The Acoustics of the Tech Museum of Innovation Challenge Those With Hearing Loss

Founded in 1998, The Tech Museum of Innovation (“The Tech” for short) in downtown San Jose, CA is an impressive facility, located in the heart of Silicon Valley.Ironically, the acoustics are far from state-of-the-art. We attended the Music for Minors gala on April 7, 2019, sitting at a table whose other guests (who included The Tech’s board chairman) agreed with us. This is a high-profile example, but we believe that most facilities lack thoughtful design (drapes, acoustical tile on the ceiling, etc.) to dampen challenging sounds or noises. We can only guess that acoustics get short shrift when buildings or rooms are designed and constructed. Restaurants, including upscale ones, are usually lacking in sound-dampening.

Voice-to-Text RogerVoice App Can Deal Even with Totally Deaf People

Many months ago while searching for innovative hearing aids we came across a couple of new ventures whose products intended to include a capability of recognizing words and displaying them on a smartphone, but those ventures apparently have not succeed as of yet. In mid-July 2018, however, we discovered a fascinating app for the iPhone that displays text on its screen corresponding to the spoken words of the person we are speaking with. It is one of a number of products called Voice over IP.

The French founder (Olivier Jeannel) was born deaf, so was very motivated to use modern technology to compensate for his disability. His and his two-cofounders’ (CTO Sidney Burks and CMO Pablo Seuc-Rocher) efforts started in 2013, and the venture had raised 660,000 Euros as of March 2018.

Thus far anyone can apparently use the app for free. We tried it, and it worked fine. (You need a high-bandwidth Internet connection: cable, 3G, or WiFi.) We spoke only in English (except for the word Guillermo, which is Spanish for William, that was recognized).The company says that it can handle English, French, Italian, Japanese (we wonder how that looks on the screen), Polish (an interesting alternative), and Spanish. One thing that it didn’t do was to handle words that we spelled out (in English), so there may be some challenges to clarifying misunderstood words.

It will be interesting to see how the company monetizes its technology. The average price of iPhone apps is only US$4.37, which is tiny compared with the price of conventional hearing aids (which rarely work as well as RogerVoice).

Most Hearing Aids Are Not Actually Used

If so many people with hearing loss don’t wear their hearing aids (in some cases because hearing aids don’t work very well), they can’t get any benefits from their preventing dementia, falls, depression, and other maladies. But there are a lot of reasons why many hearing aids don’t work well, and why people are uncomfortable even with “working” hearing aids.

One of the most frequent reasons that people put their hearing aids in a drawer and don’t wear them is that the hearing aid they purchased actually doesn’t work well FOR THEM. The process of having one’s hearing tested and a hearing aid purchased appears to suffer from a “one size fits all” syndrome. There seems to be such a a long and steep “learning curve” to the process of diagnosis, prescription, and training that many people run out of patience and simply give up. Apparently the high cost of hearing aids is not a sufficient motivation for buyers to “soldier on” to the point of discovering the benefits of the devices.

However, it is important to remember that the brain plays an important role in hearing. It is not the ear itself that needs to learn, but the brain has to learn to deal with a different set of inputs. And this cannot be done full-time, as we all have to continue all of the rest of our thinking and acting too.

The non-use of hearing aids has strongly piqued the curiosity of scientists, who have conducted numerous studies. Unfortunately these studies seem to have focused more on their methodology than on discovering the principal reasons for non-use of the hearing aids themselves.

Hearing Loss Has Huge Impact on Health

Hearing loss is associated with an increased risk of dementia, falls and depression. As people age, more and more of them suffer from hearing loss. According to the AARP 29% of people in their 50’s, 45% of people in their 60’s, and 68% of people in the 70’s have significant hearing loss. Its impact on quality of life is greater that obesity, diabetes, strokes, or cancer.

Hearing Loss Association of America

Hearing Loss Association of America (HLAA) is essentially a group of individuals who are hard of hearing, a sort of bottoms-up non-profit organization compared with many tops-down profit-oriented organizations. Because one-fifth of Americans are estimated to have some degree of hearing loss, its activities have a potential of improving the lives of nearly 50 million people. It does this via local chapters, state organizations, and a national office near Washington, DC. Local chapters are like support groups, valuable because all attendees have similar problems and can benefit considerably from the experiences and advice of other attendees.

Can Fixing Hearing Loss Prevent Dementia?

It is not surprising that a hearing aid company like Beltone would praise the value of improved hearing to reduce the likelihood of a person’s contracting Alzheimer’s disease and dementia.Beltone referred to a number of studies, which may have included the one by Johns Hopkins University School of Medicine and the National Institute on Aging.

Can Gene Therapy Overcome Hearing Loss?

It’s too soon to predict how much (if any) hearing loss can be reversed in humans, though very recent research on “Beethoven” mice is promising (the famous composer became deaf in his later years). The technique is called CRISPR-Cas, and even now is being used in China with human embroyos. To date there apparently have been no trials on living people, and it may be many years before such treatments become commonplace … assuming that they have been proven to be effective.

Gene therapy is relatively new and it may be proven to be useless, but if it is proven effective the implications for improved hearing are monumental. And the potential of improved hearing’s reducing dementia may also be monumental.

There has recently been similar progress in gene therapy for blindness although the treatment is very expensive. And in both hearing and seeing we suspect that it will take years for the processes to become reliable and cost-effective.

Not Even Good Enough for Government Work

Although we have composed several thoughtful posts regarding hearing, we did not expect to be alerted by the Federal Trade Commission (FTC) of a daylong conference on April 18. Similarly, the Wall Street Journal, which does a pretty decent job of covering hearing issues (because hearing deficiencies have a significant impact not only on people’s happiness but also on their productivity) did not mention this important conference—either before or after it. We only heard of it because the CEO of Sound World Solutions was slated to speak at the conference, and the company sent the announcement of his speaking to its customer list on April 15.

Note that although this April 18 conference was announced on January 4, it was not until March 28 that there was a preliminary agenda published or any way to submit questions provided. We did not hear about the conference itself until April 15, and we sent the following comment on April 16:

“My own hearing has diminished to the point that I need SOME form of assistance. And I can afford it. But I am baffled by the advice I get from ENT doctors, audiologists, and especially the sellers of hearing aids and PSAPs (Personal Sound Amplification Products). On my website WhyMenDieYoung.com I have posted my observations and my objections to the apparently cluelessness of these folks. I started by stating the problem , which is consonant with the text above. Then I moved on to decrying the missed opportunitycombining wireless earbuds for listening to a mobile device AND serving as hearing aids at. Apple and third-party suppliers of AirPods should have done better. Few among us would call the AirPods attractive, but because they are from Apple they have a lot of cachet. But they are unattractive in a different way from the way that conventional hearing aids are unattractive. The old saw “ children should be seen but not heard” becomes “hearing aids should be heard but not seen”. Most hearing aids look like something that many iPhone users’ grandparents might use, which is the reason that so many older folks resist using them. At least in Silicon Valley, most people would prefer to look geeky than to look senile. Most recently I followed up on the useless online hearing tests. I hope that the FTC can prod the hearing care business to get going to improve the hearing of Americans.”

On the day of the conference, there was an announcement of a Public Comment Period during April 18 through May 18. The FTC did reserve the right to review the comments, which seems rather restrictive given that the conference itself was open to the public. In any case, I was unhappy that my comment was not included among the approximately 100 total. WORSE, when I attempted to lodge a complaint, the FTC’s website’s design blocked me from doing so. Hence the title of this post.

Cheaper Hearing-Assist Devices – YES; Online Hearing Tests – NO

We can’t claim that our post a week ago, concerning iPhone earbuds and hearing aids, triggered The Wall Street Journal (WSJ) article urging Trump to appoint a savvy FDA (Food and Drug Administration) head who could pressure the hearing aid industry to offer substantially lower-priced solutions. Actually, the FDA had already in early December 2016 announced that it would (a) stop enforcing the requirement that patients get a prescription from a highly-trained and degreed specialist (audiologist) before thay can purchase hearing aids, and (b) consider creating a new category of over-the-counter products.

THE FACT THAT THERE ARE NO PRODUCT-BY-PRODUCT REPORTS (ONLY A BASIC GUIDE TO THE CATEGORY AS A WHOLE) ABOUT HEARING ASSISTANCE DEVICES FROM THE CONSUMER REPORTS ORGANIZATION SHOULD IMMEDIATELY TRIGGER SUSPICION ABOUT THIS CATEGORY OF PRODUCTS.

But thanks to our continual tracking of hearing issues and technology, we can correct some of the vagueness, omissions, and errors in the recent WSJ article. Two items were particularly wide of the mark. First was what they called an “over-the-counter hearing device”. There are two types of hearing devices— “true” hearing aids (medical devices that are regulated by national government authorities in most countries) and small audio amplifiers often called PSAPs (Personal Sound Amplification Products). Hearing aids are expensive (typically $1,500-6,000), may not be covered (even for military veterans) by medical insurance, and are mostly sold by small and specialized organizations who employ highly-trained audiologists. (An interesting exception is Costco, which sells units (made by Sivantos, formerly Siemens) only in the low-priced end of the range and appears to have—or is in the process of recruiting–degreed audiologists.) PSAPs cost as little as $30 and as much as about $750 (including both left and right ears). The WSJ article was vague, but apparently it was advocating that hearing aids should be sold without a prescription. However, given the difference in price ranges, they well could have been talking mainly about PSAPs. We have personally had highly mixed results with PSAPs. The $30 models were, unsurprisingly, junk. The highly-publicized (because of its design based on the R&D conducted by the noted Dr. Rodney Perkins) Soundhawk brand quickly went bankrupt (pretty-but-operationally-challenged design and poor customer service due to its low-budget phone-and-web nature). The clunky-looking models from PerfectChoiceHD and SoundWorld Solutions sell in the $350-750 range and MAY be adequate for many people with only modest hearing problems. We tested the SoundWorld Solutions model but could not find much or any hearing improvement.

Second was the article’s advice to take a free online hearing test. We reviewed 15 different ones. With one exception, they were useless or even worse. Some of them were disguised self-serving means of prospecting for potential customers because they required you to register. We realize that it is good business not to give away what you sell, but the tests weren’t very good anyway (some were just a few multiple-test questions). Others required you to wear headphones or use a telephone, which would potentially add a lot of noise that compromised the test (and likely preclude your wearing any PSAPs for comparison purposes). The exception was the innovative innovative Online Hearing Test and Audiogram Printout, which enabled us to create a crude hearing loss vs. frequency curve like the one that illustrates this post. But this curve, or the better ones prepared by trained audiologists using professional equipment, appears to be essentially useless, and mainly a selling tool of audiologists. It is unlikely to help anyone purchase a PSAP. It MIGHT give SOME guidance in selecting a hearing aid, but the features, appearance, and—most importantly—actual experience during the warranty period are likely far more important.

Does Generation Gap Prevent Earbuds’ Serving as Hearing Aids?

When Apple announced the iPhone 7 in September 2016, there was much gnashing of teeth because of its omission of a headphone jack. But after the furor died down, the main complaint became the $160 price of the Apple AirPods, which are reckoned to be the best alternative as of December 2016.

Few among us would call the AirPods attractive, but because they are from Apple they have a lot of cachet. But they are unattractive in a different way from the way that conventional hearing aids are unattractive. The old saw “ children should be seen but not heard” becomes “hearing aids should be heard but not seen”. Most hearing aids look like something that many iPhone users’ grandparents might use, which is the reason that so many older folks resist using them. At least in Silicon Valley, most people would prefer to look geeky than to look senile.

While the Apple AirPods are functionally attractive, they are not aesthetically attractive. But a bunch of competitors, attracted by the big market, are offering attractive ones. Unfortunately, at least some of these are crowdfunded, with ambitious plans but little chance for success. So their customers should be wary that they may have to endure long delays and ultimate failures.

If you are asking yourself why some of these attractive ear buds can’t include the capabilities of hearing aids, or at least the capabilities of their little sibling–PSAPs (Personal Sound Amplification Products), so are we. Some of the hearing aid companies now have models that work with the iPhone, but they have kept the old-fashioned ugliness. Ditto the Sound World Solutions PSAP. Only the now-defunct Soundhawk had a design that looked geeky but modern. The bottom line: we can only hope that SOMEONE figures it out.