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New BHI Research (Part 2)
Efficacy of Hearing Aids in Achieving
Compensation Equity in the Workplace
Sergei Kochkin, PhD
Agenda
• Impact of hearing aids on income and
employment
• Impact of mini-BTEs on the market
• Validation of the BHI Quick Hearing Check
• Impact of Direct mail and PSAP on private
practices
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Efficacy of Hearing Aids in Achieving
Compensation Equity in the Workplace,
The Hearing Journal, October 2010
Update of 2005 study
• What is the mitigating impact of hearing aids on
income for hearing aid users compared to non-users
controlling for demography and hearing loss?
• Are people with hearing loss more likely to be
unemployed?
• Do people with hearing loss believe their
compensation is equitable compared to their peers
with equal skills, experience, and education?
• Do people with hearing loss believe they have been
passed over for promotions?
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Method
• MarkeTrak VIII database
– Aided: 1818 households in which the head of
household or spouse indicated that one or more or
them had a hearing loss and that one or both wore a
hearing aid.
– Unaided: 3232 households where neither the head of
household nor spouse wore a hearing aid, but where
one or both reported having a hearing loss.
– Normal hearing: 34,351 households in which neither
the head of household nor spouse reported having a
hearing loss.
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Method
• People with hearing loss segmented into ten hearing
loss groups (deciles) based on subjective information
(via factor analysis):
–
–
–
–
–
Ears impaired
Gallaudet scale
Subjective evaluation of loss
BHI Quick Hearing Check (15 items)
Plomp difficulty of hearing in noise scale
• Controlled for demography (household composition,
age, geography and degree of hearing loss) in
calculating income per household.
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Income declines as a function of hearing loss
Mild
Moderate
Severe
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Significant divergence in income profiles for aided
and unaided households
Mild
Moderate
Severe
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Estimated Income loss ($000) compared to normal hearing
households (n=34,351) by severity of hearing loss for aided
(n=1,818) and unaided (n=3,232) households
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Salary differential ($000) between aided and unaided
subjects by severity of hearing loss in deciles
$$ (000)
• Mitigating impact of hearing
aids for mild HL = 90-100%
• Mitigating impact hearing
aids for moderate to severe
HL = 77% - 65%
• The estimated cost in lost
earnings due to untreated
hearing loss is $176 billion
• cost to society in terms of
unrealized federal taxes is
$26 billion.
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Unaided individuals have significantly higher unemployment rates
Segmentation in hearing loss quintiles
Considering only individuals still in the workforce
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Key findings
• No evidence that people with hearing loss
– feel passed over for promotion more than normal hearing
subjects.
– feel discriminated against in the workplace with exception
of older people with hearing loss.
• Hearing aid efficacy
– Use of hearing aids have significant impact on achieving
compensation equity for people with HL in the workplace.
– Unaided subjects more than twice as likely to be
unemployed.
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Leveraging these findings
• Cost to individual and society is very large and needs
to be leveraged:
• Convince people with HL to seek early solution
to their hearing loss.
• Convince HR executives that aided individuals
are good for their corporations.
• Convince politicians that tax credits will help
people with hearing loss become more
productive citizens
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Leveraging income study in media
Tools on BHI website
• 1 page media or patient
handout
• Detailed fact sheet on income
study for media and patient
• OpEd pieces which may be
modified to promote
audiology practice
• Handout to Human Resource
executives
• Sample media clips from
colleagues
• Customizable press release
• The original publication
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Examples of leveraging income study in media
Current OpEd Piece
Sample Private Practice Ad
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Example : Leveraging income study in media
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Mini-BTEs attract new market, users more
satisfied
Hearing Journal, March 2011
Introduction
• BTE hearing aids represented less than 20% of hearing
aid sales prior to 2000.
• With introduction of open-fit hearing aids and receiverin-the-canal hearing aids (RIC), BTEs now represent
63% of all hearing aid sales.
• In looking at the resurgence of BTE hearing aids, we
wanted to answer two key questions:
– Did mini-BTE hearing aids result in market expansion?
– Do mini-BTEs improve the consumer's experience with
hearing aids?
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Hearing aid style mix (%) CY 2005-2008
Source = MarkeTrak VIII Database
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Method
• Simple comparison
– Mini-BTE users
– Traditional style users
• First look at demography
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Demography
Mini-BTE versus traditional style HA
• No age differences between the two samples
• Mini-BTE users
– more likely to appeal to males 64% versus 58%
– on average earn $15,000 more per year
– more likely to be married (72% versus 61%)
– more likely to be in the work force (38% versus 26%)
– have a less severe hearing loss and less difficulty hearing
in noise
– more likely to purchase binaural hearing aids and more
likely to have a bilateral loss
– more likely to be a new users (59% versus 41%)
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Customer satisfaction
Mini-BTE compared to traditional style
Controlling for degree of hearing loss (ANCOVA)
• Overall satisfaction ratings are significantly higher for
mini-BTE hearing aids (85% versus 76%)
• No significant differences in:
– perceptions of benefit or value (despite higher $$),
– hearing aids in the drawer
– brand loyalty
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Customer satisfaction
Mini-BTE compared to traditional style
Controlling for degree of hearing loss
• Significant differences with corresponding practical
significance (10% or more):
– Product variables: visibility, warranty
– Sound quality variables: all 13 variables measured
– 4/19 listening situations: performance on cell
phones, telephones, in large group situations and
in the schoolroom/classroom
– lower on ability to control volume
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Key findings
• Did not tap into younger segments of people with hearing
loss.
• But is expansionary influencing HA purchases by:
• more affluent
• more active and elderly consumer segments
• with milder hearing losses
• Controlling for degree of hearing loss mini-BTE hearing
aids would appear to offer significant improvements in:
•
•
•
•
overall satisfaction
cosmetics
sound quality
multiple environmental listening utility (MELU)
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The Validity and Reliability of the
BHI Quick Hearing Check
Kochkin, S. and Bentler, R.
The Hearing Review, November 2010
Introduction
• Key obstacle to hearing aid adoption is
awareness of degree of hearing loss
– 50% of people admitting hearing loss have
never had their hearing tested professionally
– Have insufficient information to seek a
hearing solution and to visit an audiologist
– Problem recognition is a precursor to
problem resolution
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Introduction
• Wide-scale availability of simple self-measures
of hearing loss may influence increased
throughput into audiologist offices
• BHI adopts the American Cancer Society and
American Diabetes Association models with
online testing: “Are you at risk”…if so visit an
audiologist
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BHI Quick Hearing Check
• 15 items – standard “signs of hearing loss”.
Sample items:
–
–
–
–
I have a problem over the telephone
I have trouble understanding things on TV
I have to strain to understand conversations
Many people I talk to seem to mumble
• Based on AAO-HNS 5 minute test
• Revised by Koike and validated on small sample
(n=74) but not in use today
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BHI Quick Hearing Check
• BHI adopted the test
• Changed to 5 point Likert scale (Strongly agree –
Strongly disagree)
• Validated on 11,000 subjects using 4 databases:
•
•
•
•
NCOA database – self perceptions
NCOA database – spouse perceptions
MarkeTrak VIII database – self perceptions
Objective HL information from 64 clinics on 987 patients
– Audiogram (5 frequencies)
– Speech discrimination scores
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BHI Quick Hearing Check reliability
• Separate factor analysis of NCOA and MarkeTrak
database items demonstrate one dimension:
– Unidimensionality means we can add the items
together
• Reliability (internal consistent – Cronbach’s alpha)
very high where a score of 100% is perfection:
– NCOA database = 95%
– MarkeTrak = 94%
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Objective Validity
Correlation between audiogram
information and BHI Quick Hearing
Check
Relationship between the BHI Quick Hearing Check and
average speech threshold scores
Model = better ear
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Relationship between the BHI Quick Hearing Check and
average threshold scores
Model = 5PTA both ears
y = 25.38 + .6787x
R2 = .84
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Probability of hearing loss of 40 dB (both ear average) or higher
based on BHI Quick Hearing Check scores
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Subjective Validity
Correlations between subjective
measures of hearing loss and the
BHI Quick Hearing Check
Average BHI Quick Hearing Check Score by level of performance
on the Gallaudet Scale
Self-ratings MarkeTrak VIII
N=7,201, r=.49
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Average BHI Quick Hearing Check Score by level of self and
family member perception of hearing loss
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Average BHI Quick Hearing Check score by level of
Plomp’s difficulty of hearing in noise scale
Self ratings – MarkeTrak VIII
N=7,201, r=.64
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Concurrent Validity
BHI Quick Hearing Check
correlations with issues tangentially
related to hearing loss
Scores on the BHI Quick Hearing Check
correlated with QOL issues
•
According to spouses of people with
HL:
– Concerns about safety
– Family accommodation
– Rejected by others
– Withdrawal
– Difficulty in communication
– Independence of person
– Effect of hearing loss on family
– Compensatory behavior
– Cognitive functioning
– Self confidence
– Discrimination against individual
– Anger & frustration
– Emotional stability
– Introversion
• According to individual with HL:
– Anger & frustration
– Withdrawal
– Impact of hearing on health
– Phobia symptoms
– Paranoia
– Overall health and pain
assessment
– Anxiety symptoms
– Activity on phone with social
network
– Depression symptoms
– Problems with friends
– Problems with all
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relationships
Use of the new
BHI online hearing test
• Complete redesign of BHI
online hearing test
• URL created
– www.hearingcheck.org
• Items presented one at a
time with background
photo
• Internet banner ads now
directing traffic to the test
as well as Google ads
• BHSM initiative similar to
American Diabetes and
Cancer risk test
campaigns.
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BHI Online Hearing Test
• Comprehensive report:
– BHI Quick Hearing Check
score
– Norm compared to U.S.
population with HL
– Estimated dB loss better ear –
speech range
– Estimated dB loss 5 tone –
PTA both ears
– Probability HL > 40 dB in both
ears
– Subjective classification of HL
based on consumer
perceptions (standard
audiological classification
judged too conservative
based on consumer
perceptions)
– Recommendation
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Using the new
online hearing test at BHI
• Encouraging hearing
health industry to link to
this online hearing test at
www.hearingcheck.org
• Developed logos for
hyperlinking
• Also available in paperand-pencil form
–
–
–
–
Drug store
Ads
Chiropractor offices
Health fair handout
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Impact of Direct Mail and Low Cost
Listening Devices on Hearing Aid Sales
Hearing Review, June 2010
Introduction
• Low cost listening devices (PSAPs) and direct mail hearing aids
have been available for at least 25 years.
• PSAPS
•
•
•
•
Price range $20-$50
Some infomercials 2 for $19.95
Most notable historically Whisper 2000
Legal as long as they don’t target people with hearing
loss.
• Direct mail
– Products such as Crystal Ear usually sells in the $300 range
– Some DM firms even allow consumer to take their own ear
impressions
– Legal in many states with medical waiver
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Introduction
• Recent proliferation of devices with extensive television
ads.
–
–
–
–
Lee Major’s Bionic Ear
Silver Sonic XL
Loud N’clear
+ dozen others
• Apparently tend to be introduced close to recessions
• How many people with hearing loss are using them?
• Do these devices cannibalize legitimate hearing aids
sales?
• How do people with hearing loss rate these products?
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Sample of products
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Resurgence of Internet, DM and over-thecounter sold hearing aids
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Direct mail firms selling pre-programmed
digital open fit hearing aids ($400-$895)
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Increased trend in non-owner purchase
of listening devices
• Use less expensive device in place of hearing aids
• MarkeTrak III (1993)
– 2.6% “somewhat a reason”
– 1.1% “definitely a reason”
– 3.7% Total
• MarkeTrak VII (2004)
– 5% “somewhat a reason”
– 3% “definitely a reason”
– 8% Total
• MarkeTrak VIII (2008) – analysis to follow
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Relative internet ranking (000)
Internet ALDs versus HIA members
62
67
74
Silver Sonic
Songbird
Loud n Clear
118
HIA10
156
178
HIA9
HIA8
271
HIA7
334
356
385
397
427
462
Ampli-ear
HIA6
HIA5
HIA4
HIA3
HIA2
576
HIA1
0
100
200
Note: Lower ranks denote higher traffic
300
400
Rank (000)
500
600
700
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Estimated web visitors per month
ALDs versus HIA members
ALD= Songbird, Sonic XL, Loud n Clear, Ampli-ear
2008
Jan
HIA
ALD
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2009
Jan
0
100000
200000
300000
400000
500000
600000
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Summary demography
Custom vs DM vs PSAP
Demography
Custom
Direct
Mail
PSAP
Male %
59
71
53
Age (mean)
71
71
66
Income (Median)
41k
31k
31k
Income (Mode)
112k
21k
24k
Employed (%)
29
28
35
Marital Status (%)
62
52
57
Binaural HA (%)
76
41
n/a
Yrs aware of HL - Mn
7
8
15
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Targeting
• Direct mail hearing aids are marketed to compensate for
hearing loss where legal
– Some calling them PSAPs
– Due to legitimization of them by FDA
• PSAPs not sold to compensate for hearing loss
• But here are some of the PSAP ad messages:
– Never miss another word at lectures, movies,
shows, or even church
– Turn up the volume on what people around you are saying
– Listen at the level you want without disturbing others
– Hear a pin drop from across the room
– Turns ordinary hearing into extraordinary hearing
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Hearing loss distribution
• What is the hearing loss profile of DM and
PSAP customers:
– People with admitted hearing loss
– Compared to your typical patient
• And what is the likelihood PSAPs took business
away from you?
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Hearing loss decile distribution of owners of custom hearing aids,
direct mail hearing aids and
personal sound amplifying products (PSAP)
Decile 50% or higher
83%
79%
72%
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Likelihood of purchasing custom hearing aids in absence of
PSAP as reported by non-owner population
Overall likelihood = 17.8%
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The numbers please!
• 3.28% (280,000 people) of hearing aid owners
indicated they received their hearing aids by
direct mail (2008)
– 3.68% (270,000) were direct mail hearing aid owners
in 2004
• 4.79% of the non-adopter population uses PSAPs
representing 1,237,700 people
• Total market = 1.5 million people with hearing
loss.
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Cannibalization
• Probable cannibalization of custom hearing aid
market by PSAP owners approximately 17.8%
• Translating into 220,310 PSAPs probably siphoned
off from the custom hearing aid market
• Considering a four year purchase cycle the
hearing aid industry is probably losing about
55,000 patients a year
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Conclusions
• Approximately 1.5 million people with hearing impairments use
either direct mail or personal sound amplification to compensate
for their hearing loss.
– Number much higher if you consider over-the-counter preprogrammed hearing aids at Walmart, Drugstores, Sam’s Club, etc.
• Users of these devises on average have incomes $10,000 less than
custom hearing aid users.
• 3 out of 4 PSAP or direct mail hearing aid users have hearing loss
profiles equivalent to the custom hearing aid user
• The PSAP user has been aware of their hearing loss on average for
10 years compared to 3 years for the typical hearing aid user.
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Conclusions
• Little doubt that PSAPs are used to compensate for
hearing loss
• Estimate that less than 18% of PSAP users
substituted personal sound amplification products
for custom hearing aids
• In the absence of PSAPs in the market place in all
likelihood the majority would have lived with their
hearing loss
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