The Hearable Lament: 

 Hearing Economics looks forward to this time next year when we get to see the 2017 Hearables Hot Potato finalists.  Of course they’ll be tinier and cuter, but we hope they’ll also be multitalented, highly articulate, and dedicated to assisting everyone with ears, even people with hearing loss who want to listen to music while they swim.   (Hearables post from last year)

2015 was first dubbed the Year of the Hearable, then it was thought to move to 2016. Not so much. Now, at the end of 2017, our own Big 6 are making Hearables, even as the upstart Hearable innovators are struggling to stay afloat and figure out fulfillment or just closing shop.  This week, an Oticon device described in the media as a “Fitbit for your ears” won an important award in the consumer electronics industry (CES 2018 Innovation Award in the Software and Mobile Apps).

The device is worn in the ear and tracks fitness, hence it is a Hearable but not a hearing aid. The Hearable lament for those with hearing loss remains lamentable. We’re still awaiting the swiss army knife for the ears, per the Hearable promise.

 

GN Hearing Carves Out a Hearable Hearing Aid

Meanwhile, Resound’s patent #9788128 heralds “A new method of communicating a message to a human wearing a hearing instrument,” anticipated in the past as a Hearable/Personal Assistant.  As envisioned, the device accesses the Internet (or perhaps some other wide-area-network) to retrieve messages and convert them to speech, store and date-stamp them, and play back to the wearer. 

In the words of the patent, the device:

is provided with capability of presenting speech messages, such as calendar reminders, tweets, sms-messages, notifications, etc., e.g., from a user’s time management and communication systems at selected points in time.  … Personal time management may be performed with a computer, e.g. using an email system with electronic calendar, to-do-lists, and notes to manage daily activities and communications. Communication may also be performed via electronic social and professional networks. 

Almost as an after-thought, the patent adds that:

Optionally, the hearing instrument comprises a hearing aid. 

Hearing Economics is happy to end the year by welcoming in a Hearable for those with hearing loss, even if it’s just on the drawing board as we end 2017.  Maybe 2018 will be the real Year of the Hearable.

 

The October 2017 List

 

Description

Patent Number

Assignee

Issued

Systems and methods for detecting degradation of a microphone included in an auditory prosthesis system

9775998

Advanced Bionics AG (Staefa, CH)

10/03/2017

System comprising a cochlear stimulation device and a second hearing stimulation device and a method for adjustment according to a response to combined stimulation

9775999

Advanced Bionics AG (Staefa, CH)

10/03/2017

Programming systems for eliciting evoked responses in a cochlear implant patient and performing predetermined actions in accordance with the evoked responses

9776000

Advanced Bionics AG (Staefa, CH)

10/03/2017

Interaural coherence based cochlear stimulation using adapted envelope processing

9776001

MED-EL Elektromedizinische Geraete GmbH (Innsbruck, AT)

10/03/2017

Neural coding with short inter pulse intervals

9775997

MED-EL Elektromedizinische Geraete GmbH (Innsbruck, AT)

10/03/2017

Audio control using auditory event detection

9780751

Dolby Laboratories Licensing Corp (San Francisco, CA)

10/03/2017

Feature-based level control using loudness growth functions

9780747

Cochlear Limited (Macquarie University, NSW, AU)

10/03/2017

Medical device implantation imaging

9775539

Cochlear Limited (Macquarie University, NSW, AU)

10/03/2017

Hearing assistance device with a low-power mode

9781521

Oticon A/S (Smorum, DK)

10/03/2017

Communication System

9781524

Oticon A/S (Smorum, DK)

10/03/2017

Systems and methods for detecting degradation of a microphone included in an auditory prosthesis system

9781522

Advanced Bionics AG (Staefa, CH)

10/03/2017

Hearing instrument

9781523

Sonova AG (Stafa, CH)

10/03/2017

Portable monitoring device with hearing aid and EEG monitor

9782103

Widex A/S (Lynge, DK)

10/10/2017

Audio control using auditory event detection

9787268

Dolby Laboratories Licensing Corp (San Francisco, CA)

10/10/2017

Audio control using auditory event detection

9787269

Dolby Laboratories Licensing Corp (San Francisco, CA)

10/10/2017

Canal hearing device with elongate frequency shaping sound channel

9788126

iHear Medical Inc (San Leandro, CA)

10/10/2017

Hearing instrument with off-line speech messages

9788128

GN Hearing A/S (Ballerup, DK)

10/10/2017

Wireless charging system for hearing instruments

9788129

Siemens Aktiengesellschaft (Munich, DE)

10/10/2017

Removable battery holder in a hearing assistance device

9788130

Advanced Bionics AG (Staefa, CH)

10/10/2017

Method and device for the improved perception of one’s own voice

9788127

Sivantos Inc. (Singapore, SG)

10/10/2017

System and method for designing hearing aid components with a flexible cover

9788131

Sivantos Inc. (Singapore, SG)

10/10/2017

Personalization of auditory stimulus

9794672

Nura Holdings Pty Ltd (Brunswick, AU)

10/17/2017

Sound processor apparatuses with a multipurpose interface assembly for use in an auditory prosthesis system

9794696

Advanced Bionics AG (Staefa, CH)

10/17/2017

Systems and methods for managing wireless communication links for hearing assistance devices

9794697

Starkey Laboratories Inc (Eden Prairie, MN)

10/17/2017

Hearing device considering external environment of user and control method of hearing device

9794699

Samsung Electronics Co. Ltd (Suwon-si, KR)

10/17/2017

Hearing aid with occlusion reduction

9794700

Sivantos Inc. (Piscataway, NJ)

10/17/2017

Gateway for a wireless hearing assistance device

9794701

Starkey Laboratories Inc (Eden Prairie, MN)

10/17/2017

Low-power active bone conduction devices

9794703

Cochlear Limited (Macquarie University, NSW, AU)

10/17/2017

Signal processing for hearing prostheses

9794698

Cochlear Limited (Macquarie University, NSW, AU)

10/17/2017

Implantable microphone for hearing systems

9794702

MED-EL Elektromedizinische Geraete GmbH (Innsbruck, AT)

10/17/2017

Template for bilateral symmetric stimulator fixation/implantation

9788914

MED-EL Elektromedizinische Geraete GmbH (Innsbruck, AT)

10/17/2017

Hearing aid tuning system and method

9794705

Bowie-Wiggins LLC (Burien, WA)

10/17/2017

Detection of whistling in an audio system

9794695

GN Hearing A/S (Ballerup, DK)

10/17/2017

Auditory perceptual systems

9795325

Posit Science Corp. (San Francisco, CA)

10/24/2017

Hearing device comprising a directional system

9800981

Bernafon AG (Bern, CH)

10/24/2017

Auditory stimulus for auditory rehabilitation

9801570

Massachusetts Eye & Ear Infirmary (Boston, MA)

10/31/2017

Inductive signal and energy transfer through the external auditory canal

9802043

MED-EL Elektromedizinische Geraete GmbH (Innsbruck, AT)

10/31/2017

System and method for neural hearing stimulation

9802044

Advanced Bionics AG (Staefa, CH)

10/31/2017

Hearing device and methods for wireless remote control of an appliance

9805590

iHear Medical Inc (San Leandro, CA)

1031/2017

System and/or method for enhancing hearing using a camera module, processor and/or audio input and/or output devices

9807492

Ambarella Inc. (Santa Clara, CA)

10/31/2017

Hearing device adapted for estimating a current real ear to coupler difference

9807522

Oticon A/S (Smorum, DK)

10/31/2017

Hearing aid antenna with symmetrical performance

9807523

Starkey Laboratories Inc (Eden Prairie, MN)

10/31/2017

Trenched sealing retainer for canal hearing device

9807524

iHear Medical Inc (San Leandro, CA)

10/31/2017

Apparatus and method for determining parameter using auditory model of hearing loss patient

9807526

Samsung Electronics Co. Ltd (Suwon-si, KR)

10/31/2017

Hearing Aid

D801536

GN Hearing A/S (Ballerup, DK)

10/31/2017

 

feature image from gizmoway

Barbara Weinstein PhD

Barbara Weinstein’s “Downstream Consequences of Aging” appears bi-monthly at HearingHealthMatters.org. Today’s post is part 2 of a series on reframing the clinical conversation with older adults.

 

The hearing healthcare delivery landscape is in transition with the emphasis being placed on affordability and access.  President Trump’s signing of the 2017 Food and Drug Reauthorization Act, guarantees that a new category of OTC hearing aids will be forthcoming within the next few years.

 

Hearing Loss as a Social Construct with Consequences

 

The top-down changes are an opportunity for audiologists to revisit and reframe our approach to clinical practice with the emphasis on the patient rather than on the technology.  

We must engage with persons with hearing loss in new and better ways with a focus on the environmental and psychosocial underpinnings of age related hearing loss, I have posed five myths held by held by stakeholders in hearing health care. I follow each myth by my thoughts about how audiologists might broaden our framework for addressing the experiences of persons with hearing loss. 

Perhaps approaching hearing loss as a social construct with consequences in large part depending on the interaction between the persons with hearing loss and their physical and social environments might help us to optimize outcomes associated with their clinical encounter.

 

Myth I. Audiologist=Hearing Aid Salesperson

 

I recently conducted an informal survey of members of the local HLAA Chapter regarding their perceptions of the hearing health care services which they received. The consensus was that audiologists sell hearing aids and are not educated or skilled at assisting persons with hearing loss self manage the communication challenges posed by hearing loss.

To put it mildly, I was shocked by these very strong convictions.  We need to position ourselves as hearing/communication ambassadors whose primary focus is to help parsons with hearing loss overcome the communication barriers caused by their loss of hearing. We are the experts who can help persons with hearing loss self manage the social and physical environments in which they live and interact, thereby enhancing the quality of their interactions and enabling them to remain socially engaged.

Bottom line, social engagement is the key to long life and adds to life expectancy. The most important outcome of our clinical encounters should be to help our patients maintain their participation in meaningful social and intellectual activities and the technology we dispense is a means to this end.

 

Myth 2. Hearing Aids Prevent or Forestall the Onset of Senile Dementia

 

The evidence to date is clear……hearing aids DO NOT prevent dementia. BUT, hearing aids, when fit correctly in the context of a rehabilitation program, can optimize communication function thereby facilitating social engagement (measured in terms of contact with family and friends participation in social activities, and quality of interactions).

Hearing assistance may reduce the burden on cognitive processing, especially in challenging listening environment. Further, by helping persons maintain social enagement and social connectedness, hearing aids may in fact have a protective effect thereby reducing the risk of developing dementia (Fratiglioni, Wang, Ericsson, Maytan, and Winblad, 2000).

Consider the argument that hearing aids are a cognitive reserve enhancing and lifestyle intervention which when fit and used properly will help persons with hearing loss remain intellectually stimulated and socially engaged.

 

Myth 3. The Audiologist Knows Best and Told Me I am a Candidate for Hearing Aids

 

Shared decision making (SDM) and preference based treatment should guide clinical practice. A bidirectional process between a clinician and a patient suffering from a preference-sensitive condition (e.g. hearing loss), SDM helps the patient decide among multiple acceptable intervention choices in accordance with their lifestyle preferences (Spatz, Krumholz & Moulton, 2017).

Since persons with hearing loss often opine that they would like to be offered a range of options, SDM using patient decision aids (PDAs) is an ideal approach to engaging patients in a transparent manner when there are multiple treatment options from which to choose, High quality evidence based patient decision aids delineating the options, their risks and benefits can help facilitate patient course of action especially when there is more than one reasonable option (Stacey, Bennett, Barry, et al., 2011).

To date, patients are told that hearing aids have a clear advantage in terms of health outcomes but with the availability of hearables, self fitting hearing aids, PSAPs, to name a few a more broad based conversation may be in order. The majority of respondents to my survey lamented the fact that it took an average of three different audiologist visits before they were convinced that they were receiving high quality care.  It is noteworthy that the factors associated with patient judgments of high quality health care include participation in decision making, self management support, and involvement in care processes (Maskrey & Gordon, 2017).

 

Myth 4. Clinical Encounters are Patient Focused and Centered

 

Respondents to my survey overwhelmingly commented that their audiologist did not take the time to learn about them; they rarely inquired about their “hearing loss journey.”  We must take the time to learn more about our patients.

To ensure that we are meeting our patient’s needs we should understand the motivations, priorities, and preferences of our patients. Engagement means ensuring that our patients are active participants in their care and that our patient’s lifestyle informs the discussion of treatment options. Make sure to:

  1.  inquire about the availability of social support network so critical to hearing aid satisfaction; 
  2. understand your patient’s activity levels-whether they are socially active;
  3. gain insight in to their satisfaction with the quality and quantify of their social contacts.

The latter information must inform counseling, It goes without saying that understanding our patients’ hearing challenges in communicative environments (e.g at home, with family members, in large group meetings) is key, and understanding how they self manage their hearing problems can help optimize outcomes. Table 1 lists some sample questions which you may pose.

Table 1. Sample Questions Regarding Self-Management of Hearing Loss

  • Do you inform and/or remind family and friends of their hearing?
  • Do you ask others to remove their hands from in front of their mouth when speaking?
  • Do you tell your primary care physician that you have a hearing loss and some difficulty communicating and suggest ways to optimize the clinical encounter?
  • If you are in a noisy room, how do you manage the situation?
  • Do you ever use hearing apps on your smartphone?
  • Do you find yourself putting in more and more effort to understand others when they are speaking?
  • Do you find yourself decreasing your engagement in social activities because of communication challenges?

 

Myth 5. The Focus of Clinical Encounters is on Helping Patient to Self Manage their Hearing Loss

 

Audiologists and persons with hearing loss differ on this point as respondents were uniform in their comments that “it is all about the technology,” and they learned about self management through “trial and error.”  Self-management is a critical component of hearing health care delivery (Powers, Bardsley, Cypress., et al.,2015).  According to Hogan, et al.,(2015) physical stress is higher and wellbeing is lower when the fit between the person’s hearing related coping ability is mismatched with the demands or social ability to self manage in challenging social or physical environments (Hogan, Reynolds, & Byrne, 2012).

Stated differently, low self-confidence due to hearing impairment combined with poor perceived self-rated capacity to manage hearing and listening impairments were closely associated with lower quality of life ratings. In short, anxiety seems to increase and self confidence decreases as self management skills decline. Note also that Hogan, et al., (2015) found that “objective” measures of hearing status (i.e. the audiogram) did not correlate with self-reported physical and mental health outcomes.

To support and optimize self-management skill development and maintenance it is important to take advantage of opportunities before, during, and after the clinical encounter. That is, it is critical that we assess our patient’s self-management skill set, availability of support mechanisms (e.g. family members, HLAA) and factors that may serve as barriers to self-management including stigma or “fear of being found out!’

Table 2 lists some self management intervention strategies for promoting and optimizing hearing aid use (Barker, Mackenzie, Elliott., et al., (2016).

Table 2. Self-management Strategies  (Barker, Mackenzie, Elliott, et al. (2016)

  • Assess-self management skill set including impact of hearing loss, difficulties, facilitators and obstacles
  • Activate and educate your patients and their family members about behaviors they can adopt to overcome communication challenges and barriers
  • Make sure to encourage your patients to practice the new skills they have acquired
  • Refer patients to a local chapter of HLAA for support
  • Discuss the importance of sharing information about hearing status during all health care encounters including acute and primary care settings

 

Concluding Remarks

 

Audiologists must remain part of the solution to communication challenges posed by hearing loss and should be the go to professional for persons with hearing loss. Our patients must understand and experience the value added of working with an audiologist for ALL of their hearing health care needs.

In anticipation of top down changes in the hearing health care delivery system, we must reflect and prepare to initiate bottom up changes including a re-envisioning of the audiology Scope of Practice, our approach to the clinical encounter and associated outcomes. We should renew our focus on rehabilitation in support of helping patients to self-manage the stress and challenges associated with hearing loss. The latter was the foundation for the birth of the Profession of Audiology.

In closing, I concur with Alhanbali, et al. (2017) who underscored the import of educating persons with hearing loss about how to minimize the communication challenges posed by hearing loss and to make every effort to include social/psychological factors in our work with persons with hearing loss.

 

References

 

Alhanbali, S., Dawes, P., Lloyd, S. & Munro, K. (2017). Hearing handicap and speech recognition correlate with self reported listening effort and fatigue. Ear and Hearing. Oct 31 2017 published ahead of print.

Barker, F., Mackenzie, E., Elliott, L., et al., (2016). Interventions to improve hearing aid use in adult auditory rehabilitation. Cochrane Database of Systematic Reviews. Cochrane Database of Systematic Reviews. No 8. 

Hogan, A., Phillips, R., Brumby, S., et al., (2015). Higher social distress and lower psycho-social wellbeing: Examining the coping capacity and health of people with hearing impairment. Disability and Rehabilitation. Jan 5 2015, published online.

Hogan A, Reynolds K, Byrne D. (2012). Identity, social position, wellbeing and health: insights from Australians living with hearing loss. In: Banwell C, Ulijaszek S, Dixon J, eds. When culture impacts health. United States: Academic Press: pp. 95–104.

Maskrey, N., & Gordon, A. (2017). Shared understanding with patients. JAMA Internal Medicine.177: 1247-1248.

Spatz, E., Krumholz, H. & Moulton, B. (2017). Prime Time for Shared Decision Making. JAMA. 317: 1309-1310.

Powers, M., Bardsley, J., Cypress, M., et al. (2015). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics . Diabetes Care. 38:1372-82.

Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, et al. (2011). Decision aids for people facing health treatment or screening decisionsCochrane Database of Systematic Reviews. 2011; (10).

 

 

 

 

 Barbara E. Weinstein, Ph.D. earned her doctorate from Columbia University, where she continued on as a faculty member and developed the Hearing Handicap Inventory with her mentor, Dr. Ira Ventry. Dr. Weinstein’s research interests range from screening, quantification of psychosocial effects of hearing loss, senile dementia, and patient reported outcomes assessment. Her passion is educating health professionals and the public about the trajectory of untreated age-related hearing loss and the importance of referral and management. The author of both editions of Geriatric Audiology, Dr. Weinstein has written numerous manuscripts and spoken worldwide on hearing loss in the elderly.  Dr. Weinstein is the founding Executive Officer of Health Sciences Doctoral Programs at the Graduate Center, CUNY which included doctoral programs in public health, audiology, nursing sciences and physical therapy. She was the first Executive Officer the CUNY AuD program and is a Professor in the Doctor of Audiology program and the Ph.D. program in Speech, Language and Hearing Sciences at the Graduate Center, CUNY.

feature photo courtesy of shannon christy