2016: Will it be the Year of the Disruption? Gosh, I Hope So.

Hearing Health & Technology Matters
February 16, 2016

By Kim Cavitt, AuD

kim cavitt

Kim Cavitt, AuD

So, did my provocative title get you to keep reading?  Please say yes because it is important for readers to learn more about the disruptive forces at play in our industry.

Unlike many contributors before me, I see the audiology and hearing aid industry differently.  I do not fear the disruption. I welcome it because there are a few key facts that I cannot deny. The risks of untreated cognitive issues, dementia, depression, and, if you believe the preliminary research, early mortality, far outweigh the relatively small risks of a small percentage of later diagnosed, but treatable otologic conditions being diagnosed later or missed entirely.

At this writing, per NIDCD, “Among adults aged 70 and older with hearing loss that could benefit from hearing aids, fewer than one in three (30 percent) has ever used them. Even fewer adults aged 20 to 69 (approximately 16 percent) who could benefit from wearing hearing aids have ever used them.” These are statistics we should be just as concerned about. We KNOW we are currently leaving these hearing-impaired individuals behind. 

The 10-15% of hearing loss that is related to medically or surgically treatable otologic conditions only have the possibility of being missed with over the counter offerings.


Have We Missed the Signs?


Consumers for the past decade have been clamoring for lower cost amplification solutions, improved accessibility to technology, transparent, unbundled delivery and pricing options, and access to assistive listening devices and aural rehabilitation.  But, let’s be honest, we, as an industry, have not responded.  We have instead focused on increasing the average selling price and maintaining the status quo.

Consumers, in turn, have been searching for technologies that could meet their needs. They have gravitated towards Big Box retailers and various online solutions, such as personal sound amplification products (PSAPs), FDA regulated hearing aids, third-party administrated discount programs, and managed care-sponsored solutions.


Our failure to evolve and reach more of the hearing-impaired populace helped fuel these disruptions. We are not merely victims of circumstances.



How has retail marketing impacted the hearing aid industry?

First, and I cannot say this loud enough, to consumers, hearing aids are NOT really medical devices.  They are consumer products.  Now, before you shoot the messenger, hear me out.  When we market, via direct mail, newspaper, TV, radio and the internet, hearing aid price promotions (rather than services and audiologic care), this and that for “free” or “complimentary” (merely a classier way to say “free”), “buy one, get one: promotions and “trade-in” programs, we essentially made an FDA regulated medical device a retail product.  So, we now have to pay the piper and play in the retail sandbox.

That sandbox just happens to be chock-full of disruptive innovations.

Now, while I doubt most of you want to read the quintessential text on disruptive innovation, Clayton Christensen’s book The Innovator’s Dilemma, I do encourage you to read a short piece from the Harvard Business Review on the topic as it captures the key elements of Christensen’s work.   This will illustrate that audiology, as a profession, is a bit late to the type of disruption that has faced many other businesses.

For a profession based on science and evidence-based practice, we tend to ignore research when it does not serve our purposes. I strongly encourage you to read the recent works of the Hearing Aid Research Lab at the University of Memphis, the work of Amyn Amlani, PhD at University of North Texas , and all of the proceedings from the National Academies of Science, Engineering and Medicine as it relates to accessible, affordable hearing care.

All of this work points to the fact that there are value-based products currently available in the marketplace, both provider-driven and direct-to-consumer, which can remediate hearing loss in an easier, more cost effective manner.  In my work, both on my own and through my student mentorship at Northwestern University, I have touched, listened to, and/or studied many of these disruptive products.  I just did not assume they were crap because they were non-traditional, not picked by me or did not come from one of six companies; I sought to find out the answers myself.


What I learned is that there are many excellent value-based or direct-to-consumer products that can effectively fit mild to moderate, sensorineural hearing losses at much lower price points.  These do not replace traditional hearing aids; they expand the market.


Heck, I firmly believe that many of them will be “gateway drugs” to more advanced, traditionally delivered technologies. This is what happened to the prescription lens industry when reading glasses hit the market.  I encourage all of you to learn about these products, test them, and experiment on them with your patients. I have created a list for your review:


Value-Based Traditional Hearing Aids

Amplification Apps

Online Retailers/Mail Order/Referral Retailers

PSAPs and Hearables


Where do We Go From Here?



Pocketalker Amplifier

Now, all is absolutely not lost for the audiology profession. First, almost all of you have already dispensed a PSAP.  You just call it a Pocketalker.

Many of these new entrants into the market should be approached no differently. They offer the consumer an accessible, low cost alternative when their situation or needs warrant it. Actually, these disruptions, if we respond accordingly, afford us many opportunities to reach a new, untapped group or demographic of hearing impaired individuals.

Disruptive entities cannot provide the gold standard: an audiologic, diagnostic evaluation. They cannot provide a comprehensive case history and review of systems, the otoscopy and bone conduction testing required to diagnose a conductive versus a sensorineural hearing loss, speech-in-noise testing, real-ear measurement/speech mapping, aural rehabilitation, a personalized hearing aid inventory or a hands-on hearing aid fitting.  We can and should offer these things.

Research shows, time and time again, that when we practice evidence-based care, patient performance with amplification, improves.  We simply have to provide this level of care, consistently. If we provide this type of service-driven care and embrace consumers who procure their aids by non-traditional means, we will always have a valuable, irreplaceable role in the amplification delivery process.   Let us seize this opportunity by being engaged in these disruptions, rather than fighting them.

The train has left the station folks.  Are we going to get on?


Kim Cavitt, AuD was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career.  Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc.  Audiology Resources, Inc. provides comprehensive operational and reimbursement consulting services to hearing healthcare providers. She currently serves as the Immediate Past-President of the Academy of Doctors of Audiology (ADA), as a Representative to the Audiology Quality Consortium (AQC) and as a member of the State of Illinois Speech Pathology and Audiology Licensure Board.  She also serves on committees through ADA and ASHA and is an Adjunct Lecturer at Northwestern University.

  1. GREAT POST! Kudos on your bravery for saying what needs to be said. If we don’t shift our myopic focus from hearing aids to the big picture of providing comprehensive receptive communication needs assessment via the employment of a FULL RANGE of technologies and strategies, we will be left in the dust. Our future is in our hands and it’s time to be offensive, not defensive.

  2. Excellent and eminently sensible post. Thank you so much for taking the consumer’s needs and wallets into consideration. I hope this is widely read.

  3. excellent column, and I too appreciate your candor–we have to somehow co-exist in the sandbox:)

  4. Kim what a fabulous , thoughtful and frank column!! We have to be able to see beyond ourselves… the days are gone that no one really knows what we do. We now have to be accountable to the consumer !

  5. Yes, Dr. Cavitt, your provocative title did get me to keep on reading (though I would have gladly done so anyway knowing you were the author). It’s good to shake things up and explore and adopt innovative approaches to the delivery of hearing health care. Thank you for providing us with some good food for thought. I do have a comment, however. You state, emphatically, that to consumers, “hearing aids are NOT really medical devices” but that’s not what the data suggest. According to the latest MarkeTrak survey (MT9) when respondents were asked specifically about the medical vs. consumer nature of hearing aids, 43% reported that they considered hearing aids “definitely” a medical device, 28% considered hearing aids “more of a medical device” than a consumer product, and another 23% thought of them as “an equal mix” of medical and consumer product. Only 8% considered hearing aids as either “definitely” a consumer product or more of a consumer product than a medical device. The Consumer Electronics Association (CEA) study on consumer attitudes toward PSAPs is often cited as evidence for the public’s perception of hearing aids as a consumer product, but that question is never directly asked of the respondents. The CEA data does suggest that many consumers would like to buy hearing assistance products (i.e. non-prescription hearing devices) the same way they purchase reading glasses (this was a report on PSAPs, after all) but there is no mention about their attitude toward hearing aids.

    1. Thank you for your comment. I have always respected you and your work.

      In your comment you referenced MarketTrak IX data regarding whether or not consumers considered a hearing aid to be a medical device or not. I perused all of the publicly available MarketTrak IX data and this data you reference was not available in any of the information. This always has been and will continue to be my issue with MarketTrak data. I know of no entity, outside of HIA or BHI, that actually sees all of the data gathered, yet it is cited by those who have access. I, like many others, would love the opportunity to review all of the data, learn more about the respondents, and see what the trends are in patient/consumer perspective and sentiment.

      As the products and distribution model evolves, data and research will be tantamount in gauging consumer perspectives, performance and long-term outcomes.

  6. Does anyone know of an excellent hearing aid device for profound severe deafness (I have not much high frequency left in both ears) and work as a Hospital Orderly (20 yrs) and its getting harder.Plus my Phonak Nadia was a dissapointment compared to previous Phonak aids (that were robust/reliably consistent) and I put that down to being made in China (breaks easily within a short space of time average performance). Also not interested in getting Cochlear (why put parts in your head made in China). Thanks for frank column Miss.

  7. What a great post and thank you for linking all the different PSAP websites.

    I am convinced that if consumers were fit with:

    a. Durable basic hearing technology hearing aids – that provide good audibility for their degree of hearing loss
    b. their devices came equipped with activated telecoils
    c. Included in this fitting is either a Bluetooth TV transmitter or hearing loop amplifier (so that they can hear TV well – a huge issue for many consumers)
    d. And their house of worship or favorite public venue were to equipped with a hearing loop

    Their needs would be well met *without* spending the thousands of dollars that some now spend (or do not spend and go without) plus consumer satisfaction with hearing aids would rise dramatically. See here: https://goo.gl/f46c2O

  8. Wonderful post Dr. Cavitt!!! You really hit the nail on the head. I’m constantly hearing and reading that we need to show value for our services, so I am really glad you brought up the following:

    “When we market, via direct mail, newspaper, TV, radio and the internet,
    hearing aid price promotions (rather than services and audiologic care),
    this and that for “free” or “complimentary” (merely a classier way to say “free”),
    “buy one, get one: promotions and “trade-in” programs,
    we essentially made an FDA regulated medical device a retail product.”

    It makes it really hard for professionals to justify charges when FREE is the first thing the person sees and/or hears from advertising. When you advertise in such a way, you are already devaluing your services. Horrible! Another issue that I feel needs addressed is the absolute ridiculous number of tech levels that HA manufacturers put out. I truly find it unjustifiable, especially without sound research showing level 1 is better than level 2, 3 better than 4, etc…. Enough ranting 🙂

    Keep up the great posts!!

  9. One area where audiologists could make a dramatic impact on consumer satisfaction is to embrace t-coils and hearing loops. Accessibility needs to include the hard of hearing and that should be a priority for practitioners.

  10. Too many audiologists don’t tell their clients about ALDs and telecoils. They also don’t offer information on support such as hearing loss organizations and sadly many audioligists know nothing about state run deaf and hard of hearing services. Hearing loss support has been essential to my growth and confidence as hard of hearing. Those services I found all on my own after years of floundering. At least if a person doesn’t learn about ALDs at an audiologist office, they WILL at a support group. Five minutes or a flyer full of information would help people new to hearing loss tremendously.

  11. Dr. Cavitt:

    This “hard of hearing” reader is applauding you with great enthusiasm. Thank you for your prudent and thoughtful suggestions to your peers.

    While reading your article, I had a flashback. Do you recall a little company called that made film for cameras back in the 1980s? This Rochester, New York legacy was the only game in America. While I worked for them (as a contract employee) we heard about something called “digital” cameras. Well, bottom line is that this legendary company did NOT evolve quickly. They dug in their heels and continued to sell the high-quality film and high-quality photographic prints. They had the global market. They ignored the new products on the horizon.

    In 1989, along with 15,000 other global employees, I lost my job. That was a big lesson. Corporations (and industries such as the hearing health industry) need to pay attention to the consumers and competition.

    Since I will continue to be a hearing aid user, I thank you for raising this important topic.

    Oh, and by the way, it is my sincere belief that 2016 is “The Year of Hearing Loop.” Watch and see.

    Or better yet, will you join us?

    Best regards,
    Dee Bolemon

  12. While PSAP’s are needed to fit all populations, the simplicity of such devices will preclude the need for audiologists to be involved in the selling and fitting processes. The Au.D qualification will be well over the requirement for such professionals to be really involved in such basic products.

    Does it mean that it could herald the demise of audiology as a profession, and leaving it to be scientific interest only?

    Jay Muhury.

    1. Long term this is not out of the question since high margin hearing aids pay 90% of audiologist salaries due diagnostic work having terrible reimbursement….legitimate questions the profession ought to think about.

      Who wants to owe $120K or more for an AuD when you are now earning a salary commensurate to those with bachelors degrees or less?

      “I’m sorry, Doc I must not have heard you correctly: You said you make how much..and you went to school for how long? Eight years!!?!!? …That can’t be right, my dental hygienist makes more than that!”

  13. “Digital Disruption, Unleashing the Next Wave of Innovation” is the complete title to James McQuivey’s, best selling, analytic work out of Forrester Research. He Refers to the works cited by Dr. Cavitt as the basis for much of his research.

    McQuivey, and the team at Forrester clearly, and thoroughly investigate, then discuss both the opportunities presented by this “Digital Disruption”, as well as decisively delineating the management, and business structures that will be both the winners, and losers going forward. Using clear examples, and well researched analysis they apply the scientific method to business trends, and the chaos brought about by the digital age. It is simply a must read in these disruptive times.

    Oh, and given their research, there will be big losers. Those who fail to adapt, have silo-ed management, are isolated and insulated from internal, or consumer feedback will have little chance in a world that moves faster than their perception of their needs.

    When the Federal courts affirm that Walmart, Walgreens, or even your grandmother can sell hearing aids without your AUD, PHD, BC/HIS, ACA, or even a license of any sort, it’s time to wake up, or join those losers delineated so clearly by McQuivey, as having expired due to an inability to adapt to a very changed environment.

    Great Post Dr. Cavitt!

    Thank you for reaffirming the position I’ve been advocating for years.

    All the Best,


  14. Dr. Cavitt:

    Has anything changed in the marketplace and your profession since this post?

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