1. MarkeTrak V:Why My Hearing Aids Are in the Drawer Sergei Kochkin, Ph.D. Knowles Electronics, Inc. February 2000

2. Methodology Knowles has conducted national surveys of U.S. Hearing aid Market since 1989. National family opinion panel 80,000 households 13,492 hearing-impaired households Detailed questionnaire 2,720 hearing aid owners. Response rate 83%

3. Methodology Consumers who own a hearing aid but NEVER wear it = hearing aid in the drawer. Hearing aids in drawer = 16.2% respondents. Told to explain why non-use in MarkeTrak survey. Received 348 letters. Content coding yielded 567 comments.

4. Hearing Aids in the Drawer are Related to Age of the Instrument

5. 907,120 Customers do not Use Their Hearing Instruments 325,000 1-4 years

6. Reasons for Non-Use Poor benefit (30%) - 268,507

7. Reasons for Non-Use Poor Benefit I threw it away it was worthless to me I dont see much difference with them. I feel I was sold one under false pretense. Dont feel I really needed one There is no improvement in my hearing with the aids. Where there is a slight improvement in my hearing, it is minimal.

8. Reasons for Non-Use Poor Benefit I dont wear the aids at all. The problems appears to be clarity of words. Volume is OK but I cant distinguish words I have not been able to wear the H.A. since the day I received it. It was made wrong and the Company said there was nothing wrong with it.

9. Reasons for Non-Use Poor Benefit It is not worth the trouble or expense for the small difference in hearing. I wish I had my money back. _____ aims at taking old peoples money for little value. All the aids do is amplify the sound that I cant discriminate with an aid in the ear.

10. Reasons for Non-Use Poor Benefit When ______sold me the H.A., I was confident it would help me hear better. When I received it and wore it every day, it did not make my hearing any better. So, I dont wear the HA and feel like I wasted my money. I tried to return it and the person did not seem to want to help me. I am quite dissatisfied with the whole experience.

11. Reasons for Non-Use Poor Benefit I cant hear high pitch sounds with the behind the ear model. H.A.s amplify everything but human voices which is what you need to hear. ____plugs are not worth the price.

12. Reasons for Non-Use #1. Poor benefit (30%) - 268,507 #2. Background noise (25%) - 229,383

13. Reasons for Non-Use Background Noise I will not wear my H.A. because it increases background noise. And therefore, after a while I get a headache and get somewhat nervous. It catches all the sound on the road, TV, etc at the same time. Background noise is distracting.

14. Reasons for Non-Use Background Noise H.A.s dont work when there is a lot of background noise. This is when you need them to work. Background noise really drives him crazy. My problem is with background noise. All my H.A.s do is amplify so they are of little help.

15. Reasons for Non-Use Background Noise I dont wear my H.A. because I need it at a dance, restaurants, and large groups. All the H.A. does is increase all sound including background sounds. No help. Sudden loud noise is a killer. H.A. amplify other sounds so much that I actually feel pain.

16. Reasons for Non-Use Background Noise If someone drops a spoon on the table it is like a rifle going off. Hate them. They dont work for me. All sounds are amplified. Never knew there were so many. I cant adjust the H.A. constantly to every noise.

17. Reasons for Non-Use #1. Poor benefit (30%) - 268,507 #2. Background noise (25%) - 229,383 #3. Fit & Comfort (19%) - 169,431

18. Reasons for Non-Use Fit & Comfort My hearing aids are too big for my ears. It is uncomfortable and my wife says I dont listen to her anyway. It hurts my ears. I do not like the feel of it in my ear.

19. Reasons for Non-Use Fit & Comfort I dont wear my H.A. because they plug up my ears and feel uncomfortable. My H.A. has the tendency to fall out when I am working hard in hot weather. Its hard to keep it in my ear. I travel for business a lot and cant risk it falling out of my ear.

20. Reasons for Non-Use #1. Poor benefit (30%) - 268,507 #2. Background noise (25%) - 229,383 #3. Fit & Comfort (19%) - 169,431 #4. Negative side effects (11%) - 99,048

21. Ears that hurt Too much pressure in the ears Blisters in ears Rashes in ears Itching ears Dizzy Nervous Reasons for Non-Use Negative Side-effects

22. Ears that sweat Builds up wax in inner ear Headache Hair gets caught in hearing aid Infections in ear Problems chewing or swallowing Plugs up ears Reasons for Non-Use Negative Side-effects

23. Reasons for Non-Use #1. Poor benefit (30%) - 268,507 #2. Background noise (25%) - 229,383 #3. Fit & Comfort (19%) - 169,431 #4. Negative side effects (11%) - 99,048 #5. Price & cost (10%) - 93,839

24. Reasons for Non-Use Price & Cost I bought the H.A. when I was teaching. I had trouble hearing students questions. Since retiring I have stopped using them. They were costing too much for what good I was able to get from them. Programmable H.A. would be desirable but they cost too much.

25. Reasons for Non-Use Price & Cost My current H.A. are broken & I am unable to afford the cost of a replacement. They are too old for service. The expense of owning and maintaining are too great. HMO does not cover for HA. Price is high.

26. Reasons for Non-Use Price & Cost I enjoyed my H.A., but they burned up in a house fire and I cant afford another one. I wish an aid would be developed to allow us to hear natural sound and an aid with a reasonable price. If I could afford it, I would buy a different brand.

27. Reasons for Non-Use Price & Cost My H.A. was never dependable. Taking it in for an adjustment was only a headache as it never performed very long. Had to be looked at again. The last time I had trouble, the office wanted to send it to _____ at $200 & just to check it, plus another $200 to repair it.

28. Reasons for Non-Use #1. Poor benefit (30%) - 268,507 #2. Background noise (25%) - 229,383 #3. Fit & Comfort (19%) - 169,431 #4. Negative side effects (11%) - 99,048 #5. Price & cost (10%) - 93,839 #6. Dont need help (8%) - 72,987

29. I work and live alone and do not need the aid most of the time. I had an operation on my right ear and I can hear better again. I dont talk to anyone during the day. Reasons for Non-Use Dont Need Help

30. I can hear most everything without H.A.s I feel I was sold under false pretense. I dont feel I really needed one. Dont wear very often since my hearing loss is only 35 degrees.

31. Reasons for Non-Use #1. Poor benefit (30%) - 268,507 #2. Background noise (25%) - 229,383 #3. Fit & Comfort (19%) - 169,431 #4. Negative side effects (11%) - 99,048 #5. Price & cost (10%) - 93,839 #6. Dont need help (8%) - 72,987 #7. Broke or does not work (8%) - 68,814

32. Reasons for Non-Use Broke or does not Work After a year, the H.A. is down. I cant afford to repair them. Because it doesnt work. ______ refused to do anything. The man that sold it to me has been fired. It does not work right.

33. Reasons for Non-Use Broke or does not Work I dont wear it because after the warranty expired it got broken. It would cost $1,200 to replace it, so I quit wearing it. The housing is currently broken and will have to be glued back together. This is the fourth time it has broken.

34. Reasons for Non-Use Broke or does not Work It seems as if the aids were in the shop for repair more than in my ear. They are still not adjusted correctly for my comfort level. The cost of the repairs were too much. It is easier to go without them and have everyone speak louder. I have 2 H.A.s that dont work. It costs $200 a piece cash to have them fixed.

35. Reasons for Non-Use #8. Sound quality (6%) - 57,329

36. Reasons for Non-Use Sound Quality Never got true sound clarity I wanted Uncomfortable sound Sound of crickets Unnatural Distorted Slight hiss Tinny Picks up wind

37. Reasons for Non-Use Sound Quality Chewing and swallowing noise Poor fidelity Cant stand sound of my voice Hollow sound Aversiveness of sounds (running water, sharp sounds)

38. Reasons for Non-Use #8. Sound quality (6%) - 57,329 #9. Wont wear - unspecified (6%) - 57,556 #10. Volume control adjust. (5%) - 44,314

39. I have trouble adjusting the sound. Hard to adjust. Every time the phone rings I have to adjust the volume. They need adjusting, because the background noises are annoying. Reasons for Non-Use Volume Control Adjustments

40. They are a bother having to turn up & down too often. The volume never stays at setting. I cant adjust H.A. constantly to every noise.

41. Reasons for Non-Use #8. Sound quality (6%) - 57,329 #9. Wont wear - unspecified (6%) - 57,556 #10. Volume control adjust. (5%) - 44,314 #11. Whistling & feedback (4%) - 39,100 #12. Nuisance / hassle (4%) -38,371 #13. Poor service (3%) - 28,673 #14. High frequency Loss (3%) - 26,067

42. Reasons for Non-Use #15. Stigma of wearing (3%) - 26,037 #16. Profound hearing loss (3%) - 23,460 #17. Work in limited situations (3%)-23,460 #18. Uncomfortably loud (2%) - 27,114 #19. Battery life (2%) - 19,186

43. Reasons for Non-Use 1% or less of mentions Does not work on phone Monaural aids inadequate Expectations not met Has Tinnitus Manual dexterity Forget to use Family pressure Feels like ear plugs Poor directivity Low gain Lost hearing aids Ear wax problem Rare social user

44. Key Findings 907k inactive hearing aid owners in the United States. Key reasons: Poor benefit Background noise Fit and comfort Cost Negative side effects Hearing aids broke

45. Dispenser does have control over hearing aids in the drawer # 1. Poor benefit: Use programmable technology (analog or DSP) Pre-post benefit measurement Real ear measurement 90 day post fitting customer satisfaction survey. 100% money back guarantee Aural rehabilitation Significant impact on hearing aid satisfaction. Return rates been shown to be cut in half.

46. Dispenser does have control over hearing aids in the drawer # 2. Hearing in noise 100% use of dual microphones – not just in high-end product DSP for comfort in noise Volume control necessary for some segments Manual omni/directional switch necessary for some consumers Binaural fitting for bilateral loss customers (85% rate in US- much lower in Europe) Deep-fitting CICs give some benefit. Aural rehabilitation

47. Dispenser does have control over hearing aids in the drawer #3. Fit and Comfort Extreme vigilance during impression taking. Multiple shell impressions if necessary with best going to the manufacturer. Silicone material considered superior. Explore emerging soft shell technology for difficult cases. Rework within office. Assess manual dexterity and visual acuity considerations relative to hearing aid style. 14 or 30 day trial post-fitting subjective measure of fit and comfort.