Advances in Audiology, Las Vegas Soren Hougaard, EHIMA 1
1. An overview of the surveyed markets 2. Hearing rehabilitation: Societal and personal benefits 3. Satisfaction with and reasons not to use hearing aids 2
1. An overview of the surveyed markets 3
Short interviews Long interviews Representative HA owners HA non-owners UK 14896 501 795 Germany (GER) 13922 500 864 France (FRA) 15430 502 809 Norway (NOR) 14866 691 618 Switzerland (CH) 14836 514 813 Italy (ITA) 15536 510 801 JapanTrak (JAP) 15036 450 898 Total 104 522 3668 5598 EuroTrak and JapanTrak were designed and executed by www.anovum.com 4
% self-reported hearing impaired (Base: population) Differences may be caused by: Age-gender-structure (=age pyramid) Awareness: Hearing tests, health care systems etc. Prevention / Work situation Other factors 12.5% 11.6% 10.9% 11.3% 9.4% 9.1% 8.8% 8.8% Germany Italy Japan France UK Norway Switzerland USA (MarkeTrak 2012 2009) 5
Age group Age group Age group Age group Age group Age group 74+ 74+ 65-74 65-74 older populations: 55-64 45-54 35-44 25-34 55-64 45-54 35-44 25-34 15-24 15-24 <= 14 <= 14 Women: Unimpaired non-owner Women: Impaired non-user Women: HA owner Men: Unimpaired non-owner Men: Impaired non-user Men: HA owner Women: Unimpaired non-owner Women: Impaired non-user Women: HA owner Men: Unimpaired non-owner Men: Impaired non-user Men: HA owner 74+ 74+ 74+ 74+ 65-74 65-74 65-74 65-74 55-64 55-64 55-64 55-64 45-54 45-54 45-54 45-54 35-44 35-44 35-44 35-44 25-34 25-34 25-34 25-34 15-24 15-24 15-24 15-24 <= 14 <= 14 <= 14 <= 14 Women: Unimpaired non-owner Women: Impaired non-user Women: HA owner Men: Unimpaired non-owner Men: Impaired non-user Men: HA owner Women: Unimpaired non-owner Women: Impaired non-user Women: HA owner Men: Unimpaired non-owner Men: Impaired non-user Men: HA owner Women: Unimpaired non-owner Women: Impaired non-user Women: HA owner Men: Unimpaired non-owner Men: Impaired non-user Men: HA owner Women: Unimpaired non-owner Women: Impaired non-user Women: HA owner Men: Unimpaired non-owner Men: Impaired non-user Men: HA owner 6
Adoption: Proportion of people with hearing aid (% of population) and adoption rate (% of stated impaired) Differences may be caused by: Health care system Reimbursement system / income structure Market development Culture Other factors. 42.5% 41.1% 38.8% 34.0% 30.4% 29.6% 24.6% 14.1% 3.7% 3.7% 3.4% 4.2% 2.8% 2.9% 1.5% 2.8% Norway UK Switzerland Germany France Italy Japan USA (MarkeTrak 2012 (% of population) 2012 (% of stated impaired) 2008) 7
% Binaural fitting Differences may be caused by: Health care system Reimbursement system / income structure Market development Professional attitude 76% 75% 74% 75% 76% 74% 63% 64% 60% 60% 61% 58% 59% 47% 44% 39% 36% Norway Switzerland Germany France UK Italy Japan 2012/2011 2010 2009 or earlier (EuroTrak 2009) 8
Do you have tinnitus (ringing or other noises in the ears or head) in one or both ears? No 67% 70% 71% 74% 74% 75% 80% Yes, sometimes 26% 25% 22% 20% 21% 20% 15% 3% 4% 2% 3% 4% 3% 4% 2% 2% 3% 2% 3% 2% 3% Italy Japan Germany Norway France UK Switzerland Yes permamently in both ears Yes permamently in one ear 9
Have you ever thought about a treatment of your tinnitus? Differences may be caused by: Health care system / income structure Culture etc. sometimes Tinnitus permanently Tinnitus 47% 48% 83% 81% 79% 75% 90% 40% 45% 12% 14% 13% 22% 13% 5% 7% 4% 8% 3% 2% 8% 16% 17% 31% 51% 43% 49% 52% 46% 49% 42% 13% 31% 36% 36% 36% 34% 27% 26% 39% 15% 12% Germany France Italy Japan Switzerland UK Norway I have never considered a treatment I have considered a treatment but did not have one I have / have had a treatment 10
Drop-out 1: not discussed with doctor Drop-out 2: Doctor did not recommend Drop-out 3: Not bought/received Hearing impaired Stated hearing impaired Discussed with ENT/GP Positive medical Advice Discussed with HA dispenser/au diologist Owner of a hearing aid 11
100% 90% 100% Drop out: 20% 80% 70% 60% 50% 40% 30% 20% 80% 48% Drop out: 40% 42% 38% 34% Impaired ENT/Doctor Recommend Owner Drop out: 29% 10% 0% All hearing impaired Discussed hearing loss with ear doctor and/or family doctor Positive medical advice (Ear doctor or family doctor recommend further action) Discussed hearing loss with HA dispenser/audiologist Positive advice HA dispenser/audiologist Bought hearing aid 12
100% 90% 100% Drop out: 20% 100% 90% 80% 70% 60% 50% 40% 30% 100% 76% Drop out: 24% 58% Drop out: 23% 51% Drop out: 27% 41% 43% 80% 70% 60% 50% 40% 30% 20% 10% 0% All hearing impaired 80% Discussed hearing loss with ear doctor and/or family doctor 48% Drop out: 40% Positive medical advice (Ear doctor or family doctor recommend further action) 42% Discussed hearing loss with HA dispenser/audiologist 38% 34% Impaired ENT/Doctor Recommend Owner Positive advice HA dispenser/audiologist Drop out: 29% Bought hearing aid 20% Impaired ENT/Doctor Recommend Owner 10% 0% All hearing impaired Discussed hearing loss with ear Positive medical advice (Ear doctor Discussed hearing loss with HA doctor and/or family doctor or family doctor recommend dispenser/audiologist further action) Positive advice HA dispenser/audiologist Bought hearing aid 100% 90% 80% 70% 100% 76% Drop out: 24% Drop out: 37% 60% 50% 40% 30% 20% 10% 48% 37% Drop out: 37% 34% 30% Impaired ENT/Doctor Recommend Owner 0% All hearing impaired Discussed hearing loss with ear Positive medical advice (Ear doctor Discussed hearing loss with HA doctor and/or family doctor or family doctor recommend dispenser/audiologist further action) Positive advice HA dispenser/audiologist Bought hearing aid 100% 90% 100% Drop out: 27% 80% 70% 60% 50% 40% 30% 20% 73% Drop out: 39% 44% 48% 39% 39% Impaired ENT/Doctor Recommend Owner Drop out: 13% 10% 0% All hearing impaired Discussed hearing loss with ear Positive medical advice (Ear doctor Discussed hearing loss with HA doctor and/or family doctor or family doctor recommend dispenser/audiologist further action) Positive advice HA dispenser/audiologist Bought hearing aid 13
OECD Data shows: 1. The density of practicing physicians is lower in the UK 2. People in the UK go to the doctors less often EuroTrak 2012 shows: People in the UK rarely take hearing tests Have you ever had your hearing tested? (Base:population) 37% 29% 56% 14% 24% 18% 31% 21% 40% 55% 53% 36% 21% 28% 15% 16% 22% 26% 30% 16% 17% 16% 19% 13% 13% 12% 12% 10% No, never Yes, more than 5 years ago Yes, in the last 1-5 years Yes, in the last 12 months Japan Germany Italy Switzerland Norway France UK 14
Recommendations by profession 85% 49% 38% 43% 37% 26% 14% 13% 15% GP ENT Audiologist (inc. NHS) Referred to an ear doctor (ENT) 73% 89% 44% 22% 31% 31% 9% 11% 11% GP ENT Audiologist Referred to a hearing aid dispenser / audiologist (incl. NHS) Recommended to get a hearing aid Recommended no 76% 90% further action 49% 38% 14% 13% 43% 37% 26% 85% 15% 19% 11% 12% 33% 37% 38% 10% G GP ENT Audiologist 15
Top 10 reasons for not having a hearing aid Cannot afford a hearing aid Cannot afford a hearing aid 55 23 22 Ear doctors opinion (ENT) 49 24 27 Have more serious priorities 41 28 31 Hearing loss not severe enough 37 26 37 They do not work well in noisy situations 37 24 39 Hearing Aid Dispenser/Audiologists opinion 37 23 39 They do not restore your hearing to normal 33 27 39 Uncomfortable 33 26 41 Family doctors opinion (GP) 34 23 43 Hear well enough in most situations 25 30 45 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Reason Somewhat a reason Not a reason 16
2. Hearing rehabilitation: Societal and personal benefits 17
How useful are your hearing aids on your job? Switzerland 10% 20% 70% France 5% 32% 63% Germany 8% 30% 62% Norway 14% 27% 59% Italy 10% 36% 54% UK 17% 33% 50% Japan 12% 46% 42% Of no use Of some use Of significant use N: UK 144/FRA 204/ GER 209 18
Countries are sorted by the average rather+strongly agree over the three questions Disagree strongly Rather disagree Neutral Rather agree Strongly agree I think that people with an untreated hearing loss tend to be less promoted in their job Germany Switzerland Italy UK France Japan Norway 9% 10% 8% 4% 3% 7% 6% 15% 12% 8% 8% 13% 14% 12% 35% 19% 34% 44% 44% 39% 39% 31% 41% 30% 25% 29% 25% 24% 19% 15% 16% 19% 16% 16% 11% I think that people with an untreated hearing loss tend not to get the job they deserve Germany Switzerland Italy UK France Japan Norway 8% 9% 7% 3% 7% 2% 7% 7% 11% 7% 12% 11% 12% 12% 31% 26% 35% 45% 45% 40% 35% 28% 39% 32% 25% 26% 25% 30% 26% 14% 16% 21% 19% 16% 12% I think that people with an untreated hearing loss tend to be under-salaried Germany Switzerland Italy UK France Japan Norway 11% 14% 9% 5% 4% 7% 10% 15% 11% 9% 9% 12% 15% 18% 37% 37% 47% 55% 36% 58% 43% 25% 27% 30% 25% 15% 15% 16% 16% 8% 13% 14% 17% 8% 7% Base: Hearing aid owners 19
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% of people with depression symptoms Hearing aid Top 50% hearing loss, no hearing aid Italy 32% 37% Depression symptoms: PHQ-2 Screening: In the last 2 weeks: Little interest or pleasure Feeling down, depressed, hopeless UK Germany Japan France 16% 19% 14% 17% 21% 27% 29% 41% Norway 9% 21% Switzerland 4% 11% Top 50% means six tiles 4-6 with a similar degree of hearing loss as hearing aid owners: Construction of 6-groups: A factor analysis was performed to identify one factor degree of hearing loss. The following questions were included in the factor: Number of ears impaired (one or two) Stated hearing loss (Mild to Profound) Scores on 6 APHAB-EC like questions (Scaled 1-5) When NOT using a hearing aid, how difficult is it for you to follow conversations in the presence of noise People were segmented into 6 groups of same size (16.67% of all hearing impaired in the sample). 21
% of people getting more forgetful Yes somewhat more Yes, much more JAP with hearing aid JAP no hearing aid (but sig. HL top 50%) ITA with hearing aid ITA no hearing aid (but sig. HL top 50%) 59% 61% 66% 66% 15% 19% 6% 13% Dementia symptom: Getting more forgetful in the last year? GER with hearing aid GER no hearing aid (but sig. HL top 50%) UK with hearing aid UK no hearing aid (but sig. HL top 50%) CH with hearing aid CH no hearing aid (but sig. HL top 50%) 57% 56% 56% 56% 63% 69% 4% 4% 2% 17% 7% 5% FRA with hearing aid FRA no hearing aid (but sig. HL top 50%) 54% 62% 3% 6% NOR with hearing aid NOR no hearing aid (but sig. HL top 50%) 42% 52% 3% 5% Base: Hearing aid owners and non owners with top 50% hearing loss Top 50% means six tiles 4-6 with a similar degree of hearing loss as hearing aid owners: Construction of 6-groups: A factor analysis was performed to identify one factor degree of hearing loss. The following questions were included in the factor: Number of ears impaired (one or two) Stated hearing loss (Mild to Profound) Scores on 6 APHAB-EC like questions (Scaled 1-5) When NOT using a hearing aid, how difficult is it for you to follow conversations in the presence of noise People were segmented into 6 groups of same size (16.67% of all hearing impaired in the sample). 22
Mentally and physically exhausted people. cost CHF 4.2 billions/year in Switzerland CH-Blick; 13.4.2012 23
Rather agree Strongly agree In the evenings I often feel physically exhausted Hearing aid No hearing aid (but significant hearing loss top 50%) ITA UK GER JAP FRA NOR CH ITA UK GER JAP FRA NOR CH 29% 30% 26% 26% 25% 29% 38% 40% 37% 47% 44% 31% 32% 26% 16% 15% 11% 18% 8% 10% 18% 24% 15% 15% 26% 27% 15% 16% In the evenings I often feel mentally exhausted Hearing aid ITA UK GER JAP FRA NOR CH 23% 24% 23% 20% 17% 15% 35% 6% 6% 13% 11% 7% 10% 15% No hearing aid (but significant hearing loss top 50%) ITA UK GER JAP FRA NOR CH 38% 42% 35% 40% 22% 28% 25% 20% 14% 12% 14% 10% 25% 18% Top 50% means six tiles 4-6 with a similar degree of hearing loss as hearing aid owners: Construction of 6-groups: A factor analysis was performed to identify one factor degree of hearing loss. The following questions were included in the factor: Number of ears impaired (one or two) Stated hearing loss (Mild to Profound) Scores on 6 APHAB-EC like questions (Scaled 1-5) When NOT using a hearing aid, how difficult is it for you to follow conversations in the presence of noise People were segmented into 6 groups of same size (16.67% of all hearing impaired in the sample). 24
3. Satisfaction with and reasons not to use hearing aids 25
Overall satisfaction with HA % % satisfied Switzerland (n=514) 1 5 10 19 46 19 84% France (n=502) 1 4 7 7 17 50 14 80% Germany (n=500) 2 3 3 15 26 35 16 77% UK (n=501) 7 3 8 9 22 35 16 72% Norway (n=691) 3 4 11 11 14 43 14 72% Italy (n=510) 3 7 20 40 24 6 70% Japan (n=450) 5 12 20 27 21 14 1 36%! 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% very dissatisfied dissatisfied somewhat dissatisfied neutral somewhat satisfied satisfied very satisfied 26
Overall satisfaction with HA CH 2010 or after (n=270) CH 2009 or earlier (n=238) 10 3 01 8 10 9 18 20 48 44 21 17 FRA 2010 or after (n=287) FRA 2009 or earlier (n=202) 11 4 0 7 8 12 17 5 17 57 42 17 12 GER 2010 or after (n=236) GER 2009 or earlier (n=249) 1 3 5 10 5 18 24 27 43 28 20 13 UK 2010 or after (n=295) UK 2009 or earlier (n=163) 7 9 3 7 5 6 12 10 22 25 38 28 18 11 NOR 2010 or after (n=334) NOR 2009 or earlier (n=329) 2 3 4 5 11 11 6 12 12 16 49 40 18 11 ITA 2010 or after (n=310) ITA 2009 or earlier (n=160) 12 5 4 12 15 21 44 35 26 23 8 5 JAP 2010 or after (n=201) JAP 2009 or earlier (n=213) 2 6 6 16 18 26 26 24 25 18 22 9 3 0 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% very dissatisfied dissatisfied somewhat dissatisfied neutral somewhat satisfied satisfied very satisfied 27
Overall satisfaction with HA CH HA worn up to 4 hrs/day (n=138) CH HA worn 4-8 hrs/day (n=115) CH HA worn more than 8 hrs/day (n=261) 1 3 03 10 5 8 11 4 18 12 17 28 47 62 30 26 13 11 FRA HA worn up to 4 hrs/day (n=73) FRA HA worn 4-8 hrs/day (n=145) FRA HA worn more than 8 hrs/day (n=284) 1 3 2 0 3 16 12 5 5 4 15 6 19 25 53 20 54 28 19 9 2 GER HA worn up to 4 hrs/day (n=135) GER HA worn 4-8 hrs/day (n=144) GER HA worn more than 8 hrs/day (n=221) 5 10 201 11 12 10 11 29 26 28 37 20 44 18 24 13 6 UK HA worn up to 4 hrs/day (n=134) UK HA worn 4-8 hrs/day (n=131) UK HA worn more than 8 hrs/day (n=236) 6 13 3 5 1 5 8 9 5 3 11 21 29 22 42 18 35 20 17 20 7 NOR HA worn up to 4 hrs/day (n=225) NOR HA worn 4-8 hrs/day (n=146) NOR HA worn more than 8 hrs/day (n=320) 1 5 2 2 2 7 9 16 5 13 6 11 17 21 49 16 51 30 24 5 9 ITA HA worn up to 4 hrs/day (n=119) ITA HA worn 4-8 hrs/day (n=177) ITA HA worn more than 8 hrs/day (n=213) 1 9 1 8 1 3 13 13 21 30 39 46 33 34 18 12 9 3 5 JAP HA worn up to 4 hrs/day (n=192) JAP HA worn 4-8 hrs/day (n=109) JAP HA worn more than 8 hrs/day (n=149) 1 4 8 5 7 18 20 15 23 27 25 28 27 29 14 16 22 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 8 2 2 1 very dissatisfied dissatisfied somewhat dissatisfied neutral somewhat satisfied satisfied very satisfied 28
% better + a lot better Communicate more effectively Participate in group activities Sense of safety Social life Relationships at home 20 22 23 76 72 69 66 65 57 37 63 68 59 60 65 48 59 59 53 61 60 42 41 67 56 60 59 66 48 69 56 54 53 63 44 FRA CH NOR GER ITA UK JAP 29
How did the following aspects change since person X is wearing hearing aids? % better +a lot better Communication with Person X Social activities together with Person X Personal relationship with Person X Quarrels/disputes with Person X 58 53 56 60 47 42 22 51 49 41 43 34 26 11 45 46 37 28 29 21 13 38 42 33 23 22 17 12 FRA ITA GER CH UK NOR JAP 30
Bars represent importance within each country (individual scale size per country) Reasons % somewhat a reason + a reason ITA FRA GER UK NOR CH JAP Uncomfortable 68 59 62 74 59 52 73 Hearing loss not severe enough 63 63 58 72 61 62 63 Hear well enough in most situations 73 55 68 54 68 64 49 They do not restore your hearing to normal 62 61 68 59 55 51 59 They do not work well in noisy situations 58 61 64 57 69 56 49 Have more serious priorities 65 69 54 62 44 * * Would be embarrassed to wear a hearing aid 65 * 55 52 39 * 41 Ear doctors opinion (ENT) * 73 55 * 42 53 * Bad design 65 * * 47 * * 37 Cannot afford a hearing aid 63 78 58 * * * * Have tinnitus (ringing in ears) * * * * 41 39 38 Hearing Aid Dispenser/Audiologists opinion * 61 * * * 46 * Do not admit I have a hearing loss in public 59 * * 46 * * * Family doctors opinion (GP) * 57 * * * 40 * Another hearing aid owners opinion * * 51 * * 40 * Have hearing loss only with high pitch sounds * * * * 38 * 40 Have not had hearing tested yet * * * 50 * * * Have hearing loss only with low frequency sounds * * * * * * 40 Sorted by overall importance * not within the Top10 reasons for this country Base: non owners Top 50% HL 31
Bars represent importance within each country (individual scale size per country) Reasons % somewhat a reason + a reason FRA CH NOR ITA UK GER JAP They do not restore your hearing to normal 75 77 75 76 84 77 84 They do not work well in noisy situations 79 91 88 73 67 80 86 Uncomfortable 79 76 59 45 75 62 87 Have tried hearing aid and they do not work 62 56 72 65 72 47 86 Hear well enough in most situations 81 89 84 56 65 73 * Hearing loss not severe enough 69 69 60 * 40 77 31 Have hearing loss in only one ear 67 * 43 * 40 48 31 Have hearing loss only with high pitch sounds * 69 41 * 39 55 28 Bad design * * * 54 42 43 30 Do not admit I have a hearing loss in public 63 44 * 55 * * * Would be embarrassed to wear a hearing aid * 50 * * 43 43 25 Have tinnitus (ringing in ears) 61 * 34 * * * 36 Have more serious priorities * 45 39 * * 49 * Have hearing loss only with low frequency sounds 65 * * * * * * Have Sensor-neural hearing loss (nerve deafness) * * * 53 * * * Social / Family opinion such as child, spouse, friend * * * 48 * * * I have vision or dexterity problems * * * 48 * * * Sorted by overall importance * not within the Top10 reasons for this country Owners who don t use, low sample sizes! 32
Non-owner: Think about the option to obtain / purchase a hearing aid. What do you think would influence you to obtain / purchase a hearing aid? CH Non- Owner (n=813) UK Non- Owner (n=795) FRA Non- Owner (n=809) GER Non- Owner (n=864) ITA Non- Owner (n=801) JAP Non- Owner (n=898) NOR Non- Owner (n=618) Influenceing factors non-owners Bars represent importance within each country (individual scale size per country) Hearing loss got worse 82% 69% 64% 74% 51% 65% 42% ENT/ Ear Doctor 51% 47% 53% 51% 51% 40% 33% GP /Family doctor 35% 58% 20% 23% 25% 32% 28% Spouse, relative, child, friend 47% 28% 26% 35% 16% 29% 30% Price of hearing aid 30% 32% 49% 28% 34% 21% 13% Free (Insurance, hearing aid free of charge) 35% 22% 42% 33% 18% 13% 17% Another hearing aid owner (word of mouth) 36% 25% 19% 17% 19% 13% 18% Hearing aid dispenser / Audiologist / Akustiker 38% 17% 22% 30% 26% 9% 27% Financial Situation improved 13% 15% 23% 22% 20% 8% * Safety concerns 19% * 17% 8% 18% 11% 10% Audiologist (NHS) * 38% * * * * Information/advice about hearing loss from consumer organisation or charity 13% * * * * * 10% Co-worker or boss 12% * * * * * * Hearing loss article or literature * * * * * 7% * Newspaper advertisement * * * * * 3% * Sorted by overall importance 33
We need to educate ENT doctors better We need to inform the hearing impaired better about reimbursement possibilities We should advocate adult screening programs (NB: diabetes!) We should educate politicians about the social cost issues (labor market, burn-outs, depression, dementia,) Channel more info to tinnitus patients re treatment options? 34
EHIMA Soeren Hougaard EHIMA secretary general Phone: (+45) 4045 7135 Email: sh@ehima.com sh@ehima.com 35
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GER UK FRA CH ITA NOR JAP 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Dispenser Listening situation Sound quality signal process. Product features %satisfied= % somewhat satisfied + % satisfied + % very satisfied HA-owners 37