It turns out these things are all important in clinical outcomes for listening comfort and intelligibility. I've built a modern hearing aid and done extensive patient testing - the details matter and it's not just electrical or algorithm problems but tough mechanical and UX challenges to get something more state of the art.
While I haven't worn many neck mounted devices, the Bose Headphones can get crazy feedback and the feedback path is similar. This would cause squealing discomfort for patients and everyone around them.