Hearables: Better Hearing, Less Stigma?

As the Longevity Explorers explore products and emerging technologies that can improve quality of life as we grow older, the emerging category of hearables stands out as especially noteworthy. Here is why.

For a variety of reasons, hearables have the potential to deliver the benefits of “better hearing” to a far broader segment of the population than is served by today’s “hearing aid industry”.

This includes people with quite modest hearing “issues”, and people who are put off by the perceived “stigma” or cost of conventional hearing aids, or the “bother” of the whole process of engaging with the medical system.

If you know anyone who has difficulty staying on top of the conversation in a noisy restaurant; or who can’t always make out the dialog in a movie against the noisy background soundtrack; or who needs the TV turned up louder than their spouse would prefer, read on.

Overview

This article is to explain in more detail exactly what hearables are; who they are good for; and why they are an especially important product category.

Hearables are a product category that includes a variety of “devices” that go in your ears. They include consumer electronics devices such as Apple AirPods and other “smart” wireless earbuds, but also include high end “hearing aids” that both compensate for “hearing loss” and connect to various consumer gadgets wirelessly.

The reasons hearables are so important are twofold.

1. Hearables represent a blurring of what used to be two distinct types of products: consumer electronics that people “want” (“aspirational products”); and “assistive products” that people might “need”, but often do not really “want”.
2. The very large and well resourced companies making the sort of “aspirational hearables” that many people really “want” (e.g. Apple) are starting to add “better hearing features” to those products.

The idea of “aspirational products” that people really want — that also happen to enable you to “hear better” — is quite disruptive.

These products have the potential to unlock “better hearing” for a very large number of people — who today find their quality of life impacted by hearing issues that “get in the way of living life the way they want to”, but don’t rise to the level of “It’s time to get a hearing aid”.

Although this is a relatively new product category, there are already some rather interesting products and brands, and we discuss them, and provide some ideas of where to start if this category of products sounds useful for you or for someone you know.

Table of Contents

• What Are Hearables?
• Why are Aspirational Hearables Important?
• Who Might Benefit from Hearables? Use Cases.
• Specific Hearable Categories and Product Examples.

Disclaimers: While we think hearables are interesting for a certain segment of the population, they are not equivalent in performance to well designed and professionally fitted hearing aids, especially for people with significant hearing loss. This article is for informational purposes only and is not intended to be medical advice. If in doubt, we recommend consulting an audiologist. This article is not intended to market any specific product or make specific product claims (see vendor websites for specific product details). This work is NOT sponsored by any vendor or other third party. 

What Are Hearables?

The term “hearable” has morphed a little in meaning over time, and today is defined to include any “device” that fits in or on an ear — and which includes some type of wireless link to something else, such as a smart phone, computer, or TV (Ref. 1).

This means that “hearables” include the wireless earbuds one sees everywhere (e.g. Apple AirPods), Bluetooth headsets, as well as many modern models of hearing aid. But by this definition, hearables do not include “wired” earbuds or headsets, and nor do they include older “hearing aids” that do not have the capability of connecting wirelessly to other gadgets.

Caption: Apple AirPods — the quintessential hearable.

Taxonomy of Hearables

The figure below illustrates the Tech-enhanced Life “taxonomy” of hearables.

Caption: Hearables Taxonomy

A few years ago, a discussion of “gadgets for your ears” might have talked about these two categories:

1. “hearing aids” for people with “hearing loss” (with a nod to “personal amplifier products”); and
2. “earbuds” for people “streaming music” or “talking on their smartphone”.

This no longer seems the most useful way to think about taxonomy however, because:

• “conventional hearing aids” now often include connectivity — bluetooth connections to smartphones that among other things can allow streaming of music or talking on the phone; and
• “earbuds” are starting to include what we think of as “better hearing features” — often features that resemble those you might find in a conventional hearing aid, although perhaps as yet not as advanced.

This has resulted in a sort of hybrid category that combines some features of wireless earbuds and some features of hearing aids — and which we call “Hearables with Better Hearing Functions“.

This category can be further subdivided into hearables that are “aspirational“, and hearables that are “assistive“.

Read on to understand what we mean by these terms and subcategories.

“Better Hearing” Features

“Better hearing” features include a wide variety of capabilities such as active noise cancellation; the ability to selectively boost the gain in various frequency bands to compensate for hearing “issues”; background noise cancellation; directionality; and algorithms that can separate speech from noise.

• All conventional hearing aids and personal amplification products include some “better hearing features”.
• Some airpods and earbuds include “better hearing features”, but some do not.

It’s important to note that “better hearing features” are not just of relevance to people with “hearing loss”.

For example, hearing better in a crowded restaurant can be important to people who would be classified by an audiologist as having “normal” hearing. Being able to distinguish the dialog in a movie from the noisy background soundtrack can be useful to people who would not normally be thought of as candidates for a “hearing aid”. And blocking out background noise on an airplane so we can hear the movie or music, or sleep better, is useful for most people.

Better Hearing vs Hearing Enhancement

Hearables with better hearing features are sometimes referred to as hearing enhancement hearables or enhanced-hearing earbuds.

These terms sometimes imply hearing that is “better than normal“. Whereas what we are interested in here is “better than without the hearable” — which is subtly different.

“Aspirational Devices” vs “Assistive Devices”

Within the category of “Hearables with Better Hearing Features“, the really interesting split is between products that are seen as “aspirational” and products that are seen as “assistive“.

At the heart of what makes hearables so important, and potentially disruptive, is the fact that many hearables are what we call “aspirational” products — which means that people actually want them.

The distinction between aspirational and assistive devices is less about a difference in technical capability, and more about a difference of focus and aesthetics.

Assistive Devices for Hearing

On the one hand, are what we think of as “assistive devices” for hearing.

The hallmark of assistive devices is that they are designed to help overcome a “disability”. In the case of “conventional hearing aids”, they are targeted at compensating for “hearing loss”.

Conventional hearing aids fall into this category, regardless of whether or not they have a wireless link with the outside world, as do other devices that help with hearing, such as what are often called personal amplifiers.

An important consequence of the focus on “compensating for a disability” is that the focus of the conventional hearing aid industry for years has been “invisibility”.

Conventional hearing aid innovations have been about making the device small, blending it in with hair and skin tones, and marketing the product as something not really noticeable.

And, while there is nothing “wrong” with this approach, it has some important technology implications — because there is almost always a tradeoff between size, technical capability, and cost. And so if the focus is on “small”, engineers usually need to make tradeoffs either about capability or about cost.

This is one of several factors that explain why hearing aids are rather expensive.

Aspirational Devices for Hearing

In contrast, the Apple AirPods (and its competitor wireless earbuds) are what we think of as “aspirational devices“.

Big consumer brands like Apple have made hearables like AirPods desirable “accessories”, that can help you do a variety of things — like listen to music or talk on the phone — in ways that society sees as “better” than how we did those things in the past. And over time these products have become something people “want”. In other words — aspirational.

An important consequence of this approach is that an aspirational hearable such as an AirPod does not need to be small and invisible. On the contrary, it can be rather noticeable, and perhaps that is even a “feature”.

This completely changes the axis of competition — from “small and invisible (but expensive)” to “performant and desirable and less expensive”.

Aspirational + Better Hearing Features

Now at first, these aspirational devices for hearing did not seem to overlap with the assistive devices for hearing at all.

• The hipster listening to music on her airpods seemed like a completely different customer than the frail elderly person with her hearing aids.
• And, at first, aspirational hearables did not offer much in the way of “better hearing features“.

BUT, over the last few years some interesting trends have started to emerge.

• More and more hipsters are developing some hearing “issues”, so the need for features that can deliver “better hearing” becomes relevant to the original audience who wanted the aspirational devices. And the product developers are starting to innovate along the “better hearing” axis.
• Relieved of the constraints of size and invisibility, which have been the traditional axis of competition for hearing aids, engineers can start creating “better hearing” innovations without needing to massively increase costs.

For this article we are especially interested in the sub-category of hearables that are both “aspirational“, and include “better hearing features“.

The key features of aspirational hearables with better hearing features are that they:

• are a piece of consumer electronics — for example a smart wireless earbud (the white things that a large fraction of the younger population of the US wear in their ears much of the day to listen to music or make calls);
• serve a valuable function quite apart from “improving hearing” — such as letting you connect wirelessly to a smartphone or TV — which might be the main reason to buy the product;
• have some capability to improve hearing (for some people and in some situations);
• have a cost of a few $hundreds, rather than the few $thousands that a hearing aid costs;
• are designed to be “self service”, rather than “fitted and adjusted by an audiologist”.

Regulatory Issues

There are some regulatory issues that are important in thinking about the hearables space, and while the details are beyond the scope of this article, thse key points are worth noting (see more at Ref. 2).

1. Medical devices are regulated in the USA by the FDA, which dictates a variety of things, including aspects of performance and how the products can be marketed.
2. “Hearing Aids” are medical devices designed for people with “hearing loss”. In principle, a “hearable” could also be a “hearing aid”, but to be classified as such and sold in the USA,  it would need to be approved by the FDA.
3. This has historically played a role in the way the hearing aid industry has been organized and in the interplay between the products themselves and the professional services involved with configuring and fitting them.
4. The regulatory environment for hearing aids is in the process of changing, in particular as it relates to OTC hearing aids, and this is likely to impact the future of hearables. For example, many observers believe that in time some “aspirational hearables” will be allowed to be marketed as hearing aids, and that the tight connection between hearing aids and professional fittting services will be relaxed. [This has already been mandated but not yet implemented as of mid 2021].  

Why are “Aspirational” Hearables Important?

Aspirational hearables are an example of a trend that is playing out in several product categories: the convergence of “consumer electronics” and “agetech”.

We expect the implications of this trend to be more, and better, hearing-related products, which will appeal to a much broader spectrum of individuals — leading to better hearing for more people.

Convergence of Consumer Electronics (Audio) and Agetech

An emerging trend we have written about elsewhere is the convergence of consumer electronics (e.g. Apple Watch) and “Agetech” (products for old people).

The idea is that, increasingly, one can get features in regular consumer electronics that happen to be especially useful for older adults (fall detection and alerts in an Apple Watch are an obvious example).

The reason this is important is that a trendy piece of consumer electronics is an aspirational object, whereas conventional agetech products have usually been seen as “beige and boring” — and are seen by some as being stigmatizing.

If you have a choice between a trendy consumer gadget that helps you age in place better, or a “beige, boring” product that is clearly branded as being for “frail old people”, which seems more desirable?

The hope is that this trend leads to a virtuous circle.

• More people buy the products.
• The companies prosper and can devote ever increasing resources to making the next products “better“.
• Because the products focus on the needs of consumers in general and not just “the elderly”, the target markets are far larger, which leads to all sorts of scale advantages.

In the case of hearables, it seems to be music that is driving much of the innovation in hearables — described by some pundits as a trend toward “personalized music”.

The good news is that “personalized music” needs “better hearing features” — so we can “hear the music like we used to”.

Better Hearing for More People

A key reason that hearables are especially noteworthy, is that they have the potential to bring “better hearing” to a very large number of people who would benefit from such capability but do not get it today.

As background to this assertion, consider this factoid. The NIH estimates that well over 30 million Americans report some trouble hearing; and that, among adults over 70 yrs old who could benefit from hearing aids, less than one in three have ever used them (Ref. 3).

And this almost certainly ignores people who have “good” hearing, but can’t hear in settings like noisy restaurants, or who would benefit from other “better hearing features” that are not normally thought of as being for “hearing loss”.

We think the emergence of hearables that are “aspirational devices with better hearing features” has the potential to change this situation for several reasons.

1. By definition, “aspirational devices” change the conversation from “maybe I will have to get a hearing aid when my hearing loss gets sufficiently bad” to “I want that device because it is cool and trendy and has a variety of other desirable capabilities — and if it happens to make hearing the TV easier as well, that would be a good thing”.
2. By avoiding the need to make devices “invisible“, hearables can make very different tradeoffs between technical capability and cost than can “conventional hearing aids”. This means hearables are coming to market at far lower price points than hearing aids (although thus far with lesser technical capability). So, people who are put off hearing aids for cost reasons are now able to benefit from the “better hearing” features of a hearable — for now most suited to those who don’t need the most advanced capabilities of conventional hearing aids.
3. Another reason hearables have a very different price point than conventional hearing aids is that they are designed to be “self fitting” and “self set up” — whereas “conventional hearing aids” are designed to be “fitted and setup by a professional”. Audiologists argue that a professional fit and setup leads to the best possible hearing performance, which makes sense. But some people might prefer a less perfect but cheaper “solution”. And over time, perhaps the self fit will approach the performance of the professional fit for many people.
4. Today, the aspirational hearables probably cannot compete with conventional hearing aids for “best possible hearing features”. But over time, and once some regulatory issues are sorted out, without the limitations of size and invisibility and requirement for professional fitting, it seems entirely feasible that aspirational hearables could have equal performance to “hearing aids”, but at a far lower price point. Or if not at a lower overall price point, at least at a lower price per unit of capability.  

Who Might Benefit from Hearables? Use Cases.

Back in the day, there were three groups of people:

• those with “perfect” hearing;
• those who “had hearing aids“; and
• those who “noticed some hearing issues” but were not ready to adopt hearing aids.

It is this third group for whom hearables are especially intriguing — particularly if the reasons for not getting hearing aids relate to cost, the perceived stigma of wearing hearing aids, or the “bother” of the whole process of engaging with the medical system.

See below for some specific scenarios.

Notes:

1. As of 2021 when this was prepared, people with more than mild hearing issues are likely to be best served by conventional hearing aids (themselves a type of hearable), the more advanced of which include many or all of the features appropriate for the use cases below.
2. An intriguing aspect of aspirational hearables, like the smart wireless earbuds, is that they are much less expensive than a high-end hearing aid, and do not require the medical appointments you need to get started with a hearing aid. So the “hurdle” for trying one out seems far lower.

Uses for Hearables: Scenarios

Situations in which people might benefit from “hearables with better hearing features” include the following scenarios.

In most / all of these scenarios two sorts of hearable will work. You can use an aspirational hearable like a wireless earbud (e.g. Apple AirPod) with “better hearing features”, or you can use a modern hearing aid with Bluetooth connectivity.

Difficulty Hearing TV, Movies, Computer, Phone

The classic “problem” is when a couple are watching TV, and one person needs the sound way louder than the other to be able to hear. Related, but a bit different, many people have issues making out what the movie actor is saying against loud background soundtracks.

The key feature of a hearable is the ability to connect directly (typically via Bluetooth) with other electronics like a TV, smartphone, or computer.

This means that, rather than having the TV etc broadcast sound using its (possibly low quality) speaker, the signal is sent directly to your hearable via a wireless signal (Bluetooth) and then turned into relatively high quality sound right there in/on your ear. This alone likely makes the sound better than just relying on the speaker in the TV, smartphone, or computer.

In addition, if the hearable includes better hearing features, you can likely adjust it so that it selectively boosts certain frequencies to compensate for your hearing imperfections. And some hearables have additional features that can block background noise or help pick speech out of background.

The other key aspect of using a hearable to hear TV, movies, phone calls etc is that you can adjust the volume of the sound you hear on your hearable, without impacting the volume others hear.

To make all this work you need two things. You need the appropriate hearable with connectivity, and you need a TV, or smartphone, or other device that is set up to connect to the hearable via Bluetooth.

The Longevity Explorers have been exploring hearing gadgets that can make TV watching better.

• Read Hearing the TV Better: Older Adults Explore.

Difficulty Hearing in Noisy Environments (e.g. Restaurants)

A common complaint among the Longevity Explorers is difficulty hearing your dinner companions in a noisy restaurant.

This is also something that hearables can help with in theory, although we are not sure just how well today’s hearables work for this use case, as we have not yet done a hands-on evaluation of this capability (please add comments if you have tried this).

There are a few things to look for in a hearable if you care about this scenario.

1. Some hearables come with a capability of “directionality“, which means they can selectively amplify sounds coming from a specific direction compared to background noise.
2. Some hearables make it possible to place a microphone near the other diners that can pick up their speech more clearly and send it directly to your hearable via Bluetooth. For example, with the Apple AirPods, you can in principle use an iPhone placed on the table near the other diners to act as a microphone and relay the signal to your Hearable (the feature is called “Live Listen”). High-end hearing aids often have special “accessory microphones” designed to be used like this.
3. Some hearables have built in algorithms to separate speech from “noise”. We have not tried to evaluate how well these work.

Difficulty Hearing in a Group / Meeting / Lecture / Party

Today, in some settings like lecture halls, or movie theatres, the sound system may be equipped with a “Loop” system that can send a signal wirelessly to a hearing aid equipped with a T-coil. This works well, but requires you to have a hearing aid, and the room to be “wired” appropriately.

In the future, it seems realistic that sound systems will come with the capability to broadcast sound via Bluetooth, so that people can connect to it using the Bluetooth in a “hearable”. However, we don’t believe this is yet widespread.

Another “challenge” that needs solving, but which we don’t think is yet solved, is the challenge of hearing in a group discussion (for example around a conference table). We can imagine a number of possible, inexpensive solutions to this, involving Bluetooth and hearables. However as best we know these also are not yet widespread.

If you know of good solutions, or are working on one, feel free to use the comments section at the bottom to share with others.

Difficulty Hearing One-on-One

The challenge of hearing in a one-on-one conversation is what hearing aids are designed to address as their “primary use case”.

If you have significant difficulty with this scenario, you likely would benefit from a hearing aid, rather than a more aspirational hearable like a wireless earbud.

However as features like transparency mode, and personalized frequency band amplification become available in aspirational hearables, perhaps these will also be useful for better hearing in a one-on-one setting. We are currently exploring some hearables that may have this capability already.

Starting Early: Train Your Brain.

One of the subtle challenges associated with hearing is that it is not just the ear which is involved in determining what sounds mean, but also the brain.

There are several factors that suggest that the approach of “waiting as long as possible before getting a hearing aid” is suboptimal.

1. There are suggestions that delaying doing anything about hearing “issues” can interfere with cognitive activity, and also that it may be harder to “retrain” the brain to hear well again later (Ref. 4).
2. Also, a classic trap with just “accepting” some decline in hearing capability is that you start adjusting your life in ways that contribute to isolation (for example you avoid groups, or dining out).
3. And recent research from Johns Hopkins shows that even mild hearing loss can increase the risk of dementia. While they have not yet shown that “correcting that hearing loss” using hearables or hearing aids can reduce that risk, as the researchers say “What we do know is that there’s no downside to using hearing aids. They help most people who try them. And in those people, they can make all the difference in the world—allowing people to reengage with friends and family and to be more involved again.” (Frank Lin, MD, PhD, Johns Hopkins, Ref. 5).

The idea that an aspirational hearable could be the “on-ramp” to hearing compensation seems attractive due to the low costs, and lack of perceived stigma.  

Specific Hearable Brands & Products

In this article, we are not trying to compare or review specific products. However, here is an overview of the notable brands and products as of mid 2021.

As explained above, within the category of “Hearables with Better Hearing Features” that is our focus here, there are two important sub-categories.

1. Aspirational Products: which today are mostly embodied as Wireless Earbuds with Connectivity and Better Hearing Features, although some cross-over products are emerging.
2. Assistive Products: which today are embodied as Advanced Hearing Aids with Connectivity.

Wireless Earbuds with Connectivity and Better Hearing Features: Aspirational

These products fall squarely into the “aspirational hearables” category.

These products have the following characteristics. They:

• look and feel like a piece of “aspirational” consumer electronics;
• have the form factor of a “wireless earbud”;
• have “connectitivy” via Bluetooth to various other gadgets, likely including smartphone, computer, and perhaps TV;
• include some “better hearing features”;
• have price points in the $hundreds (or even less);
• can be set up and adjusted by the user, and do not require an audiologist consultation.

This category is very active with new products coming to market quite frequently.

Consumer Behemoths

Big consumer electronics brands like Google, Apple, Amazon, and Samsung are all active in this space.

The most notable product is the Apple AirPod which in 2021 has added a variety of “Better Hearing Features” to the AirPod Pro via updates to its smartphone iOS.

But Amazon has the “Echo Buds” and Google has the “Pixel Buds” and Samsung has the “Galaxy Buds”.

For now, the better hearing features in these products (other than Apple) are rather limited, but we are hoping this will be an active dimension of competition going forward for these companies.

Consumer Audio Companies

Consumer audio companies are also getting into the competition, with a wide variety of companies bringing wireless earbuds to market, including Bose, Sennheiser, Sony, Jabra, and numerous others.

As best we can tell from some Internet browsing, these products are focused on “listening to music”, and other than noise cancellation do not seem to have added much in the way of “Better Hearing Features” as yet.

Hearables Insurgents

There is a handful of small startup companies who are leading the charge on “smart wireless earbuds with better hearing features”, and who played a key role several years ago in starting the “better hearing” hearables trend.

The companies with interesting hearables products from this category include the following. [Links go to the Tech-enhanced Life database, where you can learn more about the products and find links to the vendor websites.]

• Nuheara
• Olive Union
• BeHear: Alango (WearandHear.com)

Other companies working on interesting “future products” in this category include:

• Lizn

In other “things to note”, there is a very intriguing Jacoti / Qualcomm partnership that might lead to a variety of sophisticated better hearing features being embedded into the chips inside a much broader range of wireless earbuds.

Advanced Hearing Aids with Connectivity: Assistive or Cross-over

The major hearing aid companies have started to add “connectivity” features to their hearing aids, although they are not yet in “all” hearing aids.

These products fall into the “assistive hearables” category, and have the following characteristics. They:

• have the form factor of, and look and feel like, a “hearing aid” — which means the emphasis is on “small and discreet and hard to notice”;
• have “connectitivy” via Bluetooth to various other gadgets, likely including smartphone, computer, and perhaps TV;
• include state of the art “better hearing features”;
• require professional “fitting” and “setup and adjustment” (an audiologist);
• have price points in the $thousands.

The major hearing aid brands are:

• Phonak; Unitron; Oticon; Widex; Signia; ReSound; Beltone; Starkey; and Costco (which sells white labelled products from some of the above companies).

All of these brands have a high end product with Bluetooth connectivity — which makes it a “hearable”. However the exact details of what each product can do vary quite a bit as far as Bluetooth connectivity is concerned, and some require an extra “Bluetooth streamer”. The differences are beyond the scope of this article, but be aware that there are such differences.

If you care about the “absolute best” hearing, and don’t care about price or any potential “stigma” of wearing a hearing aid, in 2021 products from this category are likely to be “best performing” — especially if you have more than very mild hearing “issues”.

Cross-over Products

In an interesting twist, Phonak has made an attempt at a “cross-over” product, which combines the technology capability of an advanced hearing aid with the “aspirational” aspects of a “wireless earbud”.

This product is called the Virto Marvel Black. The tagline used by Phonak is “A hearing aid that’s just like an earbud“.

However it still has the high price point and requirement for professional fitting of an advanced hearing aid.

Key Differentiators

The most obvious differentiators to think about are the appearance and comfort of the device, and the degree to which the “better hearing features” are matched to your personal hearing situation.

And for many, cost, and whether or not the product needs a professional “fit and ongoing adjustment”, are important considerations.

Battery Management

Also very important, and sometimes overlooked are issues of battery management.

All these products are powered by some type of battery. In the case of many hearing aids, these batteries need replacing, typically every few days or maybe once a week.

For some hearing aids, and most of the “wireless earbuds”, the battery is a “rechargeable” one, which means you don’t need to fiddle replacing it, but you do need to recharge it.

The time between charges is a very important variable.

For the typical earbuds, time between recharging is usually a few hours. These products are designed for intermittent use (e.g. in a specific situation) — rather than continuous, all day wear.

In contrast, most hearing aids are designed to be worn for a day at a time, continuously.

However, the typical hearing aid does not expect you to use it for extensive audio streaming. We are unclear on how badly that impacts battery life, and that is worth checking if you are thinking of buying a hearing aid with the expectation of using it a lot to stream music, or watch TV, or talk on the phone.

Learn More

For more coverage of “hearing” by Tech-enhanced Life and the Longevity Explorers:

• View Topic Hub: Hearing.

References

1. Nick Hunn: Hearables Market Report

2. FDA discussions on hearing aids.

3. NIH / NIDCD Statistics on hearing.

4. Hearing Aids May Help Improve Brain Function

5. The Hidden Risks of Hearing Loss

6. Hearing Tracker: Guide to Hearables

7. Wikipedia: Hearables