What Makes A Hearing Aid A Hearing Aid?

As an audiologist, the majority of my day is spent diagnosing and treating hearing loss.  As a result of my education and training, I understand that treating hearing loss is a process and requires the care and expertise of a trained professional to rehabilitate the patient to their maximum potential.  This may require counseling, aural rehabilitation, auditory training, communication strategies or assistive devices. However due to the constant bombardment of many internet sellers or big box retail outlets, this has set into motion the mindset for most patients to feel that all they need is a product and therefore are drawn to the cheapest option or the best deal!  One question I am asked frequently is “why should I spend $X amount on hearing aids when I can purchase a pair at the grocery store down the street for a fraction of the cost?”  

I feel that one answer to this question lies in the confusion between hearing aids and personal sound amplification products or PSAPs.

Hearing Aids

According to the FDA, a hearing aid is defined as “any wearable instrument or device designed for, offered for the purpose of, or represented as aiding persons with or compensating for, impaired hearing” (21 CFR 801.420).  They can be considered a Class I or Class II medical device.  As such, manufacturers must adhere to strict guidelines on the manufacturing and design of the devices, as well as spend thousands of dollars in registration fees.

Hearing aids also require the medical clearance of a physician and must also include a medical evaluation for hearing aid candidacy dated no longer than 6 months prior to the fitting of the hearing aids.  

Hearing aids are very sophisticated computers that have an array of features to address various situations and complex listening environments.  They employ options such as directional microphones, advanced noise reduction, wireless communication between instruments, speech enhancement and feedback control.  Also, they allow the audiologist or dispenser to program the devices to the patient’s degree of hearing loss, ensuring the amplification is appropriate, comfortable and safely fit.

I work with several hearing aid manufacturers and I am always eager to learn about the newest features and options on the products.  With each new generation of devices, the manufacturers and other third parties (such as universities), spend a significant amount of time and money to research their products and verify claims on the benefit of these new features.  As a result, I am able to feel confident in fitting these products to my patients knowing they are receiving the highest quality and the best chance for communication success with these devices.

This brings up another reason why hearing aids tend to be more expensive than PSAPs–the professional fitting them.  Hearing aids require a hearing test, selection of appropriate styles as well as programming by a hearing care professional.  Since these services are incorporated into the overall cost of the devices, hearing aids are almost always the more expensive option.

Personal Sound Amplification Products (PSAPs)

Personal sound amplification products (or PSAPs) on the other hand are intended as a recreational product for users with normal hearing to simply increase volume in one specific situation.  Examples include those used for hearing game while hunting, bird watchers or those that may need to hear at a distance like in a large lecture hall or classroom.   

The FDA further states that these products are not intended to diagnose, treat or mitigate disease and therefore there is no regulation for these products–vastly different from the regulations set for hearing aids.  They are not considered medical devices and therefore are not held to the same standards as hearing aids per the FDA.   

To further understand the difference between PSAPs and hearing aids, I like using the analogy of a basic calculator versus a tablet/ipad.  The calculator does a great job for basic math functions, but should you require the need to stream a movie, check the stock market or read a book the tablet far exceeds the capabilities of the calculator.  You would need to purchase several different products in order to perform the same tasks of the tablet.

There is a place for PSAPs and I often recommend them to my patients.  They are typically those I have found to have normal hearing sensitivity but notice significant hearing difficulties in certain situations, such as with the TV or on the phone at work.  

However, I have also seen the misuse of these products as well.  Some patients I have seen spend hundreds of dollars on these devices without benefit only to find they had middle ear fluid or a wax impaction and should have been treated by a physician.  Sadly due to their negative experience they are now wary of a technology solution for their hearing difficulties, yet had they consulted with a hearing care professional this unfortunate situation could have been avoided.

As an audiologist the majority of my day is spent diagnosing and treating hearing loss.  As a result of my education and training, I understand that treating hearing loss is a process and requires the care and expertise of a trained professional to rehabilitate the patient to their maximum potential.  This may require counseling, aural rehabilitation, auditory training, communication strategies or assistive devices. However due to the constant bombardment of many internet sellers or big box retail outlets, this has set into motion the mindset for most patients to feel that all they need is a product and therefore are drawn to the cheapest option or the best deal!  One question I am asked frequently is “why should I spend $X amount on hearing aids when I can purchase a pair at the grocery store down the street for a fraction of the cost?”  

I feel that one answer to this question lies in the confusion between hearing aids and personal sound amplification products or PSAPs.

What’s Next?

So how should a patient proceed? I encourage you to start by talking to your primary care physician.  Your physician will be able to guide you to a medical professional trained in hearing health.  A caring healthcare provider wants you to get the most out of your treatment solution as well as find something that fits your budget. Also, they will help to rule out problems with the ear that require medical treatment.