1. New Research from BHI (Methods of Promoting Your Practice) Sergei Kochkin, PhD.

2. Agenda Update of Best Practices – impact of hearing aids on quality of lifeUpdate of Best Practices – impact of hearing aids on quality of life Impact of hearing aids on income and employmentImpact of hearing aids on income and employment Economics of verification and validation on private practicesEconomics of verification and validation on private practices Positive impact of mini-BTEs on the marketPositive impact of mini-BTEs on the market Prevalence of tinnitus and treatment efficacyPrevalence of tinnitus and treatment efficacy If time:If time: –Validation of the BHI Quick Hearing Check –Impact of direct mail and PSAP on private practices 2

3. Promotion Goal to leverage positive research findings from non-profit BHI to promote your practice.Goal to leverage positive research findings from non-profit BHI to promote your practice. Redesign of HHP section on BHI website to make resources more accessibleRedesign of HHP section on BHI website to make resources more accessible Our general design for campaignsOur general design for campaigns –National press release –Customizable press release for audiologists –Media handout or backgrounder 3

4. 4 New HHP Resource Section www.betterhearing.org/professionals www.betterhearing.org/professionals

5. Benefit & Quality of Life Changes Associated with Hearing Aid Usage June 2011 Hearing Journal

6. Method Consumers rated on 0-100% scale hearing handicap improvement in 10 acoustic environments due to their hearing aids.Consumers rated on 0-100% scale hearing handicap improvement in 10 acoustic environments due to their hearing aids. Consumers rated 14 QOL changes in their life due to hearing aidsConsumers rated 14 QOL changes in their life due to hearing aids N=1,900 for hearing aids <= 4 yrs of ageN=1,900 for hearing aids <= 4 yrs of age 6

7. Hearing handicap improvement (%) Mean = 55% 7

8. Hearing handicap improvement (%) for the U.S. population in 10 listening situations 8

9. Quality of life changes attributed to hearing aid usage by hearing aid owners 9

10. Quality of life changes attributed to hearing aid usage 75% of hearing aid owners experience improvement in at least 1 of 14 QOL issues. 10

11. Consumer satisfaction with QOL changes attributed to hearing aid usage 8 of 10 people are satisfied with QOL changes in their life due to hearing aids. 11

12. Hearing handicap improvement (%) segmented by composite best practices ranking scored in percentiles 12

13. QOL changes attributed to hearing aids by hearing aid owners segmented by composite best practices ranking scored in percentiles 13

14. Overall consumer success (mean=5, std=2) by level of composite best practices ranking scored in percentiles Highly vulnerable to disruptive technologies: over- the-counter, direct- mail and personal sound amplifier Products (PSAP) 14

15. Summary The average benefit (hearing handicap improvement) achieved by patients with recent hearing aid technology is 55%.The average benefit (hearing handicap improvement) achieved by patients with recent hearing aid technology is 55%. The upper bounds of hearing handicap improvement may be in the 65-70% range.The upper bounds of hearing handicap improvement may be in the 65-70% range. Wireless revolution and inductive looping should improve this figure.Wireless revolution and inductive looping should improve this figure. 75% patients report at least one area of their life was improved through wearing hearing aids.75% patients report at least one area of their life was improved through wearing hearing aids. 8 out of 10 hearing aid users are satisfied with the changes that have occurred in their lives due to hearing aids8 out of 10 hearing aid users are satisfied with the changes that have occurred in their lives due to hearing aids 9 out of 10 patients are projected to experience significant improvements in their QOL once they experience a 70% reduction in their hearing handicap.9 out of 10 patients are projected to experience significant improvements in their QOL once they experience a 70% reduction in their hearing handicap. Strong relationship between quality hearing healthcare, benefit and quality of life improvementsStrong relationship between quality hearing healthcare, benefit and quality of life improvements 15

16. Promotion Use the positive findings of hearing aids and quality of life in your press releases to promote your practice. http://www.betterhearing.org/profe ssionals/public_relations_campaig ns.cfmhttp://www.betterhearing.org/profe ssionals/public_relations_campaig ns.cfm –Under 2011 customer satisfaction campaign –Local press release –Backgrounder for media See how other audiologists are using our material – sample media clippings. 16

17. Efficacy of Hearing Aids in Achieving Compensation Equity in the Workplace The Hearing Journal October 2010

18. 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?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?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 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?Do people with hearing loss believe they have been passed over for promotions? 18

19. Method MarkeTrak VIII databaseMarkeTrak 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. 19

20. Method People with hearing loss segmented into ten hearing loss groups (deciles) based on subjective information (via factor analysis):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.Controlled for demography (household composition, age, geography and degree of hearing loss) in calculating income per household. 20

21. Income declines as a function of hearing loss MildModerateSevere 21

22. Significant divergence in income profiles for aided and unaided households Mild Moderate Severe 22

23. 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 23

24. Salary differential ($000) between aided and unaided subjects by severity of hearing loss in deciles 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. $$ (000) 24

25. Unaided individuals have significantly higher unemployment rates Segmentation in hearing loss quintiles Considering only individuals still in the workforce 25

26. Key findings No evidence that people with hearing lossNo 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 efficacyHearing 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. 26

27. Leveraging these findings Cost to individual and society is very large and needs to be leveraged: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 people with HL to seek early solution to their hearing loss. Convince HR executives that aided individuals are good for their corporations.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 citizensConvince politicians that tax credits will help people with hearing loss become more productive citizens 27

28. 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 28

29. Examples of leveraging income study in media Current OpEd Piece Sample Private Practice Ad 29

30. Example : Leveraging income study in media 30

31. Mini-BTEs attract new market, users more satisfied Hearing Journal March 2011

32. Introduction BTE hearing aids represented less than 20% of hearing aid sales prior to 2000.BTE hearing aids represented less than 20% of hearing aid sales prior to 2000. With introduction of open-fit hearing aids and receiver-in-the-canal hearing aids (RIC), BTEs now represent 63% of all hearing aid sales.With introduction of open-fit hearing aids and receiver-in-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: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? 32

33. Hearing aid style mix (%) CY 2005-2008 Source = MarkeTrak VIII Database 33

34. Method Simple comparisonSimple comparison –Mini-BTE users –Traditional style users First look at demographyFirst look at demography 34

35. Demography Mini-BTE versus traditional style HA No age differences between the two samplesNo age differences between the two samples Mini-BTE usersMini-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%) 35

36. 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%)Overall satisfaction ratings are significantly higher for mini-BTE hearing aids (85% versus 76%) No significant differences in:No significant differences in: –perceptions of benefit or value (despite higher $$), –hearing aids in the drawer –brand loyalty 36

37. Customer satisfaction Mini-BTE compared to traditional style Controlling for degree of hearing loss Significant differences with corresponding practical significance (10% or more):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 37

38. Key findings Did not tap into younger segments of people with hearing loss.Did not tap into younger segments of people with hearing loss. But is expansionary influencing HA purchases by:But is expansionary influencing HA purchases by: more affluentmore affluent more active and elderly consumer segmentsmore active and elderly consumer segments with milder hearing losseswith milder hearing losses Controlling for degree of hearing loss mini-BTE hearing aids would appear to offer significant improvements in:Controlling for degree of hearing loss mini-BTE hearing aids would appear to offer significant improvements in: overall satisfactionoverall satisfaction cosmeticscosmetics sound qualitysound quality multiple environmental listening utility (MELU)multiple environmental listening utility (MELU) 38

39. Promotion Promote the positive benefits of mini-BTE based on BHI on consumer feedback: overall satisfaction cosmetics sound quality multiple environmental listening utility (MELU) 39

40. Economics of Verification and Validation on Private Practices Hearing Review June 2011 40

41. Introduction – Time is Money! In Best Practice publication it was determined that the number of patient visits to adjust the hearing aid were highly correlated with real- world success.In Best Practice publication it was determined that the number of patient visits to adjust the hearing aid were highly correlated with real- world success. Comparing patients who experienced above or below average success with their hearing aids the following was discovered: Comparing patients who experienced above or below average success with their hearing aids the following was discovered: –76% of above average patients were fit in 1-2 visits compared to 40% of below average patients –47% of below average patients required 4-6 visits to fit their hearing aids compared to 7% of above average patients. 41

42. Introduction – Time is Money! Highly successful patients required fewer visits to the clinic.Highly successful patients required fewer visits to the clinic. What could explain this difference in number of visits?What could explain this difference in number of visits? Hypothesis = lack of verification (real-ear measurement) and validation (confirmation of a patients performance with their hearing aids) during the hearing aid fitting increased the number of patient visits. For some patients the result was:Hypothesis = lack of verification (real-ear measurement) and validation (confirmation of a patients performance with their hearing aids) during the hearing aid fitting increased the number of patient visits. For some patients the result was: –Less than optimum fit, –reduced hearing aid utility, –mediocre benefit each of –End result = rejection and return of the hearing aids for credit. In this study we will explore the relationship between verification, validation and patient visits.In this study we will explore the relationship between verification, validation and patient visits. 42

43. Percent of patients reporting that verification and/or validation was used during the hearing aid fitting process (New hearing aids, n=787)

44. Average patient visits to fit hearing aids based on use of verification (REM) & validation procedures (objective or subjective). Patient visits=3.57 – REM*.75 – validate*1.02 + V+V*.6

45. Simulating Impact of V + V In 2010, nearly 2.7 million hearing aids were fit in the U.S. hearing aid market representing over 1.5 million patients (binaural rate=74.3% in 2008).In 2010, nearly 2.7 million hearing aids were fit in the U.S. hearing aid market representing over 1.5 million patients (binaural rate=74.3% in 2008). Assuming the same distribution of best practices as noted by patients and the estimate of reduced patient visits.Assuming the same distribution of best practices as noted by patients and the estimate of reduced patient visits. The systematic utilization of both verification and validation procedures while fitting hearing aids will reduce patient visits by a total of 521,779 visits.The systematic utilization of both verification and validation procedures while fitting hearing aids will reduce patient visits by a total of 521,779 visits. This is an opportunity available for every one of the 64% of U.S. practices not utilizing both verification and validation.This is an opportunity available for every one of the 64% of U.S. practices not utilizing both verification and validation. 45

46. Simulating Impact of V + V Assuming 45 minutes a visit:Assuming 45 minutes a visit: –inclusion of these best practices could reduce the time spent with patients in fitting hearing aids by 391,334 hours in a single. –Manpower cost @$144 per hour = $56.3 million –Much higher cost when you consider lost revenue due to hearing aid returns (18.6% national average) This additional time frees the hearing healthcare professional for additional counseling, marketing, community outreach or in fitting new patients with hearing aids.This additional time frees the hearing healthcare professional for additional counseling, marketing, community outreach or in fitting new patients with hearing aids. 46

47. Prevalence of Tinnitus and Efficacy of Treatments Co-authors Richard Tyler – U of Iowa Jennifer Born - ATA Hearing Review November 2011 47

48. Introduction 40% of non-adopters do not see audiologists for their hearing loss because they have tinnitus and believe nothing can be done. (MarkeTrak VII).40% of non-adopters do not see audiologists for their hearing loss because they have tinnitus and believe nothing can be done. (MarkeTrak VII). Thus they suffer from both untreated hearing loss and tinnitus.Thus they suffer from both untreated hearing loss and tinnitus. Need to convince people with tinnitus that by visiting an audiologist you can help them manage their tinnitus.Need to convince people with tinnitus that by visiting an audiologist you can help them manage their tinnitus. 48

49. Method 80,000 household MarkeTrak survey where we added to our normal screening survey Does anyone in your household have tinnitus (ringing in their ears). – captured up to 5 family members.80,000 household MarkeTrak survey where we added to our normal screening survey Does anyone in your household have tinnitus (ringing in their ears). – captured up to 5 family members. Scales: time of day experienced, loudness, annoyanceScales: time of day experienced, loudness, annoyance Impact on lifeImpact on life Efficacy: nine treatment methodsEfficacy: nine treatment methods Hearing aids: Direct probeHearing aids: Direct probe 49

50. Tinnitus population (millions, 2008)

51. Population Commentary Approximately 30 million experience persistent tinnitus (10% population)Approximately 30 million experience persistent tinnitus (10% population) Around half of hearing aid owners and non-adopters report tinnitusAround half of hearing aid owners and non-adopters report tinnitus Another 13 million people are aware of their tinnitus but not hearing lossAnother 13 million people are aware of their tinnitus but not hearing loss The market for hearing healthcare much larger than thoughtThe market for hearing healthcare much larger than thought 51

52. Incidence of tinnitus by age group. Incidence derived by comparing age population from NFO panel with U.S. Bureau of Census population in 2008.

53. Tinnitus Demography Commentary Peaks at ages 65-84; 85+ drop due to:Peaks at ages 65-84; 85+ drop due to: –Lack of family member awareness –Non-survey of nursing homes Tends to affect:Tends to affect: –Lower educated –Smaller rural communities –Retirees and those on medical disability –Single people –Lower income 53

54. Severity of Tinnitus (Means on 0-100% scale; n=3,187) % time of day: 49% time of day: 49% Loudness: 41%Loudness: 41% Annoyance: 39%Annoyance: 39% Disabling estimate (70-100%) – 22%Disabling estimate (70-100%) – 22% Key QOL impact:Key QOL impact: –Ability to hear –Ability to concentrate –Ability to sleep 54

55. Impact of tinnitus on quality of life (n=3,431)

56. Efficacy of treatments (n=3,473 on 0-100% scale) Aided awareness on 9 treatmentsAided awareness on 9 treatments –Hearing aids; music; medication; relaxation; HHP counseling; Non-wearable sound generator; herbs/dietary supplements; wearable sound generator; psychological counseling Consumer asked:Consumer asked: –If they tried treatment for their tinnitus –0-100% scale on efficacy or tinnitus mitigation. 56

57. Efficacy of Treatments No method tried by more than 7% of people.No method tried by more than 7% of people. Hearing aids were not viewed as a treatment.Hearing aids were not viewed as a treatment. Highest rated (median mitigation):Highest rated (median mitigation): –Hearing aids (34%) –Music (30%) –Relaxation techniques (10%) 57

58. Direct Query on Hearing Aids. Effectiveness in mitigating effects of tinnitus (n=1,314)

59. Direct Query How often hearing aids are effective in mitigating effects of tinnitus (n=553)

60. Greater chance of tinnitus mitigation with hearing aids when best practices used in hearing aid fitting (n=732)

61. Opportunity People may not visit you for their hearing loss but they may if you hold the promise of relief for their tinnitus.People may not visit you for their hearing loss but they may if you hold the promise of relief for their tinnitus. The market for hearing healthcare is dramatically expanded when you consider:The market for hearing healthcare is dramatically expanded when you consider: –40% of non-adopters with hearing loss not visiting audiologists because they have tinnitus –13 million additional with tinnitus reporting they do not have hearing loss 61

62. Promotion Move toward ADA sponsored Tinnitus Management Certification Program if you do not have the credentials now for tinnitus management.Move toward ADA sponsored Tinnitus Management Certification Program if you do not have the credentials now for tinnitus management. Review BHI material on setting up a tinnitus clinic.Review BHI material on setting up a tinnitus clinic.BHI material BHI material Distribute BHI Guide to TinnitusDistribute BHI Guide to Tinnitus 62

63. Promotion Take a course in Cognitive Behavioral Therapy.Take a course in Cognitive Behavioral Therapy. Learn about tinnitus management resources and outcome measures.Learn about tinnitus management resources and outcome measures. Read and distribute a good consumer handbook on tinnitus to your patients with tinnitus.Read and distribute a good consumer handbook on tinnitus to your patients with tinnitus. 63

64. Promotion Learn from your peers on how to promote tinnitus in your practice.Learn from your peers on how to promote tinnitus in your practice. Look for updated Opinion Editorials from BHI in the future.Look for updated Opinion Editorials from BHI in the future.Opinion Editorials Opinion Editorials Set correct expectations on tinnitus mitigation with HA:Set correct expectations on tinnitus mitigation with HA: –30% moderate – substantial relief –Could be 50%-60% with best practices. 64

65. The Validity and Reliability of the BHI Quick Hearing Check Kochkin, S. and Bentler, R. The Hearing Review November 2010

66. Introduction Key obstacle to hearing aid adoption is awareness of degree of hearing lossKey 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 66

67. Introduction Wide-scale availability of simple self- measures of hearing loss may influence increased throughput into audiologist officesWide-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 audiologistBHI adopts the American Cancer Society and American Diabetes Association models with online testing: Are you at risk…if so visit an audiologist 67

68. BHI Quick Hearing Check 15 items – standard signs of hearing loss. Sample items: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 testBased on AAO-HNS 5 minute test Revised by Koike and validated on small sample (n=74) but not in use todayRevised by Koike and validated on small sample (n=74) but not in use today 68

69. BHI Quick Hearing Check BHI adopted the testBHI adopted the test Changed to 5 point Likert scale (Strongly agree – Strongly disagree)Changed to 5 point Likert scale (Strongly agree – Strongly disagree) Validated on 11,000 subjects using 4 databases:Validated on 11,000 subjects using 4 databases: NCOA database – self perceptionsNCOA database – self perceptions NCOA database – spouse perceptionsNCOA database – spouse perceptions MarkeTrak VIII database – self perceptionsMarkeTrak VIII database – self perceptions Objective HL information from 64 clinics on 987 patientsObjective HL information from 64 clinics on 987 patients –Audiogram (5 frequencies) –Speech discrimination scores 69

70. BHI Quick Hearing Check reliability Separate factor analysis of NCOA and MarkeTrak database items demonstrate one dimension:Separate factor analysis of NCOA and MarkeTrak database items demonstrate one dimension: –Unidimensionality means we can add the items together Reliability (internal consistent – Cronbachs alpha) very high where a score of 100% is perfection:Reliability (internal consistent – Cronbachs alpha) very high where a score of 100% is perfection: –NCOA database = 95% –MarkeTrak = 94% 70

71. Objective Validity Correlation between audiogram information and BHI Quick Hearing Check

72. Relationship between the BHI Quick Hearing Check and average speech threshold scores Model = better ear 72

73. Relationship between the BHI Quick Hearing Check and average threshold scores Model = 5PTA both ears y = 25.38 +.6787x R 2 =.84 73

74. Probability of hearing loss of 40 dB (both ear average) or higher based on BHI Quick Hearing Check scores 74

75. Subjective Validity Correlations between subjective measures of hearing loss and the BHI Quick Hearing Check

76. Average BHI Quick Hearing Check Score by level of performance on the Gallaudet Scale Self-ratings MarkeTrak VIII N=7,201, r=.49 76

77. Average BHI Quick Hearing Check Score by level of self and family member perception of hearing loss 77

78. Average BHI Quick Hearing Check score by level of Plomps difficulty of hearing in noise scale Self ratings – MarkeTrak VIII N=7,201, r=.64 78

79. Concurrent Validity BHI Quick Hearing Check correlations with issues tangentially related to hearing loss

80. Scores on the BHI Quick Hearing Check correlated with QOL issues According to spouses of people with HL: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 relationships 80

81. Promotion using the new BHI online hearing test Complete redesign of BHI online hearing testComplete redesign of BHI online hearing test URL createdURL created –www.hearingcheck.org www.hearingcheck.org Items presented one at a time with background photoItems presented one at a time with background photo Internet banner ads now directing traffic to the test as well as Google adsInternet banner ads now directing traffic to the test as well as Google ads BHSM initiative similar to American Diabetes and Cancer risk test campaigns.BHSM initiative similar to American Diabetes and Cancer risk test campaigns. 81

82. BHI Online Hearing Test Comprehensive report: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 82

83. Using the new online hearing test at BHI Encouraging hearing health industry to link to this online hearing test at www.hearingcheck.orgEncouraging hearing health industry to link to this online hearing test at www.hearingcheck.org www.hearingcheck.org Developed logos for hyperlinking. Placement on your websiteDeveloped logos for hyperlinking. Placement on your websitelogos forlogos for Also available in paper- and-pencil formAlso available in paper- and-pencil form –Drug store –Ads –Chiropractor offices –Health fair handout 83

84. Impact of Direct Mail and Low Cost Listening Devices on Hearing Aid Sales Hearing Review June 2010

85. Introduction Low cost listening devices (PSAPs) and direct mail hearing aids have been available for at least 25 years.Low cost listening devices (PSAPs) and direct mail hearing aids have been available for at least 25 years. PSAPSPSAPS Price range $20-$50Price range $20-$50 Some infomercials 2 for $19.95Some infomercials 2 for $19.95 Most notable historically Whisper 2000Most notable historically Whisper 2000 Legal as long as they dont target people with hearing loss.Legal as long as they dont target people with hearing loss. Direct mailDirect 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 85

86. Introduction Recent proliferation of devices with extensive television ads.Recent proliferation of devices with extensive television ads. –Lee Majors Bionic Ear –Silver Sonic XL –Loud Nclear –+ dozen others Apparently tend to be introduced close to recessionsApparently tend to be introduced close to recessions How many people with hearing loss are using them?How many people with hearing loss are using them? Do these devices cannibalize legitimate hearing aids sales?Do these devices cannibalize legitimate hearing aids sales? How do people with hearing loss rate these products?How do people with hearing loss rate these products? 86

87. Sample products 87

88. Resurgence of Internet, DM and over-the-counter sold hearing aids 88

89. Direct mail firms selling pre-programmed digital open fit hearing aids ($400-$895) 89

90. Increased trend in non-owner purchase of listening devices Use less expensive device in place of hearing aidsUse less expensive device in place of hearing aids MarkeTrak III (1993)MarkeTrak III (1993) –2.6% somewhat a reason –1.1% definitely a reason –3.7% Total MarkeTrak VII (2004)MarkeTrak VII (2004) –5% somewhat a reason –3% definitely a reason –8% Total MarkeTrak VIII (2008) – analysis to followMarkeTrak VIII (2008) – analysis to follow 90

91. Relative internet ranking (000) Internet ALDs versus HIA members Note: Lower ranks denote higher traffic 91

92. Estimated web visitors per month ALDs versus HIA members ALD= Songbird, Sonic XL, Loud n Clear, Ampli-ear 2008 2009 92

93. Summary demography Custom vs DM vs PSAP DemographyCustomDirect Mail PSAP Male %597153 Age (mean)71 66 Income (Median)41k31k Income (Mode)112k21k24k Employed (%)292835 Marital Status (%)625257 Binaural HA (%)7641n/a Yrs aware of HL - Mean 7815 93

94. Targeting Direct mail hearing aids are marketed to compensate for hearing loss where legalDirect 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 lossPSAPs not sold to compensate for hearing loss But here are some of the PSAP ad messages: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 94

95. Hearing loss distribution What is the hearing loss profile of DM and PSAP customers: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?And what is the likelihood PSAPs took business away from you? 95

96. 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% 96

97. Likelihood of purchasing custom hearing aids in absence of PSAP as reported by non-owner population Overall likelihood = 17.8% 97

98. The numbers please! 3.28% (280,000 people) of hearing aid owners indicated they received their hearing aids by direct mail (2008)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 people4.79% of the non-adopter population uses PSAPs representing 1,237,700 people Total market = 1.5 million people with hearing loss.Total market = 1.5 million people with hearing loss. 98

99. Cannibalization Probable cannibalization of custom hearing aid market by PSAP owners approximately 17.8%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 marketTranslating 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 yearConsidering a four year purchase cycle the hearing aid industry is probably losing about 55,000 patients a year 99

100. Conclusions Approximately 1.5 million people with hearing impairments use either direct mail or personal sound amplification to compensate for their hearing loss.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 pre- programmed hearing aids at Walmart, Drugstores, Sams Club, etc. Users of these devises on average have incomes $10,000 less than custom hearing aid users.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 user3 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 (median).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 (median). 100

101. Conclusions Little doubt that PSAPs are used to compensate for hearing lossLittle 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 aidsEstimate 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 lossIn the absence of PSAPs in the market place in all likelihood the majority would have lived with their hearing loss 101

102. Promotion Markets are perfect! Products and services will be developed and introduced to meet unmet consumer needs.Markets are perfect! Products and services will be developed and introduced to meet unmet consumer needs. The best strategy is to practice BEST PRACTICESThe best strategy is to practice BEST PRACTICES Share our eGuide and press on How to Buy Hearing aids and let the public know this is the ONLY hearing solution.Share our eGuide and press on How to Buy Hearing aids and let the public know this is the ONLY hearing solution.press Share our press release: BHI Warns on Do-it-Yourself Hearing Care.Share our press release: BHI Warns on Do-it-Yourself Hearing Care.press releasepress release 102

103. Acknowledgement All MarkeTrak research is made possible by a special grant from Knowles Electronics.All MarkeTrak research is made possible by a special grant from Knowles Electronics. 103