PSAPs appear to work (but preventing hearing loss is better)

Photo credit: Hadley Paul Garland licensed under CC BY-SA 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

Personal sound amplification products (PSAPs) appear to work. What is a PSAP? It’s really a hearing aid but it’s called a PSAP to avoid federal and state regulations. PSAPs can be sold directly to consumers without a physician or audiologist evaluation, and they are much cheaper than conventional hearing aids–in the range of $350 a pair instead of $3000 apiece.

This Research Letter in a recent issue of JAMA compared five PSAPs with a conventional hearing aid. The Johns Hopkins research team reported that some of the PSAPs worked quite well. Four of the PSAPs are traditional “behind the ear” devices that look like cheaper, less well made versions of traditional hearing aids, but one, the Etymotic Bean, might be placed into the newer category of “hearables” that are marketed as “smart earbuds.”

Why is this report important? PSAPs were strongly recommended by two recent expert federal reports (a report from the President’s Council of Advisors on Science and Technology in October 2015​ and a report from the National Academy of Medicine) as a solution–perhaps the solution–to the nation’s epidemic of hearing loss in older Americans.

To some they are the holy grail for hearing loss, enabling all to hear well without spending thousands of dollars. To others, especially audiologists and hearing aid dispensers, they are an existential threat. If grandma and grandpa can buy much cheaper hearing aids on their own from Amazon or Costco, why see an audiologist or hearing aid dispenser? Just buy your PSAPs online or at your nearby big box store.

Unfortunately, neither federal report mentioned the prevention as a solution for hearing loss. As I said in my presentation at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich on June 20, 2017, significant hearing loss is probably not part of normal aging but is noise-induced hearing loss caused by a lifetime of excessive noise exposure.

The inconvenient truth about hearing aids is that they don’t work very well at helping users understand speech in normal, everyday situations. For obvious reasons, there is little peer-reviewed research on this topic in the audiology literature, but two studies report approximately 40% non-usage rates. There is no reason to expect–especially without any training and teaching by an audiologist–that PSAP users will have any greater success.

Needing hearing aids or PSAPs in old age to treat hearing loss is not normal, just as needing complete dentures in old age because of tooth loss from poor dental care is not normal. Both are the only remedies available when we have failed to protect what Mother Nature gave us. But it’s much better to protect your ears and preserve your hearing than to use even the best hearing aid or the less costly PSAP alternatives.

The time to start protecting your ears is now! If it sounds too loud, it IS too loud. Avoid loud noise, and if you can’t avoid it, wear hearing protection.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

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