October 19, 2015 MDC meeting Copenhagen Admiral Hotel

Minutes from last meeting, Sept 7, 2015 Hear-it conversion rates: KR create graphsDone All: link to Hear-it videos. Soren P send list of videos/links?? KR: make two more videosOngoing KR: review Google ranking, esp. GER??? SH: circulate final wording of 2 x common stanceDone SH: incorporate MDC changes into final budget draftDone NB: present longitudinal EuroTrak trends/findingsToday SH: Send 21 German EuroTrak slides to MDCDone TD: send SH contacts for Belgian manufacturers org: UnamecDone SH: Offer Poland 100% payment of first round of EuroTrakDone SH: discuss EuroTrak DK with LFHDone FER: UK payment of 50% - follow upDone… SH: identify PR ideas from Anovum’s slides. Use Agency for press releasesOngoing SH + Carole Rogin: communication plan WITH budgetNo KR: B. Shield + Mark Atherton: what exactly will they survey???? SH: Get WHO involvement in consumer protection against PSAPsDone OB + SH: update Board on IOM meetingsDone SH: contact head of Danish ENTs prior to EMHF roundtableDone SH: clarify a few topics with Peter Nordqvist, then approve project Done 2

Today’s agenda Approval of minutes, comments to agenda Hear-it EuroTrak and MT9: status + additional projects WHO: Make Listening Safe Coalition for Global Hearing Health Market challenges MDC budget 2016 SH performing for individual EHIMA members Next meetings Misc Summary: MDC presentation to the Board 3

Hear-it Progress report: Kim

Key Messages Funnel strategy works – high rates of conversion New HTML5 hearing test launched Impressive number of hearing tests taken Social media activities intensified, results positive. First five hear-it videos launched

Total – visitors per month

Top 10 countries: Oct 2014 – Sep 2015 United States, 17,9% = 352,540 visitors Brazil, 9,7% = 191,041 visitors Spain, 7,3% = 143,773 visitors Mexico, 5,8% = 114,230 visitors Germany: 5.6% = 110,292 visitors France, 4,5% = 88,627 visitors United Kingdom, 4,2% = 82,719 visitors Columbia 4% = 78,780 visitors Argentina, 3,9% = 76,810 visitors India, 3,1 % = 61,054 visitors

Total – end of funnel pages

Total – hearing tests

Sound demos

Which hearing aid should I choose?

Conversion rates overview (%) LanguageEnglishSpanishGermanFrenchPort Hearing Tests Sound demos HI choice Other end- of-funnel 7,15,6135,58,1 Overall

Social media Facebook FB likes up from 1,198 to 16,588 from October 2014 to September 30. Non organic growth Twitter 1403 followers many tweets and retweets of our articles It seems that Twitter is the better channel to focus on

New html 5 hearing test

Videos Five uploaded Three more to come in 2015 Are your headphones too loud? HA useful at the work place Quality of life – use HA!

They ”stole” our site – but it has been fixed

Common stance: EHIMA Final proposal to the Board

Common stance: hand-out to Board EHIMA believes in the right of every hearing impaired person to hear well. We therefore support the UN Declaration on the Rights of Persons with Disabilities ( as well as the UN Convention on the Rights of the Child, esp. Article EHIMA works to build and support public awareness of hearing loss and tinnitus, including information on how to seek help EHIMA strives to cooperate with both professional and user organizations EHIMA supports professional counseling and fitting of hearing aids by qualified professionals, who are kept up to date by a mandatory continuing education system EHIMA believes that hearing aids are Medical Devices, for the benefit and safety of the hearing impaired EHIMA supports the introduction of hearing screening programs both for newborns, children and adults, to ensure early intervention and optimum cognitive capacities EHIMA does not support the use of PSAPs for treatment of hearing loss, as they are not tested and controlled for the purpose of correcting hearing loss. For maximum user safety, only officially approved medical devices should be used to correct for hearing loss. EHIMA strives to ensure interference-free access to standardized wireless communication

Common stance: PSAPs Final proposal to the Board

Common stance: PSAPs. NB: bibliographical references! Action point: Nikolai Board will get final version once we have bibliographical references SH will take up the topic in the ”Executive session” of the Board meeting. US situation evolving so fast that our present common stance (US) may not be ideal: –We look defensive –In public opinion, industry is lumped with dispensers and combined, we’re seen as too expensive, barriers to affordability and accessibility –Some think the FDA has painted itself into a corner. Maybe we shouldn’t jump into the same corner?

EuroTrak 2015 and MT9 Updates

EuroTrak updates JapanTrak: Done. Report free for use Italy:Done. Under embargo until November 3rd Germany:Done. 21 slides selected for our free use France:Done. Report free for use UK:Done. Report free for use Switzerland:Done. Report free for use Norway: Postponed DenmarkAd hoc group of manufacturers + retail chains willing to pay. EHIMA to contribute with 1,500€ Belgium:Big interest from Amplifon, - but not from Lapperre. Holland:Big interest from Amplifon & AEA Poland:They have been offered a first round for free (Sept 28) 22

EuroTrak 2009 – 2015: Longitudinal trends Based on additional analysis of 3 rounds of EuroTrak in GER – FRA – UK 2009 –

Hearing aid adoption increases Page 24 % of hearing impaired © Anovum - EuroTrak GER FRA UK pooled Statistical significance (90%): 2015>2012> >2012 -

Image of hearing aids is improving: Top 10 reasons for non adoption for top 50 % HL Page 25 Uncomfortable* N=716/713/603 EuroTrak pooled data GER, FRA, UK, 2009, 2012, 2015 Hear well enough in most situations Hearing loss not severe enough Do not restore your hearing to normal They do not work well in noisy situations Cannot afford a hearing aid Have more serious priorities Ear doctors opinion (ENT) Embarrassed to wear a hearing aid** Bad design** **no longer a top 10 reason in 2015 #1#2#3#4#5 #6#7#8#9#10 © Anovum - EuroTrak GER FRA UK pooled * 55% Physical – hurts, too big

Hearing aids are improving - dispensers' service remains excellent Page 26 DispenserProduct features Product performance (Sound quality, signal process. and listening situations) EuroTrak pooled data GER, FRA, UK, 2009, 2012, 2015: Hearing aid owners © Anovum - EuroTrak GER FRA UK pooled Trends % «satisfied»

Satisfaction with HA in difficult listening situations is improving Page 27 © Anovum - EuroTrak GER FRA UK pooled N=4’133 EuroTrak pooled data GER, FRA, UK, 2009, 2012, 2015: HA owners Trends % «satisfied»

Binaural fitting rate increases Page 28 © Anovum - EuroTrak GER FRA UK pooled Do you own or use a hearing aid ?  Yes, for one ear / Yes, for both ears Statistical significance (95%): 2015>2012>2009

Binaural fitting outperforms monaural fitting for mild, moderate and severe hearing loss Apparently the benefit is smallest for profound losses and highest for mild losses (small samples though) Page 29 Degree of Hearing loss (self stated) % Satisfied Bilateral fittingMonaural fitting Mild 72% n=183 59% n=39 Moderate 83% n= % n=233 Severe 77% n=955 67% n=181 Profound 78% n=237 76% n=69 EuroTrak pooled data GER, FRA, UK, 2009, 2012, 2015: Hearing aid owners with binaural hearing loss. © Anovum - EuroTrak GER FRA UK pooled

Compliance is higher with binaurally fitted hearing aids Approximately how many hours a day do you wear your hearing aids? Note: if you never wear it, write in 0. Page 30 EuroTrak pooled data GER, FRA, UK, 2009, 2012, 2015: Hearing aid owners with binaural hearing loss. © Anovum - EuroTrak GER FRA UK pooled

Hearing aid owners feel less exhausted In the evenings I often feel physically exhausted In the evenings I often feel mentally exhausted Page 31 Base: Hearing aid n=2923 / Top 50 % hearing loss, no hearing aid=2085 *Differences are statistically significant (95%). EuroTrak pooled data GER, FRA, UK, 2009, 2012, 2015 * * * * * * * © Anovum - EuroTrak GER FRA UK pooled * 50% hearing loss refers to a group with a similar degree of hearing loss as hearing aid owners.

Hearing aid owners have a lower risk of being depressed (PHQ-2 Screening) and feel less forgetful Depression symptoms: PHQ-2 Screening: In the last 2 weeks: Little interest or pleasure Feeling down, depressed, hopeless Dementia symptom: Getting more forgetful in the last year? Base: Hearing aid n=2126 / Top 50 % hearing loss, no hearing aid=857 Page 32 *Differences are statistically significant (95%). Top 50% hearing loss refers to a group with a similar degree of hearing loss as hearing aid owners. * * * * * * EuroTrak pooled data GER, FRA, UK, 2012, 2015 * © Anovum - EuroTrak GER FRA UK pooled

Compared to your peers of equal age, education and skill how would you rate the compensation that you receive for the job you perform ? EuroTrak pooled data GER, FRA, UK, 2009, 2012, fulltime or part time employed * Hearing impaired without hearing aids declare more often to receive a worse salary than their peers *Differences are statistically significant (95%). Top 50% hearing loss refers to a group with a similar degree of hearing loss as hearing aid owners. 33 © Anovum - EuroTrak GER FRA UK pooled

EuroTrak & MT9 communication plans General comparison EuroTrak 2015 – MT9. Anovum + SH Hearing loss and co-morbidities. Anovum + SH Dementia / Cognitive decline. Carole Rogin Distribution systems’ effect on adoption rate, HA use, user satisfaction, etc. Primarily for IOM lobbying. Carole Rogin ”The bigger story” (Quality of life, labor market, burn-outs…) TBD Why so low awareness of wireless connectivity?” TBD EuroTrak 2009 – 2015: trends. TBD

EuroTrak & MT9 communication plans Carole and SH to develop a common communication strategy Carole to possibly involve AARP SH to reach out to AEA, EFHOH and WHO Leverage Social Media reach of Hear-It and BHI 10K Euro allocated for professional PR as the ambition is to reach beyond trade media only

New research idea from Amplifon Idea comes from Luis Godinho’s article: which distribution system is the most efficient (Audio Infos FRA, Sept Soon in English)

Compliance Index: meaning and calculation

Compliance index – calculation based on EuroTrak data 1/2

Compliance index – calculation based on EuroTrak data 2/2 Compliance index – the higher the better Clear discrepances between number of hearing aids sold and people who claim to use a hearing aid. Similar index for similar reimbursement systems Necessity of deeper dive into: UK and Denmark: split between private and public system Reasons for no use To be evaluated: possible extension to the Netherland

Prevalence of hearing loss and ageing per country

Refund system and use time of HA

Observed improvements after HA adoption EuroTrak 2015 (n=> 2500 hearing aid owners ) © Anovum EuroTrak 2015 Physical health Mental ability / memory Sense of independence Ability to participate in group activities Mental/emotional health Sense of safety Social life Confidence in yourself Relationships at home Feelings about yourself Relationships at work Overall ability to communicate effectively in most situations

Objectives Completion of the analysis, with the introduction of more and better segmented data Preparation of a comprehensive dossier, with a clear comparison of the most important European countries (the ones already examined by EuroTrak plus, maybe, the Netherlands) in terms of compliance index, average use time, observed improvements and (to be discussed) Public investment. Presentation of the dossier to relevant institutions

To be studied UK - difference between private market users and NHS users (is the low compliance index in the UK only related to the NHS system or equally distributed between the two systems?) In general - reasons for no use or limited use (less than one hour per day): lack of post sale services, no satisfying improvement achieved, lack of comfort, no trial period, long waiting list, no personalized services, lack of professionalism etc.

Cooperation? Our question is if we can share this research with EHIMA. Of course, crucial is that EHIMA shares with us the same position and interest. Amplifon could be sponsor of the project, providing in addition its specific know how for the countries where we operate. It’s clear that we can carry out this research on our own, but we think that, joining our forces, we can come to a more comprehensive, reliable and convincing result and that a similar dossier gains political weight if realized and validated by an European Association. SH: AEA also interested in supporting this project.

WHO conference: Make listening Safe

WHO Conference: Make Listening Safe ”Promoting safe listening through personal audio devices” SH coordinated with Mark Laureyns, AEA, who showed documentation of all the products that violate the rules Also coordination with EFHOH who gave strong backing to Mark’s presentation Goal: WHO help us promote ”Safe listening” – and implement monitoring of adherence to rules & regulations

Coalition for Global Hearing Health Gallaudet University, Washington DK October

Coalition for Global Hearing Health SH presented on the topic: ”The societal and economic impact of treated hearing loss is – good!” Presentation had been discussed with HIA (Carole Rogin) The Coalition for Global Hearing Health is a US-based non-profit organization. Their purpose is to advocate for effective hearing health services and policies. 185 attendees from around the world Very positive reactions from many stakeholders. The Coalition will contact EHIMA re further cooperation

Market challenges

USA IOM (Institute of Medicine) PCAST (President’s Council of Advisors on Science & Technology) Johns Hopkins (Frank Lin) Mead Killion HLAA ADA – Ear Venture FDA undecided Affordability River

France Report from Consumers’ Association describes French HA market as ”locked – to the detriment of the user” Journalists blew this up as big scandal in TV and printed media UNSAF has responded in detail – and has contacted key persons in Health Ministry Press reaction ”worse” than the report itself Six big health insurance companies will possibly cooperate to lower prices Le Monde: next slide

France: Le Monde

Austria TV consumer program with hidden camera shows ”less than ethical” behaviour from dispensers/Akustiker Discussions about ”secret” cooperation with ENT doctors Health Insurance companies ”considering changes” A Dr Probst even suggesting ”communist style” state funding and/or tenders

Australia Oct 5, TV: ”There is evidence the audiology industry (NB!) is rife with predatory practices and kick backs, yet the Government is considering selling the agency that administer hearing services to some of the most vulnerable”

UK North Staffordshire Clinical Commissioning Group finally decided to cut NHS spending for mild and (most) moderate losses EHIMA position?

MDC budget proposal 2016

B16 EHIMA MDC

B16 hear-it

SH performing for individual members Nothing to report

Next meetings

MDCFeb 2, 2016Berlin MDC + BoardApril 19, 2016Amsterdam, Sheraton Airport MDC 5 Sept 2016Berlin MDC + BoardOct 24, 2016Copenhagen

Misc.

Summary of today’s decisions See: MDC presentation to Board