The FDA wants you to be able to buy a hearing aid without a prescription
npr.org
npr.org
On the headphones side, we are getting smaller, truly-wireless headphones with some ambient sound features (such as noise cancellation, and iOS hearing features). New trends like AR would just accelerate the change due to the need to solve all day worn audio devices.
On the hearing aids side, almost every hearing aid today acts as an always connected set of headphones for your mobile phone (and has been like that for years on iOS).
Deregulating this could bring the tech industry innovation to hearing aids through natural progression of headphones technology.
This trend would make hearing aids not just target hearing impaired people, but also individual with normal hearing. For example, features such as protecting your ears against a sudden loud noise, silencing a loud restaurant so you can have a quiet conversation or improving the audio of a soft speaker could be useful for everyone.
(I have a friend who's an audiologist...watch Starkey, they are very proactive about industry changes and headwinds.)
Watch Oticon, and Sonova (Phonak/Unitron).
Reminds me of the Artemis Fowl series or the first Iron Man, awesome to see former science fiction coming closer to reality. Adaptive ear protection in real life would be really interesting on construction sites or for musicians...
I’m sure that I’m not the only one in this boat, but I may be one of the rare males complaining about their wife snoring.
also long term use of ear plugs with sleeping can cause unwanted side-effects.
When we sleep our hearing system does not turn off (safety), and when you wear ear plugs while sleeping you run the risk of making your hearing work harder - and then if you have no plugs in your hearing system is now (hopefully temporarily) more sensitive than before.
Has anyone here tried them? I'm very curious how well they'd work to use at concerts.
Not as much reduction in harmful sounds (do not use with heavy equipment for example) but do a great job of equally attenuating a wide freq band.
I suspect, like the earphone market, this is going to become a marketing-driven race to the bottom that swamps any genuine technical improvement.
If anything the Chinese are disrupting this market, in price, volume and choice. Just like they're doing with cheap lenses such as omnivision.
I still wear real ear protection, but for the odd cut, or for any other day to day situation with loud noises the AirPods do a good job.
Would you be willing to give a personal experience? Have you tried transparent mode in windy conditions?
This is especially in question, to me, with the numerous reports of people getting tinnitus while wearing the airpods with noise cancellation on.
You don't really need fancy noise cancelling for tinnitus prevention, just some form of bung in your ear.
Apple has a real opportunity here, and they are slow in seizing it. I suspect some kind of an arrangement with the hearing aid manufacturers regarding iPhone-ready hearing aids.
The name of the game here is to allow people to dial in their own preferred level of compression (amplifying soft sounds more than looks sounds) and equalization using their iPhones.
Apple could have such a great product here, if they would just add gain comparable to the currently available hearing assist devices, and then add compression, equalization, and clipping of loud noises.
Simple amplification isn’t enough.
Or just buy a decent set of earplugs that dont require charging, bluetooth or $200.
Yes i use noice cancellation and voice isolation on my iphone here in india where noise is out of control. I can even take calls now outside in traffic and it sounds like i am in a quite room to the other person. This one of the greatest technological improvements in the recent past for me personally.
Amusingly this already exists, there are a bunch of ear muffs (and some in ear equivalents I think) that relay sounds from outside in that cut off when a threshold is reached. They're pretty much exclusively sold for use with firearms, I'd love to see them developed more to work better in a setting other than the woods and shooting range.
I've done this on a couple of hunts and it's amazing to hear everything -- you can't believe how loud grass brushing against you can be. It's like you can hear like the elk do. Well, not quite... Good sets (I like MSA Sordin) have excellent stereo imaging in front of you as well.
In shooting classes, I turn them backwards so the microphones point at the instructor.
If so, then hard-of-hearing people who work in secure areas where they can't bring their phones will be very unhappy...
*Hearing test
* Hearing aid fitting
* Usage counselling
* Follow up adjustments
* Annual retest of your hearing
* Replacement of lost hearing aids
* Unlimited repair for 3 years ??
====== I got out of the Audiology field in 2015. At that time all the above was included for every hearing aid we sold (Prices varied from $750 / ear - $3600 / ear.
When I was in that field many companies tried "pay as you go" models, instead of bundles.
You know what happened? People paid the minimum (test, and fit) the never returned for repairs or re-tunings.
And then complained to everyone that "hearing aids don't work".
Buy a hearing aid today from any major provider in Canada and you get:
Initial test
Initial fitting
Follow up tests
Follow up re tunes
Counselling
repairs - including full replacement in case of loss
Batteries
In-clinic repairs and cleanings.
100% return, and in some cases $0.00 3 month trial period.
There is far more to fixing your hearing issues that just amplifying sound. Sadly, most people wait too long before trying a hearing aid, and give up because they hear too much noise.
Imagine returning your eye glasses because you still see ugly people.
I truly wish hearing aids were far cheaper, and that was a very hard part of my job and one of the reasons why I changed careers.
What are the primary cost components? The primary components are: Microphone {cheap to produce} Receiver (speaker) {cheap to produce} Processing Chip {expensive to R&D, cheap to produce}
Are the people doing these jobs highly paid? Salary in Canada was between $60,000 (diploma) - $100,000 (Doctorate) when I left the industry.
Are they highly paid because of high costs of college tuition? Depends, but after leaving for IT and making more than that with less education - I am unsure if they are "highly paid"
Would free college help lower their costs? I would hope so, but doubt the savings would pass on to the consumer.
Yes, there’s a lot of overcharging in this business, because the manufacturers charge what the market will bear, and because of insurance and lack of competition due to all the regulations they have to comply with, the market can bear a very high price.
But it’s still a very hard problem, and there’s a very significant component of user training over the long term that is required. When you were a newborn, you didn’t learn to hear and speak your native language in a single day, you didn’t learn to see and recognize faces and read written words in a single day. You shouldn’t expect a hearing aid to magically fix you in a single day — your brain needs time to retrain.
No. Hunters (and shooters) have been buying electronic ear protection for years at much lower prices. There is no FDA approval, and they are not needed so the manufactures have to compete. The result is hearing aids in everything but the FDA approval. Some people find they work better than hearing aids because the manufactures have to tune them to work well for their customers which means background noise reduction (not just gun noise reduction)
Don't get me wrong, those who are borderline find the hunters hearing protection better. If your hearing is very bad you need expert tuning for just year ears, and that can't be offered without FDA approval.
The high end ones are $200, and internally pretty much the same thing other than the programming. The cheap ones are $30 (but not programmable)
I realized one thing that would help is "open hardware". If you're supposed to see a doctor to measure and tune some value maybe a device with an open interface and an app would suffice (which I think others here mentioned today).
The reason I asked about the cost of the doctor is I am interested in doing things like giving them free school in order to lower their need to charge high prices. Generally I would rather every person has a good local doctor they can see for free, but we could also deregulate these devices and let people sort out amongst themselves how to get the right fit. I would just want to take care that people aren't damaging their hearing further with improper use.
"...the new AirPods feature Adaptive EQ that tunes sound in real time based on how AirPods fit in the user’s ear. An inward-facing microphone monitors for sound, and then Adaptive EQ, powered by computational audio, tunes the low and mid frequencies to account for what may be lost due to variances in fit. "
"To help with sound clarity, beamforming microphones block out ambient noise and focus on the user’s voice, while users can also enjoy a hands-free experience by simply saying 'Hey Siri' for requests."
https://www.apple.com/newsroom/2021/10/introducing-the-next-...
Do you know what the status quo in the US is? (I don't, other than the prescription requirement from the article.) What you describe for Canada sounds pretty good to me, but I wouldn't assume any part of US healthcare is as inexpensive as Canadian healthcare or that the regulations are as well thought out.
"2-week FREE hearing aid trial* Try before you buy, absolutely free! Take a new pair of hearing aids home for two weeks to see how they work in everyday situations — no money down and no obligation.
3 years FREE Batteries Get three years of batteries included with your purchase no matter what hearing aids you buy. Each year you will receive a box of 60 batteries for each hearing aid.
3-year Warranty and 3-year Loss & Damage Enjoy a three-year manufacturer repair warranty and three years’ loss and damage coverage for all hearing aids" https://www.connecthearing.com/cost-of-hearing-aids/the-conn...
If one model (pay as you go) causes harm to the whole industry (people know believe hearing aids do not work) then why would the industry continue?
As far as I know (at least for Canada, circa 2015) there were no laws or regs stating how, what or when to charge for services. --other than some kind of return period.
And then still be able to return it at least within the first 30 days of paying for it?
It is a pretty sweet deal if you can afford it. They do just ship you already-programmed replacements if you've lost one. No questions asked. Free adjustments. Very comprehensive. It's pleasant and stress-free while you're covered by one of those packages.
But it's if you can afford it. When you can't afford the all-exclusive package there's really not much else. I spent about half of my childhood, teens and 20s without hearing aids due to cost. Held back my education at all levels. Even when I went to university, while I was eligible for provincial funding for hearing aids at a student, I was still expected to pay the cost up-front first. Independent adult students don't usually have $5000 cash lying around. I missed most of my first year.
On a related note, dentistry is another one that is usually not covered at all. Why even basic dental isn't covered by government healthcare as a prevention initiative still surprises me. Bad teeth can kill you / give you cancer / wreck chaos and damage organs in general etc and its all often detectable at early stages.
Public healthcare should just cover it.
What if, instead, the calibration process worked constantly? Give the user a button to press when they don't hear something well, and another when they do. Let them have this for a month, let them try it in their kitchen, their bedroom, the local shop or bar, outdoors. Run some reinforcement learning algorithm to optimize for getting more "good" presses and fewer "bad" ones. Optionally, adapt separately to each environment.
Is there a "smart" hearing aid calibrator that works like this? If not, but you think it's plausible, I'm interested in working on it.
I have many ideas about how the industry can be improved, especially with the use of a smart phone app and user interactions.
Not only is it plausible, but would make the clinicians (fitter) job easier and lead to far more hearing aid sales.
then there's also additional complications like types of hearing loss impacting calibration - some people react very negatively to higher (or lower) frequencies than others do, to the point facial stimulation can happen, and some people just have a frankly tricky profile that requires a trained audiologist on hand to work with them through several sessions, if not outright yearly on top of that, since the nerves and brain output can change by itself.
(source: have a cochlear implant, been doing the described experience since I was ~ 3yrs old.)
I've had audiograms taken on moderate and bad days, and the difference in frequency response was significant (up to 30dBA difference across only the lower frequency bands).
Based on my observations of my father's struggles with various hearing aids, hearing aid smartphone apps are just as terrible as any other apps developed by hardware manufacturers. Don't expect the "clinicians" to help with this aspect either, because they were trained on a previous version of a different app and how could they be expected to figure out the apps that are used now?
On TVs, they call those buttons volume buttons, it is revolutionary.
This is of course a huge oversimplification, and aiming for it is probably what the industry is doing.
Also a problem if you're not a native speaker. I am fluent in English and have been able to watch movies without subtitles for 20 years at least, probably more.
But put me in a noisy bar and my error correction suffers a lot. Suddenly it's hard to follow a conversation that in my native language would be effortless.
The worst situation is listening to a loud video on bad speakers. Doesn't matter how much you crank the volume, people are hard to understand because the brain's error correction isn't good enough. Use a good speaker and turn down the volume, suddenly it's perfect.
And just like the TV remote they increase all sounds - good (speech) and bad (music and explosions).
The issue is not just "is it loud enough" but rather, "can you understand what you want to hear when you want to hear it?"
imagine yourself at a busy restaurant. you want to hear your spouses speach better, and the wait staff- but turning their speech up also turns up the people you do not want to hear.
how do you fix that?
noise reduction, speech enhancement, directional microphones are just some of the tools a hearing aid uses.
But ultimately what needs to happen is your brain works harder at comprehending what you want to hear(yes, it is work, and like all work people do not want to do it).
So they think...hmmm, I will just pay $xxxx.xx and I wont have to work anymore.
Whether like me, you never got the hang of a retainer after braces - or went off braces too soon, in my case - there has been a number of companies trying to get costs down and make the process less expensive and onerous.
Yet, talking to my regular dentist, who has used Invisalign with patients before, it's not the fact that there are more competitors in the field, essentially putting pressure on the DMD's and others to up their game, it's that after the initial consult, the entire process is (largely) unsupervised.
If you don't fit (or tune) something like this properly, it doesn't work.
but your idea is great too. if you can't hear one frequency, let's amplify all frequencies till the one you need gets loud enough, and go deaf to the other ones in a year. when you get old and need a hearing aid, you should stick with your method.
This may not apply if your hearing loss was sudden, but many people get hearing aids only after years of decline. Your brain adapts to what it has available and you learn to hear as best you can with the limited stimulus. When you finally get hearing aids, it feels like your ears have been unblocked.
When it comes to interpreting speech though, especially in noisy circumstances, you have to give it time. Your brain isn't used to using the extra stimulus to interpret speech. In fact, it may have gotten used to hearing loss filtering out background noise and you may initially find all the stimulus makes it harder to interpret speech because of all the background noise you now hear that you previously didn't.
If you don't have patience and start immediately futzing with volume all the time, you never give your brain a chance to adapt, and will be very dissatisfied.
When programmed properly, I find my hearing aids on their various speech modes to sound distinctly artificial and processed. I imagine it would be jarring to the uninitiated. Like a good speech codec or vocoder. It's unlike anything else.
But having grown up with DSP hearing aids doing this all my life, I find speech coming through them very comprehensible, often shockingly so compared to my normal hearing -- even with other amplification like regular headphones. I do dislike my hearing aids for music, though, even on the normal or music settings.
Some people argue that ethics have nothing to do with it, but if that were the case, highly expensive insurances would be mandatory, and payouts would be zero since business-wise that makes a lot of money without being ethically encumbered.
Is tuning (and retuning) something that could be automated? Because of tinnitus, my hearing is not the same every day and so static settings feel like the wrong solution.
Of the people I know who have gotten hearing aids, every single one of them was disappointed. Every single one of them still had trouble hearing. As far as I can tell, the only thing the audiologists appear to be able to be able to correct for (with current hearing aids) is "make it louder". If more than that is needed, it's a vicious cycle of taking it home, realizing it's not really helping, and bringing it back to try a new one.
The above seems to be particularly true when the hearing problem is heavily weighed towards not being able to hear certain/higher frequencies, so can "hear" people talking, but can't understand it; especially if there's any background noise at all.
I sympathize that your job was hard and that the clients made it harder. But the clients following directions and trying multiple different hearing aids ... doesn't really solve the problem in a lot of cases. Hearing aids are very expensive, far too expensive for a result of "I still can't understand people talking to me".
Imagine not reading for 10 years because of bad eyesight, eye glasses do not make it so your brain can read, but instead makes it easier for your brain to see the symbols. your brain still needs to decode and comprehend them.
Our hearing system is far more complicated. You can look in the direction you want to see....but you hear all around you, even through walls.
You cannot stop hearing, even in your sleep. It is far more crucial to our environmental awareness than more people realize.
Or, alternatively, it's exactly what I said and the device + audiologist combination just isn't up to correcting a lot of common hearing issues. That seems far more likely than the vast majority of people doing everything wrong.
In your analogy, it would be like if my vision got worse and I got eyeglasses which partially restored it, but mirrored everything upside down with tons of static. Now I've got to learn to read upside down and tune out the static, but don't worry because I get 10 free lessons with a reading instructor. Oh and none of this was clearly explained to me or part of my expectation when buying glasses.
And once you put on your glasses everything is brighter.
You need to adjust to the change, and then slowley adapt.
Now what if putting on the glasses meant you saw far more on your peripheral vision?
This too would be a big change and a barrier to getting better.
Hearing aids are the exact same. It's slightly unnatural but once you learn how to use the tool, it's a super power. I can hear conversations in crowded bars when normal people can't. Loud noises compress in a pleasant fashion. I just have to get used to some occasional spatial distortion and subtle flanging
Sounds like the calibration needs to happen in the home, not the doctor's office.
Are you suggesting that getting hearing aids preserves your hearing or simply that people with advanced hearing loss benefit less from them?
Imagine if you stopped playing basketball because of a bad knee.
Then years later you get a knee brace and are able to play again.
How long, and how much practice would you need before you could play at the level you were at before the knee problem?
And without properly fixing the problem (just using a mobility aid) could you ever return to pre-knee problem levels?
As well you may want to work with a Speech Language Pathologist.
Beyond that I'm not sure why I'd need professionals rather than an app to do some hearing tests.
The new schema may not be a panacea but I don't expect it to be worse than the status quo.
The return period is 6 months, I think. You also get one free replacement in the first 3 years if it is lost or chewed up by your dog.
Vision care is another area I’d expect to see more changes and disruption coming down the pipeline. Vision care is very important and advanced cases require special skills, but it’s also unclear why many routine checks couldn’t just be done by a family doctor.
The US requires one to see a “doctor of optometry” to get a basic single vision prescription. That industry used to make its money turning around and selling you glasses from the same office but that whole industry has been turned upside down by online retailers like Warby Parker and such. Why the US can’t follow the models followed most elsewhere in the world is unclear, but it would remove a lot of extra steps and costs in getting a basic care of glasses. Ophthalmology (medical doctors) are still very much a thing but most countries don’t have this model of needed a “prescription” from an optometrist for a basic pair of single vision specs.
To the contrary, it is very clear: regulatory capture.
(Yes, I'm exactly one of those people sensitive to "minute variations".)
On a whim I asked at a glasses store in the mall if they could measure mine. They happily did it for free. Your milage may vary on that of course, depending on the person you interact with.
https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-...
Apparently the need for this gets more important as you get older:
https://healthy.kaiserpermanente.org/health-wellness/health-...
Yes some office have fancier equipment, but here it’s unclear if that’s actually better for patients and public health or just a way to bill more. Doing a basic exam and then referring those to true specialists is generally the model followed by nearly everything else in healthcare.
We're supposed to go EVERY YEAR?
I, for one, am glad to see this bill.
Here, the machine results are used as a starting point, validated by A/B but I don't know if the human part is effective or just theater.
iCare Tonometer
Just a note, but optometrists are "doctors" (because optometry is a doctoral degree), but not doctors in the colloquial sense, ie people with MDs who work in hospitals.
Ophthalmologists are the MDs that specialize in eye disease, and are the ones that treat infection and do surgery.
Only one of those parts can be done without a doctor or highly specialized equipment.
Extending your logic to other areas would end up with absurdities like needing a doctor to measure your waist size before you can buy clothes. "You should visit your doctor regularly anyway, what's the value of allowing people to buy pants without a prescription?"
Also, if someone feels they would get better vision correction working with a trained professional, I'm fine with that. I only object to _requiring_ a doctor's prescription to get glasses.
*Edit, saw your comment about not referring to the entire checkup.
On the flip side it used to be very easy to get antibiotics without a prescription there. I'd be surprised if this is still the case.
Some physician groups fought that tooth and nail… not because there was any real evidence of people dropping dead from mis-prescribed vaccines but because it was a good stream of easy revenue for their office billing insurers for giving the shot. This change was much better for consumers and for public health overall by making vaccines more readily accessible.
I think this influenced the ability to see characters which greatly impacted reading ability.
For instance, I am supposed to redo my sleep apnea test every so often. But it's out of pocket? Why bother, I know mine is due to my genetics (I'm not overweight). So why am I subjected to reproving my need for a prescription?
For eyeglasses, if someone wants to continue the same prescription they can't.
It's like healthcare in the USA is a damn subscription model with yearly fees to keep getting things just prescribed (let alone treatment on top).
They said that an auto-PAP is not the first choice. A CPAP is a better choice, if it will work for you at the pressures you need. But they only work up to certain levels of pressure.
An auto-PAP will work to higher levels of pressure, but then it has to continually adjust the levels of pressure that it applies based on the resistance it senses, and that is not as good for you as constant pressure.
And there’s no way a CPAP or auto-PAP is going to wake me up at night, short of causing me to go into an apnea condition and potentially die.
Thank you, but no. I’ll stick with my CPAP.
What? You don't need a medical prescription to order glasses online. You can put in whatever numbers you want and they'll happily make them.
You'd be an idiot to do so, however, as your vision can change with age.
[0] Some places will reject it just because they don't want to deal with your complaints about a new pair not working. Other places will read what's on your current pair and match that. It really depends on who is making the glasses.
Not to mention, getting an eye exam is more than just clearing up your vision. It can reveal other issues (and not just eye related! They can often see other problems, like say, cholesterol issues, for example.)
I just use reading glasses but the desired strength can vary day to day depending on what you are doing and my eyes vary too. This can be dealt with easier by having a number of pairs of reading glasses and seeing which works best rather than doing prescription stuff. You can buy reading glasses for £1 here so I tend to get a few.
I'd still recommend going to a good optometrist occasionally in case there is something more worrying up with your eyes.
Crude but realistic: There is a pretty high number of (often but not always overweight) undiagnosed/untreated people suffering from obstructive sleep apnea on the roads every day. They are causing a number of avoidable accidents every day.
I think it's criminal to make CPAP as unaccessible as it is in the US.
I refuse to sleep a single night without it.
If it's important, then it's important for everyone.
Really, isn’t it all areas?
You can take virtual eye exams, which are reviewed by doctors to issue a prescription.
The real issue isn't the basic care of glasses, instead it's the screening of your eye health.
When you go to Urgent Care, say for a laceration, they do a quick work up, including taking your temp, blood pressure, blood o2, weight and height.
Having your eyes checked out in person with a comprehensive eye exam annually is a good habit. And tying it renewing an Rx for Contacts / Glasses just makes it easier to do.
Ordinary GPs aren't experts and the equipment for doing vision checks is expensive and consumes space.
IMO, medical care should be completely re-organized. Get rid of GPs as a profession (outside of cruise ships and the military) and GP practices entirely. Instead, have community clinics for everyday medical needs spread out over the country that have a team of skilled nurses for triage with a number of subject-expert doctors at the second level, and large/university clinics for everything the community clinics can't deal with (urgent/trauma care, oncology).
That would also shorten training times and effort for new doctors by a significant degree - e.g. in Germany, an ophtalmologist requires a full medical degree (over six years, not counting waiting times because medical study places are short in supply) followed by five years of specialized training. Realistically, training any expert doctor now takes at least twelve to fifteen years... and that's frankly absurd, and part of why medical costs are so sky-rocketing. Not many students make the ridiculously high entry requirements, many don't survive that time (and sometimes literally - suicide rates among medical students are way above average!), and those who have their MD are left with fifteen years worth of student debt which means they have to charge extraordinary hourly rates simply to be able to pay back the loans.
Medicine is not tech support with tier levels :( I would stick to talking about things you know, because medicine is not one of them.
Even though it's probably not that complicated, it's probably beyond the scope of a regular doctor to do proper checks - and - it's probably more expensive than getting your eyes checked by an optometrist, which is usually pretty cheap.
In fact, the optometrist model i.e. regulated specialization for something that we don't need very expensive doctors for, is probably a good model for hearing. If there's something more complicated, then they refer you to the ophthalmologist etc..
We should be trying to do this with everything i.e. get people into 3 year specialization programs which make basic health things affordable, and leave more complex cases to MDs.
This is not really the case. Online, warby Parker, etc. have built scale but the traditional retail still makes a significant portion of their profits here. And it’s a healthy business by most standards. The staff and employed OD are typically compensated heavily through variable compensation. The primary industry metric is “capture rate”, the percentage of people that buy eye wear after the exam. If I recall correctly it’s about 65-70%. From an incentive perspective, the doctors and staff are salespeople through and through.
Like all segments of healthcare, it has really started to consolidate. The independents/regional brands operating now will likely sell to PE roll up play when the foundering doctor retires. PE will exit to conglomerates. Most of these are boomer’s and this form of consolidation is well under way. The already high margins can easily be improved by centralizing back office, etc.
The vertical integration in the industry is insane. Luxottica for example leads retail, frame manufacturing, lens fabrication (laboratory), and owns the #2 insurance provider (of 2 main players). They have such power they can and do “force” independent retailers to use their POS software.
Warby Parker has some hipness and definitely grew quickly. But, they hardly put a dent in the market. There may be some evidence that they expanded it, as happens with fashion. They would be more akin to Blue Nile in the jewelry space. Independent jewelers still dominate that market.
If you can afford the $5,000 - great! The current system works for you. 80% of people cannot and so are stuck.
For folks with mild/moderate loss (where a LOT of people don't get help) something as simple as letting Apple tweak noise cancellation to be voice enhancing and providing a tuning and hearing test app in the iphone would be a godsend.
The elderly miss out on a lot of family life because of hearing issues - people stop talking to them even if they are fully sound of mind because of this issue. I've seen this personally.
And for all those who say apple is just a consumer products company and there is no way their $180 - $250 airpods can provide any benefit I think you might be surprised.
The only issue is that they are very visible and only last 4 hours each charge (I suppose you could get two pairs and switch between them every four hours).
Why this matters: Hearing loss is not uniform across frequencies, and we use huge portions of the spectrum for different functions (truck backup beepers vs. car engine noises, both used to identify what's coming your way).
It's probably good enough for an temporary situation, but I wouldn't trust it long term. Improper amplification can damage your hearing further.
* If the earbuds you use to perform the hearing test are the same ones you use with the resulting EQ profile, why does it matter whether the earbuds are flat or not? If you're taking measurements in a transformed coordinate space, and applying those measurements in the same transformed coordinate space, shouldn't that be equivalent to taking measurements in the original coordinate space and applying them in the original coordinate space?
* Why isn't active noise cancellation a good enough form of noise isolation?
* If using an EQ profile that only matches your hearing loss imperfectly can damage your hearing, wouldn't the same thing apply to EQ profiles that aren't intended to correct hearing, like the media player presets "classical music", "rock music", etc.? For that matter, wouldn't it apply to a flat EQ profile? Is there something special about an imperfect hearing correction EQ profile, compared to other EQ profiles?
You also have to account for the microphone, which can (and will) have its own bias. Measuring from a flat response source, and producing for a flat response mic/speaker combination will produce the most accurate results.
> active noise cancellation
ANC creates sound artifacts at low volumes. It also provides, in ideal circumstances, around 25Db of noise reduction. You probably want between 40 and 80Db (or more) of noise reduction, depending on the ambient noise level around you. The threshold of hearing hovers around 10Db for healthy ears. Healthy ears can hearing your own heartbeat in an anechoic chamber (as close to 0Db as we can get).
> wouldn't the same thing apply to EQ profiles that aren't intended to correct hearing
If you're correcting for a 40Db loss at one frequency (taken randomly from the surrounding threads), applying it to a frequency where you have only 20Db loss can result in an extra 20Db of sound at that frequency. 20Db is 4x louder by perception, and over 6x higher pressure.
For a point of reference, Apple music's EQ curves are 12Db, 24Db if you set the extremes. So yes, they could damage your hearing, but that will depend more on the volume than the EQ.
a) conduct a hearing test
b) do a hearing based EQ on incoming sound?
c) do sound profiles (ie, optimize for speech?)
Realize that calling already may use some of this - using microphones to pick out speech from background noise etc.
For folks who have hearing issues you could have one device that would cover your movie watching, your phone calls, and hearing enhancement. For $180.
It could not. A hearing test requires an environment with exceptional isolation and flat-response drivers (iPods are not remotely flat) to be done properly.
> do a hearing based EQ on incoming sound
It could, given a proper prescription for the EQ, and an understanding of the response curve of the iPods' mic and drivers.
> do sound profiles
Not required, the EQ is tied to your hearing damage, not your environment.
On a whim I tried Apple's wireless sync. It's end to end, and works as well as I could with manual tuning (which I would do by filming at high speed a time audio sync track)
https://www.reddit.com/r/appletv/comments/itm711/psa_wireles...
So they demonstrated a consumer device could, in a few seconds, generate a fantastic sync solution across my entire input -> output -> room stack. Or I could spend an hour fiddling around in settings.
Airpod pro's provide a some level of isolation already especially if you run the fit check. airpods are also not that bad.
You could do a calibration curve at factory if needed for drivers. You could run a very user friendly process to fine tune, in the comfort of your own home, a profile of your hearing loss. You could update this anytime.
You could then also obviously offer some presets to amplify things in a targeted way. At the dinner table? Focus on voices. At a concert, do a music preset.
We've heard all this before with camera's by the way. The iphone doesn't have a "real camera". Yes, I used to shoot full frame. Yes, the iphone's cameras are "crap". But for many people they are "good enough", and they have other benefits, ease of use, easy to learn, not a big extra expense etc.
Let the market decide, apple can provide a warning -> if you want to wait for insurance to approve a hearing test, then schedule one, then wait for a device to be ordered and ship, then go back, then be dependent on an audiologist to tune things for you etc you should do so, but if you want, try out little app here to see if it helps.
I really hate it when people say "let the market decide" when it comes to health care. It's how we get $10,000 suppositories (a story earlier this week).
It appears you really like Apple's audio hardware (whereas I think it's middling crap), know little about hearing loss, and I don't feel like arguing the points.
Congratulations, you win.
As to whether AirPods etc are crap - I’ll let you have you opinion- I like them and they seem to sell well
Perfect is perfectly acceptable to aim for, when it comes to your hearing for life.
Without controlled test environment you cannot compare as your test environment will change your thresholds, and therefore make the test invalid.
I would spend $10,000+ if my tinnitus could be cured permanently though.
The drumming-on-the-back-of-the-skull trick lasts just long enough for me to realize what the world could sound like. (I tend to not do it anymore due to the mild depression I get realizing how fleeting the relief is)
Most ppl don't know that this even exists in their airpods because the settings are hidden deep inside hearing accessiblity .
It's amazingly stupid that I, as a tourist, who knows exactly what types of contacts I need, may need to get a US prescription for contacts.
Edit: it occurs to me that this may very well be one of those things that's dependent on state laws, so your mileage may vary. Worth a try, in any event.
Edit 2: and yeah, this is for old-school glasses. The requirements for contacts may be more stringent.
First, always have a list of all relevant phone numbers (at a minimum, but other information is helpful too) to any healthcare entity you need to work with. Your primary care doctor, your pharmacy, your hospital, your preferred lab, any specialists. Also have all your insurance information on that same list - especially the different numbers for different departments (e.g. provider lines, authorization lines, etc). Just assume they don't have any of your information on file or their information is inaccurate and needs to be updated.
Always get a paper copy if possible (I think some things have to be electronic in certain states, but just strongly emphasize getting a paper copy for anything else). Pharmacies, labs, other offices always say whatever you need wasn't sent (even if you watch them send the request and it says it successfully went through). And yes make sure it has the doctor's signature on it! I'm not sure if it's specific to insurance companies or just certain medications, but they sometimes require diagnosis codes in some states. Find out prescribing rules in your state... I think it has to do with narcotics, so make sure you know the rules in your state for narcotic prescription.
Always know, ahead of time, the exact lab you're going to and hound the doctor's office about using the right paper work and ensuring diagnosis codes are present (there is apparently no universal lab paper work, so knowing ahead of time is important). Get a paper version of the signed referral. It needs to have the diagnosis codes and whatever other codes are required for billing (honestly not sure why medical offices aren't doing this by default, but whatever). Make sure one of "with contrast" or "without contrast" is selected if you see those options on the request sheet for radiology. Assume you won't be able to contact the doctor after this visit to have the lab order sent again. Also assume that even if you can reach the doctor, that the lab won't accept the order without a written copy.
Always get confirmation from the doctor if the prescription is covered by insurance. There are apps like Coverage Search[0] that can give you some information about whether it will be covered or not.
And of course there are a bunch of other annoying little rules that I just haven't encountered yet.
On top of the ridiculous costs, it's your responsibility to make sure things go smoothly ;) gotta love US healthcare
[0]: https://apps.apple.com/us/app/coverage-search/id834992816
I’m only commenting on what I’ve seen. I’m sure a lot of people get through the system just fine with no issues. But this list is a compilation of many people experiencing issues receiving healthcare.
I've just learned some new things about the eyeglass rule from a sibling in this thread.
Just curious, since you mention that you're soon to be in the business of eye exams, do you think at some point your business is going to have to maintain this status quo in order to 'play ball' legislatively during your growth phase? If yes, how do you feel about that? If no, can you explain why you'd be exempt? Are these laws something that articulates with your business model or is this only in adjacent businesses like providing lenses?
* I've tried to buy contacts online in the US with an expired prescription, the retailers say their hands are tied, they need a current dated one.
I now just buy contacts online from Europe or New Zealand. No BS, same price, the EU company I buy from includes a mini bag of haribo gummies :)
I've used Coastal and Zenni for glasses. No problems.
edit thinking about it a little bit i could see it being harmful to not have someone go through the "you don't want to do this or else you could potentially lose your eyesight" talk at least once.
I would love to do that, could you share which vendors you use?
Looking through my email receipts, I've used:
lenstore.co.uk
visiondirect.co.uk
contactsexpress.ca
specsavers.co.nz
You can be 1 year and 11 months into your prescription and buy 4 years worth of lenses, but at the two year mark, you can't purchase them at all without another visit to the doctor and explicit approval for a specific prescription.
My particular annoyance is that I usually buy a year or two worth of lenses at a time - one set usually lasts a month, but I don't wear them every day. So I can stretch out the time a bit further. By the time I'm down to my last set and want to resupply, I'm required to visit an optometrist. Spending money on another eye exam that tells me nothing new. It's even more frustrating if I completely run out and have to use a set longer than is ideal while waiting for an opportunity to visit a doctor.
I get that wearing the wrong prescription lenses isn't ideal, but I don't understand why prescription lenses are gatekept like narcotics. If you can't see well or have the wrong prescription, there's a natural incentive to visit an optometrist and figure out exactly what you need.
Unfortunately, the answer is regulatory capture. Optometrists in the US make the majority of their income [1] from selling glasses and contact lenses, which of course they also prescribe. There's been a lot of lobbying, collusion, and non-compliance in the industry which the (admittedly biased) link below outlines well.
And an eye exam for specialty contact lenses is way more than $100. Really, more than $100 in many places just for a simple reading glasses RX. And many docs won't just do your Rx. They require you do a full exam.
Was very interesting to play around and helped me isolate the 2 prescriptions that my eyes drift back and forth from.
Something that eye doctors had given up on trying to help me.
Just checking because it looks like you're from '79 and talk about drifting vision: you know about presbyopia and accommodation? You might need multi-focals.
Prism glasses fixes this. But it’s a completely different power. +3 goes to -1 or anything in between.
As pressure goes down it reverts. Medication or activity can drop or raise it in an hour or less.
No more worrying that I’m about to stick myself with the wrong prescription because the optician (yes, that’s who measures you for glasses in Germany) or I lost patience trying to find the boundary between spherical and cylindrical correction, or doing this at the wrong time of day, all for less than a pair of glasses costs.
Any brand recommendations?
Many shops won’t sell you glasses unless your prescription is under 1 year old. This allows them to charge you for an exam when you don’t necessarily need it.
Probably not quite as good as a live view, but not bad.
And I find sites like Zenni are so cheap that it's worth taking the risk: an ugly pair can go in the car /gym bag / work desk for if I lose a contact lens.
From the Contact Lens Rule [1]: "a contact lens seller cannot provide contact lenses to its customer unless the seller either obtains a copy of the prescription or verifies the prescription information with the prescriber"
The Eyeglass Rule [2] doesn't contain this stipulation.
https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-...
https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-...
In California, for example, you can't buy prescription glasses without an active prescription.
I found this out when my glasses broke on the weekend and couldn't get replacements before talking to a doctor -- none of which had availability for several days. So I suffered from headaches and poor vision for several days thanks to this ridiculous regulation.
Maybe it's a Tesla-style showroom thing where you look at the frames in store but technically buy the glasses online.
Neither the FDA nor FTC at the federal level technically require prescriptions for glasses. Indeed, most online glasses shops will simply take you at your word that you have a prescription, presumably because they are located in a state that nominally requires a prescription, but places no requirement on the shops to verify that the customer really does have one.
This is totally different from contacts, where at the federal level, sellers must verify the prescription with the prescriber, except that if 8 business hours have passed since they started trying to contact the prescriber, without hearing back, the prescription is considered verified. (That last is to prevent the prescriber from trying to prevent customer from getting lenses elsewhere by refusing to verify).
Here in The Netherlands, I can walk in a shop and get contact lenses off a shelf. It does not even need to be a dedicated shop. These are available in generic care shops where you can also buy shampoo, vitamins, and even some medicines that don't require prescriptions.
Maybe your post was sarcasm though :)
That's the economic progress of humanity. We automate, and jobs that were once valued are no longer needed.
Easy to look at a specific instance and fight against the change, but in the long run it's better for everybody.
Glasses/Vision in particular costs hundreds more than it needs to. Glasses could be produced and sold at $10-20 bucks if regulations were eased. What is the material cost to produce these? You can get reading glasses in grocery stores for a few dollars.
I'm fairly well off and even I feel bad paying over a hundred dollars for some of this stuff. Imagine all the lower earners/poor that pay hundreds of dollars for glasses for no reason other than protectionism.
The entire eye exam can be automated very easily (and I believe already has). Would be easy to have machine learning algorithms that can diagnose problems from the image of your retina scan. I really don't think it'd be that difficult, if it doesn't exist already.
Can we get hearing aids that are bigger? These small hearing aids make it easier to lose, and I do not mind looking "disabled" to people.
Also would like to use bluetooth to both locate the hearing aids, and to connect to devices as needed.
Would be cool if the battery can be recharged as needed, maybe through usb-c if possible, but magnetic charging would be acceptable.
I’m ok with the cost since it’s effectively half for me and really $3K six or seven years would be fine considering the quality of life improvement. Being in large group meetings with multiple teams discussing project planning could be painful for me. And it helps with your relationship. When there’s a background noise source like road noise or AC or a running faucet your brain will fill in based on the frequencies it can hear and you will hear completely different words.
It's because they can only be sold with a prescription which means a lot of overhead and the expectation of large margins for everybody.
Get rid of that requirement and those will be be $600 hearing aids.
I've personally worn them since my mid 20's. I'm glad that I ignored the perceived stigma of wearing hearing aids and got them. They are like glasses for my ears.
Do you charge one ear at a time so you are never without some level of hearing?
Can you comment on the Live Listen feature of AirPods?
> Do you charge on ear at a time so you are never without some level of hearing?
I'm completely deaf in one ear, so I only wear one hearing aid. If I take it out, I have zero hearing, so... nope.
Most hearing aids do not have rechargeable batteries, either, so we have to change out the batteries on a regular basis. My battery lasts about 7-10 days before I need to replace them.
> Can you comment on the Live Listen feature of AirPods?
It's not powerful enough to act as a hearing aid for my level of hearing loss, nor is it calibrated correctly.
To that last point, hearing loss is not simply a lowering of volume. It impacts different frequencies at different levels, so the normal amplification that comes from an AirPod or similar headphone is not sufficient to compensate for anything other than very very mild hearing loss.
I'm not of the age or occupation where I need hearing aids, but I think that I'd like overnight inductive charging, and I'd take them out and charge them while sleeping.
So why hasn't it happened? Those people who said "regulatory capture" get a gold star. A small group who will suffer a lot manage to defeat a much bigger group who will benefit by a much smaller amount.
I maintain that, if automobiles were invented today, the horse-and-buggy industry would be able to successfully fend them off, based on the path regulatory capture has taken in the last 150 years.
Cronyism is the word should have been looking for.
I’d argue that there should be a giant warning on the box about proper tuning, and leave it at that.
These are limited to 85db output. I have a pair that I use in my woodshop as hearing protection, which they are rated for, and really like that my music or podcast stays at a consistent volume. I also have volume normalizing turned on in Spotify.
This will have to be paid for somehow, and somebody has to do the tests to know what to set. Same as glasses. So we should be able to get the raw aids at a lower cost and then deal with the extras. Costco sells reduced priced aids, so there's a little flexibility in the industry.
For my last set pre-covid, there were behind-ear (big), in ear (small) and in ear canal (very small). If you saw True Lies, their "radios" were probably dummy in-ear-canal aids. As I'm not blessed with a 15+ dex and like other posters I don't mind being see so the behind ears are ok. They can be hidden as dangly earrings with a sheath to make it interesting if you'd like. Otherwise, it's a bloody conservative industry re: colors. I wanted blue and red so it matched stereo wires :-).
And my attempt at bluetooth connectivity for phone calls failed as the things could not stay sync'd during conversations. Better to just use a headset.
And that is what you should use the money you paid for....getting proper follow up and adjustments, including making your BT work.
BT and hearing aids have been used for over 10 years.
I went for an eyetest. A woman with 3 years post-grad training sat down for 45 minutes, ran a battery of tests, detected a bacterial infection in my eye, sent me for a hospital appointment the next day, and gave me a prescription that I filled out online. My payment to her - 25 quid.
I did get her some chocolates to say thank you.
Now name another (para-)medical area where the medical part is a loss leader for the rest? (I am worried i will hear a lot of Americans ...)
Free hearing evaluation, discovered ear infections, referred back to GP. At no time was I compensated by the client or the government.
https://hackaday.com/2013/12/15/diy-hearing-aid/
No mention of DIY hearing aids from the FDA.
A pair of bluetooth streaming rechargable ones is about $3000. With Transparency mode and the latest software for AirPod pros, you can adjust the frequency distribution, and get what seem to be servicable hearing aids for $250.
What I'd like is proper (medical) assessment and fitting, but of cheaper commodity aids that are much much better made with better apps than most of those on the market now.
it is the fitting and follow up where the money you spend should be going. -- that and repairs and regular maintenance.
The adjustment offered by something like the AirPods Pro seem much more effective.
Most of my rejected fittings were from people who had far too high expectations. that did not stop me from trying, and when unable to get success provide a 100% refund, and refer to a different AUD.
Of course, the vision folks turned it into a racket for extracting cash. So ideally we'd want to avoid that and perhaps fix the vision racket while we are at it.
So, there should be some barrier to entry. Just not at $3500 an ear.
A hearing aid - AIDS you in hearing, but your brain does the processing and speech comprehension.
if you start wearing a hearing aid now you will just get lazier with your "hearing". Just like if your knees are sore, and you get a knee brace - when you should have done exercises to improve your muscles supporting your knee - the brace will do more harm than good.
A "iphone hearing test' is a useful screening tool, and no more sadly.
And there is more that is taken in to account when setting the hearing aids, such as: Age Speech comprehension issues Loudness thresholds cognitive issues
As well there are a handfull of "red flags" that are looked for, some of which can only be done with a visual examination, and others by more involved audiometric testing.
Cost is still a challenge, of course. But I'd like to point out that my current set of aids ($2800 pair) just hit the 5-year mark of usage, and they are still working perfectly. For devices that I use ~16 hours a day, everyday, it's amazing. However, it took 3 visits to the audiologist to get the tuning/fitting just right. For the first month of use, these hearing aids were "garbage" (I was really frustrated). But once we hit the mark, I have had zero complaints ever since.
So, that all said, there is tremendous value to initiatives like the Bose SoundControl Hearing Aids (~$900 pair off-the-shelf hearing aids), but the biggest hurdle they face is the fitting/tuning portion. I've tried them, but they don't fit my ears well, so I can't use them effectively (yet - I want to try adjusting the receiver cables).
I'm hopeful this is just the turbulent beginning of a new hearing aid market that expands access to as many people as possible, because it is far from a solved problem.
The biggest thing the FDA could do would be to standardize a digital format for hearing tests and require new hearing aids to be programmed on the basis of the standard format. This would allow people to go in-person to get their hearing checked by a technician, get a test result, and then program that test result into any hearing aid of their choice bought on the open market.
So, yesterday's "treatments" for people with problems are becoming today's augmentations for otherwise healthy people.
--In years past, you might have a cardiologist prescribe the use of a constant heart monitor for a few days to track & diagnose issues. Now, you can get a cheap device that does that-- among other things-- for yourself. (Yes, the expensive specialized versions are still better)
--Glasses were for people with vision problems (or simple fashion) but now are in the early stages of AR, and (relatively) mainstream use for simple augmentations like music listening and personal assistants.
I'm sure I'm missing lots of other examples.
We need a ground-up reassessment of the whole concept of prescriptions. If it doesn't present a systemic risk it should be over the counter. If everyone over-uses antibiotics we might all die. Fine. But if some goober misuses blood pressure medicine, they can only hurt themself. Let people buy albuterol inhalers without permission. It's going to be fine.
Sometimes even the most very basic counselling has quite an effect.
Perhaps we should create a nursing/paramedic level specialization for this and allow those people to offer such services.
How were these ever prescription devices to begin with?
Hearing aids can exceed 120dB.
As well improper mid-long term use can cause comprehension and "hearing in difficult situations" issues.
I fail to see how adequate directions for use could not be prepared.
Do you have the tools to measure how loud your headphones are? I don't. And so I keep them as low as I can.
Is there a limiter in amplifying headphones to keep them from going above a certain threshold (like 80Db)?
Also hearing aids have manual volume control which a licensed professional has no influence over, so that doesn't really make sense as a justification for limiting availability.
It's certainly possible to apply volume limiting to headphones, though again the people using amplifying headphones typically are dealing with the opposite problem.
hearing loss is far more than just "make it louder".
I’m not sure hearing aids can really replace headphones for phone calls etc until both HAs and phones support BT 5.2, and I don’t really want buy several $K of hearing aids that only work some of the time.
Are there different types? Like with equalizers or volume controls?
Why can't a person, who is hard of hearing, go to a store, pick one and start using it? Granted, let FDA approve them and mandate using only FDA approved ones.
You will buy them over-the-counter here, and I have seen even a vending machine full of them. (That was in Lithuania, IIRC.)
What is the rationale for this?
As well improper use can cause permanent damage.
I also don't believe deregulating the market is going to work. The reason prices are so high is because there is a small monopoly of manufacturers that control global supply and a small cadre of middle-men that are allowed to create whatever markup they like.
Deregulating the middle men doesn't really solve the fundamental problem. I would expect a lot of patent lawsuits to be filed against small manufacturers and distributors if the government gets it's way here.
It's an attempt to solve an endemic lack of regulation with even less regulation.
Perhaps I missed it....
Things like being required to go to a doctor and pay big $$$ to get a hearing aid or not being allowed to import drugs from countries where they are cheaper are absolutely not "free market".
Even during COVID the country could not deploy cheap rapid tests but only super expensive PCR tests.
Gotta put your mask on first.
To be serious: amount of things that are "prescription only", even if they can cause only minimal harm, is astounding.
Or what if the ENTs haven't lobbied lately but instead the device makers did this time?
Same shit as levothyroxine, a basic medication used by millions, being prescription only. And many other drugs.
https://pubmed.ncbi.nlm.nih.gov/16086703/#:~:text=Death%20ra....