Why Aren’t More People Buying Over-The-Counter Hearing Aids?

When Frank Lin was in junior high, his grandma started wearing hearing aids. During dinner conversations, she was often painfully silent, and communicating by phone was nearly impossible. As a kid, Lin imagined “what her life would be like if she wasn’t always struggling to communicate.”

It was around that time that Lin became interested in otolaryngology, the study of the ears, nose, and throat. He would go on to study to be an ENT physician, which, he hoped, could equip him to help patients with similar age-related hardships.

Those aspirations sharpened during his residency at Johns Hopkins University School of Medicine in the late 2000s. Administering hearing tests in the clinic, Lin noticed that his colleagues had vastly different reactions to the same results in young versus old patients. If mild deficits showed up in a kid, “it would be like, ‘Oh, that hearing is critically important,’” said Lin, who today is the director of the Cochlear Center for Hearing and Public Health at Hopkins. But when they saw that same mild to moderate hearing loss in a 70-something patient, many would downplay the findings.

Yet today, research increasingly suggests that untreated hearing loss puts people at higher risk for cognitive decline and dementia. And, unlike during Lin’s early training, many patients can now do something about it: They can assess their own hearing using online tests or mobile phone apps, and purchase over-the-counter hearing aids, which are generally more affordable their predecessors and came under regulation by the Food and Drug Administration in October 2022.

Despite this expanded accessibility, interest in direct-to-consumer hearing devices has lagged thus far — in part, experts suggest, due to physician inattention to adult hearing health, inadequate insurance coverage for hearing aids, and lingering stigma around the issue. (As Lin put it: “There’s always been this notion that everyone has it as you get older, how can it be important?”) Even now, hearing tests aren’t necessarily recommended for individuals unless they report a problem.

Meanwhile, interest has surged in other consumer audio products that are less expensive than most hearing aids and have features that may help with mild hearing loss: wearable devices like Apple’s AirPods and Sony’s LinkBuds. And this fall, the Consumer Technology Association, a trade group representing the $505 billion U.S. consumer technology industry, released a standard metric for consumer electronics products to report a person’s hearing status. While yearly sale estimates for hearing aids hover around 20 million units worldwide, the fast-growing global market for consumer earbuds now tops 300 million.

The trend has some experts — including Lin, who is a consultant for Apple and on the advisory board for Sharper Sense — wondering if public interest in hearing health could ultimately be driven less by the medical community and more by technology companies wanting to boost consumer awareness of their audio products.

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About one in five Americans over the age of 12 struggles with hearing, and the percentage creeps higher with each decade of life. Among those who have reached their 70th birthday, roughly two-thirds have hearing difficulties. One vexing aspect is that hearing loss often emerges imperceptibly, with no obvious benchmarks to announce its arrival. “It’s very obvious when our vision starts to change. You can’t read the back of the soup can,” said Stephanie Czuhajewski, the executive director of the Academy of Doctors of Audiology. (Audiologists treat and manage hearing loss and balance disorders.) Yet with hearing loss, she said, “it sneaks up on you.” 

Some people remain unaware of their hearing struggles despite test results showing clear deficits. In a national study of adults between the ages of 20 and 69, more than two-thirds of participants with demonstrated hearing loss believed their hearing was fine. Even in the subset with more pronounced difficulties, 43 percent continued to report that their hearing seemed normal. This may be, in part, because some everyday noises are subtle. People don’t remember that they used to hear background noises, for instance, like birds singing and leaves rustling, said Kate Carr, president of the Hearing Industries Association, a trade group. (Carr will retire from her position on Dec. 31 and become a strategic adviser for the organization.)

Part of what makes it hard to notice one’s own hearing loss is the body’s ability to adapt and accommodate. For nearly three decades, 54-year-old Geoff McKonly has only been hearing out of his left ear; in 1997, doctors cut his right auditory nerve during a surgery to remove a fast-growing tumor. Yet having lived more than half his life with just one working ear, “you do a lot to compensate,” said McKonly, a furniture maker in Southampton, Massachusetts. “Most of the time, it’s not something I even think about.”

While hearing loss may be common, only about one in three older adults who could benefit from hearing aids have used them, several estimates suggest. Adoption rates appear to be edging upward in recent years, though on the whole, have only risen modestly since the 1950s, when devices were larger and clunkier.

By comparison, today’s hearing aids are a technological marvel — tiny, lightweight, and often lasting a full day without charging. Why are they still underused?

Cost is a key barrier. A 2022 survey of more than 15,000 U.S. households, conducted by the Hearing Industries Association before the FDA established the over-the-counter category, identified 2,079 respondents who chose not to get hearing aids despite reporting having hearing loss. From a list of possible reasons, more than half chose “too expensive” as the top response.