Over-the-counter hearing aids: what my first three months were actually like
When the audiologist said "hearing aids," I heard "old." I was 58, still conducting a summer community band, and I pictured the beige things my grandfather used to whistle with at the dinner table. It took me most of a year to come around. I wish it had taken a week.
I ended up with the over-the-counter kind. Below is what I learned about them, and a week-by-week account of the first three months, the awkward parts included.
Why so few people who need them wear them
I wasn't unusual in dragging my feet. The NIDCD's statistics on hearing put it starkly.
| Age group | Have ever used them |
|---|---|
| Aged 70 and older | 30% |
| Aged 20 to 69 | about 16% |
Source: NIDCD quick statistics on hearing.
So fewer than one in three older adults who could use hearing aids has ever tried them, and among people my age and younger it's about one in six. Cost, stigma and hassle are the usual reasons. Over-the-counter hearing aids were created to take a bite out of the first and last of those.
Who over-the-counter hearing aids are for
In October 2022 the FDA created a new category of hearing aids you can buy in a store or online without a prescription, a medical exam or a fitting by an audiologist. The FDA's guide to OTC hearing aids spells out who they're for: adults 18 and older with perceived mild to moderate hearing loss. They're not meant for severe or profound loss, and anyone under 18 still needs a prescription.
The FDA lists signs that suggest mild to moderate loss, and reading them felt like reading my own file:
- trouble hearing speech in noisy places;
- finding it hard to follow conversation in groups;
- trouble hearing on the phone;
- listening makes you tired;
- turning the TV up louder than other people like it.
| Over-the-counter | Prescription | |
|---|---|---|
| Who can buy | Adults 18 and over | Anyone, through a licensed professional |
| Degree of loss | Perceived mild to moderate | Any degree, including severe and profound |
| Exam or fitting required | No | Yes |
| Where to buy | Stores and online | Audiologists and hearing aid dispensers |
| Adjustment | You, usually with a phone app | The professional, at fitting and follow-ups |
| Original Medicare coverage | No | No |
That last row stung. Medicare's own coverage page says plainly that it doesn't cover hearing aids or the exams for fitting them, though some Medicare Advantage plans add a hearing benefit. If you're near 65, check what your plan covers before you shop.
Why I still got a test first
You don't need a hearing test to buy OTC hearing aids. I'd still get one, for three reasons. The test tells you whether your loss is actually in the mild to moderate range. It catches problems that hearing aids won't fix, like wax or fluid. And it gives you a baseline, so in a few years you'll know whether things are changing. My audiologist was happy to talk through OTC options even though she sells prescription ones, which I appreciated.
The first three months
| Week | What happened | What I did |
|---|---|---|
| 1 | My own voice sounded loud and hollow. Chewing was deafening. Paper crinkled like a snare drum | Wore them 2 to 3 hours a day at home, in quiet rooms |
| 2 to 3 | Turn signals, the microwave beep and birds came back. I'd forgotten the fridge hums | Added the car and a quiet lunch out |
| 4 to 6 | My brain stopped noticing the hiss of the air vents. Dinner with my wife got easier | All-day wear, set up a noisy-room program in the app |
| 7 to 12 | Restaurants were better but not easy. Band rehearsal was a different story | Kept them out for loud rehearsals, used musician's earplugs instead |
The thing nobody told me: the first two weeks are the worst, and they're the brain's fault, not the device's. After years of missing high-pitched sounds, the brain has to get used to hearing them again. Everything seems tinny and too sharp. If you take them out every time that happens, you never get past it. Wear them a little longer each day.
The NIDCD's hearing aid page makes the same point about patience and about returning to your provider, or the app, to fine-tune things.
The settings that mattered
Most OTC hearing aids now come with a phone app, and some start with a short hearing check inside the app that sets them up for your ears. Mine did. A few things in that app made a bigger difference than I expected.
The volume and treble controls were the obvious ones. Turning the treble up slightly, rather than the overall volume, brought back consonants without making everything louder. The noisy-room program narrowed the microphones toward whatever was in front of me. And the feedback setting stopped the faint whistle I got when I hugged my granddaughter or put on a hat, which had been driving me up the wall in week two.
What I didn't use much: the dozen preset environments with names like "outdoors" and "music." I found two settings I liked, quiet and noisy, and stuck with them. Simpler was better, and it meant I actually remembered to switch when I walked into a loud room.
What I'd do differently
- Start sooner. I spent a year straining at concerts and dinners for no good reason.
- Read the return policy before buying, and mark the date. Most OTC sellers offer a trial period. I almost went past mine.
- Begin at home in quiet rooms, not at a party.
- Keep a short daily note: where I wore them, what was hard, what was better. It made the app settings much easier to adjust.
- Protect the hearing I have left. Hearing aids don't stop the loss from progressing. Earplugs at loud events do.
On that last point, I found good company in a hearing site called Improve Hearing Naturally, which has plain-English guides on everything from muffled ears to sudden hearing loss. Its piece on everyday ways to protect the hearing you still have covers noise, diet, exercise and smoking, and is a good companion to a new pair of hearing aids.
Were they worth it?
Yes. Not because they made my hearing normal, which they didn't, but because they took the effort out of ordinary conversation. I used to come home from a dinner party wiped out and short-tempered. Now I come home tired the normal amount. That turned out to be the thing I'd been missing, and it's the subject of the next piece.