Lively: Committed to Audiology

At Lively, our commitment to audiology runs deep: Not only are we advised by some of the top audiologists in the world, but we make sure each and every Lively client meets face-to-face with a licensed audiologist.

However, as a new company we realize there are bound to be questions about us and our use of technology for hearing assessments and remote face-to-face care. We've therefore created this page to help provide clarification and background to the professional community.

The Science of Online Hearing Tests

Thanks to significant technological advancements and research1 over the past few years, online hearing tests can now be used to safely and effectively fit hearing aids.2

Building on this work, we've done a tremendous amount of research on a wide-range of devices and headphones, and have developed our own online hearing assessment with what we've learned. Given our pre-launch testing across different transducers and operating systems, we're confident that when augmented with face-to-face support and ongoing remote tunings by a Lively audiologist our test enables us to effectively fit a hearing aid and improve a client's hearing. So far, our approach has proven well-founded, as we've received excellent initial customer satisfaction scores.

Of course, providing effective audiological care extends beyond a customer's online hearing test and initial fitting. Lively customers are monitored for improvement, and our audiologists use the Client Oriented Scale of Improvement (COSI) to ensure we address their specific hearing needs and goals.

Focusing On Accessibility

Hearing care has an accessibility problem. In fact, 70-85% of adults 50+ with hearing loss do not receive the care they need.

We're committed to changing this. We use telemedicine technologies and online hearing assessments at Lively to make audiologist-tuned and monitored hearing aids available to anyone who meets the requirements and has an internet connection. Recent studies have shown that approaches like ours are effective at making hearing care more accessible.3

While Lively can help increase the accessibility of hearing care, there will always be a need for traditional audiology practices. Many patients will opt for in-person care, or will need access to procedures such as otoscopy, probe-microphone measures, and advanced diagnostic testing. For these reasons, Lively will never replace the traditional model, only augment it.

The Highest Standards

We're committed to complying with all laws and regulations related to online audiology and our legal team works closely with our Board of Advisors and company executives to ensure Lively always upholds the highest standards of the industry.

Come Grow With Us

If you're a licensed audiologist and want to help Lively make audiologist-based hearing care more accessible, let us know. While our waiting list is full, we'll be happy to reach out as soon as there's an opening.

Frequently asked questions

  • As a result of considerable tele-audiology research in recent years (Swanepoel et al, 2010; Krumm, 2016), remote hearing assessment and hearing aid fitting is now recognized as an evidence-based approach for providing hearing services to more people who need them. For proof of this positive change in professional opinion, you might want to read two editorials in the Journal of the American Academy of Audiology - one in the June 2016 issue entitled "Perceptions of Internet Delivery of Hearing aids (Jacobson, 2016) and the other, published in February 2017 entitled "Build a better assessment and patients will beat a path to your clinic (McCaslin, 2017).

  • Yes. Audiologists were involved from the outset in the development of the Lively approach for hearing assessment and hearing aid fitting. These leaders in the profession still provide expert advice on the entire process. In addition, full-time audiologists are in close and constant contact with people who turn to Lively as an option for amplification, beginning with initial questions about Lively and the initial online hearing assessment to the hearing aid fitting and throughout long-term follow up.

  • That's a reasonable question because as audiologists we typically perform an inspection of the patient's external ear canals before beginning hearing assessment. Perhaps someday technology will be available for self-examination or online directed examination of the external ear canals. Until then, Lively takes several steps to address the issue of ear canal status. Prospective Lively users are specifically asked about past problems with excessive cerumen. Persons with such a history are encouraged to seek medical consultation. In addition, prospective Lively users complete the Consumer Ear Disease Risk Assessment, or CEDRA. The National Institutes of Health funded research on this validated 15-item consumer questionnaire to detect disease risk before a person purchases hearing aids. You can access CEDRA on the Lively website.

    It's appropriate to also point out here that within the past few years we've witnessed a trend toward relaxation of Federal requirements for a medical examination prior to the purchase of hearing aids. The proposed Over-the-Counter Hearing Act of 2017 is one example.

  • No. Children or anyone under the age of 18 years should seek hearing health care directly from a licensed audiologist. Lively is for adults who are concerned about their hearing, and who are motivated to look into the possibility of amplification to improve their communication abilities.

  • We can anticipate that in a small proportion of adults hearing loss is a symptom of a disease requiring medical evaluation and possible treatment. Scores on the CEDRA will identify those patients. Someone who contacts Lively and reports problems such as sudden onset hearing loss, a unilateral hearing loss, or a progressive hearing loss are advised to seek medical attention. However, according to published research (Zapala et al, 2010), the majority of older adults with hearing impairment do not need medical services. Direct access for hearing problems poses little risk in this population.

  • Yes. Research from around the world confirms that pure tone hearing screening and assessment conducted online, or even with a smart phone, yields results comparable to the conventional hearing assessment conducted by an audiologist with the patient in a sound-treated room (Whitton et al. Validation of a self-administered audiometry application: An equivalence study. Laryngoscope, 126 (10), 2382-2388, 2016). You'll find on this Lively website links to some of the papers reporting data in support of online hearing testing. You can find many more with a PubMed literature search at In fact, there are also plenty of papers validating online assessment of speech perception in quiet and noise.

  • As we mentioned in the response to previous questions, strategies for hearing assessment and rehabilitation of hearing loss are rapidly changing. Tele-audiology is now a reality for hearing health care. Almost anything an audiologist does in a traditional clinical setting can now be done just as well remotely using technology and techniques involved in tele-audiology. Outcome research within the past decade confirms that audiology services delivered via tele-audiology produce patient benefit equivalent to what we would expect for traditional face-to-face clinical services that are consistent with best practices.

  • While probe-microphone verification represents an audiologic best practice, technological developments such adaptation algorithms, Lively's frequent face-to-face follow-up schedule and our ability to remotely fine-tune the full suite of hearing aid features has yielded excellent client outcomes.

  • As noted above, we schedule regular and frequent face-to-face follow-up appointments after the hearing aid fitting. This allows us to identify any problems requiring additional instruction, counseling and/or program modifications which we can implement remotely. Our protocol includes the use of the COSI to identify client-specific problems, establish client-specific goals and measure client-perceived outcomes.

  • Actually, the Lively model expands and extends audiology services to more patients. It's important to reiterate that audiologists are involved in each step of the Lively process. People with hearing loss and difficulties with communication now have different options for seeking hearing health care. These people value convenience and cost-effectiveness as they attempt to find a solution to their communication problems. The increased public interest in OTC products is evidence for this trend. Lively offers an attractive audiology-focused option for adults who have hearing loss and who have decided it's time to do something about it.