Quiet cheers to Speech-Language Audiology Canada for adding an Over the Counter Hearing Aid Resource Centre to their website. While these products can help improve access to hearing healthcare, SAC emphasizes “the need for strong regulation, clinical support, and public education to ensure their safe and effective use.” Unaided hearing loss is linked to a higher risk of dementia. Untreated distressing tinnitus and hyperacusis are linked to lower well-being. Hearing aids fit to each person’s needs are important for better health, hearing, and speech communication.
Nowadays, you don’t need a prescription. Manufacturers can call anything a hearing aid for selling directly to the public with no quality control oversight, e.g. retail stores, online, in USA. Even back when there was American FDA oversight, studies found too many over the counter hearing aids or personal sound amplification systems don’t work as advertised. This included 100% manufacturing defect rates in aids under $150, and 66% defect rates in aids under $500.
Problems with new low cost over the counter hearing aids included:
- static.
- distortion.
- too loud or over amplified.
- no amplification or high frequency boost.
- broken volume controls.
- faulty microphones, switches, and telecoils.
- worse speech understanding when wearing the “hearing aids” than without.
If you’re buying without a prescription, around $1000 a pair seems to be the minimum cost for aids from reputable manufacturers that include recommended basic features. I’ve seen aids with the same features ranging from $1000 to over $3500. Don’t assume higher price means a better aid.
People with tinnitus or hyperacusis get the most benefit from professionally fit hearing aids, custom programmed to their hearing health needs and loudness comfort levels. This includes as open fit or “breathable” styles as possible and NOT styles that block off ear canals, e.g. “invisible”, in-the-canal, in-the-ear, earbuds, headphones.
Hyperacusis needs to be treated before adding amplification. If you have hyperacusis, consider combination aids with sound generators plus amplification. This way you can very slowly start using sound, and wait to turn on the hearing aid amplification until your hyperacusis has improved. Again, this is much easier with professional guidance, e.g. audiologist.
Healthcare for hearing aids should cover at least the most basic features needed for better hearing and speech communication. Whether considering over the counter or low cost prescription hearing aids, these basic digital features include:
- Pair of well-fitting hearing aids.
- As open fit style as possible if you have tinnitus or hyperacusis.
- Volume control, adjustable.
- Directional microphones to better understand speech.
- Telecoil for phone conversations and disability access.
- 2+ listening programs, e.g. one for quiet, one for noisy environments.
- Wireless connectivity with Bluetooth enabled devices.
- Lithium rechargeable batteries and overnight recharging station.
- Some manufacturers are offering over the counter combination hearing aids that include sound generators plus amplification. [Professional fitting and guidance is preferred, since custom programmed output limits will make soundscapes most comfortable.]
- To improve speech understanding in difficult listening situations, consider hearing aid connectivity to assistive listening devices like remote directional microphones or use with useful apps like SoundPrint (Yelp for Quiet), HeardThat (speech in noise understanding), or captioned mobile phone call services, e.g. Rogervoice.
Keep in mind that around $1000 is also a potential budget for a pair of professionally fit hearing aids with all of the above features. Almost every hearing healthcare clinic offers free hearing testing. If you need hearing aids or combination aids, it’s fine to ask about lower priced options. Sometimes this is called “unbundled” pricing. Also, do they have any older models or lightly used loaner aids at a discount? Do they do hearing aid rentals? These are more common now in Canada, and can be more affordable than a big upfront cost. Are there any fees for returns or exchanges during the trial period?
In the biggest irony of all, personal listening manufacturers are offering “hearing aid” features on devices used with earbuds or headphones. In 2020, the World Health Organization estimated that nearly 50% of children, teens, and young adults worldwide use personal audio systems at volume settings loud enough to cause hearing loss.
If ears bled from harmful exposures, there might be a recall or regulatory oversight. Instead of mandatory engineered noise control and safer personal listening, we are seeing generations of unprotected young people damaged into future hearing aid consumers.
If you have tinnitus or hyperacusis, I don’t recommend using earbuds or headphones as hearing aids given closed fit and risk of noise damage or worsening symptoms with extended hours of daily use.
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