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Research ArticleTools for Practice

How useful are direct-to-consumer hearing aids?

Émélie Braschi and Samantha S. Moe
Canadian Family Physician July/August 2024; 70 (7-8) 475; DOI: https://doi.org/10.46747/cfp.700708475
Émélie Braschi
Hospitalist at the Élisabeth Bruyère Hospital in Ottawa, Ont, and a physician adviser at the College of Family Physicians of Canada.
MD PhD CCFP
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Samantha S. Moe
Clinical Evidence Expert at the College of Family Physicians of Canada.
PharmD ACPR
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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.

Notes

Tools for Practice articles in CFP are adapted from peer-reviewed articles at http://www.toolsforpractice.ca and summarize practice-changing medical evidence for primary care. Coordinated by Dr G. Michael Allan and Dr Adrienne J. Lindblad, articles are developed by the Patients, Experience, Evidence, Research (PEER) team and supported by the College of Family Physicians of Canada and its Alberta, Ontario, and Saskatchewan Chapters. Feedback is welcome at toolsforpractice{at}cfpc.ca.

Footnotes

  • Competing interests

    None declared

  • This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to https://www.cfp.ca and click on the Mainpro+ link.

  • La traduction en français de cet article se trouve à https://www.cfp.ca dans la table des matières du numéro de juillet/août 2024 à la page e100.

  • Copyright © 2024 the College of Family Physicians of Canada

References

  1. 1.↵
    1. Chen CH,
    2. Huang CY,
    3. Cheng HL,
    4. Lin HYH,
    5. Chu YC,
    6. Chang CY, et al.
    Comparison of personal sound amplification products and conventional hearing aids for patients with hearing loss: a systematic review with meta-analysis. EClinicalMedicine 2022;46:101378.
    OpenUrl
  2. 2.
    1. Maidment DW,
    2. Barker AB,
    3. Xia J,
    4. Ferguson MA.
    A systematic review and meta-analysis assessing the effectiveness of alternative listening devices to conventional hearing aids in adults with hearing loss. Int J Audiol 2018;57(10):721-9.
    OpenUrlCrossRefPubMed
  3. 3.
    1. Manchaiah V,
    2. Taylor B,
    3. Dockens AL,
    4. Tran NR,
    5. Lane K,
    6. Castle M, et al.
    Applications of direct-to-consumer hearing devices for adults with hearing loss: a review. Clin Interv Aging 2017;12:859-71.
    OpenUrl
  4. 4.↵
    1. Tran NR,
    2. Manchaiah V.
    Outcomes of direct-to-consumer hearing devices for people with hearing loss: a review. J Audiol Otol 2018;22(4):178-88. Epub 2018 Aug 22.
    OpenUrl
  5. 5.↵
    1. Kim GY,
    2. Kim S,
    3. Jo M,
    4. Seol HY,
    5. Cho YS,
    6. Lim J, et al.
    Hearing and speech perception for people with hearing loss using personal sound amplification products. J Korean Med Sci 2022;37(12):e94.
    OpenUrl
  6. 6.↵
    1. Almufarrij I,
    2. Dillon H,
    3. Muro KJ.
    Do we need audiogram-based prescriptions? A systematic review. Int J Audiol 2023;62(6):500-11. Epub 2022 May 9.
    OpenUrl
  7. 7.↵
    1. De Sousa KC,
    2. Manchaiah V,
    3. Moore DR,
    4. Graham MA,
    5. Swanepoel DW.
    Effectiveness of an over-the-counter self-fitting hearing aid compared with an audiologist-fitted hearing aid: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2023;149(6):522-30.
    OpenUrl
  8. 8.↵
    1. Reed NS,
    2. Betz J,
    3. Kendig N,
    4. Korczak M,
    5. Lin FR.
    Personal sound amplification products vs a conventional hearing aid for speech understanding in noise. JAMA 2017;318(1):89-90.
    OpenUrl
  9. 9.↵
    1. US Preventive Services Task Force;
    2. Krist AH,
    3. Davidson KW,
    4. Mangione CM,
    5. Cabana M,
    6. Caughey AB, et al.
    Screening for hearing loss in older adults: US Preventive Services Task Force recommendation statement. JAMA 2021;325(12):1196-201.
    OpenUrlPubMed
  10. 10.↵
    1. Michels TC,
    2. Duffy MT,
    3. Rogers DJ.
    Hearing loss in adults: differential diagnosis and treatment. Am Fam Physician 2019;100(2):98-108.
    OpenUrl
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Canadian Family Physician: 70 (7-8)
Canadian Family Physician
Vol. 70, Issue 7-8
July/August 2024
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How useful are direct-to-consumer hearing aids?
Émélie Braschi, Samantha S. Moe
Canadian Family Physician Jul 2024, 70 (7-8) 475; DOI: 10.46747/cfp.700708475

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