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Comment by pugworthy | Hacker News Reader

You want to know what's outrageously expensive, yet equally important for basic ability to function in the workplace and other situations? Hearing aids. Hearing aids are glasses for your ears. But compared to them, glasses are unbelievably dirt cheap, and basically fully covered by a lot of decent company insurance plans. Hearing aids? Not the case.

Imagine if glasses cost $2-3000 per lens. PER LENS. And your company insurance offered to cover some of it, but limited you to ONE PAIR IN YOUR LIFETIME. That's the policy of my Fortune 50 employer believe it or not.

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My wife was an office manager at an Audiologist's office. She has some crazy stories about that. Unfortunately, lots of people who don't hear well also shout all the time. Just part of doing business. :-) (Edit: She corrected me. SHE had to shout all the time.)

Also, many people purchase hearing aids and then never wear them, because they can't stand the "new" influx of noise and most of it doesn't seem necessary or even desirable. So they effectively spend the money and then feel ripped off, in a sense. Or their spouse, who paid for the hearing aids and basically feels like they burned up thousands of dollars for nothing, is very upset.

I know if I started to lose my hearing--not all, but maybe 30-40% reduction--I'd probably be quite happy with the turning-down of all that noise I deal with daily. I'd especially like it when spending time with my Cantonese in-laws. Shouting is the default conversational mode there.

Story time!

A caucasian friend got a ride home by his Chinese friend and dad to visit them.

Once the dad was out of sight, he asked his friend what he was arguing with his dad about.

Chinese friend was confused about the question and didn't understand why he was asking. Then he said: "Oh, we were just talking about how nice the wedding was that we went to".

As far as turning down noise, I highly recommend Etymotic's ER-20xs[1]: they reduce noise by 20db, and do so more evenly than, say, earplugs. I use them every single day. When walking near roads (cars), on buses, on the subway, at concerts. It's automatic to the point that whenever something gets louder than my comfort level, I pop them in. 99% of people don't notice them, just friends and family.

It's also changed my perception of noise, in that the expected noise level of the roadway is what I hear with them in, for better or for worse. In truly loud environments, such as bars, I find that I actually hear better.

1: https://www.etymotic.com/consumer/hearing-protection/er20xs....

Oh cool, thanks so much for posting this. I've just ordered a pair.

I've always wanted the ability to just "turn down" the sound of everyday life. I've actually wondered if some of my social anxiety has come from hearing sounds a little more intensely than some people, since after a hearing exam I apparently have super good hearing.

At times I've done audio recording without a monitor to hear my own voice. The result is me having in earbuds while speaking, and so I can't hear myself as well.

I noticed that I spoke louder and more confidently. So I've wondered if wearing something like these could be an effective way to help with social anxiety? Guess we'll see. Cheers!

As I understand it, some of the newer (and likely more expensive) hearing aids support bluetooth, and you can change the levels and tuning from your phone. That would give you the best of both worlds, since you could give yourself good hearing for very important things (meetings, etc) or enjoyable things things that benefit from good hearing (some movies, listening to music, etc).

I've only tried one model, but I was disappointed in the sound quality for music. Hearing aid speakers apparently aren't intended to reproduce the full range of frequencies like headphones.

It's probably convenient for voice calls, though.

I think there are likely some that are okay, given my limited knowledge of the subject, which is really just from hearing Adam Savage talk on the Still Untitled podcast about the new ones he got, how his hearing loss it at a different frequency than most people, and how it used to be a big ordeal to get them tuned for specific frequencies (you had to schedule an appointment). His new ones allowed him to re-tune for different types of listening through his phone.

Even if that capability doesn't specifically address the range frequency required for music listening adequately, I imagine there are specialty hearing aids (likely at a hefty price increase) that do, catering to musicians that suffer hearing loss.

For live sound and for people who don't have too much hearing loss, the hearing aid doesn't have to reproduce all the sound. Instead it supplements what's already there. Some of the sound goes through a vent directly to your ear. A hearing aid doesn't have to reproduce deep bass notes, for example.

And for a lot of live music, it's plenty loud enough and protection from (further) hearing loss would be more of an issue.

The main issue I have with my hearing aid when playing music is that the feedback cancelation isn't as good as I'd like for pure, higher pitched notes. (Feedback protection is needed because sound goes out the vent as well as in and that reaches the microphone.)

This. The prices are unbelievable! And $3000 is for the "cheap" ones! I was about to post the same thing and then found your post.

I will add, that getting access to the frequency curve adjustment software for each device is difficult (everybody needs a different adjustment curve and other params tweaked), prohibited and also expensive. They are often set incorrectly in the first instance and require repeat visits to an audiologist and tweaking.

So much so that I've been considering at all sorts of dodgy routes to getting control of this myself, including reverse engineering and ordering device-coupling hardware from shady non-western web sites, so that I can program them myself.

I'm really really hoping that this market will be disrupted soon, but I'm not holding my breath.

My mother has been mostly deaf her whole life. Just the introduction of Bluetooth in the hearing aid (10 years after it was mainstream) was life changing for her (being able to talk on the phone better, watching movies on her iPad, etc.). But god is the hardware freaking expensive.

Fixing this is my dream job.

Wow. USD 3000 is a bit too much. Can you show an example of which kind of device this is (some link)? When I search on Amazon.com for 'hearing aid', the ones that show up are pretty cheap (e.g. USD 54 to 100ish)? Apologies for my ignorance.

Amazon don't sell hearing aids, and cannot legally. They can sell "hearing assistance" devices or other loophole names (or just foreign sellers that don't give a darn). In the US a hearing aid is only available from medical suppliers via a doctor's prescription.

The person above wasn't being hyperbolic when they said it can be $3K e.g.: https://www.healthyhearing.com/help/hearing-aids/prices

Hearing aides are also insanely cheap to produce, they are not complicated devices and that market is only surviving due to the medical device status of them causing a high barrier to entry.

There are actually some decent alternatives avaliable on alibaba and other Chinese outlets. I helped my father with getting a pair, they were 125 and have been performing well for 1.5 years now. Sure, I wouldn't trust alibaba for most medical devices, but something like hearing aids should be safe enough. His insurance wouldn't kick in anything, and while he could afford the price he would never spend it. Since he so badly needed them, I suggested he try a pair of the cheaper ones, and the difference in quality of life was staggering.

beware of cheap hearing aids, hearing loss is almost never uniform, so if they aren't adjusted properly they can be far too loud in the parts of the audio spectrum where hearing is less damaged, and can in fact cause further hearing loss.

Not that this is any excuse for them costing $20,000, but its something to keep in mind, cheap abibaba ones likely just make all frequencies louder.

It seems like this could easily be solved by selling the hearing aids with a smartphone app to test your hearing and tune the aids, and a pair of flat frequency response headphones for testing.

Read about the OTC hearing aid law signed 2 years ago. http://www.hearingreview.com/2017/08/president-trump-signs-o...

tl;dr: The gist is that, by near year I think, people with mild-to-moderate hearing loss will be able to buy hearing aids without having to see a doctor or get a prescription. (I'm always amazed when the bureaucracy makes something easier rather than more difficult.)

Retirees have lots of time to vote.

This is essentially the system sold by Blamey Saunders in Australia. My pair work reasonably well.

Wow, it's crazy that those are still $3000 for essentially a microphone, DSP chip, maybe a small microcontroller and a BLE chip, and a driver. Something like the Airpods are probably on the same level of technical complexity, but an order of magnitude cheaper.

Can you post a link to the model you got? Looking for alternatives for my dad as well. Thanks.

I wouldn't say "insanely cheap", from what I understand the production costs are something like $50-$150 per unit (not per pair!) and that's with cheap overseas labor, although cheaper devices exist. They are not complicated devices inasmuch as we don't consider circuits complicated, any more. There's a lot of R&D that has gone into making those things work the way they do.

I do think that the prices are inflated, and will drop, I just also think that they're complicated devices that aren't so easy to make.

Those are similar COGS to like, iphones, a luxury good. If they only cost $600-1000 I think that'd be significantly less egregious than $2000-3000.

I’d take issue with “not complicated.” They are very tiny, have to be very low power, and they run a surprising amount of real-time DSP. Then the whole electronics package has to be integrated with an acoustics package including multiple microphones and transducers. And the higher quality all of those acoustical components are, the more transparent the end product. And it all has to be durable enough for continuous wear by a human for multiple years. I wouldn’t diminish what cutting edge hearing aides do, they can be quite impressive technically.

I doubt the size constraint is pressing (as modern electronics go) unless you're trying to hide them. My decades-old high-power analog aids fit behind the ear.

Power constraints seem pretty tight, though. Modern hearing aids have radios in them for continuously sending audio data between the left and right sides, and they run for a week on a hearing aid battery.

Hearing aids are sold to hunters at a much lower price (as noise protection and low noise enhancement). The same work goes into them, but they are not medical devices so they have to be affordable.

Those hearing aids aren't even remotely close to the $3,000 hearing aids a full-time wearer uses. It's kind of like comparing a free solar-powered swag calculator to a TI-84 graphing calculator.

Although, much like the TI-84, $3,000 hearing aids probably are overpriced.

Comparing these two types of hearing aids is similar to comparing a magnifying glass with normal glasses.

A magnifying glass might do the job good enough, and I know people who decided to not buy glasses but just use a magnifying glass to read.

Or, if your eyes are roughly equivalent in prescription need, you buy a $10 pair of reading glasses at any drug store.

This is true - the modern devices with real-time DSP _are_ amazing. I strongly suspect that the eye-watering prices are still massively overblown, though.

I ask seriously: could this be replicated with AirPods and an iPhone, in software?

I vaguely recall hearing about some work on this front. I suspect however that latency may be an issue.

The latency between the AirPods and the iPhone is too high for the iPhone to do any of the real-time work. I have no idea if the AirPods have a DSP that would be able to do that work.

But cheap, small, low power DSPs can do an amazing amount of work these days. Even if the AirPods don't have such a DSP, they're a good example of a reasonably complex piece of electronics with speakers and a microphone that sits in your ear, but costs an order of magnitude less than hearing aids. I think they're a good datapoint to argue that a truly free market could make much cheaper hearing aids.

https://www.cnbc.com/2019/01/20/how-to-turn-airpods-into-hea...

Everything you described would be impressive if this were 1980.

Decent hearing aides are quite expensive, complex devices with a substantial amount of R&D and non-trivial silicon.

For those who are interested, The Amp Hour has a great episode with Jørgen Jakobsen who talks about his experience in the industry and its quirks.

https://theamphour.com/338-an-interview-with-jorgen-jakobsen...

How are hearing aids priced in other countries compared to the US?

I live in the former USSR, in a very poor country. Hearing aids here are primitive, no fancy schmancy DSP bad really cheap. $10-20 or smth.

Bose just recently got FDA approval for their first non-prescription/self fitting hearing aids.

I think this is why Bose entered the market with “hearphones” to help hear people in crowded bars. So they could try to market them without spending the money to be a medical device.

> help hear people in crowded bars.

It's a tall people problem too. You can hear everyone in the bar except person in front of you, 30cm below.

What a relief to know I’m not the only one!

It’s a short people problem too, for the same reason. At least the tall person can lean over.

This applies to all medical everything.

Yes, this is true. I'm actually fortunate in that I'm completely deaf in one ear and "only" profoundly deaf in the other. That means I only have to spend $3000 instead of 2x that. It's ridiculous. My hearing aid is 6 years old and I'm sure it's about to fail, but I can't afford a new one right now. It's absolute insanity.

Do the $3000 hearing aids differ significantly than, say, this:

https://www.amazon.de/Audiben-PSA-H%C3%B6rverst%C3%A4rker-Pr...

I'm not sure. My hearing loss is bad enough ("profoundly deaf" --- basically, the next level down is "totally deaf") that I wouldn't try an off the shelf aid without an audiologist's support.

My $3,000 hearing aid (which has allowed me to hear better than I ever have before and is worth every dollar) has, for example, 2 microphones, 4 switchable DSP programs to match different sound environments, telecoil (essential in my work), a level of water resistance (sweat and dirt is the primary killer of my hearing aids, worn 18 hours a day), and with an external receiver I can directly receive bluetooth and external microphones.

That’s about $150 worth of parts.

Plus R&D, plus technical and warranty support, plus 6 audiologist fitting appointments, plus all the other standard business expenses and, yes, profit.

Parts are a minor piece of the puzzle.

Yes, mine does the same. It's a really nice hearing aid. It's just a shame it's so expensive and not covered by insurance. I literally cannot function at a job without one, but insurance (or disability) won't cover it. Bizarre.

Go to Costco, if you are willing to pass up oticons.

I had a $6000 pair of hearing aids that were lost. I replaced them with $1600 pair from Costco. Most of the time I can’t tell the difference. When I can, I wouldn’t be able to say which is better, just that I notice they didn’t sound the same.

Yeah. I've demoed the Costco ones, but they weren't great. My hearing loss isn't just a minor loss. I'm classified as "profoundly deaf", which requires serious amplification. Unfortunately, Oticon and its ilk are the ones that allow me to be functional in the real world :/

I'd encourage HNers to try self-programming.

I have Phonak HAs so I can buy the programmer (iCube) and software (Target) off ebay for $450 and a pair of hearing aids two generations old for $500-$1000. And if they break or I lose them, buy a replacement and the total is still less than buying from an audiologist.

It's also more flexible. Hearing feedback? Run the feedback test/modeling program. Can swap hearing aids between ears. Friend lose a hearing aid? Let them borrow yours (suitably programmed) and use foam inserts for earmolds (can buy or take a soldering iron to foam earplugs).

One word: Costco. The hearing aids alone pay for decades of membership fees.

My partner used to spend $10,000AUD on each hearing aid. It was insane. Now that we're going to Costco, she's paying $3000AUD each. It's still really expensive, but it's a darn sight better.

I think the OTC hearing aid law will go into effect next year. For mild of moderate hearing loss, you will be able to buy the hearing aid directly without dealing with the hearing aid specialist.

It was signed in August 2017 and the FDA has 3 years to allow sale of hearing aids for mild to moderate hearing loss.

Yeah, hearing aids seem to be a clearly over priced pseudo-monoplistic small set of companies. There are people selling mobile phone connected hearing aid like things for drastically less money, but they run into the hearing aid cabal.

I'm using hearing aids for almost 8 years now. Without them I can't interact with people without shouting or repeatedly asking them to repeat what they have said. I always have to take them out if I want to listen to music, when it rains very heavy, have to take shower or want to wear some headphones.

Initially it was very hard, but after a while you create habits around them and they become very natural. But still, even with a hearing aid, dont' forget that it doesn't improve your hearing, it just normalizes to a level where you can hear normal. In fact, because you're now running all the sound through a filter, a lot of frequencies get lost (in addition to the ones you're not able to hear anymore).

Anyway, I agree that nobody talks about the pricing. A good pair (say Oticon OPN 1) would cost me minimum $6.5K. Looking forward to see how Bose disrupts the whole industry with their entry level "hearphones".

Hearing aid is medical device. That means lots of regulation, entire floor full of departments existing just to make sure things pass regulatory assessments. Remove those and the cost might come down significantly, but will be willing to do that?

i believe it.

bose might be poised to get in to that market. their 'hearphones' struck me as a first attempt, although it's not marketed as a medical device (AFAIR).

I'm seeing more and more of these "smart headphones" that happen to maybe increase selective noises and cancel some others out but are not "hearing aids" due to the medical device designation.

i've been using bose qc20 for a few years for the noise cancelling. I'm curious about the 'hearphones' - to know if the effect is similar to the qc20 'pass through' mode - which still muffles some background noise but opens up to allow voice frequencies through. can't get any clarification if the effect is similar or something radically new, and don't want to spend that much $ to find out. :)

I have a pair of Sony MDX-1000X headphones. Very good noise canceling. Passthru is a joke though. Everything passthru is slightly usable. Vvice passthru is horrible.

I learned you can't assume anything when you buy an expensive set of noise-canceling headphones and then spend an international flight with two people behind you prattling. It just made their conversation clearer.

Also nearly jumped out of my seat in a terminal when a gate announcement was made. Guy across from me pulled out his IEM and said "you know airports increased the volumes on their announcements because people wearing headphones were missing their flights?"

IEMs - best invention ever. Can't wait for adblock glasses.

QC20 are 'in-ear' not 'over the ear', with their molded rubbery ear plug things to help block out leakage. they're not perfect, and on their own, yes, noise cancelling can just make voice somewhat clearer. I always pipe a bit of grey noise through the ears to mask that (unless I'm piping music through).

Overall they're pretty good though. Until I got a pair and watched movies in a plane wearing them I never really realized how high I had to pump the volume to overcome the engine noise.I pretty much wear them all the time in a plane now even if just to use the noise cancelling.

AirPods are being used as de facto hearing aids as well.

https://www.usatoday.com/story/tech/talkingtech/2018/06/26/a...

Bose recently got FDA approval for their "self-fitting hearing aid"

https://www.hearingtracker.com/bose-hearing-aid

iOS 12 Live Listen can use airpods to relay audio from the iPhone mike, a capability previously limited to hearing aids. Can be useful in a pinch.

https://appleinsider.com/articles/18/11/11/how-to-use-airpod...

There is a new company out there that solves the cost problem by offering advanced hearing aids with a remote care from an audiologist using video conference (vs. a doctor's office visit). A friend of a friend loves their device and said that service was really good too. http://listenlively.com

What's crazier is that cochlear implants are covered by insurance.

Free Market! Free market anyone!?

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