This article is specifically about the hearing aid itself, not the fitting process.
Modern hearing aids are an amazing technology, sound processing gets better and better each year, the ability to hear in noise improves which each new device. Bluetooth connectivity is pretty much a solved problem. They are small and discreet and work extremely well for a long time. I am hugely impressed with hearing aid technology and I won't hesitate to recommend them to anyone with a hearing loss.
Why aren't people buying them?
According to industry surveys, it seems that only 34% (1) of the people who could be wearing a hearing aid in the US are and 41% in the UK (2). That is a low adoption rate for people with a problem that could be solved by easily accessible technology. So why don't people adopt them? According to MarkeTrak in the US, the reasons why are as follows:
For people who know they have a loss, but haven't done anything about it:
- Can hear well enough 43%
- Too expensive 40%
- Can't afford 24%
- Have other priorities 20%
- No coverage/insurance 19%
- Too embarrassing 17%
- Not enough benefit 17%
- Do not know where to get tested 14%
- Too noticeable/visible
- Afraid of becoming dependent 12%
- Unattractive 12%
- Uncomfortable physically 12%
- Too young to have hearing aids 11%
For non-owners who have been recommended a hearing aid by a professional:
- Too expensive 42%
- Can't afford 26%
- Can hear well enough 22%
- No insurance/coverage (affordability again) 21%
- Got PSAP/Hearing Aid directly 17%
- Have other priorities 14%
- Too embarrassing to wear 14%
- Not enough benefit to justify 13%
The biggest impediment to adoption is cost, 40% in one group and 42% in the other say they are too expensive and 24% and 26% respectively say they simply can't afford them. In all honesty, if we dig deeper, some of this may be a value versus cost equation. By that I mean, some of the 40% who say they are too expensive may have the finances to proceed but aren't convinced that the value they deliver outweighs the cost.
Staying younger for longer is a lot of value!
More often than not, the value delivered probably outweighs the cost. Hearing aids, when needed, deliver a whole new lease on life, allowing you to be socially active and engaged, which means that you will stay younger for longer, and that is the truth.
One way or the other, cost of hearing aids impedes adoption
But hearing aids aren't special!
They aren't any different to other great tech products out there. The latest MacBook Air is hugely impressive, smartphones are an amazing technology and a huge leap from the old bricks that people used to carry around in the 1980s. High-end technology is all around us, hearing aids aren't special in that respect.
But we think about them differently, they are marketed to us differently
Hearing aids are marketed as "medical devices" that need to be supplied by a trained professional, which drives the way we think about them. While they are classed as medical devices, for most people with a run of the mill sensorineural hearing loss, there are no underlying medical problems. The damage has been done, and it can't be fixed.
The only treatment is hearing aids, while there is a deep skill-set to testing and fitting hearing aids. There are no medical contra-indications for fitting hearing aids for a typical sensorineural hearing loss. As I said, hearing aids are just tech, high-end complex tech, but tech nonetheless.
Laptops and smartphones are now everyday products that millions of us use without even thinking about it, even though they are highly technical. How many people who use an Android smartphone would know how to write a new display driver for it so that it would work with a Smart TV? Not many.
How many users of the MacBook Air M1 know how the caching on the new Apple-made microprocessor works to speed up applications? Not many. But we don't need to. We can use these highly-technical products to play games, send messages, post on Facebook, paint, write, keep finances and a million other things because...
Good software makes hard things easy
There has been some feedback from my Netflix article that "patients can't set up their hearing aids, it's dangerous", "they will over-amplify and make their hearing worse", "the general public doesn't understand how to treat a hearing loss". And that is absolutely correct, we can't use the current software the audiologists use to set up hearing aids for us, that software is designed to be used by trained professionals, it's not for us.
But that doesn't mean a self-fit approach won't work
An Indiana University study, published in the American Journal of Audiology, compared outcomes among three groups of patients: one that got a hearing aid that included the services of an audiologist; one that followed an over-the-counter process, choosing a pre-programmed hearing aid, which was the same high-end digital pair as the first group but without a fitting; and a control group that got a professional fitting for a placebo hearing aid that had no amplification.
The researchers found that hearing aids helped both the audiologist group and the OTC group. However, the OTC group was less satisfied with the hearing aids and less likely to purchase them after the trial. About 55% of the OTC participants said they were likely to purchase their hearing aids after the trial vs. 81% for the audiologist group.
There are some important caveats here, the first is that this was a short and small scale study. The second and most important caveat in my mind is the fact that the OTC group, had no control over the settings of their devices. They were pre-programmed with three different sound profiles that they could change between.
The author explained that the OTC group did not have a wide array of choices. They could choose only one type of hearing aid—a high-end one with three pre-set programming options. In this way, that group did not get access to OTC devices as we envisage them now, yet 55% were happy to purchase after the limited trial.
What we need is software that makes a hard thing easy
This is not an impossible task. The programming of hearing aids needs to be reframed from the perspective of the person with a hearing loss. Software does this all the time, it is designed to be usable by the target audience if you use Microsoft Word to write a letter you don't need to know how Bézier curves are being used to render the words on the screen, or how the things you write are stored on the disk as 1s and 0s.
The problem isn't that the general public can't use the currently-available specialist software for audiologists. The problem is that no-one has yet written software that we can use.
The technology is available to make this happen, someone just needs to build it. If we think about a hearing aid from a pure technology point of view, we see that it's no different to iPads/iPhones/laptops/etc in that it has inputs, it processes them, and it produces outputs. That's basically it. We need software that will allow the general public to select how to manipulate those inputs and tweak those outputs.
Modern hearing aids are already excellent at receiving sound inputs, processing them and outputting a different sound. The big manufacturers have been improving the hearing aids over many years to do exactly this. We don't need improved hearing aids, we just need a different way to control them.
The other piece of the puzzle is the actual hearing aid itself. The physical thing that goes in your ear. Is that "special" and requires expert fitting? There are certainly some fiddly bits at the moment, changing a wire is not as easy as it could be and cleaning wax guards requires some poking about, these would definitely cause problems for someone with mobility issues.
Is that enough to say we can't use over-the-counter self-fitting hearing aids? I don't think so
Firstly, video tutorials would take care of a lot of those problems. While custom made hearing aids would not be available, most Receiver In Canal hearing aids are very discreet. If there was a mass-market hearing aid on the shelf at the local electronic store it would be physically more robust, but not much.
Hearing aids already have a pretty good lifespan, mine have always lasted me at least five years and even then I only needed to change them because my hearing had gotten worse and I needed something more powerful. They aren't flimsy products today and with a little more thought on the problem parts they could easily be handled by the general public. They aren't special.
Good technology makes hard things easy
There will, of course, be some people who can't use this generic hearing aid for whatever reason, but the majority could and probably would. Even those that can't use it will probably know someone who can help them out. Dismissing people's ability to use a hearing aid off-the-shelf because current tech is too hard for them is missing the point, once a product that is aimed specifically at the non-professional is available, people will quickly work out what to do and they'll be aided by the software/hardware designed for that exact purpose.
Will they be suitable for everyone with hearing loss, no probably not. Will some people need medical intervention because of some underlying medical condition, yes they will. Will they be the most suitable device for you in the long term, maybe not. But for the bulk of people with sensorineural hearing loss, a self-fit approach will be suitable, convenient and finally cost-effective for their first time around the roundabout.
More than that, if a self-fit hearing aid helps people to understand that cost versus value ratio in a better way, maybe they will be quicker to see a professional in the long term.
- Marketrak IX: https://www.audiologyonline.com/articles/20q-understanding-today-s-consumers-26648
- EuroTrak IV: https://www.ehima.com/wp-content/uploads/2020/07/EuroTrak-Trends-2009-2020-June-2020.pdf
- Hearing Aid Adoption and Satisfaction With the Device Increase with Audiologist Involvement: https://leader.pubs.asha.org/do/10.1044/hearing-aid-adoption-and-satisfaction-with-the-device-increase-with-audiologist-involvement/full/