How useful are direct-to-consumer hearing aids?

Clinical question

Do self-fitted hearing aids improve hearing for adults with mild to moderately severe hearing loss?

Bottom line

Some, not all, direct-to-consumer (DTC) self-fitted hearing aids are likely comparable to audiogram-fitted conventional hearing aids and tend to cost less.

Evidence

Conventional hearing aids are adjusted to patients’ specific hearing characteristics using an audiogram. For DTC hearing aids, patients used smartphone applications or preprogrammed settings to self-fit them. Results were statistically different unless indicated.

• Four systematic reviews compared audiogram-fitted conventional hearing aids with self-fitted DTC devices.^1-4 The most recent examined 5 RCTs or crossover studies involving patients with mild to moderately severe hearing loss (N=124).¹ Speech intelligibility did not differ.

  • - An additional crossover study assessed percentage of words recognized (PWR) scores in participants with various degrees of hearing loss (N=57).⁵ In those with moderately severe hearing loss (n=15), median PWR scores were higher with conventional hearing aids (76% to 88%) and with DTC devices (68% to 80%) compared to unaided hearing (60%).

• A systematic review looked at 5 studies (3 RCTs and 2 crossover studies) comparing audiogram-fitted conventional hearing aids versus self-fitted DTC devices (N=176).⁶ Speech intelligibility did not differ.

  • - An additional RCT (N=64) compared audiogram-fitted and self-fitted hearing aids in patients with mild to moderate hearing loss.⁷ At 6 weeks, mean global scores on a self-assessed communication difficulties scale (range 1 to 99; lower scores indicate less difficulty) improved to 19.1 with self-fitted hearing aids (baseline 37.4) versus 24.1 with audiogram-fitted hearing aids (baseline 34.4)—not statistically different. Speech intelligibility and quality of life did not differ.

• A crossover study compared audiogram-fitted DTC and conventional hearing aids for those with mild to moderate hearing loss (N=42).⁸ At baseline mean PWR=76%. With conventional hearing aids, mean PWR=88%. Two DTC devices (mean PWR=87%) did not differ from conventional hearing aids while 3 (mean PWR ranging from 65% to 84%) were inferior.

• Limitations: Randomization and blinding were sometimes unclear. Assessments were often performed in artificial settings. Few details on quality of life were provided. Few of the devices tested are available in Canada.

Context

• Mild to moderate hearing loss is managed with hearing aids. Severe hearing loss is managed with cochlear implants or alternative communication techniques.⁹

• Costs: from $200 to $1000 (US) for DTC hearing aids and $800 to $4000 (US) for conventional hearing aids.¹⁰

Implementation

Sudden hearing loss or the presence of otologic or neurologic symptoms requires prompt audiology or otolaryngology referral.¹⁰ For patients with bilateral, gradual, or likely age-related hearing loss, the benefit of an audiogram for diagnostic clarification is unclear. In Canada hearing aids are prescribed by physicians or audiologists and referral may be appropriate to facilitate access and insurance reimbursement. Also in Canada, DTC hearing aids are being marketed for patients with normal hearing and are not regulated by Health Canada.