Most dispensers in Journal's survey report greater patient satisfaction with digitals : The Hearing Journal

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Most dispensers in Journal's survey report greater patient satisfaction with digitals

Kirkwood, David H.

The Hearing Journal 54(3):p 21-22,24,26,28,30,32, March 2001. | DOI: 10.1097/01.HJ.0000293823.37148.ea
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Hearing aid dispensers polled by The Hearing Journal gave a rousing vote of confidence to digital instruments for their effectiveness in increasing patient satisfaction. More than three-quarters of respondents to the Journal's eighth annual dispenser survey reported that their patients were more satisfied with digital signal processing (DSP) instruments than with “other advanced non-digital hearing aids.”

The survey, which this year focused on several relatively new product types, found that hearing professionals also see enhanced user satisfaction with hearing aids containing directional mics, most notably for understanding speech in noise.

Response was mixed, however, to two other new product categories—disposable hearing aids and starter devices. Most dispensers do not currently offer these products and, while many predicted that lower-cost products would attract new people into the market, many others were either unsure or said that consumers would purchase these devices instead of other hearing aids.

The survey also found a continuing strong trend toward the fitting of higher technology, including both digitally programmable analog (DPA) hearing aids and DSP aids.

As a direct result of the growing prevalence of advanced instruments, respondents reported that the average price of the hearing aids they dispensed in 2000 was $1442, an 18% increase over the average price reported in the previous year's survey. However, when results from the past three surveys were compared, the average retail prices charged in 2000 for specific types of instruments appeared to be similar to or less than in 1999 and 1998.

EXPERIENCE WITH DSP HEARING AIDS

The Journal's latest survey asked dispensers several questions related to their experience with DSP hearing aids, including whether they fit them in their practice.

Of the 252 people who answered that question, 236 (93.7%) reported dispensing at least some digital devices in 2000. By comparison, 80% of respondents in 1999 and 73% in 1998 said they offered this technology. There was little difference in this regard between audiologists and hearing instrument specialists.

Not only is the portion of dispensers who offer digital technology growing, but so too is the frequency with which they dispense them (Table 1). Among all respondents, 54% said that over 20% of the devices they dispensed in 2000 were DSP, 26% reported dispensing over 40% digital, and 8% over three-quarters. In the 1999 survey, 26% reported that over 20% of their sales were digital and just 7% said more than half were.

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Table 1:
What percentage of the hearing aids you dispensed in 2000 were digital signal processing (DSP) instruments? Percentage reported in 1999 survey is in parentheses for those response options that were the same in both surveys. The 1999 survey offered two choices above 20%: 21–50% and over 50%.

Patient satisfaction

The survey went on to ask those who dispensed digital hearing aids to compare the level of satisfaction they observed with users of these products to that of patients wearing “advanced non-digital hearing aids.”

Asked about “overall patient satisfaction,” 78% of respondents said that, “in general,” the patients whom they had fitted with digital hearing aids were either “somewhat more satisfied with DSP” (48%) or “much more satisfied with DSP” (30%) than with advanced analog products (see Table 2). Only 3% said that patients were “somewhat less satisfied” with digital and none said they were “much less satisfied.” The other 19% said that patients were about equally satisfied with the two types of technology.

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Table 2:
How does the satisfaction level of your patients who wear DSP hearing aids compare with that of patients wearing advanced non-digital instruments?

Respondents were also asked to compare patient satisfaction with digital and analog hearing aids in several specific areas (Table 2). Here, DSP devices fared well in general, but especially in the area of sound quality. Eighty-nine percent of all dispensers said that their patients were more satisfied with the sound quality of digitals; 42% reported much more patient satisfaction. Only 1% said that patients were less satisfied with digital sound quality, while 10% saw little difference.

The smallest difference between digital and analog was found in the area of understanding speech in quiet. While 62% of respondents said that their patients were generally more satisfied with digital in this condition, a large minority (37%) reported little difference.

In the more challenging condition of understanding speech in noise, 78% said that their digital patients were more satisfied than analog users, and 29% reported that they were much more satisfied.

Dispensers also reported a higher rate of patient satisfaction with DSP for listening comfort (82%) and preventing feedback (70%).

In all areas, only a very small percentage (from 0.4% to 3%) of respondents said that their patients were less satisfied with digital than with analog hearing aids.

Specific advantages

The survey asked dispensers what they have found to be “the greatest advantages of any kind with DSP fittings over other advanced non-digital fittings.”

The most common responses were flexibility of fitting, cited by 76 dispensers, and improved sound quality, which received 72 mentions. Also frequently named were better performance in noise (58) and controlling feedback (47), while more than 20 people gave DSP aids high marks for precision of fitting, improved speech understanding, ease of fitting/adjusting, and listening comfort.

Also frequently mentioned were less distortion and ability to fit unusual hearing losses.

There were a few critics of digital instruments. Six dispensers said they offered no advantages over advanced analog hearing aids.

Finally, two candid commenters listed greater profit among the advantages of digital fittings.

Discussion

As is pointed out elsewhere in this issue (see ViewPoint articles by Ross and Walden, on page 56), there has thus far been little objective evidence derived from clinical studies proving that DSP hearing aids provide superior performance to advanced analog instruments.

While the results of this survey are certainly no substitute for the findings of scientifically conducted trials, the data collected do represent a substantial amount of anecdotal evidence. It is striking that so great a majority of the audiologists and hearing instruments specialists who fit digital hearing aids perceive them to deliver enhanced patient benefits over advanced, non-digital devices.

DIRECTIONAL-MICROPHONE HEARING AIDS

Although not a new technology, the use of directional microphones in hearing aids has only recently become common. Among survey respondents, 79% reported dispensing hearing aids with directional mics last year. In this product category, there was a considerable difference among dispenser groups. While 84% of audiologists said that they fitted directional hearing aids in 2000, only 72% of non-audiologist dispensers reported doing so.

As with DSP hearing aids, the survey asked several questions about patient satisfaction with hearing aids containing directional mics.

Patient satisfaction

Notably, directional-mic hearing aids were rated very highly for the specific purpose that they are designed to serve—helping people understand speech in noise (see Table 3). Ninety-three percent of respondents said that their patients with directional mics were at least “somewhat more satisfied” in this condition than their patients without. Forty-nine percent said patients were “much more satisfied.”

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Table 3:
How does the general satisfaction level of your patients who wear hearing aids with directional mics (“directional aids”) compare with that of patients wearing otherwise comparable hearing aids without directional mics.

In two other areas—sound quality and listening comfort—a slight majority of dispensers rated directional products higher than non-directional for patient satisfaction, although many reported no difference. Most respondents saw no difference between directional and non-directional for patient satisfaction in preventing feedback or understanding speech in quiet.

In none of the areas asked about did more than 2% of respondents report that their patients with directional aids were less satisfied than those without directional mics.

DISPOSABLE AND STARTER HEARING AIDS

The survey also inquired about the experience of dispensers with two new product categories—disposable hearing aids (which, to date, are made only by Songbird Hearing, Inc.) and non-disposable starter hearing aids (of which there are several different brands).

The two categories have much in common, since the products that they contain are designed to attract new users with relatively mild hearing loss, are inexpensive to purchase, and are fitted without the taking of an ear impression. However, while the Songbird could be considered a starter device, it differs from the others both in being disposable and in being more costly over time, since the $39 hearing aid needs replacement after approximately 40 days of use. Therefore, it was placed in its own category for the purposes of this survey.

VIEWS ON DISPOSABLES

Songbird did not introduce its disposable hearing aid until the second half of 2000, and then only in certain markets. Thus, it is not surprising that only 9% of survey respondents said they have begun dispensing it. Also to be expected is that about half of the dispensers polled have not made up their minds about offering the device. Thirty-six percent said they were undecided about dispensing Songbird and an additional 15% were unfamiliar with the product.

Among those who did state an opinion, 27% said they were “definitely not interested” in offering it, while 14% said they were “interested” in doing so—in addition to the 9% who were already dispensing it. Thus, those who had formed an opinion were split fairly evenly as to whether or not to dispense the disposable device.

Hearing instrument specialists were more decided than audiologists about whether or not to dispense Songbird. Twelve percent reported that they were offering it and 18% intend to. Exactly one-third said they were not interested, leaving 37% undecided. Among audiologists, 9% were dispensing the product, 12% intended to, and 23% were not interested. Most (56%) were unsure.

Reported experience

Because of the newness of the disposable hearing aid, only 24 survey respondents said that they dispensed it in 2000, too small a sample to have much significance. Among these dispensers, 62% said that it attracted people to their practice who would not otherwise have come, while 29% were uncertain on this and 9% disagreed. Asked if many Songbird purchasers are people who would otherwise not buy hearing aids at all, 43% agreed, 38% were uncertain, and 19% disagreed.

Probably because of their brief experience with the device, 70% of respondents were either neutral or unsure if most Songbird purchasers were satisfied. The other 30% were evenly divided between those who said patients were satisfied and those who said they were not. Also, 65% of dispensers were uncertain whether or not most of their Songbird patients were ordering replacements; 20% said they were and 15% said they were not.

As to whether the introduction of the Songbird would expand the overall hearing aid market, 38% agreed (but only 5% agreed “strongly”), 38% were unsure, and 24% disagreed (10% “strongly”).

Views of all respondents

The Journal survey went on to solicit the opinions of all respondents, whether or not they had begun dispensing the Songbird (Table 4). Of these, 36% agreed with the statement that the disposable device “will expand the overall market for hearing aids.” Most of the rest (39%) were unsure, while 25% disagreed. Interestingly, this response is nearly identical to that given by the subset of respondents who do dispense the Songbird.

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Table 4:
Please indicate how much you agree or disagree with each of the preceding statements about the Songbird Disposable Hearing Aid.

A majority (55%) of dispensers agreed that purchasers of the device would generally be “people who would not otherwise buy any hearing aids at this time,” while 24% disagreed. Asked if they thought Songbird purchasers would continue to buy replacements, 51% were uncertain, but more thought they would not (31%) than thought that they would (18%). The greatest level of agreement regarding the Songbird came in response to the statement, “People who buy this product will eventually be good candidates for non-disposable hearing aids.” Fifty-six percent agreed, while only 13% disagreed.

Asked to predict the impact of disposable hearing aids on the overall hearing industry, a large number of dispensers wrote comments, which ranged everywhere from “No impact” to “Potentially, the hearing aid market could explode!” (For more comments, see sidebar.)

VIEWS ON STARTER HEARING AIDS

Several starter hearing aids have been introduced recently, perhaps beginning with the GN ReSound Avance in late 1998. Among survey respondents, 21% said they were currently offering one or more such devices, and another 11% intend to. The other 68% were evenly divided among the undecideds and those who do not plan to offer starter products.

In some areas, most respondents expressed positive views about the effect of starter devices on the hearing aid market, although many were unsure (Table 5). Most dispensers (54%) agreed that this type of product will appeal to many people who have been unwilling to buy regular hearing aids, while 20% disagreed. Only 22% of respondents agreed with the statement, “Many people who are prepared to purchase regular hearing aids will purchase starter devices instead,” while 47% disagreed.

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Table 5:
Please indicate how much you agree or disagree with each of the preceding statements about starter hearing aids.

However, the survey found some concern among dispensers about what consumers who get starter devices will do in the future. Forty-two percent of respondents agreed with the statement, “Many purchasers of starter devices will not have a good experience with them and, as a result, will be less likely to purchase regular hearing aids in the future.” Only 27% disagreed.

And asked to react to the statement, “Purchasers of starter devices will generally be more likely to purchase regular hearing aids later than if they had not bought such a device first,” 35% of dispensers agreed and 29% disagreed, with the rest being undecided.

Discussion

“Too soon to say” is the phrase that perhaps best summarizes the overall appraisal that dispensers in our survey gave to disposable and starter hearing aids. That seems appropriate in that both product types are too new for most hearing professionals to have had personal experience with them or even to have heard much about them second-hand.

However, the survey did reveal a considerable degree of consensus that disposable and starter devices appeal primarily to consumers who have never sought help for their hearing problem. Therefore, most dispensers agree, these products may serve to expand the market.

USE OF PROGRAMMABLES

Although the special focus of this latest survey was on several new types of hearing aids, the Journal also asked dispensers about a wide range of other topics.

Among the findings was that programmable hearing aids, either analog or digital, are increasingly becoming the standard fitting (Tables 1, 6). Combining the responses to two questions—“What percentage of the hearing aids you dispensed in 2000 were digitally programmable analog?” and “What percentage were DSP?”—indicates that in 2000 more than two-thirds of dispensers fitted programmable instruments on more than 40% of their patients. This finding is consistent with the report of the Hearing Industries Association that last year, for the first time, more than half the hearing aids sold in this country were programmable.

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Table 6:
What percentage of the hearing aids that you dispensed in 2000 were digitally programmable analog instruments? (1999 responses are in parentheses).

However, there are still a great many basic, non-linear hearing aids being dispensed. While 65% of the surveyed dispensers said that over 60% of their fittings in 2000 were of products containing automatic signal processing, that figure was no higher than in 1998. Also, the survey findings showed that 35% of respondents were still dispensing linear aids to at least 40% of their patients in 2000.

REGARDING PRICE

The continued fitting of linear instruments notwithstanding, clearly the trend in dispensing is toward greater use of advanced technology. That trend largely explains why the mean price that respondents charged for hearing aids in 2000 was, at $1442, $224 (18%) more than the average price of $1218 reported in the 1999 survey. (Figure 1). The mean price in 2000 was 27% higher than the $1134 reported in the 1998 survey and 49% higher than the 1997 average of $971.

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Figure 1:
What is the average price that you charged per hearing aid in 2000, including all types and styles? (Please note that the 1999, 1998, and 1997 figures were derived from the surveys conducted in those years. Also, comparisons between dispensing groups may be misleading because (1) audiologists in the survey dispense a higher percentage of more advanced instruments than do hearing instrument specialists, and (2) more specialists than audiologists include the cost of professional services in the price of the hearing aids they dispense.)

A secondary factor in the increasing price may be that a growing portion of dispensers include their charge for professional services in the price of the hearing aid. Only 17% of respondents in the latest survey said that they charged patients separately for services, compared to 24% in the previous survey.

Among dispensers who did not “bundle” services into the price of the hearing aid, the mean fee reported for professional services in 2000 was $131 per hearing aid. Only 7% of hearing instrument specialists said they charged separately for services, while 23% of audiologists said they did so. This difference may explain why, for most categories of hearing aids, specialists reported charging a slightly higher price than audiologists (Table 7).

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Table 7:
What is the average price that you charged in 2000 per hearing aid in each of the following categories? (Please note that the figures reported often include fees for professional services, which are “bundled into” the price of the instruments.)

Interestingly, despite the sharply higher reported price of the average hearing aid dispensed in 2000, the retail prices reported for many specific types of product were lower than those reported in the 1999 survey. For example, as shown in Table 7, the reported prices of most styles of digitally programmable analog hearing aids were lower in 2000 than in 1999. A similar decline was seen from 1998 to 1999. On the other hand, surveys from the past 3 years have shown the average retail prices of both non-programmable and digital instruments holding fairly steady.

REPORTED SALES PER PRACTICE LOWER

Respondents to the latest Journal survey reported that their practices sold an average of 25.9 hearing aids per month during 2000. That was nearly 10% below the mean of 28.6 units a month reported in the 1999 survey. A breakdown of monthly sales by type of dispenser (Figure 2) shows that this downward trend occurred across the board.

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Figure 2:
“How many hearing aids per month on average did you dispense in 2000?” The first figure above the column for each group is the mean number per respondent and below it is the mean number per individual dispenser (some respondents reported figures for multiple dispensers). The figure in the column is the mean number reported by respondents in the 1999 survey.

However, when the survey calculated the average number of hearing aids dispensed per person (many of the figures reported were for more than one dispenser in the same practice), the average was 18.5 a month, higher than the 16.9 reported in the 1999 survey.

Binaural rate continues to rise

The latest survey found that binaural fittings were more common than ever in 2000. On average, respondents said that 71% of their fittings were binaural, compared to the 68% reported in 1999. This was the fifth year in a row that the reported percentage of consumers fitted with two hearing aids increased. There was little difference among dispenser categories in the frequency of binaural fittings.

Small increase in new users

The percentage of patients who were first-time wearers of hearing aids increased to 56% in the latest survey from 52% the year before. However, that figure has fluctuated between 51% and 60% over the past several surveys, so there is no apparent trend. The rate in 2000 was highest for audiologists working in a physician's office (68%) and lowest for traditional dispensers (50%).

Range of products

Dispensers were asked several questions about the range of products they offer in their practice. They reported dispensing a mean of 4.3 different brands of hearing aids, with a low of 1 and a high of 14.

As for other products, 85% said they dispensed swim plugs, 83% hearing protection devices, 70% assistive listening devices, 66% private-label batteries, and 31% tinnitus maskers.

DISPENSERS REMAIN 0PTIMISTIC

Although the U.S. hearing aid market has been flat for the past 3 years, our respondents had high expectations for 2001 (Table 8). Despite only 2% growth in domestic sales in 2000, 68% of them predicted they would dispense more hearing aids this year than last, and 30% foresaw an increase of greater than 10%. Only 2% said they expected their total to decline.

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Table 8:
In comparison with 2000, do you expect the number of hearing aids that you dispense in 2001 to:

While those who answer the annual Journal survey tend to be optimistic, they were especially so in 2000. By comparison, only 59% in the 1999 survey anticipated increased sales in the year ahead.

If a positive attitude leads to success, our respondents and the many thousands of other dispensers they represent may be well on their way to a better 2001.

ACKNOWLEDGMENT

Much credit for this article belongs to Kiara S. Ebinger, an audiologist with Cochlear Corp., for her hard work and expertise in processing and analyzing the enormous amount of data received from the dispensers in this survey. Her contributions this year and in each of the previous 4 years have been essential.

About the respondents

The Hearing Journal's eighth annual dispenser survey was sent late in 2000 to 500 subscribers randomly selected from all those who dispense hearing aids. We received responses from 263, or 53%.

The respondents were a fairly representative sampling of all those in the U.S. and Canada who dispense hearing aids. Sixty-two percent were audiologists, 33% were hearing instrument specialists, and the rest were otolaryngologists/otologists or checked the “other” box.

The largest portion of respondents (34%) practiced in a retail hearing aid center, followed by physician's office (23%), private audiology practice (15%), hospital or clinic (15%), and university (6%).

Half of respondents reported working in a practice with a single office, and another 11% in a two-office practice. Only about 5% were employed in practices with more than 10 offices. Six percent said that their practice was owned by a national dispensing network.

Nearly 30% owned their practice, while an additional 15% managed it. The largest portion (43%) were full-time employees, while 11% practiced part-time.

The dispensers who replied to the survey were geographically diverse, representing 51 U.S. states and Canadian provinces. They were fairly evenly divided between newcomers to dispensing (25% had practiced for 2 years or less) and veterans (20% had more than 20 years' experience).

Fewer than 10% of the hearing professionals who responded to the Journal's survey said they had dispensed the Songbird hearing aid. However, that did not stop them from having opinions—often strong ones—about this highly publicized and novel device.

More than half of the 263 people who returned the questionnaire wrote responses to the survey item that said, “Since the Songbird disposable hearing aid is among the most talked about developments in hearing aids this year, would you please tell us what you think its impact will be.”

Not only were the comments numerous, they were very diverse as well. There were approximately an equal number of positive and negative predictions about the Songbird's impact. Many other dispensers expressed mixed feelings or said that it was too soon to judge the product.

ON THE PLUS SIDE

Many of those favorably disposed toward the product said they expected it to attract new people into the market. For example, one California hearing instrument specialist said, “I believe that many qualified candidates who are hesitant to try hearing aids due to cost will try Songbird.” An audiologist employed in a clinic in Illinois predicted that it would have “an incredible impact on baby boomers. The disposable aspect is very appealing, as is no repairs.” Similarly, a non-audiologist dispenser in Maryland said of the disposable hearing aid, “Like disposable contact lenses, I think it will be a big hit.”

The low price of the device—a suggested retail of $39 for an estimated 40 days of use—was seen by many as an advantage in attracting new clients. For example, an Idaho audiologist employed in a physician's office said, “I think it may get more of those people who aren't really committed to spending a lot of money on their hearing to give something a try.”

Several respondents were especially enthusiastic about the Songbird, including the manager of an audiology practice in Illinois, who wrote, “I think it will capture a big market. I'm excited to have something to offer my borderline patients.”

Some dispensers expect Songbird sales to have a beneficial effect on other hearing aid sales as well. For example, a long-time traditional dispenser in Colorado predicted, “It will bring people in who would otherwise not have come in to see us. They will probably buy it and eventually convert to non-disposable hearing aids.” A hearing instrument specialist in Ontario commented, “I think it will help open up the market for hearing aids and make them more accepted,” while an audiologist in a Georgia medical office said, “I think it will have a tremendous impact. It will generate press coverage for the industry and allow more people to consider amplification without a large investment.” And a university audiologist in Illinois wrote, “Those with hearing impairment will get help sooner and Songbird will prepare them to accept regular hearing aids later on.”

Several dispensers saw other benefits from the disposable device, though probably not those intended by the manufacturer. For example, the owner of a dispensing practice in Georgia called the Songbird “a great loaner while non-disposables are being repaired.”

SOME ARE NOT IMPRESSED

There were many naysayers as well, including an audiologist in practice for over 20 years who called Songbird “the Yugo of hearing aids—cheap, disposable, ultimately a failure.” A number of the dispensers surveyed said that the device would have no impact or be “a flash in the pan,” in part, some said, because consumers would be dissatisfied with its performance or its physical fit.

Others predicted that consumers would not find the low entry-level price such a bargain. For example, a specialist who owns a practice in Florida asked, “Who is going to buy a Songbird every month when they can get a custom-made aid for less in a year's time?”

Quite a few respondents feared, for a variety of reasons, that the introduction of the disposable product could have a bad effect on the sale of other hearing aids. One major concern was the $39 price of the device. A private-practice audiologist in Maine said, “I feel it will cheapen the perceived value of custom-fitted instruments. Therefore, people will delay getting custom hearing aids even longer.” Similarly, the owner of an Arkansas audiology practice stated, “People won't be as willing to pay for high-end digital aids with this cheap aid available.”

Other respondents were worried that people would have a bad experience with the device and be discouraged from trying anything else. For example, a Louisiana audiologist predicted that its impact will be “decreased customer satisfaction and a bad reputation for hearing aids.” And an audiologist employed by a physician in Alabama said, “Many will try it, but only a small percentage will continue to replace them. Those who discontinue use will be hesitant to try [other] options.”

On the other hand, some respondents feared that the Songbird might prove too satisfactory to its users. An audiologist who works in a medical office wrote, “I think that people who buy Songbird will stay with it and not even try non-disposable hearing aids.”

It remains to be seen how accurate the various predictions about the Songbird's impact will be. However, one thing is obvious from the replies to the survey: There is great interest among dispensers in how the market responds to this unique new product.

© 2001 Lippincott Williams & Wilkins, Inc.