Hearing aids are amplifying devices currently prescribed for clinical management of individuals with hearing loss. They consist of a microphone, speaker, amplifier, and battery. Sounds are picked up by the microphone, and then amplified by the amplifier and delivered through the speaker [1]. A considerable amount of literature as shown the benefits of hearing aids to improve audibility, hearing-specific health-related quality of life, and general health-related quality of life [2]. However, hearing aids are used by less than 20% of adults with hearing loss [3]. Many factors can explain the underuse of hearing aids [4, 5, 6], such as:

• Lack of perceived effectiveness of hearing aids
• Stigma around hearing loss
• Complicated hearing aid delivery system
• High cost of hearing aids, typically around $3000–$6000

The Over the Counter (OTC) Hearing Aid Act that is part of the US Food and Drug Administration (FDA) Reauthorization Act of 2017 has been offered as a solution to improve hearing aids accessibility. The OTC Act enables adults with mild to moderate hearing loss to access OTC hearing aids without consulting with a hearing aid dispenser. These devices can be bought in many big-box stores or online.

We have chosen to use the terminology “alternative listening devices” to describe all electronic device, except prescribed hearing aids, that can be used to improve hearing. Similar terminology has been proposed by other research groups, such as connected hearing health technologies [7] and direct-to-consumer hearing devices [8]. These alternative listening devices include:

• Personal sound amplification products (PSAPs)
• Hearables
• smartphone applications
• over-the-counter (OTC) hearing aids

Recently, a systematic review of scientific literature has concluded that given their availability and affordability, these alternative listening devices could be considered for patients with mild to moderate hearing loss [9].

It should be noted that over-the-counter (OTC) hearing aids are currently not available in Quebec and Canada, given the current regulations governing the sale of hearing aids. However, PSAPs and hearables can be purchased there. Recently, the Ordre des orthophonistes et audiologistes du Québec issued a position statement on over-the-counter hearing aids, urging provincial and federal governments to legislate quickly to make them available. This position statement can be viewed here: https://www.ooaq.qc.ca/decouvrir/a-propos/enonce-position-appareils-auditifs-vente-libre/

We believe in providing up-to-date and scientifically valid information to hearing health professionals and consumers with hearing loss. Therefore, we have compiled information about alternative listening devices retrieved from several studies, as well as results obtained by our research team at CRITIAS and Laval University. This database can be used by consumers to make an informed choice regarding the selection of their hearing technologies, and by hearing health professionals to enable them to make appropriate recommendations to their patients regarding alternative listening devices.

In Table 1, we provide a summary of the characteristics of the alternative listening devices currently available on the North American market (Canada and USA). The following information is provided:

• Model: alternative listening device model’s name
• Manufacturer: alternative listening device manufacturer’s name
• Cost: cost of a pair (2) of alternative listening devices
• Type and medical classification: type of alternative listening devices (OTC, PSAP, hearable)
• Style: type of device model (ITE, in-the-ear; BTE, behind-the-ear; RITE; receiver-in-the-ear; Earbud)
• Volume control/range: can the device’s volume be adjusted? How?
• Feedback management: does the device have a feedback management algorithm?
• Battery: type of battery and estimated battery life
• Streaming capability: can the device be connected to a smartphone?
• Self-fitting: can the device be adjusted to the consumer’s hearing loss, and what type of prescription formula is used?
• Noise/speech processing: what noise or speech processing programs are available in the device?
• Warranty: warranty time provided by the manufacturer

Table 1. Characteristics of the alternative listening devices.

Model	Manufacturer	Cost	Type and medical classification	Style	Volume control/range	Feedback management	Battery	Streaming capability	Self-fitting	Noise/speech processing	Warranty	Updated on
IQbuds 2 MAX Wireless Hearing Amplifier	Nuheara	599$ CAN	PSAP	Earbud	Yes, via App	Yes	Built-in rechargeable; 8 hours	Yes, Bluetooth	Yes, input audiogram in Ear IDTM (NAL-NL2)	Directional beamforming microphones, Active noise reduction	1 year	2022-12-07
Air Pods Pro (2nd generation)	Apple	329$ CAN	Hearable	Earbud	Yes, via device and App	Yes	Built-in rechargeable; 5.5 hours	Yes, Bluetooth	Yes, input audiogram in Apple Health App	Active noise reduction, Directional beamforming microphones	1 year (2 years with AppleCare+)	2022-12-07
Galaxy Buds 2 Pro	Samsung	140$ CAN	Hearable	Earbud								Coming soon
Olive SmartEar Plus	Olive Union	1,059$ USD	OTC	Earbud	Yes, via device and App	Yes	Built-in rechargeable; 7 hours	Yes, Bluetooth	Yes, hearing test in My Olive App	Active noise reduction	1 year	2022-12-07
Olive Union Bluetooth Sound Amplifier	Olive Union	250$ CAN (for one device)	PSAP	Earbud	Yes, via device and App	Yes	Built-in rechargeable; 7 hours	Yes, Bluetooth	Yes, hearing test in My Olive App	Active noise reduction	1 year	2022-12-07
BEAN Quiet Sound Amplifier	Etymotic	300$ USD	PSAP	Earbud	No	Unspecified	10 zinc-air	No	No, 2 modes (LO, 15 dB; HI, 23 dB)		1 year	2022-12-07
SONACUS™️ ITC Mini Hearing Aid v1	Sonacus	350$ USD	PSAP	Earbud	Yes, via device	Unspecified	Built-in rechargeable; battery time not stated by manufacturer	No	No (pre-programmed modes)	Active noise reduction	1 year	2022-12-07
SONACUS™️ ITC Mini Hearing Aid v2	Sonacus	720$ USD	PSAP	ITE	Yes, via device	Unspecified	10 zinc-air	No	No (pre-programmed modes)	Omnidirectional microphones, Active noise reduction	1 year	2022-12-07
Elite 7 Pro	GN	260$ CAN	Hearable	Earbud	Yes, via device and App	Unspecified	Built-in rechargeable; 8 hours	Yes, Bluetooth	No	HearThrough technology, Active noise reduction	2 years	2022-12-07
Jabra Enhance™ Plus Hearing Aids	GN	799$ USD	OTC	Earbud	Yes, via device and App	Yes	Built-in rechargeable; 12 hours	Yes, Bluetooth	Yes, personalized hearing preferences in App	Directional microphones, Active noise reduction	1 year	2022-12-07
Jabra Enhance™ Pro 10 Hearing Aids	GN	1,700$ USD Costco exclusive	OTC	RITE	Yes, via device and App	Yes	Built-in rechargeable; 8 hours	Yes, Bluetooth	Yes, personalized hearing preferences in App	Directional microphones, Active noise reduction	3 years	2022-12-07
Lexie Lumen	Lexie	799$ USD	OTC	BTE	Yes, via device and App	Yes	312 zinc-air	Yes, Bluetooth	Yes, personalized hearing preferences in App	Directional microphones, Noise reduction	1 year	2022-12-07
Lexie B1 Powered by Bose	Lexie	849$ USD	OTC	RITE	Yes, via device and App	Yes	312 zinc-air	Yes, Bluetooth	Yes, personalized hearing preferences in App	Directional microphones, Active noise reduction	1 year	2022-12-07
Lexie B2 Powered by Bose	Lexie	999$ USD	OTC	RITE	Yes, via device and App	Yes	Built-in rechargeable; 18 hours	Yes, Bluetooth	Yes, personalized hearing preferences in App	Directional microphones, Active noise reduction	1 year	2022-12-07
Bose QuietComfort Earbuds II	Bose	380$ CAN	Hearable	Earbud								Coming soon
Orka One	Orka	2,370$ USD	OTC	BTE	Yes, via App	Yes	Built-in rechargeable; 10 hours	Yes, Bluetooth	Yes, hearing test in Orka Health App	AI DeNoise, Adaptive Equalization	2 years	2022-12-13
Eargo 6	Eargo	2,950$ USD	OTC	ITE	Yes, via device and App (APP NOT AVAILABLE IN CANADA)	Yes	Built-in rechargeable; 16 hours	Yes, Bluetooth	No, remote fitting by audiologist or pre-programmed modes	Sound Adjust, Sound Match	2 years	2022-12-13
Tweak Enhance	Tweak Hearing	699$ USD	PSAP	BTE	Yes, via device and App	Yes	Built-in rechargeable; 20 hours	Yes, Bluetooth	Yes, input audiogram in App	Directional microphones	6 months	2022-12-19
E10 Self-Fitting OTC Hearing Aids	SONY	1,299$ USD	OTC	Earbud	Yes, via App (APP NOT AVAILABLE IN CANADA)	Yes	Built-in rechargeable; 23 hours	Yes, Bluetooth	Yes, pre-defined hearing profiles and personalized hearing preferences in App	Directional microphones, Active noise reduction	1 year	2022-12-19
C10 Self-Fitting OTC Hearing Aids	SONY	999$ USD	OTC	ITE	Yes, via App (APP NOT AVAILABLE IN CANADA)	Yes	10 zinc-air	Yes, Bluetooth	Yes, self-adjusts to pre-defined hearing profiles personalized hearing preferences in App	Directional microphones, Active noise reduction	1 year	2022-12-19
Best Hearing Aid Amplifier	Med CA Hearing	60$ CAN	PSAP	RITE	Yes, via device	No	Built-in rechargeable	No	No, pre-defined settings	No	30 days	2023-03-18
Britzgo Optio Hearing Aid Amplifier	Britzgo Optio Hearing Aid Amplifier	225$ CAN	PSAP	RITE	Yes, via device	No	Built-in rechargeable	No	No, pre-defined settings	Noise reduction	90 days	2023-03-18
Jinghao A39	Jinghao	110$ CAN	PSAP	Earbud								Coming soon
Sennheiser Conversation Clear Plus	Sennheiser	1,100$ CAN	PSAP	Earbud								Coming soon
HD100 Companion Hearing Aid	Sound World Solutions	735$ USD	OTC	BTE								Coming soon
HD75 OTC Hearing Aid	Sound World Solutions	500$ USD	OTC	BTE								Coming soon
CS50+ Personal Sound Amplifier	Sound World Solutions	350$ USD by ear	PSAP	BTE								Coming soon

In Table 2, we provide a summary of the alternative listening devices’ electroacoustic performances. Because prescribed hearing aids are governed by the ANSI S3.22 - Specification of Hearing Aid Characteristics standard [10], we have chosen to conduct the electroacoustic analysis by following this standard since these devices might be used by consumers with a mild to moderate hearing loss.

Please note that when the electroacoustic analysis was not conducted by our research team, the reference is provided in brackets. The following information is provided:

• Model: alternative listening device model’s name
• Manufacturer: alternative listening device manufacturer’s name
• OSPL90 Max: maximum output with a 90 dB SPL input with full on gain. The maximum OSPL90 output level shall not exceed 120 dB SPL [11].
• Frequency response: gain or amplification at various frequencies
• Frequency response smoothness: consistent gain performance across frequencies. No single peak in the one-third-octave frequency response shall exceed 12 dB [11].
• EIN: Equivalent internal noise
• THD: Total harmonic distortion in %
• Attack and Release time: time required for amplitude compression to activate or deactivate

A notation system is used to highlight the performances that do not meet () and meet () the criteria of the ANSI S3.22 (2014) [10] or ANSI/CTA 2051 (2017) [11] standards.

Table 2. Electroacoustic analysis of alternative listening devices

Model	OSPL90 Max (dB SPL)	Frequency response (Hz)	Frequency response smoothness	EIN (dB SPL)	THD @500 Hz (%)	THD @800 Hz (%)	THD @1600 Hz (%)	Attack time (ms)	Release time (ms)	Recommendation	Updated on
IQbuds 2 MAX Wireless Hearing Amplifier												Coming soon
Air Pods Pro (2nd generation)	102.0 [19]	200 - 6,300 [19]		37.0 [19]	0.0 [19]	0.0 [19]	0.0 [19]	5.2 [12]	264.3 [12]			2023-03-28
Galaxy Buds 2 Pro	95.0 [19]	200 - 6,000 [19]		39.0 [19]	0.0 [19]	0.0 [19]	0.0 [19]					2023-03-28
Olive SmartEar Plus	97.2 [13]	215 – 6,650 [13]		27.4 [13]	1.8 [13]	0.6 [13]	0.1 [13]					2022-12-07
Olive Union Bluetooth Sound Amplifier	100.0 [19]	200 - 7,550 [19]		32.0 [19]	0.0 [19]	0.0 [19]	0.0 [19]					2023-03-28
BEAN Quiet Sound Amplifier	99.0 [19]	200 - 8,000 [19]		28.0 [19]	0.0 [19]	1.0 [19]	0.0 [19]					2023-03-28
SONACUS™️ ITC Mini Hearing Aid v1												Coming soon
SONACUS™️ ITC Mini Hearing Aid v2	109.0 [19]	200 - 5,600 [19]		28.0 [19]	0.0 [19]	0.0 [19]	0.0 [19]					2023-03-28
Elite 7 Pro	89.0 [19]	200 - 8,000 [19]		48.0 [19]	0.0 [19]	0.0 [19]	1.0 [19]					2023-03-28
Jabra Enhance™ Plus Hearing Aids	110 [15]	100 – 8,700 [15]	11.5 [15]	24.0 [15]	0.4 [15]	0.4 [15]	1.0 [15]					2022-12-07
Jabra Enhance™ Pro 10 Hearing Aids	113 [14]	100 – 9,410 [14]		20.0 [14]	0.5 [14]	0.2 [14]	0.4 [14]					2022-12-07
Lexie Lumen												Coming soon
Lexie B1 Powered by Bose												Coming soon
Lexie B2 Powered by Bose												Coming soon
Bose QuietComfort Earbuds II												Coming soon
Orka One												Coming soon
Eargo 6	109 [16]	125 – 5,600 [16]		30.0 [16]	0.7 [16]	0.8 [16]	0.6 [16]					2022-12-14
Tweak Enhance												Coming soon
E10 Self-Fitting OTC Hearing Aids	118 [17]	100 – 9,500 [17]		17.0 [17]	1.0 [17]	1.0 [17]	1.0 [17]					2022-12-19
SONY C10 Self-Fitting OTC Hearing Aids	114 [18]	100 – 8,600 [18]		20.0 [18]	2.0 [18]	3.0 [18]	2.0 [18]					2022-12-19
Best Hearing Aid Amplifier	114.0 [19]	500 - 3,365 [19]		29.0 [19]	1.0 [19]	0.0 [19]	0.0 [19]					2023-03-28
Britzgo Optio Hearing Aid Amplifier	113.0 [19]	200 - 5,000 [19]		30.0 [19]	3.0 [19]	3.0 [19]	1.0 [19]					2023-03-28
Jinghao A39	109.0 [19]	400-4,000 [19]		30.0 [19]	1.0 [19]	3.0 [19]	0.0 [19]					2023-03-28
Sennheiser Conversation Clear Plus												Coming soon
HD100 Companion Hearing Aid												Coming soon
HD75 OTC Hearing Aid												Coming soon
CS50+ Personal Sound Amplifier												Coming soon

Before purchasing an alternative listening device, we highly recommend consulting an audiologist for a complete hearing evaluation and an overall needs assessment. In many cases, a prescribed hearing aid may be necessary.

To report any mistake or to add an alternative listening device to this database, kindly email Alexis Pinsonnault-Skvarenina, MPA, Ph.D., audiologist and researcher, at apinsonnault@critias.ca

^1,2 Alexis Pinsonnault-Skvarenina, MPA, Ph.D.

^3,4 Mathieu Hotton, MOA, Ph.D.

³ Béatrice Guay, audiology student

³ Émilie Morissette, audiology student

³ Anaïs Gros-Louis, audiology student

¹ Valentin Pintat, ing.

^1,2 Jérémie Voix, ing., Ph.D.

• ¹ ÉTS-EERS Industrial Research Chair in In-Ear Technologies, École de technologie supérieure, Montréal, Canada

• ² Centre for Interdisciplinary Research in Music Media and Technology, McGill University, Montréal, Canada

• ³ Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada

• ⁴ Centre interdisciplinaire de recherche en réadaptation et intégration sociale, CIUSSS de la Capitale-Nationale, Québec, Canada

Please cite as:

Pinsonnault-Skvarenina, A., Hotton, M., Guay, B., Morissette, E., Gros-Louis, A., Pintat, V., Voix, J. (2023). Survey of North American alternative listening devices: Characteristics and electroacoustic performances. ÉTS-EERS Industrial Research Chair in In-Ear Technologies. https://critias.ca/otc

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