Nearly 20 percent of Americans, or 48 million people, report having some degree of hearing loss.¹ After age 65 that percentage continues to rise as age is the strongest predictor of hearing loss.² Almost 15 percent of school-age children also have some degree of hearing loss. While hearing loss affects millions, it is an invisible condition, often creating a barrier between the sufferer and society.

In adults, the most common cause of hearing loss is noise pollution and aging. As you get older changes occur in the inner ear that may trigger a slow and steady loss of hearing. Noise-induced hearing loss may happen suddenly or more slowly over time, while hearing loss that results from an infection more often occurs suddenly.

It may be easy to take your hearing for granted as it happens without effort on your part. However, it is a complex process that begins with sound occurring in your environment and ends in your brain. Unlike other senses that involve a chemical process, such as smell, taste or sight, hearing involves strictly physical movement.

Loss of hearing may increase your risk of other health conditions and of becoming socially isolated. In an effort to reduce this risk, many turn to hearing aids to amplify the sounds in their environment. However, the cost of these little pieces of equipment may be outside your budget, and they are not covered by traditional Medicare or private insurance companies.

Recent research has found alternatives for mild or moderate hearing loss that are more cost effective. By understanding how your hearing works, and how the equipment interacts with hearing function, you may be better equipped to choose the right device for your individual needs.

How You Hear

Sound is created by causing vibrations through the air, which your ears capture. The structure of your outer ear helps you decipher the direction from which the sound originates. Once past the outer ear, the sound waves enter the ear canal and vibrate your eardrum, a thin piece of skin that sits between the outer and middle ear. However, your eardrum is far from passive. When exposed to loud noises for a prolonged period, it becomes more rigid, essentially dampening the noise level.

Once in the middle ear, the sound waves move a group of tiny bones called the malleus, the incus and the stapes. Collectively called the ossicles, these are the smallest bones in your body. They are used to amplify the force of the sound from your eardrum as it passes through the middle ear to the inner ear and the cochlea. Fluid in the cochlea conducts the sound where it is translated into nerve impulses your brain can recognize.

Finally, as sound waves reach fibers with a resonant frequency, a burst of energy is released that moves tiny hair cells in the organ of corti, a structure stretching across the length of the cochlea. The movement of these hair cells generates an electrical impulse through the cochlear nerve that transmits information to your cerebral cortex in your brain for interpretation.

The concept of how hearing works is fairly straightforward, but the specifics of how these small structures produce recognizable patterns of sound in your brain is complex. Scientists are still learning how your brain interprets these electrical signals, especially as it relates to prevention and treatment of hearing loss.

Over-the-Counter Amplifiers May Help Mild to Moderate Hearing Loss

A hearing aid is a small electronic device that makes some sounds louder.³ The device contains a microphone that accepts the sound, an amplifier that makes the sound louder and a speaker that delivers the sound into your ear.

They are primarily used to help improve both speech and hearing in people who suffer hearing loss. However, only 20 percent of people with a hearing loss actually use hearing aids, as the cost often averages $4,700 for a pair.⁴ Traditional Medicare plans and many private insurance companies don’t pay for hearing aids.

Recent research published in the Journal of the American Medical Association⁵ found over-the-counter amplifiers sold at a fraction of the cost of hearing aids can potentially improve your hearing almost as well as hearing aids. A comparison was made between five different personal sound amplification products (PSAPs) and conventional hearing aids, which require a physician’s prescription and adjustment by an audiologist.⁶

Forty-two adults whose average age was 72 and who suffered mild to moderate hearing loss participated in the comparison study. In a sound booth, the participants listened to sentences with “speech babble noise” in the background and were asked to identify what was said without assistance, equipped with a hearing aid and then with the PSAPs.⁷

Without a hearing aid, the participants understood 77 percent of what was said. With a hearing aid, they understood 88 percent, and with four of the PSAPs, accuracy was between 81 percent and 87 percent, depending upon the model. The fifth $30 model resulted in a 65 percent accuracy, less than what the participants experienced without assistance, as the amplifier was poor quality and distorted the sound.

Hearing aids are regulated by the U.S. Food and Drug Administration (FDA), but PSAPs are not. The PSAPs are available online and at stores. According to the FDA, PSAPs are designed to be used by people who do not have hearing loss, to help them distinguish distant sounds. Study author Nicholas Reed, an audiologist at Johns Hopkins School of Medicine, commented on the use of PSAPs and hearing aids:⁸

“Hearing aids are regulated medical devices and should all be able to aid someone with hearing loss. While not all hearing aids are the same, they should all be able to meet this minimum requirement of making sound louder at appropriate frequencies and with minimal distortion. The results suggest that the [PSAP] devices are technologically and objectively capable of improving speech understanding in persons with hearing loss.”