Nearly half of HHPs who participated reported that they will support patients with OTC hearing aids purchased elsewhere, whereas a quarter reported that they will sell OTC hearing aids in their clinic or website. HHPs expressed over 70% agreement in 'concern' statements in 14 of the 17 items. Issues about safety, counseling, and audiological care were the key concerns expressed by HHPs about OTC hearing aids. Some demographics (i.e., profession, primary position) were associated with responses to some statements. Two groups were identified based on the responses to concern statements. The HHPs in the first cluster 'OTC averse' (51%) agreed on all the 17 concern statements, whereas the second cluster 'OTC apprehensive' (49%) had some items rated as disagree (i.e., consumers will give up on amplification) and neither agree nor disagree (i.e., do not provide good value, warranties and return periods will be worse), and remaining items were rated as agree. OTC hearing aids were initiated to improve affordability, accessibility, and hearing aid uptake and are currently a rapidly emerging category of hearing devices. Overall, the results of the current study indicate that HHPs have serious concerns about OTC hearing aids. HHP concerns cited in this study provide useful feedback to stakeholders (e.g., HHP professional agencies, FDA, industry, and insurance payers) involved in improving OTC hearing aid implementation.

Objective and Subjective Benefit of Direct-to-Consumer Hearing Devices in Middle-Aged Adults

PURPOSE

The purpose of this project was to assess subjective and objective benefit provided by several direct-to-consumer hearing devices for middle-aged adults. The primary goal of this study was to determine the extent to which this type of device can yield benefit when users are listening in a range of acoustic conditions, rather than to compare benefit among devices.

METHOD

Participants (M age = 58 years, n = 40) completed a speech perception task with and without one of four direct-to-consumer devices. Stimuli were presented with three types of maskers (steady-state noise, modulated noise, and competing talkers) at two different signal-to-noise ratios and two target levels. Participants also rated the effort required to complete the task with and without the devices and completed a short questionnaire about device comfort and perceived effectiveness.

RESULTS

The amount of objective benefit (in terms of speech recognition accuracy) varied among the four products, with two of the four devices yielding statistically significant benefit with medium-to-large effect sizes. Reduction in self-rated listening effort was noted from the use of all four devices, with a moderate effect size. Degree of hearing loss (4-frequency pure-tone average) was not significantly associated with the amount of either subjective or objective benefit. Responses to the posttask questionnaire indicated that many of the participants would be willing to use these or similar devices in the "real world."

CONCLUSIONS

Our findings support the concept that direct-to-consumer hearing devices have the potential to improve objective and/or subjective speech recognition in middle-aged adults, at least when fit to prescriptive targets. Benefit from these devices was not related to degree of hearing loss in this sample of participants.

Perception and expectations of personal sound amplification products in Korea: A hospital-based, multi-center, cross-sectional survey

Objectives

The objective of this study was to investigate current perception and expected price of personal sound amplification products (PSAPs) and to analyze influencing factors through multi-center hospital-based surveys of outpatients, caregivers, and hearing experts.

Methods

A multi-center exploratory cross-sectional study was conducted in two groups of respondents with two separate surveys: 1) a perception survey of patients and caregivers who visited an otorhinolaryngology outpatient clinic in 5 general hospitals and 2) an opinion survey of hearing specialists about the expected price of PSAPs. A total of 197 outpatient visitors responded to the perception survey, and 42 hearing specialists responded to the opinion survey.

Results

Overall perception score (18 questions) was 3.04 (95% CI, 3.00–3.09). When 5 categories of perception (knowledge, needs, cost, expectation, and information categories) were analyzed, cost and expectation showed the highest scores of 3.33 (95% CI, 3.21–3.44) and 3.33 (95% CI, 3.27–3.40), respectively, and needs showed the lowest score of 2.23 (95% CI, 1.97–2.49). The ≥ 60-year-old group showed significantly higher perception of PSAPs (P = 0.002), and the individuals with greater severity of subjective hearing loss showed significantly higher perception of PSAPs (P = 0.002). The expected price of PSAPs of the outpatient visitors was 933.9 USD (95% CI, 811.9–1056.0) per ear. Mean expected price of PSAPs of hearing specialists was 291.3 USD (95% CI, 238.2–344.3) per ear.

Conclusion

The perception rate of PSAPs was very low, and there was a discrepancy in the expected price of PSAPs between patients/caregivers and hearing experts. Hearing specialists should make effort to improve perception of PSAPs.

Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics

Direct-to-consumer (DTC) hearing devices can be purchased without consulting a hearing health professional. This project aims to compare 28 DTC devices with the most popular hearing aid supplied by the U.K. National Health Service (NHS). The comparison was based on technical performance, cosmetic acceptability, and the ability to match commonly used gain and slope targets. Electroacoustic performance was evaluated in a 2-cc coupler. Match to prescription target for both gain and slope was measured on a Knowles Electronic Manikin for Acoustic Research using a mild and also a moderate sloping hearing loss. Using an online blinded paired comparison of each DTC and the NHS reference device, 126 participants (50 were hearing aid users and 76 were nonhearing aid users) assessed the cosmetic appearance and rated their willingness-to-wear the DTC devices. The results revealed that higher purchase prices were generally associated with a better match to prescribed gain–frequency response shapes, lower distortion, wider bandwidth, better cosmetic acceptability, and higher willingness-to-wear. On every parameter measured, there were devices that performed worse than the NHS device. Most of the devices were rated lower in terms of aesthetic design than the NHS device and provided gain–frequency responses and maximum output levels that were markedly different from those prescribed for commonly encountered audiograms. Because of the absence or inflexibility of most of the devices, they have the potential to deliver poor sound quality and uncomfortably loud sounds. The challenge for manufacturers is to develop low-cost products with cosmetic appeal and appropriate electroacoustic characteristics.

Benefits and Shortcomings of Direct-to-Consumer Hearing Devices: Analysis of Large Secondary Data Generated From Amazon Customer Reviews

Purpose The current study was aimed at understanding the benefits and shortcomings of direct-to-consumer hearing devices (DCHDs) by analyzing the large text corpus of secondary data generated from Amazon customer reviews. Method Secondary data were generated manually by gathering user feedback for 62 different DCHDs (cost range: $9.95-$635) on the Amazon.com website, which included 11,258 unique Amazon-verified customer reviews. The data were analyzed using both quantitative and qualitative analyses methods. Results The cluster analysis of large data corpus resulted in 7 unique clusters, which were labeled as (a) Issues related to fit and comfort (15%), (b) Friends and family recommendations (11.8%), (c) Issues related to sound quality (11.9%), (d) Listening and conversation (16.1%), (e) Positive customer service (12.1%), (f) General usage and customer service (14.7%), and (g) Cost and affordability (17.3%). Exploratory analysis also revealed an association between customer ratings and cost in relation to these clusters (i.e., customer reviews). For example, customer reviews about cheaper DCHDs are related to issues about sound quality, whereas reviews about expensive DCHDs are related to cost and affordability of the device. The qualitative content analysis resulted in 8 main themes, which include (a) intrinsic factors, (b) extrinsic factors, (c) supplemental items, (d) ease of use, (e) interaction with support services, (f) reasons for purchase, (g) experiences, and (h) general information. Conclusions The study using the text mining techniques highlights the benefits and shortcomings of DCHDs that are currently available in the U.S. market. Our findings relate well to the published study results of electroacoustic analysis on similar products, which provide clinicians with knowledge related to DCHDs that they can convey to consumers during clinical consultations. The findings may also be of interest to the hearing instrument industry from the perspective of developing products based on user feedback.