MarkeTrak VIII: 25 Year Trends in the Hearing Health Market How do we get on the fast track? Sergei Kochkin, Ph.D.

MarkeTrak VIII: MarkeTrak VIII: 25 Year Trends in the Hearing 25 Year Trends in the Hearing

Health MarketHealth MarketHow do we get on the fast track?How do we get on the fast track?

Sergei Kochkin, Ph.D.Sergei Kochkin, Ph.D.

AgendaAgenda• Review MarkeTrak VIII findings:Review MarkeTrak VIII findings:

– 25 year trends in the hearing health market (2008)25 year trends in the hearing health market (2008)– Customer satisfaction with hearing aids (2009)Customer satisfaction with hearing aids (2009)– Impact of HHP on consumer success with hearing Impact of HHP on consumer success with hearing

aids (2010)aids (2010)– General observations on why the hearing aid General observations on why the hearing aid

industry is underperforming.industry is underperforming.

• As we review this data: ask how can I turn this As we review this data: ask how can I turn this problem, obstacle, misinformation, consumer problem, obstacle, misinformation, consumer disappointment, etc into an opportunity? disappointment, etc into an opportunity? Focus on Focus on why we all work in an under-performing industry.why we all work in an under-performing industry.

Other planned publications in the Other planned publications in the MarkeTrak VIII seriesMarkeTrak VIII series

• Impact of hearing loss on job effectiveness Impact of hearing loss on job effectiveness (2nd edition). (2nd edition).

• Customer satisfaction with on-the-ear (open fit) Customer satisfaction with on-the-ear (open fit) hearing aids compared to traditional style HAhearing aids compared to traditional style HA

• Prevalence of tinnitus and efficacy of treatment Prevalence of tinnitus and efficacy of treatment modalities modalities

• Sources of noise which most impact Sources of noise which most impact satisfaction with hearing aidssatisfaction with hearing aids

• Perceptions of benefit and changes in quality Perceptions of benefit and changes in quality of life due to hearing aids. of life due to hearing aids.

• Impact of hearing loss on traffic accidentsImpact of hearing loss on traffic accidents

Other planned publications in the Other planned publications in the MarkeTrak VIII seriesMarkeTrak VIII series

• Use of assistive listening devices Use of assistive listening devices • Use of inexpensive listening devices (<$50) in Use of inexpensive listening devices (<$50) in

lieu of hearing aid adoption. lieu of hearing aid adoption. • Factors which would influence hearing-impaired Factors which would influence hearing-impaired

non-adopters to purchase and use hearing aids. non-adopters to purchase and use hearing aids. • Comparison of customer satisfaction in other Comparison of customer satisfaction in other

professions and with products and services in professions and with products and services in other industries (non-adopter population only). other industries (non-adopter population only).

• Media habits of the hearing-impaired Media habits of the hearing-impaired populations (owners and non-adopters). populations (owners and non-adopters).

• Reasons for hearing aid returnsReasons for hearing aid returns

25 Year Trends in The Hearing Aid 25 Year Trends in The Hearing Aid MarketMarket

October 2009 October 2009

Hearing ReviewHearing Review

Are we really on the fast track?Are we really on the fast track?

• Original cover for Original cover for the first MarkeTrak the first MarkeTrak VIII publicationVIII publication

• Changed to Changed to “Headed for the “Headed for the Fast Track?”Fast Track?”

Led to funny editorialLed to funny editorial“…or Slow Train Coming?” “…or Slow Train Coming?”

and some alternate titlesand some alternate titles• Are we on the right track? Are we on the right track? • Are we on the track at all? Are we on the track at all? • Are we headed for derailment? Are we headed for derailment? • Throw Mama on the train! Throw Mama on the train! • Why isn't there anyone under 70 on this train? Why isn't there anyone under 70 on this train? • The train has left the station leaving behind three-quarters The train has left the station leaving behind three-quarters

of its passengers of its passengers • People are in denial about their need to get on the train; it People are in denial about their need to get on the train; it

takes them 3 to 8 years just to get aboard takes them 3 to 8 years just to get aboard • Why are train rides so expensive? Why can't we deduct Why are train rides so expensive? Why can't we deduct

them from our taxes? them from our taxes? • Some still believe the train is too big and noisy—and the Some still believe the train is too big and noisy—and the

whistle drives them crazy! whistle drives them crazy! • My family doctor told me trains don't work My family doctor told me trains don't work • One of my friends told me that the train ride stinks One of my friends told me that the train ride stinks

MarkeTrak MethodologyMarkeTrak Methodology

MethodMethod• National family opinion panelNational family opinion panel

– 80,000 households 80,000 households – Balanced to 9 key census variablesBalanced to 9 key census variables– Used since 1984 starting with HIA survey.Used since 1984 starting with HIA survey.– Does not include institutional settings.Does not include institutional settings.

• Screening questions–Phase I(11-12 /2008)Screening questions–Phase I(11-12 /2008)– Hearing lossHearing loss– Hearing aidsHearing aids– TinnitusTinnitus– Physician screening for hearing lossPhysician screening for hearing loss– Detailed employment status beyond NFO panel dataDetailed employment status beyond NFO panel data– Traffic accident dataTraffic accident data

MethodMethod

• Screening survey:Screening survey:– Returns – 46,843 householdsReturns – 46,843 households– Identified 14,623 people with hearing loss and or Identified 14,623 people with hearing loss and or

tinnitustinnitus– Response rate: 59%Response rate: 59%

• Detailed survey - Phase II (1/2009)Detailed survey - Phase II (1/2009)– 7 page legal size survey7 page legal size survey– 3,779 hearing aid owners (total population)3,779 hearing aid owners (total population)– 5,500 adult non-owners (random sample)5,500 adult non-owners (random sample)– Response rate 84% & 79% respectivelyResponse rate 84% & 79% respectively– $1 incentive $1 incentive

The Hearing Loss PopulationThe Hearing Loss Population

Incidence of hearing loss per thousand householdsIncidence of hearing loss per thousand householdsThere is no hearing loss epidemic only the aging of AmericaThere is no hearing loss epidemic only the aging of America

266

274

269271

275

283

295

250

255

260

265

270

275

280

285

290

295

300

1989 1991 1994 1997 2000 2004 2008

% H

ou

seh

old

pre

vale

nce

For more than a generation the incidence of HL has been For more than a generation the incidence of HL has been about one in 10 peopleabout one in 10 people

11

.3%

10

.7%

10

.1%

10

.2%

10

.0%

10

.3%

10

.0%

7.7

%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

2008 2004 2000 1997 1994 1991 1989 1984

MarkeTrak Survey Year

Pe

rce

nt

HIA*

* Adjusted by +.7% to account for multiple hearing-impaired per household

Physician screening for hearing loss has increased primarily Physician screening for hearing loss has increased primarily among younger segments among younger segments

when you include paper and pencil screeningwhen you include paper and pencil screening

15.116.3

18.8 1816.6 16.6

1412.9

14.6

20.2

0

5

10

15

20

25

May-89 Nov-89 May-90 Nov-90 Jan-92 Dec-94 Dec-97 Dec-00 Dec-04 Dec-08

Per

cent

scr

eene

d

Key HL population dataKey HL population data

• Incidence of HL in U.S. population = 11.3%Incidence of HL in U.S. population = 11.3%– Up from 10.7% (2004)Up from 10.7% (2004)

• Admitted HL population = 34.25 million peopleAdmitted HL population = 34.25 million people– Up from 31.5 million people (2004)Up from 31.5 million people (2004)

• 6 out of 10 are male6 out of 10 are male• 60% are below retirement age60% are below retirement age

The Hearing Aid MarketThe Hearing Aid Market

Key hearing aid owner population dataKey hearing aid owner population data

• Current hearing aid owners = 8.41 million Current hearing aid owners = 8.41 million peoplepeople

• Up from 7.8 million (2004)Up from 7.8 million (2004)

Hearing aid adoption rates are now one in four people with Hearing aid adoption rates are now one in four people with admitted hearing lossadmitted hearing loss

Growth primarily VA and direct mailGrowth primarily VA and direct mail

23.8 22.9 22.621.3 20.4

22.223.5

24.6

0

5

10

15

20

25

30

1984 1989 1991 1994 1997 2000 2004 2008

% H

I A

do

ptio

n

Binaural rates continue to grow impressivelyBinaural rates continue to grow impressively

22

37

51 52

6064

7074

25

47

6165 65

74 7479

70

79

8690

85

79

0

10

20

30

40

50

60

70

80

90

100

1984 1989 1991 1994 1997 2000 2004 2008

% o

f H

ea

rin

g I

nst

rum

en

t O

wn

ers

Total Owners

Total Owners - Current year

Bilateral HL - Current year

Evidence for growth in third-party paymentEvidence for growth in third-party payment2

2.2

19

.4

17

.7

20

.8 24

.7

24

.8

21

.9

30

23

.5

21

.7 25

.6 30

.2 34 37

.3

39

.7

0

5

10

15

20

25

30

35

40

45

1984 1989 1991 1994 1997 2000 2004 2008

% o

f sa

les

Without VA With VA

Sources of third-party payment.Sources of third-party payment.Average third party payment discount achieved = 84%Average third party payment discount achieved = 84%

1

3.7

4.4

10.4

14.8

17.1

23.15

36.2

0 5 10 15 20 25 30 35 40

Family

Union

Charity

HMO

Medicaid

Medicare

Insurance

VA

% source of third party payment

Note: Total percent greater than 100% since respondents indicated they received financial help from multiple sources.

Average out-of-pocket retail price paid by consumer Average out-of-pocket retail price paid by consumer increased 17% increased 17%

((includes free, direct mail hearing aids, & all third-party discounts but excludes VA includes free, direct mail hearing aids, & all third-party discounts but excludes VA fittings)fittings)

623

557 74

2

621

680

581 81

0

681

735

779

790

67391

7

852 10

40

768

1434

1097

1601 17

89

1346

1375

1276

1215 1306

136115

14

1369

0

200

400

600

800

1000

1200

1400

1600

1800

Total BTE ITC ITE

Dol

lars

1989 1991 1994 1997 2000 2004 2008

Audiologists fit nearly two out of three hearing aidsAudiologists fit nearly two out of three hearing aids

6.9

4.8

66.4

22

4.1

1.9

44.7

49.3

4.1

2.1

28.8

7.1

2

35.9

55

4.5

1.5

31.1

65

62.9

0 10 20 30 40 50 60 70

Other

Physician

Hearing AidSpecialist

Audiologist

% of hearing aid fittings

1984 1994 20002004 2008

The average age of hearing aids has dropped to 4.1 yearsThe average age of hearing aids has dropped to 4.1 years

0

10

20

30

40

50

60

<2 yr 3-4 yrs 5-6 yrs 7-8 yrs 9+ yrs

Age of hearing aids

% o

f h

ea

rin

g a

ids

199119941997200020042008

Mean age of hearing aids:

1991 = 3.1 yrs

1994 = 3.7 yrs

1997 = 3.8 yrs

2000 = 3.8 yrs

2004 = 4.5 yrs

2008 = 4.1 yrs

New user rate(%)New user rate(%)We are unable to attract new users to the marketWe are unable to attract new users to the market

53.4

40.5

29

39

31.6

39.336.6

0

10

20

30

40

50

60

1989 1991 1994 1997 2000 2004 2008

Pe

rce

nt

of

sa

les

Average age of new hearing aid usersAverage age of new hearing aid usersWe have not tapped into the younger marketsWe have not tapped into the younger markets

66

68.467.8

66.3

68.8

69.7

68.8

63

64

65

66

67

68

69

70

71

1989 1991 1994 1997 2000 2004 2008

Ave

rag

e a

ge

The typical HA purchaser has an average household The typical HA purchaser has an average household income of $54,000 & their modal income is $125,000income of $54,000 & their modal income is $125,000

$31

$35$31

$40

$56 $54

$46

$10

$20

$30

$40

$50

$60

1989 1991 1994 1997 2000 2004 2008

Ho

use

ho

ld I

nco

me

(0

00

)

What’s the REAL market for hearing aids?What’s the REAL market for hearing aids?• Used subjective measures to segment Used subjective measures to segment

marketmarket– Number of ears impairedNumber of ears impaired– Subjective view of HLSubjective view of HL– Gallaudet scaleGallaudet scale– BHI quick hearing check BHI quick hearing check (based on revised AAO-(based on revised AAO-

HNS 5 minute hearing loss screener)HNS 5 minute hearing loss screener)– Difficulty hearing in noiseDifficulty hearing in noise

• Created single HL index (factor analysis)Created single HL index (factor analysis)• Divided total HL population into 10% HL Divided total HL population into 10% HL

segments called decilessegments called deciles– Decile 1 = Lower 10% of HL – mildDecile 1 = Lower 10% of HL – mild– Decile 10 – Top 10% of HL – severe to profoundDecile 10 – Top 10% of HL – severe to profound

Hearing aid adoption heavily dependent Hearing aid adoption heavily dependent on degree of hearing losson degree of hearing loss

47

1016

24 26

34

54

65

40

0

10

20

30

40

50

60

70

D1 D2 D3 D4 D5 D6 D7 D8 D9 D10

Hearing Loss Decile

He

ari

ng

aid

ad

op

tion

ra

te (

%) Decile 5-10=

83% hearing aid owners

43% non-adopters

Hearing aid opportunity by age group. Hearing aid opportunity by age group. The viable hearing aid market in the U.S. is about 11 million The viable hearing aid market in the U.S. is about 11 million

more people with untreated hearing lossmore people with untreated hearing loss350

24 106

90

860

42 277

111

1329

33

827

189

2977

78

2143

468

3949

195

3175

1046

2997

324

2342

1703

1740

471

1786 2228

410

228 569

1181

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Non-adopters(Deciles 1-4)

HA owners(Deciles 1-4)

Non-adopters(Deciles 5-10)

HA owners(Deciles 5-10)

Age by hearing loss decile grouping

Pe

op

le w

ith h

ea

rin

g lo

ss (

00

0)

<18 18-34 35-44 45-54 55-64 65-74 75-84 85+

Deciles 5-10=6.98 Mil. HA owners11.1 Mil. non-adopters

Hearing aid adoption rates redefinedHearing aid adoption rates redefined

• One in four people with admitted One in four people with admitted hearing loss hearing loss ownown hearing aids. hearing aids.

• 40% of people with moderate to severe 40% of people with moderate to severe hearing losshearing loss

• 9% of people with milder hearing losses9% of people with milder hearing losses

We are at the right place at the right timeWe are at the right place at the right time

• The hearing loss population is growing at the The hearing loss population is growing at the rate of 1.6 times the general population rate of 1.6 times the general population growth– primarily aging population.growth– primarily aging population.

• Digital technology and the supporting Digital technology and the supporting software is superb – and it will get better.software is superb – and it will get better.

• We have the capability of meeting the needs We have the capability of meeting the needs of the vast majority of people with hearing of the vast majority of people with hearing loss.loss.

So why are we on a such So why are we on a such a slow moving train?a slow moving train?

• Explore customer satisfaction with Explore customer satisfaction with hearing aidshearing aids

• Explore HA fitter’s role in user successExplore HA fitter’s role in user success

• Summarize with other observationsSummarize with other observations

Customer Satisfaction with Customer Satisfaction with Hearing Aids 2008Hearing Aids 2008

January 2010 January 2010

Hearing JournalHearing Journal

Key HA satisfaction measuresKey HA satisfaction measures

21

29

24

29

38

32

16

19

23

16

8

14

18

6

7

0 10 20 30 40 50 60 70 80 90 100

Value

Benefit

Overall satisfaction

Percent

Very Satisfied Satisfied Somewhat satisfied Neutral Dissatisfied

Satisfied & very satisfied customers have not Satisfied & very satisfied customers have not grown during the digital revolutiongrown during the digital revolution

21 19 21 21 21 24

40 40 39 3930

31

2323

0

10

20

30

40

50

60

70

80

90

1991 1994 1997 2000 2004 2008

% s

atis

fact

ion

Very Satisfied Satisfied Somewhat satisfied

Dissatisfaction has dropped to 14% but….Dissatisfaction has dropped to 14% but…. 8% of new hearing aids are in the drawer 8% of new hearing aids are in the drawer

1816

15

1718

14

8

109

7

10

8

0

2

4

6

8

10

12

14

16

18

20

1991 1994 1997 2000 2004 2008

Pe

rce

nt

Total Dissatisfied HA in the drawer

More than half of hearing aids in the drawer More than half of hearing aids in the drawer are </= 5 years of ageare </= 5 years of age

11.716.1

9.27.0 8.9

5.7

41.5

0.05.0

10.015.020.025.030.035.040.045.0

1 2 3 4 5 6 7+

Age of hearing aid in years

Pe

rce

nt

of

tota

l

Hearing aids in the drawerHearing aids in the drawer

• Has varied between 11.7% and 17.9% Has varied between 11.7% and 17.9% historically.historically.

• Current rate: 12.4%Current rate: 12.4%– New hearing aids (</=4 years) : 7.5%New hearing aids (</=4 years) : 7.5%– Brand new HA: 5.2%Brand new HA: 5.2%

• 1,040,000 customers never use their 1,040,000 customers never use their hearing aids.hearing aids.

• Why do so many people spend $2000-Why do so many people spend $2000-$6000 for a product that does not meet $6000 for a product that does not meet their needs?their needs?

Hearing aid usage patterns virtually unchangedHearing aid usage patterns virtually unchanged

8.8 9.2 9.68.7

9.510 1011

10 10

12 12 12 12 12

0

2

4

6

8

10

12

14

1994 1997 2000 2004 2008

Ho

urs

HA

wo

rn

Mean Median Mode

30% of new user fittings are probable failures30% of new user fittings are probable failures

12.9

23.4

69.1

3.58.5

87

0102030405060708090

100

Drawer <2 hours 4+ hours

Per

cen

t

New user Experienced user

Causes for hearing aids in drawerCauses for hearing aids in drawer

• Poor benefitPoor benefit

• Poor fit and comfort Poor fit and comfort

• Poor performance in noisePoor performance in noise

We have failed to improve positive word of mouth We have failed to improve positive word of mouth advertising and brand loyaltyadvertising and brand loyalty

81 82 82 82 80 82

44 47 47 46 48

0

10

20

30

40

50

60

70

80

90

1991 1994 1997 2000 2004 2008

Pe

rce

nt

Recommend hearing aids Repurchase Brand

Customer satisfaction with hearing aid Customer satisfaction with hearing aid product featuresproduct features

hearing aids are <= 4 years old.hearing aids are <= 4 years old.

17

21

18

16

16

35

24

24

27

28

33

32

34

36

35

45

34

43

43

44

44

45

11

11

14

22

15

8

11

13

14

15

10

14

9

12

18

6

6

6

7

7

6

5

26

25

20

9

18

17

16

13

8

7

7

0 10 20 30 40 50 60 70 80 90 100

Ease/volume adjustment

On-going expense

Warranty

Battery life

Frequency of cleaning

Length of trial period

Visibility

Reliability

Ease of insertion/removal from ear

Fit/comfort

Ease/battery change

Percent

Very satisfied Satisfied Somewhat satisfied Neutral Dissatisfied

Customer satisfaction with hearing aid Customer satisfaction with hearing aid signal processing and sound qualitysignal processing and sound quality


101114131413

1717151717

2726

3431

3731

3337

364139

2124

1623

1725

1917

201521

2225

1419

13191813149

13

2014

2214

191213

1615

1810

0 10 20 30 40 50 60 70 80 90 100

Wind noise

Use In noisy situations

Chewing/swallowing sound

Comfort with loud sounds

Richness of sound/fidelity

Able to hear soft sounds

Whistling/feedback/buzzing

Natural sounding

Directionality

Sound of voice

Clearness tone/sound

Percent


Customer satisfaction with hearing aids in Customer satisfaction with hearing aids in various listening situations various listening situations


23

18

17

20

20

18

19

25

24

36

35

37

39

38

41

40

40

38

41

40

17

20

21

19

17

20

20

17

20

14

14

11

15

12

14

17

13

9

6

4

11

14

8

11

8

5

8

11

9

6

0 10 20 30 40 50 60 70 80 90 100

Place of worship

Restaurant

While shopping

Car

Listening to music

Leisure activities

Outdoors

T.V.

Small groups

One-on-one

Percent


Customer satisfaction with hearing aids in Customer satisfaction with hearing aids in various listening situations (continued) various listening situations (continued)


13

18

21

15

15

15

21

19

22

26

26

30

32

35

28

31

36

33

14

15

14

19

18

25

17

17

18

40

31

26

23

24

12

15

15

10

7

10

9

11

8

20

16

13

17

0 10 20 30 40 50 60 70 80 90 100

While in bed

School/classroom

Workplace

At sports events

Recreation and exercise

Large group

Cell phone

Concert/Movie

Telephone

Percent


Hearing aid multiple environment listening utility Hearing aid multiple environment listening utility (MELU) is not impressive.(MELU) is not impressive.

55

16

85 5 5 6

17

10 10 1114 15

23

0

10

20

30

40

50

60

None 1-19 20-39 40-59 60-79 80-99 100

Percent of listening situations

% o

f H

A o

wn

ers

Very Satisfied Satisfied or higher

Multiple environment listening utility (MELU) is highly Multiple environment listening utility (MELU) is highly related to brand repurchase and positive word of mouth related to brand repurchase and positive word of mouth

advertising.advertising.

42

60 64

7986

91 92

1116

24

3543

52

66

0102030405060708090

100

None 1-19 20-39 40-59 60-79 80-99 100

Percent of listening situations

% o

f H

A o

wn

ers

Recommend hearing aids Would repurchase HA brand

Satisfaction with benefit is highly dependent on the Satisfaction with benefit is highly dependent on the number of listening situations hearing aids worknumber of listening situations hearing aids work

…and Somewhat satisfied is hardly an endorsement…and Somewhat satisfied is hardly an endorsement

80

64

31

23

6

7

6

0 20 40 60 80 100

Very satisfied

Satisfied

Somewhat satisfied

Neutral

Somewhat dissatisfied

Dissatisfied

Very Dissatisfied

Sa

tisfa

ctio

n w

ith H

A b

en

efit

% listening situations satisfied or very satisfied

Changes since MarkeTrak VII (2004)Changes since MarkeTrak VII (2004)

• Practical Practical (at least 5% point increase)(at least 5% point increase) and and statistically significant improvements:statistically significant improvements:– Whistling and feedback (12% points, Whistling and feedback (12% points,

p<0.0001)p<0.0001)– Sound of chewing and swallowing (9% Sound of chewing and swallowing (9%

points, p<0.0001)points, p<0.0001)– Wind noise (7% points, p<0.0004)Wind noise (7% points, p<0.0004)– Use in noisy situations (7% points, Use in noisy situations (7% points,

p<0.0001)p<0.0001)– Comfort with loud sounds (5% points, Comfort with loud sounds (5% points,

p<0.001)p<0.001)

The Impact of the Hearing Health The Impact of the Hearing Health Professional on Hearing Aid User SuccessProfessional on Hearing Aid User Success

April 2010 Hearing ReviewApril 2010 Hearing Review

Co-authors & ReviewersCo-authors & Reviewers

• Co-authorsCo-authors• Sergei Kochkin, PhD (BHI)Sergei Kochkin, PhD (BHI)• Douglas L. Beck, AuD (Oticon)Douglas L. Beck, AuD (Oticon)• Laurel A. Christensen, PhD (GN Laurel A. Christensen, PhD (GN

ReSound)ReSound)• Cynthia Compton-Conley Cynthia Compton-Conley

(Gallaudet U)(Gallaudet U)• Brian J. Fligor, ScD (Harvard)Brian J. Fligor, ScD (Harvard)• Pat B. Kricos, PhD (U of Florida)Pat B. Kricos, PhD (U of Florida)• Jay McSpaden, PhD (Retired Jay McSpaden, PhD (Retired

audiologist - Oregon)audiologist - Oregon)• H. Gustav Mueller, PhD H. Gustav Mueller, PhD

(Vanderbilt)(Vanderbilt)• Michael Nilsson, PhD (Sonic Michael Nilsson, PhD (Sonic

Innovations)Innovations)• Jerry Northern, PhD (Starkey)Jerry Northern, PhD (Starkey)

• Co-authors (cont.)Co-authors (cont.)• Thomas A. Powers, PhD (Siemens)Thomas A. Powers, PhD (Siemens)• Robert W. Sweetow, PhD (U of Robert W. Sweetow, PhD (U of

C)C)• Brian Taylor, AuD (Unitron)Brian Taylor, AuD (Unitron)• Robert G. Turner, PhD (LSU)Robert G. Turner, PhD (LSU)

• ReviewersReviewers• Harvey B. Abrams, PhD (VA)Harvey B. Abrams, PhD (VA)• Ruth Bentler, PhD (U of Iowa)Ruth Bentler, PhD (U of Iowa)• Vic S. Gladstone, PhD (ASHA)Vic S. Gladstone, PhD (ASHA)• Larry Humes, PhD (Indiana U)Larry Humes, PhD (Indiana U)• Michael Valente, PhD (Washington Michael Valente, PhD (Washington

U)U)

Top 10 mistakes of cliniciansTop 10 mistakes of cliniciansChristensen & Groth (AAA)Christensen & Groth (AAA)

• Failing to use new tests to help with selection, fitting and Failing to use new tests to help with selection, fitting and counseling, counseling,

• assuming that automatic environmental steering programs assuming that automatic environmental steering programs are accurate and that the hearing aids switch appropriately, are accurate and that the hearing aids switch appropriately,

• fitting a hearing aid without buy-in from the patient, fitting a hearing aid without buy-in from the patient, • using first time, new user, or inexperienced user gain settings using first time, new user, or inexperienced user gain settings

and not revisiting the settings over time, and not revisiting the settings over time, • not doing the appropriate counseling, not doing the appropriate counseling, • not performing appropriate validation measures, not performing appropriate validation measures, • not taking manual dexterity into account when selecting the not taking manual dexterity into account when selecting the

hearing aids,hearing aids,• assuming the manufacturer defaults are right for every assuming the manufacturer defaults are right for every

patient, patient, • not understanding when to use an open fitting and when not not understanding when to use an open fitting and when not

to, to, • failing to verify the fitting with probe tube measurements.failing to verify the fitting with probe tube measurements.

THESISTHESISThe HHP has direct control over The HHP has direct control over

hearing aid user successhearing aid user success• Hearing aid quality control prior to fitHearing aid quality control prior to fit• Fit and comfort of hearing aidFit and comfort of hearing aid• Verification of fitVerification of fit• Validation of fitValidation of fit• Optimal amplification of the residual auditory Optimal amplification of the residual auditory

area of the consumer area of the consumer • Vast array of counseling toolsVast array of counseling tools• Measureable BENEFIT GUARANTEEMeasureable BENEFIT GUARANTEE• And a money back guaranteeAnd a money back guarantee

MethodMethod

• Measured 17 items of the hearing aid fitting Measured 17 items of the hearing aid fitting protocol. protocol.

• Measured 7 real-world success measuresMeasured 7 real-world success measures• Related use of protocol items to real-world Related use of protocol items to real-world

success.success.• Related total weighted protocol to successRelated total weighted protocol to success• Related unweighted protocol to success (e.g. Related unweighted protocol to success (e.g.

simple counting of steps performed)simple counting of steps performed)

Protocol items measuredProtocol items measured• Hearing tested in sound boothHearing tested in sound booth• Real ear measurement verificationReal ear measurement verification• Subjective benefit measurementSubjective benefit measurement• Objective benefit measurementObjective benefit measurement• Patient satisfaction measurementPatient satisfaction measurement• Loudness discomfort measurementLoudness discomfort measurement• Auditory retraining software therapyAuditory retraining software therapy• Aural rehabilitation groupAural rehabilitation group• Received self-help bookReceived self-help book• Received self-help videoReceived self-help video• Referred to self-help groupReferred to self-help group

Protocol items measuredProtocol items measured• Fit and comfortFit and comfort of the hearing aid of the hearing aid (single Likert (single Likert

scale item)scale item)• Achieved Sound quality : Achieved Sound quality :

– clearness of tone/soundclearness of tone/sound– whistling and feedbackwhistling and feedback– use in noisy situationsuse in noisy situations– natural soundingnatural sounding– sound of voicesound of voice– ability to hear soft soundsability to hear soft sounds– comfort with loud sounds comfort with loud sounds – single index from Factor analysis. Proxy for:single index from Factor analysis. Proxy for:

• Optimal amplification of residual auditory area of Optimal amplification of residual auditory area of patientpatient

• Functionality of hearing aid (quality control pre-fit)Functionality of hearing aid (quality control pre-fit)

Protocol items measuredProtocol items measured• Attributes of the hearing healthcare Attributes of the hearing healthcare

professionalprofessional: : – knowledge knowledge – professionalismprofessionalism– empathyempathy– creation of realistic expectationscreation of realistic expectations– explained care and maintenance of hearing aidsexplained care and maintenance of hearing aids– quality of service during the fitting processquality of service during the fitting process– quality of service after the hearing aid fittingquality of service after the hearing aid fitting– all measured on a 7 point Likert scaleall measured on a 7 point Likert scale– single index from Factor analysissingle index from Factor analysis

Protocol items measuredProtocol items measured• Attributes of the hearing healthcare Attributes of the hearing healthcare

officeoffice: : – front office stafffront office staff– hours of operationhours of operation– attractiveness and comfort of the officeattractiveness and comfort of the office– ease of access to the officeease of access to the office– convenient location convenient location – all measured on a 7 point Likert scaleall measured on a 7 point Likert scale– single index from Factor analysis.single index from Factor analysis.

Protocol items measuredProtocol items measured• Counseling:Counseling:

– the amount of time spent in hours the amount of time spent in hours explaining care and maintenance of the explaining care and maintenance of the hearing aids and hearing aids and

– the hours spent in aural rehabilitationthe hours spent in aural rehabilitation– total counseling hours spent in the first 2 total counseling hours spent in the first 2

months of the new hearing aid fitting.months of the new hearing aid fitting.

• The The number of visitsnumber of visits to get the to get the hearing aid working just right for the hearing aid working just right for the patient.patient.

Success measuresSuccess measures• Hearing aids in the drawer and hearing aid Hearing aids in the drawer and hearing aid

usage in hours.usage in hours.• Benefit. Benefit.

– Satisfaction with benefit (7 point Likert scale)Satisfaction with benefit (7 point Likert scale)– Perception of % hearing handicap reduction in Perception of % hearing handicap reduction in

10 listening situations. 10 listening situations. – Multiple Environmental Listening Utility (MELU). Multiple Environmental Listening Utility (MELU).

The percent of 19 listening situations in which The percent of 19 listening situations in which the patient was satisfied or very satisfied.the patient was satisfied or very satisfied.

• Quantified Client Oriented Scale of Improvement Quantified Client Oriented Scale of Improvement (COSI) measure.(COSI) measure.

• Only situations for which patient had need to hear.Only situations for which patient had need to hear.

Success measuresSuccess measures• Patient recommendations Patient recommendations

– Would recommend the hearing healthcare Would recommend the hearing healthcare professionalprofessional

– Would recommend hearing aids to friendsWould recommend hearing aids to friends– Would repurchase current hearing aid brandWould repurchase current hearing aid brand

• Overall success. Overall success. – A composite measure of success derived from A composite measure of success derived from

factor analyzing the above variablesfactor analyzing the above variables– Converting to factor scores and standardizing to Converting to factor scores and standardizing to

a mean of 5 and standard deviation of 2 (stanine a mean of 5 and standard deviation of 2 (stanine scores).scores).

Consumer perceptions of hearing aid fitting protocol Consumer perceptions of hearing aid fitting protocol received comparing new and experienced users.received comparing new and experienced users.

0 10 20 30 40 50 60 70 80 90 100

Hearing tested in sound booth

Loudness discomfort measurement

Objective benefit measurement

Real ear measurement verification

Received self-help book

Subjective benefit measurement

Aural education group

Customer satisfaction measurement

Received self-help video

Auditory retraining software therapy

Referred to self-help group (HLAA)

Percent of patients

New User Experienced user

Outcome measures comparing new and experienced usersOutcome measures comparing new and experienced users

54

58

63

75

73

42

56

54

71

87

74

58

0 10 20 30 40 50 60 70 80 90 100

Hearing handicapreduction

Multiple environmentlistening utility

Satisfaction with benefit

Would recommend HA

Would recommenddispenser

Would repurchase HAbrand

Percent of patients

New User Experience user

Summary of statistically significant relationships between Summary of statistically significant relationships between outcome measures and protocol items for new and outcome measures and protocol items for new and

experienced usersexperienced users

8

8

12

14

15

14

15

4

11

13

12

12

14

16

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Hearing aids in draw/hearing aid usage

Hearing handicap reduction

Would recommend HA


Would recommend dispenser

Multiple environment listening utility

Would repurchase HA brand

N of significant relationships

New User Experienced User

High-low analysisHigh-low analysis

• Compare patients experiencing below Compare patients experiencing below average (-1 std) and above average (+1 average (-1 std) and above average (+1 std) real-world std) real-world successsuccess..

• Let’s look at the patients’ experience Let’s look at the patients’ experience during the hearing aid fitting during the hearing aid fitting process!process!

A comparison of above average (+1 std) and below average (-1 std) A comparison of above average (+1 std) and below average (-1 std) hearing aid successhearing aid success as measured by subjective real-world outcomes as measured by subjective real-world outcomes

showing protocol received based on consumer perceptions.showing protocol received based on consumer perceptions.

76

31

7

53

6

58

88

51

32

79

23

82

0 20 40 60 80 100

Sound booth testing

REM

Measure subjective benefit

Measure objective benefit

Measure customer satisfaction

Measure loudness discomfort

Percent of patients

Below average success Above average success

A comparison of above average (+1 std) and below average (-1 std) A comparison of above average (+1 std) and below average (-1 std) hearing aid success as measured by subjective real-world outcomes hearing aid success as measured by subjective real-world outcomes

showing protocol received based on patient perceptions.showing protocol received based on patient perceptions.

47

14

27

13

7

17

40

36

0 10 20 30 40 50

4 or more

Three

Two

one

Number visits to adj HA

Percent of patients


A comparison of above average (+1 std) and below average (-1 std) A comparison of above average (+1 std) and below average (-1 std) hearing aid success as measured by subjective real-world outcomes hearing aid success as measured by subjective real-world outcomes

showing protocol received based on patient perceptions.showing protocol received based on patient perceptions.

47

34

15

4

20

43

37

36

39

15

10

31

47

22

0 10 20 30 40 50

None

One

Two

Three or more

Counseling Methods Used

Two or more

One

None

Hours of counseling received

Percent of patients




33

1618

1517

30

12

2119 18

2

13

28

45

13

9 8

19

36

29

0

5

10

15

20

25

30

35

40

45

50

Below avg(-2 std)

Below avg(-1 std)

Average Above avg(+1 std)

Above avg(+2 std)

Below avg(-2 std)

Below avg(-1 std)

Average Above avg(+1 std)

Above avg(+2 std)

Pe

rce

nt

of

pa

tien

ts

Below average successAbove average success

<--------Dispenser Attributes ------- > <-------- Office Attributes ------- >



55

18

15

9

3

20

17

63

0

3

9

32

56

0

1

99

0 10 20 30 40 50 60 70 80 90 100

Below avg (-2 std)

Below avg (-1 std)

Average

Above avg (+1 std)

Above avg (+2 std)

Achieved Sound Quality

Dissatisfied

Neutral/Somewhat satisfied

Satisfied/Very satisfied

Fit & Comfort


High-low analysis #2High-low analysis #2

• Use high/low difference scores from Use high/low difference scores from past analysis to weight protocol past analysis to weight protocol received.received.

• Sum weighted scoresSum weighted scores• Compare top and bottom 15% weighted Compare top and bottom 15% weighted

protocol scores.protocol scores.• Now let’s look at the patients’ real Now let’s look at the patients’ real

world outcome!world outcome!

Impact of a weighted protocol comparing the top and Impact of a weighted protocol comparing the top and bottom 15% of consumers on hearing aid success.bottom 15% of consumers on hearing aid success.

18

35

56

12

39

14

14

3

66

97

99

94

86

81

0 10 20 30 40 50 60 70 80 90 100



Would recommend HA





Percent of patients

Bottom 15% Top 15%

Total hearing aid user success achieved as a function of a Total hearing aid user success achieved as a function of a weighted fitting protocol (in stanines, n=1,613)weighted fitting protocol (in stanines, n=1,613)

Correlation = .70Correlation = .70

1.9

2.83.5

4.14.9

5.86.4 6.6 6.8

0

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8 9

Weighted protocol (mean=5, std=2)

Su

cce

ss S

core

(m

ea

n=

5,

std

=2

)

High-low analysis #3High-low analysis #3

• Simple count of protocol steps Simple count of protocol steps

• Collapsed counseling methodsCollapsed counseling methods

• Compare minimum (0-2 items) to Compare minimum (0-2 items) to comprehensive protocols (10-12 items)comprehensive protocols (10-12 items)

• Are protocols additive or multiplicative?Are protocols additive or multiplicative?

• Let’s see how the patients did in the Let’s see how the patients did in the real world!real world!

Impact of a protocol on hearing aid success comparing a Impact of a protocol on hearing aid success comparing a minimum protocol (0-2 items) to a more comprehensive minimum protocol (0-2 items) to a more comprehensive

protocol (10-12 items).protocol (10-12 items).

19

32

46

18

29

18

13

4

64

95

93

96

85

84

0 10 20 30 40 50 60 70 80 90 100



Would recommend HA





Percent of patients

Minimal protocol Comprehensive protocol

Total hearing aid user success achieved as a function of an Total hearing aid user success achieved as a function of an additive hearing aid fitting protocol (n=1,613)additive hearing aid fitting protocol (n=1,613)

Correlation = .50Correlation = .50

1.2

2.32.7

3.4

4.34.7

5.15.6 5.8 6

6.46.8 6.5

0

1

2

3

4

5

6

7

8

0 1 2 3 4 5 6 7 8 9 10 11 12

Protocol steps performed

Su

cce

ss S

core

(m

ea

n=

5,

std

=2

)

Other findingsOther findings• Factors explaining less than 1% of variance in the Factors explaining less than 1% of variance in the

hearing aid fitting protocol:hearing aid fitting protocol:– Age of the patientAge of the patient– GenderGender– User User (new versus experienced)(new versus experienced)– Size of city Size of city (rural to metropolitan)(rural to metropolitan)– Price of hearing aidPrice of hearing aid– Style of hearing aidStyle of hearing aid– Degree of hearing lossDegree of hearing loss

• Occupation of person Occupation of person (Audiologist/HIS)(Audiologist/HIS) fitting hearing fitting hearing aid explained < ½ of 1% of the protocol used OR aid explained < ½ of 1% of the protocol used OR real-world hearing aid user success. real-world hearing aid user success. – Confirmed by the Hearing Industry Association Consumer Confirmed by the Hearing Industry Association Consumer

Journey Study.Journey Study.– Audiologists and HISs are equivalent in both protocol and Audiologists and HISs are equivalent in both protocol and

ability to generate successful hearing aid users.ability to generate successful hearing aid users.

ConclusionsConclusions• What occurred in HHP offices has a very What occurred in HHP offices has a very

strong relationship to real-world success.strong relationship to real-world success.• Evidence that a weighted protocol is better Evidence that a weighted protocol is better

predictor of success then simple count of predictor of success then simple count of steps performed.steps performed.

• Variability of protocols performed and the Variability of protocols performed and the distribution of patient success is massive in distribution of patient success is massive in America.America.

• Consumer ReportsConsumer Reports estimates in a small scale estimates in a small scale study that 2 out of 3 hearing aids are misfit.study that 2 out of 3 hearing aids are misfit.

• Anecdotal reports from expert fitters indicate Anecdotal reports from expert fitters indicate that many NEW hearing aids brought in to that many NEW hearing aids brought in to their practice were programmed incorrectly.their practice were programmed incorrectly.

ConclusionsConclusions• Believe that the clinical laboratory is the “real world” Believe that the clinical laboratory is the “real world”

and that we can get a handle on the degree of misfit and that we can get a handle on the degree of misfit hearing aids in America as well as quantify the hearing aids in America as well as quantify the relative importance of various aspects of the protocol. relative importance of various aspects of the protocol.

• Further research needed:Further research needed:– What is the state of misfit hearing aids in the U.S?What is the state of misfit hearing aids in the U.S?– How many malfunctioning hearing aids are in How many malfunctioning hearing aids are in

patients’ ears?patients’ ears?– How much more benefit do patients experience How much more benefit do patients experience

when their residual auditory area is optimally when their residual auditory area is optimally amplified by experts given today’s technology and amplified by experts given today’s technology and software?software?

– How many patients are fit with inappropriate How many patients are fit with inappropriate technology technology (e.g. a CIC or open fit when they need (e.g. a CIC or open fit when they need a power BTE or full-concha)?a power BTE or full-concha)?

Conclusions (Cont.)Conclusions (Cont.)

– Can we reduce the number of hearing aids in the Can we reduce the number of hearing aids in the drawer?drawer?

– What is the relative importance of aspects of the What is the relative importance of aspects of the protocol on real world success?protocol on real world success?

– How many patients have been inappropriately fit How many patients have been inappropriately fit with hearing aids when they are not good with hearing aids when they are not good candidates candidates (e.g. motivation, acceptable noise (e.g. motivation, acceptable noise level (ANL) exceptionally high)level (ANL) exceptionally high)??

– When hearing aids are expertly fit what is the When hearing aids are expertly fit what is the likelihood of improvements in positive-word-of-likelihood of improvements in positive-word-of-mouth advertising and brand loyalty?mouth advertising and brand loyalty?

Quality control at the point of sale is Quality control at the point of sale is critical to user success & industry growthcritical to user success & industry growth

• Not all consumers are tested in a sound booth.Not all consumers are tested in a sound booth.• Many hearing aids are not tested for functionality prior to Many hearing aids are not tested for functionality prior to

the fitting.the fitting.• The majority of dispensers fail to verify the hearing aid The majority of dispensers fail to verify the hearing aid

fitting with REM.fitting with REM.– Considered by the industry intelligentsia to be Considered by the industry intelligentsia to be

unethical and unprofessionalunethical and unprofessional• Many dispensers do not validate the fitting pre/post with Many dispensers do not validate the fitting pre/post with

objective or subjective benefit measures.objective or subjective benefit measures.– ““We just don’t want to know” We just don’t want to know” (Ignorance is bliss!)(Ignorance is bliss!)– ““What should we do if we can’t find benefit – refund What should we do if we can’t find benefit – refund

the customers money”? the customers money”? (greed and unethical)(greed and unethical)• Ultimately we take the short term sale and sacrifice the Ultimately we take the short term sale and sacrifice the

long term growth and our reputation in our community.long term growth and our reputation in our community.• Aural rehabilitation is virtually non-existent.Aural rehabilitation is virtually non-existent.

OpportunitiesOpportunities• Establishment and enforcement of a standardized and Establishment and enforcement of a standardized and

comprehensive hearing aid fitting protocol comprehensive hearing aid fitting protocol (similar to (similar to Optometry)Optometry) with a with a measureable benefit guaranteemeasureable benefit guarantee will will result in:result in:– Massive market share shiftsMassive market share shifts– More positive word-of-mouth advertisingMore positive word-of-mouth advertising– Tapping new marketsTapping new markets– Greater brand Greater brand (hearing aid and distribution)(hearing aid and distribution) loyalty. loyalty.– Transforming the lives of many more hard of hearing Transforming the lives of many more hard of hearing

people, after all isn’t this our REAL business?people, after all isn’t this our REAL business?– And believe it or not stigma will evaporate for most And believe it or not stigma will evaporate for most

people when they achieve SUBSTANTIAL BENEFIT.people when they achieve SUBSTANTIAL BENEFIT.

• ULTIMATELY QUALITY WILL WIN!ULTIMATELY QUALITY WILL WIN!

Some Additional Observations on Some Additional Observations on the Hearing Aid Marketthe Hearing Aid Market

Sales growthSales growth• We are doomed to 2-3% growth unless we fix We are doomed to 2-3% growth unless we fix

the hearing aid industry.the hearing aid industry.

• This is roughly the growth rate of the elderly This is roughly the growth rate of the elderly population.population.

• A key problem is quality control at the point of A key problem is quality control at the point of sale. The fitting process has not kept pace sale. The fitting process has not kept pace with technology.with technology.

• Improvements in technology are wasted if the Improvements in technology are wasted if the hearing aid is inappropriately fit.hearing aid is inappropriately fit.

Our value proposition to society is Our value proposition to society is inequitableinequitable

• We benefit ($$) more than the consumer We benefit ($$) more than the consumer (the (the improvements in their life for which they are improvements in their life for which they are willing to pay)willing to pay)

• Estimated hearing handicap reduction:Estimated hearing handicap reduction:– 41% (Absolute benefit)/Unaided hearing problem 41% (Absolute benefit)/Unaided hearing problem

(MarkeTrak VI)(MarkeTrak VI)– Current direct measure in MarkeTrak VIII: 55%Current direct measure in MarkeTrak VIII: 55%

Customer satisfaction is highly related to $$$ Customer satisfaction is highly related to $$$ spent per 1% improvement in hearing disabilityspent per 1% improvement in hearing disabilitywhere % change = (benefit/unaided APHAB)where % change = (benefit/unaided APHAB)

253035404550556065707580859095

100

5 15 25 35 45 55 65 75 85 95 125 200 500

Price ($$) spent per 1% disability improvement

Sat

isfa

ctio

n

Overall

Benefit

Value

Poly. (Overall)

Poly. (Benefit)

Poly. (Value)

Overall customer satisfaction is dependent on price Overall customer satisfaction is dependent on price relativerelative to hearing disability improvement to hearing disability improvement

(Statistical Model)(Statistical Model)

PriceHearing disability improvement (%)

Overall Customer Satisfaction (%)

R2=.86

Negative word-of-mouth is severely Negative word-of-mouth is severely depressing throughput into HHP offices depressing throughput into HHP offices

and therefore salesand therefore sales• 19% of total adults with admitted hearing loss 19% of total adults with admitted hearing loss

don’t purchase because of other hearing aid don’t purchase because of other hearing aid owners telling them of their disappointment.owners telling them of their disappointment.

• That’s 4.4 million peopleThat’s 4.4 million people• Assuming 1.75 hearing aids each over 5 Assuming 1.75 hearing aids each over 5

purchase cycles of 5 years purchase cycles of 5 years (their average (their average age is now 60)age is now 60)

• Assuming we cannot win them back:Assuming we cannot win them back:– That’s potentially 38,200,000 hearing aids not That’s potentially 38,200,000 hearing aids not

purchased over their lifetimepurchased over their lifetime– That’s 19 years of lost sales for the whole US!That’s 19 years of lost sales for the whole US!– That’s $69 billion in lost revenue!That’s $69 billion in lost revenue!

The utility of hearing aids is poorThe utility of hearing aids is poor

• With the exception of a handful of activists With the exception of a handful of activists we have not made public places accessible we have not made public places accessible to people with hearing loss as has been done to people with hearing loss as has been done in Europe.in Europe.– Inductive looping Inductive looping (until the real wireless revolution (until the real wireless revolution

in the HA industry)in the HA industry)– Use of telecoil to double or triple functionality of Use of telecoil to double or triple functionality of

hearing aid.hearing aid.– Some HHP are now looping their patient homes Some HHP are now looping their patient homes

and therefore creating real value.and therefore creating real value.

Hearing aids and those who fit them Hearing aids and those who fit them have a horrible reputationhave a horrible reputation

• Typical 1Typical 1stst media question to me: media question to me: Why Why do so many people hate hearing aids?do so many people hate hearing aids?

• Need to demonstrate to non-adopters:Need to demonstrate to non-adopters:– That hearing aids do indeed workThat hearing aids do indeed work– That we can provide substantial benefit That we can provide substantial benefit

andand– Therefore that we can substantially Therefore that we can substantially

improve their lives improve their lives

We should leverage QOL research We should leverage QOL research more in marketing hearing aidsmore in marketing hearing aids

• Improvements in:Improvements in:– Earning powerEarning power

– Communication in relationshipsCommunication in relationships

– Intimacy and warmth in family relationshipsIntimacy and warmth in family relationships

– Ease in communicationEase in communication

– Emotional stabilityEmotional stability

– Sense of control over life eventsSense of control over life events

– Perception of mental functioningPerception of mental functioning

– Physical healthPhysical health

– Group social participationGroup social participation

– SafetySafety

We should leverage QOL research We should leverage QOL research more in marketing hearing aidsmore in marketing hearing aids

• Reductions inReductions in– Discrimination toward the person with the hearing Discrimination toward the person with the hearing

lossloss– Hearing loss compensation behaviors (i.e. pretending Hearing loss compensation behaviors (i.e. pretending

you hear)you hear)– Anger and frustration in relationshipsAnger and frustration in relationships– Depression and depressive symptomsDepression and depressive symptoms– Feelings of paranoiaFeelings of paranoia– AnxietyAnxiety– Social phobiasSocial phobias– Self-criticismSelf-criticism

Hearing aid returns are killing usHearing aid returns are killing us

• Current rate: 18.6%Current rate: 18.6%• Top reasons:Top reasons:

– Benefit (51%)Benefit (51%)– Background noise (49%)Background noise (49%)– Whistling/feedback (38%)Whistling/feedback (38%)– Poor value (36%)Poor value (36%)– Poor fit and comfort (35%)Poor fit and comfort (35%)

• Nearly a completely solvable problemNearly a completely solvable problem

Overall ConclusionOverall Conclusion

• Markets are perfect!Markets are perfect!

• If we do not adequately service people If we do not adequately service people with hearing loss someone else will with hearing loss someone else will take away our business and do it better.take away our business and do it better.

• We have a lot of baggage to overcome.We have a lot of baggage to overcome.

• Consumer stigma, while existent, is an Consumer stigma, while existent, is an industry scapegoat.industry scapegoat.

MarkeTrak VIII: 25 Year Trends in the Hearing Health Market How do we get on the fast track? Sergei Kochkin, Ph.D.

Documents

series impact of hearing

hearing health market

hearing aid industry

hearing aidssources

ear open fit hearing

impact satisfaction

impact of hhp

agenda review marketrak