The Hearing Aid's Pursuit of Invisibility (2016)

Millions of people have some degree of hearing loss. Not all hearing loss requires a hearing aid but I have been wearing hearing aids since second grade.

My very first hearing aid was a "behind the ear" model and it was very uncomfortable when I also wore glasses. The technology then was not great as it simply just amplified sound. Further, it was very visible which made me conscious about my disability.

Later in high school, I moved to an "in the canal" model. This was less visible to others and the technology was a bit better. The hearing aid would be abel to help filter out background noise which made hearing people in loud settings easier.

My current pair of hearing aids are also "in the canal" but it does a much better job filtering background noises, can be environment aware to automatically adjust volume. There are models that even have bluetooth support.

I wrote an article several years ago on what I would like to see a future hearing aid be like: https://michaelcarrano.com/blog/google-should-develop-a-hear...

One thing that isn't talked about much, to my knowledge, is that no insurance will cover the cost of hearing aids. Good hearing aids are not cheap, the model I currently have cost somewhere around $8,000 for my pair.

I feel like I comment this on every hearing impairment thread on HN, but for me invisible hearing aids are an anti feature. I prefer to wear behind the ear models as they provide a visual clue to people that I'm hearing impaired and they are more understanding about having to repeat themselves. (I started wearing them in my early 30s and I admit I was pretty self conscious about them to start with, but quickly got over it.)

Also kids notice them sometimes and are usually not shy about blurting out 'hey what's in your ears?!?' which can lead to teachable moments :)

Wearing smaller hearing aids isn't just about the look of them, they are actually much more comfortable and the designs of the in-the-ear piece of the aid lead to better sound quality and a more natural sound.

As technology improved the in-the-ear piece could become more 'open' in that it didn't have to fill the whole ear to avoid feedback, could be a soft tip that wasn't molded to an individual's canal and allowed in some unprocessed sounds that didn't travel through the aid.

It's so normal today to see people with something in their ear, usually Apple buds, and because hearing aid manufacturers have realised it's a smart move to stop marketing them as medical devices as such and positions them more as cool-tech hearing enhancers, I think the stigma of hearing loss and wearing hearing aids will soon be a thing of the past.

My parents have both gone through multiple sets of hearing aids, at many thousands of dollars a pop. Based on their experiences, when it's time for me, I will design my own, and to hell with how they look.

One problem with miniaturization is that putting the microphone close to the speaker is a recipe for feedback. Separating them by even just a few inches should make a huge difference.

Also, if you don't mind carrying a bigger battery around, you can throw a lot more processing power at the problem.

I've read that you can get satisfactory hearing aids without a prescription in some countries, and that they are much cheaper that way.

One problem is that invisible typically means small, and small typically means easy to lose - and at least with my dad's hearing aids, it means constantly worrying about accidentally knocking $1500 off the table and between some couch cushions, without noticing.

> And this is a problem, because deafness is a difference, not an impairment.

It was at this point I realized that the author is in heavy denial, even after decades of suffering. Deafness is probably the biggest impairment a human being can have, after blindness.

I've worn hearing aids my entire life and manufacturers seeming to focus on miniaturization at the expense of capability always frustrates me. This isn't just driven by business interests though, DSP and EE at that scale are really hard and it's honestly remarkable what modern digital hearing aids can do with such limited resources. It does make me wonder though what would be possible if they just threw a lot of processing power at the problem, like say a Raspberry-pi sized processing unit concealed on the body connected to wireless mics/speakers. This would allow open the possibility to having more than two mics which could help with sound localization, which is something hearing aids are still not very good at.

Maybe it's because BTEs are the only option for someone with my degree of hearing loss, but if given the choice I'd gladly choose (or at least try) a more powerful/sophisticated hearing aid over a more aesthetically pleasing one, all other factors being equal.

A recent survey of over 500 audiologists showed that the most popular (~70%) form factor of hearing aids today is the receiver in the ear (RITE). RITE aids place the hearing aid body (battery, mic, processor, etc) behind the ear, and run a thin plastic coated wire down over the front of the ear leading to the earcanal. On the end of the wire is a speaker (or receiver) that produces sound. This is an interesting shift from the past, where most people wanted hearing aids that fitted entirely in their ear. As it turns out the RITE is more or less just as invisible, but avoids some of the comfort and occlusion (blockage) issues that the fully custom in the ear hearing aids create. Either way, people want discretion, but RITEs have accomplished discretion with better performance, leading to the growth in their popularity. https://www.hearingtracker.com/audiologist-survey

It's so sad that we're still culturally at a point where people care so much what others think in terms of their appearance. I mean if someone is, god forbid, hearing impaired and are wearing a hearing aid (oh, the horror), what's the big deal? I agree with rhubarbcustard in that an nigh invisible earpiece will probably have a superior overall function, but I wish people would stop the judgment.

On that note, I'd like to see extremely visible hearing aids, that way it signals to me to speak in a way that makes myself easier to hear, stigma be darned. I'm sure anyone reading this has had experiences not hearing someone because of a bad environment or mumbling, or something else. Ideally, if you see that someone is wearing a hearing aid you would pay respect to that and go even further out of your way to make sure they can hear you (though, you should do that for everyone really).

I've worn a hearing aid since I was 4. I'm now 37, and while I've become much more open about my hearing issues, I still struggle with the issue of my hearing aid's visibility. Sure, I now have short hair (forced on me by baldness, really), sure I've opted to select a gray color instead a flesh color (thankfully, the gray is NOT (yet) to blend with the remaining hair I still have), sure, I'm much more vocal about making people aware of my "good side" and my "bad side" when walking and sitting.

But I'm still strongly resistant to the idea of adding a hearing aid to my other ear (in which I'm deaf, but the additional hearing aid would link with my current hearing aid, providing "stereo" audio of sorts). I know doing so would be a significant improvement in life -- I would be doubling my hearing capabilities, in ways. But right now I have alternate "good side" and "bad side" modes; the mode for hearing better (you need to be on my left) and the mode for hiding my disability (you should be on my right, unable to see my hearing aid). If you're an attractive female, my instinct is to have you on my right. Of course, if you're an attractive female who sits down at the bar on my right side, I will ignore you, because conversation is futile. I have to forcefully override this instinct.

In an ideal world, given current technology, there would be in-the-ear hearing aids that could wirelessly sync to my current behind-the-ear hearing aid, but that doesn't seem to exist. So I keep plodding along, basically waiting for the day when technology will FIX my hearing instead of aiding it. I expect I will be in my 60s by then.

Not to reduce the importance of this is to the hearing impaired but if we can crack this I could see these being used by most of the population.

It is strange on something seemingly so simple we don't all augment hearing.