What if, instead, the calibration process worked constantly? Give the user a button to press when they don't hear something well, and another when they do. Let them have this for a month, let them try it in their kitchen, their bedroom, the local shop or bar, outdoors. Run some reinforcement learning algorithm to optimize for getting more "good" presses and fewer "bad" ones. Optionally, adapt separately to each environment.

Is there a "smart" hearing aid calibrator that works like this? If not, but you think it's plausible, I'm interested in working on it.

This may not apply if your hearing loss was sudden, but many people get hearing aids only after years of decline. Your brain adapts to what it has available and you learn to hear as best you can with the limited stimulus. When you finally get hearing aids, it feels like your ears have been unblocked.

When it comes to interpreting speech though, especially in noisy circumstances, you have to give it time. Your brain isn't used to using the extra stimulus to interpret speech. In fact, it may have gotten used to hearing loss filtering out background noise and you may initially find all the stimulus makes it harder to interpret speech because of all the background noise you now hear that you previously didn't.

If you don't have patience and start immediately futzing with volume all the time, you never give your brain a chance to adapt, and will be very dissatisfied.

When programmed properly, I find my hearing aids on their various speech modes to sound distinctly artificial and processed. I imagine it would be jarring to the uninitiated. Like a good speech codec or vocoder. It's unlike anything else.

But having grown up with DSP hearing aids doing this all my life, I find speech coming through them very comprehensible, often shockingly so compared to my normal hearing -- even with other amplification like regular headphones. I do dislike my hearing aids for music, though, even on the normal or music settings.

I have many ideas about how the industry can be improved, especially with the use of a smart phone app and user interactions.

Not only is it plausible, but would make the clinicians (fitter) job easier and lead to far more hearing aid sales.

Based on my observations of my father's struggles with various hearing aids, hearing aid smartphone apps are just as terrible as any other apps developed by hardware manufacturers. Don't expect the "clinicians" to help with this aspect either, because they were trained on a previous version of a different app and how could they be expected to figure out the apps that are used now?

then there's also additional complications like types of hearing loss impacting calibration - some people react very negatively to higher (or lower) frequencies than others do, to the point facial stimulation can happen, and some people just have a frankly tricky profile that requires a trained audiologist on hand to work with them through several sessions, if not outright yearly on top of that, since the nerves and brain output can change by itself.

(source: have a cochlear implant, been doing the described experience since I was ~ 3yrs old.)

I've had audiograms taken on moderate and bad days, and the difference in frequency response was significant (up to 30dBA difference across only the lower frequency bands).

On TVs, they call those buttons volume buttons, it is revolutionary.

And just like the TV remote they increase all sounds - good (speech) and bad (music and explosions).

The issue is not just "is it loud enough" but rather, "can you understand what you want to hear when you want to hear it?"

imagine yourself at a busy restaurant. you want to hear your spouses speach better, and the wait staff- but turning their speech up also turns up the people you do not want to hear.

how do you fix that?

noise reduction, speech enhancement, directional microphones are just some of the tools a hearing aid uses.

But ultimately what needs to happen is your brain works harder at comprehending what you want to hear(yes, it is work, and like all work people do not want to do it).

So they think...hmmm, I will just pay $xxxx.xx and I wont have to work anymore.

Whether like me, you never got the hang of a retainer after braces - or went off braces too soon, in my case - there has been a number of companies trying to get costs down and make the process less expensive and onerous.

Yet, talking to my regular dentist, who has used Invisalign with patients before, it's not the fact that there are more competitors in the field, essentially putting pressure on the DMD's and others to up their game, it's that after the initial consult, the entire process is (largely) unsupervised.

If you don't fit (or tune) something like this properly, it doesn't work.

Also a problem if you're not a native speaker. I am fluent in English and have been able to watch movies without subtitles for 20 years at least, probably more.

But put me in a noisy bar and my error correction suffers a lot. Suddenly it's hard to follow a conversation that in my native language would be effortless.

The worst situation is listening to a loud video on bad speakers. Doesn't matter how much you crank the volume, people are hard to understand because the brain's error correction isn't good enough. Use a good speaker and turn down the volume, suddenly it's perfect.

This is of course a huge oversimplification, and aiming for it is probably what the industry is doing.

but your idea is great too. if you can't hear one frequency, let's amplify all frequencies till the one you need gets loud enough, and go deaf to the other ones in a year. when you get old and need a hearing aid, you should stick with your method.

It is a pretty sweet deal if you can afford it. They do just ship you already-programmed replacements if you've lost one. No questions asked. Free adjustments. Very comprehensive. It's pleasant and stress-free while you're covered by one of those packages.

But it's if you can afford it. When you can't afford the all-exclusive package there's really not much else. I spent about half of my childhood, teens and 20s without hearing aids due to cost. Held back my education at all levels. Even when I went to university, while I was eligible for provincial funding for hearing aids at a student, I was still expected to pay the cost up-front first. Independent adult students don't usually have $5000 cash lying around. I missed most of my first year.

On a related note, dentistry is another one that is usually not covered at all. Why even basic dental isn't covered by government healthcare as a prevention initiative still surprises me. Bad teeth can kill you / give you cancer / wreck chaos and damage organs in general etc and its all often detectable at early stages.

Of the people I know who have gotten hearing aids, every single one of them was disappointed. Every single one of them still had trouble hearing. As far as I can tell, the only thing the audiologists appear to be able to be able to correct for (with current hearing aids) is "make it louder". If more than that is needed, it's a vicious cycle of taking it home, realizing it's not really helping, and bringing it back to try a new one.

The above seems to be particularly true when the hearing problem is heavily weighed towards not being able to hear certain/higher frequencies, so can "hear" people talking, but can't understand it; especially if there's any background noise at all.

I sympathize that your job was hard and that the clients made it harder. But the clients following directions and trying multiple different hearing aids ... doesn't really solve the problem in a lot of cases. Hearing aids are very expensive, far too expensive for a result of "I still can't understand people talking to me".

Imagine not reading for 10 years because of bad eyesight, eye glasses do not make it so your brain can read, but instead makes it easier for your brain to see the symbols. your brain still needs to decode and comprehend them.

Our hearing system is far more complicated. You can look in the direction you want to see....but you hear all around you, even through walls.

You cannot stop hearing, even in your sleep. It is far more crucial to our environmental awareness than more people realize.

In your analogy, it would be like if my vision got worse and I got eyeglasses which partially restored it, but mirrored everything upside down with tons of static. Now I've got to learn to read upside down and tune out the static, but don't worry because I get 10 free lessons with a reading instructor. Oh and none of this was clearly explained to me or part of my expectation when buying glasses.

And once you put on your glasses everything is brighter.

You need to adjust to the change, and then slowley adapt.

Now what if putting on the glasses meant you saw far more on your peripheral vision?

This too would be a big change and a barrier to getting better.

Hearing aids are the exact same. It's slightly unnatural but once you learn how to use the tool, it's a super power. I can hear conversations in crowded bars when normal people can't. Loud noises compress in a pleasant fashion. I just have to get used to some occasional spatial distortion and subtle flanging

Or, alternatively, it's exactly what I said and the device + audiologist combination just isn't up to correcting a lot of common hearing issues. That seems far more likely than the vast majority of people doing everything wrong.

Sounds like the calibration needs to happen in the home, not the doctor's office.

No. Hunters (and shooters) have been buying electronic ear protection for years at much lower prices. There is no FDA approval, and they are not needed so the manufactures have to compete. The result is hearing aids in everything but the FDA approval. Some people find they work better than hearing aids because the manufactures have to tune them to work well for their customers which means background noise reduction (not just gun noise reduction)

Don't get me wrong, those who are borderline find the hunters hearing protection better. If your hearing is very bad you need expert tuning for just year ears, and that can't be offered without FDA approval.

The high end ones are $200, and internally pretty much the same thing other than the programming. The cheap ones are $30 (but not programmable)

I realized one thing that would help is "open hardware". If you're supposed to see a doctor to measure and tune some value maybe a device with an open interface and an app would suffice (which I think others here mentioned today).

The reason I asked about the cost of the doctor is I am interested in doing things like giving them free school in order to lower their need to charge high prices. Generally I would rather every person has a good local doctor they can see for free, but we could also deregulate these devices and let people sort out amongst themselves how to get the right fit. I would just want to take care that people aren't damaging their hearing further with improper use.

What are the primary cost components? The primary components are: Microphone {cheap to produce} Receiver (speaker) {cheap to produce} Processing Chip {expensive to R&D, cheap to produce}

Are the people doing these jobs highly paid? Salary in Canada was between $60,000 (diploma) - $100,000 (Doctorate) when I left the industry.

Are they highly paid because of high costs of college tuition? Depends, but after leaving for IT and making more than that with less education - I am unsure if they are "highly paid"

Would free college help lower their costs? I would hope so, but doubt the savings would pass on to the consumer.

Yes, there’s a lot of overcharging in this business, because the manufacturers charge what the market will bear, and because of insurance and lack of competition due to all the regulations they have to comply with, the market can bear a very high price.

But it’s still a very hard problem, and there’s a very significant component of user training over the long term that is required. When you were a newborn, you didn’t learn to hear and speak your native language in a single day, you didn’t learn to see and recognize faces and read written words in a single day. You shouldn’t expect a hearing aid to magically fix you in a single day — your brain needs time to retrain.

"...the new AirPods feature Adaptive EQ that tunes sound in real time based on how AirPods fit in the user’s ear. An inward-facing microphone monitors for sound, and then Adaptive EQ, powered by computational audio, tunes the low and mid frequencies to account for what may be lost due to variances in fit. "

"To help with sound clarity, beamforming microphones block out ambient noise and focus on the user’s voice, while users can also enjoy a hands-free experience by simply saying 'Hey Siri' for requests."

https://www.apple.com/newsroom/2021/10/introducing-the-next-...

Is tuning (and retuning) something that could be automated? Because of tinnitus, my hearing is not the same every day and so static settings feel like the wrong solution.

If one model (pay as you go) causes harm to the whole industry (people know believe hearing aids do not work) then why would the industry continue?

As far as I know (at least for Canada, circa 2015) there were no laws or regs stating how, what or when to charge for services. --other than some kind of return period.

And then still be able to return it at least within the first 30 days of paying for it?

The new schema may not be a panacea but I don't expect it to be worse than the status quo.

Some people argue that ethics have nothing to do with it, but if that were the case, highly expensive insurances would be mandatory, and payouts would be zero since business-wise that makes a lot of money without being ethically encumbered.

Public healthcare should just cover it.

Do you know what the status quo in the US is? (I don't, other than the prescription requirement from the article.) What you describe for Canada sounds pretty good to me, but I wouldn't assume any part of US healthcare is as inexpensive as Canadian healthcare or that the regulations are as well thought out.

"2-week FREE hearing aid trial* Try before you buy, absolutely free! Take a new pair of hearing aids home for two weeks to see how they work in everyday situations — no money down and no obligation.

3 years FREE Batteries Get three years of batteries included with your purchase no matter what hearing aids you buy. Each year you will receive a box of 60 batteries for each hearing aid.

3-year Warranty and 3-year Loss & Damage Enjoy a three-year manufacturer repair warranty and three years’ loss and damage coverage for all hearing aids" https://www.connecthearing.com/cost-of-hearing-aids/the-conn...

As well you may want to work with a Speech Language Pathologist.

Beyond that I'm not sure why I'd need professionals rather than an app to do some hearing tests.

Are you suggesting that getting hearing aids preserves your hearing or simply that people with advanced hearing loss benefit less from them?

Imagine if you stopped playing basketball because of a bad knee.

Then years later you get a knee brace and are able to play again.

How long, and how much practice would you need before you could play at the level you were at before the knee problem?

And without properly fixing the problem (just using a mobility aid) could you ever return to pre-knee problem levels?

The return period is 6 months, I think. You also get one free replacement in the first 3 years if it is lost or chewed up by your dog.