In a research letter published last year, researchers from Johns Hopkins Medicine predicted that 44 million (15%) of US adults will have some hearing loss by 2020. That number is expected to increase to 23 percent of all adults 20 and older by 2060. I'm also told by a major hearing aid company that one in six people in the US need hearing assistance, but only one out of four of those actually buy a device.
Yes people are living longer but what I take from those figures and predictions is that hearing loss, which for so long has been associated with the ageing population, appears to be having an impact on lives that are much younger. Hearing aids have existed for some time, but clearly the stigma attached to divulging your health problem to the world is still something of a problem.
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Another problem is cost. From seeing an audiologist to actually getting your hands on a suitable hearing aid, prices can start from anywhere around the $1,000 mark. If you live in the UK, there is at least the option to secure them through the NHS. In the US, you're not so fortunate.
That's why last year's decision by Senator Elizabeth Warren and other members of US Congress on both sides to reintroduce a bill on hearing aids was so important. The bill, which was signed into law by President Trump, is about making hearing aids available over the counter. It meant the Over-the-Counter Hearing Aid Act of 2017 would help deregulate an outdated industry and bring about a set of standards of OTC hearing aids and hearing-aid like solutions that could be sold to people with "mild to moderate" impairment. The result? They are then more accessible, affordable and there'll be no need to visit a healthcare professional to get them.
As a result of this law being signed, companies outside of the hearing aid realms have shown great interest in the space. The startup that is no more, Doppler Labs, makers of the sound-augmenting Here One smart earbuds was in discussions with members of Congress about this bill. This was with a view to creating its Here Two hearable that would be more focused on hearing health. "It was going to be one step closer to the true in-ear computer, but we were going to market it as the first over-the-counter hearing aid," Doppler Labs' CEO Noah Kraft told us.
Doppler Labs has not been alone in the pursuit of building a device with a purpose greater than the ability to track fitness or to plug in a smart voice assistant like Alexa. Hearable makers are priming themselves to introduce smarts that could be potentially life changing for millions of people.
Here come the hearables
While the laws that have governed the industry may have stood still, the smartening of the technology has most certainly not. Hearing aid manufacturers like ReSound or Cochlear, which partnered with Apple for its Made for iPhone implant, are just a couple of companies that have been bringing the tech into the modern age.
The new set of players turning their attention to the world of assistive hearing includes Bragi, makers of the Dash smart earbuds. Bragi recently announced Project Ears, a partnership with Mimi Hearing Technologies with the aim of building a hearing aid-like device and an FDA-approved hearable that could offer tinnitus relief.
According to Bragi's CEO Nikolaj Hviid, the idea to make a hearing aid-like device came from the discovery that users of its Dash earbuds were modifying the hearable for tinnitus relief. Bragi has already collaborated with hearing aid company Starkey Technologies for its custom fitted Dash Pro hearable.
"As Nikolaj said, one eye opener was an early Kickstarter backer who used the product for tinnitus treatment," Darko Dragicevic, executive VP, partners and solutions at Bragi told us. "Until then, it was more like a cool consumer product, but then suddenly we understood, okay it's a computer in the ear and it can do much more."
Australian startup Nuheara, much like Doppler Labs, wanted to give users of its smart earbuds better control over what they could hear in an environment, whether that was at your desk, in the office or sitting in a cafe enjoying a coffee.
When the company was founded, hearing health was a big factor in creating what eventually manifested itself as the IQBuds, according to Nuheara's co-founder David Cannington. The hearable isn't a hearing aid, but does offer smart amplification that's considered more advanced than Personal Sound Amplification Products, a solution that has been available for those who experience mild to moderate hearing loss.
Its latest range of smart earbuds brings a new Ear ID feature, which evaluates a user's own hearing profile to create a more personalised hearing experience. Cannington tells us that it uses a prescription formula called NAL-NL2, which is used by audiologists to calibrate high end hearing aids.
Challenges of building for the ear
While the likes of Bragi and Nuheara stand out as companies that are delivering on-body computing to the ear, building hearing aid-like devices throws up a whole new set of challenges. The kind of challenges that Nuheara's cofounder David Cannington expressed in his response to the passing of the OTC Hearing Aid Act last year.
"Hearing aid companies have invested hundreds of millions of dollars in research and development to improve their products. The fact is, developing hearing technology is not easy and it's a difficult leap for traditional consumer electronic companies," Cannington wrote.
Achin Bhowmik, CTO and EVP at hearing aid company Starkey Technologies, believes hearables with multi-purpose features and hearing aid-like qualities can do a great deal for removing the stigma of having something in your ear for long periods of the day. But he also recognises that there are some very distinct problems these companies need to address before they can deliver something that can really offers value to those who suffer hearing loss. "Battery life is a real issue here," Bhowmik tells us. "We have to get the device to have enough battery life for a day. When you have a consumer device like an AirPod, it lasts four or five hours a day and then you can put it in the charger. For hearing devices you need it to last an entire day. To do that and have the tiny form factor is a huge challenge."
That aim to make something that people will want to wear all day is something Thomas Behrens, chief audiologist and director for the Centre for Applied Audiology Research at hearing aid company Oticon, strongly agrees with. "These companies will face challenges of making the products easy to use and wear every day for up to 18 hours per day," Behrens told us. "People purchasing these devices will likely have high expectations, which can be difficult to meet, when you do not have the option to make precise audiological adjustments of the device to adapt to the needs of the individual."
Hearing aids are still essentially medical devices that will require in most instances an audiologist or healthcare professional on hand to educate and offer the appropriate advice on using and owning this type of device. "I took the time to visit the audiologists that dispense hearing aids," Bhowmik tells us. "I've met with many, many patients and what I've learned is that you still need medical professionals involved. For people with true hearing loss, they are still going to need that guidance and care from doctors."
The role played by a medical professional or an audiologist for these OTC hearing aid solutions is something that Dr Dave Fabry, vice president of global medical affairs for GN Hearing and ReSound, also feels remains key to the process even when the devices are becoming more standalone. "With the way this new bill is being introduced, safeguards have to be put in place to ensure that nothing that requires more medical or audiological intervention is missed," he told us. "As much as we think the technology is extremely important, it's often the role of the professional that rises to the top."
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Another sizeable obstacle these hearable makers will need to overcome comes in the form of the Food and Drug Administration (FDA). While a pilot progam with Apple, Fitbit and Samsung hopes to fast track health developments with wearable technology, there's still this question of standards. Any new hearing aid-like device needs to live up to the similar high standards that other medical devices are held to, to make sure that they are truly safe for people to use as hearing aid alternatives.
A smarter hearing future
From the hearing aid companies we've spoken to, there's a sense that the presence of companies like Bragi and Nuheara might inspire them to make smarter, feature-rich devices and help reinvent the hearing aid we know today. Ones that take us beyond the single purpose devices we've known so far. Some are going to fail, but there will be ones that learn about the right user experience and deliver the right kind of device.
Starkey Technologies' Achin Bhowmik tells us that it already has its next product coming, which will land in the middle of the year. It's embedding its hearing aids with inertial sensors that bring physical activity tracking without a phone. It will also introduce fall detection aimed at older users, and Bhowmilk hopes one day it can use AI (something he believes the industry has been a bit insular around) to offer fall prediction. There's a lot of excitement around the potential of bringing real-time translation to hearing aids as well.
Oticon, makers of the Opn hearing aid, recently announced its HearingFitness app. This combines hearing aid use with data from fitness trackers like sleep and heart rate to produce a more comprehensive overview of your health. Its hearing aids also come with IFTTT support so it works with your smart home.
"We do believe that hearing aids can become much smarter and we are looking at integrating a number of new technologies," Oticon's Thomas Behrens tells us. "We are doing research on integrating EEG into the earmoulds, so we can create an interface to the brain and monitor the mental strain that people are met with, for instance when listening to speech in noisy places, so we can make the hearing aids adapt and provide more support when the mental load is high. This often happens to hearing aid users in restaurants, cafes or at family dinners."
So there's innovation aplenty happening in both the hearing aid and hearable worlds. Clearly a lot still needs to happen from an industry and legal point of view before we see what these new players have to offer those who suffer from hearing loss. The real winners in this race to smarten up the ears will be the millions of people who should be getting some hearing assistance, but for whatever reason – cost, stigma – don't right now.
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