The Hearing Aid's Pursuit of Invisibility (2016)

https://www.theatlantic.com/technology/archive/2016/08/the-hearing-aids-pursuit-of-invisibility/494387/?single_page=true

by tintinnabula • 9 years ago

45 36 9 years ago

theatlantic.com

pavel_lishin• 9 years ago

One problem is that invisible typically means small, and small typically means easy to lose - and at least with my dad's hearing aids, it means constantly worrying about accidentally knocking $1500 off the table and between some couch cushions, without noticing.

rhubarbcustard7• 9 years ago

Wearing smaller hearing aids isn't just about the look of them, they are actually much more comfortable and the designs of the in-the-ear piece of the aid lead to better sound quality and a more natural sound.

As technology improved the in-the-ear piece could become more 'open' in that it didn't have to fill the whole ear to avoid feedback, could be a soft tip that wasn't molded to an individual's canal and allowed in some unprocessed sounds that didn't travel through the aid.

It's so normal today to see people with something in their ear, usually Apple buds, and because hearing aid manufacturers have realised it's a smart move to stop marketing them as medical devices as such and positions them more as cool-tech hearing enhancers, I think the stigma of hearing loss and wearing hearing aids will soon be a thing of the past.

skybrian2• 9 years ago

Do you have personal experience with in-the-ear hearing aids? I'm curious how they avoid feedback. (Also, falling out.)

ShannonAlther• 9 years ago

(Also, falling out.)

More or less the same way headphones do.

Kluny• 9 years ago

They're shaped to your ear canal. It's mostly surface area and friction holding them in. They really don't pop out that easily. A motorcycle helmet will do it, though.

rhubarbcustard7• 9 years ago

Yeah, I've been wearing various different models for about 30 years, I'm 42 now. I've been blogging about is for about 13 years now, what started out as a blog has turned in to more of an informational site type of thing: https://www.hearingaidknow.com/

Modern hearing aids mostly avoid feedback by having a cancelling algorithm built in to the software - they are very effective these days and you would barely ever hear a squeak. But also, there's a type of hearing aid called receiver-in-canal/ear (RIC or RIE) which has the sound output in your canal and the microphone in a small unit behind your ear and because they are far enough apart feedback does not occur. I'm wearing GN ReSound Linx 3D RICs at the moment, they are amazing tech, I can remote programme them from my iPad and stream phone calls + music directly through my hearing aids.

As someone said in another comment it is friction holding them in, a moulded aid in the canal does fit snuggly, which is what I have, but for less severe hearing losses many people wear a round one-size-fits-all flexible rubber tip in the ear, it does press against the canal enough to hold it in place but is super comfortable.

I've never once had a hearing aid pop out of my ear and I've worn them doing all sorts of sports activities.

analog31• 9 years ago

My parents have both gone through multiple sets of hearing aids, at many thousands of dollars a pop. Based on their experiences, when it's time for me, I will design my own, and to hell with how they look.

One problem with miniaturization is that putting the microphone close to the speaker is a recipe for feedback. Separating them by even just a few inches should make a huge difference.

Also, if you don't mind carrying a bigger battery around, you can throw a lot more processing power at the problem.

I've read that you can get satisfactory hearing aids without a prescription in some countries, and that they are much cheaper that way.

skybrian2• 9 years ago

These days I hear Costco has a good reputation for good prices on hearing aids. There are also companies marketing "alternatives" to hearing aids, which I'm guessing is partly to avoid regulation.

https://www.nytimes.com/2016/07/19/health/hearing-aid-altern...

nom• 9 years ago

Agreed, if you don't mind the size or appearance you should be able to build yourself an awesome hearing aid today in no time. Use a good in-ear speaker, a good mic and an external controller in a box, based on one of the many DSP chips (or just a fast SoC).

You could add filters to attenuate/amplify certain frequencies to reduce noise or amplify speech. You could connect it to your phone via bluetooth. You could even add a realtime translator and have your own bablefish!

Animats• 9 years ago

many thousands of dollars a pop.

IHear Medical was going to disrupt that. They announced a hearing aid at $199 in 2015.[1] The price keeps going up; it's now $349, plus a $129 "programming kit", plus a support plan, plus accessories...

[1] https://web.archive.org/web/20150815012857/https://store.ihe... [2] https://store.ihearmedical.com/

rhubarbcustard7• 9 years ago

The whole industry is going to be blown wide open in the US very soon. There's a bill going through to allow over-the-counter hearing aid sales rather than having to visit and audiologist.

http://hearinghealthmatters.org/hearingnewswatch/2017/otc-he...

Up till now a "hearing aid" is classed as a medical device and requires a trained medical professional to fit it.

Everyone and their dog will be getting in on the act now.

randlet2• 9 years ago

I feel like I comment this on every hearing impairment thread on HN, but for me invisible hearing aids are an anti feature. I prefer to wear behind the ear models as they provide a visual clue to people that I'm hearing impaired and they are more understanding about having to repeat themselves. (I started wearing them in my early 30s and I admit I was pretty self conscious about them to start with, but quickly got over it.)

Also kids notice them sometimes and are usually not shy about blurting out 'hey what's in your ears?!?' which can lead to teachable moments :)

rawland• 9 years ago

I'm with you.

Made them even extra geeky for visibility:

https://twitter.com/RsCircus/status/777968784783110144

The wiring of the transparent case is orange too, as previously with the grey case:

https://twitter.com/RsCircus/status/480628806097858560

(Painting them [such that the color remains] was a bit cumbersome, however, I like it ;-)

randlet2• 9 years ago

That's awesome! I'm too much of a chicken to take mine apart... I couldn't stomach the replacement cost if I bungled something up.

rhubarbcustard7• 9 years ago

"teachable moments"

Amen to that. If more people were open and talkative about their hearing loss and aids then it would be a huge help towards complete social acceptance.

_m8fo2• 9 years ago

It's so sad that we're still culturally at a point where people care so much what others think in terms of their appearance. I mean if someone is, god forbid, hearing impaired and are wearing a hearing aid (oh, the horror), what's the big deal? I agree with rhubarbcustard in that an nigh invisible earpiece will probably have a superior overall function, but I wish people would stop the judgment.

On that note, I'd like to see extremely visible hearing aids, that way it signals to me to speak in a way that makes myself easier to hear, stigma be darned. I'm sure anyone reading this has had experiences not hearing someone because of a bad environment or mumbling, or something else. Ideally, if you see that someone is wearing a hearing aid you would pay respect to that and go even further out of your way to make sure they can hear you (though, you should do that for everyone really).

burntwater2• 9 years ago

If you grow up as a schoolchild with hearing aids, you will have a very different view regarding visibility. You can't hear right, you (probably) speak funny, and now you have this.... THING.. sticking out of your body, right at eye level, which is just ripe for other kids -- not even bullies, just other normal kids -- to tease and use as a differentiator when creating social groups.

rhubarbcustard7• 9 years ago

Kids can be evil and I got teased a bit too when I was at school. I've never experienced a negative reaction to my hearing aids as an adult though. Missing what someone has said has caused problems when they've maybe thought I was being rude and ignoring them or they said something and I answered with completely the wrong thing. So, I think as an adult not being able to always hear has caused reactions in people but not the visible hearing aids themselves.

victorhooi• 9 years ago

As somebody who grew up wearing hearing-aids, the real world is unfortunately nothing like what you describe especially with younger kids (although I agree it would be lovely).

Also, you might want to tone down the mocking just a notch (that, or I'm reading too much into your tone, possibly due to my experiences).

Kids will mock you, or try to yank on them. Or when you lose them, it's funny. I used to use behind-the-ear ones, and then switch to in-the-ear aids, to be less visible.

In the words of Mark Twain - "Human beings can be awful cruel to one another".

Now that I'm older, I tend to only use them in a work context - in social settings, I tend to prefer 1:1 meetups anyhow, which makes it easier (you can lip-read easier if it's just one person at close range).

For work, people are professional, and you can trust that it's fine. And look, honestly as an adult, you assume other adults are reasonably mature and won't judge you just because you have a disability. But yeah, for children, that unfortunately doesn't always hold true.

I've actually switched to behind-the-ear again - simply because the sound quality is better, in particular the directionality.

vbernat• 9 years ago

I've actually switched to behind-the-ear again - simply because the sound quality is better, in particular the directionality.

I just switched from behind-the-ear to inside-the-ear and one of the benefits for me is the directionality. With behind-the-ear, I was unable to precisely locate some sounds and what was happening behind me was always "clearer" that what happened in front of me (annoying in the restaurant where you can follow conversations from another table, but not from yours).

_m8fo2• 9 years ago

Ah, I apologize. My intention was not to mock or patronize. I'd edit the post to make that more clear, but unfortunately I'm no longer able to edit.

aaron695• 9 years ago

Not to reduce the importance of this is to the hearing impaired but if we can crack this I could see these being used by most of the population.

It is strange on something seemingly so simple we don't all augment hearing.

mcarrano• 9 years ago

Millions of people have some degree of hearing loss. Not all hearing loss requires a hearing aid but I have been wearing hearing aids since second grade.

My very first hearing aid was a "behind the ear" model and it was very uncomfortable when I also wore glasses. The technology then was not great as it simply just amplified sound. Further, it was very visible which made me conscious about my disability.

Later in high school, I moved to an "in the canal" model. This was less visible to others and the technology was a bit better. The hearing aid would be abel to help filter out background noise which made hearing people in loud settings easier.

My current pair of hearing aids are also "in the canal" but it does a much better job filtering background noises, can be environment aware to automatically adjust volume. There are models that even have bluetooth support.

I wrote an article several years ago on what I would like to see a future hearing aid be like: https://michaelcarrano.com/blog/google-should-develop-a-hear...

One thing that isn't talked about much, to my knowledge, is that no insurance will cover the cost of hearing aids. Good hearing aids are not cheap, the model I currently have cost somewhere around $8,000 for my pair.

nerdponx• 9 years ago

no insurance will cover the cost of hearing aids

Is this is ridiculous and unreasonable as it sounds to me?

kemiller2002• 9 years ago

Yes, it is. What is also really nuts is that insurance will cover cochlear implants. I mean it's cool that they do, but my friend explained it to me that the implants are a medical procedure and the hearing aids are classified as a "luxury item" or some such. The brutal and insulting part to the story is that he found this out because his daughter had cancer, and she lost her hearing due to the chemo therapy, which means that she was forced to lose her hearing due to medical procedures.

paulddraper• 9 years ago

Maybe. Most health insurances don't cover glasses either.

stefs• 9 years ago

i live in austria. for my current pair was mostly (50-75%? i can't remember) paid by my (public) insurance and the rest was covered by an organization for helping working people with hearing loss.

burntwater2• 9 years ago

I've worn a hearing aid since I was 4. I'm now 37, and while I've become much more open about my hearing issues, I still struggle with the issue of my hearing aid's visibility. Sure, I now have short hair (forced on me by baldness, really), sure I've opted to select a gray color instead a flesh color (thankfully, the gray is NOT (yet) to blend with the remaining hair I still have), sure, I'm much more vocal about making people aware of my "good side" and my "bad side" when walking and sitting.

But I'm still strongly resistant to the idea of adding a hearing aid to my other ear (in which I'm deaf, but the additional hearing aid would link with my current hearing aid, providing "stereo" audio of sorts). I know doing so would be a significant improvement in life -- I would be doubling my hearing capabilities, in ways. But right now I have alternate "good side" and "bad side" modes; the mode for hearing better (you need to be on my left) and the mode for hiding my disability (you should be on my right, unable to see my hearing aid). If you're an attractive female, my instinct is to have you on my right. Of course, if you're an attractive female who sits down at the bar on my right side, I will ignore you, because conversation is futile. I have to forcefully override this instinct.

In an ideal world, given current technology, there would be in-the-ear hearing aids that could wirelessly sync to my current behind-the-ear hearing aid, but that doesn't seem to exist. So I keep plodding along, basically waiting for the day when technology will FIX my hearing instead of aiding it. I expect I will be in my 60s by then.

Dunan• 9 years ago

I envy your ability to be open about your (partial?) deafness. I have normal hearing in one ear but am almost entirely deaf in the other, and have looked into getting a hearing aid for it. (I'm also blind on that side, and there is no fix for that.)

Society can be pretty vicious when you ask people to stand on a specific side of you, or turn your head 180 degrees so that you can point your good ear toward them, but I think if you have a visible hearing aid, people will be less surprised if you spring a request like that on them. Paradoxical, because the device means that you can hear them no matter which side they're on!

I feel like in today's era of ubiquitous headphones you could have even a hearing aid that looked like something else, and it wouldn't look that out of place. If I get a hearing aid, I'll go for a gray (or white, or black) one like yours.

rhubarbcustard7• 9 years ago

I guess you've looked in to CROS and biCROS hearing aids?

http://phb.secondsensehearing.com/content/hearing-aid-review...

I'm pretty sure you can get an in-the-ear version of these, which would mean you could wear and almost invisible aid in your other ear.

https://www.phonak.com/uk/en/hearing-aids/phonak-cros-II.htm...

dingo_bat• 9 years ago

And this is a problem, because deafness is a difference, not an impairment.

It was at this point I realized that the author is in heavy denial, even after decades of suffering. Deafness is probably the biggest impairment a human being can have, after blindness.

pfortuny• 9 years ago

As a matter of fact, my experience is that deaf people suffer much more isolation than blind ones. Human communication may be much more important than visuals.

rhubarbcustard7• 9 years ago

It can be very isolating. I try and make sure I'm in situations where I know I will have a good chance of hearing so I can stay in the mix.

Imagine sitting around the table with 20 people, everyone else is speaking Chinese and you maybe know a few words of the language - you might grab the odd word or phrase that people have said but you are not in the conversation really. You quickly lose track of what is being talked about and as time goes on, more and more topics are discussed, you realise you don't want to say anything yourself in case what you are about to say has already been talked about and you will look stupid. So you fade in to the background and just hope no-one pipes up with, "hey, Bob, what do you think about that?".

Modern hearing aids give you great tools to combat these situations and they do work.

I guess the difference for me really is that hearing is now hard work, it's not something I can relax and do passively, I need to concentrate on words, listen hard, lip read and fill in the gaps of context I missed. It can be exhausting, especially in big groups. I've just upgraded to a pair of GN ReSound Linx 3D aids, which are a massive help to me.

funkdified• 9 years ago

A recent survey of over 500 audiologists showed that the most popular (~70%) form factor of hearing aids today is the receiver in the ear (RITE). RITE aids place the hearing aid body (battery, mic, processor, etc) behind the ear, and run a thin plastic coated wire down over the front of the ear leading to the earcanal. On the end of the wire is a speaker (or receiver) that produces sound. This is an interesting shift from the past, where most people wanted hearing aids that fitted entirely in their ear. As it turns out the RITE is more or less just as invisible, but avoids some of the comfort and occlusion (blockage) issues that the fully custom in the ear hearing aids create. Either way, people want discretion, but RITEs have accomplished discretion with better performance, leading to the growth in their popularity. https://www.hearingtracker.com/audiologist-survey

libc• 9 years ago

I've worn hearing aids my entire life and manufacturers seeming to focus on miniaturization at the expense of capability always frustrates me. This isn't just driven by business interests though, DSP and EE at that scale are really hard and it's honestly remarkable what modern digital hearing aids can do with such limited resources. It does make me wonder though what would be possible if they just threw a lot of processing power at the problem, like say a Raspberry-pi sized processing unit concealed on the body connected to wireless mics/speakers. This would allow open the possibility to having more than two mics which could help with sound localization, which is something hearing aids are still not very good at.

Maybe it's because BTEs are the only option for someone with my degree of hearing loss, but if given the choice I'd gladly choose (or at least try) a more powerful/sophisticated hearing aid over a more aesthetically pleasing one, all other factors being equal.

The Hearing Aid's Pursuit of Invisibility (2016)

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