Who Pays The Price When Assistive Tech Ignores Human Hands

A hearing aid can be top-tier technology and still fail the moment it meets a shaky hand. We sit down with Jeff Szmanda, president of Each Ear LLC and a long-time hearing aid user advocate, to talk about the overlooked problem that derails success for millions of people: simply getting a receiver in canal (RIC) hearing aid speaker into the ear comfortably, consistently, and safely. When insertion is hard, everything else unravels the fit, the sound quality, the confidence, and often the willingness to keep wearing the device at all.

Jeff walks us through the assistive technology mindset that shapes his work: ergonomic design and universal design that respect real human bodies, not idealised “average” users. He shares how his earlier inventions in workplace accessibility led him to create Groove Buttons, a small but powerful interface that supports the fingertip and fingernail so users can control the speaker without slipping. We also dig into why this matters for caregivers, for people living with arthritis, tremor, Parkinson’s disease, or numbness, and for anyone who has ever watched an expensive hearing aid fall once and then disappear into a drawer.

We widen the lens to hearing healthcare and hearing aid pricing: consolidation among manufacturers, manufacturer-owned clinics, insurance and buying groups, and how consumers can make better choices across technology levels. Jeff explains key performance differences like programmable channels and speech-in-noise processing, and we talk about the links between untreated hearing loss, social isolation, and brain health.

If you care about accessible design, better hearing outcomes, and practical guidance for families, this conversation delivers. Subscribe for more accessibility and assistive technology conversations, share this episode with someone navigating hearing loss, and leave us a review with your biggest question about hearing aids and usability.

Transcript

Welcome And Guest Introduction

Neil Milliken 0:01

Hello and welcome to Access Chat. This week I'm delighted that we're joined by Jeff Szmanda. He is the president of Each Ear LLC and is a hearing aid user advocate. So welcome, Jeff. Great to have you with us. And can you tell us a little bit about Each Ear and also the work that you've done? Because I know that you're a very inventive person and you've got some great inventions that have been supporting hearing aid users and carers. So please tell us a little bit about the work that you're doing.

Jeff Szmanda 0:34

Thank you. It's an honor to be here and I support your work entirely. Each Ear is a development company that has produced, that is to say, developed and patented a device called Groove Buttons. So it's an assistive device that allows people to insert their hearing aid speakers into their ears. It's an example of ergonomic design and universal design. And I'll be talking more about that as we go through the presentation.

The Ergonomic Keyboard Breakthrough

Neil Milliken 1:08

Okay. So that that's great. I mean, we we've been supporting the sort of disability and accessibility community for a long time. And we we spent a lot of time thinking about policy and talking about the implementation of technology, but but the the work that you're doing, you know, is really at the front end of assistive tech. So and and that's always got a warm space in my heart because I started in assistive tech some 25 years ago. So it's great to hear that. So you said you were going to present a bit more about the inventions. So you've had several, right? There's more than one that you've got the groove button, and I think you've also been recipient of some awards as well. Is that yes.

Jeff Szmanda 1:58

But it started it in about 1990. I was working in my brother's basement on a computer keyboard, and I had taken touch typing in high school. So I was a touch typist, but I was we were working on a project to help children understand and utilize real life applications of the critical thinking skills. I'm working there at about 11 o'clock at night, and my wrists became tired. They became fatigued, and I had to rest. And I thought, let me back up a second. I thought if my keyboard was bent, I could continue working. But I had to rest because I was working on a flat keyboard. Well, when you're working on a flat keyboard, you're not in a natural posture. Your hands are pronated, ulnar deviated, and extended. So what happens is that that's putting stress on the wrist. And that caused me to have to stop working. And so the initial thought impulse was well, if I could, if I could bend this keyboard, I could continue working. So my brother and I pursued that idea, and we ended up with four patents on what's called the comfort keyboard system. That's what we called it. And it's, I think you might have an image of it, but it is a keyboard that incorporates ergonomic design. It also incorporates universal design, but generally it incorporates ergonomic design. And the idea of ergonomic design, it's an applied science of equipment design intended to maximize productivity and reduce operator fatigue and discomfort. And that's exactly what we were talking about. So determining the natural posture is the easy part. All you do is just bend at the elbows, and now you're in a natural posture. The tricky part is to make that keyboard adjust to your fingertips. And so that's what we were working on. We visited virtually every machine shop in the Milwaukee area. And they were doing incredible, incredible work with medical devices and so forth. But we wanted a telescoping mount that could rotate and tilt and adjust to an infinite number of positions. So think of a car antenna that would telescope, but then we needed to have it rotate and then lock into position. And that was a challenge. That was a big challenge. So after visiting for several days, various machine shops, nobody could come up with an answer. My brother and I stopped for lunch near the stadium where the brewers play. And we stopped and there was no bartender. There was nobody in the place. And I said to my brother while we waited, I said, Bill, I said, how about a scissors type mechanism? And he went, ooh, ooh. And he took a placemat and flipped it over and started drawing what became what we call the disc lock. So it was a scissors type mechanism with a ball and socket, and it had a wedge in it. So when you screwed it down, the wedge came up and locked the scissors, the legs into place. And there we had it. So my brother was very mechanical. He got the idea from inside of an automatic car transmission. And that went on to win the first prize in the state of Wisconsin's governor's new product award competition. I think you'll see that right up over here on the wall. And then we won a national award from Johns Hopkins University because this keyboard helped people go back to work. It was helping people with all sorts of physical limitations and disabilities go back to work and continue working. And it even could be adjusted so that the two sections could be positioned for a head one or a mouth stick for people who were quadrilegia. So they wouldn't have to bend over on a flat keyboard. They could have a perfectly positioned keyboard on both sides for them. So the idea was that it became an it was actually classified by FDA as a Class B medical device. And so it was actually a medical device, and it was an assistive device. It allowed people to be included and it provided a great deal of satisfaction for us.

Debra Ruh 6:39

Jeff, I know that I actually have seen keyboards designed like that. I know things that we keep assistive technologies have changed so much over the years. So you're an assistive technology designer, it sounds like I know we're here talking about your your the hearing aids. And so, but I didn't realize that you also did other types of assistive technology as well. But how did it move from the keyboard to you supporting? I mean, only because that's sort of a different leap. So how did you go to the hearing aids? I have a bunch of questions about the hearing aids.

Speaker 1 7:15

Sure.

Debra Ruh 7:16

Questions that you probably can't answer because why do we not care about our ears in the United States when we or or our eyes or our mouth? All of that is separate from medical, regular medical coverage, which is amazing to me. Yes. Anyway.

Why Hearing Aids Are Hard To Insert

Groove Buttons And The Retrofit Fix

Jeff Szmanda 7:33

Well, that it's a great question. And here's what happened. When I when we were working on the keyboard, I spent seven years being tutored by the chairman of the industrial engineering department at UW Madison. So I spent seven years working with him. He said I had the equivalent of a master's degree in industrial engineering with that experience. But but he taught me how to convey appropriately the instructions and representations of an ergonomic device. So another lifetime or two later, I began helping people with their hearing and by fitting hearing aids. And so when I did that, the most popular style of hearing aid is called the RIC. That's the receiver in the canal. And that's where the unit sits on your ear, and then a little wire cable comes down, and then the speaker goes into the ear canal. And so I've noticed that, you know, the average age of a first-time hearing aid user is 70 years old. And, you know, 70 and beyond people have physical limitations. I've got a little numbness in my fingertips myself. So you have numbness, you can have arthritis, you can have tremor, Parkinson's disease. There's a whole number of shoulder issues, elbow issues, there's a whole number of physical limitations that make it difficult for the hearing aid user to get that speaker into their ear canal. And the way it's designed now is that the end of the speaker is either flat or has a wire coming out of it. Sometimes it's it's got a cone shape, and the fingertip slips off the end of the receiver. And so, having had this experience, I'm thinking, how can we design something that would enable the hearing aid user to more easily insert that hearing aid into their ear to manipulate, control the speaker? And so I invented the groove button. And the groove button is a design, and I know you have a photograph of it, but it's got a it's a little, it's the end of the speaker, so that the original idea was that it would be built into the speaker and it would interface with the fingertip. So the fingernail would fit into it and it would be supported. It would have a fingernail backstop, a fingernail groove, and a fingertip support. So the fingertip would fit into this and it would allow people to control it, and it works. We developed some prototypes and it really, really works, and it makes all the difference in the world, and people stress out. As a matter of fact, the industry, the Hearing Industries Association in Washington, D.C., conducted a survey, they called it a market track survey, that revealed 40% of new hearing aid users experienced difficulty inserting their hearing aids. Now you can imagine they did not publicize that, but I did learn of it, and that's quite a number, 40% of new hearing aid users. And so I offered my invention to the hearing aid manufacturers, and they have not acted yet. So that was a built-in version where they would actually build this right into the speaker. When they printed the, when they produced the speaker, they it would just come with this groove button on it. They haven't done that. It wasn't a priority for them. So then I invented a retrofit. And a retrofit is a sleeve, and they already make these sleeves for another use as a retention tail that holds it into the ear. So they've got a sleeve that fits their speakers that all have different size, different shape speakers, and they each have these sleeves that fit over them. Well, all you have to do is take that sleeve, put a hinge on it, a flap, and a clip at the bottom. And now it fits over the back of the speaker, and it's got the same interface for the fingertip.

Debra Ruh 12:00

Jeff, it's hard to understand, though, why that stuff wouldn't be included. The people, my husband had to have hearing aids. And it was surprising how expensive it was and how complex it was. And I know Antonio has a question, so let me turn it over to Antonio rather than asking another question. Go ahead, Antonio.

Antonio Vieira Santos 12:22

No, uh, Jeffrey, in I found very interesting the way you're talking about the fact, no, the experience that people have and the problems that they face when using the devices. So I'm very curious for you to tell us how do you see hearing healthcare evolving as the aging population grows?

Jeff Szmanda 12:40

Well, it's fascinating. That's really a great question, and it's an open question, and there's a lot to it. What I have seen since I started practicing in 2009 is a great deal of consolidation. So, what happened was that the major hearing aid manufacturers, the biggest ones, started a company to own themselves, and then they bought up competitors. So now there are five holding companies that virtually fit almost all of the hearing aids in the world. Five of them. And beyond that, 40% of all clinics, all hearing aid clinics, certainly in the U.S., 40% are owned by the manufacturers. So they just own just about everything. Now there have been buying groups that have started. United Healthcare was the first one. They actually bought a hearing aid manufacturer, a low-end hearing aid manufacturer, and offered insurance. We have insurance benefits. You're buying the hearing aids from our manufacturer. And it is fascinating, but it was a lower-end hearing aid manufacturer. And what happened was that people would buy this low-cost, low-end hearing aid, and then they'd it's like buying your first car. I've got wheels, you know, and after a while, boy, suspension would be nice. You start to become more familiar with the capacity with the capabilities of hearing aids, and then they would upgrade into, you know, what I would call a real hearing aid. Well, eventually other buying groups started forming, and these buying groups would do deals with the manufacturers and commit to large purchases, and then they'd go and do deals with the uh insurance companies, and they would represent the discount from the purchases in quantity as a hearing aid benefit. So some insurance benefits have an actual benefit that pays for some of that, but they start off with the deductible at a lower end and call it a benefit. And so what happened was now these large hearing aid manufacturers are purchasing those buying groups as well. So it's just incredible. United Healthcare sold their low-end hearing aid manufacturer and bought one of the buying groups. So when you're buying your hearing aids, you're actually purchasing them from the insurance company.

Debra Ruh 15:18

Right. In the United States, though, and we definitely look at this globally. So we definitely want to talk about this from global perspective.

Picking Better Hearing Aid Technology

Antonio Vieira Santos 15:29

In the country where I live, we often see celebrities in their late 60s, early 70s becoming the face of earring aids, you know, in television, in newspapers, and and in in you can easily spot that. And then you see all types of earring aids being promoted from cheap to expensive. We see even Apple getting into the business of earring aids. But how can we help people to make good choices? Because, you know, I'm sure sometimes that this could be a family member, oh, I need to buy this to my, you know, to my grandparent, I need to buy this to my father, or it could be the person that doesn't want to use earring aids can refuse to use those devices in their ear. How can we help people to make good choices?

Jeff Szmanda 16:19

Well, that's another really great question. The there are in the industry, industry-wide, there are essentially four levels of technology. And this is this is globally, because the manufacturers are global. And so there's the low-end hearing aid, the lower end technology, and then one higher, one higher, and then the top or the premium. And you really get what you pay for. I'm a big advocate of myself of the best technology because it makes a difference. Because what happens is that there are five stages of energy that go from what enters your ear is acoustic energy to the electrical energy that your brain receives, and then the brain makes a chemical reaction and understanding takes place. We hear in the brain, the hearing loss is along the way, most often in the inner ear with the 15,000 hair cells. And those degrade from age, heredity, exposure to noise, side effects from medications, illnesses, injuries. But the job of the hearing aid is to make the nearby hair cells do the job of the missing hair cells through precisely targeted amplification. And then pass that on to the brain where we hear. Well, the more intricate those electrical signals are, the more intricate those chemical reactions are in the brain, the better the brain is. In fact, in the last couple of years, they have proven that the brain can physically shrink with untreated hearing loss and can expand with amplification. So the better the quality of those chemical reactions, the more intricate they are, the better the brain is and the better the brain will be. And so I'm an advocate for the premium or or one of the best in almost all cases.

Neil Milliken 18:26

Makes perfect sense to me. I think one of the one of the things that I mean I've just been listening with interest because a few years back we had a chap called Howard Weinstein from an organization called Solar Ear, and he was also talking about the market captured by the big manufacturers and how what he was doing was getting the deaf community to manufacture hearing aids that were had rechargeable batteries and so on in developing nations, right? So because not everybody can afford the best hearing aid, and also a lot of people, even if they get donated really good quality hearing aids, then can't afford the battery replacement. So obviously, you have different economic circumstances in in different geographies and different sectors of society. Of course, if you can afford it, you have to buy the best you can because of the benefits that it gives you to your health. I'm really curious because both my parents are hearing aid users. And I've also heard about the brain shrinkage through due to hearing loss. I wonder how much of that is down to your brain being used processing signals or not processing signals, or how much of that is down to the loss of social interaction, because we know that loneliness and that lack of social interaction as a social species really does have a tremendous impact on people's health.

Questions To Ask And Useful Resources

Jeff Szmanda 19:48

Right. Yeah, and and you know, having not conducted the study, I've I couldn't pinpoint exactly what what's what, but it's always the answer is always a little bit of this and a little bit of that. Absolutely. Yeah, so let me just finish up with the technology differences. So there's two basic differences. One is how many programmable channels it has, and that's important when the hearing loss is precipitous or when it drops quickly along the frequencies. The second one is how well it distinguishes between speech and noise. So on a graph, noise looks like this, and speech looks like this. So the hearing aid can say, well, that's noise. I'll handle that one way, that's speech, I'll handle that another. How well it does that is the difference between technology. Then your point is well taken about the cost. There's something else I want to mention, and that is that I have put together a website named HearingTestprep.com. HearingTestprep.com. And that what that does is it gives the hearing aid user, the patient, prospective patient, some insight, how to, what questions to ask when they're engaging with the hearing aid practitioner or the audiologist. And that's very, very useful because it helps them really communicate and engage. So yeah, different insurance companies are going to offer different pricing, and that might be part of the research when you get insurance programs.

Debra Ruh 21:28

Yeah, I agree. At the same time, though, the thing that makes me very sad about this entire conversation is that, you know, I know a lot of people that need hearing aids and they can't afford them. And so it's like my, you know, we were blessed in my family that we could go and buy them. But the reality is the difference in the qualities of the difference, you know, the quality of your life. So it's really a shame that we have made this a political insurance ridiculousness like we have, because people really should get aid as they need it. You know, our bodies grow and we lose our hearing. But it's a good point that you were making, Neil. The isolation. I know when my my father-in-law lost his hearing, it uh it uh isolated him so much, so much, and he was in a different state from the rest of us. So it made us as a family really, really worry about him. It was very sad. So I I just think it's sad that we do not make this a priority as societies in any country. We certainly do not in the United States. If you're wealthy and you have really good insurance, you get better. Everybody else, oh well, too bad for you. So it's a shame that it's a political situation. But but Jeff, we definitely want to make sure that people know how to contact you.

Jeff Szmanda 22:41

Yes. It's really quite easy. My website is eachear.com, and my email address is Jeff at each ear.com. That's that's the simplest way to do it.

Debra Ruh 22:53

Right. I and you should make it easy.

Neil Milliken 22:55

And you've got guidance on there for caregivers as well as as well as for the hearing aid users.

Jeff Szmanda 23:03

Yes, that's right. That's right. Caregivers have to insert the hearing aid into, and sometimes, you know, into the their parents or the family or clients' ears, and they don't know which way the ear canal angles and bends. Ear canals can be just as complicated and can be different on each side, angle and bend and go in one way, can do hourglass, it can do all sorts of have all sorts of shapes and be different from each other, almost more often than not. And that and if you can't manipulate and control that speaker, you're not gonna be able to get it in sufficiently deep. And and Deborah, I want to mention one other thing that's even sadder, in my view, is that people get hearing aids, they struggle so much with insertion that if it's not inserted, there's all sorts of issues. You're not getting the prescribed prescription, uh the prescribed amplification, and the hearing aid can hang on the ear, and then if it drops, all it has to do is drop once and it goes into the drawer. I'm not losing that. I paid so much money, I'm not losing it.

Debra Ruh 24:12

And also, Jeff, I have a friend of mine who has cerebral palsy and she wears them. She she's constantly can't get it in and it's hanging off her ear, and the wax builds up, so then she can't hear from it. And they're like, every day you need to take it out and clean. And she, it's just something she struggles with. And it should not be that hard to use hearing aids.

Jeff Szmanda 24:33

No, it shouldn't, especially when state-of-the-art, ergonomic design, universal design is readily available for these hearing aid manufacturers. It's a failure on their part, and I'd like to propose something. I'd like to propose that we start labeling products as deficiently designed when their manufacturers fail to adopt readily available, state-of-the-art, ergonomic, and universal design.

Debra Ruh 25:02

You mean yeah, I'm so confused. Are you saying you want them to design for humans? Sorry. I mean, it's ridiculous. Sorry. Thank you for the same.

Final Thanks And How To Reach Jeff

Antonio Vieira Santos 25:14

It's clear, it's clear that we notice a few issues. We have the family members who are not able to help the person to use the device. We have the the individuals who are on them by themselves were not able to put them properly. So this means there's a lot of anxiety here from everyone trying to solve a problem. So can you tell us about the impact of this anxiety, not only on the caregivers, but on the users themselves? Yeah, it ends up like this to hell with it. You know, that's what that's what it says. I give up. I'm not dealing with it. And I've seen it and seen it. And people have Parkinson's, they have tremor, they have all sorts of issues that prevent them from getting these deficiently designed speakers into their ears. And I feel very, very strongly, but I deal with people directly. You have family, you understand this, everybody does. The manufacturers have failed, even though I have uh I have invented, produced, and made it so easy for them to adapt their retention tails with that sleeve. All they have to do is add a clip, a hinge, a flap, and a clip. And they have, you can now convert their regular speakers. This would cost them very little to produce and very little to distribute. It's got all the um the groove button retrofit has all of the factors that make it ideal to solve this incredible problem.

Neil Milliken 26:44

Yeah. Thank you for all of the work that you're doing. I hope that someone will pick up on it. We've reached the end of our half hour. Thank you so much for sharing with us all of the work that you're doing. Thank you to Amazon for sponsoring us and keeping us on air. And we look forward to being able to share your work with our audience. Thank you, Jeff. Thank you, thank you, thank you, folks.