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#352 Do-It-Yourself Hearing Aids


CLINICAL QUESTION
QUESTION CLINIQUE
 Do self-fitted hearing aids improve hearing for adults with mild to moderate-severe hearing loss?

BOTTOM LINE
RÉSULTAT FINAL
 Some, but not all, direct-to-consumer self-fitted hearing aids are likely comparable to conventional hearing aids fitted via audiogram, at a much lower cost. Access and guidance/regulations on direct-to-consumer self-fitted hearing aids is limited in Canada. See suggestions below. 


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EVIDENCE
DONNÉES PROBANTES
  • Conventional hearing aids: adjusted to the patient’s specific hearing characteristics using an audiogram (“audiogram-fitted”). Direct-to-consumer hearing aids: adjusted by patients themselves using smartphones/pre-programmed settings (“self-fitted”).
  • Self-fitted direct-to-consumer devices versus audiogram-fitted conventional hearing-aids:
    • Four systematic reviews.1-4 Most recent/relevant: Five randomized controlled trials (RCT) or cross-over studies (124 patients, mild-moderate hearing loss) testing direct-to-consumer devices (PS2500ampTM, CS50+ Sound World SolutionTM, FocusEar RS2TM, Tweak FocusTM, Etymotic BEANTM, Olive SmartEarTM):1
      • Speech intelligibility: No difference.
    • Additional cross-over study: 23 patients, moderate-severe hearing loss.5 Percentage words recognized (60% baseline) changed to:
      • Conventional hearing aids: 76-88%.
      • Direct-to-consumer devices: CS50+ Sound World SolutionTM  68%; Etymotic BEANTM  80%.
      • No statistical analysis.
  • Same hearing aids: Audiogram-fitted versus self-fitted.
    • One systematic review: Five randomized, quasi-randomized, or cross-over studies (176 patients).6
      • Speech intelligibility: No difference.
    • Additional RCT, 64 patients, mild-moderate hearing loss (Lexie LumenTM), 6-weeks:7
      • Self-assessed communication difficulties scale (ranges 1-99; lower=fewer difficulties): Baseline 34-37, improved to 19 self-fitted versus 24 audiogram-fitted (not statistically different).
      • Speech intelligibility, quality of life: No difference.
  • Audiogram-fitted: Direct-to-consumer devices versus conventional hearing aids.
    • Cross-over RCT, 42 patients, mild-moderate hearing loss.8 Percentage words recognized (76% baseline) changed to:
      • Conventional hearing aid: 88%.
      • Direct-to-consumer devices:
        • CS50+ Sound World SolutionTM, SoundhawkTM: 87% (no difference).
        • Etymotic BEANTM  (84%), Tweak FocusTM (81%), MSA Pro 30X Sound AmplifierTM  (65%): All inferior to conventional hearing aids.
  • Limitations: Randomization/blinding sometimes unclear; artificial setting (sound booth) often used; little quality of life information; unclear which patients would benefit from an audiogram; Canadian availability limited.
CONTEXT
CONTEXTE
  • Examples, direct-to-consumer devices available in Canada:
    • CS50+ Sound World SolutionTM (~$300).9
    • Etymotic BEANTM ($300).10
  • Mild-moderate hearing loss (26-60dB): managed with hearing aids. Severe: managed with cochlear implants/alternative communication techniques.11
  • Hearing aids ~$3,000; most provincial plans minimal coverage (example $500).12

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Author(s)
Auteur(s)
  • Émélie Braschi MD PhD
  • Samantha S. Moe PharmD

1. Chen C, Huang C, Cheng H, et al. EClinicalMedicine. 2022 Apr 7; 46:101378.

2. Maidment DW, Barker AB, Xia J, et al. Int J Audiol. 2018 Oct; 57(10):721-729.

3. Manchaiah V, Taylor B, Dockens AL, et al. Clin Interv Aging. 2017 May 18; 12:859-871.

4. Tran NR, Manchaiah V. J Audiol Otol. 2018 Oct; 22(4):178-188.

5. Kim GY, Kim S, Jo M, et al. J Korean Med Sci. 2022 Mar 28; 37(12):e94.

6. Almufarrij I, Dillon H and Muro KJ. Int J Audiol. 2023; 62(6):500-511.

7. De Sousa K, Manchaiah V, Moore DR, et al. JAMA Otolaryngol Head Neck Surg. 2023 Apr 13; e230376.

8. Reed NS, Betz J, Kendig N, et al. JAMA. 2017 Jul 4; 318(1):89-90.

9. Amazon.com. Available at: https://www.amazon.com/Sound-World-Solutions-CS50-Bluetooth/dp/B00JAWKPCW/ref=sr_1_1?crid=1X62JZ69UOWAY&keywords=sound+world+solutions+cs50%2B&qid=1698775402&sprefix=cs50+sounds+wor%2Caps%2C288&sr=8-1. Accessed: October 31, 2023.

10. ALDS Canada. Available at: https://alds.com/BEAN-PSA-by-Etymotic-c12924063. Accessed: October 31, 2023.

11. US Preventive Services Task Force. JAMA. 2021; 325(12):1196-1201.

12. Hearing Excellence. Insurance coverage and costs explained. Available at: https://hearingexcellence.ca/hearing-aid-pricing-in-ontario-insurance-coverage-and-costs-explained/. Accessed October 13, 2023.

Authors have no conflicts of interest to declare.