We are seeing a long term consolidation between hearing devices and headphones.
On the headphones side, we are getting smaller, truly-wireless headphones with some ambient sound features (such as noise cancellation, and iOS hearing features). New trends like AR would just accelerate the change due to the need to solve all day worn audio devices.
On the hearing aids side, almost every hearing aid today acts as an always connected set of headphones for your mobile phone (and has been like that for years on iOS).
Deregulating this could bring the tech industry innovation to hearing aids through natural progression of headphones technology.
This trend would make hearing aids not just target hearing impaired people, but also individual with normal hearing. For example, features such as protecting your ears against a sudden loud noise, silencing a loud restaurant so you can have a quiet conversation or improving the audio of a soft speaker could be useful for everyone.
> silencing a loud restaurant so you can have a quiet conversation or improving the audio of a soft speaker could be useful for everyone.
Yes i use noice cancellation and voice isolation on my iphone here in india where noise is out of control. I can even take calls now outside in traffic and it sounds like i am in a quite room to the other person.
This one of the greatest technological improvements in the recent past for me personally.
>This trend would make hearing aids not just target hearing impaired people, but also individual with normal hearing. For example, features such as protecting your ears against a sudden loud noise, silencing a loud restaurant so you can have a quiet conversation or improving the audio of a soft speaker could be useful for everyone.
Amusingly this already exists, there are a bunch of ear muffs (and some in ear equivalents I think) that relay sounds from outside in that cut off when a threshold is reached. They're pretty much exclusively sold for use with firearms, I'd love to see them developed more to work better in a setting other than the woods and shooting range.
Having just experienced a pair of these, it was incredible. I don't have extensive hearing loss beyond what being a teenager listening to music too loud will do for you, but the way these headphones relayed "normal" sounds while rejecting "loud" sounds was one of those - "why aren't these more popular?" moments. It felt truly superhero-esque.
What's even cooler is turning up the volume and have Spidey-Senses.
I've done this on a couple of hunts and it's amazing to hear everything -- you can't believe how loud grass brushing against you can be. It's like you can hear like the elk do. Well, not quite... Good sets (I like MSA Sordin) have excellent stereo imaging in front of you as well.
In shooting classes, I turn them backwards so the microphones point at the instructor.
Starkey is not exactly a quality company and I would be more than happy to see them put out of business. They tried to shaft their employees out of retirement money, they inflated their donation numbers, and a former executive was sent to prison for all kids of fraud.
I was just thinking about this with the announcement of the new AirPods. Apple could really take the concert earplug market while getting great natural marketing (people wearing AirPods at concerts). Just balance and lower the volume for concerts.
Getting tinnitus that was is just a function of how much sound there is in your ears. So headphones with loud rock music can cause issues, headphones on quiet less so and can block external noise, as can a blob of wax or whatever.
You don't really need fancy noise cancelling for tinnitus prevention, just some form of bung in your ear.
My AirPod Pros with transparency mode enabled and set to max volume and treble don’t provide as much gain as my MDHearingAid pair ($400), and the external sound quality isn’t as good.
Apple has a real opportunity here, and they are slow in seizing it. I suspect some kind of an arrangement with the hearing aid manufacturers regarding iPhone-ready hearing aids.
The name of the game here is to allow people to dial in their own preferred level of compression (amplifying soft sounds more than looks sounds) and equalization using their iPhones.
Yes, I’ve done that. I’m hoping that 15.1 next week will make some improvements.
Apple could have such a great product here, if they would just add gain comparable to the currently available hearing assist devices, and then add compression, equalization, and clipping of loud noises.
with a lot of woodworking tools the AirPods pros definitely offer more protection than nothing. Not sure what attenuation they offer, but for the truly damaging higher frequency noise they seem to do a pretty decent job.
I still wear real ear protection, but for the odd cut, or for any other day to day situation with loud noises the AirPods do a good job.
When I'm outside running on sidewalks along city streets, music via AirPods Pro with Noise Cancellation turned on sounds a bit better BUT I prefer to keep this feature turned off in favor of being able to hear ambient cars etc.
I’ve spent hours trying to find a review of transparent mode on AirPods or any other similar transparency modes with regards to reducing wind noise amplification while still allowing sounds of cars etc. through. I’m looking for a good solution to listening to music while riding a bike that’s safe but better sound quality than bone conduction. Sadly I can’t find any objective measurement of these combinations of noise cancellation and pass through. I can’t even find a review that mentions if this is how pass through is meant to work vs just passing along all sounds. If the latter then wind noise pass through sounds like a good way to completely ruin your hearing. I guess these days all we can find is marketing and reviews that amount to puff pieces with rare exceptions.
Would you be willing to give a personal experience? Have you tried transparent mode in windy conditions?
And yet Bose discontinued their very helpful Hearphone product and has introduced a much more expensive and less capable conventional aid, which they are marketing to older people. Very disappointing!
I know people complain about price, but custom in-ear monitors for musicians are on the same scale of price as hearing aids. Good in-ear monitors like good earphones are expensive.
I suspect, like the earphone market, this is going to become a marketing-driven race to the bottom that swamps any genuine technical improvement.
Technical improvement has been pretty stunted since the 90s anyways. The hearing aide market is insanely marked up and ends up costing an extremely significant chunk of change whenever you need a replacement. I also would mention that custom in-ear monitors for musicians apply to a really niche market as well - so we don't really have a broad market to compare either of these to.
Actually CIEM balanced armature drivers were originally made for hearing aids. They're conceptually very similar, but most of the market is consolidated to 2 main manufacturers Knowles and Sonion(+ some niche manufacturers).
If anything the Chinese are disrupting this market, in price, volume and choice. Just like they're doing with cheap lenses such as omnivision.
> features such as protecting your ears against a sudden loud noise
Reminds me of the Artemis Fowl series or the first Iron Man, awesome to see former science fiction coming closer to reality. Adaptive ear protection in real life would be really interesting on construction sites or for musicians...
That sounds like a really interesting problem. You'd need microphones good enough, small enough, and cheap enough to hear the signal,
Signals processing/machine learning software robust enough to pick up a user-selected pattern and in a reasonable latency, and then a processor small enough and power efficient enough to process it all while again also being economical enough, and then have it last 8 hours.
"Completely blocking out" is out of reach, technologically; you'd need 80+ dB of attenuation, and the best anyone can do with things that fit around your head (earplugs, noise-canceling, etc.) is about 40, before you even start to touch the questions of selectivity and power usage. If you need 80 dB of attenuation your best bet is to contract an acoustics engineer to build a wall out of several layers of different materials.
Part of snoring is low frequency sounds, which even with fully plugged ears, transmits through bone conduction.
also long term use of ear plugs with sleeping can cause unwanted side-effects.
When we sleep our hearing system does not turn off (safety), and when you wear ear plugs while sleeping you run the risk of making your hearing work harder - and then if you have no plugs in your hearing system is now (hopefully temporarily) more sensitive than before.
I've got a product similar to these and they're great. You can have a normal conversation and it didn't take me long to realize their eavesdropping potential. My Surface headphones also have a feature that more or less acts as a hearing aid.
Some years ago there was a set of headphones sold for hunting (amplifying sounds of animals and reducing gunshot noise) that were very popular among the hearing-impaired community as a cheaper alternative to hearing aids.
Yeah but have you ever worn a hearing aid? My wife has a very expensive and up to date one and there is so much white noise. She can play music on it but can't hear well enough in that ear to get any use out of that. I just don't feel like they will ever overlap that much since they have to cater to people who are quite deaf.
Would "bring[ing] the tech industry innovation to hearing aids through natural progression of headphones technology" mean that hearing aids would now need to be coupled to a smart device?
If so, then hard-of-hearing people who work in secure areas where they can't bring their phones will be very unhappy...
======
I got out of the Audiology field in 2015.
At that time all the above was included for every hearing aid we sold (Prices varied from $750 / ear - $3600 / ear.
When I was in that field many companies tried "pay as you go" models, instead of bundles.
You know what happened?
People paid the minimum (test, and fit)
the never returned for repairs or re-tunings.
And then complained to everyone that "hearing aids don't work".
Buy a hearing aid today from any major provider in Canada and you get:
Initial test
Initial fitting
Follow up tests
Follow up re tunes
Counselling
repairs - including full replacement in case of loss
Batteries
In-clinic repairs and cleanings.
100% return, and in some cases $0.00 3 month trial period.
There is far more to fixing your hearing issues that just amplifying sound. Sadly, most people wait too long before trying a hearing aid, and give up because they hear too much noise.
Imagine returning your eye glasses because you still see ugly people.
I truly wish hearing aids were far cheaper, and that was a very hard part of my job and one of the reasons why I changed careers.
I've long thought the problem with hearing aids is the calibration process. People (often old, confused, and less tech-familiar) try them on and spend half an hour answering questions about "does that sound better?"
What if, instead, the calibration process worked constantly? Give the user a button to press when they don't hear something well, and another when they do. Let them have this for a month, let them try it in their kitchen, their bedroom, the local shop or bar, outdoors. Run some reinforcement learning algorithm to optimize for getting more "good" presses and fewer "bad" ones. Optionally, adapt separately to each environment.
Is there a "smart" hearing aid calibrator that works like this? If not, but you think it's plausible, I'm interested in working on it.
There are actually a good reasons not to do this. A very large part of your hearing is brain training...your brain learning how to interpret the new stimulus it is getting. You need to give your brain time to adapt to new stimulus before evaluating whether you are hearing better or not. If you are constantly fiddling with your hearing aids, you never get the benefit of training.
This may not apply if your hearing loss was sudden, but many people get hearing aids only after years of decline. Your brain adapts to what it has available and you learn to hear as best you can with the limited stimulus. When you finally get hearing aids, it feels like your ears have been unblocked.
When it comes to interpreting speech though, especially in noisy circumstances, you have to give it time. Your brain isn't used to using the extra stimulus to interpret speech. In fact, it may have gotten used to hearing loss filtering out background noise and you may initially find all the stimulus makes it harder to interpret speech because of all the background noise you now hear that you previously didn't.
If you don't have patience and start immediately futzing with volume all the time, you never give your brain a chance to adapt, and will be very dissatisfied.
Yes! Modern hearing aids do some fancy processing to shift frequencies into the more audible range of the patient. Many people do not have a simple "not enough volume" hearing loss. Personally, it's like someone went and messed with all the settings on the audio equalizer, and then added some muffling to make sharp sounds less distinct.
When programmed properly, I find my hearing aids on their various speech modes to sound distinctly artificial and processed. I imagine it would be jarring to the uninitiated. Like a good speech codec or vocoder. It's unlike anything else.
But having grown up with DSP hearing aids doing this all my life, I find speech coming through them very comprehensible, often shockingly so compared to my normal hearing -- even with other amplification like regular headphones. I do dislike my hearing aids for music, though, even on the normal or music settings.
Couldn't this brain training effect be included in a progressive algorithm like the one suggested? Such that the brain is gradually "guided" to the best performance by ramping up the hearing aid?
My (Phonak) hearing aids had a multi-week ramp-up to full power, in order to give my brain time to slowly adjust. Dealing with things like the occlusion effect (https://en.wikipedia.org/wiki/Occlusion_effect) just takes time, and getting used to something being in your ear for a large number of hours per day.
...especially with the use of a smart phone app...
Based on my observations of my father's struggles with various hearing aids, hearing aid smartphone apps are just as terrible as any other apps developed by hardware manufacturers. Don't expect the "clinicians" to help with this aspect either, because they were trained on a previous version of a different app and how could they be expected to figure out the apps that are used now?
What's really needed is a decoupling of the hearing test from the calibration activity. A basic hearing test takes a few minutes in an isolated box with headphones (the 'ol click a button if you hear the tone test). From that profile it should be trivial to build out the profile of what frequencies to boost and what not to and program the aids there.
I appreciate the optimism (and do think there's some room for efficiency improvements!), but each step is a little more complicated than that. a true audiometric room/booth to do the testing (eg fully soundproof) in is very rarely found outside of audiologist offices or specialized academic spaces, for starters, and I do believe those are required for paperwork (whether it be insurance related part of the process to getting the right device fitted).
then there's also additional complications like types of hearing loss impacting calibration - some people react very negatively to higher (or lower) frequencies than others do, to the point facial stimulation can happen, and some people just have a frankly tricky profile that requires a trained audiologist on hand to work with them through several sessions, if not outright yearly on top of that, since the nerves and brain output can change by itself.
(source: have a cochlear implant, been doing the described experience since I was ~ 3yrs old.)
To add to this — I suffer from Ménière's disease, which manifests for me as variable hearing loss. Some days are bad, and I can hardly hear/understand speech even when someone is right in front of me and I can lip-read. Some days are good, and my hearing aids are uncomfortably loud or make things sound "weird". But most days, my hearing aids do exactly what I need them to :-)
I've had audiograms taken on moderate and bad days, and the difference in frequency response was significant (up to 30dBA difference across only the lower frequency bands).
my partners hearing aids has a smart phone app, but it seems to be built with the concept of someone else putting the calibration into it. They can then create profiles for the different situations, however it strikes me that the hearing test calibration could be done in the app as well. I would imagine for a lot of people, if you could just buy them online you wouldn't need the clinicians for many cases.
The app for my hearing aids allows my audiologist to make remote adjustments, so I don't even need to visit their office for straightforward changes. I really want to reverse-engineer it so that I can modify some of the details of the profiles myself.
All audio devices used to have an instant-feedback feature like this. You could dial it in with zero latency. Early technosapiens called it the Volume knob :-).
> What if, instead, the calibration process worked constantly? Give the user a button to press when they don't hear something well, and another when they do.
On TVs, they call those buttons volume buttons, it is revolutionary.
Hearing aids have volume controls, which some clinicians disable for new users - as it causes more problems than it fixes.
And just like the TV remote they increase all sounds - good (speech) and bad (music and explosions).
The issue is not just "is it loud enough" but rather,
"can you understand what you want to hear when you want to hear it?"
imagine yourself at a busy restaurant.
you want to hear your spouses speach better, and the wait staff- but turning their speech up also turns up the people you do not want to hear.
how do you fix that?
noise reduction, speech enhancement, directional microphones are just some of the tools a hearing aid uses.
But ultimately what needs to happen is your brain works harder at comprehending what you want to hear(yes, it is work, and like all work people do not want to do it).
So they think...hmmm, I will just pay $xxxx.xx and I wont have to work anymore.
Reminds me of the race to the bottom we're also seeing in orthodontics.
Whether like me, you never got the hang of a retainer after braces - or went off braces too soon, in my case - there has been a number of companies trying to get costs down and make the process less expensive and onerous.
Yet, talking to my regular dentist, who has used Invisalign with patients before, it's not the fact that there are more competitors in the field, essentially putting pressure on the DMD's and others to up their game, it's that after the initial consult, the entire process is (largely) unsupervised.
If you don't fit (or tune) something like this properly, it doesn't work.
A lot of the time it's not absolute volume. If you can't hear certain frequency ranges well, boosting the volume of all ranges is just going to drown out the ones you can't hear well.
Exactly - hearing is much more complicated than just noise sensitivity. For example, a somewhat underdiagnosed problems is issue with the frequency bins that the brain segments sound into for recognition deteriorating. Symptoms are - can hear just fine in a nice, uncluttered audio environment, say a test centre, but has issues if there is any significant background noise.
> Symptoms are - can hear just fine in a nice, uncluttered audio environment, say a test centre, but has issues if there is any significant background noise.
Also a problem if you're not a native speaker. I am fluent in English and have been able to watch movies without subtitles for 20 years at least, probably more.
But put me in a noisy bar and my error correction suffers a lot. Suddenly it's hard to follow a conversation that in my native language would be effortless.
The worst situation is listening to a loud video on bad speakers. Doesn't matter how much you crank the volume, people are hard to understand because the brain's error correction isn't good enough. Use a good speaker and turn down the volume, suddenly it's perfect.
Do any hearing aids frequency shift, or compress the frequency scale (e.g. just higher frequencies compressed down to lower frequencies so that voice tone stays constant and sibilants get shifted down into hearing range).
yes, I know Phonak hearing aids were doing that since about 2012.
For some of our more severe hearing impaired patients it was a noticeable improvement in speech comprehension.
That is exactly what the tech does,
automatically adjusts based on the amount of noise and speech in the environment.
And going a step further, applying directional microphone control to better pick up sounds where the speech is.
go further, and having 'hearing aids' that would let you rewind the last 5-10 seconds of a conversation to hear something again without asking people to repeat themselves...
I think this is more akin of the Android phone I have asking me if the call I just placed was: clear, had cutouts or dropouts, fuzzy background noise ... And they take that feedback and adjust my call quality in GoogleFi (in theory)... It's not just the concept of s volume button, but more the idea of reinforced (ai) learning over time, or algorithm adjustment with human feedback.
...which will simply make you more deaf. hearing aids do not simply amplify volume. you know, because they're not headphones and a microphone.
but your idea is great too. if you can't hear one frequency, let's amplify all frequencies till the one you need gets loud enough, and go deaf to the other ones in a year. when you get old and need a hearing aid, you should stick with your method.
Canadian here as well. I have a 35 dB / 70 dB loss in each ear respectively.
It is a pretty sweet deal if you can afford it. They do just ship you already-programmed replacements if you've lost one. No questions asked. Free adjustments. Very comprehensive. It's pleasant and stress-free while you're covered by one of those packages.
But it's if you can afford it. When you can't afford the all-exclusive package there's really not much else. I spent about half of my childhood, teens and 20s without hearing aids due to cost. Held back my education at all levels. Even when I went to university, while I was eligible for provincial funding for hearing aids at a student, I was still expected to pay the cost up-front first. Independent adult students don't usually have $5000 cash lying around. I missed most of my first year.
Their reasoning is that you should stop buying luxury superyachts each year and focus on your health. Its about priorities!
On a related note, dentistry is another one that is usually not covered at all. Why even basic dental isn't covered by government healthcare as a prevention initiative still surprises me. Bad teeth can kill you / give you cancer / wreck chaos and damage organs in general etc and its all often detectable at early stages.
> There is far more to fixing your hearing issues that just amplifying sound. Sadly, most people wait too long before trying a hearing aid, and give up because they hear too much noise.
Of the people I know who have gotten hearing aids, every single one of them was disappointed. Every single one of them still had trouble hearing. As far as I can tell, the only thing the audiologists appear to be able to be able to correct for (with current hearing aids) is "make it louder". If more than that is needed, it's a vicious cycle of taking it home, realizing it's not really helping, and bringing it back to try a new one.
The above seems to be particularly true when the hearing problem is heavily weighed towards not being able to hear certain/higher frequencies, so can "hear" people talking, but can't understand it; especially if there's any background noise at all.
I sympathize that your job was hard and that the clients made it harder. But the clients following directions and trying multiple different hearing aids ... doesn't really solve the problem in a lot of cases. Hearing aids are very expensive, far too expensive for a result of "I still can't understand people talking to me".
Perhaps it is because most of those people expected the hearing aid to work for them, and did not want to do any of the work they needed to do themselves.
Imagine not reading for 10 years because of bad eyesight, eye glasses do not make it so your brain can read, but instead makes it easier for your brain to see the symbols.
your brain still needs to decode and comprehend them.
Our hearing system is far more complicated.
You can look in the direction you want to see....but you hear all around you, even through walls.
You cannot stop hearing, even in your sleep. It is far more crucial to our environmental awareness than more people realize.
This honestly doesn't sound very empathetic toward patients. Many of these people had fine hearing and then lost it. They've already "learned" how to hear and they reasonably expect the hearing aid to help restore it.
In your analogy, it would be like if my vision got worse and I got eyeglasses which partially restored it, but mirrored everything upside down with tons of static. Now I've got to learn to read upside down and tune out the static, but don't worry because I get 10 free lessons with a reading instructor. Oh and none of this was clearly explained to me or part of my expectation when buying glasses.
I got high quality progressive eyeglasses some years ago. Hated it at first. It was like swimming in a fish bowl. If you don't position your head correctly things are blurry. Now it's completely natural and I love them. I had to learn.
Hearing aids are the exact same. It's slightly unnatural but once you learn how to use the tool, it's a super power. I can hear conversations in crowded bars when normal people can't. Loud noises compress in a pleasant fashion. I just have to get used to some occasional spatial distortion and subtle flanging
The thing is, though, that it appears to be very different depending on the person. And there seems to be a LOT of cases where the technology just isn't up to the task. Sure, we _can_ blame the user in every case, but if the cases are highly skewed to the users have a poor experience / not hearing well with them, then really it makes more sense to blame the technology until you have proof otherwise.
> Perhaps it is because most of those people expected the hearing aid to work for them, and did not want to do any of the work they needed to do themselves.
Or, alternatively, it's exactly what I said and the device + audiologist combination just isn't up to correcting a lot of common hearing issues. That seems far more likely than the vast majority of people doing everything wrong.
That sometimes was benificial, but mostly with just one n one and TV. Those you can control, but what about when a few more people come over?
Or when the neighbor is mowing their lawn?
Correct me if I’m wrong, but isn’t this something people could do on their own at home if the hardware had a decent setup UX / tuning instructions? This doesn’t necessarily seem like something that couldn’t be done pretty automatically.
I guess one question is: do those things have to cost thousands of dollars? What are the primary cost components? Are the people doing these jobs highly paid? Are they highly paid because of high costs of college tuition? Would free college help lower their costs?
> I guess one question is: do those things have to cost thousands of dollars?
No. Hunters (and shooters) have been buying electronic ear protection for years at much lower prices. There is no FDA approval, and they are not needed so the manufactures have to compete. The result is hearing aids in everything but the FDA approval. Some people find they work better than hearing aids because the manufactures have to tune them to work well for their customers which means background noise reduction (not just gun noise reduction)
Don't get me wrong, those who are borderline find the hunters hearing protection better. If your hearing is very bad you need expert tuning for just year ears, and that can't be offered without FDA approval.
The high end ones are $200, and internally pretty much the same thing other than the programming. The cheap ones are $30 (but not programmable)
These are good points. I was wondering about the costs of the doctor's visits, but you're right we should perhaps make those optional.
I realized one thing that would help is "open hardware". If you're supposed to see a doctor to measure and tune some value maybe a device with an open interface and an app would suffice (which I think others here mentioned today).
The reason I asked about the cost of the doctor is I am interested in doing things like giving them free school in order to lower their need to charge high prices. Generally I would rather every person has a good local doctor they can see for free, but we could also deregulate these devices and let people sort out amongst themselves how to get the right fit. I would just want to take care that people aren't damaging their hearing further with improper use.
My opinion:
do those things have to cost thousands of dollars?
--yes and no, costs could come down, but in the lifetime of a hearing aid it could be replaced 3 times or more at no charge to the user.
What are the primary cost components?
The primary components are:
Microphone {cheap to produce}
Receiver (speaker) {cheap to produce}
Processing Chip {expensive to R&D, cheap to produce}
Are the people doing these jobs highly paid?
Salary in Canada was between $60,000 (diploma) - $100,000 (Doctorate) when I left the industry.
Are they highly paid because of high costs of college tuition?
Depends, but after leaving for IT and making more than that with less education - I am unsure if they are "highly paid"
Would free college help lower their costs?
I would hope so, but doubt the savings would pass on to the consumer.
Maybe cheap to produce in larger sizes. As you have to make the components smaller and smaller to fit all the extra gubbins, each of those other components now become exponentially more expensive to design and produce.
Yes, there’s a lot of overcharging in this business, because the manufacturers charge what the market will bear, and because of insurance and lack of competition due to all the regulations they have to comply with, the market can bear a very high price.
But it’s still a very hard problem, and there’s a very significant component of user training over the long term that is required. When you were a newborn, you didn’t learn to hear and speak your native language in a single day, you didn’t learn to see and recognize faces and read written words in a single day. You shouldn’t expect a hearing aid to magically fix you in a single day — your brain needs time to retrain.
One of the costs built into hearing aids is the lavish perks that the suppliers give to the audiologists. My partner got a trip for two to the Caribbean every year, to 5-star resorts, for selling a certain number of their hearing aids. There were about 60 people in our group, probably costing well over $5,000 each.
2+ microphones, signal processing chip, audiophile+ miniature speaker, multi-octave equalizer, intercommunication between ears/dynamic adjustment, multiple profile, remote mic, bluetooth to phone. I think the top-end in-ear musician speakers are comparable, certainly in terms of sound quality. Maybe better as they have (far) more speakers/frequency response as their users are far more critical. They're not magical but they're good when there's not a lot of echo.
How does the actual hardware compare to a $180 pair of AirPods? I wonder if basically Apple and Samsung should be making these instead of smaller medical device companies.
I suspect there’s nowhere enough money for apple or Samsung to enter the medical devices field for real. I would think the headphones have a Bluetooth receiver, a d/a converter and a speaker. They rely on the associated device to handle “adjustments”. Might be noise reduceing, but that only adds a mic and a phase inverter. Much simpler device. Getting medical approval takes time and $$… Easier to put fine print that the things does not treat or cure anything.
Looking over their marketing materials, the Airpods seem to have much more power than that onboard. They use their own custom silicon chip onboard and it seems to be pretty capable. I wonder if (doubt?) medical device manufacturers are designing custom processors for their hearing aids.
"...the new AirPods feature Adaptive EQ that tunes sound in real time based on how AirPods fit in the user’s ear. An inward-facing microphone monitors for sound, and then Adaptive EQ, powered by computational audio, tunes the low and mid frequencies to account for what may be lost due to variances in fit. "
"To help with sound clarity, beamforming microphones block out ambient noise and focus on the user’s voice, while users can also enjoy a hands-free experience by simply saying 'Hey Siri' for requests."
One of the issues is that Apple can take their time processing the sound, but hearing aids have a very small window of time (< 15ms, if I remember correctly) before there is a noticeable lag between sight and sound.
For the first four items on your list, I would pay for the hardware cost of the hearing aids plus $200-$300. The last three things should be optional like Apple Care or other service contracts.
Is tuning (and retuning) something that could be automated? Because of tinnitus, my hearing is not the same every day and so static settings feel like the wrong solution.
So your argument in favour of socializing this is that people tend not behave optimally, in your view? This seems like a poor reason. Let the people who fall victim to their biases suffer the consequences, don't impose the cost of holding their hands on those who are capable of managing themselves.
I'm suggesting the model to use should be decided individually by members of the industry, not imposed on the industry as a whole. If some orgs want to use pay-as-you-go that's fine. If others want to offer more comprehensive service, that's fine too. I'm arguing for allowing the interactions to take place, even if some choices made are suboptimal.
As far as I know (at least for Canada, circa 2015) there were no laws or regs stating how, what or when to charge for services.
--other than some kind of return period.
Because it's easier to get someone to pay $100 for something they aren't sure will work (and then have their beliefs confirmed) than to get someone to pay $1000 for something they aren't sure will work (and then have their beliefs refuted)?
My wife's grandfather should have all of that through his VA, Medicare, and supplimental insurance. His hearing aids are the most annoying low quality overpriced pieces of crap you can imagine. And that stupid headphone amplifier thing they've sold him, garbage, literal garbage. A hobbyist could do better.
The new schema may not be a panacea but I don't expect it to be worse than the status quo.
Same in The Netherlands, and you don't pay out of pocket for those either in most cases. It also makes a lot of sense for an insurer if you think about it: people that are able to sense their surroundings reasonably well might be less likely to get into accidents causing that to then cost a lot of money. From an ethics standpoint it also makes sense to be in a society that aims to give people a good standard of living. Someone slowly loses the ability to listen to music for example might have a harder time enjoying life if music was an important part for them, that might cause various forms of distress which can turn into 'expensive' treatment for that.
Some people argue that ethics have nothing to do with it, but if that were the case, highly expensive insurances would be mandatory, and payouts would be zero since business-wise that makes a lot of money without being ethically encumbered.
> Buy a hearing aid today from any major provider in Canada and you get: [...]
Do you know what the status quo in the US is? (I don't, other than the prescription requirement from the article.) What you describe for Canada sounds pretty good to me, but I wouldn't assume any part of US healthcare is as inexpensive as Canadian healthcare or that the regulations are as well thought out.
No idea, but an initial search at "Connect Hearing US" (which also has a large Canadian arm states;
"2-week FREE hearing aid trial*
Try before you buy, absolutely free! Take a new pair of hearing aids home for two weeks to see how they work in everyday situations — no money down and no obligation.
3 years FREE Batteries
Get three years of batteries included with your purchase no matter what hearing aids you buy. Each year you will receive a box of 60 batteries for each hearing aid.
It is not perfect in Canada. Getting aids for our child and was shocked that this is a few grand out of pocket (after gold standard work insurance, provincial aid, etc). The province pays 500 bucks per hearing aid, which seems ridiculous given the costs. We are well to do so it doesn't matter but I am shocked that this isn't fully covered given the taxes I pay (in tech .. so you can guess). For kids, this should be fully paid by the government - no questions asked. As a few others (who seem to be knowledgeable) have posted .. if u miss out on hearing, you start to be less productive member of society. Being in a western, rich society where we pay for stupid shit all the time out of taxes, the govt not fully paying for some basic model of hearing aids seems like a crime (basically, not enough people are impacted, so politicians don't care). I'm glad the US is improving the situation here for its populace.
Maybe not a doctor, but you need someone to test your hearing and write a custom frequency map for how your ear works. Good hearing aids are not simple amplifiers, they have complex signal processing to make it easier to hear what you want to hear (if you like music they make music worse, but you can understand the lyrics - this is a simplification, but good enough)
OT but knee-related: people need to understand that function after a total knee replacement will NEVER be better than that existing at the time of the replacement. The only benefit is reduction or elimination of pain. — retired M.D. (anesthesiologist)
There are a number of healthcare areas in the US that have been protected by regulation, but it’s increasingly unclear if this is good for patients, consumers, or public health at large. The increasing sentiment seems to be probably not.
Vision care is another area I’d expect to see more changes and disruption coming down the pipeline. Vision care is very important and advanced cases require special skills, but it’s also unclear why many routine checks couldn’t just be done by a family doctor.
The US requires one to see a “doctor of optometry” to get a basic single vision prescription. That industry used to make its money turning around and selling you glasses from the same office but that whole industry has been turned upside down by online retailers like Warby Parker and such. Why the US can’t follow the models followed most elsewhere in the world is unclear, but it would remove a lot of extra steps and costs in getting a basic care of glasses. Ophthalmology (medical doctors) are still very much a thing but most countries don’t have this model of needed a “prescription” from an optometrist for a basic pair of single vision specs.
There are so many cost barriers to treatments. It's definitely not for patients at this point.
For instance, I am supposed to redo my sleep apnea test every so often. But it's out of pocket? Why bother, I know mine is due to my genetics (I'm not overweight). So why am I subjected to reproving my need for a prescription?
For eyeglasses, if someone wants to continue the same prescription they can't.
It's like healthcare in the USA is a damn subscription model with yearly fees to keep getting things just prescribed (let alone treatment on top).
That's particularly odd because the normal prescription for sleep apnea right now is for a self-adjusting PAP machine -- an APAP -- which has quite a range of pressures that it will automatically apply to minimize apneation events. And if you exceed the range, it will wake you up and alert you to that fact, too.
They said that an auto-PAP is not the first choice. A CPAP is a better choice, if it will work for you at the pressures you need. But they only work up to certain levels of pressure.
An auto-PAP will work to higher levels of pressure, but then it has to continually adjust the levels of pressure that it applies based on the resistance it senses, and that is not as good for you as constant pressure.
And there’s no way a CPAP or auto-PAP is going to wake me up at night, short of causing me to go into an apnea condition and potentially die.
> You'd be an idiot to do so, however, as your vision can change with age.
Not to mention, getting an eye exam is more than just clearing up your vision. It can reveal other issues (and not just eye related! They can often see other problems, like say, cholesterol issues, for example.)
Contacts are regulated like drugs, so, yeah. But there is no such restriction on eyeglasses (in the U.S.). Depending on the state, they do "expire" (in FL it's 5 years), but you can still use it[0]. I have bought some beaters from Zenni and made the Rx up myself (I used to work in a lab a hundred years ago, so I can figure out how much more plus my readers need).
[0] Some places will reject it just because they don't want to deal with your complaints about a new pair not working. Other places will read what's on your current pair and match that. It really depends on who is making the glasses.
>You'd be an idiot to do so, however, as your vision can change with age.
I just use reading glasses but the desired strength can vary day to day depending on what you are doing and my eyes vary too. This can be dealt with easier by having a number of pairs of reading glasses and seeing which works best rather than doing prescription stuff. You can buy reading glasses for £1 here so I tend to get a few.
I'd still recommend going to a good optometrist occasionally in case there is something more worrying up with your eyes.
I'm going through this right now. I know I probably need a cpap machine, so paying $300 out of pocket to rent a stupid device to record my sleep seems like a waste.
Crude but realistic: There is a pretty high number of (often but not always overweight) undiagnosed/untreated people suffering from obstructive sleep apnea on the roads every day. They are causing a number of avoidable accidents every day.
I think it's criminal to make CPAP as unaccessible as it is in the US.
Not to mention lost productivity. I wonder what the dollar amount for my lost productivity over my lifetime due to poor sleep would be. Probably very high.
One pretty big (and relatively unknown) law is that your doctor needs to give you your vision prescription so you can buy glasses elsewhere (usually for much cheaper). I think a lot of them get around this by letting you look for glasses while waiting and not telling you that this law exists.
The bigger issue is that a prescription alone is not enough to order new glasses, you also need pupillary distance measurements in order to ensure the lenses are ground correctly. Many many optometrists will not provide these, only the legally obligated prescription. While for most people who have minimum prescriptions you can use a phone app or similar to get a rough PD, for anyone with serious prescriptions even minute variations in PD can prevent proper vision correction.
I needed my PD to get prescription lenses for my Oculus headset and it wasn't on my prescription.
On a whim I asked at a glasses store in the mall if they could measure mine. They happily did it for free. Your milage may vary on that of course, depending on the person you interact with.
My local optometrist uses a $99 Enshey (check amazon) IPD measurement device. I guess if I was ordering glasses for my entire family (we do), it would probably be worth it.
This happened to my wife just last month. I was very frustrated when I saw that she hadn't received a PD, but I didn't realize that this is a frequent and intentional decision at this point. Extremely frustrating.
I asked about 3 times for a PD measurement at my last exam and they distracted me and failed to put it on the prescription or measure it... didn't realize this was probably intentional
Last time I got glasses I bought from them, and asked about swim goggles - which they don't carry. They then happily wrote my PD on a paper for me to use when buying swim goggles - or anything else. (too bad I lost the paper since...)
I used the "ruler on a mirror, open one eye, center it on the end of the ruler, close it and open the other eye, mark where the center is on the ruler, then read the measurement (in mm)" method. Did it a few times to be sure, exact same results every time, just have to keep your head still and geometry does the work for you. Glasses made using that measurement have been entirely fine, no problems.
Just ask for the PD on the prescription, they generally don’t mind but also won’t offer. It makes things awkward if they refuse. I ask in the exam room.
The law specifies they have to give you the paper prescription (for no extra charge beyond the cost of the exam) even if you don’t ask for it. There’s no getting around it. Either they give you the prescription after your exam or they’re not compliant with the law. Consumer ignorance or apathy isn’t a valid defense.
You're absolutely correct that this has had a huge impact. This is actually the FTC's eyeglass rule and not a separate law, something that I didn't know until they started getting involved with Right to Repair.
Life pro hack - look out for "free eye tests" - get the prescription and walk out without a purchase. Something like 90% of market is captured by Luxotica hence 4x price when compared with online.
They also get around it by first handing you a prescription that doesn't have your pupillary distance noted. It's such a passive-aggressive bullshit move.
It happens outside the U.S. as well, but the U.S. has a particularly weak form of democracy which makes it more prone to regulatory capture. In particular, money is a more powerful policial level in the U.S. than in most other democracies, and that creates a positive feedback loop that tends to encourage and reinforce regulatory capture (you use RC to make money, which you then turn around and use to pursue more RC in order to make more money...)
In china you can get prescription lenses at a local market without any involvement of a medical professional, at extremely cheap cost. There isn't much evidence that this is causing negative medical outcomes.
On the flip side it used to be very easy to get antibiotics without a prescription there. I'd be surprised if this is still the case.
Not sure why vision checks require a doctor at all. In the end, they're just relying on your responses anyway: "What's better: A or B"? In fact, I'd go further and say it doesn't even require another person.
Just a note, but optometrists are "doctors" (because optometry is a doctoral degree), but not doctors in the colloquial sense, ie people with MDs who work in hospitals.
Ophthalmologists are the MDs that specialize in eye disease, and are the ones that treat infection and do surgery.
Optometrists treat infection and disease, and can work in hospitals as well. My fiancée is an optometrist who did her residency in a hospital and has worked in hospital systems.
Vision checks have also changed a lot in the last five years or so. I have a pretty strong prescription and always used to do rounds of reading charts and "A or B", and now there's a machine that scans my eyes and gets it very close to right, with an adjustment or two at the end.
12 years ago, I walked into a second hand eye glasses shop in India and they had one of these machines. It was amazingly effective. I felt duped by all the optometrist appointments asking me about A or B.
To me, the tradeoff of an expensive modern machine vs an cheaper iterative process seems logical. I think it's funny that a second hand shop has the fancy equipment... but they must know it sells glasses more effectively.
Here, the machine results are used as a starting point, validated by A/B but I don't know if the human part is effective or just theater.
Well, assuming the optometrist charges around $50 per hour, after 10 patients it would pay for itself. I assume the machine is simply cheaper, which is why it was used.
Eye exams are not easy or one size fits all. The machine does objective refraction, which is a different and more error prone method than subjective refraction. Also for multifocals you'll need a more tailored prescription. There's definitely progress in autorefractors though!
That's like saying a family doctor will just ask you if you're feeling alright. I know optoms who have found parasites, diabetes, cancer... The complete disregard for an entire field of medicine in this thread is astounding...
*Edit, saw your comment about not referring to the entire checkup.
FWIW, a checkup for me is 1 part refraction, one part retinal inspection, one part corneal inspection, and one part automated refraction/pressure checks.
Only one of those parts can be done without a doctor or highly specialized equipment.
I guess I'm a bit confused then - if it's part and parcel of a regular checkup, what's the value of breaking the refraction out into a wholly separate activity?
Your vision could change faster than however often you need your cornea examined or whatever. Or someone may not be able to afford a doctor's visit but know they need glasses (ignoring the question of whether it's right for people to not be able to afford an eye doctor's visit).
Extending your logic to other areas would end up with absurdities like needing a doctor to measure your waist size before you can buy clothes. "You should visit your doctor regularly anyway, what's the value of allowing people to buy pants without a prescription?"
You're just as likely to get the wrong prescription with an optometrist -- they're relying on your self-report after all -- except it's harder to correct, because you need to go and make another doctor appointment to have it corrected (vs using the machine again).
Also, if someone feels they would get better vision correction working with a trained professional, I'm fine with that. I only object to _requiring_ a doctor's prescription to get glasses.
Evaluating someone's eye for glasses can be done entirely by machine as can manufacturing the glasses themselves. I do not understand why we still force people to spend 5-10 minutes sitting in a chair in a dark room going "better....no...worse...better..."
Right, but then the way to do that should have nothing to do with corrective lenses and requiring them shouldn't be an artificial barrier to getting corrective lenses.
If it's important, then it's important for everyone.
What? Doesn't 20/20, 20/15 etc. refer to visual acuity (how much detail you can see from a certain distance)? Are there people who prefer anything but the highest possible visual acuity?
This I think has a lot to do with individual experiences with optometrists. I went to probably half a dozen optometrists since adolescence before I happened to end up with one who actually made it clear there's a degree of subjectivity with an eyeglass prescription.
Getting new glasses is different from screening for eye diseases, though it's typically done at the same time. I doubt a GP would have the special equipment they use for screening? It's pretty specialized.
Apparently the need for this gets more important as you get older:
Many optometrists don’t do much more than use a hand held scope to look into your eyes. I’d imagine most GPs either have that on hand already or could get it easily. It’s not like you need an MRI machine in the office to do an eye exam.
Yes some office have fancier equipment, but here it’s unclear if that’s actually better for patients and public health or just a way to bill more. Doing a basic exam and then referring those to true specialists is generally the model followed by nearly everything else in healthcare.
I have been to maybe a half dozen different optometrists over the last 25 years and they have always used several expensive looking machines to screen for eye disease. Most frequently a machine that uses a puff of air to measure the pressure in your eye and more recently, a machine with a bright light that gets detailed imagery of the vascular structure on the back of your eye.
Yes, although that test is automated and typically done by a technician not an optometrist. You can train someone to use one of these machines in a few hours. If this was a key test no reason we couldn’t just put one in every GP office and have eye pressure checked during an annual checkup.
Those machines cost money and require some amount of training to use. Having them in an office that specializes in using them makes sense. Having your GP have every type of machine for every types of checkup (eyes, ears, CAT, MRI, etc... all things that _could_ be at the GP, but aren't) would not be cost efficient.
> but it’s also unclear why many routine checks couldn’t just be done by a family doctor
Ordinary GPs aren't experts and the equipment for doing vision checks is expensive and consumes space.
IMO, medical care should be completely re-organized. Get rid of GPs as a profession (outside of cruise ships and the military) and GP practices entirely. Instead, have community clinics for everyday medical needs spread out over the country that have a team of skilled nurses for triage with a number of subject-expert doctors at the second level, and large/university clinics for everything the community clinics can't deal with (urgent/trauma care, oncology).
That would also shorten training times and effort for new doctors by a significant degree - e.g. in Germany, an ophtalmologist requires a full medical degree (over six years, not counting waiting times because medical study places are short in supply) followed by five years of specialized training. Realistically, training any expert doctor now takes at least twelve to fifteen years... and that's frankly absurd, and part of why medical costs are so sky-rocketing. Not many students make the ridiculously high entry requirements, many don't survive that time (and sometimes literally - suicide rates among medical students are way above average!), and those who have their MD are left with fifteen years worth of student debt which means they have to charge extraordinary hourly rates simply to be able to pay back the loans.
How do the nurses know where to send the triage without a broad medical education? This has been tried and fails, and when it is fails it is not pretty. Nurses will just refer their patients to 2-3 specialists in a shotgun approach, while at the same time missing "can't miss" diagnoses that never get a referral.
Medicine is not tech support with tier levels :( I would stick to talking about things you know, because medicine is not one of them.
Vaccine administration is another area that has seen / is seeing broad deregulation. In many states one needed a medical doctor to “prescribe” a flu shot or other vaccine. Now many states have moved to allow such “prescriptions” to be written by pharmacists and issued right there on the spot in a pharmacy.
Some physician groups fought that tooth and nail… not because there was any real evidence of people dropping dead from mis-prescribed vaccines but because it was a good stream of easy revenue for their office billing insurers for giving the shot. This change was much better for consumers and for public health overall by making vaccines more readily accessible.
"it’s also unclear why many routine checks couldn’t just be done by a family doctor."
Even though it's probably not that complicated, it's probably beyond the scope of a regular doctor to do proper checks - and - it's probably more expensive than getting your eyes checked by an optometrist, which is usually pretty cheap.
In fact, the optometrist model i.e. regulated specialization for something that we don't need very expensive doctors for, is probably a good model for hearing. If there's something more complicated, then they refer you to the ophthalmologist etc..
We should be trying to do this with everything i.e. get people into 3 year specialization programs which make basic health things affordable, and leave more complex cases to MDs.
> The US requires one to see a “doctor of optometry” to get a basic single vision prescription.
You can take virtual eye exams, which are reviewed by doctors to issue a prescription.
The real issue isn't the basic care of glasses, instead it's the screening of your eye health.
When you go to Urgent Care, say for a laceration, they do a quick work up, including taking your temp, blood pressure, blood o2, weight and height.
Having your eyes checked out in person with a comprehensive eye exam annually is a good habit. And tying it renewing an Rx for Contacts / Glasses just makes it easier to do.
In Australia you need to go to an Optometrist who is not a doctor, they can't prescribe medicines. There are few independent Optoms most are employed by spectacles chains nowadays. They also do retinal scan, check for glaucoma etc. No one pays for Optoms. The government pays for one free eye checkup every 2 years (used to be 1 year). The glasses and frames you have to pay. Ophthalmologists are specialists for eye diseases and needs to be referred by either GP or Optom and costs an arm and a leg. My last visit was $400+
> That industry used to make its money turning around and selling you glasses from the same office but that whole industry has been turned upside down by online retailers like Warby Parker and such
This is not really the case. Online, warby Parker, etc. have built scale but the traditional retail still makes a significant portion of their profits here. And it’s a healthy business by most standards. The staff and employed OD are typically compensated heavily through variable compensation. The primary industry metric is “capture rate”, the percentage of people that buy eye wear after the exam. If I recall correctly it’s about 65-70%. From an incentive perspective, the doctors and staff are salespeople through and through.
Like all segments of healthcare, it has really started to consolidate. The independents/regional brands operating now will likely sell to PE roll up play when the foundering doctor retires. PE will exit to conglomerates. Most of these are boomer’s and this form of consolidation is well under way. The already high margins can easily be improved by centralizing back office, etc.
The vertical integration in the industry is insane. Luxottica for example leads retail, frame manufacturing, lens fabrication (laboratory), and owns the #2 insurance provider (of 2 main players). They have such power they can and do “force” independent retailers to use their POS software.
Warby Parker has some hipness and definitely grew quickly. But, they hardly put a dent in the market. There may be some evidence that they expanded it, as happens with fashion. They would be more akin to Blue Nile in the jewelry space. Independent jewelers still dominate that market.
If you can afford the $5,000 - great! The current system works for you. 80% of people cannot and so are stuck.
For folks with mild/moderate loss (where a LOT of people don't get help) something as simple as letting Apple tweak noise cancellation to be voice enhancing and providing a tuning and hearing test app in the iphone would be a godsend.
The elderly miss out on a lot of family life because of hearing issues - people stop talking to them even if they are fully sound of mind because of this issue. I've seen this personally.
And for all those who say apple is just a consumer products company and there is no way their $180 - $250 airpods can provide any benefit I think you might be surprised.
This is me. 28, had mild hearing loss for about 3 years now in one ear due to a bad ear infection. I can get by fine, however I'm definitely missing out on a lot of "richness" of sound. I can't hear high pitched noises, or subtle differences between noises in my left ear at all. And everything in general is a little muted. Since I can hear perfectly find out of my right ear I'm not convinced spending thousands of dollars is worth it.
I would spend $10,000+ if my tinnitus could be cured permanently though.
The drumming-on-the-back-of-the-skull trick lasts just long enough for me to realize what the world could sound like. (I tend to not do it anymore due to the mild depression I get realizing how fleeting the relief is)
i'd pay way more than 100k for a tinnitus cure. it would be worth significantly delaying retirement for. but there's nothing on the horizon. and yes, i have adapted to it well enough that it doesn't cause me anxiety and don't notice it 98% of the time. i just miss pure hearing.
FWIW, there is a nuanced difference between hearing aids and iPods. Hearing aids basically apply a hearing-capability matched EQ to the incoming sound.
Why this matters: Hearing loss is not uniform across frequencies, and we use huge portions of the spectrum for different functions (truck backup beepers vs. car engine noises, both used to identify what's coming your way).
It could not. A hearing test requires an environment with exceptional isolation and flat-response drivers (iPods are not remotely flat) to be done properly.
> do a hearing based EQ on incoming sound
It could, given a proper prescription for the EQ, and an understanding of the response curve of the iPods' mic and drivers.
> do sound profiles
Not required, the EQ is tied to your hearing damage, not your environment.
I've got a higher end audio setup, I can put the sound calibration mic in the listening position etc (think YPAO / Audyssey etc). But you get little weird sync issues at times between sources / displays etc.
On a whim I tried Apple's wireless sync. It's end to end, and works as well as I could with manual tuning (which I would do by filming at high speed a time audio sync track)
So they demonstrated a consumer device could, in a few seconds, generate a fantastic sync solution across my entire input -> output -> room stack. Or I could spend an hour fiddling around in settings.
Airpod pro's provide a some level of isolation already especially if you run the fit check. airpods are also not that bad.
You could do a calibration curve at factory if needed for drivers. You could run a very user friendly process to fine tune, in the comfort of your own home, a profile of your hearing loss. You could update this anytime.
You could then also obviously offer some presets to amplify things in a targeted way. At the dinner table? Focus on voices. At a concert, do a music preset.
We've heard all this before with camera's by the way. The iphone doesn't have a "real camera". Yes, I used to shoot full frame. Yes, the iphone's cameras are "crap". But for many people they are "good enough", and they have other benefits, ease of use, easy to learn, not a big extra expense etc.
Let the market decide, apple can provide a warning -> if you want to wait for insurance to approve a hearing test, then schedule one, then wait for a device to be ordered and ship, then go back, then be dependent on an audiologist to tune things for you etc you should do so, but if you want, try out little app here to see if it helps.
I really hate it when people say "let the market decide" when it comes to health care. It's how we get $10,000 suppositories (a story earlier this week).
It appears you really like Apple's audio hardware (whereas I think it's middling crap), know little about hearing loss, and I don't feel like arguing the points.
<i>It could not. A hearing test requires an environment with exceptional isolation</i>
Don't be so picky. Or don't let the perfect be the enemy of the good enough.
I had some trauma induced hearing loss recently and cannot hear certain frequencies at all with my left ear. When I stand outside next to the (small) waterfall with it on my left size, I can hear "part" of it from my left ear... and the other part as if it was coming from the woods on the right side. It passes right by my left ear w/o me hearing it, bounces off the woods, and comes back to me. It sounds like there's 2 different waterfalls, one on each side of me.
Trippy, isn't it? A similar phenomenon can occur without hearing damage, where the reflection to the right ear is at the right phase to cause wave-interference with the source waveform that reaches the right ear.
I don't know much about this topic, so interpret these as questions, not as arguments that I have particular confidence in:
* If the earbuds you use to perform the hearing test are the same ones you use with the resulting EQ profile, why does it matter whether the earbuds are flat or not? If you're taking measurements in a transformed coordinate space, and applying those measurements in the same transformed coordinate space, shouldn't that be equivalent to taking measurements in the original coordinate space and applying them in the original coordinate space?
* Why isn't active noise cancellation a good enough form of noise isolation?
* If using an EQ profile that only matches your hearing loss imperfectly can damage your hearing, wouldn't the same thing apply to EQ profiles that aren't intended to correct hearing, like the media player presets "classical music", "rock music", etc.? For that matter, wouldn't it apply to a flat EQ profile? Is there something special about an imperfect hearing correction EQ profile, compared to other EQ profiles?
> If the earbuds you use to perform the hearing test are the same ones you use with the resulting EQ profile
You also have to account for the microphone, which can (and will) have its own bias. Measuring from a flat response source, and producing for a flat response mic/speaker combination will produce the most accurate results.
> active noise cancellation
ANC creates sound artifacts at low volumes. It also provides, in ideal circumstances, around 25Db of noise reduction. You probably want between 40 and 80Db (or more) of noise reduction, depending on the ambient noise level around you. The threshold of hearing hovers around 10Db for healthy ears. Healthy ears can hearing your own heartbeat in an anechoic chamber (as close to 0Db as we can get).
> wouldn't the same thing apply to EQ profiles that aren't intended to correct hearing
If you're correcting for a 40Db loss at one frequency (taken randomly from the surrounding threads), applying it to a frequency where you have only 20Db loss can result in an extra 20Db of sound at that frequency. 20Db is 4x louder by perception, and over 6x higher pressure.
For a point of reference, Apple music's EQ curves are 12Db, 24Db if you set the extremes. So yes, they could damage your hearing, but that will depend more on the volume than the EQ.
I'll bet most earbuds with active noise reduction and equalization could be tweaked to provide augmentation similar to a hearing aid. The current algorithms for active noise reduction are designed to suppress external sounds -- all they have to do is invert the logic and amplify external sounds. Just add EQ to make my wife's voice come in better.
Yeah, the AirPods Pro's are amazing as hearing aids.
The only issue is that they are very visible and only last 4 hours each charge (I suppose you could get two pairs and switch between them every four hours).
Is this really a problem in practice? I've always had a valid prescription when I buy glasses, but at the glasses store I just flash them the prescription on my phone for a few seconds. It's a PDF on official looking letterhead, but I don't think there's any verification. I suppose it's probably not the best idea to fake an eyeglass prescription, but it certainly seems like it would be very easy to do.
* I had an optometrist only give me a prescription for glasses, even though I indicated I wear contact lenses on my intake form and was wearing them at the appointment! When I realised a few days later after being denied trying to buy contacts with a glasses prescription, the optometrist said I would have to come in again and pay for a full consultation (out of pocket as my insurance only covers one per year).
* I've tried to buy contacts online in the US with an expired prescription, the retailers say their hands are tied, they need a current dated one.
I now just buy contacts online from Europe or New Zealand. No BS, same price, the EU company I buy from includes a mini bag of haribo gummies :)
My contact prescription hasn't changed in 10+ years and I've been tired of having to go across town somewhere to get an eye exam, 1-800-contacts has an online exam you can take and don't need to drive anywhere and it's all digital. I've used this the last 2 times I've renewed and gotten new contacts and what I'll keep doing from here on out.
I've had a good experience from vision direct. A student I know says it's the recommended option for foreign students at the university in the UK they go to.
I've used Vision Direct (someone linked them, above) for contacts, with an "expired" subscription. Entered whatever numbers I liked (so, the ones from my existing contacts boxes), paid, and received contacts. Only slightly cheaper than buying at my optometrist's office, but saved me pointless visits resulting in "yep, looks like your eyes haven't changed... yet again". Reckon I'll stretch those to every 3-4 years rather than annually, assuming I don't notice problems sooner.
I've used Coastal and Zenni for glasses. No problems.
edit thinking about it a little bit i could see it being harmful to not have someone go through the "you don't want to do this or else you could potentially lose your eyesight" talk at least once.
For contacts, it's incredibly frustrating when your eyes barely change over many years, but prescriptions only last two years (or one, depending on state). You may need to resupply on contacts, but are not able to purchase them without a new prescription.
You can be 1 year and 11 months into your prescription and buy 4 years worth of lenses, but at the two year mark, you can't purchase them at all without another visit to the doctor and explicit approval for a specific prescription.
My particular annoyance is that I usually buy a year or two worth of lenses at a time - one set usually lasts a month, but I don't wear them every day. So I can stretch out the time a bit further. By the time I'm down to my last set and want to resupply, I'm required to visit an optometrist. Spending money on another eye exam that tells me nothing new. It's even more frustrating if I completely run out and have to use a set longer than is ideal while waiting for an opportunity to visit a doctor.
I get that wearing the wrong prescription lenses isn't ideal, but I don't understand why prescription lenses are gatekept like narcotics. If you can't see well or have the wrong prescription, there's a natural incentive to visit an optometrist and figure out exactly what you need.
> I don't understand why prescription lenses are gatekept like narcotics
Unfortunately, the answer is regulatory capture. Optometrists in the US make the majority of their income [1] from selling glasses and contact lenses, which of course they also prescribe. There's been a lot of lobbying, collusion, and non-compliance in the industry which the (admittedly biased) link below outlines well.
There isn't any verification. They certainly don't call the optometrist to verify. Not saying I've done this, but one could submit an old Rx and change the date in Photoshop as well as the name and number of the doctor and buy contact lenses or glasses online just about anywhere. Theoretically, of course.
Of course, it's also both theoretically and practically fraud, and most people would rather spend the $100 on an eye exam every 2 years than expose themselves to rx fraud (2 years jail / $2k fine)
Yes, theoretically that is a risk. But practically, it has never and would never happen.
And an eye exam for specialty contact lenses is way more than $100. Really, more than $100 in many places just for a simple reading glasses RX. And many docs won't just do your Rx. They require you do a full exam.
For the commenters asking: this applies to contact lenses, not eye glasses.
From the Contact Lens Rule [1]: "a contact lens seller cannot provide contact lenses to its customer unless the seller either obtains a copy of the prescription or verifies the prescription information with the prescriber"
The Eyeglass Rule [2] doesn't contain this stipulation.
It is amazing how things that we take for granted somewhere do not work in other countries.
Here in The Netherlands, I can walk in a shop and get contact lenses off a shelf. It does not even need to be a dedicated shop. These are available in generic care shops where you can also buy shampoo, vitamins, and even some medicines that don't require prescriptions.
In California, for example, you can't buy prescription glasses without an active prescription.
I found this out when my glasses broke on the weekend and couldn't get replacements before talking to a doctor -- none of which had availability for several days. So I suffered from headaches and poor vision for several days thanks to this ridiculous regulation.
Sure states may have that rule, but it is totally legal to go to a state that does not have the rule, buy some glasses and bring them back. (Or to buy online from a state that does not have the rule).
Neither the FDA nor FTC at the federal level technically require prescriptions for glasses. Indeed, most online glasses shops will simply take you at your word that you have a prescription, presumably because they are located in a state that nominally requires a prescription, but places no requirement on the shops to verify that the customer really does have one.
This is totally different from contacts, where at the federal level, sellers must verify the prescription with the prescriber, except that if 8 business hours have passed since they started trying to contact the prescriber, without hearing back, the prescription is considered verified. (That last is to prevent the prescriber from trying to prevent customer from getting lenses elsewhere by refusing to verify).
Cool, that's a great hacker approach! Fine-tuning like this isn't economical for eye doctors, and 99.5% of the population isn't interested but it will give you the best results.
Just checking because it looks like you're from '79 and talk about drifting vision: you know about presbyopia and accommodation? You might need multi-focals.
I need a different prescription depending on how wide my pupils are. I have separate glasses for night driving. Discovered this after a consultation with a real ophthalmologist, not an optometrist. They can dilate your pupils with eyedrops to take what’s called a wet refraction.
OMG. You may end up having changed my life - it had never occurred to me that a) this was a thing I could just up and buy, and b) it really isn’t that expensive.
No more worrying that I’m about to stick myself with the wrong prescription because the optician (yes, that’s who measures you for glasses in Germany) or I lost patience trying to find the boundary between spherical and cylindrical correction, or doing this at the wrong time of day, all for less than a pair of glasses costs.
I got a 200 dollar set that I’m happy with. It comes with “glasses” to attach the lenses to. But suggest ordering one that is more adjustable. The one it came with doesn’t adjust for distance between eyes.
I've had no trouble ordering from online retailers such as Zenni Optical just by typing in the numbers from the prescription. No signature needed. They do ask for a prescription date, and require that to have been within the last two (I think it is) years, but as far as I can remember it's all on the honor system. They don't even ask for the doctor's name.
Edit: it occurs to me that this may very well be one of those things that's dependent on state laws, so your mileage may vary. Worth a try, in any event.
Edit 2: and yeah, this is for old-school glasses. The requirements for contacts may be more stringent.
This is just a general thing I've learned from working adjacent to US healthcare... It's annoying to work with and there are all kinds of little rules because of how inefficient the system is.
First, always have a list of all relevant phone numbers (at a minimum, but other information is helpful too) to any healthcare entity you need to work with. Your primary care doctor, your pharmacy, your hospital, your preferred lab, any specialists. Also have all your insurance information on that same list - especially the different numbers for different departments (e.g. provider lines, authorization lines, etc). Just assume they don't have any of your information on file or their information is inaccurate and needs to be updated.
Always get a paper copy if possible (I think some things have to be electronic in certain states, but just strongly emphasize getting a paper copy for anything else). Pharmacies, labs, other offices always say whatever you need wasn't sent (even if you watch them send the request and it says it successfully went through). And yes make sure it has the doctor's signature on it! I'm not sure if it's specific to insurance companies or just certain medications, but they sometimes require diagnosis codes in some states. Find out prescribing rules in your state... I think it has to do with narcotics, so make sure you know the rules in your state for narcotic prescription.
Always know, ahead of time, the exact lab you're going to and hound the doctor's office about using the right paper work and ensuring diagnosis codes are present (there is apparently no universal lab paper work, so knowing ahead of time is important). Get a paper version of the signed referral. It needs to have the diagnosis codes and whatever other codes are required for billing (honestly not sure why medical offices aren't doing this by default, but whatever). Make sure one of "with contrast" or "without contrast" is selected if you see those options on the request sheet for radiology. Assume you won't be able to contact the doctor after this visit to have the lab order sent again. Also assume that even if you can reach the doctor, that the lab won't accept the order without a written copy.
Always get confirmation from the doctor if the prescription is covered by insurance. There are apps like Coverage Search[0] that can give you some information about whether it will be covered or not.
And of course there are a bunch of other annoying little rules that I just haven't encountered yet.
On top of the ridiculous costs, it's your responsibility to make sure things go smoothly ;) gotta love US healthcare
Wow, I'm so sorry you have to put up with that. My non-US experience: I logged in to a website, clicked a couple of buttons, and the doctor sent a repeat prescription to the pharmacy yesterday. I expect it to be ready to pick up later today. Done.
Exactly what you need when you are sick. That’s horrendous. Here you just get a script and walk up and pay for it. Probably more complicated if you need insurance to cover it but I guess that is rarer here in Australia. Some medicines come out pricey though I admit, for example melatonin is about $30usd a month equivalent, so there might be extra loops if you need assistance with that cost.
I’m only commenting on what I’ve seen. I’m sure a lot of people get through the system just fine with no issues. But this list is a compilation of many people experiencing issues receiving healthcare.
I'm CTO of easee, an online eye exam and have been involved in some US market research. It's a rapidly developing field and a lot of regulations are a gray area or different per state. E.g. it might be mandatory to have a valid prescription, but it might not be mandatory for the seller to verify this before selling glasses online.
I've just learned some new things about the eyeglass rule from a sibling in this thread.
I'm trying to visualize or recall any complications that could arise or have passed from shipping or receiving 'unsanctioned' glasses. I can't even imagine which regulating body would give orders to which enforcement organization that could make anything happen. To live by these rules is enabling my own abuse.
Just curious, since you mention that you're soon to be in the business of eye exams, do you think at some point your business is going to have to maintain this status quo in order to 'play ball' legislatively during your growth phase? If yes, how do you feel about that? If no, can you explain why you'd be exempt? Are these laws something that articulates with your business model or is this only in adjacent businesses like providing lenses?
I don’t buy online because I want to see how they look on my face first.
Many shops won’t sell you glasses unless your prescription is under 1 year old. This allows them to charge you for an exam when you don’t necessarily need it.
Sites like Warby Parker will send you a bunch of frames to try on for free so you can see how they look.
And I find sites like Zenni are so cheap that it's worth taking the risk: an ugly pair can go in the car /gym bag / work desk for if I lose a contact lens.
Every time I change glasses I try at least 20 frames, more likely 40 frames, before finding anything close to acceptable. Something that looks fine on a shelf most often looks ridiculous on my face. Can't imagine ordering online.
Lots of Zenni frames are so cheap that it's non-crazy to just order like 3 pair you think might work, and keep the two you like the least as backups, wearing the one that looked best. They also have "see it on your face" tech that's... OK, for narrowing it down. Better than nothing, and better than looking at them on a model.
I'm pretty sure that ship has sailed. Unless you stay indoors all the time, or maybe you live in Bush Alaska or something, your face is likely being captured and stuck in a database tens of times every single day.
How are people supposed to make money when we have machines producing all these goods!
Maybe your post was sarcasm though :)
That's the economic progress of humanity. We automate, and jobs that were once valued are no longer needed.
Easy to look at a specific instance and fight against the change, but in the long run it's better for everybody.
Glasses/Vision in particular costs hundreds more than it needs to. Glasses could be produced and sold at $10-20 bucks if regulations were eased. What is the material cost to produce these? You can get reading glasses in grocery stores for a few dollars.
I'm fairly well off and even I feel bad paying over a hundred dollars for some of this stuff. Imagine all the lower earners/poor that pay hundreds of dollars for glasses for no reason other than protectionism.
The entire eye exam can be automated very easily (and I believe already has). Would be easy to have machine learning algorithms that can diagnose problems from the image of your retina scan. I really don't think it'd be that difficult, if it doesn't exist already.
if you have an address for any length of time you could use a service like coastal.com as when I bought mine I am pretty sure they didn't ask for a formal prescription. I only have experience with them but maybe others like warby parker or the like are similar?
I've got an Oticon that has Bluetooth to connect to the phone for the purpose of changing settings, streaming as well as locating it. It charges using magnetic charging in a little (proprietary) charging station.
I have a BlueTooth-enabled hearing aid (ReSound Linq) that connects directly to my iPhone. It's a life-changing feature. It also has some capability to find hearing aids, but since I'm profoundly deaf and not wearing my hearing aid means I'm functionally completely deaf, then it's either in my ear or on my nightstand, so I've never had the problem of "where did my hearing aid go?"
You may not have meant to, but your question just reinforces the fallacy that hearing aids are for old people. Yes, hearing loss does occur with age for many, but it's not as uncommon as you might think for those not deemed "elderly".
I've personally worn them since my mid 20's. I'm glad that I ignored the perceived stigma of wearing hearing aids and got them. They are like glasses for my ears.
I wear hearing aides every day. SMALLER would be better and mine have BT5 and rechargeable. they are NOT cheap about $6k pair with 3 year complete warranty included. Again having options is the best thing, making them larger for me would mean they are more easily dislodged when I bend over to pick something up or are wearing them when working in shop. Having some that have better weather or fully waterproof would be great. I normal take them off when working outside or in the shop. The sweat makes them mostly useless because of the "noise" the sweat makes against the mics. Then the sweat also makes them slick and they will not stay in place. Having options is ideal and affordable options would be great. I don't know why these things are $6k pair when they share a lot of tech with modern in ear options from bose/apple/ect.
I stopped wearing my Oticon Opn S hearing aid when running because they don’t seem happy with sweat on a long run. That and wind noise can still be an issue. Also only having hearing loss in one ear means that they’re not really good for streaming audio but I do love being able to take phone calls with my hearing aid.
I’m ok with the cost since it’s effectively half for me and really $3K six or seven years would be fine considering the quality of life improvement. Being in large group meetings with multiple teams discussing project planning could be painful for me. And it helps with your relationship. When there’s a background noise source like road noise or AC or a running faucet your brain will fill in based on the frequencies it can hear and you will hear completely different words.
Did insurance pay for them at all? Part of it is going to be the whole "medical equipment" thing, the other is where they play games with the price because they know insurance will step in.
I would add better integration with mobile devices beyond bluetooth. I'm thinking a startup could create hearing aids with self-tuning apps that employ spectral analysis and echolocation capabilities for improving situational awareness of the wearer.
High-end hearing aids already do this on-device. I don't think it would be a great development to require hearing aid owners to own a smart phone and load an app onto it to be able to get full functionality out of their hearing aids. If the functionality needs to be externally configurable for some reason, provide an external controller that comes with the hearing aids.
I'm not of the age or occupation where I need hearing aids, but I think that I'd like overnight inductive charging, and I'd take them out and charge them while sleeping.
I'm profoundly deaf, and I can answer these questions for myself:
> Do you charge on ear at a time so you are never without some level of hearing?
I'm completely deaf in one ear, so I only wear one hearing aid. If I take it out, I have zero hearing, so... nope.
Most hearing aids do not have rechargeable batteries, either, so we have to change out the batteries on a regular basis. My battery lasts about 7-10 days before I need to replace them.
> Can you comment on the Live Listen feature of AirPods?
It's not powerful enough to act as a hearing aid for my level of hearing loss, nor is it calibrated correctly.
To that last point, hearing loss is not simply a lowering of volume. It impacts different frequencies at different levels, so the normal amplification that comes from an AirPod or similar headphone is not sufficient to compensate for anything other than very very mild hearing loss.
Almost half the comments relate to eye exams & glasses, not hearing aids. There's almost no one defending the present system, and I suspect if you took a poll of the US population, at least 90% would favor deregulating hearing aids. Probably glasses, too.
So why hasn't it happened? Those people who said "regulatory capture" get a gold star. A small group who will suffer a lot manage to defeat a much bigger group who will benefit by a much smaller amount.
Middlemen and gatekeepers are all over our medical industry. When I travel I am always surprised at how much easier it is to get drugs outside the US. Many prescription drugs here are over the counter elsewhere and much cheaper. I hope we start removing prescription gatekeeping more broadly, so I can stop paying hundreds for performative office visits that offer no value. It’s also a big time sink just to get some mundane antibiotic or skincare cream or whatever, when all that happens is that an FNP runs through the most basic Q&A script that can be self discovered online.
Capitalism (as a life goal, rather than one of many tools in a toolkit) is what makes all that possible. If can insert yourself in the middle of a transaction, and do that long enough, then you can get pretty entrenched to the point where people just expect it to be that way.
I maintain that, if automobiles were invented today, the horse-and-buggy industry would be able to successfully fend them off, based on the path regulatory capture has taken in the last 150 years.
Perhaps I should have said "societal goal". The stark contrast between those countries, and the US, is that the US collectively has this unwavering dedication to capitalism above all else, it seems in practice.
"People with mild or moderate hearing loss" should be free to purchase these sort of generic hearing aids in much the same way that buying non-prescription reading glasses is common. If problems persist, it is time to consult a professional.
Buy lightweight frames and lenses, have progressives and get anti-glare coating and "we'd be back to paying $700/pair" is like, last year if I miss a sale. Lenscrafters, not a small shop. They're all owned by the same site, and I work on the 50% off of lenses sale. Frames are 150-300 as I avoid big-name style. These are way more than +2.5 diopter reading glasses, and you might imagine that astigmatism and progressives does wonders for straight lines...
Setting FDA requriemetns on return is example of overregulation that is frankly not needed - I struggle to come up with online/DTC brand that does not have free 30 days return policy. Virtually all electronics on Amazon has free return. This is pretty much industry standard.
I don’t know about that but if there was a quality headphone that limited how loud my kid can play things and stopped spikes of loud audio during the loud parts of movies I would buy it today.
These are limited to 85db output. I have a pair that I use in my woodshop as hearing protection, which they are rated for, and really like that my music or podcast stays at a consistent volume. I also have volume normalizing turned on in Spotify.
Pointed out in a grandchild comment, but it's basically happening now. Phones will limit noise exposure from headphones, based on NOIA and similar standards.
I'm sure that's true. I'm also pretty sure that number is a lot smaller than the number of people in the general population who permanently damage their hearing using non-prescription headphones that they can purchase anywhere to listen to music every year.
Having worn hearing aids a long time (don't turn sh*t up to 11), I should point out that they require setting per-ear and one can have multiple programs (voice, music, ...). My fear of rechargeable aids is that with serious+ loss they'd burn through batteries in a (very) short time and if they're not replaceable it makes the aids disposable. Fitting is helpful as it's also done for mid-high earphones.
This will have to be paid for somehow, and somebody has to do the tests to know what to set. Same as glasses. So we should be able to get the raw aids at a lower cost and then deal with the extras. Costco sells reduced priced aids, so there's a little flexibility in the industry.
For my last set pre-covid, there were behind-ear (big), in ear (small) and in ear canal (very small). If you saw True Lies, their "radios" were probably dummy in-ear-canal aids. As I'm not blessed with a 15+ dex and like other posters I don't mind being see so the behind ears are ok. They can be hidden as dangly earrings with a sheath to make it interesting if you'd like. Otherwise, it's a bloody conservative industry re: colors. I wanted blue and red so it matched stereo wires :-).
And my attempt at bluetooth connectivity for phone calls failed as the things could not stay sync'd during conversations. Better to just use a headset.
"And my attempt at bluetooth connectivity for phone calls failed as the things could not stay sync'd during conversations. Better to just use a headset.
"
And that is what you should use the money you paid for....getting proper follow up and adjustments, including making your BT work.
BT and hearing aids have been used for over 10 years.
Apply new firmware to the hearing aids.
help you set your phone to work properly.
Return them and use a different make/model that works with your phone.
It was a new iPhone SE and a new vendor (not Phonak which didn't BT). The sound was not as good as Phonak, and the BT worked much of the time but not reliably. This, of course, was not a problem for those wearing one aid - I have two. One pays a lot of money for promise which, honestly, isn't fully delivered.
I went for an eyetest. A woman with 3 years post-grad training sat down for 45 minutes, ran a battery of tests, detected a bacterial infection in my eye, sent me for a
hospital appointment the next day, and gave me a prescription that I filled out online. My payment to her - 25 quid.
I did get her some chocolates to say thank you.
Now name another (para-)medical area where the medical part is a loss leader for the rest? (I am worried i will hear a lot of Americans ...)
But there are batteries (pun intended) of lawyers from the hearing aid manufacturers who would act against DIY kit vendors if asked. I wonder who/what is the best entity to help shield DIYers from patents...
Great news. I've been learning about and implementing real-time DSP algorithms for audio enhancement. (Cortex-M7) I started this hoping to make scifi headphone that enhance hearing for normal people with different presets, but realized what I'm essentially building is more like a hearing aid. Didn't even realize the regularly issue. (Although using the article's terminology, could probably already market this as a PSAP and be fine. (?)).
Check out nuraphones; I don't know enough about hearing and audio to know what voodoo they are doing, but as a person with significant hearing loss, the hearing customization they perform during set up allows the device to emit the right frequencies at the right volume that I can hear a significant portion of the left audio channel (which is impressive, given that I am "profoundly deaf" in that ear).
I'm pretty sure That's what 3M Peltor Comtac headsets do, they have microphones on the outside and speakers on the inside, without passing through gunshots or explosions, so you can maintain situational awareness in a combat situation.
Does this relate in any way to us getting cheaper hearing aids?
A pair of bluetooth streaming rechargable ones is about $3000. With Transparency mode and the latest software for AirPod pros, you can adjust the frequency distribution, and get what seem to be servicable hearing aids for $250.
What I'd like is proper (medical) assessment and fitting, but of cheaper commodity aids that are much much better made with better apps than most of those on the market now.
In my experience with a family member, the fitting and tuning done by the audiologist is as good as a random guess. Constant noise and screeching even after multiple, expensive tuning sessions. As a result the hearing aids get tossed away unused most of the time.
The adjustment offered by something like the AirPods Pro seem much more effective.
Most of my rejected fittings were from people who had far too high expectations.
that did not stop me from trying, and when unable to get success provide a 100% refund, and refer to a different AUD.
It has always seemed broken to me that hearing aids were not covered by healthcare, nor was there some sort of VSP like plan for hearing aids. I've worked with folks who had hearing aids from childhood and it is a big expense to bear while their glasses are subsidized.
Of course, the vision folks turned it into a racket for extracting cash. So ideally we'd want to avoid that and perhaps fix the vision racket while we are at it.
Similar frustration – I need a prescription to buy contact lenses every year. So I have to go get an annual eye checkup, which is still fine because it is preventive care and (mostly) covered by insurance. However, optometrists around me refuse to give a prescription for contact lenses without an additional $70 "contact lens fitting" fee which is not covered by insurance. The whole thing is a scam.
Audiology industry is filled with profit seeking corporations and they a have a HUGE political hand. They lobby. I would not be surprised to see the Audiology industry fight back this. They make huge profits and Audiologists are licensed workers.. Like doctors they're required to go though hoops and loops to get a license. The cochlear implant industry is the same it's all about profit and pushing the CI into babies and taking advantage of the early technology by using them on deaf people where in the future it will be more like cyborg tech way more advanced and they're just testing and pushing this huge industry. It's full of people that think a hearing aid or CI is a solution to the problem where it's really not. I would put neuro link tech into the same pool as CI tech. They're testing it on disabled people and touting the benefits while hiding the negatives.
So do I…oddly, I went and got my hearing tested and my issues are with processing, not hearing. The guy said “I actually can’t prescribe you a hearing aid, even if I wanted to.”
So, there should be some barrier to entry. Just not at $3500 an ear.
A hearing aid - AIDS you in hearing, but your brain does the processing and speech comprehension.
if you start wearing a hearing aid now you will just get lazier with your "hearing".
Just like if your knees are sore, and you get a knee brace - when you should have done exercises to improve your muscles supporting your knee - the brace will do more harm than good.
A hearing test measures how sensitive your hearing is in each ear at a range of frequencies - they send a beep at a certain frequency and ask you if you can hear it, and lower the volume until you can not hear it, raise it to confirm you can hear it. This is repeated in each ear over the normal range of hearing, nominally 20- Hz to 20,000 Hz, most older people have lost at the low and high end. The detailed frequency/volume curve allows the hearing aid to be programmed to bring hearing to the 'normal' curve. Some people may have lost hearing at certain frequencies, it may be an irrevocable loss?
That said, an iphone with headphones can easily create and administer a tone to each ear that can be varies in frequency and intensity - with the customer pushing a button when he loses the tone, repeat to confirm, then on to the next frequency until the audio range is covered. They the customer is given test results and he sets an on the phone equalizer at the values needed for each frequency and he is good to go. It needs to be made to limit the intensity to a maximum, and some gaps might remain where he has lost hair cells and will have a permanent frequency gap that can not be cured unless we learn how to grow new hair cells in the right place of the right length.
A huge market will open up, there will be a wailing and gnashing of teeth in the old FDA shielded crooks, who must adapt or fold. If they adapt, they will do well.
Well, a subjective test, in a quiet room, with test tones for references is satisfactory for most purposes - if the system determines that it is unable to assess the situation, it can be escalated to an MD.
Exactly, just useful for a screening, but not for determining actual settings.
And there is more that is taken in to account when setting the hearing aids, such as:
Age
Speech comprehension issues
Loudness thresholds
cognitive issues
As well there are a handfull of "red flags" that are looked for, some of which can only be done with a visual examination, and others by more involved audiometric testing.
The headline is deceptive. It's more like "Congress ordered the FDA to let you buy a hearing aid without a prescription, and the FDA refused for half a decade afterwards."
As someone with moderate hearing loss in both ears since ~1st grade, I'm all for expanding access to hearing aids. It took changing doctors in high school to finally get a prescription, and it was life-changing. Not cheap, but entirely worth it - I'm grateful to have had access at that point.
Cost is still a challenge, of course. But I'd like to point out that my current set of aids ($2800 pair) just hit the 5-year mark of usage, and they are still working perfectly. For devices that I use ~16 hours a day, everyday, it's amazing. However, it took 3 visits to the audiologist to get the tuning/fitting just right. For the first month of use, these hearing aids were "garbage" (I was really frustrated). But once we hit the mark, I have had zero complaints ever since.
So, that all said, there is tremendous value to initiatives like the Bose SoundControl Hearing Aids (~$900 pair off-the-shelf hearing aids), but the biggest hurdle they face is the fitting/tuning portion. I've tried them, but they don't fit my ears well, so I can't use them effectively (yet - I want to try adjusting the receiver cables).
I'm hopeful this is just the turbulent beginning of a new hearing aid market that expands access to as many people as possible, because it is far from a solved problem.
Any real attempt at hearing aid reform cannot skip in-person hearing tests. You need somebody to look inside the ear to verify that the hearing loss is not due to earwax buildup or infection, and to run a tympanogram test to check for mid-to-inner-ear issues. Maybe the rest of a hearing test could be done with current headphone technology in a quiet environment, I don't know. But until somebody makes a take-home, ML-powered widget with both a camera and a tympanogram-capable widget, people will need to show up in person to get a dependable hearing test result.
The biggest thing the FDA could do would be to standardize a digital format for hearing tests and require new hearing aids to be programmed on the basis of the standard format. This would allow people to go in-person to get their hearing checked by a technician, get a test result, and then program that test result into any hearing aid of their choice bought on the open market.
This is part of an interesting trend in technological & human development. Massively expensive & highly specialized tech is being made common place & cheap more & more often, and perhaps more quickly.
So, yesterday's "treatments" for people with problems are becoming today's augmentations for otherwise healthy people.
--In years past, you might have a cardiologist prescribe the use of a constant heart monitor for a few days to track & diagnose issues. Now, you can get a cheap device that does that-- among other things-- for yourself. (Yes, the expensive specialized versions are still better)
--Glasses were for people with vision problems (or simple fashion) but now are in the early stages of AR, and (relatively) mainstream use for simple augmentations like music listening and personal assistants.
How did we ever get to a place where you needed a prescription to buy hearing aids in the first place? Was there a bunch of hearing aid junkies knocking over liquor stores to get another hearing aid fix?
We need a ground-up reassessment of the whole concept of prescriptions. If it doesn't present a systemic risk it should be over the counter. If everyone over-uses antibiotics we might all die. Fine. But if some goober misuses blood pressure medicine, they can only hurt themself. Let people buy albuterol inhalers without permission. It's going to be fine.
I heard Apple is working on hearing aid software for AirPods. This is excellent news all around. My hearing is pretty decent (save for very mild tinnitus caused by being an "invincible" idiot when I was younger and listening to music at max volume), but I'd love to be able to use vaguely AirPod shaped, reasonably priced hearing aids which would, for example, boost speech and attenuate noise in noisy environments, especially if they are able to do so directionally, for the source in front of me.
I think a better option might be to ensure that easy and affordable access to all the 'other things' that go along with hearing aids is available. I'm not sure if it's just as simple as 'throw in a device'. I'm wary that inappropriate use and maintenance could have negative health effects.
Sometimes even the most very basic counselling has quite an effect.
Perhaps we should create a nursing/paramedic level specialization for this and allow those people to offer such services.
As some with a mild APD this would be fantastic! It has never been worth the cost and effort to get "real" hearing aids but I would probably live in the oct version.
Can't we just get rid of the prescription system in general, and make doctors advisors like lawyers are? I don't need all these gatekeepers "keeping me safe." In Mexico you can just walk into a pharmacy and buy anything. Even pain killers. And it works fine. The only drugs that seem to cause societal problems are the ones that the government tries to keep you from getting.
> Prescription device means a device that, because of its potential for harm, the method of its use or the collateral measures necessary to its use, is not safe except under the supervision of a practitioner licensed in this state to direct the use of such device and for which "adequate directions for use" cannot be prepared
How were these ever prescription devices to begin with?
How do you know when something is too loud without measuring it? If your answer is "ringing ears", you've already incurred at least some hearing damage.
Do you have the tools to measure how loud your headphones are? I don't. And so I keep them as low as I can.
Is there a limiter in amplifying headphones to keep them from going above a certain threshold (like 80Db)?
Why would you be trying to find the point at which it is too loud? The goal is to amplify things to the point that you can hear them clearly, not to go beyond that.
Also hearing aids have manual volume control which a licensed professional has no influence over, so that doesn't really make sense as a justification for limiting availability.
It's certainly possible to apply volume limiting to headphones, though again the people using amplifying headphones typically are dealing with the opposite problem.
When you have hearing loss you also have decreased loudness threshold levels, which will be freq specific. It is important that you do not exceed these levels, both for comfort and for speech understanding.
hearing loss is far more than just "make it louder".
Wouldn't it make more sense if the FDA just wanted everyone to be able to hear properly? I get that they are a policy institution and "hear better, implement it however you like" isn't much of a policy, but an almost-directive (buy whatever you want) seems to be rather decoupled from any health related issue which is what an hearing aid is for.
I understand why things like drugs we inject in our body need to be regulated. But I don't understand why hearing aids need to be regulated this way and even need a prescription. It's either "hey I can hear well and it fits my ears well" or it's "it doesn't help me hear well".
I just ordered some AirPods Pro to see if they will be adequate.
I’m not sure hearing aids can really replace headphones for phone calls etc until both HAs and phones support BT 5.2, and I don’t really want buy several $K of hearing aids that only work some of the time.
I don't get what prescription is required for a hearing aid?
Are there different types? Like with equalizers or volume controls?
Why can't a person, who is hard of hearing, go to a store, pick one and start using it? Granted, let FDA approve them and mandate using only FDA approved ones.
What is the rationale in making something like a hearing aid require a prescription? I can understand addictive drugs, you don't want them misused. What about the million other things that require a prescription?
> For decades, the FDA has regulated hearing aids as a prescription medical device — an arrangement that adds to the cost and effort people must expend to get them.
It's a treatment for a specific medical condition. Those devices and claims about them are universally regulated.
I also don't believe deregulating the market is going to work. The reason prices are so high is because there is a small monopoly of manufacturers that control global supply and a small cadre of middle-men that are allowed to create whatever markup they like.
Deregulating the middle men doesn't really solve the fundamental problem. I would expect a lot of patent lawsuits to be filed against small manufacturers and distributors if the government gets it's way here.
It's an attempt to solve an endemic lack of regulation with even less regulation.
Same rational for an eye exam and Rx.
it is more complicated than just "do you see or not?"
And medical issues can, and are, discovered with a comprehensive hearing evaluation.
Even if you disagree with this, the competition will bring prices down to non inflated levels for everyone, and your insurance premiums will likely reduce as an effect.
I tread that article, hoping it would explain why, in the giddy universe, would it ever have been a good idea to require prescriptions for hearing aids?
It's always funny to see how the land of the "free" and free market" is not very "free market" when it comes to protecting the profits of favored industries like medical even from its own citizens.
Things like being required to go to a doctor and pay big $$$ to get a hearing aid or not being allowed to import drugs from countries where they are cheaper are absolutely not "free market".
Even during COVID the country could not deploy cheap rapid tests but only super expensive PCR tests.
Well, the USA is a land of laws too. Everyone is also crying that the USA wasn't giving enough vaccines to the rest of the world and is now moving on to boosters.
On the headphones side, we are getting smaller, truly-wireless headphones with some ambient sound features (such as noise cancellation, and iOS hearing features). New trends like AR would just accelerate the change due to the need to solve all day worn audio devices.
On the hearing aids side, almost every hearing aid today acts as an always connected set of headphones for your mobile phone (and has been like that for years on iOS).
Deregulating this could bring the tech industry innovation to hearing aids through natural progression of headphones technology.
This trend would make hearing aids not just target hearing impaired people, but also individual with normal hearing. For example, features such as protecting your ears against a sudden loud noise, silencing a loud restaurant so you can have a quiet conversation or improving the audio of a soft speaker could be useful for everyone.