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10.03.2014

Digital hearing aids cost, adhd in adults free test - How to DIY

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In 2010, William Demant purchased Otix, manufacturer of Sonic Hearing Aids, and in the process acquired Hearing Life, a U.S.
But on the other hand, they are hedging their bets on independent retail by investing in partnerships with big-box retailers (Costco, Boots) and constructing branded retail chains of their own (Connect Hearing). This is the first of a series of articles that explores the relationship between the stubbornly high prices of hearing aids, and the "Big 6" manufacturers that have failed to stop continued hearing aid price increases. To put some numbers around this, let's say that Sonova, one of the big 6 manufacturers and the maker of Phonak and Unitron hearing aids, sells a hearing aid that costs $100 to produce to an independent audiologist for $300. Navigating the cacophonous streets of New York City can be daunting process for practically anyone -- and for people who wear hearing aids, the task has long been made more difficult by constant background noise and a lack of infrastructure to make the process easier.
Fortunately, there's an easy solution -- hearing loops, which allow wireless connectivity to hearing aids with telecoils, effectively transmitting sound from its source directly to the hearing aid, and mitigating the effect of background noise.
Additionally, the Hearing Access Program spearheaded a drive to install hearing loops at all of New York's ~450 subway stations, which is now complete.
Finally, the hearing aids on the subways have been getting some extra attention lately from the New York City Department of Health, with advertisements that caution headphone users to turn down their music to avoid permanent hearing loss.
We think New York City is mostly on the right track recently with hearing aids -- hearing loss should be prevented where possible, and people with hearing aids deserve to benefit from hearing loop systems in public spaces wherever possible.
In our last article, we discussed some anecdotal suggestions that hearing aid dispensers in California are likely working far below full capacity.
Thanks to publicly available data at the Hearing Aid Dispenser portal, we know that there are approximately 1,967 licensed hearing aid dispenser and dispensing audiologists in California, as of July 2013. All caveats aside – in our view, the data do seem to confirm that the hearing aid dispensing industry operates far below capacity. Paradoxically, the more hearing aid dispensers have entered the market, the more prices have climbed –more dispensers means fewer customers per dispenser, which means increasing hearing aid prices is the only way to stay in business. The only way that hearing aid dispensers can both lower prices and remain economical, is if they can manage to operate closer to full capacity – but as long as the market for hearing care is oversaturated with practices, sub-30-hour weeks will remain the norm and hearing aid prices will stay high to pay inefficient fixed costs in underutilized offices.
This is the second of a three-part article on the California hearing aid market, and the contribution of an inefficient distribution network to high hearing aid prices.
This is part one of a three part series discussing evidence for the inefficient traditional market for hearing aids.
Prices of hearing instruments are either flat or declining, binaural fittings have continued to increase in popularity, and low-cost hearing aid options are starting to make their way into the armamentarium of devices that dispensing professionals offer, according to a new survey conducted by The Hearing Review during the concluding months of 2013. Overall, a picture emerges of an industry that is witnessing some major changes in response to new technology being offered by hearing aid manufacturers, the Internet and Big Box retailers, pricing pressure exerted from forces both within and outside the traditional hearing industry, and the demands of the aging Baby Boomer generation.
However, when one looks only at those practices dispensing fewer than 100 hearing aid per month (ie, excluding the 6 largest dispensing offices in the survey), the average was 23 units, and the median was 20. Going back 20 years and comparing 2013 figures to those of 1994 and 2003 HR survey statistics,1,2 there are fewer hearing care offices today dispensing more than 20 hearing aids than in the past (Figure 3). Also included in Table 2 are the weighted average prices, which are based on the averages of the three price levels shown at the top of the table and, in the case of the total weighted averages (bottom line), the 2013 HIA statistics6 for private-sector unit volume (ie, non-VA dispensed hearing aids). Figure 5 reflects this hearing aid technology and style pricing, and compares the prices with the same CPI-adjusted (2013) data from dispenser surveys taken in 201011 and 2005.10 When comparing 2013 to 2010 CPI-adjusted figures, premium technology hearing aids have decreased in price by 2% to 9%, mid-level technology prices have remained essentially the same, and economy level prices have actually increased by 12% to 17%. For several years, industry analysts and hearing aid manufacturers have been reporting flat to declining hearing aid prices on a worldwide basis. Figure 6 summarizes previously published survey data from Hearing Instruments, Hearing Review, Hearing Journal, and the Phonak Practice Management surveys since 1980. And speaking of PSAPs… We also asked what percentage of new clients are believed to have tried a PSAP prior to purchasing a hearing aid.
Figure 7 shows historical data published in Hearing Instruments and Hearing Review surveys going back to 1979.
The base price of a set of binaural hearing aids (an average of $3,300-$6,000 as shown in Table 2) can be a shock to first-time users and a financial burden, especially those on a fixed income.
Although the 2013 survey reports a fairly substantial increase in the average weighted hearing aid price ($2,363), this was primarily due to the very large number of premium technology hearing aid sales reported by survey participants. In 2013, the average price of an economy level hearing aid (weighted by HIA statistics relative to hearing aid styles) was $1,657, while mid- and premium-level technology aids averaged $2,196 and $2,898, respectively. An average of 84% of patients were fitted with binaural hearing aids by survey respondents (median 90%), up from 80% in 2005.
Although cost remains a major deterrent in buying hearing aids, only 17% (median 10%) of patients pay using a third-party financing company or via in-house payment options that the dispensing office establishes (8%, median 5%). The average dispensing office uses its #1 brand of hearing aid for over three-quarters (77%) of its fittings.
About the author: Karl Strom is editor-in-chief and a founding editor of The Hearing Review.
The World Health Organisation estimates there are 360-million people — more than 5% of the world’s population — with a disabling loss of hearing, yet current hearing aid production meets less than 10% of global need. New digital hearing aids linked to cellphones linked to mobile phones will be an improvement on these models. An electronic hearing aid is a small device placed in or around the ear to improve the hearing of those with hearing loss. There are many features available for today's hearing aids, including volume control, remote control, telecoil, direct audio input, FM reception, Bluetooth® capabilities, directional microphone, compression, clipping, frequency shifting, wind-noise management, data logging, self-learning, moisture resistance, and earmold venting. A hearing aid with directional microphones uses two or more microphones to receive sound from multiple directions.
The heart of the system is the digital signal processor (DSP), which is where all of the benefits of a digital hearing aid are implemented.
Some hearing aids are beginning to use rechargeable single-cell lithium-ion (Li+) batteries, but most hearing aids are still powered by primary zinc-air batteries.


Although there are a large number of hearing aid brands in the marketplace, the reality is that somewhere between 90% and 95% of hearing aids are manufactured by just one of six companies, according to The Hearing Review.
In 2013 it became the main supplier to Costco, ousting Rexton (about which more in a future blog post).
This is because their profit comes from the difference between the wholesale price they charge to retailers, and the cost of manufacture. If the audiologist turned around and sold that hearing aid to a customer, a lot of people would be very happy. Sonova and its peers are relatively secretive organization -- they won't even disclose how many hearing aids they sell(!), as this would allow their audiologist customers to calculate average selling prices and use that information as negotiation leverage -- and they've been keeping their acquisition of independent hearing clinics under the radar for years. Unfortunately, adoption of hearing loops, which are widespread in Europe, has been painfully slow. It's worth noting that Starkey, a hearing aid manufacturer, helped funds these advertisements, and deserves praise for its role.
We wish that New York and other governments could see fit to bring resources to bear on making hearing aids more affordable -- but at least for now, it looks like it's up to private companies to play this role. With a few assumptions, we can also arrive at a rough estimate of the amount of time spent fitting hearing aids. As an independent check, a recent survey of hearing care professionals funded by Phonak suggests an average workweek among full-time hearing care professionals of less than 30 hours per week – or less than 75% of full-time capacity. We believe that this is because hearing aid dispensers are forced to charge high prices to those that can afford them just to cover their fixed costs stay in business, even if it means everyone else is priced out of the market. In November and again in December 2013, The Hearing Review emailed a survey via SurveyMonkey using The Hearing Review subscription database. Age of dispensing professionals reported in 3 different Hearing Review dispenser surveys taken roughly 10 years apart (1994, 2003, 2013). Figure 1 compares survey respondent ages from two other Hearing Review surveys taken roughly 10 years apart.1-2 Over the 20-year period, there is a clear trend away from practice owners in their 40s, with the majority (63%) today being in their 50s and 60s, compared to 53% and 36% for 2003 and 1994. Average hearing aids dispensed per month in three different HR dispenser surveys taken roughly 10 years apart (1994, 2003, and 2013). The median reported average number of net hearing aids dispensed per month in 2013 was 20 units, according to survey respondents. Top: Reported average and median percent utilization of economy, mid-level, and premium hearing aid lines. For example, in the 2006 dispenser survey,10 the percentages were 30%, 46%, and 24% for premium, mid, and economy level aids, respectively. The average weighted price of premium technology hearing aids decreased by 10% to 12% (decrease of $312-$384), and by 6% to 10% (decrease of $122-$235) for the mid-level aids. Historical average hearing instrument prices taken from Hearing Instruments, Hearing Journal, and Hearing Review surveys from 1980 to 2013, as well as MarkeTrak (shown in both nominal prices and 2013 CPI-adjusted prices). This may be a point that approaches the theoretical maximum (possibly 85%-90%, although I could find no data concerning unilateral hearing loss for adults or speculation on a theoretical maximum for binaural fittings). Historical percentage of binaural vs monaural fittings since 1979, as reported by Hearing Instruments and Hearing Review magazine dispenser surveys. In most years during the past 3 decades, binaural hearing aid fittings have increased by 1 to 4 percentage points.
Survey respondents indicated that half (50%, median 50%) of their patients pay for their hearing aids using a credit card, and another 37% (median 30%) pay with cash or check (Figure 8).
However, Figure 6 shows that hearing aid prices have more than doubled in the 20+ years since 1993 (an increase of 106%, or $1,218 in 2013 dollars). Just over 1 in 5 dispensing practices (21%) in the survey reported offering only one product line, while more than 3 in 5 dispensing practices (61%) offered 2 to 4 brands of hearing aids. Figure 9 compares the number of brands carried by dispensing offices in 2013 to the number of brands carried in 2005 and 2003, according to HR dispenser surveys.2,10 Ten years ago, only 6% of practices reported carrying only one brand of hearing aids compared to 21% today.
Regardless of the number of brands offered in a typical dispensing office, the average percentage of hearing aids in that office coming from the #1 brand has remained essentially the same: 77% (median 80%) of all hearing aids in 2013 compared to 72% in 2003.
When comparing 2013 to 2010 CPI-adjusted figures, premium technology hearing aids have decreased in price, mid-level technology prices have remained essentially unchanged, and economy level aids have increased in price by 12% to 17%. The average price of the very lowest priced hearing aid in a practice was $1,025 (median $995). As a group, the Big-6 hearing aid companies have increased their market dominance during the last decade, although their relative positions in the market remain fairly dynamic.
Aside from the 5% of the hearing-impaired of any age, they hope to appeal to Baby Boomers who are loath to admitting age-related disabilities.
The basic components of a hearing aid are a microphone, signal conditioning, a receiver also known as a speaker, and a battery.
The first to exist, analog hearing aids process electrical sound in the analog domain; the more recent digital hearing aids process electrical sound in the digital domain. Some of these features require external area to implement and become more difficult to include as the size of hearing aids shrinks, while other features can be implemented in all hearing aids. A remote control eliminates the need for buttons and dials on the hearing aid and can be used to control all the features of the hearing aid. This improves the signal-to-noise ratio (SNR) of speech when heard in a noisy environment, and enhances the quality of speech further when used with digital signal processing. There are five main sizes of zinc-air batteries used, depending on the hearing aid style or size, the power consumption of the circuitry, and the battery-life requirements. When used for 16 hours per day, battery life ranges from a couple of days to a few weeks, depending on the battery capacity and hearing aid design.
The lower that retail prices -- the amounts actually paid by people with hearing loss -- fall, the more hearing aids will be sold, increasing profits for manufacturers, assuming no impact on wholesale prices.


While this creates a conflict of interest between the interests of the companies' manufacturing operations (who want lots of people to have hearing aids) and their retail operations (who want hearing aid prices to stay high), it may ultimately be good for shareholders (who care about total profits), even if it's bad for consumers (who benefit from access to hearing aids at affordable prices). Only 12% were owned by a Big Box retailer, corporate chain, or hearing aid manufacturer, while 10% of respondents were not-for-profit businesses (*not included in the results of this report).
In general, larger percentages of dispensing practices are dispensing fewer hearing aids today than they were 10 and 20 years ago.
First, it should be noted that this is the first Hearing Review dispenser survey administered by email (via SurveyMonkey). Bottom: Average (median in parentheses) prices of the five major styles of hearing aids in each of the three pricing categories. However, as defined by FDA regulations, PSAPs are not designed to address hearing impairment.
In 2013, 84% of patients were fit with binaural hearing aids (median of 90%), according to this survey. A total of 83% of respondents said they used a bundled pricing system in the sale of hearing aids, while 17% itemized their product and service billings. Only one-quarter of patients pay for their hearing aids using a third-party financing company (eg, CareCredit, Wells Fargo, etc, 17%, median 10%) or via in-house payment options (8%, median 5%) that the dispensing office establishes.
The increasing frequency of binaural fittings has also greatly added to the cost of hearing aids (it should be noted, however, that some dispensers offer discounts for binaural sales). Hearing Review has published several articles by CareCredit and other industry experts about why providing financing options to patients can increase the number of first-time users, reduce returns, improve customer satisfaction and value, and decrease the business risks associated with having a high amount in accounts receivable.Additionally, an argument can be made that providing financing options represents another weapon in the battle against many of the price-centric delivery channels challenging the hearing industry. EuroTrak + JapanTrak 2012: Societal and personal benefits of hearing rehabilitation with hearing aids. The earliest analog hearing aids simply amplified both speech and noise, and were ordered after testing to determine the particular frequency response needed by the patient. Class D amplifiers are used in modern hearing aids due to their low-power operation, low distortion, and small size as compared to Class A and B amplifier. Table 1 compares the capacity and size of the five most common zinc-air batteries, and includes their color codes for easy selection and the styles of hearing aid in which they are usually used.
Sonova would also would be thrilled, because there would be a lot of demand for hearing aids at $500!
Their incentives would shift from supplying hearing aids to as many people as possible at reasonable prices, to supplying hearing aids to those who can afford them, at very high prices. About 1 in 5 were affiliated with but not owned by either a hearing aid manufacturer (9%) or a corporate chain (7%), while smaller percentages said their office was owned by either a Big Box retailer (6%) or a corporate chain (4%). Past HR surveys were conducted using only the US mail, with the mailings directed to owners and weighted according to Hearing Industries Assn (HIA) state net unit sales statistics for the private-sector market. Survey respondents reported that, on average, 37% of the hearing aids they dispensed came from premium product lines, 44% came from mid-level lines, and 19% came from economy-level hearing aid lines. The average weighted price of premium technology hearing aids has decreased by $312-$384 (in 2013 dollars), and by $122-$235 for mid-level aids, depending on the style of hearing aid.
The signal then undergoes conditioning that can be as simple as amplifying all of the sound equally, to more advanced equalization involving a digital signal processor. Newer analog hearing aids can be programmed during the fitting process, and some have multiple listening profiles that the patient can select with a button on the hearing aid.
Today's telephones and other alternate listening devices build-in this capability in order to work with a telecoil and specifically indicate that they are hearing aid compatible.
Frequency shifting uses digital signal processing to shift speech to a lower frequency, which is helpful for people with high-frequency hearing loss.
Moisture resistance helps reduce repairs due to exposure to moisture, and earmold vents provide additional comfort by reducing the closed-in sensation felt when wearing an earmold type of hearing aid. It also processes directional information and can generate its own signals to help improve fitting a hearing aid to a patient.
This compares to 74% of Big-6 hearing aids dispensed in the 2005, using a slightly different methodology.10 The rank order of the corporate groups in that older survey was Siemens, Starkey, GN, Sonova, WDH, and Widex. Digital hearing aids are also programmable during the fitting process and have multiple listening profiles that are selectable by the patient. Direct audio input and FM reception are other ways to input sound or speech into the hearing aid, the first using a wired connector as an input, and the other an FM radio receiver. Wind-noise management detects wind and eliminates the feedback that would otherwise cause ringing sounds to be heard by the hearing aid wearer.
Hearing aids that use rechargeable Li+ batteries may require a linear or switching regulator to step the battery voltage down if the circuitry cannot run directly from the typical 4.2V, single-cell Li+ battery's fully charged voltage. The ITE style moves the hearing aid into the outer ear, where it becomes a single unit with the earmold. The digitization of sound allows more advanced signal processing such as noise reduction, filtering, and acoustic feedback (ringing) control.
The vast majority of hearing aids sold today are digital because of their increased performance and flexibility over the analog versions.
The Bluetooth device can either be integral to the hearing aid or an add-on device through the telecoil or FM input. An accurate fuel gauge is critical to provide warning before the battery is depleted so that the patient is not left with a nonfunctioning hearing aid. The ITC style moves some of the hearing aid into the ear canal and reduces the space taken up in the outer ear, but is still plainly visible.



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