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Comment by KaiserPro | Hacker News Reader

One thing that the HN crowd should appreciate is just how expensive and shit hearing aids are.

go and look the up the price, they are deeply expensive, even for basic "make it louder" type aids.

Worse still, because they interfere with your ear, you tend to loose the ability to "steer" your hearing. This means that you can't tune out other conversations/noises or stuff.

The one good side effect of facebook spending billions on its (probably) futile search for practical and popular AR is https://www.projectaria.com/glasses/

Which is a (cheap) platform to do experimentation for AR type actions.

However it has eye tracking, microphone array and front facing cameras, so it can be fairly easily modified into being a steerable microphone.

View on HN

Modern hearing aids are pretty cool. They've crammed in an amazing amount of features in a super tiny form factor, with a battery that lasts for a week even when using bluetooth.

My Phonaks have the ability to automatically switch programs to some extent, and to fine tune the program using a companion app.

I can function and even have conversations to some extent in noisy environments, something that would have been impossible for me with hearing aids from a decade or so ago. I'm very grateful for this of course.

The pair costs roughly $2000. Luckily, it's covered by the national healthcare system[0] (which I of course pay for through my taxes) so I end up paying $50 every five years or so.

I hope the advances in "AI" will make it possible to not just amplify and filter (even if it's in very clever ways) but to isolate and enhance/reconstruct voices in noisy environments.

Meanwhile, I hope the trend of playing louder and louder music in cafes, restaurants and bars dies out. It's an accessibility nightmare, especially (but not only) for people with hearing loss.[1]

0: https://www.socialstyrelsen.se/en/about-us/healthcare-for-vi...

1: https://www.vox.com/2018/4/18/17168504/restaurants-noise-lev...

Those do look good, and in the last 3 years the price has dropped significantly. in the uk those cost about $3k, so not much difference. alas, they are not covered by the health service, only lesser ones.

> I hope the advances in "AI" will make it possible to not just amplify and filter (even if it's in very clever ways) but to isolate and enhance/reconstruct voices in noisy environments.

I often see AI hopes expressed in this format. I would put it another way:

> I hope the advances in "AI" will make it possible to restore hearing to baseline average human level

Wishful thinking would be to enhance it beyond baseline. It's perfectly reasonable to think AI-advances can help researchers restore hearing in most cases, and reasonably within 10 years or so.

> It's an accessibility nightmare, especially (but not only) for people with hearing loss.

I can't make out any conversation in a noisy environment so usually switch to try-to-filter-noise-and-fail plus some amateur form of lip reading which works ok for a casual conversation but not for a more serious one. Hearing is "ok" enough though when testing, so no clue what it is.

It helps a lot when the ambient noise level reduced by a few db and tuning down the music helps a lot.

I'm exactly the same, end up doing a lot of nod-and-smile which isn't ideal! My hearing isn't great in the high frequencies, but nothing major.

Same here. I have a (I think) very good ear in silent environments,for example I can hear a very faint sound at night, but I always struggled following conversations in music clubs or bar with high music volumes. I always end up nodding and saying "yeah yeah" even if I have no remote idea of what the other person is saying.

Edit: but OTOH I see people having actual conversations in those same environments, so I guess it doesn't affect everyone in the same way, and it's not either something fully related to how my eardrums are capable of working...

My experience is exactly the same. I doubt everyone is simply pretending they have any idea what everyone else is saying, so it must be something wrong with me.

I’ve had my hearing tested. It’s within normal ranges across all frequencies tested. I have to assume it’s some kind of discrimination or processing difficulty in my brain.

I’ve noticed the same effect can be triggered even in a white environment by only two or three people trying to talk to me at the same time. I can’t understand anything any of them are saying and can’t listen to just one.

I'm the same, and no, others are not pretending. It makes sense that our increased ability to recognize non-speech sounds may come at a cost of reduced ability to recognize speech.

Having worked (and frequented) loud bars and clubs for decades no one can hear anyone and just nods along.

Interesting, I'm the exact same, but so far hadn't come across anyone else with this issue.

I think the two aspects might be related. Possibly the average brain is more finetuned to recognize speech specifically, which comes at the cost of recognizing other sounds, but improves speech recognition. Ours are less finetuned, with the opposite effect.

I also have a problem with "background noise" and being unable to understand what people are saying in noisy environments.

Most people definitely do not have it as badly as I do, or they'd never go to a noisy bar and try to talk. It's simply impossible for me to do anything but pay full attention to the person talking, and even then I often have to guess many of the words.

I even went and got my hearing checked (and my wife did at the same time), but the clerk assured me that we don't definitely have hearing problems and joked that we needed marriage counseling instead. :/ It's funny now, but I was a little pissed at the time.

Anyhow, my point is that some of us do indeed "hear" worse in noisy environments, even if our ears are amazing when it's quiet.

These have been mentioned elsewhere in the comments but in case it's helpful:

* https://en.wikipedia.org/wiki/Selective_auditory_attention

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

* https://en.wikipedia.org/wiki/Cocktail_party_effect

> On the way out, I tried to mention the tough acoustics to someone at the restaurant’s front desk. I don’t think he heard me.

It's funny how for some problems the path to the solution is blocked by deadlock

> Meanwhile, I hope the trend of playing louder and louder music in cafes, restaurants and bars dies out.

I don't hold out much hope because as far as I can tell it's done to make everyone "shut up and drink". I could believe it adds at least 50% to sales because when you can't hear a word anyone says, all you can do is smile and nod and take a swig. And if the place is already full anyway, they don't care if you leave, you'll be replaced. What matters is whoever is in there taking up a space is drinking as fast as possible.

Of course, people who get substantially drunk (which is to say, customers who spend) also don't care because they're not really listening closely or making conversational sense anyway and their pain tolerance is way up, so it's just a good time to them.

Even more cynically, it also keeps the place "cool" because all the old, past-it fogeys like me don't even bother going in. From this sample of one, someone who thinks the music is too loud is un-hip, isn't adding to any hookup appeal (either not in the market or pushing the creepy end of the age range) and won't even spend much because they can't get really hammered because the hangover will take them out for two days and they can't afford to lose a weekend.

It's depressing to think of the different ways people are treated like livestock on a factory farm.

It's depressing to think of the different ways livestock are treated like livestock on a factory farm, too.

Factory farms are hell on earth.

I need to find the article about the multistory pig farm in China. The whole lifecycle from piglet to fattening up and slaughter all in one convenient location.

At least livestock gets to grow up in pasture before they’re sent to the feedlots.

This is, in fact, not always common. I guess it probably depends on the country/region to some extent.

I was thinking of cattle but totally forgot about pigs and chickens.

Not all livestock is so lucky to have been born a cow.

Not just restaurants and bars. Artificial sounds is everywhere.

There was a musician (fairly accomplished in his field) who woke up one day and started hating all music because he realized you cannot escape it. He wrote a book about it but I forget his name.

Interesting.

As an aside, I searched for "musician book can't escape music" and your comment was on the front page of the Google results in sixth position. In fact it was in nearly every search I tried. I couldn't find such a book with moderate trying, just a BBC Point of View transcript on the same thing.

It's personally not a problem I've really noticed in my day to day (for example, today I would only hear music on my headphones at work and as part of TV others in the house are watching at home), though I probably don't spend my time in the same places a musician would.

> Meanwhile, I hope the trend of playing louder and louder music in cafes, restaurants and bars dies out. It's an accessibility nightmare, especially (but not only) for people with hearing loss.

I thought it's well established that they're doing it entirely on purpose. Restaurants, cafes and bars don't make money on you chilling out and having a good time with friends; they make money on you buying food and drinks. They want you to order and consume ASAP until you're full and leave, freeing the table for the next group of customers. Loud music that prevents you from having conversations is how they make this happen.

I've been to quite empty restaurants doing the same thing though. The thing is, a lot of people seem to love it, even though they're struggling to talk to the people next to them. I don't understand it at all personally

This explanation doesn't really work for the cafes that allow people to take up space at tables for long periods just guilt-ordering a minimal amount.

The only thing worse for a cafe than to be full of people who aren't in a hurry to leave, is to be empty. During slow business hours, the venue will happily cut customers some slack, because as long as they're seen at tables, they're doing free marketing for the place. See: social proof.

Curious, is that your first pair of phonaks? If not, is the use use of bluetooth + app hurting your soul?

My current pair are about 6 years old, working fine still, thankfully... But in a recent visit to audiologist, they had me test out a newer pair... but they had a single button instead of rocker + button, and bluetooth/app was touted.

I dread the touchscreen phase of HA as a young person with functional fingers (vs elders with dexterity issues) and a preference for physical buttons (a la my 2009 car).

The idea of autoswitching the programs outside limited cases (direct audio input cables and increasingly-rare telecoil situations are the only things I would accept) also doesn't sound great! :)

Second, but first with BT.

Connecting to the app takes forever and frequently fails. It seems to clash with the Android device pairing somehow. It's not great. The only workaround I've found (if restarting the things by opening/closing the battery compartment doesn't work) is to remove the pairing and set them up again.

I also would prefer to set up the programs once and then switch them with physical buttons. I had my audiologist do something like that with my old pair. New audiologist now that doesn't seem as flexible, or maybe it's not possible.

The bad app experience is honestly a reason for me to look at other brands for my next pair.

I'd like to think that a bit of a learning curve is okay for something that's basically an extension of your body, but everything seems to be getting stevejobsified these days. (I'll be driving my 2006 Saab until my mechanic either retires or runs out of spare parts!)

> I also would prefer to set up the programs once and then switch them with physical buttons. [...] The bad app experience is honestly a reason for me to look at other brands for my next pair.

While the latter is probably the preferred approach for dealing with the issue, I'll admit my mind first went to:

If you've got time for a side-project maybe consider reverse engineering the Android app's Bluetooth support... and, you know, "just" re-implement the same thing in some stand alone hardware. :)

There may even already be a project related to your device--I'm aware of multiple health/medical-tech/device related reverse engineering projects that were primarily driven people with programming/hardware experience wanting to avoid crappy vendor apps & have control of very personally relevant devices.

Id say the hearing aids are impressive tech but also not as good as I would have thought them to be. My mother uses phonaks and they constantly give feedback or are scratchy sounds and has to go get the audiologist to adjust them.

Shes older so that might be part of the technical challenge with them but i would have expected better given the huge price tag. Feels a bit like a monopoly running the development but that is merely a hunch.

Apple AirPods Pro are doing all of this now. They’ll isolate people in front of you, can reject background noise but allow voice, etc. They can also correct both music audio and “transparency” audio using your Audiogram. Unfortunately for me, they average both ears and perform the same correction on both ears and I have notable hearing loss only on one side.

I don’t see any reason proper hearing aids can’t already be doing it now though I am sure some of them are but probably the even more ridiculously priced $8k+ models.

Nuheara is also in this space but marketed and designed more specifically to be a low budget hearing aid replacement. With a similar pride to AirPods Pro.

They do do this, and they have for 20+ years.

The expense isn't a tech problem, but an anti trust problem. A small cartel controls the supply, so the only incentive is to maximize profits, not out compete with better tech (0)

(0) https://www.thebignewsletter.com/p/silencing-the-competition...

Yup, in the US this was because they were classified as medical devices which made barrier to entry extremely high. However, the laws regulating this got looser over the last year so we will be seeing more competition now that they can be sold OTC.

The only advice on hearing aids is if you need them, get it diagnosed and intervened early. That way you get the cheapest and most reliable hearing aid that's going to work well for you.

Otherwise the stuff you described in your comment around attention filtering starts to happen because of the sensory loss. Therefore the longer you avoid hearing correction once your hearing starts to become impaired, the more complex and expensive a hearing aid you need to re-do. This is because these expensive hearing aids do a poor approximation of the things your brain/auditory cortex was doing prior to the sensory loss.

BRB - better go book a hearing test.

Yep. My grandma (may she rest in peace) had all those. I've actually thought of doing something like they did when she was alive and I've tried communicating with her at family events or in-public.

I guess they're expensive because of relations with medical / health companies being complaint makes things expensive (eg. the same display but with certification to use in a medical facility would cost many times more).

I recall being a student in the biomedical electronics/biomedical devices lab and was curious about one piece of equipment that cost about ~10k EUR.

The device is relatively simple to make so I asked my teacher why were they so expensive. He said that yeah, the engineering/manufacturing side of it is about 200 EUR, the remaining 9.8k EUR is spent on certifications/paperwork.

Obviously, wages factor into this but over time I've come to see how paperwork and paying lawyers do in fact account for the majority of the cost.

"One thing that the HN crowd should appreciate is just how expensive and shit hearing aids are."

Expensive, yes. My hearing aids cost ~$2500CAD each but "how shit hearing aids are" is not my experience at all. My hearing aids (Widex) are awesome! The quality of audio in normal situations is fantastic. My only real complaint is that they're not completely waterproof so I have to plan ahead a bit if I'm going to be outdoors in the rain.

> you tend to loose the ability to "steer" your hearing

Do people genuinely have that ability, to listen to a specific person and ignore the rest?

Asking because no matter how hard I try I can never understand a fucking thing if there's many people talking loudly in the background, it all mixes together into an incoherent whole.

"Selective auditory attention is a normal sensory process of the brain, and there can be abnormalities related to this process in people with sensory processing disorders such as autism, attention deficit hyperactive disorder,[30] post traumatic stress disorder,[31] schizophrenia,[30] selective mutism,[32] and in stand-alone auditory processing disorders.[33]"

https://en.m.wikipedia.org/wiki/Selective_auditory_attention

Ah interesting, I must have dis or that order then.

Yup I have mild ADHD and as the day wears on I find it harder to do this subconsciously. I need to start making a conscious effort to focus only on the person I’m speaking with and not the cross conversation happening at the same table.

I can sometimes do that with instruments in music. Never for people.

> Do people genuinely have that ability

Indeed! however like visual depth perception, not everyone has it. The human ear has a load of bits that allow removing noise from the signal. (I don't have a block diagram, sorry!)

In theory one should be able to locate a noise in 3D. You can test this by getting someone to hide your phone and then ring it. if you have 3d sound perception you should be able to work out if the phone is behind/front/up/down.That forms part of the "steering" ability.

Then there is filtering the noises that you don't want. Music is can be a good test for this, how many instruments played on this track, what instruments were they, what were the lyrics, etc. Being able to do this requires that you be able to filter out noises that you don't like.

Again like all human senses, there are levels of ability, and in some cases can be improved with "exercise"

But, hearing what people are saying against a loud background is really really hard, so don't worry too much. Plus voices have specific human social encoding, so they can be affected disproportionally

Looking at Apple's Airpods Pro, they're starting to get some of the features of hearing aids. E.g. features to allow doorbells through the noise cancelling.

I don't think anyone would suggest them as a realistic choice today but I could see Apple going after that market and where Apple goes others follow.

Much like the market for prescription reading glasses has been eroded by off the self glasses.

Are those project aria glasses actually available for purchase? You say cheap, that implies there’s a price somewhere. Looks like an internal experiment. I would love to be able to buy something like this, but all of the commercially available wearable computers are pretty crappy in my experience.

The French youtuber Deus Ex silicium made a through analysis. Basically, hearing aids are slightly worse than ordinary wireless headphones, but 10 times more expensive.

https://www.youtube.com/watch?v=QPmwfbLPHG8

I doubt that is true. The hearing aids sold as medical devices, have to satisfy regulatory standards. So a lot of incentive to use older reliable tech.

Not to mention, it probably takes a couple of years to get the certification for a device. So, any device to market is easily 2-3 years old tech by definition.

I think you meant "I don't doubt"? Because none of what you said sounds like a counterargument to what the parent said.

> Not to mention, it probably takes a couple of years to get the certification for a device. So, any device to market is easily 2-3 years old tech by definition.

Approval can be quicker for hearing aids as there are already works-alike devices on the market. 510(k) clearance takes less than 6 months.

From what the video says, it sounds like you could get a much better price by buying the devices directly from the constructor, even without the healthcare subsidies. But doing so means you need to calibrate them yourself.

I wonder if some constructors could target this use-case by making aids that are very easy to self-calibrate.

On the other hand, the median hearing aid user is pretty old, has lots of disposable money and has never watched a youtube tutorial in their life, so it might be a small market.

Instead of fancy shmancy AI, could a pupil tracker on eyeglasses be used to estimate where a person wants to hear and use phasing to amplify the signal from there?

You have two microphones already, spaced about 30 cm apart...

Microphones are cheap right? Just have multiple on each ear while you're squeezing in the AI features too :)

The problem, as I understand it, is that the wavelength of sound is very big relative to the microphone spacing.

I'm also far from an expert on wavelength stuff when it comes to applied uses, so I'd have similar questions.

But my hearing aids do in fact already have two mics per ear (about half an inch apart), and use them to let me block out some of the noise behind me.

I suspect you definitely get big improvements from a greater spacing in a microphone array than what fits on an ear though!

Yup thats basically what most AR glasses are capable of (or in the case of the linked aria glasses, research device that does have all the sensors.)

but you don't need eye tracking all the time, as most you can latch on to the location of the speaker without looking at them continuously.

The possibilities are rather good, but it needs someone willing to fund the research

> they are deeply expensive

Like, $50,000. I'm hoping that removing the need for prescription ones, will allow the price to go down significantly.

As an older person, I have noticed that my hearing has gotten "louder," over the years.

I still hear dB levels fine. The problem is that I hear all the noise. I used to be able to hold conversations in loud environments (like bar/restaurants), being able to hear the other person, despite the background noise.

Not that long ago, I was at dinner in a noisy restaurant. I was sitting directly across a narrow table from someone (about 30 inches -max).

I couldn't hear a word they said. They could hear me fine (they were younger).

If this works out, it might give the folks currently collecting $50K a pop, another way to charge eye-watering money.

What kind of hearing aids cost $50k?

I suspect many of them.

I was shocked, when I found out.

Of course, you aren’t just paying for the hardware. You are also paying for all the medical stuff surrounding the kit.

You can understand why vested interests fought so hard to prevent making hearing aids OTC.

Like I said, I suspect that gravy train may have derailed.

They don't cost 50k. They cost at least an order of magnitude less.

My moms hearing aids cost 3000€. They support bluetooth so she can use them with her iPhone. The price includes hearing tests, getting molds of the hearing canal, all the setup and configuration performed by skilled technicians.

Sure they are expensive, but there really isn't much of an opportunity for disruption. Customized hardware is expensive, there's no way around that.

I live in the US.

I noticed that someone else posted a comment, saying that Americans exaggerate medical costs.

We don't.

Our doctors drive Bentleys.

I'm really glad that they have broken the monopoly. Maybe some politicians retrieved their souls.

It's absolutely insane how expensive healthcare is in the US.

But THANK GOD we don't have socialism! /s

> I noticed that someone else posted a comment, saying that Americans exaggerate medical costs.

In this case, I agree that your earlier post exaggerates the cost of hearing aids in the US.

For example, [1] quotes a top price of $3500/ear. That makes $7000 total. A page full of search results [2] will tell you that prices are in ranges like $1-6k each. Even the hearing aid producers are quoting those prices. [3]

[1] https://www.hearinglife.com/hearing-aids/prices

[2] https://www.google.com/search?q=united+states+hearing+aid+pr...

[3] https://www.miracle-ear.com/hearing-aids/cost

OK. I cede the point. It's likely I'm wrong, as I am not deaf, and don't have a hearing aid, so I am not speaking from experience. I have a freind that is deaf, and has the magnetic cochlear ones.

It's not worth arguing about. This is not an area I'm anywhere near expert in, as I suspect, many other commenters are.

This is a low quality comment, that was already debunked by a google search in a comment below.

What Google search?

You mean the specific hearing aid searches?

It was a general comment on the state of health care in the US (not just hearing aids).

Before the new legislation, we couldn't just go to the corner drug store, and buy a hearing aid off the shelf. It needed to come as part of a package, including many tests and appointments with ENT folks.

But I cede the point. It was a low-quality comment that is likely to trigger folks with certain political views, and I apologize. Won't happen again.

I feel like you are still exaggerating the difficulty.

Costco has sold them for at least 10 years. You just need to make an appointment and they take care of the rest.

Maybe you're thinking about the costs of getting a cochlear implant?

Having worn hearing aids for 3 decades (in the US), and not going cheap, the high end name-brand ones have always been about 4-6k for a pair. (and most of the time growing up, health insurance didn't cover it)

From everything I've ever seen or in any conversation online, 50k is either a misremembered or made up number for BTE or in-the-canal hearing aids.

You are correct. I have a profoundly deaf friend with cochlear aids.

They are a lot more expensive.

Thanks so much for the comment.

Glad to help! At my recent audiologist appointment, it escalated to being suggested that I go for a cochlear implant consultation for one of my ears (I figured why not, despite not personally thinking this was something I'd do any time soon). Apparently it's actually quite possibly mostly covered by my health insurance due to showing medical necessity...

I'm fortunate that I could reasonably plan to pay for it myself... the bigger hold-up/concern/issue has been the drastic change in "how I hear" that it would involve. (experiences are widely variable it sounds like, but loosely about a year for the brain to gradually learn and improve how it uses the new input?)

I haven't even opened the manufacturers' books given to me, or done more research on the possibility since that appointment though...

They are not anywhere at that price. The ones europeans tend to get go for $1,806 retail I checked.

I've noticed Americans like to bs their medical costs as bad as the system is, you can't compare some newest luxury devices to what an average person is using all around the world.

In fairness to op, the out of date pricing may not be that out of date.

recent legislation in the US was meant to bring down hearing aid cost and to break the monopoly on devices. It’s seemingly worked so well that TV commercials for individual brands have started to show up for low cost aids (sub-$5k)

Hearing aids (ignoring implantable ones like BAHA and cochlear) weren’t going for anywhere near $50,000 in the US.

My dad just got hearing aids (US) about 3 weeks ago. They cost him $1600 with no insurance coverage.

That's utterly insane, and I suspect probably some outlier particularly expensive ones. You can book a fitting, and buy a choice of hearing aids, get trained, follow up, and 5 years worth of checks ups and appointments in London privately with no insurance ranging from ca $1300 to $5000. I've not even found any higher than $5k when I searched for prices in London, though I'm sure some of the Harley Street clinics will be willing to overcharge at ridiculous rates too.

You are correct. I was thinking of cochlear aids.

Just to be clear.

Looks like I’m wrong, making a general statement, based on anecdotal information.

We’ll have to see what the future holds for us.

I don’t have hearing aids, but I do suffer from hearing loss. That being said, the Apple Airpods do a wonderful job of helping with that in the adaptive or transparency modes.

Apple was working taking the platform even further at one point and I would not be surprised if we see some new announcements eventually.

Imagine if a $200 set of airpod pros outperformed top hearing aids.

Link to an article about it: https://www.techradar.com/how-to/how-to-use-your-apple-airpo...

I too suspect they're looking into it beyond existing prevention features, they've had some opt-in studies for airpods:

https://www.apple.com/newsroom/2024/05/apple-hearing-study-s...

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