Audiology - From Dependence to Independence | Wayne Staab, PhD

Continued History of the First Audiologists in the Hearing Aid Industry

A series of previous blogs featured stories from six of the first seven audiology-trained individuals employed by hearing aid manufacturers and how their backgrounds interacted with their employment positions. This is information not published previously, but important and not to be lost for historical reasons in order to record the role that early audiologists played in paving the route for audiologists currently employed at the hearing aid manufacturing level. The subjects of the previous blogs were: Robert Briskey, William Carver, Terry Griffing, Richard Scott, James Curran, and James Delk. I am the last of the original seven audiologists to contribute to the blog, and my experiences will be included in a series of blogs that will not be published sequentially, but will be spaced in blogs on this site throughout the next few months. My comments will be more extensive primarily because I am the last of the first industry audiologists to have been continuously involved and active.

Background

My introduction to audiology, hearing aids, and eventually the hearing aid industry was not a direct route. I was studying under a National Institute of Dental Research Program in the area of Cleft Palate at the University of Wisconsin – Madison in 1964. This was administered through the Department of Communication Disorders, and as luck would have it, I ended up with an office mate by the name of Jim Curran (yes, that same Jim Curren who was one of the first audiologists in industry). Jim was an audiology graduate student and he and I followed baseball closely (The Sporting News came out every Monday morning), and we had animated discussions relative to our favorite players, statistics, and teams. He often chided me saying that I needed to get into a “man’s” field, which was audiology. There were only a handful of women in audiology at that time, with audiology being primarily male dominated and speech pathology primarily female. He and Dr. Claude Hayes eventually convinced me join the “man’s” field of audiology. Today, it is almost a “no-man’s” field, which I eagerly mention to Jim whenever we get together. I finished my Master’s work in Cleft Palate and stayed on for a degree in Audiology.

In 1972 I was teaching at the University of Wisconsin-Eau Claire, and enjoying what I was doing, and it was here that my eventual final link to the hearing aid industry came about. It was my third stint at University teaching in Audiology (previously at Michigan State University and the University of North Dakota – before, during, and after earning my Ph.D.) and I had not given thought to doing anything else – other than to follow Horace Mann’s advice and to get further west. (I was raised a “westerner” believing that Kansas City was a large eastern city, and even today, believe that anything east of the Mississippi is the East). I understood the preferred, although somewhat artificial life style of University teaching, and was comfortable in knowing that unless I did something preposterous, that I would have a good job for many years. Not only did I teach, but I ran the Audiology clinic as well, often as many as 40 hours per week doing the actual testing, hearing aid evaluations, and recommendations.

In those days, audiologists did not sell hearing aids, but instead, if they were involved with hearing aids at all, performed what we called “hearing aid evaluations.” This involved trying different hearing aids on a patient and recommending for them the hearing aid that provided the highest speech discrimination score using stock acrylic earmolds that did not fit ears well. At least, theoretically, that is what was done. And, only monaural fittings were recommended – binaural fittings were considered non-beneficial and unethical. In reality, hearing aids were often selected based on size, cosmetics, biases, and hearing aid dealers that clinics felt comfortable would fit the hearing aid recommended. There were reports (some substantiated) that a few audiologists exacted payment from dealers for each hearing aid they referred, or received some other kind of compensation. However, I believe that direct payments may have been rare, but certainly other “considerations” (primary lunches to discuss hearing aids) were not uncommon. At that time the discipline of hearing and speech was more interested in becoming a “profession” and in being philanthropic than in earning revenue outside of a guaranteed and consistently-paid salary – a practice we fostered to a fault.

The truth being that we really did not know the mechanics of fitting hearing aids. Undoubtedly, the greatest disservice that we provided the patient was to recommend hearing aids with too much gain and output, and also to think that we knew more about fitting hearing aids and solving hearing loss problems than the people who were actually working with and responsible for the fittings – the traditional hearing aid dealer. We definitely had a better understanding of the anatomical and physiological mechanisms involved and the theory surrounding the hearing loss and hearing aids, but the actual patient management (fit and follow-up) was another story that we would learn only after we started selling hearing aids many years later.

The fitting approach taught in Universities at that time was that if a person had a 40 dB pure-tone average, that the hearing aid should have 40 dB average gain (at that time this was the average of 500, 1000, and 2000 Hz), plus an additional 10 dB to compensate for the hearing loss becoming poorer. Most Universities and clinics actually made up a card for each hearing aid that hearing aid dealers provided to the clinic on consignment for hearing aid evaluations that identified the instrument, the HAIC (Hearing Aid Industry Conference – pre ASA and ANSI method developed by the hearing aid industry manufacturers to allow for comparisons and descriptions of hearing aids) gain and output. The hearing aids were categorized by gain (primarily) and when a patient came to the clinic, 3 or 4 hearing aids that had comparable gains for the loss (audiogram mirroring) would be selected for comparison. As compared with a generalized “half-gain” rule used today, in which we would fit the person’s loss referenced above with approximately 20 dB gain, we were asking for 50 dB at that time! And, we were confused when patients returned to the clinic and always had the volume control turned down – which we immediately insisted should be increased to the “recommended” level. Dealers tried to tell us politely that patients would not wear their hearing aids at the high gain levels recommended, but the profession was unwilling to listen. Fortunately, all hearing aids had volume controls that the patient could adjust (although we sometimes glued them into a given gain position, especially for children), however, essentially nothing was done about the output. Output was tied to the gain – a high gain aid had a high output. An additional problem was that most hearing aid volume controls had only about a 20-dB range, meaning that if an aid had 40 dB gain, that amplification started at 20 dB.

Creating an additional problem to the inordinate amount of gain and output was that AGC hearing aids were not available, and acoustic feedback was essentially assured for any hearing aid having more than about 20 dB coupler gain because of the poorly-fitting stock earmolds used, and we really did not know how they would perform with their hearing aids until after they returned for a follow-up with the custom earmold that the dealer had made for them. Hearing aids were limited to their natural saturation, whatever that would be based on the electronics. And, it was essentially impossible to find a hearing aid that didn’t have at least 120 dB SPL output. Most were higher, with body aid average outputs in the 124 to 136 dB range and average gains in the 68 to 82 dB range. A low-amplification Telex 37 model hearing aid had an average gain of 29 dB and an output of 121 dB as reported by Consumer Reports {{1}}[[1]] Hearing aids, January 1966, A Consumer’s Union publication, 16 pages [[1]]. Audiologists kept asking for higher gains with corresponding higher outputs to fit more severe hearing losses based on this fitting philosophy, and manufacturers obliged as best they could, limited only by the transducers and amplifiers involved.

Forced Distribution

The long and short of this is that hearing aid manufacturer representatives or the local dealers visited audiology clinics to offer hearing aids on consignment that could be used for such evaluations. It was also a way for a manufacturer to obtain sales in areas where they did not have business. Audiologists would decide to have certain hearing aids in the clinic if they felt the aids might meet patient needs. The manufacturer’s rep would ask which dealers the clinic referred to, and then would visit the dealer(s) involved to let them know that their aids were now in the clinic and asked if they received a referral for that aid, if the dealer would be willing to sell it. This methodology is what I called “forced distribution.” This consignment practice continued until the early 1980s. In fact, most of the job description by what might be referred to as “second tier audiologists” – those audiologists who arrived later in the industry, had this as their primary responsibility. Periodic visits to a clinic were made to introduce new products and/or to rotate hearing aids on consignment. Initially, hearing aids were owned and placed by the dealers, but later, manufacturers provided the hearing aids for consignment in an attempt to garner more referrals. To facilitate this, it was felt that an audiologist might be a good communicator between the manufacturer and the audiologist, and this is what fostered primarily the second generation of audiologists into the hearing aid industry. An unfortunate consequence of this consignment program was that manufacturers could have in excess of a million dollars of consigned hearing aids on the shelves in audiology clinics for hearing aid evaluations, and what was even more unfortunate, was that many of the hearing aids returned to the manufacturers were still in their original packaging and had never been opened. The consignment practice contributed to the demise of some hearing aid companies.

A Little Background of My Introduction to the Industry

My first introduction to the hearing aid industry came from listening to Bob Briskey. Bob had been invited by Dr. Claude Hayes to give a presentation to the Audiology graduate students at the University of Wisconsin – Madison. This was in 1964. Zenith, the company he was with, had introduced the Zenith Vocalizer hearing aid – an aid for children having severe to profound hearing losses, and Bob had been intimately involved in its development (Figure 1). In some ways, this might have been the first major attempt at “specialized” hearing aids for a given population. Zenith also introduced a new earmold type called the Acoustic Modifier (Figure 2) in 1963 for individuals having normal hearing sensitivity to 500, 1000, or 2000 Hz, and a precipitous drop after that. This earmold actually had a series of large vents and a very short, but large hollowed-out sound bore, resulting in minimal insertion into the ear canal. A disc of porous fabric covered the multiple (primarily two) vent holes. This was a substantial departure from the custom earmolds of the day and was recommended to improve intelligibility. There was no question that Zenith was the hearing aid company “making moves” at that time, and audiologist Briskey seemed to be a contributing force that helped position Zenith among the “preferred” hearing aid companies. It seems that audiologists finally had someone in the industry they could relate to. This was not lost on a few other hearing aid manufacturers, such as Maico, Dahlberg, Telex, Audiotone, Vicon, and Qualitone, which were the other companies that early audiologists managed to enter the industry with.

Figure 1. Zenith Vocalizer III hearing aid. This was preceded by the Zenith Vocalizer and then the Vocalizer II.

Figure 2. Zenith patented Acoustic Modifier earmold.

My next exposure to an audiologist in industry was with Jim Delk, who was employed by the Vicon Instrument Company. They had developed an instrument for screening of newborns called the Apriton and he gave a presentation about it at the University of Wisconsin-Madison. The Vicon company was located in Colorado Springs and developed the instrument (Figure 3) at the initial request of Marion Downs and Graham Sterritt at the University of Colorado Medical Center in Denver. Both Bob Briskey and Jim Delk seemed excited about the work they were doing in industry and assisting in furthering actual changes rather than just talking about things that should/could be done from a theoretical point of view. This infectious attitude was not lost on me.