by Laura Smith-Olinde, Ph.D., CCC/A, and Steven E. Boone, Ph.D.

Roughly 15%, ~37.5 million people, of the entire adult U.S. population has hearing loss, but the percentages increase with age. In adults aged 55 to 64, 17% have significant hearing loss; that number goes up to 25% for adults aged 65 to 74 and is over 50% in adults older than 75 years.1

When we talk with someone who has hearing loss, we usually know it, even though we cannot see the loss directly. Studies have linked untreated hearing loss to dementia, cognitive decline, and increases in social isolation, and depression.2-6 Recent studies show that older adults using hearing aids or cochlear implants have better communication. They also have slower cognitive decline, and fewer social isolation and depression symptoms.7-10 With such positive results, urging older adults to seek healthcare for diagnosis and treatment of hearing loss makes sense.

The best hearing healthcare starts with seeing an audiologist for hearing and communication needs assessments. Assessments include listening needs for face-to-face, media (TV, radio, movies), telecommunications (phone, computer), and alerting signals (alarm clock, smoke alarm) situations.11 Audiologists should also help their clients figure out if they need any hearing assistive technologies to meet these needs and what kinds of devices may work best for them and their families. Right now, no medicine or surgery can cure age-related hearing loss. The best treatments remain aural rehabilitation and sound amplifying devices, the most well known being hearing aids. Digital hearing aids provide great sound quality, but digital technology keeps hearing aids costly ($400-$3000 per aid) and many people cannot afford them.12 Medicare does not cover hearing aids, but some Medicare Advantage plans and other insurers offer partial coverage.

It happens that there are other, lower-cost amplification choices than hearing aids: handheld devices and personal sound amplifying products (PSAPs). Handheld devices have a microphone to place near the sound source and send the sound directly to earphones either wirelessly or through a wire. Sending the sound straight to the listener bypasses other sounds in the area and makes speech easier to comprehend. One example of a handheld device is “TVEars” ($60.00 -$160.00).13 Housemates without hearing loss often complain the TV is too loud; using TVEars the person with normal hearing can set the TV volume, while the person with hearing loss adjusts the TVEars volume. Another example is the “Pocketalker Ultra 2.0” (~$175.00).13  Unlike the wireless TV Ears, the Pocketalker has a wire that plugs into the microphone and carries sound directly to the earphones. The 2.0 version also has a “telecoil” that can pick up sounds in any setting that is “looped”, for example churches and theaters. The Pocketalker microphone/amplifier is about the size of a TV remote and can be used anywhere, for example in a pharmacy, a doctor’s office, or a nursing home. A sound amplifier could help ensure that patrons with hearing loss can hear and comprehend what is said and not just nodding and smiling.

The second choice, Personal Sound Amplification Products (PSAPs), costs $10 – $400 each, making them more attractive than hearing aids. The Food and Drug Administration (FDA) classifies hearing aids as Class 1 medical devices but does not regulate PSAPs. The FDA issued guidance in 2013 on PSAPs: (1) PSAPs should not be used to treat hearing loss;(2) PSAPs should be used by those with normal hearing who need a boost in some settings; and (3) no professional fitting is needed.14  PSAPs look like hearing aids and amplify sound, but they are not designed to fit a specific hearing loss. In terms of function, a recent study 15 showed that two low-cost PSAPs (Woodland Whisper; CyberScience Amplifier) and one low-end hearing aid (MD Hearing Aid Pro) did not give enough amplification at the high pitches needed by most people with age-related hearing loss, and generated a lot of internal noise, which may interfere with listening. For all PSAPs, as hearing loss increased, none gave enough amplification for listeners. Even so, some PSAPs may be a good choice for someone with a mild hearing loss who needs “just a little help sometimes.”

In summary, there are less costly options to hearing aids available over the counter, are less expensive than hearing aids, and do not require a visit to a professional. Devices such as TVEars and Pocketalker have been available for many years and work well. PSAPs are newer, may not give enough amplification if a hearing loss is greater than “mild” and, unlike hearing aids, are not programmable. The best course of action, if possible, is to start with a hearing test and consider hearing aids. Medicare will pay for a hearing evaluation. Test results can help people understand how much hearing loss they have, and will serve as a baseline for future hearing tests.


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3Lin, F. R., Metter, E .J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L. (2011). Hearing loss and incident dementia. Archives of Neurology, 68(2), 214-220. doi:10.1001/archneurol.2010.362

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5Sung, Y. K., Li, L., Blake C., Betz, J., & Lin, F. R. (2016). Association of hearing loss and loneliness in older adults. J Aging Health, 28(6):979-94. doi: 10.1177/0898264315614570

6Paul, M., Kawachi, I., & Lin, F. R. (2014). The association between hearing loss and social isolation in older adults. Otolaryngology– Head and Neck Surgery, 150(3) 378–384.

7Mulrow, C. D., Aguilar, C., Endicott, J. E., Tuley, M. R., Velez, R., Charlip, W. S., … & DeNino, L. A. (1990). Quality-of-life changes and hearing impairment: a randomized trial. Annals of Internal Medicine, 113(3), 188-194.

8Choi, J. S., Betz, J., Li, L., Blake, C. R., Sung, Y.K., Contrera, K. J., & Lin, F. R. (2016). Association of using hearing aids or cochlear implants with changes in depressive symptoms in older adults. JAMA Otolaryngol Head Neck Surg, 142(7):652-7. doi: 10.1001/jamaoto.2016.0700

9Dawes, P., Emsley, R., Cruickshanks, K. J., Moore, D. R., Fortnum, H., Edmondson-Jones, M., … & Munro, K. J. (2015). Hearing loss and cognition: the role of hearing aids, social isolation, and depression. PloS one, 10(3), e0119616.

10Li, C. M., Zhang, X., Hoffman, H. J., Cotch, M. F., Themann, C. L., & Wilson, M. R. (2014). Hearing impairment associated with depression in US adults, National Health and Nutrition Examination Survey 2005-2010. JAMA Otolaryngology–Head & Neck Surgery, 140(4), 293-302.
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13Atcherson, S. R., Franklin, C. F., & Smith-Olinde, L. (2015). Hearing assistive and access technology. Plural Publishing, San Diego, CA.

14U.S. Food and Drug Administration (FDA). Regulatory requirements for hearing aid devices and personal sound amplification products—Draft guidance for industry and Food and Drug
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15Smith, C., Wilber, L. A., & Cavitt, K. (2016). PSAPs vs hearing aids: An electroacoustic analysis of performance and fitting capabilities. Hearing Review, 23(7), 18.