Auris Repletus by Dr. Tom Goyne

Oticon Delta on CNN

Continuing my recent theme of posting hearing aid-related YouTube.com videos, my latest discovery is a good friend of mine on CNN discussing the design of Oticon's Delta hearing aid:

By the way, that's his "winter beard".  I always amuse myself by telling him he isn't standing close enough to the razor.

Widex Inteo Video

As I wrote yesterday, the hearing aid industry is starting to market more to consumers than audiologists, which is probably a good thing.  To that end, some advertisement videos are beginning to pop up on YouTube.com and below is an ad for Widex's Inteo hearing aid.

And for the m series, i.e. mini-version:

Phonak Exélia Video

Recently, I've discovered that the hearing aid industry has made YouTube.com part of it's marketing attack, part of their recent strategy to focus more on the consumer than the audiologist, something that makes sense to me.

Below is a video for Phonak's new family of hearing aids, Exélia.

Ask Congress to Listen Up

Thirty-two million Americans suffer from some degree of hearing loss, roughly one out of every ten.  But few obtain the amplification they need to help their condition.

A large reason for this is the stigma that has been attached to hearing aids, the outdated concept that only the old and the infirm would ever consider using them.  For instance, in countries where hearing aids are routinely covered by insurance, the percentage of hearing impaired individuals using amplification is not that much different than in America.

As hearing aids continue to make great strides in both appearance and effectiveness, this stigma will most likely fade away.  But one issue that will remain will be the cost of hearing aids.  As of 2004, the average cost of a device was over $1,700.

But, help could be on the way.  The U.S. Senate's Finance Committee and the House of Representatives' Ways and Means Committee are considering a set of bills called the Hearing Aid Assistance Tax Credit.  If enacted, the tax code would allow tax credits for individuals or families $500 every five years to purchase hearing aids.

Unfortunately, similar versions of these bills have expired in Congress in the past with little or no attention given to them.  Unless more attention is paid to the current versions, they will likely experience the same fate.

I would encourage you to make your voice heard on this important issue and contact your senators and representatives.  If you're not sure how to do so, visit Congress.org and use the search box on the top left sidebar to get the contact information for your elected officials.  Send them a message and encourage them to consider this important legislation.

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As you may have noticed, in the top of the right-hand sidebar on this site now features a tracking widget for this legislation.  Check back to watch the the bills' progress.

Improved Performance Leads to Increased Acceptance of Amplification

In recent weeks, the advertising campaigns of a leading hearing aid manufacturer have received a significant amount of attention, both positive and negative (examples: 1, 2, 3).

While discussing the merits of the campaigns -- you can decide for yourself if they will be effective or not -- Phonak CEO Valentin Chapero tells Business Week, "It's very difficult when you are making a product that actually nobody wants."

It's true, there is very little demand for hearing aids, despite the fact that over 30 million Americans have some form of hearing loss.  But, there is reason to think that is going to change, and it has nothing whatsoever to do with a schnazzy ad campaign or catchy slogan.  It has everything to do with improved performance.  Several times a day, patients tell me that they are pleasantly surprised to find they have none of the complaints about hearing aids that their parents, aunts and uncles had about amplification.

The fact of the matter is, for decades hearing aids were incapable of processing sound in the manner that most patients with hearing loss need it to be processed.  They did not treat loudness growth differently across pitch ranges, something that is absolutely necessary for improved clarity along with loudness comfort.  It wasn't until the arrival of multi-channel devices in the early 1990's that this was possible, and it is only in the last five to seven years that the industry has gotten pretty good at designing devices that do it quite well (for more, read here).  It wasn't for lack of trying however, for many years we did not fully understand the nature of the ear and cochlear hearing loss and even if we did, the technology did not exist to engineer the devices anyway.

As time goes by and the success stories with hearing aids that people tell over a card game begin to finally outnumber the negative experiences recounted over the years at those same card games and family gatherings, gradually, people will become much more accepting of amplification.

Think about it this way.  If the automobile industry had failed, despite their best efforts, to improve upon the first "horseless carriages" and they remained unreliable and uncomfortable, would there be more cars in Los Angeles today than people (there really are, look it up)?  No.  Cars would have remained a product with a small niche until significant and worthwhile developments actually came about.  History tells us that when technology actually catches up with the needs of consumers, it is almost always a success.

As a matter of fact, the quality of today's hearing aids has audiologists and researchers thinking less about audibility at the ear-level and more about processing in the brain.

Open-Ear Devices Offer Great Improvement

Every once in a while, an area that had been experiencing small incremental improvements suddenly enters an era that represents a much larger advancement.  In the area of hearing aids and amplification, the recent introduction of "open-ear" devices has significantly changed the way audiologists and patients think of improving communication.

Open-ear hearing aids rest behind a patient's ear and a thin tube, almost like fishing-line, comes down the front of the pinna and curves into the ear canal [see graphic].  This configuration provides several advantages over more traditional in-the-ear or canal-style hearing aids:

• Sound-quality: Since the ear is not occluded by a hearing aid, there is no insertion loss (the additional hearing loss created when an object, such as a hearing aid, is inserted into the ear) to overcome.  Therefore, a patient's own voice will sound more natural to them and other sounds in their environment will not sound as amplified or unnatural.

• Comfort:  Because very little of the device is actually making contact with a user's ear canal, the device feels much more comfortable.  As a matter of fact, most patient's report that they forget the hearing aids are even there.

• Reliability: All of the electronic components reside in the casing behind the ear.  This makes the device much less susceptable to the hazards of the human ear canal.  Traditional hearing aids all too often break down due to cerumen and debris damage or moisture collection.  But if all of the electronics are behind the ear, all of these issues become nearly irrelavent.  Moisture is still somewhat of a concern, but not nearly to the degree that it is with traditional devices.  Anecdotally, I can report that in our offices, we rarely repair open-ear devices.

Just a few years ago, 80% of the hearing aids dispensed in the United States were hearing aids that fit entirely in the ear with only 20% of the devices dispensed fitting behind the ear.  Today, the ratio is now approximately 50/50, and that change is due to the emergence of open-ear devices.

While open-ear devices are not appropriate for everyone with hearing loss (severe losses are out of the fitting range), they are clearly one of the best options for many patients, particularly when combined with modern digital processing.  Consult your audiologist to find out if open-ear devices are right for you.

The Nature of Hearing Loss and the Fundamentals of Proper Amplification (Part IV)

For decades -- from the 1940's to the early 1990's -- the simple truth is that hearing aids were not capable of providing adequate benefit for most patients with the most common form of hearing loss in adults (sensorineural hearing loss).

For those fifty years or so, hearing instruments were only capable of making every sound louder, no matter what pitch or intensity that sound was.  Remember, as we discussed in earlier parts of this series, most patients with sensorineural hearing loss, which represent the largest bulk of patients with hearing loss by a very large margin, have normal to mildly reduced hearing in the lower pitches, while their hearing in the higher pitches is declining at a much greater rate.  Therefore, they would ideally receive more "help" from a hearing aid in the higher pitches than in the lower pitches, and even better, the hearing aid would treat loudness growth differently in those pitch ranges.

As an aside...
Several years ago, I was having a discussion with a leading executive in the hearing aid industry.  At the time, he was rather discouraged at the rate at which consumers were purchasing devices that he knew were clearly head-and-shoulders above previous generations of technology.  I was surprised at his outlook and I reminded him that you can't undo a reputation created by 50 years of poor performance in just a year or two.

Today, in my office, we are seeing much less reluctance on the part of patients to try amplification.  I'm convinced it is because finally, the majority of patients are reporting greater benefit than was possible just five years ago.

But unfortunately until the recent past, hearing aids were not up to that task and it is that reason that far too many of them spent more time in desk or bureau drawers than ears.

At an absolute bare minimum, if a patient with sensorineural hearing loss is intending to obtain amplification, the hearing aid must be able to process low pitches and high pitches independently.  Otherwise, the patient will experience a great deal of loudness without necessarily noticing improved clarity, which is the point of obtaining the device in the first place!

Fortunately, the majority of hearing aids offered today, even those that might be termed as "less-sophisticated" by today's standards are indeed capable of independent gain in the low and high pitches.  However, all too often, I meet people in my office or socially that did not obtain the proper device.

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The preceding was part of A four part series at Auris Repletus entitled, "The Nature of Hearing Loss and the Fundamentals of Proper Amplification"

- Part I; Part II; Part III; Part IV