hearing industry bugaboos

Tackling Two Big Bugaboos in the Hearing Industry

by Paul U. Teie, MS

There are two big bugaboos in the hearing industry these days.  Well, OK, there may be more – there are OTC hearing aids, audiology assistants, the pointless enmity between audiologists, hearing aid dispensers and ENTs, and I’m sure we could come up with others.  But the two that seem to be generating the most discussion these days are (bring up the spooky music) Big-Box stores and Internet hearing aid sales.  

Not to put too fine a point on it, everyone seems to hate these two entities about equally.  The biggest complaint is that both undercut the rest of us big-time on price-point. We have all developed our little spiels to counter these looming behemoths. 

I recently heard an industry big-wig say that within 5 years, Costco will almost certainly overtake the VA as the number one dispenser of hearing aids in the US. And online hearing aid sales are taking off as well. 

Just look at what Amazon has done to the retail world, not to mention the patients coming in with their piles of print-outs. These are indeed daunting competitors; it would be naїve to suggest otherwise. The question is, what can we do about them? 

First, we can stop wasting our time complaining.  There is absolutely nothing to be accomplished by moaning about the big-box business model.  There is nothing illegal or unethical about selling hearing aids at a low cost. Besides, most of us do not wish to follow that model.  

As for limiting internet sales, the jury is still out.  Our great hope is that state and/or federal legislation will put a damper on things.  How is that working out for us so far? About as well as any legislation these days. If we think we can bend all legislatures to our will on this account, may we live blissfully on in that delusion. 

Unless federal legislation is enacted (yeah, right) or all state legislatures to get on board, it will be pointless.  And say that happens – they move their servers overseas and give us all the Bronx cheer from across the waves.  


What Options Do We Have?


So, are we powerless?  Over what they do, probably.  Over what we do – NO!  Among the things that we can do are educate and adapt.  

Educate – We can take the time to educate our patients and the health care providers that refer to us, the benefits of the kind of care that we can provide. 

We provide personnel, infrastructure and service that online and big-box outlets eschew in order to keep the cost of their hearing instruments low. These are not small considerations.  Focus on what we do rather than on what they do not do.  

Adapt – Change or die.  It’s that simple. As an industry we do not adapt well to some kinds of change.  For many years, hearing aids and their industrial support infrastructure shifted only incrementally.  All that changed in the mid ‘90s with the introduction of fully digital ear-level hearing aids. Since then a new generation of digital hearing aids has come along on the order of every 12 to 18 months. 

We have been reasonably good at adapting to this kind of change in hearing aid technology. Just look at how quickly the industry adapted to the introduction of non-custom mini-BTE hearing instruments with non-custom ear couplings.  


Prepared for Change?


When it comes to process, on the other hand, change comes hard.  When was the last time you obtained speech-in-noise measures? Oh, I see, it takes too much time and besides doesn’t really help me sell hearing aids?  Seems to me that when virtually every hearing aid we dispense has directional microphones to help our patients better understand speech in noise, so it stands to reason we might want to know how well or poorly our patients understand speech in noise.  Just sayin’… 

Or how about real ear measures?  It embarrasses me how few hearing care providers routinely verify fittings via real ear measures (and I don’t mean, I fired it up once last year).  

Again, there is that pesky time issue.  I was admittedly part of the problem for many years but found that when I broke down and started doing REM all the time, it started taking less time at the front end and saved much more time on the back end.  Because my fittings were better the first time around.  

“And aren’t hearing aids so good these days that you don’t really have to verify anyway?”  Well….NO! And isn’t this the very argument online hearing aid dispensers are using to sell hearing aids to your patients?

So here comes yet another new technology that we need to start thinking about using – remote care. Signia and Widex are in the process of launching remote care capabilities (there may be others, if so, let me know).  This will allow the hearing care provider to make remotely the same hearing aid adjustments that now must be made in the office. 

Very cool! But there will be an inevitable learning curve and therein lies the Achilles heel. We must change the way we interact with our patients in order to fully take advantage of this technology.  That is not going to be easy.  

Well, maybe it will go away.  Maybe it won’t work after all.  Maybe our patients won’t want it.  

Don’t bet on it!  

Online vendors will be all over this technology.  If it is successful and if things go as I have observed them over the years, remote hearing aid adjustment will be available in virtually all hearing aids within 2 years. 

How long after the introduction of the Widex Senso did 90% of HA manufacturers have fully digital hearing aids – and how long after ReSound Air came out did virtually all manufacturers have mini-BTE slim-tube hearing aids?

Change is the one thing most people dislike even more than the way things are.  Change is hard and it just doesn’t feel good.  It is awkward and time-consuming and the first couple times I do a new thing, it makes me feel stupid in front of my patients.  

So I don’t do it.  

And nothing changes.  

Hence, well, nothing changes.  

Hearing care providers have shown great adaptability to hearing aid technology, but not to process.  Just look at the audiometric test battery.  It has been virtually unchanged for 50 years.  If we can’t even stop insisting on the use of a diagnostically weak test like SRT (don’t get me wrong – it’s the first test I do, but I recognize its uselessness) and fail to integrate diagnostically and habilitatively strong measures such as QuickSIN and REM and remote care, how do we begin to make other changes that will set us apart from the big-box and internet vendors of the world. 

I will let the Bard of Minnesota’s Iron Range, Bob Dylan, have the final word:

So you better start swimmin’ or you’ll sink like a stone;

For the times, they are a-changin’!

About Paul Teie

Paul Teie has been an audiologist since 1992, spending 15 years in direct clinical care. For the last 12 years he has found his true calling as a teacher and is currently National Educational Specialist with WSAudiology.


  1. I teach classes about becoming an informed consumer of hearing aids, and the fear of being scammed when buying a hearing aid is alive and well. I’d like to add one more to your list here, and that is the battle to recognize audiologists and hearing aid dispensers as professionals, and not profit driven sales people. One way professionals can help themselves is the point made here about education. I’d also like to reference the article in JAMA in October 2018: https://jamanetwork.com/journals/jama/article-abstract/2702687 Hearing Care? Focus on Clinical Services, Not Devices.
    Until we can differentiate the services that audiologists provide the business model will continue to be under attack, so unbundle those receipts and contracts!

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