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051 – Richard Einhorn – Jacoti + Qualcomm & The Consumerization of Hearing Health

This week’s episode of the Future Ear Radio podcast features consultant and musician, Richard Einhorn. Richard has consulted for Jacoti, a software-based hearing augmentation company, since 2014. So, when the news broke that Jacoti was partnering with Qualcomm to integrate its hearing augmentation software into Qualcomm’s chips, I figured that Richard would be a great guest to have on to talk through the details of this partnership and the implications that will stem from it (shout out to Shari Eberts for connecting me with Richard!).

We begin with Richard sharing the backstory of how he met Jacoti founder, Jacques Kinsbergen and came to be a consultant for Jacoti. Richard developed sudden hearing loss around ten years ago, and was experimenting with all kinds technology to help compensate for his loss. Due to his background in audio technology, he was drawn to many of the capabilities that smartphones were utilizing and stumbled upon Jacoti in 2014. From there, he met with the team and a business relationship was formed.

Jacoti first started at the app-level, with its smartphone app, The Listen App. Over time, however, Jacques and the team determined that the best use of its technology required it to be integrated at the chip-level, which is what led the company to approach Qualcomm. A few weeks ago, it was announced that Jacoti and Qualcomm would be partnering via Qualcomm integrating Jacoti’s technology into its chips.

This is a seminal moment in our global, collective effort to combat hearing loss, as it has the potential to introduce people to hearing augmentation and amplification at a scale not seen before. As Nick Hunn pointed out two episodes back, nearly all the hearables on the market today are powered by either Qualcomm or Broadcomm chips (excluding Apple which manufacturers its own chips). So, when one of the major chip developers provides the ability for any hearable OEM to offer Jacoti capabilities (i.e. self-administered hearing tests resulting in an audiogram), out of the box, it translates into hearing augmentation becoming a mainstream feature.

Just as we’re seeing the majority of hearable devices priced at $100 or more entering the market today having active noise cancellation (ANC) built in, the same is now possible for hearing augmentation. Qualcomm helped to standardize ANC because it enables the feature at the chip level (and is attempting to do the same for “Adaptive Noise Cancellation“). Providing white-label functionality out-of-the-box, enables hearable OEMs to provide features without having to develop or build them themselves; in essence it standardizes those features.

That’s not to say that all hearing augmentation and enhancement is created equal. There are multiple companies that provide way more depth and robust functionality around this particular feature set (i.e. Nuheara). That’s not really the point though. The point is that standardizing even a basic level of hearing enhancement helps to expose people to this functionality at scale. Most people don’t even realize they have a hearing loss, let alone what hearing correction sounds like.

This conversation was so enjoyable because Richard and I were so aligned with our thinking here. We both agree that these type of integrations have a “rising tide lifts all ships” effect. The penetration rate of hearing aids and the overall adoption numbers suggest that hearing aids are not suited to treat the full spectrum of hearing loss as they primarily cater to the more severe levels of hearing loss. However, consumer earbuds with a mild degree of augmentation provides consumers of a taste of what that correction sounds like and hopefully creates an effect whereby folks will be more open to graduating into higher levels of technology as their hearing loss progresses.

This remains to be seen whether or not hearing augmentation will appeal to consumers who fall on the mild end of the spectrum of hearing loss. What is becoming clear, however, is that the devices that will be entering the market in the coming years will be fully capable of supporting a wide variety of features that are novel today, but will be mainstream soon enough.

-Thanks for Reading-
Dave

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Transcription

David:

All right. So we’re joined here today by Richard Einhorn. Richard, tell us a little bit about who you are and what you do.

Richard Einhorn:

Sure. Basically, I have two roles that I play in the world. One is that I’m a composer and a former record producer and recording engineer. I write music and my music gets played all over the world. The other thing that I do, and the reason why I’m here is that I’m both a consultant and an advocate for better hearing loss technology. In 2010, I experienced a very devastating sensory neural hearing loss, I had pre-existing otosclerosis. And then in 2010, I lost the use of my right ear from sudden sensory neural hearing loss. And as a result, I literally plunged overnight into the world of hearing health technology.

Richard Einhorn:

Because of my background in audio technology, I’ve owned a recording studio since I was about 15 or 16 and I’ve had one throughout my life. I had one in my dorm room. I had one in all my apartments and I’m sitting in one right now. Because of this background, I realized that although hearing aids were doing me a world of good in many situations. In certain situations, I realized that there was technology that hearing aids weren’t using that I could use. And I started to play around with various solutions and started to get more and more interested in the world of hearing health technology.

Richard Einhorn:

And I started to tell people about the solutions that I was coming up to help me hear better. They told other people. And then in 2014, I formed a consulting business. And that’s basically one of the main things that I’ve been doing ever since.

David:

No, that’s awesome. Well, thank you so much for joining us today. And the reason I wanted to bring you on as a testament to what I love so much about this podcast is that as it’s grown, I’ve been fortunate to create a network. And when the news broke of what we’re going to talk about today, the news around the Qualcomm and Jacoti partnership. I had been tweeting about it, was really, really excited. And lo and behold Shari Eberts, who has been on the podcast before, she sends me an email and she says, “Hey, Dave, I saw you tweeting about this and you might be interested in speaking with my friend Richard Einhorn.” So gave me some background on you. And I was like, “Yeah, that sounds amazing. I would love to have Richard come on.”

David:

Because it sounds like you’ve worked pretty closely with Jacoti. You’ve had a relationship with them since about 2014. So just to give a little bit of context here for those that aren’t aware of the news. I think it was about last week Qualcomm announced that they are embarking on a new partnership with Jacoti. So Qualcomm being one of the lead suppliers for the computer chips that power most in-the-ear devices. I just had Nick Hunn on last week where we talked about how there’s really two suppliers, there’s Broadcom and there’s Qualcomm for the vast majority of chips.

David:

So their flagship chip, the QCC5100 which is again finding its way into more and more of these hearable devices. It’s actually now going to have the ability for OEMs to more or less enable Jacoti’s technology into it. So you almost are going to see this standardization, I think, of a level of hearing augmentation for a lot of these in-the-ear devices.

David:

They’re not going to have to create it from scratch. They’ll be able to use the out-of-the-box solution that Qualcomm has been building with Jacoti. So why don’t we just kick things off by going back for you, Richard. In terms of the relationship with Jacoti, can you just speak to how you got to know them and some of the work that you’ve done dating back to 2014? And then how things have progressed all the way up to this partnership in 2020.

Richard Einhorn:

Sure, happy to. A friend of mine in the hearing loss world lives in Silicon Valley. And he had seen a demonstration by a fellow named Jacques Kinsbergen of some very, very interesting iOS apps that basically put an audiologically valid pure tone, average hearing test into the app. And also another app that use the audiogram that was generated by the hearing test as the basis for an audiological level fitting. So my friend said, “Would you like to meet this guy because I know that you’re interested in consumer solutions for hearing health?” And he knew that I had done a lot of hacks with the iPhone in order to get it to work in restaurants, where I had an unbelievable amount of difficulty hearing.

Richard Einhorn:

So I said, “Sure, please put me in touch.” So Jacques, it turns out lives in Antwerp, Belgium. And he and I arranged to have a meeting. And I’d say that within five minutes or so, we knew immediately that we were on exactly, exactly the same wavelength. And both of us believed that a lot of consumer mobile devices, smartphones, earphones, earbuds, headphones, microphones that consumers could get. All of these things could be leveraged to vastly improve hearing health technology and people’s access with it.

Richard Einhorn:

So we started to talk and the more we talked, the more we realized that we might have some kind of business relationship together. Jacques flew me over to Europe where I met the entire company. I immediately just loved everybody. I loved the energy. And we were talking again, exactly the same language in terms of the consumerization of hearing health. So we agreed to work together, that I would be hired as a consultant for them. And I would say that almost without exception, since 2014, nearly every week, I’ve done at least some work for the company.

David:

That’s awesome. Okay. So 2014, you identify this awesome group of people that are thinking along the same lines as you. So you mentioned this thought that you had around the consumerization of hearing health. What were these conversations like, that were so prolific in your mind where you said, “Wow, these people are on the same wavelength as me.” What was it in your mind back then that you felt was lacking in the market that could be created?

Richard Einhorn:

That’s a great question. My feeling, and I want to preface my opinions here as saying that they are my opinions. I’m not an audiologist, but I have immense respect for audiologists and their trainings. I have on my shelves, several audiology textbooks and I’ve tried to read them and they’re amazing and wonderful. But I want to preface with those, but I want to say that I believed from the beginning, when I fell into this world. I felt that a lot of the technology that we were using in professional audio and that was also available at the consumer level was not being properly leveraged to help people hear better.

Richard Einhorn:

A perfect example is a smartphone, particularly, when I began, it was the iPhone. But now Android phones have caught up to the iPhone in terms of audio capability. But a smartphone has really, really, really good audio specifications and so do the typical headphones and earbuds that came with it. And it also has a pretty good microphone. And what you have in your hands, if it’s leveraged properly, could be an excellent, portable amplifier that could be used there. What you also have inside of a smartphone is the possibility for advanced digital audio signal processing.

Richard Einhorn:

As a matter of fact, in my business, which is music, and I do a lot with computer music and electronic music. You have all the things that you need in order to do a lot of very, very sophisticated signal processing, just literally in your pocket. So why isn’t this being utilized? Jacques with some absolutely brilliant engineers from Barcelona had developed some really, really fascinating apps that answered that question. Why aren’t they being utilized? Among those apps, and these were all for iOS because at the time that platform was a little bit more congenial for advanced audio technology.

Richard Einhorn:

One of those apps was literally an empirically valid pure tone, average hearing test. It uses a pair of two tones, a high tone and a low tone. And then you respond when you hear those tones, then it goes onto another pair of high and low tones, et cetera. And it created an audiogram that was nearly identical, if not identical, to my quote, official audiogram. And this was being done with an iPhone, with Apple earbuds, et cetera. It was just remarkable.

Richard Einhorn:

And then the other software that they created for the iPhone, the other app they created was an app, which took that audiogram. Or took an audiogram that you entered a quote unquote professional audiogram. Took either of these audiograms and generated a hearing fitting that was based on audiological hearing fittings like NAL-NL2. Literally, when you used that app, which was called ListenApp, you could use the iPhone with a hearing loss compensation fitting algorithm in order to hear the world.

Richard Einhorn:

So I would take my hearing aids out when I would go to a restaurant. I would then put on the regular set of Apple earbuds or a third-party set and simply hook up my phone sometimes to a remote microphone. And I would be able to hear in places where I couldn’t hear otherwise. And this is what attracted me to Jacoti’s technology. And that’s, what’s meant by the consumerization of audio.

Richard Einhorn:

What’s going on now, of course, is that the technology that was available only in a smartphone at the time. A lot of that digital signal processing, a lot of that capacity for amplification, and for pickup by microphones can now be done literally at the ear level. Rather than simply on the phone coupled to a device that’s coupled to your ears. So now all of that power… Not all that power, but a significant subset of that power can be placed literally into the ear.

Richard Einhorn:

And that was the insight that Jacques had around 2016, 2017 to create devices that could do all the hearing loss compensation that we were doing in the iPhone apps. But to do that at the ear level. And that’s when I believe conversations with Qualcomm began.

David:

Yeah, that’s fascinating for a number of reasons. Going back to what you said about the noisy restaurant, I find this really fascinating. Because back then, I think to your point, there were a number of advantages to a solution that was very smartphone centric. Some of that now has begun to graduate, I think up to the ear and it’s more or less the digital signal processing chips, the DSP chips that are capable of doing that.

David:

But I think that what I find really interesting about this whole thing is you had Jacques and his team coming at this from the approach of they started at the app level more or less. They started with the software and they realized that there were gaps in the market and gaps for the patients more or less in terms of how they use it.

David:

So when you were back in those early years, 2014 and on, did you get the sense that this was going to be a precursor for the way in which consumer devices in general would be able to graduate toward, more or less it was manifesting itself through an app. And one day you thought, “Okay, this will probably be able to move into something that can be done all at the ear level.”

David:

I’m just curious, those conversations that you were having back then was that always the mindset was like, you almost had to just bide your time as technology like Moore’s law more or less took effect. So that you could take advantage of those leaps in computing in the microtization of the devices. Was that the thought process that you had?

Richard Einhorn:

Yeah, that’s a great question. I think so, but I think the conversations were more fluid. I think that both Jacques and I, and Jacques has a far deeper understanding of the technology than I do. But I think that what Jacques and I, and the other people in the company felt from the beginning was that there was a different way to approach hearing health technology solutions. I felt from the moment my credit card was first charged for a hearing aid that these devices were very, very expensive. And I was very puzzled as to why they necessarily had to be that expensive.

Richard Einhorn:

I’ve learned a lot since that original puzzlement, but I still believe that for many situations and many hearing losses that there’s a lot of different ways that these could be handled. And if you start looking at it as we both know, somewhere between 20 and 30% maximum of the people who need hearing aids actually get them. And if you actually look around the world, those figures are even lower.

Richard Einhorn:

And both Jacques and I felt very strongly that hearing health technology should be accessible to everyone. And when you start thinking of the expense and also the considerable amount of time it takes a consumer to simply be able to put something in his or her ear and amplify sound. It seemed to both him and me independently, and then as we had conversations that there was a different way to do this.

Richard Einhorn:

So I don’t know. Almost from the moment I developed hearing loss, I always had in mind that there should be a class of devices that could be available over the counter for people with milder hearing issues. And that some devices like that could be very, very useful and could serve as a bridge for those people with progressive hearing loss towards ultimately a more involved, fine tuned adjustment experience.

Richard Einhorn:

I always felt that there wasn’t a fine line between clinical hearing loss and simply situational problems in hearing. I felt that there was always room for amplification. Live amplification products that could ultimately be customized and then customized further. And then ultimately if one is unfortunate enough to develop a clinical level of severe hearing loss, ultimately be completely curated by a highly trained professional.

Richard Einhorn:

So we batted around many, many ideas. And then Jacques had, what I think is quite an extraordinary insight in which he said, “This has to be at the operating system level. This has to be at the chip level. If we are going to truly create hearing technology that is accessible to everybody, we need to reach the chip level.” And I believe that’s when conversations with Qualcomm began.

David:

Yeah. That’s so interesting when you talk about the chip level, because I think this is starting to become apparent. I’ve been talking about this for a few years it’s like the significance of being that deeply integrated. It enables a level of standardization that you don’t see elsewhere. And a perfect example of this is what we’re seeing right now with active noise cancellation. Just about every new device, that’s about $100 or more that’s coming out in the market. They have active noise cancellation. And if you look, almost all of them are powered by the Qualcomm QCC5100. And it wasn’t long ago that Qualcomm announced that they were basically going to enable active noise cancellation for that type of chip. It was going to be like an add-on, think of it like that.

David:

So we’re seeing the same thing now. And what’s so exciting about this partnership is that we’ve been hearing about the OTC legislation. And to your point, I’m in full agreement with you. I think that we need an equivalent to Cheaters in this industry, in terms of like the parallel being Cheaters in optometry. Which I had a guest on the podcast not long ago, Dr. Kim Cavitt, she mentioned that Cheaters actually ended up growing the whole optometry market. You exposed more people to a solution.

David:

I think the same would be for this industry, like you said, you only have 20 to 30% of the people that should have hearing aids are getting them now. And it’s probably lower than that. So we need something that is at that introductory level. I’m a big, big proponent of that. And I think what’s so fascinating to me about this whole partnership is that we’ve been hearing about like, “Okay, OTC, OTC. We’re going to have these new classification of devices.”

David:

But the whole report came out during the Obama Administration where he recommended it. So that was at least four years ago. And then we had everything happened since. So this has been an ongoing thing for at least five years and we still haven’t had anything coming to market yet. And lo and behold, you have the technology just working itself out. This is what I find so fascinating about technology is that, it’s like you can try to… Inevitably it will just work itself out.

David:

And because you have just, as you outlined this progression where it was limited to the smartphone and the processing capabilities that you were able to do there, and then give it time. And now it’s being able to be handled actually on the device. So you have these in-the-ear devices that are now going to be able to support the type of hearing augmentation. And I think what’s fascinating about this is it almost renders the whole OTC conversation moot. Because you now suddenly just have these devices that are…

David:

Any in-the-ear device manufacturer, any OEM, they can create something that has a basic rudimentary level of… And honestly, I think it’s going to be better than just like a rudimentary level. I think there’ll be pretty good. And I think that you’ll have some specialization. You have companies like a Nuheara for example, where they’re doubling down in this space. So they’re going to have an advanced test. And the sophistication of their algorithms and all that will be probably head and shoulders above the rest.

David:

But regardless, it is a rising tide that’s lifting all ships. And we are going to see, I think in two to three years just about every single device. If the OEM so chooses in the same way that they’re all going to have active noise cancellation in the next few years. We’re going to see a lot of them coming to market with a level of hearing amplification. And what’s so exciting to me is that we move into a territory then where just about everything that you put in your ear can serve this purpose.

Richard Einhorn:

I couldn’t agree more. I think that this is the way it should be. I think there’s a lot of misunderstanding in my opinion of how OTC hearing devices will actually be used. I should say that I think of these things entirely from the perspective of the user. Because A, I need the device and B, I think that is the only way that these devices can be sold. And when you think about it, if you have somebody who has my level of hearing loss, which is officially a moderate to moderate severe hearing loss, bordering on the severe. If you have somebody with my level of hearing loss, the recommendation from audiologists is quite rightly to take your shower, put your hearing aids in, take them out if you go swimming. But otherwise leave them in until you go to bed at night. And that is 100% the way it should be.

Richard Einhorn:

But now think about, if you have a mild to moderate hearing loss. Are you necessarily needing to have things in your ears the entire time? And the answer is, because I’ve had mild hearing losses, often no. You don’t need them in your ear all the time. However in addition to that, many people today want a device they can stick in their ear for quote unquote lifestyle reasons. In order to listen to music, to podcast, to take video calls.

Richard Einhorn:

So the hearing aid quote unquote, functionality of these devices is one part of a larger feature set, which is primarily consumer. And the situational live ambience amplification portion of an over-the-counter hearing device, and let me switch terminology and say, an over-the-counter hearing aid will be situational. It will be used for only a few hours a day at most. And used only in specific places where you’re going to need it.

Richard Einhorn:

So when you think about it that way, do you need a $6,000 pair of hearing instruments? Do you even need $1,000 pair of hearing instruments, for something that you’re going to be using mostly for lifestyle connectivity? And this is where it goes. If you have a multitasking device that’s in your ears that gives you the joy of music. You say you have a mild hearing problems, and you have something that provides you the joy of music, gives you podcasts, gives you audio books, et cetera, et cetera, et cetera.

Richard Einhorn:

And then when you need it in a restaurant or maybe even at a business meeting or in a classroom. When you need a little bit of extra zets, you just flip on the hearing aid functionality or call it transparency mode, or call it headphone accommodations. I don’t care what you call it, but whatever you do call it, you just flip it on, boom, you have that. And then you turn it back off again. And it goes back there.

Richard Einhorn:

That’s the consumerization of hearing technology. An affordable multitasking device that’s in your ears that can help you in the situations that you need it, suitable for mild to moderate hearing loss at most.

David:

Wow. For anybody that has been a long time listener or follower of my blog knows that I’ve just been vigorously nodding my head. Because this is the thesis that I had when I started the whole blog and the podcast was that, and I actually will take it a step further. I completely agree with you. I think that this is such an important point to understand is that if you start to view this through the lens of there are multiple use cases for these devices. If it’s a spectrum, some appeal to the lifestyle side and for the call it, the mild loss, or maybe no loss end of the market. And then obviously you have the hearing aid functionality that applies toward the more severe.

David:

But I think what again is another point to this is that when you have 100 million pairs of AirPods out in circulation, it does two things. First of all, it normalizes the fact that people have things in their ears, right? So that’s going to kill stigma. I am a adamant believer that the way that stigma will actually, eventually just die is that we’re all going to walk around with things in and around our ears for extended periods of time. So that’s the first thing.

David:

The second thing that it does is it encourages developers, designers, the whole app economy to start building applications for our ears. We’re actually in the process of seeing this happen now in real-time. You just had an application called Marsbot from the company Foursquare, just come out. Where basically, you walk around, it’s like audio AR and you just walk into the proximity of something. And you hear an audio clip that it’s either a restaurant drop or somebody that reviewed the restaurant, whatever it might be.

David:

But what we’re seeing though, is because you have this consumer side that’s really burgeoning, it’s lending itself to build more things to do with your ears. And therefore more reasons to wear things in your ears for longer periods of time. And all of this creates this virtuous cycle. These network effects more or less, for people to wear things in their ears for different reasons.

David:

And I think that’s extremely important to point out when we are talking about a very prevalent problem with hearing loss, that you can’t get people to wear the solutions. And there are multiple reasons why you can’t get them to wear. They’re too expensive. They’re not accessible, there’s a negative stigma associated with them. So what we’re seeing, I really think is through a combination of these partnerships like Jacoti and Qualcomm embedding this, it’s going to take care of the accessibility issue. It’s going to become just a whole lot easier to get something on the milder end.

David:

And it’s also creating more and more users, more or less, which are incentivizing for the people that build things, the software applications for our ears. So actually the people on the moderate to severe end benefit from all this too. The huge boom in podcasting is a net benefit. If you’re a hearing aid wearer and you’re wearing hearing aids for 10 hours a day. You have the ability to seamlessly consume a podcast at any given point. And it’s invisible. That’s really, really cool.

David:

But that wouldn’t really exist if the only market for podcasters are hearing aid wearers. A large reason why there’s so much incentive to create podcasts is because there’s 100 million pairs of AirPods out there and all the other devices out there, it’s this behavioral change.

David:

So this is so interesting, it sounds like you and Jacques and others were coming to the same realization that when this whole market grows from the mild end, all the way up, everybody benefits in a certain way. Because so much of this is fluid across the whole spectrum. The rate in which you use these devices, whether it be the types of amplification. If you have somebody that has…

David:

Most hearing losses are progressive loss. So if you get into the door early on, say I’m 45 years old, I’m not going to buy a hearing aid because I don’t feel as if I have a problem that constitutes a hearing aid. I’m not on that end of the spectrum. But I want some of that functionality. Chances are I’m going to get in the door, I’m going to use something. I might then graduate into something.

David:

And then I might graduate into the point where I want an audiologist. I want to have a full hearing aid, fitting, whatever that might look like, but it is a journey. And I think that enabling the mild to moderate end of the spectrum is massively important in so many different ways to the overall adoption of hearing solutions. And ultimately trying to solve, how do we get more people to treat their hearing loss?

Richard Einhorn:

Yeah, David, I think you’re 100% right. I think there’s another piece of this which is very interesting and important to understand about the Qualcomm, Jacoti situation as well. Which is that if you look at the way in which the majors quote unquote, have approached hearing health and actually health technology in general in terms of its consumerization. At the moment, it’s like the Wild, Wild West. You’ve got all sorts of different levels of verification and verifiability and also all sorts of different levels of validity and robustness of data.

Richard Einhorn:

For example, Samsung in its offerings for quote unquote hearing health functionality. In addition to supporting need for Android hearing aids, Samsung has a whole bunch of features like enhanced ambience and things like this and also a beep level hearing test. But there’s no external quote, science there. There’s a lot of information in the consumer electronics audio space about… There’s a lot of research on how to enhance audio in the consumer electronics, but it’s not audiologically based. And it’s likely that Samsung is using that plus a combination of audiology.

Richard Einhorn:

Apple on the other hand has a very different way of looking at it. It’s more health-oriented in the more formal sense of it. You can store audiograms in the Health app, for example. You can use those audiograms then as part of headphone accommodation with the AirPods Pro in order to set personalization.

Richard Einhorn:

So there’s some integration of consumer level hearing enhancement and hearing health things. What’s interesting about the Jacoti, Qualcomm collaboration is that Jacoti has a QMS level medical system. They’ve registered ListenApp, the iOS app with the FDA as a medical hearing device. And what you have is audiograms that are empirically valid.

Richard Einhorn:

So what you have with Jacoti and with Qualcomm is the opportunity if a company wants it, and if a user wants it, to tap into valid data, in order to track one’s hearing. And also tap into what, 70 years, 80 years of legacy, audiological information on how best to compensate for hearing problems. So this is a new level of… Formality might be one word, but seriousness, I think is a more appropriate word. This is approaching hearing enhancement in a very serious way.

Richard Einhorn:

So there’s a fine continuum between consumer level hearing enhancement and hearing health, hearing loss compensation. And that’s a really important component about this. In other words, hearing health technology is growing up. And this is an example of it. Hearing health technology is growing up on a consumer platform, I should say. Obviously it’s very mature in professional medical platforms.

David:

No, I think you make a fantastic point there though, which is that you have this more professional, medically oriented aspect to the consumer side that we haven’t really quite seen. And I think that’s really important. And I love that you mentioned Apple in there too. Because again, what I think the net result of all of this is that you get more people to become aware of this. It’s a giant mechanism to drive awareness and exposure. So AirPods Pro are a great example. I’m sure that future iterations, if they see that a lot of these, their big competitor, like Apple’s the one outside of Broadcom, one chip manufacturer now, because they make all their own silicon. With the H1 chip, I’m sure they’re going to be matching tit for tat with Qualcomm, with a lot of the different features.

David:

So I’m sure Apple will be just as prominent of a player in this space. But because of, I think like as consumers, we all benefit because like you said, by having a company like Jacoti in the mix. And I love having your perspective here as a musician and somebody that comes from the pro-audio space. So I think you can really speak to the legitimacy of the way in which these are actually working from the processing level and the sound output and the quality of it.

David:

But I think that what’s so exciting about this is that as these two compete and it becomes more top of mind in the public. Where you start to have people that say, “I had no idea that I could upload an audiogram. What’s an audiogram? Oh, I have the ability to take this and I can then…” Maybe this is where the audiologist comes into play is that they are a big driver toward, “Hey, you’re not ready for a hearing aid, but better yet, why don’t we get you set up with an audiogram that you can upload into whatever sort of… If you want to use AirPods or whatever it might be. But help you to get it into Apple Health.”

David:

And then you start to have people aware that these things exist. They understand in the same way that if you have prescription lenses or contacts, you know what your diagnosis is, your prescription’s like. I think that that’s a really important step that’s lacking right now as a lot of people aren’t even aware that they have hearing loss and let alone what kind of hearing loss. Because it’s not as if it’s just like, “Oh, you have a depreciation of 25 decibels.” It’s a very complex thing that you have to understand of the type of loss that you have, which frequencies.

David:

So I just think that this is so exciting because as these types of features become just like out-of-the-box and you can enable them with one press of a button. Or you do a quick hearing test that’s standardized because of these types of integrations at the chip level. I think the net benefit though, is you just have more people that are now becoming aware of this. And then they want to eventually graduate into more sophisticated solutions as time goes on.

David:

So in my opinion, this really is… I don’t know what the counterargument to this would be. Especially given that you have this responsible party, like Jacoti, that it’s not as if they’re just coming in and they’re layering on this level of amplification. They’re just turning up the dial. There’s a lot of science that’s going into this, a lot of thought that’s going into this. And I think this is just a really, really positive thing for this whole industry. But more importantly for the general population that clearly is suffering at a large level of hearing loss. And they’re just not really treating it at scale like they should be.

Richard Einhorn:

I think you’re absolutely right. I wanted to go back to an earlier point that you made, which I think is really, really, really important to understand. Which is this issue that you mentioned of scale and of ubiquitousness and of being able to lift all boats. In other words, the people who… It’s a little bit like the way I think of gluten-free products. It’s very, very big with gluten allergies that have come up. So there’s a plethora of gluten-free products around. And the people who benefit the most of course, are the people with celiac disease because now they can have a wider thing. And it’s exactly analogous to the situation with hearing.

Richard Einhorn:

The people who will benefit most from the consumerization of hearing health… Well, there are two cohorts that will benefit. First of all, those people who couldn’t afford or couldn’t find hearing health technology around the world. Not just in the United States, but in Africa, in South America, on Native American reservations here and other places where hearing health is almost completely unknown. So those are the first people that are going to benefit from this consumerization worldwide.

Richard Einhorn:

The other group, I think that’s going to really seriously benefit from this are people with more severe hearing problems. Why? Because of this. You’re talking now, not just about a single device, you are talking about a single ear-worn device. But you’re talking about ubiquitous connectivity to an affordable device. And now you’re talking not about a hearing aid or an assistive listening device, but you’re talking about a hearing system. And the opportunity in the future to extend the functionality of an in-ear-worn live amplification device. By making remote microphones and networking of collections of remote microphones together. One can easily imagine using all of this to create systems for all sorts of extraordinary uses. Both consumer uses and quote unquote medical uses.

Richard Einhorn:

A consumer use might be to have fun at a bar, for example, with everybody, with microphones, with their in-ear devices and microphones all spread out around the place, playing some sort of a game. But consumer use is everybody sits down with an in-ear, over-the-counter hearing device, sits down, puts their mobile phone on the table. Those microphones are all interconnected automatically on a friend’s network. And now you’re talking about really serious transformative, hearing assistance in a social environment that almost everybody I know, including myself, who has a hearing loss struggles mightily with.

Richard Einhorn:

So you’re talking about really, really major levels of improvement to the ability of people to hear and to function. And that means that a lot of us… I have friends with very, very severe hearing problems who can’t afford technology or don’t have access to it for one reason or another. But if you provide consumerization paths for this, so the technology is affordable and interoperable, and that’s another thing about the Qualcomm solution. It’s cross-platform, it will work with all sorts of other things. If you’re talking about interoperable cross-platform devices, you’re talking about the potential for a real transformative moment in the history of hearing health, in my opinion.

David:

I couldn’t agree more. I love this whole thought process that you’re laying out here around this consumerization. This idea where you have… The consumerization side leads to better use cases for the medical side. That analogy that you made with gluten and celiac, that’s so on point because I’m thinking right now of the whole new Bluetooth LE Audio. So what you mentioned there, you outlined this idea where I think you’re so right. Where you’ll probably see, one of the features for the listeners, is that there’s this whole single output of audio that multiple pairs of devices can stream into. So it’s a broadcast ability.

David:

So think about this again, using your example that you described at the bar. One example of this might be that everybody that has a pair of AirPods in their pocket, put them in. And then you have the single source of audio, this remote microphone. It might be some sort of game that you play at bars or whatever that might be. So this becomes popular. Again, it comes back to this idea that suddenly the people that made the mobile ecosystem run, all of the developers come in and they start building applications around these kinds of things. Again, off of the notion that you have 100 million plus people with AirPods walking around.

David:

So you have this huge market of people, but then lo and behold, on the side, you have these hearing aid users that get to benefit from all these things too. And it might not just be these games. It might just be that I can stream at a table a remote microphone that I place. And let’s say that we have two people with hearing aids. We just set one remote microphone, maybe it’s just my phone in the middle of the table. And it’s like a directional microphone that I can just turn on and I can turn the outside sound off. And I can have a really pleasant conversation wearing my hearing aids.

David:

This is what’s so exciting to me, again, this consumerization side of things, it’s going to drive so much innovation because it’s incentivizing, it’s huge. It’s a huge market that the hearing aid market in isolation would never be able to incentivize the types of applications that are going to be developed from the consumer side of things. And it’s just, I think a fascinating way to look at things is to look at through the lens of you’re this secondary beneficiary. That gets to take advantage of all of this innovation that’s being built off of the back of the consumer side of things. So there’s a lot of that that’s going on too, that I think is important.

Richard Einhorn:

Exactly, I think the issue here is that there’s a lot that can be done through this consumerization and also through the issue of an open standard. And essentially I’m getting down to the chip level, which again, was Jacques insight and a brilliant one, I think. Enables us to create all sorts of opportunities for different devices from different manufacturers to play well together. And again, to use an analogy that I often used, it comes from my background in music.

Richard Einhorn:

In 1982, in 1983 up until around then, you had fairly flat sales on synthesizers. They were growing in the music industry. They were growing at a reasonable clip, but nothing really to write home about. And they were basically a niche player within the larger music industry. Synthesizers were not that big a deal. Pianos guitars, trombones, et cetera, they were the big players.

Richard Einhorn:

And then somebody got the bright idea to create an industry standard protocol that would enable you to hook up one synthesizer and have it play another. And this was called MIDI, the Musical Instrument Digital Interface. Nobody thought very much about it. I think they thought it was kind of a cool idea.

Richard Einhorn:

But what happened was that everybody realized. “My God, you can hook not one synthesizer up. I can hook up 16 and I can put a computer in the middle. And then suddenly I can start to create all this music from it.” So from this one simple ubiquitous standard, from a standard, a protocol that enabled you to connect third-party devices together simply and seamlessly. What you were able to do was to create completely new industries, completely new economies of scale, completely new ways of making music.

Richard Einhorn:

And now every single thing that I learned about making music up until 1983 is obsolete. There is not a single thing that I do on a day-to-day basis that almost all composers do that hasn’t been transformed by MIDI. And my personal feeling is that in a general way, the over-the-counter market for hearing devices will do something very similar.

Richard Einhorn:

You’re going to have standardization. You’re going to have interoperability of devices. You’re going to have new devices that nobody could’ve even thought of. You’re going to be seeing the leveraging of academic signal processing technologies develop extremely rapidly like blind source separation. And similar kinds of AI and machine learning based algorithms. You’re going to see active noise canceling, probably morph into something far more sophisticated than simply getting rid of a little bit of background noise, air conditioners and things like that, or airplane noise.

Richard Einhorn:

This is what this means. It means that an industry that’s a few billion dollars, is now suddenly tapped into an industry that’s worth over $500 billion. And the transformation and the opportunities for everybody, not just for me as a user, but for companies to grow is just in my opinion, extraordinary.

Richard Einhorn:

And everybody five years from now will be asking themselves the same question, “Why didn’t we do this 15 years ago? Why didn’t we do this?” It’s absurd that interconnectivity is still a problem with assistive listening devices and hearing aids. It’s absurd that wireless connectivity to mobile devices is an optional feature and not a standard part of a hearing aid and cochlear implant. These things will all become, not merely common. They’re already common. They’ll become standard. No doubt about it in my mind.

David:

Yeah, no, that’s so well said. I just think that this whole idea of standardization, you’re right. I always go back to this quote too, that the Spotify CEO, Daniel Ek said. He was talking about the valuation of Spotify and audio in general. And he lays out in this, he issues this preamble talking about the value of video, the value of text. And basically he comes to the conclusion. He said like, “Are our eyes really worth 10 times more than our ears?” And that’s such an interesting way to think about in an attention economy like we have today, where everything is so based around, where’s your attention fixated? It does seem like our ears are undervalued and underserved.

David:

And I think that, again, going off of this whole notion of taking advantage of the consumer side. And the ubiquity that I think we’re going to see with in-the-ear devices and over-the-ear devices and all these kind of different ear devices. You look at a lot of these other external trends, microphones are getting way cheaper and way smaller and way more powerful. Speakers are getting…

David:

It’s like all of the little components that go inside of these devices are becoming more and more miniaturized. A lot of the sensors, the machine learning algorithms, the data science that resides behind it to make sense of all this, is becoming so much more sophisticated. Edge computing’s going to be right on the horizon where we’re going to be able to process a lot of this stuff on-device. That’s a big reason why we’re able to do what this Jacoti partnership has laid out is because the system on a chip that Qualcomm’s developed is so sophisticated. We’re going to just keep seeing more and more iterations of this.

David:

So it certainly does feel a bit inevitable that we’re to just continue to see more possibilities unlocked around how these things can work in tandem in an ambient computing environment. Where do these things come in? I think they’re going to constantly be sinking in and out.

David:

And again, I think that from an industry perspective and just for a patient perspective is to look at that and say like… Again, if these things are going to come to fruition, there’s just more and more incentive, I think, ultimately to wear these kinds of devices. Because you’re going to be able to do just so much more with them.

David:

In the same way that your phone progressed over the last 10 years, in terms of you’re able to almost do anything with your phone today. At least in terms of what you can do with a computer. You can do everything with the phone, if not a lot more. I think we’re going to see a very similar trajectory with in-the-ear devices. And again, I just continue to think that that’s going to open the door to so many new use cases that they might have a facade that is consumer facing.

David:

But there will be portions of them that are extremely applicable to medical applications that are going to cater really nicely to folks with mild, moderate, severe, profound, whatever type of hearing loss. We’re all going to benefit from these things, because again, it is that rising tide that lifts all ships. There will be a level of standardization, like you said that will, I think just gradually rise higher and higher in terms of what anybody can get out of the box.

Richard Einhorn:

Yeah. I think you’re absolutely right. I think the main thing here is that there’s a lot of concern I know in the audiology industry and in the hearing aid industry that this is going to eat into sales. My personal feeling is that there will definitely going to be changes and there will definitely going to be things that are going to be different. But I strongly feel that if we can have people understand that their lives, that people without quote unquote hearing loss, with clinical levels of hearing loss. If we can have people understand that their lives can be improved simply by able to put something in their ear. And hear a little bit better in a lecture, a little bit better at a business meeting a little bit better at a restaurant. If we can get that, and that’s the potential of this technology, then there’s nothing, but growth there.

Richard Einhorn:

And I’m pretty darn sure we can do that because there’s data that supports the fact that if you create a better signal to noise ratio, for example in a lecture hall. The people who have access to that better signal to noise ratio understand better and retain more information. So why wouldn’t a student, if she had access to technology that could clean up the sound and amplify it, why wouldn’t she use that if she wanted to get ahead in a lecture? Of course, she would.

Richard Einhorn:

So the more people understand this, the more people will adopt this technology. The more these devices are visible, the more opportunity, and already everybody’s used to people running around with things stuck in their ears. So it’s not that big a deal anymore. But now that the devices are visible, that means there’s more room for manufacturers to create more interesting, quote, unquote i.e., more powerful devices.

Richard Einhorn:

And this is just the most exciting thing. This is what I was thinking about in 2010, 2011. This is why when Jacques had been thinking about this, in his own much more sophisticated way, at around the same time. And when I met him in 2014, it was literally like we were finishing each other’s sentences. It was like, “Oh, finally, somebody gets it.” And it was really exciting. I didn’t know you, but I’m sure we would have had that conversation back then too.

David:

Yeah, no. As we wrap up here, it’s been a great conversation and I completely agree with you. I’ve had multiple conversations on the podcast before where we’ve talked about what this means, what these types of… I think you’re right. I think it’s going to be a catalyst for change. I think this is going to be a very tumultuous time, in terms of the service model, I think is going to change a lot. The revenue generation models are going to change a lot. But I think that the point remains is that, I always go back to this quote and it’s like hearing professionals lamenting the dwindling cost of the device, should also therefore recognize the increasing value of their knowledge in their provision of expertise.

David:

And that’s so spot-on. It’s like, yeah, you’re probably going to see the margins of the devices get slashed inevitably. Because you’re going to just see more and more entrance into the market. And there’s going to be a lot of external pressure on the top that’s just going to push itself down. But because you’re going to have this, you’re going to see this massive expansion in the market.

David:

So I think that those that will succeed from the professional side of things will be those that are willing to adapt to this. And it’s going to require a rethink in terms of how do you service potentially 10 times more of the patients that you had seen before? You have to readjust the whole, you have to recalibrate the whole way that you deliver service, but that’s not to say that it’s impossible to do. In fact, it might be a really good thing, in terms of how you can go about repositioning everything and repositioning your whole value proposition. So it’s not very device-oriented, it’s more service-oriented.

David:

So I’m very of the mind that there’s going to be a lot of folks that figure this out, that succeed and do really well. Because there’s not going to be any shortage of people that I think will want experts. I think that there are going to be a lot of people that’ll be able to take things out of the box and there will be a do-it-yourself element. You’ll be able to self-program certain things, to a degree. But I think at a certain point it does become a thing where the opportunity for the professional in all the hearing aid manufacturers is like, you have this more sophisticated solution. But you have to make people aware that this is a journey.

David:

So I think this is like where the whole rubber will meet the road is figuring out where do you fit into this process? And at what point can you insert yourself into the conversation so that it makes sense from a revenue standpoint? You’re not just spinning your wheels over a subset of patients that aren’t quite ready for you yet. But also finding that happy medium to where you do make that introduction and you establish that relationship. So that when they are ready to buy something maybe more sophisticated. Or maybe they just want to consult with you, and they want you to help guide them through this lifelong process, that is their hearing loss to help match them to their solutions.

David:

So much of what we talked about today, a common denominator is complexity. I think that there’s so much complexity that is going to enter the market in terms of this solution does this, and this solution does that. Your eyes can go crossed. So by being an expert in all these different things and helping people to really make it digestible for them to understand like, “Okay, here’s where I am. Here’s some options that match what I need and we’ll monitor my progress. And this will be the expert that I have throughout my life to help guide me along this journey.”

David:

So that’s just a really long-winded way of me saying that I think there’s a lot of opportunity. But it will all probably be very, very much centered around how willing are you to change? And I think those that are willing to change are going to do really, really well in the coming years. Because I think it’s going to lend itself to people that have these types of really, really knowledgeable backgrounds in the physiology, in the actual science of all of this that can lend their expertise to any type of patient that is wherever they are on their journey.

Richard Einhorn:

I think it’s true. I think that audiologists and people that work with people with hearing loss are going to need to change. All I can say is that as I mentioned, everything that I learned back when I began my career in music has changed. We all go through this. Every single person goes through it. Again I just want to reiterate the respect I have for audiologists and their knowledge and their passion and their commitment to patients is second to none in this. I think that the audiologists I’ve worked with have to a person been wonderful and dedicated to helping me.

Richard Einhorn:

This is not about removing the audiologists from the equation. This is about providing more opportunities for people to hear better. And that provides in my opinion, experts an opportunity to help those people hear better. And I think this is the ultimate win-win for those of us with hearing loss. I just very, very, couldn’t be more excited about it.

Richard Einhorn:

And just to once again say it, I think that Jacoti’s and Qualcomm’s collaboration is an example of the hearing health part of this growing up, that they’re doing it in a very serious way, in a responsible way. And I think that that’s an indication that this part of the consumerization of hearing health is growing up and doing things properly.

David:

Richard, that was awesome. So well said. Man, this was such a great conversation, I enjoyed it. Shout out to Shari, thank you so much for connecting Richard and I. This was the first time that we’d spoke and lo and behold, you and I are like kindred spirits. I feel like we see so eye to eye with all this and just such an awesome conversation. I share your enthusiasm too.

David:

So it’s going to be really interesting to watch this all pan out. In the show notes of this, I will provide all the links for the formal announcements around this partnership between Qualcomm and Jacoti. So that those of you that are listening can read more into it. But thank you, Richard, for joining me this week. Thanks for everybody who tuned in here to the end and we will chat with you next time. Cheers.

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