Signal & Noise: Are We Entering the “Just Good Enough” Era?

Hearing Health & Technology Matters
March 3, 2015
Brian Taylor, AuD

Brian Taylor, AuD

Hearing Economics is pleased to announce Brian Taylor as a new columnist.  Dr. Taylor plans to help us get to core concepts in a series of bimonthly discussions entitled “Signal & Noise.”  Today’s post marks his debut column, describing actual data to bear on outcomes from available ear-level amplification technologies.  Welcome, Brian, and thanks for bringing data with you!


A recent McKinsey report builds a strong case for the growing demand of medical devices that are “good enough. ” In essence, these are devices that are lower priced and don’t possess many of the value-added features that are often found in the premium category. According to the report, this new segment of the market – one that values no-frills solutions – is growing twice as fast as the industry as a whole in many medical device categories.

Quoting the report, “as decision makers become more cost conscious and competition intensifies, opportunities to serve value-oriented customers in medical devices are growing fast…..the key to success does not always lie in changing the product itself, but could involve altering sales models and service offerings.” Although this report doesn’t directly mention hearing aids, it is not too big of a leap to draw parallels to the commoditization of technology occurring within our own profession.


Outcomes Data for Hearing Aid and PSAP Technologies


As this recent peer-reviewed article attests, higher cost, premium hearing aids do not provide superior outcomes when compared to lower cost, basic level technology. In a carefully designed study involving 25 participants, the researchers compared laboratory speech understanding tests, standardized self-reports, and open-ended diary entries for four pairs of hearing aids: two basic and two premium level.

Results of the month-long field trials showed no statistically or clinically significant differences between the premium and basic level hearing aids on any measures of outcome for either new or experienced hearing aid users. The results of this study suggest that hearing aids, regardless of technology level or price point, provide patients with favorable laboratory and real-world outcomes.  It should be noted, however, that all hearing aids evaluated in this study were painstakingly fitted using best-practice protocols, which likely contributed to the across-the-board positive outcomes.

Similarly, in an unpublished research study that compared basic and premium devices to two different high-quality PSAPs, the researchers found that both types of conventional hearing aids were rated higher than PSAPs for listening to conversations in quiet. Conversely, for two other listening conditions, listening to everyday noises and music, the PSAPs performed as well as the conventional hearing aids. Like the previously mentioned study, all the devices were meticulously fitted using standard protocols.


Emerging Trends in the Data


Obviously, more research examining the benefit of various levels of amplification technology is needed, but some trends are beginning to emerge:

  1. Following a best-practice protocol trumps the level of technology being dispensed. In other words, hearing aids with basic technology fitted by a professional using a standardized approach are likely to outperform premium products taken straight out of the box and placed onto a patient’s ears using a minimalist protocol.
  2. Feature creep adds complexity, cost and time, but not necessarily value. Every 12 to 18 months hearing aid manufacturers launch a new product with updated features. For about two decades, this has been an effective strategy because the marketplace (audiologists and hearing instrument specialists) is on a quest to provide patients with the latest innovations to address their needs. According to the peer-reviewed study cited above, these incremental improvements in feature performance don’t equate to incremental improvements in patient outcomes. Cost controls by third-party payers and large purchasing organizations as well as the use of evidence-based decision making by clinicians may be the only ways to stymie feature creep.
  3. High-quality PSAPs that meet a strict performance criteria may be “good enough” for some patients – it’s up to hearing care professionals to ensure those criteria are well-defined and verified for every individual.

If It’s Good Enough for Consumers, Is It Good Enough for Audiologists?


The commoditization of amplification technology does not necessarily mean the sky is falling for the profession. After all, professional expertise and judgment are needed to verify that any amplification device, regardless of sophistication and price, has a smooth, undistorted frequency response, along with other acoustic characteristics of a well-fitted hearing aid. Expertise, judgment, and patience are also necessary in the long process of helping people overcome the myriad behavioral and societal consequences of gradual, adventitious hearing loss in adults.

Rather than the sky falling, the rise of the “just good enough” market is an opportunity for audiologists, hearing instrument specialists and others associated with our professions to broaden the scale and scope of patient offerings.

This is Post 1 in the Signal & Noise series.  Click here for post 2.


Brian Taylor, AuD, is the Director of Practice Development & Clinical Affairs for Unitron. He also currently serves as the Editor of Audiology Practices, the quarterly publication of the Academy of Doctor’s of Audiology. During the first fifteen years of his career, he practiced clinical audiology in both medical and retail settings. Since 2005, Dr. Taylor has held a variety of leadership & management positions within the industry in both the United States and Europe. He has published over 50 articles and book chapters on topics related to hearing aids, diagnostic audiology and business management. Brian has authored three text books:  Fitting and Dispensing Hearing Aids (co-authored with Gus Mueller), Consultative Selling Skills for Audiologists, and Quality in Audiology: Design & Implementation of the Patient Experience.  His latest book, Marketing in an Audiology Practice, will be published in March, 2015.  Brian lives in Golden Valley, MN with his wife and three sons.

feature image courtesy of Cambridge in Color

  1. Brian,

    I’m not sure if I’ve shared this with you already, but we just did a three part series on the Soundhawk PSAP device – I think your readers would enjoy it. The first part of the series offers a commentary on PSAPs for hearing loss, and showcases the performance of the Soundhawk (and remote microphone) in a testbox. We also provide some recorded sound samples. The second part of the series discusses the effective fitting range of the Soundhawk – deduced using open-fit REMs. The last part is an official response from the Soundhawk Chief Scientific Officer, Drew Dundas, PhD.

    Here is Part I:

  2. Brian:

    Thanks for the well written article.

    However, a few questions pop to mind regarding the claim that ‘best practices’ trumped the quality of the gear being used, and that basic gear performed as well, and to the same expectations at the premium gear.

    First; There was no discussion of the brand, features, or model of either the basic, or premium aids referred to. Is it the author’s contention that manufacturer, model and chip series is irrelevant to the success of the fitting?

    Second; In the argument for ‘best practices protocols, vs. out of the box. No mention was given of either what those ever moving ‘best practices’ were, nor was their any description of the out of the box abbreviated one. Is the author comparing an elaborate set of protocols, vs none? How many? Or, what type of protocols and what were the differences?

    Lastly, a study with a breadth of twenty-five participants conducted by folks who may have an agenda regarding the amount and type of protocols to apply in both the ‘best practices’ and out of the box scenario seems rather thin, even if peer reviewed.

    Rather, I would like to see a study comparing patient satisfaction, and perceived value on a published array of the products our industry has to offer, and see if ‘best practices’ actually trumps the simplified In Situ Audiometry, protocols and that out of the box fitting so panned.

    But, naming names, and calling out brands as to what is being compared in these peer reviewed studies is something rarer than than open platform hearing aids, and add on hearing aid apps at the app store.

    Though I do believe we’ll see more of both in the future, at least the apps, and open platform instruments, in a DYI fitting using on screen, easy to follow instructions that will give a fit as good, or better than that extensive list of ‘best practice’ protocols, our industry seems so enamored with.

    Thanks again for the well written article,

    Best Wishes,


  3. I second ‘Dan’s’ question of: What were the best fit protocols used. I absolutely agree that the technology is only as good as the fitting, but am curious what this study cites as best practices.

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