Technology Innovation in Hearing Aids

Lia Best, Audiologist at Oticon Canada, transcripts from our 14th Annual Healthy Hearing Expo. Transcripts have been edited for clarity. 

Lia Best, Audiologist, speaking at Victoria Conference Centre.

We’re going to talk about some of the technology innovations in hearing aids. To look at what’s coming in the future, it’s a good idea to see how far we’ve come.


We’re going to look at hearing aid . We’re going to look inside hearing aids and see what components are in the hearing aids you are wearing or you saw out there. We will also look at the journey of the hearing aid from its conception, when it’s an idea, to when it’s being fit on somebody’s ears.

At the end, we’ll look at where we’re going with hearing aid technology and what we expect to see over the next five years.

It started with ear trumpets. This was Beethoven’s hearing apparatus for his hearing loss. The first binaural hearing aids were called the “auricle” which was ear horns connected by a wire that went into each person’s ear to enhance the pinna. That’s how the ear trumpets worked, they magnified our pinna. Animals with good hearing have larger pinna’s so that’s where we took inspiration from.

Alexander Graham Bell was credited for innovation in hearing technology with the telephone. Through his innovations in telephone technology, those innovations got put into early hearing aids.

In the 1920s, we had our first real hearing aid. This was the vacuum-tube hearing aid. This was built on telephone technology, turning speech into electrical signals and then amplifying them through a receiver. It was the first electronically available hearing aid, and it sat on a table.

Then we saw the more portable vacuum-tube hearing aids. These were worn outside the hearing aid and tucked in a pocket or in somebody’s purse. 1940, not that long ago, this is what we were working with.

Then we had the transistor. We had the first all-transistor hearing aid called the Zenith Royal T. The first transistorized eye glass hearing aid was in 1954. The Telex was considered state of the art at the time.

1996 to our present day, we’re working with digital hearing aids. The first digital hearing aids that were commercially available came out from Oticon and Widex in 1996. This is the Digi focus from Oticon.

Due to the technological advancements in other industries, hearing aids have benefited. We have smaller, more powerful batteries. We have digital circuits, magnetic induction, Bluetooth, water resistance, artificial intelligence, and more to come. In comparison to the large battery for the Aucusticon.


We’ve come a long way in power and capacity alone.

What does the global industry look like now? It has been steadily growing due to a growing aging population. We have more awareness and education about hearing loss. We have some great innovations in hearing devices. It makes sense that people might not want to wear hearing aids if they had to carry the batteries around and have extra things to carry.

The global hearing aid market is about $10 billion US annually. Compared to the cell phone market, this is a relatively small industry. According to World Health Organization, 5% of the population has hearing loss. We expect that to be 2.5 billion people by 2050 who need help with hearing loss.

The hearing industry is built on research. All the manufacturers are trying to understand and replicate what normal hearing should feel like. It takes time. It takes a lot of crafting and innovation. Unfortunately, we haven’t totally cracked the code to solve what was lost, but we’re getting closer every day to understanding how important our brains are in hearing and how much amplification alone isn’t quite enough.


What does the hearing aid industry look like in Canada? A lot of the news we get is American. A lot of the things we see and google to understand how a hearing aid is better from another, or the cost, a lot of what we see is coming from the United States and a lot of things are different there. I’m going to tell you how it works in Canada and how this is different from what you see online.

In Canada, patients cannot be fitted with a hearing aid without seeing a licensed professional. In BC they’re licensed by the College of Hearing and Health professionals of B.C. They have annual professional development, there’s audits, there’s a lot of important stuff that goes with our licensing that we stay on top of. Canada has not approved the over-the-counter use of hearing aids.

In the US, the FDA has approved some over-the-counter hearing aids. In Canada right now, this is not possible. All hearing aids are considered a medical device, and they go through Health Canada approval before they can be prescribed to patients. Before an audiogram, we need to see what hearing loss we’re trying to accommodate. When you see a licensed hearing professional, they use the information from the test and the expertise of the hearing professional to customize the fitting for you.

Over-the-counter devices are not considered prescription. They’re best for mild to moderate hearing loss. They are not customized to your hearing loss. They’re made by an electronics company like Sony or Bose. They’re considered more of an amplifier. They don’t have long warranties or no warranties at all. There’s no support from a hearing care professional. People get them from a drug store and a pamphlet tells you how to use it.

They’re kind of considered the ‘reader’ of hearing aids. From the hearing aid perspective, a lot of people were worried about the OTC FDA approval, but it’s only taking up about 1% of the market in the United States. It’s usually the people who probably weren’t quite ready to see a hearing care professional and did this just to get by. The next logical step for them will be a prescription hearing aid from a hearing care professional.

Let’s take a look inside a hearing aid. The kind of hearing aid you would see being fit at Broadmead Hearing. When you talk to the hearing manufacturers, there’s a lot of similarities in the components. This is what we call a behind-the-ear hearing aid. Most of it sits behind the ear and there’s a little bit in the ear. It could also be called a receiver, another word for speaker.

We have two microphones on top of the hearing aid. Some people ask if you can sit the microphones in a different place, but your audiologist will say no because we need them on a horizontal plane to pick up the sound. The processing in the hearing aid is dependent on where the microphones sit, so we do want them on top of the ear.

Next, we look at the LED light. A lot of hearing aids will have a light to let you know if they need charging or are done charging. Most hearing aids also have a button. We can use the button for volume control or to change programs. If you don’t have a smartphone or don’t want to carry a remote control, you can use the button on the hearing aid to make adjustments.

We use Bluetooth antennas in the hearing aid. This allows it to communicate with a smartphone like a headphone. We also have near-field magnetic induction which allows the hearing aids to talk to each other. It can take some information in through the hearing aid and tell you what’s coming in through the other side. It provides the sound from all around so they’re not operating completely independently of each other.  We want hearing aids to function like the ears, so we want them to be talking to each other.

Telecoil, which takes advantage of a loop system. If you go to a church, bank, B.C. Ferries, a lot of them are audio looped which means the hearing aid can tap into a signal coming from a microphone in the room. It can be useful in church environment; you can turn off that feature and hear what’s coming through the microphone.

 

Not many places are looped. It’s more common in Europe and Ontario. Victoria has some but not a ton. There will probably be some changes in how we think about this technology. For now, a lot of hearing aids still have a telecoil. It’s actually quite big compared to the other parts. It does take up quite a bit of space in the hearing aid.

For rechargeable hearing aids there’s contact charging or induction charging. With contact charging it needs to be on a certain place. With induction you won’t see the battery contacts. It’ll charge by induction, so it looks different. Both are good for different reasons. You can chat with the hearing aid professional about what is best for you.

A lithium ion battery, a size 13, is a rechargeable and fully encased in the hearing aid. You don’t have access to it. Even a hearing care professional doesn’t have access. So, if it needs to be changed we have to send it to the manufacturer for them to open it up and change.

At Oticon the name of our chip is the Sirius Chip but they all have a chip inside. This is where the digitization was happening. That will be built on the chip. It’s tucked in close to the battery there.

 

The end pieces that go in the ear – the dome and filter – these are things that can get clogged with wax and need replacement every month or so.

Each hearing aid has its own serial number. That’s how we know what the warranty is. If someone brought it to the clinic you could get traced back to it.

Last but not least we like to colour mark things so we don’t mix up left and right! The colour markings are blue for left, red for right. If you’re wearing hearing aids you know that. Inside a custom hearing aid – this is fully encased and goes inside the ear canal – we have these components.

We still have the 2.4 gigahertz wireless antenna. We still have the chip and a speaker. We still have NFMI. Everything is made small so that it can fit inside a custom hearing aid.

There is not a telecoil here – it is really big. It can be done but it’ll be bigger. We also don’t have a rechargeable battery. It would need to be bigger. It’s not impossible. It can be done but we are always playing the game of what we can fit and what that person needs and benefits from most.

Also considering the shape and configuration of the ear. Some people’s ears are bendy. Sometimes it sticks out a lot more than we think it will and we have to make modifications. That’s why you have a hearing care professional. They’ll work with you and go, okay I’m not sure how this is fitting. Should we make a change? So we can go back and remake this.


We will follow the journey of a hearing aid from when it was an idea to reality. This usually starts at some kind of research facility. This is where we have engineers, audiologists, PhDs – people who are not just working with clients but thinking beyond what the current hearing aid is doing and what could the future looks like when we tackle the problem of hearing loss.

Many professions work together. It’s an ideas place. A lot of what’s happening here is planning for ten years down the road. There’s another facility where the prototypes get tested. We have a research facility where prototypes are tested – is this the right button? What colours do we want them to come in? Can this hearing aid handle moisture and sweat? Will it qualify for an IP-68 rating. There’s also durability and handling testing.

Once it’s ready for the real world it goes through clinical testing on real patients. We get feedback on how it feels, sounds and performs compared to previous technology. Finally, we put it through that country’s regulatory body. For Europe it’s Medical Device Regulation and in Canada we have Health Canada.

There’s a focus on validation. We want to know if the hearing aid we put out is better than what we put out a few years ago. We do a lot of validation and studies to figure out if people like this. Do they notice a difference? It should be better because there’s a new chip. So, we need to validate and look at what this is doing beyond helping someone hear.

So better speech understanding, reduced listening effort, increased memory capacity are some of what we look at. Not just “can you hear better.” Now the company I work for also fits hearing aids on children. So, durability, handling the rough and tumble things kids do with devices. We want to do this not just for kids. It’s the same product for pediatric but it comes in different colours. The components, hardware etc. is the same. It goes through the same rigorous testing.

Here are some of the tests done before it goes to market:

At Oticon we talk about lifechanging technology. We have a portfolio with audiological features. For children, it’s crucial for them to learn and develop social skills. They aren’t thinking about the mud, water, sand, etc. It’s critical the hearing technology keeps up with the activities in everyday life.

My son’s name is Marcus, and when he was young, he’d rip out his hearing aids. He dropped it into a puddle, but it still worked. It’s very important. They are important to be durable.

We have tests to understand the impact of dropping hearing aids on the ground. Hot and cold temperature. Repeatedly pushing buttons and switches. Things we feel are very important to durability.

The IC has developed a standard called Ingrus Protection. Two numbers are expressed. The first is resistance to dust and solid material. The second number reflects resistance to moisture and water. The whole portfolio has IP 68 which is the highest level for dust and water resistance.

My daughter is five years old. She’s been wearing Oticon hearing aids since she was six months old. She likes to play in the sand. It’s important to have a hearing aid that’s sand resistant so she can enjoy herself.

Durability is crucial to make sure the users can trust that the hearing aids will be working well for them. That is very important to us.

So, you saw them mention IP 68. Most hearing aids you will see out there have IP 68 ratings. Not unique to Oticon. I think that video shows they are testing those things. We might get frustrated with buttons – it’s supposed to work, and we tested it but sometimes things happen so we have warranties, clinics, you can say “hey, this isn’t working!” We are only getting better at handling these environments.

Where does the hearing aid go next? It’s ready to be ordered. It’s going to go – you guessed it – to your licensed hearing care professional.

When you go in for your hearing test, they are the ones who will order the hearing aid through the manufacturer. We can’t distribute a hearing aid directly. It must go through a licensed hearing care professional first.

It’s important to talk about this. We might see a similar change as in the United States. We might not. I think even if it changes it’s important to talk about the importance of seeing your hearing care professional. When the hearing aid comes to the clinic it’s a blank slate. Not preprogrammed. Usually, your hearing care professional will take your audiogram and do some programming based on research and algorithms to figure out what we need to help this person hear better.

They verify the hearing aid is doing what it says. Even though computers are great we don’t want to trust it’s exactly what is happening. It’s part of our requirements to verify. We do double check that what the computer says is happening is really happening in your ear. We don’t always tell you because we’re doing a hundred other things while we move onto another part of the fitting process.

Sometimes we take time but just know it’s always being done with a new pair of hearing aids. No two people are the same. No two hearing tests – those people don’t experience sound the same. There’s an element of fine tuning your professional will do based on your feedback. Sometimes that feedback is, this is a bit too loud for me, or I’m hearing my voice, and it sounds strange or different. These are normal things to experience when you get fit with new hearing aids. Some things are not. They will know which to adjust and which to counsel you on. It’s a dialogue you want to feel comfortable to express yourself and let them know if something isn’t working for you. It does take time to get used to hearing something you haven’t for some time.

Your hearing will probably change over time, and we might need to adjust or re-program.

Then what happens to the hearing aid manufacturer? We’re here to support the professional. We don’t directly work with the client, we might not be licensed to, so we work with the hearing care professional to ensure they have the software and training they need as new products come out. There’s a relationship between the manufacturers and the hearing care professionals.

If Vivien notices something her client is dealing with, she can report it to me, I can report it to headquarters, and we can fix it. A lot of what comes out with hearing aid technology is based on feedback from the person wearing them, the person like you. It is a good pathway for communication.

We do this, and I speak as a we because I am an audiologist, because we care. Many of us work with hearing loss because we want to help. We want to make things better. A lot of the time we’ve been personally impacted, or we have a family member who has, so we look at you like a little puzzle. How can we figure this out? Which product is a good fit for you? What adjustments do we need to make? It’s not a one size fits all approach.

When I was working at Broadmead, there were birds in the bushes chittering away outside the window. People would not hear the birds on the way in, but they would on the way out. We knew the hearing aids were working.

We’re nearing the end of the talk but getting to the most inspirational part. I have a list of future innovations on here. I will talk about each one. Some are already in the hearing aid, but we’ll see an expansion of those over the next few years. Some aren’t in the hearing aid yet but will be soon.

Bluetooth LE audio. This is available in some technologies now. It’s tied to Auracast technology, which I will talk about. I’m going to talk about sensor technology, artificial intelligence, health monitoring and biometrics.

Auracast is a newer version of Bluetooth. I remember when Bluetooth entered the hearing aid world. It was a big deal. Suddenly we could connect the hearing aid to other sound sources and people could hear the person on their cell phone or the TV like it was right in their ears. The hearing aid became a headphone.

The first version was worn around your neck, called a streamer. Some of you probably remember that. As you saw through the walkthrough of the hearing aid, the chip is now inside the hearing aid. In the next few years, this will be an LE audio low energy Bluetooth called Auracast, which is going to replace Bluetooth. It’s like if Wi-Fi and Bluetooth had a baby and named it Auracast.

Just like looking for a Wi-Fi signal, you will pull out your phone to get an Auracast signal. If you had this technology you would pull out your phone and connect to the conference center’s Auracast. Then it would be looped into my microphone, and it would be like I was talking in your ear, even at the back of the room. We don’t have to worry about sound travelling long distances.

You could use it at the airport. You could use it at the gate, click on Gate C17s announcements. You could see if they were boarding zone 1 or 2 but only for that gate. The other thing is that it’s open. You don’t need to pair to anything. You enter the room and connect. This is going to have a big application for classrooms and lectures because right now, if you want to connect to a microphone using Bluetooth, you must come up to the speaker and pair your hearing aid to the microphone. When this is available, you pull up your phone, click on the broadcast you want to listen to, and it will connect.

This is very exciting but we’re about 4-5 years away from it being widespread. It will replace Bluetooth for wireless streaming. Some hearing aids have this. If you talk to the manufacturers, they are “Auracast ready.” But we might not see it for a while.

That covers the top two. Now we’re going to talk about sensor technology. We see sensor technology in using an accelerometer that knows if you’re in motion, if you stopped moving, or if you turned your head a certain way. Based on your movements, it will inform the hearing aid what you’re doing.

 

The hearing aid could focus its movements on the front if you’re looking at somebody or nodding your head. In a car, the hearing aid knows you’re going faster than you would walking, so it applies a car setting, so you can hear the back and sides, and noise reduction for the roads. They use sensors to detect what you’re doing with your hearing aid and how best to support you in that environment.

Another way we can use this technology is for fall detection. If you fall or the hearing aid does, it can notify you by a text message or notify a family member. There are applications that are health focused but also hearing focused.

Let’s move on to artificial intelligence. This a big topic and probably could have been the only topic I talked about today. There’s application of AI in almost every hearing aid you see. Some companies use AI in machine learning, so the hearing aid can be trained for different environments before it gets put on your ear. Even if you go to an environment, you’ve never been to, the hearing aid will adjust to help you. That’s one way AI can be used. In a simpler way, you could adjust them a certain way and it will remember, every time you go to an environment like this, you adjust it this way, so next time you go into this environment, I’ll adjust it for you.

We’ll see AI become more commonplace with all manufacturers. We talked a lot about frequencies and channels, lots of technicalities for dealing with sound, but now we have engineers and computer scientists involved in coming up with the design of hearing aids. A lot of disciplines are having more input into what the hearing aid is doing and making sure that we as hearing care professionals must understand it to explain it to you. I think we’ll see a lot of changes with AI.

 
The last two are connected; health monitoring and biometrics. This is kind of the future of where we see hearing aids going in the next 5-10 years. Imagine you’re in a noisy place and having a hard time hearing. You’re like, I just need to listen harder. Your body is doing something different. Your heart rate might increase, your body temperature might go up, you might perspire. This is your autonomic response. If you’re working hard, there could be a way the hearing aid could know that. There could be biometric sensors that go okay, Lia’s palms are sweaty, her heart rate is increasing, how can we help her?

Our brain is a big part of that. It’s the control centre – we don’t really have control over the autonomic nervous system, but our brain is aware of it functioning and can help us. So, it’s blending the brain and the ear and everything together and using things our body does when we work really hard. That’s one of the biometrics and health monitoring avenues that I can see us going down. When I have been at the research facilities – now it’s on a big scale. An example would be looking at pupil dilation.

With Oticon, they test to see if a new technology is better, and they look at pupil dilation. Are people working harder with the old technology? “Working harder” means your pupil dilates, your flight or fight system is working harder. These are some of the biometric things we’re looking at. We could connect things through an app – heart rate, blood pressure, steps. Some hearing aids already do that.

I think we’re seeing that there will be a useful application more than hearing aids are right now. People might come to feel like this is a helpful health tool. It’s giving more than just better hearing. That is probably five years down the road.

 

Q&A

Question: What has happened in speech understanding in the last three years?

Lia: I’d say most of them use algorithms. When we talk about speech understanding a lot of that is the brain. Even if they have a hearing aid that pulls out speech, they might need more support and time. That’s another area they are working on. Using people’s speech understanding to apply a certain amount of support in the hearing aid that would be unique to their score. That’s available now but they see more of it to come.

 

Question: Are the latest models Auracast and Telecoil ready?

Lia: A couple but not all manufacturers have released something new this year. The ones that released something new have Auracast and then the other ones will have it. So, everyone has been told to get on board. But it depends on how soon they are ready to release something new. It was a universal standard we were told to do.

Telecoil is optional. With Oticon, the hearing aid I showed you has both but because telecoil is so big not all manufacturers put it in their hearing aid. Hopefully with Auracast it should be more cost effective. Some might opt not to put telecoil in if Auracast is more widespread.

 

Question: I was curious to understand the biometrics. If the hearing aid recognizes your heart rate etc., what does it do to compensate for it?

Lia: A couple of things. It will probably increase the ability to bring out the speech from the background noise. We don’t want the hearing aid always there because it isn’t the most natural but when we are struggling, we need as much support as we can. So, the goal could be directional microphones or pulling the speech with an algorithm from the background noise or suppressing background noise even more than before.

I think – as I answer the question, I think in the constraints of what is available. There might be some better methods to support people in four or five years. There could be more. But right now, if we were going to throw in biometrics that’s what it would do.

 

Question: Is there technology to find a lost hearing aid?

Lia: Good question. Yes. Not all manufacturers have that. Some do. They use an app. It’s using Google Maps and the last known location where it was. It will tell you “You left it at the hairdresser” which is where most people leave it! They tell you that’s where it was last turned on. Some of them also do a hot and cold game where you can walk around, and the bars get bigger the closer you get but it’s not an exact science. The radius to pinpoint it is not super precise, so you’d be canvassing a large area.

Question: You need a cell phone for that?

Lia: Yes, you do need a cell phone. It uses the Bluetooth and the app from the phone. It does need to be in contact with your phone.

 

Question: Are there some hearing aids that are more suitable to listening to live performances?

Lia: So certain hearing aids that would be better for a live performance. That’s a common question people have. It would be tricky. Some people are very good at projecting and others aren’t. Or there’s an accent and it’s harder. I haven’t been to Bard on the Beach in awhile. Do they use microphones or live talking?

Speaker: Live talking. If they talk to an actor across the stage, I don’t hear anything.

Lia: In that situation proximity is the answer. How close you are to the stage. That’s the best way to overcome that challenge. Some hearing aids might be better at picking up sound at a distance. That would be a good question for the audiologist to see what they noticed with other people who tried different technologies. They are all similar when it comes to picking up sound. The closer you can get the better. Unfortunately, it’s not a great setup. If they are not using microphones most people with hearing loss will struggle.

 

Question: Some hearing aids have a music program. What does it do?

Lia: It will focus on something different than speech. With speech we want to compress the signal and turn up soft sound and turn down loud sounds and fit everything into a compact package where the best hearing is. With music programs we want a broad dynamic range. We want the soft sounds to still sound soft and the loud sounds to still sound louder so we can have the variation across instruments and for the user to hear more depth to the sound.

There’s lots of ways to do that. One is to remove a lot of the compression we put into a hearing aid signal processing and focusing on a larger bandwidth. Going all the way up to 8 or 10 kilohertz lets us have better sound quality for music. There are some manufacturers that handle music a bit better if they do things that way. That has proven with a few different research studies.

 

Question: With a high end stereo, what is the highest frequency you’ll hear from the stereo and will the hearing aid reproduce it?

Lia: It depends on the hearing aids. Most go up to 8 or 10 kilohertz which would be the premium stereo with the highest bandwidth. That’s as high as it would go.

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