This post discussion is a continuation of previous posts related to comments that many hearing professionals have expressed with concerns that OTC/PSAP hearing aid sales will result in dissatisfied users because:

  1. The instruments are not professionally fitted
  2. An audiogram is necessary
  3. OTC-sold devices (previously defined as PSAPs) are of poor quality and will not meet the needs of the hearing impaired, and
  4. Poor experiences by the purchaser will discourage them from seeking additional assistance and purchasing a “real” hearing aid
  5. A Universal, basic hearing aid cannot manage all hearing losses

This post relates to issue #5, that a universal, basic hearing aid cannot manage all hearing losses.


A Universal, basic hearing aid cannot manage all hearing losses

This is a correct statement.  There is no expectation that a universal basic hearing aid can fit all needs, just as no premium-priced hearing aid can solve all hearing needs, even with all the programming parameters available.  But, aside from this, the OTC/PSAP instruments are not intended for the entire market, but assigned to the mild-to-moderate hearing level category, which would be expected to require less adjustability than more severe and divergent hearing losses which may be better fitted with multi-parameter adjustable hearing aids.  This comparison might be analogous to a mild headache being treated with an aspirin, but a severe migraine requiring something much more potent and specific. 

What is a basic hearing aid? 

Reading through the discussions related to OTC/PSAP versus “real” hearing aids, one gets the sense that a basic hearing aid as defined by the industry is a “real” hearing aid, having fewer options/features, designed as a “starter” listening device and intended to be replaced relatively soon with a more “premium” instrument because it most likely will not adequately meet the needs of the hearing-impaired individual.  Following this line of reasoning, a basic hearing aid is a “watered-down, lesser” device because it does not include multiple features and command a premium price.

Years ago, what is known as the Harvard Report1 and the United Kingdom Medical Research Council2 suggested that the majority of patients with hearing impairment could be fitted with a hearing aid having a standard response with the slope expressed in dB per octave.  They suggested that a range of slope between 0 and +6 dB/octave, along with various other recommended parameters (e.g. sufficient gain), is the desired response.  Would this define a basic hearing aid?


Difficulty in Describing a Basic Hearing Aid

What was a premium device in the past is now considered a basic hearing aid.  Throughout the history of hearing aid development, it would be fair to say that the description of a basic hearing aid has changed, to the point that defining a basic hearing aid has become essentially an impossible task.  The reason is because what is defined as a premium hearing aid today, is likely to become the basic hearing aid of tomorrow.  Which means, that the description of a basic hearing aid may have to be redefined on essentially a continuing basis.  As such, this would follow the history of hearing aids.  A few years ago, a hearing aid having compression, a volume control, and a couple of trimmers for response and output change was considered a premium device.  Today, it might not even be considered a basic hearing aid, with many PSAPs having these, and often even more, features.

It is acknowledged that not all OTC/PSAP hearing instruments are of the same quality, just as not all professionally-sold hearing aids are of the same quality.  So, where are the red lines in the sand for OTC/PSAP hearing device quality or for hearing aid quality?  Is it a distinct line, or is it spread out over a wide range with overlap?  If spread out over a wide range, do the limits drop off suddenly, or are they merged into the next category?  If merged, how is the overlap handled?  Of course, it would be nice if we could actually identify hearing aid quality. 

Should a hearing device be considered basic based on its technology, user satisfaction, and/or benefit?  If based on these categories, we might be in for an unexpected surprise.

For example, as referenced in a previous post, and replicated here in Figure 1, in a survey comparing hearing aid benefit and satisfaction versus technology (comparing a basic hearing aid with a cost of about $500 up to one costing $4000 to the consumer), the average judged value of hearing aids (of well-fitted devices, along with patient counseling), was about the same, regardless of the purchase price.3

Figure 1. The average judged value for all the hearing aid devices, regardless of the purchase price, was about 60, regardless of the advanced features. (Calculated by Killion from Van Vliet, 2002 data and replotted here).

In a comparison of basic versus premium hearing aid acceptability of technologies on non-speech sound acceptability, no evidence was found to show that premium hearing aids yielded greater acceptability than basic hearing aids.4

OTC/PSAP Suggested Performance Standards 

The Consumer Technology Association (CTA) has proposed standards for Personal Sound Amplification Performance Criteria in an attempt to help define OTC/PSAP products.  This author finds these unreasonable, impractical, and not helpful to providing more amplification to the non-hearing aid user market and will explain the reasons for these comments in a series of later posts.

How Do OTC/PSAPs Compare with Traditional Hearing Aids?

With the discussion of OTC/PSAP hearing devices, numerous remarks have been made about the products that might be sold to consumers.  Comments range from saying that such products will destroy user’s hearing, are doomed to failure because consumers will not be satisfied with either the product and/or service, or will have a bad experience which will drive individuals away from “appropriate” hearing aid fitting.  These comments are mostly speculations without supporting evidence.  This is not to say that such actions might not occur, but evidence would help.

Paraphrasing a good and knowledgeable friend when confronted with such comments:  That individuals will be driven away with having a poor experience is like saying a person may refuse to eat again because of a bad food experience in a restaurant.  It is probably fair to say that people are smarter than this (attributed to Mead Killion).

What Does Available Data Tell Us?

Three recent reports state that OTC/PSAP hearing devices are inferior products.5,6,7   A previous post identified problems with product selection with each of these studies, suggesting that there is nothing definitive to be taken from them.

Figure 2.  Mean audiogram for the 32 subjects.  Error bars represent 1 standard deviation from the mean.

A study conducted in 2007 by Walden, et. al., compared a self-fitted PSAP device to professionally-fitted hearing aids using measures of real-ear aided gain, audibility, and speech understanding in background noise for 32 first-time hearing aid users.8  All were self-referred, averaged 63.1 years of age (range from 39-84), and included 29 males and 3 females.  Twenty-seven of the 32 were fitted binaurally.  The average audiogram is shown in Figure 2.

The hearing aids were digital, multi-band/channel/memory, wide dynamic range compression circuits (WDRC) representing a variety of hearing aid manufacturers. The style was based on the diagnostic test results and each patient’s style preference.  Most (38 of 59) were mini/micro BTE fittings.  The remainder consisted of 4 RICs, 2 standard BTEs, and 15 custom devices.  This distribution reflected the general prescription patterns for all hearing aids prescribed in the clinic.

The PSAPs provided to the participants were 16-kHz bandwidth, single-channel wide-dynamic-range-compression circuitry, and level-dependent TILL frequency response.  The 2cc coupler response curves are shown in Figure 3.  The device had two user-selected gain settings: 1) low, and 2) high, which were user-controlled for their hearing loss. Based on the hearing loss (unilateral or bilateral), participants were provided with one or two PSAPs, and four eartips were supplied (2 different-sized triple flange, 1 single flange, and 1 foam).  The user selected the type based on trial and error, and attached the tip to the PSAP.  Insertion positioning varied across users, but was based on a balance between retention and comfort.  Participants used the PSAP devices for a 3 to 6-week period between the initial hearing evaluation and the initial professional hearing aid fitting. 

Figure 3. PSAP 2cc coupler gain responses for inputs of 50 dB SPL (highest curve), 65 dB SPL (middle), and 80 dB SPL (lowest curve) for position 1 (LO gain, left graph) and position 2 (HI gain, right graph) conditions.  The PSAPs had no other controls – neither adjustable nor programmable.

Results:  Average aided gain was not significantly different between the PSAP and the prescribed hearing aids.  Tested at 50 dB HL in the sound field, average audibility was 70% for the prescribed aid, 68% for the PSAP, and 57% unaided.  Average speech recognition in background noise (QuickSIN) tested at 70 dB HL input was good with both devices:  2.9 dB SNR for the fitted aids and 3.8 dB SNR for the PSAP.  (Normal-hearing subjects typically average 2 dB SNR.)8  

Participants generally reported that the written instructions provided with the PSAP were sufficient to use the PSAP and they reported generally good subjective improvement in their hearing when using the PSAP.  Dissatisfaction with the PSAP was expressed regarding cosmetics, physical comfort with extended use, and occlusion effect.   The comments relative to the occlusion effect should not be surprising because the PSAPs were a closed fitting versus mostly open fittings for the hearing aids.  Fitting a PSAP with an open fitting would most likely render this a non-issue.  In spite of this, thirty-four percent of the participants reported they would be ‘very likely’ to continue wearing the PSAP(s).

A previous post on this site looked at consumer preference of two basic, two premium, and two PSAP hearing devices.  Results showed that PSAPs performed as well in this laboratory study as hearing aids (basic and premium) for everyday noises and music, but not for speech.   

OTC/PSAPs Will Cause Further Hearing Loss

A concern expressed by some is that unmanaged use of OTC/PSAPs could cause further hearing loss because they may be improperly fitted.  This is based on such units having dangerous decibel levels that can present a significant risk to residual hearing in laboratory testing9.  Reference was made to two reports citing high SSPL90 readings greater than 120 dB SPL in some of the units.5,7  Some legitimate questions relative to the products selected for those studies was provided in a previous report.

Regardless, further loss of hearing from hearing aid use is a legitimate concern.  However, the history of hearing aid fittings, even in an era when no hearing aid had an output less than 120 dB SPL (similar to outputs in the studies cited) offers no support for this.  It would be fair to say that current, better designed OTC/PSAP products have outputs more consistent with contemporary hearing aids.

A five-part series on the topic of hearing aids causing hearing loss was previously provided on this HHTM site (Part 1, Part 2, Part 3, Part 4, Part 5).  Part of the take-away, after reviewing studies on this topic was that:

“History is on the side of hearing aids not causing additional hearing loss.  If they did cause further hearing loss, research and actual utilization of hearing aids would reflect this.  Millions have been fitted with hearing aids and their use does not reflect further loss.  Of course, this assumes that other factors such as advancing age, medications, etc., are isolated from the impact of loud sounds.”10


User Satisfaction

A Japanese Report on The Hearing Aid Market in Japan commenting on poor customer satisfaction of OTC/PSAP products has been described as providing evidence discouraging individuals from seeking further expert help.  Unsaid was that the overall customer satisfaction with hearing aids was 39%, even though 76% of sales reported were through what would be called professional dispensers (Hearing Aid Centers, Optical Shops, Hospital/Clinic).10  Additionally, as shown in Figure 4, the percent of very dissatisfied and dissatisfied was 14% for the Hearing Aid Center sales, and 17% for Internet sales.  While these numbers are fairly similar, the very dissatisfied numbers were different, with Hearing Aid Center sales showing a 6% very dissatisfied to 0% for Internet sales.  Internet sales of “somewhat dissatisfied” was 33% versus 19% for Hearing Aid Center sales.  “Satisfied” and “very satisfied” combined showed 20% for Hearing Aid Centers and 15% for Internet sales.  One can play with these percentages as one wishes, but the “devastating” results generally attributed to Internet sales seems to be somewhat subdued.  True, the sample sizes were somewhat different, and could change the results, but the direction would be uncertain.

And, nowhere was data found that supports the statement that: “…the inadequate performance of such OTC hearing aids may cause wearers to decline to adopt hearing aid use” as referenced to the Japanese OTC experience as attributed to the 2015 Hong Kong study.6

Figure 4.  Overall satisfaction with hearing aids as reported from sales in Japan primarily related to hearing aid centers, optical shops, and Internet sales.  See text for discussion. (JapanTrak 2015).

Self-Fitting of Hearing Devices – Future Topic

OTC hearing aids assume that an individual having a mild-to-moderate hearing lose can self-fit themselves with satisfactory results.  That this can occur safely and effectively has been called into question.  That such self-diagnosis takes place routinely, in which the consumer decides, based on listening experiences, if their hearing is good or bad, is the bread and butter of the hearing aid industry.  Individuals are mostly self-referred, based on how they assess their hearing to be.  They do self-assess, and have done a rather good and significant job of this, rewarding richly the professional dispensing community.  Most hearing aid sales are self-referred, meaning that the patient has made the decision that their hearing loss is great enough for them to do something about it.  This topic will form the basis of a future post.



  1. Davis H., Stevens S. S., Nichols R. H., Hudgins C. V., Peterson G. E., Marquis R. J., Ross D. A. (1947).  Hearing aids: An experimental study of design objectives. Cambridge, MA: Harvard University Press.
  2. United Kingdom Medical Research Council. (1947).  Medical Research Council Special Report No. 261.  Hearing aids and audiometers.  London: His Majesty’s Stationery Office.
  3. Van Vliet, D. (2002). User satisfaction as a function of hearing aid technology.  Paper presented at: American Auditory Society Scientific/Technology Meeting, March 14-16, Scottsdale, AZ.
  4. Xu J, Johnson J, Cox R. (2015).  Effect of some basic and premium hearing aid technologies on non-speech sound acceptability.  Poster presented at the 169th meeting of the Acoustical Society of America, Pittsburgh, PA, May.
  5. Internal report, non-published.  PSAP devices were not identified.  Referenced by Fabry at PCAST Hearing?  Date, correct title.
  6. JapanTrak 2015. Designed and executed by Anovum (Zurich) on behalf of Japan Hearing Instruments Manufacturers Association.
  7. Chan ZYT and McPherson B. (2015).  Over-the-Counter hearing aids: a lost decade for change.  BioMed Research International, Vol. 2015, Article ID 827463, 15 pages.
  8. Walden, T., Walden, B., Van Summers, W., and Grant, K. (2007).  Comparison of Personal Sound Amplifier Products to professionally fitted hearing aids.  Army Audiology and Speech Center, Walter Reed Army Medical Center, Washington, D.C., USA.    Work supported by Etymotic Research Inc., to the T.R.U.E. Research Foundation under a Cooperative Research and Development Agreement (#MA-015).  Local monitoring of this study was provided by the Department of Clinical Investigation (DCI) under Work Unit #05-25020.
  9. Fabry D. (2017). Presentation to the Institute of Medicine (IOM)/National Academies of Science, Engineering and Medicine. On behalf of the Hearing Industries Association. 
  10. Staab W. (2013).  Hearing aids and further hearing loss? Part V.  HHTM, October 6, 2013.

This post continues the comments by many hearing professionals expressing concerns that OTC hearing aid sales will result in dissatisfied users because:

  1. The instruments are not professionally fitted
  2. An audiogram is necessary
  3. OTC-sold devices (previously/also defined as PSAPs) are of poor quality and will not meet the needs of the hearing impaired, and
  4. Poor experiences by the purchaser will discourage them from seeking additional assistance and purchasing a “real” hearing aid
  5. A Universal, basic hearing aid cannot manage all hearing losses

The objection that hearing aids are not fitted professionally in an OTC model, that an audiogram is necessary, and that OTC/PSAP product quality is poor and will not meet the needs of the hearing impaired, were discussed in previous posts.

This post looks at comments that an OTC-sold device (which can include PSAPs or OTC hearing devices) will result in poor experiences by the purchaser and will discourage them from seeking additional assistance and purchasing a “real” hearing aid.  This post jumps to various topics, some of which will be dealt with in greater detail in future writings.

Traditional Hearing Aids Versus PSAPs and/or OTC Hearing Aids

Are Hearing Aids Preferred Over PSAPs and/or OTC Hearing Aids by Users?

Limited Data Exists

To the best of this author’s knowledge, there are no viable studies that support the contention that hearing aids are preferred by consumers over OTC/PSAP products.  There are at least a few major problems when attempting to make comparisons of PSAPs and hearing aids:

  1. Investigator bias.  (The commitment by the investigator to the product in question – either professionally and/or financially).
  2. PSAPs used for comparisons in the studies and evaluated electroacoustically. Figures 1 and 2 provide PSAP examples from studies in Hong Kong and Europe.1,2  In reviewing the products, which were measured electroacoustically, it appears that these studies considered PSAPs as instruments having external button receivers primarily.  It is possible, but not probable, that there were no open or RIC-type PSAPs available for these studies unless those parts of the world are less sophisticated in product development. Figure 3 shows PSAPs that were available, at least here in the U.S. during these comparison testing periods, but essentially ignored.  All but one of the instruments in Figure 3 retail for less than $500, and are sold as PSAPs/OTC aids.
  3. Study dates. Older studies in which PSAPs were compared are unlikely to represent current PSAPs and OTC products.  Many current PSAPs and OTC hearing aids contain many of the same components found in high-end hearing aids: digital amplification, high-end feedback cancellers, microphones for omni-or directional performance, quality speakers, volume controls, T-coils, different listening programs, rechargeable, etc.  Current PSAP/OTC hearing aids are available in both open and RIC configurations.  True, one can find $29 products, and while they do not have the quality of PSAPs in the $300 to $500 range, even they can be helpful for some individuals, depending on the interest needs of those individuals.  In that sense, they might be better compared with hearing aids of 50 years ago or so.  To say that hearing aids of yore did not help anyone would be a misstatement of fact and an indictment of the hearing aid industry at that time.

Figure 1. PSAPs evaluated in the study by Chan and McPherson, 2015. All instruments, with the exception of in-the-ear devices, utilized external button receivers.

Figure 2. A sampling of the PSAPs used in the 2015 European hearing aid industry study. Heavy emphasis was on those instruments having external button-type speakers.

Figure 3. Instruments identified as PSAPs that were available, at least in the U.S. during the times that the studies identified in Figures 1 and 2 were conducted. Most consist of open or RIC-style instruments. Only one has an external button-type receiver. It is possible that none of these were available in Europe and Hong Kong during the time of those studies.

Consumer Preference

Figure 4. Audiograms of the 20 subjects in this study, with the average audiogram in red. The hearing loss range was reported in the study as ranging from mild to moderately-severe.

Another way to compare PSAPs and hearing aids, other than by electroacoustical measurements, is by consumer preference.  In a preference study of hearing aids versus PSAPs, 20 subjects, ranging in age from 26 to 83 years of age, with the hearing thresholds shown in Figure 4, were involved3.  Nine subjects were experienced hearing aid users.

The study included two premium hearing aids, two basic hearing aids, and two PSAPs.  Two manufacturers supplied the four hearing aids, and two companies supplied the two PSAPs.  All devices were adjusted as best they could to match NAL-NL2 targets.  Note: one of the PSAP units allowed only two gain setting adjustments (low and high), and no response adjustments, etc.  The hearing aids were real-ear measured on KEMAR (closed dome) as best they could to match NAL-NL2 targets.  This means that the PSAPs were primarily the basic response of the unit as off the shelf and could have been some distance from the NAL-NL2 target gains.  Amplified quiet speech, noises, and music stimuli were digitally recorded in WAV format and presented to the subjects.  Subject testing consisted of preference scores on one ear using an ER-2A insert earphone to present the recorded stimuli for each of the hearing aids, with the other ear plugged.  A double round robin, random order, was employed for presentation order, for 30 comparisons.

Results are shown in Figure 5.  PSAPs performed as well in this laboratory study as hearing aids (basic and premium) for everyday noises and music, but not for speech.   

Figure 5. Preference scores from 22 adults for hearing aids versus PSAPs for the listening conditions of quiet speech, noises, and music.

Interestingly, even though the PSAPs could not be adjusted to the NAL-NL2 targets with the same finesse as the hearing aids, it is informative to note that for speech in quiet, where the hearing aids scored higher than the PSAPs, the differences were less than 5 preference scores poorer than the premium hearing aids. And, the basic hearing aids (A and B) scored higher in quiet than the premium-priced hearing aids). The poster did not break out the experienced user preference scores for these measurements, but it would have been informative to view their preference scores to determine how their experience may or may not have influenced the overall scores.  Of some interest also, is that the OTC market is proposed for mild-to-moderate hearing losses, but some of the subjects in this study might be viewed as having hearing levels beyond this category.  As a result, this study suggests that losses even in the moderately-severe category might have results expected to be similar to those reported here.

A study that attempted to get at information as to how well consumers responded to the medical model versus the OTC model resulted in more questions about the design of the study than usable results.4

Consumer Interest in OTC Hearing Devices

This issue seems to be missing in any discussion of OTC products, but it would seem to be of obvious significance.

In previously unpublished data included in a private meeting presentation to the FDA in 2001, interest by non-hearing aid users in an OTC disposable hearing aid was strong (Figure 6).

Non-users of hearing aids would seriously consider OTC products at a combined 58% (17% definitely would buy and 41% probably would buy).  Of additional interest was that 35% of existing hearing aid users would probably, or definitely, purchase an OTC product, only down 10% from purchasing a prescription (Rx) product.5

By far, the greatest movement in hearing aid interest was by the non-user, and for an OTC product.

One might conclude that these data don’t apply because the instruments in question were disposable.  A good marketer might counter by realizing that disposable hearing aids were shown to be of interest, and perhaps such a category should be produced and sold.

Figure 6. Interest in OTC disposable hearing aids by hearing aid users and non-users of hearing aids.3 The comparison is to prescription hearing aids following the current medical model of hearing aid sales.


OTCs Will Provide Poor Results and Are of Lesser Quality.  Thus, a Bad Experience Will Discourage Users from Trying Real Hearing Aids

What does this mean?  What defines “poor results” and “lesser quality?”  The issue of OTC hearing products being of lesser quality has been qualified in a previous post.  Is it possible that a bad experience with a “real” hearing aid might lead to a person trying an OTC product where the commitment is with a small “c” rather than a capital “C” – being satisfied with the OTC cost/benefit?  

What Constitutes Poor Results?

Do “poor results” mean that an OTC hearing aid (which could also be a PSAP):

  • Cannot meet the amplification needs of the user?
  • There is no way to determine that they meet appropriate target gains?
  • They are not used all the time, or never? End up in a “dresser drawer”?
  • There is nobody to adjust the aids or provide counsel when needed?
  • Has no recorded benefit?

Interestingly, these seem to be the same questions that current research is asking about professionally-fitted hearing aids.  Evidence seems to be AWOL (absent without leave) that OTCs will provide poor results.  This must await the actual distribution model.


How would an OTC hearing aid compare with professionally fit hearing aids in terms of overall satisfaction?  There is a dearth of available studies making this comparison, but a plethora of studies looking at consumer satisfaction with traditional hearing aids.  In those studies, satisfaction is related primarily to issues mostly unrelated to the hearing aid’s electroacoustical performance:6

“Various studies have used these tools to examine the relationships between satisfaction and other factors. Findings are not always consistent across studies, but in general, hearing aid satisfaction has been found to be related to experience, expectation, personality and attitude, usage, type of hearing aids, sound quality, listening situations, and problems in hearing aid use.”6

It has been reported that 35% of patients with no measurable benefit (APHAB) were satisfied with their “real” hearing aids7.  And, interestingly, as suggested in the above quote, only 43% of overall satisfaction was related to the device, with benefit scoring poorer than satisfaction.


The concern that some have expressed is that OTC instruments (hearing aids and PSAPs), are insufficient to manage properly the needs of the hearing impaired – that they are of lesser quality.

Comments have stated that quality is poor1,2 as measured electroacoustically, and because of this, speculation has led to an assumption of unsatisfactory performance by the hearing impaired.  And thus, this would discourage consumers from considering more premium-priced amplification – that of the traditional hearing aid.  Other than anecdotal comments by those opposed to PSAPs and OTCs, no evidence can be found to support this position.

How Good Does Hearing Amplification Have to Be?

This is the million-dollar question, and no qualified answers have been forthcoming.

A strong case for the growing demand of medical devices that are “good enough” comes from a McKinsey Report.8  The Report states that “good enough” are devices that are lower priced and don’t possess many of the value-added features that are often found in the premium category.

What should be of interest is that this new market segment, one valuing no-frills solutions, is growing twice as fast as the industry as a whole in many medical device categories.  Granted, this Report does not directly mention hearing aids, but as Taylor commented, “It is not too big of a leap to draw parallels to the commoditization of technology occurring within our own profession.”8 

The following questions based on how good a hearing aid amplifier has to be has been collected from different bits of information attributed to Killion.

  1. Must it meet arbitrarily-determined and proprietary-fitting formulae target gains? Since there is no standard optimal fitting formula, it is difficult to use meeting these target levels as a guideline.  A fundamental assumption in the professional fitting of hearing aids is that the gain-frequency response of the instrument needs to be individualized to the patient’s hearing loss.  Is this factual?
  2. Must it meet some undefined real-ear (RE) target? If the RE target is based on a fitting formula that provides no standard optimal amplification, a same arbitrarily undefined goal would result.  
  3. Should there be a certain improvement in word recognition scores? This would be a dangerous approach, unless one ignored PB max measurements and instead looked at unaided versus aided scores at a normal conversational level.
  4. Should a certain SNR (signal-to-noise ratio) minimum be expected? What if there is no improvement but the patient is satisfied with the amplification?
  5. Should an OTC hearing instrument have multiple programs, or some minimum? Studies have shown that the majority of people use one setting about 80% of the time, and some never go beyond the single setting.
  6. Does it require streaming capabilities or advanced adaptive features? Are all the bells and whistles needed, and even worse if they are never used?  How good must a hearing aid be to meet the needs of the individual?  Should this not be the primary function to address? If the person says that the hearing aids work for them, and they are satisfied, has not the need been met?

A well-known and highly-respected audiologist recently commented, and confirmed to  this author via e-mail the following:

“I remember well the body aids (with Y cord) that were available in the 1950’s…my HOH students in California wore them and did quite well.  I am relatively certain they were not as good as some of today’s PSAPs.”

When favorable words about amplification can be heard even from some people who have purchased $39 units, it is logical to ask, “what is going on”?

Perhaps the basic question to ask, as some have suggested is, does customer satisfaction result from advanced amplification features, or primarily from amplification?


In a study by Van Vliet in 2002, 1499 patients of well-fitted and counseled patients were asked to judge the average value of binaural Basic, AGC, Programmable, Analog Directional, Digital, and Digital Directional hearing aids. The average judged value was 60 (on a scale from 0 to 100) for all the devices, regardless of the purchase price10.  In this study, the instruments with the most features had the highest purchase price (Figure 7).  Additionally, Figure 8 shows that even with advanced features, U.S. customer overall satisfaction with hearing aids did not improve from 1944 through 2000 (with the most recent data showing satisfaction at about 60%)11,12,13.  Lybarger (1967) reported customer satisfaction with hearing aids for all purchasers at a little over 65%.  All users, however, reported satisfaction at about 85%, and this was with 40% body or eyeglass hearing aids in the mix11.  The satisfaction percentage from Hughson in 1944 was essentially all with body-worn hearing aids12.  Is it possible that the lower satisfaction today reflects consumer expectations based on promotional information?  Regardless, this is not a healthy trend.

Figure 7. The average judged value for all the devices, regardless of the purchase price, was about 60, regardless of the advanced features. (Calculated by Killion from Van Vliet, 2002 data).

Figure 8. U.S. hearing aid trend for customer overall satisfaction with hearing aids, 1944 to 2000. Various sources.

Future posts will continue along the lines of PSAP/OTC hearing aids, including information relative to self-fit, the proposed Personal Sound Amplification Performance Criteria of the Consumer Technology Association (CTA), and “universal” hearing amplification.



  1. Chan ZYT and McPherson B. (2015).  Over-the-Counter hearing aids: a lost decade for change.  BioMed Research International, Vol. 2015, Article ID 827463, 15 pages.
  2. European Association of Hearing Aid Professionals (AEA)/European Federation of Hard of Hearing People (EFHOH), Paper on the potential risk of using ‘Personal Sound Amplification Products’ PSAPs (Dec. 2015).
  3. Xu, J., Johnson, J., Cox, R., and Breitbart, D. (2015). Laboratory Comparison of PSAPs and Hearing Aids.  American Auditory Society, Scottsdale, AZ, March, 2015.
  4. Tedeschi T. and Kihm J. (2017).  Implications of an over-the-counter approach to hearing healthcare: a consumer study.  The Hearing Review.  24(3) March; 14-22.
  5. Songbird FDA Briefing. (2000).  Disposable hearing aid concept test, July.  Staab Files.
  6. Wong LN, Hickson L, McPherson B. (2003). Hearing aid satisfaction: what does research from the past 20 years say?  Trends in Amplification, Fall: 7(4): 117-161.
  7. Kochkin, S. (2002). 10-year customer satisfaction trends in the US hearing instrument market. MarkeTrak VI, The Hearing Review, October.
  8. Llewellyn C, Podpolny D, Zerbi C. Capturing the new “value” segment in medical devices. January 2015. 
  9. Killion M. Based on what the author has taken from various communications (all kinds) and writings of Killion.
  10. Van Vliet, D. (2002). User satisfaction as a function of hearing aid technology.  Paper presented at: American Auditory Society Scientific/Technology Meeting, March 14-16, Scottsdale, AZ.
  11. Hughson, W. and Thompson, E. (1944). Archives of Otolaryngology, 39:245-249.
  12. Lybarger, S. (1967).  Referenced in: Killion, M. (2004). Myths about hearing aid benefit and satisfaction.  The Hearing Review, August, pp 14, 16, 18-20, 66.   
  13. Kochkin, S. (2002). 10-year customer satisfaction trends in the US hearing instrument market. MarkeTrak VI, The Hearing Review, October.