Hearing loss affects more than 26 million Americans age 50 and up, but nearly 80 percent of that group isn’t doing anything about it. One reason is that the cost of a traditional pair of hearing aids averages thousands of dollars.
That’s why newer, less-expensive devices, called personal sound amplification products, or PSAPs, have become a tempting alternative for many people with concerns about their hearing.
How they might help
PSAPs, often simply called amplifiers, are sold directly to consumers in stores or online. Their cost ranges from about $20 to $1,000 a pair, still a fraction of the price of hearing aids.
The devices share some characteristics with the hearing aids you get through an audiologist. And backed by the researchers we spoke with, studies suggest that PSAPs used on occasion can be helpful—particularly during the period between the earliest signs of diminished hearing and the point at which hearing loss is becoming an impediment to communication and everyday living.
“A PSAP could be the first step for entry into the hearing healthcare system,” says Barbara Weinstein, Ph.D., professor and executive officer of the doctor of audiology program at the City University of New York. “It will raise awareness to what’s out there, to the value of having sound amplified in specific situations.”
The U.S. Food and Drug Administration doesn’t regulate PSAPs because they aren’t considered medical devices like hearing aids. But that may be changing. The FDA announced in December 2016 that it will consider creating a category of over-the-counter hearing aids that “could deliver new, innovative, and lower-cost products to millions of consumers.”
“Hearing aids and PSAPs both can improve your ability to hear sound,” said Eric Mann, M.D., Ph.D., deputy director of the FDA’s Division of Ophthalmic, Neurological, and Ear, Nose, and Throat Devices, in a statement. “They are both wearable, and some of their technology and function is similar.”
But even audiologists who support the use of PSAPs for some patients warn that they’re not for everyone—and are particularly unsuitable for severe hearing loss. That’s because PSAPs can vary significantly in quality.
Certain products are no help at all and can even irritate the ears, according to Nicholas Reed, Au.D., an instructor at Johns Hopkins University School of Medicine, who is conducting research on the devices.
Traditional hearing aids
When properly fitted by an audiologist, a true hearing aid best serves the needs of someone with hearing loss. The audiologist not only tests the patient’s hearing but also profiles the contours of the ear and programs the device according to the patient’s particular needs.
This often requires multiple office visits for adjustments over a period of months. The audiologist’s time as well as the cost of the FDA-approved device itself account for much of the price of the hearing aid.
But not everyone who needs a hearing aid is willing or able to pay for one or to make all those office visits. And if you believe your hearing issues don’t yet warrant a full hearing aid, it might be worth considering a PSAP.
What to know about PSAPs
At their most basic, both hearing aids and PSAPs have a microphone, which receives ambient sound and converts it to an electrical signal. An amplifier boosts the strength of the signal, and a speaker converts the signal back for the listener. A battery powers the operation. The simplest PSAPs do merely that, but more complex models typically costing $200 to $400 per ear behave more like hearing aids.
With some low-end PSAPs, you clearly get what you pay for. “You’re basically running a computer in your ear,” Reed says. “And we all know with computers, some of these devices can make a lot of noise just processing. If that sound is loud, it doesn’t matter what you’re trying to listen to—all you’re going to hear is the hearing aid.”
Another limitation of the cheapest PSAPs is that they either amplify the entire signal they receive, across the gamut of the hearing range, or boost only the lowest tones. The trouble, explains Reed, is that age-related hearing loss occurs in the higher frequencies. It’s uncommon, in other words, for someone to need help with the lower tones.
Of 10 PSAPs Reed tested for his current research, one particular device stood out for those reasons and more: the $30 MSA 30X Sound Amplifier, sold at Walmart, drugstores, and As Seen on TV outlets. “It amplified only at some lower frequencies, added distortion, and produced noise off the charts,” he said. The Johns Hopkins researchers used a microphone system to measure sound in a lab; no individual wore the device.
Consumer Reports tested the same MSA 30X and another inexpensive model, the $20 Bell & Howell Silver Sonic XL, using a panel of employees diagnosed with mild to moderate hearing impairment. Both models, said its report, “showed very little benefit in any of our tests and sometimes actually blocked incoming sound the way earplugs do.”
Even more of a concern, Consumer Reports reported, is that inexpensive devices “have the potential to cause additional hearing damage by over-amplifying sharp noises, such as the wail of a fire engine.”
Pay a couple hundred dollars more, however, and the selection of PSAPs becomes far less problematic. Among the higher-end PSAPs Johns Hopkins tested were two that Consumer Reports also tested, the Sound World Solutions CS50+ ($350 per ear) and the Etymotic Bean ($300 per ear).
In Reed’s tests, both PSAPs’ frequency output (what the wearer of the device hears) fell within prescribed targets, and both have safeguards to keep from overamplifying any part of the hearing range.
The CS50+ can pair with other devices over Bluetooth, so you could take a phone call or stream music over it. And one version of the Etymotic Bean supports telecoil, a technology that lets the PSAP pick up sound magnetically from compatible phones and sound systems, such as in museums or speaking halls.
Panelists for Consumer Reports’ tests, though, said neither device significantly helped them decipher conversations in a noisy lab setting.
Is a PSAP for you?
At least for the models that performed better in the tests, PSAPs can benefit those with early hearing issues, Reed says. Because hearing loss is gradual, a PSAP could be helpful in specific situations where hearing difficulties are first noticeable—say, while you’re watching TV, attending religious services, or eating in a crowded restaurant.
While acceptance of any hearing device tends to be highly individual, a good PSAP can bridge the gap between no device and a full-fledged hearing aid for many.
“Using a lower-end technology now, such as an appropriate PSAP, can help set the stage for later, when your hearing does decline to the point where you are ready and motivated to purchase a hearing aid,” Weinstein says.
Setting one up is simple: Charge or pop in a battery, then choose from among multiple ear tips to attach to the PSAP before guiding it into your ear canal. Set the device in or behind the ear as instructed.
The Sound World Solutions PSAP resembles a Bluetooth headset, while the Etymotic device looks like an earplug. Further setup guidance is available via email or phone if you’re having trouble, but videos found on product websites can also walk you through it.
The two models have manual switches for loudness adjustment, but Sound World Solutions offers extra setup via smartphone, tablet, or computer so that you can adjust the bass and treble, for example, or screen out restaurant noise. Additional functions, such as call answering or music streaming, a remote microphone, and multiple listening modes, require some practice.
Certain PSAP makers advise you to gradually increase how long you use their products until you’re accustomed to them. But if you decide a PSAP isn’t for you, the major manufacturers offer 30- to 60-day money-back guarantees. Most warrant the product against defects for a year, but check terms before you buy.