What Physicians Need to Know About Over-the-Counter Hearing Aids

My 74-year-old patient, V.P., who has a history of osteoarthritis and hypertension, reports hearing loss during a wellness visit. V.P. works in customer service taking telephone calls but is becoming fatigued trying to hear customers on the phone and is concerned that hearing loss may be affecting their ability to remember details at work. On further questioning, V.P. reports slowly progressive, bilateral hearing loss without ear pain, drainage, tinnitus, or vertigo. Examination shows normal-appearing external ears without injury or deformity, clear canals bilaterally, and normal-appearing tympanic membranes.

V.P. also states that family members have been complaining about the excessive volume of the television at home. V.P. has taken a home hearing test, which shows evidence of bilateral hearing loss. My patient is concerned about the cost of prescription hearing aids and asks whether less expensive, over-the-counter (OTC) hearing aids could help or whether it would be better to see a specialist. Is my patient a suitable candidate for OTC hearing aids? What can I offer my patient to help them make the best choice?

Helen Keller famously stated that deafness separates us from people. Reports of perceived hearing loss should be taken seriously and explored with patients. Of American adults 75 years or older, 50% have perceived disabling hearing loss; fewer than one-third of patients 70 years and older who could benefit from hearing aids have ever used them.¹ Hearing loss is invisible, often unacknowledged or denied, and is a potentially modifiable risk factor for dementia.^2,3 Hearing loss is strongly tied to social determinants of health and is associated with geriatric frailty, depression, disability, social isolation, unmet medical needs, and increased health care costs. In primary care, patients are not routinely screened for hearing loss, and the issue is not often addressed.^4–6 The average age at which people first use hearing aids is 80 years, with approximately 10 years lapsing between identified hearing loss and use of amplification.⁷ Traditional Medicare Part B does not cover hearing examinations or hearing aids but does pay for hearing tests related to treating conditions other than hearing loss (e.g., memory loss). Some state Medicaid programs and more than 90% of Medicare Advantage programs pay for hearing assessments and amplification, but regulations and coverage vary among programs.^8,9

With the U.S. Food and Drug Administration (FDA) approval of OTC hearing aids in August 2022, physicians will likely have a larger role in guiding patients interested in acquiring hearing aids.¹⁰ OTC hearing aids received approval after determination that safety and effectiveness were well established and that the benefits of a regulated market for hearing aids outweighed any theoretical risks. This position is supported by the Hearing Loss Association of America as an initiative to destigmatize hearing loss and support affordable hearing care services and technology innovation for the more than 48 million Americans who experience hearing loss.¹¹

HEARING ASSESSMENT

OTC hearing aids are appropriate for adults 18 years and older who have self-perceived, mild to moderate hearing loss and who have no concerning conditions that require a formal hearing evaluation. Symptoms warranting medical evaluation, including warning symptoms as defined by the FDA (e.g., sudden-onset hearing loss, pain, vertigo, unilateral hearing loss), should be assessed by a primary care physician. Table 1 details signs and symptoms of hearing loss, including additional indications for medical assessment.¹⁰ An article containing a detailed differential diagnosis and information on the assessment of hearing loss is available in American Family Physician.¹²