How to invest in the latest developments in hearing technology

Traditionally dismissed as a relative backwater, this branch of medicine is about to move into the limelight thanks to ageing populations and major breakthroughs, says Matthew Partridge

Hearing problems are often dismissed as a niche concern when it comes to medical care. This is perhaps largely because they are seen as an inevitable consequence of getting older. But in an ageing world where one in ten people are already over the age of 65, more and more people will suffer from problems with their hearing. What’s more, there are some interesting technological developments taking place in this field. There is, in short, ample scope for this subsector to grow. Francesco Conte, JP Morgan European Smaller Companies Trust’s lead investment manager, says that €15bn is spent each year on devices such as hearing aids – just 0.2% of global health expenditure. 

Generation X can’t hear you

The demand for hearing care in all forms has grown particularly strongly in recent years. Hearing problems have overtaken eye trouble as the most common sensory disorder in the developed world, says Dr Lawrence Lustig, Howard W. Smith professor and chair of the department of otolaryngology, head and neck surgery at Columbia University Medical Center and New York Presbyterian Hospital. Lustig thinks this is largely due to an ageing population. 

However, there is also strong evidence of “an increased incidence of hearing loss among those who are still relatively young”. This may be due to the “greater ubiquity of personal audio devices” over the past four decades. This doesn’t just include all the people who spend time listening to music from their smartphones, but also the generation that first embraced the Walkman in the 1980s, now reaching middle age. Those who listened to loud music in the 1960s and 1970s are also experiencing problems.

What’s more, there is an increasing awareness that sensory health “is just as important as our physical health”, says Karen Shepherd, director of professional standards at Boots Hearingcare. Part of this is a result of the impact that poor hearing can have on someone’s mental health; people feel socially isolated. 

However, there is also increasing evidence that the quality of our hearing has an impact on our physical state. Studies show that “if you do start to lose some of your high-frequency hearing [which helps you make out high-pitched sounds] and you start to mishear certain words”, it forces you to “use other cognitive senses to try and identify what that word is”. Over time that can cause “fatigue, neural changes, and cognitive decline” – and possibly even dementia.

A 2013 study by Johns Hopkins University of 2,000 pre-screened volunteers found that declines in thinking skills happened faster among people with hearing loss than among those without it. While those with normal hearing took 11 years to develop cognitive impairments, those with hearing problems started to experience difficulties within only eight years. Although it’s possible that both hearing loss and cognitive decline were caused by an unexplained factor common to both conditions, more recent studies, including one published in the Lancet last year, suggests that early treatment, such as the use of hearing aids, can cut the risk of dementia.

Hearing aids are getting better...

The humble hearing aid remains the most visible part of the hearing-loss market. Around 17 million units were sold worldwide in 2019, and revenue is growing by around 6% a year, according to the European Hearing Instrument Manufacturers Association. However, the market for these devices is about to undergo some radical changes, says Dr Laurel Christensen, chief audiology officer for GN Hearing. At present they are only available through hearing-healthcare professionals in most countries, including America, the largest market for hearing aids. While this rule was put in place to make sure that hearing problems aren’t caused by any serious underlying medical condition, it may discourage people who could otherwise benefit from buying one.

However, in 2017 America’s Food and Drug Administration (FDA) formulated rules for a new category of hearing aid that can be purchased over the counter. They have yet to be implemented, but legislators from both political parties support the idea. As a result, people could soon be able to buy hearing aids from a supermarket, or online, without having to go to a store at all. Christensen hopes that more people with mild hearing loss problems will therefore get help for their hearing sooner.

At the same time the technology underpinning hearing aids is constantly evolving. Today’s hearing aids “are markedly different from your grandfather’s clunky” one, Christensen says. Not only are they smaller and less obtrusive, but the sound quality is also “much better”. 

For example, GN Hearing has recently launched the ReSound ONE Hearing Aid, which puts the microphone in the ear of the hearing-aid user rather than at the top of the ear, as is most common today. This improves sound quality, reduces wind noise (a major challenge with conventional hearing aids) and makes it easier for the wearer to determine the direction the sound is coming from.

Christensen expects the technology to evolve further in the next few years. She expects artificial intelligence (AI) to play a big role in the hearing aids of the future. AI will help the devices tune out unwanted sounds at the right time by learning to recognise noise patterns. 

People will also increasingly be able to personalise their hearing aids so they can set the extent of wind-noise reduction and other features. What’s more, even though overuse of personal music devices is damaging people’s hearing, hearing-aid makers are learning from designs and technology in consumers’ headsets.

... and more advanced treatments are improving too

While hearing-aid technology is constantly improving, people whose hearing loss is more profound may require more radical treatment involving surgery and more complicated devices. One of the most cutting-edge surgical procedures is cochlear implants, says Joseph Manjaly, a consultant otologist, auditory implant and ENT surgeon at University College London Hospital. The procedure, aimed at those “whose natural acoustic hearing is too poor to be amplified with conventional hearing aids”, works by implanting a device that can generate electronic signals to replace those normally produced by the cochlea, a part of the inner ear. These signals are in turn delivered by the auditory nerve to the brain, where processing allows hearing and understanding of spoken language again.

In the past, the procedure was viewed as an absolute last resort, as it is expensive (it costs the NHS around £40,000), takes several hours and will not work for all patients. However, advances in technology mean that the time required for the procedure has shrunk to less than an hour per ear, while it is now accepted that it can be a “life-changing operation” for both those who are born deaf and people who lose their remaining hearing later in life. There is also a medical consensus that it should be done as soon as possible after severe deafness is diagnosed, so the brain is still able to decode the signals coming from the device, in order to maximise the chances of success.

There is now also increasing evidence that people with hearing loss in one ear or in both can benefit from implants. Similarly, there is a drive to offer implants to babies within one year of birth, rather than waiting until they are older, to achieve better outcomes. At the same time, Manjaly also notes that other surgical implants have starting to emerge. 

The new ones include bone-conduction implants, which bypass a damaged middle ear and deliver sound directly to the inner ear, and middle-ear implants for people struggling with conventional hearing aids. There is still enormous room for growth. While according to the Ear Foundation more than 600,000 people worldwide have received cochlear implants, Reo Liao, market analyst with IG Index, believes that in the developed world alone 15 million people could benefit from some sort of implant. This means that “the global supply of cochlear implants units is still far below the number of patients who demand it” and could potentially grow twentyfold.

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