by Kathryn ‘Kat’ Penno
It’s no surprise that the healthcare industry has gained a lot of attention and media hype about being ripe for disruption. Audiology and the hearing aid market, in particular, is an interesting case. For many years the majority of the audiology profession has relied on a product to generate most of its revenue. I want to highlight the need to unbundle the product from audiological services and stress that these two need to be separate but are equally important business components that need to work seamlessly together. I’ll also go over where hearing technology is evolving and how we can leverage this to improve audiological awareness in the community and ultimately improve our service delivery.
The Hearing Aid Market: Let’s Compare Apples with Apples
The hearing aid market is currently an oligopoly and I believe that this market is certainly ripe for development (rather than disruption), however, factors such as high entry to market costs, years of research and development, mergers, economies of scale and restrictions and patents makes it difficult for new companies to enter and thus develop.
Because of the oligopoly we are seeing the rise and evolution of new types of hearing technologies. Personal Sound Amplification Products (PSAPS) and hearables are becoming more acceptable as an entry level management product for the mild to moderate hearing loss category. This product category is a perfect opportunity for audiologists to engage with these new technologies, offer them as solutions and begin the counseling and education process of hearing loss as a service component, to a category of hearing loss that is largely untouched by our profession.
To be clear, hearing aids are a medical grade device which have passed regulations by the Therapeutic Goods Association, Federal Drug Administration and other regulating associations world wide. In contrast, PSAPS and hearables/wearables/hearing products are not classified as a medical grade device. These products have a different intended use, are not regulated by the same associations and therefore, are competing in different markets.
Remember that those diagnosed with hearing loss that were recommended to wear hearing aids but instead choose to buy non-medical grade devices are choosing a substitution for hearing aids. Thus we need to compare apples with apples if we are going to analyze major market changes or shifts within the hearing aid market. These non-medical grade products should be viewed and managed as gateway products to hearing aids.
Audiologists are in a unique position to leverage these two markets to optimize our services and develop into a more relevant and well placed health profession in a technologically driven world. Our knowledge, services and insights can be used to improve these technologies, whilst also adding value to the client for when other audiological services may be needed. Some hearing technologies are claiming to disrupt the hearing aid market, which is good marketing, however hearing technologies are in a different market to hearing aids.
Though the lines between each device category may be blurred to the client, as a profession we need to ensure we remain ethical in our professional recommendations to the clients needs and offer solutions and choices to our clients, these include PSAPS or hearables.
Emerging Hearing Technologies
The market potential for wireless headphones and hearable technologies has been estimated to be between $USD12 billion to $USD 40 billion; it’s no wonder this area is gaining traction.
Research shows us that the mild to moderate hearing loss category is largely unfitted, with hearing aid penetration rates in this area being less than 10%. With recent legislative changes in the US that will soon allow Over The Counter (OTC) hearing aids to be sold, it makes sense that this market has emerged. Brands such as Wear and Hear headphones, Audeara headphones, Nura headphones, Nuheara earbuds and Bose Hearphones are all products that are marketed largely to normal hearing individuals, with the exception of a few features that are marketed to the mild to moderate hearing loss category.
This niche market, within a niche market, has been largely untouched for years and now tech start ups are emerging globally with a key focus on high quality, personalized, smart products. They can see the value in this market and are developing solutions to address it.
For example, Nuheara earbuds IQ boost use the prescriptive formula NAL-NL2 plus the EarID to obtain as close to one’s hearing profile as possible to provide accurate and unique sound profiles. Additionally, Nuheara now offers accessories such as the IQ Stream TV that strives to create a complete “hearing ecosystem” to enhance listener’s quality of life. Similarly, Nura headphones uses otoacoustic emissions (OAEs) to screen one’s hearing profile to offer personalized sound to that hearing profile. Audeara headphones perform a similar screening like Nuheara to ‘tailor your sound’ from the results.
Given these advances in hearing technologies, the affordability, ease of access and what they promise to provide, it’s no surprise our potential clients are exploring them as alternatives to traditional professional services and hearing aids.
Further, the marketing materials are excellent and highlight key features of the product, whilst penetrating and saturating social media and online marketing, as well as taking a retail path. These features, such as tailoring to your unique hearing profile and automatically adjusting the music or actively cancelling out the background noise, are certainly impressive features that may attract people with hearing concerns, and because of these features you can understand why the client may be motivated towards a PSAP or hearable device.
These brands have similar features that help market hearing thresholds or profiles and, to some extent, the importance of hearing and personalization when it comes to sound (or cancelling out noise).
Why aren’t we capitalizing upon these marketing materials and products to funnel clients into our clinics? These products could go a long way in raising the awareness of how important hearing is to each individual and by incorporating them into our services we could encourage further innovation in this field.
Do you remember the advertisements where we could see the dentist’s back and they promoted a toothpaste brand? How can we leverage our skills and knowledge to help define the functionality of PSAPs and Hearables to promote or endorse the correct device for our clients with mild to moderate hearing loss?
Patents pending for more established brands include Samsung, Apple and Bose (to name a few) reflect how large the hearable market potential is. At the same time we’ve got to think beyond the hearable hype. Hearables are certainly developing quickly, but where are they going?
I believe the hearable/wearable and voice assistant markets are only in their infancy. I believe that our eyes have reached screen time saturation. We spend on average, 11 hours/day in front of a screen or on a screen/device. So where can we go to next?
As an audiologist I can see how a hearable plus voice assistant makes sense. We use our voice to speak and ears to listen, so it makes sense to me that we pair hearing technologies to voice assistant devices to optimize our client’s quality of life and care.
Hearables will be a gateway product to voice assisted technology and hearing aids. If we capitalize upon these hearing products now we will be setting ourselves up for the next phase of technology such as the voice first or voice assisted technologies. As people live healthier, longer lives, we must support the needs and demands of clients wanting to live at home longer and to a have better quality of life.
Voice Assistant Technology
So why voice first? An aging population that has sensory loss in their fingers and issues with their eyesight will have a difficult time navigating a smartphone screen, however they are used to using their voice and may feel more confident to use their voice to command or ask questions. We also are beginning to see large companies making significant investments into voice assisted technologies and we should all try to be come more knowledgeable in this area given the prevalence of hearing loss in an aging population. Additionally, the older population is the largest age group to be adopting and using voice assisted technologies, again more reason for us to be involved in this area of healthcare technology utilization.
Voice assistants are in their infancy but they are emerging and they will make an impact. When the smartphone emerged it was slow to process or load pages and images, the screen wasn’t as clear and connectivity was poor. Now more than two thirds of the world owns a smartphone. Next came the application (app) store. The app store was initially odd to integrate into our daily lives, however as people got used to downloading and integrating the apps into their everyday lives, developers focused on quality content, user experience and interface and now we use apps every day without a second thought.
The data transfer to and from applications is commonplace in our lives. The phase we are now shifting into is wearable technologies. Apps are being designed to be more seamlessly integrated into wearables, for example tracking and monitoring heart rate or sleep patterns over time without having to use your smartphone to check the data, one can manage and check information via the wearable. The smartphone becomes the middleman.
Which leads me to think: What will happen to the middlemen over time? Are we middlemen somewhere in this equation, and if so, how relevant will we be when a hearing aid becomes open source?
The point is these new products entering the market are not hearing aids. They have a lot of good features that can help normal hearing and some hearing losses, they are competing in a larger product pool, they are cheaper, more disposable and are not entirely designed to do what a hearing aid can, but they certainly offer a lot. Hearing aids are becoming more advanced too; including artificial intelligence and machine learning capabilities plus the features of the PSAPs/hearables, plus an application to control the hearing aid to some extent, plus biometric measurements and fall detection and sometimes even remote audiological care and application in this extended equation.
We need to be thinking about how we can incorporate these technologies into our practices and into the lives of our clients, because in the near future they may all be accessible without the middleman and therefore it is vital for audiologists to remain relevant. In a technologically changing world the only viable strategy is to adopt.
To some extent I believe it is our responsibility to ensure that the blurring of these products is clearly communicated to the client to set realistic expectations of what a hearing device can do. At the same time it is also our responsibility to ensure we meet the demands of the client.
How can we do this individually, in a business, organisation and as a profession when the technology seems to capture the attention of the client and not the skills, knowledge or services of our profession? How do we ensure these work seamlessly together?
We should also note the number of crowd-funded startups that have raised capital to bring a hearing or ear related product to the market. Some have managed to raise $650K to $3million showing the popularity from the public of these products. Some of these startups have evolved into successful businesses and some have not. The ones that have not been successful from the crowd funds have gone on to work for larger hearing technology companies or hearing aid brands and made some incredible products.
We’ve got to remember it is the public that exchanges their time and money for our services and if we can’t offer them a holistic service and or product package, how can we expect to remain relevant?
The Importance of Relevance
As I stated above, we must incorporate both service and products seamlessly to remain relevant and this goes beyond just provision of hearing healthcare. From a preventative and protective point of view, I believe that relevancy keeps our message at the forefront of the client’s minds and helps minimize the impact of preventable hearing losses and ear health.
If you think back to the original 80s sunsmart slip, slop, slap with Sid the seagull campaign, the skin cancer council aimed to implement preventative and protective measures rather than reactive ones to skin cancer protection. The skin cancer council came up with a catchy jingle and easy to remember motto, which I can confidently say most Australians know off by heart and it is regarded as one of the most successful health campaigns in Australia.
Not only did the skin cancer council manage to change people’s behaviors with the campaign, they also shifted people’s attitude to being positive towards skin care protection. I can anecdotally say that most people I know use sunscreen and we are more proactive about being smart in the sun and protecting our skin. This in turn has seen a reduction in the rates and severity of skin cancers being detected at the deadlier stages and Australians are well aware of the need to protect against skin cancers as much as we can.
Do you think we need something like this when it comes to implementing and changing people’s behaviors and attitude towards hearing protection and hearing loss? I think so.
If we don’t strive to implement different measures I fear our profession will remain reactive and preventable hearing losses an afterthought. We have all of this amazing research that shows us how long people wait to use hearing aids, adoption rates of hearing aids and the impact of those who wait to use hearing aids on socio-emotional psychology. Why haven’t we been able to translate this to our normal and mild to moderate hearing loss category?
Remaining relevant is a key factor to ensuring the value of audiological services is prominent when people need it.
Tele-audiology has not received much notice, in fact, I’d go as far as saying we focus too much on the products rather than how we can incorporate them into our services and how we can improve service delivery. Did you know that physiotherapists, occupational therapists and a dentist are offering tele-health services here in Australia? I know there are remote services being offered in-house by some hearing aid companies, but what’s next for service deliveries?
There are a few startups in Australia, and across the world, doing a good job of getting the government’s attention and funding towards better access to hearing health care and screening tools.
Are audiologists and our professional bodies doing enough to engage the wider community to promote our services?
I don’t pretend to have the answers, these are just my observations and questions from what is occurring in the hearing technology market and what I discuss with my work colleagues, family, friends and clients in the clinic.
I am hopeful about the developments in the audiological industry and I hope we can work collaboratively within our profession to improve the awareness of our services and incorporate hearing technologies to improve our client’s quality of life and connectedness.
Kathryn ‘Kat’ Penno is an audiologist residing in Perth, Western Australia. Kat has recently launched an online audiological business to offer tele-health consults. As well as the audiological driven component, she is working towards establishing an online healthcare referral network where other healthcare professionals working online can refer to each other. If you are interested in more please email: firstname.lastname@example.org
Kat is passionate about improving the awareness and importance of professional audiological services. She is also keen to promote education around preventing noise induced hearing loss and getting people thinking about hearing loss management earlier. She is interested in people and how they communicate, technologies for better quality of life, online service delivery platforms and giving people choices in how they receive their health care. Kat believes in quality conversations, spending time with family and friends, road cycling adventures plus good food and fine wines.