
The Hearing Aid's Pursuit of Invisibility (2016) - tintinnabula
https://www.theatlantic.com/technology/archive/2016/08/the-hearing-aids-pursuit-of-invisibility/494387/?single_page=true
======
mcarrano
Millions of people have some degree of hearing loss. Not all hearing loss
requires a hearing aid but I have been wearing hearing aids since second
grade.

My very first hearing aid was a "behind the ear" model and it was very
uncomfortable when I also wore glasses. The technology then was not great as
it simply just amplified sound. Further, it was very visible which made me
conscious about my disability.

Later in high school, I moved to an "in the canal" model. This was less
visible to others and the technology was a bit better. The hearing aid would
be abel to help filter out background noise which made hearing people in loud
settings easier.

My current pair of hearing aids are also "in the canal" but it does a much
better job filtering background noises, can be environment aware to
automatically adjust volume. There are models that even have bluetooth
support.

I wrote an article several years ago on what I would like to see a future
hearing aid be like: [https://michaelcarrano.com/blog/google-should-develop-a-
hear...](https://michaelcarrano.com/blog/google-should-develop-a-hearing-aid)

One thing that isn't talked about much, to my knowledge, is that no insurance
will cover the cost of hearing aids. Good hearing aids are not cheap, the
model I currently have cost somewhere around $8,000 for my pair.

~~~
nerdponx
> no insurance will cover the cost of hearing aids

Is this is ridiculous and unreasonable as it sounds to me?

~~~
kemiller2002
Yes, it is. What is also really nuts is that insurance will cover cochlear
implants. I mean it's cool that they do, but my friend explained it to me that
the implants are a medical procedure and the hearing aids are classified as a
"luxury item" or some such. The brutal and insulting part to the story is that
he found this out because his daughter had cancer, and she lost her hearing
due to the chemo therapy, which means that she was forced to lose her hearing
due to medical procedures.

------
randlet
I feel like I comment this on every hearing impairment thread on HN, but for
me invisible hearing aids are an anti feature. I prefer to wear behind the ear
models as they provide a visual clue to people that I'm hearing impaired and
they are more understanding about having to repeat themselves. (I started
wearing them in my early 30s and I admit I was pretty self conscious about
them to start with, but quickly got over it.)

Also kids notice them sometimes and are usually not shy about blurting out
'hey what's in your ears?!?' which can lead to teachable moments :)

~~~
rawland
I'm with you.

Made them even extra geeky for visibility:

[https://twitter.com/RsCircus/status/777968784783110144](https://twitter.com/RsCircus/status/777968784783110144)

The wiring of the transparent case is orange too, as previously with the grey
case:

[https://twitter.com/RsCircus/status/480628806097858560](https://twitter.com/RsCircus/status/480628806097858560)

(Painting them [such that the color remains] was a bit cumbersome, however, I
like it ;-)

~~~
randlet
That's awesome! I'm too much of a chicken to take mine apart... I couldn't
stomach the replacement cost if I bungled something up.

------
rhubarbcustard
Wearing smaller hearing aids isn't just about the look of them, they are
actually much more comfortable and the designs of the in-the-ear piece of the
aid lead to better sound quality and a more natural sound.

As technology improved the in-the-ear piece could become more 'open' in that
it didn't have to fill the whole ear to avoid feedback, could be a soft tip
that wasn't molded to an individual's canal and allowed in some unprocessed
sounds that didn't travel through the aid.

It's so normal today to see people with something in their ear, usually Apple
buds, and because hearing aid manufacturers have realised it's a smart move to
stop marketing them as medical devices as such and positions them more as
cool-tech hearing enhancers, I think the stigma of hearing loss and wearing
hearing aids will soon be a thing of the past.

~~~
skybrian
Do you have personal experience with in-the-ear hearing aids? I'm curious how
they avoid feedback. (Also, falling out.)

~~~
ShannonAlther
> (Also, falling out.)

More or less the same way headphones do.

~~~
zeroer
Not very well?

------
analog31
My parents have both gone through multiple sets of hearing aids, at many
thousands of dollars a pop. Based on their experiences, when it's time for me,
I will design my own, and to hell with how they look.

One problem with miniaturization is that putting the microphone close to the
speaker is a recipe for feedback. Separating them by even just a few inches
should make a huge difference.

Also, if you don't mind carrying a bigger battery around, you can throw a lot
more processing power at the problem.

I've read that you can get satisfactory hearing aids without a prescription in
some countries, and that they are much cheaper that way.

~~~
Animats
_many thousands of dollars a pop._

IHear Medical was going to disrupt that. They announced a hearing aid at $199
in 2015.[1] The price keeps going up; it's now $349, plus a $129 "programming
kit", plus a support plan, plus accessories...

[1]
[https://web.archive.org/web/20150815012857/https://store.ihe...](https://web.archive.org/web/20150815012857/https://store.ihearmedical.com/)
[2] [https://store.ihearmedical.com/](https://store.ihearmedical.com/)

------
pavel_lishin
One problem is that invisible typically means small, and small typically means
easy to lose - and at least with my dad's hearing aids, it means constantly
worrying about accidentally knocking $1500 off the table and between some
couch cushions, without noticing.

------
dingo_bat
> And this is a problem, because deafness is a difference, not an impairment.

It was at this point I realized that the author is in heavy denial, even after
decades of suffering. Deafness is probably the biggest impairment a human
being can have, after blindness.

~~~
pfortuny
As a matter of fact, my experience is that deaf people suffer much more
isolation than blind ones. Human communication may be much more important than
visuals.

~~~
rhubarbcustard
It can be very isolating. I try and make sure I'm in situations where I know I
will have a good chance of hearing so I can stay in the mix.

Imagine sitting around the table with 20 people, everyone else is speaking
Chinese and you maybe know a few words of the language - you might grab the
odd word or phrase that people have said but you are not in the conversation
really. You quickly lose track of what is being talked about and as time goes
on, more and more topics are discussed, you realise you don't want to say
anything yourself in case what you are about to say has already been talked
about and you will look stupid. So you fade in to the background and just hope
no-one pipes up with, "hey, Bob, what do you think about that?".

Modern hearing aids give you great tools to combat these situations and they
do work.

I guess the difference for me really is that hearing is now hard work, it's
not something I can relax and do passively, I need to concentrate on words,
listen hard, lip read and fill in the gaps of context I missed. It can be
exhausting, especially in big groups. I've just upgraded to a pair of GN
ReSound Linx 3D aids, which are a massive help to me.

------
libc
I've worn hearing aids my entire life and manufacturers seeming to focus on
miniaturization at the expense of capability always frustrates me. This isn't
just driven by business interests though, DSP and EE at that scale are really
hard and it's honestly remarkable what modern digital hearing aids can do with
such limited resources. It does make me wonder though what would be possible
if they just threw a lot of processing power at the problem, like say a
Raspberry-pi sized processing unit concealed on the body connected to wireless
mics/speakers. This would allow open the possibility to having more than two
mics which could help with sound localization, which is something hearing aids
are still not very good at.

Maybe it's because BTEs are the only option for someone with my degree of
hearing loss, but if given the choice I'd gladly choose (or at least try) a
more powerful/sophisticated hearing aid over a more aesthetically pleasing
one, all other factors being equal.

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funkdified
A recent survey of over 500 audiologists showed that the most popular (~70%)
form factor of hearing aids today is the receiver in the ear (RITE). RITE aids
place the hearing aid body (battery, mic, processor, etc) behind the ear, and
run a thin plastic coated wire down over the front of the ear leading to the
earcanal. On the end of the wire is a speaker (or receiver) that produces
sound. This is an interesting shift from the past, where most people wanted
hearing aids that fitted entirely in their ear. As it turns out the RITE is
more or less just as invisible, but avoids some of the comfort and occlusion
(blockage) issues that the fully custom in the ear hearing aids create. Either
way, people want discretion, but RITEs have accomplished discretion with
better performance, leading to the growth in their popularity.
[https://www.hearingtracker.com/audiologist-
survey](https://www.hearingtracker.com/audiologist-survey)

------
tabeth
It's so sad that we're still culturally at a point where people care so much
what others think in terms of their appearance. I mean if someone is, god
forbid, hearing impaired and are wearing a _hearing aid_ (oh, the horror),
what's the big deal? I agree with rhubarbcustard in that an nigh invisible
earpiece will probably have a superior _overall_ function, but I wish people
would stop the judgment.

On that note, I'd like to see extremely visible hearing aids, that way it
signals to me to speak in a way that makes myself easier to hear, stigma be
darned. I'm sure anyone reading this has had experiences not hearing someone
because of a bad environment or mumbling, or something else. Ideally, if you
see that someone is wearing a hearing aid you would pay respect to that and go
even further out of your way to make sure they can hear you (though, you
should do that for everyone really).

~~~
victorhooi
As somebody who grew up wearing hearing-aids, the real world is unfortunately
nothing like what you describe especially with younger kids (although I agree
it would be lovely).

Also, you might want to tone down the mocking just a notch (that, or I'm
reading too much into your tone, possibly due to my experiences).

Kids will mock you, or try to yank on them. Or when you lose them, it's funny.
I used to use behind-the-ear ones, and then switch to in-the-ear aids, to be
less visible.

In the words of Mark Twain - "Human beings can be awful cruel to one another".

Now that I'm older, I tend to only use them in a work context - in social
settings, I tend to prefer 1:1 meetups anyhow, which makes it easier (you can
lip-read easier if it's just one person at close range).

For work, people are professional, and you can trust that it's fine. And look,
honestly as an adult, you assume other adults are reasonably mature and won't
judge you just because you have a disability. But yeah, for children, that
unfortunately doesn't always hold true.

I've actually switched to behind-the-ear again - simply because the sound
quality is better, in particular the directionality.

~~~
vbernat
> I've actually switched to behind-the-ear again - simply because the sound
> quality is better, in particular the directionality.

I just switched from behind-the-ear to inside-the-ear and one of the benefits
for me is the directionality. With behind-the-ear, I was unable to precisely
locate some sounds and what was happening behind me was always "clearer" that
what happened in front of me (annoying in the restaurant where you can follow
conversations from another table, but not from yours).

------
burntwater
I've worn a hearing aid since I was 4. I'm now 37, and while I've become much
more open about my hearing issues, I still struggle with the issue of my
hearing aid's visibility. Sure, I now have short hair (forced on me by
baldness, really), sure I've opted to select a gray color instead a flesh
color (thankfully, the gray is NOT (yet) to blend with the remaining hair I
still have), sure, I'm much more vocal about making people aware of my "good
side" and my "bad side" when walking and sitting.

But I'm still strongly resistant to the idea of adding a hearing aid to my
other ear (in which I'm deaf, but the additional hearing aid would link with
my current hearing aid, providing "stereo" audio of sorts). I know doing so
would be a significant improvement in life -- I would be doubling my hearing
capabilities, in ways. But right now I have alternate "good side" and "bad
side" modes; the mode for hearing better (you need to be on my left) and the
mode for hiding my disability (you should be on my right, unable to see my
hearing aid). If you're an attractive female, my instinct is to have you on my
right. Of course, if you're an attractive female who sits down at the bar on
my right side, I will ignore you, because conversation is futile. I have to
forcefully override this instinct.

In an ideal world, given current technology, there would be in-the-ear hearing
aids that could wirelessly sync to my current behind-the-ear hearing aid, but
that doesn't seem to exist. So I keep plodding along, basically waiting for
the day when technology will FIX my hearing instead of aiding it. I expect I
will be in my 60s by then.

~~~
Dunan
I envy your ability to be open about your (partial?) deafness. I have normal
hearing in one ear but am almost entirely deaf in the other, and have looked
into getting a hearing aid for it. (I'm also blind on that side, and there is
_no_ fix for that.)

Society can be pretty vicious when you ask people to stand on a specific side
of you, or turn your head 180 degrees so that you can point your good ear
toward them, but I think if you have a visible hearing aid, people will be
less surprised if you spring a request like that on them. Paradoxical, because
the device means that you can hear them no matter which side they're on!

I feel like in today's era of ubiquitous headphones you could have even a
hearing aid that looked like something else, and it wouldn't look that out of
place. If I get a hearing aid, I'll go for a gray (or white, or black) one
like yours.

------
aaron695
Not to reduce the importance of this is to the hearing impaired but if we can
crack this I could see these being used by most of the population.

It is strange on something seemingly so simple we don't all augment hearing.

