Gael Hannan, Editor
Hearing Views discusses important issues that impact both audiology professionals and the people with hearing loss that they serve. Topics range from education and advocacy to industry, technology and the client-professional relationship, and more. Comment Policy

By Michael Metz

On May 12th, Brian Taylor placed a post on this website about Samsung and Apple perhaps influencing the hearing aid field.  By now, everyone can probably discuss disruptive innovation.  If you don’t know about this concept and its application to the “P-stuff” in the title, you have probably been off the grid a little too long.  And, if you watched the FDA meeting on April 21st,  you may have some interesting conclusions.

There is a concept that concerns “low hanging fruit”—people will deal first with problems, solutions, sales, etc. that involve the least effort.  The parallel to the hearing aid industry is observable in that the industry serves at most 10-20% of the hearing impaired it seeks to help. This percentage has been stable for decades.  Those not served evidently require more than those who are receiving benefit from our present service model.

No one can predict the future but that doesn’t stop anyone from stepping up to the plate. Will PSAPs and the PCAST change the field?  How quickly?  Ian Windmill had some good opinions in a recent 20Q on AudiologyOnline. Here are some more opinions—hopeful, and not all that contrary I suspect.

Recall the entry of the “Big Box” stores and the rise of consolidated sales groups in the HA industry.  What were the effects on the industry?  Even before these two disruptions, there were attempts to introduce PSAP-like devices into the hearing aid economy.  The impact of past changes (disruptions) may have been substantial to some small companies and dispensers but hardly catastrophic to the industry.

If the past is any predictor, PSAPs will also have an effect on retail sales.  But, this effect is likely to be minimal, at least in the near term.  And, it will probably not disrupt manufacturers all that much.  Pseudo-Data (in technical terms—reasonable guesses) in support of this position:

  1. Of 33-36 million hearing impaired people in the US, about 2-3 million people per year get “typical” hearing aids. About 85% get two instruments.
  2. So, the hearing aid industry in the US sells between 2-4 million devices per year (4 million would be about 7% of 60 million potential sales—3-4% of the hearing loss population).
  3. If PSAPs take away as much as 15% of the sales, that comes to about 600,000 units—a significant number but not fatal to conventional instrument sales. (Here are two important keys—what “fruit” is first lost and who loses the most?)

Does this mean that the “Big Seven, or Big 8, or Big However Many” will counter by substituting regular, lower-tier hearing aids with PSAP-like products—both likely to have the similar wholesale profit margins?  While some manufacturers may venture into the OTC market, it seems likely that most will not disrupt their present profitable methods.  Especially when there are non-OTC products that are close in wholesale price to PSAPs and will support the present delivery system.  Of course, this argument then must evolve to treatment aspects—a topic crucial to audiologists.

Make no mistake; technology will go a long way toward solving hearing loss problems.  Think of the past 20 years and make a compelling argument to the contrary.  Would you expect that PSAPs would fail as often or more often than typical hearing aids?  (If not a higher failure rate—Yikes!)  When PSAPs evolve by adding adjustability, phone apps, or other modifications, these OTCs will become more like lower-tiered, conventional instruments.  Of course, these revisions will also likely increase cost.  And, some of these new PSAP users may seek help from a professional— help that will not be included in the PSAP purchase price.  And, so on…

Returning to the “low-hanging fruit”, what do manufacturers of PSAPs expect?  Do they think that there is a lot of potential for a product that ignores various levels of significant instruction and therapy?  What is the real potential market for these DIY things?  Surely no one is naïve enough to think that everyone needing but not using hearing aids would be a potential buyer and that they will buy one for each ear.  If PSAPs are inexpensive, how many have to be sold to reap the kinds of profits necessary to stay in business?  Just because a gigantic company participates doesn’t mean they don’t look on profit in the same manner as a smaller company.

It would seem likely that our present delivery system, in all its good and not-so-good aspects, will continue for the immediate future because it provides lots of help to lots of people.  (Just because the delivery system perseveres does not mean it’s as good as it should be.)  If Audiology adheres to the best practices in testing and rehabilitation, most dispensing audiologists will probably continue to prosper.  It would be reasonable to predict a slow adaptation of the PSAP, but if we are thorough, compassionate, and apply the best of what we know and can do, audiologists will adapt to the change—just like we did with all those past changes.  Even though painful, the adapting process might result in things getting done better.

Michael Metz, PhD

Michael Metz, PhD

Dr. Metz has been a practicing audiologist for over 45 years, having taught in several university settings and,  in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades.  Mike owned and operated a private practice in Southern California for over 30 years.  He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues.  He continues to practice in a limited manner in Irvine, California.

Angela Loavenbruck, Hearing Health MattersFrom Angela Loavenbruck, the Crabby Audiologist:

One of the reasons I love Facebook is that, in addition to its perverse ability to enable one of the all time great procrastinators, it makes it easier to run into people you haven’t seen for a very long time.  I recently became reacquainted with a young man whom I first met years ago when he was a curly haired six or seven year old not so happily sitting in my office.   Josh Valentine is now the Outreach and Communications Manager for Clean Coalition, a non-profit renewable energy group based in California, and in his spare time, he writes a blog about his experiences with hearing loss.   This has been a difficult couple of months for the audiology profession, and Josh’s blogs have been yet another reality check for me as I rethink (daily, folks!) whether I’m practicing what I preach as an audiologist.  With his permission, I am reprinting one of his blogs.  Reading his work reminded me that there is a hidden landscape going on in every scenario we try to create as audiologists – I wonder if I ever pay close enough attention to it.

Living with Hearing Loss

by Josh Valentine


I was diagnosed with moderate/severe hearing loss in both ears at the age of five. A hearing loss, or impairment, is a different kind of disability than deafness. While being deaf comes with its own culture and language, hearing loss is a largely invisible disability that can cause mental, psychological, learning, and overall health problems. While I do have problems with volume, there are certain frequencies I hear better than others. And the environment in which I’m listening to someone, or something, plays a huge role in my hearing success. Thankfully for me, my hearing hasn’t worsened too much in the 33 years since my first audiology test, but it most likely will when I hit my fifties or sixties.

My parents are neurotic New Yorkers, so the diagnosis set off a worry bomb in the Valentine household. Still, they became advocates for me. Aggressive ones. More often than not, their advocacy worked, but sometimes it backfired. It was selfish anyway: instead of advocating for hearing loss as a cause, they just wanted my teachers, camp counselors, friends, friends’ parents, everybody, to know not to give me a hard time. Hey – great for me, right? Well I’m not so sure I wanted all that attention.

When I was put into a New Jersey private school in the fifth grade in 1985, hearing aids were still large and highly visible devices jutting out of your ears. I wanted none of that. I never wore them. As they got smaller around sophomore or junior year, I still refused to wear them. Call it vanity. And I was a self-conscious, chubby high schooler surrounded by rich kids and underpaid teachers. I didn’t need anything else to validate any of my weaknesses.

My parents told the entire school. The deans, the teachers, the coaches, and the headmaster. By 1990, the Americans with Disabilities Act allowed for people like me to take “un-timed” tests. Yup – I could sit there all day and take a 45 minute test. Mrs. Stout, my sophomore year English teacher, wasn’t thrilled with the idea.

Stout taught the bible that year. She loved Jesus. She came from an Indiana farm and was probably a little bitter from the plethora of attention deficient, over-privileged kids in my class. I was a quiet and thorough student (never late, hardly absent, always did the work), but I think she still considered me just another spoiled brat.

The final exams at the end of each term were distributed in the gymnasium to the entire student body. We had about 60-90 minutes to complete the exam. I thought I was all set – UNtimed, baby! Not in Stout’s mind. She approached my desk, partially noticing that I was about three quarters of the way through, and said in her midwestern drawl, “okay, sir, your time is up.”

I politely reminded her that my test was to be un-timed. It was embarrassing for me to broach the subject, but I stood up for myself. She grabbed the test. I grabbed back. “But, Mrs. Stout, it’s un…” – the exam ripped in half. I wound up getting a C or something, which may or may not have contributed to my dad calling the dean and exclaiming to him, “that Stout is a major bitch!” He was my advocate, my dad.

Living with hearing loss has made me a profoundly focused listener, but that’s not limited to face-to-face conversations. Over 50 million Americans suffer from impaired hearing and many are in denial or simply unaware of it. I’ll keep advocating for myself and others to raise more awareness for this invisible disability.


Josh Valentine is a vegan, musician, writer, Bulldog caretaker, climate activist, skier, hearing loss advocate, and digital communications professional for renewable energy.


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