Hearing-impaired individuals, and especially older adults, find it difficult to perceive speech, especially in noise conditions.  Many turn to hearing aids to help resolve this difficulty. However, when they receive their programmed devices, the primary setting is for listening in quiet.  

To help resolve this problem, most hearing aids today are programmed for different environmental listening conditions. It is common to see such programs listed, using slightly different terminology, as: listening in quiet, listening in noise, listening to music, listening in a restaurant, comfort, etc.  Current hearing aids commonly offer 3 to 6 environmental listening options.

Still, annoyance of amplified sound through the hearing aid, due to circuitry noise and/or background noise, continues to be a major cause of hearing aid rejection. Research has shown that individuals with cochlear hearing loss (the most common type), require the primary signal to be attended to, to be much higher in level than background noise than is required for individuals having normal hearing1,2,3,4,5,6,7.


Listening in Quiet

Interestingly, the first setting for programmable hearing aids is generally for listening in a quiet environment. Why is this?  Is this an attempt to assist the user to adjust to amplification, is it actually for listening in a quiet environment, or is it just following what has been done without asking why?

In bygone years of hearing aid counseling, patients were often provided a general timetable for listening events to occur.  Such a training schedule started with quiet listening in the home (without radio, TV, or chatter of other people), and identifying the sounds around them.  This exercise was repeated until the person could clearly distinguish the various types of sounds.  From this point forward, the user would be introduced to increasingly more complex listening situations, but on a slow schedule, and with increasing wear time as they progressed.  The trend was to “make haste slowly.”  This was done to provide for an “optimal” initial listening experience.

Did this work, and do new hearing aid users follow such a training regimen? No evidence was found confirming that hearing impaired individuals actually followed such amplified listening progression schedules.  It is suspected that then, as today, when individuals obtain hearing aids, that they attempt to wear them everywhere – immediately, regardless of how they are counseled, and most of the places where they want to use them most is NOT listening in a quiet environment.   

Perhaps such a training schedule was required in the past because hearing aids were not as sophisticated in amplifying sound as today.  However, it is doubtful that the “listening in quiet” setting of today is intended to facilitate an amplified listening schedule.  So, if not, what is its purpose for listening in quiet?

 

Really, For Listening in Quiet?

This is doubtful.  Many individuals, when in a quiet environment, do not wear their hearing aids.  For some, wearing aids in quiet is unnecessary, and perhaps even unwelcomed.  They can often communicate well in a quiet location, and if listening to the TV, simple turn up the volume to suit their needs. This is easier that putting on hearing aids.  This is especially true for individuals with mild, moderate, and even some moderately-severe hearing levels.  Realistically, most hearing-impaired individuals want amplification to help them in more complex listening environments than encountered in quiet.

With this background, the question to be asked is, why is a hearing aid programmed for listening in quiet?  Is that what it is really for?  If that is the thinking behind such a setting, perhaps this thinking might be revisited.


What is a Quiet Listening Environment?

How is a quiet listening environment described?  Is this suggested to be a “quiet” home or office?   If so, how “quiet” are these “quiet” locations?   What is an acceptable noise level for an environment to be considered “quiet?”

Table 1 provides Equivalent Sound Level – Leq that quantifies a noise environment to a single value of sound level for any desired duration.  This descriptor correlates well with the effects of noise on people.  Leq is also sometimes known as Average Sound Level – LAT.  Table 1 provides some measured noise levels of various locations around the home and other locations, and the maximum acceptable equivalent sound levels.  The maximum levels are in the 50 dB range.  How do these levels compare with sound levels found in the home?  Typical home sound levels (in dB SPL) are shown in Table 2.  Most of the sounds in Table 2 exceed the maximum acceptable sound levels as suggested by Table 1, especially when compared to the “living area” category.  If that is the case, what is the purpose of “listening in quiet”, when even a quiet home is not really “quiet”?  If background noise in a quiet home is a problem, then perhaps it should be managed via some form of noise management hearing aid program.  In essence, listening in noise.

Table 1.  This table provides some measured noise levels of various locations around the home, and the maximum acceptable equivalent sound levels.  The maximum levels are in the 50 dB range.  From: http://www.engineeringtoolbox.com/decibel-dba-levels-d_728.html.

 

Table 2.  Common household items/events and the SPL levels in dB associated with them. (Redrawn and modified from Center for Hearing and Communication).  http://chchearing.org/noise/common-environmental-noise-levels/.

An office environment has often been identified as being “quiet,” and as such, would be expected to use the “listening in quiet” environmental hearing aid setting.  However, this would depend greatly on what type of work environment was involved.  Typical noise levels at work are shown in Table 3.  Again, these do not appear to be sound pressure levels associated with a “quiet” environment since most of the office conditions equal and/or exceed the recommended maximum acceptable noise level.

Table 3.  Typical background noise level (TBNL) and recommended maximum acceptable noise level (MANL) for various offices.  http://www.yourarticlelibrary.com/noise-pollution/office-noise-sources-and-control-noise-pollution/84385/.

Generally, an acceptable noise level is the highest level of background noise that a listener is willing to tolerate while listening to running speech.  If normal conversational speech is considered to be 65 dB SPL, then it would appear that many household sounds have at least a signal-to-noise ratio that is negative.  The question remains, however, is what impact do these levels have as background noises such that they could/would render amplified communication unacceptable because they are too annoying? What is the level of noise to the level of target speech before the difference between the two is acceptable to a person wearing hearing aids?

It is known that an acceptable noise level (ANL) is independent of degree of hearing loss, so that factor is taken from the equation8.  Acceptance depends, however, on the type of background noise (music vs. multi-talker, etc.).  An in-depth discussion of ANL as a test protocol is not the intent of this post.  A good discussion is presented by Recker9.


ANL (Acceptable Noise Level)

Tests exist to measure an ANL.  In ANL tests, the highest background noise level a listener deems acceptable while listening to speech at their most comfortable level (MCL) is measured.  To begin, the listener adjusts recorded running speech to their MCL through a modified method of adjustments. Next, a multi-talker babble (or other competing noise) is added to the speech. The listener adjusts the competing noise to the highest level that enables them to follow the speech passage without becoming tense or tired, in other words, to the highest level that they are willing to “put up with”. This determines the background noise level (BNL)10.  As an example, if the MCL is 75 and the BNL is 70, the ANL would be 5 dB.  Some might call this a signal-to-noise ratio (SNR), which would be correct, but the term “level” was appropriated to this in order to differentiate it from other SNR tests of speech recognition.


ANL Scores and Successful Hearing Aid Expectations

The higher the number, the worse the acceptable noise level is for the listener.  In other words, those who report small ANL level scores are more likely to be successful hearing aid users.  And, those who report large ANL level scores are less likely to be successful hearing aid users11,12,13,14.

General interpretation of the ANL score for successful hearing aid use is as follows13:

  • ANL Score of 7 dB or less – Great prognosis for regular hearing aid use and acceptance.
  • ANL Score of 8-12 dB – These scores are much more common and patients have a good (8) or bad (12) prognosis for regular and acceptable hearing aid use.  Noise reduction technologies and greater counseling are suggested.
  •  ANL Score of 13 dB or greater – Expect to spend much time in counseling.

Plyler reported than in the 25 years of research at his laboratory, ANL values ranged from -2 to 29 dB in listeners with impaired hearing10, and Nabelek, et. al. found the most frequently observed ANL value to be around 10 dB for normal and hearing impaired subjects14.  ANL results from various studies from Plyler’s lab are provided in Table 4, showing that score results were recorded often in excess of 10.  Various reasons have been suggested for the wide range in scores reported in Table 1 and elsewhere, but these are beyond the scope of this post.

Table 4.  ANL (acceptable noise levels) results from Dr. Plyer’s laboratory utilizing participants from a typical clinical caseload.

Based on the score results from Plyer’s lab, it would appear that most individuals might have trouble when using a HA in the presence of noise (ANL level scores greater than 8). 


Question

So, because hearing aids are worn essentially in a noisy environment, why not program all aids for listening in noise rather than for listening in quiet?  It is unclear what listening in quiet is intended to accomplish.

This is not a new concept, but perhaps expressed more overtly.  For example, although research has routinely shown that hearing aids improve speech perception, neither speech perception scores in quiet or in background noise appear to impact hearing aid use – certainly not to the extent expected16,17.  Additionally, Nabelek questioned if an individual’s willingness to listen in background noise might be more indicative of hearing aid use than actual speech understanding11In other words, the use of hearing aids appeared to related more to the acceptance of background noise than to speech understanding in quiet or in noise.

It has been documented also, that one of the first common complaints of hearing aid users relates to their inability to hear in background noise,18,19 not to listening in quiet.  And, since essentially all amplified listening is in a noise environment, why not program hearing aids initially to function best in that environment?  Make that the number 1 setting of the environmental listening settings?


Listening in Noise

Realistically, hearing aids are used mostly in a noisy environment – either background noise or in competing noise situations (multiple people talking in the presence of other competing sounds/noises).   If this is the case, then a reasonable question to ask is: why is listening in quiet the primary designation as the number 1 environment listening setting?  Shouldn’t it really be “listening in noise,” especially when noise is essentially impossible to avoid?

Explanations should be readily presented for programming a hearing aid’s number one setting to listening in quiet.  A convincing explanation would be welcome, especially when the majority of hearing aid wearers do not change from one environmental listening setting to another, meaning that many listen in all environments to the “speech in quiet” setting.  A common complaint if they move to a “listening in noise” setting is that the volume is no longer great enough.

Therefore, it is tempting to set the number 1 setting that individuals use to listening in noise.  If the signal is not loud enough in some environments, then allow the user to adjust the gain upward until it is acceptable, or then to move to the “speech in quiet” setting, which generally provides greater overall loudness.  The first suggestion requires a hearing aid with a user-adjustable volume control.  But, why not?  Such control is high on the demand list of hearing aid wearers as reported previously here on the HHTM site.  Read about this in Part 1, Part 2, and Part 3 related to user-adjustable volume control on hearing aids.


References

  1. Festen J. (1987).  Explorations on the difference in SRT between a stationary noise masker and an interfering speaker.  Acoust. Soc. Am., 82 (1987), p. S4.
  2. Glasberg BR, Moore BCJ. (1989).  Psychoacoustic abilities of subjects with unilateral and bilateral cochlear hearing impairments and their relationship to the ability to understand speech.  Audiol., 32 (1989), pp. 1-25.
  3. Festen JM, Plomp R. (1990).  Effects of fluctuating noise and interfering speech on the speech-reception threshold for impaired and normal hearing.  Acoust. Soc. Am., 88 (1990), pp. 1725-1736.
  4. Plomp R. (1994).  Noise, amplification, and compression: considerations of three main issues in hearing aid design.  Ear Hear., 15 (1994), pp. 2-12.
  5. Festen JM. (1993).  Contributions of co-modulation masking release and temporal resolution to the speech-reception threshold masked by an interfering voice.  Acoust. Soc. Am., 94 (1993), pp. 1295-1300.
  6. Moore BCJ. (1995).  Perceptual consequences of cochlear damage.  Oxford University Press, Oxford.
  7. Grant JW, Walden TC. (2013).  Understanding excessive SNR loss in hearing- impaired listeners.  Am. Acad. Audiol., 24 (2013), pp. 258-273.
  8. Nabelek AK, Tucker FM, & Letowski TR. (1991). Toleration of background noises: Relationship with patterns of hearing aid use by elderly persons. Journal of Speech and Hearing Research, 34, 679-685.
  9. Recker K. (2015).  Acceptable noise levels: a useful tool. Audiology Online, January 20, 2015.
  10. Plyler, P. (2015, June). 20Q: Acceptable Noise Level Test – The basics and beyond. AudiologyOnline, Article 14403. Retrieved from http://www.audiologyonline.com.
  11. Nabelek A, Tucker F, & Letowski T. (1991). Toleration of background noises: Relationship with patterns of hearing aid use by elderly persons.Journal of Speech and Hearing Research, 34,679-685.
  12. Lytle S. (1994).  A comparison of amplification efficacy and toleration of background noise in hearing impaired elderly persons. Unpublished master’s thesis, University of Tennessee, Knoxville.
  13. Nabelek A, Freyaldenhoven M, Tampas J, & Burchfield S. (2006). Acceptable noise level as a predictor of hearing aid use.Journal of the American Academy of Audiology, 17(9), 626-639.
  14. Freyhaldenhoven M, Plyler P, Thelin J, & Burchfield S.  (2006). Acceptance of noise for monaural and binaural hearing aid fittings. Journal of the American Academy of Audiology, 17, 659–666.
  15. Nabelek A, Tampas J, & Burchfield S. (2004) Comparison of speech perception in background noise with acceptance of background in aided and unaided conditions.Journal of Speech Language and Hearing Research, 47,1001-1011.
  16. Bentler R, Niebuhr J, Getta C, & Anderson C. (1993). Longitudinal study of hearing aid effectiveness. II: Subjective measures.Journal of Speech and Hearing Research, 36, 820-831.
  17. Humes L, Halling D, & Coughlin M. (1996).  Reliability and stability of various hearing aid outcome measures in a group of elderly hearing aid wearers.Journal of Speech Language and Hearing Research, 39,923-935.
  18. Kochkin S. (2002a). 10-year customer satisfaction trends in the US hearing instrument market.Hearing Review, 9(10), 14-46.
  19. Kochkin S. (2002b). Consumers rate improvements sought in hearing instruments. Hearing Review, 9(11),18-22.

This post is a continuation of two previous posts relating to a proposed PSAP “Standard” (OTC Hearing Aid Standard, and PSAP Standard Review).  This post relates to a section of the proposed “Standard” relating to the “categorization of PSAPs” (personal sound amplification products).1  

 

Categorization – Criteria for Standardization

It is not clear what the purpose is for categories of device performance.  Is the intent that a PSAP would have different levels of performance and labeled as Category 1, Category 2, or Category 3?  Is a PSAP a PSAP or not?  This suggests different levels for PSAPs.  Since there is no such categorization of hearing aids, then why for PSAPs?  With these thoughts in mind, the following is a continuation of attempting to determine what the various parts of the “Standard” relate to, and how they may or may not be significant.

 

Category I

This category is proposed to provide an acceptable range or threshold for the measurement made.  Acceptable to who – the consumer or to those writing the” Standard?”  On what basis is acceptability determined?  It is possible that a $29 unit may be just as acceptable to one person as a $3000 unit is to another person?  In speaking to a friend the other day, he commented that his dad purchased a $29 unit to help his hearing.  I asked how he was doing, and was he satisfied?  I was told that he is doing acceptably well, and that he was pleased with his purchase.  Just because a measurement meets the “Standard” says nothing about how acceptable a product is to the consumer.  Meeting or failing a single feature reminds one of something J. Donald Harris wrote about many years ago (paraphrased): just because you can find a single parameter statistically significant when viewed in isolation, it may have no significance when all parameters are combined.

 

4.1 Frequency Response Bandwidth

Figure 1.  Three different premium-priced hearing aids measured using a 2cc coupler and an open fit coupler (Frye Electronics open coupler).  How does making the measurement of a PSAP having an open fit on a 2cc coupler aid the consumer, since the responses (including the bandwidth), will be substantially different?

How does a frequency response allow a consumer a means to compare and evaluate competing systems?  The same response fitted with an open or closed dome (Figure 1) provides different end user real-ear listening experiences.  Even premium-priced hearing aids do not provide this real-ear information to the consumer.  It is suspected that few hearing aid or PSAP consumers even know what a frequency response curve is, or what it actually represents.  The “Standard” calls for measurements to be made into a 2cc coupler.  However, many PSAP instruments are sold only with an open fitting, not a closed fitting, as is measured in a 2cc coupler.  Therefore, it is confusing as to why they would be measured with a closed coupler, and then this information provided to a consumer, when it has nothing to do with the actual frequency response representation.

Figure 2.  Three premium hearing aid manufacturers’ published frequency response lower and upper limits, and actual measured responses (measured in 2016).  None met the upper limit, which most would agree is a more significant number than the lower limit.  The “Program” is the measured response after each was programmed to the same hearing thresholds.  The MZ-1 is a modified Zwislocki coupler measurement.

If truth in advertising, especially with respect to the frequency range is so important, current premium-priced hearing aids (among the Big Six) are not held to standards, as shown in Figure 2 below.  All of these instruments failed to meet their published specifications, as measured using the ANSI test measurement Standard.  It appears that PSAPs are going to be held to a higher standard.

What is magical or practical with having a low frequency cut off to extend to 250 Hz or lower?  Many currently-fitted hearing aids do not go that low.  In fact, most do not want amplification to go that low because this would amplify low-frequency background noise.  This gives the appearance of being an intended built-in failure feature for a PSAP, especially since most PSAPs are fitted with an open/vented tip, which means that amplification at frequencies this low has been acoustically removed. 

 

4.2 Frequency Response Smoothness

Figure 3.  A premium hearing aid measured using 1/3 octave bands.  The peak is 13 dB higher than the 2 lower-and higher 1/3 octave band measurements (they average 12 dB).  This instrument would not qualify as a PSAP.  Granted, this was not measured in a diffuse field (measured in a Frye 8000 Hearing aid test chamber) and used the ISTS test signal, but the unusualness of this smoothness requirement is curious.

Figure 3 shows 1/3 octave band measurements of a very popular current premium-priced hearing aid.  According to the smoothness requirement, it would fail.

 

4.3  Maximum Acoustic Output

This is not the same as for hearing aids (for protection, they use 132 dB).  Actually, isn’t this level a maximum performance standard to avoid uncomfortably loud sounds, rather than a minimum, as specified?

 

4.4  Distortion Control Limits

Measurement is a hearing aid standard.  Does anyone know what a maximum criterion for distortion is, and how does it provide a minimum performance standard?  Wouldn’t this be nice to know for hearing aids as well?  However, if there is a known threshold description for distortion that is not acceptable for a hearing aid, or to the hearing impaired listener, it appears to be in hiding.

 

4.5  Self-generated Noise Levels

This measurement requires that the PSAP have programmable capability.  If the PSAP has expansion, or other means to reduce low-frequency noise, and is not programmable, this measurement can be made, but comparison to other programmable devices (which many PSAPs are not) is not a fair comparison.  The assumption should be made that all these measurements can be tested, as outlined, and as provided by the manufacturer.  However, as seen in Figure 4, 32 dB is difficult to achieve even for premium-priced hearing aids.  The full-on equivalent input noise of the right-side instrument exceeds this level.

Figure 4.  Equivalent Input Noise levels for three premium-priced hearing aids as measured full-on.  The instrument on the right would exceed the PSAP required levels.  N3 is the audiogram to which each of the hearing aids was programmed (ANSI Standard Testing Hearing Aids – Part 2).

 

Category 2

Values that MUST be included.

This category does not include a threshold of acceptable range for the parameter measured.  If this category does not include these, why is it that values MUST be included?

 

4.6  High Frequency Gain Provided

This is a current hearing aid measurement.  It is difficult to imagine what this tells the consumer.

 

4.7  Battery Life

The proposed “Standard” states that the establishment of a common metric for battery life allows consumers to more accurately evaluate and compare devices.  This appears to be the first measurement of use to consumers written in this “Standard.”  This follows the current suggested procedure for measurement of hearing aids.  Manufacturers are to report the estimated life for a single operating charge cycle with all optional features turned on and then/also(?) report the estimated battery life for a single operating charge cycle with all optional features turned off.  Current hearing aids don’t have this requirement.  It is unusual for hearing aid manufacturers to specify a particular battery manufacturer for their products (and it is known that each battery manufacturer has different mAmp capacity for the same cell as from another manufacturer), but this “Standard” requires this of PSAPs?  This may not be realistic in that this demand is not even required for hearing aids.  One would expect a premium-priced product to provide this information, but for a PSAP?  Additionally, battery life can change rather dramatically for different environmental listening settings and as the use time lengthens, as shown in Figure 5 for a premium-priced hearing aid.  This suggests again that PSAPs are to be held to a much higher standard than are current hearing aids.

Figure 5.  Measuring and recording battery life is not as simple as using the formula provided.  The formula does not take into consideration higher current drain measurements for certain settings, or the fact that the same size cell from different manufacturers has different mAmp capacities.  How will the consumer know the mAmp capacity of a cell they purchase?  This is not published on the battery packaging.

 

 

4.8 Latency

Again, a “not to be exceeded” time of 15 msec is not a standard with regular hearing aids.  Again, a PSAP would be held to a higher standard.

 

4.9 RF-Immunity

Again, this seems to be a higher standard than with hearing aids.

 

 

Category 3

The technological capability or feature shall be reported in the device description.  The specific value/metric for measurement for this value is not within the scope of the “standard”.

 

What is considered a technological capability or feature?  Is amplification a technological capability or feature?

 

4.10 Fixed or Level Dependent Frequency Equalization – Tone Control

In a current User Instructional Booklet for a manufacturer of premium-priced hearing aids (Figure 6), this information is not required, nor is it provided.  Again, the PSAP is being held to a much higher standard as none of this is required, nor present in materials to hearing aid customers.

Figure 6.  This provides the technical data on a premium-priced hearing aid that is provided in a User Instructional Booklet.  This is the “comparison” information that hearing aid users generally receive when they purchase a hearing aid.  And, by the way, if they have already purchased in order to get this User Instructional Booklet, there is no longer a pre-comparison opportunity.

 

4.12 SNR Enhancement

The information asked for here seems to be missing in the requirements for hearing aids.

 

4.13 Noise Reduction

This is not seen in the User Instructional Booklet to the consumer.  Therefore, how does a consumer make any judgments in traditional hearing aid comparisons?  The fact is, that they don’t.  Someone else makes that decision (rightly or wrongly) for the consumer.

 

4.14 Feedback Control / Cancellation

Evidence of such feature is not present in the User Instructional Booklet of Figure 6 for premium priced hearing aids, but expected for a PSAP.  Having and stating that such a feature is available may be misleading to the consumer, because none of the feedback/cancellation systems, even in premium-priced hearing aids do not always eliminate acoustic feedback.

 

4.15 Specification and Reporting

Compliance requires reporting a description of any personalized device functionality for a PSAP, but this is not required of hearing aids.  What good is this anyway, when even with premium-priced hearing aids, the specification, especially the audiogram, provides little or no useful hearing aid fitting information (Figure 7) where the fitting targets are dramatically different by 4 manufacturers for the same audiogram.  Shouldn’t this be required also of hearing aids?

Figure 7.  Using the same audiogram (left), four premium-priced hearing aids provide very different target gains (right).  Somehow, providing audiogram information to fit a PSAP is expected to assist the consumer (if it is available) when it can’t predict an optimum fitting for premium-priced hearing aids.

 

4.16 Device Coupling to the Ear

Measurements of open or adjustable fit coupling is not in this “Standard” (other than closed fit using a 2cc coupler).  Therefore, what good is the frequency response curve at full-on gain when the majority of PSAPs are fitted using an open mold?  How would this be measured in a 2cc coupler, and if measured that way, what would this tell anyone, including any hearing professional?

 

4.17 Wireless Connectivity

Again, not required of hearing aids, but mandatory for PSAPs.

 

 

Assumed to Apply to All Categories Since These Were Not Identified with Any One Category

 

4.4.1  Output Distortion

This requirement exceeds hearing aid standards.  Hearing aid standards have no maximum distortion limitation.  Distortion is whatever is measured.  Why 5% for THD+N?  Where is the research for hearing aids to support this level?  This percentage appears to be completely arbitrary.  Digital circuitry in hearing aids generally have THD percentages of less than 1%. 

Because of this, some hearing aid engineers have suggested that they see little use in the THD in the current hearing aid standards, especially since most hearing aids are digital.  So, why put it into PSAP “Standards” where development direction has been toward digital, the same as for hearing aids?

 

4.4.2  Input Distortion

Again, this is not a requirement of current hearing aid standards.  No part of the current hearing aid standard asks for this measurement.  And, what is magic about 5% THD+N?

 

 

  1. Reporting

Wouldn’t it also be proper then that consumers were required to be given this information when purchasing hearing aids?

 

 

General “Category” Comments

The “Standard” is meant for PSAPs, but all the measurement procedures are those for hearing aids.  Therefore, this is a hearing aid standard, or as designed, a standard that makes a PSAP a hearing aid.

 

Informal Listening Tests

Such tests are not required for hearing aids.  The “Standard” states that this is “recommended,” but experience shows that “recommended” soon becomes “required.”

It is not clear which category is the highest.  Is it Category 1 or Category 3?  What is the difference between Category 1, 2, and 3? 

This proposal is more complicated and detailed than are the current hearing aid standards.

How does any of this help the consumer make an informed comparison (especially when they have little or no idea what any of the measurements mean, or how does this help penetrate the untapped market?

Does the following identify this “Standard” correctly?  Let’s make PSAPs meet most hearing aid requirements by requiring testing that may have no direct relationship to consumer satisfaction (remember, satisfaction includes not only listening, but cost, access, time, etc.).  All the suggested measurements do not necessarily make the product better along these lines, but one can argue successfully that they will all increase the end cost to the consumer.  If the measurement requirements are extensive enough, the product will have to be tested just like a hearing aid, adding costs, and moving the PSAP cost and description more in line with hearing aids.  Which group benefits from this, the consumer or the traditional hearing aid manufacturer and dispenser?  This “Standard” appears to be a “protection” publication for manufacturers and the current medical model of distribution, and not for the consumer.

If this “Standard” is voluntary, does this mean that PSAP manufacturers can sell their products without meeting any of these requirements?  If they have to meet any of these requirements, then the “Standard” is not voluntary, but mandated.

It appears that this “Standard”, as written, is an unnecessary intrusion into assisting individuals with mild-to-moderate (and perhaps even to severe) hearing levels, from purchasing products that they find useful to them, that they could purchase OTC.

 

 

Acceptance to Hearing Aid Manufacturers and Dispensers

They will like this “Standard”.  It helps maintain the status quo and adds a multitude of restrictions to PSAPs not even suggested for hearing aids.  This “Standard” makes basic amplification devices regulated just like hearing aids, except even more stringently.  It is difficult to see any real differences between this and the current hearing aid Standards that would put PSAPs at a lower measurement involvement level.

 

References

  1. ANSI/CTA Standard – Personal Sound Amplification Performance Criteria, ANSI/CTA-2051