This week on the Future Ear Radio podcast, I’m joined by Laurel Christensen, PhD, Chief Audiology Officer at GN Hearing. We had a fantastic, 60-minute discussion revolving around some of the big breakthroughs seen in hearing aid innovation dating back to the late 80’s and into today.
We begin the podcast with Laurel sharing her personal journey that begins with her first exposure to hearing healthcare as a teen working in her Dad’s ENT practice, to earning her PhD and ultimately joining GN Group, where she now serves as the company’s Chief Audiology Officer.
We talked at length about two giants in the industry, Larry Humes and Mead Killion, both of whom were largely influential to Laurel’s career trajectory. Larry as a mentor during her days at IU, who helped nudge her to get her PhD, and Mead during her time at Etymotic who taught her the ins-and-outs of hearing aids.
During the second half of the podcast, we start to get into the big hearing aid technology breakthroughs that have transpired since the late 80’s, starting with Mead & Etymotic debuting the K-AMP (wide dynamic range compression in the high frequencies). From there, we talk about the shift from analog to digital devices and the introduction of the receiver-in-the-canal (RIC) form factor, which took time to become the prevailing hearing aid form factor.
Finally, we discuss the state of today’s hearing aid technology innovation, honing in on some of the most recent products that GN has introduced, such as the Resound One that utilizes the company’s new M-RIE (microphone & receiver-in-ear) receiver. We talk about the advantages of the M-RIE, and why it is such a good representation of the types of new opportunities that manufacturers have as AI starts to enter into the product offerings in a meaningful way.
I mean, having a tiny device like a hearing aid hosting a series of receivers and microphones that are meshed together into a network and operated by a deep neural net almost sounds like something out of a science fiction novel. With the way things continue to trend with these kinds of devices, it’s hard not to think that providers and patients alike are going to be pretty blown away with what’s on the horizon with this technology.
-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 Laurel Christensen. Laurel, tell us a little bit about who you are and what you do.
Laurel Christensen:
So I’m happy to be here. I’ll start with that and I am the chief audiology officer. I would rather just say the head of audiology for GN Group. So of course GN Group is multiple brands, the best known are of course Beltone and ReSound.
Dave Kemp:
Awesome. Well thank you so much for being here today. This is going to be a great conversation. I kind of wanted to bring you on as somebody that’s been in the industry for a little while. I’ve been having a lot of these conversations lately of just kind of like with all of the change that’s taking place, I mean I just saw today they’re now saying for the umpteenth time that we’re going to get the OTC legislation, implementation, on maybe now November 7, so it’s kind of like this period of time right now in this industry that is … There’s just a lot of volatility in sort of the ways in which this could all sort of change and evolve in the next few years and so I think it’s really, really helpful, informative and educational to hear from those that have been in this space for a little while to kind of get your perspective on all of this, and so I wanted to just kind of start with your story. I think you’re a pretty well-respected and renowned person within the industry, so for those that don’t really know who you are though, can you kind of take us back to the start? How did you come to be in this whole field? What led you into this, and then we can just kind of go from there.
Laurel Christensen:
Sounds good. So I have been in the industry an awfully long time. I don’t see myself or think of myself as the age that I am which is 54 today, I’ll go ahead and reveal that. So 30+ years in the industry, it doesn’t feel like that at all, but boy, have I seen a lot of changes, and I always swore when I was the 24-year-old that I would never become one of those old people who talks about the history but I am one of those old people now that talks about the history.
Laurel Christensen:
So my start is probably like so many other audiologists. I didn’t just jump right into audiology, I started in engineering, and actually did three years of undergrad in engineering at University of Wyoming, and then kind of going into my senior year at Wyoming, I decided I don’t want to be an engineer, and I can remember my parents not being terribly happy about that, and I went to … Because I’m about done, but career counseling and things like that led me kind of to health professionals and I’m like, “I think I’m going to go into speech pathology and audiology.” Then you kind of went into all of it and I even stayed for summer school because I had to catch up and I knew about audiology because my father is an ear, nose and throat doctor. So I knew about audiology and in the summers I would actually do some work in his office. It was not fun work, it was taking the old files that were aged and moving them into a downstairs room, nothing was digital at that time, so I didn’t get to do anything fun, but part of the fun I had at points was the audiologist would let me come in sometimes when babies were being tested and such when I was in high school.
Laurel Christensen:
So I knew about audiology. Took some speech classes, took my first audiology class and I went, “Okay, this is exactly what I want to do.” So that kind of led into audiology. I finished at Wyoming undergrad, went to Indiana University for my master’s and PhD. Never really thought much about getting a PhD, I actually was asked if it was something I would be interested in by my mentor, which was Larry Humes at IU and he came one day and said, “I think you should get your PhD,” and I said, “Why?” I wasn’t that interested in doing it, didn’t really understand why that would be a good idea, and had a lot of conversations with him and ultimately made that decision, did my CFY here in Indianapolis for an ear, nose and throat doctor so I got kind of that clinical ENT experience and then I would drive back and forth between Bloomington, Indiana and Indianapolis to do work on my PhD as well. So did my PhD with Larry, a lot about speech understanding and aging. That was a big part of it. But hearing aids as well were part of it. Then I graduated and my first job was LSU Medical Center.
Laurel Christensen:
So I was down there in the Department of Communication Disorders, it’s now I think LSU Health Science Center or something, they’ve changed the name. But I was there for eight years, was a tenured professor but we were in a model where you were a clinical and you were a professor, so you always worked in the clinic, and so did a lot of seeing patients and mentoring students and then I did research and I would have to probably credit Don Schum, who was at Oticon for a lot of years, we kind of have been competitors over the years but it was Don who called one day and asked if I wanted to be part of a big clinical trial that was being done by Miracle-Ear, and it was when the FDA kind of came down on advertising hearing aids that advertising the hearing aids could help you hear in noise, and the FDA said, “Nope, you can’t advertise that anymore.”
Laurel Christensen:
So Miracle Ear is set out to prove that it was true, that hearing aids would help you hear in noise, and of course it was, but we went through a very rigid regulatory trial at three different sites, and Don Schum had asked me to be at that site and I think that’s really where I entered the hearing aid business. I was at LSU at the time but that was kind of the inspiration. I was like, “I really like hearing aid research. I really want to be a part of this.” So at one, I spent a lot of time with Mead Killion at that time because Mead would come down to LSU and he would give lectures and things. I went to Etymotic finally, left LSU, decided I really wanted to come into the industry. Did development there, mainly of things like the D-MIC and the Digi-K. I also did newborn hearing screening, a little known fact there, and actually went to Japan a lot and did newborn hearing screening while I was at Etymotic, but then after about five years at Etymotic I was recruited by ReSound.
Laurel Christensen:
So I’ve been at ReSound for 19 years in various areas. Came in as the head of research in the United States and then quickly also became the head of audiology kind of globally and now we have another head of research, that’s Andrew Dittberner, and I am audiology and commercial, training and education and external relations, KOL development, supporting the subsidiaries in the market, but also a big hand and my favorite part is the actual development of the hearing aids, no doubt about it. You started by saying there are things coming, we’ve been waiting for these OTC regs, but we’ve been talking for years about a change in this industry and it really hasn’t been upon us and there is no doubt that the change is upon us. This will be a change in our industry, and I think … I’ll give it away right now, I think for the better.
Dave Kemp:
Yeah, all right, cool. Well we’re going to definitely go through all of that, this whole idea of what’s coming and ways to think about it, but I definitely want to touch on a few things throughout your story there. What a cool story first of all. So going all the way back to your dad with … Okay, so he’s an ENT doctor. What was the state of audiology like back then? I mean as a ENT, did he ever … How were you exposed to the audiology side within his ENT process if you will?
Laurel Christensen:
Yeah, well, for anyone who’s listening to this that’s been in audiology for a long time, my dad’s first audiologist was a guy named Mike Marion, and he was a staple. He actually had the leading, the audiology meeting in Jackson Hole, Wyoming which was so popular for many years. That was my dad’s first audiologist and Mike didn’t work for my dad. Mike was progressive and he kind of had his own. I’ll work with you, so he established a model with my dad from the beginning and of course I’m biased as all get out because he’s my dad, but I’ve worked with and for ENTs and my dad was really one of a kind. He was really a good person, he was very interested in audiology, and he right away would refer to audiology. He knew about hearing aids, he wanted hearing aids, and so my dad I think was very influenced by Mike Marion, there’s no doubt about it and he had the utmost respect for audiologists. So I think that’s part of one of the reasons why I came in.
Laurel Christensen:
What was the state back then? It was horrible. Hearing aids were linear, peak clipping devices. Maybe linear compression limiting was coming in back in the day but hearing aids really only helped in quiet. There’s very good data that Mead Killion actually did that just showed that old peak clipping hearing aids actually made hearing and noise worse than anything else. We just did, and so many of them ended up in the drawer … Man has life changed since it’s been there. I mean this is an industry, we can all be, any of us in it can be so proud of what it was back then and what it is today, where we have technologies that we can help in about every situation today, and the transition that took us from linear peak clipping to where we are today with these entire auditory systems to help people hear, it’s just pretty amazing to have lived the 30+ years of all that.
Dave Kemp:
Yeah. I think it’s really interesting too, as someone like myself who was sort of … I always joke that I’m genetically predisposed to this industry. Like my parents started Oak Tree when I was three, and therefore I was … It was always kind of part of like dinner table talk, and so I kind of through osmosis became familiarized with this industry. Was it similar with you where your dad would take home work with him and you were exposed at a young age of his world and this whole idea of … I mean do you think that’s where kind of the root of your passion came from was early on?
Laurel Christensen:
Not so much like you.
Dave Kemp:
Interesting.
Laurel Christensen:
I can definitely see where it would be in yours. My dad, he was the quintessential surgeon. He grew up in Casper, Wyoming, he was the chief of surgery at the hospital, and he left in the morning before we even got out of bed, and he didn’t really talk that much about his work. We were a family that did … We owned a cabin, we skied, we backpacked, we hiked, he took care of … He wanted every mountain thing known to man and that was kind of the family event. I didn’t get exposed to the audiology side of his practice till I was in high school.
Dave Kemp:
Gotcha, okay.
Laurel Christensen:
And I have to say that the audiologist that worked there then Mike was long gone out in California by then but the audiologists who worked with him were these cool, just totally cool women who were glad to see me every day and I think that’s what sparked the interest and just that … Seeing the kids, because there were a lot of kids getting hearing tested because of tubes and all that in the ENT practice and so that was probably it for me. It was not ingrained. My dad honestly wanted us to be engineers, and I have a few brothers who are engineers.
Laurel Christensen:
My dad never pushed us into being physicians. He thought medicine was changing and that wasn’t probably the greatest thing to go into which is kind of … None of us went into medicine, however my oldest daughter wants to be a surgeon. So maybe it’s going to skip a generation here, I don’t know.
Dave Kemp:
Yeah, exactly.
Laurel Christensen:
But my dad pushed us all to engineering and I’m like, “Okay, well,” and I was biomedical engineering and my dad was very disappointed in me when I didn’t finish the engineering degree and he actually said, “You can be an audiologist but just finish that engineering degree.” Well I mean I should have taken my dad’s advice. The engineering degree would be helpful for what I do in product development today, but I’m young and stupid and I didn’t finish my engineering degree. I just went on and got my audiology degree, so it wasn’t like you … Last night, I was at a customer event and I was talking to one of our customers and she’s like, “Yeah, well, I was born into the industry.” Her mom is in private practice and she’s about to take over her mom’s private practice, so I was like yeah. It was definitely a little bit different for me.
Dave Kemp:
That’s interesting. So okay, another aspect that you mentioned sort of on your journey to ReSound is your time at IU and Larry Humes. So he’s a person that’s come up a number of times on the podcast. It sounds like you worked closely with him. What’s this thing … Like I know he is an independent researcher and he did the OTC double-blind study, but in your opinion, what’s the thing that comes to mind for you about the impact that Larry Humes made on this industry and what we should as a young person in this industry, how I should be thinking about him.
Laurel Christensen:
Yeah, well I could talk for the rest of the podcast about Larry Humes.
Dave Kemp:
Reader’s Digest version.
Laurel Christensen:
Yeah. No person has had as big an impact on my life as he did. There’s no doubt about it. He is a true mentor in every sense of the word. If you were a student of Larry’s, you could expect to be mentored, and it wasn’t let’s make it as hard for you as you possibly can so you’ll drop out of your PhD program and there are many PhD programs like that. I’ve had students come to me very upset that their mentors aren’t mentoring, they’re trying to get them to break. That is not a Larry Humes. If Larry recruited you in there and he wanted you in there, he was going to make sure that you were successful, and he spent so much time talking through our research and of course he was NIH funded for I don’t know how many years, 20 at least, I mean he had continuous funding, and so we were working in his lab and we were learning so much. My days there were very much speech understanding and aging. Was audibility the reason why speech understanding was declined with hearing loss, or was cognition a part of it? Were there peripheral aspects like temporal processing and these kinds of things?
Laurel Christensen:
So my days were all about that, and I think that is certainly an area that he had a huge impact on but prior to that he was a psychoacoustics researcher and then he kind of went into hearing aids and hearing aid benefit and did large scale studies around hearing aids and has moved now into different models of dispensing hearing aids. So of course that’s what you’re talking about is the work that he did on models of dispensing, it’s not so much OTC, but can people ultimately fit themselves and how does that work and things like that. So he now does a fair amount of consulting. He’s an emeritus faculty, but has one … I can’t remember the name, but it’s like … The distinguished professor at Indiana University. I mean you just don’t get that. He’s published hundreds and hundreds of things, but I also think one of the things I would say about Larry is he’s a quiet guy. He never went out to get the spotlight.
Laurel Christensen:
One of the things I think I respect most about him is if you … He’s kind of the smartest person in the room everywhere, but he never was the kind of researcher that got up at a convention and attacked someone up on the podium. If he wanted to chat with you about your research, he would have done that in a very different way and I actually remember as a young researcher getting attacked on the podium, and it being very traumatic for me at the time, and Larry was actually in the audience and I can just … I just remember that he was such a different guy. He was probably the smartest one there, and he always had great knowledge and expertise, but he never ever was the kind of person that would make you feel like you didn’t know what you were doing and such and he’s always just been that guy.
Laurel Christensen:
Like I said, I could go on forever. I mean he really is one of those people, and he may not come as … He didn’t have the personality of a Mead Killion or a Chuck Berlin, these very outgoing personalities. So he may not be the one that’s remembered, but man, the impact that he made on his students and there’s more than just me and then on the industry I think is really huge.
Dave Kemp:
Yeah, that’s awesome. I mean he sounds extremely humble and also like a living legend, and speaking of living legends in this space, you just mentioned his name, Mead, Mead Killion, with Etymotic. So what was the time like there? I mean I promise we’re going to get into ReSound [inaudible 00:19:07] state of the technology but I think these are such important figures that are … The old adage of we stand on the shoulders of giants, these are the giants, and I think that Mead Killion is another really good example of somebody that has completely paved the way in some regards to kind of like the current state of things. So I’m curious as like … So you had that time with Larry in undergrad and as a researcher while you were getting your AUD or your PhD and then you went and worked with Mead. What was that like?
Laurel Christensen:
Yeah. Anyone who knows Mead knows he’s a character, but an unbelievably brilliant guy, and I think if I look at my own impact on my life from him, it’s hearing aids. I learned every in and out of a hearing aid from Mead. I even taught hearing aids with Mead for a few years at Northwestern University, and he would actually make the students build their own hearing aid, and I’ve never even done that when I came to Etymotic. So I mean you learned about chip development and hybrid development and wiring and soldering and microphones and receivers and you lived it with him and I think that’s really … The hearing aids, but you look back at Mead Killion, you want to talk about hearing aids. Probably the first huge development in our industry that changed from crappy linear peak clipping was the K-AMP. Also wide dynamic range compression from the company I work for today, ReSound. Those two, Mead the K-AMP and the first wide dynamic range compression hearing aid that had really come from Eddie Villchur’s work at AT&T Bell Labs, those came on the market at the same time. One was wide dynamic range compression in the high frequencies, that was a K-AMP and the other was full band, full frequency wide dynamic range compression.
Laurel Christensen:
Mead and the work around that with Ed Villchur, then you had hearing aids that modeled what the outer hair cells do, you basically give amplification for softer sounds, you’ll leave louder sounds untouched. You don’t distort everything. This is how the ear works, and it completely changed the industry. I mean when you talk about those game-changing things that have brought us from hearing aids that didn’t work very well to what we are today, you’ve got to look at wide dynamic range compression as probably the biggest one that hit first and that was Mead. But Mead also developed the D-MIC, directional microphones are of course very important, but directional microphones have had their own history.
Laurel Christensen:
I mean they were there a long, long time ago and then they went out of favor and then in the late 90s they came back into favor and so he was developing the D-MIC but at the same time other companies were developing these two-mic directional systems and Mead was doing all kinds of things. Consumer electronics, his headphones are just incredible, and so he’s kind of known in consumer electronics, he’s known in hearing aids, but he’s made many, many huge steps forward in our industry in many ways like Larry, but Larry [inaudible 00:22:35] in the research side, Mead more on the technology side and bringing products to market and such. So both different mentors in different ways, but they have a huge impact on who you are and how you think as you go through your career.
Dave Kemp:
So when was that that the K-AMP, when was that released into the market? Like when you said this game-changing moment, when would you say that was roughly?
Laurel Christensen:
Yeah, when was it? Late 80s.
Dave Kemp:
Okay, so you would say that roughly –
Laurel Christensen:
Yeah, probably ’89, ’90, and I hope I’m not wrong.
Dave Kemp:
I think you’re probably in the ballpark. So you would say right around that time period was when we had one of the first big breakthroughs with hearing aid technology. Okay, so then into the 90s and early 2000s, like what were some other defining moments in your opinion from a technology standpoint?
Laurel Christensen:
Well so wide dynamic range compression of course and then you had probably into the 90s, you had a lot of directional microphone stuff, and now I’m going off the top of my head here but digital of course. So you’re talking about digital hearing aids in the mid to late 90s. And of course digital, they weren’t … Digital hearing aids came out when I was still working for Mead Killion, he was doing the Digi-K at that time, and analog, digital wasn’t necessarily better than analog when they came out on the market. As a matter of fact I’m not even sure they were as good as analog when they came out on the market. But it was the power of what they could do –
Dave Kemp:
Yeah, and the potential.
Laurel Christensen:
That ultimately could change the industry and you look at probably the first time that that came together, you had digital feedback cancellation. So that was Danavox, and of course that’s still, the company I work for, that was part of all the companies that came together over time. You had digital feedback control but then Danavox worked with ReSound and that was an American company in Redwood City, California and that was a Rodney Perkins, he started many companies in the industry, but they had a small hearing aid called the [Avance 00:24:54], it was this tiny little behind the ear and it had a thin tube, and people loved the cosmetics of this thing but man, it was [inaudible 00:25:02] all the time. It had no feedback control in it. You could not get much more than 15, 20 dB gain out of it. But the marriage of the Avance with the feedback control that Danavox has, because these companies ultimately combined, it gave you the first open BTE thin tube hearing aid out on the market, that was ReSound Air. That I would tell you is a massive game-changer. At that time, 80% of the U.S. was custom products, and then this little open cosmetic hearing aid came out, and I don’t even think we … This is when I joined ReSound. That was largely developed, I can’t take any credit for ReSound there, that was pretty much done when I got there.
Laurel Christensen:
But the clinical trials were happening and I have been this firm believer that I can predict the success of our products just out of our clinical trials, and this clinical trial, every single patient wanted to buy the hearing aid, and I’m like, “Whoa. We’ve got something here.” But people didn’t want it. I can tell you that. It was not well accepted onto the market and you look now where we are, but it was not some sort of massive sales boom for ReSound when Air came out.
Dave Kemp:
Interesting.
Laurel Christensen:
They didn’t really like the instant fit, they’re used to taking ear mold impressions, they have sold custom, they’re used to things being in the ear, there were not a lot of BTE sales in the United States at that time, and it took a lot of time for the thin tube receiver in the ear products, of course you had Oticon came out with the first receiver in the ear product and it was a thin tube and now the receiver is out of the housing. So very much like the ReSound Air, but the receiver in the ear, and that again continued, like this growth of the thin tube receiver in the ear BTE and then you can see where we are today. So I mean it was definitely a game-changer and why are these things game-changers? Because they solved real problems that the people we serve had, and I think that’s something we have to continually think about in development.
Laurel Christensen:
I see a lot of hearing aids jump out onto the market and we can’t even see what they changed from generation one to generation two. I hate to say that, but that’s just the facts. The marketing stories look fabulous, but the hearing aids themselves aren’t that different, and then audiologists are smart people and they fit them and their patients say, “Yeah, it sounds about the same. I’m not really hearing anything different.” When you have those big jumps, it’s because you have done something to solve a problem and so wide dynamic range compression really solved that sound quality problem of those peak clipping or compression [inaudible 00:28:13] devices.
Laurel Christensen:
Open fitting solved the occlusion problem and that was a huge problem. Most of our patients kind of start out with that kind of hearing loss. So I think when you solve the problems is when you have the big technology breakthroughs, and we have a lot of products that come out that aren’t big technology breakthroughs.
Dave Kemp:
Well I think this is interesting from what you were saying where it wasn’t initially accepted. So if I understand it, so the ReSound Air, it was like almost a precursor to the RIC style, right? It was like a … Okay, so then, so you introduced this and it sounds like maybe it was Oticon introduced the first RIC and then flash forward to today and it’s this dominant form factor within the offering. But I find this so interesting where you … People were sort of opposed to this, you sort of … It’s like history doesn’t repeat, it rhymes. It seems like that’s sort of happening in some ways right now with the industry is that there is an opposition to certain things that … It’s just because people are sort of creatures of habit and they’re conditioned to think one way and so I think that that’s really interesting though to think about because if you see where we are today and you see all these different market track reports or the market research that shows the actual of the overall hearing aid sales, the different forms that are sold. I want to say receiver in the canal now accounts for … It’s up over like 85% of the market or something like that, right?
Laurel Christensen:
It is the biggest runner of hearing aids. I mean everybody wants to sell them. It took people fitting patients and finding out they didn’t have to counsel about the sound of their own voice, because occlusion is a real problem and as much as we might have told our patients you’d get used to it, they don’t get used to it. You always have the irritating eating potato chips or chewing sounds. I mean they just don’t go away, and so you got rid of it. You solved this problem, the sound quality’s better, the cosmetics were just great. I mean you just didn’t see them, they were a tiny thin tube instead of a 13 tube and so people eventually it caught on and then everybody started making receiver [inaudible 00:30:33] and we are where we are today.
Laurel Christensen:
It’s interesting, I’ll fast forward. We have a new receiver on the market that actually has a microphone in the receiver, and it came out about a year ago and it makes complete sense. You take the microphones out of the ear and you mess up all of the pinna acoustics and the pinna acoustics are so important because we have been listening with our pinnas our entire lives. So everything I listen to sounds one way to me and everything what you listen to sounds one way to you. So when you put a hearing aid on somebody and now they’re listening above their ears, it never will sound natural to them because it’s not their ears. So every manufacturer, we build in this average pinna, and nobody has … [inaudible 00:31:29] nobody, but most people do not have an average pinna. It’s the same reason why we run real ear measurements. Everybody’s ear acoustics are different and so the whole idea of listening with your own ear, and even more than that. I mean you can only do true spatial perception, and I’m talking about spatial separation, so you know that this conversation over here is happening over on your right, and the conversation over on your left is happening on your left and you could actually spatially separate it out and attend to either one of them. Only normal hearing people can do that.
Laurel Christensen:
People with hearing aids, they can’t spatially separate, and the pinna allows you to do that. So there are just umpteen reasons why putting the microphone back in the ear is a good idea. But I can tell you, it’s a little ReSound Air like. People are like, “Why would I put that receiver in the ear?” And it’s harder to fit because of course you have a receiver next to a microphone, so it can –
Dave Kemp:
Feedback.
Laurel Christensen:
It has feedback more often and you have to be very careful and stick to the fitting range and I keep telling my sales colleagues, just keep talking about it, keep talking about it, keep talking about it. Because I guarantee to you, this is the future. Because when people figure out that everybody likes it better when they can actually listen with their own ear, everyone’s going to copy it, everyone’s going to have it, and it will be very much like receiver in the ears hearing aids. But we don’t accept sometimes the latest, greatest thing right away. It takes time and research to kind of show that they’re the right way to go.
Dave Kemp:
So this whole thing, so the M&RIE, what you described there, perfect segue by the way of … Such a natural flow there of tying what we were talking about to now all of this really cool technology which is what I wanted to get into. Because I think there’s a lot that’s going on with this. So I think you’re right, where it’s like a part of it is getting people to buy in to this is just kind of like think different, there’s a lot of logic that goes into this. But there’s also significant technology breakthroughs that have happened to enable that. When I first read about this, I was blown away at the way in which this actually works. Because in order to eliminate the feedback as I understand it is that all of these different receivers are working in simpatico as a network. It’s a neural network of all different components that are signaling to one another in such a way so that it mitigates the amount of feedback and I just think that that’s such a testament again of here we are, in 2021, and so you go back … Like you said, you have this first breakthrough in ’89 or ’90, and that kind of blows the door open on these things now start to sound pretty good.
Dave Kemp:
Flash forward to today. We have literal neural nets being baked into a device the size of a hearing aid. I think it’s just such a testament of wow, how far we’ve come and now we’re really starting to see some incredible things that are … It’s like you said where you now are able to actually give somebody that has a significant hearing loss, you can restore their ability to hear in such a way that sounds natural because the technology now allows for you to put a microphone literally in the receiver that you have in the ear canal and I think that like you said from a scientific standpoint, the way in which that replicates the pinna effect is mind-blowing from an engineering standpoint and just the sheer wow, I can’t believe how sophisticated these things are becoming.
Laurel Christensen:
I think we’re in another kind of heyday of this … If you go back just a little bit, it hasn’t been that long since we had hearing aids connecting to phones. So the first made for iPhone hearing aid was what, 2014, and then we have made for all Bluetooth connectivity, accessories. You had wireless with kind of the wireless necklaces around [inaudible 00:35:42] –
Dave Kemp:
Yeah, the streamers.
Laurel Christensen:
Magnetic induction systems, but it hasn’t been that long since we got rid of that and everyone moved over to 2.4 gigahertz. I mention all of that because there’s been this kind of … There’s been this huge emphasis on connectivity. It’s been something that some companies have been more ahead than others and some have taken the lead and back and forth but everybody’s been working on connectivity, and I think that has taken away resources from signal processing, and so now we’re getting to the connectivity side where we’re all going to be on the same … Eventually we’re all on the same wireless protocol. You can walk into a movie theater and your hearing aids are going to automatically connect to the system in there because you’re all going to be wireless. I think taking the lead in connectivity and kind of where connectivity is going, we’re probably all getting to the same place and it’s a good place.
Dave Kemp:
Good point. Yeah.
Laurel Christensen:
That’s kind of done. But we’ve spent massive amounts of energy with radio development and bringing in people who can do those kinds of things into hearing aid companies, working on connectivity to phones and streaming and all the protocols from Apple and Samsung to do those … The ASHA streaming protocols and the MFI and the resources to do the apps and to have apps control the hearing aids. We’ve spent so much time in engineering working on those that I think AI and neural nets and the M&RIE microphones and where are we going with the cognitive health and all of that. That’s kind of taken a backseat and now you’re seeing this emergence because hearing aid companies are kind of, “All right, connectivity is …” We’re maybe on par there, we’re in a good place. Let’s really focus back on signal processing and I’ve heard colleagues that don’t work in the hearing aid industry like I do say, “Is there any more signal processing we can really do or are we done?” And definitely there is more signal processing. It’s exactly what you said.
Laurel Christensen:
I mean we’re already seeing evidence of AI doing very good things with deep neural networks and you have a hearing aid that actually does an offline kind of deep neural network but it’s for environmental classification and really being able to classify environments right. Because you have to classify environments right in order to make the hearing aids do all the right things.
Laurel Christensen:
So every company is kind of going in one way or another with all of this kind of technology. I think there’s a lot with hearing and noise that we still can do and will be able to do. You see it, in articles and really cool things that are happening outside of hearing aids. You’re eventually going to be able to do that inside a hearing aid, so there is a huge future in the signal processing and I think we still have a long way to go. Otherwise it would be really boring to work in a hearing aid company I think, so …
Dave Kemp:
I think that’s really interesting though because I do agree with you. I would say that if I had to sort of almost define this last decade, it’s not a full decade, it’s more like 2014 and on, so seven, eight years, I would say it’s all about connectivity. I would say that’s been the big theme and you’re right where it’s sort of now become table stakes. I think that everybody’s sort of on par, some companies might have an edge in certain areas but I think by and large these are now primarily pretty much connected devices and that does lend itself to lots and lots of really exciting things. Things I’ve talked about ad nauseum on this podcast before. So it’s not anything new to the listeners, but I do agree with you where it’s like, “Okay, so what’s this next 10 years going to look like?” I think you’re right where it’s going to go back to, “All right, so now how do you basically take these devices and you just continue to optimize them in a way that is so seamless for the user.” Where the user is so oblivious to what’s going on, sort of in the device and behind the scenes, but to their betterment. They’re just like, “Wow, these things are incredible.”
Dave Kemp:
I just think that you get to the point to where you put these things on, they feel so natural that it’s almost as if you basically just restored that sense in such a seamless way that there’s so much room to run there. So I’m going to be really curious to see what happens over these next few years as it does seem like more of the R&D will sort of circle back around toward very audiology specific things, less of it being more like bringing hearing aids into the holistic connected ecosystem which it’s sort of already happened and it’s underway and it will continue, but I agree that it’s very, very interesting to think about what audiology looks like when you really start to layer on all the buzzwords but really truthfully, when you have the systems on a chip that these types of things have. I mean I think some of the … I feel like you would appreciate this too is if you really are looking sort of underneath the hood of the device, and you’re seeing what’s happening at the chip level, with all these systems on a chip, it’s fascinating to see what can …
Dave Kemp:
Especially when we’re talking about an industry that revolves around incredibly small devices, it’s highly, highly important to understand from a miniaturization level, what is going on right now and what doors are being opened as more of the processing and just overall the way in which the chips are architected are … They’re going to accommodate for all kinds of things that I don’t think many people are realizing, because it’s kind of such a dramatic step change again when you incorporate AI into the mix.
Laurel Christensen:
Yeah, absolutely. I think as far as we have come, and if you really do fit the system, I have been teaching hearing aids for years, I have never not been teaching hearing aids, and I finally told Rush University in Chicago I was going to retire from teaching hearing aids. But I always have told my students, as far as we have come, hearing and noise is still a problem for people who wear hearing aids. It is still the problem for people who wear hearing aids, and if you use the whole system today, and that is use the microphones, and we have this mini mic and micro mic and stuff and you can put them on a companion, but they’re great for those kind of one on one situations but they’re not going to help you hear three or four people in noise. So you can have solutions, like I said earlier, there are very few environments where we can’t help people who are hearing impaired here, and including in noise, but we’re using accessories to do it.
Laurel Christensen:
I mean I want to say the day where you don’t have to have the accessory to hear in noise with your hearing aids, and I think that’s the kind of thing we have to head to and I think there is technology and like you say, we always have more processing power, more memory. It’s always coming, that’s what happens in chip development, and I think we’re going to be able to do more and more. Our research development and the head of research at our company Andrew Dittberner assures me that there is a lot more that we can do in that area. So I think it’s going to be fun, but I always want to keep our eyes on the real prize, and the real prize is to solve the hearing and noise problem I think in a hearing aid. I think the company that really can do that, a hearing aid that can really do that is going to be the winner because it has been the biggest problem in hearing aids since I entered the industry and that’s the one thing I can tell you 30 years later, it’s better, there are things we can do, but is that problem solved and the answer is definitely no.
Dave Kemp:
It’s the holy grail, yeah. It certainly feels like that. So another thing that I think is really, really interesting that’s happening that ReSound and GN overall is sort of on the forefront of is what I’ve termed and others have described as kind of like this hearing aid hearable convergence. This idea that what we consider to be a hearing aid is sort of blending with now what we look at as earbuds and I find this to be so interesting because there’s so many interesting secondary implications that stem from this, where you have a world where it’s really hard to distinguish what exactly each device is doing. I think there’s a lot of implications around stigma and I also think that it changes the overall way in which we sort of perceive the … I think that it changes the way people perceive hearing aids because they look at it then sort of along the same lines as earbuds as well, and it just seems like …
Dave Kemp:
I’ve looked at some market data of just the consumer audio space in general, and talk about one of the spaces that really was accelerated by the pandemic. This whole true wireless earbud space has just exploded in popularity. It was already happening, it was starting to be ushered in by AirPods I think, but I think during the pandemic, a lot of people realized, “I kind of want to opt in and have a little bit better sounding headphones.” So it’s kind of like this add-on that you now have to your smartphone and so you all have come out with your Jabra line, some Jabra earbuds that basically function like hearing aids and I’m just curious to kind of get your thoughts on the overall theme of this. Because again, talking through sort of these step changes within the industry during your time, this again feels like another one, albeit the fact that it’s a little different, like it’s not sheer hearing aid innovation, it’s more of the behavioral implications that might really have an impact on driving more people toward feeling comfortable with like, “All right. I have a hearing loss. A hearing aid might not really be my cup of tea, but give me something that looks like these earbuds that …” For whatever reason, that is a lot more appealing in my opinion.
Laurel Christensen:
Yeah. Yeah, this is a big area, and one we’ve been working on a long time. I mean we knew these kinds of changes were coming into the industry over the counter, but self-fitting, which was really what [inaudible 00:46:32] kind of put in for the FDA when they approved self-fitting devices that you actually have to have a hearing healthcare professional for and so we thought this is an area that we want to get into and think about it from our company perspective, I mean we as audiologists, we see GN Hearing. But there is GN Audio in this company, and they do commercial call center headsets but they also do wireless earbuds. So you have the Jabra Elites and things, so very good, and they are a very respected brand in the Jabra. So you have this marriage of this hearing company with this audio company, just a quick aside, the other day, it was announced that we purchased SteelSeries. I don’t know if you saw that.
Dave Kemp:
Yes. I was going to ask if we could talk a little bit about that. So feel free to –
Laurel Christensen:
Yeah, it’s just kind of funny because you wake up one day and you find out your company purchased SteelSeries. Well I have to admit that I had never heard of SteelSeries and so I was telling my husband at breakfast and my 13-year-old son was at breakfast –
Dave Kemp:
I was going to say, I’m curious to hear your child’s –
Laurel Christensen:
Yeah, my company bought SteelSeries, and oh my gosh, he … “You own SteelSeries? Oh my gosh.” And he pulls up the website, “Mom, look at this keyboard. Look at this, look at this. Mom, when are we going to be able to get discounts on these products?” And I’m like, “Okay, so now I’m cool because I was never cool with the hearing aids.” But you have this side of this company that people don’t really know about in hearing. But we are a natural marriage to put out a product that can reach people we are not reaching today, and we are definitely not reaching these people today. So that, I think it’s very exciting. It’s an earbud. It goes in the ear, it is so small, and very comfortable and it’s going to stream. It doesn’t have a ton of gain, these are for mild to moderate hearing loss, and we don’t even have a regulation around OTC products, we made this for self-fitting products so that the HCP is involved in the process and getting those people into the door, helping them with this. We serve people who are older. I think it will be even the simplest and most user-friendly designs will be hard for some people to do.
Laurel Christensen:
So this is probably the most exciting thing we’re working on right now I think because I think this is the ability to reach so many more people, get people started into hearing healthcare way earlier. I just think it solves so many problems and if you can do it in a high quality way, there’s so many of these kinds of devices out there on the market that just don’t sound good. You want to do it in a high quality way that meets a target that you’re not meeting today, and partnering with a hearing healthcare professional, I think that’s the model that we are really after at this moment and we’re very excited about it. And it’s been extremely well-received and by hearing healthcare professionals, when can I get it, when can I start, when can I get training? So I think that we’ve had a lot of years to think about it and people are ready to integrate things like this into their practices.
Dave Kemp:
I want to come back to that point there, I think we’ll close with that. But I do want to say, just sticking on the whole SteelSeries piece, for me, I’m not … I used to be a gamer back in the day when I was in high school and stuff, but what I find to be so interesting about that acquisition is it’s not as if … I know that it’s kind of abstract, but what I think is really neat that I think GN is doing a good job with is bringing under an umbrella a number of sort of different fields of audio and I think the cross-pollination that’s going to occur, I think you’re already seeing it between the two worlds of consumer audio and hearing health, but gaming is a giant sandbox where some of the most pioneering stuff is happening. I mean some of the stuff that’s going on with spatial audio and just in general, I think they’re pushing the envelope because it tends to be so immersive in the games that you’re playing and stuff like that that I think what you’ll see is you’ll see some things that come from that world that they’ll just kind of find their way into the hearing health world, or vice versa.
Dave Kemp:
So I find that to be super interesting when … We really are sort of seeing right now in realtime the audio … Like audio is such a totality. Like hearing health is just one segment of it, and I think that as it becomes more of an umbrella of multiple disciplines within this field, I just think there’s going to be some really brilliant things that emerge from the cross-pollination that occurs between these disparate fields.
Laurel Christensen:
Yeah. I think there’s no doubt about it. I mentioned my gamer son, but I’ve put on his headphones and I actually use that as an example when I talk about M&RIE. That is what we’re trying to achieve with our M&RIE receiver is spatial hearing and I think that the audiologist doesn’t understand that hearing aids, the way they’re designed today, take away spatial hearing, and if you want it back, you’ve got to put a microphone in the ear and I always say it’s like the gamer headset and SteelSeries is the company doing that kind of spatial perception. Audio really does span so many things and the [inaudible 00:52:22] really excel in audio. I mean their universities have programs that are incredible, so you can hire so many professionals in this area. So it really is, it’s fun, and I think it’s kind of this … Everyone’s always saying, do you ever work with audio when you’re in hearing, and yeah, there have been some working together over the years. Now this company is really just kind of marrying up and it just makes it more fun.
Laurel Christensen:
There’s more people to work with, there’s more challenges, there’s more perspectives, and Jabra Enhance Plus is a big part of that. I think it’s the right thing to do, I think reaching more people for hearing healthcare is the right thing to do and yeah, I’m really excited about it if you can’t tell probably.
Dave Kemp:
No, yes. All right, so as we wrap here, I do want to close on this whole idea of you’re an audiologist, you’re the chief audiologist within GN. How do you see the role of the audiologist into the next five years? I mean I’m sure you have opinions on this but especially kind of like from your perspective of both wearing your manufacturer hat but also the way that you just see it as these are my colleagues, what’s your sort of take on what you think will kind of … This next few years will look like as things like OTC do kind of come online, you have these Jabra Enhance Plus type offerings that can be incorporated into the practice. I’m just curious to kind of get your take as we close.
Laurel Christensen:
Yeah. I think the audiologist is not going anywhere.
Dave Kemp:
Amen.
Laurel Christensen:
These are products that we’re talking about right now are for mild to moderate hearing loss for people who we are not serving today and we will have an opportunity to serve if we embrace this. But the audiologist is still the most important piece there is to hearing healthcare. There is nothing like the counseling and everything that an audiologist brings to the table, the knowledge, you know your customer, you know the end user, you know their problems, their pain points, how to solve them, how to counsel them, and it’s not going anywhere. I just don’t see it. We have a group of people that we serve who are older, they’re becoming more technologically savvy but hearing healthcare is not simple. Getting things in your ears and how to tune them up and how to do all of that and especially as you have more hearing loss over time. Of course great things are being done in other areas of hearing healthcare like cochlear implants and other implantables and such, so the audiologists, again, they’re going nowhere. I just think we have an opportunity to serve more people than we ever have been able to serve before.
Dave Kemp:
Well said. I love that, I love the idea that it’s an expanding market, there’s going to be more reasons for you to interact with the types of people that maybe you’ve never interacted with before. I kind of like … The throughput for me for this conversation was like you said at the beginning where we have these breakthroughs and at times, sometimes it might feel like whenever there’s something that goes against the grain a little bit, like the RIC form factor was back in the day, eventually that becomes the prevailing form factor and I think that kind of this way of thinking about the Jabra Enhance Plus and the patient that that is targeted toward, while that might not be the most prevalent type of patient that you have, the highest percentage of patients that you see, in time, that very well could be a subset of patients that really, really grows and that we look back and we see some sort of chart that shows the percentage of mild to moderate losses that you were treating or those patients that comprise that in 2021 compared to 2026. It might be kind of similar, where you see this huge uptick in adoption.
Dave Kemp:
So I just find this to be so interesting, that there’s just so much room to run in this space when we’re talking about so many people that have hearing loss and so much demand for expertise.
Laurel Christensen:
I mean it’s exactly what you say, so much demand. I mean what we do as audiologists, as hearing healthcare professionals, what we do changes people’s lives. I see it every day, I’ve seen it in my own family members, close friends. Socialization and communication with other people is so incredibly important. The need is great, the need is great, and the need is huge and audiology is going to go nowhere because people need hearing healthcare and the need is great and the reason to do it is good and it changes lives. So I mean we go into this because we’re passionate about helping people hear and I think we’re just doing more in that area.
Dave Kemp:
I love it, wow. What a great conversation. This was so much fun. I really appreciated all of the history and your perspective on the way that you see things moving. I think there’s a lot to be excited about broadly speaking but I think GN is sort of the embodiment of I think a lot of different trends that are happening right now. So it’s going to be interesting to keep an eye on.
Laurel Christensen:
Thanks. It’s been fun. It really has been. I never know what to expect, so this has been just great fun. So thanks for the invite.
Dave Kemp:
Absolutely. Thanks everybody who tuned in here to the end and we will chat with you next time. Cheers.
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.
