Hello and welcome back for another episode of the Future Ear Radio podcast!
Today’s episode features Robert Sweetow, Ph.D. (Co-Inventor and Scientific Advisor) and Miles Aron, Ph.D. (Chief Operating Officer and Co-Founder) of Neurotone AI to talk all about their flagship auditory training platform, LACE AI Pro.
Our conversation spans a wide range of topics, including the genesis of LACE, the shortcomings of the original product in hindsight, Neurotone AI’s entry into the scene and the birth of LACE AI Pro, how the product is being innovated upon in entirely new ways, and the impact that this type of auditory training has on patients and clinicians alike.
I’m personally really excited by this whole concept as this not only inceases patient satisfaction rates and reduces device returns, but also provides the clinician with a stronger value proposition. This is one more way that the clinician can add value to the patient experience by administering aural rehab in a way that is very conducive to both the patient and clinician and also allows the clincian to have oversight into one’s rehabilitation to accommodate further guidance for the patient into the future.
-Thanks for Tuning In-
Dave
EPISODE TRANSCRIPT
Dave Kemp 00:00
All right, everybody, and welcome to another episode of the Future Ear Radio Podcast. I’m really excited today to be joined by Dr Robert Sweetow and Miles Aaron, so thanks guys for coming on the podcast today. How’s everybody doing?
Miles Aron, Ph.D. 00:21
Very well. Thanks for having us, Dave.
Dave Kemp 00:23
I always like asking that question when I have two people on, because nobody really knows, like, who’s going to be answering what. So anyway, I’ll try to be a little bit more direct of who I’m who I’m addressing here. So wanted to have you guys on though today, because, you know, I’m familiar with lace AI your product, but neurotone, the sort of the parent company, has sort of been coming onto my radar in a bigger way with some of the recent news, you know, the acquisition of amtify, which we’ll get into. But wanted to have you guys on to talk about your company, your product, and how you know this is relevant for the practitioner, the practice owner, and, you know, ultimately for the patient base in the hearing healthcare market. So with that, why don’t I turn it over? We can do introductions to start. We’ll start with you, Robert, if you wouldn’t mind, just share a little bit about your background and how you sort of got involved with this company.
Robert Sweetow, Ph.D. 01:22
Okay? Well, I am, well, I’m presently retired. Sorry to say that to both of you guys who are gainfully employed and working every day. But I, I started with, well, really, with this company, I’ve been my my mentor when I was in at the university long, long time ago, when I was going for my PhD at Northwestern my mentor was Raymond Carhart, who’s considered the father of Audiology. And Carhartt really started the field of audiology as a rehab, as an oral rehab field, and unfortunately, it’s gotten a little bit away from that to some degree, because of hearing aids and so many other things. But, and by the way, I know some of your listeners who would know me might say, oh, Carhart was his mentor. I thought his mentor was AG Bell, but I’m not quite that old. So it really was. It really was Raymond Carhart, but at any rate, so I was have been an audiologist since the mid 70s, and I think that what got me interested in creating lace was, well, in part, a failure with some of my patients that I would fit them with hearing aids. I thought everything was perfect, and yet they just were not succeeding as well as they should have. And so, you know, I got very interested in gerontology and recognizing that the areas that people really fall down in are in speed of processing, working memory, attentional difficulties, executive control, things like that. And it really dawned on me that in order to complement what was going on with modern hearing aids, we really need to get the patient more engaged in improving themselves. And so I was doing some work. Well, I was sitting at my office one day, and I happened to have been the audiologist for the Grateful Dead, believe it or not, and which is, perhaps, is why I forget so many things sometimes. But I was the audiologist for the Grateful Dead, and one day I get a phone call from a gentleman named Jerry Kirby, who unfortunately, has since passed away. And Jerry and his Jerry had also been an engineer working with the Grateful Dead, so he had a connection with them, and he somehow got my name through them, and he called me up one day about a project for tinnitus, which was the main thing I had been working on at the time over at UCSF. And he came over there, and actually, the project, you might find this of some interest. His project really was talking about using a recording that would reverse the phase of a person’s tinnitus. And I said, Yeah, that’s not going to work, because tinnitus is not a real sound, so you really can’t reverse the phase. I said, however, I have been working on this other program, an oral re an auditory training program with my research colleague, Jennifer Anderson sabus. I said, you might find this of interest. So I kind of talked him out of the tinnitus project and into the auditory training project. And that’s really how lace began. So that’s that. And then, of course, you know, we had that that was in, I think, around 2005 2000 Six when, when we wrote our first paper on this, and Jerry and his team were essential in getting this going. I mean, I had no technical knowledge of how to do this kind of recording or put in these different things, but we were really limited by what the technology was at the time, and there was also limitations in terms of capital funding and things like that, for for the neurotone. And that’s when the new neuro tone AI came into play, which, and you know, we’ll get into that over the next hour and miles, will be able to explain a lot of the new approaches much better than I have so, so yeah, and then I’ve been, I kind of stepped away, actually. I left UCSF in 2010 went to get some consulting overseas with some hearing aid companies. And then once lace or once neurotone was acquired by the new neuro tone, that’s when I got back involved with it as an advisor.
Dave Kemp 06:04
Okay, awesome. There’s a lot there that we’re going to get into as this conversation unfolds. I’ll kick it over to you though miles, to give your background, I know that you’ve, you know, not been, I guess, as involved for as long as Robert has with the old, the old version of neurotone, but with this newer version, maybe you can help us to understand a little bit about this current iteration of the company and how you came to the to join.
Miles Aron, Ph.D. 06:35
Yeah, sure. So. So I guess first I got my my start in acoustics, and so I’ve been around the science of sound my whole career. That includes, I like to say, a whole range of frequencies, down to infrasound, with research at NASA and in their drone research kind of division as an intern, and later in at the Department of Energy, doing the opposite end with phonons, the very high frequencies used to detect the particles they were looking for dark matter. And that was very early, but I spent most of my early career working on ultrasound medicine, trying to deliver drugs to the brain. And got my PhD at Oxford working on on biomedical acoustics and ultrasound. And then I had an arc working more on the technical side with startups, and became sort of this swiss army knife of kind of technical startup, know how, and acoustics, and as you can imagine, discovering neurotone, and this incredible solvable problem was incredibly exciting and filled me with with purpose, and made me feel very mission, driven to work on this, and brought me back to to the the wavelengths that we can actually hear. So so I’m excited to be working with sound I can actually hear, and to be working on things that really help people. And as for the the new neurotone, as Robert mentioned, the neurotone. Ai acquired neurotone to really bring the company back to life, and we did that with the family that was involved. And we brought Robert and Jen, Jennifer Henderson, sadas, who was a co inventor of lace, along with Robert back into the picture, and then recently acquired amptify as well, bringing Nancy time, Murray and and that team into the fold as well, in order to really bring the best minds in our rehab together and try to take the problem very, very seriously. And in taking it very seriously, one of the things we’re doing is trying to make it more fun. So I think when we when we looked at at waste, we said, you know, why is? Why do almost about 100% of audiologists believe in RL rehab, and only 10% of them are practicing it in some way, and maybe not even enough among those 10% and and the reasons were basically twofold. The programs, I’ll actually go threefold. So the programs out there weren’t, weren’t necessarily fun and engaging. We said, Okay, well, we can solve that. And audiologists didn’t feel like they had enough time. And we said, Okay, well, software is a great solution for that. We can, we can solve the time problem. And there was no viable business model for audiologists. There were interesting projects in the space, but none of them were doing what hearing aids have done, which is make it so that you can thrive as a business. And when you’re in the business of helping patients, you can only do that as long as you’re actually in business. So that was sort of our focus. To solve those three let’s, let’s make auditory training fun. Let’s make it a viable business model. And, and let’s, you know, solve some the time problem as well. Yeah,
Dave Kemp 09:57
you know, I can
Robert Sweetow, Ph.D. 09:59
comment on what. Miles was just saying it was a critical error, really on our part. When we first invented lace, we we really tossed around, do we want to make this fun more game like, or do we want to make it more serious? And we made a big error in that we did, we decided, well, if we make it to game like, then people will think it’s, it’s a game and it’s not really a patient sell clinical program. So we kind of kind of dumbed it down, and I shouldn’t say dumbed it down, but we kind of made it very, you know, more serious and less game like. And in retrospect, that was a big problem because, you know, one of the reasons that the original lace, while we were getting good data showing improvement and things like that, but it wasn’t really gaining a tremendous foothold, you know, in general, with audiologists. And one of the reasons was, was that it was too boring. And so that’s, you know, one of the major shifts that has taken place now,
Miles Aron, Ph.D. 11:04
yeah, and in Robert’s defense, I’ll just say that I think the the approach of lace, I actually think was a great approach, but there was just technical limitations. We had to send an actor to the studio. A lot of times it was Robert, which people loved training with him, but he could always spend hours in the studio making content, and so the content library was sort of limited, and there were great ideas at the time, and Nancy worked on this, and Robert as well. The idea of recording the voices of your loved ones to be able to train with those familiar voices was an idea around at the time, but implementing that at a scale that patients could access was impossible. So, so I think, you know, we’re not, we’re not taking it to, you know, shooting hoops in bass, shooting basketball hoops as a game like in the way that we’ve seen, you know, amped. I do necessarily, but we are thinking about, how do we engage you with something like a streak that’ll come keep you coming back every day, and we’re very focused on using AI to get past that hurdle of just having a lot of content to make it more interesting. And in doing so, we created these life like digital human like avatars that do the auditory training for you, and we can make them say whatever we want. They have incredible, incredibly accurate lip movements. So they can actually be used to train lip reading, and that’s something you’ll see us do a lot more this year. But because we can program them, we’ve been able to get over 10,000 exercises into the app in just a few months. We’ve got that spanning, I think, 27 content categories now, from gardening tips to Bible verses to learning about cuisines around the world and philosophy quotes and so on and so forth. So it just becomes much more interesting when people can train with whatever they want. And then we’re also, we’ll talk about this, maybe later, but also able to use AI to simulate the voices of people in your life, of course, in a HIPAA compliant and and regulated way, permission driven way, but we can bring those voices in using AI so you can actually train with those voices. So a lot of these ideas that were really good, that Robert and colleagues had are just finally achievable at scale?
Robert Sweetow, Ph.D. 13:21
Yeah, of course, one of the things that we always worried about with the recording the significant other’s voices was I would have so many patients who would say, I don’t really want to hear what she’s saying or what he’s saying so but like miles is saying we just did not have the technical capability of doing that at the time. Yeah,
Dave Kemp 13:42
that makes sense. I mean, it sounds like the miles and team have kind of been the Calvary to help you execute the vision. And if you wouldn’t mind, actually, I think now might be a good time to pull up and Robert, you know, kind of really paint a picture of how, you know, the the, I guess, the when you formulated this whole, you know, lace and this as a solution? Can you help walk us through what, what exactly is going on during this program? And, you know, like when you’re a patient and you’re going through this aural rehabilitation, what’s the science behind it as to why you’re able to generate these improvements and things like speech and noise and all that
Robert Sweetow, Ph.D. 14:26
well, you know, I mean, what’s the main thing that patients complain about when they come into an audiologist, they go, I can’t hear a noise. And they would say, and everybody talks too fast, so, and that’s a function of you know, as you get older, your speed of processing slows down, and things like that. You’re working memory slows down. Paying attention is difficult. And there was also the question of confidence that patients that would put their hearing aids on, they would have unrealistic expectations. That’s one of the biggest changes I think I’ve seen in the field over the decades that I’ve been involved in it is that audiologists now are trying to paint a much more realistic picture to patients, that hearing aids are not going to do everything for you, and so we really wanted to get patients involved in it. And the reality is, is that any practice is going to result in some kind of benefit for a hearing impaired person. I mean, if they read the newspaper aloud, they’re going to start letting their brain form attachments with what it is this new sound that they’re hearing, which is a distorted signal, first of all, because of their hearing loss, and second of all, because the hearing aid was distorting it to some degree. So we really thought, well, we’ve got to be putting some things in there, speech and noise being the most important thing. And we decided, and again, this was part of my Raymond Carhart bias learning the difference between how a brain processes speech in a babble noise versus speech with one competing speaker. So the original lace had speech in babble, speech with one competing speaker, we time compressed speech in order to simulate very rapid speech. And I used to joke when I was giving speeches that I think, if I remember this correctly, in English, we speak and 180 words, sort of 180 words per minute, or something like that, right? Three words, fail is 180 words per minute. Yeah, and, and I would say, of course, of course, my wife speaks at 360 and my children speak at 420 words per minute. But so we wanted to have some kind of time compression in there, and so that we could simulate rapid speech. We wanted to have communication strategies in there. We wanted to be able to measure things. We originally set up something that was called Word memory, which, you know, and that was our feeble attempt at the time, to kind of address executive control and some attentional difficulties that people might be having, although now the new neurotone and thanks to miles, actually, and he’s been working with my colleague Jen on this is really working on working memory, which is much more appropriate, rather than word memory. So they’re working in that regard. We threw we had a lot of communication strategies in there, which now, as I’m sure we’ll get into later, are accompanied by visual input, which, again, at the time when we first formulated this, we as miles, was saying I was the unpaid actor. And so, you know, we really, we would go, we would run around this, run around San Francisco with a little handheld camera doing some different kind of filming. So things have changed so much. But we, you basically, we wanted to engage the patient in making them have some responsibility for their outcome, and again, that was one of the big issues. I used to say to my tinnitus patients, if you get better, it’s, you know, you don’t have to thank me. You should thank yourself, because it’s been your work that’s made it better. And it’s really the same with rehab. You know, I think that if a patient says, my hearing aids, I’ve spent 1000s of dollars on hearing aids, so I ought to be able to do perfectly. But that’s not the case. And the other issue is, and the reason that it’s called lace, which just came to me one day when I was I think, I’m sorry to say in the bathroom that was sitting around and realizing we’re not this program has nothing to do with hearing that’s what hearing aids are for. This program has to do with enhancing a person’s ability to listen, which requires attention and intention and to enhance their communication, which in which it really entails a brain function, and, you know, in knowing how to set yourself up. And fortunately, we were able to use, and this is, you know, one of, one of, one of the problems I had in all my years in audiology, when I would give presentations, is I would look at the the end the sample size of research for Audiology papers, including my own papers. And you know, we would do research with and have a sample size of 30 or 50 subjects in there. And then you would look in. The medical literature, and you would see sample sizes of 1000s. And this was, it still is a problem in audiology, but with software, and with a program like lace, and what neurotone AI has been doing for it is we can generate, we can collect data on 1000s of listeners, 1000s of users, and then be able to really formulate, create changes, improvements in the program, and provide feedback back to both the patient and to the audiologist or whoever is recommending the lace in a manner that just couldn’t be done in the old ways. So I think that that was some of the main thing. We also, I, you know, had worked early on. One of my colleagues actually over at Northwestern was Mead Killian, who had, of course, I developed the quicksin and, you know, we, and Mead was a definite believer in lace, and so he said, Yeah, you know, you could use quicksin in lace. And so that was one means of measuring progress for the patient. But then we had our own measures that have, now again, as Miles will, I’m sure, address later. Have we had our own measures of measuring progress in a number of ways that, again, we’re all centered not around hearing, but around listening and around communication.
Dave Kemp 21:36
That makes perfect sense. So I guess, what is the data as you’re able to amass more data. I mean, is it, is it sort of reinforcing everything that you always thought and some of your hunches, or were there new insights gleaned from the data you know that that you’re kind of starting to
Miles Aron, Ph.D. 21:55
see well, I mean,
Robert Sweetow, Ph.D. 21:56
for me, I think that the data that was collected at the time reinforced what we thought would happen the problem, but we also from the data, were seeing that some patients would begin it, they would do one or two sessions, and then even if they improved, and we were able to track their improvement, even if They improved after a couple sessions, they kind of quit on it because, either because it was boring or because they thought, Oh, I got improved, and so I don’t need to do any more with so that was kind of an eye opener for us. And again, was one of the things that really showed us that we were missing the boat by not making it more exciting and things like that. But, you know, and we were interested also in tracking whether or not this was improving their communication confidence. And again, we saw positive data on that. We saw positive data on speech and noise. I think if I remember back, I actually wrote down some notes here about some of the early work, but we were getting, in our very first study on all of this, we were getting over a two DB signal, noise ratio, loss, improvement on the quick sin. And so that’s really a significant amount. And we did it, I think was 2.2 at 45 DB and 1.5 at 70 dB, and we found that 85% of the subject showed improvement on the various measures that we were looking at. So we clearly we were on the right track, but just, we’re just not doing it quite right in order. And again, you know, no matter how good the program is, if people aren’t using it,
Miles Aron, Ph.D. 23:50
you know, yeah, well, I call and maybe just to toot Robert’s horn a little louder, because I think they did a fantastic job. There’s data showing that even most of the patients in the studies I was seeing were staying. You know, 75% of them were staying. So we’re always critical of the 25% the drop. But it’s not like it was nobody, like lots of people were staying through the program. It was about 75% and and the people that did it when you gave them hearing aids and then they started lace The incredible thing that was happening is that the return rates on those hearing aids was dropping by numbers that are are almost embarrassing to say out loud, because they’re so good. In one study it was 74% in another study, it was 91% and these were third party studies, one done with cycle, others with other research groups that weren’t tied to neurotone, over 1000 patients, many across many clinics in the US. So we have really good data on the impact on return rate, and what that means for the patient is exactly. That Robert was saying, and increased confidence and ownership of their journey. And when they go to put those hearing aids in the drawer because their life suddenly sounds different. They say, Well, did I do my lace or like, is it the hearing aids? Or is it my? Is it that I didn’t do my part as a patient? And they go and they train their brain, and suddenly they’re getting that 1015, 20% increase in sentence recognition, and they’re doing better in noise, and they’re understanding fast talkers, and things start going a lot better for them. I think we’ve got when I look at that data on return rates, I also think about in the draw rates, because it’s the other side of the same coin. Just because a patient didn’t return them doesn’t mean we all know. It’s over 15% of our patients, one out of six or more, is the data I’ve seen, are putting their hearing aids in the drawer. And so if they’re not putting them, or they’re not wearing them all the time, maybe they’re only wearing them two hours a day, but they should be wearing them 10 or 15 hours a day. That’s also a failure. That’s also a hearing aid rejection, and and I think laced is we don’t have that exact date on in the drawer rate, but I think it’s easy to to make the leap from the return rates are decimated, so probably the in the drawer cases are also being equally improved. And I’ll take us back to even a kind of a first principle study without lace, because Robert mentioned, you know, somebody can read a newspaper and get a benefit. If we look at the Help Program, they looked at 7000 patients. They give them three one hour oral rehab classes, and they found that that reduced returns 3x just that little extra ro rehab. And so audiologists don’t have the time to do three extra hours of appointments for every patient. They give hearing aids. Just most of them don’t. Most of them won’t. They may do it for fittings or return appointments, but they’re not going to do it as part of the affirmation phase, and that’s where lace makes it, makes it possible, and the data has overwhelmingly supported that. And then, just to the other side of your question, David, about new data, it’s very exciting. I’ll just say that we have a patent pending. We’ve got some really exciting ideas around how we can leverage that data with AI. And I’ll give you a little hint in that we’re because we’re generating all the content. We know everything your patient has heard, which means we understand the sentence complexity. We know the phonemes they’ve heard. We can ultimately kind of, kind of bring together bottom up and top down approaches in a way that still does the classical lace focus on leveraging context and leveraging your whole brain to understand what’s going on. And so for me, that’s that’s the really exciting thing about the data that’s starting to come
Dave Kemp 27:39
in. That’s really Oh, you
Robert Sweetow, Ph.D. 27:41
know, also, um, I would point out that, you know, one of the things that we learned as we were doing it is that actually audiologists in other countries, well, for example, in the UK, they have hearing therapists and so, you know, they and here in in our world, or in the United States anyway, that I think there are as at least as many speech language pathologists who are doing some kind of aura auditory training program as there are audiologists. Audiologists don’t have time to do it number one, and they just, you know, just didn’t show the same kind of interest at the time. Yeah. And the other thing that’s interesting when I think back on it, is that, you know, we recognize that hearing takes place, you know, there’s, there was kind of a cower that I know I used to present in my in my talks, where I said hearing is the most basic element of communication. It’s just having access to acoustic information. Once you can hear, then you have to listen. And if you’re going to listen, that requires both attention and intention and so and not everybody who is a perfectly good hearer or has perfectly normal hearing is a good listener, as you know, many spouses can tell you, and things like that. And then even if you can hear, and even if you’re now a good listener, then you still had to have the comprehension. And at the time, of course, we in audiology, when we developed lace, no one was talking about the relationship between cognition and cognitive deficits and hear it, which now you know is, has become a obvious. So you know if you hear and if you listen, and if you can comprehend, if you can, you know, interpret that the input properly. Then the final point in this, in this hierarchy, is you had to use effective communication strategies, because no matter how good of your hearing or listening you were, there was going to be some level of distortion coming in, whether it’s because of background noise or because of your attention or something like that. And so, you know, that also became a very essential part of the. All of this,
Dave Kemp 30:01
yeah, it’s, I mean, the cool thing with this, I feel like, especially for you Robert, is, you know, you had the vision in the right idea, but I think that it sounds like this neuro town AI group has really helped you to bring a lot of this stuff to life in a way that, you know, it was like, how do you actually execute upon this vision? And, you know, we’ve touched on a couple things that I think are just, like, highly relevant, which is, you know, the audiologist, it’s like, there’s not enough time in the day, kind of thing, right? There’s always, it’s like, there’s always kind of this, you know, dilemma of, do I have enough time to go around, even for my existing patients and all that. And so I feel like one of the biggest objectives that I sort of hear from vendors like you all is that, you know, it’s hard to get people’s attention when it’s just another thing, right? And it’s like you’re expecting me to have to now increase the workload more or less, when I’m already, you know, I have a scarcity, but I think that what’s fascinating about this is that, you know, if it can be effectively triaged to an app, more or less, you know, really, what the audiologist, I think, then, is doing is they’re provisioning this, and they’re, they’re the ones to help, to educate the patient, to say, look, you know, the journey doesn’t really stop at the point of purchase of The hearing aids. That’s kind of the beginning point. And I have to imagine that there’s probably some psychology to that whole reduction in return rates beyond just the science of improving is when you give people that ability to have some you empower them, you know, with like you actually can take control here, and you can do this exercise which is going to help to improve it. You’re ultimately empowering them. And I feel like that’s probably a huge part of this too, is that it gives like, I think Robert you mentioned, you know, it allows for them to really participate in this, in this exercise. And so I think that it’s really cool to hear that you’re enabling that whole scenario in a way that’s scalable, not just scalable across patients, but also it’s something that you can present to an audiologist in immediately, sort of address that number one concern, which is going to be, I don’t have enough time in the day and and to say, look, this is something that you can you can include in that sort of narrative when you’re doing that initial fitting, to help them to understand that there’s more to this than just like you said, hearing right? You’re not just turning up a knob and and I feel like that’s just so relevant today, where I feel like, you know, one of the biggest challenges that the audiologist really faces is, how do I differentiate in the market that is becoming increasingly it’s feeling more commoditized, and so I feel like you need to really stand apart. And what better of a way to do it than, you know, things like this, where it really does come at it from a clinical standpoint. You know, there’s a lot of clinical data that supports everything here, but now you’re able to do it in this, like, kind of gamified way that’s more, I guess, like in, you know, a little bit more, I guess, appealing to the to
Miles Aron, Ph.D. 33:08
the patient. You know, one
Robert Sweetow, Ph.D. 33:09
of my visions that I would really hope for, and, you know, and I’m hoping that the new lace really allows for this, is, if you think about other medical practices, or paramedical practices. I just had my shoulder replaced a few months ago. I wouldn’t have dreamed to not do physical therapy, and there’s no way that the surgeon would have not recommended physical therapy, you know, because no matter how good the surgery was, to get into the physical therapy, you weren’t going to get the proper outcome. And yet, that still has been a very difficult selling point to the audiologists to realize that what’s the difference here? You have a you had a physical deficit. It’s been helped with some kind of prosthesis, in many cases, and in some cases with no prosthesis. But then why not complete the journey with with therapy? And so that’s what I hope, really is our goal.
Miles Aron, Ph.D. 34:12
Yeah, I think, I think you outlined it really well. David, you know, I was talking with Jen, and one of the things she said is that she was sitting on data that she’d never actually published because she was actually concerned that audiologists would be afraid of it. And I think she presented at a conference years ago and decided not to publish it, but, but I’ll say it here, which is that lace actually reduced the number of appointments, return appointments for, you know, checkups and fittings, because the patients were just happier and so the time arguments really interesting, because by simply giving them the software, you actually free up more appointments for for new hearing aid fittings and and I would, I would ask us to take a look at the alternative to as audiologist. So what happens? So you know, it doesn’t just start with the hearing aid journey. The hearing aid purchase. What happens to all the patients that come in? You’re not going to your audiologist for fun, as fun as it is. And so you come in because you’re having some trouble, and they tell you, Oh, you’ve got mild hearing loss. You’re not ready for hearing aids yet. And then they’re like, come back in a year. And and of course, there’s, I’m not trivializing. We look at vestibular issues, we look at, you know, potential conductive hearing loss and so on, but nine times out of 10 that person is going to come back in here for a checkup. What if they could leave with something to take that journey into their own hands? What if they could start to do early intervention and preventative care? And then you look at people that are coming in and saying, You know what? Hearing aids are just too expensive today, or I’m not ready to wear them. It’s going to make me feel old. Those people maybe you can’t break through. And yeah, hopefully they’ll come back in a year. But like you said, the competition is intense. Maybe they’ll go to Costco for their first set, and then they’ll be back in your office in three years, and so we missed that whole opportunity for better care. And so I think lace also fits into to the journey for those folks. And I also think there’s a whole suite we’re seeing. It’s getting recognized more and more now, this Hidden Hearing Loss Group. We all know about APD and auditory processing disorders, but also hidden hearing loss. And you know, if that’s maybe 10% of the appointments coming in or something, those people are leaving without a solution if you’re not doing in office, Ro rehab. So this is the way that you give them any treatment. So a lot of the time, the alternative is simply nothing, and or it’s just come back in a year. And I think as a field, we just need to do better for those patients. We need to have something to give them. And I think our rehab is is the best answer we have right now, is the field and and our focus is to make it better and better and better and better. And always do that on a foundation of research, which is, you know, part of why we brought Nancy on with amtify and and certainly why Robert and Jenner motivated as well.
Dave Kemp 37:04
So if I’m a clinician practice owner and I’m interested in this, walk me through what the actual sort of like details are of how this gets introduced into a clinic. You know, like, what is the actual provision of this? Is it as simple as, hey, download this app, and here’s the sign up and and then what’s that patient expectation? Just kind of help me understand exactly what’s being communicated. To call it a new, you know, narrow tone. Customer,
Miles Aron, Ph.D. 37:35
sure. Yeah. So first, I’ll mention that the the licenses for patients are lifetime licenses, so there’s no monthly issue there. Like we give patients the software for life, and we all the upgrades that come with it. We’re gonna, we’re gonna single purchase, single purchase, just just like your hearing aids, except it actually lasts forever, and for the audiologist, we are selling them licenses at a very discounted rate and then giving them they are marketing it up so that it’s always profitable for audiologists. They should always be. We should always be a new revenue stream, just like hearing aids are. So we’re trying to figure out how to position RL rehab as like a second tool in your toolkit, if you’re an audiologist. And then all of the kind of advice and training and things like that are in the app. So when the patient gets the app, there’s an entire Learn section, and it’s got tons of video content that’s from Dr Jennifer Henderson, save us his actual course on RL rehab. And then we’re bringing in APD curriculum and cochlear implant curriculum and more hearing aid tips and more communication tips from the original lace and new ones as well. So the idea is, you’ve got your audiologist in your pocket, and critically, it’s tying the patient back to your practice. And so actually, the app is not you’ll never see neuro tones logo anywhere. You’ll never see lace. What you see is the name of your practice. It’s white labeled for the audiologist. And everything we’ve done in there is to strengthen the doctor patient bond. So we’re doing things like kudos and notifications, but they can come from your provider, not from us, and those are things that the audiologist can fine tune in a back end system to make sure it reflects the way they want to communicate to their patients. But I think that that’s one thing they’ll find there’s so many little things we put in to make make it easier on the providers. And one, just one example that would be no passwords. When we looked at the original lace, we looked through every support ticket that ever came and we said, Why are what are people complaining about? Let’s just fix those. That makes sense. You’d be shocked. 90% That where I forgot my password? Yeah, and so we got rid of passwords, and now you log in with your phone number or email, you get a one time key, and it keeps you in for as long as you as as we can and and that’s it. And we do other things, like we have the app address you by name when it knows your name. And we’re working on getting to more and more names, but I think we’ve got about 80% of the names now. Yeah, I can say we make it extremely accessible. So there’s almost only ever two buttons on a screen, and they’re pretty big. So like, this is designed for it’s great for people in their 30s and 40s to use, but it is designed to be compatible for people in their 70s and 80s, too, and 90s. Hey, we got people in our their 90s using it as a lot.
Dave Kemp 40:48
So is the what’s the patient expectation, though? Is it you need to be doing this once a week for the next 12 weeks? Or help me understand that? Yeah,
Miles Aron, Ph.D. 40:59
and so Robert can probably speak to the data here, but I believe these the studies have you doing 30 minutes a day for four weeks to see what the clinical benefit you’re seeing in those studies, it’s roughly like six hours of practice. And so we, we are working on features within the app to encourage patients to hit that clinical benefit mark where we know they’re getting, like, the full dose of lace, but if you keep doing it, you’ll just keep getting better, no doubt. And so especially as some of the things like working memory are more related to staving off cognitive decline, and more even early intervention for cognitive decline and things like that. But, yeah, it’s the expectation is that a patient’s gonna go use it. Hopefully they’ll use it, you know, three to five days a week. If they make it 15 minutes a day, they’re still gonna see improvements. We hope they’ll use it for the full 30 minutes, but the bar is pretty low, and I think we just got really lucky that the brain is so powerful that patients can get a benefit with such minimal usage. I mean, it was just kind of lucky that way. I mean, it could have been that you needed two hours a day to see a benefit, and we’d be pushing people to do two hours a day. But the fact is, you get great benefit from 15 or 30 minutes a day. And so that’s just amazing that patients can do that we’re as we start to bring in real time data, which is another project we’ve got, patients will be able to read the morning news or the sports scores. You do that for 15 minutes, and suddenly your communication and listening skills are improving. Of course, we’ve got lots of great content now, but you could just kind of see where it goes. We’re thinking about, how can we give you 15 or 30 minutes that keep you engaged, keep you happy, keep you interested, and really get you that critical dosage lace. Yeah, and I know when we
Robert Sweetow, Ph.D. 42:44
some of the data that we collected on the original lace, back in the early days of it, were showing because we weren’t sure how long a person should have to be engaged in it, we looked at the literature on some other programs and things like that. But over time, we actually shortened as Miles is saying shorten the amount of time that that a patient needed to be engaged in it before their performance level would kind of, you know, level off and so and then the other thing is, again, you know, as Miles was talking about passwords and things like that. When I think back at this, I haven’t thought about this for a long time, but when we originally developed lace, it was on a compact disc. And so, you know, and how many people had Compact Disc players or something, at least, we didn’t put it on beta, which was at least one good thing we did, but it was on a compact disc. And then one of the major hearing aid companies, I guess I could say it, I well, I shouldn’t say who it was, but one of the major hearing aid companies signed a license with the original neurotone, and they but and they labeled it with their company name. They put it on, I don’t even know what you would call it now, like a mini disc. And, you know? And I think what happened was patients would get it, and they would look at this little thing and they would say, Oh, what a nice coaster for my drink. And, you know, the match of day would put it on. And so again, that the technology has just changed so much with con in
Dave Kemp 44:19
a way you were, you, in a way, you were almost tour. I mean, right idea, but like, almost, it was the the stuff that’s really making it work today, like the fact that everybody has a smartphone, that people are very familiar with apps. You were almost a little bit too early with your idea, because now, now it’s, like, easy to not easy, but much more accessible, I guess, than it was back in the day, right? Like there’s just taught us estates a year ago.
Miles Aron, Ph.D. 44:45
I mean, this the where we’re building on the AI stuff we’re building on some of it. It’s like becoming available as we’re building. It’s like in the last year, in the last six months, three months, when we talk about cloning voices of your loved ones and doing that at scale. Like that would have been a whole startup would have been needed with right 50 million in funding, and it still would have been hard to do even just two years ago, three years ago, and now it’s like we’re doing that, you know? And that’s real, like patients today can go train. A student can train with the voice of their professor and learn to hear in school. Someone can train with the voice of their preacher. Some of them can train with the voice of their niece before a holiday party like that’s here, that’s that’s in audiology today. It’s pretty exciting.
Robert Sweetow, Ph.D. 45:28
And just to show how much things have changed over the past 20 years or so, that lace has been since we generated the idea, we actually, in our first papers, had to talk about how many people at different age levels had computers. And I mean, it was, you know, I think it was maybe at the time, 50% of people had computer knowledge and things like that, as opposed to today, where you got to figure 95% of people or something like that. But we literally had to publish, because we had to sell the idea that a computerized program would be available to people.
Dave Kemp 46:10
Yeah, I mean, I like, I’m getting really excited about this, this whole thing, because, you know, just like you said miles, like you can now through some of these new, you know, sort of like technological enablements. You’ve, you’ve got the ability where you can do the voice cloning, or you can do this, you can feed it through, you know, you can take any, it sounds like, any kind of like, you know, piece of content, and feed it through this thing. And so I look at this, and I’m like, you know, if you’re a provider, how exciting is this, that you can basically make this a an add on that, you know, is going to reduce your return rate. It’s going to free up more time. It’s going to differentiate yourself. It’s going to provide your patient with, you know, the ability to kind of have some control and some say in this whole thing, to where, you know, hey, look, you know, you’re purchasing this, what is probably the third most expensive out of, you know, out of pocket cost, unless you’re using insurance and you have some benefit. But, you know, this thing that’s like, a really sizable investment. And, you know, in order to maximize that, you know, I recommend that, you know, do you like listening to the, you know, the morning news like, you know, here, here’s how you can do it through this thing. Feed it through there. And, you know, almost, you know, subconsciously, you don’t even realize it, but you’re, you’re kind of like, you know, exercising this whole, you know, aspect of your brain. I just look at this and I’m like, it is cool to kind of see this confluence of things all come together and enable this in such a way that where Now this actually seems feasible where you could as any kind of provider, you could make this a part of any hearing aid sale, and it just, I feel like it, it’s the type of thing that it really strengthens that value proposition of buying it from the provider, right, and seeking out a provider and having them really educate you on, Like, here’s what’s happening when you’re when you’re doing this exercise, and here’s the concept of our rehabilitation and helping people to understand that, you know, like, you’re not just buying an amplifier. So like, for those reasons, I look at this and I’m like, this is a really exciting step for the profession, in particular, obviously, for the patients, but for the profession, because I think it gives the profession a stronger leg to stand on as to in this world that’s like, you know, OTC, and you can do it yourself and all that. And almost in a way, trying to circumvent the professional, I feel like this is kind of helping to to really make it clear, like there are very clear advantages of going through a professional
Miles Aron, Ph.D. 48:41
I’m so glad you said that, and we really intentionally decided to partner with independent private practices first and foremost. And we haven’t partnered with any of those other big companies or OTC. I don’t know that. You know, maybe we will in the future, if it makes sense, but, but our focus right now is 100% private practices, and it’s working with providers and doing exactly what you’re saying. Our mission is to get auto rehab to as many patients as could benefit from it. And in our view of that, it’s not that AI is going to take over, it’s that, it’s that we want to enable the providers, because ultimately, the best care comes from a provider. I don’t want to see a world where a patient gets at everything they need in air quotes through some website. I mean, they have to be connected to a real health care provider, provider and and actually, that’s what lace is trying to do. We’re trying to bolster the industry, give them another tool in their toolbox, make sure any patient that comes into the problem has a much higher percentage of walking away with the solution, and that we can actually help patients adopt more ear hearing aids, help them acclimate to their hearing aids. It really is, is is trying to work with the industry in that way.
Robert Sweetow, Ph.D. 49:58
Miles. Could you address A. Um. As as more modules are added, to late to lace, working memory, speech, reading, very various modules that will eventually be added. How will that work with somebody who’s already obtained their version of lace? Will they be able to get updates or how? Oh, yeah, yeah, yeah.
Miles Aron, Ph.D. 50:22
We’re, I mean, working memory is coming out. I believe this week it’s already in QA and staging. We’re playing with it, making sure it’s ready for release. It should be coming out very, very soon, probably by the time you hear this podcast. And every patient is going to get that at no additional cost. It’s just going to show up on their phones. One day, we’ll send them an email and let them know it’s there. So that’s, that’s the way it’s going to go. And then, you know, we’ve got the competing voices and rapid speech is, is really close behind. Just took, honestly, building this whole platform took a lot of effort, but now building out the modules on top of it’s very quick. So working memory is, is kind of different. It’s a totally new thing. But competing voices and rapid speech are very related to speech and noise. You’ll see those come out in the next, I think month or two, is fair to say, and then, and then things like speech reading, and we’re we’ve got a tinnitus program we’re working on that’s already in testing as well, and we’re looking at doing a lace for kids, all those things that just kind of open up the aperture of of who you can treat and where you can treat them. Well, actually, one of the exciting things there around treating more people is also multilingual support. So we built this from the from day one, with multilingual support built in. We haven’t released it because, frankly, jokes that we wrote in English aren’t funny in Mandarin and and there’s a little work to do there, but we, I mean, we’ve, I could show you videos of of our avatars speaking flawless Chinese and Mexican, Mexican Spanish and all that. But next to that, even for our existing patients, there’s training with different accents, and so I think you’ll see that come certainly this year. I can’t say exactly when, but that’s on the roadmap as well. And all those things will be for free for the patients. And the the only thing I could imagine ever costing anything extra is if some feature we build costs us extra and we can’t support it. So far, that’s not happened. So that’s our philosophy. Is like, let’s get all this stuff to the patients. Well, miles,
Robert Sweetow, Ph.D. 52:26
thanks. Thanks for saying that. Because now, now I know why. When I was giving speeches in other countries, and I would tell a joke, everybody in the audience would look at me like I was nuts. It would boo, you’ll
Dave Kemp 52:41
that’s funny. You know that? Well, that kind of preceded the question I was going to ask, which was, you know, kind of like, what is the, you know, future look like for you all, and as we, as we kind of head into the new year and beyond, so as we come to the close here, why don’t we just say, you know, closing thoughts, you know, whether it’s like, here’s what you should stay tuned for, or what’s getting you really excited about your product? I mean, just from this conversation, I’m excited about this prospect again, of more, more ways I feel like the provider can really elevate their value proposition, you know, and so that, for me, is the number one thing that I’m taking away is like, this is really cool. This is the type of thing that I think is going to really allow the professional to stand apart, and it puts power in the hands of the patient, which I feel like, you know, that level of of, you know, then they’re kind of, they’ve got skin in the game now, I guess, if you will. And I can totally see how that helps to drive down, you know, in addition to the actual science of the improvements that you’re getting, I just think there’s a huge psychological component of that. So closing thoughts from either of you too. Well,
Robert Sweetow, Ph.D. 53:51
I’ll go back to what I started. I think the first thing that I was saying is, you know, Carhartt developed the field of audiology as an oral rehabilitation field, and we’ve and we’ve gone away from that. And I agree with what you were saying, David, that for the industry, for the profession of audiology, it is essential that as OTC hearing aids come out, and as different software programs come out. We, you know, we don’t want audiologists to become what I used to remember as typewriter sales people or encyclopedia sales people, or something like that. And so this really does give them and also give the patient the education that hearing is different than listening, and hearing is only a component of communication, and that, you know, patients don’t come in and say, I want to communicate better. They come in and they say, I want to hear better, and it’s essential that audiologists start to or recognize that they. Need to educate, educate the patient into understanding that it is all about communication. That’s really the reason that they’ve come in. And I think that lace is a real good vehicle to get them into that area.
Miles Aron, Ph.D. 55:18
Yeah, I totally agree and and I would encourage audiologists to look at lace and look at neurotone as as more than just a product. It’s I like. I think it’s a mission, and it’s a movement, and we’re looking for partners like I don’t think of the any of the audiologists as customers. I think of them as partners, and I don’t think we can do this without them, and I think we have to do this together. And it’s like, we all believe oral rehab is better for our patients, and if, if you work with neurotone, we will invest everything we can back into making that a better experience for the patients. And I think that’s great for the field. And so, yeah, that’s that’s my vision. Let’s get on rehab to every patient that could benefit from it. End of story. And I think we’re fully dedicated to that mission. That’s
Dave Kemp 56:08
awesome. Well, I really enjoyed this conversation, guys. Robert miles, thanks so much for coming on. Thanks for everybody who’s tuned in here to the end, we will chat with you next time. Cheers.
