June 2021 CTV News London

Advancements in cochlear implant research at Western University might just be music to the ears to the deaf or hard of hearing. Western researchers, working with international colleagues, have developed a new tool that helps cochlear implant patients hear their world with improved clarity.

clarity tool

Luke Helpard, PhD candidate at Western’s School of Biomedical Engineering, said patients with cochlear implants often process sounds that seem warped or out of tune. “We call it a pitch mismatch, where frequencies are perceived different from their natural pitch. And that may not sound like a big deal, but that can have a lot of consequences for things like speech perception, music appreciation, even sound localisation.” According to the Schulich School of Medicine and Dentistry, when cochlear implants are surgically placed, electrodes are inserted along the cochlea -- the part of the inner ear that converts vibrations into pitches of sound -- and Helpard says that until now programming has been one-size-fits-all. “Some users have qualitatively reported that a cochlear implant can sound like Mickey Mouse, or Darth Vader, or these sort of warped type of hearing where it doesn’t sound natural.”

Helpard is part of a team that has come up with a tool to mathematically program the cochlear implant for each patient’s specific needs. They’re using imaging data to customise the pitch map for each patient. A pitch map refers to how simulation frequencies are assigned to each electrode, and ultimately, how sounds are perceived by the patient. “With this new tool we’re able to model individual pitch maps relatively accurately, and much more accurately than any previous approaches,” said Helpard. “So we really think this will revolutionise how cochlear implant programming will happen.”

The project is being co-led by Hanif Ladak, PhD, a professor at Schulich and the Faculty of Engineering, along with Dr. Sumit Agrawal, an associate professor at Schulich. The new tool is currently being used in trials. In a news release from Schulich, Ladak noted they’re already seeing real world results. “Typically, when we talk about math, people can’t see how it is applicable in real life. What’s beautiful about this is that our mathematical tool has an obvious real-life application and audiologists are already beginning to evaluate it in patients.” Helpard said they’re hoping the new tool will “improve quality of life overall through speech perception, music perception, and as well the ability to perceive sounds in nature.”

pitch mapImaging data is being used to customise the pitch map for each cochlear implant patient

June 2021 The Hearing Journal

brain wavesFor the first time, researchers have successfully used cochlear implants (CIs) in human adults to record their electroencephalographic (EEG) signals and get a better assessment of their hearing. Brain signals recorded by ear implants provide an objective understanding of how good or bad a person's hearing is, without the need for expensive and cumbersome equipment, according to this new study published in Scientific Reports. The technology could also pave the way for clinicians to remotely conduct CI fittings, and further, for CIs themselves to autonomously perform fittings based on EEG diagnostics.

ELECTRODES AS NEURAL SENSORS

CIs in the market each have an array of electrodes that decode external sounds and translate them into electrical signals that the brain can interpret. This study used an experimental CI with a dedicated electrode for recording EEG. “With this implant, the internal part, like the electrode array that is in the cochlea, was the same as a clinical implant. The only difference was that there was a percutaneous (through-the-skin) connector that connects the implant to the outside,” explained study first author Ben Somers, PhD, an associate professor at the KU Leuven. “Normally, this connection to the behind-the-ear piece is wireless. This connector was very convenient because it allowed us to directly access the electrodes in the cochlea to which we could connect an external EEG recording device.”

Typically, experiments that involve electroencephalography use a set of external equipment, including an electrode cap that is placed on the person's head. Somers's team minimised the requirement for “expensive equipment that is cumbersome to use,” as their paper described.

“The possibility to measure EEG with the implant electrodes would be an elegant solution to replace EEG head caps with gel electrodes that are placed on the scalp,” Somers said.  He also noted that CI electrodes have been used as sensors in various measuring and monitoring studies, but using them as EEG-recording sensors is a new approach. “The idea to use CI electrodes as sensors is not new in itself; for example, implants from all major manufacturers are able to measure impedances in the cochlea, or monitor responses of the auditory nerve to electrical stimulation (so-called ‘CAPs’ or compound action potentials). These measures are helpful, but they characterise very local, very peripheral effects in the auditory pathway. EEG is a promising technique to measure higher-level auditory diagnostics; for example, to measure how speech is processed and understood in the brain.”

OBJECTIVE AUDIOMETRY & FUTURE APPLICATIONS

Getting EEG signals from a CI user could be a more objective way to assess their hearing, as opposed to just asking them for feedback during their CI fitting. A user's opinion can be subjective, making it challenging for a trained audiologist to adjust their CI settings. Some users may also have extra difficulty in evaluating their own sense of hearing, as may be the case for persons born deaf or those with dementia. In addition, CI fittings are done during in-clinic sessions, which may not take into account variable factors like the user's different listening environments outside the clinic.

The researchers emphasise that a CI user's EEG signals provide “objective audiometry, in which brain responses evoked by auditory stimulation are collected and analysed.” An audiologist could then adjust the CI settings based directly on analysed EEG information. More than that, the researchers are hopeful their findings will be the foundation for more leaps in CI technologies.

“This will make it possible to monitor the hearing status of CI users outside of the clinic, and possibly allow an audiologist to perform remote fitting adjustments,” shared Somers. “This technology also fits within a broader vision for ‘closed-loop’ cochlear implants, which are CIs that will be able to collect EEG-based hearing diagnostics and use them to autonomously adjust their settings to improve the hearing quality for the user.”

However, Somers noted that there are important hurdles to clear along the way. “The main challenge would be to integrate the EEG functionality into cochlear implants. This is a very technical challenge and would mainly be carried out by the manufacturers of CIs,” he said. “However, the setup that we created and the results of this research provide valuable information that will help with this challenge. For instance, we were able to determine advantageous locations to place implanted recording electrodes, and have gained valuable knowledge about the signal characteristics of intracochlear EEG.

“A next step that we are looking into is to record more advanced EEG responses from our set-up: in this first study, we used relatively simple evoked potentials in response to click stimuli. In the future, we will also attempt to record steady-state responses and even responses to speech stimuli, as those could provide even more useful diagnostic information about the hearing system.

June 2021 The Hearing Journal

AH CIFF Clinical EffectivenessThe utilisation rate for cochlear implants was recently estimated at 6% for adults who meet the traditional candidacy criteria of bilateral moderate to profound sensorineural hearing loss. At the American Cochlear Implant Alliance (ACI Alliance), our mission is to eliminate barriers to cochlear implantation by sponsoring research, increasing awareness, and advocating for improved access to cochlear implants for patients of all ages.

ACI Alliance recently began a new partnership aimed at addressing low awareness of cochlear implants and their benefits within the hearing aid specialist community. We partnered with the International Hearing Society (IHS), which is a membership association for hearing health care professionals. IHS members are hearing aid dispensers who engage in testing hearing and selecting, fitting, and dispensing hearing aids. ACI Alliance and IHS worked together to create membership and educational opportunities for IHS members who are eager to learn more about when to refer their patients for a cochlear implant evaluation.

The inspiration for this partnership grew out of conversations with the state and national chapters of hearing aid specialists. From those conversations, we learned many hearing aid specialists are unsure of current FDA cochlear implant candidacy, as well as which patients might benefit from a cochlear implant evaluation, and the process of where and how to refer patients for a cochlear implant evaluation (ACI, www.acialliance.org/page/StepstoaCochlearImplant).

As a nonprofit national entity whose members span the clinical and research community, educators, adult recipients, and parents of children with hearing loss, ACI Alliance is uniquely suited to step in and fill the gap to connect hearing aid specialists with cochlear implant centres. Our work with IHS chapters also includes dissemination of information on the benefits of cochlear implants for appropriate candidates over hearing aid alone, as well as the hearing profile of patients who may benefit from a referral for a cochlear implant evaluation. It is critical to improving education and awareness of cochlear implants to all hearing health care providers as the projected number of adults affected with hearing loss is expected to rise significantly over the next few decades, and untreated hearing loss can negatively affect quality of life, communication, and cognition.

Fortunately, familiarity and comfort with virtual presentations have led to increased opportunities for members of the ACI Alliance to present this important information to more audiences through individual state IHS chapters, as well as an IHS-hosted virtual webinar in late April.

The goal of the ACI Alliance partnership with IHS is to increase knowledge about when a hearing aid patient (who is being seen by a hearing aid specialist) should be referred for a cochlear implant evaluation and how a patient can benefit from a cochlear implant over a hearing aid. ACI Alliance can mitigate barriers to CI access by broadening networks of those who are familiar with CI candidacy and outcomes, building new relationships between hearing health care and primary care professionals, and continued education for adults, parents, and family members on the topic of cochlear implants. We hope that partnering with IHS is a step in that direction as comprehensive hearing health care benefits all patients with hearing loss. We are grateful for the partnership with IHS and the progress that has been made so far.

June 2021 TVNZ

ALHD Hearing dogsYou might be familiar with guide dogs, the clever pooches that help visually impaired people that navigate the world, but perhaps lesser-known are hearing dogs.   These dogs know when a phone message needs attention, when someone is at the door or if a smoke alarm is going off.  More than that, they can help those who are hearing impaired discover a whole new way of living by being their ears. 

When Scotty Rogers started to lose his hearing, he felt his world get slowly smaller and smaller. 

“I used to have a perfect hearing until about 20 years ago, the wife and boys would say something and I’d say ‘what?’. Without his cochlear implant, he’s considered deaf.  “I found it was too much trouble going out and talking to people, you felt as if you were being a nuisance. So I just withdrew.” 

That’s until his dog Ben helped to bring him out of his shell once again.  He’s a graduate of Hearing Dogs in New Plymouth, where puppies are trained for six months learning how to alert their owners to the things they can’t hear.  Terry Darby, from Hearing Dogs, says that when the dogs are matched with a deaf person they take a week-long staycation at the charity’s cottage. 

“It becomes obvious whether they’re attaching to the dog and the dog is attaching to them. We need to get it right before the dog leaves here.” 

Purchasing and training a dog isn’t cheap, but it’s a cost that Hearing Dogs has never handed on. They're reliant on volunteers and donations to keep running.  Each Wednesday, the group runs a doggy daycare to help with the bills and an added bonus of socialising the clever pups.

June 2021 Medical News Today

An audiogram is a graph of results from an audiometer hearing test. An audiometer is a piece of electronic equipment that creates a series of tones played through headphones. A person’s audiogram visualises their audiometer test results, displaying hearing thresholds for various frequencies. This article discusses what an audiogram shows, what the symbols mean, what doctors consider a normal range, and what a person might do next after receiving their audiogram.

audiogramOne of the most fundamental hearing tests is pure tone audiometry. For this test, a hearing professional, or an audiologist, uses an audiometer to generate tones. These tones vary in frequency, or pitch, measured in Hertz (Hz), and volume, measured in decibels (db).

The test assesses a person’s left and right ear separately. When an audiologist plays a pure tone, or a sound with a single frequency, a person needs to signal when they hear the sound, typically by raising their hand or pressing a button. An audiologist determines a person’s hearing threshold for various frequencies. The hearing threshold is the softest sound a person can hear at least 50% of the time.

A person needs to wear a headphone and a bone conductor during an audiometer test. These measure a person’s hearing thresholds through air conduction and bone conduction, respectively.

Sometimes, an audiologist may apply a masking noise on the non-test ear to prevent it from participating in the other ear’s test. Most specialists mask during bone conduction tests. Also, most mask for air conduction tests when thresholds reach 40 db or louder in over-the-ear earphones, or 60 db for in-ear earphones.

An audiogram records a person’s left and right ear’s air and bone conduction threshold. An audiogram displays various numbers to represent frequencies and intensities. Frequencies are arranged horizontally from left to right. The range is from low pitch (125 Hz) to high pitch (8000 Hz). Volume is arranged vertically from top to bottom and ranges from very soft (0 db) to very loud (120 db).

Below are the specific symbols a person may see in an audiogram, along with their meaning:

  • X: left air conduction threshold
  • O: right air conduction threshold
  • >: left unmasked bone conduction threshold
  • <: right unmasked bone conduction threshold
  • ]: left masked bone conduction threshold
  • [: right unmasked bone conduction threshold

Symbols for the left ear are typically in blue, while symbols for the right ear are generally in red.

An audiologist can explain the symbols and how to read an audiogram correctly. 

Interpreting results

People can check their audiogram results to know whether they have hearing loss, as well as its type and severity. Generally, the farther the results are from the normal hearing range, the greater the hearing loss a person has.

An overview of hearing levels for adults based on a person’s volume threshold results:

Extent of hearing loss

Thresholds (db)

normal hearing

0–25 db

mild hearing loss

26–40 db

moderate hearing loss

41–55 db

moderately severe hearing loss

56–70 db

severe hearing loss

71–90 db

profound hearing loss

90 db and above

An audiologist should discuss a person’s results in detail, including explaining whether the person has any degree of hearing loss and how to use the results when making healthcare decisions.

An audiologist will use a person’s test results to determine whether they have hearing loss, as well as its type and severity.

In addition to pure tone audiometry, an audiologist may conduct a speech test or other hearing tests, including:

1. tympanometry

2. electrocochleography

3. auditory brainstem response testing

These will determine the functioning of hearing structures, such as the eardrum, inner ear, and outer ear, and the brain’s response to sound.

Audiograms and other test results can help an audiologist recommend the best hearing solutions for an individual. A person’s hearing threshold indicated by the audiogram can help determine the amplification necessary when using a hearing aid. The audiologist will also send results to the person’s referring physician, who can further discuss with the person their results and treatment options.

May 2021 PCMag.com

Many adults who would benefit from hearing aids don't use them, thanks in part to cost and stigma. But less-expensive, over-the-counter solutions, as well as the popularity wireless earbuds, are helping accelerate adoption.

tech solutionsElectronics manufacturers are increasingly producing software and products that address hearing loss. Smartphone apps, earbuds, and soundbars help people understand real-time, in-person conversations, phone calls, and streaming media.  "It's remarkable that so many more tech companies are even thinking about people with hearing loss," says Joe Montano, a New York City audiologist and professor at Cornell University's Weill Medical College. Montano was pleasantly surprised to learn that big box retailer BJ's is now selling a "dialogue clarifying" soundbar that makes it easier for people with hearing loss to understand movies and TV shows by reducing the prominence of music and sound effects in the soundtrack.

Zvox AV157 soundbarZvox AV157 soundbar

The Zvox AV157 sells for just under $200 and has a dozen settings that reduce sounds other than dialogue. Swampscott, MA-based Zvox, which also makes low-cost hearing aids and noise-cancelling Bluetooth headphones, has been in the soundbar business since 2004. The AV157 has been a godsend for Dick DeBartolo, the 75-year-old MAD Magazine writer and gadget reviewer who describes his hearing as "not tremendous.” "I just found the Zvox AV157 really amazing at clearing up the dialogue," said DeBartolo. He described watching a scene in a movie recently involving someone who was about to be hung in an old Western town. The crowd that had turned out to witness the hanging was screaming, at which point DeBartolo hit 12, the most extreme of the dozen dialogue clarifying settings. "The crowd basically vanishes," said DeBartolo. "You just hear the people who are going to do the hanging talking, which is more important to me than hearing the crowd yelling."

My wife, who has severe to profound hearing loss, has found Caption Calls, a recently enabled accessibility feature on Google's Pixel phone, to be a huge help in her struggle to understand people on the telephone. The one drawback is that the recipient of her calls hears a short pre-recorded advisory that the conversation will be captioned and some recipients promptly hang up, thinking it is a robocall. But Google's accessibility team has been advised of this shortcoming.

controlAmong adults 70 and older who would benefit from hearing aids, only 30% have ever used them according to the National Institutes of Health, and that number drops to 16% among people aged 20 to 69. Two factors figure into that phenomenon, advocates say: stigma and cost. But recent legislative and technological developments promise low-cost and stigma-free solutions.

This includes substantially cheaper over-the-counter hearing aids approved by the federal government (but still caught up in bureaucratic red tape), as well as the emergence of wireless earbuds as an affordable way to compensate for mild to moderate hearing loss. These earbuds are usually controlled by apps on smartphones.

Asked whether there was widespread awareness of the apps and earbuds in the hearing loss community, Lise Hamlin, director of public policy for the Hearing Loss Association of America (HLAA), said, "I've been hearing some good chatter about it… People like the idea of using something that looks like what everybody else is wearing."

airpods proAirPods Pro 

"Fifteen to 20 years ago, nobody would be caught dead with anything sticking out of their ears and now, of course, it's a fashion accessory," noted Richard Einhorn, the former chairman of HLAA's board. "AirPods were designed to not only be visible but really visible. You're really making a statement when you walk around with these sticks in your ears. From the standpoint of people with hearing loss, this is fantastic news because it means that people are no longer embarrassed putting things in their ears in order to hear. It's a small step now to put something in your ears to hear better."

Einhorn is a composer and record producer who suddenly lost much of his hearing in 2010. He is now a US consultant for Jacoti, a Belgian company whose key executives have spent 30-plus years working on hearing technology like cochlear implants. Jacoti's technology—and that of its competitors—will turn wireless earbuds into de facto hearing aids with a self-administered hearing test and the ability of consumers or a professional audiologist to tweak settings to compensate for hearing loss in individual patients.

"It's going to enable millions of people to hear better for the first time," said Einhorn, who notes that the frequency range for wireless earbuds is far greater than that of hearing aids. The result is that music will sound much better on the earbuds than on hearing aids, which are optimised for speech.

Jacoti signed a deal with Qualcomm in October to include its software on the chipmaker's QCC5100 Series Bluetooth Audio SoCs. Jacoti's software will be licensed by headphone and earbud manufacturers, who will load it onto the chip during the manufacturing process. Consumers will then be able to run a hearing test app on iPhones and Android phones, after which Jacoti creates a profile for each ear so the earbuds can adjust noise levels. "For example, in a busy restaurant or even in an open plan office their technology is designed to deliver assistive listening for live conversations so that those with mild to moderate hearing loss can more easily participate in conversations around them," according to Qualcomm.

Chris Havell, Qualcomm's senior director for voice and music product marketing, said the company wants to see Jacoti technology in as many earbuds as possible. "If you're going to focus on hearing enhancement and have hearing tests on the phone and make adjustments in the earbud, you want to make sure that that is done correctly," said Havell. "That's why we're engaging with Jacoti, because as a medical devices company, that's their strength.” Jacoti's hearing test apps, though they are software and not hardware, are certified as medical devices in the European Union, and are registered with the FDA in the US.

Which Apps and Devices Actually Work?

Jacoti is not the only company whose mission involves using a smartphone app and wireless earbuds to help consumers with hearing loss. Search the iPhone and Android app stores and you'll find dozens of apps, including Ear Booster, Ear Scout, HearMax, Miracle-Ear, Hear Boost, Mobile Ears, Hearing Helper and Rogervoice. Some don't claim to be dedicated to ameliorating hearing loss but simply characterise their function as hearing personalisation or amplification. Many are free but Petralex, the product of a Moscow-based company, requires a $12-per-month subscription. A company spokesman says Petralex is installed on about 7,000 devices globally.

Mimi software, the product of Berlin-based Mimi Hearing Technologies, was used to test the hearing of more than 1.7 million people last year, according to CEO Philipp Skribanowitz. Like Jacoti's technology, Mimi can be used on Qualcomm's SOC and its hearing test apps are certified as medical devices in Europe. Mimi, which means ear in Japanese, licenses its hearing-assistance algorithms to smartphone and headphone manufacturers. The software is also available on a streaming app used by Rundfunk Berlin-Brandenburg, a German public broadcasting network.

Skribanowitz estimates that Mimi technology is currently on about a million devices and projects that in five years that number will grow to 100 million. 

The irony that earbuds, which are believed to be a significant cause of hearing loss in the young, are now being used to cope with hearing loss is not lost on Skribanowitz. "Twenty, 30 years ago, occupational [exposure] was a major cause of hearing loss but today consumer electronics is one of the biggest drivers of hearing loss," he noted. In the last several years, earbuds manufactured specifically for people with hearing loss have entered the market. This product line has been referred to as smart earbuds or hearables and, with the addition of sensors, can be used for medical monitoring and fitness tracking.

olive smart earOlive Smart Ear 

Tokyo-based Olive Union makes a $300 single earbud known as the Olive Smart Ear. It is classified as a personal sound amplifying product (PSAP), which exempts it from FDA regulation as a hearing aid.

Nuheara, an Australian company, makes the IQbuds2 MAX, a set of $319 "hearing buds" that have an algorithm used by audiologists to calibrate high-end hearing aids. The algorithm is licensed from the Australian government's National Acoustic Laboratories. But Nuheara is careful not to bill itself as a hearing-aid alternative. Perhaps that's a semantic splitting of hairs because the company does say it is focused on individuals with mild hearing loss.

IQbuds2 MAXiQBuds2 Max

"Our primary target customer is a 55-year-old person who recognises they have a little bit of hearing loss but aren't prepared to get a hearing aid," said David Cannington, Nuheara's chief marketing officer. "We're not trying to replace a hearing aid and we're not trying to replace the audiologist's role in helping people that have moderate to severe hearing loss. They have to go to see an audiologist. But we're using some of the technology that is typically found in a hearing aid in a consumer device."Cannington believes there will come a day when people wear a hearable for a good part of their day. "Whether it's to hear better or do biometric readings, that day will come," he said. "There's no doubt that there's going to be massive growth in this category."

iQstream TVIQstream TV

The company also makes IQstream TV, a Bluetooth box that allows wearers of Nuheara's hearing buds to independently control the volume of TV content. The device may appeal to couples in which one partner needs more volume due to hearing loss while the other partner does not.

As electronics manufacturers cater more to consumers looking to ameliorate their hearing loss or personalise their listening experience, we can expect all sorts of new products that will prove true that line in Paul Simon’s song "The Boy In The Bubble"—"These are the days of miracle and wonder." Expect this sort of innovation to move beyond personal devices to systems that deliver customised sound to people wherever they may be, from concert halls to sports stadiums. Miracle and wonder, indeed.

March 2021 williamsonherald.com

Jaime  and Lexi VernonSongs for Sound is a nonprofit with a focus on providing hearing loss awareness and access to solutions and action through consultation.  It was founded by Jaime Vernon (R) after she received confirmation that her then13-month-old daughter, Lexi, (L) was deaf. After months of being misdiagnosed, months of lost opportunities, months of not knowing what was wrong, now there were solutions. Jaime Vernon decided to use lessons learned from those experiences to help others with hearing loss through information, assessment and resources. Missed hearing loss diagnoses are the most common story, she said.  “The real kicker for me was (that) I would rock her and sing to her during her whole first year,” Jaime said. “She would squirm and never put her head on my shoulder. I would cry. We didn’t connect.”

Lexi’s diagnosis was both a relief and a heartbreak, but hope arrived when the tot was deemed a candidate for a cochlear implant.  For 19 months, Lexi lived in a silent world, struggling to communicate. Then one day, while seated in a high chair in a strange room and distracted by the bits of snack Jaime was giving her, the audiologist turned up the sound and Lexi heard something.

“Lexi, Lexi,” her father said. “Lexi, it’s mommy and daddy,” Jaime said. 

The toddler paused, sat back as if to think and then searched for the sounds. Bubbles caught her attention while mom and dad continued speaking and pounding on the tray. Lexi flashed a broad smile that lit up her parents’ hearts and the entire room.  “Time stopped for a minute,” Jaime said.

Lexi showed no fear or consternation. Instead, her face glowed with confidence, curiosity and excitement. Two months later, while Jaime again rocked and sang a lullaby to her daughter, she felt a little head lean against her shoulder. 

With a thankful heart of a servant, that night Jaime founded Songs for Sound in memory of all the lullabies Lexi missed and so “no one will go without a lullaby.”  “I felt so much guilt (before the diagnosis) and the whole time she was carrying a burden I couldn’t do anything about,” Jaime said. “Her favourite sound is music. Now she can stream music into her implant.”

Lexi’s parents used numerous resources to help their daughter make up the lost 19 months of verbal and auditory growth. She attended the Mama Lere Hearing School at Vanderbilt University, where she learned listening, speaking, singing and reading skills, and a regular preschool, where she was exposed to “real life” activities.

To provide professional and accurate services, Songs for Sounds enlists the expertise, support and aid of experts in otolaryngology and auditory programs. Hearing tests are free, as are resources to access tools for an improved quality of life. “We have a digital system that will send information to an audiologist and help people navigate with our care team,” Jaime said. “We take information, do a profile.”

A mobile outreach unit travels to cities, towns and villages all over the country to test the hearing of babies, children, teens, adults, veterans and senior citizens and a team makes regular trips to Jamaica, which has no auditory services.  The mobile unit has six stations with auditory software provide by Dr. Antonio Curci, co-founder of MelMedtronics Inc. To date, Songs for Sounds has held 850 events, provided 26,600 hearing tests and enlisted more than 650 community partners to be a part of the care team.  “The mobile experience is a glass showroom on wheels,” Jaime said. “It opens up and you walk in. What we do is out of a place of love based on what’s best for them.”

Playing off the success of the mobile unit, Songs for Sounds is dreaming big, with plans for a brick-and-mortar facility, a safe place for those live with hearing loss and need a getaway place and a support system of others with similar issues, concerns and fears.

Lexi is now a fearless, driven, disciplined, competitive 13-year-old seventh-grader at Brentwood Academy. She pitches for the Birmingham Thunderbolts and the Brentwood Academy Middle School softball teams and is a nationally ranked pitcher in the Premier Girls Fastpitch class of 2026. Lexi also plays volleyball on a travel team. She aspires to attend Ohio State University — her mother’s alma mater — Clemson, Florida or UCLA and become a neurological surgeon.

Feb 2021 The Hearing Journal

As 2021 begins in full force with optimism for a COVID-19 endgame, economic upturn, and global healing, emerging developments in hearing technology promise a significant impact, particularly on helping audiologists and patients cope with the new normal. From improved artificial intelligence to new mask mode features, to smart earbuds, these developments are transforming hearing care provision—as well as patient expectations—as additional factors, including over-the-counter (OTC) access and diverse device price points, are entered into a complex equation.

technologyTo shed light on this interesting convergence of hearing care provision, technology, and pending regulatory changes, The Hearing Journal (HJ) hosted an online roundtable discussion with leaders from the American Academy of Audiology (AAA), Academy of Doctors of Audiology (ADA), and American Speech-Language-Hearing Association (ASHA). In this month's cover story, we continue our discussion with ADA President Victor Bray, PhD, ASHA's Vice-President for Audiology Practice, Sharon A. Sandridge, PhD, and AAA President Angela Shoup, PhD, along with HJ’s Editorial Board Chair Fan-Gang Zeng, PhD, as the discussion moderator, on optimising advances in hearing technology, including OTCs and personal sound amplification products (PSAPs), to support hearing care professionals and audiology practices this new year.

Dr. Zeng: What recent advances in hearing technology are you most excited about, and how would you incorporate these—including OTCs, PSAPs, and hearables—into your practice? Do you think these advancements are threats or opportunities?

Dr. Bray: My first answer is about audiology in general and separate from consumer electronics. The single and most important update in audiology is the seating of the new congress and resubmission of the Medicare Audiology Access and Services Act, which is jointly supported by ADA, AAA, ASHA, and HLAA. Practitioner status, direct access, and recognition of both diagnostic and rehabilitative roles of audiology are critical to the maturing of the profession and logically necessary to the proper outcome of the AuD degree transition.

More specifically to the question of consumer electronics, there have always been efforts underway to alter or even disrupt the traditional provision of amplification to audiology patients. Personally, as a participant in three different start-ups working in that space, it has always been about disrupting the current models to see if we could bring something better to market—and at times we are able to do that. Certainly, many innovative products today and those on the horizon can potentially change the way patients and consumers access the tools to enable better hearing.

Here's what I am teaching our AuD students to prepare them for the world in which they will practice upon graduation in 2023. Dr. Dillon, a decade ago, described this as “connectivity and convergence.” For example, at present, a person with impaired hearing may be fit with RIC aids, a smartphone with Bluetooth, and a remote microphone. The technology already exists today to use a pair of earbuds as the ear-level device, a Bluetooth smartphone, and an app to reshape the sound for someone with mild to moderate hearing loss, with the smartphone utilised as the remote microphone. ADA has a long history of supporting entrepreneurial activities, and we do not necessarily view the new consumer electronic offerings as a threat. Any change is a potential opportunity to find and incorporate better solutions for hearing care, and we must keep an open mind. An important development is having major companies like Apple and Google contribute to the message that hearing loss is a major health concern. This can help raise awareness that hearing loss must be addressed and not ignored by individuals, families, and our health care system. Any time audiology prioritises the needs of our patients, audiology will win out.

Dr. Sandridge: We have this motto, “Challenges are opportunities to grow.” These challenges to our profession are incredible, great opportunities to embrace. I look forward to incorporating all kinds of OTCs. [At Cleveland Clinic], we are even talking about working with our innovations team in designing our own PSAP so we can have a Cleveland Clinic-branded, very inexpensive amplifier that we can market here at the clinic. There are tremendous opportunities to get on board with all of these developments. As Victor said, anytime you can raise awareness about hearing loss and its impact on health-related quality of life—it's a win-win situation.

The other day, I had a patient come in who had two sets of PSAPs that she bought from Amazon for $37 and $70. And she got what she paid for—they were crap. We ended up getting her into very low-end hearing aids. But why not offer these as an early solution?

Years ago, we put together a questionnaire, which we recently redesigned with questions for patients, including, “Do you want to be a part-time user?” and “Do you want to just use this occasionally?” With this questionnaire, you can create a perfect avenue to offer patients with inexpensive units that they can use occasionally to just get them started [with amplification]. And when they want to use amplification full-time, you can offer them other routes. If we don't embrace them, then we are not going to be providing our patients with the whole continuum of care.

It is also an exciting time because there are so many options. The biggest challenge I see is trying to find which device to embrace and bring in. There is no reason why we can't bring in Apple AirPods and Bose products, for example, and sell them to make it convenient for the person to purchase it right there and then from us. The options are limitless, and the opportunities are there. We just have to put it in our business plan and go for it.

Dr. Shoup: Advances in technology that can offer additional benefits to patients are always an opportunity to positively impact their quality of life. However, I do think these do not replace the critical role of the audiologist. In many cases, there is an increased need for the person to have access to knowledgeable skilled providers who can review the many options and identify those best suited to meet the individuals’ hearing care needs.

It is one thing to take AirPods, for example, and put them on somebody who has perfectly normal hearing or even somebody who has a mild pure-tone hearing loss. But when we start looking at people with more complex hearing needs, they just become frustrated. Fitting the right solution into the complex communication and lifestyle needs of individuals with unique auditory systems and brain experiences really requires knowledge and experience—and that is what we bring. Furthermore, we have to ensure that multiple technologies can be appropriately integrated and that the end-user is capable of implementing the recommended strategy to effectively utilise the recommended system. These often require both provider expertise and individualised training and counselling, which could take a bit of time depending on the digital literacy gap that we may be encountering.

Regarding the type of technology I'm most excited about right now, I tend to stay very focused on patients who have significant hearing difficulties and significantly impacted auditory systems. I am most excited about the potential of new connectivity options using Bluetooth that will allow similar ease of access as we have with telecoils and loop systems. For example, having open-source options, such as the low-energy audio being developed by the European Hearing Industry Manufacturing Associations in collaboration with the Bluetooth Special Interest Group, will allow hearing aid and cochlear implant users to access sound in large venues without requiring complicated pairings or additional technology. It will be very freeing to patients! It will enhance their access to information and entertainment and their enjoyment of media. They can become more engaged with their communities. The concept of finding something that is freely accessible in entertainment venues and large group opportunities is something that I'd be most excited about.

Dr. Zeng: Based on what Angela, Sharon, and Victor just said, we are entering a very exciting time. This naturally leads to the next question: What is your personal and organisational position on the regulatory side? And perhaps, more importantly, as audiologists and as a profession, where and how can you make money as a business?

Dr. Bray: Times of change are times of opportunity. But for some people, these can be times of threat. It is an opportunity for audiology to embrace the challenge even though our initial response might be fear and threat, e.g., “This can't be good for me because it is going to change what I have been doing.” But if we look at the positive side, change can be good. It takes the right mindset to take advantage of an opportunity. Regarding OTC, ADA continues to support the bipartisan and bicameral Over-the-Counter Hearing Aid Act of 2017. We also continue to support the recommendations from the consensus report that came from ADA, AAA, ASHA, and IHS. These are established product requirements: define concise out-of-the-box labeling, define comprehensive inside-the-box labelling, define the new OTC category that is easily comprehensible by consumers, and provide adequate provisions for consumer protection. We continue to support all of those things. Many ADA members may choose to incorporate OTC devices into their practices just as many of them now incorporate PSAP amplifier options. We can also expect to see a continuation of many business practices that incorporate variations of bundling and unbundling of services from the product as determined to be the best for that audiology practice. Decisions about bundling and unbundling are not necessarily dependent upon whether we are talking about hearing devices, hearing accessories, PSAPs, or OTCs because OTCs can be successfully incorporated into a practice with either model.

Dr. Sandridge: Challenges are opportunities. OTCs were initially seen as a huge threat and a huge challenge, but we can take it as an opportunity to incorporate them. As Angela said, it is our responsibility to make sure that we educate the consumers. Noting the findings of the MarkeTrak 10 survey, the people who had gone to health care providers were very determined to go back to and get devices from health care providers because they had the knowledge and expertise. There are many opportunities for us to promote our expertise, knowledge, and abilities as professionals to consumers such that when they have a hearing problem, they may easily want to go get an inexpensive OTC or PSAP, but they know that they can come to us to help them set up their device. We'll be the professionals to help them along the way. For those who will experience distortions, and won't do well with OTCs, for example, we'll be there to help them when they realise these are not their best option.

Dr. Shoup: We at AAA are still in support of the consensus recommendations for the new OTC hearing aid classification. We very much support the idea that the individual member will have to make choices for their unique practices. The Academy does provide multiple resources to assist with planning for the unbundling of services from products.

Most important is to recognise that audiologists are integral to the accurate identification and appropriate management of hearing loss. With their knowledge base, audiologists work to develop a comprehensive treatment recommendation, which may include device selection and optimisation, as well as supportive counselling, training, and guidance through a customised hearing rehabilitation plan on what to expect and how to be successful. OTCs can be part of this process. Some patients may have already accessed OTCs before they see an audiologist. The audiologist can then work with the patient to verify whether the device meets the individual's needs. If it does not, is it possible to optimise that specific device to meet the needs as best as possible? Audiologists must also educate the patient on the appropriate use and care of the device and how to integrate the device functionality into the overall hearing rehabilitation plan.

Also in the discussion of OTC devices, we need to recognise the importance of informed choice. If patients come in with an OTC device that we think may not be best for them, we have the ability to assess it—and I've seen this work beautifully. We need to educate patients about speech sounds—which speech sounds they are getting, which ones they are not, and where the device is falling short in giving them access to those speech sounds. They can make the decision then while also considering other options and price points. We must not push these people away and keep them from getting the appropriate education so that they will address their communication needs more effectively.

Dr. Zeng: I enjoyed listening to your insightful comments. It is indeed an exciting time. Thank you for sharing your time and expertise with us in this virtual roundtabl

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