Hearables

Will the nation’s young be obese with hearing loss, too?

by Daniel Fink, MD, Chair, The Quiet Coalition

I recently read a report via AMA Wire citing a study in the New England Journal of Medicine that estimates 57% of today’s young people will be obese by age 35. One wonders how many of them, after two or three decades of listening to music from tablets or personal music players using ear buds or headphones, will also suffer hearing loss.

As long as the regulators are asleep at the wheel, and the American Association of Pediatrics fails to adequately educate parents about the dangers of hearing loss from noise exposure, I guess we’ll find out in a few decades as today’s children sign up to be fitted with hearing aids. Despite concerns about earbud and headphone abuse among children, the AAP doesn’t have sufficient information about the dangers of noise exposure for children on its healthychildren.org website.

And, meanwhile, the Federal Trade Commission has declined to take action on the basis of false advertising for headphones marketed as “safe” for hearing of children as young as age three using an 85 decibel volume limit, even though a 85 A-weighted decibels is an occupational noise exposure standard–meant for adult workers–and A-weighting usually reduces measured sound levels by 5-7 decibels. The pediatricians say nothing about these unsafe headphones.

Twenty to thirty years from now, will today’s children wonder why the government and medical professionals sat on their hands and watched as they slowly destroyed their hearing, doing little or nothing to protect those who didn’t know better on their own?

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Google defeated by Brooklyn

Photo credit: dumbonyc licensed under CC BY-SA 2.0

But the Pixel buds weren’t a total failure, as the duo found the translator worked better in quiet rooms. Which is great if you are traveling to a mythical land of quiet and the local language is preloaded in the accompanying app, but not so much for the real world.
Maybe instead of relying on some hardware and an app to do the heavy lifting, one could struggle with a phrase book and charm/offend the locals like people have been doing forever? Personally, we think there shouldn’t be a “tech solution” for everything. That said, hey Google, how about working on bringing some quiet to city streets? It’s in your self-interest, after all.

Want better sleep? Bose® has you covered

Bose® noise-masking sleepbuds™

by David M Sykes, Vice Chair, The Quiet Coalition

This CNET review is a intriguing article about Bose’s quest to tap into the auditory health and better sleep market.

PSAPs, or personal sound amplification products, is a term brought to public attention in 2015 by the White House President’s Council of Advisors on Science and Technology followed by a report from the National Academy of Medicine last October. PSAPs are an emerging class of products that are also called hearables (think wireless earbuds with extra features) that we’ve been following for the past couple of years.

PSAPs are interesting because they represent a host of tech innovations and innovative young tech companies that promises to disrupt the traditional hearing-aid industry that has been dominated for decades by a hegemonic group of risk-averse manufacturers known as the “Big Six,” a market that is carefully regulated by the FDA. The result of decades of regulation and dominance by a handful of companies is that traditional hearing aids are both absurdly expensive, and also not particularly innovative. No surprise there.

But a couple of months ago, the emerging market for PSAPs blew wide open thanks to bi-partisan legislation (the Over-The-Counter Hearing Aid Act, co-sponsored by Senators Warren and Grassley) which exempts PSAPs from regulation. And that means three things:
1. Now you can buy PSAPs directly from the manufacturers or at CVS/Walgreens etc. (“over the counter”) without a prescription and you don’t have to pay an audiologist to fit them;
2. PSAPs cost a fraction of what a pair of traditional hearing aids costs (PSAPs may cost you $150 to $400, but compare that to $4,000 to $10,000 for conventional hearing aids); and
3. Two dozen hungry, young start-ups funded through crowd-sourcing or by venture capital professionals are charging into this market.

So If you, like me, like to watch a tech-race unfold, then get out your binoculars and join the crowd at this track because its an exciting race in a market that has been moribund and over-regulated for decades.

Watching this restless bunch of young PSAP startups and their colorful jockeys (I mean their CEOs), and eyeing them very carefully, are a small but high-powered group of suits you’ll recognize from consumer electronics: Apple, Sony, Phillips, Bose, et al. Why? Because these are the big guys who are already in the ear business–they sell earbuds and headphones, among other things and wireless hearables is a potentially important new market. The ear is their turf. So if they can grab a piece of the de-regulating market for wireless hearing-assistive devices that’s a great business opportunity, right? After all, 48 million Americans are hearing-impaired so this is potentially a big niche market, and who knows how many Americans are sleep-deprived?

But what about Bose?

Bose—an intensely private, even secretive consumer electronics company headquartered on top of a small mountain near Boston—is the first of these big consumer electronics players to make a move in the PSAP race. Bose’s founder, Amar Bose, died a couple of years ago, but he was a singular, legendary force in consumer electronics and seemed to be the fountain from whom all of the company’s products poured. With his death, ownership of the company was turned over to Amar Bose’s alma mater, MIT (yes, MIT controls the majority stake but has no say in management). But can the company still innovate now that it founder and chief idea-guy is gone?

One approach to innovation is through acquisition. So last year, Bose acquired the San Diego-based startup Hush and recently announced the release of a new Bose-branded product based on the work done by three engineer-entrepreneurs who founded Hush not too long ago. If you’ve been watching this emerging market, you probably noticed that only last week, the self-declared front-runner in PSAPs/hearables a product called “Here One” from the company Doppler Labs, ran out of juice and went out of business. Why? They burned through $50 million trying to win this horse race, but then ran out of money and couldn’t get Apple or Sony or any of the rest of the big guys to pony up and buy them out. Sometimes that happens to front-runners and it’s too bad, but it clears the way for others to emerge. And Bose wants to be one of the next group as these horses round the first corner.

Now Bose, in addition to being intensely secretive, has also always done things differently. And they’re certainly going after this emerging PSAP/hearables market from some intriguing angles. For instance, they recently have launched a crowdfuning campaign for their new Bose® noise-masking sleepbuds™. Another example is their newly announced Hearphones for people who need help understanding speech in noisy environments. Both of these products indicate that Bose is probing the now-deregulated “hearing health market”—a big departure from their traditional focus on consumer electronics. Perhaps they think 48 million Americans is a viable niche market where they can beat Apple, Sony, Phillips and the Big Six hearing aid companies by getting out of the gate faster. Who knows? Bose has succeeded by focusing on niches ignored by others and they’ve got their own retail stores, so keep your eyes on them.

It’s a race. And some of us are watching closely to see what happens. If you placed a bet on Here One and lost, then just swallow hard and keep your eyes on the race. It’s only just begun.

In addition to serving as vice chair of the The Quiet Coalition, David Sykes chairs several professional organizations in acoustical science: The Acoustics Research Council, American National Standards Institute Committee S12, Workgroup 44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group—a partner of the American Hospital Association. He is the lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), a contributor to the National Academy of Engineering report “Technology for a Quieter America,” and to the US-GSA guidance “Sound Matters”, and co-founded the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute. He recently retired from the board of directors of the American Tinnitus Association. A graduate of the University of California/Berkeley with graduate degrees from Cornell University, he is a frequent organizer of and speaker at professional conferences in the U.S., Europe, Asia, and the Middle East.

Can a machine learn to solve our speech in noise problem?

by Daniel Fink, MD, Chair, The Quiet Coalition

This piece in The Hearing Journal asks, “Can a Machine Learn to Solve our Speech in Noise Problem?”

Maybe yes, maybe no.

The “speech in noise” problem is the difficulty many people with hearing loss–and even people with normal hearing as tested by pure tone audiometry–have  following a conversation if the room (often a restaurant or party) is noisy.

I have that problem, as many adults do, and I also have three problems with this article.

First, talking about a technological solution to the speech in noise problem without discussing how we can interfere with the development of this condition by simply making the world quieter to prevent hearing loss is irresponsible. Imagine public health officials in the 1950s focusing on making better wheelchairs, braces, and crutches for those affected by polio without also working to prevent polio by developing a vaccine. You can’t, because that would have be absurd. To prevent noise-induced hearing loss, we don’t need more research. We don’t need a vaccine. All we need is to make a quieter world, something that has been known for decades.

Second, an even better solution to the speech in noise problem would be to require quieter indoor spaces.

Third, requiring quieter public spaces is exactly what the Americans with Disabilities Act (ADA) requires. People with hearing loss clearly meet the ADA definition of having a disability, and they require “reasonable accommodations” to allow them to fully enjoy (yes, this is the legal standard in ADA) places open to the public. I will be speaking about “Disability Rights of Ambient Noise for People with Auditory Disabilities Under the Americans with Disabilities Act” at the December meeting of the Acoustical Society of America, in New Orleans. I recent learned that my talk will be broadcast live over the internet. Details of how to listen will be posted when they become available.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

The first one bites the dust

No longer with us

by Daniel Fink, MD, Chair, The Quiet Coalition

Some observers see great potential in a new category of electronic device called hearables, something a little less than a personal sound amplification device, or PSAP, and certainly less than a hearing aid, but designed to help adults understand conversation in noisy places.

Others of us–and I am in this latter category–don’t see much of a future for these products, which are unlikely to work well and unlikely to be attractive to consumers. After all, who wants to be the only one in the room wearing some silly-looking device?

There are several vendors trying to bring these to market but today we learned that the first one of these, Doppler Labs, bit the dust after burning through $51 million of venture capital.

Its product, Here One, only had a two-hour battery life.

One wishes the $51 million had been spent dealing with the root cause of the problem, making restaurants quieter. That’s what’s really needed to help people with hearing loss.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

A lament about hearing aids

Jennifer Finney Boylan, The New York Times, wonders: “Glasses Are Cool. Why Aren’t Hearing Aids?

I can answer that for you Jennifer:

Hearing loss is stigmatized and hearing aids are expensive, rarely covered by insurance, and don’t work as well for hearing as glasses work for sight.

In short, there is nothing at all cool about an expensive bit of kit that doesn’t work that well and is assumed to be a device meant only for the elderly.

You’re welcome.

Coping with hearing loss and noisy restaurants is not a game

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from CNN discusses a novel strategy to help people with hearing loss understand speech: a game to train the brain to process speech better.

This is a widely known but poorly understood problem–sometimes called the “Speech in Noise problem”–with people with hearing loss, but it can also affect people with normal or adequate hearing as tested by standard hearing tests (“pure tone audiometry”) who nonetheless can have problems understanding speech.

The problem is worse for those with hearing aids, which is probably why up to 40% of people with hearing aids don’t use them–they just don’t help understand speech in everyday situations. As hearing loss blogger Shari Eberts has written, hearing aids just are not like eyeglasses.

Some research supports a central cause for this, i.e., deficiencies in brain processing of auditory signals as people age. Other research puts the problem in the periphery, i.e., the ear. And the research on hidden hearing loss puts the problem in between, in the nerves connecting the ear to the brain. Most likely the explanation involves all three.

Even though the computer game reported in this story may eventually help people who struggle to understand speech, dealing with hearing loss and noisy restaurants isn’t a game.

The real answer isn’t brain training. It’s quieter restaurants, stores, and other public places.

Quieter indoor places will not only help those who already have hearing loss understand speech, they will prevent hearing loss in those still with good hearing.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Researchers confirm cheaper hearables work as well as hearing aids

by David M. Sykes, Vice Chair, The Quiet Coalition

Several Johns Hopkins researchers reported some research in the Journal of the American Medical Association that tested the notion that a cheap ($200-$400) unregulated “hearable” (also known as a personal sound amplification product or PSAP) may be a convenient and inexpensive alternative to a hearing aid.

The researchers tested a handful of the new hearable products just coming on the market and, sure enough, they perform as well as, or nearly as well as, expensive ($2000-$5000 per ear) hearing aids made by the “Big Six.” The Big Six are six companies that have controlled the hearing aid industry; their products are regulated in the U.S. by the Food and Drug Administration.

Recently legislation passed by Congress and signed into law just before the August recess, about which we have written earlier, requires the FDA to de-regulate, i.e. to take a hands-off approach to this new class of high-tech hearing devices. As a result, these new products can be sold over the counter, without a prescription.

Will you need to take them to an audiologist to get them fitted? Certainly you may choose to do so, and that may be the best option, particularly if you are concerned that improper use might endanger your hearing. But with a conventional hearing aid, patients were required to pay professional fees to an audiologist for fittings, etc., resulting in a bundled price that made the hearing aids unobtainable for many people who needed them. You can certainly expect to read articles claiming that these new devices pose a danger. Henceforth, it’s up to the consumer to decide—as he or she already does with regard to many other healthcare products, including over-the-counter drugs that formerly required a doctor’s prescription.

We say caveat emptor (buyer beware), but welcome these new products that cost 1/10th the price of conventional hearing aids. They are suitably priced to be able to meet the needs of 48 million Americans with noise-induced hearing loss, many of whom cannot afford the $4000 to $10,000 price tag for conventional hearing aids. Voters seem to want de-regulation—this is it!

In addition to serving as vice chair of the The Quiet Coalition, David Sykes chairs several professional organizations in acoustical science: The Acoustics Research Council, American National Standards Institute Committee S12, Workgroup 44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group—a partner of the American Hospital Association. He is the lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), a contributor to the National Academy of Engineering report “Technology for a Quieter America,” and to the US-GSA guidance “Sound Matters”, and co-founded the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute. He recently retired from the board of directors of the American Tinnitus Association. A graduate of the University of California/Berkeley with graduate degrees from Cornell University, he is a frequent organizer of and speaker at professional conferences in the U.S., Europe, Asia, and the Middle East.

 

New federal law deregulates and disrupts hearing aid market

Photo of Here One wireless smart earbuds courtesy of Doppler Labs

by David M. Sykes, Vice Chair, The Quiet Coalition

Who says this Congress can’t get anything done? Last week huge news appeared for 48 million Americans with hearing disorders, but the media barely noticed::

A new bipartisan law, the “Over-the-Counter Hearing Aid Act of 2017,” will deregulate the hearing aid market, dramatically lowering costs for consumers and releasing a surge of new technologies that will be sold over the counter, without a prescription. Yes, there will be losers as well as winners, but that’s the nature of change….

The new law responds to two federally sponsored reports issued last year (under the Obama Administration). The first report came from the President’s Council of Advisers on Science and Technology. The second was from the National Academy of Medicine. Passed the day before Congress adjourned, the new law creates opportunities for new technology innovators, eliminates the need to get a prescription, and dramatically cuts the cost by allowing substitutes, called “hearables” and “PSAPs” (Personal Sound Amplification Products), to be sold “over the counter.” The goal? a more efficient market that meets the needs of consumers.

As Noah Kraft, co-founder and CEO of Doppler Labs said, “[t]his industry is going to be completely disrupted. The question is by who?”

We have reported about this on several occasions over the past year, but the market disruption is getting underway much sooner that we anticipated thanks to quick action in the House of Representatives and the Senate, action that has emboldened nearly two dozen new entrants to enter the market ahead of schedule.

Who gains? 48 million Americans with incurable noise-induced hearing loss and millions more who are at risk from noise exposure. Who loses? The Big Six  who have dominated the hearing aid market for decades along with approximately 14,000 audiologists, the medical specialists whose services were previously required by the FDA to dispense and “fit” hearing aids to patients. The new Warren-Grassley OTC Act stipulates that the FDA must create a new category for “over-the-counter” hearing assistive devices and let them be sold freely, without intervention.

It’s no secret that the current Congress and the White House crave deregulation. Is deregulation potentially dangerous? Sure, but this is one instance where consumers will clearly benefit. Until now, hearing aids could cost you between $2,500 and $5,000 per ear, so $5,000 to $10,000 total. No wonder so few people have hearing aids—they weren’t covered by insurance or Medicare/Medicaid, so who could afford them? But now prices will drop to 1/10th of that—about $300 to $350 a pair–so lack of insurance coverage is less of a barrier.

We say thanks to the laudable bi-partisan cooperation between Senator Elizabeth Warren (D-MA) and Iowa Senator Chuck Grassley (R-IA) for getting this done at a time when Washington seems mired in dysfunction.

What’s the downside of this deregulatory innovation? There are many unknowns, so caveat emptor (buyer beware) and stay tuned…. But for now, it’s “Hip Hip Hooray”—or should we say, “Hear Here”!

P.S.: Our chair, Daniel Fink, MD, cautions that the real solution to the epidemic of hearing disorders in America is NOT more affordable hearing aids, but rather, a badly needed and long-awaited public health effort to prevent hearing loss—and we wholeheartedly agree with him. Prevention can be encouraged by three means:

  1. Educating people about the dangers of prolonged exposure to noise above 70 dB (permanent hearing damage occurs at levels much lower than currently recognized);
  2. Resurrecting federal efforts to reduce noise (as is being done in Europe and Asia already, where noise is recognized as a public health hazard) from obvious sources like planes, trains, trucks, consumer appliances, construction and outdoor maintenance equipment, etc.; and
  3. Educating companies in industries like aircraft manufacturing, car and truck manufacturing, mining, construction, HVAC, and appliance manufacturing, etc. that noise is harmful to public health.

Prevention can be done: currently, the European Union regulates noise emissions from 50 classes of products. According to Dr. Fink, “a hearable or PSAP is a poor substitute for well-preserved normal hearing; it’s far better to avoid loud noise or to wear earplugs!”

In addition to serving as vice chair of the The Quiet Coalition, David Sykes chairs several professional organizations in acoustical science: The Acoustics Research Council, American National Standards Institute Committee S12, Workgroup 44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group—a partner of the American Hospital Association. He is the lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), a contributor to the National Academy of Engineering report “Technology for a Quieter America,” and to the US-GSA guidance “Sound Matters”, and co-founded the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute. He recently retired from the board of directors of the American Tinnitus Association. A graduate of the University of California/Berkeley with graduate degrees from Cornell University, he is a frequent organizer of and speaker at professional conferences in the U.S., Europe, Asia, and the Middle East.

PSAPs appear to work (but preventing hearing loss is better)

Photo credit: Hadley Paul Garland licensed under CC BY-SA 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

Personal sound amplification products (PSAPs) appear to work. What is a PSAP? It’s really a hearing aid but it’s called a PSAP to avoid federal and state regulations. PSAPs can be sold directly to consumers without a physician or audiologist evaluation, and they are much cheaper than conventional hearing aids–in the range of $350 a pair instead of $3000 apiece.

This Research Letter in a recent issue of JAMA compared five PSAPs with a conventional hearing aid. The Johns Hopkins research team reported that some of the PSAPs worked quite well. Four of the PSAPs are traditional “behind the ear” devices that look like cheaper, less well made versions of traditional hearing aids, but one, the Etymotic Bean, might be placed into the newer category of “hearables” that are marketed as “smart earbuds.”

Why is this report important? PSAPs were strongly recommended by two recent expert federal reports (a report from the President’s Council of Advisors on Science and Technology in October 2015​ and a report from the National Academy of Medicine) as a solution–perhaps the solution–to the nation’s epidemic of hearing loss in older Americans.

To some they are the holy grail for hearing loss, enabling all to hear well without spending thousands of dollars. To others, especially audiologists and hearing aid dispensers, they are an existential threat. If grandma and grandpa can buy much cheaper hearing aids on their own from Amazon or Costco, why see an audiologist or hearing aid dispenser? Just buy your PSAPs online or at your nearby big box store.

Unfortunately, neither federal report mentioned the prevention as a solution for hearing loss. As I said in my presentation at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich on June 20, 2017, significant hearing loss is probably not part of normal aging but is noise-induced hearing loss caused by a lifetime of excessive noise exposure.

The inconvenient truth about hearing aids is that they don’t work very well at helping users understand speech in normal, everyday situations. For obvious reasons, there is little peer-reviewed research on this topic in the audiology literature, but two studies report approximately 40% non-usage rates. There is no reason to expect–especially without any training and teaching by an audiologist–that PSAP users will have any greater success.

Needing hearing aids or PSAPs in old age to treat hearing loss is not normal, just as needing complete dentures in old age because of tooth loss from poor dental care is not normal. Both are the only remedies available when we have failed to protect what Mother Nature gave us. But it’s much better to protect your ears and preserve your hearing than to use even the best hearing aid or the less costly PSAP alternatives.

The time to start protecting your ears is now! If it sounds too loud, it IS too loud. Avoid loud noise, and if you can’t avoid it, wear hearing protection.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.