Can you hear me now?

photo of a woman smiling as she is about to insert a hearing aid into her ear

Glasses have become such a fashion statement that some people without vision problems don them merely for looks. But that trend is decidedly different from hearing loss, since tens of millions of Americans continue to struggle to hear sounds that would add context and color to their daily lives.

Only about one in five people who need hearing aids gets them, according to the FDA. Various factors contribute to the gap, but in large part, it's simply a matter of reluctance: many people refuse to acknowledge they can't hear well or won't jump from acceptance to action, says Dr. James Naples, an otolaryngologist (ear, nose, and throat specialist) at Harvard-affiliated Beth Israel Deaconess Medical Center.

"Putting hearing aids on is taking an invisible condition and making it visible," he says. "But our world is incredibly dependent on hearing, and restoring it allows you to maintain connections in your verbal and social world."

Signs you shouldn't ignore

As evidence mounts that untreated hearing loss is associated with serious health risks such as dementia, depression, and falls, we can't afford to ignore the problem, Dr. Naples says. Apparently there's a gender gap when it comes to doing just that: while men are twice as likely as women to experience hearing loss, women are more likely to seek help, according to the National Institute on Deafness and Other Communication Disorders.

Seeking help is "a really good thing — it's being proactive about your health," Dr. Naples says. "The biggest benefit is that you can get care at an earlier point, when you have the luxury of being able to decide what to do."

Certain signs suggest a hearing test would be a good idea, including routinely needing people to speak louder, turning up the TV volume, and having trouble distinguishing individual voices in crowds. But some symptoms demand evaluation. People with hearing loss in only one ear, pain, ear drainage, or vertigo should see a doctor quickly, Dr. Naples says.

The most streamlined process to obtain hearing aids starts with a visit to an audiologist, who performs a hearing test to determine your type of hearing loss. Then, an otolaryngologist typically decides if hearing aids are an appropriate remedy or if another problem needs to be investigated. If you're deemed to need hearing aids, the third step is a hearing aid evaluation, in which you try some out with an audiologist. At its most efficient, the entire process involves two clinicians and three visits.

"Hearing loss can be caused by a long list of things, but often we don't know what's causing it until we look," Dr. Naples says. "A hearing test is like a screening test: it helps determine what type of hearing loss you have and if something else needs to be looked at."

Now we can pop into the store for hearing aids

But there are pros and cons to over the-counter versions.

With a single pair of prescription hearing aids costing as much as $6,000 — and few health insurance plans covering the devices — many people who need them have simply been priced out.

Until now. Following years of Congressional effort, the FDA paved the way in August 2022 for over-the-counter (OTC) hearing aids to become available to adults without a prescription. OTC versions were expected to become widely available from big-box stores, drugstores, and websites by October.

The much-heralded announcement marked a shift in a long-standard process that required comprehensive testing with an audiologist or physician before a person could get hearing aids. Now, picking up a pair of hearing aids might be as straightforward as choosing a new pair of reading glasses. But can OTC hearing aids be as effective as prescribed versions?

"Their potential is good, but there are going to be some hiccups as well," says Dr. James Naples, an otolaryngologist at Beth Israel Deaconess Medical Center. "They offer easier access to hearing aids for a huge portion of the public, but my concern is they will delay diagnosis for those who have a condition that needs to be addressed."

The biggest pro? OTC versions should be far less expensive than prescription hearing aids, though still hundreds (or rarely, thousands) of dollars, he says. Still, the expertise that helped create these products costs money. "If people expect $10 hearing aids, they may not get the technology they need to hear well," Dr. Naples says.

OTC hearing aids also pose several cons, Dr. Naples says:

They can't treat all forms of hearing loss. "They should be labeled with a list of symptoms that point you toward calling a doctor," he says.
They can't be customized to amplify certain sounds or tune out background noise, as prescription versions typically can. "You're probably going to be choosing a one-size-fits-all model, as opposed to optimizing sound just for your hearing pattern," he says.
They can't be easily fixed. Audiologists can often repair a broken or malfunctioning prescription hearing aid, acting as a sort of insurance policy if you need help. But OTC versions aren't likely to offer such obvious support.

Ultimately, "it's impossible to tell" who would be best suited for OTC hearing aids, Dr. Naples says. "If your needs fit the one-size-fits-all model, then you may do great with OTC. Not everyone needs to spend thousands of dollars on hearing aids, but until you try them out, you don't really know."

Easing the transition

The biggest barrier to integrating hearing aids into daily life may be a mental one. "People just don't like the idea of having to do something different," Dr. Naples says. "I simplify this by telling them to consider ways to make hearing aids part of their daily routine — for example, placing their hearing aids next to their toothbrush so it becomes part of what they do to start their day."

He offers these additional tips to ease the transition.

Try them at home first. Before venturing out with your new hearing aids, spend time in your quiet, familiar environment. It's an ideal place to "retrain" yourself to speak at a more appropriate volume for others and to adjust your TV volume to suit your new abilities.

Be patient. It takes time for hearing aids to feel like a natural part of your ear. Gradually wear them a few more hours each day. Within a few weeks, you should be wearing them regularly.

Anticipate your needs. There will be some places where you can't manage without your hearing aids and others where they're totally unnecessary. You may need them if you're going to a board meeting or the theater, but not if you're quietly reading at home.

Tweak your fit. See your audiologist for follow-up appointments to adjust your hearing aid settings as you learn how the devices work for your needs. And let your clinician know if your hearing aids hurt, since many types can be custom-fit. "Comfort can be an issue, but that shouldn't deter you from getting them," Dr. Naples says.

Share perspectives. Ask friends and family members who use hearing aids about their experience. They've likely endured similar frustrations and can offer helpful guidance.