Blog of 11/10/25

It is a common misconception that to treat hearing loss, one must simply turn the
volume up. If that were true, people who have hearing loss would love OTC hearing
aids. In my 20 years of treating hearing loss, I have never met a person who loves their
OTC hearing aids. Here is why.

First, our inner ear is like a piano. We have different keys to bring sound together
as a whole. Hearing loss does not affect every key the same. It is very possible, and
even common, to have normal hearing in the low frequencies (bass pitches) and a
significant hearing loss in the high frequencies (treble pitches). OTC hearing aids
amplify every pitch equally, which creates upward spread of masking. Upward spread
of masking is when the louder bass tones drown out any amplification in the high
pitches. That is why an OTC hearing aid makes everything louder but not clearer.
“I can hear that people are talking, but I can’t understand what they’re saying,” is
the most common complaint I hear from patients. This is because the most common
type of hearing loss is high pitch hearing loss with normal to near normal low pitch
hearing. This type of hearing loss does not need volume. It needs clarity, something
OTC hearing aids simply cannot provide. Prescription hearing aids allow the hearing
healthcare provider to program the patient’s specific hearing loss prescription into the
hearing device to avoid upward spread of masking and only provide clarity where the
patient’s specific deficit is.

“I can hear perfectly in a quiet room, but I can’t hear when there is background
noise, like a restaurant,” is another common symptom I hear patients report. This is also
a common symptom of high pitch hearing loss. The background noise is a restaurant is
typically concentrated in the low pitches which naturally causes an upward spread of
masking so the patient cannot hear the high pitch consonants that are so important to
speech understanding and clarity. Vowels are in the low pitches, and consonants are
concentrated in the high pitch range. There are 5 vowels and 21 consonants in the
alphabet. If we can only hear vowels, it makes everyone sound like Charlie Brown’s
teacher. An OTC hearing aid just makes Charlie Brown’s teacher louder, and a
prescription hearing aid makes her clearer.

Hearing aid manufacturers have performed years and years of research and
development to develop mathematical algorithms to reduce background noise and draw
out the clarity of speech. In the last couple of years, they have cracked the hearing aid
processing code, and my patients hear amazing in background noise situations. They
are thrilled that the background noise sounds softer than the speech of the person they
are talking to, and I have even seen hearing aid wearers communicating better than
their normal hearing peers! OTC hearing aids have zero mathematical algorithms for
reducing background noise. It is not possible to hear better in noisy situations with an
OTC hearing aid.

Finally, because I have treated a lot of patients who have tried multiple OTC
hearing aids and come into my office to “finally do this right,” I can speak on the
durability of OTC hearing aids. Based on the report of my patients, the average OTC
life ranges from 2 weeks to 2 months before it breaks. The average lifespan of a
prescription hearing aid is 5 years. I have seen so many people waste so much money
on the OTC market unnecessarily when if they would have just “done it right” the first
time, they would have saved a ton of money.

I know in a digital world where we can order something on Amazon and have it
on our doorstep the next day, it is tempting to purchase an over-the-counter hearing aid
online with the hopes that annoying hearing loss will be fixed. However, hearing loss is
a medical condition that needs to be treated with a prescription hearing aid by a
licensed hearing healthcare provider. You wouldn’t purchase a pacemaker online for
your heart condition, would you?