Applications of direct-to-consumer hearing devices for adults with hearing loss: a review

Abstract

BackgroundThis systematic literature review is aimed at investigating applications of direct-to-consumer hearing devices for adults with hearing loss. This review discusses three categories of direct-to-consumer hearing devices: 1) personal sound amplification products (PSAPs), 2) direct-mail hearing aids, and 3) over-the-counter (OTC) hearing aids.MethodA literature review was conducted using EBSCOhost and included the databases CINAHL, MEDLINE, and PsycINFO. After applying prior agreed inclusion and exclusion criteria, 13 reports were included in the review.ResultsIncluded studies fell into three domains: 1) electroacoustic characteristics, 2) consumer surveys, and 3) outcome evaluations. Electroacoustic characteristics of these devices vary significantly with some meeting the stringent acoustic criteria used for hearing aids, while others producing dangerous output levels (ie, over 120-dB sound pressure level). Low-end (or low-cost) devices were typically poor in acoustic quality and did not meet gain levels necessary for most adult and elderly hearing loss patterns (eg, presbycusis), especially in high frequencies. Despite direct-mail hearing aids and PSAPs being associated with lower satisfaction when compared to hearing aids purchased through hearing health care professionals, consumer surveys suggest that 5%–19% of people with hearing loss purchase hearing aids through direct-mail or online. Studies on outcome evaluation suggest positive outcomes of OTC devices in the elderly population. Of note, OTC outcomes appear better when a hearing health care professional supports these users.ConclusionWhile some direct-to-consumer hearing devices have the capability to produce adverse effects due to production of dangerously high sound levels and internal noise, the existing literature suggests that there are potential benefits of these devices. Research of direct-to-consumer hearing devices is limited, and current published studies are of weak quality. Much effort is needed to understand the benefits and limitations of such devices on people with hearing loss.

Addressing age related hearing loss through engineering accessible and affordable hearing technology

“…Such an approach to combine appropriate technology with a local support base is essential to meet the needs of LMIC, as there is a chronic shortage of trained support personnel for hearing aids [31,40] The LoCHAid represents an opportunity to change the value proposition of hearing aids. In European countries such as the United Kingdom, where hearing aids are fully or partially covered under governmental health programs such as National Health Service, uptake remains low at 30% too [8,13,34]. Social stigma is one of the barriers; however, that may be changing with the arrival of an aging population that has grown more comfortable with technology and have a desire for more fashionable, robust, and better hearing technology [1,34].…”

“…In low-and middle-income countries (LMIC), hearing aid adoption rates are below 3% whereas in non-LMIC countries, the adoption rate is around 20% [1]. Various reasons (e.g., self-reported hearing disability, access to hearing healthcare) may contribute to this poor uptake [8]; however, cost is one of the most substantial factors [8][9][10][11][12][13][14]. The retail price of a pair of hearing aids range between $1,000 (low-end) to $8,000 (highend), with an average price being $4,700 in the United States [7,15].…”

“…Even though various low-cost solutions (< $300) have been developed in the last decade such as personal sound amplifiers (PSAPs), they have been reported to have poor acoustic characteristics and often do not meet the acoustic characteristics needed to treat ARHL. They are characterised by having too much low frequency gain and limited high frequency gain, dangerous levels of amplification, excessive internal noise, and high distortion [11,13,14,[16][17][18][19]. Moreover, over-the-counter (OTC) hearing aids and PSAPs are still between $100 and $500 [11,14,[17][18][19], which is significantly expensive for people living in LMIC, where the annual healthcare expenditure per capita ranges from $5 to $50 (2010 USD) [20,21].…”

Biomedical device innovation methodology: applications in biophotonics

“…Importantly, they found that along with the usual problems of hearing aids, such as the stigma associated with wearing them, there were significant audio feedback issues limiting use beyond certain levels of hearing loss. 28,29 Identifying the gap in the hearing loss population allowed Earlens to invent a solution that amplifies sound through light and, therefore, avoid traditional hearing aid feedback issues. …”

“…47 In addition, acceptance and uptake of hearing aids have been demonstrated to be poor. 28 Many patients note that there is a stigma to using hearing aids and that while hearing aids provide some hearing benefit, the technology has limitations in terms of feedback and frequency range. The scope of this problem is large, and while there are currently alternative solutions, e.g., traditional hearing aids, to help these patients, this problem represents the origins of a clinical need.…”