This is the third of a four-part installment on consumer perceptions of hearing aid satisfaction and benefit.
Part I evaluated detailed historical consumer satisfaction with hearing aids.1
Part II studied the relationship between best practices in fitting hearing aids and outcomes.2
Part III looks at the impact that mini-BTE hearing aids have had on the consumer with a hearing impairment.
Part IV will evaluate consumer perceptions of benefit specifically experienced through wearing hearing aids.
Behind-the-ear (BTE) hearing aids represented less than 20% of hearing aid sales prior to 2000 and appeared to be on the decline as a style of hearing aid choice by consumers. With the introduction of open-fit hearing aids and receiver-in-the-canal (RIC) hearing aids however, BTEs now represent 63% of all hearing aid sales.3
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?
In our MarkeTrak survey, the generic term “mini-BTE” was used to represent both open-fit and RIC hearing aids, as well as on-the-ear (OTE) hearing aids. We did not ask the consumers to identify which of the two mini-BTE style hearing aids were in their ears, since we did not believe this was a distinction that they could accurately make.
The detailed methodology of the MarkeTrak VIII survey is documented in the first publication in this series.4 In evaluating customer satisfaction with hearing aids, this paper will focus on hearing aids four years of age or less.
In January 2009, we sent an extensive, seven-page, legal-size survey to the total universe of hearing aid owners identified (n=3789) during the screening phase; 3,174 surveys were returned, representing an 84% response rate.
The consumers were asked to rate their hearing aid experience on 44 items, using a 7-point Likert scale: very dissatisfied, dissatisfied, somewhat dissatisfied, neutral, somewhat satisfied, satisfied, and very satisfied.
The attitude items covered overall satisfaction, product features, product performance, and satisfaction in 19 listening situations. In addition, consumers were asked if they would recommend hearing aids to their friends, how many hours a day they wear their hearing aids, and whether or not they would repurchase their current brand of hearing aid.
Hearing aid sample
As shown in Figure 1, a query of the MarkeTrak VIII database yielded 487 mini-BTE hearing aid users (25.3% of all hearing aid users) and 1,449 users of traditional hearing aids: 21.8% BTE, 27.7% in-the-canal (ITC) visible, 10% ITC invisible, 8% in-the-ear (ITE) full concha, and 8.4% ITE partial concha. All purchases were for the years 2005–2008.
In Table 1, the demography and hearing loss characteristics of the people using mini-BTE and traditional hearing aids is shown. From this table we can conclude the following:
* There are no age differences between the two samples.
* Mini-BTE hearing aids appeal more to males than traditional style hearing aids (64% vs. 58%).
* Mini-BTE hearing aid users on average earn $15,000 more per year.
* Mini-BTE hearing aid users are more likely to be married (72% vs. 61%).
* Mini-BTE hearing aid users are more likely to be in the work force (38% vs. 26%).
* Mini-BTE hearing aid users have a less severe hearing loss and less difficulty hearing in noise.
* Mini-BTE users are more likely to purchase binaural hearing aids and more likely to have a bilateral loss.
* There is a greater incidence of new users of mini-BTE hearing aids than new users of traditional hearing aid styles (59% vs. 41%).
Customer satisfaction differences
The key finding from the analysis is that mini-BTE hearing aids are tapping an entirely new hearing aid user segment, not a younger segment, but one who is more affluent, in a marital relationship, and in the workforce. More importantly, their hearing loss is significantly lower than that of the traditional hearing aid user.
As a result of this finding, we compared satisfaction ratings with hearing aids, controlling for degree of hearing loss. Customer satisfaction ratings for mini-BTE hearing aid users and users of traditional style hearing aids are reported in Table 2; least squares means from analysis of covariance is used to determine if the differences are significant at the p<.01 level or better.
Overall satisfaction ratings are significantly higher for mini-BTE hearing aids (85% vs. 76%); however there are no significant differences in perceptions of benefit or value, despite the fact that mini-BTE hearing aid prices are considerably higher than those of traditional hearing aids.
Focusing on product-specific satisfaction rating differences of 10 percentage points or more, mini-BTE hearing aids are shown to be superior in visibility (88% vs. 75%) and warranty (76% vs. 66%). However, mini-BTE hearing aids are rated lower in ability to adjust volume (51% vs. 63%).
With respect to sound quality and signal processing, mini-BTE hearing aids are rated between 10%-13% points higher than traditional style hearing aids on all 11 variables measured in this category.
Mini-BTE hearing aids do not appear to have a practical impact on reducing the number of hearing aids that aren't worn or on the consumer's likelihood of recommending hearing aids or the dispenser, or in establishing brand loyalty.
Of the 19 listening situations measured (Table 3), four show significant improvements in consumer satisfaction correlated with mini-BTE hearing aid usage: performance on cell phones (80% vs. 65%) and telephones (83% vs. 70%), in large group situations (76% vs. 66%) and in the schoolroom/classroom (68% vs. 57%).
So what's the consumer appeal for mini-BTE hearing aids? In a 2006 Internet survey5,6 of 232 users of mini-BTE hearing aids users (completed by their hearing healthcare provider), it was concluded that:
* Mini-BTE hearing aids were expansionary (68% new users) in that 22% of mini-BTE purchasers would have purchased no hearing aid in the absence of mini-BTE hearing aids, and were on average 9 years younger.
* The top reasons for mini-BTE appeal in rank order were: less occlusion, fit and comfort, better sound quality, better benefit, less visibility, and better directionality.
* Least important factors were: instant fit, less returns, no need for ear impression, more colors, and greater power.
The general consensus among experts7–11 on the appeal of mini-BTE hearing aids (open-fit and RIC) is as follows:
* It's nearly invisible due to the use of thin-tubes.
* Occlusion is reduced; therefore there is a reduction in the aversion of the sound of chewing, swallowing, and the sound of the consumer's voice.
* They are more natural sounding and overall sound quality is better.
* Feedback is reduced, especially for RIC hearing aids.
* There is also a debate as to whether the open fit hearing aids obviate the impact of directional microphones.
Based on consumer data we can conclude the following:
* Mini-BTE hearing aids did not tap into younger segments of people with hearing loss.
* Mini-BTE hearing aids are expansionary and did influence more affluent and more active elderly consumer segments to come forward for a solution for their hearing loss; they also tapped into segments of people with milder hearing losses.
* Controlling for degree of hearing loss, mini-BTE hearing aids would appear to offer significant improvements in overall satisfaction, cosmetics, sound quality in all areas, and multiple environmental listening utility.
* Mini-BTE hearing aids did not improve consumer perceptions of fit and comfort, benefit, value, or impact reductions of hearing aids not being worn; nor did they generate more positive word-of-mouth advertising or develop greater hearing aid brand loyalty.
This study was made possible by a special grant from Knowles Electronics, LLC, Itasca, IL.