A note about hearing technology

As one who is also afflicted with severe hearing loss, I’d like to say thanks for posting this interesting explanation of hearing aids.

One of the issues that so often leagues any advanced field is a number of people who are knowledgeable in an unrelated field believing that their knowledge makes them equally knowledgeable in every other field and commenting based on that assumption. Equally those who have a little knowledge assuming that they are now experts.
Amongst my many official hats (mediator, software developer, electrician etc etc) I occasionally take part in overseas outreach programmes, ostensibly evangelical outreach, but there isn’t any preaching involved as we go for more practical reasons. Last time I was helping rebuild someone’s fence and roof in Romania. Every time I’ve been out I’ve faced two issues on returning: I find that I’m personally very pissed off at people in the west who act as if their tiny little probems are the end of the world (and I include AGW in this bracket as it’s very definitely a Rich Westerner Problem); and I find no end of people explaining that the five or ten minutes they spent watching a video about orphans in china is exactly the same as the week I spent labouring for some poor sod in the middle of Icephalia, Frozenia (yes it’s made up before you ask) who couldnt even afford the cement we were using to repair his home.
It’s a cliché that a little knowledge is a dangerous thing. It’s also a frustrating thing, especially when people argue from their ignorance and thaat little bit of knowledge to make a political point.

Very informative, thanks, Anthony!

Interesting, thanks Anthony.
Makes you think what today’s computers would cost if mass production was not available, or even if we had computers at all due to high cost.

Australia Hears ( http://www.australiahears.com.au ) has developed a new technology hearing aid, based on research from the ‘Bionic Ear’ project. I purchased two BTE units, which I can program myself, for less than $1000USD each. The hearing aids, and accessories including the hardware/software programming interface, can be purchased on line at the above address.

Thank you for shining a light on a little commented upon area of modern living, Anthony, which more and more of the disco and Walkman generation are going to be experiencing over the coming years. I’ve also worn aids for 20 years now and have experienced the move from analogue to digital technology. All of the points you make are, in my experience, very true and especially the role played by a good audiologist and and well fitting molds. The last aids I purchased (in 2010 at a cost of over $9,000 here in the UK) were only chosen after my audiologist had made up 3 other sets of molds for both BTE and complete ITC models of 3 different brands, and tailored the sound profile to my exact hearing loss (very severe ski slope). The sound characteristics and performance of all 4 aids differed hugely and in fact by far more than I could ever detect in comparing HIFI systems when I had normal hearing. In the end I chose to stay with my existing brand (Widex) for the familiar, smooth, natural sound they produced.
My advice would be to choose a good audiologist (from recommendation) who is non-aligned to any one manufacturer (becoming more difficult) and work closely with them.
Yes, modern aids are incredibly expensive but they enabled me to continue working in very demanding roles for at least another 10 years beyond the point where I would have had to give up without them

Small technical error in your otherwise excellent description of the technology behind these devices. It is the bias voltage (at which conduction starts in a diode) that you are referring to , not the breakdown voltage, which is the point at which the diode stops blocking the reverse current and ceases to be a rectifier. This usually measured in hundreds of volts not tenths of volts.

Anthony said: “Construction of aids is done by hand by technicians, especially with the popular ITC (in the canal) aids. ”
The telly show How It’s Made has shown how fiddly and intricate making hearing aids can be.
How It’s Made – Hearing Aids

I still have reasonably good hearing, but I also recognize that I’ve had adequate noise exposure to reduce my hearing even more than age would indicate as I get older. I expect to need aids at some point.
The anonymous “slashdot” reader is one of those who believes that someone else should pay for their “stuff”. They “need” it, so shouldn’t be required to pay themselves. They expect that government with its’ big pile of money will pay, giving zero thought to where that money comes from. Typical human nature. Especially in the US.

Thanks for this. Nice to know one is not alone. I am totally deaf in my left ear with severe high frequency loss in my right ear. I wear just the one BTE model with no frequency control, just volume. I am unable to source sounds such that if anyone calls me from my deaf side I invariably look the wrong way. Sometimes people think I am being rude. Conversations in a crowded environment are virtually impossible. Be nice if something can be done about tinitus.

“The only chip material that works well for this is germanium, which has a diode junction breakdown voltage of ~ 0.3V as opposed to the ubiquitous silicon used in consumer electronics which has an ~ 0.7V breakdown voltage.”
Not the breakdown voltage, but the forward voltage: the voltage across the p-n junction when it is forward biased and conducting normally. Breakdown voltage relates to conduction under reverse bias, for example avalanche breakdown, which is much higher than a fraction of a volt (apart from low voltage Zener diodes, normally designed to be tens, hundreds or even thousands of volts).
Germanium is really useful for low voltage circuits and I have used germanium junctions myself. However, there are silicon audio circuits that work very well off 1.3 – 1.5V: I have a Panasonic compact cassette player that has everything, motor, control and amplifier, working off a single 1.5V AA battery. Perhaps this is mainly analog circuitry, but CMOS and switched capacitor systems working at 1V supply voltage (and below) have been around for over 10 years, and silicon on insulator digital circuits can work with supply voltages in the 0.6V range, which is very useful for RFID applications (which are very high volume, low cost).
REPLY: You are correct, I meant forward voltage, but wrote the post late at night. My bad. When I asked about the technology two years ago, they told me they were using germanium because they couldn’t get the battery life they needed with silicon – Anthony

There are cheaper alternatives. Last January I bought 2 behind the ear hearing aids online for a little more than $300 USD. They are not fancy. They are not hand fitted. They only have 2 frequency ranges which you set manually, but they have vastly improved my hearing.
Within a month of purchasing them, I forgot them in my white-shirt pocket, and didn’t remember them until the laundry was half way through the wash cycle ~ very hot water & 2 cups of bleach with detergent. . .After drying overnight, the hearing aids survived fully functional, which looking online appears to be extremely rare for higher prices hearing aids to function after being washed.
I am a beekeeper and the first time I worked my bees, I put my veil on and I had my hearing aids in. When I removed my bee veil, the close fit around my head apparently ripped out one of the hearing aids. I didn’t notice until later and I could never find it, so I bought a second set in order to replace the one I lost.
It’s not difficult to see that I could easily have been on my 3rd set of hearing aids. . . I shudder if they had been the expensive models.
I have 1 remaining, still in the box hearing aid and I am getting ready to buy a third set for backup. One of the hearing aids presently has dead spots in the volume control range, which I attribute to possibly being due to the corrosive effects of its hot water/bleach/detergent bath a few months ago.
They are not the most invisible hearing aids. There is a small clear plastic tube which runs from the behind he ear unit, into the ear canal, but I can swallow a bit of pride and fashion for a savings of 1000’s of dollars. . .
There are alternatives. . .

You are right. It is easy to complain about “big corporations” exploiting customers with high prices, but in many cases -not just hearing aids- there is actually a lot of workmanship that goes into the product.

I paid only around $375 for my BTE frequency tuned aid. Granted, the testing and fitting was at no cost to me as a military retiree. I don’t think Starkey contracted with Fort Bragg to loose money and Medicare and Tri-Care for Life pay nothing for aids. These aids had a one year customer satisfaction money back warrenty that my wife used to replace the more expensive in the ear aids with the more comfortable BTE with simple tube fits.

My dad just got a pair of these two years ago. I was shocked at what he had to pay (just over $3000 US). I understand now and will be printing this article (and comments) out for him.
I’ll be joining him in the fitting room soon — kids, always wear your ear protection around heavy equipment and Iron Maiden in concert.

I agree. I too believe that there is probably $3000 profit in a hearing aid. Look at the technology and miniaturization in the Iphone and look at what the Iphone sells for. . .and there surely is healthy profit in the Iphone. You cannot convince me the cost for hearing aids is justified.

As a former certified ASHA-certified Audiologist and now hearing-impaired senior, I appreciate your comments. I can recall how primitive earlier aids were, and how I counseled my clients about them. If one is hearing impaired, there isn’t a price that’s too expensive, because to do without one (or 2) is to make one unable to function well in society. The field has progressed by leaps and bounds in the last few decades.

About a dozen years ago, I had a nice expensive pair of hearing aids that worked beautifully. There was just one small problem: I was allergic to the hypo-allergenic plastic they were made from. I had noticed that my ear canals were a little itchy, but attributed that to not being used to the hearing aids. it wasn’t until a doctor kept noticing that my ear canals were constantly red and abraded looking that I realized what the problem was. After about six months, and several prescriptions of cortisone creams, my ears were back to normal. The hearing aids are in a box in a drawer, and I simply ask people to repeat things. Alas, even though hearing aids are hand-made, they are still made from stock materials which cannot be deviated from.

It’s a cliché that a little knowledge is a dangerous thing. It’s also a frustrating thing, especially when people argue from their ignorance and thaat little bit of knowledge to make a political point.

Too true. I currently live in Riyadh, Saudi Arabia, and I can’t even begin to tell you of the number of sophisticated Europeans who think they know all about the U.S. just from watching the movies. Also, I’ve found there are many people, as has been said, who, because they are expert in their fields of endeavor, feel that their opinions in unrelated areas should be given the same respect.
We have a word for that: “Arrogance.”

To put it bluntly, you don’t know what you are talking about! The hearing aid industry is 10% actually helping people and 90% scam.
1. Germanium vs silicon is not the issue. Hearing aid technology is way behind the times. You only need a bluetooth device at the ear (with microphone) and then an app on your cell phone. After all, regardless of what the HA manufacturers want you to believe, a modern nearing aid is only an audio equalizer with possibly some noise reduction. It is ridiculous to try to stuff the electronics in or behind your ear. That’s like trying to put your entire cell phone in your ear.
2. With the in the ear speakers or the audio tube to the ear, there is no molding required, just an assortment of different size tips. The open design of the tips let you use what natural hearing you have left. To plug the ear canal completely with a molded piece makes no sense, as you lose the benefit of your unaided hearing, which in lots of people, is completely normal at lower frequencies.
3. One question here, if the spectral hearing test is so important, why are you not given a hearing test AFTER the fitting of the hearing aid to see how the HA improves your hearing? How many people reading this rant had a second test AFTER the fitting? At your next adjustment, ask for a post adjustment hearing test, after all, it only takes 10-15 minutes with a competent technician.
4. See 1 above.
5. See all of the above.
6. Maybe the customer just wasn’t helped by the aid.
7. That simple amplifier concept is still around as a marketing tool. Amplify small sounds up to full level and the customer thinks, wow, these things really work.
Read Consumer Reports reviews of hearing aids. And before you drop $3-$6k on hearing aids, go to the local sporting goods store and buy a set of “hunters ears”, you might be surprised at what you get for .01x the cost of aids.
YMMV 🙂
Mitch
REPLY: As a person who lost part of his remaining hearing due to the crude simple amplifier aids he was forced to wear as a child amplifying the wrong frequencies as well as the right ones, I’m quite certain you are laughably ignorant of the issues. Walk a mile in my shoes. Visit the factory and talk to the president like I did to check out the company and the product. Learn about the stigma of large unsightly aids for children, learn about how you lose the ability to identify sounds directionally or pick out words in a conversation from noise when you don’t have bidirectional advantage of both ears and the function the pinna provide, which can’t be duplicated with an iPhone and a bluetooth. Learn about feedback, especially for aids that restore 50% or higher losses and why custom earmolds are required for that purpose.
Re: simple amps Wear “Hunters ears” or an iPhone setup 24/7 and tell me how good your hearing is in a week when you take them off.
Power consumption is a big issue also, aids are expected to last a few days on a single battery, if most of the power is being used to overcome the forward diode voltage, it gets lost as heat instead of being applied to amplification use.
And finally, “Maybe the customer just wasn’t helped by the aid.” Learning to wear a hearing aid requires retraining your brain, like learning to use any prosthetic. Some people can learn to adapt to the new sound environment of a hearing aid, some can’t or won’t because they view it as a stigma, or loss of independence. Thus the success rate is lower than it could be.
Learn all these things firsthand, and then you can comment intelligently on the issue from experience.
– Anthony

For several years I was a computerised notetaker for the deaf (sitting in a classroom typing what the instructors said on a laptop for a deaf student to read), and even now, as an English prof, I set aside some time each semester to do notetaking if there is a shortage of notetakers. (NB: There is always a shortage of notetakers.) Some of the classes I’ve been assigned to are for Hearing Specialists, so I’ve learned a fair amount about the processes involved in testing, fitting, and prescribing hearing aids.
I hadn’t, though, ever heard how labour intensive and complicated the actual manufacturing of a hearing aid was. Thanks for the insight.
(PS: If anyone is interested in becoming a notetaker for the deaf — and can type over 70 wpm — check out the Deaf and Hard of Hearing Services departments in your local colleges and universities. They are always in need.)

Anthony…. I’ve been a regular here from the beginning of the WUWT enterprise…This actually may be one of the best posts you’ve even written,,,, And that’s saying a lot!!!!
Sonicfrog

I have seen some discussion about using an iPhone as a hearing aid. http://iphoneapplicationlist.com/forum/have-an-idea-for-a-cool-app/i-phone-as-hearing-aid/ http://scienceroll.com/2009/07/12/iphone-hearing-aid/ It sounds like a pretty cheap solution.

Anthony, the power budget of a hearing aid is beyond the scope of what can be intelligently discussed on a blog (which is why discussing climate science on a blog is risible), but if I had to guess, the final drive electronics use the bulk of the power, and an audio DSP made specifically for low power consumption isn’t that much of a draw.
Having said that, if the hearing aid manufacturer is having chips made to the purpose, they may not even be true DSPs, they may be analog/digital hybrids. For example, Cypress has a chip called the PSOC which can do a lot of tasks that would otherwise require a full DSP, but in fact, they are an analog hybrid, and you use the digital core to configure the analog blocks into a filter, for example. Or, if you know ahead of time that the only DSP function needed will be, for example, an IIR, you can design a dedicated IIR machine, that will be a lot smaller and lower power consumption than a full DSP.
Too little information to discuss this intelligently on a blog.

F.Mitchell at 8.03am has a point about cramming all the electronics into the ear. I am dependent on a modern hearing aid (I only have one working ear) . Last year I updated to an Oticon Streamer which allows my mobile phone to connect via a Bluetooth adaptor (“Streamer”) worn round the neck) directly into my ear, a fantastic improvement which makes it so easy to use the phone and also the TV. So why cant my aid just be an audio Bluetooth driven speaker and have the microphones and electronics in a “Streamer” with all the benefits of battery size? I appreciate not everybody is happy to wear some evidence of their disability round their neck but it could drastically cut costs.

Anthony, I am deaf in one ear due to an auto accident and total severing of the nerve. I have been resistant to obtaining a hearing aid in my remaining good ear (right side) for the reason you state “amplification only increases hearing loss”. So I must ask, “Have you continued to loose hearing with the modern aids you purchase”?
Mods, please forward this to Anthony as this is a genuine request. If he wants, he can e-mail me personally.
REPLY: The early aids with simple linear amps did in fact cause additional loss over time. The new ones that are spectrum matched don’t appear to have caused as much, though there has been some. Some loss due to the elevated volume. Unless you are losing ability in the good ear, I would advise against it unless a doctor gives you some valid medical reason to do so. – Anthony

Dave says:
September 10, 2011 at 9:25 am
I have lived with tinitus for many years. Like Anthony, I learned how to live with it. Don’t let worrying about it reduce your quality of life. Accept it as your new norm.

I’m losing a little high frequency in my opinion. Sometimes I can hear people well, but have to ask them to repeat so that I understand, especially when there is background noise. Happens mostly with women (no pun intended).

Interesting. This really seems to suggest that the hearing aid industry is stuck in old fashioned kind of cottage manufacture sort of like for eyeglasses a couple of decades ago. A little careful thought might create its equivalent of Lenscrafters, which could come along undercutting everyone and changing it forever. I can think of three or four technologies that would make immediate improvements.
Very helpful post. Thanks

REPLY: With the potential damage to remaining hearing for “low cost fittings”, while some price reduction would be welcome, turning it into a commodity may not be a good thing. Think how well “discount surgery” has done over the years. Would you really want to entrust your remaining hearing to a cheap Chinese hearing aid? I wouldn’t. I’m thrilled that I can have this professionally done in the USA. And the cost/benefit ration is in my opinion high, given the alternative. New aids with proper care can last as long as 5-8 years, about the life of an automobile. Financing is a solution. – Anthony

Ha! I knew it. First, big Pharma, then big oil. Now, the latest corporate boogieman is……………wait for it………..big ears.
I have a partial hand prosthetic, with individual powered fingers. The cost of this device is $68,000, mostly because the components are hand made, have to be fit and customized, and have a high initial failure rate, with a lot of rework being done. Until people come with standardized parts, not much can be done about it.

The listed reasons for the expense of hearing aids explains why they should perhaps cost $500 or $1000 for a high end one, but not $3000. It can not be denied that there are many business men and even doctors who will sell you something at full list price (more than double what you could get it for if you shopped around or haggled) if you’ll fall for it. It has been documented that hospitals often bill more than three or four times the price they bill insurance companies. It is not imaginary that you will get highly overcharged if you don’t shop around. People often don’t shop around or haggle for their hearing aid.
You can get a variety of basic amplifying aids shipped from dealextreeme for $10 to $15. That gives you an idea of the basic hardware cost. Germanium digital hearing aid chips with the basic signal processing features have been on the market for a decade, and thus should only cost a few tens of dollars more. The testing and customized fitting and frequency adjusting can be done at a profit for $1000 each on the lower end aids, proving those are not the sources of the huge cost of the $3000 aids. And of course if you go to the wrong audiologist, he may charge you $2000 for the exact same aid and quality of service that another doctor will give you for $1000.

i’ve been wearing CiC’s since i was about 20 (i’m 39 now) and what i’ve always been curious about is how the price of an aid can drop 30-50% just by going down a quality tier or two when the labor is still the same. you might get 8 instead of 16 channels and maybe (slightly) less sound processing but you can save thousands of dollars….

Applegate (September 10, 2011 at 7:50 am) wrote:
[…] I recently obtained BTE aids for $7000 the pair. These should require no such custom manufacture since the aid itself is in a large standard size/shape package that connects to the ear through a simple tube. I now question whether those types should be so expensive. Even if I returned them, the aid itself could be resold.
Welcome to the wonderful world of medical devices! The US Food and Drug Administration (FDA) has an endless collection of rules about medical devices. You certainly couldn’t sell a returned hearing aid as “new”, if the FDA permitted it to be resold at all. Whatever the outcome, the manufacturer takes a bath on each returned device.

The only real problem I have with hearing aids is the absolute loss of common sense in people around us.
I probably wrecked my ears with 72 years of flying airplanes, driving, running chainsaws and lawnmowers and such, all without ear protection.
The problem is that people think that (for all problems including differing languages) by making things louder the problem will be solved.
For people like me, if you talk so loud that my ears bleed, I will still be unable to understand you,
The damage to my hearing (which I do not understand at all) is such that I can not understand what I hear.
In an anechoic chamber (a really really quiet room) listening to an audiologist read a list of words at a fairly low volume (my best chance) through an earpnone there are some words I can not make out if I can’t see her lips.
So, to stop family members and other “friends” from hammering on me about getting over my vanity and getting a hearing aid, I got one (a BTE, not-custom-molded) at a “reasonable” (see discussion above to calibrate “reasonable”) price and with it, I can hear and understand people sitting or standing (or lying) to my right in a fairly quiet room. Even it the HA is in my pocket.
Somebody asked about on-going costs. The batteries cost a bit over a dollar apiece and last about a week. I replaced the ear-wax filter for the first time in nearly a year that I have had the device–there at most of about a dozen of the original package left–I have no idea what they cost if I live long enough to use them all up. The soft-rubber cone thing the receiver is in looks like it will fail eventually (it turns wrong-side-out sometimes when I take it out of my ear), I have another in the original set, and I have no idea what they cost.

Dave says:
September 10, 2011 at 9:25 am
Anthony or readers. For me this is a timely discussion, over the last 2 years my hearing has degraded ,but worse I have a constant ringing in the ear. There’s lots of info in the net but does anybody know if there is a real cure or research that will help this problem or am I dammed?
###
Your are probably only dammed if you are a river. Seriously, I have been dealing with sever tinnitus for decades. For me, according to the doctors, it is caused by nerve damage, and therefor not treatable.
I have tried to learn Anthony’s trick, but have been unsuccessful. I can think away the pain and even somewhat the effects of burns, a skill I learned as a cook by applying what I was taught in Karate. But maybe because of my ASD, I just can not ignore sounds, though I am sure most normal people can learn to do it.

Re:Marcos says:
September 10, 2011 at 11:30 am
“i’ve been wearing CiC’s since i was about 20 (i’m 39 now) and what i’ve always been curious about is how the price of an aid can drop 30-50% just by going down a quality tier or two when the labor is still the same. you might get 8 instead of 16 channels and maybe (slightly) less sound processing but you can save thousands of dollars….”
Labor hasn’t that much to do with the phenomenon you describe. A truism of the electronics business is that you’d better recover all your R&D costs and rake in probably 90% of all the profit you ever expect to make on a new widget in the first year after introduction to the marketplace. After that, competition (some of it copy-cat) will drive down the price to commodity proportions. I try to wait until they’re practically giving away long-in-the-tooth electronic widgets as door stops (can’t resist cutting edge artificial limb technology though).

About 25 years ago I worked with a venture capitalist who wanted to create a national chain of hearing aid stores, in essence doing for hearing aids what Pearle Vision and Lenscrafters did when they revolutionized the eyewear retailing industry. His hypothesis was that the “mom and pop” nature of hearing aid retailing was grossly inefficient and with changes in how the product was retailed, the costs could be lowered considerably. After a month or so we dropped the idea because we found that the density of people with hearing problems in most metro areas was not sufficient to support even a modest sized retail establishment. Given reasonable assumptions of the market share the new business concept might earn, the number of potential customers that lived within a reasonable driving distance of most strip malls was insufficient to generate a reasonable return on investment. We found that there were only to market areas in the country where the customer density was adequate — Sun City, AZ and Tampa, FL. People that believe the “market works” will not be surprised to learn that high volume strip mall hearing aid retail outlets already in operation in both of those markets. In spite of technological advances that we knew were coming, demographics and the frequency of hearing loss within the general population dictated that hearing aid retailing was and would remain for some time a cottage industry.

Whoops, posted automatically when I went to get the patent number: 2,006,676
Please note the “assignee”. Sunoco Oil company. NO they did not “buy Garrett out”. Consider the engineering level of the time, the Sunoco ENGINEERS looked at it, determined it had NO MERIT, and it was never pursued.
Origin of the URBAN LEGEND. Pure and simple.

Retired Engineer (September 10, 2011 at 9:10 am) wrote:
The silicon / germanium argument is a red herring. Perhaps true for bipolar transistors but not for FET’s. Several companies sell CMOS amplifiers, pico power, and operation below 1 volt.
The answer isn’t a collection of discrete parts, no matter how capable or low-power, but an integrated solution. It’s a very expensive undertaking, though, and takes several years to go from “let’s do it” to “it works”.
The company I work for has integrated the major functionality of its pacemakers and implantable defibrillators. The pacemaker we released a couple of years ago, built on the integrated chipset, uses a 2.7 volt lithium primary cell for power, which is switched down to run the (silicon) CPU and DSP at 1 volt. With reasonable settings, the battery can be expected to last more than 10 years.
A hearing aid requires more output power than a pacemaker, but has the advantage of using replaceable batteries (pacemaker batteries are most emphatically not replaceable). Output power can be significantly reduced over older designs by using a Class D amplifier (switched output transistors, followed by a filter).
The ultimate goal should be to integrate the microphone amplifier, the A/D converter, the DSP, the controls, the output stage, and even the Bluetooth interface onto a single chip. From then on, you differentiate your products by changing the software. Occasionally, you update the chip set as newer technologies become available, allowing you to do more with less power, or to do new things you couldn’t do before.
Retired Engineer (September 10, 2011 at 9:10 am) continued:
… My complaint is with non-rechargeable batteries. Why not Li-ion or Li-PO? I talked to an engineer at Starkey and he said “we can’t do that” and nothing more. Illegal? or an ‘arrangement’ with battery makers?
My last job was at a manufacturer of test and measurement instruments. We had a product (which I hadn’t designed) that contained a rechargeable battery for memory backup. We had two suppliers for the battery. One manufacturer’s batteries would grow metal whiskers through the separator, shorting out the cell, which allowed the memory contents to evaporate. The other manufacturer’s batteries would lose their electrolyte through the seals, eventually becoming an open circuit, which allowed the memory contents to evaporate. We had a second source for the part, but lousy results no matter which one we used. (My designs all used primary cells — non-rechargeable batteries.)
In general, batteries are the pits. During their discharge life, the battery voltage and impedance change in ways that can cause the circuitry the battery powers to misbehave. Primary cells have fewer odd behaviors than rechargeable batteries, they have higher energy densities, and they’re more reliable.
If your hearing aid battery (a primary cell) dies in the middle of the day, you can replace the battery and be back in business in minutes. If you had to recharge your hearing aid before you could use it again, you may well be out of operation for the rest of the day. For hearing aids, replaceable batteries are the way to go.

Excellent commentary.
The author of the Slashdot post would also be upset, presumably, that an iPhone costs so much more than wireless household phones did in the 90s.

This makes me feel very humble. Thank you everyone. It puts in perspective the £500 it costs here for me to get a pair of hearing aids with Specsavers, or free for one non-adjustable hearing aid on the NHS.
I’ve become painfully aware of my hearing problems in the last month, after flying to Norway, losing a substantial part of my hearing after the flight, and having the embarrassment of asking my hostess cousin to repeat almost everything she said, whether she spoke Norwegian or English. It really was not nice after a week.

Polistra:
“This particular bubble has been around for a long time. It’s not the germanium in the DSP, it’s just an ordinary cartel arrangement between the few HA manufacturers.”
—
You might have been told that it was cartel, but in the real world there are very few cartels that operate successfully. It can only “work” with things of limited supply. Hearing aids, or anything that can be manufactured in infinite quantities are a poor choice for a cartel.
Like commenter Shanghai Dan, I too spent way too much time in China. Shenzhen, during the boom years of late 1980’s to late 1990s in my case & high tech. Any time a company tries to gouge the consumer, they are very quickly undercut by competition. An attempted cartel is undermined by competition that will appear very quickly.
Therefore – if there really is a cartel, I would propose to Shanghai Dan that we go into business together, launch a cheaper copy and break their cartel 😉
To the commenter who questioned labor competing, thus lowering labor costs. Yes and no. Labor is in finite supply, especially skilled labor, which is why CEO’s and sports stars make so much. If a labor market has over supply wages go down but if it is tight, as it will be in any good economy, wages go up. Just like any market. The role of government should be limited to just making sure markets are free, fair, open and functioning. Beyond that, freedom leads to prosperity, with a few bumps along the way of course.

this is very simple to solve: buy it on uk, from prices ranging from 6 to 160 pounds. See here:
http://www.amazon.co.uk/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=hearing+aid&x=0&y=0

Kozlowski,
Drop me a line…:) Always looking to expand markets! But the reality is the $300 of parts in the hearing aid as the BOM cost translates to $600-$700 (after import duties) cost for the brand, who sells for maybe a 40 point gross margin to the audiologist – who charges a lot to cover the costs of office visits and fitting.
There really isn’t a huge amount of margin in it – because it’s an extremely time and labor intensive process to get them working right. Medical practitioners are not cheap per hour – you drop 18-20 hours of audiologist or doctor time into diagnosis and fitting and it’ll easily eat up $2000 right there.

Hearing aids are controlled by a cartel. There is no place to obtain even a rudimentary hearing aid circuit drawing to see what’s really involved. There is virtually no detailed information available, frequency response, etc. You have to rely on the vendor; for him the sky is the limit. A lot can be done with dsps and their programming these days. Once you have a good algorithm (one time expense), it can be tweaked and tweaked and tweaked. If hearing aids were sold in a way that was competive, you would be surprised how quickly the price would decrease and the utility would increase. Competition is non-existant in the hearing aid field! It’s the difference between a Volkswagon and a Lexus. Both will get you where you’re going.
The OP works for Starkey. Of course he will justify the high cost. Every one of his arguments can be refuted, but everyone here seems to believe him. Competition and openness will bring prices down — way down.

“Power consumption is an issue, if most of the battery power is used overcoming forward breakdown voltage it gets lost as heat. ”
Not with FET’s. They can operate on very low voltage and low power. All DSP chips are MOS, from day 1. First NMOS in the 70’s and now some CMOS. Power and density. Y’all can’t make that out of Germanium. So it remains a red herring. ‘Forward voltage’ refers to the drop across a P-N junction (diode) which doesn’t apply to MOS. Some DSP ‘cores’ now run at 0.9 volts. Faster and lower power. In the last 20 years, possible to combine both analog amplifiers and digital signal processing on the same chip.
Germanium is nonsense.
Starkey doesn’t really overcharge, given the engineering they put in. (they have or had an R&D faciliy in Colorado Springs) but I question whether they really need that much engineering.
As for rechargeable batteries – been using them for years in many applications. Growth of microfibers was a problem with Ni-Cd’s. NiMH cured that. Lithium made it even better. Pacemakers already use primary (non-rechargeable) lithiums. Did some work for CardiacPacemaker in MN a long time ago. HA’s could use inductive coupling, charge overnight in a small dual ‘bucket’ on the nightstand. Single cell lithiums (various types) are quite reliable.
As for tinnitus, have had it for years, many possible causes, no real cures. Sometimes tones, sometimes a whooshing. Comes and goes, fatigue seems to make it worse. You might think there would be more ongoing research, my ENT doc says not really.

Thanks for an interesting post Anthony. I’m 72 and have worn hearing aids for about 12 yrs now. So I have moved from the analog to digital types and now to the blue tooth eqipped latest technology from Phonak (Swiss). Yes they are expensive but without them I am nearly deaf. In my case, both my parents needed hearing aids in their senior years and their working environment had little to do with their or my hearing loss.
One of the things I haven’t seen mentioned in the posts is that for people with severe hearing loss, behind the ear types are essentially mandatory, in order to build in the power that is required. However the latest are less bulky than those of 4 years ago in my case and this is helpful when eyeglasses arms compete for the space behind your ear. I get nearly two weeks out of batteries with essentially full time wear.
The technology in this field moves as fast or faster that that of computers, in my experience. More advanced models with improved features every two years or so it seems. Directional microphones, multiple programs for ditterent situations and bluetooth devices to wear to help with TV listening. However trying to hear, or understand a conversation is a crowded dining room or meeting room is still a real challenge. The directional microphones have helped here.
As others have mentioned, the facility where I bought these aids are always there to service them when it is required and usually for no or little charge. The tubes and filters need to be replaced about every six months and adjustments to the programs made using their computer software. They can even tell how many hours a day you wear your aids, how often you crank up the volume and which programs you tend to use most. In other words, these are not simple devices.
Yes they are expensive, but compared to doing without them I am very glad they are available and will scrimp on other items to make their purchase possible.
Thanks again for a very interesting post.
Ron Sinclair

All very interesting. Neither of my parents ever had hearing aids, Daddy because he didn’t need one and Mom because she didn’t think she needed one. :). Her hearing loss was the result of a bout of Scarlet Fever when she was 8, and evidently–she said–a hearing aid wouldn’t help her much. Plus she was very cheap, and since she’d got along for 60 years without one clearly she could save her money for something else.
So far my hearing is fine, but it’s nice to know the technology is out there when/if it stops being fine.

Re the comment that you should expect hearing aids to last for 2-3years. I’ve been wearing hearing aids for 40years. My last 2 aids, both analogue, have lasted well over 10 years each.

Anthony, thanks for an excellent post on hearing aids. I can see why they are relatively expensive. While there may not be a cartel keeping the prices high, I would have thought that, with time, procedures could be standardised so that people could do a lot of the preparatory work themselves. And competition should, over time, drive down hearing aid prices. Even so, because hearing is so precious, professional help is probably best, and that costs money.
I have loss in my right ear, from otosclerosis see http://en.wikipedia.org/wiki/Otosclerosis , which has now given me high frequency tinnitus in that ear. My choice was an operation (stapedectomy see http://en.wikipedia.org/wiki/Stapedectomy), which the ENT surgeon thought would be too risky, or a hearing aid (Phonak Versata). This helps me hear better and also helps to mask the tinnitus, though this varies from day-to-day. Today, my right ear humming away!
Dave asked about what can be done for tinnitus. From my own experience, I suggest he sees an audiologist who will be able to say whether the tinnitus is due to otosclerosis or it’s sensori-neural or there’s some other cause. If it’s sclerosis then a stapedectomy may be the answer. If this cannot be done then a good hearing aid will help to mask the tinnitus. I’ve tried an aid that generated white noise, which helps some people. In my case it didn’t but may do the trick for Dave.

WOW!! What an informative and useful discussion.
After owning 3 sets of HAs over the past 20 years, I have an observation about the following comment …
“The average person goes back to the audiologists between 12 and 18 times in their first year – and that is almost always covered in the purchase price of the aids. At an average cost of $100 per office visit, it’s quick to see that upwards of $2500 of a set of hearing aids can be just for the audiologist’s office time.”
The average of 12-18 visits strikes me as quite high. In my experience, in two of my HA cases, there was no need for a follow up visit, while in the 3rd case an adjustment was necessary to tweek my right-side HA. Thus, counting the initial hearing evaluation visit and the subsequent “installation visit” for the aids (two ITE and now a BTE), the average time spent with the audiologists for each set of HA was less than 20% (at most) of the claimed 12-18 average.
Hmmmm … maybe that provides a persuasive reason to negotiate/obtain a better price with the audiologist next time.
Many thanks, Anthony, for getting this “off topic” topic in front of such a well informed group of readers.

If I may be pardoned for going OT from the OT topic, I was interested in the case of tinnitus being dealt with as a vitamin C deficiency. I have an inner ear problem, not hearing but balance. At first it was assumed to be an inner ear infection, but antibiotics and elapsed time, both usually equally effective for infections, did not help. I did a lot of reading, and found the answer: I had a manganese deficiency. A supplement fixes the problem for me, but not for everyone. Didn’t seem to help my tinnitus, though. I just had to get used to having my own flock of cicadas following me around.

A few months ago I got an infection in my left ear that caused a temporary loss of hearing. After the infection cleared up, my hearing returned to its previous state. Based on my doctors tests, he sent me to an audiologist for a hearing assessment which confirmed that I had mild to moderately severe, age-related hearing loss in both ears. I was offered three levels of hearing aids ranging from $3,750 to $6,000 for a pair of hearing aids. I thanked the audiologist and explained that I believed that I could get near-top-of-the-line house-brand hearing aids from the Costco store across the street for $2,000 per pair. A little further research confirmed the hearing aids offered by Costco were manufactured by one of the top manufacturers and the specifications were comparable to that manufacturer’s top hearing aids which were available from full-service, independent audiologists for $6,000.
The latest hearing aids are true digital signal processors and are nothing like the simple hunter’s ears amplifiers. My hearing aids have sixteen frequency channels which can be individually set to fit the aids to my hearing loss. I have five different programs that help match the ambient hearing conditions. The hearing aids communicate with each other wirelessly to locate speech sounds and discriminate against annoying background noise.
http://shop.costco.com/In-The-Warehouse/Hearing-Aid-Center/Kirkland-Signature.aspx
I don’t have complicated hearing problems, so I felt comfortable using a licensed Hearing Aid Specialist with a Master’s degree instead of a PhD audiologist. With more difficult hearing problems, I might have chosen otherwise. For many years, I used optometrists for my glasses, but I am going to an ophthalmologist as my eye problems get more complex. The service at Costco has been excellent. The woman I work with encourages me to return frequently (at no additional cost) for inspections and to try tweaks to the programs. I have returned for inspections/adjustments six times in six months – not because of problems. We have made changes and improvements at each visit. The Hearing Aid Specialist has used these visits to provide an on-going educational process. Hearing aids are not just plug-and-go. You need to learn how to maintain them and use them, and you need to learn to have realistic expectations. I use a behind-the-ear model. The sound generating module is on a wire and it slips into the ear canal and is held in place by a small plastic cone.
My only connection with Costco is as a satisfied customer. They offer a 90-day money-back guarantee – and it works. I have a friend who returned his after 89 days. Here’s another link to the Costco hearing aids showing the available models and price ranges.
http://shop.costco.com/In-The-Warehouse/Hearing-Aid-Center/Styles.aspx
That’s a $2000 price for two top-of-the-line hearing aids all services included: ninety-day trial, no charge for followup adjustments, loss and damage replacement, rechargeable batteries with charger. Costco requires a $50 annual membership. That $50 is your only risk if you choose to try Costco hearing aids.
My ophthalmologist said he was not allowed to recommend eyeglass suppliers, but he did “suggest” that I consider the price and service from the Costco opticians. The price for my no-line bifocals at Costco was about half that of Lenscrafters, and I have been pleased with them.
If nothing else, you can use this as a bargaining chip with other suppliers. I had some follow-up negotiations with my first audiologist, and she offered some price concessions after she had a chance to review the Costco product offering. She admitted that she could not come close to matching the Costco price for a comparable product. The Costco Kirkland Signature is a re-branded Rexton hearing aid. Rexton is a subsidiary of Siemens. At the time I purchased my hearing aids, the Costco Kirkland Signature specifications seemed to be nearly identical to those of the Siemens Pure 701 models. Keep in mind that hearing aid manufacturer’s are getting into the new-model-year style of marketing, so you can expect rapidly changing model specifications to promote the latest and greatest features.

Retired Engineer (September 10, 2011 at 7:53 pm) wrote in part:
As for tinnitus, have had it for years, many possible causes, no real cures. Sometimes tones, sometimes a whooshing. Comes and goes, fatigue seems to make it worse. You might think there would be more ongoing research, my ENT doc says not really.
Like Retired Engineer and many others, I have tinnitus. Mine isn’t caused by a condition that’s presently curable, so my left ear whistles along 24/7, with my right ear making it a duet from time to time. It’s a high-pitched whistle at relatively low volume, so I normally don’t notice it.
If my tinnitus were louder, I would avail myself of current treatments. One that I have (but don’t use) is a CD that has tracks with tones of various frequencies. Listening to a sound that’s close to the frequency of the tinnitus whistle can cause the tinnitus to become less obtrusive by taking advantage of the self-masking effect.
If a person is in an area where there’s a repetitive or recurring sound (e.g., a hum from fluorescent lighting or the “tick-tock” sound made by a mechanical clock), the brain will soon assign it nearly zero significance. From that point on, only changes in the background sound will be noticed. Adding a masking tone to the “background” that’s close to the frequency of the tinnitus often causes both the masking sound and the tinnitus to be suppressed.
Masking tones don’t have to be continuous, or of a constant frequency. Allanj (September 11, 2011 at 1:03 am) reported that he has a hearing aid that produces “a continuing sound like a [x]ylophone playing random notes.” He says it has reduced his tinnitus by 25 dB, going from a very loud and obtrusive sound to a soft one that is much easier to live with.
To find out if you can be helped, you need to begin with an audiologist or with an Ear, Nose, and Throat (ENT) specialist who is both interested and experienced in the treatment of tinnitus patients. If the first audiologist or ENT you go to tells you, “You’ll just have to live with it”, dump him and find one who is more knowledgeable.
If you’re having trouble finding treatment where you live, search for “tinnitus treatment center”. A Google search for that phrase found 437,000 results. With any luck, there will be one near you. (Be wary of any “tinnitus treatment center” that isn’t associated with a major hospital and/or medical school. It may consist of little more than a cynical GP who’s certain he’s stumbled upon a surefire get-rich-quick scheme.)
Research into cures for tinnitus is ongoing. You can find information about current research, along with information about available treatments, from the American Tinnitus Association. If you want to make a contribution to help push the research forward, I’m sure they won’t refuse it.

I am fortunate to still have excellent hearing.
My wife was born hard of hearing. The simple hearing aids of the time were expensive and made her hearing worse after a few hours, and irritated her ear canals.
If I needed a hearing aid I would not relish spending thousands of dollars every few years, plus buying tiny expensive batteries.
How about a cheaper solution – attach cheap larger amplifiers and larger batteries to spectacle frames and connect to the ear through a simple tube. Thus allergic reactions are less likely. Unobtrusive controls on the sides of the frames would be easy to adjust.
Anyone who comments on the apperance of hearing aids can go jump in the lake. Do they laugh at crutches and wheelchairs too?

Retired Engineer (September 10, 2011 at 7:53 pm) wrote:
… As for rechargeable batteries – been using them for years in many applications. Growth of microfibers was a problem with Ni-Cd’s. NiMH cured that. Lithium made it even better. … HA’s could use inductive coupling, charge overnight in a small dual ‘bucket’ on the nightstand. Single cell lithiums (various types) are quite reliable.
There’s no question that today’s rechargeable batteries are leagues ahead of the old NICADs. They still have fundamental problems, though. Most people think of batteries as electrical components. They aren’t. They’re chemical components whose chemical reactions separate atoms into positive ions and electrons. When a lithium battery is discharged, the positive lithium ions move from the anode to the cathode through the electrolyte, crossing the separator on their journey from one plate to the other. The electrons flow out of the anode (the negative terminal), through the circuit that’s being powered, and back into the cathode (the positive terminal).
When a rechargeable lithium battery is charged, the process is reversed. An applied voltage drives current in the reverse direction, causing lithium ions to flow through the electrolyte from the cathode to the anode. Unfortunately, no one gave the little ions house numbers or street addresses, so instead of going back to the spot they left, they return willy-nilly. The cycling of lithium ions back and forth between anode and cathode causes a gradual degradation of the positive and negative plates. This changes the battery’s discharge characteristics, gradually decreasing the available energy and altering the voltage and impedance during discharge. That’s the reason your new laptop runs six hours on a charge, but a year later runs less than two hours before needing to be plugged in.
Rechargeable batteries can be used in non-critical applications. Bob Sullivan (September 11, 2011 at 2:27 pm) pointed out that Costco is selling hearing aids at dramatically reduced prices, including a pair of digital hearing aids for $1,999.99. The pair comes with both rechargeable and zinc-air batteries. Normally, one would use the rechargeable batteries, but if a rechargeable runs down during the day, it takes only a couple of minutes to pull it out, tuck the rechargeable battery away safely, and insert a zinc-air battery.
Retired Engineer (September 10, 2011 at 7:53 pm) also wrote:
… Pacemakers already use primary (non-rechargeable) lithiums. Did some work for CardiacPacemaker in MN a long time ago. …
During their lifetime, pacemakers measure the battery’s characteristics (output voltage and impedance) to calculate when the battery will be six months from exhaustion. That point begins the “Elective Replacement Interval” (ERI), during which time the pacemaker needs to be explanted and replaced. When it enters ERI, the pacemaker turns off some features and reduces the pacing rate to prolong battery life. If a rechargeable battery were used, the incremental modification of the battery’s characteristics would make it impossible to perform the ERI calculations with any certainty.
Pacemakers use primary cells, and that’s unlikely to change for a very long time. Pacemakers are safety-critical systems. If the patient is pacemaker-dependent, failure to provide appropriate pacing support will kill him. Safety is such a priority that the batteries aren’t soldered into the circuit — they’re welded. In such an environment, rechargeable batteries pose too great a risk.

The process of assembling hearing aids that Anthony described is archaic and goes a long way towards explaining the outrageous cost of these simple devices. Instead of a room full of technicians there should be a line of robots, assembling the devices faster, more accurately, and far more cheaply than human hands. But a monopoly doesn’t need to make capital investments, and gathers its inflated profits despite using technology that is a full 3 decades behind the times.
I’m an electrical engineer, small business owner, and economist. Like every other electrical engineer who has commented on this thread, I say that the germanium use is not only a red herring, but a sign of archaic technology. The developers of battery-operated devices everywhere have to worry about power use and battery life, and they don’t use germanium. The job of hearing aid is precise and delicate but straightforward.
You can buy a wireless residential weather station for about $100 that runs a year or two from one set of batteries, with 5 different sensors and an RF transmitter – and there isn’t a spec of germanium in it. Give that one up, it’s a losing argument.
There are 4 reasons US hearing aids cost 10x more than they should:
1) FDA regulation of hearing aids as class 1 medical devices. FDA rules drive up costs and restricts competition and new entrants to the market.
2) State licensure of audiologists. This cartel is behaving exactly as economists know all monopolies behave: prices go up, and quality of service goes down. Audiologists used to be masters-level degree programs. In 2007, the Doctor of Audiology (Au.D.) started being required by many states. There are no longer any professional programs in audiology which offer the master’s degree.
The profession did not grow more demanding in 2007. The tools and technology are better, the process should be simpler. This is simple monopoly economics as work: restrict the supply of audiologists with ever-increasing education and license requirements so that they can charge $100 per hour or more.
3) A limited market. High prices cause demand to be low. As one commenter pointed out, only 2 cities in the country have enough demand to support a mall-type store – and they already have them. The fact that the market is limited by the outrageous prices doesn’t bother the people collecting their monopoly profits.
4) Some people are willing to pay. There’s nothing wrong with Anthony and the other defenders of the status quo being comfortable paying thousands of dollars for their equipment, it is their money and their choice. What is wrong is a system that raises prices so high that millions of people go without hearing aids rather than submit to the gouging. Their loss hurts all of us.

The medical business can confuse people. The price of a device in theory may include much time measuring (which Anthony covers) or coaching on its use (as its required with CPAP sleep apnea equipment, as well as trying other interfaces to get proper fit). “Shanghai Dan”’s post covers that in part. That cost to the provider will vary considerably with the individual customer. Note however that subsequent purchases of the same product will not need that service so should be priced lower.
The key is to ensure your provider is providing full service – quiz them, get a promise of support in writing.
Another problem is insurance companies, which in the US are driven substantially by government meddling (and in Canada and UK are the government, with the same bureaucratic methods as the US combination of insurance companies and government (all government in the case of Medicare). They usually pay providers far less than list price, sometimes the providers try to make it up on non-insurance customers, but some businesses (like a dentist I used) give a discount (in part for no paperwork & immediate payment).
Medical providers like doctors get wrapped up in that system and become inefficient – and arrogant.

BTW, for those whose hearing seems to be deteriorating, do check for ear wax buildup (your doctor should be able to check that). And do be aware that there is a phenomenon that increases with age of the brain not being good at screening out interfering sounds – I have great difficulty where there are echos or many people are talking in the background. I _speculate_ that hearing loss in one ear could have similar effect due not supporting any ability the brain has to selectively listen – a good ear exam is probably wise anyway. (I _speculate_ that with both ears working the brain can screen out , if you can see the speaker. Oh, there is the problem of people’s voice quality (some people limited frequency range, some do not enunciate clearly (one cause is tilting head downward to read notes – get a teleprompter! (maybe one of those little displays worn on glasses?).
OTOH, lip-reading sounds like a good skill for us aging types to develop. 😉
An example of inefficiency is my mother’s eye doctor. She had separate visits for a peripheral vision test, a redo of the test, and seeing the doctor.
In contrast the eye doctor I go to has technicians doing that test and others, redoing as necessary (including re-educating me as the test depends on the user’s approach to how sure to be that they saw the fleeting gray patch, then after a short wait I see the doctor who may require redo on my way out (and returning to her office if I fail again) – one visit.