Evidence for OTC Hearing Aid Disruption (Or Lack Thereof), Part 3

June 13, 2017

By Garrett Thompson, AuD

In Part 2 of this series we examined two studies relating to OTC hearing devices. Today, in Part 3, we will continue to take a hard look at the data associated with OTC devices.


Study #3


Kochkin (2014) conducted a large survey of traditional hearing aid (THA) users and direct-mail (DM) hearing aid users. In total, 1,721 THA users and 2,332 DM completed the 7-page survey. The THA sample was drawn from Kochkin’s (2012) MarkeTrak VIII data, and the DM sample were customers of the largest US direct-mail hearing aid firm (Kochkin, 2014). The samples include individuals with a range of hearing loss configurations, income, and education levels; all participants were adults.

DM hearing aids were not programmed to the hearing test of an individual, but rather were pre-programmed with amplification profiles that fit the most common hearing losses; this is somewhat analogous to an OTC consumer experience. The THA group was also broken into deciles based on the level of audiology best practices (BP) they received, where BP1 is a minimal hearing aid fitting protocol, BP10 is a comprehensive hearing aid fitting protocol, and BP5 is the median (Kochkin, 2014).


Results of the survey revealed that both THA and DM hearing aids were efficacious in that they both improved listening performance in various situations and quality of life (QOL).


hearing aid quality of life

Figure 3, Quality of Life Changes Attributed to Hearing Aid Use, Comparing Direct-Mail and Traditional Hearing Aid Fittings Ranked by Best Practices (Kochkin, 2014)


As seen in Figure 3, 46% of DM users perceived either “better” or “a lot better” QOL. For the THA group, the level of best practices greatly impacted the improvement in QOL. Audiology services at or below the median BP decile produced no better QOL improvement than the DM delivery model; BP5 resulted in “better” or “a lot better” QOL in 39% of subjects, less than the 46% produced by DM. The most comprehensive fitting protocol, however, resulted in “better” or “a lot better” QOL in 75% of subjects, significantly higher than the DM users.

As a measure of value, Kochkin calculated the dollars spent for each percentage-point reduction in hearing handicap.


direct mail hearing aids

Figure 4, Value of Device Purchase, Expressed as Median Dollars Spent for Each Percentage-Point Reduction in Hearing Handicap (Kochkin, 2014)


As seen in Figure 4 above, DM users perceived higher value in the devices than the THA group as a whole and higher than even the most comprehensive BP service. Although the overall hearing handicap reduction was less than the THA model, because the cost was significantly less, the value of DM aids was greater (Kochkin, 2014).


hearing loss dollars spent

Figure 5, Overall Consumer Success with Hearing Aids as a Function of Value, Comparing Direct-Mail and Traditional Hearing Aid Fittings Ranked by Best Practices (Kochkin, 2014)


Figure 5, above, graphically displays consumer success as a function of value for each of the BP deciles and the DM aids. The results reveal that a DM model of hearing aid delivery is moderately successful and has high value, while a comprehensive traditional fitting protocol (BP10) is highly successful and has moderate value.


A median fitting protocol (BP5) leads to the same level of success as DM but delivers dramatically less value to the patient/consumer.


Overall, Kochkin (2014) found that patient satisfaction was highly driven by perceptions of value.


Study #4


Convery et al. (2016) sought to evaluate the performance of individuals as they attempted the complete process of self-fitting a hearing device. Mimicking the framework of an OTC experience, they used a commercially available product (SoundWorld Solutions RIC-style HA). The sample was comprised of 40 adults aged 50-88 years with mild to moderately-severe sensorineural hearing loss, half of which were experienced and half inexperienced hearing aid users; 24 participants brought a family member for assistance, as needed. Participants followed a set of written and illustrated instructions to perform the multi-step fitting procedure, and success was determined by whether they could complete the entire task (Convery et al., 2016).

Results revealed that 55% of participants were able to successfully complete the self-testing and self-fitting task. This is similar to the 58% of participants that were able to complete audiograms for both ears using in-situ audiometry in an earlier study by the same authors (Convery et al., 2015).

Although success versus failure in this study (Convery et al., 2016) was based exclusively on the seven-step testing and fitting process, it should also be noted that only 16 participants (40%) were able to successfully navigate the process of pairing the devices to the tablet which was necessary for hearing testing and fitting (Convery et al., 2016).


Interestingly, the individuals who received help from a family member were no more likely to complete the task than those who didn’t. There was also no difference in success rate between the experienced and inexperienced group, although the types of mistakes differed between groups.


The most frequent failure was due to poor insertion of the RIC earpiece in the ear, success on this task was 77%; this is consistent with previous data from these researchers in whichsuccess rates for insertion were previously found to be 58% (2011) and 77% (2015). The authors note that participants who made mistakes in the self-fitting process were generally unaware that they had done so (Convery et al., 2016).


**Please stay tuned, in the next installment of The Young & the RIC-less, we continue to examine studies from around the world that look at how real people with hearing loss view the issue of OTC.



Garrett Thompson, AuD is a recent graduate of the City University of New York and just completed his externship at the Callier Center of UT-Dallas. He was a national finalist in the 2015 Academy of Doctors of Audiology student business plan competition. His writing has previously been featured in Audiology Today and Audiology Practices. Thompson received a BA in Economics from Boston College. Contact him at [email protected] or @Dr_Audball

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