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Views and Vision

doi: 10.1097/01.HJ.0000489200.17208.28
Views and Vision
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Views and Vision brings together diverse voices from the hearing industry to comment on relevant issues affecting audiology and hearing health.

For this month, the spotlight is on “Disruptive Innovations in Hearing Health Care,” an issue discussed at length in the May 2016 cover story http://ow.ly/cM7i300THW1.

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JAMES V. RIPPY, MS, AUD

Affiliated Audiology Center, Inc.

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Disruptive innovation occurs in almost every industry, so its impact on audiology is not unique. What remains to be seen is whether audiologists will unite in a way to secure their place in the future or allow outside pressures to change the way audiologists treat patients.

Previous articles have identified personal sound amplification products (PSAPs), hearables, and the introduction to foreign technologies as disruptive areas that are changing our profession. I believe that disruptive innovation can provide an opportunity for audiologists to reinvent how hearing health care is provided. I also feel like this is where our profession is missing the mark: Everyone can identify the threats we face, yet no one identifies a solution!

One of the most attainable changes is the hearing aid invoice cost. Cost is an important issue that must be addressed to compete in a disruptive landscape. Product invoice cost is one of the first issues we need to change—and quickly, if possible. If audiologists can unite through organizations like the Alpaca Audiology negotiating network, then we stand a chance to not only survive the change but also be in control of it.

Right now, most innovations coming to the hearing industry are not in the hands of the professionals. Most innovation is at the corporate level or through the introduction of new companies and products. Without new clinical practice innovations, we are just along for the ride. However, if one of the innovations were to place the purchasing power back into the hands of audiologists, a paradigm shift could occur.

We have an opportunity as a profession to unite and take back the industry that we are slowly losing to others (e.g., third party insurance, manufacturer-owned retail, big box stores, etc.). If we start purchasing as one entity, we could become the largest purchasing entity in the country, and that would change the relationship between the clinical practice and the device industry.

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KENNETH E. SMITH, PHD, AND BETH L. EHRLICH, AUD

The Hearing Center of Castro Valley

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We have been in private practice for 30 plus years and have seen more than our share of “disruptors.” These have included ITE aids; programmable, digital, big box store dispensing, mail order hearing aids, and the rise of insurance coverage for hearing aids. In theory, any of these could have had a dramatic effect on market penetration. In reality, none have had a significant effect.

Now, we are all concerned about the rise of PSAPs. This is nothing new if you've been reading magazines that advertise inexpensive speech “clarifiers” for years. If price were the issue, we would all have been out of business long ago.

Of bigger interest to us has been the research coming out of Johns Hopkins, describing auditory deprivation, or “use it or lose it.” This research, combined with new research on the effects of amplification on auditory function over time, will be the real determiners of the PSAP vs. hearing aid debate.

If consistent use of amplification is a prerequisite to healthy brain function as one ages, then the idea of a “part time” solution is untenable, at best. The issue can't be related to size or price. Manufacturers argue that they have “real” hearing aids that would retail below $300. The real issues, to us, relate to professional evaluation, prequalification of the patient and family for the level of technology recommended, fitting and programming expertise, extensive counseling, patient and family education, and a program of systematic care that includes monitoring of hearing aid use and hearing levels using data logging. All of this requires time, overhead expense, education, and a professional commitment that costs money.

Hopefully, we are not headed back to the ASHA-inspired days when audiologists could not dispense hearing aids because profit was associated with ethical sin. “Margins,” the dirty word referred to in the article, allow for these professional evaluation and fitting services. Do we really think that patients can select and successfully use their own technology type? Our experience would indicate that they cannot.

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PAMELA BURTON, AUD

Vice President of Product Management & Customer Care, Signia

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As more PSAPs enter the market, it's critical that the hearing aid industry continues to educate the public on the vast differences between PSAPs and FDA-approved hearing aids. Manufacturers collectively have hundreds of years of experience researching and developing safe, well-designed, and highly sophisticated hearing solutions that effectively treat almost any kind of hearing loss. But it's more than just expertise that separates hearing aids from PSAPs.

Successfully treating hearing loss involves stimulating the auditory neural pathways leading up to and including the brain. This is most effective when hearing aids are fit by a licensed hearing care professional trained in facilitating aural rehabilitation. No evidence exists that consumers can proficiently self-diagnose or self-treat hearing loss. This is demonstrated by a 39 percent hearing aid satisfaction rate http://ow.ly/aWtx300THC1 in Japan, where patients can purchase them directly, vs. a 90 percent satisfaction rate in the U.S. for new hearing aids under the guidance of a professional.

Manufacturers are moving beyond the ear to study how hearing loss affects the brain, in particular how hearing aids can address cognitive functions like listening effort. Hearing difficulties increase cognitive load, resulting in listening fatigue, multi-tasking difficulty, lack of energy and concentration, and increased risk of falls. Unlike PSAPs, only professionally fit hearing aids have been proven to address the consequences of listening fatigue http://ow.ly/W9lB300THOb by reducing listening effort.

Hearing aid manufacturers have developed smart hearing technology to effectively treat more patients than ever. Patients with special listening needs require far more sophisticated technology than the simple amplification most PSAPs provide.

The emergence of PSAPs has some positive implications. More manufacturers are developing essential-level technology with adaptive directionality, frequency compression, and even wireless streaming capabilities. Consumer dissatisfaction with PSAPs is also an opportunity for professionals to demonstrate the important role they play by providing diagnostic testing and premium customer service. Although PSAPs may have helped to highlight the importance of healthy hearing, the correct path to treatment is always through the hearing care professional.

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MARC SYVERTSEN

Director of Hearing Aid Battery Technology, Rayovac

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Advancements in hearing device technology have allowed hearing professionals to personalize devices in ways that drastically improve the hearing health of their patients. There is a world of possibilities that opens up as hearing aids become more prevalent and connected. I think we're only on the edge of what wireless capabilities can bring to hearing instruments. There's a lot more to see now that the technology exists.

As this technology spreads and advances, hearing devices will require more and more battery power to operate the stable of features they provide. Improvement in battery performance and runtimes is key.

Consumers are seeking innovative devices, but many are unaware of the specific qualities and features that will most benefit their unique hearing needs. They also are likely unaware of how these features may impact the performance of their hearing aid battery. It's crucial for hearing professionals and device manufacturers to remain at the forefront of industry trends and technology.

Audiologists and dispensers have the unique ability to provide a better solution for people, to be sure that the devices are truly making a difference on their hearing and in their lives—that's really the big difference and the big opportunity for hearing professionals and manufacturers.

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