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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 (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.

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.

Glasses are quite expensive in the US comparatively.

Compared to what/where? You can get a pair of prescription glasses almost anywhere for around $100.

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).

The little bridge nubins are adjustable though.

I think she didn't like those; the glasses she ended up with are the kind where the bridge is part of the plastic frame.

She can go to (say) zennioptical and pay $30 for a perfectly good pair.

I've never heard of it.

I can vouch too, $20 lenses and frames

I paid $30 for a pair of glasses from Zenniopitcal and they are of fine quality, not dissimilar than the $300 I used to pay. My girlfriend has been using them for a decade now and she's asian...

I am currently wearing my "looking at the monitor glasses" that I bought from Zenni Optical.I bought it somewhere between 4 and 6 years ago for around $15.

I have three pairs of driving glasses, a pair for running,a rimless pair, and a pair for use at work. They are all from Zenni and were all bought 4 to 6 years ago. They have various levels of tinting from none to fairly dark. Antireflection and antiscratch coating were standard. The most expensive was $30.

I would like to buy some new glasses from Zenni, but my optometric prescription has not changed and the frames and lenses are still in ridiculously good shape.

I rejoiced when my work glasses has a nasal bridge fall off. Unfortunately, I found that I was able to repair it in a few seconds.

So despite the pittance that it costs, I still use these old glasses. Perhaps if I carefully drop some dumbbells on them.... :-)

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.

> 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?

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!

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.

Please can you tell me what they are called? I think I'd find them very useful.

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)

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.

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.

I think the key word on the low-ish end is "High Fidelity"; these run appx. $15:

Etymotic https://amzn.com/dp/B0015WJQ7A

Hearos https://amzn.com/dp/B000V9PKZA

These are the earplugs I used. I'm not sure if there are better or worse out there. The price point was low enough that I just bought them without a lot of research and they worked perfectly.

https://www.amazon.de/gp/product/B00LENN4P0/

Unlike a phone, I wouldn’t say “close to a day’s usage” is acceptable for a product that allows a user to hear.

> Unlike a phone, I wouldn’t say “close to a day’s usage” is acceptable for a product that allows a user to hear.

I wasn't suggesting that people only be allowed to hear for ten hours out of every twenty-four.

As noted in the sentence that followed that one you reacted to, I went on to write:

"Certainly two recharged pairs should see you through a day."

TFA, and parent, is about how danged expensive hearing aids <tm> are -- while parent is all about the alternative of 'hearphones' that are around US$500 (about 1/6th of what hearing aids cost in Australia).

Yeah, the price makes a huge difference. My grandmother was last quoted $10,000 for hearing aids in Australia, whereas at US $500 & no medical visits I could maybe buy one as a gift, if I could be convinced it would be moderately helpful & get semi-frequent use.

(I worry that the smartphone / bluetooth connectivity is too complicated for tech-averse elderly, and that the inline volume controls are too small for arthritic hands. But I like the idea and I love my own QC25s.)

No one's suggesting that people should be forced to go without.

Rather, the problem is that people are currently going without because hearing aids can cost as much as a used car. And the batteries - which do last longer, yes - are one-time-use instead of rechargeable.

Given the choice between recharging something in the middle of the day that costs $20 to a few hundred dollars, or theoretically having multi-day battery life with hearing aids that you can't afford, the former is an easy sacrifice to make.

Around-the-ear hearing aid can optionally have rechargeable batteries.

Great. Now I have to carry around another pair of these relatively huge, bulky earphones.

The great thing about my hearing aids is I put them in and I can ignore them. Unless I'm swapping batteries, which is infrequent enough, I don't even notice I'm wearing them.

Yeah, my hearing aids were expensive. Yes, insurance doesn't usually pitch in at all for hearing aids unless there's surgery required (BAHA, cochlear, etc). It's worth it. The alternatives are toys that get in the way of just going about your normal life.

Great, now someone has to explain to you that this is not an attack on your freedom to use whatever you product you prefer.

> Unless I'm swapping batteries, which is infrequent enough, I don't even notice I'm wearing them.

Presumably when you're swapping batteries, you're not actually wearing them, no?

Anyway, I think you have missed the points being made. For people who can't afford, or don't have access to the services around, hearing aids, consultancy, replacement batteries, and so on, there's an alternative.

My point: Hearphones may be cheaper, but they aren't a substitute for hearing aids. If people want to use them in lieu of hearing aids, fine. But they're a poor substitute. Other products may be better in the future.

A more exaggerated example: Someone who is nearsighted using their smartphone to look at more distant objects. Sure, it works, but it's not exactly practical.

> Hearphones may be cheaper, but they aren't a substitute for hearing aids.

The fact that they are cheaper means that they are a substitute for hearing aids.

They may not be quite as good right now ... but we've been over the affordability aspect already.

For people without access to USD $5k for hearing aids, a 'poor substitute' may be a perfectly reasonable alternative.

As a counterpoint: my mother got the Bose Hearphones recently. She says they are worlds better than the hearing aids she used to wear.

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.

>built in larger quantities

That's the whole ball game in electronics.

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

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.

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.

where?

A quality Bluetooth headset covers all of those requirements except for Telecoil.

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.

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/SPW2430HR5...

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.

- Does not work with the available voltage

- Far too big

- Requires about 1/3 of the entire power budget

> I'm pretty sure there is space for disruption here.

[hackernews noises]

> That runs a few days and does not sound terrible?

If they are 1/10th the cost, then the number of people that could benefit goes up tremendously. I'm sure lots of people would accept having two sets that they have to charge every night if the alternative is not having any.

Just to add to this - it is true. I have researched this subject incidentally many months ago. ON Semiconductor is one of the more relevant companies in this domain. They are a public company with a market cap of $8.5B. You can look at their Ezairo series of system-on-chip products - they are built for digital hearing aids (with all consideration of power requirements, DSP/programmability etc).

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.

> 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.

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.

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.

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.

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.

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

> 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?

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.

Then how is it a problem? Buy what works no? I don't grok your statement.

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.

> 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.

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.

I can understand why you might have trouble groking this as it might be a slightly foreign concept, but not everyone even here on this forum is lucky enough to be able to throw money at all their problems.

I think you've misread the parent comment here. Grogenaut is saying, if insurance won't cover even expensive official hearing aids, then there's no reason not to go for a cheap alternative unofficial one if it's just as good or better.

However, Grogenaut has also misread Mgerdts's comment to some extent, as when Mgerdts mentioned a "problem" they meant that Derefr's question wasn't that relevant to reality, not that there's a problem selecting hearing aids.

I propose Nition be known as Explanator2000 from now on.

Agreed. I'll also try to not post from my phone.

The question obviously concerns insurance plans that DO cover hearing aids, genius.

That's still useful information for someone like me in the UK, where hearing aids are covered by our basic level of national health care, that would probably assume that that most would.

Yes, but that doesn't make it a "key problem" with the question being asked. The question was fine, even though it wasn't global in scope, but why should it have to be?

> 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?

All of the 4 points seem to refer to the IC or integrated circuit.

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

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 :-(