Turn it up!

“We call untreated hearing loss the silent epidemic,” says Ruth Bridger, marketing director of Wear&Hear, just one of the many audio companies at this year’s CES with new products for the hard of hearing. “Hearing connects us to people, and studies show that when you’re not hearing properly you have a tendency to withdraw, become isolated, depressed; it can lead to cognitive decline and even dementia.”

Around one in six people in the UK suffer from some form of hearing loss and a quarter of them remain untreated. On average, people put off getting their first hearing aid for ten years.

People who need them don’t get them for several reasons. The first is cost. In most countries it is not covered by insurance or the coverage is limited to under-18s or over-​65s. “In the States you can pay anywhere between $2,000 and $6,000 for a single hearing aid and typically you need a pair and every five years or so you need to replace them,” Bridger explains. But it’s not just cost, as the UK proves. “Do you know that out of all of the people eligible in the UK for hearing aids through the National Health Service, only about 35 per cent actually go through with it and apply and receive hearing aids? So in the UK obviously it’s not only price, there are other factors, one of which is stigma.”

People worry that wearing a hearing aid will make them look older, disabled or just hard work. “Have you ever talked to somebody with a reasonable hearing loss?” asks Stefan Zimmer, secretary general of the European Hearing Instrument Manufacturers Association (Ehima). “To be honest it is slow, you have to talk very clearly and slowly because otherwise they will not pick up what you are saying, you have to look at them all the time.”

The final reason is the devices don’t always live up to expectations. Those most likely to need hearing aids are also those mostly likely to need glasses – if only for reading. But the improvement with a pair of reading glasses is instant and obvious. “Well, that’s not the way it works with hearing aids because the brain had adapted and tried to compensate for the frequencies that are unheard and so there is a kind of a gap there; we have to retrain the brain and it doesn’t happen overnight.  It could take a month, it could take three months, and people don’t have that kind of patience.” says Bridger. “Also in this day and age, if you have a device that helps your hearing it should help your hearing in all hearing situations, not only in live conversation, which is where hearing aids are best: they’re programmed to amplify sounds in the range of human speech, but they don’t work well in, for example, a live musical concert because there are sounds from the orchestra that are well above the sounds transmitted in human speech.”

It’s not just sound in the physical space that needs to be heard better. “There’s the issue of pairing it with a smartphone, using it as a Bluetooth device,” she adds, “if my hearing aids are not connected to my phone, how do I continue to have a good conversation through my smartphone?”

Wear&Hear’s free app is designed to replace the labour-intensive and costly consultations that make medical hearing aids so expensive. “With this app anybody can test their own hearing.” Using the four microphones on each ear, it works out your hearing frequency profile and transmits that to the headset, amplifying only the sounds you personally need. It concentrates on moving, fluctuating and nearby sounds rather than background noise like traffic or aircon hum. Buttons on the headset also allow switching between three modes: live sound, audio streaming with transparency so you can still hear sounds around you, and ‘Easy Listen’ which can slow down speech from mobiles up to 40 per cent without changing the pitch. “There are some sounds like the vowel sounds that don’t need to be slowed down to improve comprehension because they’re very clear, there’s no lips and tongue involved in expressing them, but if you can think of sounds like ‘sh’ or ‘f’ or ‘t’ they’re easily lost.”

Wear&Hear is just one of the audio companies going for this large, under-tapped market with fashionable products that are more affordable, simpler to buy and do much more than amplify speech. At the 2020 CES consumer electronics show in Las Vegas, Olive, NewHear and Phonak all presented hearing aids that looked like earbuds – and sometimes functioned as such, too.

A new Bluetooth standard launched at CES brought more good news for the hard of hearing. Bluetooth LE has a new codec designed for lower power, better quality audio and sharing to allow crowds of people to hear broadcast guides in museums or commentaries in stadiums.

“It was the hearing aid industry that a number of years ago helped instigate and start this effort to develop LE Audio,” says Ken Kolderup, VP of marketing for Bluetooth SIG. “Bluetooth audio has brought tremendous benefit to a huge percentage of the global population: wireless calling, wireless listening, wireless watching and more. But there’s one community that hasn’t been able to really fully realise the benefits of Bluetooth audio and that’s the community of people with hearing loss.

“The World Health Organisation estimates that about 15 per cent of the global adult population are affected today, and the number is expected to double over the next few decades. Now with LE Audio, thanks to things like the LC3 codec and its ability to provide very high-quality audio and very low battery [drain], thanks to things like multi-stream audio, we can now also explicitly add support for Bluetooth hearing aids.”

“Developers will be able to use the Multi-Stream Audio feature to improve the performance of products like truly wireless earbuds,” said Nick Hunn, CTO of WiFore Consulting and chair of the Bluetooth SIG Hearing Aid Working Group. “For example, they can provide a better stereo-imaging experience, make the use of voice assistant services more seamless, and make switching between multiple audio source devices smoother.”

“Imagine using a Bluetooth hearing aid and I go in to watch a movie at a cinema and have that audio go directly into my hearing aid,” says Kolderup, or “I’m at a conference or a lecture and have that presenter’s audio go directly into my hearing aid.”

“LE Audio will be one of the most significant advances for users of hearing aids and hearing implants,” says Zimmer. “Ehima engineers have contributed their specialist knowledge to improve the audio experience especially for hard-of-hearing people. As a result, within a few years most new phones and TVs will be equally accessible to users with hearing loss.”

Ehima’s members make hearing aids that still look like hearing aids, but they’ve come a long way from the beige blobs they once were. The electronics has shrunk to make them discreet in-ear devices and they won’t be driven out by cheaper, more fashionable looking brands just yet, says Zimmer. “I think there will always be the need for the professionals to do the job for those that have serious problems,” he says.

“There will also be an opportunity to buy something easy that might help some people for quite a while until they have a more severe problem, and then they will be used to the idea of having a hearing aid or hearing device, which is good.” But it’s a stretch, he says, to think people will get a hearing aid because they like their headphone brand. Most people don’t know what brand their device is anyway, just where they bought it.

What about endorsement? Look what Dr Dre’s endorsement did for the Beats brand of headphones. Could an older rock star do something similar or some of these hearing aid hybrids? Maybe a Rolling Stone? “We have tried, believe me we have tried,” he says, but it’s not compatible with their image. “Their agents tell them it’s not a good idea.”

Disguising hearing aids also has its drawbacks. “There’s a big difference between listening to music on the way to work and then sitting at a birthday party with Aunt Agnes wearing your ear buds. People are going to think ‘are you listening to the football results or are you with us?’. What’s happening? What do you think when you see people with headphones on? Do you think they’re available for a conversation?”

Designs good for music aren’t always good for the hard of hearing and vice versa. The closed design of ear buds with larger drivers produce a better musical sound, especially at the lower end. Hearing aids tend towards a smaller, open design. Cover them with your thumbs and you’ll hear a stronger bass, Zimmer explains, but when you speak you experience occlusion: “Just put your thumb in the ear and say something, it’s 'whir-whir-whir' inside your head. This is another reason why these open devices have helped in making hearing aids acceptable, because you don’t get that terrible hum in your ears.”

For people choosing a hearing aid, how cool they look is pretty low down their list. But if the consumer devices reach more people earlier that must be good for the consumer brands, the medical suppliers and most of all, people who otherwise would be suffering from the silent but preventable epidemic.