Hearing Aid Technology Levels: Time for a change?
23 December 2020
Hearing Aid Technology Levels: Time for a change?
I have been an audiologist in the UK for approximately 1 3 years now and ventured in to the independent sector approximately 5 years ago. When I transitioned from NHS to private, I was immediately struck with the phenomenal amount of choice that the client and audiologist have when picking the most appropriate hearing aid for their needs.
All hearing aid manufacturers have a system of offering varying levels of technology. It is a standardised system of 3 or 4 technology levels at different price brackets.
I may be alone on this, but I have always believed hearing aid technology levels are too vague and difficult to explain in evidence-based practice.
Hearing Aid Technology Levels
Hearing aid technology levels are marketed as the various performance levels of the hearing aid. As an example, a manufacturer may have the essential, standard, advanced or premium offering. As you go up in the levels you ‘unlock’ new features that may help improve the long term outcome for your client.
Common features that are unlocked include:
- Improved noise reduction
- Improved directionality
- Accelerometer integration
- Wireless communication between hearing aids
- AI and machine learning features
- Improved microphone input levels
Each of these features are designed to assist the client in a range of difficult listening scenarios. It makes sense on paper but when you start to think about it in more detail it starts to unravel.
Manufacturer sponsored studies on hearing aid technology levels
Many of the statistics that manufacturers openly share are from self-sponsored studies. This doesn’t mean that the studies are fundamentally flawed or conducted in an unethical way. It just means that there is a bias to be aware of.
For the purpose of this article I have tried to exclude manufacturer sponsored articles. Recent independent research in this field is quite limited but I have provided a brief summary of some of the studies below.
Independent studies on hearing aid technology levels
The main theme from the research I have conducted is that, ‘there is no evidence to suggest that premium-feature devices yield better outcomes than basic-feature devices from the patient’s subjective point of view.’ (Cox 2016)
However, Chinnaraj (2017) did find that, ‘wireless hearing aids do benefit the individuals with a mild to moderate degree of hearing loss in speech perception in noise and localization in the given stimulus conditions’. Automatic binaural directionality in wireless hearing aids is usually only a premium feature and so this is an important differentiator between the premium and lower models.
Both Johnson (2017) and Yu-Hsiang Wu (2019) shared similar conclusions. Both studies found that, ‘Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world.’
Summary and discussion of the independent research
As we can see, there is little recent independent evidence to suggest a significant difference between the basic and premium technology levels, particularly in a real world setting.
At this point though, I would like to highlight the significant limitations of conducting research in this area:
- Technology moves on too quickly. A new feature released by a manufacturer might be ground breaking and may demonstrate huge differences in performance, but research will always be two steps behind.
- You can’t generalise one study using one or two manufacturers to all manufacturers of hearing aids.
- There are too many variables. Prescriptions, processing strategies, ear canal shapes and size, acoustic parameters all have an influence on the outcome of a fitting. It is nearly impossible to generalise these findings across an entire population and even if you did, the technology would have moved on.
- Small sample sizes. Some of the studies actually had quite good sample sizes for a study in this field but even then we are talking about a limited number of individuals which will certainly affect the ability to generalise.
So what can we conclude from all of the above? That we can’t be certain of the benefit. If we can’t be certain of the benefit; then why are we charging our clients more for the privilege?
Without enough evidence, it becomes difficult for you as a clinician to provide your clients with an informed justification for your actions. So what other approach can you take?
Single technology level offering
A single technology offering could be the answer. You could fit the lowest technology level on offer by the manufacturers that meets your requirements. Your ethical justification could be that there is little independent evidence to warrant selling anything above it.
This is similar to the NHS model. For the NHS, the manufacturers only offer one technology level. It has a combination of basic and advanced features but is bespoke to their requirements. Which? Magazine found that approximately 80% of people that access NHS audiology are satisfied with their hearing aids. So this system clearly works for the majority. However, one of the main criticisms of the NHS is the lack of choice.
So how do we find the balance of finding the technology level that is right for the client, offer choice, and still leaning on the evidence we have?
I feel the answer may be to flip the NHS model upside down and offer a premium-only model with premium devices from multiple manufacturers. You offer the very best technology by each given manufacturer, but you assess the technology yourself against your own key criteria to create bespoke packages.
My team and I recently implemented a premium only. It appears to be working well for us. We all feel much more comfortable with the discussion and recommendations as we know our clients are always receiving the best technology available from the family of hearing aids on offer.
What do we offer?
We still offer 3 technology levels:
Each offering only uses top-of-the-range technology by a given manufacturer. So you may then ask, how do we differentiate our price points? It’s quite simple.
Our platinum offering is the hearing aid company that we feel offers the best overall product and service. We take into consideration hearing aid features, performance, design, ease of use, customer and tech support from the manufacturer, and logistics (such as next day delivery, extended warranty on hearing aids/receivers). We will review this annually to maintain independence.
Our gold range will differ according to the best product and deal that is available at the time. This allows us to remain completely independent. To help with price points we may do a bulk buy to bring the price down which allows us to offer the price competitively. However, it is still a premium level hearing aid. It is usually the sister companies of the major 6 that offer the best price points at this level, but we know that the build quality is just as good.
For our silver level, we prescribe previous generation premium level technology. It’s like getting an iPhone 11 instead of an iPhone 12. Previous generation products were released approximately 2 years prior and they are likely to be more robust due to firmware upgrades and improvements. We are also likely to have larger provisions of spares and repairs for this aid.
Benefits of premium-only model
We have seen a surge of clients going for our platinum package since introducing the premium only model. I’m not sure on the reasons for this. Perhaps it is the psychology of our clients only wanting the best?! It’s unlikely.
The more likely reason is that we are more comfortable at explaining the differences in the platinum, gold, and silver range. The very fact that we devised this new model demonstrates that we never really felt inspired by the previous one set by the manufacturers. This feeling of ownership with our offering will almost certainly come across in our explanations. We feel like we’re doing a better job, and perhaps it is this that is shining through.
Limitations of a premium-only model
There are of course limitations to this approach:
- It makes it difficult to be competitive with businesses advertising entry-level products.
- It may narrow profit margins depending on the price structure
- It requires more work to maintain the model to ensure the offering is always relevant and up to date.
These limitations will be difficult to justify and overcome for many businesses. The hearing aid industry is becomingly increasingly crowded, but perhaps this is a differentiator your business needs.
In future, I hope more hearing care providers will reconsider their approach to hearing technology price points. The premium-only model has helped to lead our business down the path of becoming increasingly service led and less product/technology orientated.
Perhaps though, the magic isn’t in the premium only model, but instead it is about taking ownership about what we offer. It may just be the process of self-reflection that has resulted in the positive outcome.
What are your thoughts on the premium only model? Do you see it as a viable option for your hearing care business?