Comparison of personal sound amplification products and conventional hearing aids for patients with hearing loss: A systematic review with meta-analysis

Abstract

Background: Hearing loss is a common morbidity that requires a hearing device to improve quality of life and prevent sequelae, such as dementia, depression falls, and cardiovascular disease. However, conventional hearing aids have some limitations, including poor accessibility and unaffordability. Consequently, personal sound amplification products (PSAPs) are considered a potential first-line alternative remedy for patients with hearing loss. The main objective of this study was to compare the efficacy of PSAPs and conventional hearing aids regarding hearing benefits in patients with hearing loss.

Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases and reference lists were searched from inception to January 12, 2022. Studies including randomised, controlled trials; nonrandomised, controlled trials; or observational studies comparing PSAPs and hearing aids with regard to hearing gain performance (e.g., speech intelligence) were considered eligible. The review was registered prospectively on PROSPERO (CRD42021267187).

Findings: Of 599 records identified in the preliminary search, five studies were included in the review and meta-analysis. A total of 124 patients were divided into the PSAP group and the conventional hearing aid group. Five studies including seven groups compared differences for speech intelligence in the signal-noise ratio (SNR) on the hearing in noise test (HINT) between PSAPs and conventional hearing aids. The pooled results showed nonsignificant differences in speech intelligence (SMD, 0.14; 95% CI, -0.19 to 0.47; P = .41; I ²=65%), sound quality (SMD, -0.37; 95% CI, -0.87 to 0.13; P = .15; I ²=77%) and listening effort (SMD 0.02; 95% CI, -0.24 to 0.29; P = .86; I ²=32%). Nonsignificant results were also observed in subsequent analyses after excluding patients with moderately severe hearing loss. Complete sensitivity analyses with all of the possible combinations suggested nonsignificant results in most of the comparisons between PSAPs and conventional hearing aids.

Interpretation: PSAPs are potentially beneficial as conventional hearing aids are in patients with hearing loss. The different features among PSAPs should be considered for patients indicated for hearing devices.

Funding: This work was supported by grants from Ministry of Science and Technology (MOST-10-2622-8-075-001) and Veterans General Hospitals and University System of Taiwan Joint Research Program (VGHUST111-G6-11-2 and VGHUST111c-140).

Keywords: Conventional hearing aids; Hearing impairment; Meta-analysis; PSAP; Personal sound amplification products.

Figure 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. A total of 599 records were identified in the preliminary search. After removing duplicates and screening titles and abstracts, 31 studies eventually underwent a full-text review. Of those, 26 studies were excluded due to having unfavourable comparators, irrelevant outcomes or an inadequate study design. As a result, five eligible observational studies were included.

Figure 2

Comparison of speech intelligence between personal sound amplification products (PSAPs) and conventional hearing aids. (A) The pooled result showed nonsignificant difference (SMD, 0.14; 95% CI, -0.19 to 0.47; P = .41; I²=65%). (B) After excluding the patients with moderately severe hearing loss in Cho et al., the result remained nonsignificant (SMD, 0; 95% CI, -0.23 to 0.23; P = .98; I²=24%). IV indicates the inverse variance method; SW indicates that the analysis adopted the Sound World Solutions CS50+ PSAP used in Brody et al.; MHL indicates mild hearing loss; MDHL indicates moderate hearing loss; MSHL indicates moderately severe hearing loss; PHA indicates premium hearing aid used in Cho et al.

Figure 3

Comparison of sound quality between PSAPs and conventional hearing aids. (A) The pooled result showed nonsignificant difference (SMD, -0.37; 95% CI, -0.87 to 0.13; P = .15; I²=77%). (B) After excluding the patients with moderately severe hearing loss in Cho et al., the result remained nonsignificant (SMD, -0.42; 95% CI, -1.08 to 0.23; P = .21; I²=83%). IV indicates the inverse variance method; SW indicates that the analysis adopted Sound World Solutions CS50+ PSAP used in Brody et al.; MHL indicates mild hearing loss; MDHL indicates moderate hearing loss; MSHL indicates moderately severe hearing loss; PHA indicates premium hearing aid used in Cho et al.

Figure 4

Comparison of listening effort between PSAPs and conventional hearing aids. (A) The pooled result showed nonsignificant difference (SMD 0.02; 95% CI, -0.24 to 0.29; P = .86; I²=32%). (B) After excluding the patients with moderately severe hearing loss in Cho et al., the result remained nonsignificant (SMD, 0.07; 95% CI, -0.28 to 0.42; P = .69; I²=49%). IV indicates the inverse variance method; SW indicates that the analysis adopted Sound World Solutions CS50+ PSAP used in Brody et al.; MHL indicates mild hearing loss; MDHL indicates moderate hearing loss; MSHL indicates moderately severe hearing loss; PHA indicates premium hearing aid used in Cho et al.