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Challenging Assumptions in Hearing Care

Windmill, Ian, M., PhD

doi: 10.1097/01.HJ.0000533797.64224.01

Dr. Windmill is the immediate past-president of the American Academy of Audiology (AAA) and the clinical director of the division of audiology at Cincinnati Children's Hospital Medical Center.

The advent of over-the-counter (OTC) amplification devices has evoked a variety of reactions within the hearing care community. While some see opportunities, more commonly some have concerns about the potential negative impact of OTC on hearing care practices. Many of the negative reactions to the OTC issue are based on a set of historical assumptions that may or may not be accurate.

In their book, Blue Ocean Shift: Beyond Competing (2017), Kim and Mauborne noted that it is often the historical assumptions that constrain thinking regarding new opportunities in the marketplace. For example, there is a long-held assumption that hearing aids are the only technological treatment for most people with hearing loss (leaving aside the important role of cochlear implants). This assumption has driven much of hearing care, particularly the partnership between providers and the industry. Hearing aids are wonderfully impressive in both their design and performance. However, our role is to provide hearing care, not just sell hearing aids, so we should be open to the concept that other technologies may be beneficial to some segments of our patients. There exists the opportunity to incorporate non-amplification devices into our practice, much like dermatologists sell skin care products over the counter.

A common assumption is that OTC and/or PSAP companies produce devices that are inadequate or inferior. While there are “crappy” devices on the market, some companies are working to produce devices that are both adequate and appropriate. Some of these devices may not meet the needs of many people with hearing loss, but they might meet the needs of a few, such as those with difficulty hearing in noise but have no pure tone hearing loss.

Another assumption is that the entry of OTC devices will negatively affect the volume of patients seeking amplification through historical avenues. This is an easy assumption to make if we define our target market as people who currently exist in the market. Of course, this assumption ignores the additional variables at play that will potentially positively affect patient volumes moving forward, including the doubling of the population of people aged 60 years and older over the next 30 years, the opportunity to provide audiologic services to populations other than those with pure tone hearing loss (e.g., cognitive decline), and the continued evolution of amplification devices into health devices that might include additional medical applications, such as biometrics or fall prevention technology (Slashgear, 2018).

One final assumption is that our competitive strategy is based on the device, rather than on the value of professional care. Certainly, there are consumers who will be swayed by advertising for inexpensive technologies. But as technologies evolve, we can create new demand, not fight over existing demand. In this regard, the impact of OTC-type devices may not be noticed to any great degree.

Focusing on the value of hearing care, rather than the technology, provides the opportunity to affect the decision-making of the consumer. Innovation within the value proposition anchors the technology to the value consumers seek, not to the cleverness of the technology. Given that the advent of OTC-type devices is only a few years out, there is time to re-examine our assumptions, consider our options and alternatives, develop value-based practices, and, ultimately, mitigate the impact of the direct-to-consumer models.

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