March 2011 -
Cell phone inspires ear
specialist to design affordable hearing aid
March 2011 -
Affordable Hearing Aids
More on this and related
Editor: In his workshop at the SHHH national convention Dr. Robert
Oliveria discussed the importance of providing hearing help to people
who are just recognizing their need for hearing assistance. He reviewed
the various devices on the market, how they are marketed, and how they
have been received. It looks as if inexpensive, low-power devices that
can be bought without the assistance of a hearing professional are with
us to stay.
What do you think of this development? Do you think you would have
used a device earlier if a "starter device" had been available
to you? Do you think buying a "hearing aid" from a mass
marketer (e.g. Radio Shack) is a good idea? What effect will these
devices have on the price of hearing aids? We'd love to hear your
opinion on this.
Thanks to Cheryl Heppner of NVRC for recording the proceedings and
writing this up.
Oliveira's mother, who lives in Florida, saw a Crystal Ear ad in
"Parade" magazine, one of the places it has been promoted
aggressively. He guesses that his mother has early, mild hearing loss.
Curious to know more about the Crystal Ear, she asked his opinion.
"Well, you know, it's not a hearing aid," she said. He asked
why she didn't think it was a hearing aid, and she told him "It's
only $300 and my friends spend over $1000 for their hearing aids."
He encouraged his mother to see a speech and hearing professional but
found her hesitant. "I'm afraid they're going to sell me
something," she said.
Oliveira thinks this is a common concern. Crystal Ear is defined by
the Food and Drug Administration as an assistive listening device for
people with mild to moderate hearing loss. The FDA had challenged the
marketing of the device as a hearing aid. Oliveira has inspected the
Crystal Ear and found that is has good quality Class D circuit, 20
decibel test gain, and components from a well known, reputable
manufacturer. It's available at the company's website and through an 800
number. The company is getting ready to sell the device by retail, and
the cost is under $300. It's an "instant" fit device that has
a one-size-fits-all earmold with a slightly rubbery plastic shell. It
comes with a video.
Oliveira's opinion of the device is that it is the right idea but
poorly executed. Hearing health professionals uniformly hate the device
because the ads bad-mouth them and hearing aids. The focus is also on
making the sale for the device and not delivering the best product. The
company selling Crystal Ear has antagonized several state Attorney
Generals and some are still dealing with complaints.
What is really needed, in Oliveira's opinion, is a
professionally-endorsed starter device with a target of giving better
understanding of words, a problem encountered in the early stages of
hearing loss. It should have an instant fit, requiring no impression or
audiogram and must have exceptional sound quality. There should be no
risk to the patient from a too-high output, following OSHA guidelines. A
basic tone test to assist with settings might be helpful and it does not
necessarily need to be done by a professional. The device should retail
for less than $100. Sales must link it to a real hearing aid source.
There should be an easy return privilege.
To do this, the FDA needs a new category outside that of a hearing
aid. Oliveira compares it to the way topical steroids are handled. You
can go into a drug store and buy a mild one, but at higher dosage
levels, you must have a prescription.
To assist people in knowing whether they could be helped by the
device, there could be a few simple questions such as whether, when
watching TV with others who have normal hearing, they routinely find
they want the volume higher. The instructions would say that if they
find the device too strong, there is no need for it. If they are
satisfied, they should use it until they need to move up to a hearing
aid. If it's too weak, they need a real hearing aid now.
Benefits to a hearing health practitioner and product developer would
include introducing the patient to hearing help sooner, expanding the
overall market, and establishing brand loyalty. If professional
endorsements are involved in its development, people will have
confidence in the product. It gives a feeder system that links the
hearing health practitioner to future patients. Oliveira strongly feels
that hearing health professionals will not lose patients because of this
In his talks with hearing health professionals, Oliveira has asked
them how much of their practice is product and how much is process. Most
say about 41% is product and 59% is process, but he thinks it's more
like 30% product and 70% process.
Fears that would have to be address for this starter device:
- You would have to sell a lot of $100 devices to get the income you
can get from a $2000 hearing aid.
- A patient might have impaired hearing due to a tumor and you could
miss it by making this starter device easily available, raising
liability issues Oliveira feels that numbers make it worthwhile and
patients who need a little hearing help know that they need it. It's
like people who hit age 40 and suddenly realize when they are looking at
a map that they can't read it. Younger patients are more comfortable
with self help and resist going to practitioners, so this device would
appeal to them.
There are now 5 devices in the early hearing loss category:
1. A&M "Hear & Go" is a canal-sized device for mild
hearing loss that is the size of a dime and sells for about $200. It has
an adjusted fit with 3 circuit options, including wide dynamic range (WDR)
and has K-AMP. It is not made in the US but was demonstrated recently at
the American Academy of Audiology convention. The company making it is
partly owned by Siemens, the largest single manufacturer of hearing aids
in the world.
2. Audina EZ Ear is for mild to moderate loss and sells for about
3. Audio D Simplicitity is for mild loss. It is the first CIC-sized
device. It has WDR circuit, K-AMP, and retails for about $300. It is
just beginning to be seen in the US.
4. GN ReSound Advance is one of the largest companies. Its starter
device has been out for two years and was the first one in the
professional market. It's a mini BTE worn more on the top of the ear
rather than behind the ear. It has a tube so fine that it's almost like
a hair. It is for mild to moderate loss and sells for about $500. One
problem with this device is that people wearing it forget that they have
it. When they bend over, it falls off and they don't even realize it.
5. Songbird Disposable is getting a lot of attention. It was launched
in March and is a very, very important development. It comes out of what
was once the RCA Lab and is the first disposable hearing aid. Designed
for mild to moderate hearing loss, it will cost $40 and last 40 days
until the battery wears out. The company which makes it has very
long-range agreements with manufacturers in the US and Japan to provide
components. The microphone on it is 7 times larger than usual. The
company claims the ear mold will fit 90% of ears. However, Oliveira says
he has the most studied ears around -- so many MRIs have been done to
study his hears that he jokes "put me in a pool and I float to the
North." He has also seen studies of ear canals by the National
Institutes of Health, which included closed and open jaw MRIs and many
other factors. He estimates that fitting 70% of all ears is probably
The Songbird has 9 circuits the practitioner can choose from, using a
small machine. He finds it interesting that the company decided to
introduce it through professionals and register it as a hearing aid.
Similar to this is the Conforma, which comes from a company in Salt
Lake City. It has excellent sound processing and the company's
reputation is superb. A neat device, it is elegant and comfortable in
the ear. The difficulty is its cost. It is intended for those with more
severe hearing loss and sells for over $2000, maybe as high as $3000 at
retail. Sleeves that cover the device last about a week and cost $1-$2 a
pop. The company is working to make them less expensive.
Two women in Atlanta, Georgia tried a novel approach to marketing
hearing aids. They had billboard ads for the Advance hearing aid that
called them "Like reading glasses for the ear." They got a
heavy response. The first time the ad was used for three months, it
resulted in 276 people coming to see them. Of this group, 132 bought the
entry-level device and another 118 bought hearing aids. The second time
they ran the ad for three months, they got 195 responses. Of those, 85
bought entry-level devices and 126 bought hearing aids.
Oliveira feels that starter devices need top-level marketing. He
envisions them being sold in pharmacies or at Radio Shack. Pharmacists
have training similar to audiologists, but the two professions need more
linkage. They could also be sold at health fairs and online. A national
telephone system could be used to give a speech test and refer people to
a local supplier.
While visiting Japan, Oliveira saw a lot of ads in the newspapers for
starter hearing devices. In a country with half the population of the
US, they are selling 60,000 to 100,000 of the starter devices a year.
For starter devices to be successful, professionals need to endorse
them. Entry-level standards must be established so that no devices are
junk ones. A patient bill of rights should be developed, so patients
don't get bad services.
To reach Dr. Robert Oliveira: firstname.lastname@example.org.
-- Cheryl Heppner, NVRC
*Copyright 2000 by Northern Virginia Resource Center for Deaf and
Hard of Hearing Persons, 10363 Democracy Lane, Fairfax, VA 22030.
Contact: NVRCinfo@aol.com/www.nvrc.org. Please share this information
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