The Future is Now: A Conversation about Self-Fitting Hearing Aids with Elaine Saunders

In the hearing healthcare field, there is a lot of talk about disruptive innovation, but very few individuals have put disruption into practice. One such person is Elaine Saunders, a renowned hearing scientist, award winning entrepreneur and founder of Blamey Saunders Hears, an Australian company that manufacturers hearing aids sold on-line, directly to consumers

Brian Taylor, Editor-In-Chief at HHTM, recently exchanged emails with Dr. Saunders. It was an opportunity to learn more about her innovative company and get her opinion about the evolving nature of over-the-counter hearing aids. Skeptics of a direct-to-consumer hearing aid service delivery model ought to be impressed by the scientific rigor, transparency and consumer-friendly nature of the Blamey Saunders Hears business model. Read the transcript below to learn more.

 

BT: Hello, Elaine. Thanks for agreeing to participate in this virtual conversation with me. Let me start by asking you to describe your company…your motivation for starting it, and the products you dispense.

 

Elaine Saunders, PhD

ES: Blamey Saunders Hears is a Profit for Purpose company with the mission to make a global impact in hearing healthcare. Established in Australia, Blamey Saunders Hears is committed to empowering clients to take control of their hearing. Science tells us that client satisfaction is increased when users are given control of their hearing aid settings – they are more likely to understand the hearing process and make a commitment to wearing their hearing aids.

Our goal is to deliver a fully client-centered model, overcoming difficulties of accessing face-to- face care, with a commitment to exceptional products and services.  We are driven by research and technology development, accessing enabling tools. We continuously commit to development and sharing quality knowledge, providing best-practice client centered hearing health services, and high-quality hearing aids at affordable, transparent prices. 

Our product solution consists of three hearing aids and a software system that enables clients to self-test and manage their own hearing healthcare.

Most recently we have launched a hearing aid that tackles the problems of hearing aid appearance and ease of use for dexterity challenge and diminished eye sight. It’s a modular hearing aid.  The unique advantage of this aid is its magnetized battery connection system where the brain houses the DSP and the battery module is magnetised to facilitate ease in self-management. The magnetized battery also provides a cost-effective methodology to upgrade user benefits and personalize the device. We have innovations in wireless technology and health monitoring systems under development in production at present.

 

BT: Please describe your business model. What is the process a client goes through to purchase hearing aids? Also, from your website it looks like clients can see an audiologist in person at a clinic. How is that appointment triggered or does a client make that decision on their own? 

 

ES: The Blamey Saunders Hears business model is a blended one where a client can choose to be fully independent via an online self-prescription, seek a small amount of help on the phone/video conference, or attend a comprehensive diagnostic appointment at one of our regional service centres. Data analysis of our clients’ journeys clearly demonstrates it’s an “attitude” towards self-help and confidence in technology that is a core determinant of the likely hearing aid journey a client will take. It is wrong to think that online confidence is the territory of the baby boomer – we have seniors in their 90’s very competent and self-motivated to manage their health independently.

In the case of an online self-help journey a client starts by finding us at blameysaunders.com.au. Here there is a free and scientifically validated speech perception test (SPT):  https://apps.blameysaunders.com.au/wordtest/.  The results of this test provide a word score – which is simple for a client to understand, does not require an audiogram nor complicated battery of clinical tests that a clinician needs to decipher.

It’s important to note that this is a test of hearing for speech.  It is not a differential diagnosis of the cause of hearing loss. An example is shown below of a Speech Perception Test for a person with a mild to moderate high frequency loss. The ten-word categories enable us to clearly isolate where a person is having difficulty hearing speech focusing on things like contour, vowel length and nasality.

Our website advises people to get their aural health checked by a General Practitioner (GP), who is the primary healthcare coordinator in Australia.

 

 

Following the test, generally the client speaks to one of our tele-audiologists for support working through the online process and/or request for further hearing health information.   Sometimes a client chooses to go through the whole process unassisted, although this would be in the minority of cases.  During the teleaudiology consultation, questions are answered and the consultation is much like an initial face to face appointment.  We use the Blamey Saunders model of care, which is based on the Goldstein and Stephens model. 

This model, which has been refined and capitalizes on 25 years of clinical experience (Kramer) provides a consultative process that combines client attitude, hearing disorder and related conditions, to advise on the best model of care.  Pending on client characteristics, confidence and desire our team may recommend a full audiological consultation, face to face support, teleaudiology, or a combination.  This distance provision of consultation may also result in the client being advised to seek further medical guidance, or another provider, if we can’t supply the solution the client seeks. As a tele-health provider, we are very accessible, and are approached for many aspects of audiological advice.   

The results of the SPT are stored in an encrypted data base, and an individual’s results are used to set-up the first fit settings in the hearing aids. In the case of an online order or teleaudiology assisted order the hearing aids are posted out with initial settings based on their SPT, their audiogram if they can provide one, or both.  We then advise the client to fine tune their hearing aids themselves via the Blamey Saunders Hears app, with or without our help as they prefer.  We encourage clients to repeat the SPT with their hearing aids fitted as part of an aural rehabilitation process which includes multiple structured telephone counselling sessions based on establishing COSI goals.

Our client care is externally audited via client questionnaire and the results published on our website. This rehabilitation process continues to be further refined as we learn more about teleaduiology rehab. To date we have instigated improvements to lower hearing aid return rates to less than 6% and improve our net promoter score to 63 which is a very strong globally benchmarked result.

 

BT: You mentioned your IHearYou app. How does the app work?

 

ES: Studies show that better client outcomes are achieved by enabling a client to fine tune their hearing aids.  Our IHearYou® system is the software that enables the client to fine tune and self-programme. “IHearYou” refers to the whole software and DSP system, all of which has been optimised for a self-fit approach.  Our latest product – Facett™- uses 96 channels of Sonite processing, which is a noncompressive amplifier. 

saunders hearing aid programming
Connecting the programmer

The App and user interface software has been designed for simplicity.  The user just listens to in-situ chimes and balances five to an approximately comfortable level, to establish the frequency shaping of the output.  As there are no compression knee points and compression ratios to deal with, the next stage of optimisation is to turn on the hearing aids and adjust the volume for overall preference. 

 

This fitting data is stored in the Blamey Saunders data base.  The client can fine tune their hearing aids further using pre-set enhancements or by adjusting the hearing aid output characteristics directly.  If the client is having difficulty, the fitting can be done remotely by our teleaudiology team. 

saunders facett charging station
Facett Pod and 4 rechargeable modules

The IHearYou system enables the user settings to be logged in our central database so the teleaudiology team and the client have transparent access to fine-tuning the settings. This enables a proactive partnership where together the client and our team customize the most effective settings to suit the client.

 

It is important that we have confidence that the client can handle “the fiddly bits” of the process.  That’s why Facett has been designed with modular rechargeable batteries so that it is easy and obvious how to change batteries.  Introduction of Facett has also enables the programmer to be manufactured with a simpler magnetised connector.

 

BT: Many of our readers at HHTM are hearing healthcare professionals. I anticipate that some of them will have a desire to know the research that underpins your self-fitting devices and direct-to-consumer business model.  Could you provide some references from the literature on the effectiveness of self-fitting hearing aids sold directly to consumers?

 

ES: Sure. Here is a list of relevant published studies:

  1. Blamey PJ, Blamey JK, Saunders E. Effectiveness of a teleaudiology approach to hearing aid fitting. J Telemed Telecare. 2015;21(8):474-478. 
  2. Rushbrooke E, Houston TK. Telepractice in Audiology. Plural Publishing; 2016.
  3. Beckett RC, Saunders E, Blamey PJ. Optimizing Hearing Aid Utilisation using Telemedicine Tools.  In: Miranda IM, Martinho R, Rijo R, editors. Encyclopedia of E-Health and Telemedicine, IGI Global, 2016. , pp.72-85Blamey PJ, Saunders E. Predicting speech perception from the audiogram and vice versa.  Canadian J Audiology 2(2) 2015.
  4. Keach EE. Investigation of hearing aid provision via the first-fit efficacy of three adaptive dynamic range optimisation (ADRO) fitting methods. Master of Audiology thesis, University of Auckland, 2013

Other references are:

  1. Crawford Shearer NB.  Health Empowerment Theory as a Guide for Practice.
  2. Goldstein DP, Stephens SD. Audiological rehabilitation: management model I. Audiology. 1981;20(5):432-52.

 

BT: As a general topic, I am curious about your opinion about over-the-counter hearing aids being sold directly to consumers. 

 

ES: As we (Blamey Saunders Hears) understand it “OTC” encapsulates a myriad of delivery options from over-the-counter sales in a pharmacy-style setting to completely online sales.  Although it’s not very clearly defined to us as to what OTC means, in relation to hearing aids in the US.  Critically though, OTC is a delivery model, not a device description. 

 

In our experience it is very wrong and ineffective to expect a client to completely self-help. One of the most critical proficiencies we have is the development of a blended framework of care within which clients get the level of service and quality of hearing aid that they want.  This varies from none to full face to face audiological support. We can’t see how a business model can work effectively without access to service and aftercare, and a way of identifying people who need or want help. In our experience teleaudiology allows the audiologist more time for complex cases and clients with the self-motivation and desire to manage their own hearing aids.   

 

The great advantages of self-fit, combining teleaudiology support, is that it aligns with the goal of good client outcomes.  The end-to-end system includes the online Speech Perception Test, the fitting predictions, the hearing aids and the easy to handle hearing aid design parallels with eHealth goals to enable clients increasing accessibility and lowering individual cost to serve. 

 

There are different approaches to self-fit, and there is no up-to-date literature on comparisons of self-fit approaches.  The Blamey Saunders approach is to try to reduce barriers to getting hearing aids, while empowering clients and being fully client centered.   We are achieving this with an end-to-end system, that is especially designed for this purpose. The teleaudiology team has training for this model of care. 

 

At the heart of what we do sits the belief that a client will be motivated to manage their hearing health care best if they can personally access services in their most appropriate way.

 

Can Americans buy your products online and get them shipped to the US?

 

Blamey Saunders Hears Facett hearing aids products are available anywhere in the world, including in the USA, and we welcome partnering with audiologists.

To learn more about Dr. Saunders’s company, see: https://www.blameysaunders.com.au

To learn more about Dr. Saunders, go to:

 

Facett™ is a Trademark of Blamey Saunders Hears

IHearYou® is a Registered Trademark of Blamey Saunders Hears

 

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P R

According to this article, Dr. Saunders goal states “Our goal is to deliver a fully client-centered model, overcoming difficulties of accessing face-to- face care, with a commitment to exceptional products and services. We are driven by research and technology development, accessing enabling tools. We continuously commit to development and sharing quality knowledge, providing best-practice client centered hearing health services, and high-quality hearing aids at affordable, transparent prices”. I am confused at the “affordable prices”. On their website, the prices are higher than what we charge for comparable levels of technology. I believe this is true of most of the places in the area I practice in.
ex. they (Blamey Saunders) list the hightest model at $3100ea/ $5990set.

Robert

Good point!

However, the Australian dollar is worth about 75% of US dollar currently, so that does make a slightt difference. Also, I believe their national health insurance covers some or all of purchase price of hearing aids.

anjan muhury

It is obvious that Dr. Saunders know little about cochlear limitations. The pathological cochlear loses 75% of its efficiency when the transference occurs from the fluid wave train to ionic transfers. The control of efferent function by the outer hair cells in normal ears is variously measured to be approximately =/- 12-15 db . The ear with a neurosensory hearing loss cannot sense variations beyond =/- 3-5 db and the window of adjustment is very narrow, and can only be performed for hearing aid adjustments by a trained professional. The self fitted seeker knows nothing about these because they need education in OAE/ audiometric interpretations.
Therefore its never a good idea to leave adjustment controls in the hands of the patient. Yes, they can use a remote control for volume/ program functions, but never on adjustments !

Bill Franklin

Anjan, you clearly only gave this article a surface-reading, otherwise your response would be different. First, Dr. Saunders is a well-known and respected hearing scientist, therefore she is likely better versed on cochlear pathology than the vast majority of hearing professionals today. Secondly, if you read her response, she isn’t advocating for an off-the-shelf approach completely in the end-user’s hands. She specifically encourages involvement with a professional. Here’s a direct quote from the article: “In our experience it is very wrong and ineffective to expect a client to completely self-help. One of the most critical proficiencies we have is the development of a blended framework of care within which clients get the level of service and quality of hearing aid that they want.” Personally, I applaud her approach and anticipate something like this to be more disruptive to the hearing industry than say Apple or Samsung creating an OTC hearing… Read more »