1. MarkeTrak VII Impact of Untreated Hearing Loss on Household Income (Oct 2005 HR)

2. Objective Research has established link between hearing loss and:Research has established link between hearing loss and: Unemployment Unemployment Underemployment (salary & position) Underemployment (salary & position) Educational achievement Educational achievement Primarily profound hearing loss population.Primarily profound hearing loss population.

3. Objective Need for understanding impact of untreated hearing loss in employment and scholastic situations for typical hearing loss profile since majority of people with hearing loss are not deaf.Need for understanding impact of untreated hearing loss in employment and scholastic situations for typical hearing loss profile since majority of people with hearing loss are not deaf. Support consumer educational objectives Support consumer educational objectives Secure needed support services for children Secure needed support services for children Support tax-credit initiative Support tax-credit initiative To get media attention To get media attention

4. Method MarkeTrak VII database from National Family Opinion Panel:MarkeTrak VII database from National Family Opinion Panel: 1,891 households – aided (head of household or spouse) 1,891 households – aided (head of household or spouse) 1,954 households – unaided (head of household or spouse) 1,954 households – unaided (head of household or spouse) 39,420 households – no hearing loss (head of household and spouse) 39,420 households – no hearing loss (head of household and spouse)

5. Method Household income predicted with following variables (which were related to hearing aid ownership):Household income predicted with following variables (which were related to hearing aid ownership): Hearing loss - factor analysis score Hearing loss - factor analysis score Gallaudet Scale, Gallaudet Scale, Number of ears impaired, Number of ears impaired, Subjective hearing loss, Subjective hearing loss, Unaided abbreviated profile of hearing aid benefit). Unaided abbreviated profile of hearing aid benefit). Hearing loss measure expressed as deciles taking the value 10% (mild) to 100% (profound). Normal hearing coded as none. Hearing loss measure expressed as deciles taking the value 10% (mild) to 100% (profound). Normal hearing coded as none.

6. Method Household income predicted with following variables (Continued):Household income predicted with following variables (Continued): Household designation (7 point classification of household composition) Household designation (7 point classification of household composition) Marital status (2 point classification) Marital status (2 point classification) Age (12 brackets) Age (12 brackets) Geography ( 9 regions) Geography ( 9 regions) Market size (range from 2 million) Market size (range from 2 million) Group (aided, unaided, normal) Group (aided, unaided, normal)

7. Method Analysis of variance:Analysis of variance: All variables significant at p<.0001 level All variables significant at p<.0001 level Hearing loss by group interaction significant at p<.0001 level indicative of different income slopes as a function of hearing loss. Hearing loss by group interaction significant at p<.0001 level indicative of different income slopes as a function of hearing loss. Least square household income means calculated (see next chart) Least square household income means calculated (see next chart)

8. Relationship between hearing loss and household income MildModerateProfound

9. Relationship between hearing loss and household income Aided versus unaided least square means MarkeTrak VII (n=43,265 households; 3,845 hearing impaired) MildModerateProfound

10. Linear (smoothed) relationship between household income and hearing loss Unaided household income = :Unaided household income = : $53.5k - $2.25k (for every decile of hearing loss). $53.5k - $2.25k (for every decile of hearing loss). Aided household income = ;Aided household income = ; $54.1k - $1.13k (for every decile of hearing loss). $54.1k - $1.13k (for every decile of hearing loss). While both treated and untreated hearing loss groups show deterioration of income as their hearing loss worsens the income decline is cut in half for hearing aid owners. For example, the difference between decile 1 (mild) and decile 10 (profound) incomes is as follows:While both treated and untreated hearing loss groups show deterioration of income as their hearing loss worsens the income decline is cut in half for hearing aid owners. For example, the difference between decile 1 (mild) and decile 10 (profound) incomes is as follows: Unaided income differential - $20,200 Unaided income differential - $20,200 Aided income differential - $10,200 Aided income differential - $10,200

11. Household income differential– aided versus unaided as a function of severity of hearing loss (smoothed)

12. Simulation of income loss Currently 24.08 million people with admitted hearing loss, who do not use hearing aids in the U.S.Currently 24.08 million people with admitted hearing loss, who do not use hearing aids in the U.S. Non-owner population segmented into hearing loss decile group:Non-owner population segmented into hearing loss decile group: Non-owner hearing loss significantly lower than hearing aid owner population hearing loss. Non-owner hearing loss significantly lower than hearing aid owner population hearing loss. Cross multiplying population size by income differential:Cross multiplying population size by income differential: Estimated loss in income due to untreated hearing loss. Estimated loss in income due to untreated hearing loss. Estimated Federal taxes not realized due to untreated hearing loss assuming 15% tax bracket (simplified). Estimated Federal taxes not realized due to untreated hearing loss assuming 15% tax bracket (simplified).

13. Simulated household income loss and unrealized Federal Taxes from non-aided households Hearing Loss (Decile) Current HL DistributionPopulation Size (Millions) Annual Lost Income ($Billions) Annual unrealized Federal Taxes ($Billions) 10%18.1%4.36$7.36$1.10 20%17.0%4.09$11.46$1.72 30%14.6%3.53$13.81$2.07 40%12.0%3.90$15.92$2.19 50%10.8%2.59$15.92$2.39 60%08.1%1.95$14.16$2.12 70%06.8%1.63$13.64$2.05 80%05.7%1.38$13.11$1.97 90%04.2%1.00$10.61$1.59 100%02.8%0.67$7.80$1.17 Total100%24.08$122.4$18.4

14. Conclusions & Commentary The greater the hearing loss the greater the decline in household income.The greater the hearing loss the greater the decline in household income. On average, the use of hearing aids would appear to mitigate income loss by 50%.On average, the use of hearing aids would appear to mitigate income loss by 50%. For sensitivity analysis one can assume no impact on bottom 30% of population with hearing loss. No matter what cut-off is accepted the impact on household income and unrealized Federal taxes will be significant.For sensitivity analysis one can assume no impact on bottom 30% of population with hearing loss. No matter what cut-off is accepted the impact on household income and unrealized Federal taxes will be significant. The diverging income profiles (e.g. interactive slopes) of aided and unaided households leads one to conclude that there is a probable positive causal relationship between hearing loss treatment and household income.The diverging income profiles (e.g. interactive slopes) of aided and unaided households leads one to conclude that there is a probable positive causal relationship between hearing loss treatment and household income.

15. 21 Year Trends July 2005 Hearing Review

16. Hearing Loss Population has doubled since 1984 and will reach 41 million by 2025

17. Hearing instrument adoption rates are improving