Disruption, Opportunity and the Future of Audiology New devices and technology are changing hearing health care. So what’s next? All Ears on Audiology
Free
All Ears on Audiology  |   October 01, 2016
Disruption, Opportunity and the Future of Audiology
Author Notes
  • Mark Krumm, PhD, CCC-A, is an associate professor in the School of Health Sciences at Kent State University. He chaired ASHA’s 2005 committee on telepractice and was also a member of the 2009 National Institute on Deafness and Other Communication Disorders Working Group on Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss. He is an affiliate of ASHA Special Interest Groups 9, Hearing and Hearing Disorders in Childhood; and 18, Telepractice. mkrumm@kent.edu
    Mark Krumm, PhD, CCC-A, is an associate professor in the School of Health Sciences at Kent State University. He chaired ASHA’s 2005 committee on telepractice and was also a member of the 2009 National Institute on Deafness and Other Communication Disorders Working Group on Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss. He is an affiliate of ASHA Special Interest Groups 9, Hearing and Hearing Disorders in Childhood; and 18, Telepractice. mkrumm@kent.edu×
Article Information
Hearing & Speech Perception / Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / All Ears on Audiology
All Ears on Audiology   |   October 01, 2016
Disruption, Opportunity and the Future of Audiology
The ASHA Leader, October 2016, Vol. 21, 16-18. doi:10.1044/leader.AEA.21102016.16
The ASHA Leader, October 2016, Vol. 21, 16-18. doi:10.1044/leader.AEA.21102016.16
There is little doubt audiologists are concerned about the future and their livelihood. With the availability of personal sound amplification products (PSAPs), direct-to-consumer hearing aids and “hearables”—and the attention of the U.S. Food and Drug Administration (FDA), the National Academy of Sciences (NAS) and the President’s Council of Advisors on Science and Technology focused on affordability and accessibility in hearing health care—the crystal ball shows a number of disruptive forces changing the services landscape for audiologists.
Consumers already are buying discounted hearing aids, PSAPs and assistive listening devices from highly accessible internet “kiosks”—and this trend will grow as Internet-savvy consumers go online to address their hearing loss (see sources).
The devices
Certain devices are at the center of change: No other device better exemplifies this than the PSAP, which costs, on average, $100 to $600. Consumers are likely purchasing these devices as low-cost solutions to address hearing needs, as documented in a recent Leader feature. Although PSAPs cannot be advertised as hearing aids, according to FDA regulations (though this may change—the FDA hosted a public workshop on these regulations in April), the distinction is not always clear in product advertisements. Further blurring these lines, PSAPs may be configured with features and capabilities paralleling typical hearing aids (see sources).
In addition to PSAPs, direct-to-consumer (DTC) hearing aids can be purchased online through familiar “big box” stores, such as Walmart, Sam’s Club and Sears. (Costco customers must visit an in-store Hearing Aid Center to purchase hearing aids.) DTC sales do not violate current licensure laws in most states, as long as medical waivers are obtained by sellers prior to purchase (though 14 states have restrictions on mail-order hearing aids). These waivers are provided online in a variety of ways, including pop-up windows, which must be acknowledged by consumers before completing their purchase.
Consumers are also not required to have a hearing test before purchasing hearing aids or PSAPs online. Consequently, the consumer may use these devices without knowing if they are appropriate for their hearing loss. (One of ASHA’s major concerns about recent NAS recommendations is that they do not mention the need for audiologic evaluation prior to purchasing over-the-counter hearing devices; NAS also suggests the removal of the medical waiver requirement.) Nevertheless, verified purchasers who review their amplification products online appear to see DTC sales as a positive.
It’s possible that consumers feel they have little to lose with online purchases, given low device costs, liberal refund policies and extended trial periods. For example, a customer can buy pair of open-fit hearing aids at a well-known big-box store for less than $1,000 online with a 90-day free trial period. If they are unhappy with their hearing aids, they will receive a total refund. (In contrast, consumers buying through a dispenser may have only a 30- to 45-day trial period—though sometimes audiologists can work to extend the time frame with the manufacturer—and may not receive a complete refund when factoring in initial fitting and/or counseling charges.)
But these DTC hearing aids are not premium products. They are “basic devices with non-linear programming containing the essential features required by the entry hearing loss population,” according to Robert Artigues, vice president of sales and marketing for hearing aid manufacturer General Hearing Instruments, Inc. For consumers with mild hearing loss, it may not matter—they often find such basic devices acceptable. This view is consistent with outcomes noted in a 2014 paper by Robyn M. Cox, Jani A. Johnson and Jingjing Xu in the journal Gerontology, which found that people with hearing loss may not detect a substantial difference in quality between low-end and high-end hearing aids for speech, music and noise.
Yet another category of amplification is “wearable” or “hearable” devices (see sources). While a wearable is often found on the wrist and can have a number of different features such as fitness tracking, texting, email and GPS-mapping capabilities (Fitbit wristbands and the Apple Watch are two popular examples), a “hearable” often functions like a wearable but doubles as an amplification device. Intelligent software uses amplification to enhance the listener’s experience based on learned environment characteristics (music concerts, airplanes and other uniquely noisy environments).

Consumers might turn to the internet for hearing-related products. Draws include transparency of product pricing, affordability, support, warranty, money-back guarantees and consumer ratings.

A broad future for audiology
While some clinicians may perceive this new technology and access as a threat, others may view it as an opportunity for service expansion. Why might consumers turn to the internet for hearing-related products? Draws likely include transparency of product pricing, affordability, support, warranty, money-back guarantees and consumer ratings. Some companies selling online also have audiologists on staff available for consultation and support, while others may already include the cost of a fitting with a local audiologist in the online price.
This process will become more consumer-friendly if hearing aids sold online incorporate in-situ testing and automated prescriptive amplification supported by consumer instrument fittings through telepractice (see sources). And although there likely will be some business models created that exclude audiologists, many of the elements of audiology practice today will still be present 10 years from now. Audiologists will likely partner with companies that value our services, including counseling and audiologic (also known as aural or auditory) rehabilitation (AR)—which would reduce return rates and benefit their bottom lines—by supporting the company’s products in their offices or doing final tunings via the internet.
It is difficult to judge how audiologists will react to internet market changes in the long term. Audiologists may respond with in-kind internet prices and services. Perhaps audiologists may even choose to provide services incorporating economy hearing aids and PSAPs for consumers with mild to moderate hearing loss; such services could help adults who could benefit from hearing aids but have never used them—70 percent of adults 70 and older with hearing loss and 84 percent of adults 20–69 with hearing loss, according to the National Institute on Deafness and Other Communication Disorders.
Audiologists will likely continue with traditional services and dispense premium hearing aids for users who have specialized hearing needs. Clinicians may also see patients wishing to use hearables, and they can provide guidance on systems incorporating smartphones, hearing aids, assistive devices and smart home technology to achieve desired communication, health and social goals.

Counseling and AR are the domains in which audiologists can distinguish themselves from other providers.

In this scenario, AR could gain greater acceptance by consumers eager to increase communication competency through skill-building and communication strategies that cannot be achieved solely through amplification.
Practitioners can use unique and cost-effective delivery systems to provide AR services online or face to face, particularly for upcoming generations of consumers who already use the internet for health care. Examples of innovative internet treatment programs—such as cognitive behavioral therapy exercises and counseling by email—are described in the September 2015 issue of the American Journal of Audiology regarding auditory training, tinnitus, balance and other audiology services.
Counseling and AR are the domains in which audiologists can distinguish themselves from other providers. Audiologists stand to capitalize on new hearing technologies by broadening their services into AR, counseling, hearable technology and (possibly) entry-level hearing aid sales while supplementing services with telepractice. In so doing, they can grow consumer demand for their services.
Sources
Jacobson, G. (2016). Perceptions of Internet delivery of hearing aids. Journal of the American Academy of Audiology, 27(6), 424. [Article] [PubMed]
Jacobson, G. (2016). Perceptions of Internet delivery of hearing aids. Journal of the American Academy of Audiology, 27(6), 424. [Article] [PubMed]×
Keidser, G., & Convery, E. (2016). Self-fitting hearing aids: Status quo and future predictions. Trends in Hearing, 20(10), 1–15.
Keidser, G., & Convery, E. (2016). Self-fitting hearing aids: Status quo and future predictions. Trends in Hearing, 20(10), 1–15.×
Staab, W. ( 2016, March). Hearables—wearables—earables? Hearing Health Matters.
Staab, W. ( 2016, March). Hearables—wearables—earables? Hearing Health Matters.×
1 Comment
October 4, 2016
Amber Powner
The Future of Audiology
The focus of audiology is changing; with this change, we need to address the culture surrounding audiology and assistive technology. Audiologists need to put their money where their mouths are - instead of advertising audiology clinics as a "one stop shop" for hearing technology, we need to expand to "hearing healthcare professionals." That means being well-educated and equipped to handle hearing loss prevention questions and counseling, regular comprehensive exams, and great relationships with referring physicians. There's a reason why hearing tests aren't part of the standard physical protocol - this needs to change! Support your patients and the future of our profession by stressing yourself as a hearing healthcare expert, and with this change, patients will change with us.
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2016
Volume 21, Issue 10