September 17, 2024 • 26 mins
Can Apple's AirPods Pro 2 truly compete with traditional prescription hearing aids?
In this episode of the Hearing Matters Podcast, we offer an in-depth look into the FDA approved Apple AirPods Pro 2 as potential over-the-counter hearing aids. We address the technical differences, including latency issues, fit, battery life, costs and more.
Drs. Darrow and Beck discuss the social stigma traditionally associated with wearing hearing aids, and the potential for trendy alternatives like AirPods to shift public perception and make hearing aids more socially acceptable. This episode delivers a compelling discussion on affordability, accessibility, and much more!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Keith Darrow (00:00):
I'm going to really geek out here for a
second.
Prescription hearing technologyhas a latency or a time delay
from the time the sound gets toit to it gets presented into the
ears.
It has a time delay of aboutfive milliseconds which is not
detectable by humans.
Basically, I'm going to justsay there is no delay, there's
no ability to perceive a delaywhen using prescription hearing
(00:22):
technology.
Well, these AirPods, whilethey're great AirPod Pro 2, at
least the records indicatethere's 126 millisecond delay.
What does that mean?
Anything over 40 millisecondscan give you the sense of an
echo.
It's not going to sync up withthe lips.
That echo in background noiseis only going to keep
(00:45):
compounding itself to a pointwhere it might actually be
better to go without the AirPodPros in background noise than it
would be to have them, becauseit can really confuse the brain,
really mess with the processing.
So right now there's reallysignificant limitations to when
and where you can use thisover-the-counter technology.
Blaise M. Delfino, M.S. (01:12):
You're tuned in to the Hearing Matters
podcast, the show thatdiscusses hearing technology,
best practices and a globalepidemic hearing loss.
Before we kick this episode off, a special thank you to our
partners Redux (01:25):
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Welcome back to another episodeof the Hearing Matters podcast.
I'm your founder and host,blaise Delfino, and, as a
friendly reminder, this podcastis separate from my work at
Starkey.
Dr. Douglas L. Beck (01:53):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast, and
today I'm interviewing my verydear friend, dr Keith Darrow.
Keith, how are you?
Hey?
Dr. Keith Darrow (02:02):
Dr Beck, thank you so much for having me here.
What an important and timelytopic, so thanks for doing this.
Dr. Douglas L. Beck (02:09):
Yeah, you bet.
Well, the topic of the day, bythe way, is that the FDA has
said that Apple AirPods 2 canbecome hearing aids.
And it's interesting because,of course, we've had OTC now for
two years, but this is thefirst time the agency the FDA
has authorized over-the-counterhearing aid software.
So the FDA began allowing OTCback in 2022, looking at
(02:32):
affordability and accessibility,and now we're at this new level
where Apple AirPods theirsoftware has been approved as a
potential OTC device.
Is that right?
Am I encapsulating thatcorrectly?
Dr. Keith Darrow (02:45):
No, I think you summarized it perfectly and
I think that, look, we're stillin the wild wild west when it
comes to this over-the-countercategory.
But I genuinely appreciate whatApple has done, which is bring
more awareness to hearing loss,as far as I'm concerned, bring
more awareness to the fact that,as far as I'm concerned, bring
(03:05):
more awareness to the fact thatthere is a separate category of
technology that falls into theover-the-counter or, as I like
to refer to it, as the DIYcategory.
Right, do it at home, treatyour own hearing loss type
category.
For us, it further elevateswhat we do, which is provide
prescription hearing technologyto medically treat hearing loss
(03:27):
and tinnitus.
So we're comparing apples andscrewdrivers here.
Dr. Douglas L. Beck (03:31):
First of all, I think it's important to
understand and please correct meI think this is only really
applicable to the AirPods Pro 2.
Is that right?
Dr. Keith Darrow (03:40):
Yes, it is.
That is the way that they haveput it out so far.
We all know that there's goingto be the AirPods 3 that comes
out.
I mean, to me, what they'vedone is basically drawn a line
in the sand that this technologyis capable.
Nothing before it, buteverything after it will be.
That's typically how Appleworks they introduce something
new and then they continue tomake it only better over time.
(04:03):
But yes, apple AirPod Pro 2.
Dr. Douglas L. Beck (04:07):
Right, right, and I want to be clear
this is mine for a couple ofyears now.
I guess I got this when theyfirst came out, the Pro 2.
And they have ear tips on them,and this is a very, very
important characteristic,because this ear tip comes off
right, and then you have justthe receiving end.
The important thing here, Ithink, that so many of us have
maintained, is that you have tohave an excellent seal.
(04:28):
If you just have a loose devicein your ear without sealing the
ear canal, you're not going toget these benefits.
Dr. Keith Darrow (04:34):
Exactly, it's very temperamental, and I think
anybody who's worn the AirPodstoo, I mean, I've got them in my
ears right now, right, sure,but if I start walking around
and I start having aconversation, I don't know about
you and maybe it's my ears, butthey definitely start to slip
out, and I've had thatconversation with several other
people.
Frankly, when I do I wear themat the gym I have this little
(04:56):
lock feature, you know, thatbasically goes up and locks them
in.
Otherwise they're they're allover the place.
Fit is definitely.
While the tips give them a goodfit, they help to block out
background noise.
That, once again, we're talkingabout people who have their own
hearing loss and we're tryingto do a one-size-fits-all, which
(05:17):
is why there are significantlimitations to this.
Dr. Douglas L. Beck (05:20):
Yeah, this is an important point.
If you go to the chronology andyou try to find well, what's
AirPod Pro 1, 2, 3, and 4, andnow they're coming out with
AirPods 4, and that's kind of aone size fits most, so I'm not
really that impressed with that.
The most popular of all havebeen the AirPods Pro, and the
ones we're talking about now arethe AirPods Pro 2.
(05:40):
Now are the AirPods Pro 2.
Now the interesting thing to meis when you think about AirPods
and I agree, it's a remarkablygood product but battery life is
somewhere between four and sixhours.
So if you're going to try touse them for a hearing aid, you
might need two or three pairs.
And I don't say that kiddingaround, I'm totally serious,
because I used to wear myAirPods Pro 2.
(06:02):
I'd wear them as you may recallthis, from in the morning.
I'm wearing them until aboutnoon or so.
I take them out, I put them inthe charger, I put in pair
number two and then I reverse itat dinnertime.
So that might be a way tomanage it.
I have not seen that theAirPods Pro 2 will have much of
a longer battery life.
Moving forward, it looks likethey're in the four to six hours
(06:24):
.
Now you have to be careful whenyou look at battery life,
because they say up to 30 hourswith the case.
Well, yeah, because the case isits own battery charger as well
.
I think you have to take thatinto consideration.
Dr. Keith Darrow (06:36):
But even, doug and I think this is an
important point for people torealize, especially if you're
listening to this podcast andyou're in the field of hearing
healthcare you're trying tofigure out how am I going to
talk my patients through this?
Yes, apple will tell you four tosix hours, but if you have the
noise reduction on, if they'reprobably more than a month old,
(07:00):
I mean, look, I get about two totwo and a half hours out of
mine, and that's on a fullcharge, right, and so that
battery does wear down over time.
So, look, I think this is adeal breaker, right, when it
comes to treating hearing loss.
This over-the-counter product,this Apple AirPod Pro 2,
realistically will get you abouttwo and a half hours, even
(07:22):
though they say four to six.
That's without the noisereduction on, that's with volume
turned down.
I get a couple of hours out ofmine, and it's really important
that the brain is stimulated bysound all day, not just two to
three hours, so that, rightthere, sort of, might it help
you hear better in some limitedsituations for a limited amount
(07:44):
of time.
Sure, is it the proper tool touse to treat your hearing loss
and tinnitus?
I don't think so.
Dr. Douglas L. Beck (07:52):
Yeah, I think of it as an adjunct device
.
And here's the thing, thoughwhen you think about hearing
aids in the USA generally, youknow, if you include the big box
stores and the VA, we sellbetween, I think, five, six,
seven million units per year.
Apple AirPods have already soldover 150 million pairs, so you
(08:13):
know that's pretty substantial.
People do like AirPods, pods, Ilike air pods.
I think the directionality, thenoise reduction very, very good
.
But I think your point is theoverriding point that if you're
going to use these as hearingaids, you're going to need two
or three pairs or you're goingto have a little bit of
difficulty but let me.
Dr. Keith Darrow (08:30):
but let me say this, doug, let's peel back the
layers a little bit there,because you just threw out a
huge number 150 million AirPodshave been sold.
Hearing aids are not even.
They're not in the same league,right?
However, 94% last I checked theonly data I could find 94% of
the 150 million were sold topeople under the age of 40.
(08:53):
I have two pairs and you havethree pairs, so we make up a lot
of that.
Other 6%.
Right, yeah, we do, and so Ithink.
But that's really important tosay okay, why did Apple do this?
Look, I'm sure they have greatintentions and I'm not trying to
say anything negative, but,truth be told, there are
corporate bigwigs that aresitting around saying how do we
(09:14):
sell more of these?
Well, let's talk to the peoplethat aren't buying them.
And what do we talk to olderadults about?
Hey, this can help you hearbetter.
Dr. Douglas L. Beck (09:23):
I like that .
I think that's insightful.
Let me just underscore thenumbers.
I looked up the same paper.
I think Most AirPod users 60%of them are between age 18 and
25, 34% between 26 and 35.
So that, right there, that's 94, 95% under age 35.
So you and I have just changedtheir statistics.
(09:44):
But the thing we didn't talkabout is price, and the thing is
these are pretty cheap.
I mean, these are 249 bucks.
Maybe you can buy a rebuiltpair for 199.
And this, to me, is veryimportant because you know, the
reason that we got into the FDAOTC rules and regs was access
and affordability.
Now I have a brand new papercoming out, I believe in the
Hearing Review this week, and Ipointed out I'm going to read
(10:08):
you this little section herewhen we're talking about
affordability and accessibility,which again was the motivating
factors for the FDA, we observetoday access appears to have
been increased.
Access is pretty good.
You can get hearing aids almostanywhere.
Now, however, the better OTCproducts often cost $1,000 to
$29.50 per pair.
(10:29):
Now that's, according to theNational Council of Aging,
placing the better OTCs beyondthe reach of most people that
OTC was created to help.
Cber 2024 reports that at BestBuy OTC products range, per pair
, $200 to $2,550.
And Susie Orman we all knowSusie Orman.
She was publishing in NASDAQthat most Americans 60% do not
(10:52):
have $500 for an emergency.
As such, it seems pretty hardto imagine that most Americans
are going to spend more than$500 on a pair of hearing aids.
So this is a unique niche inthe market.
They're going for very, veryinexpensive and very, very high
quality.
Now what would you say if thebatteries on these AirPods?
What if they lasted 16 hours?
Dr. Keith Darrow (11:14):
No, and here's why.
So that's a great question,right, because right now I don't
want hearing providers to justrely on the.
Well, it doesn't last as long,because they can fix that.
If you can get prescriptionhearing technology to last 12 to
15 hours, Apple can make itlast 30 hours.
If they really wanted to right,they could figure that out.
(11:34):
They're much smarter than wegive them credit for.
Here's the issue as it standstoday.
Number one the biggest complaintof our patients is hearing in
background noise.
And while you might want to say, oh, but AirPods have noise
reduction, they do.
I love having my AirPod Pros inon an airplane because it does
(11:56):
really well with that constantmotor noise, sort of bringing
that down.
However, at least as of today,when it comes to using AirPod
Pros in a restaurant setting, ina real life situation, hanging
out with friends or colleagues,right now it does have noise
reduction, but only in a veryspecific beam forming pattern,
(12:18):
in that you can hear the personthat's directly in front of you
pretty well.
It can separate speech andnoise by about 7 dB, which is
impressive.
But only this.
We don't live in that world,doug.
Right?
What hearing technology?
What all the majormanufacturers have done over the
last few years is taken thatbeam and they've essentially
(12:41):
made it almost 360, in that itpicks up speech and reduces
background noise, just like thebrain does.
It doesn't have this sort ofbeam forming technology, so
right there, that's one reallimitation, because you're still
not going to hear great inbackground noise.
Blaise M. Delfino, M.S. - HIS (12:58):
I want to back up a second.
Dr. Keith Darrow (13:00):
You're talking about price, right, so let's
talk about the affordability andaccess.
I've been trying to tell peoplethis for the longest time
Hearing aids are not expensive.
We have to get that thought outof our mind.
That's part of the problem.
Is we put up this barrier.
We talk about cost.
Frankly, the same stuff thatI'm putting in people's ears you
(13:22):
just said it you can get themover the counter for $2,500.
You can get Oticon, Widex,Phonix.
You can get them in big boxstores, you can get them on
Amazon.
You can get them all for apretty decent price.
It might be somewhere between$1,500 and $2,500.
Hearing aids are not expensive.
What's expensive is us and Ishouldn't even use the word
(13:47):
expensive it's the value that weprovide.
It's the care, the customizedprescription, the follow-up care
.
You know I've seen some studiesthat say audiologists, if you
take into account a four-yeartreatment program and consider
all the times you meet with yourpatients, the clean-in checks,
(14:07):
the annuals, if everything'sincluded, it boils down to like
20 bucks an hour.
Right, Like it's somethingwhere the cost is in us and you
have to be able to justify yourcost, and I think that we
absolutely do, because to datethere's never been a study
showing that a over-the-counter,a DIY hearing aid can provide
true medical value.
(14:28):
People might say OTC soundsgood, but they've never been
shown to reduce the risk of afall, reduce the risk of
cognitive decline, improvecognitive performance, increase
quality of life, reduce tinnitusI mean, you can't even talk
about tinnitus and theseover-the-counter widgets, right?
Dr. Douglas L. Beck (14:46):
Yeah, these are all good points and these
are things that help separateOTC or DIY from prescriptive
hearing aids.
Right, when you're looking atthe literature on cognition,
when you're looking at theliterature on cognition, when
you're looking at the literatureon satisfaction, those things
are basically done based onprescriptive hearing aids.
And the other thing that wehaven't talked about at all,
which I think is worthy of a fewminutes here, is the issue of
(15:06):
stigma, because when you'rewearing your AirPods, these are
considered to be somewhat cooland trendy and great, but stigma
of traditional hearing aids isvery real.
I'll give you four quotes from2024.
Forbes 2024, reports people withhearing loss avoid hearing aids
for many reasons and socialstigma plays a significant role.
(15:30):
In their survey, 48% ofrespondents believe there is a
stigma associated with hearingaids and they report 63% of
millennials, 47% of Gen Xers and41% of boomers agree there's a
stigma.
Now that's Forbes 2024.
Webmd 2024 says the same thing62% of Americans wear visible
(15:50):
corrective eyewear and 45million wear contact lenses,
which is kind of incredible.
Yet only 15% of people withhearing loss wear hearing aids.
This is Beadle Genstead et al2024.
Younger and older adults mighthold negative, implicit
attitudes towards older andyounger people who wear hearing
aids.
And finally, I'll give you NickBach, ekberg and Waite 2024,
(16:13):
explored how and when astigma-induced identity threat
is experienced by adults withhearing loss and their family
members.
All participants in their studybelieved hearing loss and
hearing aids were associatedwith stigma.
So I wonder, when we're talkingabout something like Apple
AirPods which are admittedlycool and trendy and maybe sexy
and maybe much more acceptableis that a factor?
(16:34):
When you talk to patients, doyou consider stigma?
Do you talk to them about that?
Dr. Keith Darrow (16:38):
Look absolutely Well, and I'll tell
you what I would challenge you,because my bet is, if you go
back to some of thosepublications I don't know, 50
years ago, 40 years ago they'dprobably say the same thing
about glasses.
Remember glasses?
You were four eyes, you wereteased by people.
Something was wrong with you,you were blind.
(17:00):
So, look, I almost think it's agood thing.
The fact that you can readthese in major publications says
we're talking about it more.
The fact that Apple's talkingabout hearing loss and hearing
aids means we're talking aboutit more.
It means our society is on thepath to acceptance.
But you're right, doug, thestigma is real.
Here's what I can tell you Inthe month of September 2024, I'm
(17:24):
going to travel to, I'll be inWaycross, georgia, little Rock,
arkansas, madison, Wisconsin,new Jersey.
I do these symposiums all thetime, these patient-facing
symposiums, and I always startwith the question of hey, 90% of
people with hearing loss donothing about it, right?
(17:45):
You guys are a great group forme to ask this question why Tell
me what's going on?
Now, admittedly, it's a bit ofa plant, because I know the
answer and undoubtedly, there'salways several people who raise
their hand and say stigma.
So the stigma is real, but theonly way to fight back against
the stigma is to talk about itmore Podcast articles.
(18:08):
You know Apple having theshining star of technology and
software to talk about hearingloss and hearing aids.
Thank you, thank you, apple.
Dr. Douglas L. Beck (18:20):
In my new article coming out in October in
the Hearing Review.
That's all about custom-madeproducts and the reason that I
write about that is because Iwear a set of IICs invisible in
the canal hearing aids when evenI'm lecturing at your events,
at audiology experts and things.
Nobody's ever noticed them andI think this is.
It makes me more comfortable tohave that in my ear and to give
(18:42):
me that security blanket thatI'm hearing much better and I
can attend much better to what'sbeing said.
I like that a lot, but I don'twant to have a giant hearing aid
or a BTE or a Rick or a right.
This is my own personalpreference and I know that maybe
that's a vanity issue, but youknow I don't have that much that
I can hold onto there, so I'lltake what I can get.
(19:02):
But you know this is very realwhen people don't discuss the
stigma of hearing aids, it's the800 pound gorilla in the room
for most patients.
You know, when we talk aboutaccess and affordability, that's
cool and those are importantthings.
But I think the third thingthat impacts who gets hearing
aids and who doesn't is stigmaand cosmetic issues.
Dr. Keith Darrow (19:24):
It is absolutely a real issue.
As I sit here today in theclinic, I just saw a patient
this morning and I had thisdiscussion and I just I always
have to be real and I alwayshave to say, look, I respect
that, I understand it, andhere's the way I approach it.
Number one I'm going torecommend the best prescription
(19:45):
technology that meets yourhearing needs and, if I can, I
will make it as invisible aspossible.
I certainly understand and Irespect your concerns of vanity
and stigma, but hearing is thesingle most important thing I do
and we can't compromise that.
And then you've probably heardme say this too.
(20:06):
I'll often joke with patientsand say, look, I understand you
don't want to walk around with abeige banana behind your ear.
Thankfully, those days aremostly gone.
But think about it this way.
People might say, oh, what'sthat thing behind your ear?
And then they just okay, theygo about their day and they
don't think about it.
If you're a mom or dad andyou're sitting at the dinner
(20:27):
table with your family andyou're not interacting, if
you're starting to isolateyourself, if you're
inappropriately laughing atjokes that weren't a joke while
somebody's telling a story, ifyou're trying to fudge your way
through a conversation.
You know what happens.
The second you get up,everybody starts talking about
you.
Everybody starts talking aboutthe stigma of mom's getting old.
(20:51):
What are we going to do withher?
Is it dementia?
What's going on here, when inreality, you could just be
hearing so you know?
Yeah, maybe wearing a tinypiece of prescription hearing
technology.
If it gets you hearing betterand interacting more, I'm all
for it.
Dr. Douglas L. Beck (21:07):
Yeah, that's great, all right.
So the bottom line, you know, Ithink we're both agreeing that
the new application of the AppleAirPods 2 Pro is very
appropriate for some people.
Some of the time it doesn'treplace prescription hearing
aids.
It has assets, it hasliabilities, it has pros and
cons, and I want to alsoencourage people to take their
(21:30):
online hearing test associatedwith this.
I did that today, the MimiM-I-M-I.
I thought it was pretty good,to be honest, and it's kind of a
von Beckeshe sort of a test.
If you haven't taken it before,you press the button or you
hold the button in while you'rehearing the beep.
When you can no longer hear it,you let go, which is kind of
what we used to do with Beckesheback in the 30s, 40s, 50s and
(21:50):
60s, and I can tell you my testwas pretty darn accurate.
Dr. Keith Darrow (21:54):
So I would encourage that and I think and I
, but I let me tag, let me justjump onto this.
I would encourage you youanybody out there to acknowledge
that, while that test may bepretty good and it might
actually align pretty well withthe beeps we do in the clinic,
yeah.
The beeps.
Is this much of the hearingtest right?
(22:14):
Absolutely, the beeps tells usyour ability to perceive beeps.
Yes, I don't know about you,Doug.
I've been doing this for over20 years.
No patients ever come in andsaid I can't hear beeps.
Can you help me with that Right?
So there's a lot more to it andI think if you use that as a,
dare I say, a cursory test tosay, hmm, is my hearing normal
(22:35):
or not, and then I would alsoencourage you to say look, if
you're not hearing as well asyou used to in background noise,
even though your hearing stillseems normal, undergo a full
evaluation so that youunderstand exactly how your
brain is processing.
Dr. Douglas L. Beck (22:51):
Yeah, and this is so important right,
hearing tests online.
They can do beeps online.
They're fairly accurate.
Again, the Mimi test I tookthat I thought it was pretty
close to my actual hearing test.
However, an actualcomprehensive audiometric
evaluation is not just aboutbeeps.
As Dr Darrell was saying, weneed to do speech and noise
tests, we need to do listeningand communication assessments
(23:12):
and we need to do boneconduction testing and we need
to check your eardrum throughtympanometry and we also need to
do reflexes ipsilateral andcontralateral and otoacoustic
emissions.
That tells us what's going onwith your auditory system.
Dr. Keith Darrow (23:25):
Exactly the beeps are in my practice in the
hearing and brain centers.
The beeps are one-seventh.
I don't know what that ispercentage-wise, but it's a very
small percentage.
Dr. Douglas L. Beck (23:35):
It's one-seventh yeah, I'm going to
give it about 18%, 17%, thereyou go.
Dr. Keith Darrow (23:39):
It's one-seventh of the overall
cognitive screening anddiagnostic evaluation process.
Dr. Douglas L. Beck (23:45):
The other thing is that these AirPods are
meant for people with mild ormoderate loss and they would not
be sufficient for anybody withmoderately severe, severe or
profound loss.
Dr Darrow, I want to thank youfor your time and I want to
thank you for your knowledge onthis topic.
I think this is so important.
Consumers obviously are goingto be looking at this as well.
Professionals and they should.
It's a very, very clevertechnology.
It has some very good assetsand it has some liabilities as
(24:09):
well.
Not a panacea.
It doesn't replace anyprofessional care at all.
I always want to urge people ifyou have hearing loss or you
have listening difficulty,particularly in noise, a pure
tone hearing test isn't going totell us what we need to know.
We need to get you into theoffice for comprehensive
audiometric evaluation,including listening and
communication assessments,speech and noise, bone
conduction, hearing tympanograms, otoacoustic emissions reflexes
(24:31):
, ipsy and contra.
Then we know what's going onand it's the same thing we do in
medicine it's diagnosis first,treatment second.
Dr Darrell, thank you so much.
Have a wonderful day.
Dr. Keith Darrow (24:43):
Thank you.
I'm going to really geek out here for a
second.
Prescription hearing technologyhas a latency or a time delay
from the time the sound gets toit to it gets presented into the
ears.
It has a time delay of aboutfive milliseconds which is not
detectable by humans.
Basically, I'm going to justsay there is no delay, there's
no ability to perceive a delaywhen using prescription hearing
(00:22):
technology.
Well, these AirPods, whilethey're great AirPod Pro 2, at
least the records indicatethere's 126 millisecond delay.
What does that mean?
Anything over 40 millisecondscan give you the sense of an
echo.
It's not going to sync up withthe lips.
That echo in background noiseis only going to keep
(00:45):
compounding itself to a pointwhere it might actually be
better to go without the AirPodPros in background noise than it
would be to have them, becauseit can really confuse the brain,
really mess with the processing.
So right now there's reallysignificant limitations to when
and where you can use thisover-the-counter technology.
Blaise M. Delfino, M.S. (01:12):
You're tuned in to the Hearing Matters
podcast, the show thatdiscusses hearing technology,
best practices and a globalepidemic hearing loss.
Before we kick this episode off, a special thank you to our
partners Redux (01:25):
Faster, drier, smarter, verified.
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Built for the entire hearing care practice.
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the world's first custom adjustable earplug.
Welcome back to another episodeof the Hearing Matters podcast.
I'm your founder and host,blaise Delfino, and, as a
friendly reminder, this podcastis separate from my work at
Starkey.
Dr. Douglas L. Beck (01:53):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast, and
today I'm interviewing my verydear friend, dr Keith Darrow.
Keith, how are you?
Hey?
Dr. Keith Darrow (02:02):
Dr Beck, thank you so much for having me here.
What an important and timelytopic, so thanks for doing this.
Dr. Douglas L. Beck (02:09):
Yeah, you bet.
Well, the topic of the day, bythe way, is that the FDA has
said that Apple AirPods 2 canbecome hearing aids.
And it's interesting because,of course, we've had OTC now for
two years, but this is thefirst time the agency the FDA
has authorized over-the-counterhearing aid software.
So the FDA began allowing OTCback in 2022, looking at
(02:32):
affordability and accessibility,and now we're at this new level
where Apple AirPods theirsoftware has been approved as a
potential OTC device.
Is that right?
Am I encapsulating thatcorrectly?
Dr. Keith Darrow (02:45):
No, I think you summarized it perfectly and
I think that, look, we're stillin the wild wild west when it
comes to this over-the-countercategory.
But I genuinely appreciate whatApple has done, which is bring
more awareness to hearing loss,as far as I'm concerned, bring
more awareness to the fact that,as far as I'm concerned, bring
(03:05):
more awareness to the fact thatthere is a separate category of
technology that falls into theover-the-counter or, as I like
to refer to it, as the DIYcategory.
Right, do it at home, treatyour own hearing loss type
category.
For us, it further elevateswhat we do, which is provide
prescription hearing technologyto medically treat hearing loss
(03:27):
and tinnitus.
So we're comparing apples andscrewdrivers here.
Dr. Douglas L. Beck (03:31):
First of all, I think it's important to
understand and please correct meI think this is only really
applicable to the AirPods Pro 2.
Is that right?
Dr. Keith Darrow (03:40):
Yes, it is.
That is the way that they haveput it out so far.
We all know that there's goingto be the AirPods 3 that comes
out.
I mean, to me, what they'vedone is basically drawn a line
in the sand that this technologyis capable.
Nothing before it, buteverything after it will be.
That's typically how Appleworks they introduce something
new and then they continue tomake it only better over time.
(04:03):
But yes, apple AirPod Pro 2.
Dr. Douglas L. Beck (04:07):
Right, right, and I want to be clear
this is mine for a couple ofyears now.
I guess I got this when theyfirst came out, the Pro 2.
And they have ear tips on them,and this is a very, very
important characteristic,because this ear tip comes off
right, and then you have justthe receiving end.
The important thing here, Ithink, that so many of us have
maintained, is that you have tohave an excellent seal.
(04:28):
If you just have a loose devicein your ear without sealing the
ear canal, you're not going toget these benefits.
Dr. Keith Darrow (04:34):
Exactly, it's very temperamental, and I think
anybody who's worn the AirPodstoo, I mean, I've got them in my
ears right now, right, sure,but if I start walking around
and I start having aconversation, I don't know about
you and maybe it's my ears, butthey definitely start to slip
out, and I've had thatconversation with several other
people.
Frankly, when I do I wear themat the gym I have this little
(04:56):
lock feature, you know, thatbasically goes up and locks them
in.
Otherwise they're they're allover the place.
Fit is definitely.
While the tips give them a goodfit, they help to block out
background noise.
That, once again, we're talkingabout people who have their own
hearing loss and we're tryingto do a one-size-fits-all, which
(05:17):
is why there are significantlimitations to this.
Dr. Douglas L. Beck (05:20):
Yeah, this is an important point.
If you go to the chronology andyou try to find well, what's
AirPod Pro 1, 2, 3, and 4, andnow they're coming out with
AirPods 4, and that's kind of aone size fits most, so I'm not
really that impressed with that.
The most popular of all havebeen the AirPods Pro, and the
ones we're talking about now arethe AirPods Pro 2.
(05:40):
Now are the AirPods Pro 2.
Now the interesting thing to meis when you think about AirPods
and I agree, it's a remarkablygood product but battery life is
somewhere between four and sixhours.
So if you're going to try touse them for a hearing aid, you
might need two or three pairs.
And I don't say that kiddingaround, I'm totally serious,
because I used to wear myAirPods Pro 2.
(06:02):
I'd wear them as you may recallthis, from in the morning.
I'm wearing them until aboutnoon or so.
I take them out, I put them inthe charger, I put in pair
number two and then I reverse itat dinnertime.
So that might be a way tomanage it.
I have not seen that theAirPods Pro 2 will have much of
a longer battery life.
Moving forward, it looks likethey're in the four to six hours
(06:24):
.
Now you have to be careful whenyou look at battery life,
because they say up to 30 hourswith the case.
Well, yeah, because the case isits own battery charger as well
.
I think you have to take thatinto consideration.
Dr. Keith Darrow (06:36):
But even, doug and I think this is an
important point for people torealize, especially if you're
listening to this podcast andyou're in the field of hearing
healthcare you're trying tofigure out how am I going to
talk my patients through this?
Yes, apple will tell you four tosix hours, but if you have the
noise reduction on, if they'reprobably more than a month old,
(07:00):
I mean, look, I get about two totwo and a half hours out of
mine, and that's on a fullcharge, right, and so that
battery does wear down over time.
So, look, I think this is adeal breaker, right, when it
comes to treating hearing loss.
This over-the-counter product,this Apple AirPod Pro 2,
realistically will get you abouttwo and a half hours, even
(07:22):
though they say four to six.
That's without the noisereduction on, that's with volume
turned down.
I get a couple of hours out ofmine, and it's really important
that the brain is stimulated bysound all day, not just two to
three hours, so that, rightthere, sort of, might it help
you hear better in some limitedsituations for a limited amount
(07:44):
of time.
Sure, is it the proper tool touse to treat your hearing loss
and tinnitus?
I don't think so.
Dr. Douglas L. Beck (07:52):
Yeah, I think of it as an adjunct device
.
And here's the thing, thoughwhen you think about hearing
aids in the USA generally, youknow, if you include the big box
stores and the VA, we sellbetween, I think, five, six,
seven million units per year.
Apple AirPods have already soldover 150 million pairs, so you
(08:13):
know that's pretty substantial.
People do like AirPods, pods, Ilike air pods.
I think the directionality, thenoise reduction very, very good
.
But I think your point is theoverriding point that if you're
going to use these as hearingaids, you're going to need two
or three pairs or you're goingto have a little bit of
difficulty but let me.
Dr. Keith Darrow (08:30):
but let me say this, doug, let's peel back the
layers a little bit there,because you just threw out a
huge number 150 million AirPodshave been sold.
Hearing aids are not even.
They're not in the same league,right?
However, 94% last I checked theonly data I could find 94% of
the 150 million were sold topeople under the age of 40.
(08:53):
I have two pairs and you havethree pairs, so we make up a lot
of that.
Other 6%.
Right, yeah, we do, and so Ithink.
But that's really important tosay okay, why did Apple do this?
Look, I'm sure they have greatintentions and I'm not trying to
say anything negative, but,truth be told, there are
corporate bigwigs that aresitting around saying how do we
(09:14):
sell more of these?
Well, let's talk to the peoplethat aren't buying them.
And what do we talk to olderadults about?
Hey, this can help you hearbetter.
Dr. Douglas L. Beck (09:23):
I like that .
I think that's insightful.
Let me just underscore thenumbers.
I looked up the same paper.
I think Most AirPod users 60%of them are between age 18 and
25, 34% between 26 and 35.
So that, right there, that's 94, 95% under age 35.
So you and I have just changedtheir statistics.
(09:44):
But the thing we didn't talkabout is price, and the thing is
these are pretty cheap.
I mean, these are 249 bucks.
Maybe you can buy a rebuiltpair for 199.
And this, to me, is veryimportant because you know, the
reason that we got into the FDAOTC rules and regs was access
and affordability.
Now I have a brand new papercoming out, I believe in the
Hearing Review this week, and Ipointed out I'm going to read
(10:08):
you this little section herewhen we're talking about
affordability and accessibility,which again was the motivating
factors for the FDA, we observetoday access appears to have
been increased.
Access is pretty good.
You can get hearing aids almostanywhere.
Now, however, the better OTCproducts often cost $1,000 to
$29.50 per pair.
(10:29):
Now that's, according to theNational Council of Aging,
placing the better OTCs beyondthe reach of most people that
OTC was created to help.
Cber 2024 reports that at BestBuy OTC products range, per pair
, $200 to $2,550.
And Susie Orman we all knowSusie Orman.
She was publishing in NASDAQthat most Americans 60% do not
(10:52):
have $500 for an emergency.
As such, it seems pretty hardto imagine that most Americans
are going to spend more than$500 on a pair of hearing aids.
So this is a unique niche inthe market.
They're going for very, veryinexpensive and very, very high
quality.
Now what would you say if thebatteries on these AirPods?
What if they lasted 16 hours?
Dr. Keith Darrow (11:14):
No, and here's why.
So that's a great question,right, because right now I don't
want hearing providers to justrely on the.
Well, it doesn't last as long,because they can fix that.
If you can get prescriptionhearing technology to last 12 to
15 hours, Apple can make itlast 30 hours.
If they really wanted to right,they could figure that out.
(11:34):
They're much smarter than wegive them credit for.
Here's the issue as it standstoday.
Number one the biggest complaintof our patients is hearing in
background noise.
And while you might want to say, oh, but AirPods have noise
reduction, they do.
I love having my AirPod Pros inon an airplane because it does
(11:56):
really well with that constantmotor noise, sort of bringing
that down.
However, at least as of today,when it comes to using AirPod
Pros in a restaurant setting, ina real life situation, hanging
out with friends or colleagues,right now it does have noise
reduction, but only in a veryspecific beam forming pattern,
(12:18):
in that you can hear the personthat's directly in front of you
pretty well.
It can separate speech andnoise by about 7 dB, which is
impressive.
But only this.
We don't live in that world,doug.
Right?
What hearing technology?
What all the majormanufacturers have done over the
last few years is taken thatbeam and they've essentially
(12:41):
made it almost 360, in that itpicks up speech and reduces
background noise, just like thebrain does.
It doesn't have this sort ofbeam forming technology, so
right there, that's one reallimitation, because you're still
not going to hear great inbackground noise.
Blaise M. Delfino, M.S. - HIS (12:58):
I want to back up a second.
Dr. Keith Darrow (13:00):
You're talking about price, right, so let's
talk about the affordability andaccess.
I've been trying to tell peoplethis for the longest time
Hearing aids are not expensive.
We have to get that thought outof our mind.
That's part of the problem.
Is we put up this barrier.
We talk about cost.
Frankly, the same stuff thatI'm putting in people's ears you
(13:22):
just said it you can get themover the counter for $2,500.
You can get Oticon, Widex,Phonix.
You can get them in big boxstores, you can get them on
Amazon.
You can get them all for apretty decent price.
It might be somewhere between$1,500 and $2,500.
Hearing aids are not expensive.
What's expensive is us and Ishouldn't even use the word
(13:47):
expensive it's the value that weprovide.
It's the care, the customizedprescription, the follow-up care
.
You know I've seen some studiesthat say audiologists, if you
take into account a four-yeartreatment program and consider
all the times you meet with yourpatients, the clean-in checks,
(14:07):
the annuals, if everything'sincluded, it boils down to like
20 bucks an hour.
Right, Like it's somethingwhere the cost is in us and you
have to be able to justify yourcost, and I think that we
absolutely do, because to datethere's never been a study
showing that a over-the-counter,a DIY hearing aid can provide
true medical value.
(14:28):
People might say OTC soundsgood, but they've never been
shown to reduce the risk of afall, reduce the risk of
cognitive decline, improvecognitive performance, increase
quality of life, reduce tinnitusI mean, you can't even talk
about tinnitus and theseover-the-counter widgets, right?
Dr. Douglas L. Beck (14:46):
Yeah, these are all good points and these
are things that help separateOTC or DIY from prescriptive
hearing aids.
Right, when you're looking atthe literature on cognition,
when you're looking at theliterature on cognition, when
you're looking at the literatureon satisfaction, those things
are basically done based onprescriptive hearing aids.
And the other thing that wehaven't talked about at all,
which I think is worthy of a fewminutes here, is the issue of
(15:06):
stigma, because when you'rewearing your AirPods, these are
considered to be somewhat cooland trendy and great, but stigma
of traditional hearing aids isvery real.
I'll give you four quotes from2024.
Forbes 2024, reports people withhearing loss avoid hearing aids
for many reasons and socialstigma plays a significant role.
(15:30):
In their survey, 48% ofrespondents believe there is a
stigma associated with hearingaids and they report 63% of
millennials, 47% of Gen Xers and41% of boomers agree there's a
stigma.
Now that's Forbes 2024.
Webmd 2024 says the same thing62% of Americans wear visible
(15:50):
corrective eyewear and 45million wear contact lenses,
which is kind of incredible.
Yet only 15% of people withhearing loss wear hearing aids.
This is Beadle Genstead et al2024.
Younger and older adults mighthold negative, implicit
attitudes towards older andyounger people who wear hearing
aids.
And finally, I'll give you NickBach, ekberg and Waite 2024,
(16:13):
explored how and when astigma-induced identity threat
is experienced by adults withhearing loss and their family
members.
All participants in their studybelieved hearing loss and
hearing aids were associatedwith stigma.
So I wonder, when we're talkingabout something like Apple
AirPods which are admittedlycool and trendy and maybe sexy
and maybe much more acceptableis that a factor?
(16:34):
When you talk to patients, doyou consider stigma?
Do you talk to them about that?
Dr. Keith Darrow (16:38):
Look absolutely Well, and I'll tell
you what I would challenge you,because my bet is, if you go
back to some of thosepublications I don't know, 50
years ago, 40 years ago they'dprobably say the same thing
about glasses.
Remember glasses?
You were four eyes, you wereteased by people.
Something was wrong with you,you were blind.
(17:00):
So, look, I almost think it's agood thing.
The fact that you can readthese in major publications says
we're talking about it more.
The fact that Apple's talkingabout hearing loss and hearing
aids means we're talking aboutit more.
It means our society is on thepath to acceptance.
But you're right, doug, thestigma is real.
Here's what I can tell you Inthe month of September 2024, I'm
(17:24):
going to travel to, I'll be inWaycross, georgia, little Rock,
arkansas, madison, Wisconsin,new Jersey.
I do these symposiums all thetime, these patient-facing
symposiums, and I always startwith the question of hey, 90% of
people with hearing loss donothing about it, right?
(17:45):
You guys are a great group forme to ask this question why Tell
me what's going on?
Now, admittedly, it's a bit ofa plant, because I know the
answer and undoubtedly, there'salways several people who raise
their hand and say stigma.
So the stigma is real, but theonly way to fight back against
the stigma is to talk about itmore Podcast articles.
(18:08):
You know Apple having theshining star of technology and
software to talk about hearingloss and hearing aids.
Thank you, thank you, apple.
Dr. Douglas L. Beck (18:20):
In my new article coming out in October in
the Hearing Review.
That's all about custom-madeproducts and the reason that I
write about that is because Iwear a set of IICs invisible in
the canal hearing aids when evenI'm lecturing at your events,
at audiology experts and things.
Nobody's ever noticed them andI think this is.
It makes me more comfortable tohave that in my ear and to give
(18:42):
me that security blanket thatI'm hearing much better and I
can attend much better to what'sbeing said.
I like that a lot, but I don'twant to have a giant hearing aid
or a BTE or a Rick or a right.
This is my own personalpreference and I know that maybe
that's a vanity issue, but youknow I don't have that much that
I can hold onto there, so I'lltake what I can get.
(19:02):
But you know this is very realwhen people don't discuss the
stigma of hearing aids, it's the800 pound gorilla in the room
for most patients.
You know, when we talk aboutaccess and affordability, that's
cool and those are importantthings.
But I think the third thingthat impacts who gets hearing
aids and who doesn't is stigmaand cosmetic issues.
Dr. Keith Darrow (19:24):
It is absolutely a real issue.
As I sit here today in theclinic, I just saw a patient
this morning and I had thisdiscussion and I just I always
have to be real and I alwayshave to say, look, I respect
that, I understand it, andhere's the way I approach it.
Number one I'm going torecommend the best prescription
(19:45):
technology that meets yourhearing needs and, if I can, I
will make it as invisible aspossible.
I certainly understand and Irespect your concerns of vanity
and stigma, but hearing is thesingle most important thing I do
and we can't compromise that.
And then you've probably heardme say this too.
(20:06):
I'll often joke with patientsand say, look, I understand you
don't want to walk around with abeige banana behind your ear.
Thankfully, those days aremostly gone.
But think about it this way.
People might say, oh, what'sthat thing behind your ear?
And then they just okay, theygo about their day and they
don't think about it.
If you're a mom or dad andyou're sitting at the dinner
(20:27):
table with your family andyou're not interacting, if
you're starting to isolateyourself, if you're
inappropriately laughing atjokes that weren't a joke while
somebody's telling a story, ifyou're trying to fudge your way
through a conversation.
You know what happens.
The second you get up,everybody starts talking about
you.
Everybody starts talking aboutthe stigma of mom's getting old.
(20:51):
What are we going to do withher?
Is it dementia?
What's going on here, when inreality, you could just be
hearing so you know?
Yeah, maybe wearing a tinypiece of prescription hearing
technology.
If it gets you hearing betterand interacting more, I'm all
for it.
Dr. Douglas L. Beck (21:07):
Yeah, that's great, all right.
So the bottom line, you know, Ithink we're both agreeing that
the new application of the AppleAirPods 2 Pro is very
appropriate for some people.
Some of the time it doesn'treplace prescription hearing
aids.
It has assets, it hasliabilities, it has pros and
cons, and I want to alsoencourage people to take their
(21:30):
online hearing test associatedwith this.
I did that today, the MimiM-I-M-I.
I thought it was pretty good,to be honest, and it's kind of a
von Beckeshe sort of a test.
If you haven't taken it before,you press the button or you
hold the button in while you'rehearing the beep.
When you can no longer hear it,you let go, which is kind of
what we used to do with Beckesheback in the 30s, 40s, 50s and
(21:50):
60s, and I can tell you my testwas pretty darn accurate.
Dr. Keith Darrow (21:54):
So I would encourage that and I think and I
, but I let me tag, let me justjump onto this.
I would encourage you youanybody out there to acknowledge
that, while that test may bepretty good and it might
actually align pretty well withthe beeps we do in the clinic,
yeah.
The beeps.
Is this much of the hearingtest right?
(22:14):
Absolutely, the beeps tells usyour ability to perceive beeps.
Yes, I don't know about you,Doug.
I've been doing this for over20 years.
No patients ever come in andsaid I can't hear beeps.
Can you help me with that Right?
So there's a lot more to it andI think if you use that as a,
dare I say, a cursory test tosay, hmm, is my hearing normal
(22:35):
or not, and then I would alsoencourage you to say look, if
you're not hearing as well asyou used to in background noise,
even though your hearing stillseems normal, undergo a full
evaluation so that youunderstand exactly how your
brain is processing.
Dr. Douglas L. Beck (22:51):
Yeah, and this is so important right,
hearing tests online.
They can do beeps online.
They're fairly accurate.
Again, the Mimi test I tookthat I thought it was pretty
close to my actual hearing test.
However, an actualcomprehensive audiometric
evaluation is not just aboutbeeps.
As Dr Darrell was saying, weneed to do speech and noise
tests, we need to do listeningand communication assessments
(23:12):
and we need to do boneconduction testing and we need
to check your eardrum throughtympanometry and we also need to
do reflexes ipsilateral andcontralateral and otoacoustic
emissions.
That tells us what's going onwith your auditory system.
Dr. Keith Darrow (23:25):
Exactly the beeps are in my practice in the
hearing and brain centers.
The beeps are one-seventh.
I don't know what that ispercentage-wise, but it's a very
small percentage.
Dr. Douglas L. Beck (23:35):
It's one-seventh yeah, I'm going to
give it about 18%, 17%, thereyou go.
Dr. Keith Darrow (23:39):
It's one-seventh of the overall
cognitive screening anddiagnostic evaluation process.
Dr. Douglas L. Beck (23:45):
The other thing is that these AirPods are
meant for people with mild ormoderate loss and they would not
be sufficient for anybody withmoderately severe, severe or
profound loss.
Dr Darrow, I want to thank youfor your time and I want to
thank you for your knowledge onthis topic.
I think this is so important.
Consumers obviously are goingto be looking at this as well.
Professionals and they should.
It's a very, very clevertechnology.
It has some very good assetsand it has some liabilities as
(24:09):
well.
Not a panacea.
It doesn't replace anyprofessional care at all.
I always want to urge people ifyou have hearing loss or you
have listening difficulty,particularly in noise, a pure
tone hearing test isn't going totell us what we need to know.
We need to get you into theoffice for comprehensive
audiometric evaluation,including listening and
communication assessments,speech and noise, bone
conduction, hearing tympanograms, otoacoustic emissions reflexes
(24:31):
, ipsy and contra.
Then we know what's going onand it's the same thing we do in
medicine it's diagnosis first,treatment second.
Dr Darrell, thank you so much.
Have a wonderful day.
Dr. Keith Darrow (24:43):
Thank you.
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