Assistive Listening Devices (ALDs)
Assistive listening devices can work with your hearing aids or independently to improve your hearing. Some examples include:
Personal Sound Amplification Product (PSAPs)
There is no doubt that if someone is having problems hearing and they purchase an over-the-counter product or PSAP (Personal Sound Amplification Product), they may indeed get benefit from the device. However, since PSAPs are not regulated in the same way as hearing aids, the device makes sound louder but it doesn’t actually ‘fit’ the loss. In our practice, we have seen many of these devices that individuals have purchased.
Click the images below to see the results of the tests we’ve done on these products.
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Photo 1: Real-Ear Measurement
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Photo 2: Real-ear measures with a programmable PSAP purchased by a patient online.
Photo 1: Real-Ear Measurement
We have tested them with Real Ear Measures and found that the devices sorely lack the necessary signal processing necessary to address the hearing loss. In photo #1, you can see that the solid green line does not match up with the dotted green line. The dotted green line is the target we aim for to ensure that average conversational loudness is heard by the patient. This device clearly is not providing the necessary loudness and since it is a PSAP, it has limited to no ability for us to ‘close the gap’.
Photo 2: Real-ear measures with a programmable PSAP purchased by a patient online.
Contrast this PSAP to the one in photo #2. This device actually does a pretty good job at meeting the target’s but again we were limited in how much we could program the device to the patient’s hearing loss.
FDA-approved devices at big box retailers
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Photo 3: Real-ear measures with actual hearing aid purchased at a big-box retailer (before we adjusted the aid using real-ear testing).
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Photo 4: Real-ear testing with big-box retailer hearing aid after programming for a few minutes.
Photo 3: Real-ear measures with actual hearing aid purchased at a big-box retailer (before we adjusted the aid using real-ear testing).
Contrast these PSAP magnifiers to hearing aids that were purchased at a big-box retailer. The hearing aids purchased at big box retailers are good, state of the art devices that are truly hearing aids, i.e., they meet the FDA’s regulation for sale as hearing aids. However, again, it all about how the device is fit to the individual to meet the needs of their hearing loss. In photo #3, we tested the hearing aid a patient purchased at a big-box retail store and found that the target gain was not close at all to the necessary loudness. The patient complained that the aids were just not working; she was not hearing as good as she had hoped.
Photo 4: Real-ear testing with big-box retailer hearing aid after programming for a few minutes.
After just a few minutes programming of the aid, the result is clear in Photo #4.
We were able to meet the target for soft, average and loud sounds and the patient finally heard what she should hear–adequate loudness as measured through the devices as they were intended to work.
When Real-Ear Testing is NOT Completed
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Photo 5: Hearing aid prescribed at a well-known medical center before real-ear testing is done to set the aid appropriately.
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Photo 6: Hearing aid obtained at a well-known medical center after real-ear testing was completed and aid was programmed appropriately.
Photo 5: Hearing aid prescribed at a well-known medical center before real-ear testing is done to set the aid appropriately.
The importance of real-ear testing and the impact on the quality of your hearing.
At Potomac Audiology, our main goals are to assess your hearing status and understand your hearing abilities and problems then work with you to improve those problems. There are many ways to accomplish this from simple education about how to improve your everyday listening environments to hearing aids and other assistive listening devices.
When we prescribe hearing aids for you, we ensure the aids are fit appropriately using real-ear testing that measures what the aids are doing in your ear canal; we determine the output of the device ‘in situ’ or ‘in position’ because that is where you will wear the aids!
Lest you think we are only concerned with people who sell hearing aids over the internet and through print media or even at big box retailers, we have indeed had patients come to our practice because they are frustrated with their new aids not working well and after just a few minutes with the patient making the real-ear measures, we find (in many cases) that the aids are just fine, the fitting however was not done appropriately because real-ear testing was not done.
To illustrate, in Photo #5 you will see a screen shot of a real ear test with a ‘state of the art’ hearing aid that a patient brought in for testing after she moved to the area. She had obtained the aids at a well-known medical center and just assumed because of the facility’s reputation she was getting the best care.
Turns out the aids were not fit using real-ear testing. The aids were simply pulled out of the box and set to the manufacturer’s ‘first fit’ which means the prescription was based on the audiologic evaluation alone; this is never good enough as the ear canal and eardrum will always have an effect on the overall fitting that leads to the gain and output profile necessary to meet the patient’s hearing loss needs.
Photo 6: Hearing aid obtained at a well-known medical center after real-ear testing was completed and aid was programmed appropriately.
After just a few minutes of programming the hearing aids and making some adjustments (luckily we had access to the programming software needed for these specific aids) we were able to fit the aids for each ear for soft, average and loud input sounds (Photo #6).
The patient was so pleased; she had no idea that real-ear testing was required to effectively fit the aids but she was glad we did it and she is now hearing effectively with her hearing aids.
Getting the most effective treatment plan for your hearing.
Ask plenty of questions of your medical providers; ask them how to help you get to better hearing. Generally speaking, seeing an audiologist who will perform a comprehensive hearing and communication assessment and who will help you determine the most effective treatment plan and who will measure the hearing aids and other devices using state of the art, gold standard medical practice (including real-ear measures to verify the functionality of the hearing aids) is the best pathway to better hearing and overall better health.
