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Thanks to the new over-the-counter (OTC) hearing aid law, hearing aids have never been easier to purchase in the United States. Consumers now have easy access to self-fitting hearing aids—no medical appointment necessary—at major retailers like Best Buy, Walmart, and Amazon.
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With this change arises a new concern regarding consumer safety. In the past, hearing care providers have been the main “watch-dogs” for evaluating products. The new landscape however, leaves consumers on their own to vet hearing aids and navigate the claims made by sellers. For example, here are two claims from direct-to-consumer (DTC) sellers:
Eargo 6 marketing claimSound Adjust identifies the background noise and automatically reduces it, allowing speech to come through more clearly.
EarCentric marketing claimAdvanced noise cancellation provides effortless hearing. No longer will you need to ask them to raise their voice. Every conversation will be clear as day!
Marketing claims like these can be found across the industry, sometimes from reputable companies (and sometimes otherwise), making it very hard for consumers to know who to believe. Pricing also adds to the confusion as there can be thousands of dollars difference between devices. How can hearing aids that vary greatly in price have the similar claims?
To help answer this question, we took a look at four hearing aids available through the popular online retailer Amazon. At the time of this review, the products we tested were the top 4 Amazon Best Sellers in the Hearing Aid category. All devices were tested in the HearAdvisor™ lab and compared to an average prescription hearing aid. Continue reading to learn more and hear the differences for yourself in our video review.
We looked at Amazon’s Best Selling hearing products under $200 and selected the top devices for testing. Each product went through objective testing at the HearAdvisor lab, where industry standards and predictive models are used to estimate audio performance. We also conducted hands-on evaluations to assess ease of use, comfort, Bluetooth capabilities, and more.
After testing, we ranked the products using our HearingTracker score, which considers both lab and hands-on testing. From there, we selected the top options to highlight different needs like best overall value, discreet style, and easiest product to use.
We tested the Audien Hearing Atom, EarCentric EasyCharge Hearing Aid, Autiphon U0 Series, and the HSKLOCK Premium Digital Hearing Aid. All of these devices claimed to either be actual hearing aids and or to improve communication ability. They were also all listed as best sellers within Amazon’s “Hearing Aid” category. It should be noted that HearingTracker has not verified the FDA registration of any of these devices.
We also tested one of the latest generation receiver-in-canal (RIC) prescription hearing aids from a major manufacturer. Comparisons among these devices can be seen further below.
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Audien Atom is a rechargeable in-the-canal (ITC) style device. They can take up to 4 hours to charge at which point they will provide up to 20 hours of battery life. They are easy to use as there is no associated app or complicated setup. Each earpiece has an on/off switch and small volume dial which can be adjusted using either the included tool or any other small flat-head screwdriver. These devices are not wireless, so any volume adjustments need to be made on each earpiece.
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Included with the Atom devices, you will find user manuals, a charging base, a USB-C cable and wall plug, extra ear domes, wax guards, and cleaning supplies. A cloth carrying case is also included for storage.
EarCentric look more similar to traditional hearing aids and are a behind-the-ear (BTE) style device. However, they are of a slightly older design using slim tubes to carry sound amplified within the body of the device down into your ears. They are also rechargeable which can take up to 3 hours. EarCentric magnetically lock in the base and, once ready, have a battery life of up to 22 hours. These devices have both a multi-function button and volume switch. A long press of the button will power the devices on or off while a short press will switch between either an “Everyday” or “Speech-in-Noise” program.
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In the box, you will find user manuals, a charging base, USB cable and wall plug, cleaning supplies, and a hard shell carrying case. Various slim tube lengths and ear domes are also provided which can help you find a good fit.
Auriphon U0 Hearing Aids are similar to Audien Atom in style and size. They are again a rechargeable ITC style device having only a rotary volume dial for adjustments. No other program or on/off switching is available. As with all other devices discussed so far, Autiphon magnetically lock in the base and will take roughly 2 hours to charge. Autiphon claims to have an impressive 50 hour battery life once ready.
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Autiphon includes similar offerings to other devices such as a user guide, USB cable (though you will need your own wall plug), extra domes, wax guards, and a cleaning brush. The included case is uniquely both a carrying case and a portable charger.
Last on our list were the HSKLock Hearing Aids. They are much larger than any other devices we tested and arguably more antiquated based on both the size and lack of rechargeability. The main body of HSKLock Hearing Aids sits above and behind the ear while the earpiece, which houses the speaker, fits down into your ear canal. They are powered by traditional hearing aid batteries which are inserted via a swiveling battery door on the bottom of each device. Both an on/off switch and rotary volume dial can be found on these devices but there is no program switching.
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Our collection of Amazon hearing aids were subjected to a series of audio tests in the lab. I also spent some time handling and using the devices to get a more subjective feel for how usability, comfort, and sound quality.
Most of the Amazon products fit similar to other earbuds or hearing aid style devices. They were moderately comfortable and had good retention within my ears. This was especially true of EarCentric due to the overall style, weight, and assortment of slim tube sizes. The Autiphon U0 Series devices plugged my ear to a greater degree due to their coupling and ITC design. This offered the benefit of a fuller overall sound quality—though at the expense of occlusion and hearing my own voice more while speaking (see Figure 3 below). The greatest exception with overall comfort and use was the HSKLock Hearing Aid. Due to the increased physical size, it was less comfortable behind my ear and I had a greater perception of its presence.
From a general use standpoint, a major drawback to these devices was the limited functionality. Today's technology standards are rather high and we expect features such as remote control and wireless streaming at entry-level costs. Apple AirPods Pro are a great example of this. None of these Amazon devices offered wireless connectivity and, excluding EarCentric Hearing Aids, adjustments were limited to volume changes. This restriction was surprising as wireless functionality is becoming more normalized in the OTC market.
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All devices were tested in the HearAdvisor™ lab. Watch this video for a quick overview and read our whitepaper for more detailed information. Ultimately, we attempted to program all of the Amazon devices similarly based on a standard N3 mild-to-moderate sloping hearing loss configuration1. This meant adjusting all available settings to best match the NAL-NL2 1000 Hz 65 dB input target for that N3 hearing loss. If you are not familiar with targets, NAL-NL2 refers to a commonly used amplification prescription algorithm which outputs how much gain a hearing aid should provide given an input hearing loss. 1000 Hz was chosen as the Amazon devices did not provide much gain above this range. Lastly, the N3 hearing loss configuration was selected as it is a close approximation of the middle of the aided population.
After testing the Amazon products, it was clear that their ability to reproduce sound varied greatly and their output was generally limited to a relatively narrow frequency range. One of the most notable findings was that these products struggled to provide adequate amplification at and above roughly 2000 Hz. This frequency range is commonly regarded as the most important band for speech intelligibility3. This can be seen more clearly in Figure 1 below. The Real-Ear Insertion Gain (REIG) for a conversational input (65 dB SPL) across all Amazon products is plotted against the desired NAL-NL2 targets for our N3 hearing loss (seen as a dashed line). In ideal settings where speech understanding is optimized via clinical best-practices, the colored gain lines for each device would follow the dashed line. This was not however what we found even after adjusting all available parameters.
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We also tested a latest generation receiver-in-canal (RIC) prescription device from one of the major hearing aid manufacturers. The same REIG plots can be seen in Figure 2 below. The device’s output after an initial fit (without advanced tuning or probe tube measurements) is shown by the brighter orange line. The darker orange line indicates the “Tuned” output after settings were adjusted to best match targets. In both cases, the prescription device can be seen following the dashed line and providing more gain at and above that 2000 Hz region.
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Fit and overall comfort was discussed above where it was mentioned that the Autiphon device provided a more “plugged” feel. This can be seen objectively in Figure 3 with the occluded insertion gain. For those not familiar with occluded insertion gain, it shows the difference in ear drum levels between the open ear and the ear with a device inserted and powered off. A non-occluding device, or one that does not obstruct your ear canal opening, will have an occluded insertion gain closer to a 0dB horizontal line. A hearing product that plugs your ear, like a hearing protection device, will reduce sound levels in your ear canal more.
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Occluding hearing devices can be less desirable as they cause the user's voice to sound unnatural2. This happens because the body-transmitted own-voice sounds that would otherwise leave the ear canal are trapped inside it This was certainly my subjective experience with Autiphon as my voice took on a “boomy” sound quality. With that said, occlusion can be necessary in order to provide sufficient amplification and reduce chances of feedback. A hearing care provider is generally responsible for balancing this tradeoff and matching hearing needs with appropriate levels of occlusion.
Increased occlusion also has the potential benefit of providing a fuller sound quality because less sound leaks out of the ear. This can be highly desirable for specific uses such as music listening. Several comments on the associated Youtube video are a testament to this, whereby people subjectively prefer the sound quality of the Autiphon device as it is “fuller”. This tradeoff can be seen in Figure 1 where the blue Autiphon line is lower indicating more occlusion. It can also be seen in Figure 3 having greater output in the 600-1000 Hz region. See if you can hear that difference in the sound samples below.
Here are sound samples so you can hear how these devices performed with your own ears. It is worth noting that what sounds good from a quality standpoint may not be what is needed to improve speech clarity. Individuals who have already gone through the hearing aid fitting process may have experienced this, whereby amplifying higher frequencies initially sounds “tinny” or “metallic”. Over time however, the brain acclimatizes to hearing in a more natural balanced manner. Be sure to put on a good set of earbuds or over-ear headphones before pressing play.
Are Amazon or Prescription hearing aids better for you? While this may seem like a loaded question, everyone's needs and budget are different. We assessed this using a scientific algorithm that models the auditory system of people with hearing loss and has been shown to predict intelligibility in a wide range of environments4 . The model is sensitive to both increases in audibility (e.g., from gain) and increases in signal-to-noise ratio (e.g., from directional processing).
On this measure, the prescription device did however objectively substantially outperform the Amazon products in nearly every measure. This was also found to be the case when comparing the Amazon products to an average of this measure for prescription devices. Figure 4 shows the difference between our Amazon devices and the average “tuned” scores across 6 major-brand hearing aids (individual ratings also provided in Table 1). Again, tuned indicates that device settings were adjusted to best match targets.
While a few of the Amazon products offered some benefits, it does not approach the improvements seen from prescription devices. The difference often amounts to less than half of the expected improvement in speech intelligibility. EarCentric EasyCharge Hearing Aids were even predicted to make intelligibility worse than being unaided in both quiet and noisy situations. It is clear that, for an N3 hearing loss, the prescription devices will deliver far more speech intelligibility benefit than this group of Amazon top selling devices.
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Device | Benefit in Quiet | Benefit in Noise | Own Voice Not Boomy |
|---|---|---|---|
Audien Hearing Atom | 1.5 | 0.4 | 2.1 |
EarCentric EasyCharge | 0 | 0 | 1.9 |
Autiphon U0 Series | 1.9 | 1.1 | 0 |
HSKLock | 2.0 | 0.1 | 2.8 |
Rx Tuned Average | 4.3 | 2.4 | 2.5 |
It is worth noting that all devices struggled more to improve speech clarity in the presence of background noise. Remote microphones and various communication strategies can help in this area. Sometimes it just takes calling the restaurant ahead of time to reserve the quiet table.
To address the elephant in the room—Amazon products are much cheaper, they do not require you to visit a doctor's office, and some may provide marginal improvements. The cost to benefit ratio may therefore seem enticing and you will ultimately have to decide whether that is a worthwhile gamble. With that said, other wireless earbuds and OTC hearing aids offer better performance than this set, on-ear hearing tests, app control, and wireless streaming at a similar price point. This should become more prevalent as companies enter the OTC market. Regardless, it is always beneficial to have unbiased information about a product before investing in it. Your ears deserve it.
Steve Taddei, Au.D., vereint seinen Abschluss in Audiotechnik vom Columbia College Chicago mit seinem Doktorat in Audiologie der Northern Illinois University, um Hörtechnologien voranzutreiben und das Bewusstsein für Hörverlust als Laborleiter bei HearAdvisor zu schärfen. Er trägt auch zu verbraucherfokussierten Bewertungen von Hörgeräten und Ohrstöpseln auf HearingTracker.com bei und inspiriert zukünftige Fachleute durch seine Positionen als Lehrbeauftragter an mehreren Hochschulen, um die nächste Generation zu ermutigen, ihre Leidenschaften zu entdecken und zu verfolgen.
