Date of Award

August 2020

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Communication Sciences and Disorders


Karen A. Doherty


Over-the-Counter Hearing Aids

Subject Categories

Social and Behavioral Sciences


Purpose: The Over-The-Counter (OTC) Hearing Aid Act was introduced in an effort to make hearing aids more accessible and affordable. Implementation of this law will go into effect in 2020. It is assumed that the average consumer will be able to self-navigate an OTC hearing aid fitting. In the OTC hearing aid model consumers are expected to self-diagnose, self-treat, and self manage their hearing loss. The purpose of the present study was to assess how well the average consumer can perform each step in the OTC hearing aid model, and identify factors related to self-identification of candidacy, device selection, and self-fitting of an OTC hearing aid.

Method: Participants included 52 adults who were 40 years of age and older, self-reported having trouble hearing and were interested in trying an OTC hearing aid. They had to have owned a smartphone and had no prior hearing aid experience. Data was collected over two tests sessions. During the first session all participants were asked to report their degree of hearing loss, identify if they thought they were at risk for having ear disease, and completed questionnaires related to demographics, health literacy, hearing aid self-efficacy, health locus of control, and technology commitment and usage. Also, participants completed three cognitive tasks and were given a hearing test and administered three cognitive measures: the Reading-SPAN, Digit Symbol Substitution Task, and the Simon task. During the second test session participants were asked to browse three different OTC hearing aids online and select the device they preferred. They were asked to complete a questionnaire regarding potential reasons for why they selected a particular device. The OTC hearing aid they selected was given in its original packaging, and participants were asked to set the device up without any assistance. The Practical Hearing Aid Skills Test- Revised (PHAST-R) along with three questions related to Bluetooth connectivity was used to evaluate the participants’ hearing aid handling skills. Real-ear verification was performed to assess how closely the participant’s settings were to NAL-NL2 prescriptive targets. Last, participants completed the Consumer Ear Disease Risk Assessment (CEDRA) to determine if participants correctly self-identified the risk for ear-disease.

Results: Only 38% of participants were able to correctly classify their hearing status in both ears, with pure tone average being a significant predictor of correct hearing status classification. A majority of the participants who misclassified their hearing status had normal hearing, but self-reported they had a hearing loss. Eighty-eight percent of the participants who were identified for being at risk for ear disease misclassified their risk for ear disease. Years of education was inversely related to correctly self-identifying risk for ear disease. Sixty percent of the participants who were flagged by the CEDRA and 30% of normal-hearing participants indicated that they would purchase an OTC hearing aid at the end of the study. Participants’ scores ranged from 45-100% on the PHAST-R and Bluetooth connectivity assessment. The type of the manufacturer’s instructional material was significantly associated with participants’ hearing aid and Bluetooth connectivity skills. For the normal-hearing participants all of the OTC devices attenuated speech, and none of the devices met NAL-NL2 targets in the high frequencies for the hearing-impaired participants. Income status and technology commitment was not predictive of OTC hearing aid device selection and all participants ranked ‘easy to read descriptions’ and ‘website appearance’ as the main factors that influenced their decision to select a device.

Conclusions: Most participants were unable to successfully navigate all of the steps in the OTC hearing aid model. Some of the participants who had normal hearing but self-reported a hearing loss and the participants who were at risk for ear disease said they would purchase an OTC hearing aid as a treatment option. Unfortunately, both groups are not the intended user of an OTC hearing aid. Manufacturer instructional material can impact set up and programming of an OTC device. However, users may still run into fitting and programming challenges that will require the assistance of a hearing health care professional.


Open Access