One of the things that has always bothered me about the hearing aid space, is the lack of a variety of skin tone options for mid to darker skin tones. Recently I went on a deep-dive of information seeking about Over-the-Counter (OTC) hearing aids. I came across a fascinating article by Kirjava and Faulkner (2024) that compared the color options available of FDA cleared OTC hearing aids with a range of skin colors. The authors comment “structural racism in the form of colorism has not been evaluated in the OTC hearing aid market. If present, this colorism may potentially limit OTC hearing aid uptake for individuals with relatively darker skin. As OTC hearing aids are an emerging market in the United States, there is room for great improvement in product selection, as hopefully the awareness of colorism with these devices will change future colorway options”.
To give some history, OTC hearing aids are fairly new the the market. in 2022, the FDA created a new category of self-fitting hearing aids in part to help increase access to hearing care for Americans. The biggest barriers to people with impaired hearing to obtain hearing aids is access and cost. OTC devices are supposed to be the solution to that. This article, however, adds an additional barrier: skin color choices.
In their research, Kirjava and Faulkner (2024) identified 134 FDA cleared OTC hearing devices registered in the FDA database. Of those 134, they removed duplicate listings, devices where no images could be found online, devices where no skin-color models were available, and where the models could not be matched to the FDA database resulting in 83 devices included in the data set.
Once the data set was established, they selected a single-pixel of color from the phots of the devices they were able to obtain. The HEX color value was then converted to a CIELAB color. From there, an 11 color skin-color palette was used to represent a variety of skin colors. The skin color with the smallest difference value to the CIELAB color difference formula were “recorded at that device’s most similar skin color”.
The results revealed, not surprisingly, that the 5 lightest skin colors accounted for 81.8% of devices. According to the authors “far more hearing aids in the sample were offered in relatively lighter color, with few or no options available for darker skin colors”. Based on these results “BIPOC individuals are much less likely to have access to OTC hearing aids that best reflect their skin tone, which both perpetuates systemic racism in product development and limits more affordable hearing care options due to the stigma that can come with visibly wearing a hearing aid”.
The OTC market is emerging, but these findings are important for Audiologists to consider when discussing amplification options for their BIPOC patients. Having items that match your skin-tone is a big deal, especially when there are many other barriers to healthcare in the first place.
Dr. White, AuD 