tinnitus management app oto

App Based Tinnitus Management: Interview with Ed Farrar and Anna Pugh of Oto

This week, host Dave Kemp is joined by Dr. Edmund Farrar and Anna Pugh of UK-based startup: Oto

Oto is an app-based digital health solution for people suffering from tinnitus. Over the past year, the company has witnessed significant growth and aims to expand access to more people with tinnitus through its platform “using accessible, science-backed and evidence-based digital tools”.

In January, the company announced it had raised £510,000 and was selected for the renowned Y Combinator startup accelerator program. In addition, the company recently announced a global collaboration for tinnitus support with Australian hearable maker, Nuheara.

Full Episode Transcript

Dave Kemp 0:10
Okay, so we are joined here today by Ed Farrar and Anna Pugh. Ed, Anna, tell us a little bit about who you are and what you do. We’ll start with you, Ed.

Edmund Farrar 0:20
Thanks so much, Davis. It’s really great to be on the podcast again. So my name is Ed Farrar, and thanks for the introduction. I’m a medical doctor by background. I graduated medical school in 2015. And very shortly after joining the Air Force, and the visual plan for me was to train as a as a surgeon in the airforce. But during my time in the military, I developed- mild thankfully- mild tinnitus, and I got used to it fairly quickly. But during the time, the military I saw a large number of men and women with actually, unfortunately, severe tinnitus, and it was having a big impact on their quality of life. And in speaking to these people, I realized, okay, well there’s a, there’s a big problem here, there’s, as we know, it’s very difficult to access any kind of help if you have tinnitus. And of course, there’s no cure. effective treatment does exist in the form of cognitive behavioral therapy, but to access this here in the UK, can take months, if you’re lucky, you know, perhaps over a year if you’re unlucky, so I got together my my co founder, George, who was a doctor in the Navy also has tinnitus himself, he suffered with it a bit more than I did. And we thought, okay, we’ve got an opportunity to use the skills we’ve learned as doctors, and also in the military to create a digital scalable solution for tinnitus that could hopefully help not just people in the UK, but people all over the world. And it was around this time, we were sort of exploring a few early ideas. And it was around this time we met Anna. And actually, Anna, I remember reached out to me, I think I posted something on LinkedIn. And you know, Anna was very excited to get in touch. And it was, of course, I’m really, really amazing that she she did reach out because I suppose we wouldn’t be where we are today. If you hadn’t done

Dave Kemp 2:13
Anna you want to go off that and just sort of…

Anna Pugh 2:16
Yeah, I mean, that’s, that’s amazing. Hi, Dave. It’s lovely to be back. I’m on appeal, I’m hearing therapist, audiologist and very long standing, I won’t go into when I trained. But I’ve been around for a while. And I was very aware that I couldn’t reach as many people as I want to, there’s only, you know, I’m only me. I’ve been into training and taught people but it’s it’s very much about that interaction with people. And I was flirting with the idea of an app, but I have no technical skills. So I had no idea how to make an app, although I had an idea about I’d really liked one. And Ed posted something I was like, Ah, that might be the very thing. And so I was really excited. And you know, together and with with Lily, and with Jake, and with the other people in the team, it’s very much a team effort. It’s been astonishing. And you know, I posted the other day that we’d now hit 100,000 sessions, which is I get very emotional about it. I think that’s just astonishing that we can make a difference to people and help them manage their tinnitus. I have tinnitus as well. My tinnitus is not very friendly, and and very aggressive and very loud, and very intrusive at times. So it’s some of the the well, most of the treatments on the app or most of the ideas in the app. I’ve I’ve used myself as well as my patients. But one of the things that’s fantastic about the app is that it’s made me rethink about how I deliver my own therapy, my one to one therapy and how we how the app has changed my traditional thinking. And it’s all thanks to Ed and George sort of leadership on that. And that’s really exciting.

Yeah I think we’re gonna come back to that 100,000 person mark, if you will, because I think that’s such a unbelievable milestone. And I think it is such a testament of like the outsize impact that you’re now making like you had identified early on. I really like being able to help people. This is kind of my life’s work, you know, this particular facet of audiology, and now you’re really able to do that through the help of Ed and his team and everything that you’re doing at Oto. So I guess, Ed, I’m curious to hear from you a little bit. You know, the genesis of asking you two back on, on This Week in Hearing you had come on my original. The first time I talked about you was on FuturEar. But I saw that you had this huge raise So wanted to just give a huge shout out to that. And that you’re also part of the the current Y Combinator class, which is a huge honor. So if you wouldn’t mind just going through both the raise, maybe some of the process that went involved there, explaining what Y Combinator is, and the significance of that, because for me, as somebody that has followed that space really closely, it’s really exciting to see kind of one of our own within this industry be part of this cohort. It’s a big deal. So wanted to kind of just kick things off right there.

Edmund Farrar 5:34
Well, thank you, Dave. That’s very kind. And I remember, when we spoke last time, I think it was around a year ago, actually, we only very recently launched the app. Just to recap, Oto is a mobile app that allows anyone to access instantly access, digital tinnitus support. And it’s all evidence based, bringing together the sort of the latest therapeutic techniques that Anna uses routinely in practice. So the funding round came together, we decided we wanted to grow Oto, we wanted to grow the team, we wanted to reach more people internationally. And we wanted to validate what we were doing in the app was effective, the support that we were providing was having a real world impact on people’s lives. And obviously, to do all those things costs money. So we thought, okay, we’ve we’ve, we’ve got a huge market opportunity here a big problem. That’s having a real world impact on people’s lives all over the world. Let’s, let’s raise some money and grow faster, and do these things that we wanted to do, and get to the sort of the point of help for everyone all over the world. So we’ve raised 510,000 pounds. We closed the round in November last year, primarily angel investors, but also a few, a few European funds as well. And yeah, the investors have been hugely, hugely supportive so far, so so really thankful, thankful to that. Now, Y Combinator is, I’m sure many of you listeners probably won’t have heard of it. But in the startup world, is generally regarded to be sort of the top startup accelerator. It’s the accelerator that all startups try to try to get into. And we’re very lucky to be part of this, this current cohort. And we were going to use this to sort of really try and do as much learning as possible in a short space of time, about our users about how to grow the business, how to raise more money, you know, business partnerships, that kind of thing. And use the experience to really supercharge the growth of Oto and reach more people around the world. So yeah, I suppose there’s there’s two focuses really of the this accelerator, this three month program, the first focus will be will be improving the product and ensuring that we’re delivering the best possible experience the best help for people with tinnitus. And the second sort of thing is quite so reaching more people with tinnitus around the world. We’re currently available all over the world, but sort of our main user base is in the UK, US, and some in Canada, and Australia. So we want to grow that number, and ensure that we’re delivering value to more people around the world with tinnitus. So the program is three months finishes, and we’re halfway through now finishes in March. And in March time, we will will raise another funding round of a higher magnitude then the one last time of which we’ll use to, again further continue to develop the product, grow the team, and just do things do you think genuinely, generally faster. Yeah, so really exciting time for the company

Dave Kemp 8:45
Yeah, I think it’s fantastic. Like you said, it’s been about a year, and I’m just blown away with the progress that you’ve made. Like, you know, getting into Y Combinator is a huge deal. Have you having this raise, like you now have some money to put toward the development of this, Anna, from where you sit, as somebody that’s just sort of come into this world of a startup working here. What’s your experience been like? And and what’s your sort of impression of what you’re trying to all do with, with Oto in general?

Anna Pugh 9:15
Yeah, it’s been it’s been astonishing, listening to Ed and George and the team talking about the way that that the Accelerator has worked and the encouragement that they’re getting is great validation for us that we know that we’re making a difference in the real world, but also making a commercial product that people who want to invest in and want to buy and want to use all of those things. So it has longevity as well, which is really important. And some sustainability and some some opportunities to grow as well, which is really important. So that’s, that’s exciting. For me, quite often, if I’m honest, I’m out of my depth sometimes when I listen to what this means But then on other bits when we’re talking about the user experience, and we’re getting some real manageable data which endorsed have to use to demonstrate effectiveness and, and raise money, all of that stuff is is brilliant. And it’s all powerful for to reflect back on my therapy and to change what we’re delivering on this content and making sure that we’re meeting people’s needs and expectations. And so being able to have the time, which is what the funding has given us, and the resources and the staff to enable us to do all of that is great. I mean, when there were when there were only a few of us, it was really difficult. And if I’m honest, it was very much Oto is kind of something that happens on a Tuesday afternoon. And now it’s, you know, we’ve got full time staff really drilling in on it, getting some of the real content and the data together, to give endorse the information that they need to go forward, which is, which is wonderful. And reflecting back on for me for therapy and for content. So it you know, it works in both ways.

Dave Kemp 11:12
Yeah. i It’s fascinating. I love your vantage too Anna, as somebody that this is like your passion, and you’re really being able to manifest it in a very powerful way through this app, I think is just so me. So Ed, I’m curious, like in 2022, you know, what’s going to be the big focus this year for you all, I know that, obviously, right now you’re in the throes of Y Combinator. And then obviously, there’s a raise that’s going to be following on the heels of that, you sort of laid out the key high level objectives. But I guess getting down a little bit into the weeds like Where where is the development going to be focused around? And what ways can you improve this based on just the first year of doing this? Like, it just feels like such a frontier and so exciting of like, what what can be done now that you have this application that can facilitate what had historically been done more in like an in person setting? So you have this ability to really proliferate this type of science. Where’s your head at with what 2022 looks like?

Edmund Farrar 12:19
Yeah, it’s a it’s a hugely exciting year for us. So our, our end goal is to build the definitive solution for anyone with tinnitus, definitive digital solution. And what I mean by that is, if someone has tinnitus, the place to go is Oto. And you know, we are only sort of other that we’ve only taken sort of the first steps in that journey. Now we’ve got loads and loads of work ahead of us to make make some significant progress and achieve that goal. And what do I mean by that? Well, we’ve made a great start with the app, and the app is helping 1000s of people around the world with tinnitus. But we can help these people more. And we can provide a more effective solution than what we’re currently offering. And in order to do that, there’s a whole number of a whole number of things we can do, and whether that be improving product features, delivering therapy to them in different ways, optimizing the way in which we deliver the therapy to them, delivering new sounds and sort of overall, improving the sort of the content in the app and the delivery of that content. So that’s the first first thing I would say, you know, we want to really be optimizing so that people are getting the best experience that they can get through through the through this this method of delivery. I think the second thing I would I would say is we have we’ve just launched a you know, we just launched a partnership with with Nuheara. So Nuheara, international hearable manufacturer I’m sure many of your listeners are familiar with, he built a really really cool products that allow sort of augmented augmented hearing, I suppose, through to these to these wearable devices. And in partnership with Nuheara, we are delivering a world first when it comes to holistic tinnitus management. So a combination of mobile app, digital digital device, digital support, plus the hearable or earbud that really is sort of something that’s not really been been been done before. When it comes to when it when it comes to variables and when it comes to hearing health in general. So we really want to lean into that partnership and and really help both our customers and new heroes customers get the most out of that. And that’s something we look to continue sort of, you know, the next day, hopefully many years to come. And then of course, we want to we want to we want to grow the company. So I mentioned I mentioned the growth we want to be reaching people in new ways. Around the world. So you know, we, how we how we, how we reach people, whether that’s paid marketing, whether that’s organic marketing firms, that kind of thing. And just working out how we can reach as many people as possible with Oto but yeah, the the primary focus really is the product, optimizing the product to deliver the most value to people with tinnitus. And I suppose the other thing I’d add to that as well, and maybe Anna can elaborate here, but we’re very much focused at the beginning on the beginning of someone’s tinnitus journey. When someone is first looking for a solution when they’re looking online, they’re speaking so audiologist, they’re looking app store for that solution for tinnitus, and it comes to us but we need to figure out how we can continue to help people throughout their sort of the actually that because you know, tinnitus is incurable throughout their lifetime with tinnitus, whether it be someone that’s had tinnitus for 30 years, or you know, was diagnosed a few months ago. How do we continue to help these people whether it be maintain their their habituation, help them through a spike, and that’s something that I think is really uncharted territory, with, with with digital solutions in general, but I think a real big opportunity for us.

Anna Pugh 16:10
It’s it’s an enormous opportunity for us. And it’s one of the things that as the content team are working on, is is how to provide that sustainability for people because as Ed says, tinnitus, we we deal with tinnitus, and we learn how to cope with tinnitus. But it doesn’t, it doesn’t cure, it doesn’t stop if we’re not offering a cure. So there will be times when your tinnitus raises again, and you need that little bit of extra support. So we’re looking at embedding that, that attachment that support throughout our content, so that the app becomes meaningful to somebody so that when they when they have a bad day, they can think of Oto and they they’ve got somebody something there that can help them. And we’re doing that as, as Ed said, through our marketing and immediate but also our relationship with, with companies like Nuheara, which I can’t explain to you how excited I was about that, when they first sort of mentioned, it was like, Oh, I think they’re fabulous, I was very excited. And it’s because it’s such a novel idea to be in someone’s ear and to have such cool piece of kit as well. It’s fantastic. But also it’s the people elements as well. So we’re working with audiologists we’re working with, with other providers to look at how they get support to people and how they work with the people that they see in their clinics everyday. So it’s getting both of those elements, right is really important. And that’s why we’re spending a lot of time in the beginning, making sure that we get that, that that foundation, correct. And it’s all our therapies are evidence based. So we you know, we need to justifying and qualify, all the things that we we really liked before it’s put into the app. So there’s a lot of that preparation work, as well as all the fantastic marketing and, and social media stuff that we’re doing.

Dave Kemp 18:14
Yeah, I mean, a few things here. So regarding the Nuheara partnership, I agree, I think that’s so exciting. And so novel, you know, for me, the way I look at it is, you know, we’ve kind of been in this nascent era, where you have all of this software that’s kind of emerging and bubbling up. So auto fits into that. And then you have everything that’s happening on the hearables. And the TWS side of things, where you just have this massive, massive proliferation of earbuds. And this normalization, where people are walking around with things in and around their ears for extended periods of time. And so now you sort of get to the convergence. And this is where things get really exciting. And, you know, kind of like my initial take for this was well, now we’ve just entered into the first or one of the one of the first, let’s say, one of the first, you know, instances where you have a hearable company that has hearable specific apps that can be downloaded for those devices. And so I think hearing health is a really obvious area of applications that we’re going to see more and more of this where you’ll just be able to buy, you know, a piece of hardware, and then you’ll download the types of applications that are unique for you as a user. And so if you know, let’s say my brother and I both have, you know, a pair of Nuheara IQ buds, I have tinnitus, he doesn’t, you know, he goes in, he downloads something that’s, you know, in line with what he wants, whereas I download this particular application, and so you can kind of follow this out where it is this inversion of how these devices get priced, which is the, you know, the hardware sort of gets commoditized and then you have the software application layer that gets layered on top of it out of the smartphone. I mean, it really is like pretty akin to the smartphone. So it’s it’s incredibly indicative. I think of The future and what’s coming is that there’s going to be lots and lots of these types of applications, I think. And so I think it is really exciting is like you kind of follow the trajectory of this out a little bit. And what’s really tantalizing is this opportunity where you do have that sort of proactive element to this where, you know, I have, I have the, you know, my everyday pair of earbuds, these hearables that have the tinnitus therapy baked into it. And over time, it actually starts to understand when maybe I’m actually in need of something like that. So it just starts to engage me with the tinnitus therapy proactively. That’s the kind of stuff we’re moving toward. And those are the doors that are going to be opened here. And so that’s where I look at this and say, Man, we are really moving into this new frontier, where it goes from being something that is really kind of inaccessible in the sense that if you do have debilitating tinnitus, let’s say you have to go you have to schedule a time with a professional, meet them in their clinic, get some sort of, you know, therapy, materials that you’re going to do. And you’re going to do this on your own. Now we’re moving to this point where you have Anna, who, you know, basically is able to kind of Port her knowledge and expertise into something like Oto, and it can reach 100,000 people in a calendar year. That, to me is the foundation of a way in which you actually can combat something like tinnitus at scale. So that gives me a lot of encouragement hope about kind of, like, what’s on the horizon here is that these things in isolation are powerful. But when you start to kind of combine these building blocks that are all starting to kind of formulate, and mature in tandem, that’s when the fun really begins.

Edmund Farrar 21:41
Yeah, I’d say, Dave, I agree completely. And with the recent regulatory change in the US, you’re so right, you know, the themes are going to change a lot over the next 12 to 18 months. And I think we’ve been we’ve actually been auto we’ve been very lucky with the timing of that, when we can, we can work with these really exciting companies. We work with a really exciting company like you here to deliver better support, where it where it may be needed, at a probably better, better, many cases, better value as well. So really, really exciting, exciting, exciting timing for us.

Dave Kemp 22:17
Yeah, for sure. So I guess, you know, kind of going back though, to some of the different things that were mentioned. You know, previously, I do think that this whole idea of audiologists are going to be your biggest advocates. So it’s kind of a two fold question that I have. So the first half is, how have you gotten 100,000 users, or sessions, if you will, in your first year, and you know, just disclose whatever you want. You don’t have to give away any secrets or anything like that. But I am curious what your current strategy is. And then without making this too much of a loaded question, are you looking at the hearing professional as your sort of auxilary workforce and advocates that can spread the good word of Oto far and wide and make people make their patients aware that this exists. So I guess, again, let’s start just with how did you get to the point to where you are now and what tactics are successful? And then are you looking into the future of utilizing the the current labor force to your betterment?

Edmund Farrar 23:28
Yeah, very, two very interesting questions. On the first one, I’ve just asked to think about the number of people who have tinnitus, what is the first thing they do, when they realize they’ve got this horrendous, horrendous condition that’s, that’s going to, they think, is going to ruin their life. And what most people do is they Google it, or they go on the App Store, and they search for something. And we’ve been able to really take advantage of that. Firstly, by some, some optimization of the App Store landing pages, a large number of our downloads have come from people just searching the App Store’s google playstore, Apple App Store, but also optimizing content for web. So we’ve got a whole load of free resources online on our website, that we’ve put a lot of time into making and delivering value to people through this content, in the hopes that after they’ve read these, these articles, they will then go on to to download the app and give it a try. And that’s been really successful for us. So I’d say up in sort of, sort of the majority of last year, that was the majority of our growth, really, and then this year, we’re looking into a number of other sort of growth channels. I mentioned pension, paid marketing and a few other things we’re looking into as well. And this is your second question. We want to empower audiologists, as well as individuals with tinnitus, and we think Oto is an amazing tool to to help audiologists. deliver evidence based care to their clients to their patients. And that ranges from audiologists with audiologist like Anna with with decades of experience of, you know, people you know, audiologists like Anna that know tinnitus better than anyone else, all the way to the other end of the spectrum of audiologists that are actually very uncomfortable with with managing people with tinnitus, or helping people with tinnitus. And we’ve we hope that the app can actually be used at any one of these points. And you know, I’m sure Anna, Anna will be able to be able to start me off on this but I think Oto can be used as a as a health care professional, whatever level of experience you have with with tinnitus, as an adjunct to the care you’re currently providing and the care you want to provide, with your with your regular follow ups and with your with your spoken in person therapy, or online therapy, or, as a tool for audiologists to use to say, Look, I’m sorry, I don’t have much experience with tinnitus, or I don’t offer much tinnitus support. But I know this really great app that you can use. And I can I can explain to you how to get the most out of it. So that’s that’s the aim here. You know, we’re all about empowerment, and not just the empowerment of the individual using the app to take control of their own of their own care pathway and their own journey, but also of the healthcare professional as well.

Anna Pugh 26:26
I’d certainly sort of repeat that completely. It is all about getting audiologists engaged and empowered by the the app, lots of audiologist, as you know, covers such a wide range of skills. And we include what you call in America, the hearing aid professionals and all those kind of guys as well. It’s very much as such a huge range of skill. So some people will be great at balance, some people will be great at hearing aid technology, some who will be great at rehabilitation, some people will be great at tinnitus. And it’s really hard to be great at everything. And so what the app offers is for those people, it’s an it’s an additional support for you as a professional, that you can have confidence that it’s evidence based, that you’re giving somebody the support that’s that’s qualified, that ratified that we know what we’re talking about, which is really important, I think, as well for your own professional credibility. And yes, a lot of our contacts are from, from hearing professionals who know about us have heard about us who’ve I witted on about to bless them, who, who will refer their patients and the people that they work with, because it’s, it’s an ongoing thing, even if you’re really good at tinnitus support, you’re only going to see your patient sporadically once once every three months, once every six months, once a year, depending on your your contract with that person. So also can be their daily therapy daily support those those anchor spots, when people are having crisis, information that signposting all of that stuff is within our app. So it gives people a lot more than just a masking sound generator, which a lot of tinnitus apps tend to be it’s it’s much more than that what I’m saying it’s much more than that, because this isn’t my time to be saying it’s much more than that, like, show off a bit. But that’s that’s what it is. It’s it’s much more than just something that makes a noise and somebody there.

Dave Kemp 28:50
Yeah, that’s great. I just think it’s really interesting. It goes in and follows along a lot of these conversations that have been discussed lately, which is kind of like, you know, in this era, as a hearing professional, how do you differentiate? And I think that the answer is it’s really multifaceted, and I think it’s there’s a lot of optionality. But I think that you do have to do things to stand apart. And I think that just even being well versed in what’s available, something like this, like if you said, tinnitus isn’t really your cup of tea, and you prefer to just kind of refer that on to something that, you know, you can still have a finger on the pulse, and you can engage them on the progress that they’re making, but it’s something that’s being done on a routine basis, sort of, it’s more patient centered care, I mean, they’re able to do that on their own without your intervention, which is screams scalability there as well. So as we kind of come to the close here, I just wanted to give you two the option like any kind of closing thoughts, anything that you want to share knowing that much most of most of the audience here will be industry professionals and hearing professionals so just curious of how you guys think you know that the last message that you want to share.

Edmund Farrar 30:02
Yeah sure. Thank you. Thank you, David. It’s been a really, really interesting discussion. So thank you so much for having us on. Ya know I’m always interested in hearing from people that are interested in tinnitus interested in hearing health. It’s such an exciting time to be in this industry at the moment, I’m so glad that I’ve been had the opportunity to get involved. So I’m an, Anna will testify that I love to love to speak to new people and lots of love to make connections. So please do get in touch. If you’d like to talk about Oto about if you think we could help you, from a perspective of from an audiologist perspective, if recommending Oto to your patients is something you’d be interested in and then please let us know we have some information on our website and some information I can I can email you too as well. You can either connect with me on LinkedIn or send me an email my email address is {ed@joinoto.com} Yeah, you know, I think it’s this is something that can, I hope can can really help can really help clients can really help patients. And we’ve seen it in audiologist that we’re currently working with so so please do get in touch but yeah, I don’t know if he’s anything he wants to add there Anna.

Anna Pugh 31:15
Only that you know, give it a try. Like listening to hearing aids when when you get a new product, give it a listen. Give it a try. See what you think and let us know we’re very keen to get feedback from from users and from professionals so that we can grow and develop and change and, and learn. So give it a listen and let us know what you think.

Dave Kemp 31:38
Fantastic. Well, thank you two so much. Best of luck with Y Combinator, the next fundraise and just everything that you guys are building. I’m a big fan and I can’t wait to have you on again in the not too distant future to give another update and hear the progress that you’ve made then. So thanks, everybody, and we will chat with you next time.

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About the Panel

Dr. Edmund Farrar is the co-founder of Oto, a digital health startup that allows anyone to instantly access science-based treatment for tinnitus and other underserved chronic conditions. Before Oto, Ed spent 6 years as an RAF doctor. 


Anna Pugh is the Hearing Therapist for Oto. She is an experienced Hearing Therapist Audiologist providing specialist counseling, advice and support for people with tinnitus, listening training for people with hearing loss and communication issues.


Dave Kemp is the Director of Business Development & Marketing at Oaktree Products and the Founder & Editor of Future Ear. In 2017, Dave launched his blog, FutureEar.co, where he writes about what’s happening at the intersection of voice technology, wearables and hearing healthcare. In 2019, Dave started the Future Ear Radio podcast, where he and his guests discuss emerging technology pertaining to hearing aids and consumer hearables. He has been published in the Harvard Business Review, co-authored the book, “Voice Technology in Healthcare,” writes frequently for the prominent voice technology website, Voicebot.ai, and has been featured on NPR’s Marketplace.

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