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Prescription vs. Over-the-Counter Hearing Aids

An audiologist offers advice for finding the right hearing device.


hearing aids

With the new rule regulating over-the-counter hearing aids taking effect in October, there’s been a flood of information. And it’s sure to be followed by a flood of new hearing devices on the market.

This may make buying a hearing aid overwhelming. Confusing even. There’s nobody more prepared to help you prepare for this decision than an audiologist. The Iowa Clinic’s Brooke Welch, AuD, provides guidance so you can better understand your hearing aid options..

What’s changing with the new hearing aid rule?

The new regulation makes hearing aids available over-the-counter for the first time. That means you can shop for a hearing aid at the same shop where you get acetaminophen, ibuprofen and everything else in your medicine cabinet.

This isn’t just a matter of hearing aids hitting store shelves. The rule also changes how the term “hearing aid” is actually defined and how products should be labeled. But there are also similar hearing devices out there that may easily be confused with hearing aids.

“A lot of the products that have been on the market are not technically OTC hearing aids — they’re called personal amplifiers,” Dr. Welch says. “They’re pretty basic and not suitable for most people with hearing loss.”

So what’s the difference between prescription and OTC hearing aids?

Up until now, all hearing aids were prescription hearing aids. The rule change basically creates two new categories of devices: prescription and over-the-counter.

Prescription hearing aids are the traditional ones you get from an audiologist who diagnoses your hearing loss. They are custom-fit to your needs and ears.

“We measure your hearing to see if you’re even a candidate. And we rule out other issues with your ears that might prevent you from getting hearing aids,” Dr. Welch says. “Ultimately, prescription hearing aids are exactly fit to your hearing and based on your communication difficulties.”

Over-the-counter hearing aids are medical devices sold online or in stores without a prescription — or as much as a visit to the doctor. While each product is required to meet certain design requirements and is regulated by the Food and Drug Administration, they are not required to meet the needs of your ears.

“With over-the-counter hearing aids, it’s really based on self-diagnosis. You’re not required to get any testing. There’s no one to provide any guidance. It’s just, “Do I feel I have a certain amount of hearing difficulty?’” says Dr. Welch. “You pick the product, just like if you were shopping for anything else at the store. Then, you’re on your own as far as setup, maintenance and care.”

Who can wear over-the-counter hearing aids?

OTC hearing aids are designed for adults with mild to moderate hearing loss. If you feel like you’re hard of hearing, they may be for you. But there’s no way to know if you have hearing loss — or how much — without the appropriate hearing testing.

There are also other conditions that could rule out the over-the-counter option for you, says Dr. Welch:

  • Drainage coming out of your ear
  • Pain or pressure in your ears
  • Hearing loss or ringing (tinnitus) only in one ear
  • A noticeable difference in hearing between ears
  • Sudden, quickly worsening, or fluctuating hearing loss
  • Dizziness

“Those are general red flags that we look for when you come in for a hearing test. You would want those things evaluated before you purchase an over-the-counter hearing aid, just to cover your bases before you put anything in your ear,” she says.

“It’s best to get that medical evaluation from an audiologist before you just go grab something off the shelf to try. Then you can make an educated decision about what you need, whether you decide on prescription or over the counter.”

Is there a difference in the price of hearing aids?

Affordability and accessibility are two of the main goals in making hearing aids available over the counter. That does not mean they’ll come cheap. Hearing devices are advanced technology. They will all perform certain baseline functions required by the FDA, but many will come with additional bells and whistles that will push the price point higher.

The American Speech-Language Hearing Association estimates that OTC hearing aids will cost $1,000 a pair, on average. As more manufacturers come to market, you’ll likely see a broad range with options below that level and others closer in price to prescription hearing aids.

“At The Iowa Clinic, our prescription hearing aids range from around $2,000 to over $5,000. There are options in between, but it really depends on what you need,” Dr. Welch says.

Traditionally, there’s more value baked into the cost of a prescription hearing aid. You get:

  • Periodic hearing and hearing aid checks
  • Hearing aid cleanings
  • Programming adjustments for better performance
  • Maintenance and care for both your hearing aids and your ears

“Our policy is that there’s no charge for those visits for the life of your hearing aid. It’s all included in the price we quote up front,” Dr. Welch says. “You get care from an audiologist, a warranty and a return period to make sure the hearing aids work for you. And when there’s a problem, we take care of it here in the office or send it to the manufacturer to fix.”

How do I know which hearing aid is the best fit?

If you’ve ever worn a pair of earbuds (or several), you know that fitting anything in your ear can be tricky. And with hearing aids, fit is everything.

“Most of the products are going to be one size fits most, and that’s really tough with ears, which come in all shapes and sizes. For example, your ear canal might be really narrow or have a sharp bend,” Dr. Welch says. “If the hearing aid is loose or doesn’t fit, it could fall out and get lost or break. And it’s not going to have the appropriate sound coming in or provide good amplification.”

Prescription hearing aids are custom-tailored to your ears. Both physically to the size and shape of your ears and functionally to the exact specifications for your hearing loss.

“Hearing for each person is super unique. It’s not like eyesight, where you can just go get a pair of cheaters at the store that will work fine to improve your up-close vision,” Dr. Welch says.

“Everyone has a different hearing level. And your hearing problems — and needs — may vary in different environments,” she adds. “Ultimately, coming in to get an evaluation with an audiologist is going to be your best bet. If you’re going to spend that much money, you might as well get something that you know is right for you.”

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