Sept 2019 Slate Magazine

The world has rediscovered the virtues of analog sound. Why has the hearing aid industry gone completely digital?

digital aids

For an avid record collector with profound hearing loss—the past decade has produced severe cognitive dissonance caused by two contrary developments. First, vinyl came back; then, good hearing aids went away. In the 2000s, the industry’s half-dozen major manufacturers began to phase out hearing aids with analog sound and switched comprehensively to producing and selling digital hearing aids. With the ageing of the gigantic baby boomer demographic, along with the steady population of those born with congenital hearing loss, hundreds of thousands of users need new hearing aids each year. The global market value is expected to crest $12 billion annually in the next six years. Touting the supposed benefits of digital technology has helped manufacturers control their prices and market share.

The shift in the hearing aid market came at a time of almost universal renewed appreciation for the qualities of analog sound. Vinyl records have witnessed a major revival over the past decade. Forbes estimated that combined sales of new and used records topped $700 million in 2017 (the most recent year for which full data was available). Steve Jobs, who perhaps did more than any other individual to universalise digital music, himself listened exclusively to vinyl records. Even cassette tapes have seen a comeback. Yet the hearing aid market has gone in the opposite direction.

Digital technology may offer advantages in its ability to tailor amplification to a particular individual’s loss profile as well as the availability of programmed settings for different social situations, plus extra bells and whistles like Bluetooth and app-tracker options. What it cannot do is faithfully reproduce natural sound in a way that is subjectively satisfying and moving and true. As legendary musician Neil Young complained: “We’ve gained control, but we’ve lost the sound. The sound is gone.” This is no slur against the technicians and engineers who design the aids: they are up against millions of years of evolution. Analog aids merely amplify existing sound—a more sophisticated version of an ear trumpet—such that there is no real interruption of the original acoustic wave. Digital aids, by contrast, pick up the sound, process it into binary digital information, and then reproduce the sound as a new wave using a built-in digital-to-analog converter. Digital devices thus have to re-create the activity that our brains and ears co-evolved for eons to perform. It is hubris to think that a few decades of research and development might not fall short.

The old analog hearing aid technology had limitations: It was prone to feedback, and it did not always adjust well to different aural situations, such as crowded restaurants or large auditoriums with poor acoustics. In compensation, the user lived in a world that was saturated with sound, rich and crisp in detail. No amount of added Bluetooth connectivity or Fitbit trackers can change the underlying fact that the digital processor samples incoming sound at a rate far lower than that of an old CD player, effectively turning the entire world into a giant MP3 file. Children’s voices, fallen leaves, birdsong, the Beatles: All of these have been rendered and reshaped so that the listener perceives a wholly synthetic world.

For those who are unable to adjust, it is alienating on a neurological level. In fact, it is estimated that almost a quarter of all hearing aid users are not satisfied—often profoundly so—with the sound produced by their hearing aids. A perusal of online message boards gives a clue to the scope of the problem, where the complaints range from the heartrending (“I can no longer hear my daughter’s voice like I used to”) to the hyperbolic (“I think I’ll just move to India”).

The sensible solution here would be to present consumers with a choice: allow them to buy digitals or analogs (or both) according to their personal preferences, just as the recording industry has returned to selling vinyl records alongside its digital streams and downloads. Hearing aid manufacturers have instead elected to deny consumers that choice, while insisting that there are no unique problems with digital. This response amounts to saying, to paraphrase Richard Pryor: Who you gonna believe, me or your lying ears?

In language that echoes that of the recording industry decades prior, hearing aid manufacturers tout the supposed superiority of digital technology, without ever really explaining why. A generous reading of the evidence would be that this industry is re-creating old errors; the cynical one would be that focusing exclusively on digital has allowed manufacturers to maintain astronomically high prices—on average, about $2,500 for a single device, almost twice that for a pair (with the majority of users requiring a pair).

Though the industry is opaque, its profit margins are generally understood to be sizeable, and an oligopoly of six manufacturers effectively controls the global market. A more competitive market would almost certainly see at least one firm prepared to offer analog devices at costs undercutting its rivals.

The problem may be that of the dozens of audiologists and technicians I’ve met or spoken with over the years, not one has been hearing-impaired, nor do press releases mention hearing loss of any executives. Executives, consultants, engineers, audiologists—I think it’s safe to say that at least the vast majority are themselves hearing in analog. Their preference for digital sound is an abstraction, linked not to a true understanding of how sound works on the human brain but to the demands of marketing and financial bottom lines. In this, the parallels with male designers of women’s products are striking. The point is not that digital technology confers no benefits. It’s that those benefits are not so conclusive as to warrant the elimination of analog devices. And those of us with sensory memory of analog aids—as well as newcomers who remain dissatisfied with the current products—intuitively grasp that digital technology is unable to deliver sound in a way that makes us feel at home in the world.

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