Over the Counter Hearing Aids

The Over the Counter Hearing Act of 2017 requires the FDA to create a category for certain hearing aids intended for use by adults over the age of 18 years with mild to moderate hearing loss. The device will be available over the counter without the supervision, prescription, or other order, involvement or intervention of a licensed person to customers through in-person transactions, by mail or online.

Currently, hearing aids are intended to compensate for impaired hearing and are programmed to fit a specific hearing loss by hearing professionals who are licensed in the state where they practice. The hearing evaluation determines the maximum power output of the hearing aid and the gain and frequency response that will be required to restore audibility and maintain comfort.

The new category will allow the consumer through “tools, tests, or software…to control the over-the-counter hearing aid and customize it to the user’s hearing needs.” OTC devices may include tests for self-assessment of hearing loss. These applications are currently available on a variety of hearing aids that can be used by the consumer or adjusted remotely by a hearing professional.

The Over the Counter Hearing Aid Act of 2017 states that the new category will use the same fundamental technology as traditional hearing aids.  The labeling requirements will differ from existing hearing aids considering that the new category will be sold without the involvement of a professional.

OTC products can be distinguished from Personal Sound Amplification Devices (PSAPs) which are wearable electronic products that are not intended to compensate for impaired hearing but rather intended for non-hearing-impaired consumers to amplify sounds in certain environments, such as hunting or other recreational activities.

FDA is required by law to issue a proposed rule by August of 2020, but this could occur earlier.   This will be followed by a comment period of probably 60 days.  FDA will then have six months to review the comments, make any changes in the proposal, write a preamble, and obtain all necessary signoffs.

Hearing Health Care Professional Associations Consensus Paper

In August of 2018, the major representatives of the hearing healthcare professionals, the American Academy of Audiology (AAA), Academy of Doctors of Audiology (ADA), American Speech-Language and Hearing Association (ASHA) and International Hearing Society (IHS), released a Consensus Paper with five key recommendations for the new rule. The recommendations are:

1. Products requirements for OTC devices with a) the 2 cc coupler HFA full on gain, as measured at an input level of 50 dB SPL per ANSI S3.22-2014, is 25 dB or lower; and b) the peak (or maximum) 2 cc coupler OSPL90, per ANSI S3.22-2014, is not greater than 110 dB SPL in combination with input compression and volume control.
2. Outside-the-box labeling include recognition that the intended use/usage and a notice that hearing loss being a medical condition best addressed in consultation with a licensed professional.
3. Inside-the-box labeling include a strong warning that the device is not intended for children under the age of 18.
4. FDA to maintain the same risk category as air conduction hearing aids and to require the initial OTC air conduction hearing devices undergo the 510(k) process.
5. FDA to establish strong consumer protection laws (e.g. return and refund policies, unsubstantiated and false claims…) and the necessary processes and resources to enforce then.

HIA endorsed the Consensus Paper recommendations and has encouraged the FDA to include them in the proposed rule.