OTC hearing aids have no professional support ecosystem for fitting or troubleshooting

The FDA's 2022 OTC hearing aid rule created a new category of devices that adults with mild-to-moderate hearing loss can buy without a prescription, at prices of $200-$1,000 vs. $4,000-$7,000 for prescription aids. But the rule created a support vacuum: audiologists generally cannot use manufacturer proprietary fitting software on OTC devices, limiting them to adjusting only the user-facing settings. Many audiologists are reluctant to service OTC aids at all because there is no established reimbursement pathway. So what? Buyers who struggle with fit, feedback, or sound quality have nowhere to turn except YouTube videos and Reddit threads. So what? An estimated 80% of people with hearing loss qualify for OTC aids, but without professional guidance, many get devices that are poorly fitted to their ear canals or inappropriately amplified for their hearing profile. So what? They conclude 'hearing aids don't work for me' and return to untreated hearing loss -- the very outcome the OTC rule was designed to prevent. This persists because the OTC regulation focused entirely on removing purchase barriers without building any corresponding support infrastructure, and audiologists' business models depend on bundled prescription sales that OTC devices threaten.