Total cost of ownership

Buyers should not only focus on the initial product prices but should also consider the costs associated with repairs, battery replacements, ear dome or earmould replacements, and other post-fitting services. The total cost of ownership approach allows for a well-informed procurement preference.

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Ear domes and/or Earmoulds

Ear domes (also known as ear tips or ear cushions): These are small, bell-shaped silicone pieces that connect to the end of the hearing-aid tubing. It rests deep inside the ear canal. They are available in many different shapes and sizes to fit just about anyone’s ears. These small attachments are often soft and pliable and serve a crucial role in ensuring comfort and effective sound transmission for the wearer. They play a vital role in sealing the ear canal, which helps to improve sound quality, reduce background noise, and prevent feedback in hearing aids or earphones, ultimately enhancing the overall listening experience for users.

Earmoulds: Usually made of medical-grade plastic or silicone, these are custom- made so that they sit comfortably within the user’s ear canal, preventing a feedback loop, which is a high-pitched whistling that is caused when the amplified sound leaks out and is re-amplified. The process to develop custom-made earmoulds requires specialized equipment and materials, adding to the supply-chain complexity of hearing aids and time required for service provision and fitting. In most places, earmould impressions are sent to a lab where a trained technician develops the mould. This can add additional waiting time and requires follow-up visits to the clinic, which may limit access. Furthermore, earmoulds typically last 2 to 3 years for adults and 6 to 12 months for children. These earmoulds need to be made consistently available to ensure long- term usage. The medical-grade silicone or plastic is often unavailable locally and must be imported.

Table 37: Difference between earmoulds and ear domes

Ear domes Earmoulds
a hearing aid device. It has a beige-colored body that fits behind the ear. Attached to the main body is a clear, flexible tube that leads to an earpiece. There is a red arrow pointing to the earpiece, which is circled in red.
a hearing aid device. It consists of a beige-colored behind-the-ear (BTE) component connected to a clear, custom-molded earpiece that fits inside the ear canal. There is a red arrow pointing to the clear earpiece, which is encircled in red.
Function Small, soft attachments at the end of the hearing aid's sound tube Custom-made or semi-custom earpieces
Customization Available in various standard sizes and shapes Custom-made based on ear impressions
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Ear domes Earmoulds
Application

Mild to moderate hearing loss

Harnesses low frequencies and allows the hearing aid to amplify higher frequencies to be heard more clearly

Severe or profound hearing loss

Close fit stops amplified noises from moving back out of the canal and producing the high- pitched whistling noise created from loud sounds that leak out and become reamplified. This is known as a feedback loop

Comfort and Aesthetics Available in various standard sizes and shapes High level of comfort, secure fit
Cost < 1 dollar 18 – 19 dollars

i https://www.hearingaidaccessory.com/shop/domes/oticon-minifit-hearing-aid-domes-x2-sample-domes/

ii https://www.ihear.in/wp-content/uploads/2023/05/Resound-Pricelist-March-2023.pdf

Although ear domes provide less customization, which can potentially lead to comfort issues or reduced sound quality, they are advantageous in resource-limited settings. The trade-off between customization and cost becomes particularly relevant when considering the unique needs and constraints present in LMICs. With technological advancements, good quality hearing-aid models now offer suitable feedback cancellation, and hence the need for using earmoulds is reduced. They are thus required only for those with higher grades of hearing loss where greater amplification is needed and hence, they have a greater chance of feedback.

Batteries

Hearing aids either use a replaceable zinc-air battery or a rechargeable lithium-ion battery. When using a disposable battery, users would need to replace the battery every 135 – 540 hours of usage, depending on the processing power and features of the hearing aid. The size of the battery used in a specific hearing aid is also developed for and unique to hearing aids. Hence, local availability of a specific battery size is a key consideration. Hearing-aid batteries cost between 0.35 and 0.70 dollar per battery across LMIC markets, which translates to about 12 –50 dollars per year in battery costs depending on the depletion rate. When using a rechargeable battery, hearing aids need to be charged every day and batteries need to be replaced in 2 to 3 years. Rechargeable batteries typically cost above 30 dollars, translating into a yearly cost of 10 to 15 dollars along with a charger cost of 100 dollars which translates to 33 –50 yearly cost.

Rechargeable batteries have higher upfront costs making them more cost-prohibitive. Rechargeable batteries are better than zinc-air batteries when it comes to pollution levels of the environment. Most of the leading companies offer rechargeable hearing aids.

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Table 38: Indicative price of hearing aids accessories

Accessories Indicative Price (in United States dollars)
Zinc-air batteries 0.35 – 0.70
Rechargeable battery i 31
Charger 100 – 130
Hard BTE earmould 19
Soft BTE earmould 18

ihttps://www.ihear.in/wp-content/uploads/2023/08/OTICON-Hearing-Aid-Price-in-Kolkata.pdf↩︎