4.4. In the absence of a global standard, quality products struggle to compete in unregulated markets as many low-cost suppliers have emerged that have products of variable or unknown quality.

In order to respond to the need for hearing aids at lower price points in L.M.I.C.s, multiple smaller manufacturers, primarily Chinese, offer products at lower prices but of unknown quality. These include suppliers who are either manufacturing in L.M.I.C.s or primarily supplying to L.M.I.C.s. These companies have not been able to establish any reputation and due to the lack of global quality certifying mechanisms, it is difficult to differentiate between high and low quality in this category.

Anecdotally, quality concerns include poor sound amplification, over-amplification, lack of directional microphones, and poor durability. Products, as seen in Figure 5, are commonly sold through an unregulated market at retail points, such as small electronics shops, at price points as low as U.S.$4 and often without appropriate tests or provision.