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Survey finds higher sales and prices, plus more open fittings and directional mics

Johnson, Earl E.

doi: 10.1097/01.HJ.0000285746.08599.a4

A report on the findings of the 2007 Hearing Journal/Audiology Online Dispenser Survey.

Earl E. Johnson, MS, is a PhD candidate in Hearing and Speech Sciences at Vanderbilt University. He is also an audiologist and has been a research assistant in the Dan Maddox Hearing Aid Research Laboratory for the past 4–1/2 years. Readers may contact the author at

The March 2007 Cover Story with its focus on brand preference in hearing aid dispensing included only a subset of the responses to the questions asked in this year's annual Hearing Journal/Audiology Online dispenser survey conducted in January 2007. This article reports the survey's findings on a broad range of other professional issues and activities.

Two-thousand-and-six was a very good year for hearing aid dispensers, according to the 489 dispensing audiologists and hearing instrument specialists surveyed by HJ and AO. Most respondents said their sales were up last year from 2005 (Figure 1), and a bullish 74% predicted that growth would continue in 2007 (Figure 2).

The survey was e-mailed to AO's address list as well as to the members of the International Hearing Society. Of the dispensers who participated, 75% were audiologists and 25% were hearing instrument specialists. In addition to the 489 dispensing professionals, 84 additional respondents were audiologists who do not dispense hearing aids in their practices; they answered questions not related to hearing aids. More detail on the demographics on the respondents appeared in HJ's March 2007 Cover Story.

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Overall, respondents reported dispensing an average of 36 hearing aids per month in 2006, up from 32 in 2005. It should be noted that this figure is per response and, in many cases, represents the efforts of multiple dispensers in a single office or even a network of practices. Another way of examining the dispensing data is to fix the practice size. When we analyzed sales only by single-office practices, we found that an average of 24 hearing aids a month were dispensed in 2006 compared with 22 in 2005. That represents a 9% increase, close to the nearly 8% increase in total sales in 2006 reported by the Hearing Industries Association.

We also calculated the number of hearing aids dispensed per month per dispenser. To do this, we divided the average monthly sales in each response by the number of dispensers that the respondent said contributed to those sales. This number was 15, the same as last year, though up from 13 hearing aids a month reported in 2004 and 12 in 2003.

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As in past years, the survey asked participants how much they charged in 2006 for five styles of hearing aids in each of four categories (Figure 3). These included “traditional,” i.e., analog, signal processing devices, and three categories of digital signal processing instruments: low-end, mid-level, and high-end. This year, we added a fifth style—the mini-BTE—to the established categories of BTE, ITE, ITC, and CIC.

After careful consideration, “mini-BTE” was selected as the term that best encompasses all small BTE hearing aids, as opposed to the larger, traditional behind-the-ear devices. The mini-BTE category includes products of any receiver location, acoustic or electrical routing of the sound, or openness of the ear canal.

The average prices in Figure 3 represent the amount charged by the large majority (87%) of dispensers in the survey who reported bundling the cost of services in with the price of the hearing aid itself. Meanwhile, the remaining 13% who charge separately for products and services reported charging an average of $346 per hearing aid for their fitting services, about 8% more than the service charge of $319 reported for 2005.

When asked the overall average unit price they charged for all hearing aids sold last year, regardless of style and technologic level, the dispensers who bundle said it was $1912, the highest yet recorded by our survey and about 2% more than 2005's average price of $1868.

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Along with tracking price changes over the past years, our annual surveys have also kept a close eye on the popularity of bilateral and open fittings and of certain product features. This year's product feature list was more inclusive than those of previous years. In answering these questions, dispensers were asked to estimate what percentage of all their hearing aid fittings in 2006 had certain features and characteristics. The responses appear in Figure 4.

Analysis of the responses from all dispensers showed a statistically insignificant increase of 2% in the use of DSP and bilateral hearing aid fittings. However, when it came to directional microphones, telecoils, and open fittings, the survey revealed significant increases in their popularity of 12%, 8%, and 12%, respectively, from 2005 to 2006.

In two of these areas, the growth in use was especially great among hearing instrument specialists. Their reported use of directional microphones increased by 16% in 2006, compared to the 10% reported by audiologists. A similar pattern was seen in open fittings, where traditional dispensers reported an increase of 14% in 2006, while among audiologists the year-to-year increase in the use of open fittings was 11%. However, as shown in Figure 5, despite their increasing use of open fittings and directional technology, specialists still reported using them less frequently than audiologists in 2006.

New in this year's survey were questions about the use of feedback reduction, noise reduction, and data logging (also shown in Figure 4).

In many areas, survey responses varied by profession. Specifically, using arcsine transformation values of the percentages, statistically significant differences were shown on all items in Figure 5 except bilateral and open fittings.

Given the large percentage differences in gender between the two professions (i.e. 77.7% of the audiologists were women and 66.4% of the hearing instrument specialists were men), it seemed possible that the differences between responses by profession were gender-based. However, analysis showed that, for the most part, the differences between men and women were less common and smaller than those between audiologists and specialists.

Within a group of 367 dispensing audiologists, statistically significant differences were seen only in the use of data logging and telecoils, both product features that women reported dispensing more often than men. Among the hearing instrument specialists, the only significant difference by gender was that women reported a higher percentage of open fittings.

Another demographic variable, work location, was shown to impact dispensing patterns significantly. Specifically, whether an audiologist worked in a physician's office, a hospital/clinic, university, or a private practice had a significant effect on the frequency with which they dispensed hearing aids with the features shown in Table 1.

Meanwhile, at least among audiologists, their length of work experience or the particular educational degrees they held (i.e., master's, AuD, or PhD) were found to have no significant effect on what they dispensed.

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Several survey questions focused on practice patterns unrelated to the dispensing of hearing aids. On these questions, the input of all 573 respondents was considered. As in the past, the most commonly offered products (other than hearing aids and non-custom batteries) were custom hearing protection and swim plugs followed by listening devices for the television and telephone (Figure 8).

Concomitantly, the least offered devices were tinnitus masking devices and alerting devices. It is surprising non-custom hearing protection devices, offered in only 37% of practice locations, were not available more often. Admittedly, these non-custom products might decrease the sale of custom hearing protection devices. But, revenue from their sales combined with the sales of earplugs and swim plugs only generate 1.7% of practice revenues, as shown in the next section. This seems to be an excellent opportunity for practitioners to offer a great public service by providing non-custom hearing protection devices at little cost to patients.

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A question about the percentage of practice revenues generated by various products and services made it clear that in 2006, as always, hearing aids were the cash cow of most hearing healthcare offices. On average, dispensers said that over 60% of their income came from the sale of hearing aids.

Diagnostics followed a distant second to hearing aid sales, accounting for a re-ported 15% of practice revenues (see Figure 9). Meanwhile, hearing aid repairs, cleaning, and maintenance rounded out the top five revenue sources.

Only 10 of the responses (∼2%) re-ported that vestibular services accounted for more than 25% of their practice's revenues. Perhaps this is due to the small number of practices that offer primarily vestibular services or a lack of participation in the survey by those with vestibular practices.

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One of the final questions on the survey asked dispensers what most frequently brought clients to their offices and clinics. No, we're not talking here about whether people drove or took the bus or used an in-car GPS system or MapQuest to find their way. Instead, we're talking about the relative effectiveness of various marketing approaches, shown in Tables 2 and 3.

As has been true for years, the most common source of new patients in 2006 was a medical or professional referral; referrals by friends and family finished a strong second. These two motivating factors were followed by newspaper advertising, direct mail, and medical insurance referrals as other primary sources. Most of the responses that fell into the “others” category came from audiologists in the Department of Veterans Affairs, who reported that their new patients came from within the VA system.

While it's undoubtedly true that there is no better source of new patients than a strong referral network, it should be pointed out that the relatively small number of first-time patients attracted by certain marketing strategies does not necessarily mean that these strategies will be ineffective for those who use them. In some cases, their low scores in the survey may simply reflect the fact that not many dispensers are using these approaches.

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Author's acknowledgment

Many thanks to David Kirkwood, editor of The Hearing Journal; Dr. Gus Mueller, contributing editor of The Hearing Journal; Dr. Paul Dybala, editor/president of Audiology Online; Russell Kacer, marketing director of Audiology Online; and the International Hearing Society.

© 2007 Lippincott Williams & Wilkins, Inc.