If you are experiencing signs of hearing loss and have done any internet research about amplification, you have probably come across several seemingly synonymous products which are functionally quite different: hearing aids, over-the-counter (OTCs), and personal sound amplification products (PSAPs).
So which device should you choose? Let’s start by comparing PSAP vs Hearing Aid in this article.
What is a hearing aid?
A hearing aid is an electronic device worn on the ear to provide a customized level of amplification determined by an individual’s degree and type of hearing loss. Hearing aids are selected and programmed by an audiologist or dispenser and customized to the individual patient. They come in a variety of styles including behind-the-ear (BTE), receiver-in-canal or receiver-in-the-ear (RIC/RITE), in-the-ear, (ITE), completely-in-canal (CIC), and invisible-in-canal (IIC).
Hearing aids are a medical device that is regulated by the Food and Drug Administration (FDA), meaning that they go through rigorous testing before being commercially available. Additionally, hearing aids are only fit after completion of a diagnostic hearing test and the determination that an individual is a good audiological and medical candidate for amplification.
What is a PSAP?
A personal sound amplification product, or PSAP, is a device that looks similar to a behind-the-ear hearing aid. It is designed to make sound louder. It is not customized for the individual’s hearing loss, nor is it discriminating between different sounds in the environment and making determinations about what to amplify (i.e. speech versus noise). PSAPs can be purchased in stores or online and are generally quite inexpensive. In a nutshell, PSAPs are worn on the ears and make everything universally louder. They are not FDA regulated and can be purchased directly by consumers.
What is an OTC?
Over-the-counter hearing aids, commonly referred to as “OTCs” are a class somewhere in between traditional hearing aids and PSAPs. They can be purchased directly by consumers but do have some degree of customization beyond what is offered with PSAPs. In August of 2022, the FDA passed legislation allowing these types of devices to be sold directly to consumers; so, they are regulated by the FDA, but are not fit by a licensed professional.
Many OTCs have a “self-fitting” model, meaning that the patient will self-administer a hearing test and the OTC devices will accommodate that measured hearing loss, to some extent. OTCs also have more sophisticated technology for determining speech versus noise than what is available in a PSAP but are not as advanced as traditional hearing aids.
You can think about hearing aids, OTCs, and PSAPs as a sort of spectrum of high-end technology to low-end technology. If we were to compare these devices to televisions, traditional hearing aids would be your HD TV with Bluetooth compatibility and a full suite of specialty channels. OTCs are a mid-level TV with basic cable, and PSAPs are a television with one channel that is either on or off.
PSAP vs Hearing Aid: How Should I Choose?
There are many considerations when making a decision regarding amplification. Here are a few of the main factors that might influence where to start.
As with many things, more technology means more expensive, which can be a significant determining factor. Medicare does not cover the cost of hearing aids. Some commercial insurers offer some level of hearing aid benefit which will contribute to the cost but likely not cover them entirely. Hearing aids can cost anywhere from $2,000-$7,000 for a pair depending on the technology level and the services bundled in. The common model in the United States is to include service fees, repair costs, warranty, cleaning, etc., in the cost of the hearing aids, so while they are a large investment up front, the continued maintenance of being a hearing aid user should be minimal at least for the first few years.
OTCs are still an investment, with an average cost of $1,600-$3,000 for a pair, according to the National Council on Aging (2022). This would not include any services from a professional and relies on the user to perform their hearing test and run the programming algorithm accordingly.
PSAPs are definitely the least expensive option, sold for as low as $50 for a pair. They do not have any accompanying service or technology to customize them to the individual but are more comparable to wearing a small set of microphones on your ears.
With any of these devices, it is important to investigate the trial period. State laws mandate trial periods for traditional hearing aids, which can range anywhere from 30 days to 180 days and may vary depending on the setting where you purchase the hearing aids. Some OTCs also offer a trial period of 30-45 days. Be mindful that it often takes time to adjust to amplification and that the benefits may not be immediate. Being aware of the trial period for your devices can lessen some of the financial stress if you are unsure about whether you are making the right decision.
Degree/Type Of Hearing Loss
Traditional hearing aids are designed to fit hearing losses from mild to profound and hearing losses that are sensorineural, conductive, or mixed. Hearing aids are only fit after a diagnostic hearing test, and this may involve a referral to a physician, depending on the results of the hearing test. For example, suppose there is a significant difference in hearing sensitivity between the two ears. In that case, the audiologist will likely refer to an ear, nose, and throat physician to confirm there is not an underlying medical issue causing the asymmetry.
Additionally, an audiologist may make a recommendation about a specific style of hearing aid best suited for the degree of hearing loss, such as an open-fit RIC/RITE for sloping, high-frequency hearing losses commonly seen in aging. OTCs are designed for mild-moderate hearing losses and are usually fit based on a self-administered hearing test. This type of at-home hearing test is not going to be as precise as a diagnostic audiogram because of the equipment used and because of the environment in which the test is performed (a soundproof both vs. your home). This means there is potential for over- or under-amplification, depending on the accuracy of the hearing test.
PSAPs do not require any type of hearing test to function, as they make all sounds louder. It is important to recognize that, aside from the lack of distinction between noise and speech, PSAPs also have the potential to provide too much amplification, which can ultimately exacerbate hearing loss if worn long-term. Likewise, they may not be sufficient for greater degrees of hearing loss. Additionally, most hearing losses are more severe in the higher frequencies (pitches), which would not be accounted for with PSAPs. This could result in distorted sound quality.
In the case of both PSAP vs hearing aid, it is possible that underlying medical or audiological conditions causing or contributing to hearing loss could be missed. Even something as simple as excessive cerumen (earwax) would not be identified by going the direct-to-consumer route. This has the potential to influence the accuracy of the hearing test and also limit the functionality of the devices. Additionally, introducing an object into your ear canal promotes the production of more wax, so daily use of hearing aids could contribute further to the issue.
If you suspect there might be any underlying issue with your hearing loss, or you are experiencing symptoms in addition to hearing loss, such as tinnitus, ear pain, dizziness, or vertigo, you should consult a professional for a full diagnostic audiogram prior to pursuing amplification, even if you choose not to go with traditional hearing aids.
Traditional hearing aids are quite sophisticated, and the technology has come a long way regarding connectivity, hearing in noise, and ease-of-use features regarding rechargeability and user controls. Hearing aids can be as simple or complicated as the user wants. They can be programmed in a “set it and forget it” model, in which the user simply puts them on in the morning and takes them off before bed, allowing the hearing aids to transition in and out of different environments and make automatic, adaptive changes accordingly.
Other users like to stream media and call through their hearing aids via Bluetooth, change programs manually on a proprietary app, and use additional assistive listening devices such as remote microphones for more difficult listening environments. OTCs rely upon some degree of tech-savviness on the user’s part to self-administer the hearing test and use the programming algorithm. They also have some flexibility to make changes based on environment and volume control. PSAPs are more of an on/off device with some volume control.
Users who require more advanced technology in their daily life or, on the opposite end of the spectrum, who need more personalized guidance from a professional on the use of their devices, may find benefit in the added service component of traditional hearing aids. Other users on the fence about pursuing amplification or feeling confident in the user-directed application may do quite well with OTCs. For some users, PSAPs or OTCs may also serve as a stepping stone to ultimately pursue traditional hearing aids down the road.
PSAP vs Hearing Aid Conclusion
If you are considering amplification, obtaining a professional hearing test is always a good place to start. It will provide some peace of mind that you a good audiological and medical candidate for amplification, and you are not obligated to purchase hearing aids from that professional on that day. You may choose to look at your hearing test results and do some educated research on the best option for you based on your financial situation, hearing loss degree and type, and your lifestyle and technology needs.
Erin Edwards received her Doctor of Audiology degree from Towson University in 2015 and her Ph.D. in Education and Leadership from Pacific University in 2022. She has worked with patients of all ages in a variety of settings and has a specific interest in cochlear implants, the relationship of hearing loss and dementia, and interdisciplinary healthcare.