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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.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


Lucas Verburg November 14, 2023

Relevant in current economy

Susanne Schloegl November 14, 2023

Very interesting.

Mitchell Schipper November 14, 2023

Good article

Richard Milde November 14, 2023

I’m going to start recommending those now.

Atef Tanious November 14, 2023

good

Mary Boegel November 14, 2023

Very helpful as I had heard that the direct to consumer hearing aides were becoming available and want to know how to advise patients.

H WILLIAM November 14, 2023

good to know

Andrew Affleck November 14, 2023

conventional hearing aids better but if cost is an issue the self adjusted will do

Oluwafemi Ajibade-Peters November 14, 2023

Conventional hearing aids are better than self fitted aids due to the process and professionals involved, however cost is also something to consider, so having a self fitted one is better than nothing

tia renouf November 14, 2023

interesting

Azim Jiwani November 14, 2023

Vert interesting and useful analysis.

Girma Mekonnen Tizazu November 14, 2023

Interesting

Ruth Connelly November 15, 2023

good to know

Taha Abdulkhaliq November 15, 2023

Good article

Joanna Hill November 15, 2023

h aids with audiograms are still very costly

Joanna Hill November 15, 2023

thank you for article

Pierre-Paul Tellier November 19, 2023

Useful information

Alan Katz December 13, 2023

Clearly where cost is an issue the OTC aids may be a good option. Would be good to know if private insurance covers these, If not we will bw more likley to suggest convesntional products even though the more expensive option may not be required

Robert Duggan January 16, 2024

Interesting

Gillian Rosenthal February 8, 2024

Interesting. OTC products better than I had previously believed to be the case. The data implies that the extra cost may not be worthwhile.


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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.