{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T19:44:16Z","timestamp":1794080656462,"version":"4.8.0"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>The poor affordability of hearing aids (HAs) limits their adoption. To justify higher costs, HAs fitted by audiologists (AUD service model) and high-end HAs should deliver better outcomes than over-the-counter (OTC) service models and low-end HAs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the effect of HA service models (AUD, OTC, and a hybrid OTC+ model) and technology levels (high end and low end) on patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This randomized clinical trial was conducted at the University of Iowa and Vanderbilt University Medical Center in research laboratories from February 2019 to December 2023 and included adults older than 55 years with mild to moderate hearing loss and no previous HA experience who were randomly assigned to 1 of 6 parallel groups, representing factorial combinations of 3 service models and 2 technology levels. The data were analyzed between January 2024 and March 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>The trial included 3 service models: AUD, in which audiologists fitted prescription HAs following best practices; OTC+, in which audiologists provided limited services for OTC HAs; and OTC, in which participants independently used OTC HAs. OTC HAs were simulated using prescription HAs. Two models of prescription HAs were used throughout the trial: a high-end HA with advanced features and a low-end HA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome measure was the Glasgow Hearing Aid Benefit Profile (GHABP), which was administered using ecological momentary assessment (EMA). EMA-GHABP was conducted preintervention and throughout the seventh week postintervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 245 participants completed the study (121 women [49.4%]; mean [SD] age, 67.7 [8.1] years). After controlling for preintervention scores, the postintervention EMA-GHABP global score (ranging from 1 to 5) for AUD was significantly higher (indicating better outcomes) than for OTC+ and OTC by 0.33 points (95% CI, 0.14-0.52) and 0.32 points (95% CI, 0.13-0.51), respectively. The difference between OTC+ and OTC was not significant (0.02 points, 95% CI, \u22120.21 to 0.18). Nevertheless, EMA-GHABP global scores for OTC+ and OTC were close to 4 points, indicating positive outcomes. The effect of technology level and interaction between service model and technology level were not significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The trial results suggest that while OTC+ and OTC were effective, they did not achieve the same outcomes as AUD. As high-end and low-end HAs yielded similar outcomes, support for the higher cost of high-end HAs was not identified for individuals with mild to moderate hearing loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03579563?term=NCT03579563&amp;amp;amp;rank=1\">NCT03579563<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2025.1008","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T11:01:38Z","timestamp":1747306898000},"page":"684","source":"Crossref","is-referenced-by-count":18,"title":["Hearing Aid Service Models, Technology, and Patient Outcomes"],"prefix":"10.1001","volume":"151","author":[{"given":"Yu-Hsiang","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Communication Sciences and Disorders, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Stangl","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences and Disorders, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjersten","family":"Branscome","sequence":"additional","affiliation":[{"name":"Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Oleson","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Ricketts","sequence":"additional","affiliation":[{"name":"Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"7","key":"ooi250021r1","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1001\/jamaoto.2016.4642","article-title":"Addressing estimated hearing loss in adults in 2060.","volume":"143","author":"Goman","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"8","key":"ooi250021r2","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1001\/jama.2016.7916","article-title":"Priorities for improving hearing health care for adults: a report from the National Academies of Sciences, Engineering, and Medicine.","volume":"316","author":"Lin","year":"2016","journal-title":"JAMA"},{"issue":"2","key":"ooi250021r4","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.maturitas.2012.03.010","article-title":"Hearing handicap, rather than measured hearing impairment, predicts poorer quality of life over 10 years in older adults.","volume":"72","author":"Gopinath","year":"2012","journal-title":"Maturitas"},{"issue":"3","key":"ooi250021r5","doi-asserted-by":"publisher","first-page":"188","DOI":"10.7326\/0003-4819-113-3-188","article-title":"Quality-of-life changes and hearing impairment: a randomized trial.","volume":"113","author":"Mulrow","year":"1990","journal-title":"Ann Intern Med"},{"issue":"9","key":"ooi250021r6","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012023.pub2","article-title":"Hearing aids for mild to moderate hearing loss in adults.","volume":"9","author":"Ferguson","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"10404","key":"ooi250021r7","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/S0140-6736(23)01406-X","article-title":"Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial.","volume":"402","author":"Lin","year":"2023","journal-title":"Lancet"},{"issue":"5","key":"ooi250021r8","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1093\/gerona\/glr002","article-title":"Hearing loss prevalence and risk factors among older adults in the United States.","volume":"66","author":"Lin","year":"2011","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"3","key":"ooi250021r9","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1001\/archinternmed.2011.1408","article-title":"Prevalence of hearing aid use among older adults in the United States.","volume":"172","author":"Chien","year":"2012","journal-title":"Arch Intern Med"},{"issue":"8","key":"ooi250021r10","first-page":"12","article-title":"MarkeTrak 10: hearing aids in an era of disruption and DTC\/OTC devices.","volume":"26","author":"Powers","year":"2019","journal-title":"Hearing Review"},{"issue":"6","key":"ooi250021r11","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1093\/geront\/gny051","article-title":"Determinants of hearing aid use among older Americans with hearing loss.","volume":"59","author":"McKee","year":"2019","journal-title":"Gerontologist"},{"issue":"3","key":"ooi250021r12","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igab021","article-title":"Factors associated with hearing aid use among Medicare beneficiaries.","volume":"5","author":"Assi","year":"2021","journal-title":"Innov Aging"},{"issue":"3","key":"ooi250021r13","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1080\/17483107.2020.1822449","article-title":"Hearing aid affordability in the United States.","volume":"18","author":"Jilla","year":"2023","journal-title":"Disabil Rehabil Assist Technol"},{"issue":"6","key":"ooi250021r16","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1001\/jamaoto.2023.0376","article-title":"Effectiveness of an over-the-counter self-fitting hearing aid compared with an audiologist-fitted hearing aid: a randomized clinical trial.","volume":"149","author":"De Sousa","year":"2023","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"1","key":"ooi250021r17","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1044\/2017_AJA-16-0111","article-title":"The effects of service-delivery model and purchase price on hearing-aid outcomes in older adults: a randomized double-blind placebo-controlled clinical trial.","volume":"26","author":"Humes","year":"2017","journal-title":"Am J Audiol"},{"issue":"4","key":"ooi250021r18","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1097\/AUD.0000000000000672","article-title":"Efficacy and effectiveness of advanced hearing aid directional and noise reduction technologies for older adults with mild to moderate hearing loss.","volume":"40","author":"Wu","year":"2019","journal-title":"Ear Hear"},{"issue":"4","key":"ooi250021r19","doi-asserted-by":"publisher","first-page":"e224","DOI":"10.1097\/AUD.0000000000000277","article-title":"Impact of hearing aid technology on outcomes in daily life I: the patients\u2019 perspective.","volume":"37","author":"Cox","year":"2016","journal-title":"Ear Hear"},{"issue":"6","key":"ooi250021r20","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1159\/000362547","article-title":"Impact of advanced hearing aid technology on speech understanding for older listeners with mild to moderate, adult-onset, sensorineural hearing loss.","volume":"60","author":"Cox","year":"2014","journal-title":"Gerontology"},{"issue":"5","key":"ooi250021r21","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1097\/AUD.0000000000000327","article-title":"Impact of hearing aid technology on outcomes in daily life II: speech understanding and listening effort.","volume":"37","author":"Johnson","year":"2016","journal-title":"Ear Hear"},{"issue":"6","key":"ooi250021r22","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1097\/AUD.0000000000000473","article-title":"Impact of hearing aid technology on outcomes in daily life III: localization.","volume":"38","author":"Johnson","year":"2017","journal-title":"Ear Hear"},{"key":"ooi250021r23","doi-asserted-by":"publisher","DOI":"10.3389\/fauot.2023.1167853","article-title":"The role of hearing professionals for over-the-counter hearing aids.","volume":"1","author":"Perez-Heydrich","year":"2023","journal-title":"Frontiers in Audiology and Otology"},{"issue":"02","key":"ooi250021r25","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1055\/s-0042-1748460","article-title":"Glasgow hearing aid benefit profile: derivation and validation of a client-centered outcome measure for hearing aid services.","volume":"10","author":"Gatehouse","year":"1999","journal-title":"J Am Acad Audiol"},{"issue":"1","key":"ooi250021r26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1146\/annurev.clinpsy.3.022806.091415","article-title":"Ecological momentary assessment.","volume":"4","author":"Shiffman","year":"2008","journal-title":"Annu Rev Clin Psychol"},{"issue":"10","key":"ooi250021r27","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1055\/s-0040-1719133","article-title":"Comparison of in-situ and retrospective self-reports on assessing hearing aid outcomes.","volume":"31","author":"Wu","year":"2020","journal-title":"J Am Acad Audiol"},{"issue":"1","key":"ooi250021r30","first-page":"27","article-title":"Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids.","volume":"8","author":"Dillon","year":"1997","journal-title":"J Am Acad Audiol"},{"issue":"2","key":"ooi250021r32","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/00025572-199502000-00001","article-title":"Using loudness data for hearing aid selection: The IHAFF approach.","volume":"48","author":"Cox","year":"1995","journal-title":"Hear J"},{"issue":"4 Pt 1","key":"ooi250021r33","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.1121\/1.1784440","article-title":"Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal-hearing and hearing-impaired listeners.","volume":"116","author":"Killion","year":"2004","journal-title":"J Acoust Soc Am"},{"issue":"1","key":"ooi250021r34","doi-asserted-by":"publisher","DOI":"10.4081\/audiores.2011.e24","article-title":"The NAL-NL2 prescription procedure.","volume":"1","author":"Keidser","year":"2011","journal-title":"Audiol Res"},{"issue":"1","key":"ooi250021r35","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1044\/2020_AJA-20-00085","article-title":"Toward a new evidence-based fitting paradigm for over-the-counter hearing aids.","volume":"30","author":"Urbanski","year":"2021","journal-title":"Am J Audiol"},{"issue":"1","key":"ooi250021r36","first-page":"1","article-title":"Efficacy and effectiveness of evidence-based non\u2013self-fitting presets compared to prescription hearing aid fittings and a personal sound amplification product.","volume":"33","author":"Venkitakrishnan","year":"2023","journal-title":"Am J Audiol"},{"issue":"5","key":"ooi250021r37","doi-asserted-by":"publisher","first-page":"345","DOI":"10.3109\/14992027.2013.876110","article-title":"Proposed norms for the Glasgow hearing-aid benefit profile (Ghabp) questionnaire.","volume":"53","author":"Whitmer","year":"2014","journal-title":"Int J Audiol"},{"issue":"2","key":"ooi250021r38","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1044\/jshr.3302.343","article-title":"Development of the profile of hearing aid performance (PHAP).","volume":"33","author":"Cox","year":"1990","journal-title":"J Speech Hear Res"},{"issue":"3","key":"ooi250021r39","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/00003446-198205000-00006","article-title":"The hearing handicap inventory for the elderly: a new tool.","volume":"3","author":"Ventry","year":"1982","journal-title":"Ear Hear"},{"issue":"6","key":"ooi250021r40","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1097\/00003446-199012000-00004","article-title":"The Hearing Handicap Inventory for Adults: psychometric adequacy and audiometric correlates.","volume":"11","author":"Newman","year":"1990","journal-title":"Ear Hear"},{"issue":"4","key":"ooi250021r41","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1097\/00003446-199908000-00004","article-title":"Measuring satisfaction with amplification in daily life: the SADL scale.","volume":"20","author":"Cox","year":"1999","journal-title":"Ear Hear"},{"issue":"5","key":"ooi250021r42","doi-asserted-by":"publisher","first-page":"119S","DOI":"10.1097\/00003446-198710001-00010","article-title":"Development of the connected speech test (CST).","volume":"8","author":"Cox","year":"1987","journal-title":"Ear Hear"},{"issue":"4","key":"ooi250021r45","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"ooi250021r46","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.12740\/PP\/45368","article-title":"Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? meta-analysis.","volume":"50","author":"Ciesielska","year":"2016","journal-title":"Psychiatr Pol"},{"key":"ooi250021r47","doi-asserted-by":"publisher","DOI":"10.3389\/fauot.2024.1411397","article-title":"Would a comprehensive hearing aid fitting process lead to placebo effects compared to a simple process?","volume":"2","author":"Wu","year":"2024","journal-title":"Frontiers in Audiology and Otology"},{"issue":"2","key":"ooi250021r48","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1044\/2022_AJA-22-00130","article-title":"Comparing hearing aid outcomes in adults using over-the-counter and hearing care professional service delivery models.","volume":"32","author":"Swanepoel","year":"2023","journal-title":"Am J Audiol"},{"issue":"02","key":"ooi250021r49","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/01.HJ.0000919772.00462.3e","article-title":"Hearing aid user perspectives: reasons and recommendations for prescription and over-the-counter device uptake.","volume":"76","author":"Knoetze","year":"2023","journal-title":"Hear J"},{"key":"ooi250021r31","first-page":"101","volume-title":"Essentials of modern hearing Aids: Selection, fitting, and verification","author":"Ricketts","year":"2017"},{"key":"ooi250021r43","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2023"},{"key":"ooi250021r3","unstructured":"World Health Organization. Deafness and hearing loss. Accessed August 26, 2024. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/deafness-and-hearing-loss"},{"key":"ooi250021r14","unstructured":"US Food and Drug Administration. Medical devices; ear, nose, and throat devices; establishing over-the-counter hearing aids. Accessed August 26, 2024. https:\/\/www.federalregister.gov\/d\/2022-17230"},{"key":"ooi250021r15","unstructured":"Strom? K, Copithorne? D. The best OTC hearing aids of 2024 and what they cost. Accessed December 20, 2024. https:\/\/www.hearingtracker.com\/otc-hearing-aids"},{"key":"ooi250021r24","unstructured":"Taylor? B, Mueller? HG. Research QuickTakes volume 5: OTC hearing aids\u2014pros, cons, and implementation strategies. Accessed August 26, 2024. https:\/\/www.audiologyonline.com\/articles\/research-quicktakes-volume-5-otc-28695"},{"key":"ooi250021r28","unstructured":"Haahr? M. True random number service. Accessed March 11, 2025. https:\/\/www.random.org"},{"key":"ooi250021r29","unstructured":"American Academy of Audiology. Guidelines for the audiologic management of adult hearing impairment. Accessed August 26, 2024. https:\/\/www.audiology.org\/practice-guideline\/guidelines-for-the-audiologic-management-of-adult-hearing-impairment\/"},{"key":"ooi250021r44","unstructured":"Lenth? R. Estimated marginal means, aka least-squares means. Accessed August 26, 2024. https:\/\/CRAN.R-project.org\/package=emmeans"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2833823\/jamaotolaryngology_wu_2025_oi_250021_1752092940.87052.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T15:00:47Z","timestamp":1752159647000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2833823"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":49,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2025.1008","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2025,7,1]]}}}