Soren Hougaard, EHIMA - Anovum 2012.… · European Hearing Instrument Manufacturers Association...

European Hearing Instrument Manufacturers Association

Advances in Audiology, Las Vegas Soren Hougaard, EHIMA

1

http://www.anovum.com/en.html


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


EuroTrak and JapanTrak were designed and executed by

www.anovum.com 4

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

http://www.anovum.com/



12.5% 11.6%

10.9%

9.4% 9.1% 8.8% 8.8%

11.3%

Germany Italy Japan France UK Norway Switzerland USA

(MarkeTrak

2009) 2012

% 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

Source: EuroTrak /JapanTrak 5



<= 14

15 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

74+

Ag

e g

rou

p

Women: Unimpaired non-owner Women: Impaired non-user Women: HA owner

Men: Unimpaired non-owner Men: Impaired non-user Men: HA owner

<= 14

15 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

74+

Ag

e g

rou

p



<= 14

15 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

74+

Ag

e g

rou

p



<= 14

15 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

74+

Ag

e g

rou

p



<= 14

15 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

74+

Ag

e g

rou

p



<= 14

15 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

74+

Ag

e g

rou

p



“older” populations:




3.7% 3.7% 3.4% 4.2% 2.8% 2.9%

1.5% 2.8%

42.5% 41.1% 38.8%

34.0%

30.4% 29.6%

14.1%

24.6%

Norway UK Switzerland Germany France Italy Japan USA

(MarkeTrak

2008) 2012 (% of population) 2012 (% of stated impaired)

Adoption: Proportion of people with hearing aid (% of population) and adoption rate (% of stated impaired)

Source: EuroTrak /JapanTrak


• Health care system

• Reimbursement system / income structure

• Market development

• Culture

• Other factors.

7



76% 74% 76% 74%

64%

44% 39%

75% 75%

63% 60% 61% 59%

36%

60% 58%

47%

Norway Switzerland Germany France UK Italy Japan

2012/2011 2010 2009 or earlier (EuroTrak 2009)



• Health care system

• Reimbursement system / income structure

• Market development

• Professional “attitude”

% Binaural fitting

8



4% 2% 3% 2% 2% 2% 2% 3% 3% 4% 4% 3% 3% 3%

26% 25% 22% 20% 21% 20% 15%

67% 70% 71% 74% 74% 75% 80%

Italy Japan Germany Norway France UK Switzerland

No

Yes, sometimes

Yes permamently in

both ears

Yes permamently in

one ear

Do you have tinnitus (ringing or other noises in the ears or head) in one or both ears ?




39% 36% 34% 27% 26%

15% 12%

46%

13%

49% 42%

31% 36% 36%

16%

51%

17% 31%

43% 49% 52%

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

13% 5% 7% 4% 8% 3% 2%

40%

12%

45%

14% 13% 22% 8%

47%

83%

48%

81% 79% 75% 90%

permanently

Tinnitus

sometimes

Tinnitus



• Health care system / income structure

• Culture

• etc.

Have you ever thought about a treatment of your tinnitus?

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/audiologist

Owner of a hearing aid




100%

80%

48%42%

38% 34%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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

40%

29%

20%Drop out:

Drop out:

Drop out:

Impaired ENT/Doctor OwnerRecommend




100%

80%

48%42%

38% 34%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



further action)



Bought hearing aid

40%

29%

20%Drop out:

Drop out:

Drop out:


100%

76%

48%37% 34% 30%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



further action)



Bought hearing aid

37%

37%

24%Drop out:

Drop out:

Drop out:


100%

76%

58%51%

41% 43%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



further action)



Bought hearing aid

23%

27%

24%Drop out:

Drop out:

Drop out:


100%

73%

44% 48%39% 39%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



further action)



Bought hearing aid

39%

13%

27%Drop out:

Drop out:

Drop out:


So

urc

e: E

uro

Tra

k /Ja

pa

nT

rak

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


31% 19% 13% 13% 12% 12% 10%

18% 28%

16% 26% 30%

17% 16%

14% 24%

15%

21%

36%

16% 22%

37% 29%

56% 40%

21%

55% 53%

Japan Germany Italy Switzerland Norway France UK

No, never

Yes, more than 5 years

ago Yes, in the last 1-5

years Yes, in the last 12

months

Have you ever had your hearing tested? (Base:population)

14



49% 38% 43%

14% 37%

85%

13% 26%

15%

GP ENT Audiologist (inc. NHS)

73%

22% 31% 9%

31%

89%

11%

44%

11%

GP ENT Audiologist

76%

19% 33%

11% 37%

90%

12% 38%

10%

GP ENT Audiologist

49% 38% 43% 14% 37% 85% 13% 26% 15%

G…

Referred to an ear

doctor (ENT)

Referred to a hearing

aid dispenser /

audiologist (incl.

NHS) Recommended to get

a hearing aid

Recommended no

further action


Recommendations by profession

15



25

34

33

33

37

37

37

41

49

55

30

23

26

27

23

24

26

28

24

23

45

43

41

39

39

39

37

31

27

22

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Hear well enough in most situations

Family doctors opinion (GP)

Uncomfortable

They do not restore your hearing to normal

Hearing Aid Dispenser/Audiologists opinion

They do not work well in noisy situations

Hearing loss not severe enough

Have more serious priorities

Ear doctors opinion (ENT)

Cannot afford a hearing aid

Reason Somewhat a reason Not a reason

Cannot afford a hearing aid

Top 10 reasons for not having a hearing aid




2. Hearing rehabilitation: Societal and personal benefits

17


How useful are your hearing aids on your job?

12%

17%

10%

14%

8%

5%

10%

46%

33%

36%

27%

30%

32%

20%

42%

50%

54%

59%

62%

63%

70%

Japan

UK

Italy

Norway

Germany

France

Switzerland

Of no use Of some use Of significant use

N: UK 144/FRA 204/ GER 209 Source: EuroTrak /JapanTrak

18



9%

10%

8%

4%

3%

7%

14%

8%

9%

7%

3%

2%

7%

11%

11%

14%

9%

5%

4%

7%

15%

6%

15%

12%

8%

8%

13%

12%

7%

12%

11%

7%

7%

12%

12%

10%

15%

11%

9%

9%

12%

18%

35%

19%

34%

44%

44%

39%

39%

31%

26%

35%

45%

45%

40%

35%

37%

36%

37%

47%

55%

58%

43%

31%

41%

30%

25%

29%

25%

24%

28%

39%

32%

25%

26%

25%

30%

25%

27%

30%

25%

15%

15%

16%

19%

15%

16%

19%

16%

16%

11%

26%

14%

16%

21%

19%

16%

12%

16%

8%

13%

14%

17%

8%

7%

Germany

Switzerland

Italy

UK

France

Japan

Norway

Germany

Switzerland

Italy

UK

France

Japan

Norway

Germany

Switzerland

Italy

UK

France

Japan

Norway

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

I think that people with an untreated hearing loss tend

not to get the job they deserve

I think that people with an untreated hearing loss tend to

be under-salaried


Countr

ies a

re s

ort

ed b

y th

e a

vera

ge “

rath

er+

str

ongly

agre

e”

over

the thre

e q

uestions

Base: Hearing aid owners

19


European Hearing Instrument Manufacturers Association Source: EuroTrak /JapanTrak

20



32%

16%

19%

14%

17%

9%

4%

37%

41%

29%

27%

21%

21%

11%

Italy

UK

Germany

Japan

France

Norway

Switzerland

Hearing aid Top 50% hearing loss, no hearing aid

Depression symptoms: PHQ-2 Screening: In the last 2 weeks: • Little interest or pleasure • Feeling down, depressed, hopeless


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 with depression symptoms



59%

61%

66%

66%

57%

69%

56%

56%

56%

63%

54%

62%

42%

52%

15%

19%

6%

13%

4%

5%

4%

17%

2%

7%

3%

6%

3%

5%

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%)

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%)

FRA with hearing aid FRA no hearing aid (but sig. HL top 50%)

NOR with hearing aid NOR no hearing aid (but sig. HL top 50%)

Yes somewhat more Yes, much more

Base: Hearing aid owners and non owners with top 50% hearing loss

Dementia symptom: •Getting more forgetful in the last year?









% of people getting more forgetful



Source: CH-Blick; 13.4.2012

Mentally and

physically

exhausted

people

….

cost CHF 4.2

billions/year

in Switzerland




38%

29%

30%

26%

26%

25%

29%

40%

37%

47%

44%

31%

32%

26%

35%

23%

24%

23%

20%

17%

15%

38%

42%

35%

40%

22%

28%

25%

15%

16%

15%

11%

18%

8%

10%

26%

27%

15%

16%

24%

15%

18%

15%

13%

11%

7%

10%

6%

6%

25%

18%

14%

10%

20%

14%

12%

ITA UK

GER JAP FRA NOR

CH

ITA UK

GER JAP FRA NOR

CH

ITA UK

GER JAP FRA NOR

CH

ITA UK

GER JAP FRA NOR

CH

Rather agree Strongly agree

In the evenings I often feel

physically exhausted

In the evenings I often feel

mentally exhausted

No hearing aid (but significant hearing

loss top 50%)

Hearing aid

No hearing aid (but significant hearing

loss top 50%)

Hearing aid











3. Satisfaction with and reasons not to use hearing aids

25


5

3

7

2

1

1

12

3

4

3

3

4

1

20

7

11

8

3

7

5

27

20

11

9

15

7

10

21

40

14

22

26

17

19

14

24

43

35

35

50

46

1

6

14

16

16

14

19

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Japan (n=450)

Italy (n=510)

Norway (n=691)

UK (n=501)

Germany (n=500)

France (n=502)

Switzerland (n=514)

very dissatisfied dissatisfied somewhat dissatisfied neutral

somewhat satisfied satisfied very satisfied


% Overall satisfaction with HA

26

% satisfied

84%

80%

77%

72%

72%

70%

36% !



6

2

1

4

2

9

7

3

1

0

1

0

1

18

6

5

2

5

3

5

3

5

1

7

1

1

0

26

16

12

4

11

11

12

7

5

1

12

4

8

3

24

26

21

15

12

6

10

6

18

10

5

8

9

10

18

25

35

44

16

12

25

22

27

24

17

17

20

18

9

22

23

26

40

49

28

38

28

43

42

57

44

48

0

3

5

8

11

18

11

18

13

20

17

12

17

21

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

JAP 2009 or earlier (n=213)

JAP 2010 or after (n=201)

ITA 2009 or earlier (n=160)

ITA 2010 or after (n=310)

NOR 2009 or earlier (n=329)

NOR 2010 or after (n=334)

UK 2009 or earlier (n=163)

UK 2010 or after (n=295)

GER 2009 or earlier (n=249)

GER 2010 or after (n=236)

FRA 2009 or earlier (n=202)

FRA 2010 or after (n=287)

CH 2009 or earlier (n=238)

CH 2010 or after (n=270)

very dissatisfied dissatisfied somewhat dissatisfied neutral somewhat satisfied satisfied very satisfied


Overall satisfaction with HA

27



1 4

8

1 1

2 1

5

5 6

13

2 0

5

0 1 3

1 0 1

7 5

18

1 1

9

2 2

9

1 3

9

0 1

11

3 2

16

0 0

3

15 20

23

3 8

13

7 16

13

8 5

11

1 0

11

5 12

6

5 3

8

27 25

28

13 21

30

5 6

21

3 5

22

10 12

28

5 4

25

4 11

18

27 29

14

39 46

33

11 17

16

21 29

18

26 29

20

15 19

20

17 12

28

22 16

8

34 18

12

49 51

30

42 35

20

37 44

18

53 54

28

47 62

30

1 2 2

9 5 3

24 9

5

20 17

7

24 13

6

19 9

2

26 11

13

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

JAP HA worn more than 8 hrs/day (n=149) JAP HA worn 4-8 hrs/day (n=109)

JAP HA worn up to 4 hrs/day (n=192)

ITA HA worn more than 8 hrs/day (n=213) ITA HA worn 4-8 hrs/day (n=177)

ITA HA worn up to 4 hrs/day (n=119)

NOR HA worn more than 8 hrs/day (n=320) NOR HA worn 4-8 hrs/day (n=146)

NOR HA worn up to 4 hrs/day (n=225)

UK HA worn more than 8 hrs/day (n=236) UK HA worn 4-8 hrs/day (n=131)

UK HA worn up to 4 hrs/day (n=134)

GER HA worn more than 8 hrs/day (n=221) GER HA worn 4-8 hrs/day (n=144)

GER HA worn up to 4 hrs/day (n=135)

FRA HA worn more than 8 hrs/day (n=284) FRA HA worn 4-8 hrs/day (n=145)

FRA HA worn up to 4 hrs/day (n=73)

CH HA worn more than 8 hrs/day (n=261) CH HA worn 4-8 hrs/day (n=115)

CH HA worn up to 4 hrs/day (n=138)

very dissatisfied dissatisfied somewhat dissatisfied neutral somewhat satisfied satisfied very satisfied


Overall satisfaction with HA

28



23

20

41

22

37

44

48

42

48

57

63

66

60

65

65

53

59

61

60

66

54

60

53

59

69

56

56

59

68

72

69

67

59

63

76

Relationships at home

Social life

Sense of safety

Participate in group activities

Communicate more effectively

% better + a lot better

FRA

CH

NOR

GER

ITA

UK

JAP

29 Source: EuroTrak /JapanTrak



How did the following aspects change since person X is wearing hearing aids?

12

13

11

22

17

21

26

42

22

29

34

47

23

28

43

60

33

37

41

56

42

46

49

53

38

45

51

58

Quarrels/disputes with Person X

Personal relationship with Person X

Social activities together with Person X

Communication with Person X

% better +a lot better

FRA

ITA

GER

CH

UK

NOR

JAP




Base: non owners Top 50% HL


So

rted

by o

ve

rall im

po

rtan

ce

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

* not within the Top10 reasons for this country



Owners who don‘t use, low sample sizes!


So

rted

by o

ve

rall im

po

rtan

ce


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 * * *

* not within the Top10 reasons for this country



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 ?


So

rted

by o

ve

rall im

po

rtan

ce

Influenceing factors non-owners

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)


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 l iterature * * * * * 7% *

Newspaper advertisement * * * * * 3% *



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: [email protected]

35

[email protected]


36


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

GER UK FRA CH ITA NOR JAP

HA-owners

Dispenser Sound quality

signal process. Product features

Listening situation

%satisfied= % somewhat satisfied + % satisfied + % very satisfied



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