An Audiologist in the Wilderness – Part IV

Into the jaws of the beast (continued)

This is a continuation of Parts I  and II and III of “An Audiologist in the Wilderness” by James Curran.

James Curran, M.S.

For nearly four years I crisscrossed the U.S. for Dahlberg, traveled to Europe and Canada, speaking to dealers in their offices, at regional meetings, at conventions and state meetings, and similarly to audiologists at various meetings. I was convinced of the efficacy of open mold fittings; performing them properly in the beginning involved using CROS. I had our eyeglass products modified to accept CROS connections and spent hours demonstrating, often one on one, but usually to groups how to grind trenches in the back of plastic frames, lay in plastic to cover over the wire, solder the leads to the appropriate parts of the amplifier and microphone, and close the assembly properly. This required hauling a grinding motor and small tools, buffing wheels, cement, wire, etc., with me. It was a very effective demonstration, for most dealers never did any bench work, and by showing that I knew my way around product helped win their trust. Incidentally, my championing of the open mold concept eventually got me into trouble with Ken Dahlberg who owned the company, for his proudest moment was the introduction of the in the ear Miracle Ear aid, which was normally fitted with a closed mold. Sales of the Miracle Ear began to slow in the company and eyeglass aids increased as time went on. Our relationship was never good, and it eventually culminated in him firing me, a tale for later.

My main area of concentration was to teach dealers how to conduct proper hearing tests. Besides the terrible equipment they were using, the techniques for threshold testing were criminal. For example, many dealers delivered a continuous tone into the ear high above expected threshold, and then slowly attenuated it, asking the customer to drop his/her hand when it was gone. Testing in this way you could get some pretty thrilling thresholds, but most dealers did not realize it.  Down ten, up five was unknown to them. And most wanted the customer to watch them, so they could make a grimace or give looks of surprise and shake their heads in wonderment at how bad the customer’s hearing was turning out.

Of course there was reluctance by some to change their ways. But the regional managers for Dalhlberg strongly encouraged their dealers, who were all franchisees, and they were told they should start doing things the right way. Within the company, Bob Winslow and Al Schwab were the motivating force behind this push. I used common sense and simple logic to persuade them to learn new tricks. First, I explained, doing a rigorous pure-tone threshold test in the recommended way would build trust in the tester’s competence, and speech testing done properly could be a beautiful demonstration of the customer’s inadequate listening skills if a spouse were present.  A more compelling scenario was when a customer returned with a problem. If the initial test was faultily done, and the retest showed a different result, one might conclude the customer’s hearing had changed. But if either or both tests were not done properly, the dealer never knew if changed hearing was really the problem. This could send the dealer on a wild goose chase, for he might conclude the aid was faulty or needed repair, or the settings needed to be changed, or the earmold or tubing needed replacing. Slowly it began to dawn on the dealer organization that by comparison, doing the testing the right way provided them a far more powerful, convincing demonstration/tool at their disposal than any of the old ways.

We cajoled and wheedled, encouraging them to stop using all their old audiometers and purchase appropriate ones, for the adding of faulty calibration to faulty testing technique just confounded their problems. The new audiometer included masking capability, bone conduction and a master hearing aid, and although heavier, was light years more impressive looking, accurate and easy to calibrate. I wrote several articles for The Hearing Dealer and the National Hearing Aid Journal, the dealer organs of the day, about doing things the right way. In one article I actually wrote about the concept of reliability (repeatability) relating some of the statistical procedures used in agriculture to tease out the best crops.  Early on, I wrote one of the very first articles on open mold amplification, a compelling rationale complete with idealized response curves. Things were so primitive then, and not only at Dahlberg by the way, that we obtained curves by using the cap of an ink pen as a coupler to simulate the open ear canal! Being able to obtain legitimate real ear curves was some years in the future. Harry Teder, the head engineer at Telex, remarked later that he didn’t really believe that there was that much change to the response in the open ear until he tried it for himself. Such was the level of our acoustic knowledge then. The folks at Oticon then published several articles showing what happened in the open ear when the tube had either a thin or fat O.D., was shortened, or elongated, or the I.D. varied.

Another hurdle to fitting properly was understanding the idea of compression. There were any number of misleading articles and claims floating around, so Bill Ely (a superlative, young graduate engineer who had recently come to Dahlberg from Zenith) and I wrote an article, called Clearing the Compression Jungle, which tried to nail down once and for all the various factors involved in such a circuit.  Looking back it was rather simple-minded by today’s standards, and not too terribly accurate. But more than one audiologist related to me it was the first article they had read that helped them understand compression. Incidentally after Bill Ely came to Dahlberg, we joined together to upgrade Dahlberg’s quality control procedures and to champion advanced fitting concepts. Eventually, all Dahlberg aids were tested at final inspection to more rigorous standards, and when directional aids were introduced to the market by Maico, we purchased small anechoic chambers for research and production. We visited with the audiologists in Washington, DC to understand better the requirements of the VA, and shortly thereafter we were put on the VA contract, a first for Dahlberg. Bill and I stayed together as partners and close friends for the next 12 years and both of us eventually were hired at other companies, first, Qualitone and then, Maico.

The ideas I developed as a dealer helped me greatly when it came to helping design new products. My take was that the hearing aids of the day were not flexible, not adjustable enough. So I advocated hard for more trimmer controls, switches and earhooks with response modifying capabilities. This point of view was resisted throughout Dahlberg, and later at other companies I worked at. First, executives in production, rightly so, insisted that increasing the number of connections, leads, and components in the product would lead to a higher failure rate. A number of good studies showed this possibility was true, given the technology of the day. Second, the marketing people held that the dealer organization and even the regional managers would misinterpret, not understand or not be able to take advantage of advances that were too complicated. Again, true in many respects. Third, the more controls on the aid, the larger the case had to be, and it would not sell because small size was an overwhelming consideration in the marketplace. This was absolutely true, I learned later to my chagrin, after herding a design into production at Dalhlberg that contained a myriad of bells and whistles. Unfortunately, the case size was disproportionately large for the gain and output it provided, and it failed dramatically. Fourth and finally, more features meant greater manufacturing cost and that could result in lowering profitability.

These considerations highlight one of the basic conflicts that existed between the technically adventurous in most companies, and those who just wanted a simple product they could easily sell. Even one of the most highly regarded companies of the day, Radioear, had its share of internal push and pull. Sam Lybarger, surely the greatest and most influential of all pioneering engineers in the industry, sometimes encountered resistance to his product ideas from others within his company. I looked at his products with admiration and tried to sell his ideas at Dalhlberg, for his products had influenced me even before I began to dispense. I absorbed the above lessons the hard way, but never ceased to push products in the direction of adjustability, trying to keep in mind limitations

So what did my fellow audiologists think of my going over to the dark side? Mixed reviews. Ed Johnson, the Director of Audiology at the House Clinic in Los Angeles said one day, “You’re a good guy, but you ought to get out of Dahlberg, for that company has the worst dealers and the worst sales practices, and they will never change.” I took quiet umbrage at this, for many of the dealers and managers had become good friends, and I knew they were not as evil as represented. But the blatant advertising that Dahlberg was using to get leads, what the ads promised and claimed, was basically false and misleading advertising. That and the Dahlberg manpower “specialty selling “model stuck in the audiology community’s craw. It was upon these that their judgments rested. I understood, and wished that Dahlberg would change, and lobbied always for changes in our sales approach. But I was whistling Dixie.

Parenthetically, many years later, President Reagan was one of Ed’s patients at the House Clinic, and Starkey, whom I had just joined, had recently placed an early prototype of our first in-the-canal hearing aid in their clinic. Reagan’s impressions were sent to me at Starkey by a trusted dealer, By Burton, at Ed Johnson’s direction, to make sure they were taken care of by me personally. They called to tell me they were on the way, but once the impressions were delivered to my desk everyone at Starkey knew of it and I never saw them again until the aids were built. But Reagan’s fitting caused a sensation in the industry and I feel privileged to this day for having been the first to be entrusted with his impressions.

We had booths at the ASHA conventions to show our products, but it was fairly pointless. I remember once in Detroit two young women passing us by and one saying, with a face,  “Ugh, hearing aids. I‘m not going to waste my time talking to those people.” So we stood there, watching the passing parade and visiting with our competitors. The hearing aid companies held open houses in the evenings in their hotel suites, and the audiologists and especially the speech pathologists would make the rounds, eating, imbibing and freeloading. A few companies benefited from this such as Radioear, Zenith and Audiotone for they wanted to influence audiologists to recommend their products. Incidentally, since audiologists were evaluating and recommending hearing aids for their patients, but not selling them, those companies that wished to have them recommend their aids bore a huge expense when they placed aids in the clinics. Dahlberg was not readily welcomed in most clinics, save where a specific dealer had warm relations.

I was an audiologist through and through, even though I necessarily represented my company and its dealers. I always interacted with other audiologists as one, without trying to use it to curry favor. I made the rounds of important clinics trying to place our aids. Since I rarely encountered face to face rejection or any personally directed opprobrium from the audiologists I met, I probably was blithely unaware of what they really thought, which was just as well. I was never approached by any audiologist who requested a bribe for recommending Dahlberg products, nor indeed, was I approached this way when I worked at other companies. But I did became aware, with shock, that a few audiologists whom I respected had compromised themselves, one whom I knew personally by the way, totally redecorating his home with the monies he received from the local dealer. And, regrettably, some of these audiologists were leaders in the profession. The dealers that were aware of these unethical behaviors to a man decried the hypocrisy of the audiologists who were on the take. One unfortunate audiologist was filmed secretly having a homosexual affair, and true to the times, to escape the shame, was blackmailed by the dealer into directing his referrals to him. So I saw the good, the bad and the ugly over the years. But, except for the few, I found that audiologists were as a whole true to their professional ideals, and were not influenced by offers of money or gifts for their referrals.

Some days I walked a tightrope within the company and without. This was a time of great turmoil, for audiologists had been the enemy for so long, it was hard for some of the old timers in the companies to accept our ideas. During the early years many of us switched companies more than once, much of it caused by the unyielding attitudes of entrenched executives who fought change. The few of us who worked in the companies formed a tight bond, one that still remains, for it was us against the world. One time, about 1974, we all cooperated in a venture sponsored by HAIC (the Hearing Aid Industry Conference) traveling as a group to various parts of the country giving classes to dealers about the latest developments in hearing aid testing and fitting. It was great fun to be with kindred souls.

But at bottom, none of the negative attitudes towards audiologists really mattered to me for I was absolutely convinced I was on the right path, and I did not hesitate to speak out. My sense of self-righteousness eventually got me into real trouble. The owner, Ken Dalhlberg, was strongly in the camp of disliking audiologists, but he had been convinced by the other executives the company needed one. For the first three years he was essentially an absentee owner. Eventually however, he got interested again. I hardly spent any time with him then when he did not gibe me for one thing or another, and we eventually had words one too many times. So after making the other executives (I was a vice-president by then) vote up or down at a meeting on whether I should stay or be let go, and winning the vote (his being the deciding one), he called me in and said my services were no longer needed. One of the executives had tears in his eyes when he left the office after that meeting, but I understood: they had no alternative.

Ken was the perfect model of the self-made man. He had no more than a high school education, but he could hold his own in any area important to the success of his company. He was a bona-fide ace in WWII, having shot down 15 planes. He was shot down himself over enemy territory three times, and managed to escape back to England twice. He ended the war in a concentration camp, and upon release returned to work as a salesman at Telex. He learned about hearing aids there, and when he started his own company, he would carry aids with him in his flights all over the country as a pilot in the Air Force Reserve, and demonstrate them to potential customers. While I was at Dahlberg, he got caught up in the Watergate affair by accident, but he never seemed to be very concerned; he knew he had taken no part in the skullduggery. So Ken was a real hero and a charming, dynamic entrepreneur, but we both held views about the hearing aid industry that were diametrically opposed, and something had to give.

And Ken was right to let me go. He had introduced the first successful ITE aid to the market, and made a fortune with it. He named it “Miracle Ear.” a name that made my teeth ache when I heard it (and still does), and which I was trying hard to eliminate from our advertising. Manpower specialty selling, with its ravenous appetite for lead advertising and its potential for abuse, would never be abandoned by the company. The Miracle Ear was fitted with an essentially closed earmold and here I was, elevating open mold fittings, just the opposite of how Ken’s baby was fitted.  It was time to look for another job within the industry.

In the end, I was successful in initiating changes in the dealer organization. Many Dahlberg dealers bought into what I was selling, and over the years when I would meet them, were grateful for my help. More importantly, by then I had seen a few and then a few more audiologists join companies. And each year, one by one, other audiologists went into private practice to dispense despite ASHA. Seeing this happen reinforced me in my original belief that audiologists rightfully belonged in the hearing aid world and that it was a good thing for the future of the profession.

To be continued in the next blog which addresses the topic “I join the carnival.”