Part of a series of posted versions of articles I have written about hearing aids. This one appeared online in 2019, on HVY Journalists here.
The world for people with hearing loss has not changed to a great degree over decades, despite advances in technology such as technology and home sound equipment. Hearing aid provision, particularly by the United Kingdom’s National Health Service is determined by the use of a supplier with a monopoly on Behind the Ear (BTE) hearing aids, which do not benefit the wearer and can in fact be uncomfortable and distort the sound of the world around them.
The information even says that the smallest hearing aids – like many of the most effective hearing aids these are not powerful enough to assist with severe hearing loss – this piece states that Completely In the Canal (CIC) hearing aids, “are quite fiddly and some can only be put in and taken out by a hearing aid specialist” according to the NHS audiology department.
To a hearing aid wearer, the above is of little use as sleeping in a hearing aid is uncomfortable and ears tend to gather wax to deal with alien items in the canal. From a look at the misinformation – or maybe partial ignorance due to lack of first hand personal experience – expressed on the National Health Service’s page about hearing aids, this article in the Guardian newspaper from 2012 still describes the state of hearing aid provision today in 2019. The link to the implementation guide mentioned is now extinct.
People with hearing loss have not been actively recruited into hearing aid provision and courses, such as this one at University College London, require two years clinical experience or a ‘relevant’ honours degree in a British university. This course also requires substantial financial investment, the total cost of which is described but not shown.
People with severe hearing loss have a higher mountain to climb to Hear the World than those with mild to moderate hearing loss, who can attain access to the spoken and audio world around them much more effectively and cheaper than companies and the NHS, which provide hearing aids would have you believe.
By way of no information for customers and an insufficiently qualified patient-to-doctor style relationship of imposed dependence for the hard of hearing on the knowledge – or lack thereof – of the hearing aid dispenser, the hearing aid industry still targets and even sometimes exploit a predominantly older customer base for profit rather than for the benefit of the user.
The performance of the whole industry has not improved in any way in relation to advances in all types of sound technology. Imagine going to the NHS for a pair of glasses and being given mirrors and a magnifying glass. That is the level of hearing assistance almost proudly announced on the NHS website.
Moving into the private market, very few hearing aid dispensers have the first hand experience to know that people with hearing loss primarily what is being said to them and yet the test to gauge hearing loss does not test clarify of speaking, which falls in the middle sound frequencies and is often drowned out by higher and lower frequency sounds to make hearing someone speak in a noisy room impossible for most people, especially those who are hard of hearing. The other important information to know is, common sense really, that an ear rejects anything which seems alien to it and wax builds up, making hearing even more difficult.
A trip to Specsavers, who entered the hearing aid market in the previous decade, or Boots Hearing Centres will provide you with no more product awareness or hearing aid information than the NHS or even Deafness charities. The financial motivation is just not there for hearing aid manufacturers to want to match their customers with the best help they can provide. Instead they sell extremely expensive hearing aids that are not comfortable to wear and do not provide the best access to the hearing world around you.
When you walk into your local electrical store to find new home entertainment or stereo equipment and being presented with a wind-up gramophone with a digital chip in the needle, connected by a lead to a small speaker. You would probably not be able to hear the record playing over the sound of someone hoovering the aisles of the shop. Until the turn of the millennium, you would still be able to get a gramophone with an analogue trumpet, in hearing aid comparison terms.
Despite the lack of product information given to potential hearing aid customers, charities and the NHS still put the onus squarely on the consumer, not the lack of verified product information they provide. This has not changed in decades, as the Action On Hearing Loss websites illustrates, saying that 30-40% of those who could benefit from hearing aids actually have them. They do not mention that 90% of those with hearing aids that are not right for them do not wear them, despite spending hundreds of pounds on them. The writing doesn’t even address the customer but talks about them in the third person as if to an imaginary carer. The home stereo equipment is like:
Everyone who buys one of our new digital gramophone’s today will be able to actually play a record rather than just attaching them to a wall. Only 20% of vinyl owners have tried one of our latest range of wind-up gramophones and they would enjoy more music if they bought one.
Various companies that provide hearing aids are still in operation and they might have a shop on the high street, but you are likely to be treated like a patient visiting their doctor, not a paying customer. Used to dealing with elderly people who call a number advertised in their newspaper or a pamphlet, the hearing aid industry does not “read the room” in general, when it comes to an inquiry from a young adult with hearing loss who wants to join in the banter at work and be able to chat in the pub with everyone else.
The process will be to wait until they want to acknowledge you, then after booking a hearing test to be shown the most expensive and not most effective aids by someone who doesn’t really know or care how they work, which you then pay 4 or 5 times more for than a pair of seeing glasses and wait as many times longer for the hearing aids. Along the way, your ear will probably need to be cleared of wax for the hearing aid mould to be made, extending the wait. This is reminiscent of waiting extra long for a set of holiday snaps to be printed to perhaps discover that the lens cap had been left on for half of the ones that were not in focus.
However, in countries that value communication a little more than in the United Kingdom, such as Spain and Ireland, hearing aid centres exist right alongside opticians, as this article in the hearing aid trade magazine ENT News illustrates. Until the late 1980s, the NHS had the monopoly on seeing glasses provision until the market was deregulated and there are now at least a handful of places to get your eyesight corrected on every high street, and the products are clearly displayed. Although Specsavers and Boots have entered the hearing aid sector this millennium, few dispensers have ever needed a hearing aid themselves and so how can they understand what the customer wants?
Luckily, innovative hearing aid development companies have discovered what hearing aid wearers want by asking for feedback from people for feedback in the past. Some innovative companies have open sessions where potential customers can try the sound technology and feel of various hearing aids being developed.
As early as 1993, a hearing aid dispenser working for Hidden Hearing whose wife wore a hearing aid, recommended a “programmable” hearing aid as the best correction for moderate hearing loss. This is the difference between a pair of prescription spectacles compared to a magnifying glass and mirrors. Three decades ago, this hearing technology was the most advanced and expensive as most hearing aids at the time just made everything louder in the way reading glasses make everything close up larger. Up to 10 million people in the United Kingdom are estimated to benefit from a hearing aid and yet the penetration of the market has not changed, despite the reduced prices available through digital technology.
The evidence has been shown that price and size of aid do not compare with being able to hear what people are saying to you and around you, with natural sounds such as leaves rustling or cars driving past or even music at a party in the background not drowning out speech. This does not mean, as does happen, that a hearing costing thousands of pounds is better than a “poppit” aid (a £50 earpiece to amplify sound, which is the equivalent of £2 reading glasses from the supermarket).
Firstly, here is a user’s guide, from first hand experience from someone with over fifty decibel (moderate) hearing loss, to give you a little more product information. On today’s market, hearing aids are all digital and programmable set to correct the hearing loss derived from a test for hearing a range of sound frequencies, not actual speech with realistic noise in the background, however sophisticated hearing aid dispensers can replicate these environments when you go to try your new aid for the first time for the variety of settings (phone Telecoil, directional, omni-directional, surround sound etc).
Behind the Ear (BTE) – This is the type of hearing aid provided free in the United Kingdom by the National Health Service. The manufacturer has provided these aids to the NHS for decades and has a monopoly on this, the largest, customer base and therefore no alternatives are provided. There is a plastic tube with a little speaker in the ear, while the sound is picked up from a microphone that sits outside the ear entirely, which means that you might hear the conversation behind you and not those you are speaking to. We may as well never have developed ear lobes to sort the sound we need to hear at all. The ear also reacts to this plastic insertion as it is expected to and builds up with wax, making it difficult to wear for very long. The industry’s excuse is that hearing aids take some time to adjust to, which is simply untrue and comes from someone who has never ever listened through a hearing aid.
In The Ear – this in itself works fine as the sound is collected within the ear lobes, making sound more natural that if it is fed in from a microphone outside the ear. However, this hearing aid needs to be programmed to correct the wearer’s actual hearing loss and to benefit from both a telecoil (for the phone, supermarkets, shops and theatres with loop systems). Unfortunately both directional microphones, telecoils and loop systems worked better with analogue technology, although that was not powerful enough for those with moderate to severe hearing loss.
In the Canal – For most wearers, this is an ideal size for various reasons. One is that as they still cost over £500 for a basic, programmable hearing aid that sits in the canal, it doesn’t want to be so small that it can fly out of our fingers and get lost amongst stuff. To place this aid in the ear and remove it, this is the best size. Hearing aids require more features than can be applied to a smaller earpiece that provide vital wearing comfort and this aid has room for these and can be handled with ease.
Therefore, there is little point mentioning other styles of hearing aid at this point, so pictures in the gallery below give you a brief idea to recognise them when they are presented to you by a hearing aid dispenser. These are like selling someone a car stereo for their living room, totally not matched to the customer’s requirements.
For comfort so that the aid that lets you hear what is going on around you, the TV, chatter, socialising, the doorbell, the phone and on stage performance, a hearing aid cannot do what NHS hearing aids do, which is “box you in”. This is where the ear cannot breathe and therefore builds up more wax to defend itself from a perceived intrusion. Therefore you need to ensure your hearing aid dispenser includes an air vent that provides an open canal from inside the ear to the outside of the aid, so your ear can breathe.
As hearing aid companies just want to make as much money from the 30-40% of their potential customer base as possible, they will try to sell to your vanity. It is very important that a hearing aid is to hear, not to be invisible. For an entry level customer who has a limited budget, they will try and sell the cheapest hearing aids to make, perhaps even from the one supplier to the NHS.
Therefore, here is a guide to the various features that make a hearing aid do its job for someone with mild to significant (but not severe) hearing loss:
- In the Ear or In the Canal. The piece fits inside the ear so the sound to be heard has passed by the ear lobes before being amplified.
- Air ventilation. An air vent channel from outside to in, so the ear canal can breathe. Beware of badly designed aids with ear vents that do not extend all the way through.
- Directional microphone. This is a digital program setting on the hearing aid to focus the sound collection particularly on the area in front of you, to particularly help with conversations in noisy environments such as at parties.
- Telecoil. This is for the telephone or other hearing assistance systems, such as in shops and is best as a changeable setting, not automatic, as can be added to some hearing aids. We can select this option ourselves and do not need hearing aids to make decisions for us anymore than people want their wheelchairs to head to the shops when the fridge is out of milk.
- Volume dial. There is nothing worse than a piece of technology deciding for you how much you can hear.
- Programmable. This is now standard on most hearing aids, where the hearing test will provide a chart by which to set the hearing correction. However, hearing aid dispensers do not necessarily have experience of wearing a hearing aid, so to hear what people are saying, on TV, at work, in a bar, at home or on stage, high and low frequencies in our hearing loss do not need to be corrected as much as the softer frequencies in the middle range do, which is where human speech is found.
Anyone who has worn a hearing aid out to a restaurant and asked their companions to repeat everything when the chink of a knife on a plate drowns it out or their ear has become blocked and they are lip-reading to hear above the conversation on nearby tables or jumped at the sudden beep of a lorry reversing outside might want to know that, although the hearing aid market does so little to entice the other 60% of people who could benefit from a hearing aid, immediate, comfortable and sustainable hearing correction to give you access to work, life, love and play is available for just over £500. The more people that buy aids that work for them, this price will come down to be in line with a visit to the optician in the near future.