Why aren't there more hearing aid startups?

I’ve worked in the industry, and try to remember that people’s hearing can change rapidly and customers are finicky so your novel tech will need to be adjusted by someone who isn’t about to learn a tech stack for one line of products. We had patients that would come in every couple of weeks for years, asking for slight changes to their frequency range.

The hearing aids themselves will be physically abused. Worn in saunas, get packed with ear wax, be left in freezing temps, get chewed up by pets, stepped on, dropped into sinks and toilets. It’s actually incredible that most are repairable despite all of that, without even needing to return to the manufacturer.

They also need to be usable by those with limited mobility and no ability to use tech, and relatives with no idea what to do except replace the battery and put them in the ears.

Hardware is tough. Medical hardware doubly (triply?) so. Also realtime audio processing in a power and space limited, heavily patented and proprietary industry isn't for the faint of heart.

That said with the recent changes allowing OTC hearing aids as of 2022 and companies like rewind.ai chasing always-on audio recording I imagine we'll see some interesting innovations in this space over the next few years.

I was an early employee at Whisper so I got to see many of the challenges in this space first hand. I can't speak to the specifics of Whisper leaving the market, but I can say generally that bringing a new piece of medical hardware to market is very hard for a startup to pull off.

In the early days you need to bring together a group of people with a diverse set of skills --- mechanical engineers, electrical engineers, firmware engineers, audio engineers, regulatory specialists, people with experience working with factories, along with ML engineers in our case. You need a lot more people to bring a product to market than if you're building another SaaS company. (And, of course, all your code is running on a chip that has to be small enough to fit behind their ear.) Then hardware startups also have a problem that they tend to have slower growth and lower margins than successful software startups. So later stage VCs are more inclined to invest in software startups.

Hearing aids are also unique in that they require a lot of tuning to get the audio to sound as natural as possible. There are dozens of algorithms that process different features of the audio, things like wind noise reduction and feedback cancellation, and some of them can be a bit finicky. Companies like Oticon or Widex have hundreds of engineers who have been tuning these algorithms for decades. (Another advantage the big guys have is that they can make custom silicon So if you want a top of the line hearing aid the bar is very high. Then until recently there were big barriers to entry on the sales side --- you weren't selling just to the customer, you were also selling to the audiologist, and many audiologists have incentives to (mostly) sell a single brand. This is less of a barrier now with the recent changes to allow hearing aids to be sold over-the-counter.

I do hope to see another startup give it a go because I still think there's room for disruption --- the big companies move a lot slower than a startup can, and the ODML space is developing very, very quickly. But it's not a project for the faint of heart.

Hello, my name is Blue. I am also severely hearing loss. We have developed hearing aids, but we are currently only sold in Taiwan. Other countries will start selling them this year(FDA approved). If you are interested, you can follow otoadd (https://otoadd.com/index-en.html)

Not sure but can mention some challenges:

- The power budget of a traditional HA is ~1mW and operate on ~1V. Existing vendors use custom silicon with sub-threshold designs to hit this. I see this as one of their largest moats. Lipo rechargeable wearables work around this problem.

- Customers for your product want their hearing back, and that's not something HAs realistically provide. So selling them is pretty weird as your customer isn't going to be completely satisfied and newer HAs won't improve much along this dimension. On the other hand you can sell "comfort" via noise reduction, bluetooth streaming, and whatever technology buzzwords you can fit on a brochure.

- But can my fancier DSP algorithms improve speech understanding in noise? Maybe, but you've got a 10ms latency budget in which to do so. Hard to compete with the human brain which can cheat and backdate perceptions into the past.

- FM systems, on the other hand, can dramatically improve speech understanding by eliminating noise and echoes. Right now it's only a fit for situations where you can mic the speaker. Traditional HA companies have a hand in making these.

Cost of entry is immense. As with anything medical or food and drug related, there are large (and expensive) obstacles to hurdle before any product can enter the market. It's a rather difficult market to get into without a large amount of capital at your disposal.

Most startups are not technical problems. Hearing aids are no different.

There is a stigma with hearing aids. You have to get over both the internal ego and the external stigma. For many people, that means admitting they're aging and "need help".

Frankly, it really doesn't matter how amazing the hardware is. That's just an incredibly challenging problem to overcome.

I don’t know about hearing aid startups, but if someone can make an aid with decent Bluetooth I would love to hear about it. I recently got a pair of Otacon Real 1s and the Bluetooth has a range of about 1 foot. If I pair my iPhone and stream music it will cut out if I put it in my front pocket. They were basically a $3000 mistake, after insurance.

https://www.relajet.com/ - started by a friend with hearing loss

I have been working in the hearing aid industry for over two decades and it’s quite a specific niche. It’s where Medical Model meets Consumer Electronics. So on the medical side you need proper diagnostics by an Audiologist and then very demanding ongoing support and patient hand-holding. Here one uses the expensive medical grade devices R&D’d by the Big5 global majors who have consolidated the whole market. It’s high margin and clinicians like it. On the the other hand there is very common presbycusis or age related high frequency loss or noise induced loss which almost everyone ends up getting (with marginal frustration) - this is the market the new OTC class of ‘starter products’ is aiming for and they are DTC sold online. They are low margin and quite hit and miss at this stage, but can potentially grow the market (create awareness). Competition will be fierce (soon Apple/Android pods will do the same)and the Big5 are all scrambling to buy up potential OTC device companies eg. Sonova Group Switzerland (Phonak, Unitron) has bough Sennheiser consumer division, Sony is working with Signia/Siemens etc (they want to own the whole escalator to high margin medical grade devices). I have it directly from the co-founder of hear.com the worlds largest online h/a marketer and networked referral source that they blew several million euro on a DTC/onlinetest/delivery model which was a total fail (“not interested!!)Then there’s the unit economics: only a small percentage of humanity has moderate to severe hearing loss (MUST act) so the R&D to sales ratio is terrible compared to eg Samsung that makes a billion TV or fridges. And then you must plug that device into the medical supply chain where each degreed professional ads their margin. So, because of the monopolistic tendency with high barriers to entry in a niche market with intensive personal service under a medical umbrella, I think it calls for disruption but it’s tough. My sense it that the cheap OTC market grows rapidly but there’s not a killing to be made, and the Big5 get more concentrated and smarter as real-time AI (liked to a smartphone-hearing aid) solves speech to noise ratios with advances algorithms.The hearing impaired consumer will always pay top dollar for this as ‘to be human is to communicate’. HM

It doesn't even need to be a startup: hearing aids are techically inferior to mid-range earbuds, yet cost more than 10x more. I'm guessing it's a certification+distribution issue, like for smartphones in the US. I've heard Bose has something in test though ?

Dunno.

TI has a useful page though:

https://www.ti.com/solution/hearing-aid

That page basically says use an all in one "MSP430F5510" MPU with "CC2640R2F" Bluetooth.

Here’s a Swedish one https://ondemove.eu/products/

Auricle (W21) and AudioFocus (S19) were two YC startups around hearing, I'm not sure what the status of them is though.

The concentration of power and wealth dis-incentives competition in the market.

Not sure, have yet to hear from one

Am I the only one who is surprised AirPods aren’t doing this (yet) ?

I have healthcare and if you need a hearing aid you get one so who the hell cares how expensive it is?