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Human Link Conference emphasizes need to match technology to the individual person

Hoffmann, Candace

doi: 10.1097/01.HJ.0000294499.17411.8d

Audiologists could learn a thing or two from Harley Davidson, a marketing professional said at Oticon, Inc.'s Human Link conference held November 4–6 in Fort Lauderdale, FL.

“They don't sell motorcycles, they sell a lifestyle,” said Stephen W. Brown, PhD, professor and director of the Center for Services Marketing and Management at Arizona State University.

While a hearing aid is certainly not as sexy as a motorcycle, the profound effect hearing loss has on quality of life means that a hearing device does as much for self-esteem and keeping people involved in the mainstream of life as the notorious “hog.” So, the question Brown posed is, why aren't more people exploring options to help their hearing loss?

At a time when most businesses catering to the aging population are experiencing record growth, one is not, Brown told listeners. Yours.

“Statistics show that only one in five people with hearing loss seeks hearing instruments as a solution,” he said. Perhaps, he suggested, it is because practitioners often place more emphasis on technical advances than on consumer education.

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In keeping with Oticon's Human Link approach to hearing care, speakers at the meeting attended by over 600 professionals from 25 countries explored new audiologic technology and especially how it is inextricably bound and influenced by the human element in the chain.

Donald Schum, PhD, Oticon's director of audiology, said that audiologists need to address patient expectations and prepare them for success with hearing aids in the initial encounter.

To build trust, we need to give patients realistic expectations during the fitting session, he said. In tracking patients over several months after the fitting session, Schum found that patients reported receiving less benefit from their hearing aids than they expected at the outset. “It's important to keep in mind that some patients will be looking for things you cannot provide,” he advised.

Building trust and patient loyalty and convincing patients that this piece of plastic you're inserting into their ear really is a good thing can be undermined if they are not prepared for what they are about to experience, he said.

“When you fit a hearing aid, are you a missionary or are you an intruder?,” Schum asked. Consider: A patient who seeks help may have been living with hearing loss for a long time. On average, most patients don't even seek help until they've noticed loss for about 7 years. So, sticking something in the ear that makes their own voice sound horrible and begins to whistle is not what they expect.

“We think we've done something wonderful, but in reality what we are in their minds, on that day, is an intruder,” Schum said. “We've done something abrupt and sometimes even negative in their life and we expect them to say ‘Oh wow, you've just done a wonderful thing for me.’”

Schum explained that patients come to the fitting session with a whole set of expectations. Sorting through these expectations may be as important as the fitting because it will “insure that the patient is prepared to be accepting of amplification.”

Schum, who was a clinician before joining Oticon, said the most disappointing aspect of treating patients is when they complain of whistling, discomfort, the device only working every other day, hating their own voice, or other problems that could have been helped earlier. When he queried the patients as to why they didn't seek help for such problems, they told him they just thought it was part of the package with hearing aids.

“I realized that I was not doing a very good job of preparing patients for what they should expect from the fitting session,” Schum said.

Patients need to be assured that their problems can be managed and solutions will be found and worked on beyond the fitting session, Schum said. The hallmark of building a better business is customer loyalty and trust, and this begins at the fitting session. He added that knowing you are their partner throughout the life of their hearing aids instills this trust in patients.

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Among the prominent presenters were Harvey Dillon, PhD, deputy research director of Australia's National Acoustic Laboratory (NAL) Hearing Aid Research Center; Stuart Gatehouse, PhD, scientist-in-charge of the MRC Institute of Hearing Research in Glasgow, Scotland; and keynote speaker Claus Elberling, Doctor of Medical Sciences, a researcher at Eriksholm, Oticon's research center in Denmark. All agreed that the human element of the hearing aid fitting equation cannot be ignored.







Gatehouse discussed how a patient's individual “auditory ecology” impacts his or her perceptions of hearing loss and hearing aids.

He also reported the results of a study assessing the benefits and limitations of non-linear hearing aids. He said, “We think we learned that the answer you get depends on where you look. If we look purely at satisfaction factors, we get one answer. If we just look at the comfort factor, we get another answer.”

Dilloreviewed the use of the COSI (Client Oriented Scale of Improvement) outcome measure in a rehabilitation program. He also discussed the fitting of patients with non-linear amplification by means of the NAL-NL1 selection procedure, which is designed to optimize speech intelligibility while keeping total loudness at no more than is perceived by a normal-hearing person. However, he noted, even when using the precise fitting strategies of NAL-NL1, the clinician cannot ignore the human component.

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Beyond auditory factors

“You're looking at the audiogram with the underlying assumption that the audiogram reflects the sensory cells in the cochlea,” Elberling said. “But, following the thought of the ‘human link,’ we should not treat the audiogram, we should treat the whole person.”

Elberling said that beyond the cochlea, the cochlea interacts with the brain at the end of which is the auditory pathway to the auditory cortex. The auditory cortex, he explained, reflects maturation processes, information processes, and, eventually, plasticity processes, which are very important for hearing aid fitting and management.

We must remember, he said, that the other resident functions of the brain include those that characterize the individual, namely personality and cognitive skills, and these go hand in hand with the specific auditory environment in which a person resides.

Elberling noted that the ability to manipulate short-term, or working, memory seems to be important for how well one performs and which hearing algorithm is preferred. This ability can easily be assessed by using a reading span test that takes about 10 minutes.

Studies, he said, have shown that people with low cognitive abilities may have difficulty suppressing interfering sounds, and the new sounds provided by hearing aids may be disturbing initially. Those with higher cognitive skills appear to find the interference less disturbing and move through it.

“It's a new thing out there, testing a non-auditory factor of the individuals that seems to be highly important for how we treat them,” he said.

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In an industry where the technology keeps improving and new devices are making it easier to meet each individual patient's needs, speakers said that keeping patient expectations in mind may help better prepare them for amplification, as well as establishing a trusting relationship with the provider that goes beyond the fitting session.

In the not-too-distant future, Elberling said, we will see interactive strategies that will help patients fine-tune their hearing devices for normality, tone, loudness, speech intelligibility, noise, comfort, and distortion, all through an interactive computer touch screen.

“Acoustic ecology” may well become a new buzzword. “It should be possible to generate a concise questionnaire for the ecologic domain which would help to distinguish between restricted versus varied lifestyles,” Gatehouse said. The research challenges will be how to interface the pre-fitting prescriptive approach with user adjustment philosophy and information gleaned during early hearing aid experience.

“We cannot pay attention to one little domain,” Gatehouse said. “We have to look at the individual, the individual psychology, who they are and what they want.”

And that may indeed be the point at which audiology professionals will be selling a lifestyle.

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Peter Mark, MD, vice-president of marketing for Oticon, Inc., may have summed up the future importance of the human link concisely in his talk on using “old” and “new” media to build patient-professional relationships. Now that the baby boom generation is entering the realm of the hearing challenged, he said, they bring a very different personality into the mix and hearing devices may begin to appear sexier.

Mark noted that members of this self-aware, never-going-to-grow-old generation are technology happy. They are wired. Soon, therefore, it may be impossible to distinguish hearing aids from other devices that people wear in their ear to receive phone messages or keep tabs on the Internet. In one fell swoop, the long-standing stigma of wearing hearing devices could disappear, he said. However, he added, be prepared: This is not your father's generation of hearing aid clients.

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Oticon's Human Link conference wasn't all work and no play. Participants enjoyed a dinner cruise on the Intracoastal waterway. On the final evening of the conference, Tom Whittaker, an adventure education professor and double amputee who scaled Mt. Everest, shared his thoughts and inspiration with the assembled audiologists.

The conference was also enriched by its international flavor. To assist participants, who spoke 14 different languages, the proceedings were translated from English into French, German, Italian, Japanese, and Spanish.

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