future of audiology care

Hearing Healthcare 2020: The Future of Audiology

In conjunction with the American Academy of Audiology’s annual meeting, Hearing Health & Technology Matters (HHTM) planned to post several short articles this week from well-respected thought leaders within the profession. Although meeting plans have been derailed, we still felt it would be beneficial to read the thoughtful views from some of our esteemed colleagues during this time of great uncertainty. 

Although clinical audiology and the business of audiology are likely to be forever altered in unforeseen ways by the Covid 19 pandemic, the steady thoughts from some of our colleagues — that we will post this week — can help us see some light at the end of this difficult worldwide struggle. 

–Brian Taylor, AuD, HHTM Editor-at-Large

 

Table of Contents:

 

 

Some Thoughts on the Future of Audiology

by Nancy Tye-Murray, PhD

Nancy Tye-Murray, PhD

Lately, I’ve been the belle of the ball at social events. This isn’t because of my sparkling wit (my kids and hair dresser can attest to this), but rather, I’m of an age where my compatriots are beginning to suffer hearing loss and as the expert in the room I’m peppered with questions, the most common being, “Why should I go to an audiologist when I can get good hearing aids for so much cheaper at Costco?” 

I don’t always have a compelling answer. 

We’re supposed to say that the level of service is higher at a clinic. But if you compare patients’ experience at many Costco’s to that which they receive in a private practice audiology office, there often isn’t much difference other than the private practice has prettier décor and better music. At either venue, patients will receive an audiogram, monosyllabic word recognition testing in quiet, and if indicated, an appropriately fitted hearing aid. What they’re unlikely to receive is word recognition testing in background noise or speechreading testing—weirdly enough, given that most conversation occurs in environments with noise and occurs face-to-face—and they’re unlikely to receive aural rehabilitation.  

I speak from experience on this latter point. As CEO of clEAR, we created an economical and efficient online aural rehabilitation program that allows audiologists to provide gamified auditory brain training, supplemented with encouragement and counseling (with a no-cost option of a clEAR audiologist providing the support). To date, roughly 1000 audiologists have registered as clEAR providers. Of these, 90% have never once tried the program with patients. Why? A survey revealed audiologists either don’t have time to enroll patients or rehab isn’t a money-maker.

It seems that audiologists still need to embrace a more online/telehealth model of practice and be more willing to experiment with new offerings. And of course, there is the issue of time and money.

If audiologists are to remain relevant, apart from embracing new solutions and procedures, here’s what I hope our future holds:

The scope of audiology becomes more specialized and the general AuD requirement might be replaced with a lesser degree (e.g., MS or MA) and supplemented with specialization in specific areas of practice, similar to the medical model of residency. A current challenge new audiologists face is student debt, having paid for 4 years of undergraduate schooling and then up to 5 years of post-graduate training. By limiting their time in school and targeting their focus while they’re there, we could reduce debt and thereby take the onus off audiologists to make big money quickly through hearing aid sales and afford them the time to provide in-depth diagnostics and aural rehabilitation. We might also avoid overtraining; e.g., a private practice audiologist will never be called upon to perform intra-operative monitoring.

Another plus in changing our current educational practices might be to re-invigorate the doctoral program.  My sense is that fewer and fewer students pursue doctorate degrees and research careers because the AuD is so expensive and time consuming. This may be the reason that both our diagnostics and aural rehabilitation methodologies have, at least to some extent, stagnated and why we are still practicing in much the same way that audiologists did 40 years ago. 

In 1980, Jim Jerger, talking about our practice of assessing word discrimination in quiet (but he could have been talking about our profession in general), noted, “We are, at the moment, becalmed in a windless sea of monosyllables. We can sail further only on the fresh winds of imagination” (Mueller & Hornsby, 2020). Maybe it’s time for the weather vane to turn.

 

References:

Mueller, G., & Hornsby, B. (2020).  20 Q: Word recognition testing—let’s just agree to do it right! 20 Questions with Gus Mueller, https://www.audiologyonline.com/articles/20q-word-recognition-testing-let-26478, Retrieved 03/05/20.

 

Nancy Tye-Murray, PhD is professor of audiology and communication sciences at Washington University, St. Louis, MO.

 

Value Based Audiologic Care

by Barry Freeman, PhD

Barry Freeman, PhD

Historically, we asked the question: “How do audiologists receive better recognition for who we are and what we do?”  Among the solutions were the need to identify the intrinsic and extrinsic factors that impact our recognition as qualified cost-effective practitioners who are capable of diagnosing, managing and treating our patients.  Intrinsically, as we act, behave, and present ourselves as professionals, we will be viewed extrinsically in that manner.  

In past decades, the intrinsic focus included following best practices, adhering to our professional code of ethics, monitoring how we introduce ourselves, training front-line personnel, assuring the professional appearance of our clinical facilities, and making sure our marketing materials communicated an audiologic message rather than a focus on product sales. 

This approach helped Audiology transition and become an independent healthcare profession that is recognized by our unified degree (AuD.), State Licensure, an independent Occupational Code granted by the U.S. Department of Labor, and Provider Status with direct access to patients by most insurance programs including the Federal Employee Health Benefit Plans and private insurance.  

Yet, we still have not been granted this status by CMS and Medicare.  As a profession, intrinsically, we have spent decades believing that we could achieve this recognition by demonstrating that direct access to audiology services would be less expensive than the current model which requires a physician referral.  Yet, while cost-effective care is important, we, also, have learned CMS prioritizes Value Based Care (VBC) where providers:

  • Adhere to clinical best practices with a focus on wellness and prevention.
  • Offer Proactive, Preventative, and Efficient Care. 
  • Manage people’s wellness, instead of treating hearing and balance disorders as they occur.
  • Identify hearing and balance risk as well as manage and treat existing disorders associated with hearing loss or balance disorders.  

It appears from an analysis of more than a decade of data provided by CMS on the services provided by audiologists to Medicare beneficiaries, the traditional intrinsic view of minimizing diagnostic procedures is inconsistent with the goals of Medicare (Windmill and Freeman, 2019; Windmill, Freeman, Freeman and Hall, 2019; Windmill and Freeman, 2020; Freeman and Windmill, 2020). 

Rather than permitting Medicare beneficiaries direct access to Audiology services, Medicare requires a physician referral for medically necessary Audiology services for the purposes of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms. As revealed by the data analysis, for at least the past decade, the typical audiologic evaluation consists of an audiogram, speech testing in quiet, and, perhaps, a tympanogram. This appears inconsistent with the request of the referring physicians and Medicare which is seeking audiologic information associated with as many as 16 different chronic or non-chronic healthcare conditions including fall risk, diabetes, hypertension, heart disease, cognitive disorders, and cardiac problems.  

Extrinsically, before trusting audiologists with independent decision-making responsibilities for Medicare beneficiaries, they want audiologists, intrinsically, to demonstrate the ability to provide Value Based Audiologic Care by proactively focusing on prevention and efficient care.  It’s less about the number of procedures and more about the outcomes and information necessary to manage the healthcare and wellness of their patients and beneficiaries.  

Audiologists must start using their full scope of practice to meet the Value Based Care demands of third parties like Medicare. Only when we intrinsically demonstrate the ability to diagnose, manage, and treat our patients, will we be recognized and trusted, extrinsically, by third parties to make independent decisions of medical necessity, patient management, and treatment. 

 

References:

  • Freeman, B.A. and Windmill, I.M. (2020).  Audiology Fee Schedules:  What we can learn from the Medicare database (In Press).
  • Windmill, I.M. and Freeman, B.A. (2020).  Medicare’s message to Audiologists: Diagnose, manage, treat & prevent hearing and balance disorders.  Presentation at American Academy of Audiology, April 2020, New Orleans.
  • Windmill, I.M. and Freeman, B.A. (2019).  Medicare, Hearing Care, and Audiology: Data-Driven Perspectives, Audiology Today, March/April.
  • Windmill, I.M., Freeman, B.A., Freeman, J.S., Hall, J. (2019).  The Economics of Medicare and Audiology: Triumph or Tragedy? Featured session, American Academy of Audiology, Columbus.

 

Barry A. Freeman, PhD, is a former president of the American Academy of Audiology. He received the Distinguished Achievement Award from the Academy in 2006.

 

 

A Transformation to Personalized Hearing Care

by Ian M. Windmill, PhD

Ian Windmill, PhD

Tele-health, wearable health technologies, the transformation of the health care delivery system, self-diagnosing and self-treating apps, artificial intelligence and big data will all impact the delivery of hearing care in the future.  As has become common understanding over the past decade, the trajectory of knowledge in health care is steeply upward, with hearing care a contributing partner. 

In a general sense, hearing care has been about the identification of hearing loss and the use of technologies to mitigate that loss, both in children and adults. In some respects this may be thought of as “audiogram-based” care as both diagnosis and treatment continue to revolve around responses to several pure tones in a narrow frequency range of hearing. Both conceptually and pragmatically, a shift in this foundation is necessary in order to advance hearing care. 

While we are familiar with the concept of “patient-centered care” there is movement towards the concept of “personalized care”. That is, care that is driven by the broader personal attributes of the patient, and not just their audiometric profile. Two evolving areas serve as examples of a shift to personalized care.  The first is the need to consider that patients may have a multitude of concomitant (comorbid) health concerns. The emerging relationship of hearing loss and dementia has brought about greater understanding of the need to consider the relationship of hearing to other health concerns. In the same vein, the relationship of hearing to conditions such as hypertension, hyperlipidemia, rheumatoid arthritis, and diabetes need to be considered when determining a care plan. 

If the eyes are the window to the soul, the ear may very well become the window to health.

A second area is the role of genetics in determining health outcomes.  It is not hard to imagine a future where genetic profiling will occur and the risk for various forms of hearing loss can be determined, including risk for exogenous causes such as noise induced loss.   This knowledge will force a more robust role in the prevention of hearing loss and their related comorbid conditions.

Similarly, gene therapies for the treatment of genetically caused health concerns are expanding.  A recent publication by the UBS financial group on the top long-term investment areas included the following quote: “Genetic therapies…harbor the potential to revolutionize healthcare delivery and disrupt the biopharma industry.  Such therapies…hold out the promise of curing chronic diseases with a single treatment, improving outcomes while reducing or even eliminating out-patient costs.” (Year Ahead 2020: UBS House View)  

Already gene therapies are being used to treat spinal muscular atrophy (SMA) and some forms of retinal neuropathy.  The application of gene therapies to treat hearing loss are currently being investigated in humans. 

Genetic treatments for hearing loss have the potential to significantly alter the care pathway for persons with hearing loss.  The path may necessarily include trials with gene-based treatments and subsequent audiologic monitoring for improvements.  It is not hard to imagine that varying degrees of improvement will be realized, from those whose treatments “cures” the hearing loss to those who realize little to no improvement.  

The necessity to understand these relationships within any given patient will require a deeper understanding of individual patient characteristics, and a more targeted assessment process that extends well beyond the pure tone audiogram.  In a personalized care system, the results of the audiologic examination would be combined with the results of other medical assessments to create a single, coordinated, personalized treatment plan that will account for all health-related concerns.

 

Ian M. Windmill, Ph.D. is the clinical director of audiology at Cincinnati Children’s Hospital Medical Center

 

 

The future of audiology is embracing the democratization of hearing healthcare over the next few years

by Kevin H. Franck, PhD, MBA

Kevin Franck, PhD, MBA

I believe that in the next few years (2020-2023), the biggest opportunities and challenges for the profession will come from the development of new technology and the availability of new data. These will have three effects on the profession of audiology.

First, more people will pay attention to hearing loss. If/as hearing interventions are shown with data from well-designed research studies to causally impact other health conditions, more people will be interested in hearing. Patients who have – and clinicians who treat – these impacted health conditions will want to mitigate them with hearing interventions.

Payers will be more open to expanding coverage because the data about health economics of hearing and hearing interventions will become more favorable. Our opportunity is to demonstrate that we can promote data-driven messaging in the challenge marketing claims that can be overly optimistic at times.

Second, more types of people and organizations will quantify hearing and advise what to do. Technology including better user interfaces are enabling more people to measure hearing, including people with hearing loss themselves. Reliable and effective diagnostic tests have been developed for some populations that are more resilient to calibration, background noise and specialized training. Combined with the near ubiquitous smartphone & tablet platforms, these technologies are deployed widely and inexpensively.

Specific tools include questionnaires (such as CEDRA), digit triple test, and some implementations of hearing threshold tests (such as Mimi and Shoebox on calibrated iOS platforms that continuously measure background noise and monitor data reliability). This means that more kinds of business will be providing guidance on what to do with hearing loss.

As a profession our opportunity will be to reinforce good technologies and guidance, and work to improve those that fall short to make them better. Often guidance won’t be based on any insight other than the result, which could present a challenge without knowing more about the person with hearing loss.

Guidance will sometimes be provided by organizations not financially conflicted with selling products and services, (typically from organizations whose web addresses end in .org such as WHO and HLAA), sometimes by profit-driven organizations (typically .com), but also by those who do sell products and provide clinical service (typically .edu like this author). People with hearing loss will need to be wise to consider from whom their advice comes.

Third, more types of technology will help people with hearing loss. Technology designed to improve hearing for everyone – but especially for people with hearing loss – already exists in consumer platforms (such as Apple’s Live Listen), in many Personal Sound Amplification Products (such as Bose Hearphones and SonicTechnology Super Ear) and software (such as SonicCloud). Online hearing aid companies (such as Audicus and Lively) are using telemedicine and remote technology to provide hearing care .

In the next few years, the Food and Drug Administration’s class of Over-The-Counter hearing aids will be defined. New companies, and companies already familiar to audiology will sell these devices. Existing medical hearing device companies will more completely integrate consumer technology standards to improve compatibility with non-medical products. More options available at more price points will lower barriers for adoption of hearing intervention. People who don’t perceive hearing problems will still benefit from products that improve hearing. People who perceive some hearing loss, but not enough to seek clinical help will be able to find benefit earlier than they would have otherwise. People who seek clinical help will have more options available at more price points.

 If audiology promotes the good self-care technology, our opportunity will be to receive business when people who use them need professional assistance. Our challenge will be to connect our businesses to these new ones for a cohesive patient journey through the stages of their hearing loss.

In the next few years, Audiology has opportunities to lead the way in democratizing access to hearing healthcare, each presenting challenges. Audiology can organize itself into fewer professional organizations for a more powerful and consistent outward voice in collaboration and setting policy. The challenge will be overcoming the small differences that set us apart.

Audiology can use and promote outcome measures that can be used outside of traditional clinics to be able to guide patients to good solutions. The challenge will be shifting our focus outward from the booth. Audiology can support new types of people who provide hearing solutions like clinicians in fields who see patients with common comorbidities and sellers of direct-to-consumer / over-the-counter products. The challenge will be adapting our business models to accommodate. If we can manage these opportunities and challenges, I believe that hearing outcomes will improve and the business of providing hearing healthcare will be healthy, too.

 

Kevin H. Franck, PhD, MBA, CCC-A is the director of audiology at Massachusetts Eye and Ear in Boston.

 

 

Future of Audiology: Technology

by Lindsey E. Jorgensen

Lindsey Jorgensen, Au.D. Ph.D.

The future of audiology is likely to be defined by the changing use of technology utilized by our aging patients. The rapid expansion of technology in the last five years has allowed patients and professionals to interact and provide patient care without being in the same location.

According to the 2019 Pew Research Center report1, 73% of adults 65 and older logged on to the internet which is an increase from just 43% of adults over the age of 65 who used the internet in 2010.2 Not only are older adults utilizing the internet more, they are transitioning to using smartphones use with 42% of adults over 65 years of age report they have or use a smartphone2; although we all know that using and being proficient are two very different things.

In response to the changes in the use of smart technology, hearing aid manufacturers have been increasingly using smartphone connectivity and applications to improve the user’s experience. All major hearing aid manufacturers have at least one hearing aid that connects to a smartphone. 

Particularly for aging patients, audiologists have always considered things like dexterity when selecting the appropriate hearing aid model and coupling options, but we must now consider if the smartphone apps are appropriate for the patient. Because, on average, older adults report having more difficulties using technology than other age groups and tend to shy away from complicated technologies3, these technology choices tend to be even more patient and device specific.

Our field of audiology is changing drastically when we add in new hearing aid technology along with pairing to mobile technology. However, as our aging patients have technology integrated into their daily (okay and let’s be honest, hourly) life and technology advances at even a faster pace, I am sure that hearing aid technology will keep in stride. Therefore, we will need to keep up with all the technological interactions.

I remember when my biggest frustration was when the cable-connected hearing aid would not be recognized by the computer or when the patient changed their potentiometers and now could not hear. Now my day is full of asking what kind of phone a patient has, how often they use it, do they have any other technology at home, and more questions related to outside technology than the new devices that they just purchased.

I think all of us have considered hiring a high-school student to connect everyone’s smart phones and answer all the connectivity questions. We are all conscious of the smartphone services we offer to patients now, but they must also be mindful as these services expand.

These additional technologies have also allowed for a provider to remotely adjust the hearing aids to resolve patient complaints without the patient or the provider coming in physical contact. The current body of research suggests that the ability to provide teleaudiology services, especially hearing aid related services, will likely be a part of future clinical practice and additionally reduce patient and partner stress.4-,6

It is likely that this functionality, and thus the research surrounding it will see a burst of growth following the novel coronavirus (COVID-19) pandemic. Providers in non-life saving healthcare professions (like audiology) are being asked by our government and professional organizations to provide our essential services via tele-service to reduce the rate in which COVID-19 is spreading.

While COVID-19 will shape us all as a society and, particularly, healthcare; the increase in technology use by our patients will shape our interactions with our patients during this trying time and in the future. 

 

References

  1. Pew Research Center. (2019). Internet/Broadband fact sheet [Fact Sheet]. Retrieved from https://www.pewresearch.org/internet/fact-sheet/internet-broadband/
  2. Anderson, M., & Perrin, A. (2017, May 17). Tech adoption climbs among older adults. Retrieved from https://www.pewresearch.org/internet/2017/05/17/tech-adoption-climbs-among-older-adults/
  3. Motti, L. G., Vigouroux, N., & Gorce, P. (2013). Interaction techniques for older adults using touchscreen devices: A literature review. In Proceedings of the 25th IEME Conference Francophone on L’Interaction Homme-Machine (pp. 125–134). New York, NY: ACM. doi:10.1145/2534903.2534920
  4. Bush, M. L., Thompson, R., Irungu, C., & Ayugi, J. (2016). The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review. Otology & Neurotology37(10), 1466–1474. 
  5. Tao, K. F., Brennan-Jones, C. G., Capobianco-Fava, D. M., Jayakody, D. M., Friedland, P. L., Swanepoel, D. W., & Eikelboom, R. H. (2018). Teleaudiology services for rehabilitation with hearing aids in adults: A systematic review. Journal of Speech, Language, and Hearing Research61(7), 1831-1849.
  6. Jorgensen, L., Van Gerpen, T., Powers, T.A., Apel, D. (2019). Benefit of using telecare for dementia patients with hearing loss and their caregivers. Hearing Review, 26(6), 22-25.

 

Lindsey E. Jorgensen Au.D. Ph.D. is a professor in the Department of Communication Sciences and Disorders at University of South Dakota

   

 

Stop Trying to Sell Hearing Aids and Get Busy Guiding Consumers with Hearing Difficulties to Action

by Terry MacTaggert

Terry MacTaggert

Six years ago, I wrote an article, published in Audiology Practices, arguing that significant change should be anticipated in the hearing health marketplace. A combination of new technologies, major demographic trends and emerging consumer attitudes towards their well being basically guaranteed that development. Disruption of the traditional business model would occur as a result of those forces as well as the immense opportunity of unfulfilled demand perceived to be available by many outsiders, some of whom already had had multi millions of customers. The article went on to describe in more detail the new, less expensive devices that would be marketed, the additional channels that would make them available as well as the internet becoming the major communication source for persons seeking help with their hearing and communication.

Since then I have written several posts (see “What about hearing triage“) describing this inevitability in more detail. Since these posts, more than a year ago, several key questions remain:

  • How far reaching will this disruption become?
  • How will the industry adapt?

Let’s address these questions.  The Direct to Consumer (DTC) revolution for hearing instruments is underway and gaining traction. The FDA mandate to specify the terms under which the new class of listening devices, sold over-the-counter, will become available will, of course, be a game changer. There is already plenty of evidence that such devices are available at retail and via the internet. 

Turning, potentially tipping, points like this have affected many industries and the variety of responses is instructive. Some enterprises have been sluggish and ended up disappearing. Others have been more agile and adaptive, changing their proposition and continuing to thrive. Whether the hearing aid segment of the hearing health landscape remains dominated over time by relatively few players is open to question. There is little doubt that others, in some with cases with much larger scale and far greater reach, will enter the arena.

This juncture creates an opportunity to consider deeply what should happen (a values question) as well as the size of the stakes (more of an economic one). We have argued for some time that hearing loss is the largest untreated chronic health condition in our society. And that the numbers typically quoted – 37 million plus in the United States, for example, are significantly understated (NIH, 2016). For example, a recent study (Sawyer, et al 2020) from the UK found that 40% of adults between the ages of 50 and 89 have a measured hearing loss, but do not report any difficulty with their hearing (Sawyer et al 2020).

These figures from the US and UK indicate hearing loss and its long-term consequences are not taken serious by the public. Indeed, data collected by my company, Summus Hearing Solutions supports this fact: The public is generally unaware of the debilitating effects of hearing loss.  

Regardless of the precise number, there is no question that many more individuals are left out of the assessment and treatment process than are accommodated by it. And given what we now know about the hazards of ignoring hearing loss and the problems of late diagnosis, that abandonment (a word deliberately chosen to underscore my point) should be considered unacceptable. As practitioners with the most experience in dealing with hearing issues, audiologists should be cultivating ways to overcome this indifferent, “so many on the sidelines” conundrum. 

Why not begin by thinking boldly? Assume there are at least seventy million people in the U.S. and Canada with self-perceived communication difficulties and/or varying degrees of permanent hearing loss – sensorineural patterns within the normal range through profound degree of hearing loss. How might they be tested and empowered to take control of their hearing health?

Too often the industry starts with a solution – a device, usually with a number of services bundled with it. Compare that with what the contemporary consumer wants:  An accessible, reliable and private way of measuring their hearing. When it comes to other types of self-assessment, however, most of us have become suspicious of providing personal information before the need is evident and the service provider is trusted.

A credible self-screening tool must not only be easy to use and reliable, but audiologically valid – that is, the consumer is informed about his or her hearing status and the implications for any next steps that are warranted. Some of the basics include establishing the interpreted result as a baseline, informing one’s family physician and maintaining a vigilant stance for the future. 

Finally, to the extent that a product or service could be helpful, such advice can then be offered. A minority (our data sets indicate that an average of 30% of those 45 years of age or older) will test with a sensorineural hearing loss, the more advanced of whom (including many “mild” and “moderate”) should consider a remedial device, such as a quality PSAP or starter hearing aid and many of those are becoming aware of some degree of hearing change. Another 15%-20% will have indications of a conductive change where, if the condition is persistent, their pharmacist and doctor are obvious sources of medical support. Most will display normal patterns and levels where coaching about frequent updating is appropriate.

Figure 1 describes the paradigm of test → interpretation → implications for action → potential solutions. It is the essence of Health Tech and personalized medicine, and represents an enormous shift towards Medicine 3.0. For those unfamiliar with the term, Medicine 3.0, it is a health-related extension of the concept of Web 3.0 whereby the users’ interface with the data and information available on the web is personalized to optimize their experience. A primary goal of Medicine 3.0 is to use consumer technology, such as social media and smartphone-enabled apps to actively engage persons with hearing difficulties in their ability to self-direct their own care. 

 Figure 1 The help seeking journey for the person with hearing difficulties in Medicine 3.0

The meta issue, directly related to the application of Medicine 3.0 within the profession of Audiology, can be stated quite simply: How can tens of millions more consumers become engaged in the hearing health process? There is not one answer; rather a constellation of related steps involving a number of players and technologies. And the outcomes remain speculative as the process, by definition, will be incremental with learning and adjustments required at each step. 

A good starting point is to ensure that the overriding message is consumer, rather than product oriented – how to create value by providing timely information, education and guidance rather than a “fix” via a hearing device.

Sensorineural changes can begin at birth or be acquired at a relatively young age (particularly now with the “gaming and earbuds generation”) rather than suddenly appearing at 60 or older. Even when exacerbated by noise, ototoxic medications and/or one or more disease states, such changes usually worsen gradually. Pattern recognition algorithmic routines can detect early changes within the normal range thereby identifying younger a well as older people that are entering their “hearing journey”.

The cohort of those who should be concerned about their hearing sensitivity  is very broad and will benefit from early identification. We do this with sight and blood pressure; why not hearing?

We have found a receptive audience among this much larger target group. When testing is provided in an accessible, efficient and private fashion with no strings attached, most people regardless of their age, are interested in participating. This receptive audience is prepared to take guidance providing it is well explained and not biased towards a particular solution. When adequately prompted, there is often an appreciation of the widespread nature of the problem. Those with signs of hearing loss appreciate they are in good company – there is nothing unusual or abnormal about acknowledging and dealing with the condition.

Another key involves recognizing that the industry as it stands now cannot alone solve the problem of poor uptake of treatment options and lack of awareness that hearing loss is a consequential problem if left untreated. Even if concerted action was taken by every audiologist and hearing instrument specialist, the proportion of those impacted would fall well short.

Natural biases and business-traditional imperatives among many and the dominant bricks and mortar distribution infrastructure with limited reliance on the internet assures that the problem of poor uptake and lack of awareness among most of the population will remain unresolved. Adding thousands of family physicians and pharmacists would clearly help, although a continuing campaign with enough incentives would need to be created to sustain their efforts. Existing hearing health providers will need to evolve and receive help from other healthcare professions if the goal of greater awareness among the public is to be entertained.

Reducing regulations and creating an environment where individuals are empowered to seek knowledge as well as what next steps make sense is vital. The industry with more of a 21st century face can provide an important part of that engine providing much greater reliance on the internet is assumed. Adoption of hearing health as a priority by governments and public health agencies is also essential. Greater testing of school age children, for example, with educational extensions for parents about their child’s and their own well being would be additive.

Leveraging corporations and their insurers forms part of the mix. And the influence of new players, those offering less expansive hearing devices and including at least a few of the FAMGA (Facebook, Apple, Microsoft, Google, Amazon) technology group, each with a stake in healthcare can be enormous, as well.

Some of these drivers are already underway although most are motivated by appeals to their audiences or members to acquire product. Whether the net effect is to turn on or off most consumers receiving these messages remains to be seen. What is certain is that awareness of hearing and hearing health issues is increasing and will likely continue to do so.

Making it simple for consumers to test themselves reliably and follow the Health Tech process to a logical conclusion is also a requirement. There are many tests available, most via the internet, beyond those provided by in-house by industry professionals. Many of the protocols followed are of dubious quality and almost none, if any at all, offer reliable interpretation. The presence of “Click-Bait” (i.e. You’ve been tested and need a (expensive) hearing aid!) is all too evident, even with some of those that offer “professional” intervention along the way.

What is needed is a simple application widely available on the internet via thousands of websites that can be accessed with a browser or QR code using any connected device, any time from anywhere, particularly from home. Such a medium would provide an interpreted test and explanatory report for the user at a minimal, if any, cost. A further comfort would be the assurance that personal information required to report would not be stored, much less shared, unless the user wished it to be for follow-up evaluation or support. We can anticipate such an innovation to become available soon.

So what else might we do short of letting market forces alone confront the problem as important as those forces can be?

The industry itself can provide part of the solution. Adopting more of a counselling stance (and likely charging for it), partnering with doctors and pharmacies and using the internet to a much greater extent to extend reach are all part of the equation. So is offering more devices at a wider range of prices as is unbundling and making related services transparent to clientele. 

 

References:

  • National Institutes of Health Quick Facts About Hearing. December, 15 2016. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing. Downloaded February 25, 2020. 
  • Sawyers, C, et al (2020) Biopsychological classification of hearing health seeking in adults aged over 50 years in England. Ear and Hearing. Published-ahead-of-print. 

 

Terry Mactaggart is the President and CEO of Ultimate Kiosk Inc. and Summus Hearing Solutions Inc., AI-enabled software companies with proprietary technologies aimed at capitalizing on opportunities in international hearing health. He has substantial experience with private venture creation, financing and growth as an investor, consultant, director, chairman and president of a number of companies – both privately owned and publicly traded – as well as of a private equity fund. A broad international perspective has been gained from these activities as well as from his leadership of The Niagara Institute and his time with the World Bank. Terry has a BA (Political Science and Economics) from the University of Toronto and an MBA from Stanford University. He can be reached at terry.mactaggart@bell.net


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1 Comment

  1. I appreciate the broad overview from the various contributors. During this age of rapid change in health care, students and audiologists need to become aware of and understand both internal and external forces applying pressure on our profession so they can learn to quickly adapt. Rigorous open exchanges can offer important contributions to this process.

    For perspective to my comments, I have practiced audiology for 43 years. Part of that time was devoted to cochlear implant and middle ear implant research and working at an otology clinic. I have owned and operated my private practice for 38 years. I have served on numerous AAA and ADA committees, served on the AFA Board, and am a past-president of the Academy of Doctors of Audiology.

    The focus of my response is directed at Nancy Tye-Murray, Ph.D.’s “Some Thoughts on the Future of Audiology.” I agree with her comments about audiologist’s need to provide aural rehabilitation programs, auditory brain training, and telehealth to improve patient care. However, I am shocked by and profoundly disagree with much of the rest of what Dr. Tye-Murray wrote.

    **Read entire statement from Dr. Engelmman here.**

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