Change is the new normal for the U.S. hearing aid industry.
The majority of hearing aids are still sold at brick-and-mortar stores by independent hearing aid dispensers and audiologists, and by large hearing aid chains and franchises.
Hamilton County is home to nine hearing instrument specialists and 19 audiologists with active licenses, according to the Tennessee Department of Health. Neighboring counties in Tennessee have 10 audiologists and five hearing instrument specialists.
But big box retailers, Internet sales and technological advances are making inroads in the industry.
Local audiology businesses say they provide personalized service and help those with hearing problems find the right equipment. Although consumers can buy cheaper hearing aids online, hearing aid providers say, they may not be the right type or fitted properly without some expert advice. Hearing tests also can uncover medical conditions that cause hearing loss, they say, from ear wax build-up to serious problems.
"The quality of the instrument dictates your investment," says John Staten, who owns the two Signal Hearing Aid Centers in town and has decades of experience fitting hearing aids. "You can get a good hearing aid anywhere from $1,000, each, to $2,750, each."
Good hearing aids last, on average, four to six years, he said.
Hearing aids can help with more than hearing, Staten said, citing a Johns Hopkins University study showing that people with hearing loss are more likely to get dementia. The strain of decoding sounds over the years may overwhelm the brains of people with hearing loss, the researchers found, leaving them more vulnerable to dementia.
A recent study even suggested older adults with hearing impairment may have a higher risk of dying than people with normal hearing.
"In the simplest terms, the worse the patient's hearing loss, the greater the risk of death," John Hopkins University researcher Kevin Contrera said in a recently published study of 1,666 adults over the age of 70.
Financial aid programs are available to help those who can't afford hearing aids, said Derek and Megan Johnson, the owners of Chattanooga-based Johnson Audiology, and health insurance often covers more than patients think.
"The goal here is very simple: Helping every patient who walks through the door," Megan Johnson said.
Huge market, low penetration
The potential market for hearing aids is huge, since one in three Americans between the ages of 65 and 74 has hearing loss and nearly half of those over 75 have difficulty hearing, according to the National Institute on Deafness. An estimated 30 million to 48 million Americans have hearing loss that diminishes the quality of their lives — academically, professionally and medically as well as socially.
And market penetration is low: Only 20 percent of those who might benefit from treatment actually seek help, according to the American Speech-Language-Hearing Association. The trade group calls untreated hearing loss in 36 million adults who need help "a growing national epidemic."
Cost is one reason that more people who need hearing aids don't get them, according to the President's Council of Advisors on Science and Technology.
The average price of one hearing aid in 2014 was $2,363, according to an October report by the president's council titled "Aging America and Hearing Loss: Imperative of Improved Hearing Technologies." The report said that many, if not most, people need two hearing aids — one in each ear — doubling the cost.
And most people also have to cover the cost entirely out of pocket, the report said, since Medicare and most health insurance plans don't cover hearing aids.
"High costs are a major obstacle for many people. One survey found that 64 percent of people with the most serious hearing loss reported that they could not afford a hearing aid, and over 75 percent identified financial factors as a barrier," the report said.
But factors are at play to lower hearing aid prices.
Big box stores have started to sell more hearing aids, notably Costco, which has captured an estimated 10 percent of the market.
Hearing aid sales rose by about 5 percent in 2014, according to the website hearingmojo.com, and Costco and the Veteran's Administration drove that growth by selling almost one-third of the 3 million hearing aids sold.
At the Costco in Fort Oglethorpe, Ga., a second hearing aid booth is being added, and one has been there since the store opened in 2010, said Shelia Helms, a hearing specialist there. Costco charges between $1,800 and $2,800 for a pair of hearing aids.
Change driven by Internet, technology
Online retailers have come onto the scene, too, including Audicus, a Manhattan, N.Y.-based web-based retailer that launched in June 2012. It says it keeps prices low by eliminating middle men. Health insurers have partnered with online hearing aid companies. For example, United Healthcare sells hearing aids directly through a sister company, HealthInnovations, and Blue Cross Blue Shield has partnered with TruHearing.
Southern Medical Hearing Centers, which has offices in Chattanooga, Cleveland, Tenn., and Dalton, Ga., offers hearing aids that can be adjusted remotely "anywhere you have access to a computer," the business says, which spares hearing aid users a time-consuming visit to the clinic to have the hearing aids adjusted.
Technological change is shaking up the hearing aid landscape in other ways.
Any stigma that hearing aids have as being "uncool" could take a 180-degree turn, since some high tech firms think that "wearables" — technology such as the Apple Watch and Google Glass eyeglasses — might work best in the ear as "hearables."
And some people with some difficulty hearing have opted for personal sound amplification products (PSAPs) a new category of small, technologically-advanced hearing amplifiers that can fit inside the ear and use technology including Bluetooth connectivity — but don't do everything a full-fledged hearing aid can, such as limit distortion.
They're not approved as medical devices by the federal Food and Drug Administration, and can't be advertised as hearing aids. They've been called the auditory version of "reading glasses," since they're available at such places as drug stores.