Usability of Over-the-Counter (OTC) Hearing Aids

Overview

Over-the-counter (OTC) hearing aids were introduced to improve access to hearing care for adults with perceived mild-to-moderate hearing loss. However, access alone does not ensure effective use. Many individuals encounter challenges with device setup, sound quality, expectations, and long-term adherence—particularly without professional guidance.

This project evaluates the usability, performance, and perceived value of OTC hearing aids to identify barriers and inform strategies that improve real-world outcomes.

Objectives

  • Evaluate usability across key tasks (e.g., setup, insertion, app navigation)
  • Assess device performance in controlled and simulated real-world environments
  • Examine user perceptions of benefit, satisfaction, and listening effort
  • Identify predictors of successful self-fitting and sustained use
  • Evaluate perceived value through willingness-to-pay (WTP) measures

Methods

This project integrates behavioral, electroacoustic, and self-report data:

  • Usability Testing: Structured task-based assessments of setup, handling, and app use
  • Speech-in-Noise Performance: Laboratory-based testing, including simulated real-world environments (e.g., R-SPACE paradigm)
  • Self-Report Measures: Perceived benefit, satisfaction, and listening effort
  • Economic Evaluation: Willingness-to-pay (WTP) and value perception
  • Mixed Methods: Quantitative outcomes paired with qualitative insights on user experience

Current Status

Primary usability data collection is complete. Ongoing analyses are examining predictors of successful self-fitting, performance outcomes, and value perception.

Selected Outputs

Peer-Reviewed Publications

  • Coco, L. et al. (2025). Usability of over-the-counter hearing aids in older adults. American Journal of Audiology.
  • Coco, L. et al. (In Press). Perceptions of over-the-counter hearing aids: A qualitative study informed by the Technology Acceptance Model. Journal of the American Academy of Audiology.
  • Coco, L. (2024). Amplifying Access: Progress After 1 Year of Over-the-Counter Hearing Aids. Perspectives of the ASHA SIGs.

Presentations

  • Hearing Aid DIY: Predictors of Successful Self-Fitting for OTC Hearing Aids – American Auditory Society (2025)
  • Are OTC Hearing Aids User-Friendly? – International Hearing Aid Research Conference (IHCON) (2024)
  • How Usable Are OTC Hearing Aids? – ASHA Convention (2023)
  • Hearing Health DIY: Real-World Potential and Limitations of OTC Hearing Aids – Coalition for Global Hearing Health (Plenary, 2023)

Funding

This work is supported by:

  • San Diego State University SEED Grant – “Hearing Aid DIY” (Principal Investigator)

Team

  • Principal Investigator: Laura Coco, PhD, AuD, CCC-A
  • AuD student researchers (projects on usability, self-fitting, and technology familiarity)
  • Undergraduate research assistants supporting data collection and analysis

Opportunities to Get Involved

This project offers strong opportunities for student training in translational hearing science:

  • Data analysis (usability metrics, Willing to Pay [WTP] data, additional qualitative analyses)
  • Manuscript development and conference presentations
  • Ongoing and future studies on OTC hearing technology and self-managed care

For current openings, see the Open Positions page.

Why This Matters

OTC hearing aids represent a major shift toward self-directed hearing care. However, without attention to usability and user experience, expanded access may not translate into meaningful benefit. This work identifies the conditions under which OTC devices are effective—and where additional support or design improvements are needed.