This week on The Future Ear Radio podcast, I’m joined by Brian Taylor, AuD – Director of Clinical Content Development at Signia. Today’s conversation continues the discussion had on the podcast recently on episodes 74 (Kim Cavitt & Geoff Cooling), 72 (Abram Bailey and Steve Taddei), and episode 69 (Kat Penno and Andy Bellavia). The big question that all of these conversations attempt to seek an answer to is, “where do hearing professionals fit into this expanding part of the market that caters to folks with mild-moderate hearing losses?”
We talk through the Hearing Care Professionals role for this portion of the market, and the type of service delivery model innovation that might be necessary in order to realistically service people with milder forms of hearing loss.
As we discuss during this episode, there are three big buckets that house the vast majority of objections to hearing solution adoption – Price, Access and Stigma. In many ways, each of these three buckets are being systematically chipped away at in a variety of ways (which makes doing this podcast all the more interesting).
The negative stigma that surrounds hearing aids and the outdated connotations that the general public seems to have when it comes to their perception of what a hearing aid looks and functions like, is at the root of many candidates’ objections. This is why a device like Signia’s Active Pro is such an exciting development, as it represents the convergence happening between hearing aids and hearables. At a certain point, it’s going to be very hard to distinguish between whether someone is wearing a hearing aid or a hearable, as the line between the two continues to blur.
In my opinion, this blurring of the lines, combined with the sheer proliferation of AirPods (100+ million user base) and all the other hearable devices that are selling en-masse, ultimately might equate to one of the most potent combatants of this negative stigma. As I have mentioned so many times on this podcast, the really big shift that’s taken place since AirPods launched in 2016 is that it’s become normalized for people to wear wireless earbuds for extended periods of time. We’ve undergone a major cultural shift with our consumer technology (which I think will be the largest obstacle that augmented reality faces…).
Furthermore, this swelling consumer hearable userbase is incentivizing developers to build apps specifically for our ears (i.e. Clubhouse). This is the same type of virtuous flywheel that we saw with the mobile app economy and the network effects that began to be generated from the onset of the iPhone app store. It’s why the second post I wrote on this blog was about network effects… and that’s what is so exciting. The network effects are starting to really kick in, and guess what? Hearing aids get to take advantage of all the value that’s being built for devices like AirPods. Hearing aid wearers are a secondary beneficiary that gets to tap into this ecosystem as well.
Put all of this together and what we’re seeing is a world where people actually want to wear ear-worn devices for an increasing amount of time. Whether that’s consumer earbuds, RIC hearing aids, or earbuds that function like hearing aids, it’s looking more and more like we’re destined for a future where everyone chooses something(s) and it will be harder and harder to tell why exactly people are wearing their chosen device. Which might end up being the most effective way to combat stigma.
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp:
Hi, I’m your host Dave Kemp, and this is Future Ear Radio. Each episode, we’re breaking down one new thing, one cool new finding that’s happening in the world of hearables, the world of voice technology. How are these worlds starting to intersect? How are these worlds starting to collide? What cool things are going to come from this intersection of technology? Without further ado, let’s get on with the show. All right, so we are joined here today by a great guest, Mr. Brian Taylor. Brian, tell us a little bit about who you are and what you do.
Brian Taylor:
Dave, thanks for having me on your podcast. I am an audiologist, I have been for more than 30 years. My current role is director of clinical content development for Signia, which is one of the hearing aid manufacturers inside of the WS Audiology company. And in addition to that, I’m an adjunct professor at the University of Wisconsin. I’ve taught a class there, just recently wrapped up a class. And I’m also the editor of the journal called Audiology Practices, which is a part of the ADA, Academy of Doctors of Audiology group.
Dave Kemp:
Well, awesome. Thank you so much for being here. I should have corrected myself at the beginning, I should’ve said Dr. Brian Taylor because you did mention that you’ve been an audiologist for 30 years. I’ve had a chance to know you for a few years now, and I’ve always enjoyed our conversations. You’ve written a bunch of books, I think you’re just very, very well-versed in this whole industry. So you’re the perfect candidate of the type of people that I love to have on the podcast and have these conversations with. So I think this is going to be a really good discussion because as we were talking about before we started recording here, this is a continuation of a lot of these conversations that I’ve been having lately going back to where I’m talking with Andy Bellavia and Kat Penno, and then I talked with Steve Taddei and Abraham Bailey. And then most recently I talked with Kim Cavitt, and Geoff Cooling.
Dave Kemp:
And the basis for these conversations has all revolved around this idea of, man, there’s a lot of momentum happening in this industry right now. You look at it from, if you just want to list out all the different moves, Bose introduces a hearing aid, Jabra, which is owned by GN, they’ve released for that consumer brand, now they’re going to have a hearing aid that’s going to start by being sold in Costco. You have what’s happening in the hearables world where the hearables hearing aid convergence with Jacoti and Qualcomm partnering and issuing this licensing of what’s called OTC ready, which is basically going to be the ability for any OEM out there, any of the manufacturers that are building one of these hearable devices with that QC5100 Qualcomm chip in it. They’ve now partnered with Jacoti so that you can just basically turn on that functionality.
Dave Kemp:
The list goes on and on, I could keep going. But ultimately what we’re getting at is there’s a lot of movement, and a lot of the movement pertains to what I think a lot of us in the hearing healthcare industry refer to as the mild to moderate end of the market. And this obviously all coincides with the impending OTC legislation that at a certain point probably in 2022 we’ll see implemented, which will allow for hearing aids to be sold over the counter. And again, that whole thing was initiated by Obama in the PCAST recommendation that he had where he basically suggested that we should have more affordable options that can be sold over the counter.
Dave Kemp:
And so really I think it’s like we’re in this period right now where it’s getting really interesting. So when we sat down to flesh out what an episode would look like together, you sent me a number of different papers that have resonated with you recently. And so I read through them, so I read a few of these. Seems to be the one person that really stands out for you is Larry Humes the professor at IU.
Dave Kemp:
I was reading through it, and what really caught my attention in the way that I wanted to kick off this conversation was he basically concluded one of the papers where he said, “Ultimately,” and I’m reading this now in quotes, “ultimately the goal is not to take opportunities away from any specific hearing healthcare professional within the existing model or service provision. This model has served the needs of many individuals quite well and will continue to do so. The focus in the upcoming decade will be to expand the market and the alternatives available to adults with ‘normal, slight, or mild hearing losses’ and the consequent perceived hearing difficulties. These individuals, many of whom are older adults represent the 75 to 85% of those with hearing needs who have not been met by prevailing hearing health care system. So before now I kick this over to you, that’s exactly what the title of the last podcast conversation that I had with Geoff and Kim was the hearing healthcare professional’s role in an expanding market.
Dave Kemp:
So I firmly agree with him where what we’re going to see over this next 10 years is going to largely be catered around what I consider to be a new side of the industry that’s not really ever been tapped into before. As he says, it’s not as if the existing model is what’s being disrupted, if you will, or it’s under attack. I think that that is cemented in place, and it’s very helpful for those that are accessing it through there. But it’s not really designed for the people like he mentioned who have ‘normal, slight, or mild hearing losses’, and they might have very specific difficulties. So I just wanted to frame this conversation broadly here and kick it over to you to get your thoughts on maybe how we’ve even got to this point and just your general view of where things are now starting to head in light of all this flurry of news and activity that’s been happening over the course of the last few months.
Brian Taylor:
Sure. You’re making my head spin, Dave, just mentioning all those things that are happening in the market. It seemed like on a weekly basis that I’ve shared with my students, I’ve been in the industry or the profession for 30 plus years. And I think that people that are just entering the profession are probably going to see more changes in the next five years than people like me who have been around for more than three decades saw over that entire span. So yeah, I think things are changing rapidly. It’s really important for people to pay attention. The other thing that you bring to my mind is a quote or something that I’ve heard Dan Quall who’s a friend of mine who works at Fuel Medical says, and that is there are a whole lot of people out there that have a 500 or $1,000 problem, and historically we’ve only offered them a 4 or $5,000 solution.
Brian Taylor:
And I think that gets at those individuals that are at the bottom of that pyramid that we’ve talked about, those people with mild to high-frequency moderate hearing loss that historically don’t even know that we exist as a profession often don’t use any kind of device. I think that it’s probably a different business model, a different practice model that’s needed to something that they would value. Historically what we do, test somebody, recommend fit hearing aids, have them come back three or four times over the course of six months for some follow-up appointments. That clinical model probably doesn’t work very effectively for those 60% of the population that has a hearing loss. Those 60% that are in the mild category just don’t find that to be valuable. I mean, there’s a lot-
Dave Kemp:
I agree. And I think that sort of gets at this whole thought, which is when I think back to the genesis of the whole OTC Act and the sentiment in the industry around it, I think it was a very understandably. Anytime anybody comes for your … If you ever feel like you’re threatened, of course then these things look like threats. And so I think initially OTC was positioned as if it was going to really threaten the current, I guess, revenue model and the overall business, if you will, that so many of these companies and this industry are based around. And so I think that when you really start to read through not only the data but also look at some of the different ways in which there have been surveys. I know Brent Edwards, he had a really interesting market track 10-piece that you sent to me as well.
Dave Kemp:
One of the things that always stands out in my mind that I think is so important is as he found in this study, so I think it was 3,000 adults that was the end that they were using for this piece of research. They found that of people that have been exposed to a hearing care professional. So if you’ve bought a pair of hearing aids or you’ve seen an audiologist or a hearing care professional, 88% of them indicated that if they were given that option again now knowing what they know in that experience that they’ve had, 88% indicated that they would definitely or would likely go and see an audiologist or hearing care professional as opposed to a do-it-yourself over-the-counter solution.
Dave Kemp:
And I just find that to be such an important statistic for just a wide variety of different reasons. But I wanted to get your thoughts on this because I think that that number, it’s a little bit of almost a double-edged sword because on one hand, it’s amazing. I think it really is a testament to the value that the professional really provides. But I think that the other side of that is how do you make people aware that this experience exists when we enter into an era where there are just that many more avenues of access to these kinds of solutions where it might not involve them? And so it’s almost you’re trying to provide, solicit this you should go this route. But to your point, it might not really make sense because it’s not fitting into the current delivery model.
Dave Kemp:
So it seems to be that one of the biggest names of the game right now is going to be a matter of how do you expose more people into that audiological value so that you get more and more of those that fall into this bucket of 88% would want to go that route?
Brian Taylor:
Yeah. I think that speaks to the complex nature of hearing loss and trying to figure out what’s going to work best for somebody. You think about people that raise their hand and say, “I have trouble with my hearing.” It usually takes the proverbial 7 to 10 years to get there. Usually people in that category tend to skew a little bit older, they have other health conditions. And so I think at some point along the patient journey, they’re looking for guidance. I think historically that guidance has always been along all segments of the patient journey from testing to fitting to follow up. I think really one of the more exciting opportunities because of Telecare, because of the ability to maybe buy devices online is it allows the patient to pick and choose the segment of the journey where they want to involve a professional.
Brian Taylor:
Maybe they want the professional at the beginning to help them navigate the choices. Maybe they want the professional to help them better understand their hearing loss and some of the treatment options. Maybe they need help learning how to get the device in and out of their ear and all those kinds of things so they can be a consistent hearing aid wear. So I think there’s all kinds of opportunities to deconstruct the patient journey and offer value where a patient pick and choose along the way where they want to engage the professional.
Dave Kemp:
Yeah. I love that. You said navigate, and that brings to mind when I was speaking with Kim and Geoff. Kim used the analogy of let the patient be the captain of their own journey. They’re going to be the one that’s ultimately deciding where they want to go. But the professional’s role is really that of a navigator, it’s to steer them and provide them a map as to their options. And I loved that analogy because, again, as you mentioned too, it seems to me like a part of the solution here, again, if the whole name of the game is exposure, and we know this to be probably a market that’s not going to be nearly as time intensive because of the severity. So if you’re not seeing a professional today, you haven’t reached a point to where it’s that Dan Quall saying where it’s like, okay, it’s a $300 problem, not a $3,000 problem.
Dave Kemp:
And so you feel as if that’s just not the right avenue for you. As we as an industry I think start to cater to this entirely new part of the market that is more on this more mild or hidden hearing loss end of the market or very situational side of the market where it’s like I really struggle in these specific instances, I struggle in these conference meetings that I have at work. So it seems to me that, okay, if you start to put the pieces together here and you say, “Well, what is my role there?” Well, clearly what would be beneficial would be for somebody to advise them on their options that exist. And this is where I think it gets really interesting is to figure out, so how do you make that conducive to being able to see a whole lot of people. And that screams online tele-health remote services.
Brian Taylor:
Yeah, there’s no doubt about it. Just in the last few months, I’ve seen a tremendous number of papers. A lot of them come from the UK, South Africa, some leading researchers in those parts of the world that have used online testing. And they’re showing that it’s a tool that engages people in the process. Think about a hearing loss like a lot of other chronic conditions is something that obviously nobody wants to have. They try to live with it as long as they can. And the fact that you’re raising your hand and saying I want to come into the clinic, that doesn’t happen right away. And a lot of people, if given the option to from the comforts of home investigate their situation, even do some measurement of their situation and using a tool that might be vetted and has some validation behind it, I think is a great way to get people engaged in the process without having them to go through the emotional ordeal of making an appointment, getting dragged into the office by a spouse.
Brian Taylor:
When you think about the hearing loss through the lens of a chronic condition, these online tools have a tremendous amount of appeal I think to a lot of especially younger individuals. When I mean younger, I mean people under the age of like 65 that tend to have a milder hearing loss. I’m a big believer, I’m trying to figure out a way to engage them using an online tool, for example, to test their hearing or to disseminate information about the consequences of untreated hearing loss. So anyway, there’s all kinds of opportunities I think to rethink the traditional clinical model.
Dave Kemp:
Yeah. And I think you’re really touching on a few things that are very top of mind for me as well. So let’s stick with online tools. So one big element is a screener. I think just even having something, again, in the absence of this all not being something that’s administered by your physician, which is its own whole nother conversation there. Checkout for anybody that’s listening and interested what Johns Hopkins, and specifically Nick Reed are doing around the ACHIEVE trial, which is really trying to combat this. But because of the fact that very few people ever are really given a assessment even in the sense of … Because again, this is, for the most part, very progressive in terms of you lose your hearing progressively bit by bit over time.
Dave Kemp:
And therefore, it’s really hard to even see when it’s happening until the point where you’re blasting the TV, and usually it’s your spouse or your child or whoever you’re living with is like, “Man, you got to go get this thing checked out because you can’t hear worth a shit anymore.” This seems to me like a really, really good opportunity though for the industry to really get in rally around. I do think that this idea of embedding a online hearing screener on every single website in the industry, every hearing care professional’s website. And having it be a triage thing where you go on there. And that’s a really effective way to capture that lead and then say, “Okay, would you like to schedule a visit and come see us and get really a full audiological evaluation and meet with this person?”
Dave Kemp:
Again, when we’re talking about something that seems to be such a psychological thing where so much of it is ego and you don’t want to admit that I probably have a problem. And so in the absence of there really being anything that actually gives you an objective, yeah, you need to come and see me, it seems like we’re just going to continue to be in this state of giving people the option to cop out because there’s nothing clinically that suggests that they need to come see you other than they’re listening to their TV at full blast. They almost seem trivial, but I think they’re so important when we’re looking at the broad population, and we know there to be just this massive hindrance of adoption because of the fact that, again, there’s about five really major factors that play into this it seems like. But it ultimately boils down to you’re giving people just that much more of a reason to not come see you when they don’t want to come see you in the first place it feels like.
Brian Taylor:
Yeah. Just like I said, I think it’s normal human behavior when you have a condition that’s slow onset, it’s just easy to ignore it for a while. There’s a model that I often, I use this a lot in my courses, and I’ve written about it. It’s called the stages of change model. It’s a way to think about a person that has the condition, the behaviors associated with it over time. There’s pre-contemplation, contemplation, preparation, and then action. And pre-contemplation is really that the person that has the condition is unaware that it exists and other people are saying, “You need to do something about it.” There’s been a couple of studies that have looked at this. It takes somebody usually on average about 9, 10 years to get into the action stage.
Brian Taylor:
And the problem with that is, and this goes to some of the work that’s happening at Johns Hopkins. There’s an otologist by the name of Justin Golub at Columbia University Medical School in New York City that has looked at the relationship between subclinical hearing loss, which is basically low, normal scores on the audiogram, the relationship between subclinical hearing loss and depressive symptoms and cognitive dysfunction or cognitive decline. And showing that even though they technically have normal hearing, they’re starting to see some early cognitive decline, more likely to have some depressive symptoms. The whole point is we need to figure out a way to intervene earlier with people when the loss is mild or when they’re younger, because there’s all kinds of benefits.
Brian Taylor:
That’s what Nick Reed’s group is looking at in their ACHIEVE study, I believe. Unfortunately I think over time, we’ve built a clinical model that doesn’t really cater to somebody that has a milder hearing loss, that might be younger. And that’s the exciting thing about some of this internet web based testing, the use of decision aids on a website to help somebody navigate what their options might be. That’s why manufacturers are starting to bring new products to market that may not be necessarily hearing aids in the conventional sense of the term as far as how they look. So I think everybody’s starting to pay attention to this and they recognize the need for earlier intervention, try to grow the market.
Dave Kemp:
Well, let’s stick on this one for a little bit here because I think that what Signia has done with the Active is just such a representation of what’s to come. Just for those that don’t know, do you want to talk real quickly about what the Active is?
Brian Taylor:
Sure. Well, I’ll use your term, Dave, it’s a hybrid device. If you map out anything, any kind of device that goes in, around or near your ear that amplifies sound, I think you can map them out on a continuum. On one end of the continuum, you have devices that are, I would say, 100% conventional hearing aids. And they have things in them like feedback cancellors and the ability of the two hearing aids to communicate so that you get very effective bilateral beam forming systems for noise reduction, and a few other things that are unique to the hearing aid world. And then on the other end of the spectrum, you have devices that amplify sounds that are more like consumer earbuds.
Brian Taylor:
They might have a low end amplifier built into them, and of course there’s been a number of those that have come onto the market over the last decade or so known as PSAPs, Personal Sound Amplification Products. Well, now I would say we have in the middle of this continuum these hybrid devices that some of them skew more towards hearing aids, some skew more towards consumer earbuds. I believe that the Signia Active product is the first fully featured device that’s disguised as a consumer ear bud and really sits smack-dab in the middle of that continuum.
Dave Kemp:
Yeah. I think this is so fascinating. So I would say that the reason for low hearing aid adoption is threefold. It fits in usually three buckets. There’s some nuance to this. But generally speaking, I think it comes down to a combination of the stigma associated with it, the high price point associated with hearing aids historically, and the access in terms of getting that. You have to go see a provider. And for some people, that’s a lot harder than for others. If you live in a city, you can choose from a variety of different providers. Whereas if you’re in a rural part of the country, there might be one person that you can go to that’s 40 miles away. And so I think that there are these three things.
Dave Kemp:
And what is so exciting right now in my opinion is that we’re seeing all three of them are being systematically chipped away at. And the stigma one I think is maybe the most interesting because what’s really happening is there is a major cultural shift that’s underway in terms of the behavior of which we use audio devices. And I’ve had this conversation a bunch before, but I’ll rehash it here a little bit, which is AirPods were one of the most important things to happen for the hearing industry in the last five years, in really ever. And the reason being is because it has normalized wearing things in and around your ears for extended periods of time. Up until then, you had people that obviously would wear headphones. But because of the plug, that always limited to the usage to a single session, if you will. You would put them on and then you would listen to whatever you wanted to listen to or you’d take a phone call and then you’d take them off.
Dave Kemp:
But with AirPods, I think that that’s really when, so roughly 2017, when we started as a society to normalize wearing things in your ears. I mean, you talk to many people when they’re talking about their AirPods, they’re like, “I don’t have anything playing right now, but I know I’m going to get a call. I’m going to want to be able to just pull up Twitter or Instagram and have the audio already, I don’t have to continually place it in and out, in and out, in and out.” And so you’re left with this shift that’s taken place that I think is so important where you now have this. Because the by-product of that is if you walk into now that the pandemic is starting to ease up in the states, go to an airport, go to a train station, go to a busy area and just count the number of different devices that you see in people’s ears.
Dave Kemp:
Because the first thing you’ll notice is man, just about everybody here has something in their ears. And then the second thing is there’s a lot of different form factors that they’re wearing. And so why does this have anything to do with what you had just mentioned with Signia Active? Well, the reason that it has something to do with it is because when we now start to enter into a world where hearing aids start to look like earbuds, what we’re really going to move into is an era where no one’s going to know why anyone is wearing the thing in their ear. Because I might be wearing my AirPods because I’m a big podcaster, the guy next to me is wearing it because they love music and they’re listening to a ton of different music. Girl next to me, she’s got the job where she’s constantly taking calls throughout the day. And then the person over there, they’re wearing something that looks like Signia Active, and they’re actually wearing it for the ambient amplification features.
Dave Kemp:
So I just think that it’s something that will take time, but you cannot under count and discredit just the sheer importance of this normalization. There’s arguments to be made of why this might be a little bit detrimental from like a societal standpoint. But I don’t think that you can make an argument that this is bad from a hearing healthcare standpoint other than maybe it might pronounce hearing loss levels higher if people are just blasting their eardrums. But again, that’s a conversation for a different day. I think by and large what this really ultimately equates to is the stigma that’s so pervasive around hearing aids.
Dave Kemp:
When the hearing aids now start to look undistinguishable from all these other things that we’re wearing in our ears, it allows for people to operate and treat it and combat their hearing loss, and no one really never knows in the same way that it’s hard to tell nowadays if people are wearing glasses because they’re fashionable and they’re designer glasses or they’re prescription lenses. And I think that’s a really, really positive development as it relates here. And the Signia Active is such a good example of why I think we’re going to see a lot of stuff that looks like this where it’s going to just be harder and harder to tell what’s what.
Brian Taylor:
Yeah, I agree. It’s a product that’s designed for a couple of different under served markets. One, we already talked about, that group of people that are reluctant, maybe they have an aidable hearing loss, a hearing care professional to look at their tests and say, “This person is a hearing aid candidate.” But they’re still in that pre-contemplation phase where they’re not even aware that a problem exists or maybe they’re denying it. And maybe a device like this that looks more like a consumer earbud would be something they would find appealing. Then there’s another group of people, and I use the term subclinical hearing loss. There’s a couple of different studies that say that 12 to 15% of the entire US adult population, I don’t know what that number is exactly, but it’s a few million people out there have normal audiograms, they’re on the low end of normal, but they have self-reported hearing difficulty.
Brian Taylor:
I think a device like this would be appealing to them. And then of course, you just have people out there that have self-reported hearing difficulty, have an aidable hearing loss on their audiogram, and for whatever reason haven’t embraced hearing aids. And maybe a device like Active would be appealing to them as well. So whatever it is. The positive for consumers and professionals alike I think is that choice is good. It’s good to have more than one or two options available to people. And that’s something that we out of embrace. Last time I checked, only 15 to 30% of people with hearing loss were wearing hearing aids. So it’s really imperative for all of us to think of ways to grow the market.
Dave Kemp:
So one of the different things that you sent me too was Larry Humes’, another Larry Humes’ study. So he took basically some research from Franklin and Nick Reed at Johns Hopkins where they were talking about the need for a universal testing or a universal metric for hearing loss. And they were arguing that it should basically be the results of pure tone audiometry. And in Larry’s paper, he basically outlined that they agree wholeheartedly, but they think that maybe you should augment it with a little bit of a self-assessment questionnaire. And so, again, going off of this whole idea of in this world where you will have the ability to maybe provide these kinds of online tools, whether it be a hearing screener or even a full blown online hearing test that has a 5,00, 1,000, 2,000, 4000 Hertz frequency or you do this in clinic and you give them the results. And then you can add in this element of having the survey data. Again, what’s exciting to me is that really chips away at the avenue of access piece to hindrance.
Brian Taylor:
Right. And I think this is one of the most interesting things about audiology and hearing care professional work in general. I think in that you mentioned the Nick Reed, Franklin paper, they were advocating for a universal metric like a pure tone average. And that’s all well and good, I think that we need something like that. I’ve used this term now, subclinical hearing loss a few times. And that speaks to the crude nature of the pure tone audiogram. It’s a tool that’s been around for like 100 years. And for those of you out there that are not well-versed in the audiogram, the normal range is about 30 DB from minus 10 to 20 to 25 DB. That’s a huge range.
Brian Taylor:
And if you’re on the low end of that range, chances are pretty good over the last 10 or 20 years you’ve migrated from the upper end of normal to the lower end of normal and you’re noticing you’re having some communication difficulty. Anyway, that’s framing hearing loss in medical terms more or less. And of course, there’s a number of conditions that need attention from an ENT or nodal laryngologist than an audiologist or hearing care professional’s trained to recognize and detect. And there are just, to go off on a little bit of the tangent, Dave, there are some tools out there using machine learning that automate that process and help an individual make a decision, do they have a medical problem with their ear or not? I think some people you’ve had on the podcast recently have mentioned. It’s called the Consumer Ear Disease Risk Assessment, CEDRA developed by some Mayo Clinic and Northwestern University people that uses machine learning to help a person detect the probability of having a condition that requires medical attention.
Brian Taylor:
So that’s the medical side of things. But what it misses is the functional component because the audiogram is so crude and you’re on the low end of normal, it’s quite possible that you could have day-to-day communication struggles. And so in the article that you mentioned, I think it was written by both Larry Humes and Barbara Weinstein. It was published a few months back in JAMA Otolaryngology. They were advocating for a metric that measures the functional impact that a hearing loss might have. And Barbara Weinstein who was at City University of New York back in the early 80s, so this is 40 years ago was a co-developer of a tool called the Hearing Handicap Inventory, which in its long form is 25 questions that look at basically the impact hearing loss might have on emotional impact and social impact. And this is a validated tool.
Brian Taylor:
There’s a screening version that’s only 10 questions, there’s the HHIE for the elderly. And of course, that’s an outdated term. So now it’s the Hearing Handicap Inventory for Adults, HHIA. And then just in the last couple of years, some researchers at the University of South Carolina updated it and they called it the Revised HHI. Anyway, the point is Larry Humes, Barbara Weinstein in this short piece in JAMA and a longer piece that Larry wrote for Ear and Hearing basically saying that every clinician should be measuring auditory wellness, the functional capability of the individual or the impact on functional ability that the person has because of a hearing loss. They should be measuring that with this one version, pick the version you want of this Hearing Handicap Inventory. And I couldn’t agree more with that.
Brian Taylor:
I think that this is a huge opportunity for our profession to move away from the medical model, even though, yes, that’s still important and look more at hearing loss as the lens of the chronic care model and how do we help this person get by better and function better day-to-day. The tool that gauges that is this HHI questionnaire. And then if I could go one step further, I’ll just say that in one of Larry’s papers, he talks about people that had essentially normal audiograms, but on the HHI questionnaire, they were really struggling. And those people that were struggling that had normal audiograms were fitted with hearing aids and actually had the same or similar measured benefit as people that had mild and moderate hearing loss. Which again, from the clinician’s point of view shows that’s a huge opportunity to bring something of value to an underserved group, people with normal hearing on the audiogram but self-reported hearing difficulties. And having devices and tools, interventions available that would be valued by that segment would be important.
Dave Kemp:
Yeah. I agree with that wholeheartedly. And I think that this idea of, you start to put these things into, you assemble them together, and it’s like okay, you have these online hearing screeners on your website, and then maybe that graduates into something that’s a more sophisticated version of that that’s really giving you an even more robust assessment. And then you combine it with something like this questionnaire, again, that’s administered through your website or where it’s done as a follow-up from that initial consultation that you have. It just seems like these are all elements to this new world where you’re going to be catering to … It’s the whole notion of you can’t just assume that you’re going to take a round peg and stick it in a square peg or a square hole.
Dave Kemp:
We’ve always just assumed that you have this as the one type of solution that I have for you. And I think that’s what’s really exciting is that, again, it goes back to this optionality is communicating that optionality as to, okay, let’s first get an idea of who you are and all the different challenges that present themselves to you. And then that’s that whole navigator role. Everything that we’ve been talking about today I think ties to this notion of by being a navigator, what that implies is that you’re going to have to be really knowledgeable about what it is that exists today from a information gathering standpoint and making that really widely available to your patients and making it really easy to access too. So again, that screams online to me. But for others, maybe there’s an element of this that you do in the clinic.
Dave Kemp:
But then in addition to that, you have all these different kinds of devices that are becoming available. And I think it’s understanding that, yes, the business model that revolves around these is different in terms of the amount of revenue that you can generate and the amount of profit that you make per device. But at the end of the day, the real reason that people are seeking you out is your expertise, this idea that they need somebody to help guide them through this. Because what’s undeniable is that the market seems to be getting more complex. From a patient standpoint, from the consumer standpoint, there’s more and more options. Options are good, but options also can be paralyzing when you’re given too much choice. And so that’s why I think that in a world which is increasing in complexity, it increases the demand for somebody to help solve that complexity.
Dave Kemp:
And that’s where the provider I think really stands to gain is if they can do so in such a way that is highly conducive and accessible. I think that that whole idea is a really secure future proof concept. And that’s where I think the big questions are going to really present themselves over these next few years is it’s not going to really be is there demand in the market for you? It’s a matter of how do you capture that demand and then service that demand in a way that is … It’s something that I think clinics are going to have to ask themselves, do they want to do this? Because if they do, I think it implies you’re going to need to do something to facilitate a whole lot more patient interactions because this likely implies that you’re going to just be seen a lot more people because it will be higher volume. But it will be probably lower dollar per patient, if you will, in terms of revenue.
Dave Kemp:
Now, again, going all the way back to the Larry Humes quote that I had at the beginning where he’s saying we don’t really see that this is going to impact any specific hearing professional within the existing model, this is an expansion. All of this is to say that, again, if you look at this from the viewpoint of why our hearing aid penetration rates as low as they’ve been, and it seems to be that we can’t crack it. And you start to unwind, okay, if it’s really a combination of these major three things, stigma, access, and cost, and we’re seeing them systematically be broken down so that it’s further enabling and incentivizing people with … It’s the Dan Quall thing where it’s the people that have the $300 problem, if you’re presenting them with a $300 solution that matches their personal parameters, that’s what’s happening right now it feels like.
Dave Kemp:
And then the implications of that is just this expanding market. And I think that’s where this is all coming down to is, what does the professional do in this world? And from what I’ve been able to gather so far, it’s very much what Kim Cavitt said, which is the navigation piece. That seems to be at the heart of where the value really will ultimately lie because that’s where the values always lie. But it’s now that you’re able to present new solutions that are catering to the people that fit into this more mild end of the market.
Brian Taylor:
Right. Well, I wanted to maybe go back and explore, you mentioned those three things that hold people back, price, access. Well, I think one of the things around access, which is interesting that I’d like to touch on is the average person that is fitted with a pair of hearing aids sees the provider I think between on average three or four times over the course of the first year. And that’s something that I think we have to find a way to … For those that don’t want to do that, that’s a lot of time away from their job or waiting in the waiting room for a visit that may only take a few minutes to have their hearing aid adjusted. I think there’s opportunities using artificial intelligence, machine learning to allow the patient to take over some control of the hearing aid so they can self-adjust in a viable way without having to take up precious clinical time that’s an inconvenience for them.
Dave Kemp:
Yeah. I think too, a lot of it is going to be probably driven around the apps. I think that’s one of the most exciting things about made for iPhone hearing aids in this just world full of Bluetooth enabled hearing aids is that it fostered then the ability to then for the manufacturer standpoint, we need an app, and what can we do with that app? And that app is just going to get built more and more as time goes on.
Dave Kemp:
Again, that’s where I’m saying that what does the next, to Larry’s point, if the next decade is all about this expanding part of the market, the manufacturers are going to be doing a lot to help enable that too. You look at it as a current clinic that fits call it Signia hearing aids, it’s in Signia’s best interest then to have the ability for, like you said, if there are three to four follow-up visits, and a lot of that visit is more just Q&A, information gathering, are you happy with your experience? Do we need to make any adjustments? Why can’t you just do that through something that looks a lot more like Zoom than having somebody come in and spend all that time, like you said?
Brian Taylor:
Yeah, if the patient wants that.
Dave Kemp:
Exactly. And it’s not to say that you have to force them into these new online models, don’t get me wrong. I understand that this is largely a patient demographic that’s populated by quite older adults. And therefore, they might not have the proclivity or any desire to have this done through online things. But to your point, when we’re looking at a lot of what isn’t being treated on an audiogram at pures, you have normal hearing loss. But obviously, you know that not to be the case. And again, this is where a lot of those people are probably more situational instances. They probably have some deficit at a certain frequency or something like that, and they really struggle with that particularly frequency. Whether it’s I really struggle with my grandchildren because they might have the higher frequency voices. And therefore those specific voices are challenging for that person to hear.
Dave Kemp:
So a hearing aid might be a great solution for them or something a little bit more watered down might be great too. So that’s again where I think this gets interesting is that that first initial visit we really understand as the provider I think, okay, here is exactly what the challenges are that this person’s laid out. And then that information is stored, we now know that exists. And so when we go to have that follow-up, I just think that … All of this really to me is a matter of how do you, okay, if a lot of what the current model offers isn’t appealing to this expansion of the market, then that presents the question of, well, what would need to be done in order to do that?
Dave Kemp:
Because it seems to me that if you have 88% of people that have experienced the professional’s service as saying that they would opt to experience that again and go through the professional if presented that or a do-it-yourself option. So there’s a lot of value there, but then you got to make it so that that value more or less is just much more conducive. And that’s why I just think that a combination of online video conferencing, online tools to gather information, really allowing people to access your stuff and your services on their own time, I think that’s what it comes down to.
Brian Taylor:
Yeah. You’re starting to see that with different groups around the world, actually that have this blended model where a person can pick and choose do they want to see the provider in person or do they want to see them remotely? And that blended model seems to really drive high outcomes, which is good. One of the things that’s really interesting to me that’s a little bit of a dilemma as a clinician is the use of these, I’ll just call them self-adjusting hearing aids. As a clinician, I would wonder is a machine learning algorithm in a hearing aid that can adjust just a little bit of coaching from a provider, is that going to take away what I do in the clinic when somebody needs an adjustment?
Brian Taylor:
As you know, Dave, a lot of people come in, they’re fitted with hearing aids. And sometime after, could be a year or longer, typically it’s the first few months, first few weeks, they need some adjustments, “I don’t hear very well in background noise, can you adjust my hearing aid?” Well, they make an appointment with their provider, they come in. And the provider using their best clinical judgment, their experience how to navigate that manufacturer’s fitting software, they make the adjustment for the patient. The alternative to that is to use a machine learning algorithm. In the Signia world, we call this Signia Assistant. And basically, it’s taking the profile using anonymatized data from thousands of similar fittings from around the world, people that had the similar audiogram, similar parameters fit into their hearing aids.
Brian Taylor:
And it’s using all of that data that it’s collected and allowing the patient through an app interface to make adjustments based on thousands of data points rather than on, let’s just say the single data point of an experienced clinician. To me, that’s a dilemma for the profession or for the professional, do I allow the patient to make this adjustment or do I want the patient to come in? Do I want to make it easier for my patient or do I want to maintain control? So those are some of the real challenges that I think we have to sort out as a profession over the next few years.
Dave Kemp:
And that’s a big, I think probably one of the more compelling arguments as to why I think that the professional, they need to really think through this. Because if the whole basis of your value is call it adjustments, and that progressively can be handled. Like you said, because of the fact that you have 10,000 different inputs that are the determination of the way in which that algorithm is refined, then I think that needs to be seriously considered as to is that viable if my business is built around this? There’s definitely I think ways to look at this and question the longevity of the professional from that particular aspect. But I think that the person that definitely doesn’t suffer is going to be the patient.
Dave Kemp:
And I think that if it means that we move into a world where these things are able to on the fly constantly reprogram themselves and get better in terms of catering to your specific hearing profile, I think that’s actually a positive. And I don’t think that we should be opposed to that because it might mean that there’s less instances in which your services will be required. Because I think what that implies is there’s just that many more people that are treating their hearing loss. And so then that begs the question, what is the role of the professional? And this is something I’ve asked a number of people on this. And again, I’ll go back to what Kim Cavitt said, I think she pretty much nailed it. It’s all about audiology and just understanding that the value really is in your culmination of everything that you know and the ability to distill that down effectively for people as an expert.
Dave Kemp:
So I think that there’s ways in which maybe the scope of service gets expanded where it’s more … Because it’s something where so long as it is right now, there’s no cure in sight. So it’s something that you’ll have to live with. So there’s a lot of different rehabilitation things, lots of different coping, coaching strategies that can be communicated. But the fact of the matter that as you’re bringing up is these are the things that I think we as an industry really need to think about.
Dave Kemp:
And if I were a practicing audiologist or just a professional in general, I would be slightly worried about that, about what happens in five years, call it, when that part of my job becomes obsolete by technology? But that’s something that we’re facing writ large at the world right now is this whole question of, what will life look like in a world that’s very much operated by AI and the questions you have to be seen? But I don’t think that there’s much of a scenario where it’s as if all of the expertise that is derived from this profession goes away. I think it just shifts around in different ways.
Brian Taylor:
100% agree. There’s always going to be a place for humanistic communication where you’re helping somebody with boosting their skills and knowledge, capabilities, that kind of thing. I think that’s not going to ever go out of style, especially with much of the demographic that we work with.
Dave Kemp:
So as we come to the close here, this has been a great conversation. I always love just thinking through all this with lots of smart, intelligent people around the industry. So what does the next few years look like in your opinion? Let’s just say that, call it early 2022 OTC really goes into effect. We continue to see more momentum from both the legacy manufacturers but also maybe some new players that cater to this and this idea of an expanding market. Where are some of the things I guess that you’re going to be keeping an eye on and are the most exciting things that you think are on the horizon or what you’re hoping comes about over the next few years?
Brian Taylor:
Wow, that’s a lot to chew on.
Dave Kemp:
Yeah, it’s pretty loaded. I love to ask the most difficult question at the end.
Brian Taylor:
I have a couple of thoughts on that. I think number one I would pay real close attention to the legislation, the possibility of Medicare being expanded to age 60 and allowing for hearing aid coverage. Talk about a business if Medicare paid for hearing aids, that would really change the dynamic in a hurry. You need to have audiology assistance to offload some of the more routine things when you’re working with the patient. Probably would need more of that blended model where you’re taking some of the visits into the virtual world. With respect to innovations in the hearing aid world, I always say that hearing aids have been incrementally improving since the late 90s when digital became a reality. And those innovations usually are involving three different buckets.
Brian Taylor:
There’s core signal processing, which is really around having the hearing aid incrementally get better at amplifying in challenging situations. We’ve seen bilateral beam forming, we’ve seen these really interesting things around split processing where you can take some of the sounds that the hearing aid thinks are speech and amplify them in a completely different way than other sounds that the hearing aid is trained to think as background noise. So I think signal classification systems inside of a hearing aid, a lot of people call them artificial intelligence. They’ve been in hearing aids for many years. They’re going to become even more sophisticated over the next 5 to 10 years, you’re going to see that innovation. I think when it comes to wireless connectivity you’re going to continue to see that evolve and become easier for people to use.
Brian Taylor:
And then the third bucket in innovations inside of hearing aids, I’ll just call it personalization, the ability to self-adjust and maybe even self-fit your hearing aid. To me, that’s where that Bose product that you mentioned early on here is really interesting because it’s a pretty new validated self-fitting approach that doesn’t require an audiogram. Not to get too geeky here, but we’ve been fitting hearing aids using the prescriptive method which is developed in Australia and in Canada, two separate similar methods called the NAL and the DSL back in the 70s and 80s that required an audiogram as the starting point thresholds. While with this Bose algorithm, you don’t have to have a hearing test done to arrive at a very similar outcome according to at least one study that they’ve done.
Brian Taylor:
So I think you’ll see more and more around self-adjustment and self-fitting, which at the core is really machine learning and neural networks. Again, been in hearing aids for a while, but they just get more and more sophisticated, more and more user-friendly. So I guess top of mind, we can expect I think even more faster incremental improvements around how hearing aids perform and what they look like.
Dave Kemp:
I love it.
Brian Taylor:
Yeah, it’s an exciting time. And plus you have all these new … I think it’s great to see some of these new companies trying to come into the fold. As long as they bring a high quality device to market, that’s good for the consumer. And I think competition is good for the industry, it forces you to raise your level of play.
Dave Kemp:
Yeah, I couldn’t agree more with all that. As you were breaking out some of those different components of innovation, there’s a article that I read, it’s kind of old actually, I think it’s 8 or 10 years old. But it was from Chris Anderson, he is the CEO of 3D Robotics. And he’s just a really, really elegant writer. There’s a few things he’s written that just really stood out in my mind.
Brian Taylor:
Is he the guy that wrote The Long Tail?
Dave Kemp:
He wrote The Long Tail, yes. He did The Long Tail and he also … Yes, The Long Tail is a very good one. Anybody that’s listening that’s never read that, go read that. And also google The Peace Dividends of the Smartphone War because it really is probably the best explanation as to what we’re now seeing with consumer technology, which is when you have a race between Apple and its competitors to the handset war of arming our global population at this point. I can’t even remember the amount of smartphone proliferation, it’s gigantic. So when you have billions of smartphones out there, that also means that there were billions of little radios and cameras and all the little antennas and radios. So every little thing that goes into a smartphone, it also goes into drones, it goes into hearing aids, it goes into these consumer audio devices.
Dave Kemp:
We now live in an age where there’s just so much innovation happening and the downstream effects of that supply chain and all the little components that make it up. And hearing aids are a perfect example of we’re going to continue to see so much innovation from the components within the devices so that it’s capable of supporting multiple Bluetooth protocols and capable of doing crazy things with the signal processing. And so all of that is to say that in the next three to five years, we’re due for so much more innovation largely derived from what’s happening with consumer technology at scale. And I think that’s just a really fascinating thing again is, it’s easy when you’re operating in this industry to just fixate on what’s going on in it, but you really need to take a step back and realize that we’re really this really small little subset of a much, much bigger consumer technology space because we’re a medical device industry, but we’re also a consumer technology. So it’s a very interesting line that this industry straddles, and it gets to benefit in unique ways on both sides of the fence.
Brian Taylor:
Well, as long as somebody can bring to market a product that can lower the signal or improve the signal to noise ratio at an affordable price point, make an easy to use, that would be something that we would all benefit from that we don’t really have yet. We have hearing aids that have great directional microphones in them and noise reduction. But something that maybe doesn’t amplify sound very much but it improves the signal to noise ratio and does it in an easy way would be something I’d like to see come to market.
Dave Kemp:
Well, my gut tells me that’s probably going to be something that’s a very AI-oriented product. Something that is, you’re right, it’s taking a different approach to it where what it’s really maybe going to do is it’s going to identify the sources of background sound and allow you to really control your audio acoustic environment so that you’re really able to mute sounds and amplify other sounds. And basically I think of it almost like, it creates a number of different files for you that you can then tweak and you’re almost mixing your environment in real time. I think that’s probably coming because it seems like the pieces are there.
Brian Taylor:
Maybe they’ll have it on the Oaktree website.
Dave Kemp:
Yeah, maybe.
Brian Taylor:
By the way, you guys do a great job with that. Is it still on your website, you evaluate different products?
Dave Kemp:
Yep, yep. That is something that Dr. Bankaitis here did.
Brian Taylor:
Yeah, that’s really a helpful tool.
Dave Kemp:
Absolutely. Really if we’re going to be getting real here, the whole point of this podcast was to sort of serve a similar effect, which is everybody’s really, really, really busy. It’s hard enough to even stay on top of all the news that really pertains to the industry, let alone a lot of this what’s going on in the tech space that’s so impactful to every single industry. So this is just my attempt to be like, “Okay, well here just take an hour, listen to this, and it will help to educate you a little bit.” Which is a lot of what we do here at Oaktree is just to understand and say, “You all are very busy medical professionals, how can we support you in any way? Whether it’s through our business or it be through just supporting people with information.”
Dave Kemp:
So anyway, Brian, this has been a fantastic conversation, always a lot of fun to have you on and just get your thoughts on the way that this whole industry is taking shape. One thing is for certain, the momentum is just increasing, change is happening quicker and quicker. It feels like more and more urgent almost to get your head around this and figure out, okay, what’s coming next, and how do I best prepare myself for it?
Brian Taylor:
Yeah, I know. It’s been a pleasure talking with you, Dave, it’s a lot to go through in an hour, maybe next time we can talk about the Cardinals.
Dave Kemp:
No, not right now, maybe in 2022 when we solve a lot of our deficiencies right now. I came out hot at the beginning of the season, I was all about talking baseball. And now we’re in fourth place, and I’m like, “You know what, I don’t know if I need to be talking as much baseball on the podcast,” especially with a Brewers fan.
Brian Taylor:
Yeah, yeah. I know it’s a long season, so you have to temper your expectations.
Dave Kemp:
True. And I will say, I’d be more than happy with the Brewers winning the NL Central as long as it’s not the Cubs. Shout out to any of the Cubs fans listening now [crosstalk 01:03:27] Cardinals fan.
Brian Taylor:
I hope Kim isn’t listening.
Dave Kemp:
She’s just blocked me on Twitter. Awesome, Brian. Well, thank you so much, and thanks for everybody who tuned in here to the end, and we will chat with you next time.
Brian Taylor:
Nice. Talk to you later Dave, bye.
Dave Kemp:
Thanks for tuning in today. I hope you enjoyed this episode of Future Ear Radio. For more content like this, just head over to futureear.co where you can read all the articles that I’ve been writing these past few years on the worlds of voice technology and hearables and how the two are beginning to intersect. Thanks for tuning in, and I’ll chat with you next time.
