Evaluation of Communication Outcomes With Over-the-Counter Hearing Aids
Authors: Szatkowski Grace , Souza Pamela Elizabeth 
Published: December 2024

Objectives:
Over-the-counter (OTC) hearing aids are a treatment option for adults with mild-to-moderate hearing loss. Previous investigations demonstrated the benefits of OTC hearing aids, primarily self-fit OTCs (i.e., self-adjustable with a smartphone or tablet), on self-reported hearing aid benefit and speech recognition using standardized measures. However, less is known regarding whether OTC hearing aids effectively improve aspects of everyday communication, particularly with preprogrammed OTCs (i.e., OTCs with manufacturer-defined programs). The goal of this study was to evaluate the benefits of preprogrammed OTC hearing aids for two important aspects of communication: (1) conversation efficiency, or the time taken during conversations with a familiar communication partner (e.g., one’s spouse) and (2) auditory recall following speech recognition, a critical aspect of participation during conversations.

Design:
This study used a within-subject design with thirty adults with mild-to-moderate hearing loss and their familiar communication partners. Participants were fitted with preprogrammed OTC hearing aids using the default program with the best match to target for each listener. The primary outcome measures were conversation efficiency and auditory recall. Speech recognition-in-noise served as a secondary measure. Conversation efficiency was evaluated using the DiapixUK task, a “spot-the-difference” conversation task in quiet, and measured as the sum of time taken to correctly identify differences between two similar pictures. Within-subject comparisons were made for hearing aid condition (without and with OTC hearing aids in the default setting). Auditory recall was assessed with the Repeat and Recall Test following speech recognition-in-noise with low- and high-context sentence presentations at 5- and 10-dB signal to noise ratios. In addition to the mentioned hearing aid conditions, an additional comparison was made with the OTC hearing aid noise-reduction program. Linear mixed-effects models were used to evaluate the effect of OTC hearing aid use on primary measures of efficiency and recall. Friedman signed-rank test was used to evaluate speech recognition scores.

Results:
We did not find a significant improvement in conversation efficiency with OTC hearing aid use compared with the unaided condition. For auditory recall, we observed the poorest median recall scores with the default program and the best median scores with the noise-reduction program, although neither observation was statistically significant. Sentence recognition scores were near ceiling in the unaided condition and were poorest with use of the OTC hearing aids in the default program across most signal to noise ratio and context test conditions. Our findings did not show improvements in communication outcomes with OTC hearing aid use. Small to medium effect sizes for our data may be indicative of the limitations of the OTC hearing aids to improve communication outcomes for our sampled population and communication scenarios.

Conclusions:
The results of this study provide insights into the effects of OTC hearing aids on communication abilities at first fitting. We identified features of preprogrammed OTC hearing aids that may be limiting potential communication benefits among listeners with mild-to-moderate hearing loss. Future investigations that compare communication outcomes across various types of OTC hearing aids may provide valuable insights for identifying the most suitable recipients for specific OTC hearing aid models.