Monday, 23 May 2011

An answer to the question of hearing aid price....

Here's an answer I posted on the question of hearing aid costs on the Hearing Aid Forums - it's relevant here as it covers my experience of how the industry is 'seen' by the differing groups that make up the industry:

Originally Posted by daerron View Post
The cost of the hardware is a probably a small determining factor in terms of the overall cost picture. The development of the DSP software would amount to a much higher cost overall. This is also where the innovation would be mostly concentrated as hardware gradually improves over time. In addition these devices have to undergo rigorous hardware and software certification to ensure that are fit for medical use and undergo clinical trials which could take a substantial time. There are also environmental tests to ensure that HAs can handle humidity and temperature variances that will be encountered. These kind of tests are very very expensive.. We could mostly blame the regulations around the use of medical devices for their cost, but they are there to protect you.

From the comments so far there appears to be a disconnect (and a bit of distrust) between the medical profession, HA manufacturers and end users... The industry could benefit from having a more open relationship between its end users.

I think it would be quite helpful if users were allowed to adjust some of the settings on the HAs on their own, or create their own personalised profiles or EQ curves (within safe guidelines). The audiologist would basically fit the aid, lock the audio curve response and the end user can create their own custom profiles with software based on this. Can't see why this wouldn't be possible through bluetooth.
Don't forget that the people you are reading from on here represent a self-slecting, tech savvy, motivated group; who's opinions might not fully reflect the needs of the wider hearing community.

The polarity of opinion and arguments may be a little off kilter, but I can make a few observations: 

1: It costs the same to manufacture a high end hearing aid as it does a more basic one - anyone who advocates a top end aid to people without offering the mid-range product is doing them a disservice. Especially if they won't miss the last 0.1% SNR improvement while skiing.

2: Despite assertions against: all hearing aids from the major manufacturers use the same 'quality' mics and receivers - (hardware) individual debris screening systems may be different but otherwise its a level playing field. (NB Soundlens is different)

3: The consumer price of the hearing aid HAS NOTHING TO DO WITH THE COMPONENT PRICE, like the actual value of the piece of plastic that a dentist inserts in your tooth. What you are paying for is the degree of perceived benefit.
a: R+D is a significant cost, but isn't the reason why they are expensive.
b: Hearing aids cost more in wealthier markets: usually as a function of the Audiologists labour time. 
c: An Audiologists pricing model is not for the benefit of individual customers: it is based on the long term survival of their business.
d: When you examine your own personal needs, you are only capable of seeing the sub-micro side of the hearing aids market: the Audiologists also only have a micro view: which means they can't buck the market. The Manufacturers get a Macro view, but they don't want to alter their higher profit situation.
e: Manufacturer delivery is essentially a Cartel mechanism, with large entry barriers, anyone entering the market in the last 10-15 years has been swallowed up or simply doesn't compete with the big boys, who steal their ideas or just out-market them. 

All this was catalysed by a guy called Lars Kolind (who used to run Oticon in the 80s-90s), who basically doubled the sale price of hearing aids using the Mercedes principle: 'If its expensive: people will be attracted by the exclusivity'. This is an unusual paradox, which represents a reversal of normal price elasticity/demand models, but it's why things like Apple products are successful: or perhaps in reverse, why you won't buy a KIA or cheap clothes that perform equally well as their expensive counterparts.

So: beating your Audiologist over the head about price isn't really the answer, nor ZCT's arguments -as valid as they are, or even Govt legislation (they are not medical devices in the UK and pricing is equal); what you have is a peculiar market shaped by the customer, with their collective idiosyncrasies and needs.

Monday, 16 May 2011

BSHAA Conference 2011

After the conference, party and ridiculous time spent in the car (thanks to the Forest play-off against Swansea) that was the conference over and done with for another year. Two major points to offer about the logistics: Nottingham isn't two hours drive from everywhere within England and Wales, in addition, having a conference spilt across two locations is still a poor option alongside the single centre approach.

A good mix of speakers this year with a reasonably broad set of subjects, from personal motivation to the very interesting ENT lecture albeit with a bit of a flat delivery which probably wasn't quite the tonic at the grave-yard shift: first up on the Saturday.

Highs for me personally were the Staying Brilliant session from Andy Cope and The Science of Customer Service - both of which in varying ways conveyed the importance of positive thinking through random acts of kindness.

Tuesday, 10 May 2011

RIC overview, culled from Hearing aid Forums.

A Receiver In Canal hearing aid is typically a small capsule resting on the top of the ear, with a tiny plastic coated wire running from the capsule into the ear. The ear piece can be custom designed to the shape of the ear or can be a soft rubber fitting, often with holes around it to allow natural sound to get in (and escape).

So why should you want one?

1) They are usually a standard design, unlike a CIC or other custom product. So the components in the capsule are always placed in the same place in each device. This eliminates the problems associated with having to design each hearing aid to the shape of your ear. This should really help ensure greater longevity.

2) Good RIC hearing instruments have their power determined by the receiver (loudspeaker) placed in the ear. Therefore, should your hearing get worse, it should be possible to upgrade the power output considerably without buying a new hearing aids. New receivers should be a nominal cost and should be fitted by your hearing professional, without having to send your aids in for repair. So a good RIC can fit the most mild of losses, right up to an incredibly severe loss.

3) Because of their standard design, should the aids ever fail, your hearing professional should be able to easily arrange for you to have loaner hearing aids while your aid(s) are being repaired.

4) Because they are often a little bigger than a custom product in terms of component real estate they should be able to include tricks like Bluetooth compatibility, ear to ear communication, telecoil compatibility, media streaming, and remote control access.

5) They not only have the ability to adjust to perhaps one of the widest range of hearing losses of any style, but it should be possible to download new software on to them as improvements are made.

6) The increased space between microphones and receiver should, together with a sophisticated electronic filter, help make feedback issues a thing of the past. Issues of mechanical feedback where vibrations in the shell of a custom aid can cause problems is also not a problem thanks to this separation.

7) Many models are now available that are waterproof. Or at the very least far more water resistant than other styles of hearing aid. This should ensure greater longevity, and a more 'hardy' hearing aid.

8) If you somehow manage to get wax or other ear debris beyond the wax guard and damage the receiver, it should be easily replaced or repaired, by your hearing professional in his or her office, without needing to send them away.

9) The device should be very lightweight and comfortable if fitted properly.

10) Because the receiver is in the ear canal, the distance from the sound source, and your ear drum is small, so therefore less power is needed to provide sufficient help. Less power usually means less distortion.

11) Cosmetically, this is one of the most discrete hearing aids you can get. Especially if you have hair near your ears.

12) There is space for two microphones on most RIC hearing aids, and this in turn allows additional tricks to help you in a background noise, including directional amplification.

13) The thin tube that runs into the ear can be made incredibly small, and so is less of a hindrance to wearing glasses than a traditional BTE.

14) The amount of ear blockage on the smallest and most open fitting is perfect for typical noise induced or high frequency losses where the patient has good low frequency hearing and is susceptible to occlusion (blocked up sensation when wearing hearing aids).

15) The standard design usually ensures good access for programming cables for adjustments, if the aids cannot be wirelessly programmed.

Well that's all I have time for. 15 good reasons to consider a RIC.

Friday, 6 May 2011

April's gone: in a blur, but with the odd CROS word.

All a bit mental over the last few weeks so no opportunity to update this:

However, despite adverse trading conditions, there was some success in fitting the Phonak CROS system which has the superb advantage of just being an add-on to the existing wireles BTE (usually the Micro M model). Yes: it eats batteries, Yes: the puny ear-hook supplied with it is next to useless, and Yes: it's a faff to program as the programming steps cannot be completed with the mic 'live', but, what a step forward for users.

The improvement over what previous CROS wearers had been expected to up with is immense, and the fitting capability for those with significant asymmetry is huge.

An Example: Mr PH, retired from a successful business, still active and enjoys touring around the country in his motor-home. Mr PH  has struggled for years with various high power aids on the poorer right ear (70-80-90-90-100-off), usually the results have lacked clarity, given masses of feedback and caused problems with the skin fauna of the right EAM. More specifically, the good low frequency results from his Left ear (10-10-20-25-40-55) probably have resulted in a great deal of transcranial performance with an element of masking as the receiver distorted to produce the higher output levels.  

Mr PH was advised to try the Solana Micro M as he needed a reasonable level of processing in the better ear. The fitting was completed through Target, despite being a bit lumpy in application seems to suit the user well. From past experience of Target it was noted that the appropriate acoustic coupling was selected prior to running the Feedback/Gain Modeller part of the program. Once this was completed the gain was re-established using the canal impedance measures obtained by the system.

The remote mic was duly fitted with the only limiting factor being the issue that the programming steps to balance the mic are not completed while the mic is 'live' : it's a more 'try this/try that' approach, which has the slightly dubious benefit of regularly muting the remote side in a 'now you see it, now you don't' effect on the customer: who may already be going through a bit of a head-spin by hearing sounds from all around for the first time in a while.

Physically the only complaint about the system is that the Mini shell used for the remote mic will not take a standard thin tube as a safer locating device, with the canal lock attached. It will take a receiver, but unless you're in a habit of throwing them away as a redundant bit of kit, it may be preferable to use one of Resound's older thin tubes, with an externally threaded coupling, which seems to sit in the hole quite happily.

More adjustments to follow, but the customer still says it's the clearest he's heard since wearing an aid on day one. More importantly, he paid without hesitation, which says a lot for the performance of the system. Now, where are are those extra batteries he's going to need ?