Factors Associated with Traditional Hearing Aid Conversion: A Cross-sectional Survey Study

Introduction: Hearing aid adoption remains below 50% despite known benefits for cognitive health and quality of life. Following FDA approval of over-the-counter hearing aids (OTC HA), understanding longitudinal amplification decisions may identify factors driving delayed adoption or device substitution.

Methods: Patients who completed a hearing aid evaluation (HAE) between 1/1/2024 - 9/1/25 but declined traditional hearing aids (THA) were surveyed from 10/1/25 - present using an audiologist-developed questionnaire. Of 184 patients contacted, 48 responded (26.1%), with audiological, demographic, and social factors extracted from charts.

Results: Of 48 patients (23 female; 64.6% White; 61.7% partnered) who initially declined THAs, 16 (33.3%) later acquired THAs, 3 (6.3%) both THA and OTC, 10 (20.8%) OTC, and 19 (39.6%) remain unaided. Mean age differed significantly across groups (THA 72.1±15.9; THA+OTC 77.3±6.5; OTC 67.1±8.7; none 56.4±15.6 years; p< 0.01), as did better ear PTA (THA 34.9±16.7; THA+OTC 42.3±4.5; OTC 29.6±13.6; none 22.2±14.0 dB; p< 0.05). Satisfaction scores (1=very satisfied to 5=very dissatisfied) were significantly better for THA (n=16, mean=1.69) and THA+OTC (n=3, mean=1.67) users compared to OTC-only users (n=5/10, mean=3.40; p=0.031). Social vulnerability index (SVI) did not differ significantly across groups (p=0.66) ( THA 0.55±0.31; THA+OTC 0.53±0.11; OTC 0.52±0.26; none 0.65±0.29), and neither did partnered status. Patients citing cost had the lowest THA acquisition (21.1%), with 52.6% remaining unaided. Healthcare utilization variables (post HAE PCP visits, ENT visits, ED visits, hospitalizations, and missed/cancelled appointments) showed no significant associations (all p>0.25).

Conclusions: HA adoption following initial rejection at HAE reflects patient clinical need and cost, not disengagement from care or SVI. Growing OTC options facilitate substitution in mild loss, while greater impairment drives THA use. Patient satisfaction favored THA, highlighting persistent quality gaps that should inform counseling and policy in the evolving amplification landscape.