OTC Hearing Aid Quality

Many hearing professionals have expressed concerns that poor OTC hearing aid quality will result in dissatisfied users, for the following reasons:

  1. The instruments are not professionally fitted
  2. An audiogram is necessary
  3. OTC-sold devices (previously defined as PSAPs) are of poor quality and will not meet the needs of the hearing impaired, and
  4. Poor experiences by the purchaser will discourage them from seeking additional assistance and purchasing a “real” hearing aid
  5. A Universal, basic hearing aid cannot manage all hearing losses

The objection that hearing aids are not fitted professionally in an OTC model, and that an audiogram is necessary were discussed in previous posts.

OTC Hearing Aids Are Poor Quality and Do Not Meet Consumer Needs

This post looks at comments that an OTC-sold device (previously identified as PSAPs) are of poor quality and will not meet the needs of the hearing-impaired individual.  The two parts of this comment must be addressed by two questions:

  1. How is quality defined?
  2. How might OTC hearing aids not meet the needs of the hearing impaired?

The answers to these questions logically require more than supposition, conjecture, or unsupported statements. Because the OTC device can be identified currently as either a hearing aid or a PSAP, the following discussion relates to both classes of hearing devices.

How is a Quality Hearing Aid Defined?

Is it actually necessary to define a high-quality hearing aid in order to determine what a “poor” quality hearing aid is?  The answer is “no.”  Still, the discussion must be focused on the product itself.  (This discussion does not focus on the service quality, because that part has been managed in a recent post).

That quality is important to business (which in this case is the sale of hearing aids) and is difficult to define, should be no surprise to anyone. So, how is quality defined? One method that might be suggested is to define quality as designed to meet ISO 9000. ISO 9000 defines quality as the degree to which a commodity meets the requirements of the customer at the start of its life.3

At face value, this might appear to be a good starting point. However, using an ISO 9001 (updated) quality management system cannot provide quality and reliability.  It is for this reason that ISO 9001 actually has such a poor reputation. It tells only what is required to build a quality management system.  It does not tell how to design and create quality products and services.  Therefore, what follows is a good definition of quality:

Quality is about meeting the needs and expectations of consumers.1  It is an experience of the customer, with quality product perception coming from the design specifications and the manufacture standards achieved.2

Hearing aid quality should not be defined by its price, the number of user controls, the size, shape, electroacoustical performance, physical properties, or other hearing aid features or programming software.

What Customers Want

Customers want quality that is appropriate to the price they are prepared to pay and the level of competition in the market for a similar product.  Key aspects of quality for the customer include1:

  • Good design – looks and style
  • Good functionality – it does the job well
  • Reliable – acceptable level of breakdowns or failure
  • Consistency
  • Durable – lasts as long as it should
  • Good after-sales service
  • Value for money

The late American Management guru Peter Drucker described quality in referring to contemporary principles in healthcare as follows:

“Quality in a product or service is not what the supplier puts in. It is what the customer gets out and is willing to pay for. A product is not quality because it is hard to make and costs a lot of money, as manufacturers typically believe. This is incompetence.    Customers pay only for what is of use to them and gives them value. Nothing else constitutes quality.”3

“Value for money” is especially important, because in most markets there is room for products of different overall levels of quality, and the customer must be satisfied that the price fairly reflects the quality.

Some products are identified as “basic,” having none of the extra features and benefits of more expensive alternatives.  As an example, women’s clothing can be purchased from Target or from Chico’s.  Even though that from Target might be considered “low quality” in terms of style or features, these products still give good value for the money for their overall level of quality for the population served.  Would it be fair to demand that Target have the same quality (and related price) as Chico’s?  This seems to be the argument presented by some who suggest that low-cost hearing aids are an inferior quality compared to premium-priced hearing aids.  Really?

In reality, for OTC hearing aids to be acceptable, they fundamentally require a good design so that the product can be produced efficiently, reliably, and at the lowest possible cost.  To succeed in the marketplace, OTC hearing aids must be produced to deliver expectations customers will accept.  This is what they look for to decide if the product is of sufficient quality or not.  Some expectations are higher than others, and vice versa.  

Because customers judge quality through their perceptions, this makes measuring customer satisfaction with quality difficult.  Yet, quality is delivered when a minimum requirement of a specified performance standard is achieved, not when a maximum is achieved.  What this means is that hearing aid quality might best be described based on the expectations acceptable to consumers related to the “value for the money spent.”

Snoopy and Hearing Aid Quality

Analogies often help in understanding issues. 

Two people want to go fishing together, but don’t know if they will like fishing or not.  The options are to purchase a $500 Shimano bait-casting rod and reel, or a Snoopy $10 rod and reel. Both can catch fish, but there are definitely differences between the two. The Shamino has a higher gear ratio, can hold more line, has extra buttons, level winding, a better drag, etc.  The Snoopy rod and reel is intended to cast and reel in fish (and, I might mention, without the rat’s-nest line backlash that often results from a poor cast with the more expensive Shimano – personal experience). 

One person purchases the Snoopy rod and reel and he catches two, 1-lb largemouth bass. He’s happy.  The product worked to his satisfaction and he uses it again and again until it no longer meets his expectations, at which time he may decide to upgrade his equipment.  However, it is doubtful if the next jump will be to the $500 unit.  If he never fishes again, or fishes seldom, the Snoopy functions to his satisfaction – the quality of the product meets his expectations.

The other person purchases the Shamino rod and reel.  He also catches 2, 1-lb largemouth bass, and is somewhat satisfied, most likely expecting that such a fine product should catch more fish than his partner’s Snoopy rig.  After all, he paid a lot more for it.  And, being a new fisherman with a rod and reel used mostly by accomplished fisherman, he spent much of his time untangling his line (again, personal experience).  Additionally, he is somewhat chagrined because his expensive equipment and the Snoopy outfit caught the same amount and size fish.

In this analogy, the “low quality” product in terms of style and features provided good monetary value for the overall level of quality.  And, along these lines, it is known that many PSAPs provide the same acceptable performance as do some premium-priced hearing aids.

More on this in a following post.


  1. Riley, J. (2009).  Q&A – Define what is meant by quality.  Explore Business, tutor2u. https://www.tutor2u.net/business/blog/qa-define-what-is-meant-by-quality.
  2. Sondalini, M. Lifetime Reliability Solutions / World Class Asset Reliability.  http://www.lifetime-reliability.com/cms/free-articles/work-quality-assurance/what-is-quality/.
  3. The Quotations Page. Classic Quotes.  Peter Drucker on Quality.  http://www.quotationspage.com/quote/4773.html

About Wayne Staab

Dr. Wayne Staab is an internationally recognized authority on hearing aids. As President of Dr. Wayne J. Staab and Associates, he is engaged in consulting, research, development, manufacturing, education, and marketing projects related to hearing. Interests away from business include fishing, hunting, hiking, mountain biking, golf, travel, tennis, softball, lecturing, sporting clays, 4-wheeling, archery, swimming, guitar, computers, and photography. Among other pursuits.

1 Comment

  1. Excellent points, Wayne. I think there is some confusion over the word “quality”. Quality in hearing care is how it fitted, programmed, and verified. The hardware quality is a given or it should not be on the market. For years we’ve driven home in our CE instructions that the best built hearing aid that is absent a competent and caring professional is no more valuable to the end user than the lowest quality hearing aid. There seems to be this terribly misinformed belief among proponents of OTC that somehow assuring quality of hardware makes things all better. But those of us who’ve been in the front line trenches know that it is knowledge and skill that trumps every other consideration. OTCs, no matter how high of quality, are setting up the hearing impaired user for a fall, else why license regs and rules, FDA & FTC consumer safety nets, or professional education at all?

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