Consumerization of healthcare: why the hearing aid market might be the next to feel disruption

We went to see an elderly family friend this weekend. The first thing we noticed upon entering her house was the decibel level. She was watching a game show on TV, and the volume was set so high it was like being hit by a fire hose of sound.

Think of it as Google Glass, but for the ear.

She's in her 80s and uses a hearing aid. Unfortunately, she told us her $3,000+ hearing aid doesn't work worth a darn, insurance won't cover a replacement, and so she listens to the TV at a level that makes the shingles on the roof vibrate.

I didn't know much about hearing aids, but I learned a lot talking to our elderly friend and my wife, who's an RN.

The hearing aid business is huge. According to The Hearing Review, nearly 3 million hearing aids were "dispensed" in 2013, a full 20 percent of which were distributed by the Department of Veterans Affairs. This market usually grows at about 2-4 percent per year, but last year it grew by 4.8 percent.

With hearing aids starting at about $1,400 each and going up and up and up in price, the hearing aid market is at least worth $5 billion. Now, it turns out that, as with many medically-dispensed devices, hearing aids come in a huge variety, based on patient need -- from those that just sit behind the ear and magnify sound to those that are surgically installed inside the ear for a direct tech-to-bone connection.

This is a huge market even if you ignore the most medically complex devices. 52.2 percent of all hearing aids dispensed in 2013 were like my friend's -- a behind-the-ear device that pumps sound into an earplug either via a wire or -- like those nasty headphones on airplanes -- by air pressure.

I've been thinking a lot about consumer electronics and health-related devices ever since the Apple Watch announcement. My wife has an Android Wear watch that connects to her phone, and we've been nosing around an upcoming device called the Moto Hint.

The Moto Hint is a very tiny Bluetooth earphone that fits inside the ear and, in addition to answering the phone and letting you talk, it can send Okay Google (and, presumably Siri) queries to a linked smartphone. Now, rather than just answering the phone, you can actually talk to your phone through just the device mounted in the ear.

Think of it as Google Glass, but for the ear.

This got me thinking about my friend. As a consumer device, the Hint is a little pricey: $149 for a Bluetooth earphone is a bit much. But $149 for a replacement hearing aid is disruptive, 1/20th of the price that my friend had to pay -- and then couldn't replace.

As it turns out, there's a category of devices that help hearing but aren't allowed to be called hearing aids. According to the FDA (which is the agency that regulates hearing aids in the United States), these are Personal Sound Amplification Devices (PSADs). A 2009-vintage Web page on the FDA site describes "Hearing Aids and Personal Sound Amplifiers: Know the Difference."

According to Dr. Eric Mann, Deputy Director of FDA’s Division of Ophthalmic, Neurological, And Ear, Nose, and Throat Devices, "Hearing aids and personal sound amplification products (PSAPS) can both improve our ability to hear sound. They are both wearable, and some of their technology and function is similar."

Remember, though, that this was posted on October 20, 2009. This was iPhone 3GS vintage. The iPad hadn't even been released yet. Bluetooth 3.0 had just been adopted as a standard. There was no low-energy, long-lasting Bluetooth. Inductive chargers were rare. Windows 7 was still two days from being released to the general public.

You get the idea. A lot has changed in the consumer technology world since the FDA last updated its advice on hearing aids.

The FDA site goes on to give some very sound advice from Dr. Mann, which I'll pass along to you (and then criticize):

Mann notes, however, that the products are different in that only hearing aids are intended to make up for impaired hearing.

He says consumers should buy a personal sound amplifier only after ruling out hearing loss as a reason for getting one. "If you suspect hearing loss, get your hearing evaluated by a health care professional," he adds.

Choosing a PSAP as a substitute for a hearing aid can lead to more damage to your hearing, says Mann. "It can cause a delay in diagnosis of a potentially treatable condition. And that delay can allow the condition to get worse and lead to other complications," he says.

Clearly, any discussion of anything medical should include the suggestion to see your doctor. So I dutifully remind you that I'm not a medical professional and suggest that you go see your doctor.

All of this is a given. But in a world where insurance rules, sometimes seeing a doctor won't solve the problem. My elderly friend is a good example. She's in her 80s, knows quite well she has hearing loss, and has been prescribed (and has paid for out of her limited fixed income and dwindling savings), a hearing aid that no longer works.

Also, a lot of people who have been diagnosed with hearing loss and told they need a hearing aid avoid getting one for fear of looking old. This isn't an issue of simple vanity, it may put careers and potential relationships at risk, especially in markets where age is a prejudicial issue. By replacing the hearing aid with an exciting new Bluetooth headset, wearers no longer have to appear "old and out of touch". Instead, they'll fit in by looking just as dorky as anyone else with a Bluetooth headset.

In a perfect world, my friend would be able to get another hearing aid and be done with it. But we don't live in a perfect world -- and hearing aids have certain limitations that Bluetooth earphones do not.

For example, with a hearing aid, she has difficulty bringing her Moto X up to her ear and listening, because the hearing aid gets in the way. So she uses the Moto X on the other ear, which means she's always shouting into the phone and can't hear anyone on the other end.

She's also not yet used to the idea of carrying her phone with her everywhere she goes. When she goes from her living room to her bedroom (using a cane or a walker), she often leaves her phone in the other room. She has her hearing aid on, but it doesn't do much good, which is why the TV blares at such a high volume.

On the other hand, if she had a device like the Moto Hint, she could theoretically leave her phone on its charger and still answer calls. She could tell the Hint who to dial ("Call my son") and it send that request to Okay Google. Okay Google, running on the Moto X, would dial the phone, pumping sound directly into her ear in via the Moto Hint earpiece.

Let me note now that I haven't looked at the Hint yet, so I'm just working off the marketing literature. This is all assuming it works as promised. Given how nice the Moto X and the Moto 360 have turned out to be, I'm guessing the Hint might be all it promises, as well.

But what about listening to TV? Well, with something like a Bluetooth earpiece, she could theoretically bind the TV to her earpiece and listen to it in her ear without all the ambient sound pollution. Not all TVs have a Bluetooth output, but there are many Bluetooth transmitters that can solve this problem for under $100.

Finally, what about talking to people in the room and, you know, hearing? I typed "hearing aid" into the search box on the Google Play store and it turned up scroll after scroll of apps that promised to take ambient sound, amplify it, and pump it to a Bluetooth earpiece.

All of this falls into the category of consumerization of healthcare, but with the extreme costs and unhelpful insurance companies, patients are taking matters into their own hands. Clearly, the $149 cost of the Moto Hint and the various free or $0.99 hearing aid apps don't come with an audiologist consult, but for struggling, abandoned patients like my friend, this new crop of small, highly sophisticated Bluetooth headsets might be a game changer.

What other fields are ripe for disruption? TalkBack below.

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