Author: Nicholas S. Reed, AuD

OTC hearing aids won’t be out until at the earliest 2020-2021 once the regulations go into effect.  What to do until then? Enter the PSAP.

In a previous blog post, we talked about the Over-The-Counter (OTC) Hearing Aid Act. However, OTC hearing aids won’t be out until at the earliest 2020-2021 once the regulations go into effect.  What to do until then? Enter the PSAP. Personal sound amplification products or PSAPs are not hearing aids as they are not regulated by the FDA. Some of them have a similar appearance to hearing aids, and, although they can’t be advertised as helping one’s hearing, they can often function as such. Generally, only worn on one ear (i.e. sold as individual units), advances in technology have propelled some of these devices into the spotlight as having similar technologic capabilities as hearing aids. In fact, some of these devices are being used in studies already as over-the-counter solutions for low cost care to address hearing loss.

I think the keyword in that last sentence is “some.” The current PSAP market is unregulated and consists of some fantastic devices that may provide a low-cost option to enter the hearing device market. However, there are many other, much more limited devices which are not technologically capable of improving listening. In fact, in studies where we’ve teamed up with students and faculty from the Towson University Audiology program, we’ve found that poor devices can actually make it more difficult to listen compared to no device at all. These devices produce static and distortion that make listening even more difficulty and these devices demonstrate that simply turning up the volume clearly doesn’t help – for example, think about when you have a bad cell phone connection, volume doesn’t really help as it’s the signal itself which is distorted. For the average consumer, this unregulated market can present a difficult market to navigate.

If you’ve decided you need help and are not ready to try hearing aids, but where trying something is better than nothing at this moment, how do you know a good PSAP from a not so good one?

If you’re interested in trusting the opinion of others, there are already some reviews available from organizations like Consumer Reports and The Wirecutter. These organizations have made an attempt to help parse apart the market and highlight some quality devices. Further, it does not hurt to ask a professional for their opinion. An audiologist is an expert in hearing care and can quickly tell a quality device from a less than capable device. Some (but not all) audiologists can provide such consultation and evaluation services on a fee-for-service basis.

If you’re shopping around on your own, it’s best to avoid very inexpensive devices (less than $100-$150) that make claims that are too good to be true but offer little substance about technologic capabilities. Instead look for devices that actually offer specifications. For example, a good company will actually tell the consumer the technologic capabilities and features of the device rather than simply relying on claims about how great their device is. These specifications and features may read like a foreign language. Some key words to look for include the frequency response (i.e. the range of frequencies that device can amplify sounds – a good device should amplify above at least 2000 Hz), the number of channels (these allow for customization at different frequencies or pitches – more = better) the device has and the output levels (in decibels or dB) of the device.

Other tech features to look for include microphone directionality, noise reduction, feedback cancellation/suppression, Bluetooth (enables customization via a smartphone), a telecoil, and remote microphones.

• Directionality and digital noise reduction are features that aim to help speech-understanding in noise by attempting to focus on what’s in front of the wearer and reducing sound that has the characteristics of noise (e.g. a steady hum sound like an air conditioning unit) via a digital process. They are not perfect but may help slightly improve a tough situation.
• Feedback suppression helps reduce that high-pitched whistling sound sometimes associated with hearing devices. Keep in mind, a proper fit (i.e. a snug earpiece) will help reduce feedback.
• Bluetooth connections to smartphones are particularly useful and a hallmark of higher quality devices as it allows greater customization than just a typical volume control. Some PSAP manufacturers have smartphone apps that offer a hearing test from the device to customize the PSAP, and some have a preference guide that offers examples of different feature combinations for the wearer’s preference (think about this slightly like when the optometrist says which do you prefer, number 1 or number 2 and so on). Bluetooth also opens the potentials for streaming music or calls.
• The telecoil is a copper wire sensor in the PSAP that allows for more direct access to sound wirelessly with compatible telephones and public and private spaces (e.g. museums, concert halls, etc) equipped with an induction loop to emit a wireless signal for direct connection. Note that not all locations have induction loops (in fact, too few do).
• A few PSAPs provide a remote microphone that allows for a more direct signal to the device. The remote mic is placed near a signal of interest (clipped to the lapel of a speaker or placed near a podium) and transmit directly to the PSAP. This is a great way to overcome a specific difficult listening situation like a noisy restaurant when you want to hear one other person.

Something to keep in mind if you are inclined to pursue a PSAP is to have reasonable expectations.

Always remember that it takes time to acclimate to any form of amplification and what you consider noise isn’t necessarily what the device considers noise (i.e. the device can’t select sounds that are pleasant and unpleasant to the user – our brains have to filter those sounds). Moreover, these devices are not perfect and are not miracle devices. They represent a potential early step for someone needing help in specific situations. If you find they aren’t meeting all your needs, it may be time to consult an audiologist for help customizing and maximizing the device’s capability or considering different options, like hearing aids.

One last point, if you think you have hearing loss, getting a formal evaluation by an audiologist is always recommended to establish a baseline and rule out any known, treatable causes for hearing loss. Such evaluations are covered by Medicare (with a physician’s referral) and nearly all insurance companies.