NANCY MACKLIN Hi everyone thank you for taking time out of your busy schedules to join us this evening to start I would like to thank Cindy Thompson from Alternative Communication Services for providing CART this evening. And welcome Dr. Abram Bailey who will be presenting “Improve Your Next Hearing Experience with Hearing Tracker” I’m very excited to hear your presentation, Dr. Bailey. I know that this is an area of interest for our members and it looks like you have a lot of good information to present this evening so I’ll let you go ahead and get started. Thanks again.
DR. ABRAM BAILEY Okay. Thank you, nancy. I hope everyone can hear me all right. I’m not actually seeing the CART coming through on my screen I’m not sure if that’s something that’s meant to be live. Or –.
NANCY MACKLIN All you need to do is click the CC button at the top. Or hit control F .
DR. ABRAM BAILEY I just didn’t want to get started until I made sure that was working. So thank you for the nice introduction. And yeah, I just wanted to sort of reiterate thank you guys for coming. I know it’s a busy holiday season for most of you. And it’s definitely full on for us here, as well, down in Austin. But I hope to give you some good information that will prove to be valuable for you. And hopefully some of the ones that miss this presentation can catch it on the recording for later. So I guess I’ll go ahead and get started. So obviously the name of the talk is “Improve Your Next Hearing Experience with Hearing Tracker.” I’ve kind of already had the introduction — introduction but this is me, april — this is me Abram Bailey I’m a doctor of audiology I graduated from Vanderbilt University in I’m a member of the academy of doctors of audiology and the New Zealand Audiological Society I’m a licensed audiologist in Texas residing in Austin and I’m originally from New Orleans. So I guess we’ll just get started with a little outline of the presentation. First we’ll talk about the big problem with hearing care. Next I’ll explain what to look for in a hearing provider and how to make sense of hearing aid features. While you should leave the actual hearing aid selecting to your audiologist I would recommend becoming familiar with hearing aid features and technologies so you can be an educated participant in the hearing aid selection process. After this learning session, I’ll show you how to apply your new knowledge to locate exceptional hearing aid providers and hearing aids using Hearing Tracker. So what is the big problem with hearing care? Consumer Reports estimates that as many as two – thirds of the — of hearing aids in the U.S. are misfit. Meanwhile, a large percentage of audiologists still fail to provide essential services. And this is important because receiving essential services greatly improves chances for success with hearing aids. So what kind of essential services might you be missing out on. There was a survey of audiologists conducted in by ASHA the American speech hearing association that found that a large percentage of audiologists still fail to provide validation of aided outcomes using speech validation of outcomes by self questionnaires verification and performance with measures. I know some of you may not know what any of those things are. And I’m going to try to go through in more detail and try to kind of explain it to the non-audiologists who are here with us tonight. And I also wanted to read this question from Sergei Kochkin many of you may know who he is he’s done a lot of research to sort of track the hearing market and lots and lots of surveys with big populations — populations. A conclusion he recently drew in after doing a survey was that consumers can be satisfied with a hearing aid but significantly more satisfied if all best practices are So that’s something I’m going to focus on a lot tonight. We’re going to call them essential services. But you might also call these best practices from the perspective of an audiologist. So with all of this in mind, all of these problems, what is the good news? So there are plenty of audiologists out there who do provide essential services. Who do have best practices. And I’m going to try to explain to you what those things are. And how I’m hoping that Hearing Tracker can help you to locate people that provide those services. So how to — how to find a hearing provider. First step, know what to look for. So again we’re going to be talking about essential services. This is what I think you need to try to understand so that you can try to look for these things in a provider. After we talk about the essential services, we’re going to talk about successful patients. Because that’s another thing you’re going to look for. If you can find a successful patient of an audiologist, that’s a good sign. So maybe that’s someone you should visit, as well. Another possibly less important but still significant factor may be the educational background of the audiologist. I’m not just saying that because I have a doctor of audiology. It is something that might make somebody slightly more qualified to deal with complex problems. So depending on what kind of person you are. If you’re a very straightforward kind of a patient. Or someone who has more complex needs, the educational background of your provider may make a significant difference. And we’ll talk about that a little more. Okay. So what are essential services in audiology and how do I find them? Pardon me; I’m going to read from my notes because I want to be very clear. So fortunately you don’t have to look far to find a good guideline for essential services in audiology. The American Academy of Audiology formed a Task Force in with the expressed purpose of developing a national guideline for fitting hearing aids to adults the Task Force spent three years developing the guideline and poured over the best research available in audiology to determine which clinical services mattered most to patient outcomes. The guideline is also endorsed by the American Speech Language Hearing Association. This guideline is readily available online and I will post a link to it in my webinar. However, I would like to spend a few minutes going over the guideline to help you understand it as a consumer the guideline includes service recommendations in a few key areas including the auditory assessment, the needs assessment, quality control, hearing aid fitting and orientation, counselling and outcome assessment. So we’ll start with the auditory assessment. So these are some of the recommended services as recommended by the guideline. So first we want to see a comprehensive case history and that means your audiologist is asking you all about your past, anything to do with your ears or that might be a factor in your medical history related to your ears your hearing history your current hearing problems, all of these things. And a lot of these things are going to be pretty standard. But some of the things we’re going to talk about are more exceptional tests that not everybody does provide. The next step is diagnosing hearing loss. Obviously this is something that most providers are going to have to do to get anywhere with you as a patient. But you know the diagnosis just as a comment here, it should include a tympanometry test they put a small probe into your ear which puts a little bit pressure into your ear that will give the audiologist some idea of what’s going on behind your eardrum. If you’ve got any physical issues that might be causing you to have a hearing loss and that is something that’s important and if there are any medical issues there, there may be a need to refer you on. So — so I’ve pretty much covered that. Measure of loudness discomfort levels. This is something it’s kind of a frustrating test for the patient because the audiologist has to play some kind of loud beeps in your ear while they are doing the hearing test. Unfortunately it’s not fun. But it does have a reward. Which is when we get to fitting the hearing aid, we actually know where your loudness discomfort levels are. So that we can try to keep the hearing aid levels underneath that so that you don’t have to be as disturbed by your hearing aid. I mean, you will eventually get into the right place by a little to and fro with your audiologist. They can always turn down the hearing aids later. But this just gets them in the right ballpark a little bit easier. It’s a little bit more of an organized way of doing it, the otoscopic inspection so that’s just looking in your ears with a scope and making sure everything looks okay in there and many audiologists today are getting involved with cerumen management so that means being able to remove ear wax from your ears while you’re there in the clinic that will save you a lot of time if you can find an audiologist who does provide that service, not everyone does but just make sure they have had some level of extra training to do that or a lot of experience. Because sometimes providers do take risks I believe when it comes to that. So you want to make sure that you trust the person who is providing that service. Another part of the auditory assessment is counselling. So basically once your — your test is done and before the test even there needs to be some counselling to the patient to the family. I also want to just say this right up front that it’s always recommended if you’re going to go to your audiologist to try to bring somebody with you who is like a communication partner, someone that you’re close to. Someone who knows you well. Because they are going to learn from that experience. And they are also going to be able to provide information about you that might be valuable to the provider. They are also going to establish candidacy and motivation toward amplification. So these are all of the important steps that kind of happen during that initial auditory assessment. Okay. So moving on to the needs assessment. So this is where the audiologist is going to get even more information about you. About your hearing needs and goals. So in order to provide any kind of recommended treatment, the audiologist needs to have some kind of goals in mind. And they need to know you know what you’re kind of — what you’re driven to really with your needs. To do this, you could simply have a conversation with your audiologist. And that’s a very informal way of doing it. And lots and lots of people do that. But I’m a firm believer that you should complete what we’re calling now income measurements. And those can include a whole bunch of different surveys that are more formalized and validated. Through lots of experience that we’ve had with these surveys in the field. One example is called the Hearing Handicap Inventory. Another one is called the Abbreviated Profile of Hearing Aid Benefit. So these questionnaires hopefully you’ve seen. Hopefully you’ve got an audiologist who does actually run with these kinds of tests. And the other thing that’s kind of a bonus with these income measurements is once you’re actually done with the whole process of having your hearing aids fitted, at the very end you’ll have a chance to complete kind of a second part to this income measure and we call those an outcome measure and by gathering this information up front we have a different comparison of it before and after to see how you’ve done as a patient with the treatment that we have provided. Okay. So we’re learning about current hearing difficulties. We’re learning about level of perceived handicap. We’re learning about hearing goals and motivation. And we’re learning about treatment expectations. So hopefully that appointment is taken very seriously by your audiologist and they try to gather as much good information from you as possible to make the right recommendations. The audiologist should also at that time do some assessments of your dexterity it and vision and make sure that you have adequate support systems in terms of help for you to be a successful hearing aid user. If you’ve got problems with your manual dexterity that’s going to be an important factor in driving the decision about the type of hearing aid that’s recommended. If you can’t see very well, then it’s going to be important that you get a large battery for example or hearing aid that’s not microscopic. So these are things to consider at this stage. Okay. So these are some hearing aid considerations. Basically these are things that audiologists should be thinking about when they recommend a hearing aid. They should be thinking about the style of the hearing aid. Is it an in the ear hearing aid is it this kind of hearing aid that goes behind the ear with a thin wire. Is it a big behind ear with a mold. That’s what we mean when we say hearing aid style. The volume of the hearing aid and the frequency range. So depending on your particular level of loss, the audiologist is going to be able to recommend a hearing aid that is going to be adequate for that level of loss in terms of volume. And this is something — this is one of the big things I think about actually have a — having a hearing aid selected by a good audiologist as opposed to just getting something off the Internet you can be sure that if you can trust your audiologist that you’ll get a hearing aid that has adequate volume and hopefully has a little bit of extra range if your hearing gets worse so it can be turned up without you having to buy a new one. The other one — the other thing is frequency range. If you have hearing loss let’s say only in the higher pitches and it’s only mild, well, you might benefit from having a hearing aid that produces very, very high pitches. Whereas a lot of people, their hearing kind of slopes down and they really can’t make any use of those extra high pitches. So your audiologist shouldn’t be trying to sell you an extra high frequency hearing aid if you can’t even make use of those sounds. Okay. So ear canal size and geometry. This is a big one. You cannot physically use some hearing aids with some patients. If they have got a really nice cylindrical ear canal, you might be able to get away with a completely in the canal hearing aid if they have a really tiny ear canal that’s windy and bendy forget about it it’s not going to work you have to get one with a thin tube that can get into a — that geometry ordering something off the Internet you’re not going to — sorry that’s not the topic of the conversation but this gets me thinking about it. Ease of insertion and manipulation. This is something that I think if you have a chance to practice with the audiologist in the clinic like for example if you’ve got this hearing aid shown in the picture u it’s easy for the audiologist to have a demonstration hearing aid in the clinic for you to pick up and try onto your ear before you even come in for the hearing aid fitting and that will save you both time. So if they have a custom made hearing aid, that may not be possible because it’s got to be made for your But when possible, I think it’s a great idea to have a little check of that and make sure the patient is comfortable getting a hearing aid in touching the little buttons, removing the hearing aid. So need for specific features. So telecoil, nancy and I were just talking about telecoils earlier. This is I believe a really important hardware feature for a hearing aid. It’s what allows you to pick up the telephone and telecoil loops. I still think even with all of the modern technology that’s out today with streaming that a telecoil is still very valuable. And should still be considered. Not everybody needs a telecoil if you have a mild hearing loss and you’ll have an open fitting style of hearing aid there may not be any point to that. But these are the thing — things the audiologist should be thinking about when they get to know you when they measure your hearing loss what they are thinking about the style of hearing aid you need when they are thinking about your hearing needs, do you have trouble on the telephone, is going to church your primary hearing need? If so is your church looped with a telecoil loop. DAI, that’s direct audio in put. I won’t cover all of the features. I will go into them a little bit later. But these again are some of the things that your audiologist should be thinking about when they are deciding on a hearing aid to fit you with. Comfort and skin sensitivity I can’t tell you the number of patients I’ve had who have had itchy ears and we’ve had to sort of modify the hearing aid that we chose for them. So it doesn’t hurt to ask those questions up front to just try to — again, save time for both the patient and the doctor. Occlusion. Many of you may know what that is. It’s when you have a hearing aid kind of blocking your ear. And you’re talking. And you can hear your vase — voice in the ear. That’s something we need to think about when we’re recommending a hearing aid. Is this something that’s likely to bother the person? Are we going to be creating a lot of occlusion with this type of recommendation. And then obviously we need to talk — talk about cosmetic concerns. So how do you want to look with your hearing aid? Is that a big concern for you? And I’m sure many of you have been through this decision making process with an audiologist and it is pretty standard. But it’s just important that an audiologist follows all of these steps when they go ahead and choose a hearing aid and they should be talking to you about it. Okay. So this is one that I really like. Performing electroacoustic testing. We’re calling this quality I did write some notes here. So I’ll go ahead and read Due to quality control issues in hearing aid factories, new hearing aids should always under go quality checks before being fitted. Your audiologist can check that the microphone, speaker and amplifier are all working properly using an electroacoustic test box which is considered an essential piece of clinical equipment. In the test box, sound is played out and the response from the hearing aid is measured. Every hearing aid comes with a set of acoustic benchmarks from the factory. Which should be reproducible in the clinic by putting the hearing aid into the test box and taking the measurement. Your audiologist should also perform an electrode — electroacoustic assessment following a hearing aid repair. They should be diligent in verifying the work of the repair facility and ensuring that your hearing aid has not been damaged — damaged during shipping. Finally your audiologist should measure your hearing aid settings in the test box after your hearing aids have been set up for you. Your audiologist may make small adjustments throughout the hearing aid evaluation process but when you have decided you are happy with the settings, the audiologist should make a record of the hearing aid’s performance. If this has been done your audiologist and anyone else trained to use the test box will be able to quickly and accurately test your hearing aid for a drop in performance. Such a test might be used at an annual checkup. So basically the idea is you can see the woman in the picture. She’s put the hearing aid in the box. The sound comes through from a little speaker that’s inside that box. So she would have to close the box. And the hearing aid picks up that sound. Amplifies it and that sound that gets amplified by the hearing aid gets picked up by a microphone. So there’s lots of testing that can be done, even without having the patient in the room to ensure that the hearing aid is working the way that it should. And those tests should be done on a regular basis after these kinds of events. And the measurements that are taken at each of those times should be printed off and put into the patient’s file. So that’s something that you can kind of check on your audiologist about and say, have you been running measurements of my hearing aid in a test box? You know is this something you do on a regular basis here? It’s not fundamental. But I think it would save a lot of problems if everyone was doing this. Okay. So sorry; we’re going to talk a little bit more in the technical area about hearing aid fittings. So these are some of the recommendations that the guideline makes for So verify that the hearing aid is meeting your prescription. Okay. So what does that mean? I can probably just kind of go verbatim. So let’s talk about this guy down here pointing his finger at the computer. That’s actually a friend of mine named Doug. And I told him he would be in the presentation tonight. And that is a picture of him that was taken when we were back at Vanderbilt. And that a girl in the picture is another friend of mine named Elise. Anyway, what the audiologist should do is they should — once they’ve got your hearing test result, they put it into a computer. And the computer generates a prescription based on your hearing loss. So this is something that a little more than half of audiologists are doing right now. And that’s a survey of audiologists. I don’t know what the numbers are like for hearing instrument specialists. But suffice to say that there are a lot of people out there who are not receiving this service. And I’ll explain the service a little bit more and why I think it’s important. So once they have a prescription on the computer, they are going to take a measurement from inside of your ear to make sure that the hearing aid is up to scratch with your prescription. So if you look at that ear on the right there, you can see that there’s a little tiny tube which is going into the man’s ear. And it’s coming up from the bottom. That tube is actually a tube microphone. So it goes down in the ear past where the speaker is and it can actually measure the sound that’s coming through the hearing aid. So looking back at that box or the computer on the left so what happens is that computer plays out sounds and those sounds arrive at the hearing aid, the hearing aid amplifies the sounds. And then those sounds go into your ear. When the sounds go into your ear, the microphone picks up the sound. So that’s how we do it. And then what we do is we make adjustments to the hearing aid while we’re taking those measurements to try to get the hearing aid closer to your prescription. And the reason prescriptions are so important is because when these prescriptive formulas are created, they are created for the purpose of bringing speech into the audible hearing So if we don’t follow a prescription, it’s highly likely that your hearing aids are not going to be giving you the maximum benefit that they could. And this is a touchy issue. A lot of people say that you know they weren’t trained on these machines. And it’s not important. And you can do it kind of by talking to the patient and asking how things sound and I think some people probably are better at that than others. And maybe some people do that well. But I think for the most part, the reason why this is important is because it gets the audiologist into a kind of — into the ballpark so that they at least know if the hearing aid is capable of meeting your prescription. At least they know it’s capable of giving you maximum bin — benefit. Maybe you don’t want the hearing aid set that way, maybe it’s the too loud or too sharp. But one day, if you’re a new users — user of hearing aids one day soon after a while you may want the hearing aid loud — louder than you want it on the first day. So we know when we have done this test that the hearing aids can be adjusted up to the point that they need to be if that comes. So anyway, it’s just –s it’s an objective measurement. And it makes audiology a heck of a lot more scientific. And I think without it, practitioners are really operating blindly to try to get the sound right for you. So I’ll get off my pedestal about that now. Other thing we can do with that tool is we can verify the hearing aids aren’t too loud. So when we took those loudness discomfort levels earlier the at your auditory assessment, now we can punch those numbers into our measurement box and then we can make sure that the hearing aids aren’t exceeding those levels. So again it’s just getting it all right with science. So the other thing we can do is we can verify the features of the hearing aid such as the telecoil and the directional microphones. So if we put the hearing aid into the telecoil mode and hold it up to your ear we can see it’s working we can also check that in the test box but this is another way to do it and there are even ways to check the direction at — directional microphones. For example, we can have the patient turn their seat around and we can take a measurement from behind them or take a measurement from the front and then we can compare those results and make sure that the sound that’s coming in from the front was coming in louder. And I’ll just make a note about this. If you have this test done, it’s really important that the sound that you hear, it’s not like a beeping sound because that’s old equipment and the new hearing aids they don’t respond as well to that. So when you have this kind of test done you should be hearing speech sounds. It can be speech like noise or it can be someone actually speaking. It depends on the tools that they actually have at the clinic. But if it’s — if it sounds kind of like speech then they are probably doing it right. Okay. So I’m going to skip that. I’m going to see if I had anything else written down that I wanted to tell you about. No. Okay. So the orientation. You’re going to want to talk about your audiologist is going to need to give you some information and counselling on hearing aid features. Insertion and removal, battery use, care and cleaning, comfort and feedback and by feedback I mean the whistling, telephone use, and any warranty information about your hearing aids. So this is kind of the basic information. Once you’ve had your hearing aid fitting, you shouldn’t be kicked out the door. You should have someone maybe it’s not your audiologist but it’s someone at the clinic who is going to spend some time with you making sure that you understand how the hearing aid operates, how to use it, how to clean it, warranty, all of that stuff. By the end of the orientation you should be competent and able to do all of these things yourself. And I’m realizing that the time is flying by faster than I thought it would so I’m going to try to speed up a little if So the essential services, this is counselling and follow-up. Now when you kind of — once you’ve had that kind of basic orientation, it’s good for the audiologist to go over some of these other thing — things so adjusting to amplification, your goals and expectations, talking about those after the hearing aid fitting. Talking about what it’s going to be like to be out there in background noise, as — at a restaurant, what it’s going to be like watching TV, listening to the radio, all of these things, they should be discussed before you leave the clinic so that you have really a good understanding of the experience that you’re going — about to go through so you feel motivated, as well, with kind of over coming the challenge of this new hearing aid They should talk about listening and communication strategies it’s helpful again if you have your communication partners there with you whether it’s your wife or your husband, your son, your father, whoever it is that you talk to the most, bring that person into the clinic with you. Hearing assistive technology. I mean this should be discussed and discussed and discussed from beginning to end. When you have your initial hearing aid conversation these things should be considered. Not everybody needs a hearing aid. Sometimes like just say your only issue is television. Well maybe you just need a television amplifier or something that’s going to broadcast the sound over to you while you watch TV or maybe it’s just the phone you have a problem with. Sorry; I skipped. So — and the other thing with hearing assistive technology is sometimes hearing assistive technology needs to be used in conjunction with your hearing aids. So sometimes hearing aids are the answer. But you might also need an FM system or an amplified telephone or other things that are going to be used together with your hearing aids. So these should all be talked about with your audiologist. Your audiologist should bring these things up. I hope they. Speech reading that’s just lipreading, that kind of stuff obviously that’s going to be more — for some people more than others. The ones that need that service the — the more profound your loss is the more likely you’ll need help with that. Okay. So we’re getting close to the end here. This is the last slide I have an — on essential services I’m sorry I spent so much time on it I did think it was important and worth talking about so I hope it’s going to be — it’s been educational . Now you’re at the sort of final appointment so after you’ve gone out and tried your hearing aids and come back to the audiologist, what they are going to do is — what they should be doing is taking those initial income surveys you completed at the beginning like the HHI or APHAB which had basically benchmarked where you were. And they are going to run hopefully those tests again those surveys again to make sure that you have seen a positive change due to having the hearing aids fitted. Or the hearing assistive technology. These can be done for that, too. So did you experience a huge benefit. That’s a good thing. And that’s something that the audiologist needs to be aware of. If you did not have a big positive change, then the audiologist should kind of have a big conversation with you. And see if there’s anything else that can be done with the hearing aids. Have they — maybe they need to consider other hearing assistive technology that they need to add into the picture. So that’s the way that those appointments should kind of end I guess is on a good note with your audiologist feeling that there has been a positive change and that the hearing aids have made a difference Okay. So how to find a hearing provider. So talk to friends. Hearing loss is nothing to be ashamed about. Find a friend with hearing aids and ask about their experience. Use your knowledge of essential services to get a gauge on the quality of care they received. So perhaps you guys knew about all of those things I talked about already. But if you didn’t, now you’ve got something to talk about. You’ve got new questions to ask your friends. Did they have you fill out all of these surveys at the beginning and the end. Did they sit you in front of the box and play sounds out? Those kind of questions you can ask now. So I kind of just said what I wrote here. But the other thing I wanted to talk about is with your HLAA meetings, I know a lot of you I met at HLAA in Austin this year and a lot of you told me that one of the big topics at your local chapter meetings is talking about the local audiologists in your area. Unfortunately some people put it to me this way, they said, well, basically we get together and mono about them and complain about them — moan about them and complain about them because they are not happy with their audiologist but I’m hoping to drive more constructive meetings where you try to idea — identify who in the group has been to an audiologist who has provided these kinds of essential services and who has also had a positive outcome with his hearing aids or her hearing aids. And the other thing is look online. And I don’t want you guys to think that I think hearing — that I think Hearing Tracker is the only place to look in fact I’ll say to you that Hearing Tracker is a relatively young Web site. And that we only really got our start in March. I do think that Hearing Tracker is going to become the primary resource for looking online to find a provider. But I don’t think that that time has come yet. However, I would still look there. On the chance that your provider is listed, that you’ve got some providers listed or reviewed in your area. And we’ll talk a little bit more about that. All right. So I did tell you one last thing that I was going to talk about was how to find a hearing provider in that section of how to find a hearing provider is educational background and I said it’s less important but worth considering. So in the U.S., the three kind of I guess biggest or best educational backgrounds that you could find would be the Masters of Science in audiology and that used to be the main sort of program for clinical audiologists up until when that was replaced by the doctor of audiology. And it did go from being a two year to a four year program and I think the Masters of Science maybe did have a year of clinical after the two years. So maybe it was actually a three year program but at any rate they have added at least a year. And kind of got us — us to do a few extra things like study more about balance and dizziness and get a little bit deeper into the anatomy and stuff like that. But really most people I know who have a most — Masters of Science, MS are great audiologists so long as they have good experience and know what they are doing. But you can meet a doctor of audiology who is not the best at fitting hearing aids either so there’s so many things to consider and definitely looking only at their education isn’t the answer but it’s another piece of the puzzle. Doctor of philosophy in audiology I know some doctors some PhDs who are great in the clinic. Some are more research focused. But certainly if they are out there practicing and they have a PhD in audiology they are worth considering to see. Okay. So understanding hearing aid features. And I’m calling this apples and apples versus apples and oranges. And I didn’t take too many notes. So basically here I’m calling these the apples and apples features. So they are kind of yes or no features. These are hearing aid features — features that — they are either included or they are not. So the telecoil is an easy one. That’s a hardware feature. So either the hearing aid has a telecoil — in it or it doesn’t. Volume control button same story if the hearing aid has a volume control button you can control the volume with a button if it doesn’t then maybe you’ll need a remote control or you maybe won’t have control over the volume. Push button. Again, same story. As the volume control. You can change the manual programs of the hearing aid for different settings using a manual button indicate it has a button if it doesn’t have a button then it will either be fully automatic or you’ll need a remote control or a SmartPhone to control it. Directional microphone, % of hearing aids today have directional microphones. So that’s not such a big deal to kind of need to look for that. Now with hearing aids it’s gotten more into an apples and oranges situation with directional microphones where you have so many different kinds of digital algorithms for how directional microphones are controlled. And that is kind of you know beyond the scope of just doing a simple product comparison. Synchronization and streaming. Synchronization is when a hearing aid — when you for example tap a button on one hearing aid and it changes the setting in that hearing aid and also changes the setting in the other It can also mean automatic changes in a hearing aid are synchronized so for example the volume if it automatically adjusts in one hearing aid, it adjusts in the other and there’s other ways that that’s used but that’s the idea with synchronization and that’s fundamentally different from streaming which is where you’re actually taking the sound from one hearing aid and sending the entire sound to the other hearing aid. So I’m aware of a few companies that now do streaming of phone calls from one ear to the other I know Phonak does it and I’m pretty sure — maybe Starkey I’m not sure but basically you hold the phone up to your ear the sound from that ear can come into this ear so your telephone conversation is now coming into both ears and there’s other ways that that kind of streaming technology is used for kind of sophisticated comparisons of sounds that are coming in to both ears and a lot of that stuff is still a little bit experimental but there’s still some research to suggest that the sound quality or the potential to benefit can be better with some of these new streaming technologies. That is kind of an apples and orange one because what’s being done with streaming may be different in different products but it’s worth thinking about and talking why — talking to your audiologist about. SmartPhone compatibility. Either the hearing aid can talk to a SmartPhone or it can’t. And this is something that’s all the rage right now. A lot of hearing aids are capable of doing this. You can control it with your iPhone. You may be able to stream music from your iPhone or talk on Skype with your iPhone there’s also ones for Android I think Siemens has Android right now. So that’s really cool stuff. And I think that’s going to continue to kind of get better and better and help people who have those phones. Music program. That’s a lot of hearing aids have music programs. Very few don’t. But that’s still something that you should ask about if music is important to you because hearing aids by nature are processing sound with speech in mind. And the way that hearing aids process speech sounds to make those phonemes audible and comfortable is very, very different from the way you may want music processed. So not having a music program and liking music could be a problem. The IP rating is basically going to be ingress. I think it’s called ingress protection. But it’s kind of like a rating of a hearing aid, how well it repels water or withstands water and also physical ingress so things like dust. I have had a lot of patients who worked in factories or places like that where there’s lots and lots of dust being kicked up. And it’s really, really important if you’re in a dirty or a wet environment or if you like to go hiking in the out doors up in Washington or something where it’s raining all the time, you need to think about getting a hearing aid that has some kind of IP rating. I know a lot of the hearing aids now are being made with little rubber gaskets around all of the orifices and those need to be replaced from time to time but it’s getting really, really good now and I’m really excited because I had so many problems a few years back with hearing aids and moisture and sweat and dust. So that has come a long way. DAI is direct audio in put. Some of you may be familiar with that where you have a big behind the ear hearing aid and you can actually plug directly into that and you might be able to plug in like an MP player or an FM system and get sound streaming into your hearing aid. So that’s also FM systems, that’s where you can kind of usually use with a DAI but sometimes you can use it wirelessly without the DAI. That’s where someone can take a microphone and stand far away from you like on the other side of the room or just even the other side of the table. Hold the microphone near to them and the sound comes straight into your ears. Manual programs, that kind of relates to the push button. Basically you know if you want to change the hearing aid settings from one kind of environment to another like say quiet environment, noisy environment, you may have — you may want more manual programs. So if you’re someone who has a bunch of different environments and you’re kind of a control freak and you really want to have control over how the hearing aid sounds in those environments, it may be important for you to consider a hearing aid with lots of manual programs. If you’re somebody who doesn’t really care and you just want the hearing aid to be automatic it may not be a big deal at. Battery size. Battery life, that’s something to consider. And I’m sure that your audiologist will talk to you about that. But the smaller the battery, the smaller the battery life. I’ve seen battery life as little as two to three days and I won’t name hearing aids that have that kind of performance. But I can tell you that the same battery in different hearing aids is not always the same with the amount of lifetime. A microphone array is where you’ve got this actually relates to streaming. So when the sound can go from one hearing aid to the other hearing aid, with the microphone array, they can actually combine the sound from both hearing aids to have like a four — four microphones going at the same time all being compared by the hearing aid. And the theory is that you can actually do some kind of beam forming and create like a super directional hearing aid and I do think there’s a lot of potential for that to help people in background noise. It’s still not going to be better than like say an FM system but it’s worth considering if you really are struggling in background noise and don’t want to carry around an FM system. Bandwidth I talked a little bit about that earlier. I’ll skip that one. Channels that’s kind of the same thing as programs. Well not programs but bands. I’ll skip that one, as well. I could get into a lot about that. Accessories, that’s going to be like your remote controls, your streamers, the things you might use to say pick up a telephone call. TV adaptors, all of these kinds of things that hearing aids can potentially be purchased together with. It may be worth doing some exploring about the accessories that are available for your hearing aids. If you might need some of those things. I’ve had a lot of people not even get the accessories at first and then come back to me and say well I’m really happy with the hearing aids but I’m still struggling with the phone or I’m still struggling with the TV. And sometimes you fit that person with a hearing aid — hearing aid that doesn’t have any accessories available you’re like this is not good I — I can’t help this person with this issue so think about those things before jumping in. Okay. So here are some more features. I’m sorry this is so long this is what I’m calling the more apples to oranges I’m calling it algorithms and strategies I’m just going to breeze through this as fast as I can. Digital snows — noise suppression. That’s the hearing aid turning down sound kind of background noise sound and I want to be clear that it’s oftentimes sold as a way to turn down background noise and make speech more audible. But there’s not a lot of evidence to support that. Really it’s a comfort thing. So digital noise suppression makes sometimes loud situations more comfortable. Not necessarily making them any easier to hear. Feedback suppression is getting rid of the whistling. Reverberation suppression like when you’re in an echoy room trying to dumb down some of that echoyness because those echoes can smear sound and make it harder for you to pick up on phonemes and parts of speech. Wind suppression that’s another one that’s highly variable between different hearing aids. Every hearing aid company has a different idea of how to deal with noise suppression, feedback suppression reverberation suppression, wind suppression and all of the different hearing aid companies explain all of this stuff on their Web sites in great detail sometimes without any real good engineering background but they do explain it. And the reason — part of the reason why I’m talking about all of this sufficient is to ex — stuff is to explain why I’ve listed certain features on Hearing Tracker and not others. Because a lot of the things that — a lot of things you see here on this page and sorry I didn’t real — read the other ones but a lot of these things you’ll find in almost every hearing aid now. It’s very, very common for most hearing aids to have to some degree they are going to have some of these things. And you know the hearing aid manufacturers they do all kinds of funny things like they will say with digital noise suppression they will say you’ll get dB, decibels, noise suppression with the cheaper hearing but with the more expensive one you’ll get decibels of hearing — of suppression so it can get really complicated so it’s basically something that you’ll have to do research beyond Hearing Tracker to learn more about these features with a specific product or something you’ll want to talk to your audiologist about. So “Improve Your Next Hearing Experience with Hearing Tracker” I’m sorry it’s taken me a little while to get here and I really wanted to have some discussion with you guys so I’ll try to go as quickly as I can. Now there’s a few thing on this page that are really important. One is you can see where it says underneath her name hearing provider in Greenville under that it says service quality complete and verified provider complete now this is a new things — thing we’re doing with Hearing Tracker I’m sorry it’s not further along than it is because I think this is going to be a really, really valuable thing for consumers. Basically with the service quality batch — service quality badge what we have done is we have created a best practice protocol survey which audiologists can complete. And they tell us if they are providing all of these essential services that we talked about earlier in the presentation. If they are providing the vast majority of those things, I can tell you that no one — I don’t think anyone has submitted the survey and said they have done everything. But if they are like over %, then we’re going to give them the service quality badge. The verified provider badge is a little different. They’ve got to send us some patient files to review. And they need to take all of the names of the patients out. So that we don’t find out who those people are. Because we don’t want to know. But we need to see some documentation from the provider to show us that they are actually providing these services. So the service quality badge, I think it’s still got some value. But that is not verified. So they could just be telling us that they do those things. I think the mere fact that they have completed the survey and said they do those things, it’s a good thing, it’s a positive thing. But if you see the verified provider badge, which there are very few in our system right now, and that’s something we’re working on in trying to educate people about, then that’s a great thing and that means we have personally had a look at that person’s work and want to put our name on it. Okay the other thing that you can see on this page is you can see the person has got some user reviews. They’ve got a % score. Now, I might just take a moment to explain how our scoring works on the providers. You’ll notice a lot of these providers have a really pretty good score and the reason for that is because the surveys that are completed by their patients are generally very positive. So the ones who are participating with our system are usually pretty good and they are usually pretty confident that their patients are happy. So I don’t want you to think that these reviews are meaningless. I’ve been dealing with a lot of these people on a personal level back and forth with email and on the phone I’ve seen some of their files and I’ve got a good feeling — a good feeling about this and I’ve actually received a number of patient surveys that have been completed on paper and mailed in to me from real patients so I know for a fact that a lot of these, the vast majority are genuine reviews from genuine patients. So — so take that for what it’s worth. But stay tuned because I’m hoping to build a really big repository of these reviews to help people. The other thing when you go on to Hearing Tracker, we have something called the Hearing Tracker rank. And that’s driven by the patient reviews. But — but it’s also driven by the audiologist outcomes. So if the audiologist has had their patients complete an outcome measure with their hearing aids as part of their review, they get extra bonus points and they get pushed up in the rankings so that’s something if they are high in the ranks then you can tell they have done something good . Okay. So some of you may have used our Web site already. We’ve got a really great searching system that’s backed by a super powerful database. And basically you can search for providers based on any number of things. You can find out what services they provide by just clicking a button if you need a hearing aid evaluation or a dizziness and balance evaluation you can find out what brands they fit. What kind of education they have. Qualifications that they have. So you can literally tick — tick a box for I want somebody who fits Phonak hearing aids and then search your ZIP code and hopefully someone will come up. Again we’re still adding providers but you can see how it’s going to work once we get more of these people in you can also narrow down the providers by Hearing Tracker awards and those the badges you saw on the other page the service quality verified provider so you can click those by the way the excellence reward is if they have ten or more reviews and a score over % there’s only one person at the moment that has that hearing aid products and customer reviews this is a sample hearing aid page you can click on the review button if you want to review it. If you click on the purchase button what happens is it brings you to a list of providers in your area that fit that brand so that you can go and have a discussion with them we’re not trying to sell you a hearing aid through our Web site. We just want you — to help you connect with a local audiologist you can discuss it more with you can say I’m interested in this hearing aid you may not be a candidate for it but it’s something you can get on the right track to have a discussion with somebody about it again you can look at verified reviews the features of the hearing aids all of those features we talked about earlier that are part of my apples and apples features you can click on and it will nay — narrow down the hearing aids based on that feature I think I’m at the end I’m really happy to be here I only have five minutes for questions so I’m really sorry about that.
NANCY MACKLIN That was —
DR. ABRAM BAILEY Nancy, are you there.
NANCY MACKLIN Yeah, that was great information. I’ve been reading the comments that people have put in the chat box and I think we’re going to have to do a sequel. But in any event, let me get started on the questions because there are several here. Joe Gordon wants to know my question is that an in the ear hearing aid can cost $, but many times the mold is so un contractor — un comfortable why don’t the hearing aid companies get more involved with molds?
DR. ABRAM BAILEY Okay so you’re referring — did he say an in the ear hearing aid or behind the ear hearing aid.
NANCY MACKLIN It must be behind the ear is what he means I guess.
DR. ABRAM BAILEY Yeah I’m guessing that he means behind the ear because oftentimes what happens is the audiologist will order the actual hearing device from the manufacturer and they will order an earmold from a separate company. There’s so many different companies out there that provide earmolds. You have kind of given me an idea to try to find out — maybe a survey would be good to try to find out which ones are actually producing the best results. I know hearing aid companies are involved with earmolds when it comes to certain products some of the hard shell tips that go on the end of the behind the ear hearing aid so if you have a behind the ear hearing aid with a wire and hard shell tip those are sometimes D printed at the hearing aid factory I know when I worked in New Zealand we had to order those from a place in Canada and it took a while to get them and it was actually happening at the Phonak facility I think in Canada. I don’t know why — I think there’s not a lot of money in earmolds. That’s my guess. They are fairly in expensive to purchase wholesale and I know that they are kind of trouble some because they need to be sent back and forth sometimes and I don’t know if it would kind of add a lot to their business to get into that.
NANCY MACKLIN The next question comes from Susie how do you know you can trust the AuD with cerumen management.
DR. ABRAM BAILEY I’m going to be brutally honest and say I wouldn’t necessarily trust everyone if they had a specific course in cerumen management as part of their AuD program then I think that’s someone you can probably trust but I would really discuss that with the person if you’re not comfortable or if you have any doubts. My program at Vanderbilt, top university, did not include a cerumen management course. So I’m not sure that everyone is going to be very well trained out there. Unless they have had some specific experience.
NANCY MACKLIN Okay. Susie also says in my years of having four different hearing aids and working with five AuDs never, ever did the AuDs use these forms I’m assuming she’s referring to the surveys.
DR. ABRAM BAILEY Yeah. That’s a big problem. Yeah we really need to work on incorporating that better and we have gotten a little bit better like the surveys that we do show that more and more audiologists are doing those things but it’s not exactly happening fast and these surveys have been around for decades so it’s something I’m trying to raise awareness on.
NANCY MACKLIN Harassy would like to know during normal conversation is the telecoil of any value if there’s no hearing loop.
DR. ABRAM BAILEY No. No, it’s not. Possibly if you have — you can get like a neckloop which can communicate with your telecoil. And that neckloop can receive sound from an FM system. So if you wanted to have an FM system to help you in background noise, you could do it through your Telecoils.
NANCY MACKLIN Susie also wants to know with these selling devices with only one or two manufacturers have do you make sure you get the best one, volume and frequency-wise for your specific needs?
DR. ABRAM BAILEY This is a big problem in our industry right now. Where a lot of audiologists basically the private practice audiologists is — it’s kind of like a dying breed I think in the last ten years or so it’s dropped from % of practices were privately owned and autonomous and now I think it’s something like %. That’s some work from Dave Smerga with odd net he talked a little bit about that and did some studies on that. I don’t remember — I can’t remember the name of the study right now but if you want to get in touch with me, I can send you that information.
NANCY MACKLIN Okay. As it’s o’clock I just want to check with Cindy, cindy, are you able to stay on just a few more minutes until we get through the questions (Sure, no problem)
NANCY MACKLIN Great. She said sure. Okay. Next question, is the test described for checking against the prescription the same as real ear testing?
DR. ABRAM BAILEY Yes.
NANCY MACKLIN And is the prescription generated by the computer reliable?
DR. ABRAM BAILEY Well, the — it’s subject to user error. So basically there’s a number of different prescriptive methods and it’s up to your audiologist to choose which one to use. So there’s some that are actually made for children. And there’s some that are made for adults. And there’s some that are better for people with high pitched hearing loss and there are some better for people with low pitched hearing loss. So it really depends on your audiologist if they have, first of all, chosen the right prescriptive method to create your prescription. So it does get a little complicated. But they need to choose the right one. And then some of them actually the require extra in put. So there’s one called the now NL and with that one you have to put in the gender of the patient, you have to tell how old the patient is, how many years of experience they have with hearing aids. I forget all of the factors. But some audiologists just skip that part and they don’t put that extra information in and that actually changes the prescription so yes, the computer may not give the right prescription all the time and again that is large — I would say it’s not so much computer’s fault as it is the person using the computer.
NANCY MACKLIN Is the test box the same as real error measurements?
DR. ABRAM BAILEY It’s sometimes the part of the same device. And it’s sometimes separate. So actually the one that I showed you in my presentation in the photograph had a test box inside. Do you remember one where the man was pointing at the computer? That one actually the has a test box and a measurement so really a — a measurement system in one but for example the fry system has two separate ones and yeah there’s a bunch of different manufacturers and some of them have been combined — have them combined.
NANCY MACKLIN Okay. Audiologist Julia would like to know how much audiologists have registered thus far on Hearing Tracker and where are they located?
DR. ABRAM BAILEY There are about I think audiologists who have registered. So again it’s a far cry from the , plus we have listed on there. But it’s a start. And it’s not a bad start for starting in March. And I do encourage everyone listening to please talk to your audiologists, ask them to sign up. Ask them to participate with this project. Because I thinks important. I couldn’t tell you where they all are. That is a good question. I know we’re — where a lot of them are. But they are really scattered all around the country. I will try to create a map for you. I can generate a map for you. But I haven’t done that yet. So it’s a good idea.
NANCY MACKLIN Bruce asks what is an FM system I think I might defer in the interest of time to the HLAA Web site at hearingloss.org we have a massive section on assistive technology and I think you’ll be able to find the answer to your questions there about FMs and infrared and hearing loops. Okay. I think that is all the questions. And this was very interesting. This is such great information. For new hearing aid users and those that are looking to make a change. And I thank you very much Abram for providing this information and taking time to present this evening. I really appreciate it.
DR. ABRAM BAILEY Oh no problem and I’ll try to make a copy of the guideline available for you guys. The other thing I’m hoping to do is create like a checklist that you can use. There are some checklists out there but I would like to create a new better one based on the guidelines so that you can you know find out from your audiologist whether or not these are some services that they are going to provide. But let me create that. And maybe I can get Nancy to send it out to the people who were here today once I’ve done that and I just want to thank you guys again for coming in today, tonight. At this time — at this time of year so thank you so much for being here and thank you for the questions.
NANCY MACKLIN Sure. I’m happy to post that. Along with your PowerPoint. And don’t forget, also, we have a downloadable form on our Web site and available from our office that is a consumer’s checklist for purchasing a hearing aid which is a great tool to take to your audiologist to make sure that you ask those questions and get good information when choosing a hearing aid.
DR. ABRAM BAILEY That’s good maybe I don’t have to create one. (Chuckles).
NANCY MACKLIN Yes look at that. It’s a really good tool. But if you have any suggestions for improving that, please let us know because we do update that form occasionally.
DR. ABRAM BAILEY Okay. Cool.
NANCY MACKLIN Again thank you, happy Holidays to everybody and thank you again. Good night.
DR. ABRAM BAILEY Good night.