The wider context

The COCOHA project has a sharp focus on the goal of developing a cognitively-controlled hearing aid.  However we must be aware of the wider context: the needs of the (ever widening) population that we wish to help, the industry that caters to these needs, the technological, marketing, distribution and funding constraints that determine the viability of possible solutions. Whatever we contribute via COCOHA must fit within this landscape.

Solutions are mainly developed by the Hearing Aid industry, including the “big six” William Denant (Oticon), Sonova (Phonak), Sivantos (Siemens), GN Resound, Widex, Starkey and other smaller actors.  A more detailed map of this landscape is shown below, see also Healthy Hearing’s commented list of Hearing Aid Manufacturers.

A map of the major players in the Hearing Aid industry (from Hearing Tracker)
The boundaries between players are shifting, via mergers and acquisitions, and the contours of the industry itself are being eroded by the emergence of new players. Emerging trends include deregulation, lower cost solutions dispensed over the counter and online, Personal Sound Amplification Products (PSAP), Hearables, wellness devices, wireless, and the encroachment of smartphones on the PSAP and Hearable markets:
  • Deregulation.  The ecosystem of makers and dispensers is so far sheltered by regulatory barriers (see for example FDA guidance), now perceived as partly responsible for the low uptake of hearing aids. As argued by Mead Killion, impairment is often the result of a normal aging process, and regulating devices as medical makes little sense if it results in fewer people using them. In the US, the recent PCAST recommendations (slidescommentscriticism) and activities of the US Institute of Medicine’s specialized committee harbinger a major shift in regulatory policy, at least in the US.
  • Lower-cost solutions dispensed online (see blog of Kim Cavitt for pointers). The cost of hearing aids, and the networks that dispense them, is often cited as an obstacle to their availability to those that need them. See Holly Hosford-Dunn’s 21-part series on Hearing Aid Pricing (follow links for parts 1-20). This trend is significant for COCOHA in that can lead to a wider range of technical solutions, although it may also drag them down to lower quality.
  • PSAPs  and Hearables.  See Mead Killion on the boundary between PSAPs and hearing aids (follow link for part 2), and Holly Hosford-Dunn’s very informative 13-part series on Hearables (follow links for parts 1-12), and 5-part series on market forces that govern the competition between HAs and Hearables (follow links for parts 1-4). It is often assumed that HAs ensure the best performance, but this assumption has been challenged. The recently announced partnership between Starkey and Braggi signals that the idea of a convergence between HAs and Hearables may be more than just an idea. For COCOHA this trend is important as it may relax the technical and market constraints of HAs, and thus removing barriers to the concept of “cognitive control” of the device. It also vastly expands the range of potential configurations for the “acoustic scene analysis” postulated by the COCOHA model.
  • Wellness devices. Devices that track health data such as heart rate, physical activity and so on are becoming popular.  Many are wrist-based, on the model of Apple’s iWatch, but the ear is emerging as possibly a better place to gather the data. Going from vital parameters to brain signals is a natural step, and the idea of collecting them from an ear-borne Hearable is emerging as an alternative to the scalp. This of course immediately relevant to COCOHA, making the idea of gathering brain signals more mainstream and palatable. Wellness devices and Hearables cater to an affluent and trendy market, blurring the boundaries between these and HAs can help remove stigma-related obstacles to HAs.
  • Wireless audio streaming. High-end hearing aids offer wireless audio streaming between devices on either ear. This allows signals to presented optimally to both ears, and/or signals from microphones on both devices to be merged for acoustic signal processing. Wireless also allows streaming from an external device such as a smartphone.  Wireless streaming has been around for a long time in the form of telecoilsloops and FM. New protocols such as Bluetooth are popular, although they may suffer from deficient latency characteristics. From the COCOHA perspective, wireless is an essential ingredient in acoustic scene analysis.  See Apple’s petitions to remove telecoil and to improve compatibility, Cynthia Compton-Conley’s 2-part series on Wireless Systems for Hearing Aids (follow link for part 1), Wayne Staab’s 6-part series on Bluetooth (follow links for parts 1-5).
  • Smartphones.  Phones and hearing aids both deal with sound, and both are indispensable accessories for the hearing impaired. It makes sense to look to merge the two in a single device, and smartphone makers such as Apple and Samsung are poised to enter the HA market.  Many commercially-available hearing aids already use a smartphone for adjustments, or communication, and there are numerous apps for hearing assessment or training.  From the COCOHA perspective, the smartphone is a potential bridgehead for a wide-range microphone array, particularly if latency issues can be solved (i.e. adoption of a protocol with lower latency than Bluetooth).
  • Patents. Recent Apple patents. Holly Hosford-Dunn’s multi-post review of hearing device patents (follow links for earlier posts), Patent Tales, Patent Trolls, Patent Fights, Patent War (of the Worlds), Oticon vs GN Resound.

In summary, the landscape around hear aids is shifting rapidly, with new players and new concepts ready to come in.  From the perspective of COCOHA this evolution is highly significant because (a) it signals that we should not be limited by current hearing aid technical or marketing constraints, particularly as our project aims at the future of hearing aids, and (b) it places COCOHA squarely in the main stream of this rapid and disruptive evolution. Many of these trends involve external devices (such as smartphone) that can relieve the HA from  computationally-expensive and power-hungry functions, and give it access to wider networks of sound-gathering devices.

Some useful blogs and resources: Hearing Health and Technology Matters is a rich repository of highly informative articles, very well written but unfortunately a bit hard to browse.  Others are the Healthy Hearing Report, Hearing TrackerAudiology World News,, David Copithorne’s Hearing Mojo, Abraham Bailey’s Hearing Tracker, Dan Schwartz’s The Hearing Blog, Cynthia Compton Conley’s blog, IOM presentation slides.  Our partner at UCL is curating a very interesting page of links. The Hearing Aid’s big six have formed a Hearing Industry Research Consortium to tackle together some of the new challenges. A thesis looks at the market changes faced by our partner Oticon.