Enabling Greater Access to Ear & Hearing Health Services: Interview with TympaHealth CEO, Dr. Krishan Ramdoo

Amyn Amlani 0:10
Welcome to This Week in Hearing. I’m your moderator, Amyn Amlani. And I am joined today by Dr. Krishan Ramdoo, who is the Chief Executive Officer and founder of Tympa Health Technologies in the UK. So thank you for being here today.

Krishan Ramdoo 0:27
Nice to be here.

Amyn Amlani 0:29
So, you know, your product is really fascinating to me. And I really looking forward to this conversation. But before we dive into the product and what it offers, can you give us a little bit about your background and a little bit about the motivation behind your company?

Krishan Ramdoo 0:48
Yeah, thank you for having me. Real pleasure to be here. So I’m by background myself, I’m an ENT surgeon. By background, I’ve been a practicing clinician for about 12 years now. I’ve also been doing my PhD in hearing health. So now a little bit about the space. And in England, we have the National Health System. And there’s a program in the national health system called the NHS England Clinical Entrepreneur Program. And that’s where they choose clinicians who are doing exciting things, and help them to kind of commercialize their ideas, I was fortunate to be one of the first 10 in the country to be appointed to that. And so all of that came about because I had this idea and innovation to how I could change the way Ear and Hearing Health was delivered, not only here in the developed world, but you know, around the whole world in the developing low income resource countries. And it really started with one patient who I saw and so I was very junior – early resident, I would say for you guys over there, where I sort of patient she came into I was currently covering care of the elderly, with the geriatric wards. And she came in and she was 79 year old lady and came in confused. And she was treated with by the attending team for an infection. But after being treated with that she was still confused, disengaged with the ward disengaged with her family. So me being a budding ENT surgeon, I thought well, let me have a look in her ears so I had look in her ears and lo and behold, there was full of cerumen. And I thought, well, let me take it down to the end department remove it, and had a look at her eardrum after that, and then got her a hearing test. And lo and behold, she had a age related hearing loss. I arranged for her to be fitted with a hearing aid, followed up six months later. And she was a completely new lady. She was planning her 80th birthday engaged with a family. And that really triggered for me, I said, Well, that’s simple intervention I did there made such a big impact on that lady’s life. And you know, as I progressed, in my career, I was seeing so many more patients coming to my clinic, which I said, well, there has to be a better way where some of these things can be done outside of the specialist environment. And how could we put that in the hands of a allied health professional, so a non ENT surgeon, but provide them with the right tools to do something accurately, efficiently and ultimately better for the patient, and do that in a digital manner. And fundamentally, all of that experiences where Tympa Health came from. And we’ve now managed to develop a solution, which allows you to take the whole clinic out into the community, but still link in with a specialist, it allows you to do looking in there. So digital otoscopy, wax removal, and a hearing screen, all of that is then pulled together into digital record, which can be shared with any specialist in any location. And it just makes the whole process more efficient. And in the US, you know, we link to a lot of billable codes, as well. And I think with the advent of the way of let’s say, the changing landscape in the US, which is kind of pertinent to our conversation. I think Tympa has a real role to play and how we can provide that that due diligence before someone has hits fitted with either a hearing aid or an over the counter for that matter than I guess I’ve I’ve got one here as well, which I can show you if you want to.

Amyn Amlani 4:25
Oh absolutely. You know and one of the questions that comes to mind. And again, I’m really intrigued by all of this is you know, the consumer is now self sufficient, right self efficacy comes in and they’re going to take care of themselves. And you’ve created this tool. Just a real quick question. Have you found that the elderly are able to use this tool? I know it’s a smartphone based tool. But are they able to use it and use it successfully and and can you share any of your any of that information that that you might have?

Krishan Ramdoo 4:58
So the way that the tool actually works, It’s it’s delivered with, it needs to be an allied health professional. So it could be a physician’s assistant, a nurse, a pharmacist or pharmacy assistants. But what we’ve enabled with Tympa, because in the UK here, we’re in multiple sectors, we’re in pharmacies, we’re in opticians, we’re in the NHS, retirement villages. What it does, it enables better access. And an answer to kind of, obviously, we don’t expect consumers to do it themselves. I mean, that could be something future if we decide to do. But what it enables is better access to be able to see a specialist is very challenging wherever you are in the world. And so it enables almost a gold standard assessment to be done in the comfort of their own home, it was a retirement village, or somewhere a bit more local, an urgent care center or a pharmacy, an optical setting. And I think that that is what enabled us to get some traction, I mean, to date, the kit has been used on more than 200,000 patients, where they’ve been able to access care much quicker. And then from that point of contact with whoever the health professional was, they’re then able to put them in the right direction of an appropriate person. If they fail the screening hearing test. They know that when they’re going to see the audiologist, they’re likely to require some aiding and in answer in some respects, your question, the way that this tool works, it’s really been supportive in customer customer engagement. I mean, it comes in a very straightforward, simple box like this, which has a set of headphones in there. The timekeeper tool itself is really simple to use. So you know, has a normal light, that that you’d have a speculum that goes on. So that gives you the diagnostic quality, you then have this spacing mechanism, which allows you to do the wax removal. And you have the headphones, which the elderly patient, let’s say, will put put on, and then they tap the screen when they see the screen of the fit, which really gets engagement is the fact that everything that is done is seen on the screen. And the patient really gets engaged. And so when they’re being sent on lets say to an audiologist, they will be fully engaged with their hearing journey, which we know as you know very well, you know, it takes someone on this five to seven years to think about doing something about their hearing. So if you’re putting it in a location that’s more easier accessible in the community, they’re more likely to think about it. And that then goes on the other side was from a diagnostic perspective, if they remove cerumen, or if they see something on on otoscopy that can be sent to an ENT surgeon say, hey, this needs looking at.

Amyn Amlani 7:52
So so in order to move the patient from using the screener and say that they need, you know, an in office consultation. Is there a network that you’re associated with? How does how does that transition take place?

Krishan Ramdoo 8:07
So here in the UK, obviously, we work in multiple sectors, like I said, and we’re now finding that towards the end, certainly the we’re in three of the top five high street audiology branches within the country here. But in the sectors, let’s say, such as the pharmacies, when they fail the screening hearing test, we’re in a position to then say, well, these are other partners, which you could go to, and almost work in a referral type manner. And the hearing providers, and here we’re slightly different from US, because we have the NHS as well. So you can either go down the NHS route, or there’s some providers who are obviously private providers. And then you know, we support them in that journey by giving them appropriate advice as well.

Amyn Amlani 8:59
Okay, so that’s, that’s really interesting. And then I’m going to change the topic a little bit, you’ve also got this machine learning aspect of it. That that you have predictive diagnosis, and you’ve got some remote care options. Can you speak to that a little bit, please?

Krishan Ramdoo 9:12
Yeah, so that’s a really exciting part of our future. So we certainly have extremely if not, I would say one of the world’s largest banks of ear and hearing health images and videos. I work with a a great team ENT surgeons, from all over London, and all over the country, actually, who we work together to label those images and videos. And so we’ve labeled more than 25,000 already, and out of the 250,000 images and videos that we have, and that has given us almost greater than what it has given us. And we’re publishing a paper on it soon. More than 90% sensitivity and specificity around almost condition analysis. So you look at normal, abnormal, cerumen, poor quality, and then it starts to go down, as we start to see more conditions and the way it works now for that in the hands of the non specialist, they can click the button, and it will can be access to our internal audiologist team. If the internal audiology team and not sure it click another button, it comes to ENT, the team that we work with provide an opinion and it goes back down. So that end customer patient, let’s say, gets an opinion within a period of time. And we’re short period of time 72 hours at the most. And the way the machine learning comes into it is that starts to add in and we haven’t deployed it yet we can but we’re looking at the best way to do that is it will add another layer that even if the end user thinks that it’s normal, if the machine learning comes in and says, Hey, let’s say there’s a red dot, you need to get this escalated. It’s almost that another layer of governance that comes in, and we’re going to publish the papers on it first, and then we’re ready to deploy it really

Amyn Amlani 11:10
well, that’s absolutely fascinating. And then you also have training academies and research academies, and you’ve won all these awards, it’s Can you talk a little bit about that, it’s again, it’s really fascinating.

Krishan Ramdoo 11:21
So the training is probably a really, really important part of how we’ve managed to upskill, the allied health professional. So we’ve got a great training team. And what we do is we have the at the moment, and it is the fact that highest accredited training program in the whole of the country. Our training is accredited by ENT UK, the British society of audiology, the British society of hearing aid audiologists. And it’s a journey. So it’s almost like a, they have a process to go through, they have a webinar, they have a learning management system to go to. And then they have an in person training day. And the thing which timber does differently to any other training company is that instead of, you know, my surgical training is very much you go on a course, you do the course you think you know, you’re ready to go out. But as soon as you’re in your own environment, you’ve forgotten half the things that I did in the training course. So what we’ve done is that our trainers will go out and see that individual client in their own environment and make sure their setup, know how to use the equipment. It’s a very tech heavy service well with all the added machine learning, so making sure they’re comfortable with that. And then we sign them off there. And then and that has really enabled us to scale. Because people have become really confident in using the system. And the way that we’ve done that, and we kind of range from our big customers. So for example, Boots, who is owned by Walgreens over here, they’ve rolled out with our system in their stores, we do a kind of, for us to be able to scale with them when you’re training, the trainer type type training. But for others, we just do individual training. And so we’ve been quite bespoke with that. And I think that has has led us to, you know, the small successes that we’ve had. We’ve also been lucky, as you mentioned, with the awards, we’ve got multiple patents on the product. So it’s a very innovative solution. And a lot of those awards have been based around user interface, very easy to use, very simple, very

smart interface. And, as your last point, I think, fundamentally, you know, I’ve been really keen to make sure everything we do is evidence base. So

we have every two months, we call it the Tympa Health Institute for Research where a bunch of people at Tympa academic individuals from across the country, in COVID, we kind of set it up where you know, we’d have a big virtual meeting. And we look at cool things that are happening in the air and hearing health space. And to be honest, it doesn’t have to be always related to Tympa, but what it does do is it collaborates and thinks of how we can think outside the box. And we can publish papers on it. And you know, I think that drives innovation. And you know, working with some really, really, we’ve we’ve even had people from the states join. So we had a Harvard professor join us a few months ago, because he just heard about us and said, Oh, this is new and innovative. And I think that’s how our kind of culture and ethos is within the system is let’s just keep doing what we’re doing publish and grow off the back of that.

Amyn Amlani 14:34
Wow. That’s that’s amazing. And I also know that you and you mentioned this earlier that you are deploying this product in developing countries. For example, Cambodia and India. Can you speak to that a little bit?

Krishan Ramdoo 14:49
Yeah, so it’s, it’s if I if I was to say the mission here at Tympa, and I think even if you’d ask the whole team, I think we want to create a solution that’s available for everybody. it’s a solution that yes, it scales here in the developed world. But for me to look back and think that Tympa has been a success is for us to be able to get into the low income resource, developing world countries, and deliver them a solution, which they never would have had access to specialists, they never would have had access to. And you could take this briefcase that I’ve got here, and go and deliver that service. And so we wanted to kind of see the, how that would work in practice, you know, obviously, it needs infrastructure support. And so we went out to Cambodia, I had a colleague who took it with him to Cambodia, and you know, he trained up some of the nurses there. And they were like, you know, transformative to the way they deliver services. And we’ve got another group that are going out to Nepal, who were looking to support, I think, with any young company or fast growing company, for us to be able to sustain and do it correctly, we want to really make sure that we deliver it in a smart way so that those end users who sometimes perhaps need it more, we are able to support them. So we’re just looking at the best way to deploy that. But it’s a huge part of our mission and vision of where we want to get to with Tympa, because we really, really feel there’s an opportunity to do that.

Amyn Amlani 16:21
Yeah, that’s great. Just a couple more questions. One is, is your product available in the US at this at this time.

Krishan Ramdoo 16:29
So we are FDA registered, and we are coming to the US, what we are doing is doing a big piece of work on kind of the reimbursement code, which we fit into which we fit into quite a lot. And yeah, I mean, we’re ready to definitely do some really good pilots, making sure that the model that we have in the UK is can be replicated in the US, and we’re ready to come. We’re HIPAA compliant as well. So we’re just taking our time to make sure that we do it in the right way. You know, history is littered with UK companies trying to come and crack America. So we want to make sure we do it correctly.

Amyn Amlani 17:14
When we wish you the best of luck, and we’re looking forward to seeing you guys your last question. What’s the future? What does the future hold? So five years from now, if we were to do this again? What what do you expect?

Krishan Ramdoo 17:27
Well, I think definitely a lot of product development, I think, in my head. And even written down, I think within our kind of objectives. We already know what this is funnier version two. And we already know version 3,4,5, probably looks like. And I would definitely say that, from a company perspective. In that time, I’d expect to be you know, supporting the developing world. I think from a product development, there’ll be a lot more coming with the machine learning and data size that we’re looking at and predictability fix that we’re looking at with the data set that we’re bringing in. And also, from a hardware perspective, there’s much more which we can do. From analysis, from even the ability to look within the ear canal and eardrum, I think there’s a lot of things that we can start to do. I mean, the the ear drum is, you know, has, it’s very similar to what you might be able to see within the eyes and pathology that behind the eardrum as well. So I think there’s a lot of things which we have in our, our future that we think we can really build on and what we’ve got here is a great foundation, I think can really support the journey. For over the counter. I’m a big fan of providing the right due diligence to make sure that if someone does pick up an over the counter, we’ve made sure there’s no pathology there. There’s no cerumen, they haven’t got a severe hearing loss. I think one of the things for the US is Tympa as a very simple solution could sit in any place and provide that due diligence to make sure that someone isn’t having an over the counter. And perhaps masking something more sinister. And you can do this assessment really quickly with Tympa

Amyn Amlani 19:27
and you’ve sold me on this concept. I’ve been very intrigued and I’m glad that we’ve been able to have this conversation. And you know, I’m a fan and I’m looking forward to seeing you guys. I’m rooting you on from the sidelines. I like to see you guys move forward with this and bring it to the States at some point. And so, you know, hopefully down the road, we’ll be able to reengage and say we had a conversation back then, in this way you guys are now so I’m really looking forward to that and best of luck to you guys.

Krishan Ramdoo 19:56
Thank you very much. Thank you for having me.

Amyn Amlani 19:59
Thanks for being here.