Hearing Healthcare 2020 is a column where we explore the forces behind the changing landscape and disruptions impacting the hearing healthcare industry.
This week, HHTM President and CEO, Kevin Liebe, caught up with Patricia Trautwein, AuD, Vice President, Product Management & Marketing at Cochlear Americas to discuss issues surrounding auditory implant technology.
KL: Some studies have indicated that perhaps less than 10% of people that are candidates for cochlear implants are actually receiving and using them. What do you attribute this to?
PT: Lack of awareness. Most individuals who can benefit from a cochlear implant today are aging adults not receiving enough benefit from hearing aids.
Unfortunately, many aging adults may not be aware that cochlear implants are an option for them because:
- They are not getting the appropriate referral for a cochlear implant evaluation.
- They think their hearing is not bad enough for a cochlear implant.
- They think they cannot afford a cochlear implant. This may be because they had to pay out of pocket for their hearing aids when in fact cochlear implants are routinely covered by insurance and Medicare.
KL: What do you think are the biggest misconceptions about cochlear implants and other auditory implant technologies among professionals today?
PT: Among healthcare professionals, we can focus on the top 3.
First, there are misconceptions on when to recommend a cochlear implant. The candidacy criteria can be confusing for professionals not familiar with audiograms and even for those of us who are familiar! Consider cholesterol, which is part of most annual health exams; we know that levels over 200 are considered high and result in a referral for further medical evaluation. For hearing loss, we do not have a simple number on which to determine when the loss is “high” and needs a referral for audiological and/or medical management. Nor do we have hearing screening as part of routine annual physicals.
In recent market research, we found that both consumers and healthcare professionals could identify what was normal for vision and cholesterol, but not hearing. If we are to see more people accessing treatments for hearing loss whether that be with hearing aids or cochlear implants, we need to establish simpler metrics for what is normal and what levels warrant various treatment options. Cochlear implants are FDA approved for people with moderate sloping to profound hearing loss.
For hearing health professionals, a simple metric to use is when the Pure Tone Average (PTA) exceeds 70 dB, recommend a cochlear implant evaluation.
Second, many healthcare professionals, including hearing healthcare, are not sure who to refer a potential cochlear implant candidate to for an evaluation. We have an easy to use clinic finder available on our website that outlines hearing implant providers in an individual’s area. Additionally, we have created a program called the Cochlear Provider Network (CPN), which enables independent dispensing audiology/audiology-ENT practices to expand their services to include cochlear implants and become part of a medical network that helps people with hearing loss achieve optimal outcomes. This means there are more audiologists who can service their patient population with the full breadth of audiological services, while providing their patients with the appropriate treatment they need.
Third, healthcare professionals may not be familiar with the proven real-life benefits of cochlear implants over hearing aids, making it difficult to counsel a potential candidate for a cochlear implant. In a recent clinical trial, 93 percent of people significantly improved their speech understanding with a cochlear implant compared to a powerful hearing aid, and 83 percent of those individuals reported a statistically significant improvement in Quality of Life after receiving their implant.
KL: What do you think are the biggest misconceptions held by consumers?
PT: There are a variety of reasons we know people delay moving forward with a cochlear implant; some of them include:
People do not think their hearing is “bad enough” for a cochlear implant. If a person is in properly-fit hearing aids and continuing to frequently ask people to repeat themselves, they indicate they are only hearing half (or less) of what is said in a conversation, and denote it sounds like everyone is mumbling, it’s time to recommend a cochlear implant evaluation.
People often think they should wait and de-prioritize their hearing health. Research shows those with hearing loss can hear better sooner and experience the health benefits and improved hearing outcomes of cochlear implantation before hearing loss progresses to profound. Studies have shown that people with cochlear implants experience improvements in overall health, reduced social isolation and improved hearing abilities. People do not have to wait (and should not wait) to lose all their hearing to benefit from a cochlear implant. The sooner they act, the sooner they can overcome the impacts moderate to profound hearing loss has on everyday life.
People believe that cochlear implants are just for kids. The industry has done such a great job serving children with hearing loss and highlighting the success of children with cochlear implants that a lot of aging adults think cochlear implants are only for kids. However, our internal data shows that most people getting cochlear implants are adults 65 years of age with the range being from 18 to 100+ years of age. I think we as an industry and the external media need to make a concerted effort to underscore the importance of healthy hearing and proper treatment of hearing loss as a critical part of healthy aging.
People often think they can’t afford cochlear implants, but they are unaware cochlear implants are covered by Medicare, most insurance plans and typically Medicaid. A person should talk with their insurance provider or hearing implant specialist to determine their eligibility for coverage, which usually consists of paying the out of pocket required by their health plan.
A lot of people believe cochlear implant surgery is a major surgery. However, cochlear implant surgery is a fairly routine, outpatient surgery. It is typically performed under general anesthesia and takes around two hours per ear. We find most people can get back to normal activities a few days after the surgery.
KL: Many hearing professionals are aware of how rapidly hearing aid technology is changing and improving, but few are aware of how much has changed with respect to implant technology. What have been some of the biggest changes and improvements in implants that have been witnessed over the past 5 years?
PT: Like hearing aids, hearing implants have advanced to meet the needs of an increasingly connected world. Over the last 5 years, Cochlear has led the way in providing:
- Direct streaming capabilities across Apple and Android devices: The Cochlear Nucleus 7 Sound Processor is the only cochlear implant sound processor to provide direct streaming between compatible smartphones without an intermediate device, so our recipients can more easily connect to technology we all know and use every day.
- Apps: Recipients of the Cochlear Nucleus 7 Sound Processor can use the Nucleus Smart App to control and monitor their hearing experience. The Nucleus Smart App offers a range of first-of-its-kind features for users. From locating a lost or misplaced sound processor using the Find My Processor feature, to confidently tracking progress with the Hearing Tracker feature, or reducing noise from behind with the ForwardFocus feature, recipients can experience unprecedented connectivity and performance in managing their hearing.
- Smart wireless devices: With our range of True Wireless accessories, we were the first in the industry to provide wireless devices that stream sound directly to the sound processor using built-in 2.4 GHz wireless protocol that Bluetooth and Wi-Fi devices depend on without the need for neck-worn loops or attachments to the sound processor.
- Style: Wearing options to fit one’s lifestyle. The smallest and lightest cochlear implant sound processors in two wearing options; the Nucleus 7 Sound Processor sits behind the ear while the Kanso Sound Processor provides an option that is worn completely off the ear.
- Online services: Using modern cloud platforms, Cochlear offers connected care services, including Cochlear Link, myCochlearClinic, DocuSign, remote programming and a variety of other services, to help our professionals more efficiently manage their business and service patient needs how and when they want it.
- Innovations for those with single-sided deafness (SSD), conductive and mixed hearing loss: We just launched our newest bone conduction hearing solution, the Osia System, a new category of bone conduction hearing solutions that uses digital piezoelectric stimulation to bypass damaged areas of the natural hearing system to send sound vibrations directly to the inner ear through bone conduction. This innovation gives clinicians an entirely new option to improve hearing outcomes for people with chronic mixed, conductive hearing losses or single-sided deafness.
KL: In 2017, Cochlear acquired Sycle, the world’s largest supplier of audiology office management software. What sort of insights has the company gained as a result of the acquisition? Any surprises?
PT: We appreciate audiologists’ and hearing healthcare providers’ dedication and ability to treat their patients, as we all have an aligned desire to help people hear. We understand more and more that the relationship between the patient and professional is key to the effective management of hearing loss.
What we continue to learn is that too many people simply do not seek treatment for their hearing loss, be that in the hearing aid or the cochlear implant channel. But through this acquisition, we are able to strengthen the relationship between the hearing aid and cochlear implant channels; leveraging best practices and systems to streamline patient care so that more people will have access to a continuum of care and the optimal treatment solution.
In addition to Sycle, we continue to strengthen our Smart Hearing Alliance with GN Hearing, providing the most advanced, smart bimodal solution, so a person can make the most out of hearing with both ears and allowing the clinician to provide a range of hearing healthcare solutions for their patient.
We’ve also invested in Johns Hopkins Bloomberg School of Public Health’s efforts to address hearing loss and Dr. Frank Lin’s research focusing on the impact of hearing loss on brain health.
We continue to look for opportunities and partnerships that support our mission and approach to hearing health, which is three-pronged:
- Prevention (hearing health)
- Monitoring (check for hearing loss)
- Treatment (access to appropriate treatment options)
KL:What areas of improvement might consumers and professionals anticipate seeing over the next 5 years with respect to cochlear implants and other implanted audio devices?
From Cochlear, we’re keen to deliver on the following:
- Expanding our connected care offerings to benefit consumers and professionals. Connected care, including telehealth options, will help with cochlear implant access issues for consumers (think servicing in remote areas and servicing choices for follow up visits) as well as helping professionals better manage their case load.
- Continuing to innovate our portfolio for consumer lifestyle choices, including size reductions, battery/power options, water wear, connectivity functionality, on-the-go charging, etc., without compromising on hearing performance.
- Continuing to focus on hearing performance holistically. Research with our Slim Modiolar electrode (CI532) shows we are able to maximize outcomes by combining acoustic with electric hearing. Other areas of focus for hearing performance include bimodal solutions, hearing in noise and music appreciation.
- Advocating for and advancing standards in treatment and care. This includes:
- Establishing simpler metrics for what is normal hearing and what levels warrant various treatment options.
- Providing healthcare professionals with a greater understanding of cochlear implant candidacy and referral pathways.
- Simplifying reimbursement and insurance guidance for patients, professionals and payers.
- Developing further partnerships with clinicians to define a 21st century care model for hearing health; this could include artificial intelligence, machine learning, augmented experiences, remote health, etc.
- Continuing to deliver the highest quality and reliability in our cochlear implant technology. We understand that when a patient and professional choose a hearing implant, it begins a lifelong partnership. So quality is of utmost importance to us.
KL: You mention the cochlear provider network, which aims to expand patient access to qualified hearing professionals. How do audiology practices become part of this network and is education a component of membership? It sounds as though many practicing clinicians may not be fully aware of the most up to date implant candidacy criteria.
PT: Any audiologist who has a passion for great patient care, a full spectrum of patient solutions, and differentiation of their practice should explore becoming a member of the Cochlear Provider Network.
Interested practices can get more information on the Cochlear Provider Network here.
Yes, education is a critical part of the program and training is part of the network.
KL: Patricia, thanks for sharing your perspective with us today
PT: Thank you, Kevin, for inviting Cochlear to be part of the conversation on transformative hearing healthcare.
We’re excited for the opportunities to work with audiologists and other hearing healthcare providers to establish a continuum of care that helps more people hear.
Patricia Trautwein, AuD is Vice President of Product Management & Marketing for Cochlear Americas. Patricia’s nearly 30 years in the hearing healthcare industry includes roles in research and clinical studies, product management, education and training, sales and marketing. As Cochlear Americas’ VP of Product Management & Marketing, Patricia is responsible for the Marketing Strategy and Operations, Communications and Public Relations, Brand Ambassador Program, Digital Marketing, Product Management, and Professional Engagement and Education. Her organization is responsible for positioning Cochlear Americas’ growth strategy, cultivating opportunities in new and existing customer markets, and growing demand for Cochlear’s hearing solutions in the region.
Kevin Liebe, AuD, is President and CEO of Hearing Health & Technology Matters (HHTM). He also serves as a Scientific Advisor to Neosensory, a Silicon Valley based startup pioneering experiences in sensory augmentation. As an audiologist, Kevin has experience in variety of settings, including private practice, ENT, and industry. He is a past president and board member of the Washington State Academy of Audiology