Laurel Christensen, PhD @ GN Hearing
04 November 2020
In Episode 5 of the Hearing Tracker Podcast, we had the pleasure of interviewing Laurel Christensen, PhD, Chief Audiology Officer at GN Hearing. Dr Christensen discusses the latest hearing-enhancement technologies developed by GN, including the new M&RIE (microphone-and-receiver-in-ear) hearing aid form factor, which improves sound quality, sound localization, and wind noise.
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Steve Taddei (Host): Thank you for tuning into the Hearing Tracker Podcast. I'm your host Steve Taddei, and on this episode, we are joined by Dr. Laurel Christensen. And she is the Chief Audiology Officer at GN Hearing, and she has more than 25 years of experience in the hearing industry. Laurel, thank you so much for joining us.
Dr Laurel Christensen: Thanks for having me. It's my pleasure.
Host: Can you give us a brief background about yourself and what you've been doing in hearing before we get started?
Christensen: Uh, sure. I have been more than 25 years ... even more than 30 years ... uh, at this point ...it's been a long time. Uh, I actually started my career at LSU Medical Center in New Orleans, had great mentors, uh, there, and, and ultimately came to Chicago to work for Etymotic Research. Uh, but hearing aids has always been my passion. And so about 18 years ago, ReSound asked if I would join, uh, to be the head of research, uh, in the United States at that time. And over 18 years, my job has changed. I've spent, uh, all of the time for the most part, uh, in, in research and development and, and, you know, that's my passion. I really enjoy watching technology change. And, and if you look at this industry, at least from where it was when I started 30 years ago, man, have we made improvements in hearing aids. I mean, back at that time, linear peak clipping, distortive... no wonder they ended up all in the drawer to where we are today with incredibly good sound quality, connectivity, and, and really the ability for people to hear in noise in many situations. So, I mean, we've really gone from, from hearing aids that really didn't help much of anybody to hearing aids that that can really change people's lives today. You know, when you look in particular every few years, we actually have these big innovations that push the industry forward. And that's the... those are the ones that I look the most forward to.
Host: On that note of really progressive innovation, I know ReSound recently released their new product line. Can you talk to us about what was launched and in your opinion, what is the most significant innovation in this new product line?
Christensen: So we just launched ReSound One... so a new high-end product line for ReSound. And in my opinion, this is another one of those really large leaps forward in the industry. Uh, and you know, you have to humor me because I have been around for a long time. So I do spend a lot of time going back talking about what once was, but I think if you look across developments in, in the industry... before we had hearing aids that could be fit completely open in the ear, most hearing aids, 80% of the hearing aids in the United States at that time, were custom products. They put a lot of plastic in the ear. They occluded your ear canal. And so people felt like their head was in a barrel. You know, the sound of their own voice was not natural, and an overall sound quality just was not great. And because of digital, we have the ability to create feedback cancellation algorithms. So, what made it so that you had to have a plugged up hearing aid was that if you didn't have that plug, you had feedback. And so once you could actually cancel the feedback, kind of coming back out of the ear and going back through the microphone, once you could have an algorithm that would cancel that, you could open up the ear canal. And so what happened is we have these beautiful thin tubes with these tiny little hearing aids... absolutely turned over the industry. We went from 80%, uh, custom in the ear occlusive products to today....80% of the hearing aids sold in the United States are, are behind the ear. And the majority of those are these small receiver in the ear products. If you look at those products, as much as they changed the industry, they actually took the microphone from the ear. So the microphone, you know, had been in the ear for most products that are custom. And we remove those microphones and put them on the top. And we did it for good reason. You know, you wanted to separate the receiver and the microphone and get less feedback and the style of hearing aid being very cosmetic that way. But when you remove the microphones from the ear like that, you also remove all the acoustics of the ear. And our ear - everybody's ear - is individual. And everybody's ear is their own. And you hear with your own ear ... the vast majority of people who wear hearing aids are elderly people who have been normal hearing their whole lives. They're used to their own ear, their own acoustics, the resonances of their own ear. They're used to being able to localize sound because of their own ear. And when we take those microphones out of the ear, we lose all that. So the big innovation in ReSound One is a new receiver called the microphone and receiver in ear. We call it M&RIE for short, and it actually puts the microphone back into the ear, right next to the receiver.
Host: Our hearing system is very intentional that our ears function as like satellite dishes to capture sound. And as they capture sound, it's bumping into all the little ridges that we see in our ears. Our brains get very used to that specific signature. So moving the microphones up above your ear can play with our brains expectation. It's great to be able to take the microphone, put it back in the ear canal, where it will be more consistent with what our brains are used to. It really is a fantastic innovation. I think this is the first time there has been a behind the ear style device that had the microphone still within the natural acoustic pathway.
Christensen: You know, the idea has been out there, but no one has been able to accomplish it because of feedback. That's really the big thing. You, you actually have to be able to have good feedback control and you need to be able to get a lot of amplification in a hearing aid, and the louder you make the sound, the more you amplify it, the more, you know, you're going to be likely to have this acoustic feedback, that annoying whistling that hearing aids can produce. And so we needed to have a feedback canceller that worked extremely well. And the development here is not small. You're putting a microphone really right next to a receiver. So you're in the worst situation possible for feedback. And so while the idea has been out there, no one's been able to accomplish it and get an appropriate amount of gain. And certainly no one has accomplished it in a hearing aid that also continues to have microphones on top of the ears for hearing in noise, because we do still use those microphones on the hearing aid that's above the ear to actually help people hear in noise better. So this hearing aid has three microphones on each hearing aid and they're used in a way that you're... you're using the one inside the ear at the appropriate times. And you're using the ones that are above the ear at the appropriate time, so that you're able to hear and really hear naturally in a lot of situations. And so that's what makes this very unique. Although I think everybody knows hearing with the microphone in the ear has been the right way to do it for years, it's been accomplishing it technologically.
Host: I have not had the chance to try out ReSound One devices yet. How have the responses has been on your end? Have they noted an improvement in just the naturalness of the sound quality?
Christensen: Yeah, absolutely. People have been blown away by it. I actually had the opportunity just yesterday to talk to, um, someone that's fit with the hearing aids. And he was talking about wind noise reduction in particular. He's a kayaker. And he was talking about the fact that, you know, he's outside all the time... and when you put microphones above the ears on the hearing aids -behind the ears, there. The wind just comes right across them. And so we noise with hearing aids can be something that's quite annoying. But when you put the microphone down in the ear canal, it's just naturally shielded for wind. So that's, you know, something we don't even really talk about in terms of the sound quality, but the wind noise is great. And then he actually is also a fisherman and he had this great story about the fact that he could tell now the distance that the fish were. He could hear 'em jump and he knew what direction, but he also could tell the distance and he had never been able to do that before. And that's exactly what this product brings. We've been able to localize with hearing aids for a long time, because we've been able to...kind of build an average ear response back into the hearing aid. So what that means is, you know, all ears have acoustics where we amplify sound, ...your ear has these resonances, and we've been able to build that average resonance back in digitally into the hearing aid, but only if your ear is average does that sound natural to you. And really, you know, nobody's got the average ear. Our ears are, you know, very much like a fingerprint. Everybody's got a different shape and size in your ear canal, you know, they're all different. And so when you can actually listen with your own ear and hear acoustically in your own ear, then you get this ability to not only know where the sound was coming from, but how far away the sound is you get this kind of true spatial perception. And I'm normal hearing. So I'll just say that up front. But I listen to hearing aids all the time. You know, when you develop hearing aids for a living, hearing aids are always in your ears. I got the finished version of ReSound One, and I went on a hike with one of my kids up in Wisconsin, on Lake Michigan. And I had my hearing aids in and I kept getting very frustrated with my hearing aids that day because I kept thinking they weren't working. And ultimately what I figured out is that I'm so used to listening to the processed sound and it sounding processed because it's picking the sound up above my ear instead of in my ear. And I kept thinking that I wasn't listening with the hearing aids. It was too natural. And I would go to the app. You know, we have apps that can control these hearing aids. So I kept going onto my phone on the app and messing with the volume control and finding out, yes, indeed. These hearing aids were working and were on, but the sound quality was so natural, I was a little taken aback by being able to hear pretty naturally in an outdoor experience like that. When you listen with your own ears, It truly makes a difference in terms of sound quality because your sound quality that's good is due to your own ear. It isn't due necessarily to everything we do inside that hearing aid.
Host: Localization or detecting where sounds are coming from is a big issue for people who'd end up switching over to a behind the ear or receiver in the ear style device. Definitely look forward to hearing what that sounds like for myself. I know ReSound has helped deal with this in the past, but telehealth is a really hot topic right now due to COVID-19. What is ReSound doing to help connect doctors and patients in a virtual world like we have right now?
Christensen: That's such a great question and such an important topic today. We have had for a while, something with our hearing aids called remote fine tuning. And that's been out on the, on the market for a couple, two, three years. And what that has been is that a patient can go into our app. Again, you have to have your smartphone in your app and you could go in there and, and you could immediately just request assistance from your hearing healthcare professional and say, you know, I'm in this situation. I'm not hearing very well. And you could actually put in a request to your hearing health care professional that you might need some changes to your hearing aids. And then the hearing healthcare professional could get back to you by ultimately making some changes - because they can make the changes to your hearing aid on their computers - and they could send essentially back to your phone new programs for your hearing aids. And then you would upload those programs into your hearing aids. So we've been doing this, you would call it, you know, asynchronous, because you're not talking to the healthcare professional at the same time. We've been doing that for a long time, but as COVID, you know, really started, we were working on what we call ReSound Assist Live. We already had that ReSound Assist. That was the asynchronous. We were working on a live one where the healthcare professional could be talking to the patient live and having adjustments to the hearing aid made right away. And we launched that very shortly after kind of the lockdowns went into effect. And again, this is something that you do through the app and the hearing health care professional ...you'd make an appointment, and the hearing healthcare professional calls the patient, and you can see each other. It's very much like a FaceTime call, but it's done through our app and the hearing aid can be completely programmed in that manner. And you can have a ... a complete fitting, even some kinds of evaluation because you can actually test hearing through hearing aids today. So there's a whole lot you can do in order to get hearing aids without ever having to leave your house. Yeah, I take care of my mom who lives in our home, who's, you know, 83 years old. And I'll tell you from my perspective, as a caregiver, having the ability to not have to get her in the car and get her to an appointment is huge. And there are these silver linings in COVID. As bad as this situation has been, I think that one of those is that telehealth is becoming a norm. And the convenience factor... I mean, obviously there's a health factor now of just keeping people apart. But the convenience factor for the population that we serve is huge. And I think this has pushed a lot of professionals to get familiar with it and to get signed up and to be able to use this. And I think this is going to be really important for hearing healthcare professionals. This is going to set you apart from the person down the street who doesn't use it because, you know, people don't want for a small adjustment to have to leave their house. I think these are really important things for people who are ... who have a little bit harder time getting around.
Host: From your experience with ReSound Assist ...the synchronous and asynchronous methods... is it mainly used for first appointments? Follow-up appointments? Is it the completely asynchronous method of remote fine tuning? What do you find being the most popular or preferred choice?
Christensen: I think right now in COVID, how all of this started, we're doing it as followup appointments. That has been what it has been used for the most. There are ways to do this. We, we had, uh, customers who would have patients drive up...not get out of their cars. They would do a hearing test on 'em, like from their car. And there are audiometers that can do that. And so, would do a hearing test on 'em, get all of the information that they needed, and then would pre-program hearing aids, send them home, and then do the fittings completely through telehealth. And so just to continue to serve patients, there was some, you know, very creative, very innovative thinking about how to do it. And you can do the fittings a hundred percent, uh, via telehealth. I actually, when I was fit with my ReSound Ones, we were doing a lot of testing of the system at that point, and one of my staff fit me from her house. And she, you know, she mailed me my hearing aids, I put them on, she called me up and my fitting was done completely remotely by one of my staff . You can do everything from the beginning, you know, and obviously I'm an audiologist, I want people to come in and sit into test booth and have a real hearing evaluation because there are so many things we can do actually in a hearing evaluation like speech and noise and getting uncomfortable measures. There are things we can test that can help with hearing aid fitting. So sure. I would much rather have the full evaluation. But in these times we have to do things a little bit differently. So it has really allowed us to continue to have hearing healthcare without some of the hearing evaluations that we would want to do. And I, you know, I think, and one of the most interesting thing that's happening in our field right now is this explosion of literature with the relationship between hearing loss and other health problems. So these co-morbidities that come with having a hearing loss. And we know there's a link of hearing loss to dementia. We certainly know there's links of hearing loss to depression and to loneliness. And there are even people fall more often who have untreated hearing loss. And I think leaving your hearing loss untreated is not a solution. And so being able to do these things from telehealth is really the way to go for patients that can't get out today. And I know maybe we'll be doing this... I hope not, but boy, we might be doing this for some months ...and it just, there's no reason to not treat your hearing loss. And I know from my own experience ya know we're doing a lot of these Zoom kind of meetings, and you might be talking to your grandchildren or your children, you know, through these computers and you need to be able to hear them. And hearing aids can help with all of that. So it shouldn't be put off just because you can't get out today.
Host: That is such a great point. COVID-19 has definitely pushed the field of audiology forward probably four or five years in the technology that we're having to adapt now. And at the heart of it is exactly what you said. It is putting it at a point where then accessibility can be improved.
Christensen: Well, it's interesting. We're, we're in an interesting time for our industry around hearing because of over the counter hearing aids, they, you know, we're about ready to see that. The FDA has delayed some of the regulations around that, but you are going to be able to set access, hearing healthcare over the, over the counter. And today you can certainly access hearing healthcare through some of these high-end headphones, where you can do some shaping to give yourself some amplification in areas and to test your hearing. So, you know, these are things that are there. I certainly hope that it is going to bring hearing healthcare to more people that need it, especially as people just start to lose their hearing. We know the average age of the hearing aid user is still right around 70. But that isn't the time when you, you know, have just started to lose your hearing. You're losing your hearing way back, you know, I'm, I'm over the age of 50 today, and I can tell you that these whole mask things are making me crazy because I just, you know, I am having a lot of trouble hearing when there's any noise in the background at all. And I'm sure everybody is out there, no matter what your hearing is, but even in your fifties, certainly your sixties, you're just starting because of aging to lose some hearing. You know, having something that can give you some amplification with like the AirPods and the things that you mentioned out there, I think are helpful. And I do believe that people will think that they're helpful, but they're going to be helpful to a certain point. And then there is true, true help in really modern hearing aids today. And with modern hearing aids today, you're looking at directional solutions where you can have, you can have a solution that takes noise out of the signal and amplifies the speech to the front that you actually want amplified a little bit more. You have very good noise reduction strategies... that are a little different than what you find in your AirPods. You know, we have noise reduction strategies where we're trying to actually take out some speech and not just airplane noise or, or that kind of noise. So, and you have to do it in a way that people can still hear the sound that they want to hear. So you've very sophisticated noise reduction. And you know, you really do need amplification geared to your particular hearing loss. And so I think it's great for kind of mild hearing loss. And I think people will like it. But what I hope is that it leads people when they truly have problems when they really can't hear when it's impacting their relationships, when they're not hearing in meetings, when they're not hearing the TV, that they come in and get hearing healthcare from a hearing healthcare professional, and move to true amplification, true hearing aid devices. You know, I do think it will help. We have a market where, you know, many people with mild to moderate hearing loss, don't do anything about their hearing. And as I already said, you just shouldn't do that. Untreated hearing loss is really linked to other comorbidities, dementia being a major one. You need to be doing something about that. When you have mild hearing loss, not when you have worse hearing loss. So I hope it gets people into amplification and it gets them started on amplification, and then they move on to hearing aids that can really help them as they have more and more problems. And the message that I like to get out to people is that hearing aids are full ecosystems today. You can stream from your TV wirelessly. You can stream from your telephones wirelessly. You can actually give your spouse or significant other a microphone and go into a restaurant and you can hear them right in your ear because the microphone is attached to them. And you have, you know... it takes all the noise out and you can hear so. The sophistication of a hearing aid and the ecosystem built around it ... quite something today. And I think ultimately that's not going away where, where you really are going to have the big solutions in true amplification. But these over-the-counter, or, or headphone solutions I think are a good starting point for some patients.
Host: Yeah. I like that you called it an ecosystem. So it's very true. The technology around us is just integrating more and more with all the other technology that's around us. You also mentioned face masks. And I think everyone at this point understands that they cause communication barriers just because they're covering up your lips. So you lose a visual cues. They're also impeding the natural way that sound would leave your mouth. Are there any recommendations you have for hearing aid users who are struggling that much more now because they've lost those visual cues and the speech clarity has gone down because of the masks?
Christensen: Uh, absolutely. You know, the biggest thing that you can do is get a little bit more high-frequency amplification because what is blocked by the mask are high frequencies. And so it's like your "s" sounds and "sh" and "th" and, and these high frequency sounds carry a lot of information in the speech signal. If you can't hear those high frequency sounds, it sounds like everybody is mumbling to you and you can't make things out. It's very much like it is when you lose your hearing just as you're getting older. But those high frequencies are blocked by those masks, and so, you know, you can have a program put in your hearing aids. If you have hearing aids today, you can have a new program just called a mask program that actually will be amplifying the high frequencies a little bit more. We actually have some recommendations to change a few things about our hearing aids for a mask program. And it's something that you can request from your hearing healthcare professional. I think every manufacturer out there today has some sort of recommendations for how to set up a hearing aid so that you can hear people talking behind masks a little bit. I would encourage anyone who has this ability to do it remotely through some sort of telehealth solution, to request a mask program from their hearing health care professional. And, hopefully it could just be put in your hearing aids by uploading it through your telephone. So certainly that technology is there. Otherwise, you know, go in and have a mask program put in. But a little bit more amplification or help in those high frequencies can make hearing someone speaking with a mask on easier.
Host: And like you said before with this concept of the ecosystem, almost every manufacturer now has an app on their phone that can control the hearing aids. And within that app, there's also an, I know ReSound certainly has this, there's a three band equalizer where it gives you a little bit of control over the lower frequency ranges, the mid-frequency ranges, and then those higher frequency ranges, which are what Laurel mentioned are going to affect the constant clarity. The S's the T's. So if you are someone who is not able to get into a clinic right away, or even while you're waiting to get into a clinic for your own just experience, you can pull up your app and you can definitely try boosting the higher frequencies and see, or not see, hear that difference of getting some of that clarity back. And then you have that on your phone and you can save that as a preset.
Christensen: That is a great point without having to do anything and opening your apps... these apps on smartphones, you know, really give the hearing aid user so much more control. You can actually increase in decrease noise reduction in wind noise reduction, you change programs... but like you say, you also can increase the high frequencies a little bit, uh, just on your app for many manufacturers. So that's a great point.
Host: Before we wrap things up. Is there anything else that you wanted to share with us?
Christensen: Hey, you know what, we've already talked a lot about ReSound One. Um, you know, there's a lot of features inside that hearing aid. And I would, you know, I would also mention that it comes in different styles, but one of them is rechargeable, and rechargeable has become such a great product today in our industry. I think people shy away a little bit from it because maybe the hearing aid will die in the, in the middle of the day, and they won't have their hearing aids and this would not work very well. But with the lithium ion batteries that are in there and ...they can last up to 30 hours, um, many of the different models can last up to 30 hours. Even if you stream, maybe from your TV, or have some sort of wireless connection to your TV, and maybe you watch TV a lot, you can still do that for many, many hours a day. And your, in your hearing aids won't die. If you have a fairly normal sleep schedule and you just put your hearing aids into the, uh, into the charger every night, they will be fully charged in only three hours, and they will last more than one full day. And then you don't have to mess with buying batteries. You don't have to mess with changing them and then falling on the floor and not being able to get them in and out, and all of the issues that come with these tiny little batteries that are so annoying in hearing aids. So it's always good to mention that those rechargeables are out there and they really are becoming very popular, uh, in hearing aids.
Host: ReSound also has a tinnitus relief app. And honestly, it is something I recommend to patients all the time, because it is an all in one solution, or just aid, because it provides different maskers, and one of the favorite things I like about your tinnitus relief app is that it allows you to create your own soundscape. For those who don't know. I mean, tinnitus is generally associated with stress and where it's generated in the brainstem. Many times it triggers this fight or flight response... and without getting into it too deep, having the ability to, when you're stressed, as opposed to putting on just white noise, to put on a soundscape that you have created that is salient and triggers a happier memory and situation to you, is fantastic. On top of the different meditation techniques and just awareness that's on there. So thank you very much for that app. That is honestly something I use personally, and I recommend it on a daily basis for those who struggle with tinnitus.
Christensen: It is a great app. We have had really, really talented people in the company that have, uh, put that app together through the years. And, you know, I even use it... if I can't sleep some nights, uh, especially in a hotel where it might be noisy, I just turn on my app next to me and you can make your own sounds... the waves can come in, and you can have, you know, the wind in trees and you can have music. I mean, it's ...there are so many things you can do with it, even as a normal hearing person. I use it, but it's a great, it's a great tinnitus, uh, help. There's no doubt it.
Host: Well, Dr. Laurel, thank you so much for joining us and telling us about the M&RIE, the microphone and receiver in the ear, and the ReSound One product release. It has been a pleasure speaking with you.
Christensen: Thanks uh, I really appreciate your having me.
Host: And if you'd like to learn more about ReSound, feel free to check them out at ReSound.com, and thank you everyone for tuning in this has been the Hearing Tracker podcast.