1. MarkeTrak VIII: 25 Year Trends in the Hearing Health Market How do we get on the fast track? Sergei Kochkin, Ph.D.

2. Agenda Review MarkeTrak VIII findings:Review MarkeTrak VIII findings: –25 year trends in the hearing health market (2008) –Customer satisfaction with hearing aids (2009) –Impact of HHP on consumer success with hearing aids (2010) –General observations on why the hearing aid industry is underperforming. As we review this data: ask how can I turn this problem, obstacle, misinformation, consumer disappointment, etc into an opportunity? Focus on why we all work in an under-performing industry.As we review this data: ask how can I turn this problem, obstacle, misinformation, consumer disappointment, etc into an opportunity? Focus on why we all work in an under-performing industry.

3. Other planned publications in the MarkeTrak VIII series Impact of hearing loss on job effectiveness (2nd edition).Impact of hearing loss on job effectiveness (2nd edition). Customer satisfaction with on-the-ear (open fit) hearing aids compared to traditional style HACustomer satisfaction with on-the-ear (open fit) hearing aids compared to traditional style HA Prevalence of tinnitus and efficacy of treatment modalitiesPrevalence of tinnitus and efficacy of treatment modalities Sources of noise which most impact satisfaction with hearing aidsSources of noise which most impact satisfaction with hearing aids Perceptions of benefit and changes in quality of life due to hearing aids.Perceptions of benefit and changes in quality of life due to hearing aids. Impact of hearing loss on traffic accidentsImpact of hearing loss on traffic accidents

4. Other planned publications in the MarkeTrak VIII series Use of assistive listening devicesUse of assistive listening devices Use of inexpensive listening devices (<$50) in lieu of hearing aid adoption.Use of inexpensive listening devices (<$50) in lieu of hearing aid adoption. Factors which would influence hearing- impaired non-adopters to purchase and use hearing aids.Factors which would influence hearing- impaired non-adopters to purchase and use hearing aids. Comparison of customer satisfaction in other professions and with products and services in other industries (non-adopter population only).Comparison of customer satisfaction in other professions and with products and services in other industries (non-adopter population only). Media habits of the hearing-impaired populations (owners and non-adopters).Media habits of the hearing-impaired populations (owners and non-adopters). Reasons for hearing aid returnsReasons for hearing aid returns

5. 25 Year Trends in The Hearing Aid Market October 2009 Hearing Review

6. Are we really on the fast track? Original cover for the first MarkeTrak VIII publicationOriginal cover for the first MarkeTrak VIII publication Changed to Headed for the Fast Track?Changed to Headed for the Fast Track?

7. Led to funny editorial …or Slow Train Coming? and some alternate titles Are we on the right track?Are we on the right track? Are we on the track at all?Are we on the track at all? Are we headed for derailment?Are we headed for derailment? Throw Mama on the train!Throw Mama on the train! Why isn't there anyone under 70 on this train?Why isn't there anyone under 70 on this train? The train has left the station leaving behind three-quarters of its passengersThe train has left the station leaving behind three-quarters of its passengers People are in denial about their need to get on the train; it takes them 3 to 8 years just to get aboardPeople are in denial about their need to get on the train; it takes them 3 to 8 years just to get aboard Why are train rides so expensive? Why can't we deduct them from our taxes?Why are train rides so expensive? Why can't we deduct them from our taxes? Some still believe the train is too big and noisyand the whistle drives them crazy!Some still believe the train is too big and noisyand the whistle drives them crazy! My family doctor told me trains don't workMy family doctor told me trains don't work One of my friends told me that the train ride stinksOne of my friends told me that the train ride stinks

8. MarkeTrak Methodology

9. Method National family opinion panelNational family opinion panel –80,000 households –Balanced to 9 key census variables –Used since 1984 starting with HIA survey. –Does not include institutional settings. Screening questions–Phase I(11-12 /2008)Screening questions–Phase I(11-12 /2008) –Hearing loss –Hearing aids –Tinnitus –Physician screening for hearing loss –Detailed employment status beyond NFO panel data –Traffic accident data

10. Method Screening survey:Screening survey: –Returns – 46,843 households –Identified 14,623 people with hearing loss and or tinnitus –Response rate: 59% Detailed survey - Phase II (1/2009)Detailed survey - Phase II (1/2009) –7 page legal size survey –3,779 hearing aid owners (total population) –5,500 adult non-owners (random sample) –Response rate 84% & 79% respectively –$1 incentive

11. The Hearing Loss Population

12. Incidence of hearing loss per thousand households There is no hearing loss epidemic only the aging of America

13. For more than a generation the incidence of HL has been about one in 10 people HIA* * Adjusted by +.7% to account for multiple hearing-impaired per household

14. Physician screening for hearing loss has increased primarily among younger segments when you include paper and pencil screening

15. Key HL population data Incidence of HL in U.S. population = 11.3%Incidence of HL in U.S. population = 11.3% –Up from 10.7% (2004) Admitted HL population = 34.25 million peopleAdmitted HL population = 34.25 million people –Up from 31.5 million people (2004) 6 out of 10 are male6 out of 10 are male 60% are below retirement age60% are below retirement age

16. The Hearing Aid Market

17. Key hearing aid owner population data Current hearing aid owners = 8.41 million peopleCurrent hearing aid owners = 8.41 million people Up from 7.8 million (2004)Up from 7.8 million (2004)

18. Hearing aid adoption rates are now one in four people with admitted hearing loss Growth primarily VA and direct mail

19. Binaural rates continue to grow impressively

20. Evidence for growth in third-party payment

21. Sources of third-party payment. Average third party payment discount achieved = 84% Note: Total percent greater than 100% since respondents indicated they received financial help from multiple sources.

22. Average out-of-pocket retail price paid by consumer increased 17% (includes free, direct mail hearing aids, & all third-party discounts but excludes VA fittings)

23. Audiologists fit nearly two out of three hearing aids

24. The average age of hearing aids has dropped to 4.1 years Mean age of hearing aids: 1991 = 3.1 yrs 1994 = 3.7 yrs 1997 = 3.8 yrs 2000 = 3.8 yrs 2004 = 4.5 yrs 2008 = 4.1 yrs

25. New user rate(%) We are unable to attract new users to the market

26. Average age of new hearing aid users We have not tapped into the younger markets

27. The typical HA purchaser has an average household income of $54,000 & their modal income is $125,000

28. Whats the REAL market for hearing aids? Used subjective measures to segment marketUsed subjective measures to segment market –Number of ears impaired –Subjective view of HL –Gallaudet scale –BHI quick hearing check (based on revised AAO- HNS 5 minute hearing loss screener) –Difficulty hearing in noise Created single HL index (factor analysis)Created single HL index (factor analysis) Divided total HL population into 10% HL segments called decilesDivided total HL population into 10% HL segments called deciles –Decile 1 = Lower 10% of HL – mild –Decile 10 – Top 10% of HL – severe to profound

29. Hearing aid adoption heavily dependent on degree of hearing loss Decile 5-10= 83% hearing aid owners 43% non-adopters

30. Hearing aid opportunity by age group. The viable hearing aid market in the U.S. is about 11 million more people with untreated hearing loss Deciles 5-10= 6.98 Mil. HA owners 11.1 Mil. non-adopters

31. Hearing aid adoption rates redefined One in four people with admitted hearing loss own hearing aids.One in four people with admitted hearing loss own hearing aids. 40% of people with moderate to severe hearing loss40% of people with moderate to severe hearing loss 9% of people with milder hearing losses9% of people with milder hearing losses

32. We are at the right place at the right time The hearing loss population is growing at the rate of 1.6 times the general population growth– primarily aging population.The hearing loss population is growing at the rate of 1.6 times the general population growth– primarily aging population. Digital technology and the supporting software is superb – and it will get better.Digital technology and the supporting software is superb – and it will get better. We have the capability of meeting the needs of the vast majority of people with hearing loss.We have the capability of meeting the needs of the vast majority of people with hearing loss.

33. So why are we on a such a slow moving train? Explore customer satisfaction with hearing aidsExplore customer satisfaction with hearing aids Explore HA fitters role in user successExplore HA fitters role in user success Summarize with other observationsSummarize with other observations

34. Customer Satisfaction with Hearing Aids 2008 January 2010 Hearing Journal

35. Key HA satisfaction measures

36. Satisfied & very satisfied customers have not grown during the digital revolution

37. Dissatisfaction has dropped to 14% but…. 8% of new hearing aids are in the drawer

38. More than half of hearing aids in the drawer are </= 5 years of age

39. Hearing aids in the drawer Has varied between 11.7% and 17.9% historically.Has varied between 11.7% and 17.9% historically. Current rate: 12.4%Current rate: 12.4% –New hearing aids (</=4 years) : 7.5% –Brand new HA: 5.2% 1,040,000 customers never use their hearing aids.1,040,000 customers never use their hearing aids. Why do so many people spend $2000- $6000 for a product that does not meet their needs?Why do so many people spend $2000- $6000 for a product that does not meet their needs?

40. Hearing aid usage patterns virtually unchanged

41. 30% of new user fittings are probable failures

42. Causes for hearing aids in drawer Poor benefitPoor benefit Poor fit and comfortPoor fit and comfort Poor performance in noisePoor performance in noise

43. We have failed to improve positive word of mouth advertising and brand loyalty

44. Customer satisfaction with hearing aid product features hearing aids are <= 4 years old.

45. Customer satisfaction with hearing aid signal processing and sound quality hearing aids are <= 4 years old.

46. Customer satisfaction with hearing aids in various listening situations hearing aids are <= 4 years old.

47. Customer satisfaction with hearing aids in various listening situations (continued) hearing aids are <= 4 years old.

48. Hearing aid multiple environment listening utility (MELU) is not impressive.

49. Multiple environment listening utility (MELU) is highly related to brand repurchase and positive word of mouth advertising.

50. Satisfaction with benefit is highly dependent on the number of listening situations hearing aids work …and Somewhat satisfied is hardly an endorsement

51. Changes since MarkeTrak VII (2004) Practical (at least 5% point increase) and statistically significant improvements:Practical (at least 5% point increase) and statistically significant improvements: –Whistling and feedback (12% points, p<0.0001) –Sound of chewing and swallowing (9% points, p<0.0001) –Wind noise (7% points, p<0.0004) –Use in noisy situations (7% points, p<0.0001) –Comfort with loud sounds (5% points, p<0.001)

52. The Impact of the Hearing Health Professional on Hearing Aid User Success April 2010 Hearing Review

53. Co-authors & Reviewers Co-authorsCo-authors Sergei Kochkin, PhD (BHI)Sergei Kochkin, PhD (BHI) Douglas L. Beck, AuD (Oticon)Douglas L. Beck, AuD (Oticon) Laurel A. Christensen, PhD (GN ReSound)Laurel A. Christensen, PhD (GN ReSound) Cynthia Compton-Conley (Gallaudet U)Cynthia Compton-Conley (Gallaudet U) Brian J. Fligor, ScD (Harvard)Brian J. Fligor, ScD (Harvard) Pat B. Kricos, PhD (U of Florida)Pat B. Kricos, PhD (U of Florida) Jay McSpaden, PhD (Retired audiologist - Oregon)Jay McSpaden, PhD (Retired audiologist - Oregon) H. Gustav Mueller, PhD (Vanderbilt)H. Gustav Mueller, PhD (Vanderbilt) Michael Nilsson, PhD (Sonic Innovations)Michael Nilsson, PhD (Sonic Innovations) Jerry Northern, PhD (Starkey)Jerry Northern, PhD (Starkey) Co-authors (cont.) Thomas A. Powers, PhD (Siemens) Robert W. Sweetow, PhD (U of C) Brian Taylor, AuD (Unitron) Robert G. Turner, PhD (LSU) Reviewers Harvey B. Abrams, PhD (VA) Ruth Bentler, PhD (U of Iowa) Vic S. Gladstone, PhD (ASHA) Larry Humes, PhD (Indiana U) Michael Valente, PhD (Washington U)

54. Top 10 mistakes of clinicians Christensen & Groth (AAA) Failing to use new tests to help with selection, fitting and counseling,Failing to use new tests to help with selection, fitting and counseling, assuming that automatic environmental steering programs are accurate and that the hearing aids switch appropriately,assuming that automatic environmental steering programs are accurate and that the hearing aids switch appropriately, fitting a hearing aid without buy-in from the patient,fitting a hearing aid without buy-in from the patient, using first time, new user, or inexperienced user gain settings and not revisiting the settings over time,using first time, new user, or inexperienced user gain settings and not revisiting the settings over time, not doing the appropriate counseling,not doing the appropriate counseling, not performing appropriate validation measures,not performing appropriate validation measures, not taking manual dexterity into account when selecting the hearing aids,not taking manual dexterity into account when selecting the hearing aids, assuming the manufacturer defaults are right for every patient,assuming the manufacturer defaults are right for every patient, not understanding when to use an open fitting and when not to,not understanding when to use an open fitting and when not to, failing to verify the fitting with probe tube measurements.failing to verify the fitting with probe tube measurements.

55. THESIS The HHP has direct control over hearing aid user success Hearing aid quality control prior to fitHearing aid quality control prior to fit Fit and comfort of hearing aidFit and comfort of hearing aid Verification of fitVerification of fit Validation of fitValidation of fit Optimal amplification of the residual auditory area of the consumerOptimal amplification of the residual auditory area of the consumer Vast array of counseling toolsVast array of counseling tools Measureable BENEFIT GUARANTEEMeasureable BENEFIT GUARANTEE And a money back guaranteeAnd a money back guarantee

56. Method Measured 17 items of the hearing aid fitting protocol.Measured 17 items of the hearing aid fitting protocol. Measured 7 real-world success measuresMeasured 7 real-world success measures Related use of protocol items to real-world success.Related use of protocol items to real-world success. Related total weighted protocol to successRelated total weighted protocol to success Related unweighted protocol to success (e.g. simple counting of steps performed)Related unweighted protocol to success (e.g. simple counting of steps performed)

57. Protocol items measured Hearing tested in sound boothHearing tested in sound booth Real ear measurement verificationReal ear measurement verification Subjective benefit measurementSubjective benefit measurement Objective benefit measurementObjective benefit measurement Patient satisfaction measurementPatient satisfaction measurement Loudness discomfort measurementLoudness discomfort measurement Auditory retraining software therapyAuditory retraining software therapy Aural rehabilitation groupAural rehabilitation group Received self-help bookReceived self-help book Received self-help videoReceived self-help video Referred to self-help groupReferred to self-help group

58. Protocol items measured Fit and comfort of the hearing aid (single Likert scale item)Fit and comfort of the hearing aid (single Likert scale item) Achieved Sound quality :Achieved Sound quality : –clearness of tone/sound –whistling and feedback –use in noisy situations –natural sounding –sound of voice –ability to hear soft sounds –comfort with loud sounds –single index from Factor analysis. Proxy for: Optimal amplification of residual auditory area of patientOptimal amplification of residual auditory area of patient Functionality of hearing aid (quality control pre-fit)Functionality of hearing aid (quality control pre-fit)

59. Protocol items measured Attributes of the hearing healthcare professional:Attributes of the hearing healthcare professional: –knowledge –professionalism –empathy –creation of realistic expectations –explained care and maintenance of hearing aids –quality of service during the fitting process –quality of service after the hearing aid fitting –all measured on a 7 point Likert scale –single index from Factor analysis

60. Protocol items measured Attributes of the hearing healthcare office:Attributes of the hearing healthcare office: –front office staff –hours of operation –attractiveness and comfort of the office –ease of access to the office –convenient location –all measured on a 7 point Likert scale –single index from Factor analysis.

61. Protocol items measured Counseling:Counseling: –the amount of time spent in hours explaining care and maintenance of the hearing aids and –the hours spent in aural rehabilitation –total counseling hours spent in the first 2 months of the new hearing aid fitting. The number of visits to get the hearing aid working just right for the patient.The number of visits to get the hearing aid working just right for the patient.

62. Success measures Hearing aids in the drawer and hearing aid usage in hours.Hearing aids in the drawer and hearing aid usage in hours. Benefit.Benefit. –Satisfaction with benefit (7 point Likert scale) –Perception of % hearing handicap reduction in 10 listening situations. –Multiple Environmental Listening Utility (MELU). The percent of 19 listening situations in which the patient was satisfied or very satisfied. Quantified Client Oriented Scale of Improvement (COSI) measure.Quantified Client Oriented Scale of Improvement (COSI) measure. Only situations for which patient had need to hear.Only situations for which patient had need to hear.

63. Success measures Patient recommendationsPatient recommendations –Would recommend the hearing healthcare professional –Would recommend hearing aids to friends –Would repurchase current hearing aid brand Overall success.Overall success. –A composite measure of success derived from factor analyzing the above variables –Converting to factor scores and standardizing to a mean of 5 and standard deviation of 2 (stanine scores).

64. Consumer perceptions of hearing aid fitting protocol received comparing new and experienced users.

65. Outcome measures comparing new and experienced users

66. Summary of statistically significant relationships between outcome measures and protocol items for new and experienced users

67. High-low analysis Compare patients experiencing below average (-1 std) and above average (+1 std) real-world success.Compare patients experiencing below average (-1 std) and above average (+1 std) real-world success. Lets look at the patients experience during the hearing aid fitting process!Lets look at the patients experience during the hearing aid fitting process!

68. A comparison of above average (+1 std) and below average (-1 std) hearing aid success as measured by subjective real-world outcomes showing protocol received based on consumer perceptions.

69. A comparison of above average (+1 std) and below average (-1 std) hearing aid success as measured by subjective real-world outcomes showing protocol received based on patient perceptions.

71. A comparison of above average (+1 std) and below average (-1 std) hearing aid success as measured by subjective real-world outcomes showing protocol received based on consumer perceptions.

72. A comparison of above average (+1 std) and below average (-1 std) hearing aid success as measured by subjective real-world outcomes showing protocol received based on consumer perceptions.

73. High-low analysis #2 Use high/low difference scores from past analysis to weight protocol received.Use high/low difference scores from past analysis to weight protocol received. Sum weighted scoresSum weighted scores Compare top and bottom 15% weighted protocol scores.Compare top and bottom 15% weighted protocol scores. Now lets look at the patients real world outcome!Now lets look at the patients real world outcome!

74. Impact of a weighted protocol comparing the top and bottom 15% of consumers on hearing aid success.

75. Total hearing aid user success achieved as a function of a weighted fitting protocol (in stanines, n=1,613) Correlation =.70

76. High-low analysis #3 Simple count of protocol stepsSimple count of protocol steps Collapsed counseling methodsCollapsed counseling methods Compare minimum (0-2 items) to comprehensive protocols (10-12 items)Compare minimum (0-2 items) to comprehensive protocols (10-12 items) Are protocols additive or multiplicative?Are protocols additive or multiplicative? Lets see how the patients did in the real world!Lets see how the patients did in the real world!

77. Impact of a protocol on hearing aid success comparing a minimum protocol (0-2 items) to a more comprehensive protocol (10-12 items).

78. Total hearing aid user success achieved as a function of an additive hearing aid fitting protocol (n=1,613) Correlation =.50

79. Other findings Factors explaining less than 1% of variance in the hearing aid fitting protocol:Factors explaining less than 1% of variance in the hearing aid fitting protocol: –Age of the patient –Gender –User (new versus experienced) –Size of city (rural to metropolitan) –Price of hearing aid –Style of hearing aid –Degree of hearing loss Occupation of person (Audiologist/HIS) fitting hearing aid explained < ½ of 1% of the protocol used OR real-world hearing aid user success.Occupation of person (Audiologist/HIS) fitting hearing aid explained < ½ of 1% of the protocol used OR real-world hearing aid user success. –Confirmed by the Hearing Industry Association Consumer Journey Study. –Audiologists and HISs are equivalent in both protocol and ability to generate successful hearing aid users.

80. Conclusions What occurred in HHP offices has a very strong relationship to real-world success.What occurred in HHP offices has a very strong relationship to real-world success. Evidence that a weighted protocol is better predictor of success then simple count of steps performed.Evidence that a weighted protocol is better predictor of success then simple count of steps performed. Variability of protocols performed and the distribution of patient success is massive in America.Variability of protocols performed and the distribution of patient success is massive in America. Consumer Reports estimates in a small scale study that 2 out of 3 hearing aids are misfit.Consumer Reports estimates in a small scale study that 2 out of 3 hearing aids are misfit. Anecdotal reports from expert fitters indicate that many NEW hearing aids brought in to their practice were programmed incorrectly.Anecdotal reports from expert fitters indicate that many NEW hearing aids brought in to their practice were programmed incorrectly.

81. Conclusions Believe that the clinical laboratory is the real world and that we can get a handle on the degree of misfit hearing aids in America as well as quantify the relative importance of various aspects of the protocol.Believe that the clinical laboratory is the real world and that we can get a handle on the degree of misfit hearing aids in America as well as quantify the relative importance of various aspects of the protocol. Further research needed:Further research needed: –What is the state of misfit hearing aids in the U.S? –How many malfunctioning hearing aids are in patients ears? –How much more benefit do patients experience when their residual auditory area is optimally amplified by experts given todays technology and software? –How many patients are fit with inappropriate technology (e.g. a CIC or open fit when they need a power BTE or full-concha)?

82. Conclusions (Cont.) –Can we reduce the number of hearing aids in the drawer? –What is the relative importance of aspects of the protocol on real world success? –How many patients have been inappropriately fit with hearing aids when they are not good candidates (e.g. motivation, acceptable noise level (ANL) exceptionally high)? –When hearing aids are expertly fit what is the likelihood of improvements in positive-word-of- mouth advertising and brand loyalty?

83. Quality control at the point of sale is critical to user success & industry growth Not all consumers are tested in a sound booth.Not all consumers are tested in a sound booth. Many hearing aids are not tested for functionality prior to the fitting.Many hearing aids are not tested for functionality prior to the fitting. The majority of dispensers fail to verify the hearing aid fitting with REM.The majority of dispensers fail to verify the hearing aid fitting with REM. –Considered by the industry intelligentsia to be unethical and unprofessional Many dispensers do not validate the fitting pre/post with objective or subjective benefit measures.Many dispensers do not validate the fitting pre/post with objective or subjective benefit measures. –We just dont want to know (Ignorance is bliss!) –What should we do if we cant find benefit – refund the customers money? (greed and unethical) Ultimately we take the short term sale and sacrifice the long term growth and our reputation in our community.Ultimately we take the short term sale and sacrifice the long term growth and our reputation in our community. Aural rehabilitation is virtually non-existent.Aural rehabilitation is virtually non-existent.

84. Opportunities Establishment and enforcement of a standardized and comprehensive hearing aid fitting protocol (similar to Optometry) with a measureable benefit guarantee will result in:Establishment and enforcement of a standardized and comprehensive hearing aid fitting protocol (similar to Optometry) with a measureable benefit guarantee will result in: –Massive market share shifts –More positive word-of-mouth advertising –Tapping new markets –Greater brand (hearing aid and distribution) loyalty. –Transforming the lives of many more hard of hearing people, after all isnt this our REAL business? –And believe it or not stigma will evaporate for most people when they achieve SUBSTANTIAL BENEFIT. ULTIMATELY QUALITY WILL WIN!ULTIMATELY QUALITY WILL WIN!

85. Some Additional Observations on the Hearing Aid Market

86. Sales growth We are doomed to 2-3% growth unless we fix the hearing aid industry.We are doomed to 2-3% growth unless we fix the hearing aid industry. This is roughly the growth rate of the elderly population.This is roughly the growth rate of the elderly population. A key problem is quality control at the point of sale. The fitting process has not kept pace with technology.A key problem is quality control at the point of sale. The fitting process has not kept pace with technology. Improvements in technology are wasted if the hearing aid is inappropriately fit.Improvements in technology are wasted if the hearing aid is inappropriately fit.

87. Our value proposition to society is inequitable We benefit ($$) more than the consumer (the improvements in their life for which they are willing to pay)We benefit ($$) more than the consumer (the improvements in their life for which they are willing to pay) Estimated hearing handicap reduction:Estimated hearing handicap reduction: – 41% (Absolute benefit)/Unaided hearing problem (MarkeTrak VI) –Current direct measure in MarkeTrak VIII: 55%

88. Customer satisfaction is highly related to $$$ spent per 1% improvement in hearing disability where % change = (benefit/unaided APHAB)

89. Overall customer satisfaction is dependent on price relative to hearing disability improvement (Statistical Model) Price Hearing disability improvement (%) Overall Customer Satisfaction (%) R 2 =.86

90. Negative word-of-mouth is severely depressing throughput into HHP offices and therefore sales 19% of total adults with admitted hearing loss dont purchase because of other hearing aid owners telling them of their disappointment.19% of total adults with admitted hearing loss dont purchase because of other hearing aid owners telling them of their disappointment. Thats 4.4 million peopleThats 4.4 million people Assuming 1.75 hearing aids each over 5 purchase cycles of 5 years (their average age is now 60)Assuming 1.75 hearing aids each over 5 purchase cycles of 5 years (their average age is now 60) Assuming we cannot win them back:Assuming we cannot win them back: –Thats potentially 38,200,000 hearing aids not purchased over their lifetime –Thats 19 years of lost sales for the whole US! –Thats $69 billion in lost revenue!

91. The utility of hearing aids is poor With the exception of a handful of activists we have not made public places accessible to people with hearing loss as has been done in Europe.With the exception of a handful of activists we have not made public places accessible to people with hearing loss as has been done in Europe. –Inductive looping (until the real wireless revolution in the HA industry) –Use of telecoil to double or triple functionality of hearing aid. –Some HHP are now looping their patient homes and therefore creating real value.

92. Hearing aids and those who fit them have a horrible reputation Typical 1 st media question to me: Why do so many people hate hearing aids?Typical 1 st media question to me: Why do so many people hate hearing aids? Need to demonstrate to non-adopters:Need to demonstrate to non-adopters: –That hearing aids do indeed work –That we can provide substantial benefit and –Therefore that we can substantially improve their lives

93. We should leverage QOL research more in marketing hearing aids Improvements in:Improvements in: –Earning power –Communication in relationships –Intimacy and warmth in family relationships –Ease in communication –Emotional stability –Sense of control over life events –Perception of mental functioning –Physical health –Group social participation –Safety

94. We should leverage QOL research more in marketing hearing aids Reductions inReductions in –Discrimination toward the person with the hearing loss –Hearing loss compensation behaviors (i.e. pretending you hear) –Anger and frustration in relationships –Depression and depressive symptoms –Feelings of paranoia –Anxiety –Social phobias –Self-criticism

95. Hearing aid returns are killing us Current rate: 18.6%Current rate: 18.6% Top reasons:Top reasons: –Benefit (51%) –Background noise (49%) –Whistling/feedback (38%) –Poor value (36%) –Poor fit and comfort (35%) Nearly a completely solvable problemNearly a completely solvable problem

96. Overall Conclusion Markets are perfect!Markets are perfect! If we do not adequately service people with hearing loss someone else will take away our business and do it better.If we do not adequately service people with hearing loss someone else will take away our business and do it better. We have a lot of baggage to overcome.We have a lot of baggage to overcome. Consumer stigma, while existent, is an industry scapegoat.Consumer stigma, while existent, is an industry scapegoat.