Abstract
Objective
To analyze public perceptions of over‐the‐counter (OTC) hearing aids through sentiment and thematic analysis of online consumer reviews and their changes over time.
Study Design
Sentiment and thematic analysis.
Setting
Online reviews from third‐party and product websites.
Methods
All English online consumer reviews posted between 2016 and 2024 for OTC hearing aids (83 models) were recorded (n = 21,727). Sentiment analysis was performed using Valence Aware Dictionary and Sentiment Reasoner (VADER), a rule‐based sentiment analysis tool incorporating natural language processing. VADER provides scores for each review ranging from −1 (most negative), 0 (neutral), to 1 (most positive). Additional thematic analysis was performed for the top 100 most positive, neutral, and negative reviews (n = 300).
Results
Overall, mean (SD) VADER sentiment score of online reviews was generally positive at 0.587 (0.411). Multivariable regression analysis showed that higher VADER scores were associated with higher‐priced and behind‐the‐ear (BTE) type hearing aids. Although there was a significant increase in a number of reviews after the Food and Drug Administration's new establishment of the OTC hearing aid category in 2022, the mean sentiment scores slightly decreased (β =−.10, [95%CI: −0.12 to −0.09]). Thematic analysis revealed that positive sentiments highlighted the affordability and time‐saving benefits of OTC hearing aids as alternatives to prescription models. Negative sentiments centered on sound quality, challenges with customer service, and inadequate amplification for those with severe hearing loss.
Conclusion
Customers generally viewed OTC hearing aids positively, while mixed experiences were present. When used as indicated for adults with mild to moderate hearing loss, OTC hearing aids may offer a viable alternative to prescription devices, improving accessibility and affordability.
Keywords: OTC hearing aids, over‐the‐counter hearing aids, thematic analysis, VADER analysis
Hearing loss is highly prevalent affecting one‐fourth of adults older than 50 years and two‐thirds older than 70 years. 1 Hearing aids are often the first‐line management option for those with hearing loss. Fitting of conventional prescription hearing aids provides professional consultation and comprehensive orientation. However, there also exist barriers such as time‐intensive assessment and fitting processes, high device costs, and limited hearing care access in underserved areas. 2
The Over‐the‐Counter (OTC) Hearing Aid Act was passed by the US Congress in 2017 to address some of these barriers to conventional hearing care. 3 The law's key provisions included the establishment of a new category of OTC hearing aids, finalized by the US Food and Drug Administration (FDA) in 2022, which can be purchased without a prescription or medical evaluation. These changes aimed to enhance accessibility and affordability of hearing care by creating OTC hearing aids as an option for individuals with perceived hearing loss who may not consult specialists. The expansion of the OTC hearing aid market was expected to ensure safety, foster competition, and drive innovation in higher‐quality hearing solutions. 4 Although not suitable for those with severe hearing loss or children, FDA‐approved OTC hearing aids offer an alternative for adults with perceived mild to moderate hearing loss.
Although public awareness of OTC hearing aids has increased in recent years, their safety and effectiveness remain topics of debate among health professionals. 5 , 6 , 7 Public perception of OTC hearing aids is currently unknown. Gaining a deeper understanding of consumer experiences and sentiments will provide valuable insights into their benefits, risks, and impact on overall hearing care. Since OTC hearing aids are available directly to consumers without formal feedback to health care professionals, we propose analyzing online consumer reviews to capture comprehensive public perspectives on OTC hearing aids.
Prior studies have employed thematic analysis to examine public perceptions of conventional prescription hearing aids. 8 However, no studies to date have conducted sentiment and thematic analysis to assess public perceptions of OTC hearing aids. The Valence Aware Dictionary and Sentiment Reasoner (VADER) framework is a rule‐based model that combines sentiment lexicon with heuristics to assess the polarity and intensity of sentiments within textual data, making it effective in evaluating large volumes of reviews. This study aims to utilize the VADER framework to analyze public perceptions of OTC hearing aids and how these perceptions have evolved over time.
Methods
This is a qualitative analysis of English‐language user online reviews (n = 21,727) posted between January 2016 and February 2024 for OTC hearing aids. Reviews were gathered from third‐party (Amazon, Best Buy, BTA mall, CVS, Crutchfield, FSA Store, Hearing Tracker, QVC, Sam's Club, Target, and Walmart) and product websites. The selection of platforms was determined through team discussions involving physicians, audiologists, and researchers, who completed searches across various engines. According to the policy‐defining activities that constitute research at the University of Southern California, this work meets the criteria for operational improvement activities exempt from Institutional Review Board review.
Dates, star ratings, and contents of the reviews were recorded. Sentiment analysis was performed using VADER, a Python package part of the Natural Language Toolkit. VADER calculates a compound sentiment score by scanning for words in its dictionary that humans have previously rated for positivity and negativity. 9 , 10 In conjunction with equations that consider punctuation, capitalization, and word modulator, a sentiment score between −1 and +1 is calculated, with 1 being the most positive sentiment and −1 being the most negative sentiment. 9 Per convention outlined in VADER's documentation, positive reviews were defined as compound sentiment scores >0.05, neutral reviews with scores <0.05 and >−0.05, and negative reviews with scores <−0.05. To assess miscategorization, 4‐ and 5‐star reviews with negative VADER scores were additionally reviewed. In total, 715 reviews primarily mentioning experiences with prescription hearing aids were excluded for “wrong subject matter” as the reviews directed their negative feedback toward a subject separate from the OTC hearing aid. Similar exclusion criteria were implemented toward reviews with 1 or 2 stars with positive VADER scores. VADER scores of 0 were reviewed because many reviews were written in Spanish, with spelling mistakes, poor grammar, or figures of speech, excluding another 1268 reviews.
Multivariable regression was used to examine associations between VADER scores and cost, type of hearing aid, date of purchase (before or after October 17, 2022), and location of review (third‐party website or brand website). Regression analyses were conducted using STATA (version 18.0, StataCorp. LLC).
For the thematic analysis, two reviewers independently analyzed 100 randomly selected reviews to extract themes and subthemes. Final themes and subthemes were decided after iterative team discussions. Based on VADER scores, the 100 reviews closest to 1, categorized as 100 most positive, the 100 reviews closest to 0, categorized as 100 most neutral, and the 100 reviews closest to −1, categorized as 100 most negative, were chosen for thematic analysis. Three independent raters categorized 300 reviews into the themes and subthemes based on grounded theory. Reviews were assigned themes that at least two out of three independent raters agreed on. Multiple themes were allowed for each review.
Results
Online reviews were collected for 22 OTC hearing aid brands and 83 models. In total, 4 models from 2 brands of OTC hearing aids were posted prior to 2017 (OTC Hearing Aid Act), 22 models from 9 brands were posted between 2017 and 2022, and 57 models from 11 brands were posted after 2022 (FDA's establishment of OTC hearing aid regulation). In total, 22.9% of the reviews were from third‐party sites and 77.1% were from the products' official websites.
Sentiment Analysis and Star Ratings
Sentiment analysis resulted in a mean (SD) sentiment score of 0.587 (0.411), with scores ranging from −0.989 (most negative review) to 1.000 (most positive review). Distribution of sentiment scores is shown in Figure 1A. Star ratings were available in all reviews, and its distribution is shown in Figure 1B. The correlation between sentiment scores and star ratings is shown in Figure 2.
Figure 1.
(A) Distribution based on Valence Aware Dictionary and Sentiment Reasoner (VADER) scores. (B) Distribution based on star ratings.
Figure 2.
Average Valence Aware Dictionary and Sentiment Reasoner (VADER) scores of each star rating.
The number of reviews per month and monthly mean sentiment score from July 2017 to February 2024 are presented in Figures 3A and B, respectively. The number of reviews per month increased around July 2022, shortly before the new FDA‐approved OTC hearing aids became available on the market in October 2022, and peaked in March 2023 with 975 reviews.
Figure 3.
(A) Total reviews per month. (B) Average Valence Aware Dictionary and Sentiment Reasoner (VADER) score by month.
Multivariable regression analysis was conducted to examine the associations of VADER scores with the following variables: cost, type of hearing aid, date of review (before vs after October 17, 2022), and location of review (brand website vs third‐party website) (Table 1). Higher cost was significantly associated with a higher VADER score. Using BTE hearing aids as the reference group, completely‐in‐canal (CIC) hearing aids, earbuds, in‐the‐ear (ITE) hearing aids, and over‐the‐ear (OTE) hearing aids had lower VADER scores (Table 1). Reviews published after October 17, 2022, showed lower VADER scores compared to those published before this date (β = −.10, [95% CI: −0.12 to −0.09]). VADER scores from reviews on third‐party websites were lower compared to reviews made on the brand's website (β = −.03, [95% CI: −0.05 to −0.01]).
Table 1.
Multivariable Linear Regression Analysis Examining Association of Valence Aware Dictionary and Sentiment Reasoner (VADER) Score With Cost, Type of Hearing Aid, Date of Review, and Review Location
| β‐Coefficient | 95% confidence interval | |
|---|---|---|
| Cost (per $100 increase) | .0074 | 0.0063‐0.0085 |
| Type of hearing aid | ||
| Behind the ear (BTE) | Reference | Reference |
| Completely‐in‐canal (CIC) | −.11 | −0.14 to −0.09 |
| Earbuds | −.04 | −0.06 to −0.01 |
| In‐the‐ear (ITE) | −.16 | −0.18 to −0.14 |
| Over‐the‐ear (OTE) | −.13 | –0.15 to −0.11 |
| In‐the‐canal (ITC) | .05 | −0.16 to 0.26 |
| Date of review | ||
| Before October 17, 2022 | Reference | Reference |
| After October 17, 2022 | −.1 | −0.12 to −0.09 |
| Review location | ||
| Brand website | Reference | Reference |
| Third‐party website | −.03 | −0.05 to −0.01 |
Thematic Analysis
Thematic Analysis of the 100 Most Positive Reviews
The top themes that emerged were product features (98%), product enhancement (97%), and user experience (95%) (Table 2). The top subthemes included sound amplification (85%), sound quality (84%), and easy setup (82%).
Table 2.
Themes and Subthemes Used in Thematic Analysis of 100 Most Positive Reviews Based on Valence Aware Dictionary and Sentiment Reasoner (VADER) a
| Themes | Subthemes |
|---|---|
| 100 most positive reviews | |
| Product features (98%) | Noise control (65%) |
| Sound amplification (85%) | |
| Feedback (22%) | |
| Sound quality (84%) | |
| Sound discrimination (50%) | |
| Battery life (60%) | |
| Bluetooth capability (44%) | |
| Connection stability (15%) | |
| Manufacturing defect (0%) | |
| Product enhancement (97%) | Visibility (48%) |
| Appearance (46%) | |
| Fit (61%) | |
| Comfort (76%) | |
| Accessories (60%) | |
| Case (30%) | |
| Maintenance/cleaning (20%) | |
| User experience (95%) | Installation (37%) |
| Customization (72%) | |
| Easy setup (82%) | |
| App connection (67%) | |
| Device setup (47%) | |
| Impact on quality of life (59%) | Relationship improvement/exacerbation (15%) |
| Symptom improvement/exacerbation (68%) | |
| Purchase experience (44%) | Customer service (39%) |
| Return process (7%) | |
| Warranty (5%) | |
| Affordability (58%) | |
| OTC versus prescription hearing aids (56%) | |
Abbreviation: OTC, over‐the‐counter.
If a review was categorized into a subtheme, the theme would also be counted, but a review could be categorized into a theme without being categorized into a subtheme.
Most positive reviews emphasize users' favorite features of OTC hearing aids and describe their experiences after using them. One reviewer brought up sound quality and customizability of OTC hearing aids: “I have a hard time hearing higher frequencies so I can adjust the treble setting to make it easier for me to hear people. Usually, I hear very muffled sounds, but these brought the high end back into my hearing that I have been missing for so many years!” Another reviewer describes the easy setup and comfort of OTC hearing aids: “the only setup to the aids is insertion of the battery. These hearing aids are small… it works extremely well. I never had hearing aids that would stay in my ear, not fall off my ear, and be comfortable all day.”
OTC versus prescription hearing aid theme constituted 56% of the reviews and addressed barriers for prescription hearing aids, notably accessibility and cost. One reviewer recounts their experience in obtaining both prescription and OTC hearing aids: “I went to my local audiologist; she helped me try several custom‐molded [hearing aids]. My audiologist earned her money, but the final bill was expensive… I decided to give [OTC hearing aids] a shot and in short, they don't have the fine‐tuned audio curves that my audiologist created, but they do help, and at a fraction of the price. They're a fantastic option for people who don't have money for traditional hearing aids or are just dipping their feet into the idea.” Some reviews highlighted challenges related to accessibility: “I can use the app to make adjustments! The expensive hearing aids required a hospital audiogram, and a doctor's visit, and a second visit to an audiologist just to make an adjustment. This cost hundreds of dollars whenever I needed it to make an adjustment, and took months to plan.” These reviews highlight that some consumers find OTC hearing aids more convenient and user‐friendly than conventional prescription hearing aids, valuing accessibility and ease of maintenance.
Thematic Analysis of the 100 Most Negative Reviews
The top themes that emerged were product features (70%), purchase experience (52%), and product enhancement (45%) (Table 3). The top subthemes included sound amplification (34%), customer service (33%), and return process (30%).
Table 3.
Themes and Subthemes Used in Thematic Analysis of 100 Most Negative Reviews Based on Valence Aware Dictionary and Sentiment Reasoner (VADER) a
| Themes | Subthemes |
|---|---|
| 100 most negative reviews | |
| Product features (70%) | Noise control (16%) |
| Sound amplification (34%) | |
| |
| Sound quality (27%) | |
| Sound discrimination (12%) | |
| Battery life (17%) | |
| Bluetooth capability (5%) | |
| Connection stability (4%) | |
| Manufacturing defect (10%) | |
| Product enhancement (45%) | Visibility (2%) |
| Appearance (2%) | |
| Fit (25%) | |
| Comfort (27%) | |
| Accessories (10%) | |
| |
| User experience (43%) | Installation (3%) |
| Customization (5%) | |
| Easy setup (15%) | |
| |
| Impact on quality of life (27%) | Relationship improvement/exacerbation (0%) |
| Symptom improvement/exacerbation (16%) | |
| Purchase experience (52%) | Customer service (33%) |
| Return process (30%) | |
| Warranty (2%) | |
| Affordability (8%) | |
| OTC versus prescription hearing aids (8%) | |
Abbreviation: OTC, over‐the‐counter.
If a review was categorized into a subtheme, the theme would also be counted, but a review could be categorized into a theme without being categorized into a subtheme.
Most negative reviews highlight struggles with operating the device and with customer service. A common complaint involves product features: “The frequency adjustment is horrendous—it is a slider between bass and treble, as opposed to a real equalizer function. If your hearing loss varies over the frequency spectrum, this app is useless.” Additionally, 33% of the reviews reported difficulties with customer support: “I purchased the hearing aid with high hopes, but the right aid started to give me problems in less than a week. When I contacted customer support for help, I was met with an extremely rude and unhelpful agent. Save yourself the trouble and look elsewhere for a hearing aid that actually functions and is supported by a company that cares about their customers.” Fit and comfort are also mentioned in 27% of the negative reviews: “They did not fit well, even with the smallest tip. I tried to see if they would fit without a tip—they did not. Very uncomfortable and irritated the inside of my ear.”
OTC versus prescription hearing aids consisted of 8% of the reviews. Some reviewers expressed eagerness, then disappointment toward replacing their prescription hearing aid with OTC hearing aids: “I've worn hearing aids for ten years. I was excited to see that OTC hearing aids are now available. The biggest thing I noticed was that they were not loud enough, even at the highest setting… I wore them to work and could not hear normal conversation, no matter what mode I tried. I was very disappointed they didn't work out. I really wanted them to.”
Thematic Analysis of the 100 Most Neutral Reviews
The top themes that emerged were product features (54%), impact on quality of life (37%), and product enhancement (29%) (Table 4). The top subthemes included sound amplification (22%), symptom improvement/exacerbation (20%), and customer service (19%).
Table 4.
Themes and Subthemes Used in Thematic Analysis of 100 Most Neutral Reviews Based on Valence Aware Dictionary and Sentiment Reasoner (VADER) a
| Themes | Subthemes |
|---|---|
| 100 most neutral reviews | |
| Product features (54%) | Noise control (9%) |
| Sound amplification (22%) | |
| |
| Sound quality (19%) | |
| Sound discrimination (6%) | |
| Battery life (10%) | |
| Bluetooth capability (1%) | |
| Connection stability (3%) | |
| Manufacturing defect (4%) | |
| Product enhancement (29%) | Visibility (2%) |
| Appearance (2%) | |
| Fit (12%) | |
| Comfort (11%) | |
| Accessories (5%) | |
| |
| User experience (21%) | Installation (1%) |
| Customization (5%) | |
| Easy setup (6%) | |
| |
| Device setup (3%) | |
| Impact on quality of life (37%) | Relationship improvement/exacerbation (2%) |
| Symptom improvement/exacerbation (20%) | |
| Purchase experience (26%) | Customer service (19%) |
| Return process (8%) | |
| Warranty (3%) | |
| Affordability (17%) | |
| OTC versus prescription hearing aids (2%) | |
Abbreviation: OTC, over‐the‐counter.
If a review was categorized into a subtheme, the theme would also be counted, but a review could be categorized into a theme without being categorized into a subtheme.
Most reviews focused on product features and their impact on quality of life. Some reviews not only praised its operability but also noted discomfort: “The sound quality was great, being able to listen to music and talk on it was nice but the product physically hurt my ears. If the design changes I will reconsider.” Many reviews in this category mention sufficient product operability, but with a flaw: “These hearing aids work okay especially in a noisy place however, there is a persistent background noise which is very obvious in a quiet environment.” Another review mentions limitations of OTC hearing aids: “not enough volume for my right ear which has more severe hearing loss than my left. I think they would work for someone with mild to moderate hearing loss. Works great in my left ear, but you have to buy two.”
Discussion
This study investigated public perceptions of OTC hearing aids based on online customer reviews from 2017 to 2024 using sentiment and thematic analysis. Although professional consultation needs to be considered to accurately access the type and severity of hearing loss, OTC hearing aids present a potentially more accessible and affordable option for adults with mild to moderate hearing loss. The mean sentiment score was generally positive. Thematic analysis revealed that the most expressed themes included product features (sound amplification and quality), product enhancement (product appearance, fit, and comfort), and user experience (setup and installation). Representative quotes are seen in Table 5.
Table 5.
Representative Quotes From Positive, Neutral, and Negative Reviews Based on Valence Aware Dictionary and Sentiment Reasoner (VADER) Score
| Category | Review quote | VADER |
|---|---|---|
| Impact on quality of life | ||
| Positive | “I found that these did a great job of amplifying softer sounds so I could hear them better and blocking out the louder sounds around me as well this was great in crowded noisy places like a restaurant usually, I have to ask people to repeat themselves, but somehow these things picked out the things I wanted to hear and amplified them over the things I didn't want to hear its truly amazing technology!” | 0.9981 |
| Neutral | “The hearing aids are very satisfying and have helped me with my daily routine the only disappointment is the batteries don't last long and are expensive.” | −0.002 |
| Negative | “I regularly found myself struggling to get a hold of the tiny filament that would enable me to get the device out of my ear I really regret making such an expensive purchase, given how terribly it failed me. The next time I go shopping for a hearing aid, I will do it under the guidance of a professional audiologist.” | −0.9894 |
| User experience | ||
| Positive | “Once you're in, the setup wizard is very user‐friendly with easy‐to‐understand instructions/easy‐to‐follow pictures that guide you through everything from fitment to pairing to sound adjustment including tweaks for volume as well as clarity the sound profile is saved to the aids so you don't have to be near your phone (or connected to it) to leverage the adjustments you've made you can tailor the sound further in the app by mirroring sound levels in both hearing aids or balance levels separately there are also advanced sound controls.” | 0.9991 |
| Neutral | “The connection to the app is very difficult doesn't work much of the time eventually it is doable but very frustrating also reaching help is very often busy and you don't always get a call back.” | −0.010 |
| Negative | “I have an Iphone with the latest IOS installed and every day I place the [OTC hearing aid] into my ears and feel I would like to adjust them regarding settings, I must power off my phone and then restart it in order to make the app recognize my hearing aids! I have complained and was told they are aware of it, but I have no idea when or if they will fix this problem so while the hearing aids themselves seem to be a decent product and buy, I would not recommend them to anyone at this point the frustration of the need to power down and restart your phone every time you feel the need to make an adjustment, via their own app, is a serious strike against one of their most important selling points.” | −0.9913 |
| Purchase experience | ||
| Positive | “The price was over half off with better warranty and trial time. I was so impressed and haven't looked back even after I personalized them and was completely satisfied – [OTC hearing aid company] set up an appointment to check on me and the online Dr tweeked them even better I cannot compliment [OTC hearing aid company]'s customer service, online Dr and the product enough I am just a happy customer.” | 0.9972 |
| Neutral | “One of the units does not amplify well at all poor quality and unable to return through Amazon save your money for a real set of hearing aids, these are garbage.” | −0.004 |
| Negative | “I cannot connect at all or the left ear connects and unable to connect with the right ear. I have spoken to one doctor and different specialists and nobody can fix them. I suggested to [OTC hearing aid company] to at least replace the right ear ‐ the control hearing aid but they won't do it and I am really upset. I know they are having growing pains but give me a break. I had called the specialist line and of course I was on hold for 45 minutes! I then gave up and used their automatic we will hold your name in cue and call you when your place (lottery) in line came up well, my phone rang, an auto attendant was on the line telling me that they were not able to answer my call at this time and to call back the next day ‐ really?!” | −0.9679 |
| Product features | ||
| Positive | “I found the [OTC hearing aid] is reasonably small and discreet, jammed with medical‐grade audio technology, and comfortable for lengthy listening sessions. I wear these to my physical therapy and outdoor activities where I can now hear everything and enjoy music the software. [OTC hearing aid] have rechargeable batteries, and are recharging whenever you place them into their carry case. Includes my favorite ‘memory foam’ tips which are soft, solid foam which you squeeze to place into your ears where they expand for a secure but comfortable fit. Easy bluetooth, we were ready to take the hearing test which customizes the ear buds for each end user it begins with noise level, provides test tones, and you receive a complete hearing assessment which creates compensating adjustments. The ear id app tab it allows me to use these earbuds with those enhancements turned on or off as expected.” | 0.9997 |
| Neutral | “I have had a hard time finding the right rubber seal for the ear canal it has a high‐pitched squeal when it breaks the seal it has helped with me not having to turn the tv up from down to I don't talk as loud in conversation as I hear a lot better they do take getting used to mine do not fit as far into my ear like the pictures but it could just be my ears.” | −0.001 |
| Negative | “Too loud and distorted. I am having problems keeping them in my ears. I've used other hearing aids, but have to say these are the worst they are uncomfortable and are hard to get set in my ears even on the lowest setting the sounds are way too loud and very distorted even on the lowest setting, I could catch some of the words, but not much better than if I don't have any hearing aids in at all while saying hello to my friends in the foyer, it was like being surrounded by barking dogs so I took one out, that was better I'm disappointed, I guess I'll have to return them.” | −0.972 |
| Product enhancement | ||
| Positive | “I have been pleasantly surprised general build quality, battery performance, and their ability to help me hear have all be great and beyond original expectations. These bare small, similar to a typical pair of ear buds you'd buy for music, and not very noticeable when you are wearing them especially in the natural color that I got. It is recognized as a hearing assistant device versus ear buds once set‐up on your phone and uses the typical bluetooth connection during the initial set‐up. I think this is a great simple ui design for older folks.” | 0.9992 |
| Neutral | “Purchased these for my husband he was very impressed with the sound quality he used them every day for about months, cleaning them on a regular basis the battery life was originally about hours but has slowly dwindled to about ‐ hours before needing to be charged we are going to attempt a warranty exchange I will update this review after that.” | −0.001 |
| Negative | “After weeks of fiddling with the three sound settings and volume controls, I never found anything satisfactory for enhanced hearing either it was too soft or too loud with odd interference noises the devices are extremely sensitive to any blockage from wax or other particles, resulting in the aids turning off and on while in the ear I carefully cleaned the devices per the directions and cleaned my ears more, but the problem continued.” | −0.9454 |
| Affordability | ||
| Positive | “The [OTC hearing aid] offers a great alternative for those suffering hearing loss compared to the cost of traditional hearing aids these over‐the‐counter hearing aids cost significantly less and allow one to determine how disciplined the wearer will be in using these on a daily basis. [OTC hearing aid company] has done a good job in packaging the hearing aids and providing everything that one will need to get them set up and personalized it's nice that they include a quick start guide.” | 0.9991 |
| Neutral | “I've been wearing hearing aids since because of their high cost, I have stopped going through an audiologist ‐ my insurance doesn't cover the cost of the testing or the instruments aside from one evening when I was having trouble adjusting the volume, I have felt very comfortable wearing these.” | −0.002 |
| Negative | “These hearing aids work pretty well but not perfect the sound quality is a bit harsh and not great at high frequencies these aides will be on the expensive side to maintain as they will charge for everything needed to keep them maintained including receivers and wire at $ per side there are other items that cost also.” | −0.8919 |
| OTC versus prescription HA | ||
| Positive | “Compared to prescription hearing aids, the [OTC hearing aid] are relatively affordable, which can be a significant advantage. They are priced reasonably, making them accessible to a broader range of customers amplification: they offer high‐quality amplification to hear sounds that they might otherwise miss as an ai language model. [OTC hearing aid company] is a well‐known and respected brand, so you can be confident that you are getting a quality product.” | 0.999 |
| Neutral | “I only hope you continue to provide it year after year because if I have to go to an audiologist it would defeat the purpose of buying [OTC hearing aid].” | −0.0258 |
| Negative | “My right rx hearing aid died and I was told by my audiologist that an adjustable otc ha might work well for me. I had no trouble syncing them to the [OTC hearing aid] app on my android tablet. I am unable to raise the volume high enough for my hearing loss I also saw what other reviews had critiqued before me: the app is severely limited in the ability to properly adjust. Most notable, the frequency adjustment is horrendous ‐ it is a slider between bass and treble, as opposed to a real equalizer function if, like me, your hearing loss varies over the frequency spectrum and is not poorer for either high or low frequencies, this app is useless.” | −0.9359 |
Abbreviation: OTC, over‐the‐counter.
When detailing their experience with the product, reviewers reported the functionality of the product, or lack thereof, by describing product features such as sound amplification and sound quality. Positive reviews reported significant improvements in symptoms and were pleased with the quality, whereas negative reviews mentioned feedback and described little to no improvement in overall hearing. Notably, some reviewers admitted no professional assessment before trying the OTC hearing aids in hopes of addressing their hearing loss without the help of a medical professional.
Thematic analysis of the most positive reviews demonstrated multiple barriers to the conventional hearing aid fitting process. Whether they do not view their hearing loss as a major hindrance to their lifestyle, are unsure which medical professionals to see, or are disgruntled from their health care experience, many reviews report trying OTC hearing aids for the first time to address their hearing loss. Some reviewers wanted to trial OTC hearing aids before investing in prescription hearing aids and found them ideal for their hearing needs. Meanwhile, others were frustrated by the inconvenience of follow‐ups and adjustments with audiologists, especially when living in remote areas. In total, 56% of the reviews included in the thematic analysis reported a better experience with OTC hearing aids than with prescription hearing aids. These underscore potential benefits of OTC hearing aids in offering greater flexibility, affordability, and autonomy for users, particularly for those who have found conventional prescription options more restrictive and expensive. Furthermore, for many concerned about the stigma associated with hearing aid use, OTC hearing aids offer consumers a wider range of discreet and personalized options, “I felt the difference from my [prescription hearing aid]; they fit like a glove… I wore them to a social gathering and no one had a clue I had something so small with such rich sound! I finally feel me again!”
Among negative reviews, most issues reported were insufficient sound amplification and poor customer service. It is difficult to determine whether these issues are due to defective products, improper installation, or the hearing loss exceeding the severity for which OTC hearing aids are designed. However, these issues are not surprising, given that consumers must manage the fitting process on their own for OTC hearing aids, which is a key difference compared to prescription hearing aids. Although OTC hearing aids offer an additional option for individuals with perceived mild to moderate hearing loss, it may be challenging for consumers to determine the extent of their hearing loss without diagnostic testing. Although mobile hearing screening applications are becoming more accurate, it is still encouraged for adults who notice hearing difficulties to undergo professional evaluation to assess their eligibility for OTC hearing aids. 11 , 12
Consumers also brought up issues with OTC hearing aids that are commonly noticed with prescription hearing aids such as discomfort from hearing aid tips, background noise, and feedback noise. Although common for both types of hearing aids, prescription hearing aids offer additional support, such as reevaluation with audiologists for program adjustments, trials of different hearing aid types, and custom earmolds to address these issues before a user stops using them. In contrast, consumers purchasing OTC hearing aids often lack access to such counseling. As the OTC hearing aid market continues to expand, it will be important to find ways to support consumers through educational resources. All OTC hearing aids studied offer a return policy ranging from 45 to 100 days, enabling consumers to try the device and find the right fit. Some OTC hearing aid brands offer access to an online audiologist for further evaluation and troubleshooting. The abandonment of hearing aids by individuals with hearing loss after a poor experience with a single OTC device should be prevented.
When observing trends, there was a significant increase in the number of reviews shortly before the establishment of FDA‐approved OTC hearing aids in 2022. With the FDA's endorsement and increased media coverage, public awareness of OTC hearing aids as an option has grown, and more people are willing to try them. This study demonstrated the potential impact of public health policies on public awareness of health care seen with an almost 400% growth in the number of reviews shortly after the FDA's final approval of the proposal. As the expanding market offers more affordable and convenient alternatives, continued research and collaboration among stakeholders are required to refine these policies to further support safe and effective use.
Although some comparisons between OTC and prescription hearing aids were made to highlight key themes in user reviews, our primary focus was on analyzing public sentiment specifically toward OTC hearing aids rather than making direct comparisons between the two categories. Future studies examining prescription hearing aid reviews in parallel could offer deeper insights into how OTC devices compare to prescription options and further contextualize user experiences.
This study has limitations. First, the authenticity of online reviews could not be fully validated. E‐commerce platforms may be vulnerable to manipulation, as there is no definitive way to determine whether negative reviews were filtered out or falsified positive reviews were added. We note that the Federal Trade Commission implemented a ban on fake reviews beginning in October 2024. Since the reviews in this study were gathered in February 2025 and our review data set includes entries dating back to 2016, reviews may still have been influenced by biases present on previously unregulated platforms. Future studies could enhance verification by directly contacting customers and incorporating consumer surveys or structured interviews. In addition, granted that reliable and authentic reviews are ensured, the biased nature of online reviews should be taken into account. To mitigate this, this study utilized a thematic review to capture a broader range of perspectives. However, in the statistical analysis using VADER, customers with stronger opinions—whether positive or negative—are more likely to share their experiences, potentially skewing the data toward more extreme viewpoints while underrepresenting neutral feedback.
Conclusion
The OTC hearing aid market and public awareness have significantly expanded since the FDA established regulations to promote their safe and effective use. Overall, public perception toward OTC hearing aids, based on sentiment and thematic analysis of online customer reviews, has remained positive. As awareness of OTC hearing aids and the market continue to grow, there should also be efforts from various stakeholders to provide guidance and education.
Author Contributions
Joshua W. Cho, study conception, data acquisition and analysis, data interpretation, drafting of manuscript, critical revision; Olivia Tandadjaja, data acquisition and interpretation, drafting of manuscript, critical revision; Charlie Henriks, data acquisition and analysis, critical revision; Malaika Jamal, data acquisition, drafting of manuscript, critical revision; Kaitlin Hori, data analysis and interpretation, critical revision; Joel Feier, data analysis, critical revision; Ziphron Russel, data acquisition and analysis, critical revision; Ethan Lawrence, data acquisition, critical revision; Nicole Greene, data interpretation, critical revision; Janet S. Choi, conception and design of work, data acquisition and analysis, interpretation of data, drafting of manuscript, critical revision.
Disclosures
Competing interests
The authors declare that there is no conflict of interest.
Funding source
None.
Acknowledgments
None.
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