09/15/17

1

2017

Game Changers in Hearing Aids

What is the Impact of Game Changers in the Hearing World?

• Paradigm Shifting

• Connectivity • To Audio Sources

• To Apps

• Between Hearing Aids

• To Professional Services

A Paradox of Game Changers?

Internet Research

Personalization

“Maker Culture”/

DIY

Connectivity

Social Media

…Or a Convergence of Game Changers?

Internet Research

Personalization

“Maker Culture”/

DIY

Connectivity

Social Media

What are the Capabilities of Connectivity Today?

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Connectivity in Amplification

• Environmental classification

• Feedback suppression

• Directionality

• Noise reduction

The Hearing Aid

Sound Connectivity

Made for iPhone®

Personalization

Accessories

• Remote control

• Tinnitus masking

• Special functions

(frequency shaping, geo-

tagging, Find My Hearing

Aid, etc.)

Marketrak 9

76% 78% 80% 82% 84% 86% 88% 90% 92%

Hearing Aid Only

Hearing Aid+Accessory

Hearing Aid+Accessory+App

Satisfaction: Hearing Aid Alone vs. Hearing System

%Satisfaction

Connectivity to Audio Sources and Apps

The challenge

Listening in noise

Listening over distance

Listening in environments with reverberation

And…listening without visual cues

(e.g., phone)

11

An Effective Solution…

12

Improving Signal-to-Noise Ratio (SNR)

Via Wireless Signal Transmission

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Wireless Signal Transmission via Accessories

Wireless accessories overcome many problems that hearing aids alone cannot address:

• Hearing aids continue to become smaller causing difficulty handling controls for people with dexterity issues

• Many hearing aid users have difficulty hearing or understanding television and prefer volume levels that are uncomfortably loud for others in the room

• Hearing aid users often have difficulty hearing on the telephone, particularly mobile phones

• Difficulty hearing in noise where the hearing aid directional microphones are not enough to help the user

Benefit

Users can understand speech in noisy reverberant environments with the addition of accessories to their hearing system.

Signal Transmission

Signal Transmission

Analog Digital

Telecoil

FM

Infrared

NFMI + Bluetooth (open platform RF)

Proprietary radio frequency (RF) 900 MHz

Proprietary radio frequency (RF) 2.4 GHz

Digital wireless can be used for transmission with extra devices and/or between hearing aids (ear-to-ear)

Telecoils

Looping and T-coils

The signal is transmitted electromagnetically, and requires a telecoil in the hearing instrument.

Trans-

mitter

Receiver

Telecoil

Advantages Drawbacks

Improved signal-to-noise ratio

Can install loops pretty much anywhere, including at home

Telephone

Integrated seamlessly into HA

Can still use with earphones with no hearing aid

Convenient

Uses programmable HA frequency shaping

Loop systems in public venues are expensive and require installation of loop

More expensive than FM or IR system

Cannot be used in more than one location at a time, or else interference will occur

Telecoil strength varies across HA models, telephones

FM Systems

Uses radio frequency transmission

Modified or modulates a electromagnetic wave as a carrier of the signal

The transmitter selects the carrier frequency and the receiver must tune to the carrier

Long range (1000’)

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Advantages

Improved SNR

Used personally or with a group

Uses HA frequency shaping

Can separate multiple transmission signals via channels

Doesn’t require installation of loop (like telecoil loop systems)

Drawbacks

Requires use of extra equipment (receiver) even when used with Has

Personal receivers are expensive

Not always secure

Must be tuned into correct channel

FM Systems & Benefits Infrared (IR)

Similar to FM but uses a much higher carrier frequency

Uses AM instead of FM by pulsing the signal through the wave

Operates at almost the same frequency as light, so acts like light

Infrared

Advantages Drawbacks

Improved SNR

More secure than FM

Can be used personally or with a group

Inexpensive (~$40 home, $3000 group)

Can be used with or without HAs

Need line of sight

Does not take advantage of HA frequency shaping

Requires use of extra equipment (receiver, neckloop) even when used with HAs

Prone to interference from other light sources

#1: Automatic Soap Dispenser vs. Wall Heater Remote Control

2 Fun Examples of Interference in Daily Life

#2: “Trick-Or-Treat” Bowl vs. the Sun

Analog vs. Digital

An “apple to oranges” comparison

Both types have pros and cons

Analog- less power consumption, may be better for large environments like theaters or lecture halls, “universal”

Digital- Opens up the world of modern technology to be used with hearing aids, may not require as much “extra equipment”

Listeners can successfully use both types!

Digital wireless transmission

Audio source to accessory

Analog-to-digital conversion (ADC)

Greater the information being sent, the more energy/time it takes to be sent

Must code digital signal to reduce size

Send digital signal to transmitter/receiver

Get the signal from the first device, send the signal to second device

Decode audio signal

Digital-to-analog conversion (DAC)

Hearing aid

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What Else Is There to Know about the

Evolution of Wireless Signal Transmission?

Let’s Talk about Digital Delay!

Delay of Transmission

What is an acceptable delay?

An undesirable lip-sync effect occurs at

120 ms when the visual occurs before

the audio

Sound Delayed with respect to Vision

An undesirable effect occurs at 120 ms when the visual

occurs before the audio

Delay of Transmission

How about an open ear?

So as wireless technology evolved, it became necessary to ensure that the delay was less than 40 ms.

Transmission delay of 40 ms interferes with speech

intelligibility benefit of wireless transmission for

open fittings due to echo (Whitmer et al., 2011)

NFMI

Near Field Magnetic Induction

NFMI systems contain strong transmission energy within the localized magnetic field

The power density of near-field transmissions is extremely restrictive – once you leave the transmission area, the signal strength rapidly deteriorates

The carrier frequency is generally 10-14MHz

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NFMI

NFMI is great for HA-to-device (such as remote control) or ear to ear transmission of audio signals because transmission takes place within a small area (around 1m)

Acceptable power consumption for hearing aid

Signal is strong within transmission area, is weak enough outside area to decrease chance of interference with other WL signals

BUT- long-range signals cannot be transmitted using this technique

NMFI combined with Bluetooth (RF)

Bluetooth radio frequency is used for communication between audio source (such as cell phone) and a gateway device (streamer)

NFMI transmission is used between the streamer and hearing aids

Streamer is typically worn around the neck as the hearing aids/user needs to be within the NFMI field

Near Field Magnetic Induction (NFMI)

A/D

Bluetooth

Coding

Bluetooth

Decoding

NFMI

Coding

2.4 GHz 2.4 GHz

Bluetooth radio frequency is used for communication between an

accessory and a “Gateway device” and NFMI transmission is used

from the “Gateway device” to the hearing instruments.

NFMI Combined with Bluetooth

• Considerations for this approach:

• Need to wear the gateway device around the neck

• Sound quality can be affected by orientation of the gateway device and HA

• Sound quality can also be affected by the delay of additional components

Why is it called Bluetooth?

Fun facts:

Named for the 10th century Danish King, Harald "Bluetooth" Gormsson, that united warring tribes

His initials (in runic alphabet) make the logo

His nickname is thought to have come from a darkened front tooth as a result of fight or battle

The Bluetooth technology was developed by Ericsson in 1994

What is Bluetooth?

Bluetooth is a unique wireless technology intended to realize three objectives:

Eliminate the connection of wires

Allow multiple devices to be connected at the same time, and to function as an intelligent whole

Make location centric connectivity seamless

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Proprietary Radio Frequency Systems

A/D

Proprietary

Coding

Proprietary

Decoding

2.4 GHz

900 MHz

866 MHz

2.4 GHz

900 MHz

866 MHz

Wireless Systems based on Proprietary Radio Frequency (RF)

• The proprietary RF system uses a radio to generate an electrical wave and an antenna to send the information. This type of transmission is referred to as “far-field”

• The electrical wave carries the information

• Uses ISM bands - Industrial, Scientific and Medical Frequency Band

ISM Bands

• ISM bandwidth is defined by the ITU-R (International Telecommunications Union) for radio communication.

• Higher frequency transmission allows for greater data transmission.

• A trade off exists between amount of data transferred and current consumption.

• 900 MHz (US, Greenland, & some eastern Pacific Islands)

• 868 MHz (EU)

• 2.4 GHz (Worldwide, no geographical limitations)

• Primary drawbacks are:

• Battery drain or power requirements

ISM Bands

Why Doesn’t 2.4 GHz or Proprietary RF Require

a Body-Worn Streamer?

Conventional wireless transmission hits the thermal noise floor at 1 meter.2.4 GHz transmits as far as 10 meters before it hits the thermal noise floor.

Uses frequency hopping to transmit packets of data

Can use up to 79 frequencies (1MHz intervals) in the 2.4GHz spectrum

Personal network for up to 7 devices in theory

2.4 GHz radio frequency

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freq

uen

cies

headset

Wireless mouse

Mp3 player

Cell phone

HAs

HAs

headset

Mp3 player

Mp3 player

HAs

Wireless mouse

Cell phoneCell phone

Cell phone

HAs

headset

headset

Devices agree on transmission frequency to send

and receive each small data packet

time

2.4 GHz radio frequency Antenna in Hearing Instrument

HI built-in

antenna

The Reception

“Doughnut”

Flexible antennaAntenna45 mm long

Antenna in Proprietary 2.4 GHz TV / Audio Streamer

Hold it!

• So what is the difference between proprietary 2.4 GHz wireless and Bluetooth?

• They are transmitting in the same frequency band (2.4 GHz), they are both based on radio frequency

• But the protocols, or the rules guiding the data transmission, makes our RF transmission proprietary

• Bluetooth is an open platform, meaning many devices can use it

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Bluetooth Smart

• Introduced in 2011

• Contains a low energy feature that has enabled a new breed of products that can communicate wirelessly for long periods of time without requiring much power

• Products include fitness monitors and many others. They can transmit data to Bluetooth Smart Ready devices, such as PCs, tablets and smartphones.

Digital Wireless Transmission: Bluetooth Low Energy

2014

Bluetooth & Bluetooth Smart

• Latency for Bluetooth protocol exceeds 40ms and is often up to 125ms depending on the audio compression technique used

• Combinations of the streamed sound with amplified sound or direct sound of this magnitude are perceptible as echoes and even lip synch issues when watching television

• Even small delays, though not consciously perceived, will cause a mismatch between audio and visual signals has a significant negative impact on the television viewing experience (Reeves & Voelker, 1993)

• Bluetooth Smart eliminated the ‘audio’ channel to allow for fast and efficient transmission of data

Some 2.4 GHz Languages

2.4 GHz

Proprietary

Language

Apple

Audio

Streaming

Bluetooth

Smart

End User Benefits

Wireless Fitting: Benefits for Fitter and Patient

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NEW Noahlink Wireless Who can benefit?

Problems Solutions

Feedback on the phone

Family member says TV is still too loud/can’t hear TV

Can’t hear speaker in church/lecture/meetings

Can’t hear in noise (car or restaurant)

No need to hold the phone to the ear

Sound is processed through the HAs

Listen can receive the signal of interest from mouth to ear

Impact of Improving Multiple Environmental Listening

Utility (MELU) on Overall Satisfaction

(All hearing aid owners n=2,572)

918 19

27

37

5158 56

66

78 7782

89 90 89

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Number of Listening Situations Satisfied

% S

ati

sfa

cti

on

Kochkin (2005) MarkeTrak VII

Who Would Benefit from a TV Streamer Accessory?

Couples who disagree about TV volume

Any end user who struggles to understand what is being said without closed caption activated on theirtelevision

Who Would Benefit from a Phone Accessory?

Any user with a Bluetooth enabled phone who has difficulty understanding speech on the phone when using other methods (unaided, acoustic phone program or telecoil)

Any user who would like to talk on the phone hands free

Who Would Benefit from a Remote Control?

Any end user wishing to make changes to the hearing instrument settings discreetly, without having to draw attention to the hearing instruments.

Any end user with manual dexterity issues limiting their range of motion for their arms or who have difficulty finding or feeling the hearing instrument controls with their fingers.

Any end user who has selected a micro hearing instrument model for cosmetic reasons and who wants to be able to make changes to the volume and program settings in the device

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Who would benefit from a Remote Microphone Accessory?

Anyone who wants to make listening easier in noisy situations or at a distance

Anyone who has one or more situations they struggle with despite hearing aids

The 2.4GHz Wireless Revolution Made for iPhone (Mfi)

- A direct connection to everything they love

” ”

GN ReSound, all rights reserved. Apple, the Apple logo, iPhone, iPad and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries.

Apps Offer…

Convenience

Internal locus of control

More personalized settingsVolume

Bass/treble

Favorites

Geo-tagging

Favorites

Three-dot menuMap view Detail viewList view

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Lab Test Results: Directionality, FM and Remote Microphone

Comparison

-18

-16

-14

-12

-10

-8

-6

-4

-2

0

AdaptiveDirectionality

FM system +HA mic

Remote mic+ HA mic

SNR

(d

B)

Lab Test Results: Distance

-25.0

-20.0

-15.0

-10.0

-5.0

0.0

1.5 metersdistance

3.0 metersdistance

6.0 metersdistance

Adaptive Directional SNR

Wireless Remote Mic SNR

Wireless Remote Mic + HIMic SNR

Updated Proof of Benefit Testing

• Objective:

• To validate the speech intelligibility benefit obtained with a newer wireless remote microphone, as compared to directionality alone.

• To compare speech intelligibility benefit of a newer remote microphone with a newer FM system.

Methods

• Test material

• Dantale II test material (Wagener et al, 2003)

• Test setup

• The Dantale II material was presented from a Brüel & Kjær head and torso simulator (HATS).

• The external microphones were placed on the torso of the HATS

• The speech intelligibility tests were conducted with a fixed speech level of 55 dB SPL, while the noise level was adaptively varied to find the SRT.

Updated Proof of Benefit Results

• Wireless remote

microphone

provides 15dB

more SNR benefit

than directionality.

• No significant

differences in

speech

intelligibility

between updated

remote

microphone and

updated FM

system

technologies.

Remote

MicFM

System

Directional

Mics Alone

SR

T (

dB

SN

R)

Benefit of Remote Microphone and Bimodal

Wolfe, J. Cochlear Wireless Accessories for Bimodal Users. Presentation, San Antonio, TX, 2015.

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GN ReSound, all rights reserved. Apple, the Apple logo, iPhone, iPad and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries.

(Jespersen & Kirkwood, 2015)

Benefit of Phone Accessory vs. MFI Streaming of FaceTimeTest Condition 1: Acoustic Phone

Unilateral Audio

Test Conditions 2-3:

Phone Accessory, Audio Only

Unilateral Streaming Bilateral Streaming

Test Conditions 4-5:

Phone Accessory, Audiovisual

Unilateral Streaming Bilateral Streaming

Test Conditions 6-7:

MFi, Audio Only

Unilateral Streaming Bilateral Streaming

Test Conditions 8-9:

MFi, Audiovisual

Unilateral Streaming Bilateral Streaming

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Test Participants

15 individuals with severe-to-profound hearing loss (10 male & 5 female)

Median age: 77 years

Median years of experience with amplification: 32

(1st quartile: 25; 3rd quartile: 39)

Test Setup

Testing was done in a sound treated room with a loudspeaker setup as shown below:

45°

315

°

225

°

135

°

Test Material and Procedure

Test material

Dantale I speech material

Procedure

9 phone conditions completed over 2 sessions (counterbalanced test order).

Each session initiated with two training rounds; one being the audio only signal and one being the audiovisual signal.

Aim to obtain a percentage correct score for each test condition.

Speech and noise presented at constant SNR level of either 10/13/16/20 dB. The SNR level at which the participant had around 60% correct with the audio only signal was chosen.

Results:

Unilateral Audio Conditions (n=15)

6%

45% 45%

0%

20%

40%

60%

80%

100%

Acoustic Phone AudioUnilateral

Phone Accessory AudioUnilateral

MFi Audio Unilateral

Mean

Perc

en

t C

orr

ect

The Phone Accessory and MFi phone handling strategies provide a

significant benefit compared to acoustic phone, even in the unilateral

condition.

Results:

Benefit of Bilateral Streaming (n=15)

55%

65%

0%

20%

40%

60%

80%

100%

Unilateral Streaming Bilateral Streaming

Mean

Perc

en

t C

orr

ect

A bilateral phone handling strategy provides an average significant benefit

of 10% for both wireless connectivity solutions (Phone Accessory & MFi)

compared to a unilateral strategy.

Results:

Benefit of Visual Information (n=15)

48%

71%

0%

20%

40%

60%

80%

100%

Audio Audiovisual

Mean

Perc

en

t C

orr

ect

A visual phone handling strategy provides an average significant benefit of 23% for

both wireless connectivity solutions (Phone Accessory and MFi) and in both the

unilateral and bilateral condition.

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Results:

Benefit of bilateral- & visual information (n=15)

6%

78% 77%

0%

20%

40%

60%

80%

100%

Acoustic Phone AudioUnilateral

Phone AccessoryAudiovisual Bilateral

MFi Audiovisual Bilateral

Mean

Perc

en

t C

orr

ect

A bilateral, audiovisual phone handling strategy provides an large significant

benefit for both wireless connectivity solutions (Phone Accessory and MFi) as

compared to the traditional phone use solution.

What It Really Means

Pilot Study: Remote Control Apps as a Way of Helping Patients

Accept Prescriptive Targets?

• Why?

“What if it’s too loud?”

“I don’t want to have to

come right back to have

the volume changed

right afterwards!”

Why Was the Study Conducted?

Purpose: Evaluate the impact of clinician-directed versus patient-directed hearing aid gain settings, via real-ear insertion gain measurements.

Group A: Traditional fitting method, where the audiologist asked “How Does It Sound?” and made adjustments to the fitting through the fitting software based on patient’s initial reactions.

Group B: Patients were fitted with hearing aids pre-programmed to target settings, and then muted and the app volume set to the lowest level. They were then asked to increase the volume on the app to a comfortable level.

Differences in Patient Engagement were intrinsic to the design of Group A vs. Group B interactions.

How Does

it Sound?

Increase the volume so

that it’s comfortable and

helps you hear well

iPhone for

patient to

adjust volume

during fitting

Group A

Group B

Research Question: How do the Fitting Methods Influence the

Hearing Aid Gain Settings?

Null Hypothesis: No Difference in Final Gain Settings between Groups

Started at experienced target

settings.

Hypothesis: Will end visit with

decreased gain settings with

respect to target gains.

Started at experienced target

settings, but muted and with app

VC at lowest point. Unmuted

hearing aids and asked to adjust

to a comfortable yet beneficial

level.

Hypothesis: Will choose to

increase gain settings to about

the same level as Group A.

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Participants

• 14 participants completed the pilot study.

• Ages ranged from 50-81 with and mean of 67 years.

• All were experienced with amplification (a mix of manufacturers).

Results: Group A Subjects Wanted Less Gain than Targets

Results: Group B Subjects Increased Gain to Prescribed

Target Levels

Connectivity Between Hearing Aids

Connectivity and programming

Convenience features

Synchronized volume control and push button

Automatic telephone handling

Enhanced signal processing

Using wireless capability to make a feature work better/provide better benefit, e.g., Coordinated automatic directionality, coordinated tinnitus sound generator

“Binaural” processing

Using exchange of data for streaming or enhanced signal processing to do any or all of the following:

Maximize speech audibility

Maintain listening comfort

How is Wireless Used in Our Industry?

4 Goals of Wireless Technology in Hearing Aids Today:

Re

qu

ire

s e

ar-

to-e

ar

wir

ele

ss

tra

ns

mis

sio

n

Speed of Ear-to-Ear Transmission

• How fast is it?

• Actual transmission of the signal is 108 m/sec (the speed of light)

• How long does it take for the signal to be transmitted?

• There is a delay that involves processing of the action to initiate the transmission.

• For exchanging data about the environment, this involves the time for each hearing aid to update the analysis of the environment, and then for the hearing aid to initiate the transmission. Therefore, about 1-2 seconds.

• For user actions like VC and program changes, some processing also has to occur in the hearing aid for it to initiate the transmission.

• Plus, for this VC and program changes, there is commonly an added delay of about 400 ms to avoid the beeps being on top of each other on the two ears.

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Speed of 2.4 GHz Ear-to-Ear Transmission

• How long does it actually take between the time a signal is initiated on one ear and received on the other?

• This is variable and depends on the individual and the environment.

• The device initiating the action will continue to send the data packages of info to the other ear until the other ear says it got the info.

• There is a time out on the order of up to 120 seconds.

• After this limit is reached, the HI will stop trying to send the info (until a new action is initiated).

• For user operations like VC and program change, the shortest possible time would be around 400-500ms because of the built-in delay.

• If there is no acknowledgement from the receiver ear by the end of the time-out period, the transmission is cancelled.

Why the Redundancy in 2.4 GHz Ear-to-Ear Transmission?

1. 2.4 GHz does not travel through or around objects easily.

• The antennae are designed in such a way that they point the signal to refract around a surface rather than just directing into free space.

• This means it works well for most people, less great on others.

Why the Redundancy in 2.4 GHz Ear-to-Ear Transmission?

2. Environments that provide no surfaces for reflection of the transmission can degrade performance, so there can be more variation depending on where you are.

• Easier to get reliable e2e performance in a building than in an open park!

3 Tactics to Achieve These Ear-to-Ear Goals:

Mirror operation from one side to other

Synchronized volume control

Steering of other algorithmsAutomatic directional steering

Binaural compression

Streaming of soundSound is streamed for other ear for audibility, or is used for enhanced signal processing

• CROS

• Coordinated automatic directionality

Connectivity to Professional Services

What are the Demands of Hearing Healthcare Consumers?

• Growing body of research

• Information searching on a topic of interest: Top online activity for Baby Boomer or seniors via smart phone or tablet (IPSOS and Google, 2013)

• Significant number of study participants willing to use telemedicine for audiological care (Eikelboom and Atlas, 2005)

• Reasons?

• Reduction of waiting time for appointments

• Reduced costs

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What are the Demands of Hearing Healthcare Consumers?

•Perceptions of internet-based hearing instrument acquisition

• 18 experienced HA users

• Results:

• Participants noted greater convenience for fitting and follow-up needs

• E.g., fine tuning in real-world listening environments with professional guidance

• HOWEVER…

• Patients preferred audiologist expertise to pure online solutions

• Patients expressed trust in audiologists over online retailers

Chandra N, Searchfield GD. (2016). Perceptions toward internet-based delivery of hearing aids among

older hearing-impaired adults. J Am Acad Audiol 27:441-457.

Our Patients Need and Want Us!

Humes L, Rogers S, Quigley T, Main A, Kinney D, Herring C. The effects of service delivery model and purchase price on hearing aid outcomes in older adults: a randomized double-blind placebo-controlled clinical trial. American Journal of Audiology. 2017; Accessed online on March 10, 2017 at: http://aja.pubs.asha.org/ epdf.aspx?doi=10.1044/2017_aja-16-0111.

Reprinted version in ASHA Leader

Paradigm Shifting: Patients as Consumers

• Examples:

• Ratings and surveys of medical professionals and facilities

• “How long was your wait time before seeing the doctor?”

• HealthGrades and other online ratings for providers

• Price-shopping

Paradigm Shifting: Patients as Consumers

• Examples:

• Ratings and surveys of medical professionals and facilities

• “How long was your wait time before seeing the doctor?”

• HealthGrades and other online ratings for providers

• Price-shopping

Greater Patient Engagement

How Can We as Hearing and Health Professionals Meet These Changing Needs?

• Greater patient engagement

• Better goal achievement and functional outcomes have been attributed to patients and their families becoming more actively involved in the process

Turner-Stokes L, Rose H, Ashford S, Singer S. (2015). Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitation. International Journal of Therapy and Rehabilitation 22(5). Accessed online on July 6, 2016 at: http://www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2015.22.5.210.

• Engaged health care recipients are proactive

• Tend to achieve better outcomes than those less engaged in their care

Hibbard JH, Greene J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2):207-214.

Financial Link to Patient Empowerment

• 33,000-patient study on patient empowerment

• Patients with lowest “activation” or engagement score on a survey had significantly higher costs

• Why?

• Increased need for multiple follow-up visits

Hibbard JH, Greene J, Overton V. (2013). Patients with lower activation associated with higher costs; delivery systems. Health Affairs 32(2):216-222.

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Professional Guidance

• Of course, not EVERY individual is the best candidate for self-engagement

• Professional responsibility to consider the individual patient when determining how best and how much to promote self-engagement

• BUT, professional support to encourage greater engagement and understanding can actually increase a patient’s activation level

(Hibbard JH, Greene J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2):207-214.)

• Since many patients are already online and making active choices about providers and services, it may make sense to promote higher levels of engagement

Audiological Touchpoints that Currently Promote Patient Engagement and Satisfaction

• Increased satisfaction and reduced return rates due to

• Verification measures

• Outcome measures (questionnaires, sound field SNR testing)

Valente M, Potts LG, Valente M. (1995). Signal testing approaches; clinical procedures to improve user satisfaction with hearing aids. In: Tobin H, ed. Practical Hearing Aid Selection and Fitting. Baltimore: Department of Veterans Affairs: Chapter 6.

• Patients’ self-perception of benefit and satisfaction

• Counseling

• General communication between patient and professional

Street RL, Makoul G, Arora NK, Epstein, RM. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling 74(3):295-301.

Strom KE. (2005). HR interviews Sergei Kochkin, PhD. Hearing Review, 12(11):24-32, 82.

Even When Programming and Fine-Tuning the Hearing Aid?

• Survey of 100 hearing aid users

• 90% said they wanted to be more actively involved in the HA fitting process!

Schweitzer C, Mortz M, Vaughan N. (1999). Perhaps not by prescription—but by perception. High Perform Hear Solutions 3:58–62.

More Personalization = More Engagement!

• Greater value shown to be perceived for products or processes in which the user had a role in creating

Norton MI, Mochon D, Ariely D. (2012). The “Ikea Effect”: When labor leads to love. Journal of Consumer Psychology 22(3): 453-60.

• In the realm of hearing aids, user-controlled apps and “favorite” settings can achieve the same effect

STRICTLY CONFIDENTIAL / FOR INTERNAL USE ONLY

Patient Hearing care

professional

Fitting

software or

web portal

User app

Cloud

Hearing care

professionals’

benefits:

• Higher user

satisfaction

• More efficient clinic

management – with

more time for

valuable counselling

• Reduced return

rates

Users’ benefits:

• More efficient fitting

process – with

intuitive, on-the-go

fine-tuning

capabilities

• Better fit and

consequently better

sound quality

Online Services

Personalization + Convenience + Professional Care

Connectivity to the Audiologist Adds Up

Better hearing

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Connectivity to the Audiologist Adds Up

Better hearing

Better hearingGreater satisfactionMore likely to purchase

Connectivity to the Audiologist Adds Up

Better hearing

Better hearingGreater satisfactionMore likely to purchase

Better hearingGreater satisfactionMore likely to purchaseBetter relationshipsGreater convenience

Game Changers in Hearing Aids

CONNECTIVITY