Not an audiologist, but an engineer/musician with some mild hearing loss and some interest in these things.

What needs to happen to bring the prices down is a unified prescription for hearing aids, like we have with eyeglasses. You can get your eye exam, request your prescription, and take it anywhere you want -- Costco, Zenni, or your local shop. That facilitates apples-to-apples competition.

There's nothing like that with hearing aids. Each company's aids need to be fitted with that company's software, and if you want to switch to a different brand, you need to go through the fitting process all over again. You can get a copy of your audiogram, but that doesn't capture everything that goes into a hearing aid fitting. What the manufacturers do is provide different fitting profiles for different types of losses (old-age loss, noise-induced loss, cookie bite loss, and so forth) and then tweak from there. You can't just take your profile from one manufacturer and move it to another.

For a comprehensive hearing aid prescription, you'd need to know exactly how much conductive loss you have at each critical band of hearing (https://en.wikipedia.org/wiki/Bark_scale). Additionally, you need to know how much loudness recruitment (nonlinear increase of perceived loudness in response to linear increase of sound intensity) you have at each band. The problem is that right now, it's prohibitive to measure all that -- you'd be in the silent room pushing buttons in response to beeps for hours. I'm hoping that eventually, AI can help with that by taking over that manual work and allowing for more fine-grained audiometric data. Rather than trying to build noise cancelling, etc. into the hearing aids themselves, maybe we can provide accurate enough prescriptions so that the brain gets the information it needs to do the processing itself just like it does for a non-hearing-impaired person.

Sure, that's an audiogram. It tells you what your threshold of hearing is at a certain set of frequencies. Additionally, sometimes they'll do bone conduction, which can characterize whether your loss is conductive (for example, trouble with the bones in your inner ear) or sensorineural (for example, cochlear damage from noise exposure). But that's just a starting point for fitting a hearing aid -- it's not like a glasses prescription that tells the optometrist exactly how to cut the lens.

Fellow HA wearer here - close on 25 years now. I agree that disruption in manufacturing is important, but I also think there are a few other areas that could use disruption.

First, remove the stigma of hearing aids and hearing loss. It's not an old person's thing, and it's not something you have to hide. For me, they are glasses for my ears. That cost thousands of dollars. I want options. I want colors. I want "Ray Ban" to brand hearing aids. I do not want to browse a selection of colors that are clearly meant to either blend with my skin color or my hair color. Don't market to me that they are "hardly visible" as if I should be ashamed of them and hide them.

Second, make insurance work better. For a time, I had a state job, and the state insurance would pay $200 per hearing aid. That's nowhere close to the cost - probably about 10% of the cost. $200 gets you a cheap "hearing device" you'd get out of the back of an AARP magazine with pictures of silver haired people. In my current job (Fortune 50 company), they will pay 90% of the cost for hearing aids, but they will only buy me one pair in my life time. IN MY LIFE TIME. Utterly ridiculous. I could lose one or have one damaged, and be on my own for the $2500-3500 (each) replacement cost depending on what I got.

Agreed on both counts. Wearing hearing aids for essentially my whole life I've been made fun of for it maybe once or twice, and that did suck, but there's so much more stigma in an oticon pamphlet than I've ever experienced in real life. It definitely feels like a pitch aimed at older people who are in denial about losing their hearing, no matter how many pictures of teens chatting in a circle they put in there. Matching colors, assurances that they're unnoticeable, the implication that you need hearing aids to be "normal" (true-ish for me, but still not appreciated), and so on.

Insurance is a joke. Every private insurance plan I've ever had, even my current otherwise decent one, has paid a total of 0% for anything HA-related. And it's not just the hearing aids themselves, it's the tests and the followups and the fittings and on and on. It really adds up. Iirc medicaid actually had decent coverage, but I wasn't paying for it at the time so I don't know have numbers.

I say only half facetiously, make them look like AirPods. It’s considered perfectly normal to have one or two in your ears much of the time.

1) I don't want to be confused with someone who won't take their earphones out

2) this is another form of camouflage which is indicative of something that sour be hidden or shameful

So, take the idea that Starkey is going on, but make them ostentatious? Kind of the way arm and leg prostheses have gone now that 3D printing has reached consumers?

They should be like glasses, as they serve quite a similar function. But they are even less evident, so unless you wear bright pink aids, they shouldn't probably attract any attention (they don't really change your look, do they?).

Everything else means there's still a stigma.

Ostentatious - characterized by vulgar or pretentious display; designed to impress or attract notice.

That is not at ALL what we want. Not even close.

I'm convinced that the real reason why hearing aids remain so expensive is because of the need to see an audiologist. In a day and age where Shenzhen makes hardware iteration cheap for Chinese hardware companies, it makes very little sense for the hearing aids themselves to be so expensive.

I'd love to hack on mine, but I lack the hardware setup that connects the hearing aids to a computer for programming, not to mention a copy of the Noah programming utility itself. Everything is completely closed - good luck finding an audiologist who's gone far enough into software programming and the open-source world to appreciate the benefits that FOSS brings. The UX shouldn't be so complicated - instead of the frequency-oriented UX that Noah presents to an audiologist userbase (which is well familiar with the underlying science and has an interest in working quickly and efficiently so as to proceed to their next patient appointment), have a more optician-inspired UX, which plays a sound or speech track and asks you questions like "does this track or this other track sound better to you?" and "does this sound too quiet or too loud?" over and over again until the end user "dials in" the right fit.

Self-programming is a viable option.

In the past HA companies had a problem: audiologists weren't technical and didn't know how to program the increasingly sophisticated hearing aids. So the fitting software (1) automatically produces a reasonable fit and (2) at least the ones I've used have a section that asks questions and makes adjustments based on the answers.

It's also worth noting that there isn't really a "correct prescription" but rather it's an art of arriving at settings based on the client's goals and feedback. The audiogram is a diagnostic tool but only a starting point for determining HA settings. From the HA dispenser's perspective, adjusting settings costs them time and therefore money after they've made the sale. From the client's perspective, you'd need to visit the audiologist for every adjustment. Self-programming avoids the problem.

The programming hardware, software, and used hearing aids are all available on ebay. The prices are such that your average HN reader wouldn't have to worry too much about replacement costs if a HA breaks or goes missing. And the flexibility is great too.

You may not need NOAH. For a Phonak hearing aid you only need the iCube II (programming device) and Phonak Target (programming software). The NOAH software is an optional place to store customer data which is useful in a clinic that sells hearing aids from different manufacturers.

The problem is that patients don't always know what is supposed to sound right, especially if they've been going without hearing aids for years. If you take a person with a high-frequency loss and correct it to the normal range, they'll often complain that everything sounds sharp, or there are too many noises and it's hard to concentrate. Only after wearing them for a while does their brain learn to filter out the normal environmental sounds and adjust to the "new normal".

Which is precisely why home self-programming is so important. It allows patients to go back and re-program as often as they feel necessary, and such additional tunings would not cost the patient the cost of additional audiologist visits.

I guess the question is whether ignorance is bliss. If a patient self-sets a hearing aid to a level that the patient thinks is great, but isn't theoretically as great as it could be, is that actually a problem?

> I'm convinced that the real reason why hearing aids remain so expensive is because of the need to see an audiologist.

That might change in 2020 in the US because some laws have been enacted that will allow some hearing aids (for mild hearing loss?) to be sold directly to the customer.

> why hearing aids remain so expensive is because of the need to see an audiologist.

A bit like the need to see an optometrist to get glasses. When I was in Beijing a few years ago I went to the glasses district (basically a few buildings all in the same area that are floor-upon-floor of eye glass shops)... I was able to get a thorough exam from the salesman, and had a custom made pair of glasses in a couple hours for under $50US.

Is that a U.S. thing, having to see an optometrist? I did not need glasses when I lived in the U.S. But now living in a developing country my experience is similar to yours. Multiple eye glass shops in the shopping malls will check your eyes and cut lenses in a couple of hours. Cost depends mostly on how much you want to spend on frames - name brands are more expensive.

I've looked at the financials of hearing aid companies before. And the short answer is that the money is not going to the hearing aid company. Of the $5k you spent on your hearing aid, the hearing aid company was probably paid $500, and the other $4.5k went to the audiologist.

Watch out what you ask for. The disruption might be a "low cost" model that listens to everything you say, and works as a mobile cash register for amazon or an "interest tracker" for google.

:)