
Why Are Hearing Aids So Expensive? - ezhil
https://www.nytimes.com/2017/10/20/well/live/why-are-hearing-aids-so-expensive.html
======
paulgerhardt
>Experts don’t know exactly why hearing aids are still so costly

No, they do.

The short answer is: you need to develop your own custom IC's that 1) have
analog circuitry 2) support Telecoil[1] - an ancient induction standard from
the 1970's 3) are made by 1 of 4 companies in Copenhagen or Switzerland - one
of which has 55% market share and 4) run on fumes. Seriously, the crest factor
on these is ridiculous.

The long answer is available in this great podcast episode:
[https://theamphour.com/338-an-interview-with-jorgen-
jakobsen...](https://theamphour.com/338-an-interview-with-jorgen-jakobsen/)

Of course, Bluetooth alternatives to hearing aids are being developed. People
in the industry know this and joke about it. But, crucially, they can't be
called "hearing aids". It's a protected term. An interesting example are
Bose's new $500 "Hearphones" strongly targeted at an older demographic[2] with
features like Bluetooth and tunable noise cancellation based off their earlier
$300 QC30 dynamic noise cancelling platform. But also not the exact same use
case. More power intensive. More capable. But less endurance.

[1]
[https://en.wikipedia.org/wiki/Hearing_aid#Telecoil](https://en.wikipedia.org/wiki/Hearing_aid#Telecoil)
[2]
[https://www.bose.com/en_us/products/headphones/conversation_...](https://www.bose.com/en_us/products/headphones/conversation_enhancing_headphones/hearphones.html)

~~~
wrycoder
One can buy complex hearing instrument silicon now for $60 per ear quantity
one. Dual mic, echo cancellation, equalization, noise cancellation, bluetooth,
telecoil, etc. There is no excuse.

~~~
AstralStorm
That runs a few days and does not sound terrible?

See, one balanced armature transducer will cost you about this much.
Electronics is not the problem, power requirements and miniature size are. In
a hearing aid, the main power cost is the transducers (including MEMS
microphones) and amplifiers.

BA transducers are so expensive because only 3 companies make them. (Knowles,
Sonion and one other I do not remember off the top of head.) Only a few more
make MEMS microphones.

This is also on the verge or actually nanotechnology which is why Chinese
manufacturers couldn't get in.

Trying to use a dynamic driver or microphone instead will cost you about half
of battery life and will be larger.

~~~
makapuf
I dont known anything, but a Knowles MEMS microphone on digikey is $1 qty 1
[0]. A few 100 uA consumption.

I'm pretty sure there is space for disruption here.

[0] : [https://www.digikey.com/product-
detail/en/knowles/SPW2430HR5...](https://www.digikey.com/product-
detail/en/knowles/SPW2430HR5H-B/423-1394-1-ND/5052772)

~~~
AstralStorm
Yes, MEMS microphones of ok quality are a few dollars but you need a few or an
array (worse quality ones are cheaper), balanced armature of good quality are
not cheap. This one has really bad SNR (-42 dB)

The space requires micromechanical research and manufacturing expertise. Good
luck "disrupting" it.

------
antognini
A few weeks ago I talked with a guy whose startup was developing a better
hearing aid. As a few other commentators have mentioned, a hearing aid does
not just amplify volume --- that is useless for people with hearing loss. The
problem with hearing loss is generally not so much that you can't hear
anything at all. It's that it becomes extremely difficult to distinguish
speech from background noise.

The ideal hearing aid will amplify those frequencies at which speech is
present, while suppressing frequencies that contain background noise. But
currently hearing aids use a pretty dumb set of heuristics to figure out which
is which. For instance they'll try to estimate how far the source of the noise
is and will suppress it if it's more than, say 15 feet away. But if your SO is
calling you from the kitchen that means that you're not going to hear them.
Similarly they'll amplify frequencies associated with sibilants (s sounds, for
example) because those are really important for speech, but that means that
wind sounds or rustling paper also gets amplified.

There's a huge opportunity here to apply deep learning to determine which
frequencies to amplify and which to suppress. It's a challenging hardware
problem, but the deep learning part of it has largely been solved. (Or at
least, the current state of the art using deep learning is way, way better
than what commercial hearing aids currently do.)

~~~
LX8DvZFL
> The problem with hearing loss is generally not so much that you can't hear
> anything at all. It's that it becomes extremely difficult to distinguish
> speech from background noise.

The problem with hearing loss is that _you can 't hear_. In most cases,
there's a loss of high-frequency hearing, you can't hear sibilants and thus
can't parse the speech.

Speech-in-noise is a specific situation that HAs do not handle well. It's less
of an issue with un-aided hearing thanks to the shape of our ears.

> The ideal hearing aid will amplify those frequencies at which speech is
> present, while suppressing frequencies that contain background noise

Every modern hearing aid does this already.

> a pretty dumb set of heuristics to figure out which is which

Dumb? Billions of dollars are waiting for the person who can make noise
reduction work really really well. It's surprisingly difficult, even with
unlimited computation power.

> they'll try to estimate how far the source of the noise is

This is 100% fiction. No HA on the planet calculates distance-to-noise.

You can spot the HAs that do because they require three microphones _not in a
straight line_. Probably a triangle.

You might be thinking of beamforming, where the HA calculates the direction of
the sound and can optionally focus amplification on sounds coming from that
direction. Typically, sounds behind the listener are amplified less than
sounds coming from in front of the listener. This is a useful refinement done
by every modern HA.

> wind sounds or rustling paper also gets amplified

That is unfortunate. There is significant research going into recognising
speech patterns so that the HA can make these decisions better. Unfortunately,
none have shown useful results yet.

> huge opportunity here to apply deep learning

To do what, exactly? Why DL? How do you propose to run DL on a 1MHz CPU with
16kb of RAM and a battery the size of a bee's genitals?

> It's a challenging hardware problem

The hardware has been known and fixed for 20 years. What would you change?
Software is where all of the improvements have come from for a very long time.

> deep learning part of it has largely been solved

Cite me a paper and we can make billions.

~~~
antognini
It sounds like you know a lot about this field! I'll confess that I'm a
neophyte. I'm working on audio research right now, but all I know about
hearing aids is my one conversation with the whisper.ai CEO.

> Cite me a paper and we can make billions.

The relevant paper is Hershey et al., 2015 [1]. There are some audio examples
here as well [2]. The idea is that a deep NN can apply a spectral mask and
isolate a single speaker when many speakers are talking (or there's background
noise). Of course a standard hearing aid has pretty limited hardware, which is
why the hard part for them is developing a small enough device that can do the
inference in real time. (They cheat a little bit and actually do all the
processing on a larger device that you keep in your pocket --- it's not done
locally behind the ear.)

[1]: [https://arxiv.org/abs/1508.04306](https://arxiv.org/abs/1508.04306)

[2]: [http://www.merl.com/demos/deep-
clustering](http://www.merl.com/demos/deep-clustering)

------
gws
Working inside the industry I can tell you that there are a lot of
misconceptions when you look at things from the outside. Hearing aids are not
so expensive because of the hardware but because of two other things: 1.
customer acquisition cost and 2. service cost.

1\. People do not want hearing aids (typically they do not even want to accept
they have a hearing loss). You need to spend an awful lot in communication and
marketing and humans you can talk to in a store to convince them to try one.

2\. Hearing aids are not glasses that you put on and the problem is solved. It
takes 6-12 months to get the full benefits and you need multiple visits to the
store with humans to hand-hold you through the process or you will just stop
wearing them.

And did I mention the average customer is 70 year old? Explain to me how a 70
year old that does not want a hearing aid will buy one online

~~~
kelvin0
Well from my point of view this is completely opposite to what I've witnessed
firsthand. People DO know they have hearing loss and WANT to fix it. It
becomes very awkward for them in social settings and they are not able to
follow the simplest group conversation.

Case in point: my dad and grandma. They both got the 'free' hearing aids (we
live in Canada) and these supposedly really cost the government (or taxpayers)
upwards of $2000 for each ear, and they SUCK. The alternative was to dish out
$5000 per ear for a marginally better product. They both ended up not using
them because it was such a hassle and it basically drove them nuts. They
didn't fit very well and constantly amplified even the slightest noise, and
basically did nothing in ways of helping their hearing at a normal
conversation.

Recently though, they finally got a great hearing aid (forgot the name) and
paid less than $500 (from their wallet) and it vastly outperforms any other
hearing aid they've ever tried. I know they work because because they actually
WEAR them now because they are NOT ALWAYS BUZZING and amplifying ambient noise
and they are ADJUSTED PERFECTLY to hold onto their ears. That's disruption for
ya ....

~~~
Flip-per
Could you please look up and post the name of these?

~~~
kelvin0
The model they use is the AIR from mdhearingaid.com.

I am in no way affiliated to these folks. But I would like to thank them for a
great product (on behalf of my family)!

------
randyrand
Botched medical regulations gone haywire.

The same reason health care is expensive in general.

When side step the regulations and buy outisde the health care industry - say,
amazon.com - hearing aids magically become $38.

[https://www.amazon.com/Sentire-Med-Enhancement-Amplifier-
amp...](https://www.amazon.com/Sentire-Med-Enhancement-Amplifier-
amplification/dp/B072M7T6FX/ref=sr_1_4_a_it?ie=UTF8&qid=1508803182&sr=8-4&keywords=hearing+aid)

Health care is more than ripe for deregulation and monopoly/union busting -
but the American medical association lobby is one of the strongest in the
world.

~~~
Frondo
I am reluctant to accept an anti-regulation message from someone whose name
seems a likely riff on Ayn Rand, but setting that aside...

I'm also reluctant to look at deregulating hearing aids without looking at
some of what the regulations do...

Like, something that came up on HN a few years ago was another thread about
hearing aids, and one thing I remember from that was that cheap hearing aids
can actually do further damage to a person's ears, because of how they do or
don't amplify the sounds appropriately.

Maybe the regulations, in this case, are there to prevent people from paying
$38 for a hearing aid that wrecks their sense of hearing further. If that is
the case--and I don't know that it is, but I think health equipment merits a
degree of caution--then I think that's a good place for regulations.

Very few people would be able to properly evaluate whether a given cheap
hearing aid would be one that worked without harm or would be one that caused
further hearing loss. Very few. That's exactly the place in society for
regulations--when few people are capable of making an informed decision, etc.

It's certainly _easy_ to blame regulations for this and everything wrong with
American health care, but I don't know if it's sensible here or in general--or
if blaming regulations (and consequently removing them) would actually lead to
the outcomes people claim they would. My gut tells me that the problems we
have lie elsewhere in the medical system, not in the regulations concerning
medical devices or medicines.

~~~
abecedarius
I wear hearing aids selected by an audiologist, have probably had some extra
damage to my hearing from them, and wish I could buy open hearing aids I could
program myself. I don't blame the system for the damage, but do for the
restricted choice.

Generally consumer protection by regulation seems to suffer from a form of
regulatory capture -- measures that are great at entrenching the existing
players get disproportionate emphasis. You end up e.g. restricting the supply
of doctors and then not bothering to make them wash their hands. I'm not
saying regulation can't ever do net good, but you have to watch it like a
hawk, and who has the incentive to?

~~~
forapurpose
> Generally consumer protection by regulation seems to suffer from a form of
> regulatory capture ...

I've heard these theories a lot, but I almost never see much evidence; is
there any evidence it applies in this situation?

> doctors

I think it's very important to regulate doctors and medical care. I don't want
any quack hanging out a shingle and treating people. The same goes for medical
devices.

------
lvspiff
As a spouse of someone with a cochlear implant I've asked this question
repeatedly. The cost of everything around that hearing device is insane - want
a cord so you can listen to audio? That's $500. Want a device to make it
easier to hear TV? That's another $750. Operate over bluetooth? Nope we can't
do that. Need a new battery? That's a grand. Its insane what they get away
with

~~~
sdrothrock
Don't forget that cochlear implants are basically a locked-in monopoly. If
you've got an implant from company A, then you're stuck with company A's
processors and accessories unless you plan on having another surgery to take
out the implant and put in a different one -- which most surgeons would not
recommend for any reason short of actual damage.

I picked Advanced Bionics and regularly pay around $2000 a year in batteries,
parts (cables, various pieces) etc. alone -- none of which is covered by my
insurance here in Japan. Currently I'm waiting on a replacement processor
(which is two or three generations old) that I'll pay around $600 out of
pocket for. It doesn't seem like much, but due to rain and humidity I end up
opening it myself and cleaning it several times a year because I can't afford
to get it repaired/replaced.

If I want to upgrade to the newest processor, which is lighter, has better
audio quality, and is MUCH more water resistant (a major problem with my
current model), it will cost me around $7000 -- and that's a DEAL because the
processor JUST got approved in Japan.

After March 2018, the price will go up to $14,000 for a processor. Of course,
it's not covered by insurance, so I have to pay for it all out of pocket.

I asked the doctor I was seeing what Japanese cochlear implantees do; I've
seen so few successful/independent ones and couldn't imagine any of them
paying for any of this. He said they usually hobble along with replacement
parts/charity and never upgrade the processor because they can't afford it. He
also mentioned that many of them have such a low level of recovered hearing
and speech that newer processors, frankly, would not give a measurable QOL
benefit, which is another rant entirely...

I'm glad I'm not bilaterally implanted -- there's no way I could afford TWICE
the costs.

~~~
veb
That's the great thing about being in New Zealand, I get upgraded for free
every 7 years. A pack of 50 batteries will cost me $30. But mine has
rechargeable batteries too if I need.

Surprised Japan doesn't do the same. However, maybe it's an Advanced Bionics
thing - we can't get them on the public system here. I chose Med-el (the other
option is Cochlear).

~~~
sdrothrock
I'm on AB and my friend is on Cochlear; he's always amazed at the terrible
service I get and the prices I pay.

> I get upgraded for free every 7 years.

I trade mine in for replacement (on my dime) because it's completely broken
every 4-5 years.

> A pack of 50 batteries will cost me $30

A single battery runs me around $200-300. My charger breaks all the time too,
so that's another $100-200 depending on what's broken... how are you getting a
pack of 50 for $30? What do you even do with 50 batteries?

I have four that I cycle through (the big powercels) but that's because I
apparently have thick skin/a thick skull and I only get 10 hours of use out of
a battery rated for 20+.

Edit: Oh -- misread! I thought you said you were on AB, but you've got a
MedEl. I don't think I've ever actually seen those... they weren't even an
option at Hopkins when I was going through the pre-screening. The two options
I got were AB and Cochlear.

~~~
veb
That's odd, if it's completely broken before 7 years, then it's replaced under
warranty for me. Still free.

By batteries, I'm talking disposable batteries, not the rechargeable ones. So
50 will last me a while. I like the disposables best.

This is mine:
[http://www.medel.com/int/sonnet](http://www.medel.com/int/sonnet)

------
hprotagonist
This is my field, more or less, though I'm on the basic research side.

Traditional hearing aid companies have no idea how large a freight train is
barreling down on them in the form of Apple and Google. It's going to be a fun
ride.

~~~
peterburkimsher
I'm disappointed in the lack of innovation in the tech industry. Many people
talk about many different topics, and come back to the refrain "Wait for Apple
and Google to do it".

Why not make a startup?

Waiting for large companies to innovate is like saying "I won't build the
Apple II because I'd rather wait for the IBM PC to be invented".

The fact that these market leaders (IBM and DEC then, Apple and Google now)
have so much power to uproot industries means that people are afraid to pursue
their ideas. I don't have a full solution, but investors like Y Combinator are
certainly helping.

~~~
hprotagonist
>Why not make a startup?

as other commenters on this thread have noted (correctly), medtech doesn't
work that way. You need a long runway, and the regulatory scene does not favor
"move fast and deafen people".

~~~
AstralStorm
Deafening is easy to avoid. The main concern is about effectiveness and this
is tested in medical trials. Second concern is with infections caused due to
design.

------
vec
My wife is an audiologist, so I admit to being a bit biased, but it seems like
most of the comments are missing one of the main drivers of hearing aid cost.

Traditionally, audiology offices undercharge dramatically for their initial
consultation and testing, then provide full service for the lifetime of the
device. And not just normal electronics service. Often patients will come back
every week or two for months to get the fit just right or to get some coaching
relearning how to hear conversations or just having the nice lady in the white
coat show them how to replace a battery for the fifth time. A lot of clinics
will even throw in "free" batteries for life. The cost of all that service
ends up getting rolled into the initial purchase price for the hearing aids.

This is dumb. Most audiologists that I know think it's dumb, but it is the
status quo. There's a move in the industry toward "unbundled" billing (i.e.
charging an hourly rate for services and selling the aids at a much more
standard retail markup) that I hope catches on, but it's a hard sell to charge
for services that the clinic down the road is providing for "free", even if
the total cost of ownership is the same.

~~~
wccrawford
I was going to bring up the cost of glasses as something similar, but I think
your answer explains a lot of that, too.

I recently went and got my eyes checked, and the doctor assured me that they
had low-cost glasses. Their progressive bifocals _lenses only_ started at
$300. I pretended to still be interested, then gave an excuse and left.

I purchased some online and got them for less than $100, shipping included. I
threw in a regular pair of distance glasses for less than $40, too.

Why is it so much cheaper? Because they can charge it. I'm sure some of the
cost is in maintaining staff to help adjust the glasses, and sell them in the
first place. But I got my main glasses for less than 1/3 of the prices that
they wanted for just the lenses.

Their frames were $100+ that I saw. I'm sure they had some around $50, but
that's still more than my entire pair of distance glasses cost.

------
adzm
I cannot wait. There is such an opportunity for innovation as well. Hearing is
such a psychological thing as well as physical. I had to really research on my
own and bother an audiologist directly in order to tweak mine properly.

I wanted to take advantage of my hearing loss to also allow myself augmented,
improved hearing for specific scenarios as well. I would love a platform that
allows me to do so!

Regardless of the poor quality of the article, the relevant legislation is
Over-the-Counter Hearing Aid Act of 2017

[https://www.congress.gov/bill/115th-congress/senate-
bill/670...](https://www.congress.gov/bill/115th-congress/senate-
bill/670?q=%7b%22search%22%3A%5B%22Over+the+Counter+Hearing+Aid+Act+of+2017%22%5D%7d&r=2)

~~~
wrycoder
Are you sure this legislation isn't a covert increase in regulation of hearing
assit devices by the hearing instrument cartel?

~~~
wbrenner
There have been talks about this sort of regulatory change has been a long
time coming and has been trending this way for a least a couple years (see
link below). This is just the first time the hearing instrument cartel hasn't
been able to beat it back. Based on my educated guess it is no coincidence
that the bill was introduced by a Senator whose state shares a headquarters
with Bose.

[https://obamawhitehouse.archives.gov/blog/2015/10/26/%E2%80%...](https://obamawhitehouse.archives.gov/blog/2015/10/26/%E2%80%8Bpcast-
recommends-changes-promote-innovation-hearing-technologies)

------
veb
Has everyone noticed that Apple might be moving into this market in some form?

\- [https://www.engadget.com/2017/07/26/apple-cochlear-made-
for-...](https://www.engadget.com/2017/07/26/apple-cochlear-made-for-iphone-
implant/)

\- [http://www.hearingreview.com/2017/08/president-trump-
signs-o...](http://www.hearingreview.com/2017/08/president-trump-signs-otc-
hearing-aid-legislation-law/)

\- [https://www.nytimes.com/2017/06/12/health/hearing-aids-
congr...](https://www.nytimes.com/2017/06/12/health/hearing-aids-
congress.html)

\- [https://www.technologyreview.com/s/608597/how-your-apple-
wir...](https://www.technologyreview.com/s/608597/how-your-apple-wireless-
earbuds-could-double-hearing-aids/)

I've been following it, and it all looks rather interesting. I wonder what
changes we'll see soon.

My nephew (3) was just given the Nucleus 7 cochlear implant and my sister says
it's great. She can tell all sorts of things - how much he's heard, where it
is, and all that jazz - including wireless streaming to the device from an
iPhone.

------
cddotdotslash
Some of the comments on here demonstrate that few readers actually know what a
hearing aid does. In a majority of hearing loss cases, you can't simply
amplify the sound and call it a day. If you want to do that, go buy a $20
amplifying device online. Hearing loss is usually characterized by an
inability to hear different frequencies at differing levels. When you get a
hearing aid, the audiologist has to tune it to your particular graph. Most
modern hearing aids also come with speech detection, background noise
reduction, etc., also tuned to the wearer's loss. Mine have bluetooth
capabilities built in as well and can be synced to my phone, laptop, etc.

Not everything is something you can throw some Arduino parts and Python code
at, contrary to what half of HN seems to think some times. This isn't to say
that prices are not ridiculously high, but at the end of the day, they are a
medical device that require a trained professional to tune.

Source: worn hearing aids since I was 3 years old.

~~~
analog31
My relative has had hearing aids for many years. Her loss is profound, and her
hearing aids are apparently quite sophisticated. The "tuning" consists of the
audiologist fiddling with a GUI while my relative says if it sounds better or
worse.

Maybe it's not a racket, but they're trying awfully damn hard to make it seem
like one.

~~~
planteen
That isn't how it works at all. It is far more than an audiologist "fiddling
with a GUI". The audiologist first does a hearing test, which is gives an
audiogram which is a gain versus frequency plot that takes into account equal
loudness curves. This is how they know to recommend hearing aids in the first
place. This is the initial basis for tuning. Final tuning lets them adjust for
things like ear canal size.

If patents tuned it themselves, they would have too little gain at high
frequencies since they may not have heard these frequencies in years and think
they sound unnatural. It takes a while to become "used" to hearing aids
because patients haven't heard the usual sounds of life like paper rustling in
years.

~~~
solatic
That's why the real question is whether audiologists can be automated away. Is
it really so hard to imagine an at-home, self-administered hearing test? Put
on a harness, hook it up to your smartphone, answer questions whether the
tones are too loud or too quiet by tapping on the screen. Answer speech-
comprehension questions by tapping out the word you hear. The app can then
program, based on the test results, your hearing aids, sold to you by the same
manufacturer of the app and the harness.

People who think that hearing aids can be replaced by a $200 in-ear amplifier
don't understand the domain they're talking about, but there's still much that
could be disrupted within this space.

~~~
planteen
That's an interesting idea. You are missing the part where an audiologist
inspects your ear to see if there is a ton of earwax, infection, or other
foreign body. There is also more test equipment than that often goes with a
hearing test. I know some audiogram and reflex results can be indicative of
things like a brain tumor which will result in an immediate referral to a ENT.

And there's the whole counseling aspect of telling someone they (or their
child) has a hearing loss.

~~~
solatic
Checking if an ear is affected by earwax / infection / foreign body can be
carried out by a nurse, who doesn't need nearly as much education. This is
besides the fact that audiologists don't typically deal with earwax /
infections / foreign bodies anyway, and typically refer to an ENT anyway. Even
after regulation which only permits the sale of the physical equipment which
would pair with your smartphone after a prescription from an ENT who sees no
sign of other problems, it would still drastically reduce costs for the end
consumer, who would never need to set foot in an audiology office.

And pediatric hearing loss is a fraction of all hearing loss patients... don't
make the perfect the enemy of the good ;)

~~~
planteen
So it sounds like you are proposing a way of doing audiograms at home. I don't
think this is the most significant cost of hearing aids. What is the average
cost of an audiogram, maybe $100? You can already buy hearing aids online if
you submit an audiogram. If you still need to visit an ENT office anyway, many
larger ENT clinics (especially at hospitals) have audiologists in the clinic
already.

------
Animats
IHear Medical was a IndieGoGo project intended to bring the price of hearing
aids down to $200. That was back in 2014. Several years later, they're up to
$1000 for a "complete package".[1]

[1]
[http://www.ihearmedical.com/vippackages/](http://www.ihearmedical.com/vippackages/)

~~~
vbernat
That's interesting: for the iHearHD, you go from 1000$ to 1500$ if you want a
2-year warranty. I always got at least a 4-year warranty for my regular
hearing aids. Even assuming a linear cost, a iHearHD with a 4-year warranty
would be around the same price as regular hearing aids.

~~~
Animats
_You go from 1000$ to 1500$ if you want a 2-year warranty._

That's incredibly high. Even Best Buy's overpriced warranties aren't that
expensive.

~~~
vbernat
This also includes 1 additional year of batteries (something worth 50-100$).
But this may also be a signal they are not confident they are reliable enough?

------
scorown
Lots of armchair experts here. Ultimately, a hearing aid is much more than
just a sound amplifier. Imagine wearing a cheap sound amplification device
that gradually increases hearing loss and causing tinnitus.

------
Jemaclus
I just wish hearing aids were covered by insurance. Mine aren't, which means
if mine breaks, I'm paying $3500 out of pocket... for one. And I'm one of the
"lucky" ones in that I can only hear out of one ear (and thus only need one
hearing aid). For someone who needs two, that's $7000.

Insane.

~~~
mgerdts
I also only need one hearing aid. Luckily I was able to get it from Costco
($800, free exam) and insurance picked up 80%. This year insurance changed
such that the hearing aids are mail order and are more expensive than my co-
pay at Costco.

The one hearing aid scenario is problematic for any sort of headset. If I use
earbuds, I can only hear well in one of them. If I were to spend the extra
money to get the bluetooth accessory, that would only go to the ear with the
hearing aid.

I'd love to be able to input my audiogram into my phone and have it adjust the
headset amplification at various frequencies in each ear accordingly.

Even better would be for noise cancelling headphones to be able to also use an
audiogram to have the headphones act as hearing aids when not in noise
cancelling mode.

~~~
Jemaclus
My hearing loss is severe, so I can't just get Costco hearing aids... and
insurance never covers it. They cover the audiologist exam, but not the
hearing aid itself. It sucks so bad. And yes, if I want Bluetooth accessories,
it's even more expensive. My current hearing aid is "Made for iPhone" or
whatever, so it can stream directly from my iPhone, which is awesome.
Unfortunately, my brand new Apple Watch isn't, so I still have to carry my
phone with me on runs or whatever, while my wife can just wear her watch and
Bluetooth headphones...

First world problems, I guess?

------
simonblack
Few hearing-aid companies. Highly specialised product. They can charge pretty
much what they want. And they do. The retail price has a very sizable level of
over-charging built in, and many times the client is talked into a product
which is much more costly than the one which is necessary.

(The place I worked at many decades ago used to be an agent for one of the
major hearing-aid companies.)

------
peterburkimsher
I've been to so many concerts (450+ shows from 300+ bands) and I listen to
music all day at my desk. My Gran has hearing aids, and her mum was totally
deaf. My dad's hearing is getting worse too. I'm sure that I'm going to go
deaf eventually, and it will be a sad day when that time comes.

If you're interested in real-time audio effects on smartphones, AudioGraph is
an app I've been playing with.

[http://zerokidz.com/audiograph/Home.html](http://zerokidz.com/audiograph/Home.html)

It lets you listen to input signals through the iPhone microphone, do some
effects, and pass the output to headphones.

With the right hardware, it's also possible to turn the iPhone into a wireless
mic using a Bluetooth headset adaptor (e.g. Sony MW600). Plug the MW600 into
the speakers, plug a Kokkia Bluetooth transmitter into the iPhone, run
AudioGraph, and speak into the iPhone mic. There's a little lag, but it works
well enough for me.

I expect that when my hearing gets worse, I'll use regular headphones (maybe
custom-molded Ultimate Ears UE4s) with my iPhone, and do the "tuning" effects
using AudioGraph. Being able to pass my smartphone to someone so they can
speak into it like a microphone would be much easier than having to lean over
so a hearing aid could be closer.

~~~
0xbear
Or you could, you know, wear ear plugs at those shows. That’s what the
musicians do.

~~~
petre
And then you'd actually hear the music instead of constant thrashing.

~~~
peterburkimsher
If I want to listen to music, I'll get the CD version and listen to it in a
quiet room on my nice headphones.

I go to concerts to mosh, buy signed CDs/T-shirts/posters/pins, and meet other
fans.

Meeting people requires talking. Earplugs, like the headphones I wear in the
office, are a social signal to tell people "don't talk to me". I'm well aware
of the dangers to my health, but I've met too many good friends at shows to
stop trying to socialise with people who obviously share something in common
(taste in music). I'm shy around total strangers, so it's at common-interest
events like concerts where I have a starting point to talk about, and thus
meet people.

~~~
Kluny
> Meeting people requires talking. Earplugs, like the headphones I wear in the
> office, are a social signal to tell people "don't talk to me".

That's a hell of a sacrifice to make based on something that's almost purely
your imagination. You can have custom earplugs made for $140 that are clear
and almost unnoticeable, which will block the majority of damaging frequencies
while still allowing you to hear talking pretty well. I promise, no one is
going to stop talking to you when you have them in.

The isolation I've experienced from hearing loss is so profound and damaging
that it's painful to see how casually you treat it. I'd pay any amount of
money to get my hearing back.

------
DanielBMarkham
"Why are hearing aids so incredibly costly?"

"...Experts don’t know exactly why hearing aids are still so costly..."

So the article headline poses a question that writer confesses in the second
paragraph not to know the answer to. No, strike that. The author claims that
_experts_ don't know the answer to that.

And I scan HN and get answers almost immediately.

HN is great, no doubt, but it's not HN. This is an author who doesn't know how
pricing works _and doesn 't know how to talk to people about how pricing
works_, which is much more troubling. And the editors must feel that this is
the normal state of things.

Pricing may be a bit of a black art in certain markets, but it's no mystery
unsolvable by experts. You can bet _somebody_ is setting prices on these
things, and when they set them there's a lot of market and historical data
being used to do so.

There are simply not-so-many reasons why some things are priced much higher
than other things, and these reasons are all well-known and understood. When I
read articles like this, it makes me much more critical of every other NYT
times article that involves "experts".

Great article for HN because it involves startups, markets, new business
opportunities, tech, and so forth. Not such a great article for the NYT,
sadly.

------
soneca
A social business in Brazil has an alternative:

[http://www.solarear.com.br/](http://www.solarear.com.br/) (There is an
english version, just click the british flag closer to the footer)

 _" Solar Ear manufactures low cost, solar rechargeable and environment
friendly hearing aids so you can hear perfectly again. Our products are
manufactured by deaf workers with high quality components."_

------
analog31
Disclosure: I'm not a doctor or audiologist.

Hearing loss runs in my family. When it's time for me, I plan to roll my own.
I suspect that if you get rid of just one requirement, it becomes easy. That
requirement is to stuff the whole thing in your ear. If the electronics can be
in a separate box (or in a smartphone as mentioned), then analog, signal
processing, and battery power all become trivial.

~~~
mildavw
My dad is 81 and started having hearing loss a few years ago. He just sent me
a pic showing the degree to which he was able to shrink his DIY hearing aid
once he settled on the circuit design:

[https://photos.app.goo.gl/4lOwfrVJ3bfRWkEm1](https://photos.app.goo.gl/4lOwfrVJ3bfRWkEm1)

(Stereo mics and amp with two-channel parametric EQ on each side. About 6"
wide and runs on two 9v batteries, if you're curious!)

He took it to a Bose showroom to compare it to their Hearphones. All (Bose
people included) agreed that his amp and EQ was superior. Cost for parts is
~$200. He's had a lot of fun building them for himself and his friends.

~~~
simcop2387
I'd bet it'd be possible to make this much smaller and about half the cost.
But I think it'd also end up a lot more difficult to adjust as needed since
you'd end up with either tiny pots for adjustment or having to fix the values
of everything and use single resistors. Going full DSP would allow you to make
this fairly small and cheap (maybe the size of a 9 volt battery) but much more
annoying to build and work on if you don't have the skill set. I'd bet this
would be a good spot for someone to design a nice open hardware project that'd
benefit a lot of people, and if it's setup as kits for headphones that just
happen to work well as hearing aids you can probably avoid some of the
regulatory issues even though you couldn't ever call them what they are.

------
tim333
Anecdotal and I'm in the UK but you can get them from £10 up, eg. this one for
£20 [https://www.amazon.co.uk/Hearing-Rechargeable-rAdjustable-
Am...](https://www.amazon.co.uk/Hearing-Rechargeable-rAdjustable-Amplifier-
Audiphone/dp/B072LQ84JG/ref=sr_1_7_a_it?ie=UTF8&qid=1508843784&sr=8-7&keywords=hearing+aid)
but my dad pays £2000+ for similar looking but much fancier state of the art
ones.

Reasons

\- better quality - the good ones are small computers that use very little
power and try to pick out voices from background etc. Apparently the
challenging bit for him is dinner parties where you are trying to hear one
voice out of several people talking.

\- it includes an Audiologist - he's 87 and needs a bit of help on the tech
side

\- I guess he has the money and values hearing more than the 2k.

It would be cool if computer analysis could understand the several
conversations at the party and you could click on the one you wanted or point
that way or similar. Maybe in the future, probably won't be cheap.

------
jokoon
I thought they were expensive because you have to individually tune some sort
of equalizer, depending of the damaged frequencies of the user.

Also the hardware is not really very cheap either, you have to insert it deep
into the ear, and the microphone should be sensitive enough to capture all
kinds of sounds, at at all distances and air conditions, removing noise, etc.
Microphones have always been expensive. It also would be running 24/7.

But to be honest, price should drop indeed. But everybody knows that
everything relative to health will often be overpriced if not regulated,
especially if it involves any sort of technology.

~~~
emiliobumachar
"But everybody knows that everything relative to health will often be
overpriced if not regulated, especially if it involves any sort of
technology."

How much is a band-aid? Oh, technology. Ok, how about a digital thermometer?

I think the problem is the opposite. Lots of regulation, however benefits they
bring, will raise prices and discourage outsiders from offering competitors.

From the article:

"[A new law] includes a provision for selling hearing aids over the counter to
adults with mild to moderate hearing loss in two to three years. [...] Under
the new law, hearing aids are expected to cost around $300 or less per ear."

This seems to imply that today, and for the next two years, you cannot legally
sell a competing, cheaper aid unless you can get doctors to recommend it. Even
if it's just as good, it will take a large marketing effort to show it to
doctors.

Now, these regulations do bring benefits. But let's not lose sight of their
costs.

------
kibwen
_> “Eighty percent of people who could benefit from a hearing aid don’t get
one,” Ms. Kelley said, often because of cost or access to care. “Some of the
reason is stigma: They don’t want to be seen as being old.”_

I'm hopeful this will change. I know a fair number of people around 30 with
mild hearing loss, and one who does wear a hearing aid. A history of dangerous
headphone volume among my cohorts will probably exacerbate things. Ideally
hearing aids would carry no more of a stigma than glasses (FSVO "ideal" :P ).

------
patentatt
Regarding patents, many may not know that there is a coalition of hearing aids
manufacturers who jointly act in this space. On the plus side, they claim to
clear patent trolls from the field. You decide:

[http://www.himpp.info](http://www.himpp.info)

------
ilitirit
Going by what I've heard from a relative who is an MD, the question is rather
why _low-quality_ hearing aids are expensive. The thing is, the average
consumer doesn't know much about these things and how they are supposed to
work. What the general sound quality should be. How long are they supposed to
last etc. So you have loads of companies selling low-quality hearing aids at
the same cost as the good quality ones. The consumers don't really know better
because they are relying on the word of their doctors or consultants.
Surprisingly, not many doctors know much about this industry either.

------
blacksoil
Reading replies here, sounds like the problem to get HA on budget are decent
power consumption and miniaturization.

I wonder if coming up with a earpiece-with-smartphone like combo can be a
solution? So the main device with the battery and signal processing SOC is
separated from the earpiece. This main device can live in a pocket or attached
to the user's belt, while connected to the earpiece through wire.

Perhaps no the most convenient solution, but would it be possible to make such
device available cheaply off the selves?

------
coupdejarnac
I developed a hearing aid/amplifier app for iOS a few years ago, and I think
many people now realize that a free or cheap app can really help with hearing
loss. I probably ought to dust off the codebase and modernize it.

People should still go see an audiologist to properly characterize their
hearing loss and use that knowledge to choose a suitable product. There are a
lot of hearing aid alternatives already out there, but they cannot be marketed
to people with hearing loss until the new law takes effect.

------
danschumann
Hearing aids are covered by insurance, so there is no cost pressure to bring
the cost down. Contact lenses are one of the only medical devices where their
price went down in the last few decades. This is because people pay out of
pocket. It's the same concept behind rising tuition. If people don't see the
cost directly come out of their own pocket (either through insurance or
student loans), they don't complain about cost as much, and it sky-rockets.

~~~
pkaye
Which country are you from? In the US, hearing aids are not covered by most
health insurance (much like glasses.) In fact I think it is explicitly written
in the Medicare laws that they are not covered. So I don't think the rest of
your thesis applies.

------
nostromo
Things that are paid for by other people tend to be expensive.

~~~
randyrand
Auto-repair/auto-insurance doesn't fit this explanation. Repair is still a
competitive industry with rather low margins.

~~~
refurb
The counter argument would be that there is enough business that isn't paid by
insurance companies to keep competition high.

If no one paid for car repair out of pocket, prices would be much higher.

~~~
mcny
They are too high at the dealership. At least, they feel high compared to what
a knowledgeable friend who knows how to get used parts (junkyard etc) will
charge for parts.

------
nas
Consider going to Costco. I think my Dad pays around 500 CAD for his set. They
would likely cost more than double at other places. The service at Costco is
great as well.

Also, as other people have said, they are expensive because they are
technologically advanced and expensive to manufacture. You can build some kind
of hearing aid for less than $100 but it will not compare with a $500 one.

~~~
analog31
Canada may be cheaper than US. But still, I've heard the same advice in US.

~~~
fma
I bought my glasses from Costco, even though it's "out of network" for my
vision insurance. Still a hell lot cheaper than Lenscrafter, etc.

I imagine the same applies for hearing aside

------
ultim8k
As with everything else, they are expensive until someone decides to reduce
the production cost and sell them cheaper.

------
Flands
I wonder if there some day will be therapy (stem cells?) or a medical
procedure to repair damaged ears.

~~~
jfountain2015
There are a couple of genetic therapy cures in trials...

[http://entcolumbia.org/world-s-first-gene-therapy-trial-
hear...](http://entcolumbia.org/world-s-first-gene-therapy-trial-hearing-loss)

Also promising is a solution using Crispr

[https://www.technologyreview.com/s/608899/the-easiest-
place-...](https://www.technologyreview.com/s/608899/the-easiest-place-to-use-
crispr-might-be-in-your-ear/)

------
Ice_cream_suit
Some non-US prices:
[http://www.calcuttahearing.com/shrobonee/Siemens%20Hearing%2...](http://www.calcuttahearing.com/shrobonee/Siemens%20Hearing%20Aid%20price%20list%202017%20download.pdf)

------
aaron695
As someone with un-impaired hearing I really don't get why I can't a
programmable enhanced hearing device for less than $100.

Fuck Magic Leap, surly enhancing hearing is easier and cheaper.

Block traffic. Enhance birds. Perhaps translate. Listen to tv how I want.

~~~
ianhowson
There are things like SportEar, marketed to hunters, where they want (a)
enhanced hearing in quiet environments, and (b) suppression of very loud
sounds. Some of them are just rebadged hearing aids with unvented receivers.

AirPods is the closest you can get right now.

I've considered buying Resound wireless HAs for that purpose before. Instead I
just walk around with IEMs and push-to-hear mic all day.

------
Ice_cream_suit
The Siemens Orion is sold in India for around $250.

While it is not a premium hearing aid, it appears to be adequate for at least
some.

Unbranded Chinese hearing aids are available for around $25.

------
gooch9
My solution - buy a high end smart phone - the more (directional) mics it has
the better. Add a high quality "spouse mic" that you can place whereever you
want on conference table/dining table/nightstand/next to the door bell. Most
phones, home assitants, the kinect etc come with with mic arrays and have
ridiculously sophisticated audio stacks. You can't do cutting edge speech rec
without those stacks.

These ridiculous hearing aid companies are going to go the way of dinosaurs
soon. And good riddance.

~~~
PhasmaFelis
I'm not really sure what you're proposing here. Any system that requires
location-based setup seems obviously inferior to a system that rides in your
ear and just works wherever you go.

------
arghwhat
I'm going to be that annoying guy: They're free* in Scandinavia, including
batteries for life.

* "Free" meaning "paid for by the tax-sponsored public health insurance", which people up here would call "free".

~~~
grzm
An alternative phrasing could be:

> _In Scandinavia, hearing aids (with a lifetime supply batteries) are
> supplied without additional cost as part of the national health care
> program._

~~~
arghwhat
Ah, thank you! That phrasing is much better, and saves the footnote, without
which someone would _surely_ respond about how it "clearly isn't free"...

------
dogruck
This sentence gave me alarm bells of weak or biased science writing:

> Experts don’t know exactly why hearing aids are still so costly, except that
> companies continue to invest in improvements, and fees usually cover the
> services of a highly trained audiologist.

~~~
colonelxc
So it sounds like they do know why they are still so costly...

~~~
ghostbrainalpha
Two hearing aids cost $7,000 because they cover a Dr visit?

And the point of the Dr. visit is to tell you if your hearing loss requires a
hearing aid, or is just the result of wax buildup.

So...basically, the Dr. visit could be replaced with a Q-Tip.

Maybe each pair of hearing aids results in $6,500 worth of audio research, but
if so, I think those researchers may not be a great return on that money.

It's a matter of time before Apple's Ear Buds, come with a $200 hearing aid
upgrade.

~~~
gumby
By the way, _don 't_ stick a Q tip in your ear. Even the manufacturer tells
you not to, or at least their lawyers have told them to say that.

[http://www.sciencemag.org/news/2017/01/no-more-q-tips-
your-e...](http://www.sciencemag.org/news/2017/01/no-more-q-tips-your-ears-
really-are-self-cleaning) . Or if you prefer video,
[https://www.youtube.com/watch?v=cYqeUJda2Qs](https://www.youtube.com/watch?v=cYqeUJda2Qs)

~~~
paulmd
Yes, the modern medical recommendation is "don't fuck with your ear canal".
Nothing goes in there, and Q-tips are "officially" just for cleaning around
the outer parts of your ear (lol ok). They can cause some real hardcore wax
impaction and introduce germs, they are not a medically recommended product at
this point.

Earwax is a natural antibacterial mechanism, like mucus. If your ears are
fucked up they do sell Debrox kits with a compound to soften it and an
irrigation bulb, use those. The irrigation does a number on your ear's
protections too though.

