Starkey and the Future of Hearing Aids(bloomberg.com)
bloomberg.com
Starkey and the Future of Hearing Aids
https://www.bloomberg.com/news/features/2019-04-18/the-future-of-wearable-tech-is-called-a-hearing-aid
50 comments
Not an audiologist, but an engineer/musician with some mild hearing loss and some interest in these things.
What needs to happen to bring the prices down is a unified prescription for hearing aids, like we have with eyeglasses. You can get your eye exam, request your prescription, and take it anywhere you want -- Costco, Zenni, or your local shop. That facilitates apples-to-apples competition.
There's nothing like that with hearing aids. Each company's aids need to be fitted with that company's software, and if you want to switch to a different brand, you need to go through the fitting process all over again. You can get a copy of your audiogram, but that doesn't capture everything that goes into a hearing aid fitting. What the manufacturers do is provide different fitting profiles for different types of losses (old-age loss, noise-induced loss, cookie bite loss, and so forth) and then tweak from there. You can't just take your profile from one manufacturer and move it to another.
For a comprehensive hearing aid prescription, you'd need to know exactly how much conductive loss you have at each critical band of hearing (https://en.wikipedia.org/wiki/Bark_scale). Additionally, you need to know how much loudness recruitment (nonlinear increase of perceived loudness in response to linear increase of sound intensity) you have at each band. The problem is that right now, it's prohibitive to measure all that -- you'd be in the silent room pushing buttons in response to beeps for hours. I'm hoping that eventually, AI can help with that by taking over that manual work and allowing for more fine-grained audiometric data. Rather than trying to build noise cancelling, etc. into the hearing aids themselves, maybe we can provide accurate enough prescriptions so that the brain gets the information it needs to do the processing itself just like it does for a non-hearing-impaired person.
What needs to happen to bring the prices down is a unified prescription for hearing aids, like we have with eyeglasses. You can get your eye exam, request your prescription, and take it anywhere you want -- Costco, Zenni, or your local shop. That facilitates apples-to-apples competition.
There's nothing like that with hearing aids. Each company's aids need to be fitted with that company's software, and if you want to switch to a different brand, you need to go through the fitting process all over again. You can get a copy of your audiogram, but that doesn't capture everything that goes into a hearing aid fitting. What the manufacturers do is provide different fitting profiles for different types of losses (old-age loss, noise-induced loss, cookie bite loss, and so forth) and then tweak from there. You can't just take your profile from one manufacturer and move it to another.
For a comprehensive hearing aid prescription, you'd need to know exactly how much conductive loss you have at each critical band of hearing (https://en.wikipedia.org/wiki/Bark_scale). Additionally, you need to know how much loudness recruitment (nonlinear increase of perceived loudness in response to linear increase of sound intensity) you have at each band. The problem is that right now, it's prohibitive to measure all that -- you'd be in the silent room pushing buttons in response to beeps for hours. I'm hoping that eventually, AI can help with that by taking over that manual work and allowing for more fine-grained audiometric data. Rather than trying to build noise cancelling, etc. into the hearing aids themselves, maybe we can provide accurate enough prescriptions so that the brain gets the information it needs to do the processing itself just like it does for a non-hearing-impaired person.
Just an FYI -- you can get a hearing test at Costco or you can request your results and bring them to Costco.
Sure, that's an audiogram. It tells you what your threshold of hearing is at a certain set of frequencies. Additionally, sometimes they'll do bone conduction, which can characterize whether your loss is conductive (for example, trouble with the bones in your inner ear) or sensorineural (for example, cochlear damage from noise exposure). But that's just a starting point for fitting a hearing aid -- it's not like a glasses prescription that tells the optometrist exactly how to cut the lens.
Fellow HA wearer here - close on 25 years now. I agree that disruption in manufacturing is important, but I also think there are a few other areas that could use disruption.
First, remove the stigma of hearing aids and hearing loss. It's not an old person's thing, and it's not something you have to hide. For me, they are glasses for my ears. That cost thousands of dollars. I want options. I want colors. I want "Ray Ban" to brand hearing aids. I do not want to browse a selection of colors that are clearly meant to either blend with my skin color or my hair color. Don't market to me that they are "hardly visible" as if I should be ashamed of them and hide them.
Second, make insurance work better. For a time, I had a state job, and the state insurance would pay $200 per hearing aid. That's nowhere close to the cost - probably about 10% of the cost. $200 gets you a cheap "hearing device" you'd get out of the back of an AARP magazine with pictures of silver haired people. In my current job (Fortune 50 company), they will pay 90% of the cost for hearing aids, but they will only buy me one pair in my life time. IN MY LIFE TIME. Utterly ridiculous. I could lose one or have one damaged, and be on my own for the $2500-3500 (each) replacement cost depending on what I got.
First, remove the stigma of hearing aids and hearing loss. It's not an old person's thing, and it's not something you have to hide. For me, they are glasses for my ears. That cost thousands of dollars. I want options. I want colors. I want "Ray Ban" to brand hearing aids. I do not want to browse a selection of colors that are clearly meant to either blend with my skin color or my hair color. Don't market to me that they are "hardly visible" as if I should be ashamed of them and hide them.
Second, make insurance work better. For a time, I had a state job, and the state insurance would pay $200 per hearing aid. That's nowhere close to the cost - probably about 10% of the cost. $200 gets you a cheap "hearing device" you'd get out of the back of an AARP magazine with pictures of silver haired people. In my current job (Fortune 50 company), they will pay 90% of the cost for hearing aids, but they will only buy me one pair in my life time. IN MY LIFE TIME. Utterly ridiculous. I could lose one or have one damaged, and be on my own for the $2500-3500 (each) replacement cost depending on what I got.
Agreed on both counts. Wearing hearing aids for essentially my whole life I've been made fun of for it maybe once or twice, and that did suck, but there's so much more stigma in an oticon pamphlet than I've ever experienced in real life. It definitely feels like a pitch aimed at older people who are in denial about losing their hearing, no matter how many pictures of teens chatting in a circle they put in there. Matching colors, assurances that they're unnoticeable, the implication that you need hearing aids to be "normal" (true-ish for me, but still not appreciated), and so on.
Insurance is a joke. Every private insurance plan I've ever had, even my current otherwise decent one, has paid a total of 0% for anything HA-related. And it's not just the hearing aids themselves, it's the tests and the followups and the fittings and on and on. It really adds up. Iirc medicaid actually had decent coverage, but I wasn't paying for it at the time so I don't know have numbers.
Insurance is a joke. Every private insurance plan I've ever had, even my current otherwise decent one, has paid a total of 0% for anything HA-related. And it's not just the hearing aids themselves, it's the tests and the followups and the fittings and on and on. It really adds up. Iirc medicaid actually had decent coverage, but I wasn't paying for it at the time so I don't know have numbers.
I say only half facetiously, make them look like AirPods. It’s considered perfectly normal to have one or two in your ears much of the time.
1) I don't want to be confused with someone who won't take their earphones out
2) this is another form of camouflage which is indicative of something that sour be hidden or shameful
2) this is another form of camouflage which is indicative of something that sour be hidden or shameful
So, take the idea that Starkey is going on, but make them ostentatious? Kind of the way arm and leg prostheses have gone now that 3D printing has reached consumers?
They should be like glasses, as they serve quite a similar function. But they are even less evident, so unless you wear bright pink aids, they shouldn't probably attract any attention (they don't really change your look, do they?).
Everything else means there's still a stigma.
Everything else means there's still a stigma.
Ostentatious - characterized by vulgar or pretentious display; designed to impress or attract notice.
That is not at ALL what we want. Not even close.
That is not at ALL what we want. Not even close.
I'm convinced that the real reason why hearing aids remain so expensive is because of the need to see an audiologist. In a day and age where Shenzhen makes hardware iteration cheap for Chinese hardware companies, it makes very little sense for the hearing aids themselves to be so expensive.
I'd love to hack on mine, but I lack the hardware setup that connects the hearing aids to a computer for programming, not to mention a copy of the Noah programming utility itself. Everything is completely closed - good luck finding an audiologist who's gone far enough into software programming and the open-source world to appreciate the benefits that FOSS brings. The UX shouldn't be so complicated - instead of the frequency-oriented UX that Noah presents to an audiologist userbase (which is well familiar with the underlying science and has an interest in working quickly and efficiently so as to proceed to their next patient appointment), have a more optician-inspired UX, which plays a sound or speech track and asks you questions like "does this track or this other track sound better to you?" and "does this sound too quiet or too loud?" over and over again until the end user "dials in" the right fit.
I'd love to hack on mine, but I lack the hardware setup that connects the hearing aids to a computer for programming, not to mention a copy of the Noah programming utility itself. Everything is completely closed - good luck finding an audiologist who's gone far enough into software programming and the open-source world to appreciate the benefits that FOSS brings. The UX shouldn't be so complicated - instead of the frequency-oriented UX that Noah presents to an audiologist userbase (which is well familiar with the underlying science and has an interest in working quickly and efficiently so as to proceed to their next patient appointment), have a more optician-inspired UX, which plays a sound or speech track and asks you questions like "does this track or this other track sound better to you?" and "does this sound too quiet or too loud?" over and over again until the end user "dials in" the right fit.
Self-programming is a viable option.
In the past HA companies had a problem: audiologists weren't technical and didn't know how to program the increasingly sophisticated hearing aids. So the fitting software (1) automatically produces a reasonable fit and (2) at least the ones I've used have a section that asks questions and makes adjustments based on the answers.
It's also worth noting that there isn't really a "correct prescription" but rather it's an art of arriving at settings based on the client's goals and feedback. The audiogram is a diagnostic tool but only a starting point for determining HA settings. From the HA dispenser's perspective, adjusting settings costs them time and therefore money after they've made the sale. From the client's perspective, you'd need to visit the audiologist for every adjustment. Self-programming avoids the problem.
The programming hardware, software, and used hearing aids are all available on ebay. The prices are such that your average HN reader wouldn't have to worry too much about replacement costs if a HA breaks or goes missing. And the flexibility is great too.
You may not need NOAH. For a Phonak hearing aid you only need the iCube II (programming device) and Phonak Target (programming software). The NOAH software is an optional place to store customer data which is useful in a clinic that sells hearing aids from different manufacturers.
In the past HA companies had a problem: audiologists weren't technical and didn't know how to program the increasingly sophisticated hearing aids. So the fitting software (1) automatically produces a reasonable fit and (2) at least the ones I've used have a section that asks questions and makes adjustments based on the answers.
It's also worth noting that there isn't really a "correct prescription" but rather it's an art of arriving at settings based on the client's goals and feedback. The audiogram is a diagnostic tool but only a starting point for determining HA settings. From the HA dispenser's perspective, adjusting settings costs them time and therefore money after they've made the sale. From the client's perspective, you'd need to visit the audiologist for every adjustment. Self-programming avoids the problem.
The programming hardware, software, and used hearing aids are all available on ebay. The prices are such that your average HN reader wouldn't have to worry too much about replacement costs if a HA breaks or goes missing. And the flexibility is great too.
You may not need NOAH. For a Phonak hearing aid you only need the iCube II (programming device) and Phonak Target (programming software). The NOAH software is an optional place to store customer data which is useful in a clinic that sells hearing aids from different manufacturers.
The problem is that patients don't always know what is supposed to sound right, especially if they've been going without hearing aids for years. If you take a person with a high-frequency loss and correct it to the normal range, they'll often complain that everything sounds sharp, or there are too many noises and it's hard to concentrate. Only after wearing them for a while does their brain learn to filter out the normal environmental sounds and adjust to the "new normal".
Which is precisely why home self-programming is so important. It allows patients to go back and re-program as often as they feel necessary, and such additional tunings would not cost the patient the cost of additional audiologist visits.
I guess the question is whether ignorance is bliss. If a patient self-sets a hearing aid to a level that the patient thinks is great, but isn't theoretically as great as it could be, is that actually a problem?
I guess the question is whether ignorance is bliss. If a patient self-sets a hearing aid to a level that the patient thinks is great, but isn't theoretically as great as it could be, is that actually a problem?
> I'm convinced that the real reason why hearing aids remain so expensive is because of the need to see an audiologist.
That might change in 2020 in the US because some laws have been enacted that will allow some hearing aids (for mild hearing loss?) to be sold directly to the customer.
That might change in 2020 in the US because some laws have been enacted that will allow some hearing aids (for mild hearing loss?) to be sold directly to the customer.
> why hearing aids remain so expensive is because of the need to see an audiologist.
A bit like the need to see an optometrist to get glasses. When I was in Beijing a few years ago I went to the glasses district (basically a few buildings all in the same area that are floor-upon-floor of eye glass shops)... I was able to get a thorough exam from the salesman, and had a custom made pair of glasses in a couple hours for under $50US.
A bit like the need to see an optometrist to get glasses. When I was in Beijing a few years ago I went to the glasses district (basically a few buildings all in the same area that are floor-upon-floor of eye glass shops)... I was able to get a thorough exam from the salesman, and had a custom made pair of glasses in a couple hours for under $50US.
Is that a U.S. thing, having to see an optometrist? I did not need glasses when I lived in the U.S. But now living in a developing country my experience is similar to yours. Multiple eye glass shops in the shopping malls will check your eyes and cut lenses in a couple of hours. Cost depends mostly on how much you want to spend on frames - name brands are more expensive.
I've looked at the financials of hearing aid companies before. And the short answer is that the money is not going to the hearing aid company. Of the $5k you spent on your hearing aid, the hearing aid company was probably paid $500, and the other $4.5k went to the audiologist.
Watch out what you ask for. The disruption might be a "low cost" model that listens to everything you say, and works as a mobile cash register for amazon or an "interest tracker" for google.
:)
:)
Most hearing aids these days just boost certain frequency bands due to band-specific hearing loss. I saw a research project awhile back that was using neural networks to discern speech from background noise, and cancel the background noise. I'm hoping the feature comes to hearing aids soon!
Modern hearing aids have DSP chips that do various kinds of processing. (Most obviously, they are pretty good at canceling feedback, though it's still sometimes annoying when playing music.) The marketing literature for the hearing aids I bought 8 years ago claimed that they do all sorts of fancy things.
However, it's much like reading the marketing literature for a TV or a camera. There are a lot of impressive-sounding trademarked terms being thrown around about for the various ways that hearing aids improve sound quality, but without independent evaluations it's hard to tell if they are doing anything or it's just hype for pretty simple algorithms.
A case in point from the article: "The Livio AI, as the new device is called, uses tiny sensors plus, as its name suggests, artificial intelligence to selectively filter noise and focus on specific sound sources—for instance, the person across the table in a busy restaurant [...]"
My hearing aids supposedly do that too, but it's hard to tell. How much is a real improvement how much is updated buzzwords?
(Natural language translation, on the other hand, would be quite the thing, if it worked.)
"The cost is next-level, too: $2,500 to $3,000 per hearing aid or more, depending on the doctor and his or her services."
Mine cost about the same. Nothing unusual there. (Actually what is new is that prices for low-end hearing aids went down due to Costco's competition.)
However, it's much like reading the marketing literature for a TV or a camera. There are a lot of impressive-sounding trademarked terms being thrown around about for the various ways that hearing aids improve sound quality, but without independent evaluations it's hard to tell if they are doing anything or it's just hype for pretty simple algorithms.
A case in point from the article: "The Livio AI, as the new device is called, uses tiny sensors plus, as its name suggests, artificial intelligence to selectively filter noise and focus on specific sound sources—for instance, the person across the table in a busy restaurant [...]"
My hearing aids supposedly do that too, but it's hard to tell. How much is a real improvement how much is updated buzzwords?
(Natural language translation, on the other hand, would be quite the thing, if it worked.)
"The cost is next-level, too: $2,500 to $3,000 per hearing aid or more, depending on the doctor and his or her services."
Mine cost about the same. Nothing unusual there. (Actually what is new is that prices for low-end hearing aids went down due to Costco's competition.)
For what it's worth, my last pair of digital aids were purchased circa 2011 as well, and the pair I recently (last few months) got aren't just better, they're astonishingly better. I ended up going with Phonak Audeo M's over the Starkey Livio AI's but it was a close decision. My two cents is that if you've got the inclination/resources, it might be worthwhile to pay a visit to an audiologist you trust to see what the state of the art is like.
I recently made a similar upgrade (old ones from 2010-ish) and I was also impressed by how much better the new ones were. The old pair's performance may have degraded over time, but the way the new ones blew them out of the water I doubt it was just that.
What pushed you over the edge to the Audeo?
The Audeo M's (are? were?) the only ones with native, in-device/streamer-less bluetooth. They work just like bluetooth headphones/mic (used so far with: osx, android, linux desktop) and the sound quality is outstanding. The only minor irritant I've found so far is that you have to effectively power cycle them to re-pair to another device (eg phone to work laptop).
[deleted]
Mine use low power wireless to coordinate sound amplification, and they are 4 years old. They can be a lot fancier than you're imagining - but at a price of thousands of dollars each.
https://www.crunchbase.com/organization/whisper-3
Whisper is trying to do this. It's a super hard problem space to work on (for a variety of reasons, most notably power constraints for in-ear/near-ear devices). You just need more cycles per second to do higher resolution fourier transforms.
Whisper is trying to do this. It's a super hard problem space to work on (for a variety of reasons, most notably power constraints for in-ear/near-ear devices). You just need more cycles per second to do higher resolution fourier transforms.
Nice PR piece :)
We need dramatic improvement in battery capacity to put machine learning in hearing aid, it's far away
We need dramatic improvement in battery capacity to put machine learning in hearing aid, it's far away
The article suggests any ML is happening in the paired smartphone, though it doesn't give details. I doubt there's enough room or cooling in the hearing aid itself, let alone battery.
The smartphone just switches modes and adjusts the volume. AFAICT these modern hearing aids are doing something like dynamic EQ, based on frequency level detection. The programs that dynamically adjust the EQ levels are trained on test material and then the audiologist or the user can switch between programs and adjust the levels based on the user's hearing response curve.
So what happens in real time on the device is fairly simple.
AFAICT - someone please correct me if they know otherwise.
So what happens in real time on the device is fairly simple.
AFAICT - someone please correct me if they know otherwise.
That can't work because of the lag of the phone to hearing aid communication
It wouldn't necessarily need to be realtime - if you're using the device to build/tweak a "fingerprint" of background noise or required corrections, you could do that analysis with samples and periodically push the resulting filter profiles back to the earpiece (or something similar) after the phone has done the number crunching to generate them.
My $2k hearing aids got stolen when the office I worked on got burglarized (seriously, who steals custom fit hearing aids?). I replaced them with the $500 Bose Hearphones and haven't looked back. My hearing aids were not high end, the only advantages it had was that it was more discreet and it's batteries lasted a whole week, but with the Hearphones I also get noise cancelling(love it on bart and the open office), easy access to volume control, it's rechargeable, it connects to my phone via bluetooth so I can listen to music, take calls, talk to Google Assistant, etc. All for 1/4 of the price of my cheap(by hearing aid standards) hearing aid.
I really hope that Apple has a health device future in mind for the Airpods.
AirPods already can provide some hearing assistance in some situations through the "Live Listen" feature: https://www.wikihow.com/Use-Airpods-As-Hearing-Aids
Yes. I wouldn't be surprised if this is the sort of direction that truly disrupts the hearing aid industry - something that can leverage the scale on in-demand consumer electronics to bring the cost down, but with enough DSP capability to do interesting things. Perhaps in custom fit (or refit) packaging for more comfort.
Doesn't have to be apple specifically, of course.
Doesn't have to be apple specifically, of course.
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Star Trek's Universal Translator version .000002...
https://en.wikipedia.org/wiki/Universal_translator
(Arguably Alexa/Cortana/Siri/Watson -- were version .000001...)
https://en.wikipedia.org/wiki/Universal_translator
(Arguably Alexa/Cortana/Siri/Watson -- were version .000001...)
Wow the guy admits that hearing aids were inexpensive and simple while they charged $2,500 for them. I want super hearing and I want to control it from my phone. Waiting on Silicon Valley or China to make it happen.
Check out Bose Hearphones. Not cheap at $499, but less than $2,500.
https://www.bose.com/en_us/products/wellness/conversation_en...
https://www.bose.com/en_us/products/wellness/conversation_en...
I have used a pair of those in an extraordinarily loud bar. One of those places where you have to stand two feet away from each other and yell. I’m pretty deaf, but it was the other people asking me to repeat. I was understanding them fairly well. I get similar reports from other users.
They are expensive due to regulation as medical devices.
They are expensive because of the rent-seeking cartel that adds more dubious features while gradually raising the price. Even MDHearingAid, which started under $500, with a stated policy of serving a wide market at a low price, recently added one more microphone and doubled their price. They keep sending me offers of $50 off, if I buy two. Got greedy, like the rest.
Oh the good ol' "rent seeking cartel" meme again. Never heard that before.
Even though the same rent seeking cartel produces the same non medical hearing loss grade devices at lower prices. Good call.
Even though the same rent seeking cartel produces the same non medical hearing loss grade devices at lower prices. Good call.
They preferably do not. They do defend their lower flank against the coming disruption, e.g. via Costco. MDHearingAid is not part of the group of five, they are a disruptor.
Until recently, the non-medical devices have been simple amplifiers, which are technically not competitive.
Rent-seeking because they successfully lobby for Federal regulation that locks out competition by providing a high barrier to market entry.
Until recently, the non-medical devices have been simple amplifiers, which are technically not competitive.
Rent-seeking because they successfully lobby for Federal regulation that locks out competition by providing a high barrier to market entry.
Hearing aids now have an OTC (over the counter) bill passed in the FDA. Senator Warren lobbied for the bill for Bose. I think Bose is going to attempt to break into the D2C space with hearing aids.
So you can buy them cheaply online from low-regulation countries? Or those with broad black markets?
If Doc Emmett Brown wasn't based on Bill Austin, he should have been
Bose tries to break the market with their "Hearphones", which costs $500, but it's not in the same league as the current HA brands (Oticon, Phonak, Resound, Starkey, etc...). There is tons of opportunity here. Hope I see the days where I don't have to pay a fortune for a pair of hearing aids.