Sound Preference: Bridging the Gap in Hearing Aid Fit and Satisfaction

Welcome to This Week in Hearing. Hi, I’m Bob Traynor, your host for this episode, which is coming to you from WSA headquarters in Copenhagen, Denmark. Today my guest is Lise Henningsen, Head of Audiology Evidence and Validation. Thanks for having us having us here, Lisa, with you and your colleagues and being such gracious hosts for our podcast today. And to start things off, I’d kind of like to have you give us an idea of your journey in audiology that brought you all the way to the headquarters of WSA here in Copenhagen.

Thank you, Bob, and thank you for inviting me on the podcast. I’m really excited to be here and share insights and also a little bit about my journey. So I am a speech and hearing scientist by training. I have my degree from the University of Copenhagen here in Denmark. But I actually spent a year of postgraduate studies at Washington University in St. Louis after I finished my degree here in Denmark.

Oh, that has to be with my old friend Mike Valente.

It was. Mike Valente was there and a lot of other good people. And I was I was fortunate enough at that point in time that a former vice president of research and development at GN Danavox came to visit and show off some hearing aids. And when he did that, I got really intrigued with the industry. I got intrigued with working with the industry and actually going into industry rather than going into clinical work. I’d worked as a clinical audiologist for a couple of years before going to the US, so I knew that work. But actually working in the industry sounded really, really exciting. So I onboarded into the industry in the R&D world and have worked as a scientific audiologist for a good number of years in R&D before moving through the organization and joining this company 25 years ago.

Wow.

And have worked both in R&D, in our audiology laboratories, and in the last 15, 20 years, I’ve been working with with marketing and product management, audiology communication, evidence, claims, scientific research, and driving the audiology narrative for the house.

You know, it’s always so much more credible to me as a clinician to hear another clinician and the kinds of things that has led to your work here on the corporate side that leads to the products that all of us really know and love and want to work with, with our patients to help their journey in their hearing all over the map. So now today we’re talking about one of your projects that’s just— and I assume that since it’s your project, pretty close to this thing, but it’s something called Sound Preference. And you and I know that there have been many, many patients over the years that, you know, you put this on, you work so hard to get it fitted, and then all of a sudden they come back, you know, I just don’t like this thing. And so can you tell us a little bit about what’s— what the sound preference process might be, and, and just a little bit about why we— you might have chosen this kind of an avenue?

I’m happy to share that. It goes back to when I started out as an audiologist, really. And as you say, we’ve all met those clients in our clinics where we do our best, we pick the right product, we do the right fitting, we do everything by the book, and it doesn’t result in joy. It results in, “I’m not happy with this. It sounds strange. Why do I have to work so hard to get this right?” Can I still return this thing? Can I return— exactly, exactly. And throughout my years, I have met so many I see so many people where they walk into our clinic downstairs here at WSA. They come in with their shoulders up under their ears, and they look frustrated and distraught. And they say, “I have these hearing aids. It’s just hurting to wear them. I can’t hear a thing.” We inspect the fittings. They’re good on every mark. I mean, they fit to target. It’s perfect for their hearing loss. But then we think, maybe we want to swap to a different ‘Maybe we want to swap to a different brand.’ And the minute we do that, shoulders drop, eyes turn on, and people go, ‘But now I can’t hear it.’ And I go, ‘But you’re not supposed to hear it. You’re supposed to be hearing me. Can you hear me?’ And they go, ‘Yeah, I can hear you fine, but I can’t hear it.’ And I say, ‘Well, that’s what a hearing aid should be. It should be a hearing aid that you can’t hear, but you would hear what you want to hear.’ This is much better. So that enigma and that paradox has been with me for a very long time. In my first years in this company, for the good portion of my career in this company, I came from the Widex side of the house, of the WSA house. And when we merged with our colleagues from the Signia world into WSA, I had been working as a professional in this industry advocating for Widex all my life. Everybody who Who knows me knows me, that I’ve taught Widex, I’ve spoken Widex, I’ve believed in Widex. And on the day of the merger, I looked at myself in the mirror and I said, Lisa, come on, from now on you’ve got to just trust that there is a brother brand in the house that is just as relevant as the Widex brand. I didn’t know anything about Signia at the time, but I spent a good amount of time getting to know my colleagues in the Signia world. And I found out there were great audiology people. They had great vision. They had visions that went in a very, very new direction compared to where I was going in my previous work as a Widex audiologist.

So maybe if a patient comes to Lisa to get a hearing aid, it might not just always be a Widex device.

Exactly.

Okay.

That was a revelation that came to me after the merger, because I realized that there are two sides to the coin here, maybe even more sides to the coin, but at least two sides to the coin. And all of a sudden, I had an insight into an audiology vision that was new and different to me. And what we can see in our clinic here at the office is that some people really just pick up and adopt one side of the coin. One sound philosophy and other people pick up and adopt another, the other sound philosophy. And we were intrigued by this because we were thinking, there’s got to be more to this than just random choices. There’s got to be more that drives this. And I’ve always had this suspicion that preference is something we need to listen to in audiology. Preference is something that we can’t touch, we can’t measure it, in our clinic, but it’s there and it works with us. It also sometimes works against us. But is there something about people’s sound preference that could guide us in how to actually recommend hearing aids?

Well, and, you know, for years clinicians, clinicians that care about preferences that patients have, clinicians that have, that also work very hard to fit hearing aids each and every day, they have like 3 different brands that they play, because I always did in my place. And the idea behind that is, well, you might— if people kept coming back with something, then you probably just didn’t get it right, or that’s not the product that processes correctly for them. And do you think that this might be one of the reasons why 2 people with the same audiometric configurations might just— one might just love it and somebody else might just hate it.

I think that’s exactly right, and I’ve seen that too often for it just to be a coincidence. I’ve seen so many clients with similar audiograms and with similar challenges in real-life hearing go with different brands and different sound profiles. This is not news. This is something that every practicing audiologist has seen. And as an audiologist, throughout our careers, we work with it as an intuition. We almost get it before our clients get it, right? We say, “We better go in this direction or that direction.” But we’re playing up against a preference that is really not well expressed by the end user, but it’s there and it’s playing with us. And I think the research that we are doing right now, digging into sound preference, understanding what it drives and how it drives adoption and how it drives acceptance of hearing aids, might actually be the new level in audiology where we can combine everything we know about audiology today and hearing aids today with a new understanding of what goes on inside the hearing aid wearer and what plays against us or with us from within that user.

Wow. And of course, can you tell us just a little about— I know you’re involved in the research component of what’s going on in this Sound Preference Project. Can you tell us a little bit? We don’t have time to go through the 2-hour version, but could you give us just the highlights of some of the research that’s going on here at WSA relative to in regards to sound preference?

So in regards to sound preference, one of the founding insights we have already now is that we’ve tested with hundreds of people with normal hearing and with hearing loss their immediate preference of two distinct sound designs, one based in the frequency domain time processing and one in the time domain processing. And what we see from all the research we’re doing in different studies is that the speech The split is almost 50/50 across preference in all groups, but what we also see is about 20% of the subjects we’ve tested— this is hundreds of subjects— have a very strong preference for frequency domain processing, and 20% of them have a very strong preference for time domain processing. What that means is, if you don’t have both options, in your shops and you don’t offer products with both directions and sound processing, what you’re essentially doing is there are 20% of your customer base that you’re fitting with a sound design that might not be a perfect match to their individual preference.

That means that they’re going to be keeping coming back for follow-up visit, follow-up visit, follow-up visit, and we’re pulling our hair out, rechecking everything and doing all these kinds of things.

That’s what we’re seeing anecdotally, and that’s what we’re seeing also from our research in our clinics, that those clients that come back for continuous fine-tunings, have continuous complaints about, “I don’t really like it, I don’t feel comfortable, it doesn’t sound right for me,” they’re the ones that we might actually have done better by if we had understood what their sound preference was, because they probably have a strong preference. And they would probably be better off if we swapped to a contrasted sound design. Not something of the same kind, but something that’s truly different.

Now, does this mean that instead of doing some of what’s called best practices these days, and what we have always called best practices, where we do some real ear measurement and we’ve reached target and those kinds of things. Does that mean we’re going to throw that away and then do a— and just do subjective interactive kinds of assessment?

No, never. I don’t think so. I think this is not undermining any kind of professional audiological best practice at all. It’s actually laying itself on top of that. Because of course, everything we do We need to do it in a way that we secure audibility and intelligibility. That’s why people come in. That’s why they come. They have a hearing loss. They can’t understand. They can’t hear. We need to make sure that that is fixed. But today, there are 5— big 5 manufacturers in the world that make high-grade medical devices, premium hearing aids, invest millions of dollars in research and development. And all of those hearing aids can deliver on fit-to-target and intelligibility and audibility. That’s a given. It’s a hard fact. We wouldn’t be able to be in this business if we didn’t deliver on that. But it is how we deliver on that that’s important for the end user, and especially for those who have a strong preference. And this is where the domain of audiology is almost leveling up. Because what the audiology profession now needs to do is to use everything that they know about hearing aids. Everything they know about hearing loss, and now also everything they know about the individual and combine it in the right way. Because the matching of that triangle becomes the magic that makes it happen for the end user. Because you know what, Bob? 50% of all of the people who start a hearing journey, they drop out of the hearing journey. So 50% of all users around the world on average will drop out from when they start a new hearing journey to getting a hearing aid. This means that 50% of the potential of people we can change lives for with hearing aids, they drop out. And most of them drop out of the journey because the hearing aid sound doesn’t sit right with them. They don’t feel comfortable wearing the hearing aids. It doesn’t feel right for them. If sound and sound experience is one of the key drivers for boarding the journey to better hearing, then there’s something wrong with how we start that sound journey for them. And that is why preference is important to talk about.

Seems like that means that maybe we might have to have individuals where we program up one and see how that goes, and if it doesn’t go well, then we program up something else. Might not even be a Widex device, might be a Signia device, it might be a Starkey device. We don’t know about that. But whatever the processing is might be better from one versus another.

Yes. I think the directions we’re seeing right now in the research we’re doing is there has to be a very definite contrast in the sound design and in the audiological philosophy of the products. And in our house, we have exactly that. We have that with the Widex audiological North Star and with the Signia audiological North Star. That’s the type of contrast we’re looking for. And we can see that between the big 5 as well.

And you and I remember with the old products that we used to have, you know, single channel analog with screwdrivers and the whole thing. There wasn’t much difference among the products that we dealt with at that time. It was kind of like, well, I like those guys better than I like these guys, and that kind of thing. But the idea is that now with all the proprietary technology, there are some— a lot of very good proprietary technologies. And so it’s just a matter of digesting that, those proprietary technologies for a particular individual.

It is. And it’s understanding what that proprietary technology and audiology does and what’s the intention of that audiology. And if you look at our two audiology north stars, they are quite contrasted and set up in quite different ways. And this means that they are true choices. It’s a true choice between one or the other. The Widex audiological north star of our house is to provide full audibility, natural audibility for all sounds— soft, normal, loud. We’re not, in that North Star, going to attenuate background noise and lift up a speech signal in a way that changes the natural representation of those sounds because we believe in that natural representation.

That’s been a Widex since 1956, hasn’t it?

Exactly. For Signia, It’s a completely different North Star. It’s just as relevant because some people have a really strong preference for that, just like they have for Widex. For Signia, it’s about making sure that distinct speakers stand out, maybe at the expense of audibility of the background and keeping the background noise more attenuated. But this is what some people find is natural. This is what some people find links to their sound preference. And this is why that solution is correct for them and matches them in the most convenient way.

So how do you think that the— what’s going to be the end result of this sound preference thing?

What—

why— I mean, yes, we want our patients to be satisfied and happy, but do you think it’s going to do anything to the return rate, for example, which is always a big deal, not only for for clinics, but also for manufacturers as well.

You know what, I think this will have huge impact on the conversion of an individual from non-hearing to hearing. Because what preference does, it allows the conversation to depart from something that’s important to the individual rather than from the hearing loss of the individual. And if the end user commits to his preference and talks about his preference with the results of a conversation around sound preference, that becomes his stake in the game. And he will be more committed to the solution that’s recommended to him because it departs from his preference. And this is where the difference is compared to just purely focusing on the audiological component, where this is your hearing loss, this is the amount of gain you need, this is the fit-to-target we need to do, and this is the amount of work that you need to do in order to get acclimatized to the new sound that you’re going to hear. If we start from a position of you have a strong preference for sound, for a certain sound design, it also becomes a more positive journey of I have a preference, I need to go with it, I need to lean into it. And it becomes a much more positive transition for the person who doesn’t hear anything to begin with into a new hearing world with a preferred sound.

You know, part of this though is, you know, when you’re in a clinic, as we know, you’re working with the person, you’re taking a lot of time with them and so on. Is this going to add a whole lot of time to what we have to do to facilitate this whole thing?

So in our work with Sound Preference, we have developed a very short and efficient a tool to actually assess the sound preference profile of the individual user. It’s sound— it’s 5 sound pairs that people have to listen to through headphones, and the assessment indicates whether or not you are one of those who have a really strong preference, or whether you are one of those who can actually go either way. Either result is a good outcome. This particular assessment can be done even before you go into the fitting appointment. It can be done in the reception area with the front of staff office. And then that becomes a diagnostic clue that is given to the hearing care professional as part of all the other clues that he gathers through his diagnostic work. So this doesn’t add a lot of time and complexity in the workflow, but it adds insight that might actually end up ensuring that the end game, the fine-tuning the adoption of the device becomes much more easy to work with for the end user.

So the whole thing can be done before they even talk to either one of us. Yeah. And it can be digested into— after we go through our regular evaluations and so on. Yeah. That’s how we might select the type of product that we want to use for the patients.

The essential part here, Bob, is to actually identify those with a strong preference. Because those with a strong preference are also the ones that we struggle with if we get it wrong from the start. It’s not that people can’t acclimatize to hearing aids that have a sound profile that doesn’t match their preference. We all have plasticity in our brain. We can adapt to a lot of things, and we follow the recommendations of our professional. However, that process of acclimatization could be much more easy and less problematic if that particular recommendation is matched to the sound preference of the individual.

Now, I imagine, since sound preference is something that I haven’t heard manufacturers talk about in the past, that there’s probably a future for more research in this area to facilitate some of the fittings that last on our patients. So what kind of future what does this bring to the research that you and your colleagues here at WSA are going to consider?

So right now, we’re doing several research projects on sound preference. We’re doing a study with Washington University where we’re actually looking at acclimatization in first-time wearers, where we use the indication of the sound preference assessment. As part of the fitting process. And this is going to be a fully controlled scientific study so that we have all the parameters under control, so we actually see how that ladders up to outcome and return rate and conversion.

Yeah.

We’re also doing a study at Vanderbilt University where we’re trying to look at the effect on mood and sound preference, because we have previous research that shows that if you’re fitted with a hearing aid that does that you don’t like, with a sound that you don’t like, it actually can affect your general mood. And we have a suspicion that if you are fitted with a hearing aid that doesn’t really match your preference, it might have the same effect. So we’re looking into that. But then we’re also looking at big-scale studies in retail organizations, trying to see how we can fit that into the clinic workflow and how that affects conversion, but also number of follow-up visits. And all of this is happening as we speak over the next 6 months.

Well, so I think that we’ve pretty well knocked out this discussion of sound preference, but to me it’s a refreshing discussion. I’ve always been a person that, that not only wanted to get the technical components of a fitting correct, but also the social, psychological, interactive things with not only the patient, but my personal style to their personal style and all these kinds of things. And choosing products based on preferences is a certain step in the right direction.

It is.

And thank you for having us here at WSA Audiology here in Copenhagen. And today my guest has been Lisa Henningsen, Head of Audiology Evidence and Validation And thank you for being with us at This Week in Hearing. Join us another time when we investigate some of the interesting components of audiology.