$1 hearing aid could treat millions with hearing loss | Hacker News Reader

$1 hearing aid could treat millions with hearing loss

sciencemag.org

633 pointsgumby191 comments

Hearing aids (nor cochlear implants, for that matter) do not "restore hearing", except for light hearing loss. They are only like crutches (not even wheelchair). For example, to follow conversations or phone/skype with multiple people is very exhausting even with fancy device, because in most cases the "bandwidth" to the brain just isn't available.

That said, the hearing aids vendor lock-in is really atrocious and can use a disruption. They don't like users configuring the aids themselves, you are expected to make appointments with audiologist - in fact several of them because every hearing loss is different and it's hard to exactly measure, so usually the aids won't fit on first or second try. The algorithms are strictly proprietary - when there's 40dB difference between responses to different frequencies such as I have, usual equalizer won't do. To enable bluetooth the rule is to buy expensive add-on streamer.

For a few dollars more it is possible to put a FPGA with perhaps a neural accelerator on it. It may tremendously simplify some of the DSP stack. More importantly, there should be a full-proof app or UI to allow the user to tune the hearing aid appropriately (or coupled with a training course for audiologists in the targeted regions to do so).

Hearing aids are tremendously constrained with regards to power and mechanics. There is no way you will be able to get an FPGA in a hearing aid. An FPGA runnning complex DSP algorithms will:

1. Get hot. I don't want a +60C FPGA in my ear.

2. Eat up the battery. The batteries are small and fiddly to replace for an 85 year old with bad eyes and arthritis in the fingers. They should last for at least a week before needing replacing. No they are generally not rechargeable in the device. That would require a connector, which takes up precious volume. Wireless recharging requires a coil with the same problem.

3. Take up way too much PCB real estate. They are just too big to fit in your ear. Sure, you can run a wire to a box outside the ear, but that messes with the fashion statement. Most hearing aid users want small and discrete, so the world isn't reminded they have a disability.

Besides, why would you put an FPGA in there? Hearing aids already feature some of the most high-grade low-power DSP ASICs available, custom made for that companys DSP algorithms.

> a connector, which take up precious volume. Wireless recharging requires a coil with the same problem.

Couldn’t a “connector” just be a tiny gold contact to meet another in a charging cradle/case like a smart watch or wireless earbuds? Would that be too big?

More than just a connector, it also needs a charging circuit, which would also take up space.

Does that charging circuit need to be inside the hearing aid, and not in the charging cradle/case/dock thing?

Generally, yes. The circuitry for power does more than charge the battery, it provides power regulation to prevent over discharge and reduce the likelihood of short circuits (among other things)

About the precious volume and heat - the technology still seems very unimpressive given we have wireless earbuds in stores. Mounting something behind the ear doesn't seem very extravagant these days and vendors only profit from this forced conservative approach because it smothers any potential competition that thinks it has to be this way.

Yes. Plenty of people prefer behind the ear devices because they are either rechargable, or brightly coloured. Young people in particular benefit from being able to chose an aid that's brightly coloured, and you see some YP modify their aids with skins or stickers.

Here's the colour range for one modern aid: https://www.fmhearingsystems.co.uk/PDF/FocusColours.jpg

Rechargable: https://www.phonak.com/uk/en/about-us/rechargeable-technolog...

Having a brightly coloured hearing aid as an adult doesn’t look professional. Are these marketed towards younger people?

As an adult, I want a brightly colored hearing aid. I don't care about hiding my disability—in fact I'd rather it be difficult for others to ignore—and I want it to be easy to find if my kids knock one out of my ears which happens less now that they're six but still happens.

Why not? People wear brightly colored jewelry or “statement” eyewear in a professional context all the time.

Are you saying that it’s “professional” to hide your disability if you have hearing loss? If so, then I strongly disagree. It’s a personal choice.

Indeed, to make an even more direct comparison: brightly coloured glasses are very common these days. They seem to be treated like neckties: it's acceptable for them to standout even in very formal situations.

I didn’t mean it to be about ‘hiding’ your disability. I wear glasses and I would never wear brightly coloured rims in a professional environment. By my own standards, in a work place you stand out by the merits of your work, not on what you’re wearing.

Dude... chill.

Even if you can be “right” you’ll be alone on Merit Island, let it go it doesn’t matter have some fun and let others have their “things” too.

This is your opinion. In many parts of the world, criticizing a piece of accessibility equipment as unprofessional is likely an HR violation, and probably grounds for termination.

It is and you are correct. It’s not unreasonable for someone to want a more neutral colour if that is their preference though. Some HA users are self conscious and hide that they are wearing them.

There are trade-offs.

Behind the ear is great when you still have reasonable hearing in a good chunk of the spectrum, so the dome from the BTE provides the boost that is additive to the natural signal.

Wireless earbuds' counterparts in the hearing aid world are called "in ear" or "in canal" or "completely in canal" or "hidden", and they provide some benefits, but do have a couple of drawbacks: they can often give the impression of a plugged ear because they keep the natural signal out (exacerbating tinnitus, which is common with hearing loss), and they can irritate the ear canal from all the friction (that part of our body is very sensitive). They can also prevent the natural outflow of cerumen (wax) and cause its accumulation.

is it possible to use the users phone for those calculations ?

Think about a dumb hearing aid, with a microphone and bluetooth connection, which is able to connect to any compatible phone and phone does the processing.

Realtime audio is tricky without hardware acceleration.

A recent smartphone has enough hardware for that, I would think, and if it hasn’t, but the idea made sense, it would be added. If the hardware can power a GPU and a million-pixel display, it can power quite a beefy DSP, too.

I would worry about the latency of a round-trip over Bluetooth. Google search tells me it’s, optimistically, 100ms single-trip, so 200ms round trip (https://www.headphonesty.com/2020/07/fix-sound-delay-bluetoo...)

Can anyone who knows about Bluetooth comment on why I can ping google in 50ms (wirelessly, even), but a Bluetooth round trip over a few centimetres takes 2 - 3X that?

Please don’t think of me as an expert, because the sum of my knowledge comes from browsing Wikipedia articles. But the summary of the issue is that Bluetooth gets all its energy efficiency and robustness by constantly scanning the spectrum it is to live in, and hopping around extremely fast to different slices of channels, essentially taking advantage of the tiny “gaps” in other signaling protocols that share the same free spectrum. In other words it operates on sloppy seconds/scraps like a vulture, which means it’s timing is very loose and cannot provide any guarantees. But it’s very low power as a result because it almost never has to shout over anyone else.

As callalex mentioned, the spread spectrum could introduce some delays into something like first packet response but this isn't necessarily the crux of the issue. Once a channel is being used, it can often stick around on that particular channel for a while so subsequent packets wouldn't necessarily have to do the whole spread spectrum dance until the devices start experiencing issues. IIRC there's some amount of stickiness to the spread spectrum utilization, but I could be wrong.

You're a tad bit incorrect on Bluetooth round trip a few centimers being 150+ms. Plenty of game controllers operate on or on top of Bluetooth and do not have 150ms latency. Headset Profile (HSP) bluetooth also does not (usually) have 150ms+ latency, usually more along the lines of maybe 30ms latency while many Bluetooth controllers will have <10ms latency.

https://www.reddit.com/r/RocketLeague/comments/8wvf9u/contro...

I'm not the person who designs codecs, but I'd wager most of the lag seen with Bluetooth audio systems come from the codecs. Bluetooth devices are often incredibly power constrained, so codecs operating over Bluetooth are usually trying to balance quality with computational complexity and dealing with packetization of the audio. When you're listening to an audio stream, it appears like a continuous stream of data. In reality, its chunks of data. You're listening to a previous chunk of data while the device is waiting to get the next packet, apply error correction to it, decode the very highly compressed data, and have the waveform ready to go out to your ears all on usually pretty cheap and highly power constrained equipment. It then has to be a bit tolerant to the above mentioned spread spectrum and a potential dropped packet here and there while still seeming to just be a continuous audio stream.

So in short, there's latency in a lot of Bluetooth audio codecs because the designers of the codecs felt the latency tradeoff was acceptable given the bandwidth, compute, power, and quality envelopes based on technology available at the time of crafting the codec.

Meanwhile, you're sending out pings on a device with keys on the keyboard bigger than the battery on a lot of bluetooth headsets with many orders of magnitude more processing power whose wireless connection is not normally that much of a power concern encoding/decoding extremely basic data to one of the companies with the most privately owned fiber with billions of dollars of computing equipment.

See madspindel's comment above ^^^ about Bluetooth 5.2 LE Audio and this:

LE Audio: Announced in January 2020 at CES by the Bluetooth SIG, LE Audio will run on the Bluetooth Low Energy radio lowering battery consumption, and allow the protocol to carry sound and add features such as one set of headphones connecting to multiple audio sources or multiple headphones connecting to one source It uses a new LC3 codec. BLE Audio will also add support for hearing aids.

And wireless introduces significant latency! You don't want wireless anything if you can at all avoid it with real time audio.

Easier said than done. I developed a hearing aid app for iOS.

full-proof -> fool-proof

NOT being pedantic, just trying to be helpful / educational (esp given the large % of non-native English speakers on HN)

Sorry the auto correct changed the spelling. I meant fool-proof. I am a native speaker.

Eargo lets you calibrate yourself, but the devices themselves are still fairly expensive.

Multiple-decades of hearing aid wearing here. I agree with most of that. I ended up buying the programmer for my aids to do small tweaks (not the prescription/audiogram, just the program configuration where you can edit the level of DSP in various situations).

I would say that this latest generation of hearing aids (Phonak Marvel) is the first generation where I've felt like they've got it right. Direct bluetooth connection that just works, and with a very wide range of volume adjustment (older models that used add-on streamer would not go loud enough). People receiving my voice over bluetooth, using the hearing aid's onboard microphones, report good sound quality. Magic.

And the Phonak Marvel's retail price is north of $1,000 USD. Can some of the cost to the individual be defrayed through medical insurance in the US?

My insurance covers hearing aids, but it definitely varies.

I've never had insurance cover hearing aids. It's criminal that something so essential isn't covered.

Some medical insurance plans provide coverage. I previously had a plan that covered the cost up to a certain amount per hearing aid, but only like once every couple of years. So if you were like me, and only needed one hearing aid, they would cover $800 for one ear or $1,600 for two. But I couldn’t, say, get one for $1,600.

Now I have a plan with a different employer that doesn’t cover them at all.

I'm about to trial a replacement for my current HA (about 5 years old) for the Phonak Paradise (the just released successor to the Marvel). The bluetooth connectivity has been a big reason why I want to upgrade - the work from home situation this year with constant phone calls and Zoom meeting requiring headsets has been a constant annoyance.

I use an Airpod in my right ear and leave one HA in my left for those situations - but its fiddly and annoying to keep switching things in and out. The new IOS14 feature where I can tailor the Airpod audio response to my hearing frequency loss is simply amazing! However, being able to connect/stream audio directly to my HA will be even better.

They are seriously pricey though - cheapest model is Aus$2700 (US$2000) and the top line model is Aus$8400 (US$5900). However, given I feel I got made redundant from a previous job five years ago due to my hearing loss (1), I'll basically spend 'whatever' to ensure I can hear as easily as possible.

(1) In that job, I was wondering why as the years went on, I felt like I was struggling to pickup new concepts or get a handle on projects as fast as I used to. I seriously felt like I was getting stupider. After I got my hearing aids, I realised how much speech I was missing - I was heavily relying on lip reading and also using the context of conversation to fill in the gaps of words I couldn't hear. Which is passable in general conversation - but when managing new projects or new technology concepts, you don't have the experience to generate the context that fills in the gaps. It was literally life-changing when I got my HA. Go an get your hearing tested if you ever feel you are even remotely struggling with your hearing!

> The new IOS14 feature where I can tailor the Airpod audio response to my hearing frequency loss is simply amazing!

What feature is it? Can’t the same be achieved with EQ?

https://support.apple.com/en-in/HT211218

I'm not sure ... i was under the understanding the that EQ function on iOS only applied to music. I guess the other advantage is that audiogram function makes it a one-click accurate configuration of the 'EQ' based on a hearing test.

Wow, I wrote Apple and suggested they do exactly that. That this feature isn't part of the "introduction to your airpods" stuff is wrong. It should be!

Whats your view of the Phonak aids? As a user, would you say they are worth the money?

> They are seriously pricey though - cheapest model is Aus$2700 (US$2000) and the top line model is Aus$8400 (US$5900)

I don't disagree that those are not cheap, but custom in-ear monitors for musicians are almost exactly the same price range.

It doesn't seem like the medical profession is actually gouging people in this instance.

This may be a dumb question, but could a phone app work for a good number of people? Not sure off hand how not to amplify your own voice, but otherwise a phone can easily do the DSP work can use wired or bluetooth headphones.

I suspect the main issue is latency

It's because it's a medical device. The OTC Hearing Aid Act will change that so Bose (and I would guess Samsung and Apple in the future) can sell hearing aids directly to consumers.

Bluetooth 5.2 LE Audio will solve the vendor lock-in. So the future looks bright for us with hearing loss.

Edit: And with iOS 14 you can use AirPods Pro as hearings aids by adding an audiogram to the Apple Health app. Works really well.

There is a hearing aid app called Fennex that seems to be very highly rated. It works with any IPhone running iOS 11 or later (thus less expensive IPhones) and works with any Bluetooth earbuds, not necessarily the AirPods Pro (thus less expensive earbuds). I have never owned an IPhone, but this app seriously tempts me to buy one.

iPhone SE locked down to a specific carrier used in A-rate (best quality) goes for $50 on ebay. iOS14 is guaranteed to work on it for at least one year.

Edit: I am not an Apple guy but needed some cheap AF development hardware.

I developed a hearing aid app for iOS in the past. You might not be happy with the delay that wireless earphones introduce.

Apple already sells a hearing aid that they can’t legally call ‘hearing aid’. https://support.apple.com/en-us/HT209082:

“With Live Listen, your iPhone, iPad, or iPod touch can act like a microphone that sends sound to your AirPods or Powerbeats Pro. Live Listen can help you hear a conversation in a noisy area or even hear someone speaking across the room.”

It even supports hearing aids (a few? Some? Many? The most popular? I wouldn’t know). See https://support.apple.com/en-us/HT210386

Unfortunately live listen is more like a replacement for remote microphones, not the hearing aids themselves. It adds around 70ms latency with a bluetooth headset. This is enough to be very uncomfortable. For comparison, most hearing aids on the market today have around 8ms of end to end latency.

Source: I've built a hearing aid and done extensive latency tests :)

Hmm and I also heard John Carmack talking about problems with audio latency in conversations. 70ms is a lot!

I have a major hearing impairment in one ear. Using one AirPod with Live Listen was completely unusable to me because of this latency.

I had a hearing aid app on the iOS app store for a few years, and all I got was whinging about my app not fully supporting Airpods/bluetooth headphones. I had in the app description and on the website recommending using wired headphones so there was no delay, but people don't understand how things work even when they are told point blank. The reason why people don't notice the delay with bluetooth devices during media playback is that media is delayed to sync with the bluetooth audio. When Apple deprecated wired headphones, I called it a day.

thanks for sharing! what’s considered the lower bound for comfortable latency?

In audio a delay of about 5 milliseconds is the most you can comfortably accept without it seeming really annoying.

Well-designed, expensive hearing aids have extremely low latency, but there are theoretical limit. The more frequency domain processing you want to do, the more samples you need to do it, and the more delay you're going to have even in the best-case engineering.

Smartphones are unfortunately typically not able to meet these kind of specifications. Much longer delays are acceptable in voice communication because you don't hear your own voice and the delayed voice at the same time.

Point being, it really has to be a specialized device designed from the ground up to keep the latency close to the theoretical low limit.

My gosh, thanks for posting this! It's been very frustrating watching hearing loss affect my older family members and seeing how bad the hearing aid situation is. The OTC Act + the updated Audio spec looks like the right solution!

Cochlear implants do not "restore hearing" but they do allow people who are completely deaf to sense sound well enough to understand speech.

That's a huge change in a deaf person's life.

> to sense sound well enough

My understanding is that it's like a low-sighted person being able to see contrasts and outlines of things. It's enough to differentiate things, but significantly less than the detail of regular ability.

That could be for Deaf people. I'm a cochlear implant user, having been hearing impaired most of my life. Because I know what things sound like, I have an advantage over Deaf users of CIs. Thus, for me, hearing is like the difference between a RAW image or the same image in JPEG with heavy artifacting, or like seeing something in 60fps- you know what you're sensing, but it's just off a little, but still much better than sensing nothing or very little at all.

There are several simulators on the Internet, so you can hear what it sounds like.

Cochlear implant user here - they completely changed the arc of my life. I lost my hearing when I was 12 and was deaf for 15 years, so I do have some sense of what normal hearing is like. Sound quality is pretty good in the speech-level frequencies but degrades when you move away from that range (music sounds worse than I remember). That being said, I score in the 90%+ percentile for speech recognition and am able to talk on the phone with no problems.

There's no telling where I would be without my cochlear implants, but they truly have provided me a second chance at life. I got married, went to a great graduate program, and have a high paying, fulfilling job - all products of being able to communicate effectively.

Communication underpins fulfillment and self-worth. Any product that helps those in need communicate better is a net positive.

Music sounds worse today even for people with perfect hearing.. :)

I work on ecommerce, so I often see trendy products being marketed: usually sourced from China and hyped to sell at 20-50x its price.

I am trying to see how different this device is compared to sound amplifiers marketed as 'miracle hearing aids' found in any ecommerce site. The last thing HN wants is to fall victim to an advertorial disguised as a scientific discovery.

Note: I worked for a company that wrote 'scientific' articles like this as landing pages.

Yep. I have a pair of fully functional Bluetooth earbuds that cost $8 including shipping. It is already possible to make cheap amplifying earbuds. The problems are largely regulatory. I’m glad someone said the US passed or will pass a law that allows earbud manufacturers to sell their devices as hearing aids. I found a broken/crushed AirPod on the ground and my goodness they pack serious engineering into those tiny things.

This all sounds similar to my experience with CPAP machines.

> That said, the hearing aids vendor lock-in is really atrocious and can use a disruption

Agreed about the disruption in this space.

> They don't like users configuring the aids themselves

I get the feeling most users don't want to configure the aids themselves, and even if they did, wouldn't feel comfortable doing it or don't have the ability or audiology knowledge needed.

Later on you mention how helping with hearing loss is not quick or straightforward, which seems to support that the default of encouraging sessions with an expert is right approach, at least to start.

I think skype is exhausting not for this reason but because algorithms cut speakers out when someone else starts speaking for echo and feedback suppression. I wish there was true full-duplex mode that assumes everyone is wearing headphones, so there aren't any reverberation concerns.

+1, definitely.

> Hearing aids (nor cochlear implants, for that matter) do not "restore hearing", except for light hearing loss

This claim is totally false for cochlear implants. I am a cochlear implant recipient and before the implant I had essentially no hearing in my right ear ("profoundly deaf"). With the implant in my right ear my hearing has been restored to 90%+ of normal hearing.

What does 90% mean, and out of curiosity can you distinguish two notes one semitone apart on e.g. a piano?

After my cochlear implant operation I volunteered to participate in an in-depth research study to collect data on post-op outcomes for cochlear implant recipients (coincidentally at the Eye & Ear hospital in Melbourne where the multi-channel cochlear implant was invented and first implanted in 1978 by Graeme Clark).

I did a whole raft of audiology tests and for the speech comprehension tests in particular I scored 90%+ compared to people with normal hearing. (They're tough tests too, trying to pick out a sentence from a lot of background noise which is a worst-case scenario for hard of hearing people.)

I was told that my outcome was better than average, but I was a younger than average adult recipient given than I was in my early 40's, compared to most (in Australia at least) who are 60+.

And yes I can now distinguish all notes on a piano.

Thanks for sharing. This is getting into territory that non-musically trained hearing people would probably have difficultly, but can you distinguish between a C major chord and a C minor chord? And do you have any other feelings about it, like one sounding sad or happy?

I don't think any of this is particularly relevant to understanding spoken language, but I'm just curious about your outcome.

I'd be surprised if a majority of current CI users could distinguish e.g. middle C from C# (not identify the note, but just perceive a difference between them), but I don't know that many CI users.

Yes, I can distinguish between a C major chord and a C minor chord. I took piano lessons as a kid and learned some formal music theory.

Note though that I had perfectly normal hearing until my late 30s, and only have an implant in one ear. After my implant operation my brain "knew" what it should be hearing from the implant signal. This is apparently true of many adult CI recipients and the unexpected plasticity of adult brains to adjust to the CI signal is an active area of research.

I think that the typical outcomes for people who have cochlear implants when they are born deaf would be quite different to adult recipients like me who grew up with normal hearing.

The most accurate description is probably the authors built a hearing aid from the 1960s with only $1 today [0]. Its worn around the neck, doesn't have any fitting, doesn't appear to have beamforming or feedback management, and low amplification.

It turns out these things are all important in clinical outcomes for listening comfort and intelligibility. I've built a modern hearing aid and done extensive patient testing - the details matter and it's not just electrical or algorithm problems but tough mechanical and UX challenges to get something more state of the art.

While I haven't worn many neck mounted devices, the Bose Headphones can get crazy feedback and the feedback path is similar. This would cause squealing discomfort for patients and everyone around them.

[0] https://en.wikipedia.org/wiki/History_of_hearing_aids

This.

The other issue to contend with in his grandparents demographic is the perception of being deaf and being seen wearing such a big bulky item. Image consciousness is a large hurdle to overcome these

Great ingenuity but commercially it's hard to see it take traction

At first, it seemed like a laudable effort. I hate it, though, when someone makes a github repo and sticks a single zip file in it: https://github.com/bhamla-lab/LoCHAid-2020-PLOS-ONE

So I found the pdf in the zip file where you can see what it is. It's a MAX 98306 amp. The only peripherals are the typical filter capacitors, resistors, volume pot, microphone, etc. So, it's basically this: https://www.adafruit.com/product/987

Actually it uses two IC's and the more interesting one, in relative terms, is the MAX9814[1] microphone amplifier with automatic gain control.

I suspect there are cheaper class-D IC's that could be used than the MAX98306, but for a prototype why not.

It also puts the volume control potentiometer on the amplifier output which seems wasteful for a battery operated device.

[1]: https://www.maximintegrated.com/en/products/analog/audio/MAX...

Looks like that's it in the first photo in the article: he's holding it in his hands and using earbuds. Presumably it would go in a pocket or clip on to your belt.

I was surprised to see a git repo consisting of one zip file. And that zip file itself contains a zip file.

And not even a ReadMe file to accompany either ZIP file.

Looks like Chinese manufactures already sell hearing aid devices in the 25-50 USD price range. https://www.banggood.com/search/hearing-aid.html Unlike the device from the article (which would cost more like 10 USD than 1), these are rechargeable and fully integrated over-the-ear units.

Would love to see a low-cost open/hackable hearingaid/hearable though. For example BOM of 5-10 USD. But then it should use a reprogrammable chip for the signal processing, so that one can make improvements in software. Even the cheapest and simplest hardware is harder / more expensive to improve than software.

Damn that link made me happy. Was wondering if anyone has done to hearing aids what they did for glasses.

We just brought my father progressive glasses for 100usd (would be 400+usd here at a 'normal' store). Now he needs a hearing aid and we're dreading the multi-hundred payment on top of what is covered with insurance for a basic device.

So.. What's the catch with these cheap hearing aids? Why would we not buy these?

quality? doesn't this question apply to every cheap Chinese product? My mom has had poor hearing for decades and always spent thousands on her hearing aids for marginal improvements in quality (e.g. noise cancelling, size, noticeability). The only thing that really made a big improvement was when she finally got a cochlear implant.

> doesn't this question apply to every cheap Chinese product?

The question is always valid but the answer isn't always the same.

I'm thinking specifically of cheap eyeglasses.I've had nothing but good experiences buying glasses that cost 10-20% of what I would pay from a local store.

What's a good place for buying these cheap eyeglasses?

I've only used Zenni Optical. Their glasses start under $10 but different frames and different lenses can change the price.

My biggest complaint with Zenni is that shipping can sometimes be slow. I've waited 4 weeks for glasses to show up and other times it's only a week. I think it depends if they come from China or their US facility.

+1 for zenni. Have three pairs from them now, all of them good quality and spot on for my prescription. And the most expensive of them was $50 with lenses.

Just like anything else you can by "cheap" or you can pay more and get a better product 99% of the time. I find chinese tools and electronics are just fine if you aren't going bargain basement.

I just got myself some Costco Signature hearing aids a month ago. Its $1499/pair. Its made by a major manufacturer named Phonak. The feature set is close to their top of the line model. Half the cost of the hearing aids in the US is actually the fitting by the audiologist and they have to pay for their expenses. You have to spend considerable time with the audiologist to measure, fit and calibrate the device to your needs. Costco is able to minimize the cost overhead since the office is inside a normal Costco store.

The hard part about hearing aids is making them work in noise. You don't want to just amplify everything or you just hear more noise. Also you need to tune it to your hearing loss otherwise you may damage your hearing. They do things like expanding the dynamics or compressing to prevent loud noises. They suppress wind noise. They can focus on the voice of someone in a group of people.

So the catch with the cheaper hearing aids is that may not help help your dad with understand speech as well as a better quality one.

I'd suggest you watch the videos of Dr Clif Aud on Youtube. He is very informative.

Why are multiple audiologist visits necessary? Can’t they just take a 3d scan of your ear and have a computer decide which shape will fit best? I recall when Apple introduced the EarPods, they said they scanned thousands of ears and derived a shape that would fit the most. So it is possible...

I went with standard domes but it took a second visit to get the size right since they take time to conform to your ears. Custom molds are another option but they told it I would get a more plugged up feeling so I stay with a more open dome unless really needed. Also there is some time for adapting to any changes in settings. They also bump up the gain with each visit to reach target levels. A big jump might be too much.

I think there is room for optimizing the whole process but anything medical related tends to move slowly. I still find the phone app a little slow and cumbersome. And switching between bluetooth devices is a pain. I wish Apple and Google would put more effort in improving that aspect.

they have to tune the DSP settings to get the amplification et al. profiles to match the patient's individual hearing loss pattern. that takes custom interface/programmer hardware the manufacturers generally only (afaik) give to licensed audiologists as it takes specialized education to do this work properly. the ear dome/mold bits themselves are a minor component of the overall fitting process. (src: been wearing hearing aids for about thirty years)

These are hearing amplifiers, not hearing aids. The difference being that hearing aids can boost certain frequency bands to compensate for hearing loss at those frequencies. The hearing amplifiers boost all the audio frequencies in a one size fits all manner. There's no signal processing going on. Maybe that is good enough for your father, maybe not.

"noise reduction" means these amplify the vocal range without amplifying the low or high, dsp, maybe not, but at least a lot and hof.

Honestly what is needed is a cheap secondary device like a mobile phone which contains a custom designed chip to do Machine learning fast on sound and transmit it to the ear. Even if this costs 500 $ i would reckon the benefit would be worth it. I guess battery technology has advanced to a level that the said device can easily be recharged daily or probably swapped with batteries if needed.

As an aside, there's a lot of exciting regenerative work going on related to hearing at the moment. Sometime soon we may no longer need hearing aids. There are some neat drugs either in clinical trials or about to begin clinical trials that will re-grow hair cells and broken synapses in the cochlea (ex: FX-322, OTO-413, OTO-6XX).

I am closely following FX-322, but mostly for tinnitus. I do have hearing loss, but it is that disrupting so far. But the tinnitus is something I could definitely live without.

Any other clinical trials that you can recommend ? Has the path from clinical trials to commercial launch shortened ?

Are any of these supposed to work on congenital hearing loss, or only when hearing loss is caused by damage/age?

It depends on the nature of the hearing loss, for example, FX-322 and OTO-6XX appear to work by triggering regeneration of hair cells, while OTO-413 appears to work by triggering regeneration of synaptic connections (both of which are probably egregious oversimplifications because I am a security nerd, not a medical researcher :P)

In theory i believe if regeneration of cells is involved it should work with congenital but i guess there might be other complexities that might be involved (not a medical professional).

Stefan Heller from Stanford's lab had set a goal somewhere around in 2010 to cure hearing loss by 2020 by trying to convert stem cells to hair cells. I have never heard of any breakthrough. I hope this happens in 10 more years at least.

This is similar to how Frequency's FX-322 drug works. It stimulates progenitor cells [1] within the cochlea to divide and form new hair cells. From what I've read, progenitor cells are basically one step away from a stem cell.

[1] https://en.wikipedia.org/wiki/Progenitor_cell

thanks, looks interesting. I hope these are only first steps to more interesting developments.

wow! ah, other than naive googling on those drug candidate identifiers, are there any sources you'd recommend to read more about this?

(I have a genetic condition that tl;dr impacts hair cell substrate material leading to hearing loss by early teens. Being able to hear natively again would be ... words fail me.)

Personal sound amplification devices already exist at significantly less cost than conventional hearing aids. https://jamanetwork.com/journals/jama/fullarticle/2635618 https://www.nytimes.com/wirecutter/reviews/best-personal-sou...

This is not a $1 hearing aid and never will be. The material cost of almost any device is insignificant compared to the overall cost of manufacturing, testing, and distributing it. The barrier to low-cost hearing aids in most countries is medical regulation and liability coverage, not expensive parts. Maybe India's regulations are lax enough that someone could bulk-manufacture cheap, poorly-tested medical devices to get the price down to a few dollars, but there's no technological breakthrough in this "new device" that would enable that; if there were a viable market, it would already be manufactured. There's no profit to be made, so why would anyone bother?

>There's no profit to be made, so why would anyone bother?

Really dude?

> if there were a viable market, it would already be manufactured

Yup. https://m.aliexpress.com/wholesale/hearing+aid.html?channel=...

> if there were a viable market, it would already be manufactured. There's no profit to be made, so why would anyone bother?

Big market, not super-complex tech, it's only matter of time when cheap solution comes.

I never wrote part 2 of this blog post, but there's a $300 open source hearing aid that can do way more than most hearing aids: https://shapr.github.io/posts/2019-08-03-tympan.html

Here's the organization building this thing: https://shop.tympan.org/

I'm kinda excited about the four microphone board, where you can subtract the ambient noise behind the listener from the noise in the direction they're facing.

Can i mail you ? Where are you based in ?

The blueprints are hosted on github: https://github.com/bhamla-lab/LoCHAid-2020-PLOS-ONE

Edit: there is also a video showing the building process: https://www.youtube.com/watch?v=e0gnbOJ3nDo

And the original scholarly article:

https://journals.plos.org/plosone/article?id=10.1371/journal...

I was told I could benefit from hearing aids, but was told they would cost $5K to $8K depending on which ones I wanted. I've decided for now that I'll put up with the issues associated with not having them for now. I was also told they blue tooth doesn't work very well if you have an android phone, so I'm hoping that there can be some real innovation and competition in this space to drive the prices down and also improve the technology!

If you have access to Costco their in house brand is much less (~$1600 pair) and good. Also I really like Bose Hearphones which work better for me and were $500, assuming you don't mind looking like you are on a conference call all the time.

If you can find your way to Costco, make an appointment with their audiologist. The test is free and hearing aids are less than $900 each. Follow-up visits are free. You do not need a Costco membership unless you decide to make a purchase. If you are unhappy with your purchase you can get a refund on the hearing aids and the membership.

I believe that most of their hearing aids support bluetooth, but only when you get a pair. I only need one, so no bluetooth for me.

I've had fittings by two people at Costco. One is an audiologist and the other was less credentialed, but I forget the title. I could hear better when fitted by the audiologist.

This is so true! We were told 8k, Costco got us a top of the line set with all of the features the other set had for less than 2k for the set. Costco made a customer for life out of that deal. They do glasses as well, though I haven't used them for that and don't know if the discounts are as good or not.

I don't have any first-hand experience to share, but my wife used to work at https://www.audicus.com/ which is a startup focused on exactly this problem, in case you're interested in further research.

That seems really high. I have the fanciest hearing aids that Costco sells (rechargeable, Bluetooth, optional external microphone) and I spent under $5K on it.

I just started using hearing aids and went with the Costco Signature. Half the cost of hearing aids is the office overheads since hearing aids need significant tuning. Costco is able to leverage its existing store overhead to minimize it. The Costco ones re made by Phonak and based on the features on the Phonak Marvel series.

Have you seen https://www.listenlively.com/ They're a fair bit below what you've quoted above.

I get that this product is about super low cost but seems to me that with a custom firmware, the AirPods Pro could do a brilliant job of noise cancellation and amplification of specific frequency bands. Ostensibly, you could even employ some ML to enhance clarity of spoken words, etc - like Krisp

You might be interested in this other comment chain: https://news.ycombinator.com/item?id=24580446

here's a more detailed write-up including pictures of the device:

https://journals.plos.org/plosone/article?id=10.1371/journal...

It's a crude, bulky, ugly, and fragile thing and the $1 price is not realistic - but it would be less than $10. It seems like a decent product for the poorest places - which is their goal.

The hearing aid biz in the US is glaringly inefficient and obviously ripe for disruption - but this product will not do it here. There's definitely a demand for hearing aids in the couple-of-hundred dollar range that doesn't require audiologist visits and insurance hassle - but the entrenched interests will not help bring it about.

This is basically using academic journals as a marketing channel. As someone else linked above, there are tons of similar devices available from China, probably even using the same chips, at equally low prices.

Based on the MAX9814 chip, which costs 0.75 USD in 2.5K volume, leaving 0.25 USD for everything else. The design is not integrated much (many connectors), so assembly costs will be high. It also requires 2xAA batteries as a consumable, which consumer has to pay as well.

So this is not a 1 USD hearing aid in any way. And if current units are 500 USD, then going down to 50 or 10 USD would already be a huge improvement.

The pdf shows a MAX98306. Curious where you saw the MAX9814.

The HearingAid.sch PDF says MAX9814 on the JP1 connector on the left side. So are they actually using both?

The MAX9814 is the microphone.

Here's the BOM which shows the full breakdown coming in under $1.

https://journals.plos.org/plosone/article?id=10.1371/journal... (Table 1)

Just the BOM image so it's easier to read: https://journals.plos.org/plosone/article/figure/image?size=...

Also, I'm not sure where he's getting the prices. Prices for the MAX98306 and MAX9814 seem higher, even in high quantities, than what he's showing.

Interesting that they list the cost of raw PLA pellets for the "mass production cost" of the 3d printed case.

This is starting to smell like an exercise in making an incorrect BOM to justify the result they were looking for. Nobody will 3d print you a case for $0.06. If what they meant was that they'd 3d print the case themselves, then it should be the filament or resin listed on the BOM. You probably can get a plastic part pretty close to that price, but not 3d printed, it would be injection molded.

If you read enough of Nature and Science you will realize that skilled scientists are practiced in the art of misrepresenting many details of their work to get published.

Note that the pricing in there is organized around the idea of a very massive custom purchase by a large company.

I don't think there's anything wrong with them citing volume pricing per se. You'd expect something like a hearing aid to be mass produced.

It's the incongruency of the materials listed with the actual materials that would be used in a mass production scenario that I find unscrupulous.

You can find plenty of these "personal amplifier" devices for $15 or so. I doubt they are making $14 on each one.

https://www.ebay.com/sch/i.html?_from=R40&_trksid=p2380057.m...

> The MAX9814 is the microphone.

It's the microphone amplifier. This unit still needs an external microphone, as well as headset/plugs.

I'm not surprised that someone who can fit two "AA" batteries in their ear has trouble hearing!

>assembly costs will be high

You read the article and know this is intended for DIY assembly, correct? That it's not a commercial product?

With all the advances in tech, why does it seem that hearing aids are still from the 80s?

I guess ultimately you're limited by your interface to the brain (something maybe neuralink could address?), but even still shouldn't there be some "magic" machine learning stuff going on in this space? Not at all an expert in audio processing, but I would imagine that we could do a decent job distinguishing voices from background noise, automatically thresholding sound in different environments, and possibly modulating sounds into different frequency bands when there are e.g. multiple speakers.

For all I know, stuff like this is already going on.

My mother, who's fully deaf in one year and mostly deaf in the other, has heavily depended on strong and expensive hearing aids her whole life.

Over the years her hearing aids have improved in battery life, gotten smaller, and improved in things like filtering background noise. Every new hearing aid would start by sounding distorted and weird but her brain adapts to the new sounds after a couple of weeks.

The single largest life improvement I've seen for her was about 10 year ago when she could finally get a hearing aid with bluetooth. Suddenly she didn't have to decide between the "whistling" (feedback) or not hearing to talk on the phone. We got her an iPad and she stopped watching TV almost entirely and now watches YouTube and Netflix. And she can do her yoga over Skype.

Her biggest challenge, at this point, isn't a hearing aid problem but a bluetooh one. Her iPhone inconstantly switches between her hearing aid and her Volkswagen (pre-CarPlay).

I agree hearing aids are stuck in the past, but I'm also convinced most of the problems are lower hanging fruit than a neuralink :).

If she likes watching on a TV, the Apple TV can talk to bluetooth audio devices. Have never tried it, but it would probably be able to talk to the hearing aids directly.

These days they are fairly sophisticated; my hearing aids will automatically switch between several different programs depending on the environment. (It doesn't work how I'd like it to, though, so I have a program that I manually set for music.) There is also a phone app for adjusting settings, though it's limited and buggy.

It's difficult to evaluate hearing aids because they are proprietary. Reading about the features in a brochure for a hearing aid is like reading the features for a TV set or stereo. Who knows what those trademarked terms really mean when it comes to how the code works?

Would be cool to create an open standard and perhaps even open source the development. If nothing else, I would imagine that there are quite a few hearing impaired engineers and scientists out there that would gladly work on something like this if it meant that they themselves could benefit from the improvements.

Both https://audatic.ai/ and https://whisper.ai/ are taking the ML approach for speech enhancement, and the large companies are starting to get on board. It's the future!

I agree! We're working on this at AudioFocus (YC S19). You can see an old demo here: https://www.audiofocus.io/demo

There are a lot of challenges with putting this in a hearing aid: low latency inference (10ms), small power budget, consistent performance, fault tolerance, etc. Still a fair amount of R&D to be done, but change is coming.

Is it too difficult to ask for one that distributes the processes between phone/external device, rims of glasses and in the ear speaker. It will go a long way in addressing the issue of stigma and enabling more people to use it early.

A big hurdle for doing this is latency, every time you hop from one device to another you're adding at least ~10ms of latency if it's over anything like bluetooth. There might a clever way to do it, it's something I'm thinking about but it's too early to say.

For now it looks like it's going to be a behind-the-ear hearing aid. Maybe in 5-10 years it could fit in your ear canal.

How many microphones do you need to do this filtering? I wear hearing aids myself and if you can do it that that level on a real hearing aid that would be amazing.

In this demo there is only one microphone on the phone. But we're working on stereo (2) microphones now. That will help make it more reliable, lower latency, and give you spatial awareness (awareness of the direction of sound).

Glad you're excited about it!

So this is a very simple circuit. Basically a microphone amplifier directly connected to some earphones with a volume knob. No frequency control of any kind. I'm wondering why this sort of device is not already available like loupe type glasses that we can easily find. I'm thinking this has something to do with legislation and maximum allowed earphone sound levels? Or maybe it is too crude to be actually useful?

It is available, even as in-ear style "hearing aid", for <$10 from the usual factories. I gather it's a little problematic selling them in the US due to medical device regulations...

You can choose among hundreds of cheap "hearing aids" on Amazon.

They can be sold here, but they can't be marketed as "hearing aids" afaik.

15dB amplification is very little. A 15dB hearing loss can really go unnoticed. It may help a few people, however this will never be a medical device mainly because it has no medical use.

This is awesome news.

Public Service Announcement: If you're operating power equipment, wear your ear protection! I didn't, and now have permanent hearing loss. Be smarter!

I've been using over-the-ear hearing aids for about 8 years and they have become a part of my life, like contact lenses. The technology has improved dramatically but it's simply not fun having something riding on your ear. They need adjustment throughout the day, and now that facemasks are a thing they're always getting snagged. And there are just some situations where they aren't ideal: many people talking at once in different parts of a room, or when there is any kind of heavy background noise (fire alarms, sirens, etc.).

That's why the neural implant that Musk recently demonstrated excites me to no end. Everything is inside the body, no need to amplify or filter anything, just interface directly with the nerves and compensate for the damage. I hope I don't have to wait more than ten years to get one.

Related to hearing problems there is also a thing called"Auditory processing disorder":

Individuals with APD usually have normal structure and function of the outer, middle, and inner ear (peripheral hearing). However, they cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech. It is thought that these difficulties arise from dysfunction in the central nervous system

https://en.wikipedia.org/wiki/Auditory_processing_disorder

TL;DR: someone could make bank selling < 150USD a pop receiver-in-canal wireless bluetooth headphones.

This is semi OT. I use a hearing aid every day. the hearing aid features are turned off, i just use it for bluetooth streaming and phone conversations. it is a receiver in canal hearing aid, and I've put a non-occluding ear dome on it so I can hear normally with it in, but when I play music, the music just arrives in my ear. its also very discrete, people dont notice it unless i tell them its there.

Why someone doesn't take a cheap android/iphone bluetooth-compatible receiver in canal hearing aid and sell it not as a certified hearing device (heck, disable the hearing aid part in sw) but as a discrete wireless headphone set is a mystery to me.

Wireless headphones give me earaches with pressure on my ear canal, over the ear headphones give me headaches with pressure on my ears, then glasses, then skull. Custom in-ear monitors conform to my ears just fine but block out most other sound and have wires to deal with.

These? I put them in, forget about them for a long time, and have sound just floating into my ears when I turn on music.

It's my go-to startup idea.

A few notes here:

* This is intended to treat presbycusis, or old-age hearing loss, where the highest frequencies are lost first. It would not be effective for noise-induced hearing loss, where the frequencies around 4 KHz are lost first (the "s" and "f" sounds in speech). This matters in the low-income countries it's targeted for, because occupational health is not as strict and PPE is not as widely utilized, so people are more often exposed to damaging levels of noise at work.

* It does not handle loudness recruitment, a common effect of damage to the outer hairs in the cochlea which causes loudness perception to become non-linear. Someone with a moderate hearing loss would hear an 80 dB sound as just a few dB softer than someone with normal hearing, but a 40 dB sound as many dB softer than someone with normal hearing, and a 20 dB sound as not audible at all. So if you do what this hearing aid does and boost it all by 15 dB, the 20 dB sound becomes barely audible, the 40 dB sound is perceived as "about right", but the 80 dB sound is perceived as nearly 95 dB (really freaking loud). You have to have some non-linear compression in there to adjust for this, and not just overall -- it needs to be per frequency band (https://en.wikipedia.org/wiki/Bark_scale) to match the way the ear works.

* Another commenter mentioned that the "bandwidth to the brain" is not available. That's only true in the case of damage to the inner hairs of the cochlea. What's more common is damage to the outer hairs, which amplify the sounds, and that can be compensated for with a hearing aid.

What we really need is a common way to program a hearing aid, so we can have apples-to-apples competition. Right now, when you go to the audiologist, you get an audiogram, which tells you the minimum threshold of sound that you can perceive at each frequency band. But beyond that, there are proprietary adjustments for compression, noise reduction, profiles for different types of loss, and so forth. It's not like getting glasses, where your prescription fully defines the lens, and you can take it to any vendor and have them make it for you.

Edit: If you're really into this stuff from a technical perspective, http://refined-audiometrics.com/wordpress1/ is worth a read -- it's a project by an engineer who experienced a hearing loss later in life who has built a software system to make music sound right for him again, basically building a "super hearing aid" running on a desktop CPU to do more fine-grained processing than what is possible within the power budget and form factor of a regular hearing aid.

This is nice, I was looking at this problem a while back and was wondering whether implementing sound amplification features on cheap TWS earphones can solve that[1], of course it wouldn't be $1 and I wonder whether the latency of BLE would defeat its purpose.

[1] https://needgap.com/problems/22-enabling-hearing-aid-feature...

My mother has been wearing Hearing Aids for over 20 years. These days she has trouble with hearing what is on TV even with a powerful hearing aid. Most times she just sits quietly in front of the TV watching moving pictures.

I have always wondered why it is so difficult to make hearing aid which can be connected to a bluetooth enabled TV or Mobile phone, so senior citizens can watch TV or talk to their loved one. Whatever is available on the market is so expensive.

Well, my mom has one of those.

They are actually two pieces, one is a match-box sized thingy that can connect to Bluetooth devices and that she wears around her neck that transmits to the devices in her ears and also has a microphone, it is very handy as she can easily answer the phone by pressing a button on it (leaving the telephone in the bag, it works as hand-free) and it also has two buttons that can regulate the volume of the hearing aids (the volume of her hearing aids can be regulated also through a teeny-tiny button on the back of the hearing aid, right hand one up, left hand down, but she simply cannot find/push them properly).

We got the above first to better adjust volume and for the telephone use, then she started getting issue with the TV and we bought the following.

Then there is a small transmitter connected to the TV that can link to the matchbox-like device (that has a fourth button to connect/disconnect to the TV device), it has both RCA plug and an optical input.

She is very, very happy of this setup for the TV, much more than what she had before (wireless headphones).

Prices are steep, to give you an idea, if I recall correctly:

hearing aids € 2,500

neck matchbox-like thingy € 250

TV transmitter € 300

They do come up on ebay - I got the tv link for my cochlear implant for £30. Yes, I was lucky. I assume it was a deceased estate sale, and I'm grateful for their consideration. A charity shop specialising in recycling of this kind of tech would fill a definite gap in the market.

Thank you for giving a detailed explanation. I have got a general idea. I wish you could share photos, so I can replicate it for my Mom.

The issue is the wireless protocol used by the hearing aids (which I believe it is proprietary).

The TV box thingy is like a "normal" Bluetooth transmitter for a TV, the only differences are that my mom's one has direct RCA and optical instead of an audio jack and a blue led to show it is powered and a brightish orange one to show if the connection is active, here it is:

https://www.hab.online/product/oticon-connectline-tv/

The neck thingy is this one: https://www.hab.online/product/oticon-streamer-pro/

The above (UK) site seems to have all versions of these thingies, here:

https://www.hab.online/product-category/wireless-and-remotes...

The alternative:

https://www.hab.online/product/oticon-connectclip/

we tried but it is too small for my mom to use comfortably.

Here is the manual of the streamer, with more details:

https://www.oticon.com/-/media/oticon-us/main/download-cente...

Check also this:

https://www.ndcs.org.uk/information-and-support/technology-f...

Thank you, friend!

There are bluetooth enabled hearing aids. Also you can get normal headphones with bluetooth capability. I have 60dB hearing loss and use the bluetooth headphones from time to time both with and without my hearing aids.

> the scientists anticipate that LoCHAid’s parts will wear out after about a year and a half.

Why would that be, I wonder. Anyone know?

Perhaps the AA batteries need changing that frequently?

Or thats the average time till they get crushed/wet/stood on by the user?

I wonder how different it is from something like this: https://www.ebay.com/itm/Pocket-Hearing-Aid-Sound-Voice-Ampl...

Ah yes, the hearing aid 'racket', and it is indeed a racket hidden under medical device laws. One hopes this will change once that law passes. The hearing aid racket people are hard at work lobbying to block it.

Hearing aids are useless for people with tinnitus like my grandmother.

The most expensive or cheapest are all the same when you have a medium high pitched buzz in your ear all day

Ok I will bit, I want to build this and redistribute in Africa, I lack technical knowledge to do this, what is best approach?

Talk to a Chinese factory on what’s the lowest price they’ll sell you the hearing aids for that they already make at near-cost prices. The article is literally a “my first soldering project” combining an OTS microphone amp module with an R-C high pass filter. https://www.ebay.co.uk/itm/Rechargeable-Digital-Hearing-Aid-...

The $1 figure in the headline is clickbait as it’s only the cost of components for the PCB. Add the PCB + mechanical components + battery + plastic enclosure + assembly + testing + factory margin + overhead and it would be a miracle to come under the cost of existing low-cost hearing aids.

That's not true, the $1 figure for all of the parts. Here's the original, search for "Table 1" for the BOM

https://journals.plos.org/plosone/article?id=10.1371/journal...

Good luck sourcing 3d-printed casings at 0.06 USD, or PCB at 0.05 USD a piece, even in 10k or higher scale.

And of course in addition to the BOM comes production costs.

The casing is just a rectangular plastic box with some holes in it, I'm sure you could get some made at that price.

Even if the PCB costs 5x the quoted price, you're still rounding down to $1.

That said, I have no idea what production costs are for something like this.

I can understand how it may seem that way when a plastic takeaway box costs $0.1, why should this cost any more...

The article's cost assumption is just based on the cost of the raw plastic material, which is hilarious (3D printer time doesn't really come free).

But in more realistic mass production you'd make a mold, and the cost of the mold is dependent on how many "shots" you want to get out of it. Making plastic parts at the cost of takeaway boxes requires expensive high-volume molds.

At 10k volume you'd be happy to get the box for $1 including amortised mold cost (though in reality the box could be much smaller, reducing mold & material costs some).

The casing is about 2 hours 3d-printing a piece. That is 20'000 printer hours for 10k units, giving a machine-time cost of 0.025 USD (including plastic). That is off by a factor of 10-100, at least.

For injection molding, one would need to make the molds. That would cost probably more than 1000 USD, excluding engineering costs (the design is not injection molding ready). Amortizing the mold costs over 10k units alone would be 0.1 USD per unit. Then comes actually making the parts. Maybe 0.5 USD is doable.

I checked an off-the-shelf casing (no custom molds needed) it was quoted at 0.20 USD at 1K units - but this then needs to be CNC machined on 2 sides to add the necessary openings. Probably 1 USD a piece, at the least.

The costs in the scientific article does make any sense. It is really sad to see that it gets through peer review so easily... I mean OK that the scientist does not really know what things cost to produce, but then they need to consult someone who does! Ask a manufacturing or even a design house for a cost estimate. Quality check your numbers at least a little bit.

I would estimate the PCB costs, excluding Assembly time, to be 10x the quoted price.

The BOM prices are just wrong. You can find the volume pricing for the MAX9814 and MAX98306. Those two alone add up to more than $1.

Reminds of the clock boy who designed CPUs

Step one is to come in contact with an electrical/industrial engineer who will be able to assist you in the manufacturing aspects.

Say you want a order of 10 million made up for a name brand company to a Chinese company.

Send in the plans for them to check. Put on an expensive looking logo and paperwork.

Done.

Talk to someone in Africa who works with repairing mobile phones, laptops etc. They will have enough skills to assemble such a device.

Recruit one of them or work with of them to make the devices in bulk.

Repair and bulk assembly are substantially different expertise. Almost no matter how cheap the local labor is, doing automated assembly with manual finishing is probably going to be way cheaper in China (especially since the supply chain for components is well established there).

Unfortunately that $1 aid will cost $1000 when it hits the public market. It would be nice to see open source hardware in medical devices. And a health/safety approval of the DESIGN. At least devices that won't kill you if they fail. So I can build my own like I build my own desktop computer.

Buying any Chinese electronics off Aliexpress doesn't excite me too much. Generally, they suck.

Too bad we live in the kind of world where the biggest hearing aid manufacturer will read this, raise additional capital, buy the patent & rights to the $1 hearing aid and then sell hearing aids for $5,000 each they'll bill to medicare and big health insurance co.

Patent this? This is just a microphone, an amplifier and a headphone jack. That's the most obvious thing.

There is no real innovation here. The work being done here is closer to a market research: find the cheapest components that do the job.

Cheap is also its only quality. $5000 hearing aids are better in every other aspect. It makes no sense for big hearing aid manufacturers to use anything about this design.

It does seem like a bit of a missed opportunity - even slipping in the most basic ots equaliser or dsp would add a minimal amount to the BOM, whilst moving from a late 70s format aid to late 80s, albeit in a dated form factor. (Chest worn isn't too terrible IME, but expect to replace the "wiring harness" to the earphones on a regular basis.)

You can already buy cheap amplifiers like this on Amazon.

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