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Where Is the Steve Jobs of Hearing Loss?

Why are hearing aids so expensive, and so often ineffective?

In response to my Times piece on the statistical association between hearing loss and dementia, many many writers complained about the cost and ineffectiveness of hearing aids. One writer wrote directly to me, a long and detailed note about his frustrations with hearing aids.

He wrote, in part:

"In today's world of microelectronics which can almost put a full PC on the head of a pin there's no excuse for why the industry can't design a hearing aid at a reasonable price with enough electronic complexity to nearly exactly compensate for the tested responce curve of a person's hearing."

I referred the email to Richard Einhorn, a composer and classical music producer who knows more about sound technology than anyone I know. He gave me permission to reprint his response here. It goes a long way towards answering that question, Where is the Steve Jobs of hearing los

"I completely share your exasperation with the hearing loss industry. However, I've been studying the situation for nearly 3 years now - since I suddenly lost most of my hearing, likely from a virus - and the situation is a bit more complicated than it appeared at first to this musician and former record producer.

"Frequency response can and is compensated for by hearing aids but not as precisely as you and I know is possible. Still, hearing aids do boost in the speech range and competent audiologists (there are a few) do know how to compensate for specific high frequency losses. Could it be more precise? Oh, yes! Hearing aids could be dramatically improved in terms of frequency response, equalization, compression, limiting, and gating - not to mention total harmonic distortion and dynamic range, both of which are far worse than they are even in inexpensive modern audio devices (such as a decent mp3 player). Hearing aid sound is to good sound as Radio Shack is to Genelec (a great audio product company).

"However, the problem with hearing loss is that often it is not just a volume loss or frequency loss but also often includes frequency sensitivity loss and other distortions (look up hyperacusis and hearing loss/recruitment). These are all but intractable problems that cannot be compensated for by eq, gain boosts, or any kind of signal processing available today. I used to think that frequency compensation by eq would be enough - like you, I have a background in pro audio - but there is much more going on that those of us in music/pro audio never have needed to consider. If you're interested, I suggest looking at the opening chapters of Moore's Cochlear Hearing Loss or doing a lot of googling on both inner hair cells and outer hair cells. The inner ear is truly amazing in what it does. It is very complicated; equalization won't help for many kinds of problems. Sadly, nothing will if the distortion is bad enough, as it is in my right ear. Speech now sounds like a sci-fi robot through that ear; no amount of even the most advanced spectral processing can unscramble and undistort the sound.

"That said, you are also right that hearing aids are overpriced, sound crummy, and that audiologists for the most part don't understand audio except in the most rudimentary fashion (neither, btw, do most otologists, which is quite remarkable). The tech in hearing aids is, by my estimation, between 5 to 15 years behind what you and I know from live performance, recording studios and even home recording. And the hype the companies use to sell hearing aids is scandalous.

"Don't get me wrong: Hearing aids, despite being overpriced and mediocre products, are important for general hearing healh with moderate to severe hearing loss. However, in many specific situations, specific solutions are needed. Incredibly, signal to noise ratio is poorly addressed by the vast majority of hearing loss products, including hearing aids. They actually think they can compensate for poor signal to noise ratio by fancy DSP! Anyone who's done even a day's worth of recording knows better. Also, nothing will compensate fully for damaged hearing. There is nothing available that will "correct" bad hearing the way glasses can often correct bad eyesight.

"Regarding your own "moderate" loss, I would suggest that you get to a decent audiologist and get an audiogram, speech in noise tests, etc. At the very least, I think we all need to know what we're dealing with even if we decide to forgo the current ridiculously expensive hearing aids, at least until our hearing gets worse. Hearing loss is a very, very nasty condition with a lot of ramifications that go beyond not being able to hear - Katherine's written about Frank Lin's research on the association between hearing loss and dementia, for example. It is unclear whether hearing aids can help forestall hearing loss-related dementia, but it stands to reason that they might, at least partly."

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