You May Have Signs of Hearing Loss and Not Know It. Here’s How OTC Hearing Aids Can Help.

Updated February 9, 2023

Rose Maura Lorre

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After years of delays, hearing aids are now available over the counter—and with them, the opportunity to more broadly and easily address one of the most undertreated health problems among American adults. Wirecutter senior staff writer Lauren Dragan, who spent two-plus years (in collaboration with the Hearing Loss Association of America) researching and testing for the OTC hearing aids guide we published in August, is confident that the devices we recommend in that guide could offer substantial hearing help to millions of people who might significantly benefit from the technology.

The trickier part may be getting all those people to realize that hearing loss is happening to them. We can help.

No single over-the-counter hearing device is perfect for everyone, so we offer different recommendations for different priorities and budgets.

The evidence pointing to widespread hearing loss among the 21-and-up crowd is eye-popping. The Centers for Disease Control and Prevention says that hearing loss from all causes is "the third most common chronic physical condition in the United States and is twice as prevalent as diabetes or cancer," while noise-induced hearing loss is experienced by roughly 24% of all US adults, including one in five 20- to 29-year-olds. Overall, the National Institutes of Health has found that "approximately 15% of American adults (37.5 million) aged 18 and over report some trouble hearing" and "about 28.8 million U.S. adults could benefit from using hearing aids," even if their particular concerns fall far short of severe or total hearing loss.

Perhaps most shocking: Among those adults who self-reported having good or excellent hearing in a 2016 National Academies of Sciences study, nearly one in four of them actually exhibited measurable hearing loss—a sign of how adaptive the brain is to the gradual hearing loss that almost everyone experiences as they age, and one of the reasons younger adults may assume that hearing loss isn't affecting them.

"Standard hearing difficulties progress so gradually that your brain just says, ‘Okay, this is my new normal,’ rather than ringing any alarms, the way it would if you woke up one morning and suddenly you could barely hear at all," Angela Shoup, PhD, past president of the American Academy of Audiology, said in a phone interview.

To increase hearing aid access and usage, in 2017 the US government tasked the Food and Drug Administration with establishing rules and guidelines for a new class of hearing aids that could be purchased and adjusted by adults without prescriptions or in-person doctor visits. (For children and for adults with more severe hearing loss, a prescription hearing aid is still considered necessary.) The FDA finally unveiled its rulings in August, paving the way for OTC hearing aids to debut in mid-October in stores such as Best Buy, CVS, and Walmart as a way to "address perceived mild to moderate hearing loss in people aged 18 or older." (Our OTC hearing aid picks for those who are new to hearing aids, the Jabra Enhance Select 100 and Jabra Enhance Select 200, are available via the Jabra Enhance website, while our pick for those who dislike behind-the-ear devices, the Eargo 6, is available for purchase via the Eargo website or at Amazon and Best Buy.)

These hearing aids offer multiple sound modes, Bluetooth streaming capabilities, and an intuitive app.

*At the time of publishing, the price was $1,295.

These hearing aids offer multiple sound modes, Bluetooth streaming capabilities, and an intuitive app. The Pro version adds the ability to transmit your voice when you take phone calls.

*At the time of publishing, the price was $1,695.

These tiny hearing aids sit fully inside the ears, so they’re nearly invisible and don't interfere with glasses. However, they don't stream calls or music.

*At the time of publishing, the price was $2,950.

The FDA's use of the word "perceived" puts a lot of responsibility in the hands of the buyer. "To be successful with OTC devices, you first have to be able to self-identify mild to moderate hearing loss," Angela Shoup told us, "but it's very difficult for individuals to recognize they have hearing loss until they’re experiencing significant difficulty." As for what "mild to moderate hearing loss" encompasses, Lauren Dragan describes it as "when you can function in the world without some kind of hearing assistance, but hearing loss is occasionally interfering with your everyday interactions."

"One of the biggest things that we hear with adult patients is, ‘Oh, I can hear, I just can't understand’—and almost always, that's the kind of mild to moderate, high-frequency hearing loss that these new hearing aids are intended to address," Lisa Vaughan, AuD, a past president of the American Academy of Audiology and now the audiology program manager at Cook Children's Medical Center, said in a phone interview.

The problem derives from a physiological aspect of aging that, depending on factors like genetic predisposition or environmental noise exposure, can begin as early as young adulthood: The small hairs in the cochlea (inner ear) that interpret high-frequency sounds—in speech, those are usually consonants that help a person distinguish similar-sounding words from one another, like "boat" versus "tote"—tend to die off first as the person gets older. "Those hairs are out there toward the edge of the cochlea," Vaughan explained. "They experience the most damage and the greatest reduction of oxygen over time, decreasing their ability to capture certain sounds and present them at a loud-enough level for the brain to process."

Shoup said that OTC hearing aids "are expected to be best at boosting loudness for specific pitches as needed by the user, so that your overall hearing experience is made clearer and sharper, rather than just across-the-board louder."

In Vaughan's experience, "I don't hear well when there's background noise" is the second most common complaint among those experiencing mild to moderate hearing loss. In addition to being higher in frequency, consonants are usually softer in volume and shorter in duration than vowel sounds, which means they tend to "get masked easily and quickly by all of that background noise," she said. (Background noise, such as voices in a crowd or the hum of air conditioning, often includes prominent mid- and lower frequencies, Lauren notes.)

If you feel like you’re constantly asking the kids in your life to repeat themselves—and you’ve presumed it's because their mouths are usually several feet below your ears—high-frequency hearing loss could be the real culprit. "When people have hearing loss, it's usually easiest to understand someone who has a low-pitched voice," Lauren says, "because you can pick up more of the context of what they’re saying even if you normally miss out on higher-frequency parts of speech."

When it comes to hearing loss, your devices often tell on you: You’re turning on subtitles even though you understand the language being spoken. People are remarking that your TV is turned up way too high. You’re ignoring your smartphone's warning that you’ve been listening to music or a podcast at a concerningly loud level for too long. You feel like your headphones just don't get loud enough.

As Lauren notes, such early indicators can help a person self-diagnose any potential hearing problems. "A lot of smartphones have health apps that track your average audio exposure," she says. "Find out if the average level on your headphones last year was quieter than it is this year. That's a pretty good indication that you might need to further investigate."

Repeated exposure to noise at rock-concert levels can damage hearing, obviously, but as one 1990s study pointed out, even the dulcet tones of a single string instrument can lead to hearing loss. Violinists and violists who performed with the Chicago Symphony Orchestra were found to have poorer hearing in the left ear—since they played their instruments tucked under the left side of the chin—than the right ear. Cellists, piano players, and other instrumentalists from the same orchestra whose instruments were not played directly under the ears did not exhibit the same hearing loss.

People in a remarkably wide variety of industries tend to experience higher-than-normal rates of hearing loss. Despite the rural environs, farming has become a hazardous occupation for hearing health, due in large part to tractors and other machinery. The same is true for forestry and commercial fishing. Hearing loss and tinnitus (ringing in the ears) are the two most common reasons for VA disability compensation claims among veterans.

Lauren adds that people in any sort of guest-services job—including bartenders, bouncers, servers, and fitness instructors—are likely to be in a too-loud environment for long stretches of time.

"One thing we know about hearing loss is that it's similar to sunburns," Lauren says. "Some people are more predisposed to it than others."

There's substantial evidence indicating that you can be genetically predisposed to developing hearing loss later in life. But similarly, Shoup told us, you could be genetically predisposed to other health conditions that tend to mess with inner-ear functionality, such as cardiovascular disease or diabetes. "The ear is a small sensory organ that has a blood supply," she explained. "Anything that could potentially impact your blood flow or general organ health can negatively impact your inner ear's sensory cells."

"If you were to look at the possible risks and side effects of common medications, many have hearing loss as a potential risk factor," Shoup said. And again, you could also be genetically predisposed to that side effect having a stronger-than-normal effect on you. "They’ve found genetic markers that make you more likely to develop hearing loss if treated with certain drug classes," she added, "such as sensitivity to pharmaceutical agents that are used to treat infections." Chemotherapy is also commonly known to affect hearing.

Good data on noise pollution is surprisingly hard to come by, but still it seems plain that this is one of the noisiest times in history. In 2013, one group of researchers estimated that 104 million individuals in the US were "at risk of noise-induced hearing loss" due to sustained exposure to high noise levels—and as far back as 1981, the EPA estimated that "nearly 100 million people in the United States (about 50% of the population) had annual exposures to traffic noise that were high enough to be harmful to health."

The next step is to get a hearing test to confirm. With the new class of OTC hearing aids comes an expanded array of options for assessing your hearing. The makers of our top-pick OTC hearing aids—the Jabra Enhance Select 100, Jabra Enhance Select 200, and Eargo 6—offer online diagnostic tests. (Here are Jabra Enhance's test and Eargo's screener.) Best Buy, which carries Eargo devices, recently debuted a new online hearing-assessment tool, while in an article published earlier this year, The New York Times recommended an online hearing test published by the Associated Press. However, as Lauren notes in our OTC hearing aids guide, you can also get checked out by a hearing professional, even if you don't purchase prescription devices: "A hearing test at an audiology office is the gold standard, but you can also ask your doctor for a hearing test during your annual physical."

Whichever path you choose to get your hearing tested, the most important part is to take action if necessary. "There can be a lot of shame and stigma wrapped up in hearing loss and hearing aids, which people still associate with harmful negative stereotypes surrounding aging. But people with hearing loss are not defined by age group, nor does hearing loss mean that a person is any less vibrant," Lauren says. "Ideally, OTC hearing aids will push hearing loss into the realm of how people deal with any other medical condition or specialized need. My hope is that, as this OTC technology grows, hearing aids just become another accessory."

If you believe that you’re a candidate for an OTC hearing aid, Lauren stresses that the try-and-buy process may involve some trial and error. That doesn't mean hearing aids aren't for you—just that it may take a while to find the best pair and acclimate to wearing it. Here's what she suggests:

This article was edited by Adrienne Maxwell and Annemarie Conte.

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