Hearing aids market in Japan - Overview

© Christian Bauer - Fotolia

As JapanTrak 2012 has demonstrated, there are a number of specificities that characterize the Japanese market which is different from other industrialized countries. To understand the Japanese market, Audio Infos presents an overview of this industry in Japan.

The number of hearing impaired people in Japan is estimated to be 14 million, some 10.9% of the population, according to JapanTrak 2012. The percentage of hearing aid users among the hearing impaired is just 14.1%. Japan is one of the countries that has a decreasing number of young people and more and more elderly people. For people from outside the country, the Japanese market may be difficult to understand. In order to provide some insight, we have prepared an overview of the market in Japan.

Manufacturers: Big seven

The Japanese market is dominated not by the “big six” (Oticon, Siemens, Starkey, GN ReSound, Widex and Phonak)” but by the “big seven” including Rion, the Japanese pioneer in hearing aid manufacture.

Before the entry of European and American manufacturers into the Japanese market, the only manufacturer was Rion. The company originated as a physics research institute and launched its first hearing aid in 1948. After its expansion into hearing aid manufacture, Rion continued to make medical and scientific equipment such as particle counters. For hearing aids, Rion has a major distribution network throughout Japan under the brand Rionet Center. Today, Rion is not the only domestic manufacturer. There is also Panasonic Hearing Instruments and Cortiton Hearing Instruments. In 1988, the Japan Hearing Instrument Manufacturers Association was established by the merger of two associations: a domestic hearing aid manufacturers association and a hearing aid importers association. The member companies are Rion, manufacturing the Rionet brand, Panasonic manufacturing the Panasonic brand, Oticon importing the Oticon brand, GN ReSound Japan importing the Danabox and ReSound brands, Cortiton Hearing Instruments manufacturing the Cortiton brand, Siemens Hearing Instruments importing the Siemens and Hansaton brands, Widex importing the Widex and Coselgi brands, Starkey Japan importing the Starkey and Omni brands, New Japan Hearing Aid importing the Beltone and Unitron brands, Bernafon importing the Bernafon brand, and lastly Phonak Japan importing the Phonak brand. It may appear surprising that the same group’s brands are imported in Japan by two different competitor companies: the GN ReSound group’s brands are imported by GN ReSound Japan and by New Japan Hearing Aid. The William Demant group’s brands are imported by Bernafon and Oticon. The reason is historical. The importers of these brands existed before the buyout of the brands by another group, and they are still working separately.

Distributors: Large and mid-sized networks

The development of distributors in Japan cannot be separated from the Association for Technical Aids (Techno Aids), a public interest corporation founded in 1987 for the welfare of disabled and elderly people. The organization belonged to the Ministry of Health, Labor and Welfare before 2011, the year when it became a public interest corporation. Techno Aids works to promote welfare equipment for people with disabilities and the elderly, including hearing aids, prosthetic legs, wheelchairs, nursing care robots, etc., offers education to people working in these health care fields, collects and distributes information about welfare equipment, and assesses welfare equipment. Previously, there were no recommendations or rules concerning hearing aid sales. In order to regulate hearing aid distribution in Japan, the Japan Hearing Instrument Distributors Association was created in 1988 in cooperation with Techno Aids. In the same year, a hearing aid section was created in Techno Aids. This means that hearing aids have been considered historically as equipment for disabled and elderly people. Today, the Japan Hearing Instrument Distributors Association has 975 members. All members are corporate members.

Main distributors

Riken Sangyo Group

The major distributors share the Japanese market geographically. When we look more closely at the members of the Japan Hearing Instrument Dispensers Association, the biggest organization is Riken Sangyo group, which has its main office in Nagoya. Riken Sangyo is not only involved in distribution. Hearing aid import and manufacture are only part of its activities. The group has two hearing aid distribution networks. Mainly in Tokai region (center of Japan and near Nagoya, including Aichi, Gifu, Mie, and Shizuoka prefectures) and the Hokuriku region including Fukui, Ishikawa and Toyama prefectures; the centers have the name Riken Sangyo Hearing Aid Center and belong to Riken Sangyo. The other one is a network in Kanto and Kansai regions, and the name of the centers is Riken Hearing Aid Center and they belong to the company “Hearing Distributor Japan” which was created by Riken Sangyo Group in order to cover Kanto, Kansai and other regions. With the two networks, the group has 82 centers. The centers are directly managed by Riken, are franchise centers, or are managed by Matsuzakaya if they are in Matsuzakaya Department Stores. As one part manufacturer, Riken Sangyo is a support member of the Japan Hearing Instrument Manufacturers Association.

Rion Network

The Japanese manufacturer Rion has the Rionet Center network all over the country. They are 100% financed by Rion or are independent companies but they have the same name as the Rionet Center. The managing companies are local distribution companies. In Kansai region, Toshin Jitsugyo is the main distributor of the Rionet brand. Toshin is a long-standing company in the hearing aid business, established in 1950, and has worked in collaboration with Rion. In 14 prefectures of Kansai, Chugoku and Shikoku regions, the company has 28 Toshin Hearing Aid Centers. The number of employees is 150. Toshin Jitsugyo is one of the three biggest distributors in Japan.

In Tokai region, Tokai Rion was created by Rion with 100% investment. Tokai Rion has 22 centers in seven prefectures in Tokai and Hokuriku regions. Twelve of them are directly managed by Tokai Rion and the others are independent centers which have a contract with Tokai Rion to sell the Rionet brand. The number of employees is 50.

Kanto Rion was also established by Rion and has six centers in the north of Tokyo, in Tochigi, Saitama and Gunma prefectures. The number of employees is 43.

Ayanokuni Rionet Center Group is a distribution network only in Saitama prefecture and has 14 centers.

Kyushu Rion is on Kyushu island, in the south of Japan. Established in 1952 by Rion, 22 centers cover seven prefectures. The number of employees is 146.

In Tohoku region, a local Rionet center network exists in each prefecture and these are not grouped by region like in Kyushu or Kanto. In Akita prefecture, there are six Akita Rion Hearing Aid Centers. In Miyagi prefecture, there are four Sendai Rion Hearing Aid Centers. In Fukushima prefecture, three Iwaki Rion Hearing Aid Centers operate and one Aizu Rion Hearing Center. In Hokkaido, Iwasaki Denshi is the sole agency of Rion. It is the biggest distribution company in Hokkaido. It has nine directly managed centers and two partner centers. Established in 1933, Iwasaki Denshi began to sell the first hearing aid made in Japan by Rion in 1948.

In Okinawa, Ryuku Hochoki is the sole agency of Rion. It has six centers in the Okinawa islands.

Even Rionet Centers and Rion’s sole agencies are strongly associated with Rion; they should sell several brands and not only the Rionet brand to be recognized as “specialized hearing aid centers” by Techno Aids.

Other distribution networks

The mid-sized hearing aid distribution networks can be found in several regions. In Tohoku region, having its main office in Yamagata city, Shudensha group has six centers called Shudensha in Yamagata prefecture. The group has four centers in Fukushima prefecture under the name Mimi Plaza.

In Chugoku region,Confort Hearing Aid Group by Chugoku Hearing Aid Center has eight centers.

Aid is a network in Tokyo, Kanagawa and Shizuoka prefectures and has 13 centers.

In Osaka, Yoshida Katue Shoten, the first specialized hearing aid center in Japan established in 1911 has four centers in Osaka, Kyoto and Kobe.

Makichie, established in 1977 is a manufacturer and distribution network selling its own products. The company has 29 centers and branches in all, across Japan. Makichie is a support member of the Japan Hearing Instrument Manufacturers Association. Widex also has a 100% hearing aid distribution network. Bloom Hearing was established to promote Widex products but also sells other brands. The name of the center is Bloom, and there are 50 centers, including partner centers throughout Japan.

Shin Nihon Hearing Aid and Hokuriku Hearing Aid belong to the MTHA group and have 100 centers throughout Japan. The MTHA group is thought to be the largest specialized hearing aid distributer network, but detailed information on the company was not communicated to Audio Infos. It seems the group follows its own path.

Opticians selling hearing aids

Opticians, competing with hard discount glasses stores, have entered the area of hearing aid distribution. A magazine and a journal for opticians have a special page on hearing aids. This means that huge numbers of opticians sell hearing aids in Japan. Big glasses companies can organize an education course for their employees so that they can sell hearing aids. They are rivals for specialized hearing aid distributors, because customers more readily go to a glasses store than to a specialized hearing aid store.

Several big optician networks and stores have committed to the hearing aid industry. One of them is Meganeno Tanaka, which has its main office in Hiroshima. It has 145 stores, of which 132 sell hearing aids. Kikuchi Megane in Aichi prefecture also has a big distribution network with 136 stores, of which 132 sell hearing aids. Meganeno Aizawa is an optician chain store which has 37 stores in Miyagi, Fukushima, Iwate and Yamagata prefectures in Tohoku region. In 26 stores, hearing aids are sold. Japan Optical mostly has sales points in department stores. The company has 30 of these sales points.

Some of these opticians are members of the Japan Hearing Instrument Distributors Association.

Certified hearing aid distributor

Techno Aids delivers the Certified Hearing Aid Distributor label when a hearing aid distributor applies for accreditation and if the distributor satisfies all the conditions required by Techno Aids: 1) the center is suitable to receive customers and do fitting work, 2) there is always a certified hearing aid technician in the center, 3) the center has the necessary equipment for fitting, and 4) if the center does repairs, it must have received approval to do the repairs according to the pharmaceutical law, etc.

The certification is for five years and every five years the centers must apply for certification. Most of the members of the Japan Hearing Instrument Dispensers Association have this certification. The certification demonstrates the high quality and serious work of the center. In Japan, there is no official certification and recognition for hearing aid technicians. This system of distributor certification allows people to distinguish the differences in quality and service when they buy hearing aids.

Internet sales

One of the most important problems in Japan is internet sales of hearing aids. Many internet sales companies sell a wide range of brands, even well-known ones but of course without fitting by professional hearing aid technicians. The Japan Hearing Instrument Dispensers Association has asked the Ministry of Health, Labor and Welfare to impose the obligation of having a certified hearing aid technician in a distributor in order to provide good quality service to customers. It is still unclear when internet sales of hearing aids will be regulated. Member companies of the Japan Hearing Instrument Manufacturers Association supply their products to internet sales outlets. It would be difficult not to sell to internet companies considering the economic impact. If a company did not sell through this channel for ethical reasons, other rival companies would take their market share.

Education system: How to become a hearing aid technician in Japan

Contrary to other industrialized countries, there is no official recognition for hearing aid technicians in Japan. Unlike nurses, speech therapists, pharmacists or physicians, there is no national examination to become a hearing aid technician. And there is no profession akin to audiologist. The reason, as mentioned above, is that hearing aids have been considered welfare equipment from the very beginning. The professionals working with hearing aids are considered to be welfare workers. There is no way of following an education in a medical school to become an audiologist. Likewise, there is no school to train hearing aid technicians. The only way to become a hearing aid technician is to undergo Hearing Aid Technicians Training by Techno Aids. To become a candidate, applicants must have a high school diploma. The first training course in this area began in 1990.

Before, the candidates were limited to employees in the hearing aids business, but since 2012, any applicant who has a high school diploma can follow first-level training by E-learning. The first level is made up of 46 hours of learning. To successfully complete the first year course, applicants must undergo training in Tokyo for two days, with about seven hours of lectures and six hours of practical training. Even with a high level of knowledge, if the person was not working in the hearing aids business, it would be difficult to work with hearing aids. Therefore, as before, those who attend the training are essentially people working in this field. At the end of this phase, training course students must pass an exam to move on to the second year program.

In the second year, 44 hours of lectures are organized over five days and deal with hearing impaired people’s psychology, medical ethics, knowledge about hearing aids and fitting, counseling, administration, and examples of patients. After the course, applicants are required to take an exam.

In the third year, there are lectures of 60 hours about medical law, hearing aid fitting and control, audiometry, impression, and hygiene management, etc.

In the fourth year, there is a one-day course of five hours about effective and safe hearing aid supply and the medical academy related to the hearing aid.

The candidates who have finished all four years and who obtain an approval from a hearing aid ENT consultant from the Oto-Rhino-Laryngological Society of Japan, Inc. can take the final exam. If candidates pass, they are awarded Hearing Aid Technician certification by Techno Aids. The certification is valid for five years. During these years, they continue to undergo training and every five years they can renew their certification.

Speech therapists can skip certain steps to become hearing aid technicians.

In 2013, 460 people became hearing aid technicians. The total number of hearing aid technicians trained since the beginning of the program is 3,099. The average level of success in the final exam over a four-year period (2010-2013) was 84.5%. Between 2010 and 2013, the number of new hearing aid technicians doubled.

Senior hearing aid technicians who contributed to create the Japan Hearing Instrument Dispensers Association collaborate actively with Techno Aids for the training and some of them are trainers.

The hearing aids industry has been trying to develop official recognition of hearing aid technicians, but their efforts with regulators have yet to succeed.

Certified hearing aid technician candidates mostly work in hearing aid centers and learn the profession from their senior colleagues during four years of training. The centers often support them financially to undergo training.

Hearing aid supply by public support

In Japan, hearing impaired individuals whose hearing level is lower than 70dB in both ears can receive a physical disability certificate from the authorities, which allows them to benefit from public financial support from their municipality. Almost 90% of the cost is paid by the municipalities. 36,000 hearing impaired persons are estimated to have received hearing aids with this system. But if Japan adopted the World Health Organization’s recommendation of fitting hearing aids from 41 dB, the number of people estimated to require hearing aids would increase to six million.

Several municipalities provide greater financial supports to elderly people or children, even if their hearing levels are not less than 70dB.

The absence of public support is a significant obstacle to sales of hearing aids for the hearing impaired who are not considered to have a physical disability.

Collaboration with ENTs

When a person goes to a hearing aid center without a letter from an ENT specialist, the hearing aid technician recommends that the person consult an ENT before returning to the center. In this case, the person can go to a hearing aid counselor physician. The hearing aid counselor system was created by the Japan Audiology Society, an academic medical society related to the Oto-Rhino-Laryngological Society of Japan, Inc. There are around 3,900 ENTs who have a title of hearing aid counselor.

Hearing aid technicians association

In order to achieve the goal of official recognition of hearing aid technicians by the government, the Japan Hearing Instrument Technicians Association was created in 2006 as a sister association of the Japan Hearing Instrument Dispensers Association. The members of the dispensers association are corporate, while the members of the technicians association are individuals. However, not all certified hearing aid technicians are members of the Japan Hearing Instrument Technicians Association and even candidates of the certified hearing instruments technician program can be members. They can obtain rapid access to information about the certification program and access to past exam questions if they are members of the Japan Hearing Instrument Technicians Association. For already certified technicians, the association offers training to maintain professional levels.

Main hearing aid events in Japan

Two important professional congresses

For hearing aid professionals, there are two main events in Japan. One is the general meetings of the Japan Hearing Instrument Dispensers Association and the Japan Hearing Instrument Technicians Association, held together at the same venue in May or June every year, in a two-day event. The events include election of officials and a conference with special guests.

Another important congress is the general meeting of the Japan Audiology Society. Most members are ENTs, but some hearing aid technicians and manufacturers are also members or support members. The congress is held in the fall. After the congress, at the same venue, a hearing aid study conference is organized. It is especially interesting for hearing aid technicians.

In both events, there is a trade show by manufacturers. New products are presented and this is a good occasion for manufacturers to renew contacts and make new clients.

Japan Hearing Aid Forum

In June 2013, the Japan Hearing Instrument Dispensers Association held a 25-year anniversary event in Tokyo named “Japan Hearing Aid Forum 2013”, a joint event of a hearing aid show for consumers and professionals and the general meetings of The Japan Hearing Instrument Dispensers Association and the Japan Hearing Instrument Technicians Association, in a building in Akihabara, the famous electronics district in Tokyo. Suzuki Tsuneyuki, President of the Japan Hearing Instrument Dispensers Association explained the purpose of the event: “There is the AAA in the United States and the EUHA in Germany for Europe. But there was no big event about hearing aids in Asia.” Over a two-day event, 18 seminars for professionals were organized by manufacturers. The public could also attend several seminars for consumers and for children. In the exhibition hall, hearing aid manufacturers, cochlear implant manufacturers, battery manufacturers, and accessory makers demonstrated their techniques and products to the public. In one booth, visitors could undergo audiometry and listen to explanations about hearing aid fitting by certified hearing aid technicians. The event totaled 2,600 visitors, higher than the goal of 2,000 visitors. The organizer plans to schedule a hearing aid forum every two or three years.

Special days for hearing aids and ears

Ears Day

Ears Day was created in 1956 following a suggestion from the Oto-Rhino-Laryngological Society of Japan, Inc. The number 3 is pronounced “Mi” in Japanese. And “MiMi” means “ear”. The ENTs in every prefecture organize conferences and free consultations for hearing impaired people.

Hearing Aids Day

The Japan Hearing Instrument Dispensers Association and the Japan Hearing Instrument Manufacturers Association jointly chose June 6th as Hearing Aids Day because the shape of the number “6” is like that of an ear and two 6’s form two ears. The purpose is to change the negative image of hearing aids, such as “they are for old people” and let people know more about hearing aids. Since 2012, a special event has been held on Hearing Aids Day: the “Hearing Aid Life Style Forum” by the Japan Hearing Instrument Manufacturers Association. The organizer advertises for hearing aid users to demonstrate on the stage their relationship with hearing aids and how they are useful in their lives, like a fashion show. Hearing aid users pre-selected in each category speak, sing, and perform their activities in a way related to their activity. The jury, including a fashion critic, chooses the best performer.

Statistics

Every year, the Japan Hearing Instrument Manufacturers Association publishes statistics on the number of hearing aids sold in Japan. According to this information, in 2013, 528,789 devices were sold. In detail: 41,329 box types (hearing device that can be put in a pocket), 41,329 BTEs, 551 glasses types, 41,320 ITEs, 181,605 custom-made devices, and 17,028 other ITEs. The number of BTEs has been increasing since 2001 or 2002. The box type has almost disappeared in other countries, but in Japan, the price is lower and for elderly people, it is simple and easy to handle. This model has a reason to continue to be used. In 2009, Panasonic launched a new small stylish model that was presented the Good Design award.

Hanyu Noriko

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