Oticon Reveal: A Hearing Aid Designed for the Brain, and Why That Matters More Than Ever

By Dr. Keith N. Darrow, Ph.D., CCC-A  |  Neuroscientist, Clinical Audiologist and Certified Dementia Practitioner

For most of my career, I have been trying to get people to understand one seemingly simple concept:

Your ears certainly play an important role. They collect sound and begin the process of converting that sound into electrical information. But ultimately, your brain has to receive that information, organize it, separate speech from noise, determine where sounds are coming from, attach meaning to words, recall memories, and decide what deserves your attention.

That is hearing.

And that is why I have spent years telling patients that treating hearing loss should never be thought of as simply “turning up the volume.”

So when Oticon recently announced its new Oticon Reveal hearing technology and centered the conversation around how providing the brain with a more complete sound environment may improve the way the brain performs during listening, they immediately had my attention.

Why?

Because this is exactly the conversation hearing healthcare desperately needs to be having.

Welcome to the Ear to Brain Conversation

Imagine trying to complete a 1,000 piece puzzle after somebody quietly removes 200 pieces.

You can still see the picture on the box. You can still recognize many of the pieces. And with enough effort, you might even figure out what the finished picture is supposed to look like.

But your job just became significantly harder.

That is similar to what happens when hearing loss begins depriving your brain of auditory information.

Your brain does not simply say, “Oh well, I guess we are missing part of the signal.” The brain goes to work. It tries to fill in the blanks. It uses context. It relies more heavily on memory. It increases attention. It recruits other neural resources.

In other words, when the ears provide less information, the brain has to work harder to understand the world around you.

Oticon calls its approach to this problem BrainHearing, built around the idea that the brain functions best when it receives access not only to speech, but also to the meaningful sounds surrounding that speech. Reveal takes that philosophy a step further with what Oticon describes as the world’s first hearing aid powered by a Dual AI system.

Instead of simply making the person in front of you louder while aggressively eliminating everything else, Reveal uses two AI systems working simultaneously: one focused on speech and another focused on meaningful environmental or contextual sounds.

Think about sitting in a restaurant with your spouse. Their voice matters. But so does the acoustic environment around you. The sound of the server approaching, the friend speaking beside you, a glass being placed on the table, somebody calling your name, or a person entering the conversation all provide information your brain can use to understand what is happening.

The goal should not be to put your brain inside an artificial sound tunnel. The goal should be to give your brain useful auditory information in the right balance.

Oticon Says Reveal Can Improve “Brain Performance,” What Does That Mean?

This is where the announcement gets particularly interesting.

Oticon reports research showing that when speech and meaningful contextual sounds are provided in an optimal balance, listeners’ brains can operate closer to natural hearing conditions. The company reports up to a 40% boost in measured brain performance under the experimental conditions used in its BrainHearing research.

That deserves attention. It also deserves the proper explanation.

This does not mean putting Oticon Reveal devices in your ears instantly makes you 40% smarter. Would not that be nice? I would probably wear two pairs!

It also does not mean that Reveal has been proven to prevent Alzheimer’s disease or improve every measure of cognitive function by 40%.

What it means is more specific, and scientifically more interesting. Oticon’s research is examining how efficiently the brain is able to process and balance auditory information when technology gives it better access to both speech and surrounding contextual sounds.

That concept fits beautifully with what neuroscience has been teaching us for years: the quality of information traveling from the ear to the brain matters.

And this is precisely why I wrote my book, Preventing Decline.

Hearing Loss Is About Much More Than Hearing

Many people still wait to treat hearing loss until they “cannot hear.” That is the old model. I believe we should be asking a much better question: what is happening to the brain while you are waiting?

In Preventing Decline, I discuss why hearing loss should be considered within the much bigger picture of brain health, cognitive health, social engagement, independence, balance, tinnitus, relationships and quality of life.

One of my central messages is that hearing loss is not simply an ear problem. It is an ear to brain problem.

Modern research continues to reinforce the connection. The landmark ACHIEVE randomized clinical trial studied older adults with untreated hearing loss. Across the entire study population, hearing intervention did not significantly change three year cognitive decline. However, among participants already at greater risk for cognitive decline, hearing intervention slowed cognitive decline by 48% over three years.

That distinction matters. Science should never be exaggerated. But it should not be ignored either. We now have randomized clinical trial evidence suggesting that properly treating hearing loss may be especially important for adults who are already at elevated risk for cognitive decline.

Similarly, the 2024 Lancet Commission on dementia prevention continues to identify hearing loss as one of the important modifiable risk factors for dementia. Other large studies have found that hearing loss is associated with increased dementia risk, while hearing aid use among people with hearing loss has been associated with lower observed dementia risk, although researchers correctly caution that association does not automatically prove causation.

This is why I want patients thinking about treatment much earlier.

Do not wait until hearing loss has taken you out of the conversation. Do not wait until restaurants become miserable. Do not wait until your spouse becomes your interpreter. And please do not wait until somebody says, “Mom just is not as engaged as she used to be.”

What About Tinnitus?

Here is another part of the ear to brain relationship many patients misunderstand.

Tinnitus, ringing, buzzing, humming or another sound nobody else can hear, commonly occurs alongside hearing loss. When auditory input is reduced or altered, changes can occur throughout the auditory system, including changes in how the brain responds to the missing or abnormal signal.

That is one reason comprehensive hearing treatment can help many tinnitus patients. Clinical research involving hearing aids has demonstrated meaningful reductions in tinnitus impact for many patients, although outcomes vary and no particular hearing aid can guarantee tinnitus relief for every individual.

In my clinical world, therefore, I do not want to ask only, “Can you hear the beep?” I want to know:

• How are you functioning?
• How are you understanding speech?
• How much effort are you using to listen?
• Are you experiencing tinnitus?
• Are you withdrawing socially?
• How is your memory?
• How is your balance?
• How is all of this affecting the people you love?

Those questions get us much closer to treating the person instead of merely treating an audiogram.

Hearing, Balance and Staying Independent

Hearing loss has also been associated with falls and declining physical function in older adults. That does not mean a hearing aid is a fall prevention device, and Reveal should not be promoted as one.

But auditory awareness is one of the many streams of sensory information the brain uses to understand the environment. Hearing treatment can therefore be an important component of a broader strategy designed to preserve communication, awareness, mobility and independence.

The same principle applies throughout modern hearing healthcare: treatment is bigger than the technology.

Reveal may be an extraordinary new tool. But it is still a tool. Proper diagnosis, verification, programming, counseling, cognitive screening when appropriate, tinnitus evaluation, ongoing treatment and follow up remain critically important.

This is exactly why I have spent so much of my career trying to move hearing healthcare beyond the “buy a hearing aid” mentality.

Oticon Reveal Represents an Important Shift

Technology has changed dramatically. Reveal provides up to 25 dB more available gain than three leading competitors in Oticon’s testing, and 94% of participants in Oticon’s research preferred Reveal to its previous Intent platform. Most importantly to me, however, the technology is designed around delivering speech and context to the brain rather than treating hearing as a simple exercise in making voices louder.

That is the direction hearing healthcare needs to go.

That is an entirely different conversation.

Your Next Step: Know Your Hearing. Know Your Brain. Know Your Options.

If you have noticed difficulty understanding speech in noise, tinnitus, asking people to repeat themselves, increasing television volume, withdrawing from conversations or feeling exhausted from trying to listen, please do not simply write it off as “normal aging.”

Get evaluated.

At Hearing and Brain Centers, our philosophy is centered around understanding the entire ear to brain connection and determining whether treatment may help you hear more naturally, reduce listening effort, improve communication and quality of life, and address the broader health consequences associated with untreated hearing loss.

For appropriate patients, the new Oticon Reveal may become an exciting part of that treatment.

Our comprehensive treatment goals may include helping patients:

• Improve auditory and cognitive function.
• Reduce the impact of tinnitus.
• Maintain greater environmental awareness and reduce factors associated with falling.
• Address hearing loss as a modifiable dementia risk factor.
• Stay socially connected and independent.
• Improve overall quality of life.

No hearing technology can promise that you will never experience dementia, never fall or completely eliminate tinnitus. But doing nothing is not a treatment strategy either. And waiting until hearing loss becomes severe makes absolutely no sense when we understand that the brain is involved from the very beginning.

Want to Learn More?

I wrote Preventing Decline: Advances in the Medical Treatment of Hearing Loss and Tinnitus because I believe the best patient is an educated patient.

If you or somebody you love is living with hearing loss or tinnitus, I invite you to request your copy of Preventing Decline and learn why hearing health and brain health should never be separated.

Then schedule a comprehensive consultation with Hearing and Brain Centers to discover whether Oticon Reveal and our comprehensive hearing and brain treatment approach are appropriate for you.

Because the goal is not simply to help you hear another beep in a sound booth. The goal is to help you stay in the conversation, stay connected, stay independent and give your brain the auditory information it needs to perform at its best.

The ears may collect the sound. But the brain is where hearing happens. And that changes everything.

Sources and further reading

This editorial references manufacturer materials and independent research. Product claims should be interpreted within the specific study conditions described by their sources; individual outcomes vary.

Medical note: This article is educational and is not a substitute for individualized medical or audiological care. No hearing technology can guarantee prevention of dementia or falls, or complete elimination of tinnitus.