I have been thinking that it might be time to get a hearing aid, so I was pleased to hear this:
The F.D.A. has now taken a final step that could put more accessible, and potentially less expensive, hearing aids in stores by the fall. People seeking out hearing aids will no longer have to be examined by a doctor first.
“As early as mid-October, Americans will be able to purchase more affordable hearing aids over the counter at pharmacies and stores across the country,” President Biden said in a statement.
....The new F.D.A. rule applies to adults ages 18 and older with mild to moderate hearing loss. People with this type of hearing loss may struggle to hear conversations on the phone or in crowded places, and find themselves consistently turning up the volume on their computers or televisions. They may have a hard time distinguishing between voices when multiple people speak at once, or right after each other, and strain to understand people wearing masks.
In my case, I'm not sure my hearing has deteriorated much over the past few years, but it's been a little sketchy for a while. Unfortunately, although modern hearing aids are supposed to be very good, they also cost a fortune: Around $1,500 for a low-end pair at Costco all the way up to $3,000 or more depending on what brand and features you want.
So I'll happily wait until October or even later to see what the market produces when it's unleashed to reach its full potential. Unfortunately, I see two ways for this potential to be unleashed:
The good. Reputable manufacturers produce high-quality products with an impressive range of features and charge only a few hundred dollars per pair.
The bad. Dodgy manufacturers, with no audiologists standing between them and their Parade/AARP/Fox News audience, produce lots of junk that's marketed with loud, misleading ads.
As always, I suppose the answer is that we'll have to take the good with the bad. The sad thing is that well off, well educated folks will mostly get the good, while poor, undereducated folks will mostly be the target for the bad.
I can hear just fine.
I just can’t understand the words.
I’m going for the long periods of silence in my golden years.
Mainly cause every time I’m around a noisy place I end up with tinnitus the next day.
Hearing aids are cheugy.
And now a PSA:
If you're going to the hospital, please wear your hearing aids. We hate having to shout questions about your bowel habits and what-have-you to the entire ED.
You gotta go to the hospital if you've got ED?????
My father gets his through the VA, free. And it's good stuff.
When we got some for my mother, it was $4k for pretty average stuff.
I foresee them in my future because there are times, events, high pitched voices, where I struggle to hear.
Some of my grandfather’s happiest moments involved turning off his hearing aid when my grandma yelled at him. “Don’t you turn your hearing aid off on me!” [Charlie brown trombone noises]
What degrades with age is not the sensitivity to sound, but the ability to separate signal from noise. The problem is not in the ears, but in the brain. Hearing aids therefore do not do what they are wanted to do, because they amplify everything. More signal, more noise; and the noise, once amplified, may punch through the threshold that the brain had established through training, so you are actually worse off than before.
You managed to get everything wrong. It really is that you can hear less. And modern hearing aids don;t amplify everything. A good audiologist can measure exactly what you can't hear and set the settings on the hearing aid to mostly amplify that,
Yes to the audiologist comment. They test your hearing and can program your hearing aids for each ear separately. I've had mine for about 4 years and they're very helpful (age 74-5). It is a relief to take them off in the evening, though. And I turn them way down when I listen to headphones.
You can also set them to deaccentuate (?) restaurant noises like clanging silverware. But general hubbub in restaurants and bars overwhelms hearing devices.
My audiologist said some neurons atrophy if you stop activating them due to hearing loss. So there's that. My wife has them, too.
As for Costco, the price is right, but depending on the store you may not be examined by an actual audiologist. You could probably buy some there and get an audiology appointment someplace else to get them set appropriately.
I'll defer to my experience, thanks.
I haven't looked at the particulars on this, which do matter. FDA has a tight set of rules for devices, which manifest in what medical claims a company can make, how it can advertise a product and how it can ship the device for commercial purposes. How this new "rule" or maybe "exception to existing rules" actually functions will matter.
The FDA could change how its rules/regulations classify hearing aids, making it substantially easier to get approval.
The FDA could hold hearing aids to the existing standards for testing but allow for wider "indications" that circumvent formal diagnosis, allowing lower-but-not-horrible quality devices onto the market for general use.
The FDA could be required to approve hearing aids marketed solely for mild/moderate hearing loss without requiring any testing, which is the nightmare scenario.
Yeah this is a continual problem with capitalism, even if the alternatives are worse. Still, there is a way to weed out the crap: places like consumerreports.com
As someone who will need hearing aids for the rest of my life to mitigate tinnitus and some hearing loss, this will likely also push down the costs for people buying doctor/audiologist prescribed hearing aids. The top of the line stuff cost me about $5K almost 2 years ago, paid for by my private insurance. Since Medicare does not pay for them (thank you Senator Manchin for shit canning previous legislation which would have expanded Medicare coverage), I will be going to Costco for replacements. CR has rated Costco No. 1 for price/service/products for hearing aids.
"The sad thing is that well off, well educated folks will mostly get the good, while poor, undereducated folks will mostly be the target for the bad."
I miss Consumer Reports. Are they still around?
https://www.consumerreports.org/
As far as I understand this situation, the main target group here are those who would be diagnosed with "presbycusis," which basically means old ears. With age, there tend to be physical changes that raise people's physical thresholds of sound perception, and in the vast majority of affected people, something over 80% I believe, the frequency ranges and pattern involved are very similar. Bill Clinton was affected by this during his term and there was a lot of publicity about it then as "rock 'n roll ears" or something like that.
Plenty of other issues can cause hearing problems (as I know from long personal experience). But when you have such a huge concentration of people with one issue that's well-mapped, the theory is that an approach like this makes sense to try. Manufacturers have seen this coming and some tried to stave it off (or address it, depending how you roll) by selling what amounts to standard-profile hearing aids for a lot less than the full-featured ones.
But they've still had to sell through audiologists, which limited how cheap they could go-- a huge chunk of what I pay at retail is really for audiological services and follow-ups over several years that you'll have to pay for separately if you buy OTC-- and meant people had to go where they might feel icky and self-conscious about what they had to do. But still, it makes sense to try it, even though it really will hurt the audiologists.
The danger, as people are pointing out, is that it's essentially self-medication. That means people can be jerked around and can easily let themselves be jerked around, just like with dietary supplements (wait for the Alex Jones line of alien-safe hearing aids-- at least his audience won't have any trouble hearing his pitch!). You can do pretty decent basic self-testing remotely on the computer-- and if I was in this group of people I would avoid like the plague any seller that didn't start with this-- and should be able to get decent results for the vast majority of people whose problem is presbycusis. Certainly better than the "personal sound amplifier" devices that've been legal over the past few years. FDA does still need to make sure OTC hearing aids are actually hearing aids.
Still, the best hearing aid is the one that's getting used. What happens with most of them is they get tried for a while and then left in a drawer. They can take a _whole lot_ of getting used to and people need to have good reasons to go through the pain of changing the way they hear and listen. For huge numbers it ultimately just isn't worth the effort. Maybe people who self-medicate this way will have more skin in the game and more reason to follow through. That would be a big improvement for them.
What frankwillhoit is referring to is a separable issue that amplification won't cure, though I think it might help with because the effort just to perceive sound can be taxing enough to interfere with understanding speech. Presbycusis, afaik, is about physical perception thresholds.
So, I mean, how come Apple ear buds are around $200, and what appears to be lesser technology is thousands of dollars?
I have not tried out my Mom's hearing aids, but just looking at them there cannot be that much technology in the small pod which goes behind her ear.
I get the audiologist angle, but one would think in 2022 you could just have something like an earbud with an internal equlizer and then anyone could self adjust it.
Most people would self adjust it to the point that they were destroying their hearing.
Those ear buds are just a cut above the level of the "personal sound amplifiers" they sell on late-night TV. You might be surprised at just how much sound processing goes on inside those pods-- not just EQ (very narrow-band), but compression, soundfield shaping, noise cancellation, speech isolation, and so on. The white papers on manufacturers' professional sites can be interesting reading if you're interested.
Kevin's option B will be the early winner and quickly drove those companies attempting option A out of business.
I wish they'd invent hearing aids that didn't need a battery change so often. It's a PITA helping my mom change hers but it's far worse without her hearing airs - they stopped working and Costco had to send them away for warranty repair.
Changing the batteries really is a gigantic pain, agreed, and especially if dexterity is an issue. I hate doing it and have had the batteries die on me in some pretty embarrassing circumstances. The major manufacturers do now sell rechargeables, which are like phones in that they need to be charged every night (they swear there's more than enough juice to get through the day). Usually they'll be put into a charging case, which makes them easier to keep track of. I have to say though the model I looked at several years ago was a tight fit in the charger and getting them out was like pulling the sword from the stone. I'm thinking they've fixed that since. Hoping, anyway.
I'm thinking these must be all in the ear? Otherwise they'd have transferred the programming to loaners.
My Oticon hearing aids use batteries. I typically get about 3 days out of a battery, so about every 3 days I change two batteries. The batteries are fairly cheap. Costco has a good deal on them. Roughly 10 cents each.
My daughter just got hearing aids with rechargeble batteries. She puts them on the charger each evening. Hasn't had them long enough to know how well this works.
I must be using way bigger batteries-- they last me about 2 weeks, probably 12-15 hours a day. In the analog instrument days a failing battery would fade out over half a day so you had plenty of warning and time to change it. With digital ones you just get the dying-battery beeps and they're gone in less than half an hour no matter where you are or what you're doing. I'm going with rechargeables next time, would have last time around except they didn't have room for telecoils, which I needed.
People who get shitty Fox News hearing aids won't be able to hear what Fox News is shouting at them.
I consider that a feature, not a bug.
I rely on the WIrecutter App from NYT…I’m certain they will give a good assessment on the hearing aides. And it’s free
I'm going to go a little contrarian on Kevin here. Hearing aids are overpriced in the US, but not by the factor of 10 that seems to be the general view. I think it's more like a factor of maybe 2. And that's for two reasons.
One is that the market-- ie the people who need them-- is wildly asymmetrical. There's the great bulk of people with presbycusis, on the one hand, who need volume and some curve shaping but whose parameters are overall very similar, and the much smaller range of people with more specific issues that need a much more sophisticated approach. It's taken audiologists and manufacturers decades to understand what that market really looks like.
But the other reason bridges these market segments. It's that amplifying ambient sound for delivery close to people's eardrums presents great difficulties for the listeners, and those difficulties are further complicated by additional peculiarities in the way that second market segment responds to amplified sound. Idiosyncratic reactions require greater capabilities, which benefit all market segments.
That point about amplifying ambient sound means that hearing aids are fundamentally different from headphones in function. You normals can get an inkling of this, assuming your smartphones will do it, by using their mics to feed your ear buds with what's going on around you. I'd bet dollars to donuts you'll be blown away by how loud and sharp and annoying ordinary clattering and clicking and background noises will sound. Anything you're actually interested in hearing will have to be picked out from that mass of sound. That's the difference between hearing aids and headphones.
And that's why manufacturers invest a lot of resources in developing tricks of sound processing and psychoacoustics. Some put a lot more into it than others; European government healthcare tends to pay for hearing aids so a lot of the more aggressive development happens there. But they've all gone digital, even the me-too makers who let others do the developing, precisely because of the sound processing it allows, the sound processing that mitigates the worst aspects of amplifying ambient sound and makes that sound tolerable for more people and that is more effective at isolating speech from other ambient sound and presenting it in intelligible and usable form. It really isn't just volume.
Developing and testing these techniques takes time and money and it's continuous. Also, most adults want hearing aids to be as inconspicuous as possible and that's another limitation that worked for decades against effective hearing aids, but smartphone miniaturization has spilled over to help that along immensely. (Gaming sound effects have had a role here too, I think.)
So in addition to paying for the audiological services, I'm paying for the long-term and future development of instruments that will do more to mitigate the problems inherent in amplifying ambient sound and blasting it on my eardrums, and that may actually help me with understanding what people are saying. What makers have been doing to deal with my segment of the market has let them identify and understand the presbycusis segment and develop what it needs, so there's important interplay, and they wouldn't have known what to do for the presbycusis market without all the development that came before.
Most people do not want, or need, simple amplification. 50 or 60 years ago it was all that _could_ be done but we've moved on, and overall with good reason. There are some people in some situations where amplification is enough-- I'm thinking of my friend's mom who doesn't leave her assisted living facility and who's very happy with a simple headphone and body mic because it's simple and not finicky and she can use it when she wants to-- but most people don't tolerate it well and ultimately won't use simple amplification devices.
That's why the FDA still need to regulate these devices and how they're sold. I hope it can resist the inevitable pressure from QVC vendors for $20 "hearing aid earrings" or whatever.
What?
"The sad thing is that well off, well educated folks will mostly get the good, while poor, undereducated folks will mostly be the target for the bad."
This is the case with almost everything.
Moving on, I think I like the idea of having less restrictions in this area. It seems like there have been some pretty good technology developments in wireless headphones, and some of that probably translates over well to hearing aids.