Does Hearing-Aid Industry still exist?

Synergy then! Actually, the noise cancellation they’re putting into better quality buds might protect hearing (when used wisely).

It’s interesting how devices evolve. I know 20 years or more ago HAs we’re hand manufacturered with tiny amplifiers and mics and all sorts of stuff. Like building a fine Swiss watch, skill with teeny tiny parts was key and required extensive experience and training to have the skills needed.

Since the move to solid state chip technology the individual processing components can now be made directly on a chip, in fact an entire system can be placed all on one chip. That’s impressive from the ability to decrease size and increase performance. From some limited poking around I noticed the trend away from the HA companies preparing specs and sending them off to be manufactured for them, to semiconductor manufacturers creating platforms HA makers could use with base functionalities present as well as the ability to program custom whatever’s code onto the chip. Here’s an interesting (undated but certainly within today’s, probably way earlier capabilities to manufacture) from a semiconductor manufacturer demonstrating the electronic backbone of what the they could offer the HA maker in technology and abilities. The need for a HA maker to design from the ground up to the availability of preassembled HA processing chips lessens the burden. It also decreases time required to speed up product cycles and lends itself to faster assembly with partial automation a possibility.

Semiconductor White Paper2

These types of evolution are well suited to bring manufacturing cost down while still allowing development of more sophisticated, improved designs. It encourages both HA makers and consumer products makers such as Bose, Sennheiser, Samsung, and even Apple the opportunity to enter the OTC market and pass along retail price decreases to establish market penetration.

The fusion of consumer audio and prescription HA makers is synergistic and hopefully improve access to hearing assistance to far more people than currently reached. It also makes it harder for HA makers to cling to high prices for their hardware.

I recognize the cost of a prescription HA I’d more than the hardest. You need an integrated system of heating specialists to test, fit, and provide follow up support throughout the lifespan of the HAs sold. That highly trained labor force does add a significant amount to the total price of “buying a hearing aid “ and not thinking about the breakdown of cost of the individual services provided. But with lower prices for the hardware, hearing aid specialists will be able to pass along some of that savings to the patient.

Look at what Costco can do with lower pricing obtained by volume buying. What would the prescription market look like if those discounts could become broadly available to Audi’s for their practice? It should lower the bar for a patient who has to pay fir the HA out of pocket.

Of course there is the new self fitting technology that further reduces labor costs at the expense of withdrawing hearing aid specialists from the equation, allowing fitting software to take the wheel.

That might sound depressing to hearing aid specialists, but there will still be significant demand as those with severe hearing loss will still require the care, and those with moderate hearing loss who get some benefit from an OTC product but recognize they may benefit more with audiologist testing and care. It can be good for everyone, but the HA industry needs to be prepared for that future market to look unlike any they faced before.

The big 6 already know that. They’re intelligent and can see the road ahead. It’s why Sonova bought Sennheiser. It’s why the other manufacturers are lining up their own plans. The good news for me is that those who suffer from hearing loss may take hearing care attainable without choosing between better hearing and quality of life or replacing their leaky roof.

@eskie227 said:

Sooner or later people were going to catch on that a pair of $200 AirPods Pro could cut distracting ambient noise as well as a $2,000 HA.

In here lies the biggest improvement to UNDERSTANDING speech that HA mfgs have not adequately addressed - noise reduction.

I have owned Bose noise canceling headphones for years and without any question this improves understanding dramatically. As a demonstration of this I asked my wife who is does not have hearing loss to listen to a TV program with the headphones and without. She said both were understandable and comparable in volume but the TV sound quality was a bit better.

I have Widex Beyond HAs. Even with their streamer (in muted mode) it is difficult to understand many speakers without looking at the closed captions. If I listen to the broadcast with my Bose NS700 (wireless headphones) without my Beyonds, the sound is dramatically clearer and I am able to understand most speakers.

With no HA or headphone, I would barely be able to tell that the TV was on!

This improvement in understanding is so profound, I am angry that HA companies have not moved more aggressively to improve the technology they offer. As article inferred, it is clear that their focus is more marketing and less innovation. Where is the Apple, SpaceX or Moderna of the HA industry?

Maybe Bose’s entry will signal a more aggressive move to make consequential improvements.

@eskie227 said:

The elder population is more likely living on fixed income with some savings they accomplished despite being of modest means. Even with Medicare parts A,B, and D, the out of pocket expenses can be pretty high. Even with a Medicare Advantage plan, when you add up the premiums, deductibles, and copays you may be looking at a maximum out of pocket expense of $7-8K before they’ll cover 100% after that (traditional Medicare with its odd 20% copay on part B, $500 per day of hospitalization for the first 5 days, and then the weird donut hole of part D prescription coverage doesn’t have a low backstop limit either).

If a person has several common medical problems, hypertension, heart disease, high cholesterol, and diabetes, they may well have to make a choice of “do I pay for all the medicines and office visits I need, or do I cut that back so I can buy premium HAs?” In truth, if they care about themselves and their health, they need those medications to avoid premature death or morbidity from their illnesses. Is passing on a HA really not caring about your health and well-being?

In most of the developed World this isn’t an issue. Countries where medical services are free at the point of supply don’t follow your model/reasoning at all.

Also, if you consider the relative wealth of each generation, the equation is massively skewed towards the ‘boomer’ generation, with Gen X coming next.

This may be different where you are.

Yeah, that was implicit in ‘MOST’ of the developed World.

I think the Wealth distribution is pretty consistent over age groups in Western society.

I am curious about the UK, and I expect as an audiologist there you might have done good insights. The NHS apparently does provide HAs (I assume at a low cost to the patient). Why do what seem like many people who are on this forum and live there end up using a private practice, or chain stores and Costco? Is it a matter of a higher quality aid, faster access, or are there other reasons?

NHS provision is free, but there’s a bit of a waiting list.

This usually buys you a pair of BTE, though in some instances RIC are fitted.

People choose private Audiology for a faster service, with greater availability on the high street. Better technology, more choices and more available aftercare.

@rbahr1900 said:

The HA manufacturers have been just ‘cashing their checks’ for a while. There is really little to no innovation happening - The technology they are using is 10+ years old - by comparison look at your cell phone and how it has changed in the last 10-15 years

Haahahahahahahahaahhaa.

Fair play that’s brilliant.

The form factors look similar but there’s no way you can say the tech inside hasn’t moved on in 10 years. That’s about four product cycles.

Cars today look similar to how they did 20 years ago, but under the hood, they can drive themselves, ring the emergency services and locate you in an accident and decision-make based on traffic, environmental concerns and safety. That’s on top of taking over from you when your ace driving skills aren’t quite on point.

The synergy between hearing-aids and general communications devices is getting closer and there will be companies who don’t make the cut. The delivery model will develop too; there’s already blurring in the OTC product areas, but to suggest that there’s a lack of innovation in this industry is utter rubbish.

The only short term glitch I see is the current shortage of simple inexpensive semiconductor chips in the market. Everything from cars (with Ford and GM forced to dial back assembly lines due to the inability to install the electronics cars rely on today) to TVs, anything with a screen, and even HAs are in such short supply prices have, in some cases, jumped 1,000% in price. Chips that sold for $0.50 are now selling for $30. A cheap mosfet switch the design of which hasn’t changed much in years, is suddenly a precious product as without it you can’t complete the build a high, or low end, electronic devices and and controls.

This is bound to impact HA makers who will have to decide if and how they can handle the increase in cost. Where it really may hit home is for anyone like Bose to introduce things like OTC aids may have to rethink their introduction timetables. We may well end up with a shortage of devices over the next year with HAs. Even Sony’s PS5, which is selling like crazy, just put out a warning that unit production may well not catch up to demand for the next year. If OTC aids are stuck in the same loop, we may be speculating about their introduction for many months before we see them.

It’s just another twist in the pathways electronic devices can be designed and marketed. The funny part is all the complex chips like all the CPUs can be made in sophisticated chip plants, while it’s the little simple cheap stuff halts production across industries.

The IC market will come back, not sure when, I am sure that they will make a lot of money off of this demand. Sonova is seeing the writing on the wall and will move into the retail space. It is a win for them as they get a distribution chain and probably some technology. I for one, have been waiting for Bose for some time.

The tech that will be essential will be ASICs, not certain what the level of discrete components in the current HA is.

Ray

@rbahr1900 said:

The technology they are using is 10+ years old - by comparison look at your cell phone and how it has changed in the last 10-15 years

I disagree. Phone technology has not fundamentally changed in the last 10 years, and the tech incorporated into phones over the past 15 years has been borrowed from other industries, photo, computer, audio. Most changes in phones have been in the form of appropriation and iteration.

Jim

Hi Jim,

For the record, I did not use the term ‘fundamentally’, and I agree that this has been an iterative process

My background is in engineering. That is 45 years of embedded processing with a specific focus processing technologies including SoC design and use. This is going back 45+ years.

Major improvements that phone technology has brought by technology include:

Chemistry: Battery tech
Software: Signal processing, Power managememnt
Hardware: SoC design, low power design
Mechanical: Optics, Packaging

In all of these areas the Cell phone has absolutely driven the technology edge. I would agree that this has been iterative, but the sharing of this tech is in exactly the other direction that you suggest. The above mentioned improvements have found their way into other commercial arenas.

The standard home computer has been slow to accept SoC technology, the exception here is the spate of products such as the Raspberry Pi, etc.

I am happy to carry this conversation on, but it should probably be off line as I don’[t want annoy / bore others.

In general, I found this entry a very useful summary of the changes going on today in the hearing devices industry. I am currently a devotee of Bose Hearphones, and I love the fact that they don’t hide behind my ear. I would welcome questions and comments from those I encounter but I never get any, except “What are you listening to?” Doctors I’ve met since I started wearing them (with the pandemic) have been fascinated and wanted to know all about them.

I don’t think R&D explains the cost of HAs at all.

The Hearing-Aid industry is still very much a protected market, where there is limited entry by vendors (audiologists) who collude with manufacturers to keep prices high.