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>Experts don’t know exactly why hearing aids are still so costly No, they do. The short answer is: you need to develop your own custom IC's that 1) have analo

>Experts don’t know exactly why hearing aids are still so costly No, they do. The short answer is: you need to develop your own custom IC's that 1) have analog circuitry 2) support Telecoil[1] - an ancient induction standard from the 1970's 3) are made by 1 of 4 companies in Copenhagen or Switzerland - one of which has 55% market share and 4) run on fumes. Seriously, the crest factor on these is ridiculous. The long answer is available in this great podcast episode: https://theamphour.com/338-an-interview-with-jorgen-jakobsen/ https://theamphour.com/338-an-interview-with-jorgen-jakobsen... Of course, Bluetooth alternatives to hearing aids are being developed. People in the industry know this and joke about it. But, crucially, they can't be called "hearing aids". It's a protected term. An interesting example are Bose's new $500 "Hearphones" strongly targeted at an older demographic[2] with features like Bluetooth and tunable noise cancellation based off their earlier $300 QC30 dynamic noise cancelling platform. But also not the exact same use case. More power intensive. More capable. But less endurance. [1] https://en.wikipedia.org/wiki/Hearing_aid#Telecoil https://en.wikipedia.org/wiki/Hearing_aid#Telecoil [2] https://www.bose.com/en_us/products/headphones/conversation_enhancing_headphones/hearphones.html https://www.bose.com/en_us/products/headphones/conversation_...

wl 9y ago
The Hearphones have a 10 hour battery life and don't have replaceable batteries. My hearing aids have a 3 day battery life and have replaceable batteries I can carry around on my keychain. They really aren't useful for the same things at all.
- Jedd 9y ago
  > The Hearphones have a 10 hour battery life and don't have replaceable batteries. My hearing aids have a 3 day battery life and have replaceable batteries I can carry around on my keychain. What's the cost of your hearing aids? How many 'hearphones' could you have for, say, 50% of that cost. 10 hour of hearing seems close enough to a day's usage, perhaps a bit shy but probably not by much. Certainly two recharged pairs should see you through a day. How much charge do they need - or rather, what's the size of a recharge battery pack, and how would you compare the cap-ex of your hearing aids versus the cost /convenience trade-offs of an alternative?
  - sigmaprimus 9y ago
    I have a friend who uses the bose headphones but when we go out to busy restaurants or other noisy places she tends to speak much to quiet for me to hear her...go figure the person without hearing loss ends up being the one having a hard time understanding!
    - cheschire 9y ago
      I've got some passive noise isolating earbuds for concerts. I wore them to Gamescom and my wife kept asking me to speak up because I had the exact same problem your friend did. I could understand her speech perfectly, but felt like I became the person yelling and making all the noise.
      - majjam 9y ago
        Please can you tell me what they are called? I think I'd find them very useful.
        lorenzhs 9y ago
        I use 3M ClearE-A-R (UF01021), they're transparent and cost about 3€ for a reusable, washable pair on Amazon Germany. It does change the sound but I think that's inevitable (EDIT: for this price range, at least)
        MrMid 9y ago
        I would not say it's inevitable. As a musician, I use Elacin filters with custom moulds, and these are great. There is no noticeable change in the sound itself, you just hear the sound at lower volume and more clearly, without most of the echoes. These are pricey though (around 200 EUR), but definitely cheaper than hearing loss.
        thaeli 9y ago
        I've also used he Etymotic "ETY Plugs" which are more expensive (about $12/pair) but are designed for flat frequency pass-through. They give moderate sound reduction without changing the sound.
- toasterlovin 9y ago
  As a counterpoint: my mother got the Bose Hearphones recently. She says they are worlds better than the hearing aids she used to wear.
wrycoder 9y ago
One can buy complex hearing instrument silicon now for $60 per ear quantity one. Dual mic, echo cancellation, equalization, noise cancellation, bluetooth, telecoil, etc. There is no excuse.
- zie 9y ago
  where?
  - LX8DvZFL 9y ago
    A quality Bluetooth headset covers all of those requirements except for Telecoil.
- AstralStorm 9y ago
  That runs a few days and does not sound terrible? See, one balanced armature transducer will cost you about this much. Electronics is not the problem, power requirements and miniature size are. In a hearing aid, the main power cost is the transducers (including MEMS microphones) and amplifiers. BA transducers are so expensive because only 3 companies make them. (Knowles, Sonion and one other I do not remember off the top of head.) Only a few more make MEMS microphones. This is also on the verge or actually nanotechnology which is why Chinese manufacturers couldn't get in. Trying to use a dynamic driver or microphone instead will cost you about half of battery life and will be larger.
  - makapuf 9y ago
    I dont known anything, but a Knowles MEMS microphone on digikey is $1 qty 1 [0]. A few 100 uA consumption. I'm pretty sure there is space for disruption here. [0] : https://www.digikey.com/product-detail/en/knowles/SPW2430HR5H-B/423-1394-1-ND/5052772 https://www.digikey.com/product-detail/en/knowles/SPW2430HR5...
    - AstralStorm 9y ago
      Yes, MEMS microphones of ok quality are a few dollars but you need a few or an array (worse quality ones are cheaper), balanced armature of good quality are not cheap. This one has really bad SNR (-42 dB) The space requires micromechanical research and manufacturing expertise. Good luck "disrupting" it.
leggomylibro 9y ago
So you're saying we can't just do it with a 555?
derefr 9y ago
> But, crucially, they can't be called "hearing aids". It's a protected term. If a doctor prescribed you hearing aids, could you get the Bluetooth kind instead, and still have them covered by your insurance? Or is this like the Epi-pen/Adrenaclick thing?
- mgerdts 9y ago
  The key problem with this question is that most insurance plans do not cover hearing aids, regardless of whether your doctor/audiologist says you need them.
  - grogenaut 9y ago
    Then how is it a problem? Buy what works no? I don't grok your statement.
    - Sacho 9y ago
      Parent asked: > If a doctor prescribed you hearing aids, could you get the Bluetooth kind instead, and still have them covered by your insurance? If insurance plans don't cover hearing aids in general, they won't cover hearing aids in any specific situation either.
      - hibbelig 9y ago
        > If insurance plans don't cover hearing aids in general, they won't cover hearing aids in any specific situation either. GP was asking about insurance plans that do.
      - mgerdts 9y ago
        My insurance would cover a hearing aid for the ear that needs a hearing aid. Whether the hearing aid supports bluetooth doesn't come into the equation. Since I only need one hearing aid, the bluetooth feature was of minimal interest. I've not heard of any hearing aids that have a microphone that is useful for the bluetooth headset profile. The microphones for this use tend to be an add-on device which may or may not come with a pair of hearing aids. Admittedly, I've not researched this area much.
LX8DvZFL 9y ago
The "technology costs money" argument makes no sense when you consider that the Apple Airpods retail for $169. They contain: - mics - DSPs - drivers (speakers) - custom wireless chipset - batteries i.e. all of the stuff that you need to build a regular HA. The differences are that: - they have shorter battery life (but a lower capacity battery) - built in larger quantities - not 'medical grade' Telecoil doesn't add significantly to the cost, but it does use a bit of internal volume. They are incredibly useful and are not going away anytime soon. It's not like you need the 2017 model of HA; for most people the 2000 model would be just fine, and (for the company) the costs of IC development and regulatory have long been recovered. ASICs are expensive to produce, but not that expensive that it adds thousands to the COGS. The real reason is simple market forces: people will pay a lot of money for healthcare. Insurance coverage in the target market determines much of the price.
- gozur88 9y ago
  >built in larger quantities That's the whole ball game in electronics.
smcl 9y ago
> you need to develop your own custom IC's that ... 3) are made by 1 of 4 companies in Copenhagen or Switzerland I'm confused - what part is custom and what is made by the Swiss and Danish companies?
- cbg0 9y ago
  All of the 4 points seem to refer to the IC or integrated circuit.
makomk 9y ago
Telecoil is, as I understand it, literally just audio transmitted at baseband over a magnetic loop system. The only slightly complicated thing about that is the receive antenna, and that's literally 1970s technology too. Also, ultra-low-power audio processing hardware is practically an off-the-shelf item these days thanks to technology improvements.
- dfox 9y ago
  What IC manufacturers sell as ultra-low-power audio ICs typically consumes order of magnitude more power than you would like for industrial IoT applications with large Li-something batteries, not to mention power envelope of hearing aid, which I would estimate as additional order of magnitude smaller.
- Izmaki 9y ago
  You will find a lot of cheaper alternatives that use off-the-shelves components but none of them work as great as ICs specially designed by the company themselves. Source: I work in the industry.
lagadu 9y ago
As far as I'm aware a huge chunk of the cost is that hearing aids because of size and low power requirements need to use balanced armatures instead of dynamic drivers to produce sound[0]. Anyone involved in the high-end IEM world will know that a pair of those costs north of $80-$100 and at least for IEMs each earpiece will contain between 1 and 6 of the little things. [0] https://en.wikipedia.org/wiki/Headphones#Balanced_armature https://en.wikipedia.org/wiki/Headphones#Balanced_armature
- rjzzleep 9y ago
  There's only a handful of companies creating BA drivers. Sonion Knowles Molex Bellsing and supposedly sony creates(used to create) some And probably some others I don't know about. Some of them cost that much yeah, but not all of them. Nowadays you can get 10BA(though it's more likely 5 doubles each side from china for $600). There are a few exceptions like noble audio that are premium priced with custom units, but most people use factory devices. You can get 3 BA sub 100 iems on aliexpress. Are they good? sometimes, but the point is I would say there's an audio revolution going on that is hardly noticeable unless you're actively watching it.
agumonkey 9y ago
how much of the medical field is slow on purpose ? I know about heavy regulations and safety standards .. but still
cmwright 9y ago
A large portion of the cost of high performance hearing aids today is not not the hearing aids themselves, its the overheads of the local office which are amortized over very few local customers. Generally, the cost of a high performance device is around $300-500 to an audiologist. This is why online companies, like https://www.embracehearing.com https://www.embracehearing.com (full disclosure, this is my father's company), are able to sell high end hearing aids for about 1/3 of the price of retail.
- greedo 9y ago
  Office overhead is just due to the monopolistic reliance on a few expensive aids. Optometry requires specialists of differing degree (optometrist vs. opthamologist) yet contacts are dirt cheap because of industry competition. The same is true of corrective glasses, LASIK etc. etc. Hearing aids shouldn't be any different.
  - emodendroket 9y ago
    Glasses are quite expensive in the US comparatively.
    - greedo 9y ago
      Compared to what/where? You can get a pair of prescription glasses almost anywhere for around $100.
      - emodendroket 9y ago
        My wife is Korean and was shocked that she couldn't get a pair for like $30. Also, I think the glasses she ended up with were probably considerably more than $100 but your options are really narrowed if you have an Asian nose (many glasses that would work fine for me just slide off of her face).
        fhood 9y ago
        The little bridge nubins are adjustable though.
lorenzhs 9y ago
I don't know if it's the same as the Bose "Hearphones", but my Sennheiser PXC550 have what Sennheiser call a TalkThrough mode. It pauses the music (if it's playing) and uses the microphones to let through sounds on the wavelengths of speech. If you combine it with noise cancelling, it definitely makes it easier to hear people in noisy environments. Looks weird to talk with over-ear headphones on, though. To be honest it feels a bit creepy to hear what people say while it looks to them like you're listening to music and can't hear them.
- vanderZwan 9y ago
  > If you combine it with noise cancelling, it definitely makes it easier to hear people in noisy environments. Does it also work when the source of noise is a crowd? I'm near-deaf on one side, which has the side-effect of not being able to isolate voices.
  - lorenzhs 9y ago
    Hm I'm not sure, I haven't used it for that so I don't know. It's mostly designed so that you don't have to take them off for a quick interaction, so it's definitely not optimized for your use case. For example, the fan noise in our server room is at least partly in the frequency spectrum it lets through, so it's useless there.
mmerlin 9y ago
Bose Hearphones app annoyingly/invasively forces you to enable GPS location tracking (also a waste of battery), and they data-mine (send back to bose servers) every song title you listen to plus your contacts list :-(

wl 9y ago

The Hearphones have a 10 hour battery life and don't have replaceable batteries. My hearing aids have a 3 day battery life and have replaceable batteries I can carry around on my keychain. They really aren't useful for the same things at all.

Jedd 9y ago
> The Hearphones have a 10 hour battery life and don't have replaceable batteries. My hearing aids have a 3 day battery life and have replaceable batteries I can carry around on my keychain. What's the cost of your hearing aids? How many 'hearphones' could you have for, say, 50% of that cost. 10 hour of hearing seems close enough to a day's usage, perhaps a bit shy but probably not by much. Certainly two recharged pairs should see you through a day. How much charge do they need - or rather, what's the size of a recharge battery pack, and how would you compare the cap-ex of your hearing aids versus the cost /convenience trade-offs of an alternative?
- sigmaprimus 9y ago
  I have a friend who uses the bose headphones but when we go out to busy restaurants or other noisy places she tends to speak much to quiet for me to hear her...go figure the person without hearing loss ends up being the one having a hard time understanding!
  - cheschire 9y ago
    I've got some passive noise isolating earbuds for concerts. I wore them to Gamescom and my wife kept asking me to speak up because I had the exact same problem your friend did. I could understand her speech perfectly, but felt like I became the person yelling and making all the noise.
    - majjam 9y ago
      Please can you tell me what they are called? I think I'd find them very useful.
      - lorenzhs 9y ago
        I use 3M ClearE-A-R (UF01021), they're transparent and cost about 3€ for a reusable, washable pair on Amazon Germany. It does change the sound but I think that's inevitable (EDIT: for this price range, at least)
        MrMid 9y ago
        I would not say it's inevitable. As a musician, I use Elacin filters with custom moulds, and these are great. There is no noticeable change in the sound itself, you just hear the sound at lower volume and more clearly, without most of the echoes. These are pricey though (around 200 EUR), but definitely cheaper than hearing loss.
        thaeli 9y ago
        I've also used he Etymotic "ETY Plugs" which are more expensive (about $12/pair) but are designed for flat frequency pass-through. They give moderate sound reduction without changing the sound.
toasterlovin 9y ago
As a counterpoint: my mother got the Bose Hearphones recently. She says they are worlds better than the hearing aids she used to wear.

wrycoder 9y ago

One can buy complex hearing instrument silicon now for $60 per ear quantity one. Dual mic, echo cancellation, equalization, noise cancellation, bluetooth, telecoil, etc. There is no excuse.

zie 9y ago
where?
- LX8DvZFL 9y ago
  A quality Bluetooth headset covers all of those requirements except for Telecoil.
AstralStorm 9y ago
That runs a few days and does not sound terrible? See, one balanced armature transducer will cost you about this much. Electronics is not the problem, power requirements and miniature size are. In a hearing aid, the main power cost is the transducers (including MEMS microphones) and amplifiers. BA transducers are so expensive because only 3 companies make them. (Knowles, Sonion and one other I do not remember off the top of head.) Only a few more make MEMS microphones. This is also on the verge or actually nanotechnology which is why Chinese manufacturers couldn't get in. Trying to use a dynamic driver or microphone instead will cost you about half of battery life and will be larger.
- makapuf 9y ago
  I dont known anything, but a Knowles MEMS microphone on digikey is $1 qty 1 [0]. A few 100 uA consumption. I'm pretty sure there is space for disruption here. [0] : https://www.digikey.com/product-detail/en/knowles/SPW2430HR5H-B/423-1394-1-ND/5052772 https://www.digikey.com/product-detail/en/knowles/SPW2430HR5...
  - AstralStorm 9y ago
    Yes, MEMS microphones of ok quality are a few dollars but you need a few or an array (worse quality ones are cheaper), balanced armature of good quality are not cheap. This one has really bad SNR (-42 dB) The space requires micromechanical research and manufacturing expertise. Good luck "disrupting" it.

leggomylibro 9y ago

So you're saying we can't just do it with a 555?

derefr 9y ago

> But, crucially, they can't be called "hearing aids". It's a protected term. If a doctor prescribed you hearing aids, could you get the Bluetooth kind instead, and still have them covered by your insurance? Or is this like the Epi-pen/Adrenaclick thing?

mgerdts 9y ago
The key problem with this question is that most insurance plans do not cover hearing aids, regardless of whether your doctor/audiologist says you need them.
- grogenaut 9y ago
  Then how is it a problem? Buy what works no? I don't grok your statement.
  - Sacho 9y ago
    Parent asked: > If a doctor prescribed you hearing aids, could you get the Bluetooth kind instead, and still have them covered by your insurance? If insurance plans don't cover hearing aids in general, they won't cover hearing aids in any specific situation either.
    - hibbelig 9y ago
      > If insurance plans don't cover hearing aids in general, they won't cover hearing aids in any specific situation either. GP was asking about insurance plans that do.
    - mgerdts 9y ago
      My insurance would cover a hearing aid for the ear that needs a hearing aid. Whether the hearing aid supports bluetooth doesn't come into the equation. Since I only need one hearing aid, the bluetooth feature was of minimal interest. I've not heard of any hearing aids that have a microphone that is useful for the bluetooth headset profile. The microphones for this use tend to be an add-on device which may or may not come with a pair of hearing aids. Admittedly, I've not researched this area much.

LX8DvZFL 9y ago

The "technology costs money" argument makes no sense when you consider that the Apple Airpods retail for $169. They contain: - mics - DSPs - drivers (speakers) - custom wireless chipset - batteries i.e. all of the stuff that you need to build a regular HA. The differences are that: - they have shorter battery life (but a lower capacity battery) - built in larger quantities - not 'medical grade' Telecoil doesn't add significantly to the cost, but it does use a bit of internal volume. They are incredibly useful and are not going away anytime soon. It's not like you need the 2017 model of HA; for most people the 2000 model would be just fine, and (for the company) the costs of IC development and regulatory have long been recovered. ASICs are expensive to produce, but not that expensive that it adds thousands to the COGS. The real reason is simple market forces: people will pay a lot of money for healthcare. Insurance coverage in the target market determines much of the price.

gozur88 9y ago
>built in larger quantities That's the whole ball game in electronics.

smcl 9y ago

> you need to develop your own custom IC's that ... 3) are made by 1 of 4 companies in Copenhagen or Switzerland I'm confused - what part is custom and what is made by the Swiss and Danish companies?

cbg0 9y ago
All of the 4 points seem to refer to the IC or integrated circuit.

makomk 9y ago

Telecoil is, as I understand it, literally just audio transmitted at baseband over a magnetic loop system. The only slightly complicated thing about that is the receive antenna, and that's literally 1970s technology too. Also, ultra-low-power audio processing hardware is practically an off-the-shelf item these days thanks to technology improvements.

dfox 9y ago
What IC manufacturers sell as ultra-low-power audio ICs typically consumes order of magnitude more power than you would like for industrial IoT applications with large Li-something batteries, not to mention power envelope of hearing aid, which I would estimate as additional order of magnitude smaller.
Izmaki 9y ago
You will find a lot of cheaper alternatives that use off-the-shelves components but none of them work as great as ICs specially designed by the company themselves. Source: I work in the industry.

lagadu 9y ago

As far as I'm aware a huge chunk of the cost is that hearing aids because of size and low power requirements need to use balanced armatures instead of dynamic drivers to produce sound[0]. Anyone involved in the high-end IEM world will know that a pair of those costs north of $80-$100 and at least for IEMs each earpiece will contain between 1 and 6 of the little things. [0] https://en.wikipedia.org/wiki/Headphones#Balanced_armature https://en.wikipedia.org/wiki/Headphones#Balanced_armature

rjzzleep 9y ago
There's only a handful of companies creating BA drivers. Sonion Knowles Molex Bellsing and supposedly sony creates(used to create) some And probably some others I don't know about. Some of them cost that much yeah, but not all of them. Nowadays you can get 10BA(though it's more likely 5 doubles each side from china for $600). There are a few exceptions like noble audio that are premium priced with custom units, but most people use factory devices. You can get 3 BA sub 100 iems on aliexpress. Are they good? sometimes, but the point is I would say there's an audio revolution going on that is hardly noticeable unless you're actively watching it.

agumonkey 9y ago

how much of the medical field is slow on purpose ? I know about heavy regulations and safety standards .. but still

cmwright 9y ago

A large portion of the cost of high performance hearing aids today is not not the hearing aids themselves, its the overheads of the local office which are amortized over very few local customers. Generally, the cost of a high performance device is around $300-500 to an audiologist. This is why online companies, like https://www.embracehearing.com https://www.embracehearing.com (full disclosure, this is my father's company), are able to sell high end hearing aids for about 1/3 of the price of retail.

greedo 9y ago
Office overhead is just due to the monopolistic reliance on a few expensive aids. Optometry requires specialists of differing degree (optometrist vs. opthamologist) yet contacts are dirt cheap because of industry competition. The same is true of corrective glasses, LASIK etc. etc. Hearing aids shouldn't be any different.
- emodendroket 9y ago
  Glasses are quite expensive in the US comparatively.
  - greedo 9y ago
    Compared to what/where? You can get a pair of prescription glasses almost anywhere for around $100.
    - emodendroket 9y ago
      My wife is Korean and was shocked that she couldn't get a pair for like $30. Also, I think the glasses she ended up with were probably considerably more than $100 but your options are really narrowed if you have an Asian nose (many glasses that would work fine for me just slide off of her face).
      - fhood 9y ago
        The little bridge nubins are adjustable though.

lorenzhs 9y ago

I don't know if it's the same as the Bose "Hearphones", but my Sennheiser PXC550 have what Sennheiser call a TalkThrough mode. It pauses the music (if it's playing) and uses the microphones to let through sounds on the wavelengths of speech. If you combine it with noise cancelling, it definitely makes it easier to hear people in noisy environments. Looks weird to talk with over-ear headphones on, though. To be honest it feels a bit creepy to hear what people say while it looks to them like you're listening to music and can't hear them.

vanderZwan 9y ago
> If you combine it with noise cancelling, it definitely makes it easier to hear people in noisy environments. Does it also work when the source of noise is a crowd? I'm near-deaf on one side, which has the side-effect of not being able to isolate voices.
- lorenzhs 9y ago
  Hm I'm not sure, I haven't used it for that so I don't know. It's mostly designed so that you don't have to take them off for a quick interaction, so it's definitely not optimized for your use case. For example, the fan noise in our server room is at least partly in the frequency spectrum it lets through, so it's useless there.

mmerlin 9y ago

Bose Hearphones app annoyingly/invasively forces you to enable GPS location tracking (also a waste of battery), and they data-mine (send back to bose servers) every song title you listen to plus your contacts list :-(