Rapid Brain Adaptation to Hearing Amplification: A Randomized Crossover Trial of Personal Sound Amplification Products

Understanding speech in noise is a common challenge for older adults, often requiring increased listening effort that can deplete cognitive resources and impair higher-order functions. Hearing aids are the gold standard intervention for hearing loss, but cost and accessibility barriers have driven interest in alternatives such as Personal Sound Amplification Products (PSAPs). While PSAPs are not medical devices, they may help reduce listening effort in certain contexts, though supporting evidence remains limited. This study examined the short-term effects of bilateral PSAP use on listening effort using self-report measures and electroencephalography (EEG) recordings of alpha-band activity (8-12 Hz) in older adults with and without hearing loss. Twenty-five participants aged 60 to 87 years completed a hearing assessment and a phonological discrimination task under three signal-to-noise ratio (SNR) conditions during two counterbalanced sessions (unaided and aided). Results showed that PSAPs significantly reduced self-reported effort. Alpha activity in the left parietotemporal regions showed event-related desynchronization (ERD) during the task, reflecting brain engagement in response to speech in noise. In the unaided condition, alpha ERD weakened as SNR decreased, with activity approaching baseline. PSAP use moderated this effect, maintaining stronger ERD under the most challenging SNR condition. Reduced alpha ERD was associated with greater self-reported effort, suggesting neural and subjective measures reflect related dimensions of listening demand. These results suggest that even brief PSAP use can reduce perceived and neural markers of listening effort. While not a replacement for hearing aids, PSAPs may offer a means for easing cognitive load during effortful listening. ClinicalTrials.gov, NCT05076045, https://clinicaltrials.gov/study/NCT05076045.