This morning I received a newsletter from Harley Street Hearing and Musicians’ Hearing Services. It is a good thing that hearing protectors are being discussed along with hearing aids. I wear a hearing aid and read this hearing news to see if my customer needs were addressed.
It has long been my suspicion that there is a disconnect between hearing aid customers and providers. It is like going to an electrical store to buy a new home entertainment system, to be sold an exorbitantly expensive, wind-up gramophone with the advice that it will take a month to get used to it.
How Hearing Aids Are Sold
In this newsletter, there is a testimonial, introduction to the team, an offer, location information, new waterproof, custom made, wireless streaming hearing aids available in different colours and a welcome message from the Clinical Director.
None of the team members mention any first hand experience with hearing loss or hearing aids. To me, this means that none of these people will relate to the challenges of hearing loss or have felt what makes a hearing aid comfortable.
When I search for photos or information about hearing loss, most people pictured are past middle age. The latest hearing aids are always represented by one style: open fit. This means the machinery of the aid rests on the back of the ear and sound is piped into the ear via tubing.
For a start, this reduces the biggest contributor to natural hearing: the ear lobes. Our ears catch sound in front of us with sophisticated curves of soft skin, which bounce different frequencies into the ear.
Imagine, if you will, the earliest hearing aids. These were called ear trumpets and they collected sound, which was fed into the ear. These were first produced over two centuries ago, notably for Ludwig Van Beethoven, who was losing his hearing. I cannot find any pictures of the style, but before electronic hearing aids with large battery packs, like those for early camcorders and cinecameras, the aid would be like a large fan, collecting sound and delivering it into the ear. This is akin to holding your hand behind your ear to hear better.
An excellent article on hearing aids and customer satisfaction, set against a backdrop of governmental funding, is available from Intechopen in a book by Stavros Hatzopoulos and Andrea Ciorba called An Excursus Into Hearing Loss, which is free to download from here. The following is a quote about customer expectations:
These data imply that a government guarantee earns the trust of hearing aid owners and is related to satisfaction. In terms of hearing aids, the role of government is not to disburse tax money but to make people with hearing loss feel secure. Thus, the current digital hearing aid has already reached the technical ceiling, and satisfaction will depend only on the user’s feelingsAn Excursus Into Hearing Loss by Stavros Hatzopoulos and Andrea Ciorba Submitted: June 14th, 2017 Reviewed: January 5th, 2018 Published: February 14th, 2018
The data referred to shows that customers in France are the most satisfied with their hearing aids, while their government provides the least funding, except for Japan and the USA, which provides none. This suggests to me that the answer to customer satisfaction is in product awareness and knowledge among customers, provided by well-informed and knowledgable providers.
Over 15 years ago, I set out finding places to write about hearing aids for consumers and had articles published in The Arberry Profile, a careers magazine for disabled graduates, The Hearing Times and a regional London newspaper. In this last publication, I encouraged hearing aid manufacturers to advertise directly to consumers to increase their product knowledge amongst the different styles and mechanics of hearing aids. I also interviewed hearing aid providers ranging from an audiologists at Specsavers with personal first hand experience of hearing loss and an audiological scientist who sold me the first hearing aid that worked for me, which I still have.
What do customers want from Hearing Aids?
Of course you know the answer: it is to hear. But hear what? What do you treasure hearing the most? Music? The sound of nature? The bustle of a city? Jokes? Office gossip? After I had written various articles on hearing aids, based on product research, interviewing people and personal experience, I applied to two London based charities in the hearing loss and Deafness sector. One was Defeating Deafness, though I suspect they wanted to defeat and end to their funding, and the other was Hearing Concern, for whom the biggest concern was hearing their coffers fill up. Yes, I am a little bitter that neither saw the value in raising awareness about how the right hearing aids could revolutionise the lives of the hard of hearing.
I have wondered what people who sell hearing aids think their customers want to hear the most? I know what I want to hear the most: what other people are saying. Hearing speech around us is the biggest factor, which connects us with the world around us.
It is not hard to imagine a politician who doesn’t want to hear what voters think. All they have to do is close their ears and just cut out the sound, to paraphrase More Than Word, by Extreme. People without hearing loss, in my view, are better able to selectively not listen than those who struggle to hear sound around them. You need to know what is being said to reject it in my view. This is why sayings such as “falling on Deaf ears” are so inaccurate in my view.
The first tip-off I was given about a “programmable” hearing aid was a kindly hearing aid dispenser, whose wife wore a hearing aid. The company he worked for at the time did not provide these things and the in-the-ear hearing aid he sold me was difficult to wear for long, whilst my ear quickly blocked up with wax. I went to my G.P. in my late 20s, having tried a few different models of hearing aid since the age of 17, and asked to be referred to the audiology department at the hospital.
As a result of this, I met Alan Aaronson, an audiological scientist who was part-funded by New Labour’s Private Public Partnership. This led me to pay half the cost of a new hearing aid, which I still have and it still works 22 years later (although it’s had a new shell and new mechanics at least once).
At first, I was offered the latest push-pull-input-output, all singing and dancing hearing aid, being sold mostly on its reassuringly expensive price. If it makes your eyes water, it’s going to work, right? That is one of the biggest fallacies of any industry: Not matching prices to features, benefits, market value, competition or customer expectations.
On inquiry about programmable hearing aids and saying that I had hearing loss in the middle frequency of sound, where human speech is, I was shown an in-the-ear model and Alan explained how he could program the aid to allow me to hear speech over background noise.
It is worth mentioning here that in 2022, many hearing aids sold are either open fit or behind-the-ear. Before the get-go, these models ignore the relationship between the ear and the brain, which means that people with hearing loss will cope with whatever comes into their ears – their own or others speech – and sort it with the help of non-verbal communication, lip-reading and predictive hearing, by guessing or knowing what is likely to be said.
Ultimately, this means that humans want to hear information more than the roar of an engine, rustle of leaves, splashing of water or clinking of cutlery.
Today, I wear a digital, in-the-canal hearing aid, which is programmable and has a digital directional microphone. In 2001, I had an analogue, in-the-ear hearing aid with a manual, directional microphone, which I could switch from surround sound to hearing what is said right in front of me: directional.
The other vitally important part of the design of a hearing aid, which was the difference between me wearing it all day or just for an hour or two, was the air vent. It turns out, the ear needs to breathe and the ‘boxed-in’ feeling that people get from various models of hearing aids is that the ear is blocked and sound is relayed to it from a pick-up outside the ear lobes.
To me this lacks basic sense. How can an entire industry not know what makes their products comfortable? How can they get away with insufficient knowledge and understanding of the biology, with which their products interact? Can you hear me? Maybe this is drowned out by the noise coming from the hearing aid industry, which by now ought to know how much money they could make if customers knew the true benefits of hearing aid technology. PRICE. SIZE. COLOUR. WATERPROOF. WIRELESS. BLUETOOTH.
WHAT WE WANT IS TO HEAR NATURALLY
The hearing aid industry makes assumptions about its customers: We are poor, old and vain. None of these inform them about what we want to hear and what makes a hearing aid comfortable to wear all day.
Have you noticed how many opticians there are on every high street? Do you know people with prescription visual aids, ie contact lenses or glasses? How many of these wear lenses or glasses all day? Do you know people who wear spectacles from the supermarket for reading but not for driving? Even in terms of eyesight, there is a lack of product knowledge, although plenty of people without 20:20 vision surely work in this very lucrative industry.
Meanwhile, how many places on the highstreet supply hearing aids? Specsavers? Boots? Maybe a specialist hearing aid supplier? Do you know the process to acquire a hearing aid? Do you know how long it takes? If I was selling hearing aids, I would find out what potential customers want to know and their answers would form the content of my newsletter.
As this is a personal blog, here is what I wanted to know about hearing aids with the answers I found, as they’re not cheap to buy privately, and this helped me find a product that worked for me. The programmable, in-the-canal hearing aid I found, with an air vent, is actually at the lower end of the product price range.
Before I start, the equivalent to the crude magnifying glasses people buy from supermarkets to help them read in terms of hearing aids is the Poppit, which costs £50 a pop. This amplifies all sound, which can make it just as hard to hear what people are saying and be overwhelming when it is also drowned out by background noise.
Hearing aid models
Open Fit – this is the most commonly pictured and advertised style. I was recruited by a hearing aid manufacturer to do some writing work in 2007 and they gave me a pair of these hearing aids, which I found ticklish and couldn’t wear for very long. They were said to be worth £3,000 each and were programmable, but the receiver was not in the ear.
Behind-the-Ear (BTE) – this is still the most commonly supplied model of hearing aid from the NHS. I also have this style, though I never wear them. I was given a pair in 1988, which college friends used to eavesdrop what was being said in the next room. They amplified everything and cut me off from the world around me. In the pub, whatever conversation I wanted to join was drowned out by what people were saying behind me. I got a programmable BTE hearing aid from the NHS in 2010, which had much better sound than the earlier one, but was still uncomfortable to wear, particularly as it blocked me in with a plastic tube and outsourced the work of my ear and brain to decipher what was said to me to machinery parked on the back of my ear.
In The Ear (ITE) – This is the model, which revolutionised my life in 2001. Back then it was analogue and required more machinery than a tiny microchip, which is used today. The difference between digital and analogue is similar to comparing the sound of a full frequency vinyl record from the 1980s with a Compact Disc. Digital music is compressed, so that digital files are not too big to send, download or sell over the Internet. By losing the highest and lowest sound frequencies through a digital hearing aid, we lose the depth of sound, like the difference between a grand piano and a keyboard with less octaves.
In the Canal (ITC) – this is the model of hearing aid I currently wear. All these hearing aids require a mould taken of the wearer’s ear to ensure it fits, which is why the process of acquiring a hearing aid takes a few weeks. To me, is the most practical size and comfortable fit, so long as there is an air vent, which travels from outside the earpiece to beside the speaker in the air canal. If, then, the sound is natural, ie set to correct the wearer’s hearing loss and not to just amplify sound, this can be worn all day with very little blockage from wax. Hearing aids, which sit in the canal come with filters, which can be cleared and changed, as well as instruments to clear wax from the air vent and the sound receiver. These can be easily inserted and removed.
Totally In The Canal (TITC) – as these hearing aids are tiny, the space for mechanics is limited, which means that these only appeared after digital technology was developed. The programmable part of the hearing aid – like an eye prescription – is stored on a microchip, however those requiring sophisticated sound collection and powerful amplification, for severe hearing loss, may find an In the Canal hearing aid easier to use. As hearing aids are expensive and small, they require careful handling and even the larger models can slip between our fingers. The air-vent would also require a fair portion of space in this size earpiece.
Features of a hearing aid
As well as the body of the hearing aid, these are the features, which can improve the benefits you can receive from wearing one or not.
Directional or Omni-directional microphone – in the ITE, ITC, or TITC hearing aids, this would be a setting, which can be changed with the touch of a button. In analogue hearing aids, which people with severe hearing loss have told me they prefer, particularly when a digital hearing aid tries to take the helm of navigating sound away from the listener, as it gives them access to a more natural sound landscape, the directional microphone could be switched from forward to back with the touch of a finger. This could provide the hearer with surround sound for a musical concert, to directing the sound source to collect from in front as our ears are designed to do with earlobes facing forwards. This makes hearing what people are saying or other important sounds, which may be warnings from sources approaching from outside our peripheral vision, more prominent over less important noise.
Programmable – this is the clever bit of the hearing aid, which corrects your hearing through a bespoke prescription. As I have hearing loss in the middle frequency, this meant that I could ask for more amplification at the tuning stage in medium pitch sounds and hear what people are saying above background noise. For those with ski-jump hearing, there can be no amplification where the most pitch is heard and more louder tuning in the middle and a little at the lesser volume end of that person’s hearing to create a more natural sound landscape. LIke the optician will ask you what letters you can see until they have found the best lenses to correct your eyesight, a hearing aid audiologist can do this with your hearing too and you can direct what you want to hear when the hearing aid is connected to computer software.
Air vent – I think this is vital for a hearing aid earpiece and it is now included by default into new hearing aids. The air needs to breathe and the air entering the ear is equal if not more important for wearer comfort as the natural order of sound with human speech being audible above background sounds from other sources. If these weren’t audible, it would sound eerily artificial, so hearing background noise is very much part of the experience.
Telecoil – this is also known as a loop system. These were common in theatres and cinemas in the early 90s, when the new technology was promoted to venues to provide hearing aid wearers with more access to dialogue in stage performances and films. There is also a symbol in banks and supermarkets where a loop system is installed, for hearing aid wearers to swithc on their telecoil and pick up amplification. The telecoil in the analogue hearing aid worked brilliantly for me, but I find the digital hearing aid tries to take over and keeps switching on and offer and beeping while using the telephone. It is now supposed to be automatic, which means I cannot control when it is on or off, as it is no longer a setting I can switch when I want to use it. This feature, in my view, has been lost with digital technology.
Just a warning: a skin-coloured hearing aid can camouflage itself amongst monkeynut shells, as I discovered the hard way in late 2011. I was staying in a twin room with a friend at a yoga weekend in Somerset, when a plate of monkeynuts appeared on the table between us. After a dip in a hot tub, I took my hearing aid off and went to sleep. Meanwhile, my friend cleared all the empty monkeynut shells into the recycling waste in the kitchen, so I woke up and looked around, with increasing panic, for my hearing aid. Luckily, my over-active imagination flicked up a picture of the monkeynuts and I rushed to the compost waste, where by pure chance my hearing aid was perched on the top of a hill of monkeynut shells.
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