Do we Need “Aud-ticians”?

What’s the most enjoyable health-related appointment you regularly make?

For me, and many others I’m sure, its going to the optometrist. The point-blank puff of air to the eyeball isn’t pleasant, but checking out the selection of eyeglass frames is. You get to try on the coolest fashions, the wackiest designs, and have fun while doing it.

Should the future of hearing care look more like what eye care currently does? Imagine this scenario:

A patient enters the hearing clinic. They check in with the receptionist, fill out the paperwork, and are asked to wait for their appointment. They wander around the clinic, looking at the latest fashions and styles of hearing aids. These hearing aids are all out in the open, sorted nicely by manufacturer and style along the walls of the clinic. There are a wide range of colours and styles displayed – but absolutely nothing flesh-toned. There are hearing aids geared towards fashion and style, some geared for durability and active lifestyles, and some aiming to be super discreet. People are able to pick up the hearing aids themselves, try them on, check out how they look in a mirror, and compare different models side-by-side. An employee can check what size of dome they might need, or walk them through possible custom fit options. Eventually, the audiologist is ready for the appointment and the patient goes through their evaluation. At the end of the appointment, they return to the front area of the clinic to continue looking at different hearing aids and further discuss their options with the audiologist.

So what are the advantages of this approach? Here are my arguments:

  1. Even before the appointment begins, the patient is trying hearing aids on. They are visualizing themselves with the devices even before a diagnosis is made. Even something as simple as being sized for domes can be influential, because for the patient it feels like they’ve already taken the first steps.
  2. Hearing aids are prominently displayed. In this case, they’re viewed as fashionable and not hidden away like something to be ashamed of. This normalizes their use and could likely help lowering the average age of first purchase.
  3. People can become more familiar with hearing aids. They’re able to touch them and hold them and feel the way they fit behind their ears. Even if they don’t need hearing aids on the day of their appointment, they’ll be more comfortable accepting the devices at a later time if required.
  4. We can accelerate the fitting cycle. Generally people go 5 years or more between purchases of hearing aids. If those coming in regularly for services get more exposure to the newest models of devices, some might be encouraged to buy new hearing aids sooner.
  5. People can see hearing aids as a fashion accessory. When you go to the optometrist, there’s usually there’s an optician to help guide you through the process. Often they’re a little eccentric and are wearing big, funky glasses that you think would look ridiculous on you, but somehow their confidence lets them pull it off. Their comfort with the products makes you, the user, more comfortable with the products too. What if we introduced a role for an “Aud-tician,” someone whose job is to help guide you through the aesthetic aspects of hearing aids? They could encourage people to go big and loud, or help them find a discreet solution if they prefer.

What do you think? Is this too far-fetched or is it exactly what we need?

Seeing Hearing Impairments

If we could see hearing impairment, what would it look like?

Here’s one way to think of it. Lets begin our analogy with an image:

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This is how a neurotypical person would see the image. The colours are vibrant, edges are clear and objects can easily be picked out. Now imagine if we saw this picture in the same way people generally think hearing impairment works – where everything is simply less intense.

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It obviously doesn’t look like our original photo, but its still easy to parse out most objects. The only aspects that are particularly difficult are those areas that were not very intense to begin with, like the shadowed trees in the background (compare this to whispers, which are generally difficult to pick up for even normal hearers). However, this image does not represent a proper visual analog to hearing impairment.

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Most hearing impairments are sensorineural, which generally means they are caused by an absence, damage, or dysfunction of the hair cells of our auditory organ, the cochlea. Normally, this pea sized organ is coiled up in our inner ear, but for illustrative purposes if we uncoil it, we can see that it has areas which respond best to different frequencies of sound. Hair cells exist throughout the cochlea and fire to sounds that correspond to their place on the cochlea. When disfunction occurs, it does not equate directly to the perception illustrated above where intensity is simply diminished; its a little more complicated than that.

To use a visual analogy, think of your TV screen or computer monitor. These machines display images using tiny little points of light called pixels. If you have more pixels per unit of surface area, you have a clearer image with a higher resolution. In your cochlea, you can think of your hair cells as pixels too, and your brain as the person watching the screen. If hair cells become damaged or dysfunctional, we have a reduced hearing resolution and our brain has less information to work with. To see this, we can simply reduce the resolution of an image. The intensities of the various colours remain the same, but the image is less clear and objects are harder to pick out, just as it can be harder for individuals with hearing impairments to pick out words from noise, even when the volume is increased.

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Of course we know there is way more to light than just intensity and resolution. Just like sound, light is made up of a range of perceptible wavelengths. It is crucial to understand that the perception of various frequencies are generally not all equally affected in those with hearing impairments.

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In this image the low frequencies (red light) have been greatly reduced in intensity. Though we lose some information about the scene (colour, shading and texture of the canoe), its still relatively easy to identify and separate objects seen. It would seem that the low frequencies are relatively unimportant for pulling out information from this image, just as low frequency hearing impairments generally have a relatively lesser impact on speech perception than higher frequencies.

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This image represents an individual with a sloping high frequency hearing impairment, where short wavelengths (green) are reduced and very short wavelengths (blue) are reduced further. Certain aspects of this image are much more difficult to perceive. The trees are difficult to parse from one another, just as the separation between sky and mountain or water to ground are harder to perceive. However, this still doesn’t quite capture the whole experience of hearing impairment either. Instead, we need to factor in our reduced “hearing resolution” which we discussed earlier.

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In this image, it becomes very difficult to perceive various aspects of this scene due to both the resolution and the colour balance. However, we’ve now seen this image several times, so lets try something new.

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How many cars are in this image? What does the green sign say? Do you see the streetlights? The mountain? The pylons?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Here is the unaltered image. A lot of information got left out in our hearing impairment simulation!

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I hope this helps to illustrate hearing impairment, though it is important to recognize that this is far from a perfect representation. In reality, everyone’s unique hearing abilities are different and other aspects of hearing loss that don’t have good visual analogues exist as well.

(This post was originally published in October, 2015)

The Face of Hearing Aids

 

Quick, picture the typical hearing aid user. What does that person look like?

Did he look like this?

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You too can look this cool with hearing aids.

If you answered yes, you’re not alone. This ~50 year old, grey-but-not-too-grey, fit, Clooney-esque male is everywhere in the hearing aid world. Some version of him can be found on nearly every single manufacturer’s website and print materials.

Now as a younger hearing aid user, I’m always a little put off by the use of this age demographic being the public face of hearing aid use. I understand that the proportion of people who need hearing aids increases with age, but couldn’t we throw in some younger models every once in a while? Manufacturers know two things that could increase sales are

1) reducing the average age of first-time customers and

2) reducing the stigma surrounding hearing aid use.

Wouldn’t both of these goals be met by using a more diverse selection of people to represent these products?

Other thoughts:

  1. Some manufacturers are getting better at reducing stigma and stereotypes of hearing aid use. Widex has a really cool range of marketing materials showing baby-boomers out hiking and mountain biking. I think Signia even features some people using hearing aids on their homepage who are only in their 40s.
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I have no witty caption here. I just hope I can be this cool at his age.

2. It seems like men are more front-and-centre in most marketing. I understand why they do this, males are generally more hesitant to start using hearing aids, but its not really the best look in 2016, is it?

3. It also seems like there’s an overrepresentation of white people in most manufacturer’s marketing materials. Whether its any more than marketing across other industries, I don’t know.

4. Do marketing people know that jobs exist outside of “businessperson?” Let’s see some other occupations using hearing aids: farmers, welders, bus drivers, etc. Not everyone lives a Google-stock-image life.

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Businesspeople applaud another businessperson. Scary clay figures watch from behind. Someone is wearing hearing aids – I think?

5. The average age of a customer at The Gap is 39. But there really aren’t a lot of 39-year-old looking people in their advertisements.

Do older adults really want to appear to be “cool older adults?” Or would they rather just appear to be younger adults? Gap’s advertising seems to suggest the latter (as do Youtube videos of Grandmas dabbing and such). Wouldn’t hearing aid manufacturers be better served promoting hearing aid use as a mainstream thing for everyone, including younger people?

6. The manufacturers that produce paediatric hearing aids actually do a really good job of showing off happy toddlers with big, bright devices. I think this goes a long way with making parents feel better about their child’s hearing.

7. However, teenagers are often neglected in these depictions. Phonak has just one page depicting adolescents with hearing aids (though its admittedly very thoughtful and well done – https://www.phonak.com/ca/en/hearing-aids/hearing-aids-for-children/hearing-aids-for-teenagers.html). But, manufacturers are getting much better at using social media to share success stories of younger adults wearing hearing aids. Check out Phonak’s Instagram page as a good example.

 

Final note: The average age at the first acquisition of a hearing aid is 63, so I don’t expect manufacturer’s to ever represent the younger population of users fully. However, I do think that a long-term approach which works towards normalizing hearing aid use across all ages would be beneficial to everyone.

Are Rechargeable Hearing Aids Right for You?

Hearing aid batteries have always been a bit of a headache. They’re not cheap, they only last about a week, and they leave a trail of yellow (or brown, or blue, or orange) stickers that follow you wherever you go. However, the newest generation of rechargeable hearing aids may offer a compelling alternative for many.

There are currently 2 major manufacturers offering rechargeable hearing aids: Phonak and Signia (formerly Siemens). Both use inductive-charging, lithium-ion technology and both claim 24 hours of battery life in a single charge. Phonak claims the time needed to fully charge the hearing aids from a conventional wall outlet-charger to be 3 hours, with 30 minutes giving you 6 hours of charge. (Unfortunately, both batteries are non-removable meaning that while they’re charging, you’ll have to be without your hearing aids.)

Signia claims this 24 hours of battery life includes unlimited wireless streaming, while Phonak more conservatively states that a 24 hour charge will allow for 80 minutes of streaming. Phonak goes on to say that if you decide to use wireless streaming for 10 straight hours, you’ll only have 6 additional hours of regular hearing available to you.

Is that good enough? There are lots of days that I listen to music or podcasts or talk on the phone for more than 80 minutes, and a good number of days where 24 hours between charges cuts it pretty close. Camping, road trips, and travelling on long flights are all situations where I want to know that I have a fully charged battery I can throw in at a moment’s notice.

Phonak does have a promising solution to this problem though: a portable power pack attachment for their standard charging case. They claim this case will provide 7 total charges for a pair of hearing aids, meaning that in theory, you could go a week without ever needing a wall outlet to recharge. However, they don’t indicate if this portable charging solution works as fast as conventional charging. If the portable charge does work that fast, then its super impressive. (Though in my experience using portable power packs for cell phones and other devices, they tend to work much slower than normal outlet-charging.)

So has the day now arrived where rechargeable hearing aids are a practical solution? For me, there are still questions to answer.

  1. Do they really last a full 24 hours?
  2. How fast does the portable charger work?
  3. A full 24 hours? Even in cold weather?
  4. How long will the batteries maintain original functioning? (I know my phone definitely does not last as long as it did when it was new.)
  5. What if the hearing aids encounter moisture? Still 24 hours?

The reasons that questions 1, 3, and 5 are basically the same is that hearing aid manufacturers have a notoriety for over exaggerating the abilities of their products – ask any audiologist if they really trust the manufacturer’s recommended fitting ranges. I really want to believe the claims made by Phonak and Signia, but I can’t quite buy into them until I hear more real world evidence of their abilities. Also, I think question 4 is really important too. 24 hours is a pretty reasonable level of battery life – although I would start to get nervous on days when all my favourite podcasts release new episodes – but if it starts to slip in a year or 2, then that’s a deal breaker. What happens if you’re in your third year with these hearing aids and you’re only getting half the original battery life? Will they let you send them in to replace the battery? Will you have to pay for that or will it be covered under warranty?

There are still a lot of questions about rechargeable hearing aids, and if I had to buy a new pair today, I don’t think I would choose rechargeable just yet. Maybe one day, when they’re available across a wider variety of hearing aid models and styles and have proven themselves in real world scenarios. However, these hearing aids in their present state do offer a wonderful advantage to a number of people. Older adults (and those with mobility impairments) often have difficulty replacing their batteries when they go dead. Heck, I’m 22 and I regularly drop batteries and watch them roll under furniture when I have to change them. Older adults may even have trouble just remembering to replace their batteries or realizing that they are dead. For these populations, today’s level of rechargeable hearing aid technology offers a way to avoid these problems – although they might not be a solution for me just yet.

A Fork in the Road: Where is Audiology Heading?

The field of audiology is due for a shake-up.

I’m not saying that I’m necessarily in favour of it, instead I’m saying that it’s going to happen whether we like it or not.

The driving force of this coming change is the ability for people outside of the traditional field of audiology to create and sell their own hearing aids or alternatives. Whether these devices can provide the best possible patient care is debatable, but the fact is that their affordability and availability may render that question irrelevant.

Currently, there are a tonne of online companies providing hearing solutions at a fraction of the cost of conventional hearing aids, often with no need for multiple appointments to fit them. Every so often a news story goes viral of a student-made cheap hearing aid, or a new IndieGoGo or Kickstarter campaign pops up with an affordable alternative. Many groups, including major hearing aid manufacturers, are currently working towards the development of fully self-fitting hearing aids, which wouldn’t require seeing a professional at all. In fact, you can even build your own hearing aids at home if you know just a little bit about computers. (http://uosdesign.org/designshow2016/group-design-project/the-raspberry-pi-hearing-aid/).

Is there another side of the story? I think so, but its certainly not getting as much attention. For me, the important change in the industry is a better understanding of how properly hearing the world around you leads to better health, specifically brain health. Its been well known for a long time that hearing better in childhood can lead to better language abilities, and ultimately academic success, later in life. However, its only now that we’re beginning to understand how maintaining hearing ability later in life can lead to better quality of life, and possibly even reduce Alzheimer’s and other forms of dementia.

Though evidence around this research is still limited, it makes intuitive sense. The human brain is entirely based on the “use it or lose it” principle. New neural connections are made when more stimulus is added, and neural connections deteriorate when stimulus is reduced. For older adults, it follows that as hearing levels decrease, so do the neural connections involved, from periphery structures in the brainstem, all the way up to the brain’s language areas. Being the language based creatures that we are, this deterioration of the language areas of our brain could potentially have rippling effects across all areas of brain functioning, including higher level functions like memory and emotion.

Despite being a young person in the field of audiology, I do have a very old-school way of thinking. In my opinion, audiology is a health profession. We need to work hard to ensure we are treated as such, and that intervention with health devices like hearing aids be kept under our sphere of influence. However, I also recognize that no matter how hard we work, we won’t be able to completely quell people’s desire for affordable, readily available devices.

It seems like there is a fork in the road ahead, but that’s not the way it has to be. What if the road just widens to encompass a broader scope of responsibilities for audiologists? Maybe we can still provide hearing health care to populations who are at greater risks for negative consequences without that care, but also provide assistance to those who seek services from other sources and just need help with fine-tuning to meet their needs.

Whatever the future looks like, there is one certainty. We as audiologists need to not only promote our profession, our skills, and our knowledge, but also use those factors to provide more value to patients. The days of having the entire field of hearing care to ourselves is over. If we want to continue to be a part of hearing healthcare system, we need to give people more reasons to use our services. What does this value look like? Is it better choice? More attentive care? A more enjoyable clinical experience? I don’t quite know, but I think we better find the answer fast.

My Experience With the Oticon Opn Hearing Aids

I currently wear two Oticon Alta CIC’s and I’ve been nothing but happy with them. However, when the Opn hearing aid came out, I had the chance to try a pair out. In many ways, I regret it.

Before I go further, I need to explain a little bit about how I like to hear. Each hearing aid manufacturer has a different approach to amplification and a person might love how one hearing aid works, but hate another. I had this experience a while ago when I demo’d a pair of brand new, high end hearing aids from MANUFACTURER X. I won’t say which manufacturer it was, because I know many people who love their hearing aids from them. But their approach just wasn’t for me. Those hearing aids spent a lot of time trying to “zero-in” on the dominant speaker in a certain situation. While sitting in a lecture hall, they did a great job of making the professor sound like a warm, pleasant audiobook playing in my head, but I struggled to hear classmates sitting nearby me. The other frustrating part was the way these hearing aids shifted their idea of who the “dominant speaker” was in a certain situation. If I was trying to hear a classmate across the room ask a question, they might decide that it was more important for me to hear a pair of classmates sitting nearby, having a conversation about something completely unrelated. These hearing aids were good in simple situations, such as hearing a lone dinner companion in a loud restaurant, but failed to capture the complexity of the auditory world around the listener (in my opinion anyways).

I like to hear everything around me. I want to hear air vents, clattering dishware, and conversations going on at the next dinner table. To not hear those things, is to live in an artificial world of “sterilized” sound. I don’t want to feel like there is a crystal clear voice inside my head, instead I want to hear the world as close to how it actually sounds. That’s what I’ve loved about my 8+ years of wearing Oticon hearing aids. In my opinion, they do a great job at this. Everything is made available for me to hear, and it feels natural. It feels real.

I thought I was happy with my Alta’s, but then I tried the Opn’s. At first, the difference wasn’t major. Over time though, the subtle differences became obvious. I could still hear the entirety of the soundscape around me, but everything felt a little more accessible (or “Opn” if you run the marketing campaign for these hearing aids). Someone on the phone in the next room wasn’t just noise to me, it was speech, with tones and intonations and a rhythm that I couldn’t hear from that far a distance with the Alta’s. Sharp, percussive sounds like clapping or footsteps felt more natural, and didn’t blend into the background noise of a room. Instead, everything stood out like the individual sounds that they were. My biggest realization about how much I liked these hearing aids came when I played music. I often take my hearing aids out to listen to songs, because there is a certain crispness and weight to music that gets lost when its processed by hearing aids. With the Opn’s, I found that these sensations of music made it through, and were actually improved. It felt like all the music I’d heard through previous hearing aids came from tiny laptop speakers, and the music from the Opn’s was like an expensive surround-sound system.

If you’ve heard about the Opn’s, you might just know them as Oticon’s direct-to-iPhone hearing aids. I was able to use this feature a little bit with a friend’s iPhone (I have an Android)  and found that the app was great and easy to use. I wish I had the opportunity to try out some of the IFTTT features as well, but unfortunately didn’t. In all honesty though, these features really wouldn’t even register for me as reasons to get these hearing aids – the difference in listening ability is more than enough. At the beginning of this post I said that in some ways I regret having tried the Opn’s. Now I know how much better they are than my current hearing aids – which I previously thought were the best out there!

If I had a need for a new pair of hearing aids, I’d get the Opn’s in a heartbeat. Unfortunately (or maybe fortunately, as a student money is always a concern), my current Alta’s are only about 2.5 years old. Trying out the Opns was more for the sake of my own curiosity than anything else. I don’t quite have the overwhelming need to upgrade right now.

(Finally, I do feel like I need to disclose that I was not motivated, financially or otherwise, by Oticon to write this post. I know how every manufacturer uses a wealth of persuasive buzzwords to make their products sound like they’re all completely revolutionary, and it can be hard for someone looking to choose a hearing aid to make sense of it all. I happened to have a very positive experience with these hearing aids, and just wanted to share that experience with others and try to explain what I found enjoyable about them. As well, its important to note that a lot of what I’ve talked about is rather subjective. Someone else could try these same hearing aids, fit the same way, and have a completely different experience.)

 

Audiodiversity

People like simplicity. Because of that, we often try to think of things as absolutes. When you think of the word “deaf” what do you think of? Many people would say that to be “deaf” means having no ability to hear at all. I know I certainly believed this at a younger age. Is it right to think of a person’s hearing abilities in terms of binary absolutes?

If we look at how other binary concepts have changed over time, there is a good argument to be made for adopting a spectral conceptualization. A favourite comparison of mine is that of the autism spectrum. People with autism are nowadays often just referred to as “on the spectrum” with a greater appreciation for the unique abilities of each individual. There’s no dividing line between “able” and “disabled” or “normal” and “abnormal.”  Instead its understood that no people’s brains are wired the same way – everyone exists on a broader, overarching spectrum. There’s even a word for this – neurodiversity.

Is it possible that audiodiversity could one day be used to refer to the unique hearing capabilities of each individual?

Currently so-called “normal” hearing thresholds have a range of 25 dB. So even in the clinically “normal” population there is still a huge range of hearing ability. Even within this population, there can be two people with the same hearing thresholds, but widely varying abilities to hear in more complex situations, such as in noise, or while simultaneously performing other tasks. As well, many people experience temporary shifts in hearing ability in their lives. Whether its due to transient ear infections, exposure to loud noises, or changes in cognitive function (the ability to apply meaning to sounds we hear). Finally, its just accepted that hearing ability will universally decline with age. Is it right to think that the elderly just one day cross over from “abled” to “disabled?” Or is it better to think of age-related hearing loss as a slow movement along a wide, but normal, hearing spectrum.

To say we currently think of hearing as a truly binary concept isn’t quite fair. We do have a third, middling category of “hard-of-hearing,” “hearing impaired,” “partly deaf” or whichever adjectives you choose to use. However fitting the entire audiodiversity of the world into these three categories still isn’t accurate. We need to appreciate that every individual has unique level of ability to hear, as well as to listen (for their brain to make sense of what they are hearing). We also need to understand that in a single moment, each person’s abilities cover a wide area of the spectrum, and their abilities in that instance depend on the context and surroundings they find themselves in. Finally, we need to realize that hearing is dynamic, and will change throughout the lifespan.

What do you think? Is audiodiversity the direction we need to move towards when it comes to thinking about hearing abilities?

(This post was originally intended to just be a revision of this previous post: https://hearington.wordpress.com/2015/09/25/a-hearing-spectrum/ but I found myself wanting to go in a bit of a different direction here)

Thoughts and Lego

As I mentioned last time, I’ve been reading Design Meets Disability by Graham Pullin and am loving his insights. In this book, Pullin looks at the changing approach to design across many different disabilities. I’ll share some of my favourite pieces below:

 

“I wanted the amputees themselves to be proud to have a prosthetic hand and pleased to look at it. And for the people around them, I wanted the prosthetic hand to be an object of healthy curiosity, a work of art.”

This quote is referring to a designer’s shiny, gold prosthetic hand designed for an amputee, but I think the same perspective can be applied to hearing aids. They don’t have to be beige and boring, they should be beautiful and eye-catching. I’ve always believed something similar. People will eventually notice your hearing aids if you spend enough time with them, so you may as well have something that you are proud to show off.

 

“…although invisible to all but intimate acquaintances. But the wearer knows they are there, and they make the clothes feel different and the wearer feel special. Whether the person decides to display or conceal her disability – and the designs of devices and prostheses should be enabling a choice of such expression – perhaps there should be a separate issue of feeling comfortable in private.”

I love this bit where Pullin compares the hidden aesthetics of a suit-jacket lining to a hearing aid. Even if its hidden most or all of the time, it should still be beautiful. These devices become a part of us in a way, and we should be proud and and find beauty in these parts of us.

 

The interviewer asked whether design implies “the idea of products that are necessarily useful,” rather than, “solely for pleasure.” Eames’ reply challenged this distinction: “Who would say that pleasure is not useful?”

What uses could aesthetic pleasure serve in hearing aids? If they looked better or more interesting, maybe more people would wear them. The people who wear them might be more proud of them, and willing to share their experiences with others. Maybe young kids would feel less stigmatized and wear them more often, or with less feelings of social inclusion.

 

This book left me feeling pretty inspired. So inspired in fact, that I took something I really like, and had plenty of, and made a mock-up of what a Lego hearing aid could look like. Its messy, imperfect, and my photography skills leave a lot to be desired. But I actually really like how it turned out. Its bright and loud and something that a younger me would have loved to wear.

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How Many Pairs of Shoes Do You Have?

I’m a fairly conservatively-dressed young male and I have several. The each serve different needs in my life, based on the activity I am doing or the place I am going. I don’t wear my running shoes to weddings, and I don’t wear my leather chukkas to the beach. However I, and everyone else who uses them, only have a single pair of hearing aids. Does that make sense?

(Ok, maybe I’m not the most conservative about fashion. I just used “chukkas” in a sentence”)

Charles Eames was a notable designer of the early 20th century who believed that “design depends largely on constraints.” (I learned this from the book Design Meets Disability by Graham Pullin. You can expect a few more posts inspired by this great read.) For shoes, this makes sense. The design of dress shoes is constrained by the need to be fashionable and match the rest of the outfit. Running shoes are much more brightly coloured, because they don’t have that constraint. Instead, they are constrained by the need to be supportive, grippy, and breathable. When it comes to hearing aids however, all of these constraints fall on a singular set of devices. Hearing aids need to be fashionable, water-resistant, perform well in noise, etc, etc, etc. This is because almost no one owns multiple sets of hearing aids.

To a large extent, this is due to cost. High quality devices aren’t cheap, forcing people to sacrifice certain wants to meet their needs. As I discussed in my last post, I gave up bright, flashy BTE hearing aids to have a pair that would be better suited for the needs of sweat-protection and phone use. Now its no secret that the cost to build hearing aids is nowhere near the cost for a consumer to purchase them. Much of the cost is due to things like research and development, and the time spent adjusting the hearing aids to the user’s needs. The actual cost of the hardware, the bits of metal and plastic that make up hearing aids, is practically nothing. If a hearing aid manufacturer offered the option of owning multiple devices for different needs at a comparable cost to a single pair of hearing aids, wouldn’t a high volume of customers switch over to that manufacturer?

(Unrelated, but if you are reading this and are in any way responsible for the hiring at Sonova, Sivantos, Oticon, Resound, Widex, Starkey, or any other hearing aid manufacturer you’ll be happy to know I don’t currently have a summer job lined up. Send me an email, we can talk.)

Imagine visiting your hearing care professional not to obtain a new set of hearing aids, but a new tool-box of hearing aids. In such a package, you might be able to pick out a fun, colourful pair of RITEs for everyday use, a more robust pair of BTEs for playing sports and exercising, and a muted, discrete pair of CICs for formal events. All of these devices would run on the same technology, so adjusting them to a user’s hearing would take far less time that fitting three sets from three different manufacturers. People wouldn’t have to give up things they want in their hearing aids for the sake of meeting their needs.

What do you think? Is this something you’d be interested in? Let me know!

 

 

 

Why I Wear CICs

 

Above are my current hearing aids, Oticon Alta CICs

 

Hearing aids come in many different sizes and styles. The largest and most visible are called behind-the-ear hearing aids (BTEs). These can come in the so-called “traditional” form, where a plastic tube carries sound from the hearing aid to a mold that sits in the ear canal, or more modern receiver-in-the-ear styles (RITEs), where a thin wire carries a signal from the body of the hearing aid to a tiny speaker that sits right in the ear canal. RITEs are generally smaller than traditional BTEs, but traditional BTEs are favoured in cases where the hearing impairment is more severe and more amplification is required. As well, traditional BTEs are favoured for children due to their robustness in face of occasional mistreatment. Together, these different types of BTE hearing aids make up about 65% of all hearing aids distributed.

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The remaining styles of hearing aids are collectively called “custom” hearing aids. Unlike BTEs, these custom hearing aids are uniquely constructed to fit a person’s specific ear shape based on an impression created by a hearing professional and sent to the manufacturer. The largest are called in-the-ear hearing aids (ITEs) and the smallest are called completely-in-the-canal hearing aids (CICs.) (Boy is this industry creative with their naming schemes!).

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When I was younger, I wore traditional BTEs as all children did, and largely still do. However, when I required a new pair 2 years ago at the age of 20, I made the choice to switch to CICs. I like to think that I am not ashamed or embarrassed of my use of hearing aids, and I can honestly say that that wasn’t the main reason for my switch. So what were my reasons for this switch?

  1. The biggest reason was sweat. With BTEs, sweat would run down the side of my head and cover the bodies of my hearing aids. The microphones would get wet, things would sound distorted, and often the hearing aids would shut down completely and require hours of drying before returning to normal functioning. I’ve found that my CICs sit far enough in my ear canal that they avoid most of this moisture. When I told my audiologists that I was considering switching to CICs, I was warned that they wouldn’t be as resistant to everyday use and would likely require more frequent repairs. So far though, I’ve found the complete opposite (though I do clean them and replace waxguards religiously).
  1. My second reason for switching to CICs was to make speaking on the phone easier. With BTEs, it takes a lot of work to hold the phone at just the right angle to hear. Oftentimes I would actually have to move the phone from my ear to my mouth, just like a walkie-talkie, to both listen and be heard. With custom hearing aids, you can just hold up the phone to your head as anyone else would. (Admittedly, the accessories to link hearing aids to phones are better than they’ve ever been, largely relieving this issue. I still do enjoy not relying on these intermediary devices though.)
  1. My final reason for switching away from BTEs was the ability to not worry about ear molds anymore. When you get a brand new pair of earmolds, they can be nearly invisible or as brightly coloured as you want them to be. However, they always fade, turn yellow, and change shape over time. They’re not terribly expensive to replace, but making multiple appointments to do so is rather inconvenient. With custom hearing aids, this problem is removed.

In the past, the number of people that could use custom hearing aids were very limited. If you had a more severe hearing loss or enjoyed the accessories that could be used by BTEs, they weren’t really a feasible option. However, thanks to advances in technology more people than ever can use custom hearing aids.

Overall, I’m very happy with this switch. Sometimes though, I actually feel really guilty. I try be an advocate for those who wear hearing aids and speak openly about my experiences, but often it feels like I’m hiding my hearing impairment by wearing CICs. I remember one experience speaking to a mom and young boy who was just fitted with hearing aids. I showed them what I wore and she said to her son, “Look at how small they are, one day you’ll be able to wear hearing aids that small.” That incident left me feeling really conflicted. That child shouldn’t be made to feel like smaller, less visible hearing aids are better.

Though I enjoy my CICs a lot for the reasons discussed, I would really like to one day get a second pair of BTE hearing aids specifically to wear while working as a hearing professional. I remember being a kid and feeling alone because I almost never saw anyone else under 70 wearing hearing aids. I would hope that if I publicly wore bigger, brigher hearing aids, it might help others feel more comfortable with their own hearing aids.