Why Over-the-Counter Hearing Aids May Harm People With Hearing Loss


It’s been almost four years, but I still remember how much it hurt. The mundane click-clack of high heels and polished dress shoes on my Mimi’s tiled kitchen floor became a cacophony of sound. Harsh, discordant — every sound echoed off the walls and the floor, assaulting my ears with pain. The buds were too big for my ear canals, the sounds too much to bear. I ran to the quiet sanctuary of my car and cried.

I have different hearing aids now — ones that were fit and programmed unique to my ears. The first pair were not. And at 26, I’m not afraid to admit my hearing loss, I’m proud of it. I’m not afraid to show off my Made for iPhone® hearing aids. They make sure I don’t miss the punch lines to funny jokes and can keep up with a conversation. But in the last few months, two things have forced me to recall those first pair of hearing aids, because the biggest difference between the failure of the first pair and the success of the second was the way they were fit and programmed.

The Grassley-Warren Over-the-Counter Hearing Aid Act of 2016 (now updated for 2017) and the U.S. Food and Drug Administration’s announcement that “it does not intend to enforce the requirement that individuals 18 and up receive a medical evaluation or sign a waiver prior to purchasing most hearing aids” has some potentially terrible consequences for patients.

Stigma and price kept me from getting help, and from face-value this act could help with both, allowing more people to afford hearing aids, and thereby increasing awareness and acceptance of both hearing aids and hearing loss. But while helping more people access hearing aids is great, that same benefit coupled with the FDA’s declaration that adults aren’t required to undergo professional testing for most hearing aids could take away the most essential part of ensuring long-term hearing aid success and satisfaction — personalization.

Hearing aids aren’t a one-size-fits-all commodity, and they shouldn’t be purchased like reading glasses. Today’s hearing aids are mini microcomputers inside the ear, constantly working to the design of each individual ear and hearing loss. For them to work properly, ear canals must be measured for proper comfort, and hearing aids need to be fit and programmed specifically for a person’s individual hearing loss, ears, and other physical attributes (e.g. does the person have vertigo or in-ear obstructions). For users to get the most out of their devices, they need to be properly educated on how to use them and what to do when issues arise.

My hearing loss is unique only to me. My ears are unique to only me. What I need out of a hearing aid is unique to my lifestyle. My learning style and technical knowledge are unique to me. When I was fit with my Made for iPhone hearing aids, it took almost five hours to fit, program and instruct me properly. But because of that, in the last two years, I’ve worn them every day, pain-free. I am now comfortable with group conversations and leading work meetings, confident in my ability to be in a restaurant or outside in a park, and I’m happy, because for once, my ears and brain aren’t draining my energy levels trying to put sounds and words together properly.

To get a better understanding at just how much personalization can be needed, let’s look at my most recent hearing aid fitting.

  • Initial testing found a severe hearing loss with working bone conduction. Great! Hearing aids can work for me.
  • Physical examination of my ears and deep ear impressions showed that I have tiny ear canals that even the kid-size earbuds don’t fit comfortably in. Invisible hearing aids — not an option. Custom earmolds — required.
  • Further testing showed I need at least 65dB to hear low-frequency sounds and 70-80dB to hear mid- to high-frequency sounds, but that my pain threshold for sound is between 80-85dB. High-level technology required to provide proper amplification without
    causing pain and discomfort.
  • Testing also showed I can hear almost “normal” in a couple low-frequency sounds. Additionally, in discussing my first pair of hearing aids, a pair of improperly fitted receiver-in-the-canal devices, it was clear to the professional that a bud occludes my ear canal too much, leaving me feeling stuffed and causing sounds to echo. I need venting to allow for sounds at this frequency to come through properly. The need for custom earmolds is affirmed.
  • I have severe tinnitus in the right ear and sometimes in the left ear as well. Tinnitus
    technology also required.
  • I have an iPhone and don’t want to touch my hearing aids if I can help it. Made for
    iPhone compatible hearing aid required.
  • Every day I walk my dog outside, attend three or four large meetings at work, have daily one-on-one discussions with my boss and coworkers and take one or two phone calls. Each week, I go out for drinks with friends to a local pub or on a date to a restaurant or outdoor festival with my boyfriend. Hearing aids must have multiple programs to account for various environments and an active lifestyle.

And what happens if my hearing aids break, or the mobile app stops working? Who do I go to for annual cleanings? Who can I call who knows not only my products but who I can trust has the knowledge and experience to make educated calls about the health of my ears? The answer: a certified hearing aid specialist or audiologist.

Hearing aids aren’t glasses. You can’t put them on, walk out the door and call it a day. They require education, time to get used to, ongoing programming and professional care. I believe to be happy with them, you need more than just technology — you need the investment of personalized care.

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Thinkstock photo by Andrey Popov.


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