Do Advances in Hearing Aid Technology Recognise the Needs of the Consumer?

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Volume dial. There is nothing worse than a piece of technology deciding for you how much you can hear.
  6. 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.

Hearing Aid Audiologists with First Hand Experience with hearing loss

Continuing my series of blogs containing articles I have written about hearing aids. This one is from 2007, which explains why 2008 is referred to in the future tense. Below is how the article appeared.

In the noisy and fast-paced city life of today even mild hearing loss could mean you are missing out unnecessarily on all sorts of interactions with other people from closest family to successful first impressions with prospective employers or a new romantic relationship.

The most surprising effect on my life from wearing hearing aids that allow me to hear normal speech going on around me without straining or lip reading is that I recognise myself if I see my reflection when out socialising as previously my face was screwed up in concentration and anticipation which made me look different and strange.

Of course finding out about hearing aids requires a visit to a hearing aid audiologist and these are not to be confused with the hearing aid salesmen who earned the hearing aid industry such a bad reputation for exploiting vulnerable people in their own homes. Hearing aid audiologists today are highly trained with a vast experience of human beings with varying degrees of hearing loss.

I interviewed three top London hearing aid audiologists: Pamela George at Hidden Hearing’s Baker Street outlet; Adam Shulberg from Cubex on New Cavendish Street, and Alan Aaronson, an independent with his hearing centre on Hoop Lane, Golders Green, who was responsible for fitting my life changing hearing aid in 1999.

Pamela George says that build up of wax in the ear can account for 10 decibels of lost hearing so seeing your GP or an ear nose throat (ENT) specialist is a useful first port of call. However the quickest way to find out if hearing aids can benefit you is to book a free hearing test appointment with Alan Aaronson in Golders Green, Hidden Hearing in Baker Street or Cubex in New Cavendish Street as Adam Shulberg says: “A hearing aid is only as good as the dispenser who fits it.”

Being able to hear well in different social and environmental settings as well as protecting your ears from damaging noise trauma are two benefits that hearing technology can provide. I am wearing a pair of hearing aids and my right ear is taking longer to get used to it as it produces more defensive wax as I haven’t worn one in my right ear before whereas my left ear took to the new aid immediately. The sound I am getting is extremely welcome though. Alan Aaronson says: “it takes from a few minutes, to a few weeks – depends on the type of hearing loss, the previous experience with an aid (or not), the type of aid, the way the aid has been programmed, venting and how adaptive to change the user is”.

Adam Shulberg says: “This varies depending on the individual. People who have never worn a hearing instrument before will take longer to adjust to the new sounds they are hearing and require more counselling; those who are experienced wearers will adapt faster. For new users we recommend wearing the hearing no more than a couple of hours a day initially and in quiet environments only, increasing by an hour each day. Within a week they are usually ready to experience the outside world. This will take more getting used to and again the level of technology will often determine how successful they cope with everyday situations.”

Pamela George describes her experience when a client tries hearing aids and hears through them for the first time: She says: “Your stomach melts. They stop frowning from straining to hear and it looks as if years have just fallen off them. Mr Patel who owns a shop in Liverpool Street brought an elderly Londoner to see me and he said ‘I can hear what you are saying to me’ when I put the hearing aids in and he stopped shouting.”

At the top end of the market there are hearing aids that are either unnoticeable such as Ion by Sonic Innovations which I am currently wearing or those designed to be seen such as Delta hearing aids by Oticon and the Phonak Audéo. Hearing aids such as these can be fitted immediately. Adam says: “long gone are the days when people try to cover up their hearing aids. Now people want to show them off.”

The wait time in the private provision of hearing aids is quick today. Aaronson says it takes a few days if you opt for ‘Express’ or from 7 to 10 days. Adam says: “Depending on the hearing loss, it is often possible to have a hearing aid fitted on the same day. For custom made in the ear models the waiting time is about about a week although 24 hours turnaround service is available at additional cost.”

Hearing aids vary greatly in price and the audiologist’s job is to recommend the best one to suit your lifestyle and hearing loss. I have mild to moderate hearing loss but actual speech was usually drowned out by other sounds which meant I couldn’t hear myself speaking and therefore I spoke very loudly, I asked people to repeat things which impeded the flow of conversation or I just missed out on information being passed around me and was laughed at when I pronounced words as they were written as I hadn’t heard them spoken. The social benefits I immediately received from the hearing aid Alan Aaronson fitted in 1999 were immediate and dramatic and since then I have totally corrected my slurred speech, can enjoy conversations, manage the volume of my voice and even speak and listen well in a room full of people chatting.

In 2008 legislation will be passed which makes it the employers’ responsibility to ensure workers’ hearing is not damaged by exposure to damaging noise in their work. Pamela says lasting damage can be prevented if it caught in time because there is a temporary threshold where the hairs in our ears have bent after exposure to excessively loud noise but they will stand up again. “After continual exposure the hairs responsible for high frequencies break off”. The solution is a sound attenuator can project musicians’ and DJs ears from high frequency hearing loss and tinnitus. Alan says these are: “custom built earplugs with special filters to allow the quality of sound to still penetrate and not get muffled.”

Do companies provide ear care for their employees as part of a benefits package? Adam says: “where there is a legal requirement for hearing impaired critical safety employees to comply with national standards. For example we work closely with many train companies whose guards’ and drivers’ hearing needs to be up to scratch.”   

If you think that you would be interested in experiencing what advanced hearing technology is available today then it would be safe to visit Alan Aaronson, Adam Shulberg or Pamela George as these reputable companies are very customer focused and spend a majority of their time fitting, repairing and servicing hearing aids. Alan says: “There are hearing aids in various price brackets from “standard” to “advanced” and I would explain the differences”.

Empowering Consumers with Product Knowledge about Hearing Aids

This is part of a series of articles I have written about hearing aids. The published work can be seen on my Scribd Page. This one is from 2008 and appeared in a regional London newspaper.

Have you experienced that feeling when you want to say something but are scared that you might make a fool of yourself? This could occur if you have been criticised many times or received negative experiences from people, or that you pick up other people’s emotions without realising and become the only person in the room who responds to them.

         Has this ever happened to you? Is this a familiar feeling that you first experienced in the classroom at school?  Perhaps you remember when a quiet spoken person seated at the back of the class piped up, the teacher replied and a whole discussion erupted in the room, but without hearing the original comment you cannot pick up the thread of conversation and get left out?

         I am sure these early experiences happened much more frequently then anyone admits as there is still a stigma attached to having less than perfect hearing.

         Due to the sophistication of our brains we learn at a young age to adapt and be able to follow the flow of conversation with even medium hearing loss, often via reading body language or acquiring the ability to lip read. Hearing loss is measured in decibels and accounts for the average level of hearing which is measured across frequencies from the highest pitched to very low sounds. Mild hearing loss starts at 25 decibels and severe hearing loss goes up to 95 decibel hearing loss before you reach deafness.

         I am not trying to sell you a hearing aid, but I am telling you that the one I bought changed my world instantly at the age of 30. I was also very lucky that I was told by an understanding hearing aid dispenser about hearing technology that would actually make a difference so I could ask for the right instrument that suited me and then bypassed the risks of being oversold something on my lack of knowledge. It is the knowledge that I have acquired that I would like to share with you.

         Firstly, go back to the examples I gave in the work meeting and the classroom and see if you recognise the experience.

         Secondly, do you find at parties that it is hard to make out what people are saying to you across a dinner table or in a crowded room and it gets frustrating as other people seem to be getting along fine?

         Thirdly, do you find you do not know what to do about it and don’t know where to start looking for answers or who you could trust to speak to about it? Have you looked on the Internet or called up a company and got the sense that they are trying to sell you something expensive that seems risky to buy because there are no guarantees that it will give the desired results?

         That is understandable.

         My fourth hearing aid was the first one that I could wear and not feel cut off from the world, disorientated and distracted by artificially amplified background noise. This hearing aid was analogue programmable In-The-Ear (ITE) with a manual directional microphone and Telecoil switch and it totally solved the difficulties I had at parties when I always ended up standing on my own because I had asked someone to repeat something so many times that they had eventually said: ‘I’m just going to the toilet, I’ll be back in a sec,’ never to see them again.

I now have a digital programmable in-the-canal (ITC) hearing aid with a directional microphone and Telecoil setting which I bought from the same dispenser, Alan Aaronson, as the previous successful one.

         One main point is both were value for money to me, costing just under £1,000 which is not expensive for a hearing aid as they can be priced at thousands of pounds each.

         The advantages it gave me were; being able to hear what people were saying in many situations in which previously I couldn’t; to be able to follow and join in group conversations, to enjoy myself at parties, to follow and participate in workshops and seminars, to complete customer transactions on the phone without having the phone slammed down on me, to pronounce words correctly and hear how people say things instead of trying to say it all from scratch myself and, very importantly, to have corrected my slurred speech (so I don’t get excluded from nightclubs). Having a hearing aid made me acceptable enough to be able to get a fixed salary in an office of people where I could be promoted and prove myself.

         You might already have all of that, but you might relate to some of these experiences. I have 50 decibel hearing loss which is half way between hearing and being deaf. However, now there are times at parties or in business meetings in loud environments when I am at an advantage over hearing people to follow what is going on and not be distracted by background noise!

         I get benefit and value from my hearing aid and it is comfortable and no one can see it as it sits in my ear canal. It is a programmable which means it is set to correct my own particular hearing loss and boost the volume of sounds that I want to hear such as human speech and not to amplify unwelcome and distracting noises like a lorry reversing or cutlery crashing on a plate. As it is programmed to my particular hearing pattern that means sound selection is orchestrated by my brain and not by the amplification, which makes the sound natural and the earpiece comfortable to the point I can’t feel it in my ear.

         My hearing aid is also digital and takes advantage of the superior sound quality now on offer, and digital hearing aids have more power than analogue ones.

         This information is useful as a purely digital hearing aid which is not programmable might give you excellent sound quality but it might take longer getting used to, especially in a behind the ear hearing aid as dispensed by the NHS.

         A very important point about hearing aids is that, like what you see or do not see, your brain actively selects what it wants to hear and people with severe hearing loss or lack of eyesight start to compensate. One way of doing this is your brain learns to anticipate what it thinks someone is likely to say and sometimes you hear something completely out of context which can be highly amusing.

         A programmable hearing aid whether it is digital or analogue is a prescription taken from your audiogram in the same way that spectacles or contact lenses are made to fit your eyeball shape and correct your eyesight. Unfortunately there are plenty of people selling hearing aids who do not know or tell you this and are happy to sell you a complicated piece of technology that is not customised to your requirements.

         Similar to Blair Hill in the book Think and Grow Rich by his father Napoleon Hill, a hearing aid can change someone’s world from one of struggle and exclusion to a new one filled with opportunity.

         If you have any sense that your hearing is not as good as it could be it is worth going to a high street shop where you can get a hearing test and see if you could benefit from a hearing aid. Currently, in Cornwall, free hearing aids are only given to those aged 55 and over. The most important thing to do then is to compare their answer with your own research from this article or from the Internet, books such as the one mentioned in the previous paragraph and via the websites of BUPA and via objective websites that provide information about hearing loss.

Here are some Internet references to get you going. If you don’t think so already, I promise you that hearing is an interesting subject for us all and it might be useful information for yourself or for a friend or family member and you can make a big difference by finding out more about it.

Hearing Aid Resource for Consumers – Ear Info

Starkey – Find the Best Hearing Aid For You – the story of Starkey, a hearing aid company started by a man with hearing loss.

RNID – Facts and Figures about Hearing Aids

About Dr Ross, a hearing aid wearer of over 50 years and writer – Hearing Research

3 now obsolete resources (great domain names) http://www.hearinghealth.com – like HearingResearch.com and http://www.thehearingaidcouncil.org.uk

Two Stories of Misidentity of Hearing Aids and Nuts – Part 2

This evening.

I am rushing to get the bus to see a talk. I can’t find my hearing aid.

The chance to get the bus comes and goes and while searching for missing hearing aid, I find the batteries for my back up.

After midnight, I return from a night of painting Falmouth a light shade of red and see the bag of nuts I had moved to my side table.

I remember, without my glasses on, picking up nuts from my bedside table – where I put my hearing aid at night – after the bag had spilled out the night before. I remember the feel of a large nut that I guessed was a Brazil.

Seeing the bag of nuts that I had folded up on the side table, I have an idea. I look inside and lo and behold, my hearing aid is in there.

Two Stories of Misidentity of Hearing Aids and Nuts – Part 1

I went on a yoga weekend last new year’s eve.

There was a hot tub, which in me induced extra sleep.

A friend had persuaded me to come on this weekend and she also found 4 days without alcohol and with a hot tub meant lots of rest. So she brought a plate of monkey nuts from the kitchen to the room we were both in.

I had booked on this weekend at last minute, so people had been paired off into twin rooms. It was only by warning the venue organisers that we both snored, that we were both in the same room. Therefore we had a plate of monkey nuts to enjoy while reading in between yoga, hot tub and food. And sleeping.

No, Apple Mac, organisers is spelt in English with an s.

Plate of monkey nuts demolished, my friend scoops the shells onto the plate and takes them to the kitchen where she leaves them on the side.

I go to put my hearing aid on to go to dinner but can”t find it.

After a few minutes of panic, I work out that my hearing aid was on the side near the monkey nut shells and resembles these in both colour and shape.

I run to the kitchen and find the plate of empty nut shells.

There amongst them is my hearing aid.