Hearing loss used to begin with regular trips to the clinic, fittings with audiologists and adjustments from a small knob on the back of the hearing aid. Now, new technologies give people more autonomy over their hearing.
When Apple unveiled the AirPods 3 – fitted with hearing aid capabilities – in September, users could test and transform their AirPods into hearing aids in minutes. But despite this feature being available in over 100 countries, Ontario residents are currently unable to access these devices.
Under the provincial Regulated Health Professions Act, a prescription from a licensed audiologist or physician is required to purchase any hearing device – a safeguard intended to protect public health. Ontario has yet to establish a framework for regulating over-the-counter hearing aids like the AirPods 3, raising questions about the safety of user-led hearing technology, and the evolving relationship between health-care professionals and those experiencing hearing loss.
Western researchers are currently navigating these very questions in their research and clinical work.
Danielle Glista, professor in the School of Communication Sciences and Disorders in the Faculty of Health Sciences, and primary investigator in the National Centre for Audiology, has built a team investigating the rise of virtual care and digital hearing tools.
Kate Pfingstgraef, a second-year master’s student in clinical science in audiology, is a member of Glista’s Connected Hearing Healthcare Lab.
Reflecting on their research, the pair spoke about the major shifts occurring within the hearing industry that are reshaping care delivery.
What tools are available for people who suspect hearing loss?
Danielle Glista (DG): Hearing technologies exist along a spectrum. On one end are provider-led models, where an assessment and hearing aid fitting occur in the clinic. On the other end of the spectrum are client-led options, such as hearing aids bought over the counter at pharmacies, or headphones like the Apple AirPods 3, which aren’t available in Ontario right now.
What we are seeing in Canada is a growth of hybrid hearing aid tools. With these semi-client led models, the audiologist will fit the hearing aid, but the patient can make limited adjustments afterwards through a mobile app.
These hearing aid-connected apps act like remote controls – with extra features. Once connected via Bluetooth or wireless connection, listeners can change features like noise reduction, speech focus or volume based on the environment, to figure out what’s going to work best for them in the moment. These tools have been a major focus of our research in the past year.
Are you missing out on better hearing if you are not connecting to an app?
Kate Pfingstgraef (KP): You would be missing out on personally adjusting additional settings like noise reduction and directing the microphone to the talker in front of you. You would still be able to make basic adjustments without the app, using a toggle on the back of the hearing aid or a small remote control – these apps are just offering a bit more.
For instance, older adults may find it hard to adjust the little toggle switch on the hearing aid. Others may be more inclined to use apps to gauge wear time or use the step counter feature integrated with their hearing aid app; the tech is great at encouraging users to be more involved in their own care.
Are these new apps changing the relationship between patient and clinician?
KP: It’s definitely going to change the relationship, but not in a negative way. These apps are giving the patient another opportunity to learn about how their hearing aids function, and work with audiologists to program the tools together. If anything, this new technology is pulling us closer together.
DG: I think it’s going to facilitate better conversations. It’s not that the user is making these changes on their own without oversight – that’s not going to be very beneficial unless they’re bringing it back to the clinician and looking at how they can improve the fitting together.
The release of the AirPods 3 was an exciting development in hearing care this year. Based on your research, do you think this technology has the potential to provide the accuracy of hearing aids?
DG: As a clinically trained audiologist, I advocate for professional assessment and prescription when fitting hearing aids. A clinician-guided prescription is going to optimize the fitting in a way that’s much better than what the individual would be able to do for themselves.
That said, evidence suggests the accuracy of self-fitted devices is improving. Many over-the-counter options, similar to the Apple AirPods 3, are guiding users through steps to program the tools themselves. This is raising awareness about hearing health, and making it more accessible. However, real-world challenges do arise, and individuals may eventually want to seek professional support to fine-tune their devices or address broader health concerns.
KP: Think of a piano: An audiologist’s hearing assessment can guide the adjustment of various sounds in level and pitch, across the entire piano. With self-fittings, you may not be able to account for that full range of hearing and level of specificity.
If these tools are available in your region, they’re a good starting point to improve access to hearing aid devices and become more aware of hearing health, but users will likely realize when it’s time to meet a professional to receive guidance or more personalized solutions.
How should health systems respond to the introduction of these new consumer technologies?
DG: It’s about meeting the person where they’re at. If these tools motivate someone to take action, then that’s a great starting point. As a profession, we need to shift how we view our role. It can feel intimidating because so much of clinic revenue traditionally comes from prescribing and selling hearing aids. But the value lies in personalized fittings, follow-up care, education and addressing holistic health issues like balance, risk of falls and even diabetes management.
Encouraging a patient-provider relationship is the answer, and hearing aid connected apps are a great example. Unlike entirely self-fitted devices, it keeps that collaboration between patient and provider, maintaining safety limits and professional oversight. Rather than viewing technological advancement as replacing professional care, we’re looking at how these tools can foster more collaborative, person-centered models.
How do you envision the future of hearing health?
DG: The tools are out there now. We recently reviewed the quality of hearing aid-connected apps in Canada, while also speaking to clinicians and young listeners to figure out what they would like to see most. We found a strong need for improved app design, a standardized way to report data, as well as guidelines to help support integration of these tools amongst clinicians.
It’s critical now that clinicians are trained to use these emerging technologies effectively, which is why I’ve begun teaching a virtual care course, the only one of its kind in Canada, as part of the clinical training program in audiology here at Western. In this course, I teach students how to work with digital technologies and virtual care delivery models. The goal is to give them diverse experiential learning opportunities to learn how to support remote delivery of audiology services. Students are then able to put their skills into practice through hands-on training, such as appointments with patients in our H.A. Leeper Speech and Hearing Clinic on campus. Without this kind of training, you’re relying on extra time at the clinic to teach yourself about virtual technologies, which doesn’t really exist for most hearing professionals.
KP: As someone who is about to enter clinical practice, having this knowledge on the current tech has given me confidence: I know it’s something I can and will use every day when a patient comes in and wants to incorporate it as part of their care. These tools are here to stay, and patients are excited to use them, so understanding and familiarizing ourselves is the first step to a well-connected hearing system.
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