Transforming Aural Rehabilitation: AI-Powered Auditory Training with LACE AI Pro

Welcome to another edition of this Week in Hearing, and this is another episode that I am really excited to moderate. Um, it’s. We’re looking today at auditory training and we’ve got the folks here from Neurotone. Neurotone, Excuse me, uh, Miles Aaron is here, he’s the coo. And um, if you haven’t heard, they just had a big acquisition that’s going to help, really help this particular area grow.

So, uh, I’m excited about this conversation. And Miles, let’s just jump into this and tell us a little bit about yourself and a little bit about Neurotone.

Sure, yeah. And thank you for having me and for the opportunity. I mean I really appreciate it. Big fan of the pod. Um, so, yeah, so my name’s Dr. Miles Aaron, co founder and COO at Neurotone. Um, I got my start in acoustics and uh, so I’m coming to this from a pretty academic perspective, but outside of hearing care itself, which I think has been an interesting journey for me, I’ve worked with the science of sound from uh, every wavelength, let’s say down to infrasound, at NASA, where I was working on helicopters, to uh, phonons, which are literally detecting particles and crystals at the Department of Energy using sound science.

And then spent most of my early career working in ultrasound medicine, uh, where I got a PhD at the University of Oxford working on using ultrasound to uh, treat brain cancer and other cancers. Um, uh, I was fortunate enough to um, work with a number of startups here in Austin and around uh, the country.

And in that um, Journey met Rick Carlson, who’s our CEO, um, who’s just a, um, phenomenal, uh, leader and an incredibly bright mind. And um, when we got to talking about Neurotone and Lace, we just realized it was the perfect opportunity for this team. So we were lucky to um, assemble an incredible team to come and sort of revitalize lace and bring it into the 21st century.

Um, after it had um, been dormant for around 10 years after the original founder’s death, it was still running orders, people were still buying just on the um, the love of Lace in the community. It survived. Um, but many people, as many people who listen to the show will know, there wasn’t much development for about a decade and then you’re suddenly seeing a lot happen.

And that’s what’s happening now. We’ve, uh, acquired Neurotone and now Amptify, and we’re um, you know, we’re making a, ah, uh, play for um, bringing oral rehabilitation to every patient in the world who could benefit from it. And in doing so, um, trying to empower hearing care professionals, uh, to finally deliver oral rehab.

So as you know, uh, uh, Today less than 10% of audiologists are implementing auditory training in their practices. But if you ask them, you’ll find that nearly 100% of them believe in it. And so there’s this gap. How do I find the time? How do I bring this, uh, valuable treatment to my patients?

And uh, that’s. That’s what Lace has been doing for the last 20 years, and that’s what we’re doing by taking it forward.

Now. That’s really interesting. And yeah, I remember back when I was working on my dissertation, uh, in the early 2000s, and we were looking at lace, and you’re right, it, uh, it kind of, um, it kind of disappeared there for a while. And now that it’s, uh, regenerated, it’s, it’s very, very cool.

As I was looking at the website, um, Bob Sweetow still looks as. As young as he ever did. Um, and uh, you know, Henderson still, and I’ve known her for a number of years as well. Uh, they, uh, I’m glad that they’re, uh, they’re continuing this cycle. So for our audience, which, uh, happens to be primarily clinicians, let’s talk first a little bit about what la.

What it does and how this oral rehab, uh, is supposed to help them, uh, with their patient care. Can we dive into that a little bit, please?

Absolutely. So, um, so. So LACE is auditory training, as we know. It’s actually, um, ah, synthetic auditory training. So I’ll get a little technical for the audience because they’re, they’re audiologists. Uh, and so there’s auditory training where you’re looking at the little pieces of words, the syllables, the phonemes, the individual words in isolation, which is something that amplify was really good.

One of the reasons that bringing us together is so exciting. Um, LACE has always been synthetic, meaning. It’s focused on sentences, paragraphs, um, learning to hear in noise, uh, in context, using context clues, really leveraging the brain. Um, and so LACE auditory training, um, has a number of modules that people probably familiar with.

There’s speech and noise training. There’s learning to listen to fast talkers, uh, or rapid speech. Um, there’s, uh, competing voices historically, which we’ll bring back as well. And then, uh, word memory. Um, Dr. Sweeto and I worked on this, but we’re actually taking it forward to what we’re calling working memory.

So it’s a Much more comprehensive memory and cognition program that’s coming out in the new year. But it’s bringing basically all of the best thinking in oral rehabilitation, um, to give patients something where they can take their hearing care journey into their own hands. So if. If you think about it this way, um, a hearing aid is a device, and for many patients, it’s something that’s happening to them, like, oh, I need.

I need this device to survive in the world. Now, um, with auditory training, you can give a patient, um, the. The. The power to. To influence how. How that affects their lives. They have the ability to, um, just like physical therapy after you get, uh, a knee replaced or something, you wouldn’t give someone the prosthetic and then just say, good luck.

You’d have them in weeks and weeks of training. Of course, in, uh, hearing care, audiologists don’t have the time to do that in the vast majority of cases. Um, if you look at the earlier literature in oral rehabilitation, there was this early study, uh, the. The help study. They looked at 7,000 patients, and they found that just three sessions of, um, oral rehabilitation counseling and in person auditory training massively, uh, helped patients.

But we know that doctors just don’t have the time to do it every time. And so, uh, LACE is putting that power in the pocket, in, on the phone, on the computer of every patient that could benefit from them so that they get that benefit, um, outside of the clinic.

And I obviously, uh, could talk for hours about all that LACE does. Maybe I should talk about, um, some of the new, um, features of lace, since I think people are probably mostly familiar with CD ROMs that they were, uh, stockpiling in their clinic closet next to hearing ear cleaning spray, uh, solution and all that.

Uh, so the new LACE is really incredible. The, uh, back in the old days, we had to send an actor to a studio, often, Dr. Sweeto, um, to record some sentences. Uh, and many of those sentences were sort of nonsensical, like the dog walks across the street backwards from right to left, and you listen to those sentences, and you would do it for a half an hour.

And all the studies show that you get an incredible benefit if you do this auditory training for half an hour a day for four weeks. That’s all it takes to get a, you know, 20% improvement in your, uh, in your sentence recognition for many people in those studies. But, yeah, so we would send Dr.

Sweeto to the studio, we’d record some content. And much of that content was honestly just not that engaging. It was fairly boring. It was, you had to do the work to get the result. And so with that in mind, um, in, in bringing Lace AI Pro to market, we said how can we make auditory training fun and engaging?

And that’s a key of what, a key focus. How we did that, um, was using the latest and greatest AI technology, um, to use AI, synthetic avatars. So we’re literally generating videos of lifelike looking people. Their lip movements are so precise that we’ve had both Dr. Swedo, Nancy Taimaray, who’s um, gone really deep into lip reading, uh, in her own research and speech reading as many call it.

Um, the lip movements are so accurate that you can use them for speech reading. So we’re able to generate these videos and we’re able to control what the avatars say using AI and synthetic voices. And by doing that, instead of having a very small library of frankly not very exciting content, we’ve uh, been able to generate over 10,000 exercises.

Um, the old lace was six hours. This one, I don’t think any patient will ever hit the bottom. And we’ll keep putting out lots more content. We’ve got 27 content channels, everything from gardening tips to Bible verses to memory. Um, Lane, you can go and listen to your uh, facts about your favorite radio hosts and TV hosts from any decade.

You can go and learn about cuisines all over the world. So whatever’s going to keep a patient interesting, that’s what our interested, that’s our focus. And then we’ve got um, a whole layer of gamification, ah, and engagement sort of features that keep patients engaged. So it’s all about, especially when they’re acclimating to new hearing aids, keeping a patient coming back in that critical period, um, for a month and then hopefully much longer.

Um, let’s see, there’s uh, so much to say about it. One of the um, one of the uh, features that I think is just absolutely groundbreaking, um, is uh, this idea of familiar voices. So if you, if you look back at the literature, you’ll see that um, it’s been established since, I think the uh, Lynn nygaard paper in 1998 talks about, which is widely cited.

Um, but certainly Nancy Ty Murray has done a lot of good work on this as well. Um, but it’s probably not surprising that our ears learn to hear voices that. That are familiar to us. We’re actually better at hearing those voices, picking them up in noise. And of course, those are the voices that are the most relevant to daily life.

Um, and so one of the things that we’ve done is we’ve taken this AI which at a first step creates a ton of incredible and fun content. And on a second step now, we can actually use that to create, um, an AI clone of voices of people in your life.

So you send a simple text message out. I say, hey, Amin, come help me on my auditory training. You just have to record this little audio. It’s all HIPAA compliant, it’s all very private, et cetera. You get the text, you record a 30 second or one minute long message, and we create this clone of your voice that’s pretty, pretty realistic.

And now you can actually do auditory training with, um, your friends, with your family. Um, there’s a lot of literature showing that students who, uh, listen to the voices of their teachers before school will actually do better in school. So that’s another application. Uh, you can imagine listening to your preacher before you go to church and doing your auditory training with them, with your, with your children and so on.

So that’s just one of many things we’re doing that I think are taking LACE from, um, from, from this kind of cumbersome program to something that’s engaging, fun, and all the more relevant and more effective.

Wow, that’s really, really cool. And I think you said, and maybe I missed it there, is it subscription based? Because the previous LACE was also was subscription prescription based, where you could purchase the opportunity to continue with LACE after the clinic. Is that still true today?

That’s a great question. And I think we’ve done one better. Um, today. A license for Lace AI Pro is a lifetime license. There’s, there’s no hidden charges. You buy a license, you have that thing for life. And you know what, in the meantime, we’re, you know, spending millions of dollars to make it better and better and better, and the patient just continues to benefit for life.

Well, that’s, that’s an incredible statement there. And as you and I were talking before we got on, the opportunities abound. Given the different market spaces that are opening up and the, you know, the different generations of, of, uh, consumers that are entering the market space. And as, as we’ve started looking as a profession, started looking at workforce, hopefully there’s an opportunity to get extenders in that could potentially help with the LACE piece so the providers can do the diagnostics with which they’re licensed.

But this component, which does not necessarily need a license, of course, it depends on your state, but would then allow for this LACE to actually gain some traction and we can close that gap that you were talking about earlier.

Well, I think you bring up a great point, and I should be, um, really, really clear with this. Our whole approach to lace, um, is focused on audiology, private practices. And we did that very intentionally, um, because the landscape is shifting so dramatically. There’s so much, um, competition, patient confusion.

The ground is shifting under our feet in a way. And I think at the same time, and I’ve heard, um, uh, this conversation on your show as well. So I know you’re familiar with the, um. But I think that, uh, audiology itself, um, has to take some pretty major steps in the coming years, um, in a way that maybe optometry or some other fields already have.

I think that one key step, um, is to make sure that every patient who walks through the door with a problem walks out with a solution. And I think that right now, and it’s not fun to say out loud, but I think, uh, a lot of people have said this to me privately, and it’s what they say all the time we’re having this conversation if your patient’s walking in with auditory processing disorder or some form of hidden hearing loss, or they’re walking in with mild hearing loss and they’re just not ready for hearing aids yet, or perhaps they’re resistant to hearing aids because of a stigma, or maybe it’s the price point.

There are many reasons, um, that patient, many times will walk out without a solution. And unless you’re maybe a very specialized clinic doing some very specialized work, which they do exist. But for the vast majority of the audiologists out there, the answer to that patient is maybe here’s some literature.

Come back in a year, let’s do another exam. And I just think that we can do better than that as a field, especially when all of us know that oral rehabilitation works and it just hasn’t been possible to implement it at scale. Uh, frankly, there hasn’t been a business model that worked for the audiologist.

If you look at hearing aids, um, an audiologist can build a thriving business on that. Of course, it’s about the patient care first. But we can’t deliver great patient care if we’re out of business.

Um.

Where I think LACE comes in is it gives you a tool, uh, for all of those patients. It’s a tool that connects the patient back to the clinic. It strengthens the, um, doctor patient Bond because, um, there’s all this automated notification stuff we do in there. We can actually do notifications that are from the doctor.

It’s an opt in feature. But you, um, could say, uh, if a patient is doing a good job on their auditory training, they could get a text message that says Dr. Amin says keep it up. Things like that, that just connect you back to the practice. Um, but yeah, I’ve heard from so many clinicians like, hey, if they come in for a hearing test and it’s not time for the hearing aid yet, I don’t know if they’re going to come back.

They could go buy online, they could go to Sam’s club. You know, there’s just all these alternate. It’s a lot of confusion. And at Neurotone, we believe that the best care has to involve a clinician. And LACE is part of the way of making sure those patients tie back to the clinic to get the best care in the clinic and now the best care out of the clinic with, uh, auditory training at home.

And that’s really well said. And um, you know, we’re hoping that uh, my. Which is the Medicare Audiology Access Improvement act act, uh, passes because what it will do is it will allow for, you know, several things. One of the more important things being is we’ll be able to be reimbursed for the treatment of, uh, devices.

Device services, not devices themselves, but the device services, which could potentially include Lace and Amplify and some of these other things. So, uh, absolutely, as you’re. As you’re talking about, you know, our need to, to evolve as a profession and mat. Um, sure. Um, that sits very heavily on my mind, uh, as we, uh, as we, uh.

Well, one is I take, uh, the president’s seat for the ADA professional, uh, organization starting in January. And uh, number two is, um, you know, um, ADA and other organizations, AAA and Asha, have started also looking at ways for this to evolve. So I’m glad that, uh, you said what you said.

Let me circle back for just a second because we’ve got this interrogation, this gap here before we can actually move in there. If you were a private practice owner today and you were interested in Lace and Amplify and you wanted to integrate it as part of your service delivery, what might that look like?

Right. Well, I think, um, first of all, classic answer. It depends on your practice. Everybody’s got a different we. There are, I’ll give you broadly, three cases, but I’m going to focus on one of them. Um, I think there are clinics that specialize on auditory processing disorder. And again that just, it’s another tool in your toolbox for patients that often that need to be in the office for counseling.

Usually now you can treat them out of the office. Um, and then I think there’s cochlear implants and hearing aids as kind of two other um, focuses. But let’s focus in on hearing aids and everything I’ll say will still apply to cochlear implant practices as well. Um, but, but if I was an audiology practitioner, uh, today I would be thinking about um, LACE as, as something that I would be prescribing with every set of hearing aids.

And, and the reasons are. Well there’s many reasons. The first reason is of course better patient care. Um, but from a business perspective, um, uh, there are now four independent uh, clinical trials, multi site clinical trials that show that if you include LACE with hearing aids for a new hearing aid user, the return rates drop dramatically.

Um, and these are studies that are not three uh, of them without any connection to Neurotone done independently. And uh, the fourth was with cycle, um, which LACE had uh, worked with in the past. So, so um, what they found though, that those return rates dropped by anywhere from 73% to 91%.

And our, our joke internally, these numbers are too good. Like we wish they were worse in a way because they just, it just seems too good to be true. But it’s three different studies. It’s a, over a thousand patients that they ran it with and um, they actually looked at the impact to those practices revenue and um, just on returns alone, like not even including revenue from selling lace, $150,000 if you, if you annualized it for, for one of those studies and another one showed $400,000 on returns alone.

And so I mean it’s just a no brainer. Um, and, and you might ask, well why, why is the return rate just getting decimated when you include LACE with uh, the hearing aids purchase ah and laces, you know, 20 times less than a hearing aid. It’s like we’re talking 1 to 2% of the price.

So it, it’s not even noticeable in, in it when you’re buying hearing, it’s hardly a difference. Right. It’s like the tax. So, but why is it so good? I, I think it’s simply that you’re giving patients confidence and you’re giving them the ability to control their own outcome and their own destiny.

And I think every time that the hearing aids, you know, suddenly your world’s sounding so different. And every time the hearing aids, like, uh, ah, this is hard. Maybe I should put these in the Dr. They look at lace and they say, well, I haven’t really finished my training yet, and so maybe that’ll help me acclimate.

And if you really do do the training with lace, you acclimate so much faster. And so that study has been done, and what they found, um, for those who got hearing aids, of course, their scores on multiple. Outcome measures improve. But for the people who also use Lace, uh, you see, um, a near 3 DB improvement in quicksand in a couple weeks.

And um, for those, I’m sure everybody knows quicksand, but basically a speech and noise test. Right. So, um, I think a lot of people, you probably heard this analogy a lot, but a lot of people think they buy glasses, you put them on and your vision’s perfect. You buy hearing aids and you put them on and everything sounds weird and you still can’t really hear a noise and it’s not perfect.

And well, it’s because we’re treating the ears, we’re amplifying the sound, but the brain is half the work. And LACE is the solution to treating the brain. So long story short, I think bundling, ah, um, um, or including LACE as a optional line item, whatever it is with hearing aids, uh, is the first thing I would do as a clinician.

And then I would look at the other cases. All those cases we mentioned where patients are coming in with a problem. Nobody goes to their audiologist because they don’t want a solution. Like, you’re not going. Most people are not going there because they want a hearing test. They’re going there because they can’t hear a noise or they’re having, having some problem in their daily life.

And so I think giving them something to walk out with is, is just the, the best thing you can do.

Yeah. And, and Miles, I really appreciate you sharing all of that data because I think it’s very important that, uh, you know, the providers have an understanding of what their benefits are, not only for their patients, but also for their practices. So I really appreciate you sharing that research and that data there.

I’m going to change the topic just a little bit and now shift over to Amplify, which is a new acquisition for you all. And I guess my first question is, is what drove that decision? Purchase them or acquire them?

Yeah, well, I, I’ll admit we definitely didn’t go into the year expecting to do it. Um, but, uh, you know, Chris and Nancy, uh, Chris Cardinal and Nancy Time reached out to us. Um, they had put a notice up on their site that that Amptify would be discontinuing, uh, service.

And um, and we had a great conversation with them and decided that there’s no way we could let this happen. Um, the patient, I mean, we just saw so many patient in Amptify. Looks like it’s not going to be there anymore. Can I get laced? What can I do?

Um, and it was very Clear that their motives were the patients First. They wanted to make sure all the patients were going to continue to get service. They wanted to make sure the providers would continue to get service. Um, and so we looked at it very closely. Um, but the real answer is that there’s really been two, there’s been two auditory training solutions out there, there’s a couple other kind of projects, but two companies leading the way and that was Amplify and Neurotone with lace.

And um, we thought bringing these two together is really the best thing you could do for the industry. It’s one of those things where maybe no one could solve it on their own, but together we all can. And we thought if you can get Dr. Swedo and Nancy Taimari and Dr.

Jen Sevis, uh, Henderson Savis and our team together that can actually build and execute all these ideas, um, it’s going to have a massive impact. Um, I also mentioned earlier, uh, that um, there’s this idea of kind of synthetic auditory training that LACE focuses on. Everything’s about context. And Amplify was really more what speech language.

Pathologists tend to focus on that bottom up syllables, phonemes, et cetera, type of auditory training. And um, I had the conversation uh, with Dr. Sweeto about this and Jennifer and said, um, do we think bringing these two things together will be better? Will the sum be better than the parts?

Um, they said undeniably it would be better, it’d be great for the patients, um, great for the providers. And so we decided to make that move. The other thing I’ll say about Amplifying is that they ran on government grants for a long time and so they’ve done an incredible amount of research.

And uh, LACE is the, we like to say it’s the single most um, clinically validated auditory training platform in history. And that’s true. But Amptify has done so much research as well and if there was anyone who was even close, it was Amptify. And so bringing the two together means that we are the most science backed solution possible.

And they had an incredible curriculum for cochlear implant users and they had a great curriculum for auditory processing disorder. And these are two things where we know auditory training works. But LACE didn’t have as much of a body of research on it or as much of a curriculum. Now we’ve kind of completed that, that trifecta, uh, cochlear hearing aids and uh, apd.

Very interesting. A couple of things going through my head. The first question I have is and maybe you can or can’t answer this is the goal in the future to keep these entities separate from the standpoint of one is called Lace and the other is called Amplify. Or is there a goal to merge them together and then you can pick and choose the attributes that you want to use clinically?

Yeah, I’m happy to answer that. Um, so we, we are going to be merging features from Amplify into Lace. So Lace is going to be the brand and the, and the product. Um, and the way that we do it will look a little different. Like we’re not going to lift and shift everything from Amplify into Lace, but we are going to work with them to take the best ideas and bring them into Lace so that we, we don’t want providers having to think about should I use this solution or that solution.

We want to give them something that just works, uh, and just gives them the best possible solution for patients. So that’s going to be the focus. It’s going to be Lace.

Really. I appreciate you sharing that. And then down the road, once you’ve combined the attributes together, you talked a little bit about AI and its um, added advantage that you all are now, uh, supplementing with um, um, the uh, LACE component. What’s next after that?

Uh, well, uh, I’m glad you mentioned that. And I will refrain from selling you our super secret project that’s happening, patent pending. Um, but, uh, I will mention that I’m very excited to launch the working memory module that I mentioned earlier, uh, soon. Um, we did a ton of work on that to just understand what auditory working memory is at a deeper level and build from the ground up on that.

And uh, you know, one of the reasons I’m excited about that is that memory, cognitive decline and the risk for dementia has been inextricably linked to hearing loss. If you look at the risk factors for dementia, you look at alcohol abuse and obesity and smoking and depression and social, um, isolation and all those factors, um, you might be surprised to see that hearing loss is a stronger factor, independent factor for predicting dementia.

I think focusing on, uh, treating the brain as well as the ears, having a holistic solution is what Lace is all about. Bringing working memory out in the new year is, uh, one of the most exciting features. Um, I’ll also mention that, uh, we are able to make our AI avatars speak other languages and have different accents.

And so we’re really excited to bring that out. There’s a ton of Spanish speakers, Mandarin speakers in the United States, and certainly, uh, going international having those different accents is Huge as well. Even native, uh, English speakers in the US Often complain that they can’t understand when someone has an accent.

And so they’re going to be able to train with those accents too. Um, and then part uh, of the amptify acquisition and bringing Nancy Taimur in is to work on lip reading and speech reading. So we’ve got a pretty exciting project for speech reading. We’ve also got a very exciting project for tinnitus that I’ve been heading up, um, that I think will, will make a splash once it comes out.

Um, and we’re also looking at doing a, um, children’s app in the, in the new year as well. So that’s just a preview of. They’re all pretty big and exciting features. Um, but gives you an idea of how innovative this team is. We’re, we’re not stopping, we’re just getting started.

I appreciate you sharing that. And for our viewers, if they have questions about, uh, Lace Amptify and uh, embedding this into their clinical practices, uh, we’ll have information for them available, um, at the bottom of our uh, podcast here and then also in the comments there. So, uh, they’ll be able to contact you.

And if there’s a special somebody, uh, or special division that they need to contact, we’ll make sure that that happens as well. Um, Miles, this has really been interesting. I’m really excited. I grew up in the era of uh, rehabilitation. I was a graduate student at Purdue when, um, I started my audiology, uh, pathway and rehab was a big, big part.

We had the communication training, uh, uh, components, uh, and I’ve talked to Nancy about this in depth and it went away as technology advanced. I’m glad to see that we’re shifting back in this, in this direction. And as you pointed out, the prosthetic alone is not going to solve the issue.

We know that from the economics and by allowing folks to uh, understand and rehearse and retrain uh, their brains into hearing sounds that they haven’t heard in a while, it’s the way to go. And so I’m really looking forward to uh, you guys, uh, really again pushing the market and for clinicians to really embracing this and utilizing it for the betterment of uh, patient care.

So thank you for what you’ve shared and I look forward to uh, having you guys on down the road so we can talk about what you’ve accomplished, the research that goes in behind it and the fact that that gap is now closed.

Thank you so much. I mean, I really appreciate the opportunity and um, I’m excited to share Lace with all the providers who might be.