Editor's Message

No Need to be Coy, Roy: No One Should be Surprised OTC Devices Resemble Traditional Hearing Aids

Brian Taylor, Au.D.

Now that the first over-the-counter hearing aids have been on the market for a few months, it’s a good time to share some thoughts on the first entrants and what to expect from new competitors who might enter this new direct-to-consumer space over the next few years.

Many in the audiology community are abuzz because they have discovered these new OTC devices are not really new. And the industry seems a little coy to come right out and say that many of these new OTCs are re-branded products that were first launched as traditional hearing aids five or more years ago.

Making matters even more interesting, there is also a common theme expressed by many audiologists that runs something along the lines of this: “I am a little disappointed that the first OTC devices are nothing more than re-packaged hearing aids that have been available from hearing care professionals for years. I was expecting something new and innovative from one of the consumer electronic giants.” I’ve heard a version of this thinking more than a few times over the past few months, and, I must admit, it’s disheartening to hear this from so many of my fellow professionals.

Why would thoughtful, highly educated clinical professionals sell their own industry suppliers short? The hearing aid industry, despite some flaws1, is more innovative than often given credit for.

It’s a little astonishing that pundits within the Audiology profession express surprise that the first OTC devices are nothing more than traditional hearing aids in disguise. Of course, they are. Because the hearing aid industry has gotten many aspects of audio performance right, it should no surprise that they are involved in the first OTC to hit the streets.2 After all, no segment of the audio world3 is better equipped to tackle the problem of enhancing speech in the presence of noise — far and away the biggest challenge for middle aged and older adults who might be struggling with their hearing — than the hearing aid industry.

No other miniaturized audio device running on a small amount of electric current, immersed in a humid, waxy ear canal for hours per day packs the punch of traditional hearing aids. Here are three essential features, available in a basic hearing aid (which today costs about the same as many OTC devices and at a price point that usually includes professional services) for almost twenty years. These features work pretty darn well and you are sure to find them in any new OTC – new, re-branded or re-packaged:

    • Wide dynamic range compression (WDRC): The ability to provide large amounts of gain, primarily for soft sounds while little to no gain is applied to louder inputs — sounds individuals with mild and moderate hearing loss often hear just fine without hearing aids. Hearing aid manufacturers have their own “flavor” of WDRC, meaning they all work a little differently. However, each “flavor” of WDRC performs the same essential job: amplify soft sounds more than loud sounds.
    • Feedback cancellers: A negative by-product of the first feature, WDRC, is feedback (that nasty squealing sound). Hearing aids have the ability to instantaneously recognize that squealing sound and cancel it without reducing the gain necessary to hear soft speech.
    • Multiple types of noise reduction algorithms: There are several types of algorithms on a single hearing aid that identify and reduce unwanted, steady-state and impulse noise — the type of noise you experience when eating dinner at your kitchen island and the appliances are running and the silverware clanks on the dish. Hearing aid manufacturers have been incrementally improving the performance of these noise reduction features for decades. Several studies demonstrate they improve listening effort and reduce fatigue when they are activated.
    • A final important point: When these features (and others) are combined in the same hearing device, all kinds of weird artifacts affecting sound quality can occur. The hearing aid industry has decades of experience and knowledge they apply to improving how these features work together. It’s doubtful any upstart OTC manufacturer, on their own without any assistance from experienced hearing aid engineers, would get these synergistic effects right for at least a few product cycles.

Get on the Bus, Gus

The Figure below, created by Gus Mueller, shows just how much patient satisfaction for noisy listening conditions has improved in the past few years. This is survey data, collected by the Hearing Industries Association about every four years for the past 30 years (MT III was collected in 1991 and MT 10 was collected in 2019). It shows the positive impact that hearing aid innovations have had on performance in challenging listening situations.

You could argue this improvement in patient satisfaction is driven more by the quality of care provided by the professional who is prescribing and fitting the device, than the device itself. Indeed, it is true that the hearing care professional plays a critical role in creating satisfied patients but having been an audiologist since 1991 (when MT III data was collected), I can tell you firsthand the consistency and quality of service has stayed the same for those 30-plus years. As a profession, we take great care of patients the same thorough and kind-hearted way today that we did in 1991!

Instead, this sudden uptick in patient satisfaction, shown in the MT VIII and MT 10 surveys, for noisy places is driven by the innovations coming from hearing aid manufacturers.

Make a new plan, Stan

Rather than anticipating novel approaches to how sound is identified and processed by hearing devices, we should be looking for upstarts to commercialize other technological breakthroughs that will address the pervasively low hearing aid uptake rates. Here are three innovations I would like to see from OTC players.

Wearer-friendly device interfaces: Make the fitting, adjustment and fine-tuning of gain, output, and other key features (directional microphones) intuitive and easy-to-do using a smartphone app, self-directed by the wearer instead of the professional. We’re already seeing in-roads in this area from Bose (and others) who have brought fresh approaches to fitting and fine-tuning — methods that could stand side-by-side with the traditional audiogram-based prescriptive method we’ve been using in clinics for about 50 years.

Extended bandwidth devices: Recent research suggests that at fairly large number of younger and middle-aged adults have normal hearing, as recorded on the audiogram, and self-reported difficulties communicating in noisy places. However, ultra-high frequency audiometry (testing beyond 8 KHz) shows substantial hearing loss in many of these individuals. Additionally, there is some evidence indicating these individuals might benefit from hearing devices that restore these ultra-high frequencies.

Traditional hearing aids tend to roll-off high frequency gain starting at about 6 KHz. Perhaps a start-up OTC company can bring a device to market that enables people with this condition to self-fit and have these ultra-high frequencies restored.

Hearing aids that effectively amplify music: Given the demand to improve speech understanding, hearing aid manufacturers have devoted tons of resources to addressing this problem. The challenge, however, is that signal processing algorithms designed to optimize speech in noise tend to not sound too good when the wearer wants to listen to music. Maybe a consumer electronic device company will commercialize a hearing aid that can be tuned by the wearer to maximize the enjoyment of music.

Given their track record, I’m betting the mainstay hearing aid manufacturers get there first. So, drop off the key, Lee, and set audiology free. ■


    • It’s a valid point that over the past 50-plus years, the hearing aid industry and the hearing healthcare professions, on a massive scale, have done little to improve the low uptake rate of hearing aids for under-served populations. When it comes to service delivery innovations we do seem to be running behind. Remote or virtual care, when combined with prescription or OTC hearing aids might move the needle on uptake rates.
    • More than 40 years ago, renowned audiologist and engineer, Mead Killion, established that the fidelity of hearing aids could be on par with sophisticated stereo equipment
    • Loosely defined as any electronic device that reproduces sound, the “audio world” includes recorded music, home theater systems, car stereos, consumer electronics such as earbuds and headphones and of course hearing aids

Brian Taylor, AuD is the senior director of audiology for Signia. Yes, he is employed by a hearing aid manufacturer. Additionally, he is (or has been) a clinician, business manager and professor. He is the co-author of the text, Fitting and Dispensing Hearing Aids, now in its third edition.