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jrace

How much would you pay for:

*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.

View on HN

I've long thought the problem with hearing aids is the calibration process. People (often old, confused, and less tech-familiar) try them on and spend half an hour answering questions about "does that sound better?"

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.

There are actually a good reasons not to do this. A very large part of your hearing is brain training...your brain learning how to interpret the new stimulus it is getting. You need to give your brain time to adapt to new stimulus before evaluating whether you are hearing better or not. If you are constantly fiddling with your hearing aids, you never get the benefit of training.

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.

I've been wearing hearing aids for almost 8 years. The brain training process is real and I'm glad the audiologist explained it.

Yes! Modern hearing aids do some fancy processing to shift frequencies into the more audible range of the patient. Many people do not have a simple "not enough volume" hearing loss. Personally, it's like someone went and messed with all the settings on the audio equalizer, and then added some muffling to make sharp sounds less distinct.

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.

Couldn't this brain training effect be included in a progressive algorithm like the one suggested? Such that the brain is gradually "guided" to the best performance by ramping up the hearing aid?

My (Phonak) hearing aids had a multi-week ramp-up to full power, in order to give my brain time to slowly adjust. Dealing with things like the occlusion effect (https://en.wikipedia.org/wiki/Occlusion_effect) just takes time, and getting used to something being in your ear for a large number of hours per day.

THere may be now, but not 5 years ago.

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.

...especially with the use of a smart phone app...

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?

What's really needed is a decoupling of the hearing test from the calibration activity. A basic hearing test takes a few minutes in an isolated box with headphones (the 'ol click a button if you hear the tone test). From that profile it should be trivial to build out the profile of what frequencies to boost and what not to and program the aids there.

I appreciate the optimism (and do think there's some room for efficiency improvements!), but each step is a little more complicated than that. a true audiometric room/booth to do the testing (eg fully soundproof) in is very rarely found outside of audiologist offices or specialized academic spaces, for starters, and I do believe those are required for paperwork (whether it be insurance related part of the process to getting the right device fitted).

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.)

To add to this — I suffer from Ménière's disease, which manifests for me as variable hearing loss. Some days are bad, and I can hardly hear/understand speech even when someone is right in front of me and I can lip-read. Some days are good, and my hearing aids are uncomfortably loud or make things sound "weird". But most days, my hearing aids do exactly what I need them to :-)

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).

my partners hearing aids has a smart phone app, but it seems to be built with the concept of someone else putting the calibration into it. They can then create profiles for the different situations, however it strikes me that the hearing test calibration could be done in the app as well. I would imagine for a lot of people, if you could just buy them online you wouldn't need the clinicians for many cases.

The app for my hearing aids allows my audiologist to make remote adjustments, so I don't even need to visit their office for straightforward changes. I really want to reverse-engineer it so that I can modify some of the details of the profiles myself.

I'd love to talk about this, could you email me at the address in my profile if you're interested?

All audio devices used to have an instant-feedback feature like this. You could dial it in with zero latency. Early technosapiens called it the Volume knob :-).

> 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.

On TVs, they call those buttons volume buttons, it is revolutionary.

Hearing aids have volume controls, which some clinicians disable for new users - as it causes more problems than it fixes.

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.

Reminds me of the race to the bottom we're also seeing in orthodontics.

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.

A lot of the time it's not absolute volume. If you can't hear certain frequency ranges well, boosting the volume of all ranges is just going to drown out the ones you can't hear well.

Exactly - hearing is much more complicated than just noise sensitivity. For example, a somewhat underdiagnosed problems is issue with the frequency bins that the brain segments sound into for recognition deteriorating. Symptoms are - can hear just fine in a nice, uncluttered audio environment, say a test centre, but has issues if there is any significant background noise.

> Symptoms are - can hear just fine in a nice, uncluttered audio environment, say a test centre, but has issues if there is any significant background noise.

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.

Do any hearing aids frequency shift, or compress the frequency scale (e.g. just higher frequencies compressed down to lower frequencies so that voice tone stays constant and sibilants get shifted down into hearing range).

yes, I know Phonak hearing aids were doing that since about 2012. For some of our more severe hearing impaired patients it was a noticeable improvement in speech comprehension.

so a smart volume button

That pays attention to the environment and changes the volume (part of the spectrum perhaps?) that is what you're likely to be listening to.

This is of course a huge oversimplification, and aiming for it is probably what the industry is doing.

That is exactly what the tech does, automatically adjusts based on the amount of noise and speech in the environment. And going a step further, applying directional microphone control to better pick up sounds where the speech is.

go further, and having 'hearing aids' that would let you rewind the last 5-10 seconds of a conversation to hear something again without asking people to repeat themselves...

I think this is more akin of the Android phone I have asking me if the call I just placed was: clear, had cutouts or dropouts, fuzzy background noise ... And they take that feedback and adjust my call quality in GoogleFi (in theory)... It's not just the concept of s volume button, but more the idea of reinforced (ai) learning over time, or algorithm adjustment with human feedback.

Definitely not the same, hearing aids do a lot more signal processing than just amplifying sound.

...which will simply make you more deaf. hearing aids do not simply amplify volume. you know, because they're not headphones and a microphone.

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.

Canadian here as well. I have a 35 dB / 70 dB loss in each ear respectively.

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.

Their reasoning is that you should stop buying luxury superyachts each year and focus on your health. Its about priorities!

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.

> 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.

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".

Perhaps it is because most of those people expected the hearing aid to work for them, and did not want to do any of the work they needed to do themselves.

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.

This honestly doesn't sound very empathetic toward patients. Many of these people had fine hearing and then lost it. They've already "learned" how to hear and they reasonably expect the hearing aid to help restore it.

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.

A better analogy is what if your vision loss was not only clarity, but also brightness?

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.

I got high quality progressive eyeglasses some years ago. Hated it at first. It was like swimming in a fish bowl. If you don't position your head correctly things are blurry. Now it's completely natural and I love them. I had to learn.

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

The thing is, though, that it appears to be very different depending on the person. And there seems to be a LOT of cases where the technology just isn't up to the task. Sure, we _can_ blame the user in every case, but if the cases are highly skewed to the users have a poor experience / not hearing well with them, then really it makes more sense to blame the technology until you have proof otherwise.

> Perhaps it is because most of those people expected the hearing aid to work for them, and did not want to do any of the work they needed to do themselves.

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.

> it's a vicious cycle of taking it home, realizing it's not really helping, and bringing it back to try a new one.

Sounds like the calibration needs to happen in the home, not the doctor's office.

That sometimes was benificial, but mostly with just one n one and TV. Those you can control, but what about when a few more people come over? Or when the neighbor is mowing their lawn?

Many companies have remote adjustment now. They connect online and the user and audiologist talk on video.

Correct me if I’m wrong, but isn’t this something people could do on their own at home if the hardware had a decent setup UX / tuning instructions? This doesn’t necessarily seem like something that couldn’t be done pretty automatically.

You’re not wrong. Most people don’t need all those overpriced ads-ons.

See the Hackaday link I posted earlier for one such example.

I guess one question is: do those things have to cost thousands of dollars? What are the primary cost components? Are the people doing these jobs highly paid? Are they highly paid because of high costs of college tuition? Would free college help lower their costs?

> I guess one question is: do those things have to cost thousands of dollars?

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)

These are good points. I was wondering about the costs of the doctor's visits, but you're right we should perhaps make those optional.

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.

My opinion: do those things have to cost thousands of dollars? --yes and no, costs could come down, but in the lifetime of a hearing aid it could be replaced 3 times or more at no charge to the user.

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.

Maybe cheap to produce in larger sizes. As you have to make the components smaller and smaller to fit all the extra gubbins, each of those other components now become exponentially more expensive to design and produce.

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.

One of the costs built into hearing aids is the lavish perks that the suppliers give to the audiologists. My partner got a trip for two to the Caribbean every year, to 5-star resorts, for selling a certain number of their hearing aids. There were about 60 people in our group, probably costing well over $5,000 each.

2+ microphones, signal processing chip, audiophile+ miniature speaker, multi-octave equalizer, intercommunication between ears/dynamic adjustment, multiple profile, remote mic, bluetooth to phone. I think the top-end in-ear musician speakers are comparable, certainly in terms of sound quality. Maybe better as they have (far) more speakers/frequency response as their users are far more critical. They're not magical but they're good when there's not a lot of echo.

How does the actual hardware compare to a $180 pair of AirPods? I wonder if basically Apple and Samsung should be making these instead of smaller medical device companies.

I suspect there’s nowhere enough money for apple or Samsung to enter the medical devices field for real. I would think the headphones have a Bluetooth receiver, a d/a converter and a speaker. They rely on the associated device to handle “adjustments”. Might be noise reduceing, but that only adds a mic and a phase inverter. Much simpler device. Getting medical approval takes time and $$… Easier to put fine print that the things does not treat or cure anything.

Looking over their marketing materials, the Airpods seem to have much more power than that onboard. They use their own custom silicon chip onboard and it seems to be pretty capable. I wonder if (doubt?) medical device manufacturers are designing custom processors for their hearing aids.

"...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-...

One of the issues is that Apple can take their time processing the sound, but hearing aids have a very small window of time (< 15ms, if I remember correctly) before there is a noticeable lag between sight and sound.

For the first four items on your list, I would pay for the hardware cost of the hearing aids plus $200-$300. The last three things should be optional like Apple Care or other service contracts.

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.

So your argument in favour of socializing this is that people tend not behave optimally, in your view? This seems like a poor reason. Let the people who fall victim to their biases suffer the consequences, don't impose the cost of holding their hands on those who are capable of managing themselves.

It was not an argument, but a statement.

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?

I'm suggesting the model to use should be decided individually by members of the industry, not imposed on the industry as a whole. If some orgs want to use pay-as-you-go that's fine. If others want to offer more comprehensive service, that's fine too. I'm arguing for allowing the interactions to take place, even if some choices made are suboptimal.

They can.

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.

Because it's easier to get someone to pay $100 for something they aren't sure will work (and then have their beliefs confirmed) than to get someone to pay $1000 for something they aren't sure will work (and then have their beliefs refuted)?

Would you rather pay $100 for something you are not sure will work...or would you rather ay $0.00 to try it first?

And then still be able to return it at least within the first 30 days of paying for it?

I think it depends on the someone in question

My wife's grandfather should have all of that through his VA, Medicare, and supplimental insurance. His hearing aids are the most annoying low quality overpriced pieces of crap you can imagine. And that stupid headphone amplifier thing they've sold him, garbage, literal garbage. A hobbyist could do better.

The new schema may not be a panacea but I don't expect it to be worse than the status quo.

The VA will not co insure with Medicare but will with private insurance companies.

Same in The Netherlands, and you don't pay out of pocket for those either in most cases. It also makes a lot of sense for an insurer if you think about it: people that are able to sense their surroundings reasonably well might be less likely to get into accidents causing that to then cost a lot of money. From an ethics standpoint it also makes sense to be in a society that aims to give people a good standard of living. Someone slowly loses the ability to listen to music for example might have a harder time enjoying life if music was an important part for them, that might cause various forms of distress which can turn into 'expensive' treatment for that.

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.

Hmm, why charge $750 instead of billing $20/month forever and giving new hardware every 3 years?

Easier pill to swallow. People on a fixed income don't want to have their benefits reduced by $20 every single month.

Public healthcare should just cover it.

> Buy a hearing aid today from any major provider in Canada and you get: [...]

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.

No idea, but an initial search at "Connect Hearing US" (which also has a large Canadian arm states;

"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...

It is not perfect in Canada. Getting aids for our child and was shocked that this is a few grand out of pocket (after gold standard work insurance, provincial aid, etc). The province pays 500 bucks per hearing aid, which seems ridiculous given the costs. We are well to do so it doesn't matter but I am shocked that this isn't fully covered given the taxes I pay (in tech .. so you can guess). For kids, this should be fully paid by the government - no questions asked. As a few others (who seem to be knowledgeable) have posted .. if u miss out on hearing, you start to be less productive member of society. Being in a western, rich society where we pay for stupid shit all the time out of taxes, the govt not fully paying for some basic model of hearing aids seems like a crime (basically, not enough people are impacted, so politicians don't care). I'm glad the US is improving the situation here for its populace.

Any insights on tuning process for little kids? (2-3 year olds?) These guys don't really have the ability to provide feedback for retuning.

Tuning for them is more about slowly increasing the sound levels overtime than adjusting for understanding.

As well you may want to work with a Speech Language Pathologist.

Why is a doctor needed to do any of that?

Maybe not a doctor, but you need someone to test your hearing and write a custom frequency map for how your ear works. Good hearing aids are not simple amplifiers, they have complex signal processing to make it easier to hear what you want to hear (if you like music they make music worse, but you can understand the lyrics - this is a simplification, but good enough)

I just looked at the NHS site and they suggest your doc check your ears are not just bunged up with wax.

Beyond that I'm not sure why I'd need professionals rather than an app to do some hearing tests.

“ Sadly, most people wait too long before trying a hearing aid, and give up because they hear too much noise.”

Are you suggesting that getting hearing aids preserves your hearing or simply that people with advanced hearing loss benefit less from them?

Hearing aids allow you - rather enable you - to listen again. Without them your understanding and comprehension gets lazy.

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?

OT but knee-related: people need to understand that function after a total knee replacement will NEVER be better than that existing at the time of the replacement. The only benefit is reduction or elimination of pain. — retired M.D. (anesthesiologist)

What you describe is almost as good as the deal anyone can get from Costco in the US.

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.

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