What’s next for Apple and hearing aids?
- Published
- in Hearables
It’s around a month since Apple received approval from the FDA to sell their AirPods Pro 2 as hearing aids. That announcement caused a flurry of excitement amongst audio industry analysts and journalists, predicting that it would change the hearing aid market. I suspect that may prove to be false. The more interesting debate is whether it will lessen the stigma which is still associated with wearing a hearing aid. Andrew Bellavia and Joao Martins have written well-considered pieces on this. It’s a topic which needs more consideration than the media’s obsession with the technology or manufacturer, as it’s still unclear how we can change society’s attitude to hearing loss.
One of the big surprises about Apple’s announcement was that it was such a big surprise. Apple has had a variety of interests in hearing aids for at least twelve years (which is four years before the launch of the Apple Watch and six years before they announced their AirPods). It’s been a multi-faceted journey, driven at the start by a desire to evade accessibility requirements. Along the way, it has encompassed a desire for cost reduction in iPhones, the development of really useful features like Live Listen, the collection of user hearing data and innovations to help general hearing health. It was also responsible for kicking off the development of the Bluetooth Low Energy Audio specifications, which are already resulting in some major changes to the way that audio experiences are being designed.
As with the introduction of the original Apple Watch, it’s not always been clear what the end goal is, but that’s true across the industry in terms of health-related wearables. Alongside the development in hearables over the past few years, we’ve seen the consumer-led “Over the Counter” (OTC) initiative in the US , letting people with low to medium levels of hearing loss purchase medically approved hearing aids without the need to visit an audiologist. That’s seen a significant tranche of venture capital pour into start-ups, although that cash injection hasn’t yet translated into any major change in the hearing aid market, or any return for the investors.
The graphic at the top of this article highlights the problem that the industry faces. It’s a well-known fact that only around 10% of people who would benefit from wearing a hearing aid have done anything about their hearing, other than blaming everyone around them for not speaking clearly. When they finally go to an audiologist, it’s normally at the insistence of their family, who have reached breaking point over the excessive volume of the TV. Many cite their decision to have a hearing test as an ultimatum between getting a hearing aid or getting a divorce. Although cost is often suggested as a barrier, the stigma appears to be just as strong in countries where hearing aids are freely available from health services or insurers.
Changing the hearing aid paradigm
There are three barriers which need to be addressed if we are going to change this attitude. The first is persuading someone that they have any hearing loss. Most people put off going to any sort of health check, and hearing loss still has one of the highest barriers. This will probably be the single largest benefit that we will see from Apple’s announcement. Overnight, hundreds of millions of people will be able to take a hearing test in the privacy of their own home. Some will do that because they think they may have a problem; others out of curiosity, and some because it’s a new Apple app and they like Apple apps. Whatever the reason, given the number of AirPod users around the world, the number who do that will probably be greater than the number of people who visit an audiologist each year.
We have no idea how many of those will show a hearing loss, nor how many of them will do anything about it. But some will. Most who do something will probably just use the features of their AirPods, but that still moves them onto a journey of addressing their hearing loss. They may start using them just for watching TV at home, but if they notice the improvement they are likely to look at how they can obtain the same experience through the rest of their daily life.
That need for hearing augmentation throughout the day leads us to the second barrier, which is to being happy to being seen wearing a hearing aid. In the wearer’s mind, they won’t be wearing a hearing aid. Their AirPods are indistinguishable from any other person’s AirPods. Nobody knows whether they are using any hearing enhancement, so there shouldn’t be any problem.
The arrival of Apple’s first AirPods started a seismic change. Although not the first wireless earbuds, they transformed what we put in our ears. Despite being derided by many in the media, they became the fastest selling consumer product ever. Many in the hearing aid industry thought that this would signal the end of the hearing aid stigma. But it didn’t. Consumers still made the distinction between a consumer product for consuming audio content, and a medical device that helped people listen more effectively. It reinforced the message to hearing aid companies to continue to make their hearing aids as small and invisible as possible, typically nestling behind the ear.
Which brings us to the third barrier, which is everybody else’s perception. Earbuds are the child of headphones and continue to promote the perception that anyone wearing them is ignoring you. That subconscious public belief is perfectly understandable, as you normally only wear earbuds when you are streaming audio content. In other words, you’ve specifically put them in your ears for that purpose. Unless you’ve worn hearing aids to enhance ambient sound, that concept of putting something in your ear to help you have a conversation is largely alien, despite the fact that is what almost all hearing aids do for the majority of the time they’re being worn.
Changing the perception that putting something in your ear is an action to prevent you listening to ambient sound is probably the most crucial point to be addressed in the journey to remove the stigma of wearing hearing aids. Whilst everyone knows that wearing glasses helps you see more clearly, few seem to recognise that putting something in your ear can help you hear more clearly. Apple’s foray into the market should help with that anomaly.
Having said that, users’ acceptance of Apple’s new AirPods as hearing aids will not just be based on their ability to improve audio legibility. Other factors come into play when you’re wearing a device all day.
Comfort
I don’t like wearing earbuds for any great length of time, as I find them uncomfortable. I’m fortunate not to have hearing loss yet, so haven’t been prescribed hearing aids, but on the occasions where I’ve had the opportunity to try them, I’ve been impressed at how much more comfortable they are compared to earbuds. Apple has done an immense amount of work in looking at ears and designing AirPods for comfort, but in my ears, they’re still in a different league. Not least because of:
Weight
Most people’s first reaction to being handed a hearing aid is how light it is. They’re typically half the weight of an earbud. That’s because they are designed with the knowledge that the average user will wear them for at least nine hours each day. Most of the time they won’t be streaming voice or music, but will just be amplifying and enhancing the ambient sound around them, so weight is really important. They need to be so light that you don’t notice you’re wearing them.
Because hearing aids are constantly working to improve what you hear, you want to leave them in your ears all day. Which leads us to:
Battery Life
A battery box for earbuds was a brilliant piece of design magic which gave users the perception that they had a battery life of hours, or even days. The reality is that they don’t. Every time you take them out of your ears and pop them back in the battery box, they’re automatically recharged, so the perceived battery life is much longer. That’s fine for earbuds, as you rarely keep them in for more than a few hours at most between those recharge cycles, but it’s no good for hearing aids. If you need hearing aids, you don’t want to have to take them out to recharge them, because you’ll miss hearing what’s going on. Hearing aids are designed to be extremely low power, so they last all day. That comes with a price tag that consumer products don’t want.
Auracast™
Apple’s first foray into hearing aid technology was to try to get around the accessibility regulations that required them to support telecoil access in every iPhone. (Other manufacturers got around this by adding telecoil support to a limited range of their phones, but Apple’s high-end only phone range meant they didn’t have this option). Their petition to the regulators in the US failed, but inadvertently kick-started the development of the Bluetooth LE Audio specifications, which include the Auracast™ broadcast experience, which brings enhanced audio sharing to both consumer audio products as well as hearing aids.
The ability to receive broadcast wireless audio is really important for people with hearing loss, as it allows them to participate in social and community events, reducing the negative effect of isolation that so often accompanies hearing loss. So, it’s bizarre that Apple hasn’t announced support for this yet, as I’m sure that their H2 chip will support it. We’re already seeing the first use of Auracast™ in public venues, with an enthusiastic response from users.
There is an immense amount of technology that goes into a hearing aid to address the issues of comfort, weight and battery life which still distinguishes them from earbuds. I have no doubt that Apple has worked hard on all of these, but they aren’t going to be their highest priority requirements for users, because the current performance and usage model is sufficient for the majority of them. Addressing them would add cost, which might hit sales. In time, these will become easier problems to solve, but consumer earbuds will have other conflicting resource requirements, as the industry wants to embrace features such as spatial audio and higher resolution codecs, which will suck up even more battery life.
Apple’s initiative is to be applauded. Hundreds of millions of people will be able to assess their hearing. A significant number may make use of the hearing enhancements to help them with their hearing, whilst a smaller number may be persuaded to go to an audiologist. Importantly, more people will talk about their hearing, which is probably the most important step in helping to remove the stigma of hearing aids, which is really a stigma about admitting that you have hearing loss. Only time will tell whether Apple’s new hearing aid features will have any effect on sales, but the more people talk about hearing loss and have a more convenient way to test their hearing, the easier it will be for them to benefit from the technologies that can help them. Which in turn should make those technologies more accessible. That’s great news for all of us, as well as being good news for the hearing aid industry. Although it’s probably bad news if you’re a divorce lawyer.