It Costs WHAT?! A Sounding Into Hearing Aids

We are accustomed to medical devices being expensive, but sometimes the costs seem to far exceed reasonable expectations. At its most simplistic, a hearing aid should just be a battery, microphone, amplifier, and speaker, all wrapped in an enclosure, right? These kinds of parts can be had for a few dimes, so why do modern hearing aids cost thousands of dollars, and why can’t they seem to go down in price?

Background

Until the nearly 1900s, the best available option for partial hearing loss was the ear trumpet, which takes the sound over a larger area and condenses it into a smaller area at the ear canal. The invention of the microphone enabled electronic hearing devices, with Miller Reese Hutchison inventing the Akouphone, a tabletop unit. By 1902 it had become a battery-powered smaller device called the Acousticon, but it was still bulky and the batteries didn’t last long and it didn’t have good volume control or frequency filtering; basically it was pretty much every V1 product, but it was still revolutionary.

The Acousticon
The Acousticon hearing aid (image is public domain)

Since it was impossible to jam vacuum tubes into people’s ears safely, it took a long time before hearing aids got significantly better, but suffice it to say that as technology improved, so did hearing aids. Advances in plastics, microelectronics, sensing, filtering, batteries, manufacturing, and all of the other things that have improved every other aspect of modern life also contributed to better hearing aids.

Now there are a variety of types, but they exist in three general categories: behind-the-ear (BTE), in-the-ear (ITE), and in-the-canal (ITC or completely-in-the-canal CTC). Their names are descriptive enough, and their advantages are easily imagined. Behind-the-ear allows for larger batteries and more complex electronics, at the expense of bulk. In-the-ear is smaller but still visible and is a compromise. In-the-canal are the smallest yet, but aren’t easy to adjust or remove, and can’t have some of the nicer features or amplify very much.

Features

Hearing aids have come a long way in 120 years. Current aids can have Bluetooth connectivity for interfacing directly with smartphones. There is also a feature called telecoil, which uses a magnetic field created by a loop in the listening area. Many meeting places, like churches and libraries, have this technology installed in meeting rooms to allow the hearing impaired to pick up and amplify the sound more clearly. Aids will have adjustable volumes and frequency ranges (to only amplify the ranges where the patient has loss, or to shift frequencies from ones where there is loss to ones where there is not), dynamic volume adjustment, noise reduction, profiles for different environments. The R&D and engineering involved in these advancements is certainly part of the high cost, but in some cases these features can be undesirable, such as when it filters out sounds you want to hear, like music. There is definitely a sweet spot between a high cost product that amplifies exactly what you want exactly how you want it but with a complicated interface for navigating all of those settings, and a cheap run-of-the-mill amplifier that barely gets the job done. The only problem is it’s a different spot for everyone.

Teardown

Not having any hearing aids around, I resorted to my favorite FCC trick for teardowns, and discovered the internal photos of a few.

Behind-the-ear units are rigid-flex PCBs folded into a variety of contortions to place all the components into the curved enclosure. Behold the Aurora BTE:

The Aurora BTE hearing aid internals

The completely-in-canal Aurora CIC is a marvel of engineering and a challenge to photograph. Fortunately their user guide has a helpful diagram to assist.The Aurora CIC teardown

Oticon Aurora CIC hearing aid
The components of a CIC hearing aid are as minimal as possible.

Designing a new one

If one were to assume that all the current manufacturers of hearing aids are misguided in their goals of making smaller and more expensive devices, and one wanted to make something for the masses of underinsured and uninsured who have mild to severe hearing loss, how would one go about it? First, let’s assume that CIC or even ITC is unrealistic, as it requires far too many customized components, including a molded shell for the user’s ears, and difficult assembly. BTE is far more accessible, as is a headphone or earbud solution.

What kind of off-the-shelf parts could be used to reduce NRE and scaling costs? A rechargeable battery would be nice, but more expensive, lower energy density, and more difficult to service than disposable cells or alkalines. How about the circuit: a pure analog solution, or a digital solution that incorporates DSP? Throw in Bluetooth or not? What knobs should it have? A digital solution with some pre-designed profiles and a knob for volume and a knob to select the profile could accomplish the vast majority of the requirements.

And this is where we come to the difference between a hearing aid and a Personal Sound Amplification Product (PSAP). There are lots of PSAPs available for a wide range of prices, with many offering all of the same features at a fraction of the cost of a hearing aid, but an equally large number of warnings about them and their inappropriateness as hearing aids. The primary concern is that they will do more harm than help, as improper amplification of frequencies can contribute to further damage, and using one can delay being seen by a professional who may be able to diagnose and treat the underlying cause before it’s too late.

Proper procedure aside, when presented with a choice between a PSAP and nothing, there are still many who will choose the PSAP, and some who have done research in it as an acceptable solution. We shared one such device in 2016, and as recently as September another group created LoCHAid with a BOM of <$1 (primarily a MAX98306 3.7W Class D amplifier).

An early version of the LoCHAid

Regulatory

Being able to slap the words “medical device” on a product automatically adds zeroes to the price, but the privilege comes with a lot of effort and cost on the part of the manufacturers as well. The regulatory requirements are rigorous. Because it is worn so close to the body for extended periods, it must pass radiation emissions tests, SAR evaluation, biocompatibility tests, and other safety tests. Acidic ear wax can have effects on the enclosure as well, and the device must not cause harm to the users. Testing and documentation and regulatory filings can occupy years of time and hundreds of thousands of dollars, and vary from country to country, so it is an effort not lightly undertaken. This is why PSAPs exist.

Conclusions

Getting involved in helping people with their medical problems, especially those who are underprivileged, is a noble endeavor. Technology has improved to the point where an open source design may even be accessible. Maybe there is a middle ground somewhere for a low-cost design with the minimum features that is safe, with an open source development environment and BSP that would allow developers to improve the audio features. There may be room in the market for budget hearing aids for low and middle-income countries. However, where health is concerned, we should be extremely careful not to create something that would cause more harm than good.

150 thoughts on “It Costs WHAT?! A Sounding Into Hearing Aids

    1. Logically, of course, you’re right. We made the bold claim, we should back it up.

      But just for curiosity’s sake, were there any tube-based in-ear hearing aids? There were “tiny” tubes made for portable radios, and, I’d presume, pack-of-cards sized hearing aid amplifiers. Anything smaller?

      1. Would it have been possible?

        Nuvistors were made in sub-centimeter sizes. The Soviets made some truly small tubes, such as the 1Ж25Р with a filament designed for 1.5 Volts and 80 milliamps and a casing just 4 mm wide. These would operate with around 10 Volts minimum, so with a stack of lithium button batteries tucked around your ear, you could in theory make a tube amp hearing aid that could operate for a few hours.

        The main issue with vacuum tubes is the filament heater. If you eliminate that with, say, a radioactive element giving off electrons, you could make the batteries last a lot longer.

      2. I once had a tube powered hearing aid which was gifted to me by a relative who knew of my love of electronics and had upgraded. The amplifier unit was about the size of a pack of cigarettes and contained everything except the earbud, including the microphone, battery, and a single pencil style triode.

        1. That’s as small as they got, and they were primitive compared to today’s hearing aids.

          Hearing aids were something that went transistor early on, they coukd be smaller, use less power, and since they were audio, it was easy to do (unlike radio that needed radio capable transistors).

          They categories in the original post (and generally) is confusing. One of those types describes behind the ear, but instead of the transducer being in the aid and sound carried via a tube to the ear, some behind the ear put the transducer into the mould that goes into the ear.

          1. In some old movies, you’ll see a person using their hearing aid while using the telephone,
            They’ll have the mouthpiece up by their mouth, but the earpiece will be down by their shirt pocket where the hearing aid is worn.

        2. During my high school days in the 50’s, I earned pocket money by repairing shirt pocket sized hearing aids using 3 tiny tubes for an audiologist. I still have a partly stripped sample in my tube collection. I hacked one into an AM receiver using a small antenna stick and diode to the wonderment of all that heard it play.

  1. The price of hearing aids in the U.S. is mind-boggling. Why people don’t import them personally is beyond me.

    What about a $1 bluetooth earphone, and a sender? Maybe starting with a smartphone app to pick up the audio, but then you could change to a dedicated device with a bit of DSP to perform some of the functions listed above.

    For longer battery life, just get a few more earphones, and charge them in rotation.

    The earphone itself contains a microphone, so maybe it could be put into a “bypass” mode where it merely outputs whet comes in, and repurpose the bluetooth ARM7 for some signal processing.

      1. Electronics can process only so much until you have to account for the human element. Amplification and being able to hear different auditory levels is not the same as word recognition. A perfect example is my wife is hard of hearing, her most recent hearing tests showed barely any differences in hearing levels in terms of DB readings however her word recognition dropped by a dramatic amount, almost 40%. Her hearing aids are bluetooth enabled as well and even then she still has trouble hearing with them. Many people have the misconception that if a person who is in the Deaf/HoH communities wear hearing aids they think they can hear 100% when unfortunately they still struggle even with assistive devices.

        1. I’ve got a similar problem. I can be at a party, and I can hear the person next to me talking, but I can’t comprehend the words due to the background noise. It took a bit of explaining to get them to understand it. I can hear just fine. Turning sounds into words with a low SNR is the problem.

          1. Once I’m in a group I cannot focus on one person’s conversation, I just hear a mumble of conversations. I’ve been wearing a hearing aid for dual purposes: hearing loss and tinnitus.

            It sucks, meetings, restaurants, parties, (all pre-COVID of course) all are very uncomfortable for me and induces anxiety because of the whole not able to distinguish the person’s I’m trying to converse with from the background of conversations.

    1. Vanity is one problem. I wouldn’t care if I wore headphones or had a flashing beacon strapped on my head. People routinely pay thousands for something tiny. Who cares? Until a few years ago you could not buy any decent “personal sound amplifiers” . Now you can buy a few which are very comparable to low-end hearing aids. They still cost a few hundred which is about 10 times what they should cost. I care for relatives who wear hearing aids. Typically around $4K a pair. NOT covered by any medical insurance. Despite the difficulty involved with a “medical device”, it’s a monumental con game. You get old, there’s a substantial chance you’ll eventually need hearing aids. There’s a good chance I’ll need hearing aids at some point. When I do, I’ll be wearing headphones with a bandolier of D cells. It’s not a bad idea to have an audiologist do an exam and prescribe gain and frequency response. There are some genuine medical issues involved. But, once you have a prescription you should be able to go to most any store and get a perfectly functional set of hearing aids for a reasonable price.

      Just like eyeglasses, the audiologist wants to sell you their brand for inflated prices. My eyeglasses would cost hundreds from the optometrist. I can order them from asia for 20 bucks including shipping. Hopefully they won’t close that loophole. I have pets. Prescription medication costs me $ hundreds. The same exact stuff from most other countries costs a quarter the price but they can’t be exported. It the USA it’s all about profit.

      1. good points. as my hearing goes away (i am 76) i will use an fm reciever, headphones and hand the person I am listening to a wireless microphone. Better to not add ambient noise to what you are trying to hear and understand. As for paying a fortune to pretend your hearing is fine….doesn’t fool anyone. as you say….who cares….its like hair color….time advances – get over it!

        1. I have a friend your age who is deaf as a stump, in fact I am going to drive him to get a cochlear implant next month. When he visits me I have a big ol pair of Koss over the ear headphones that can get very loud without distortion and I plug them into my notebook and use that as an amplifier. It works quite well. We also have fun with google’s speech to text. It gets enough things wrong for it to be humorous for both of us.

          1. Particularly humorous when you consider a child in this circumstance. Having to decipher between words is critical, especially when placed in a learning environment.

            The amount of ignorance I’ve read in this comment section is astonishing. Just buy headphones they say! Of course that works, until it doesn’t. Many folks here need to educate themselves on the differences between hearing environmental sounds or speech sounds. The impact of being unable to hear one or the other could have. (For example: my 12 year old riding her bike and wearing ear buds to ear the people taking to her but misses the car approaching from behind. Her hearing aids however, allow her to hear it all.) As someone mentioned above, there are large misconceptions when it comes to hearing loss. Educate yourself, then speak.

    2. First of all, most BT earphones are not strong/loud enough.

      Second, the way the hearing aid channels sound toward ear canal with little silicone custom-made adapter makes it easier on the ear to be basically sealed for extender periods of time. Well-fitted hearing aid is barely felt by the user..

      Third, the sound is picked by the device, processed with some DSP to mach bandwidth of the users’ ear and amplified in real time. It also includes some VGA/loudness functionality. This way binaural way of hearing is preserved. Can’t do that with single microphone in the pocket. That’s why old pocket hearing aids are not used anymore. And using (not that great) MEMS microphone integrated with the earphone to get sound to the smartphone for processing adds a bit of delay.

      Some years ago my wife’s sister had to buy two hearing aids for her kid. The units costed equivalent of 1500USD, but in our country one can get financial aid to buy equipment for people with disabilities. Once every few years. So in the end she paid only an equivalent of 375USD…

    3. There are varying level of hearing loss. I was born deaf and I needed hearing aid capable of 100 to 125dB. No Bluetooth earpiece can’t do that.

      My hearing aids were $3,200 for a pair when I got them new about 10 years ago, and $1,000 a pair about 20 years ago. My current hearing aid is still working but at 10 years it might fail and when it does fail, it probably won’t be repairable and I don’t fancy finding out what a pair will be this year.

        1. I did have the option to get one but I was already in mid 20s when they were available and none of my insurance will cover that. I guess it’s cheaper to order new hearing aids every 10 years for the next 60 years than a one time surgery for the implant.

      1. Eric if your in the US, try direct hearing.com. I bought the Phones Audeo Marvel for my wife from them recently. I want to say it was roughly $1200-1300 and you can buy from them directly. They can program it before shipped and you can call and they can readjust as needed over the phone through their app. Might be worth checking out. Previously she bought from her audiologist the past few times and they were significantly more expensive. She just uses one hearing aid, but they were charging about $2500 for a Widex one 4 years ago and about 7 years ago she had one for about $3000.

        1. Thanks for this. I bought Phonak Marvels in 2018 and paid double that (insurance covered roughly half. So in the end, it ended up being about the same).

          I’m currently eyeing the Phonak P90 Paradise for the next upgrade.

          It’s a good time to be alive if you have to deal with hearing loss.

          Cheers,

          Scott

      1. Yes, you’re absolutely right. This is a good example of the basic device specs that engineers outside the field are ignorant of. Hearing aids need a mic to receiver (speaker) latency of well below 10ms. Hearing aids with wireless mics can tolerate more delay and current devices are around 20ms.

        It seems to happen with a lot of specialized technical fields. Some people looking at the topic for the first time assume everyone working in the area is an idiot, and they haven’t tried the most basic simple minded ideas. There are actually very intelligent people in the hearing aid field and they’ve been working on these problems for years.

        Having said that, many other people regard hearing aid processing as almost magical – much more complicated than simple amplification. Actually it’s basically just dynamic range compression. This also happens with the fitting, or tuning, process. It helps to have hearing aids adjusted to your hearing loss, but unfortunately this doesn’t work at all like eyeglass prescriptions.

        I wrote a slightly technical article about some of these issues here:
        https://audsona.com/whats-the-difference-between-bluetooth-earbuds-and-hearing-aids/

  2. Hi Bob, I agree 100% this is a niche market that the hearing aid “medical” companies exploit to charge crazy prices to people and insurance. There are a couple of open source projects that have good progress. This i one of my backburner projects too: My sister had viral induced hearing reduction in one ear. She went to a specialist who hooked her up to a bone conduction head set and she could hear well. So it was a bone linkage problem. The real implant device was about $4K upward. I’ve been experimenting with conduction transducers and DSPw /codecs and this could be done much much cheaper as a diy. Minimising the footproint would be a later step. I understand a company trying to make profit, but this is such a widespread issue, I wonder at the ethics.

    1. Well you say implant. Do you really want to be sticking any old thing in one’s body? Second who’s going to be liable if things go south? We complain about cost, but some of one’s money goes towards those two issues.

  3. This is a perfect example of a project that should be open-sourced.

    The stigma of wearing earphones vanished with the smartphone generation.

    Any cell phone of even 10 or 12 years vintage has more than enough processing power to provide the dynamic filtering necessary and possibly noise cancellation.

    I use the camera in a smart phone to augment my fading vision with tiny SMT devices – so why not use a smart phone to enhance one’s hearing.

    Heck – you could almost do instantaneous language translation or text to speech too!

    1. You are so clueless.

      Hearing aids today makes even today’s flagship smartphones looking antiquated.

      Do some research on the amazing technology in modern hearing aids. They can do things like in real-time filter out the background noise and focus on the person in FRONT of you that is talking to you, and in milliseconds switch to amplifying someone in BACK of you that is speaking in your specific direction.

      A smartphone has trouble keeping a call connected and call volume at a consistent level.

      I set “volume leveling” on my phone and the calls still go up and down in volume and when I’m listening to something the phone can’t keep the volume level in real-time when say a talk show host is speaking to a guest. The host is loud and the guest low, or vice versa.

      A modern hearing aid can level things out and much, much more in a device a 20th the size of a cellphone.

      1. What you’ve described is not a limitation of a phone, it’s a limitation of the software on the phone. Ken is suggesting a hearing aid software which would of course target those features you’ve identified.

        1. I’m guessing that the compromises made with hardware would make it difficult for a phone to perform the functions if the hearing aid.
          Hearing aids can connect to your phone, but the frequency adjustments are still done in the device.
          Then again, old hearing aids attached via wire to an external processor, so maybe it could work.
          You are talking $1,000 phone and $250 earbuds.
          Could they multitask and provide the same instantaneous response that dedicated hearing aids can?

          1. Genuine question: what compromises you see with phone hardware?

            Yes, I mean like noise cancelling earphones each with a microphone that offload all the signal processing to the phone. They’re wired, and cost no where near $250, example Sony MDR-NC31E are about $30. Certainly the cost of a phone can be significant, but people do tend to have phones already.

            Given that phones can already multi-task and do live noise cancellation and taking into account that volume and frequency response are not linear, I don’t see any technical reason a phone shouldn’t be able to instantaneously boost particular frequencies. It’s basically doing the same thing as noise cancelling, but… noise boosting.

          2. Shannon and abjq: You both ask valid questions and make valid comments.

            I’ve written a 1,000 word reply and will happily post that if you want to read it.

            Or you can just go out to any of the Big 6 hearing aid manufactures website and do some research.

            The short as I can make it answers are:

            1. If the $30 Sony earbuds are so great, why does Sony make models that sell for $250?

            2. If Bluetooth earbuds, a smartphone (which most people already own), and a “little” software were a practical solution, then why do people buy hearing aids?
            The answer to your questions is the difference between a PSAP and a hearing aid.

            Also, hearing loss is a medical condition. As such, it is different for every individual. And, that individual needs professional assistance to properly correct it. Think fixing that broken bone without medical assistance.

            If you really want to learn more about hearing aids, you could go to a hearing dispenser. Or, better yet to a professional audiologist. Or try to find a forum in which those professionals are asking and answering your types of questions. (Still 200 words.)

          3. I’m not an engineer so I can’t really answer that question specifically.
            I can ask you: How much quality of life would you give up? Would you not get new glasses because they cost “too much”?

          4. >. If the $30 Sony earbuds are so great, why does Sony make models that sell for $250?

            Because they can. It’s a deliberate marketing strategy to keep people buying the $35 earbuds instead of going even lower. You can get perfectly good earbuds for $10 but when you have the ridiculously priced option, people tend to pick the middle one.

          5. That makes sense. That would explain why a lot of other things are better done by stand-alone, application specific devices. (not the right terms, but I don’t have time to look up the correct terminology right now)
            Thanks for replying. And I hate you for it. Coming back I see that I now have to read the entire comment thread because I spotted a lot of good thoughts and links to other articles.

    2. You watch too much sci-fi. “Instantaneous translation” of even “Where’s the bathroom?” (restroom, outhouse, toilet, water closet, bog, head, etc.) is years, if not decades away.

      And figuring out all the subtleties of the thousands of languages and dialects spoken on the planet will never be done by a machine. To translate a language you must know and LIVE the culture to do that properly.

        1. I haven’t read the article yet, but my gut tells me I was right about AI translation.

          Basic, “Where’s the restroom?” Might work. But Star Trek level universal translator might be a few decades away.

          Why AI Needs to Be Able to Understand All the World’s Languages
          The benefits of mobile technology are not accessible to most of the world’s 700 million illiterate people

          https://www.scientificamerican.com/article/why-ai-needs-to-be-able-to-understand-all-the-worlds-languages/

      1. You’re being a stick in the mud but I’m sure for reasons. You can buy a handheld device for $70 that will handle most people’s day to day translation needs (both ways) in dozens of languages.

  4. The price of hearing aids is so high because the cost needs to support the myriad audiology shops that are selling them. This is a career path for many people with no prior skill in the area. You can be taught become an audiologist and fit hearing aids. The relatively long life expectancy is amortized through the high cost.

    That being said, Insulin pumps and CGMS systems are very expensive too, including the consumables. While I understand that they have a lot of R&D to recover, and they have a guaranteed window of ~20 years to recover that (and more as they add newer patented technologies to existing designs), by and large they exist to print money. The Dexcom CGMS has a BOM that’s probably less than $50 for the whole system (it’s just an ARM and nRF for wireless comms). The disappointing thing about the Dexcom is that you simply “throw out” the old devices when they send you a new one, they don’t want them back and you can’t legally “resell” them to anyone or “give” them because they are covered by prescription.

    Then we get to the most idiotic of all: CPAP devices and consumables. The mask is considered a consumable, but is only available with a prescription. You can, however, purchase all of the constituent parts of a mask separately without a prescription!

    1. Yeah, one CPAP seller expects me to replace the mask every 6 months. Sometimes I get 18 months use out of one.
      Seeing what my insurance reimburses them for each mask, I can see why they want me to replace them often.
      (Now if I can find the right filter material for that postage stamp sized air filter in the main unit).

    2. You need to get your terms correct:

      1. An audiologist is a licensed, medically trained person. Often with a Master’s degree.

      2. You are talking about a “hearing aid dispenser” which is a professional like say an optician but can only perform a certain level of testing and then dispenses hearing aids.

      I probably don’t have those exactly right, and they likely vary from state to state.

      Think audiologist = pharmacist. Pharmacy aid = hearing aid dispenser.

        1. The audiologist tests your hearing, makes a chart, and then specifies in a broad sense what’s needed.

          The person at the hearing aid place finds a hearing aid to match.

    3. Not too many years ago (>1000 for such a pump, it was basically a lease.
      I got mad and wanted to develop a DIY solution, with plenty of people chiming in to test it, but stopped when I saw that most dispensing devices have patents on them – a screw inside a syringe. Plus, they eventually moved into this century and updated their designs. I think it was MedTronic.

  5. I have severe hearing loss and with it, tinnitus in my left ear because of it. Fortunately the VA is picking up the costs for my hearing loss so I don’t have to go spend the thousands it would be for me to cover it. My one issue with my current hearing aids is that I can’t wear them at work, the background noise is way too loud and I can’t hear anybody over that.

    That being said, I am hoping that in 5 years when I can get a new pair it will be ones with some noise cancelation in it. Seriously, my Bose QC35’s have it and can get rid of all the background noise, why can’t my hearing aids do it? Well, I know why, regulatory approval and the ton of paperwork that comes with that, but I’m hoping.

  6. I really love the idea of an open source hearing aid, but not JUST from the cost perspective (though that is certainly important). From my experiences with my father’s fading hearing, it seems like most of the “tweaking” that an audiologist does is simply boosting certain frequencies and cutting others. Like a parametric EQ (at best). It feels like there have got to be MUCH more interesting and effective audio processing options out there for improving performance in specific use cases (like trying to hear conversations in a crowded restaurant). Pitch shifting? Boosting or cutting transients? I’m sure audio engineers have a million tricks up their sleeves for this kind of thing.

    Building an open source digital signal processing hearing aid and having a huge maker community with a ton of different skillsets all playing around with and sharing audio processing schemes feels like a MUCH better way to come up with new, clever, and effective setups than having it all locked down and proprietary…

    1. “it seems like most of the “tweaking” that an audiologist does is simply boosting certain frequencies and cutting others”

      That is EXACTLY what needs to be done.

      Hearing aids do NOT “correct” hearing loss. (Unlike eyeglasses which do “correct” vision.)

      The purpose of hearing aids is to boost the specific frequencies which a person has trouble hearing.

      Do some research on the amazing technology in modern hearing aids. They can do things like in real-time filter out the background noise and focus on the person in FRONT of you that is talking to you, and in milliseconds switch to amplifying someone in BACK of you that is speaking in your specific direction.

      You can “open source” that.

      1. I have done some research on this, but of course it’s nowhere near my technical wheelhouse. I do take some issue with the idea that boosting frequencies is “EXACTLY” what needs to be done. It is an effective first-cut strategy, but there are several inherent issues. One is that simply boosting a frequency band runs into all kinds of issues with background noise, as well as amplification artifacts/clipping/etc. Your point about the need for smarter systems that try to localize specific sound sources essentially acknowledges this. Additionally, when you simply can’t hear a set of frequencies (or your acuity in that band is low enough), you can boost the signal all you want and it won’t make any difference. I think this is what happens a lot to my dad: he can’t hear high frequencies much at all, so he loses the sharp sounds (plosives and the like) that are pretty critical for understanding words. You can boost those frequencies to the moon (which helps him a little) but it becomes very tiring, and of course doesn’t work well with a any degree of crowd noise.

        Add to this that the only way to tweak your settings is by visiting an audiologist (who can at best set up multiple profiles for you to select from in most cases), and there’s just not a lot of room for at-home tweaking in modern commercial hearing aids.

        I’m not implying that modern hearing aids aren’t sophisticated little technological marvels (they absolutely are), I just think that a vibrant haker/maker/tweaker culture might have a role to play.

        1. I agree that a “vibrant haker/maker/tweaker culture might have a role to play”.

          One of my biggest complaints about software is that the programmers don’t have a clue how people will use it in the real world. And don’t even get me started on “designers” (website, graphic design, et al).

          Testing and user input are VERY expensive Overhead items that REDUCE profit. I haven’t come across many companies that do extensive testing. Some companies are offering up “beta” testing, but those that participate are usually “super” users who are already familiar with the products.

          Even “free” volunteer input has overhead costs associated with it, and since I’m from California, a lot of legal liability.

          It sounds like you have experience with hearing aids. You don’t mention the challenge of actually getting your dad to WEAR the frickin’ things so he can hear you…errr…I project my frustration with getting MY child to wear theirs all the time.

          This has been an interesting discussion. I need to take the time to read all of the comments that have been posted since I first read the article.

          1. :thumbs up:

            True enough about wearing them. When he first got them my dad was pretty lazy about wearing them, but as he’s aged they’ve become an almost-constant.

            I also have vested interest in this. I’m almost 40, and my hearing is far from perfect (combo of nature/genetics/too much loud music when I was younger, I expect). I’m hoping that by the time I need them, we have some better, cheaper, more hackable options.

          2. You likely will. The changes between 8 years ago and 4 years ago are amazing. 4 years ago you needed a connector for them to work with Android phones. iPhones were already supported because of Apple’s strict control of over the OS. Now Android is directly supported. My child won’t use them to play music because of how theirs interacts with phone calls. I’m guessing that has been fixed as well.
            I asked in another comment: Why not use hearing aids as high-end earbuds? They have amazing battery life. I’m guessing that they would last all day playing music because they can now last several days on one battery. They do noise canceling and with their open fit design you can easily hear what is going on around you.
            Best wishes on not needing hearing aids for many years to come. But do NOT put off being tested and getting them. Hearing aids are a quality of life improvement.

    2. Several hearing aids (including mine) claim to have directional capabilities and the smarts to pick out the best direction for what they assume you want to hear. I haven’t tried to test the beamforming that they seem to use, and most crowded spaces wind up being a challenge anyways without a remote mic close to the speaker. There is data communication between the two aids that I believe is required to establish phase relationships. For me, at least, there is a great dependency on low distortion levels that I never expected. Picking out TV sound systems isn’t practical without the ability to return them after trial. Then there are the processing artifacts. Two different brands so far have had artifacts I can hear on sustained tones. I believe this is part of the anti-feedback approach used, which is effective with high gains and short feedback paths. They are not objectionable after a few months, but I notice them when they occur. I designed a pitch shifting luggable box for a test on my ex-wife’s father-in-law years ago, based on the old bucket brigade technology (remember them?). It was a technical success but a practical failure, as the sound was too odd for him to deal with.

  7. The article ignores three fundamental points:
    1) the ear-brain combination is horribly non-linear in every way imaginable[1], and the hearing aid has to deal with that
    2) the power consumption is remarkably small, and needs to be given the size of the batteries
    3) a lot of the cost is associated with testing ears, selecting the device, configuring the device, and ensuring it is properly fitted.

    At least the article gives a nod to the concept that amateur amplifiers can permanently dmage hearing

    [1] without that it would be impossible to compress audio, e.g. MP3

    1. I’ve had two hearing aids so far at great cost, and they’ve done dick all. No perceptible improvement in speech recognition, to the point that it’s actually worse with a hearing aid than without! My issue is that one ear is decent and doesn’t need an aid, while the other has been mucked up by a severe childhood infection and subsequent surgeries. This configuration, one good ear and one bad, is apparently the hardest to correct.

      I’m glad you mentioned non-linearity, that’s one problem. Right now, they adjust for different frequencies but for a standard amplitude (i.e. lowest amplitude at which the frequency is detected), and then use the same algorithm across the board to map amplitude-in to amplitude-out. Maybe for some types of hearing loss this approach works, but for me the resulting sound does not sound correct, and the perceived differences means that the good ear input is favored while the bad ear input is discarded as garbage.

      The second problem is the slight propagation delay. It’s only milliseconds, but enough to make it appear that the sound is coming from a different direction. This is disconcerting and I suppose the brain can adapt to this, we do this kind of time shuffling all the time behind the scenes, but the audio quality needs to be improved first.

      I think what is needed is an interface to adjust various input frequency & amplitude pairs so that perceived frequency & amplitude pairs sound the same in both ears. It might mean hours at a console to configure, but with a simple enough interface and some safeguards to prevent over amplification, the user could be trusted to do it himself. I once looked into whether it was feasible, but the manufacturers keep their protocols closely guarded, so there’s no way to even confirm. With a device in the four figures, you don’t want to experiment at risk of bricking it!

      I’ll reiterate that it really sucks hearing out of only one side, e.g. conferences, parties, and just not hearing family members because of ambient noise on one side. If things have changed and some providers are now adjusting for both frequencies and amplitudes, I’d look into their product lines.

  8. Forgive me if I repeat something, I haven’t read the article or the comments yet.

    You are NOT buying the hearing aid, you are buying the audiological support that goes with them.

    For minors in my state they must visit a licensed audiologist which is covered by medical insurance. And you pay “full price” for the hearing aids which are not covered by “insurance” (see my next rant). But, most of the follow-up visits are “free”.

    For adults, most hearing aid dispensers don’t charge for the exam, or it is low-cost. You then pay “full price” for the hearing aids, but again, follow-up visits are usually free for years.

    As I often tell people: It costs $1 for the part, and $9 for the government regulation, potential legal liability for the seller.

    And if you and your commentors haven’t researched the current generation of hearing aids, then you have no clue how advanced they are.

    Bluetooth earbuds and a smartphone. You make me laugh. While that might work for a portion of those with hearing loss, the sophisticated hearing aids available today are modern marvels.

    And hearing aids do NOT correct anything, they simply selectively increase the volume for the specific frequencies that you have hearing loss in. Glasses correct your vision.

    Yes, they shouldn’t cost as much as they do, but the Big Box discounters are counting on you spending $100 every time you visit their store to have your discounted hearing aids adjusted.

    1. “And hearing aids do NOT correct anything, they simply selectively increase the volume for the specific frequencies that you have hearing loss in.”

      That would be admirably served by using “Bluetooth earbuds and a smartphone.” and a little bit of software (and I know it’s little, having implemented FIR filtering which is capable of doing exactly that.)

      1. Shannon and abjq: You both ask valid questions and make valid comments.

        I’ve written a 1,000 word reply and will happily post that if you want to read it.

        Or you can just go out to any of the Big 6 hearing aid manufactures website and do some research.

        The short as I can make it answers are:

        1. If the $30 Sony earbuds are so great, why does Sony make models that sell for $250?

        2. If Bluetooth earbuds, a smartphone (which most people already own), and a “little” software were a practical solution, then why do people buy hearing aids?
        The answer to your questions is the difference between a PSAP and a hearing aid.

        Also, hearing loss is a medical condition. As such, it is different for every individual. And, that individual needs professional assistance to properly correct it. Think fixing that broken bone without medical assistance.

        If you really want to learn more about hearing aids, you could go to a hearing dispenser. Or, better yet to a professional audiologist. Or try to find a forum in which those professionals are asking and answering your types of questions. (Still 200 words.)

        1. The $250 noise cancelling headphones are wireless with all that that necessitates. They also offer better bass response, and they’re prestige items.

          I don’t think bluetooth has anywhere close to low enough latency.

          I also wouldn’t suggest using what I’ve suggested without an audiologist, I’m proposing a hearing aid, not a game.

          1. Two more issues with using standard earbuds:
            1. All day wear. That might mean 12 to 18 hours of ACTIVE use.
            2. Aesthetics and comfort. Most people don’t want other to know they have a hearing loss.

            Although that raises the question: Why not use hearing aids as earbuds? Sure they are $1,500 a pair, but they are unobtrusive and have all day battery life. In fact, they have multiple day battery life and some are rechargeable.

        2. “Although that raises the question: Why not use hearing aids as earbuds? Sure they are $1,500 a pair, but they are unobtrusive and have all day battery life. In fact, they have multiple day battery life and some are rechargeable.”

          From what I have seen, the receivers (“speakers”) have a terrible frequency response, my phonak marvels top out at like 8-10 khz. That is not going to cut it for a discerning hearing person.
          I suppose it is because hardly anyone needing aids hears any high frequencies at all to begin with, and anything above 8 khz does little to improve speech recognition.

          1. I don’t think that was a serious question.

            People claim to have superior hearing, but I’m not sure most need better than 10K.

            But also in reality, most people aren’t going for ultra high fidelity. They’ve got their MP3s and have tossed the good stereo equipment, so they make do with small speakers or headphones, often with bluetooth connect.

            On the other hand, there’s always been the case for headphone as a better “speaker”. They go right to the ear, require little power, and the coupling makes for better frequency response.

          2. Thanks.
            I understand the words (frequency range), just not necessarily what they mean. Now I can do some more research.
            I wonder if frequency response is why my son won’t use his hearing aids when listening to online content and music. He says he doesn’t use his phone clip to connect his hearing aids (4-year old Kirkland) to his phone because it doesn’t do something (can’t remember) if he picks up a call, but it might be something else.
            I have to keep reminding myself that he has NO experience with how anything should work. And he doesn’t interact with anyone who might.
            Unfortunately, he is not very curious to try and discover things.
            For me, this is a “known unknown”.
            For him, it is a “I don’t care about that unknown”

  9. There is a barrier to entry – the medical device approval process – which is littered with costs. The FDA only regulates prescription hearing aids; it does not regulate personal sound amplification products (PSAPs).
    So hearing aid purchased under a health plan for seniors will be costly (depends on your co-pay). Many have low or no coverage under medicare etc. “Medicare doesn’t cover hearing aids or exams for fitting hearing aids. You pay 100% for hearing aids and exams. Some private plans have coverage, but the industry is such a racker that the co-pay is very high.
    If you buy from Aliexpress, you can get a good one for well under $50 https://www.aliexpress.com/wholesale?catId=0&initiative_id=SB_20210201105103&SearchText=hearing+aid

    1. You need to learn about hearing aid technology. More complex than that of a smartphone because they have to do it in a form factor a 20th in size.

      I often tell people: It costs $1 for the part, and $9 for the government regulation, potential legal liability for the seller.

      1. You need to read the article, a hearing aid doesn’t *need* to be 1/20th the size of the smartphone. The role of a hearing aid could absolutely be provided by a phone and headphones that support in-phone noise cancelling. That’s already a thing.

          1. Yes, the microphones are placed where the ears are. The head blocks, so each ear hears differently. And you can turn your head for discrimination, just as people do without hearing aids.

            Running wires to and from the ears may seem okay to many, but they get in the way when it’s necessity.

          2. I wasn’t suggesting going back to wires. Just recalling that some functions used to be done on a separate device.
            You turn your head AFTER you hear. A person with hearing loss doesn’t know because they can’t distinguish it.
            Today’s hearing aids turn your head for you.

  10. Bose Hearphones are (ahem- were) audio earphones targeted to people with hearing loss. My mom uses a pair,
    and they work great- a fraction of the cost of her regular hearing aids, and much better audio quality.

    Unfortunately, Bose discontinued the product.

  11. Most people don’t know enough about hearing loss to talk about hearing aids. Too many do think it’s just a tiny amplifier. “Turn up the volume” may mean hearing the crickets outside more than the quiet talker next to you.

    Hearing loss is about losing frequency response, and dynamic range. And it’s very personal, nobody’s hearing loss is the same as someone else’s.

    Twenty years ago it was still all analog, tiny controls that could allow some adjustment, and which had the potential of getting dirty.

    Digital makes it way easier to customize, and programming is done externally. I suspect a range of hearing aids may use the same hardware, the softare changing the cost.

    Open source onky works if it changes things. Tiny parts, and miniaturization, means you won’t be making your own hearing aid. And most people want them as small as possible, so they won’t be noticed.

    Why don’t hearing aids have bluetooth built in? Mine doesn’t, there’s an external box that feeds the hearing aid via a loop, at 13MHz.

    It’s easy to talk about the high cost, and how easy it would be to make your own, but reality is different.

    1. I’d be interested in your thoughts on my two rants. One above and one below your comment.

      My child’s hearing aids are just 4-years old and they are already “out-of-date”. They still do the job, but the technological advances over the last 8 years are amazing. Even more amazing than that of smartphones.

  12. Health is big buisness, perhaps the biggest. Entire industries being built around it. I’m not sure anything open source could survive stepping on big business toes. I would suspect anything open source that was successful in any way, would be gobbled up by some company. Imagine inventing a new effecient energy source, cheap, easy to build. Put your mind into what would follow. Seems as Charity in one way or another is the only way to tame the beast.

      1. Charity is a topic unto itself. I was really thinking charity more akin to a food pantry-soup kitchen, as a smartly run food pantry gets excellent food by various means, paying pennies on the consumer grade dollar, if not in some cases free by one means or another. This bypasses the beast known as consumerism, and the machine behind it. People come in hungry, maybe need some clothes, emotional support, then leave atleast full, in some cases with a grocery bag, clothing if available. Very good at what it does when the right people, with the right heart, run the show. Problems solved first, with cost taking second place. This is what I mean by charity. As far as hearing aides go, there is a cost behind said hearing aide, understandable, however there is also investors, board this or that, that also requires maximum profits. I’m sure thise who need the aides are very grateful, I’m not sure that should be turned i to extra profit, i.e. not charitable.

    1. Another way to look at it is that medical is expensive. Not just because it’s expensive to the user in the US, but because it’s expensive, period.

      So that really expensive drug that I get every six months, it means I won’t die. But someone had to develop that drug, and test it. It has other uses, but my disease is rare. The cost of development is high, and not a mass of buyers to divide up that cost.

      So maybe drug companies shouldn’t bother for things that won’t give a return?

      (I don’t pay for my very expensive drug, I’m not sure if it’s the government or the same drug company that pays if one has too low income)

      Rare Disease Day is the last day of February.

    2. “Entire industries being built around it. I’m not sure anything open source could survive stepping on big business toes.”

      Preview discussions about open source and code liability (it breaks you keep the pieces). See how those have gone. Medical is liability times two. Business doesn’t want it, but legal and legislative have forced it. Is that what open source wants forced on them?

  13. It’s unfortunate the writer appears to have little or no experience of the products or the process. Effective HAs are designed with moderate to high levels of audio processing, with ultra low current drain, with high build quality to give long life in often high shock and humidity environments. That’s not a trivial design and build exercise. The best HAs do an amazing job. The cheap ones you see in the chattering press generaly do not. At all.

    A majority of users are elderly. The time required to select and fit aids properly costs. You try fitting your home designed amp to your geriatric aunt and stay on speaking terms. I dare you!

    That said, the industry structure allows for poor performance and excessive profit by those seeking a swift return. Not the only industry like that. The usual approach to seeking out the reputable experts in a pool of average performers and a few sharks is critical.

  14. So the misterious time traveller woman might be wearing a primitive hearing aid apparat instead of a cell phone, huh? I should have suspected that it would be difficult to time travel the rest of the cell phone structure, lol!

  15. Listening thru bluetooth is like having mild hearing loss. I have to tell the other end of a call to please use the phone direct and not that crap. The stereo version of BT is only hifi at 5.0 not the prevailing 4.0. Using any stereo version of BT will have a delay period! Weird effect for sure, reading lips is impossible. I couldn’t watch TV like a friend does where the audio and video never is in sync because of optical connection to the amp.

    Mention of hearing damage from bad hearing aids. What about the damage to and from the sound it self. Pink noise is what exists in nature and in good mixing and recording. Since the 80’s the curve has moved up to white noise. This means up to 2 orders of magnitude MORE at the top end! Stinging treble is the norm in mixes, specifically on the radio or when MP3’s turn the treble definition into noise. Even the CD wave standard has the top third of the spectrum “pixelated”. I have noticed that high def audio if done right gets back to the natural pink noise curve.

    I had a spaced stereo pair of omni mics mounted on the headband of heavy Koss phones and a portable cassette deck in the early 70’s, I’d rig it up and let a friend with nerve loss hear the bird symphony he couldn’t hear. Back then tweeters didn’t call for power handling equal to woofer ratings because no media or producer would allow such hearing mayhem.

    NOISE $ELLS!!!

  16. Geez…. You people already covered the obvious low-cost technical solution:
    https://hackaday.com/2019/03/01/meet-tympan-the-open-hardware-hearing-aid

    Eight years of flight-deck and flight-line/mortars/rifles/pistols/machine guns followed by ten years of tanks/AAVs/LAVs/LCACs followed by twenty years in loud factories resulted in the poor hearing I have today. During late 90s, designed an analog solution that worked for speech comprehension in low-noise environments. Each successive design has had to mitigate increasing and more complex hearing loss, and each iteration had more DSP and less analog front-end stuff; that is, more code and less hardware. But the main difference for each successive design has been the cost reduction. Good op amps are less expensive, PCBs are cheaper and easier, transducer performance has increased while cost has significantly decreased, and batteries are better for same or less cost. The BoM for my first device that was actually used was approx $145 USD. My current device is a bit retro (larger than previous generation) with a $78 USD BoM.

    My only two commercial hearing aids were via the U.S. taxpayer (VA) and were not generally useful and not reliable for my various work environments. Out of 17 people that I have talked to, none have expressed satisfaction with their commercial hearing aids. I may have technical degrees, but I know very little about audiology, but my stuff works for me. Methinks that this particular segment of the health ‘care’ industry does not smell good and needs to open the windows and let the stench dissipate.

  17. Feels to me like Apple could help out here. The Airpod pro has all the basics necessary for a really good hearing aid – a microphone, a headphone, a battery and a big fat processor

    All they need to do ™ is add a “hearing Aid” mode to the setup software.

    That way there is no stigma because we old hard of hearing folks will look exactly like the young hipsters sporting their cool headphones.

    1. Most of the current-gen TWS have smart processing. Even my cheap Galaxy Buds (Plus) which are about 50$ now.
      But, most earpieces are limited to 80dB(?) due to regulatory reasons and I doubt they could exceed that even when uncapped. And there’s a significat reduction in battery life at high volumes, not that it would matter, for that price.

      But one of the biggest issues I’ve had, which I seldom see discussed here – all earphones I’ve used fall out even with moderate movement, most of them without any movement. I don’t have hearing loss (yet) but I could see a struggle in the future if we move to mass-produced hearing aids.

  18. This is a personal and aggravating problem for me. Born 90% deaf, had a surgery for a bone anchored hearing aid and was featured here with a little fun hack I did utilizing the implant. I no longer have the hearing aid, just the magnet buried into my skull. Processor got bumped by a door and broke into a million pieces, was so deflating. I just sat down and stared at it. Didn’t cry but wanted to cause that thing was $5,000 USD. Basically totaled a used Camry with no insurance and no hope of getting another one.

    I’ve experimented with my limited knowledge of electronics, bought some small amplifier module mated to an electret microphone, 18650 battery and charger module. With a male-to-male 3.5mm cable running to a surface exciter as the transducer, that sticks to the magnet on my head. it worked really well. Just not small/well crafted enough to want to use. Makes ya really stand out in a crowd with wires hanging off the back of my head!

    Occasionally I revisit the project looking for tiny bluetooth boards, but typically I just try not to think about it at all. Bums me out.

    1. That’s interesting, wow you’re not wrong though, any discussions about it seem to spin off into the woo weeds real quick. So potentially some principle of deep nerve modulation behind it. I am not surprised it got treated badly though, suggestions that there was any possible electrical interaction with the brain or nerves was aggressively railed against until closer to and into the millennium, I’m surprised that modern electroencephalography got as far as it has in that climate. It got so bad, that you had people trying to explain Galvani’s frogs legs thing as a pure ionic electrochemical effect (of course that would be part of how the probes couple to the flesh)

      You know what was so absolutely weird about that, you had “science”, not really science, more like the science-ism fan club, making claims like bodily electricity was mysterious and unknowable, i.e. that it couldn’t interact with known electricity, and obeyed different rules. Well of course this pretty much set the paradigm for discussion and we were off into crystal electricity and aural bodies etc.

  19. Having read many of the comments here, I feel the need to jump in. I am an audiologist with over 30 years of experience in fitting hearing aids. To be a licensed audiologist in the U.S., one must have at least a Master’s degree and today all graduating audiologists from accredited graduate programs will have a doctorate degree known as an AuD. Audiologists work in a variety of settings and many fit and dispense hearing aids. And, in most states you will also find licensed Hearing Aid Fitters who have satisfied whatever requirements their state has in place. When it comes to hearing aids and hearing aid technology, the average person underestimates the very specialized technology currently available in hearing aids. A state of the art hearing aid today is a sound processor making, literally, hundreds of thousands of calculations per second in order to determine the characteristics of the incoming signal. The classification and processing of sound is based on frequency, direction, duration, and decibel input all relative to an individual’s specific hearing loss. In most cases, information is shared between hearing aids. Many of today’s best hearing aids have sound classification information stored on the microchip in order to rapidly process the signal based on its characteristics with the goal always being to maximize the speech signal in the presence of anything that doesn’t have the characteristics of speech. The same is true if the incoming signal is music. In many hearing aids, the processor will classify music with the goal of maximizing the audibility of the music without some of the filtering that may otherwise be occurring in the hearing aid. Hearing aids today have dynamic directional microphones, frequency shifting, multi-channel compression, noise reduction for steady state and transient noise, anti-feedback circuits, tinnitus maskers and many features too numerous to list. Bluetooth technology is also fairly standard. Because of the many and varied adjustment handles in hearing aids there are almost an infinite number of possible combinations of settings. And while it isn’t literally infinite, I can safely say that with the advent of fully digital hearing aids I would have no two fittings that would be identical with regard to programming. And I fit several hundred hearing aids a year. Hearing aid fittings are far more prescriptive and individualized than people realize. The hearing aid industry does lack transparency (partly due to the complexity of the technology) and, sadly, has its share of opportunistic sellers. However, there are many qualified, knowledgeable and honest professionals in the field. And, hearing aids come in a wide range of prices. Hearing loss is a serious issue with many negative consequences and should not be treated as anything less.

    1. I do not doubt your sincerity, but from a geek point of view the technology is unimpressive, and replicating it for hundreds or thousands of people is trivial. If you fit several hundred a year let’s say two a day, at four hours each, and you have a $200k/year salary (that’s $100/hr) then the cost of paying you is $400. Let’s add 25% markup, so that’s $500. Let’s add $500 for a microcontroller in a plastic case, with a battery. That’s $1000. Let’s double that for contingencies, and I still only get $2000. Where is the rest of the value? The manufacturer has other customers besides you, so they can amortize their development costs over your 500 customers and everyone else in your country (or the world). Please don’t get me wrong, it is not a personal criticism, it’s just looking at the numbers and wondering why these things cost more than a car. Frankly we should be paying you your $500 for 4 hours’ work to set it up and another $50 for the hardware. Still expensive, but not unaffordable.

      1. Indeed, we’re only talking about audio frequency processing here, up to 20kHz, if you compare it with the equalisation and filtering you have to do at 270kHz just for GSM in a 1990’s mobile phone, much less a smartphone doing LTE, it’s small beer. Although it is miniaturised.

        So I guess what we need is an “open source”-friendly audiologist to help with the project. But – who would break the cartel and weigh in with detailed advice???

      2. Well, in my offices, a set of state of the art hearing aids runs about $5000.00, so you’re not too far off. But, I can tell you that I make no where near $200,000.00 a year. The average annual salary for audiologists runs around $78,000.00 and a minority are in six figures. VA audiologists are some of the top paid in our profession. The cost of the devices from the manufacturer is where the biggest factor exists. For me, when I think that merely 20 years ago I was adjusting bass/treble and peak-clipping trimpots with a jeweler’s screwdriver and telling people that, yes, your hearing aid will squeal when you put your hand over it, the current technology is impressive and has resulted in the highest rate of satisfaction with hearing instruments the industry has ever seen. Most manufacturers are spending at least 70 million a year in R&D. In 2019, there were 4.3 million hearing aids sold in the U.S.

        1. This is excellent information, but it makes the numbers look worse. If we reduce the salary component to 100k ($50/hr) that’s $200 for four hours. Let’s add the same 25% for overheads, so we’re at $250. Now we can add the plucked-from-thin-air figure of $500 for the hardware. I’m at $750 now. Double it because I’m feeling generous: $1500. Now it’s $500 less than my previously padded estimate.
          And the R&D costs of $70m per annum amortized over 4.3m customers is about $16. So of my random figure of $500 for the hardware, $16 is R&D.
          Again, this is not a personal slight, and I am grateful to be operating on representative numbers, but surely you can see why some people think there is a huge discrepancy between cost and price. Which is what the article is about.

          1. Yes. I knew that would shift your numbers in the wrong direction. I do understand the argument about price. And I do not take those questions personally. I think good hearing care professionals are in tune with that concern and I always strive to work within the budget of the individual I’m fitting. In some cases, hearing aids can cost as little as $800 a pair. But, I think those who believe they’re going to be satisfied with over the counter amplifiers and/or headphones to solve their hearing loss will be less than satisfied with the results. And, it isn’t practical in most cases. There is no doubt the hearing aid industry lacks transparency and I feel sorry for the buyer. Because of the complexity of the ear and hearing and the myriad of hearing aid choices, it is very confusing. But, it is important to find a hearing care professional you can trust. In recent years, audiologists have taken a beating in mail-order hearing aid advertising and social media and I do take that mischaracterization very personally. I do not know any audiologist who is living a life of luxury. Most audiologists are women who were drawn to fields in higher education in which they could help people. The bachelor’s degree in the field is usually in Speech Pathology and Audiology. Do you think anyone majors in that because they have designs to go out and bilk your grandma? The idea that we are out to take advantage and gouge the public would be laughable to people if they could spend a weekend at an audiology conference. Thanks for the good conversation, Andrew. I’m glad there are people out there who are interested.

  20. I thought the price is outrageous, until my mother got two devices. Now I think the price is completely justified.

    First of all, the devices have to be very carefully calibrated for each ear, to amplify only those ranges that need amplification and nothing else. If everything is amplified, then it can actually worsen the condition. And then they need careful recalibration, as the user gets used to them.

    Moreover, they are molded individually to fit into the ear canals. It is absolutely necessary, as we found out. My mother’s ear canals began changing due to the use of the aids, the aids did not fit that well and she began to experience nasty feedbacks. She is now on the third set of molds, for which she was not charged separately.

    The only thing that is actually outrageous is the price of the batteries, if you buy them through recommended channels (i.e. if you buy them at the specialist who fitted the device). They have large markups for those. But this can be solved easily.

    1. I bought Amazon brand hearing aid batteries in late 2019. About $20 Canadian for I think it was 60 batteries.

      They last as long as name brand, and I’d get about two packs for the price.

      One lasts a week or ten days, and all have been fine.

      1. Just letting you know, your results will absolutely vary. One of the biggest issues with hearing aid batteries has to do with storage conditions and time. If they are stored properly, and they are fresh, you’ll probably be good. But as experience would show, generally the bigger the store you’re buying from, the more issues you will have because of potential storage issues. Heat, cold and moisture will kill even a brand new hearing aid, so if the storage conditions aren’t climate controlled, the stickers will allow oxygen penetration and will partially activate, giving you a partial charge.

        Thankfully hearing aids are now able to have Li-Ion rechargeables(granted there are a lot of them out there that are still low quality ones), so we can get away from the disposables.

  21. As another Audiologist chiming in, you are not factoring in any of the R&D on the algorithms that are ever changing with more research, the malpractice insurance that is required to be held that is ridiculously expensive, the other employees at the office or clinic that need to be paid, the lights that need to be kept on, the regulatory expenses for FDA approval that needs to be done for each device, etc.

    As a long time Hackadayer, these breakdowns and cost comparisons have always driven me crazy, because it’s not as simple as just throwing the hardware together. IIRC the components that make up an iphone cost less than $500, go ahead and make it… IMPOSSIBLE! You might be able to make a very shitty version of it that doesn’t run the same software, doesn’t have the same shiny look, isn’t as reliable, falls apart, etc, but hey, You have an iPhOnE cLoNe! All of the time, resources, engineering, research and actual real working knowledge of the field/product are going to dictate if that is actually going to work the same or as necessary.

    A hearing aid to someone that doesn’t know anything about hearing loss(which reading through these comments is extremely apparent that even though you guys/girls are very smart in some ways, are completely oblivious in the field of audiology and medical related help). Hell, if everyone did what many of you are suggesting that you would do worked, every one of my patients would be perfectly fine with just cranking their TVs up and having people raise their voices, but guess what, that doesn’t work. There is an enormous reason why patients of mine that have been wearing hearing aids for 20/30/40/50 years ogle on about how much better hearing aids are compared to the shit of yesterday that they had to wear(which, in a similar comparison is what you all are pretty much suggesting with your “genius” ideas of just using an amplifier or cranking the volume on bluetooth headphones). And why even currently there is a huge difference in sound quality and capability between entry level and high tech in terms of sound quality and capability of hearing in more complex situations.

    At the end of the day, like so many other fields, you get what you pay for. However, with hearing, if you don’t properly prescribe the issues, bigger issues will arise. Look up the links between untreated/undertreated hearing loss and memory loss/dementia/Alzheimer’s and also the loss of speech discrimination(understanding). I unfortunately see people every day that thought they could find a way other than hearing aids to solve their issues that made much bigger problems for themselves by not doing what was necessary. Good luck to you all, you’ll need it with these mindsets.

  22. Here’s an article that seemed relevant to this discussion.

    https://www.bonappetit.com/story/just-buy-it-lodge-dutch-oven/amp

    You Need a Dutch Oven—But It Doesn’t Need to Cost $300
    You can get a good Dutch oven for the price of a pair of jeans*, and you’ll use it every day for the rest of your life.

    There is a certain amount of “brand” in the price of hearing aids. Costco’s Kirkland ones are made by one of the Big 6 manufacturers but cost about half of what the brand name ones do. But Costco expects you to buy $100 worth of stuff every time you come in to have your hearing aids serviced. Not often, but 3 or 4 times a year if you are wearing them daily and want to keep them in peak condition.

    *ROFL The writer says they don’t need to pay $300 for a fancy name brand (Lodge is THE brand in cast iron) Dutch Oven, but they are willing to pay $100 for a pair of jeans? I’m not sure about y’all, but if I pay more than even $30 for jeans, I’m livin’ high on the hog. A nice thrift store pair will do me just find for under 5 bucks.

  23. I’m working in the hearing aid industry and what’s described in the article doesn’t show the full picture.
    Hearing aid companies don’t sell their devices for thousands of dollars. I obviously can’t give you any exact numbers but I can tell you that the average selling price per device is far far less then $1000.
    The majority of the price is added by the audiologist. And they don’t do it for just for fun either. When you buy the hearing aids, you get extra services with it. For the lifetime of the devices you can go to your audiologist and for no additional cost:
    – get devices adjusted as needed
    – repaired in case of a defect

    Imagine the same for going to your car dealer and getting you car fixed for free. Wouldn’t you pay extra for that?

    That being said. I agree that the prices of hearing aids are very excessive on the consumer market.
    And there are new options on the horizon. Some countries already have “over the counter” hearing aids allowed. And other countries like the US are working on that too.
    This segment will be priced significantly different because the “middle man” (audiologist) is less or not at all involved in the process.

    Please do your research properly before posting half information that is misleading.

  24. There was a recent NYT article on the cost of hearing aids. It may have been linked in the above comments, but I didn’t see it: https://nyti.ms/3qT0zxb

    I’ve had mild-to-moderate hearing since an early age. I have the common “banana curve” loss of frequency-where I can’t hear high pitches very well but lower bass fine, due to those frequencies being on the outer part of the cochlea and possibly damaged from something. My siblings hearing loss too. It could be genetic, although I do not know anyone else with the family hearing condition. When I was on my parent’s insurance, I was fitted with nice analog, and later digital hearing aids in both ears. I can definitely say that custom fitted (pr at least reprogrammed hearing aids with a custom mold (for inner ear) hearing aids are more fine tuned for one’s hearing loss. It is like a prescription pair of glasses. Obviously you wouldn’t want to have blurry or strong prescription glasses. The cost of reprogramming hearing aids and getting a new mold is cheaper than buying new ones, so if you know of someone with hearing aids that they no longer use, I recommend buying them- my sister gave me her old digital ones because she bought new ones, and they still work after 10 years- the brand is Audina I think.

    That said, in recent years, working from home, I’ve not really felt the need to wear hearing aids. I still need to hear things that I might not (like an alarm or beeping noise), but otherwise I am not able to hear every sound that I “should be.” As for concern about appearing weird in public with large hearing aids, that no longer bothers me (when I was in elementary school, it was possible to feel more stigmatized, though).

    About 18 months ago, I bought a cheap pair of generic headphones. They are nothing compared to finely tuned digital ones, but they are 20x less in price: https://www.amazon.com/Digital-Hearing-Amplifier-Enhancement-Rechargeable/dp/B07814NYHM/ref=cm_cr_arp_d_product_top?ie=UTF8 I around $40, but since they amplify all sounds, I can’t wear them for very long, because it will cause ear pain, like any prolonged loud noise- they are more of a quick and dirty solution for hearing something, because I only need to amplify specific frequencies, not the whole scale. One thing I like about them is the rechargeable batteries, which is made affordable and replaceable with any mini-USB charger.

    If you can afford to get custom programmed hearing aids, it will be worth it- it’s also a good habit to wear them when outside, but the sounds of wind will not be filtered unless you have higher-tech ones. Driving with hearing aids is also an issue if the sounds are not reduced.

  25. > “…so why do modern hearing aids cost thousands of dollars, and why can’t they seem to go down in price?”

    tl;dr: abridged version – Because people need them, the corporations know this and charge accordingly. Just like every thing else in the medical industry, price is based on lawyers, insurance and vacation homes in Aruba. Patients be damned. Before I “offend” any of the ethical medical community here, understand that this is a generalization and as such does not apply to everyone with a broad stroke. Nevertheless, it is what it is.

    Three stories:

    1) I shattered my arm. The doctors gave me three choices – we could put a cast on it; we could insert a rod; or we could “do nothing and see what happens.” No lie. When I chose the rod and was presented with a $20k bill, my friend (who was studing to be a doctor) said, “yeah… and what is that arm worth?” Really? That’s how we base cost?

    2) I needed a small procedure. The doctor was going to do it for a couple hundred dollars. No problem. I have no trouble paying someone what their time is worth. The problem? He needed a room to do the procedure and the local hospital wanted two grand to rent that room for a hour or so! No one sees a problem with that math, I’m sure.

    3) Girlfriend had severe pain in her back. Turned out to be sciatica. Anyway, went to the emergency room and the doctor literally talked to her for five minutes. No tests. No probing. No nothing. Just talk. A shot of pain killer and another of muscle relaxer later and we’re out. We pay the $200 emergency room fee. A month or so later we get a bill from the doctor. You remember him? The one that talked to her for five minutes? Yeah… him. That bill was for $1000. For talking to her. For five minutes. You do the math. And before any of your say “well, he knew what to do” and “you’re paying for the knowledge”…. yeah. So did I. Before we even went, I told her what was wrong and the drugs she needed. But since those drugs are locked down, you HAVE to pay some quack to prescribe them.

    The medical industry needs an overhaul. Not with forced insurance. Not was “free” medical (which is NOT free since you still pay for it with higher taxes). What is needed is regulation. Prevent drug companies from highway robbery for life saving drugs. Prevent overcharging by “doctors” just because they know that the insurance companies will pay. For that matter, destroy the insurance industry. Stop ridiculous malpractice suits when there is none. THEN medical price will be reasonable again.

  26. I read a lot of comments that miss a significant characteristic of hearing aides: equalization. Without equalization, it doesn’t matter how much you amplify the audio – speech still unintelligible. (Speech is considered to span 300-4000Hz.)

    I have moderate hearing loss, and aides to help compensate (they came with a remote control / bluetooth bridge). My loss is such that I need extra gain starting at 250Hz, ramping to +20db at 4kHz, then remaining at +20db to 16kHz (there’s almost no above 12kHz). The equalizers in my desk PC and media TV/stereo are unable to provide that equalization (and the TV/stereo is shared with others).

    My workaround is to insert a 9-band graphic equalizer (Behringer MiniFBQ) into my headphone chain. The PC audio output drives the equalizer which drives a headphone amplifier. For the TV, the optical audio output is used to provide a line level output, then to the equalizer/amp as before. These work well, but are at their useful limits. The equalizer available in my Android cellphone is barely adequate.

    I’m looking at building a portable headphone equalizer/amp for use with my cellphone. You see a lot of these in similar applications to drive high end headphones, but these provide only gain. I’ve considered replicating a 5+ band graphic equalizer (too complicated to miniaturize), and a parametric equalizer (gyrator with freq tuning and a Q control – poor tuning and low gain, though the Q does broaden response at the expense of gain). I’m now looking at a state-variable filter (often used as a parametric EQ). Spice simulation in Altium helps.

    I haven’t excluded the DSP path, but this can be a power demanding solution. There is a “minDSP 2×4 HD” device that accepts stereo line audio, USB, and optical inputs, and processes digitally for 4 analog outputs. That would let me play with DSP processing before committing to a digital solution.

  27. OK. I repeat, “There is nothing new under the sun. Ecc. 1:9”
    I asked the question: Are hearing aids an alternative to earbuds for those with “normal” hearing?
    The search I did was slightly different but the top results were all about earbuds replacing hearing aids. In fact, the date on one was 2017.
    Of course, all of the top results are biased toward earbuds replacing hearing aids. I contend it is because those writing the articles have no clue about the why and how of hearing aids.
    It will take a bit longer to dig through the results to find an answer to my question.

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