VOLUME 2 | ISSUE 1 | 2012
ARE YOU
READY? THE FUTURE IS NOW Expert Q&A Kirsty Gerlach on the Importance of the Clinic Environment
Wi Series
Customizing the Wireless Experience
First Impressions Change. For all of us, sometimes it is a good thing, sometimes it isn’t. Our industry changes over time as technology advances. As we move into 2012, things are changing in ways we haven’t had to cope with in the past. The baby boom generation is turning 65 at a fast pace, and the long-promised increase in people who may be in need of our services is becoming a reality. At the same time, there is no increase in the number of providers being prepared in universities, potentially limiting access for those who need care. For years, there has been no substantial change in the percentage of people with hearing loss who get hearing aids, and there is a concern that it may be due to people not having access to hearing aids because of cost. This is being answered with more and more Internet hearing aid offerings. In fact, one major insurance company is offering to sell hearing aids directly to consumers without a local service provider! These are trends that we believe move the industry away from an optimal service model. Starkey was built on the foundation of a partnership between quality in design and manufacturing processes and quality direct clinical care delivered by audiologists and hearing instrument specialists working directly with patients toward the goal of better hearing. That partnership equips you, the care providers, with the best technology possible and enables you to provide crucial personalized service to each patient. Key elements of good hearing aid design are quality and innovation in products and the supporting software. Quality is also key in training and supporting professionals in their efforts to work directly with patients. The continuation of that quality is the direct and personalized care that patients need to gain full benefit from their hearing aids. Quality in manufacturing is not a simple process, and Keith Guggenberger, Senior Vice President of Operations at Starkey, covers it in detail in this issue of Innovations. Starkey’s comprehensive training programs – online and in person – are also outlined in this issue. Providing quality care to the patient is up to you. We believe that your care is an indispensible element of the patient journey to better hearing. Hearing aids are more than a commodity, and they cannot be sold as a plugand-play product; our traditional hearing aid patients need more than that. Starkey is committed to providing you with the tools and support you need to provide your patients with the best possible care. Innovations is another tool that provides best practices, technology information and expert opinions from around the world. Change? We aren’t afraid of change, and you shouldn’t be either. We have quality on our side, and Innovations is part of that quality care.
Dennis Van Vliet, Au.D. Editor, Innovations Senior Director of Professional Relations Starkey Laboratories, Inc.
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Technology Review
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You Asked ... Customer Service Answered
Wi Series: Customizing the Wireless Experience
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Sounding Board
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Continuing Education
The Training You Need, When You Need It
Insight from Kirsty Gerlach, M.A. 030
Giving back
The Gift of Hearing
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Employee PROFILE
TABLE OF CONTENTS
Staff Spotlight: Sid Higgins
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Business Intelligence
Baby Boomers: What You Need to Know
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Clinical Corner
Making a Case for Spectral iQ
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Tools & Resources
Sound Check: Connecting With Your Patients in the Digital Age
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Research to Reality
Rigor in Audiologic Research
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Quality
Quality — It’s the New Black
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Starkey Audiology Series
Understanding the Problems with Aided Speech Understanding
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starkey News
News & Views
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Wi Series: Customizing the Wireless Experience Elise Gregoire, Au.D., & Elizabeth Galster, Au.D.
Enhancements to technology have led to more efficient hearing aid fittings and enriched listening
Technology Review
experiences for patients with hearing impairment.
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Starkey’s Wi Series™ custom hearing aids are the industry’s first custom hearing aids that integrate a long-distance wireless antenna completely within the shell of the hearing aid. Wi Series offers all of the advantages of wireless communication and advanced signal processing in both custom and receiver-in-canal (RIC) products. Wi Series custom products include completely-in-canal (CIC), in-thecanal (ITC) and in-the-ear (ITE) styles.
INNOVATIONS | Volume 2 | Issue 1 | 2012
With Wi Series custom products, Starkey introduces new hardware designs and several new advanced features. The new hardware design integrates Starkey’s wireless antenna into the custom shell along with advanced moisture and wax protection for the receiver. Among the new features available are Voice iQ2, iQ Boost, Self Learning and Spectral iQ. The integration of IRIS™ Technology in custom hearing aids provides earto-ear processing, media streaming and wireless programming without the need for a relay device. The hardware and features of Wi Series custom hearing aids were evaluated in an eight-week clinical trial at Starkey. Twenty patients evaluated the functionality and performance of both the wireless custom products and accessories. Mean hearing loss among patients ranged from mild to severe. Both subjective and objective data were collected throughout the study and will be summarized in part throughout this paper.
Hardware Design Fitting all the necessary components of a hearing aid into the small space of a custom product presents certain challenges. One of the most important hardware components in Wi Series custom hearing aids is the wireless antenna that allows for communication between the hearing aids and the wireless accessories and programmer. This antenna must be capable of transmitting and receiving information while situated deeply in the patient’s ear canal. Operating within the 900 MHz band of the Industrial and Scientific Medical Spectrum, Wi Series products are capable of wireless communication in both near and far fields without the use of a relay device. In order to implement and achieve wireless functionality, Wi Series custom hearing aids incorporate a unique hardware design. Figure 1 is an illustration of an assembled Wi Series CIC, in which the copper wireless antenna encircles the hardware and processing components of the hearing aid, including the battery, microphone and integrated circuit. Figure 2 shows the same CIC with the components disassembled: from left to right, the faceplate, hardware components, copper wireless antenna and shell.
HyrdaShield®2 HydraShield2 is designed to protect hearing aids from many of the substances they are exposed to during typical use. HydraShield2, used on the Hear Clear wax guard, is an oleophobic and hydrophobic nano-coating that repels oils and liquids such as wax and perspiration. Figure 3 is a photograph of a drop of olive oil that has been placed on a surface that has not been treated with HydraShield2. Note that the surface absorbs the oil. Figure 4 is a photograph of a drop of olive oil that has been placed on a surface that has been treated with HydraShield2. Note that in this photograph the oil is not absorbed; rather,
Figure 1: Image of a completed Wi Series CIC hearing aid. The wireless antenna wraps around the inside components of the hearing aid.
Figure 2: Expanded side view of a Wi Series CIC hearing aid. Visible on the faceplate is the microphone port and battery door. Components fit within the wireless antenna, which slides into the shell of the hearing aid.
Figure 3: Photograph of a drop of olive oil on an untreated surface.
Figure 4: Photograph of a drop of olive oil on a surface coated with HydraShield2.
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About the Authors:
Elise Gregoire, Au.D., joined Starkey’s Clinical Product Research team in the summer of 2010 as a Research Audiologist conducting clinical research studies evaluating Starkey’s newest technological advancements. Gregoire completed her Doctorate of Audiology at Vanderbilt University in Nashville, Tenn. During her time at Vanderbilt, she worked in the Dan Maddox Hearing Aid Research Laboratories under the direction of Todd
Starkey’s SurfLink Programmer is one of the first wireless programming options that allows for truly cordless programming sessions. Automatic detection of the hearing aids via Inspire® fitting software makes engaging a patient’s hearing aids in a programming session quick and easy. In addition, the patient has the freedom to experience different listening environments within a range of approximately 20 feet while the clinician programs the hearing aids. ™
Ricketts, Ph.D., and Benjamin Hornsby, Ph.D. Prior to beginning work with Starkey, Gregoire worked as a Clinical Audiologist for Bay Audiology in New Zealand.
SurfLink Media, which can be used with all Wi Series hearing aids including the custom options, streams audio from a media device directly to patients’ hearing aids. This allows patients to connect to their television, MP3 player, computer and more. Multiple Wi Series users can connect to one media streamer, facilitating use in households with more than one Wi Series user. Because the audio is sent directly to the hearing aids, there is no perceptible delay for the listener, maintaining good sound quality. A subset of patients in this clinical trial with moderate-to-severe
Elizabeth Galster, Au.D., is a Research Audiologist with the Clinical Product Research team at Starkey, which conducts clinical research trials on emerging technology and fitting processes. Galster’s previous research focused on evaluation of signal processing algorithms, directional microphones and speech understanding in reverberation. She has also worked clinically with the Veterans Administration. Galster holds a bachelor’s from the University of Iowa and an Au.D. from Vanderbilt University.
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INNOVATIONS | Volume 2 | Issue 1 | 2012
SurfLink Media, which can be used with all Wi Series hearing aids including the custom options, streams audio from a media device directly to patients’ hearing aids.
SurfLink Remote
Wireless Hearing Aid Controls
8 7 6 5 4 3 2 1 0 1
2
3
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7
8
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10
Subjective Rating (1=poor, 10=excellent)
Figure 5: Patients’ ratings of the value and convenience of the SurfLink Remote and of the wireless hearing aid controls.
hearing loss evaluated SurfLink Media with custom hearing aids. Four of five patients with moderateto-severe hearing loss reported good or very good speech understanding when using SurfLink Media while watching television. The SurfLink Remote allows the patient to adjust various settings in the hearing aids with the simple press of a button. Three convenient remote control designs are available to accommodate any patient’s needs. During the clinical trial, patients rated the value and convenience of the remote control very highly, as shown in Figure 5. Patients who did not express satisfaction with the controls reported no need to adjust the hearing aids. With a battery life of up to five years, the SurfLink Remote provides patients with a convenient solution for adjusting their hearing aids.
Ear-to-Ear Processing In addition to the far-field communication capability used for streaming and programming, Wi Series custom hearing aids also offer near-field processing capability. Near-field communication is necessary to allow for communication between the left and right hearing aids. Because the hearing aids are capable of communicating with each other, the user is able to make adjustments to both hearing aids by using the control on only one device.
An additional benefit of ear-to-ear processing is Binaural Spatial Mapping. Binaural Spatial Mapping uses data collected from each hearing aid to arrive at optimal algorithm settings in a variety of environments, with the goal of improving patients’ speech understanding and listening comfort, particularly in the presence of background noise.
Voice iQ2 Voice iQ2 offers greater reduction of noise — when compared to the original Voice iQ design — while still preserving speech understanding. Previous studies investigating Voice iQ have reported satisfaction in background noise and no degradation of speech understanding in noise (Pisa, Burk, & Galster, 2010). Clinical data from the current study, with Wi Series custom products featuring Voice iQ2, indicate that Voice iQ2 preserves patients’ ability to understand speech in noise (Figure 6). Speech understanding in noise was evaluated using the Hearing in Noise Test (Nilsson, Soli, & Sullivan, 1994) across multiple
Mean HINT Performance (N=20) 4
HINT Threshold (dB SNR)
Wireless Accessories
Patients using wireless hearing aid controls were asked to rate their value and convenience during the clinical trial. Results are displayed in Figure 5. Patients responded favorably, noting that it was very easy to make changes to volume and memory.
Value and Convenience of Controls
Number of Participants
the oil sits like a bead on top of the surface. The Hear Clear, treated with Hydrashield2, prevents such substances from accumulating in the receiver tubing of the hearing aid, improving the durability and reliability of the hearing aid and making it easier for patients to maintain their hearing aids.
3 2 1 0 -1 -2 -3 -4 -5 -6
Voice iQ2 Off
Voice iQ2 On
Test Condition
Figure 6: Mean HINT performance with Voice iQ2 off and with Voice iQ2 on. Note that lower scores indicate better performance.
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iQ Boost Designed for use in extremely noisy environments, iQ Boost allows patients to activate directionality and more aggressive noise reduction settings. iQ Boost features specialized Voice iQ2 settings and up to 20dB of noise reduction. This is intended to improve patient comfort in extremely noisy environments. Accessed using the “Favorite” button on the SurfLink Remote, iQ Boost is designed to improve comfort in noise with the click of a button.
Self Learning Self Learning automatically adjusts the gain settings in the hearing aids in response to volume control changes made by the patient. If a patient makes consecutive, consistent adjustments to the volume of their hearing aids, the devices will slowly start to “learn” this behavior and adjust the gain to better meet the needs of the patient. Self Learning will learn preferred volume settings for different
Mean Performance on the S-Test (n=11)
2AFC Percent Correct
100 80 60
91.6 77.7
40 20 0
Spectral iQ Off
Spectral iQ On
Test Condition
Figure 7: Mean two-alternative forced choice (2AFC) percent correct scores for the S-Test. The two test conditions displayed in the figure show scores with Spectral iQ off and Spectral iQ on. Patients performed significantly better with Spectral iQ on (p<0.001).
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INNOVATIONS | Volume 2 | Issue 1 | 2012
Spectral iQ is designed to improve audibility for high-frequency speech sounds like /s/, /∫/, and /z/ for patients with steeply sloping high-frequency hearing loss. memories, allowing memory-specific learning and optimization of the hearing aid response.
Spectral iQ Spectral iQ is designed to improve audibility for high-frequency speech sounds like /s/, /∫/, and /z/ for patients with steeply sloping high-frequency hearing loss. The algorithm identifies highfrequency speech sounds and translates them to a lower frequency region where hearing thresholds are better, while also maintaining the original speech signal. This dynamic process preserves harmonic relationships, which are critical to speech understanding and sound quality, resulting in audible speech cues while maintaining excellent sound quality. Eleven of the twenty clinical trial patients met the candidacy criteria for Spectral iQ and evaluated this feature throughout the clinical trial. To evaluate patient performance with Spectral iQ, the S-Test (Robinson, Baer, & Moore, 2007) was used to evaluate a listener’s ability to detect word final /s/ or /z/ sounds. S-Test results were converted from d-prime scores to percent correct according to the procedures described by Hartmann (1997, p. 543). Figure 7 displays mean patient performance on the S-Test. Significant benefit from Spectral iQ was observed when comparing results with Spectral iQ on versus results with Spectral iQ off (p<0.001).
Overall Impressions
Conclusion
Upon completion of the clinical trial, patients completed the Device-Oriented Subjective Outcome Scale (DOSO) (Cox, Alexander, & Xu, 2009), to rate Wi Series custom hearing aids. These ratings were compared to ratings of the patients’ own hearing aids which were completed at the onset of the study. The DOSO is designed to evaluate and compare the performance of the hearing aids (Cox, Alexander, & Xu, 2009). Patients rated the Wi Series custom hearing aids significantly better than their own hearing aids on all of the subscales of the DOSO: speech cues (p<0.001), listening effort (p<0.001), pleasantness (p<0.01), quietness (p<0.001), and convenience (p<0.005) (see Figure 8).
Starkey’s Wi Series custom hearing aids are among the first hearing aids to offer near- and far-field wireless technology in combination with advanced signal processing within the case of a custom hearing aid. The use of IRIS Technology and our new features like Voice iQ2, iQ Boost, Self Learning and Spectral iQ enhance the patient experience. Starkey’s Wi Series custom products integrate exceptional sound quality, speech understanding and all the benefits of wireless communication into a smaller package than ever before. Acknowledgements The authors would like to acknowledge Roger Halberg, Ryan Owens, Keith Guggenberger, Gerald Shamba, Michelle Hicks, Ph.D., Matt Burk, Ph.D., and Amanda Wolfe, Au.D., for their contributions to this paper.
References Cox, R.M., Alexander, G.C., & Xu, J. (2009, March). Development of the DeviceOriented Subjective Outcome Scale (DOSO). Poster session presented at the annual meeting of the American Auditory Society, Scottsdale, AZ.
Mean DOSO Ratings (N=20) Own Hearing Aids
Subjective Rating (1 = not at all, 7 = tremendously)
conditions with Voice iQ2 off and with Voice iQ2 on. No significant difference in performance was observed, indicating that Voice iQ2 preserves patients’ ability to understand speech when a background noise is present.
Hartmann, W. M. (1997). Signals, sound, and sensation. Woodbury, NY: American Institute of Physics.
Wi Series Custom Hearing Aids
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Nilsson, M., Soli, S., & Sullivan, J.A. (1994). Development of the Hearing In Noise Test for the measurement of speech reception thresholds in quiet and noise. Journal of the Acoustical Society of America, 95(2), 1085–1099.
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Pisa, J., Burk, M., & Galster, E.A. (2010). Evidence-based design of a noise management algorithm. The Hearing Journal, 63(4), 42–48.
2 1 Speech Cues
Listening Effort
Pleasantness
Quietness
Convenience
DOSO Subscale
Robinson, J.D., Baer, T., & Moore, B.C. (2007). Using transposition to improve consonant discrimination and detection for listeners with severe high-frequency hearing loss. International Journal of Audiology, 46, 293–308.
Figure 8: Patients’ responses to the DOSO scale with their own hearing aids at the start of the study compared to the Wi Series custom hearing aids at the end of the study. For all subscales, the Wi Series custom hearing aids were rated significantly better than the patients own devices on each of the DOSO subscales: speech cues (p<0.001), listening effort (p<0.001), pleasantness (p<0.01), quietness (p<0.001), and convenience (p<0.005).
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CLOSE-UP
Staff Spotlight: Sid Higgins What is your background? I graduated from Ferris State University in 2008. My first job was as a mold maker in the plastics industry. After receiving my Journeyman’s credentials, I resumed my education in materials and design. My 28 years in materials and process engineering have contributed to the development of Starkey’s industrial designs, as well as Zo–n™, S Series™, Live Real Ear Measurement, capacitive switching and, most recently, AMP™. I have numerous patents in the defense, consumer and medical industries.
Employee Profile
Sid Higgins Principal Mechanical Engineer
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INNOVATIONS | Volume 2 | Issue 1 | 2012
How did you start in the hearing aid industry? I almost didn’t. When I applied at Starkey for a Mechanical Engineering position, my resume inadvertently was considered for the manager of the department opening. At the time, there were several more qualified candidates for that position, so I was placed in the reject pile. When I called to ask why I had not been considered for the Mechanical Engineering position, Starkey reviewed my file and did not understand either. I became a last-minute addition to the candidate list and ultimately was hired. The tendency to ask “why” has continually served me well from a design and personal standpoint. I have since been with Starkey for almost eight years.
What are your main job duties? I am the Principal Mechanical Engineer, Technology Development. I am responsible for leading the design of new concept developments that represent the application of new technologies and/or new engineering theories and principles into upcoming product lines. I also serve as a mechanical resource for our industrial design partners by assisting them in pushing the boundaries of design while ensuring a functional and producible product.
What is one memorable experience you have had at Starkey?
What are some of the most exciting trends you see on the horizon for hearing technology?
In my first year at Starkey, I was presented with the task of redesigning and implementing a directional microphone cover for the 675 BTE case. The previous design had proven ineffective late in the project and there was little time to develop another. The case was complete, as were the internal components, so whatever we did had to fall into existing constraints, follow the industrial design, match the acoustical performance of the previous design, be mechanically and environmentally robust, and be ready to manufacture in three weeks. What I had in my favor was residing in the same building as a machine shop, injection mold lab and personnel that rank among the best in the five-state area. With their skills at my disposal, we were able to not only design the part, but also build an injection mold and produce more than 200 pieces in just three days! When you consider that typical rapid prototype tool shops boast four- to six-week delivery times, you begin to see what a small team with a shared passion can accomplish. That mic cover is still in use today.
Invisibility: It has long been talked about, but now, from a mechanical perspective, it is becoming more attainable. The science of nanotechnology includes additives to polymers that afford stronger, thinner wall sections, and enhanced flow. In essence this enables us to create more space in the same space. When combined with advances in microelectronics, smaller devices with more functionality result. Wireless: True wireless you expect without the need for relay devices. Hearing devices that become part of a personal area network which means that they interact with your surroundings and adapt to “communicate” with the electronics at hand. Intelligence: Devices that understand or learn the user’s intent in an environment and monitor listener effort to self-adjust with no physical effort or action on the part of the user.
What is the most interesting and/or exciting part of your job? I enjoy applying new materials, processes or technologies in unique combinations, or finding novel approaches to create something unheard of in a small device. I enjoy taking the complex and redesigning or reinventing it until it is in its simplest, most reliable form. Once there, you have a solution or feature that is easy to manufacture and intuitive to operate.
What are some of the challenges you face? Navigating the intellectual property (IP) minefield can be challenging. You can have what you believe is a novel approach only to find that someone thought of something like it five years ago, patented it and set it aside. We have councils, committees and lawyers to assist, but it is up to the inventor to understand the IP landscape before expending a lot of effort.
What do you do for fun outside of work? The typical stuff — golfing, kayaking, biking, running and photography. I really enjoy traveling with my family. I feel fortunate to say that I have been married to my best friend for 28 years. My daughter is graduating from college and my son, who is in the Army, will be deploying soon, so we are in quite a state of transition. Seeing the man and woman that my son and daughter have become is the achievement of which I am the most proud. We also have a network of friends, and we are active in our community and the inner city.
Is there anything else you’d like to share? The quality of the people and the passion they share for the product and the consumer is really quite amazing at Starkey. I have worked in the defense, medical and consumer markets, and I have found this to be lacking in many companies. I can bring my best at Starkey because I am surrounded by the best.
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Spectral iQ Making a Case for
clinical corner
By Dennis Van Vliet, Au.D.
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Forrest Hatfield, a leading-edge baby boomer born in 1946, grew up in a rural, agricultural community in southern California. The unincorporated town that housed his family home recorded fewer than 1,000 residents in the 1950 census. The community primarily consisted of single-family homes on land of varying acreage that grew oranges, avocados and lemons. Many residents sold the fruit to the local packing houses for supplemental income. The rural nature of the area was such that most families kept shotguns and small bore rifles to keep rabbits and squirrels away from their crops and gardens. In this simple community, it was expected that kids learned to shoot before they reached their teens, and contraband firecrackers and cherry bombs were probably more common than Hula Hoops. This lifestyle was only the beginning of Hatfield’s exposure to noise. Now reaching 65, he looks back on experiences in Vietnam with a variety of automatic weapons; work in a machine shop during college; work as an aerospace engineer; and motorcycle riding, as contributing to his highfrequency hearing loss and constant tinnitus. Hatfield and I were classmates from kindergarten through high school, and even took a calculus class together in community college after we both finished our military service. I didn’t connect with
INNOVATIONS | Volume 2 | Issue 1 | 2012
About the Author: Dennis Van Vliet, Au.D., an audiologist with 36 years of experience, has Figure 1: Hatfield’s audiogram
provided clinical services in medical, educational and private practice settings. His professional interests have focused
about the emerging technologies using frequency narrowing to place high-frequency cues down in lower frequency areas where they could be audible. We agreed to arrange a time to look at his candidacy for something different than what he was wearing. him again until I saw him as a patient about 15 years ago. His complaint was tinnitus, and although he had hearing loss above 2,000 Hz, his lifestyle at the time was such that he had no complaints about his hearing. I counseled him about tinnitus and saw him a few times after that for routine testing and discussions about what I couldn’t do with hearing aids. After leaving private practice in 1999, I didn’t have the opportunity to follow up with him for the next 10 years. At the 50-year reunion of our eighth grade class last year, I saw Hatfield was wearing a pair of thin-tube BTEs. He reported that his hearing had progressed to a point that he was able to get some benefit from hearing aids and had used his insurance benefits to get the aids. He noted that the aids helped “some,” but that he still had difficulty in noisy environments. I talked with him
on hearing aids, and his opinions are frequently solicited in U.S. and international publications and lectures. Van Vliet earned a B.S. from the University of California, Irvine, his master’s in speech communication from California State University and an Au.D. from Central Michigan University.
When we were able to get together again, I reviewed his history and retested his hearing (Figure 1). He reported that he Forrest Hatfield had seen an otolaryngologist a couple of years ago who had recommended an MRI, the results of which ruled out causes for his hearing loss other than noise exposure. His hearing was much worse than when I had seen him in the past. We discussed his performance with his current hearing aids and where he would like improvement. He wanted help with television and home entertainment, better clarity of speech overall, and improvement in hearing environmental sounds. To get a quick and informal sense of his performance with high-frequency consonants, I presented randomly ordered words from the S-test at 50dBHL, both aided with his own hearing
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The initial fitting was done with occluding earbuds because he had been using similar coupling with his previous aids and wasn’t bothered by occlusion. However, impressions were taken for fabrication of custom molds to eventually ensure better security of fit and comfort. Following Live Real Ear Measurements, the hearing aids were fit to the eSTAT formula that prescribes gain and output, as well as parameters for the activation of Spectral iQ.
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Subjectively, Hatfield immediately appreciated the improvement in clarity of speech with the fitting. His preference was to have the gain reduced slightly from eSTAT targets for comfort. After the fitting, self-report measures included the Abbreviated Profile of Hearing Aid Benefit (APHAB), Satisfaction with Amplification in Daily Life (SADL) and the Internal Outcome Inventory for Hearing Aids (IOI-HA). Results revealed a pattern of improved performance over his old hearing aids that didn’t include wireless and Spectral iQ features. Figure 3 illustrates the benefit of the Wi Series hearing aids over the performance of his old aids. The APHAB is a self-assessment profile that reports how much difficulty a patient may be having with communication or noises (Cox & Alexander, 1995). Improvement was noted in the following categories: ease of communication, background noise, reverberant environments and aversive sounds. The benefit scores (performance on the old aids subtracted from performance on the new aids) for each of these subscales are reported in Figure 3.
Percentage of benefit: new aids vs. old
The nature of Starkey’s Spectral iQ is such that as high-frequency speech information is detected, these valuable cues are replicated at a lower, audible frequency in real time (Figure 2). The result is that
Figure 2: Inspire® programming screen illustrating the Spectral iQ source band (green) where high-frequency phoneme characteristics are copied, and target regions (yellow) where the information is replicated.
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INNOVATIONS | Volume 2 | Issue 1 | 2012
SADL Scale Norms
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60 50 40 30 20 10 0 EC
BN
RV
AV
EC = Ease of Communication
RV = Reverberation
BN = Background Noise
AV = Aversiveness
Figure 3: APHAB data plotting the reported improvement of the new hearing aids compared to the old aids (benefit).
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5
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4
Items Score
Based on his needs and performance, we agreed on a fitting with Starkey Wi Series™ i110 receiverin-canal (RIC) hearing aids, which feature Spectral iQ, Starkey’s new frequency lowering technology.
the user is able to detect the presence of speech information that would be otherwise inaudible, and the quality of speech remains markedly undistorted. Satisfaction
aids and unaided. Because of his hearing loss, it wasn’t surprising that when words with a final /s/ were presented, he was unable to identify whether the /s/ phoneme was present with or without his hearing aids. He did a little better with words ending with the voiced /z/ phoneme because of the voicing component.
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Global Score 5.5
Positive Effect 5.8
Service & Cost 6.5
Negative Features 3.0
Personal Image 6.7
SADL scores for Hatfield
3 2 1
Use
Black circle = mean score, Gray bar = 20th to 80th percentile scores Clear augmentation to “Service & Cost” = for patients who receive a free hearing aid from the VA
Ben RAL Sat RPR loth QoL Subjective problems = mod-severe+
Figure 4: SADL performance and norms.
Figure 5: IOI-HA performance compared to normative data.
The SADL was designed to evaluate the satisfaction people feel with their hearing aids (Cox & Alexander, 1999, 2001). Figure 4 displays Hatfield’s responses to the SADL subtests along with normative data for the test. His responses indicate a high degree of satisfaction with the hearing aids approaching the 80th percentile on all subtests and the global score.
and he really likes the convenience of the wireless connection with the television.
The IOI-HA addresses a minimal set of seven core outcome domains with hearing aids (Cox, Alexander, & Beyer, 2003). It can serve as a useful addendum to other outcome measures. Figure 5 compares Hatfield’s performance with clinical norms for the IOI-HA. Although he reports some residual difficulty in select situations in which he would like to hear better, his responses indicate very favorable outcomes. Outcome measures such at the APHAB, SADL and IOI-HA allow us to compare an individual’s perception of benefit to a larger population of patients that have reported their experience. Without such measures, we are left with casual interpretations of an individual’s experience. Anecdotally, Hatfield reports improvements in speech clarity; he appreciates the effect of the noise reduction in unfavorable environments;
This case study illustrates that hearing aid features appropriate for, and new to, a patient’s experience can bring added value and benefit to his or her journey. It is encouraging that new features such as Spectral iQ and wireless connectivity provide measurable benefit. The fact that they assist in spontaneous acceptance of new hearing aids has far-reaching implications. Immediate acceptance increases motivation and invites individuals like Hatfield to continue or increase their participation in social activities. After all, social interaction is a key element in the maintenance of life quality and cognitive ability. References Cox, R.M. & Alexander, G.C. (1995). The Abbreviated Profile of Hearing Aid Benefit (APHAB). Ear and Hearing, 16, 176–186. Cox, R.M. & Alexander, G.C. (1999). Measuring satisfaction with amplification in daily life: The SADL Scale. Ear and Hearing, 20, 306–320. Cox, R.M. & Alexander, G.C. (2001). Validation of the SADL Questionnaire. Ear and Hearing, 22, 151–160. Cox, R.M., Alexander, G.C., & Beyer, C.M. (2003). Norms for the International Outcome Inventory for Hearing Aids. Journal of the American Academy of Audiology, 14(8): 403–413.
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Rigor in audiologic research Starkey Laboratories, Inc.
Supporting Starkey research
• Customer needs • Review of activities in different industries • Strategic planning
are some 400 scientists and
• Collaboration with other researchers
engineers, including a staff of
• Our own prior and current research
18 research audiologists.
• Conferences • Review of scientific literature • Clinical experience
plan for and manage uncertainty, and convert assumptions into knowledge through disciplined experimentation. One of our guiding principles is that all research projects, regardless of their outcome (including failure), must result in learning.
Harvey Abrams, Ph.D., & Michelle Hicks, Ph.D.
At Starkey Laboratories, Inc.,
Research to reality
we take pride in our evidence-
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based approach to research and product development. There is a complex and rigorous process involved in bringing an idea to realization and ensuring that our features and products come to market only when they have been proven to be beneficial to patients with hearing loss. Supporting Starkey research are some 400 scientists and engineers, including a staff of 18 research audiologists with more than 175 years of combined experience in audiology and hearing science research. The primary mission of the research audiologists is to initiate, develop, execute and support research with the ultimate goal of improving the human journey for those with hearing loss. Our research audiologists conduct research in three distinct areas: Audiology Research, Clinical Comparative Research and Clinical Product Research. The Audiology Research group is responsible for the ideation and investigation
INNOVATIONS | Volume 2 | Issue 1 | 2012
of innovative hearing solutions, which they do by conducting clinical trials of prototype algorithms and technology. A key focus of this group is to better understand the nature of individual patient differences (e.g., loudness tolerance, perception of speech-in-noise, and consequences of impaired cognition) in order to design better hearing aids and assist clinicians in customizing specific hearing aid features for their patients. The goal of the Clinical Comparative Research group is to enhance Starkey’s understanding of existing and emerging technologies throughout the hearing aid industry, and to ensure that Starkey’s product claims are accurate and backed by supporting evidence. The purpose of the Clinical Product Research group is to validate products and features in Alpha and Beta clinical trials to ensure that the products released meet the needs of the hearing impaired individual and the requirements of the hearing care professional. As with any research program, the purpose of research at Starkey is to answer a question or solve a problem through a systematic process of investigation (as illustrated in Figure 1). This process is designed to develop and prove out new solutions,
At Starkey, the research process for developing new knowledge consists of a number of separate phases including ideation, discovery, execution and transfer. For each project, progress is carefully monitored and assessed at each of these phases to determine if the project should continue on its current path to success, if more data are required to make a determination about continuing, or if the project should be terminated because of limited value. Significant resources are devoted to each project, and it is imperative that satisfactory progress be made at every step along the way.
Reporting
Data analysis
How do we come up with the ideas for our research? Our ideas are driven by our commitment to improve the quality of life of individuals with hearing impairment. Our ideas arise from a number of different sources:
• Scientific and technical knowledge gaps • Competitive development
Not every idea leads to a project. If a research idea appears promising (i.e., it has potential value to the hearing impaired community) the researcher prepares a detailed research proposal, not unlike one that would be required for a government or foundation grant. Each proposal contains a statement of the problem the research project is designed to address, as well as descriptions of the general methods and the benefits that will be realized upon successful completion of the project. The research proposals are then reviewed by a scientific research council consisting of senior members of the Research and Technology division at Starkey to determine its scientific merit and value. If the project is approved, the research team is assembled.
Statement of problem
One of the hallmarks of research at Starkey is a close collaborative environment involving scientists with varied specializations. This is extremely valuable for the many research projects that involve unproven strategies and prototype technologies. Depending upon the nature of the project, the research team might consist Figure 1 of electroacoustic, mechanical, firmware and software engineers, in addition to a research audiologist and a project manager. Following
Research hypothesis
Research methods
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completion of the project, and assuming that the results have successfully demonstrated measurable benefit, the researched solution is transferred to the Product Development team where the feature is implemented and integrated with the other hardware, firmware and software features that will be available with a given product.
alpha validation trial, we will have analyzed more than 3,000 real-ear curves, 5,000 data files and 600 questionnaires, all collected during upwards of 30,000 hours of wear-time with the devices. The results of the analysis inform areas of improvement, as well as provide documentation of proven user benefit.
The product development process consists of The conclusion of the alpha validation clinical five separate phases: project definition, design, trials initiates the activities required to bring a implementation and integration, validation, and product to market. These activities include building release. It is during the validation phase that devices to have stock on hand, preparing a the Clinical Product Research group completes customer-ready version of Starkey’s fitting software the alpha validation (Inspire®), and generating education and training clinical trials. The materials and marketing goals of the alpha , documents. It is also during validation trials are this time that the Clinical to verify that the which take place over a period Product Research group software, features and of eight to ten weeks, may involve initiates activities for the hardware function as beta validation trials. The expected and desired, as many as 50 to 60 volunteer beta validation trials are and to validate user participants at a time. conducted in cooperation benefit for those with select audiology features. Verification clinics throughout the United States, including and validation of the products and features occur university clinics, medical centers and private in laboratory settings as well as by hearing practices. In order to obtain varied viewpoints and impaired individuals in their work and home experiences, clinics and audiologists are selected environments. based on a number of factors including location, The alpha validation trials begin by identifying type of practice and their familiarity with Starkey the specific research questions that are of interest products. In our experience, a beta validation trial for a given product. The research questions focus is most successful when the clinicians who are on objective and subjective user benefit of both selected are those who are willing and able to hardware and software features, and involve a follow a specific protocol are interested in clinical number of clinical tests that would be familiar to outcome measures, are looking for a challenge most clinicians, such as real-ear measures, speechand are motivated to try something new. Most in-noise testing, sound quality judgments and importantly, throughout the process clinicians are questionnaires. The clinical trials, which take place encouraged to provide honest, objective feedback over a period of eight to ten weeks, may involve that can be used to make improvements or as many as 50 to 60 volunteer participants at a changes to the software or hardware features. time. Participants for all Starkey research projects The clinicians that are selected to participate in are selected from a database of more than the beta trials travel to Starkey headquarters and 1,000 individuals from the Minneapolis-St. Paul receive training on the new products and software metropolitan area. At the conclusion of a typical
The clinical trials
features, as well as a tutorial on completing a clinically applicable research protocol. Clinicians complete the research protocol in their own clinics with their own patients and report their findings back to Starkey’s research audiologists. The results and feedback obtained from this process are used to guide and inform decision making throughout product development. Patients and clinicians ultimately benefit from this collaborative relationship, as the goal of the beta process is to improve customer satisfaction and user benefit. Our evidence-based approach to research and product development has yielded several recent successes: PureWave Feedback Eliminator, Starkey’s “best-in-class” feedback-cancellation algorithm (Galster & Galster, 2010); Voice iQ2, the next generation of our successful Voice iQ noisereduction algorithm, shown to improve comfort in noise while preserving speech understanding (Pisa, Burk, & Galster, 2010); Binaural Spatial Mapping, a unique binaural algorithm that evaluates and automatically applies settings to each hearing aid, with the goal of optimizing binaural speech understanding and comfort in noise (Banerjee, 2011); and Spectral iQ, an algorithm for patients with steeply sloping, highfrequency hearing loss, designed to improve audibility for high-frequency speech sounds like /s/, /∫/, and /z/ (Galster et al., 2011). These complex and rigorous research processes help ensure that our patients receive the benefit of innovative hearing solutions that are designed to improve their communication function and quality of life.
About the Authors:
Harvey Abrams, Ph.D., is the Director of Audiology Research for Starkey and a leader in the audiology community. He has written many papers and book chapters on evidencebased practice, outcome measures, treatment efficacy and patient quality of life, and has played a prominent role in organizations such as the American Academy of Audiology and the American Speech-Language-Hearing Association. A native of Brooklyn, N.Y., Abrams obtained his bachelor’s degree at George Washington University and both his master’s and doctorate degrees at the University of Florida.
Michelle Hicks, Ph.D., joined Starkey in April 2010 as the manager of Clinical Product Research. She obtained a Ph.D. in audiology/hearing science from Arizona State University in 1997. She worked as a professor at the University of Maryland and
References Banerjee, S. (2011). Hearing aids in the real world: Typical automatic behavior of expansion, directionality and noise management. Journal of the American Academy of Audiology, 22(1), 34–48. Galster, J.A. & Galster, E.A. (2010). How to compare feedback suppression algorithms in open-canal fittings. Hearing Review, 17(11), 38–41.
University of Utah teaching psychoacoustics, amplification and pediatric audiology. Prior to joining Starkey, Hicks worked as a research audiologist at Sonic Innovations in Salt Lake City, Utah.
Galster, J.A., Valentine, S., Dundas, J.A., & Fitz, K. (2011). Spectral iQ: Audibly improving access to high-frequency sounds. Starkey Laboratories, Inc. Technology Paper. Pisa, J., Burk, M., & Galster., E.A. (2010). Evidence-based design of a noise-management algorithm. The Hearing Journal, 63(4), 42–48.
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INNOVATIONS | Volume 2 | Issue 1 | 2012
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21
Understanding the Problems with
Benjamin W.Y. Hornsby, Ph.D.
When adjusted appropriately, hearing aids have
1. Limited Audibility Even When Aided
been shown to be both efficacious and effective
Decades of research have shown that when listening without hearing aids, the speech recognition difficulties of people with hearing loss are due primarily to reduced audibility. In general, as hearing loss increases, speech audibility in a given condition decreases, resulting in increased difficulty understanding speech. This is true both when listening in quiet and in noise (Humes, 1991). Providing well-fit hearing aids, such as ones that have been adjusted to match targets based on a generic prescriptive formula (e.g., NAL-NL1 or DSL 5.0), will improve audibility and in many cases improve understanding. However, it is important to note that matching a prescriptive target does not mean that audibility has been fully restored. In fact, it’s likely that audibility has not been fully restored since this is not the goal of the majority of popular prescriptive fitting methods.
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percent of adults who could potentially benefit from hearing aids actually obtain amplification (Kochkin, 2007). In addition, many adults with hearing loss who do obtain hearing aids use them only rarely or not at all. There are multiple reasons for the limited use and non-use of hearing aids by adults with hearing loss. However, one of the most common issues reported is limited benefit in terms of improved speech understanding, particularly when listening in background noise (Franks & Beckman, 1985; Kochkin, 2000; Lupsakko, Kautiainen, & Sulkava, 2005). In other words, despite the substantial technological advances in hearing aid design, signal processing algorithms and hearing aid fitting methods, many people with hearing loss continue to report limited aided benefit in terms of improved speech understanding. This paper addresses three specific factors that may limit the benefit provided by hearing aids.
INNOVATIONS | Volume 2 | Issue 1 | 2012
The light blue diamonds and dark blue circles represent threshold at various frequencies for someone with normal and impaired hearing, respectively. Thresholds are plotted in dBSPL rather than HL so that lower on the graph reflects better hearing. The gray line represents the rms level of average conversational speech at various frequencies while the dark red lines represent the higher and lower levels of the speech peaks and valleys. The area between the dark red lines shows the assumed 30dB dynamic range of speech. This figure shows the limited audibility of
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Fortunately for the clinician, information regarding residual deficits in audibility when aided and its potential impact on the patient is readily available. Probe microphone systems routinely use mathematical formula, such as the Speech Intelligibility Index (SII: ANSI S3.5, 1997) to quantify how much audibility has, or has not, been restored by a given hearing aid fitting. The SII, and its predecessor the Articulation Index (AI), are measures that can range between 0.0 and 1.0 which are highly correlated with speech intelligibility.
Since we can readily quantify this deficit, it might be reasonable to expect that it could be entirely resolved through the provision of well-fit hearing aids. Unfortunately, while hearing aids help, they do not fully restore audibility. Figure 2 shows the spectra of speech amplified to approximate NAL-NL1 targets for conversational speech for this degree of loss. SII calculations confirm that appropriate amplification substantially increases audibility (SII = 0.69). However, in this case, even when aided appropriately, about 30 percent of primarily high-frequency speech information remains inaudible. As mentioned above, this residual deficit in audibility is not surprising or uncommon. Restoring complete audibility to Frequency (Hz)
Frequency (Hz)
100 90 80
Level (dB SPL)
Starkey Audiology Series
(Chisolm et al., 2007). Despite this, only 20–25
conversational speech for our hypothetical person with sloping high-frequency hearing loss. In fact, if we use the SII to quantify the area and importance of speech available to this person, only about 28 percent (SII = 0.28) of speech is available. Given this limited audibility, reports of difficulties in communication in some conditions would be expected.
250
500
1000
2000
4000
125
8000
100
Speech RMS Level Speech Peaks and Valleys HI Thresholds
90
SII = 0.28
80
NH Thresholds
70
70
60
60
50 40
Audible Speech
30 20 10
Inaudible Speech
Level (dB SPL)
Aided Speech Understanding
The SII is calculated by quantifying the proportion of speech information that is audible across a specific number of frequency bands. To do this, the level of speech peaks are compared to either 1) auditory threshold and/or 2) the level of the noise (if present) in frequency-specific bands. The proportion of audible speech in a frequency region is then multiplied by the relative importance of that frequency band. Finally, the resulting band values are summed to give you an SII. The basic information used to calculate an SII is graphically illustrated in Figure 1 for a hypothetical person with mild-to-moderate (20–60dB HL) hearing loss.
50
250
500
1000
2000
4000
8000
Speech RMS Level Speech Peaks and Valleys HI Thresholds
SII = 0.69
NH Thresholds
Audible Speech
40 30 20
Inaudible Speech
10
0
0
-10
-10
-20
-20
-30
-30
Figure 1
Figure 2
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individuals with more than a mild loss is often not possible or even desirable. Issues such as feedback, loudness recruitment and sound quality make restoration of complete audibility difficult. The use of compression can reduce some issues related to loudness. However, significant compression can lead to distortion of speech cues, potentially reducing or eliminating any advantage from increased audibility (Souza et al., 2007).
About the Author: Benjamin W. Y. Hornsby, Ph.D., is Assistant Professor at Vanderbilt University in the Department of Hearing and Speech Science. Working as a part of the Dan Maddox Hearing Aid Research Laboratory, Hornsbyâ&#x20AC;&#x2122;s research focuses on factors that affect the speech understanding of persons with hearing loss.
Validated hearing aid fitting algorithms, such as NAL-NL1 and DSL 5.0, attempt to balance the competing demands for increased audibility to improve speech recognition with the need for loudness comfort and good sound quality. These algorithms have substantial research support to show they provide a good starting point in the fitting process for the majority of persons with hearing loss (Mueller, 2005). However, the fact that a potentially large portion of the speech spectrum will, by design, remain inaudible can be expected to limit hearing aid benefit in a wide range of listening situations.
2. Negative Effects of High Presentation Levels In addition to reduced audibility, aided speech understanding may remain poorer than normal due simply to the fact that sound levels are increased in the aided condition. Attempting to squeeze the normal dynamic range of speech into the residual dynamic range of someone with hearing loss may lead to complaints of excessive loudness and/or distortion of sound quality. In addition, substantial research suggests that speech understanding actually decreases when presented at levels commonly associated with aided listening (Rankovic, 1991; Studebaker et al., 1999). Studebaker and colleagues (1999) found that at a fixed signal-to-noise ratio (SNR), speech understanding systematically decreased as the level of the speech and noise increased from 69 to 99dBSPL. In other words, even though audibility remained unchanged (i.e., the SNR was constant)
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INNOVATIONS | Volume 2 | Issue 1 | 2012
as level increased, speech recognition decreased. The authors noted that magnitude of performance decrease with changing presentation levels also varied with changing SNR. Negative effects were minimal in quiet but quite substantial at some SNRs (e.g., about 30 percent at a +5dB SNR). Importantly, their work suggested that these negative effects were similar for persons with and without hearing loss.
suggest, however, that frequency resolution abilities are degraded in the presence of severe hearing loss and that these deficits can impact speech understanding. The evidence relating hearing loss to deficits in temporal processing is less clear (Reed, Braida, & Zurek, 2009). However, temporal processing abilities have been shown to deteriorate in the elderly and to negatively impact speech processing (Gifford, Bacon, & Williams, 2007).
In addition to deficits in peripheral processing, age-related declines in higher level cognitive This is a real conundrum for hearing aid designers processing (e.g., attention, working memory, and users. In order for hearing aids to be effective, inhibition) has also been shown to negatively they must amplify speech to increase audibility, impact speech processing in the elderly. however, by increasing the level of the speech, Disentangling performance may the contribution actually be degraded. of these deficits Thus, the need for In some situations, digital noise from those due to increased audibility to reduction (DNR) algorithms may help high presentation improve understanding levels and must be balanced with reduce cognitive processing demands reduced audibility the negative effects thus easing listening effort, even in the is challenging. of high presentation However, regardless levels. Since persons absence of of the relative with hearing loss must contribution, it is listen to aided speech clear that peripheral at higher than normal and central levels, their aided processing deficits may add to the communication speech understanding will likely be degraded, difficulties experienced by many older adults with particularly in noise, compared to persons without hearing loss, and potentially limit benefit provided hearing loss listening at lower levels. by hearing aids.
improvements in speech understanding.
3. Suprathreshold Deficits
Even when the effects of reduced audibility and high presentation levels are taken into account, persons with hearing loss may have poorer speech understanding than persons without hearing loss. Deficits in frequency and temporal processing are often cited as potential contributors to degraded speech understanding in persons with hearing loss. The literature examining the impact of frequency and temporal processing deficits on speech understanding is much too large to discuss in this brief paper. There is ample evidence to
So Where Do We Go from Here? Of the three factors discussed in this paper, the only one we have significant control over is residual audibility. Fortunately, knowledge regarding the potential impact of audibility is readily available with the use of probe microphone measures. It is important to remember that matching a prescriptive target likely will not restore full audibility. As discussed, depending on the overall speech and noise levels, increasing gain may not improve, and could potentially
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decrease, speech understanding. Therefore, the need for increased audibility, when making clinical decisions regarding amplification, must be balanced with the need for loudness, comfort and good sound quality. For example, suppose real-ear measures reveal a good match to target but a residual deficit in audibility, and the subjective complaints are primarily related to poor understanding (as opposed to loudness tolerance or poor sound quality). In this case, close attention should be given to aided speech levels and residual audibility when deciding on modifications to hearing aid gain. This highlights the importance of probe microphone measures in the hearing aid fitting process (Palmer, 2010).
References
Although patient age and processing ability are beyond our control, an understanding of how these factors may affect benefit from hearing aids can help us appropriately counsel individuals regarding the potential need for additional signal processing or rehabilitation options. For example, since level effects are reduced at good SNRs, directional processing or FM systems that improve the SNR may also be beneficial for reducing the negative effects of high presentation levels. Likewise, methods for improving SNR may result in increased access to speech information across a wide frequency range, which could limit the impact of poor frequency or temporal processing in any one frequency region (Thibodeau & Van Tasell, 1987). Work by Sarampalis et al. (2009) suggests that, in some situations, digital noise reduction (DNR) algorithms may help reduce cognitive processing demands and ease listening effort, even in the absence of improvements in speech understanding. There are no easy solutions to resolve these issues but, by improving our understanding of factors that limit aided speech understanding, how they interact with each other and external variables (e.g., noise) to impact aided performance, we may better understand and respond to the residual communication difficulties experienced by hearing aid users.
Kochkin, S. (2007). MarkeTrak VII: obstacles to adult non-user adoption of hearing aids. The Hearing Journal, 60(4), 24(18).
INNOVATIONS | Volume 2 | Issue 1 | 2012
ANSI (1997). ANSI S3.5–1997 American National Standard Methods for the calculation of the speech intelligibility index. American National Standard Institute. New York. Chisolm, T.H., Johnson, C.E., Danhauer, J.L., Portz, L. J., Abrams, H.B., Lesner, S., McCarthy, P.A., & Newman, C.W. (2007). A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults. Journal of the American Academy of Audiology, 18(2), 151–183. Franks, J.R., & Beckmann, N.J. (1985). Rejection of hearing aids: attitudes of a geriatric sample. Ear Hear, 6(3), 161–166.
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Gifford, R.H., Bacon, S.P., & Williams, E.J. (2007). An examination of speech recognition in a modulated background and of forward masking in younger and older listeners. Journal of Speech and Language Hearing Research, 50(4), 857–864. Humes, L.E. (1991). Understanding the speech-understanding problems of the hearing impaired. Journal of the American Academy of Audiology, 2(2), 59–69. Kochkin, S. (2000). MarkeTrak V: “Why my hearing aids are in the drawer”: The consumers’ perspective. The Hearing Journal, 53(2), 34.
Lupsakko, T.A., Kautiainen, H.J., & Sulkava, R. (2005). The non-use of hearing aids in people aged 75 years and over in the city of Kuopio in Finland. European Archives of Oto-Rhino-Laryngology, 262(3), 165–169. Mueller, H.G. (2005). Fitting hearing aids to adults using prescriptive methods: an evidence-based review of effectiveness. Journal of the American Academy of Audiology, 16(7), 448–460. Palmer, C. (2010). Meeting Hearing Aid Fitting Goals. Starkey Audiology Series, 2(1). Retrieved from www.starkeypro.com. Rankovic, C.M. (1991). An application of the articulation index to hearing aid fitting. Journal of Speech and Hearing Research, 34(2), 391–402. Reed, C.M., Braida, L.D., & Zurek, P.M. (2009). Review article: review of the literature on temporal resolution in listeners with cochlear hearing impairment: a critical assessment of the role of suprathreshold deficits. Trends in Amplification, 13(1), 4–43. Sarampalis, A., Kalluri, S., Edwards, B., & Hafter, E. (2009). Objective measures of listening effort: Effects of background noise and noise reduction. Journal of Speech and Language Hearing Research, 52(5), 1230–1240. Souza, P.E., Boike, K.T., Witherell, K., & Tremblay, K. (2007). Prediction of speech recognition from audibility in older listeners with hearing loss: effects of age, amplification, and background noise. Journal of the American Academy of Audiology, 18(1), 54– 65. Studebaker, G., Sherbecoe, R., McDaniel, D., & Gwaltney, C. (1999). Monosyllabic word recognition at higher-than-normal speech and noise levels. Journal of the Acoustical Society of America, 105(4), 2431–2444. Thibodeau, L.M. & Van Tasell, D.J. (1987). Tone detection and synthetic speech discrimination in band-reject noise by hearing-impaired listeners. Journal of the Acoustical Society of America, 82(3), 864–873.
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You Asked …
Customer Service Answered Q: Can you set up separate user name and passwords in StarkeyPro.com?
A: Yes. With separate user name and
passwords, you can restrict access to your financial records while allowing for status and warranty verifications or critical programming access for products such as AMP™.
Q: How many years can a patient extend a warranty? A: Patients can extend their original Starkey
Sounding Board
warranty up to five years for repairs, remakes and loss/damage on both standard and custom products.
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column). You can also find the application on iTunes by searching for “Starkey Laboratories” in the Apps Store. The AMP application works best when used with a mobile device and headphones. All devices are shipped in Preset #2.
Q: How much time do I have to fit my stock hearing
peak output of 95dB. It is powered by a 312 battery and requires an ear impression. It utilizes Starkey’s best-in-class feedback cancellation technology. This device comes standard with a oneyear warranty. <NRR of 24.> Magnum Ear is also available in a standard behind-the-ear case. This device is powered by a 13 battery. <NRR of 26.> SoundGear is a digital instant-fit hearing protection device. It is a non-field programmable one-memory device with peak gain of 25dB and peak output of 100dB. It is powered by a 10A battery. This device comes standard with a one-year warranty. SoundGear is nationally recognized and endorsed by Wayne LaPierre, president and CEO of the NRA. <NRR of 25.>
aids and maintain the warranty?
A: Starkey starts the warranty from the fit
Q: What is the difference between a Magnum Ear and a SoundGear hearing protection device?
egardless of make, model or age of the R hearing aid, we offer Worry Free Deluxe warranty coverage.
protection device with the option of up to four memories and a volume control. It is non-field programmable with a peak gain of 30dB and
Q: Where can I find the A: You can obtain
AMP
INNOVATIONS | Volume 2 | Issue 1 | 2012
the AMP application via StarkeyPro.com>My Account>AMP Online Fitting Tool (left
SoundGear
Q: What can I find on StarkeyPro.com? A: StarkeyPro.com is your go-to online resource
for product information, as well as Education & Training, Business Resources, Starkey Evidence and your practice-specific information.
AMP fitting application?
• Literature and product information • Ordering • Information about software, equipment, hearing protection, personal audio and more Services tarkey On Demand – T2 on Demand, • S Applications, etc. • Warranties • Batteries • Remake/repair • Patient financing Education training – in-person and online course information • Hearing Alliance • Market Advantage 360 • Marketing materials • Workshops Resources
date if it is within 15 months of the date of purchase. Name and date registration can be submitted via phone or at StarkeyPro.com.
A: Magnum Ear is a custom digital hearing
Products
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™
Beyond the fifth year they may purchase our Worry Free Deluxe repair and loss/damage coverage.
StarkeyPro.com Highlights
• Innovations • Starkey Evidence: Research briefs, clinical blog, benchmarking • Publications • Starkey Hearing Research Center About Starkey – general overview of the company My Account • • • • • • • • •
Order tracking Financial status Hearing aid history Software downloads Ordering information Contact information Online forms AMP fitting tool Marketing On Demand™
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The Training You Need, When You Need It Adequate training opportunities are an integral part of patient care. The more you know, the more you can provide the best possible service to every patient you see. Starkey’s Education & Training team
Continuing Education
Inspire software tutorials offer hearing professionals another way to learn about the Inspire programming software. Tutorials are presented in podcast form and feature real-time recordings of specific features within Inspire software with voice-over narration describing software navigation. Each podcast runs from three to eight minutes and is available on StarkeyPro.com in the Education & Training section or via YouTube in our “Starkey Laboratories, Inc.” channel.
strives to offer the most comprehensive, effective and efficient training in the industry, accommodating
In-Person Training
hearing professionals with a variety of training options.
In-person training may be provided by your Starkey Field Sales Representative or a member of the Education & Training team. These sessions may include product and software training, and patient fitting support. Appointments may also be focused around the specific needs of the hearing care office and its staff. To schedule an in-person training session, contact your Sales Representative.
By Luis Camacho, M.A.
30
Software
This article outlines the classes and venues available for hearing professionals looking for training opportunities. If you need to find your Starkey Representative or have questions about any of the options below, call 800.328.8602.
Online Options – Audiology Online Live courses are scheduled each week — typically on Tuesdays at 12:00 p.m. Eastern time — through Audiology Online. Courses are submitted to AAA, ASHA and IHS for one hour of continuing education credit (CEU). Courses cover a variety of topics, from the latest Starkey products and software to basics of hearing science and amplification. Interested? Visit StarkeyPro.com and go to the Education & Training section for details and to register, or call your Starkey Representative for more information. Additionally, Online Office Hours are held every week on Audiology Online with the goal of highlighting a specific topic. This format provides professionals with a forum to ask questions concerning fittings, Starkey products and Inspire®
INNOVATIONS | Volume 2 | Issue 1 | 2012
fitting software. The Office Hours are scheduled at various times throughout the week to give clinicians in different time zones as many opportunities as possible to have their questions answered. Finally, a comprehensive library of Recorded Courses is available at AudiologyOnline.com. These recordings cover current product and software materials, as well as archived sessions on previous topics. They are submitted for one hour of credit and give clinicians the flexibility to earn CEUs at the most convenient times.
Live Online Training Live online training provides a convenient, “virtual” training session with a member of the Education & Training team. The trainer “shares” his or her computer with attendees to demonstrate software, show videos and share presentations. A special conference call number allows twoway communication between the trainer and participant, offering a fully interactive training experience. Live online training sessions can be scheduled through a Starkey Representative.
About the Author: Luis Camacho, M.A., began working for Starkey in August 2000 as a Field Sales Representative. In 2009, he became part of the Education & Training team. Camacho received his bachelor’s and master’s degrees from Indiana University. After graduate school, he worked as a staff audiologist for an otology practice in Indianapolis where his duties included clinical audiology, special testing, hearing aid dispensing, marketing and public relations.
Regional Classes are offered throughout the year. These classes focus on the latest software, products and marketing. Regional Classes are held at various centralized locations within the sales regions to provide convenient access for professionals. Regional class materials are submitted for CEU credit and usually last from four to eight hours. Starkey Innovation Summits are offered at various times throughout the year. These classes are held at the World Headquarters in Eden Prairie, Minn. These events focus on the current product, software and marketing releases. There are also ample opportunities to tour the facility, interact with the sales team, and meet the research staff. All course materials are submitted for CEU credit. For more information about Starkey’s Education & Training opportunities, contact your Starkey Representative at 800.328.8602.
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31
Giftof Hearing
the
Barry Freeman, Ph.D.
Almost 1,600 children with hearing loss were identified and fit with amplification in Uganda in the last year.
Giving back
1-2-3 ... Advance Team — Mission — Follow-up
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INNOVATIONS | Volume 2 | Issue 1 | 2012
The Starkey Hearing Foundation has committed to donating one million hearing aids to children in the developing world by 2020 as a partner with the Clinton Global Initiative (CGI). CGI was seeking partners to address and forge solutions to the world’s most pressing challenges. By participating, the Foundation will join other partners to alleviate poverty, create a cleaner environment, and increase access to health care and education. Former President Bill Clinton explained that the goal expands beyond merely fitting a hearing aid. It provides dignity to persons with hearing loss and leads to positive social change. By networking the partnerships, a humanitarian hearing care mission to Haiti or Africa attracts other organizations and foundations that are building schools and water treatment plants. This is a strategy of “shared benefits and prosperity,” according to Clinton. The Foundation currently makes dozens of hearing care mission trips annually around the world, with children and adults in the U.S. among the largest number of recipients of hearing aids. This commitment, valued at an estimated
Top: Bill Rancic and Tani Austin with a child in Haiti. Bottom: Bill Austin fitting a child with a hearing aid in Haiti.
$125 million during the next decade, will expand Starkey’s presence in new countries to ensure that many people with hearing loss receive hearing technology and the economic and social benefits of hearing and communication. Undertaking this task requires extensive logistical effort and support. There are three phases to the mission process. In Phase I, advance teams are sent to identify children with hearing loss, conduct pre-screenings, make appropriate referrals for ear disease, take ear impressions, and work with local and national leaders to ensure safe and effective conditions to provide follow-up hearing services. During Phase II, teams return with hearing aids and custom earmolds to fit the instruments and counsel the families and educators on the proper use and maintenance of the hearing instruments. Phase III requires additional resources to ensure that proper long-term care is provided and that the initiative is sustainable. In every country visited, the Foundation cultivates local partnerships to share in the follow up and management of mission participants, giving them access to the help they need long after the mission is over. In some areas the Foundation visits, the needs of children and the hardships they have endured are
Top: A child receiving the gift of hearing during the Haiti mission. Bottom: Starkey Hearing Foundation volunteers and locals during the Haiti mission.
unimaginable. These children have basic needs for food and shelter, but they also are desperately in need of recognition and dignity if they are to lift themselves out of a seemingly hopeless cycle of poverty and abuse. In war-torn Africa, including Uganda, the Lords Resistance Army (LRA) has waged an endless war against villages, seeking children to build their military. In the mid-2000s, the Ugandan government drove the LRA out of northern Uganda, although they have since found refuge in Sudan. Despite the continuing threat posed by the LRA, Sister Rosemary Nyirumbe, a nun from Gulu, Uganda, saw a need to help the children, who often were abandoned, unable to get an education and had no means
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The [Starkey Hearing] Foundation currently makes dozens of hearing care mission trips annually around the world, with children and adults to support themselves. She began inviting them to St. Monica’s Girls Tailoring School, where she taught them basic skills like sewing and cooking. These opportunities, in turn, provided them the opportunity to regain their dignity and selfconfidence and heal from the scars of war.
Top: Children recently given the gift of hearing in Zambia. Middle: Starkey Hearing Foundation volunteers with children in Zambia. Bottom: A child using his new hearing aids in Zambia.
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INNOVATIONS | Volume 2 | Issue 1 | 2012
The Starkey Hearing Foundation team visited Nyirumbe, who was eager to provide services for these children and many others in the region. With the team’s support and training, she has developed a care and service center to support persons who are fit with hearing aids by the Foundation. According to Charles Lugemwe, this model is being carried to other parts of Uganda. Lugemwe, who lives in Uganda, has been trained to provide the follow-up and ongoing care for people fit during Foundation humanitarian activities. The Foundation worked with Lugemwe, Nyirumbe and local health care providers to identify and manage ear disease, educate about the use and care of hearing aids, provide batteries, and repair broken hearing aids. The Phase III sustainability model gives these people the ability to own and operate their own businesses. With the assistance of people like Lugemwe and Nyirumbe, almost 1,600 children with hearing loss were identified and fit with amplification in Uganda in the last year. According to Lugemwe, “these children attend more than 30 schools including schools for the
in the U.S. among the largest number of recipients of hearing aids.
About the Author: Barry Freeman is an Audiology Consultant for the Starkey Hearing Foundation. Prior to joining Starkey, he was chair and professor in the Audiology Department in the Health Professions Division at Nova Southeastern University (NSU), Ft. Lauderdale, Fla. Freeman earned his bachelor’s degree in business and economics
deaf, vocational training schools and programs, universities, and other training programs in Africa.” Similar models with the goal of building sustainable hearing care are now being implemented in Haiti, Tanzania, the Philippines, Malaysia, Mexico, El Salvador, Colombia and many other countries around the world.
from Boston University, a master’s degree in audiology and his Ph.D. in hearing and speech science from Michigan State University. Freeman has taught audiology at a number of universities. He has also been in private practice and served in a variety of roles for the American Academy of Audiology, from which he received a Distinguished
“While our goal is to make the world hear, we also are connecting with other foundations and humanitarians in an effort to improve the lives and lifestyles of all persons,” said Bill Austin, Founder of the Starkey Hearing Foundation. During the last visit, the Foundation team was accompanied by NFL players who formed Pros for Africa, an organization dedicated to providing material necessities, hope and love to the children of Africa. This, in turn, led to visits by other health care providers and sustainable humanitarian activities for food supply and water treatment programs. Austin continued, “We are proud of our effort to connect with others and meet President Clinton’s objective of improving the lives of hundreds of millions everywhere.”
Achievement Award in 2006.
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Baby Boomers: What You Need to Know Susan Good, Au.D.
As the baby boomers move into the prime demographic for hearing aids, there are a number of questions hearing care practitioners are starting to ask themselves. For example:
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INNOVATIONS | Volume 2 | Issue 1 | 2012
Baby Boomer Trends
70% of total wealth in the United States
66%
of all US stockholders
33% of all online, social media and Twitter users
38.5% of CPG dollars spending
From a marketing perspective, boomers:
67% say family, friends and
• Love discounts and aren’t afraid to ask for them.
fitness will provide happiness in retirement
• Grew up with TV and are very knowledgeable about advertising.
70% see retirement as a time to
my marketing and communications? How
• Don’t want to be considered old — in any way. They want to be “forever young.”
will I need to adapt my services?
• Like to be thought of as individuals. • Are aware of national marketing campaigns for specific hearing aid technology and name brands. • Want to see images in marketing materials that they can relate to and tend to be nostalgic.
stay active and “begin a new chapter”
(What’sNextInYourLife.com, 2011; The Nielsen Company, 2011)
What Boomers Mean for Your Business According to Futurescan 2000, “creating loyalty with baby boom-age customers may be one of the best long-term investments for any health care provider.” Figure 1 shows the population trend for people 65 and older. Of those:
80 70
Population (Millions)
Business Intelligence
Who are the boomers? How will they affect
First, a quick primer on baby boomers: Baby boomers are the generation of people born after World War II between 1946–1964. They tend to view themselves as at least 15 years younger than they really are. They live active lifestyles, travel often, are healthier and are expected to live longer than their parents. Boomers include everyone from President Bill Clinton and Sir Richard Branson to Bono. They are tech savvy, individualistic, skeptical and well informed about the issues.
• 85+ are the oldest old. Rapidly growing segment, from 5.7 million in 2010 to over19 million by 2050.
60 50 40
• 74–84 are the old. Aging boomers will greatly impact this group in a decade.
30 20 10 0 1950
1960
1970
1980
1990
2000
2010
2020
2030
Figure 1: U.S. population trends for those 65 and older.
• 65–74 are the young old. In the next 20 years, 74 million baby boomers will reach retirement age at a rate of about 10,000 per day.
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Marketing Considerations Currently, more than 20 million baby boomers face age-related vision loss and functional vision problems. In print, make materials easy to read: • Use 12-point type or larger. • Use an appropriate typeface (such as Times New Roman) that is easy to read. • Never use only ALL CAPS in longer body copy. • Be sure to have contrast between type and the background. • Make use of bullets and numbered lists. Boomers are online, so if you currently don’t use online and email marketing, you need to add it to your marketing mix. Figure 2 shows the change in connectivity from 2000 to 2010. Finally, boomers grew up with television and still watch it. Trends are showing better responses from TV ads than have been seen in the past. Television advertising is even beginning to eclipse newspaper advertising in some
59 percent of adults use online resources to obtain health and wellness information. markets. This, combined with word-of-mouth recommendations, is making brand awareness of hearing aids more of a factor than it has been in the past. At the same time, service is still king. Build your practice image as one that offers the best – the best products combined with fitting expertise and excellent service.
Boomers Have High Expectations They expect prompt and individualized service. This doesn’t necessarily mean it has to be hightouch, but it needs to feel unique to them as individuals. New hearing aids work like never before. They are better than older technology and allow people to hear with better sound quality in environments they wouldn’t have been able to a few years ago. They are cosmetically more appealing as well. They feature sleeker shapes, more color options, and styles that are hidden behind the ear or are completely in the
2010
40% Use Internet <5% Broadband at home 34% Own a cell phone 0% Connect to Internet wirelessly <10% Use “cloud” = S low, stationary connections that
74% Use Internet 63% Broadband at home 81% Own a cell phone 46% Connect to Internet wirelessly >50% Use “cloud” = F ast, mobile connections that are
are built around the computer
INNOVATIONS | Volume 2 | Issue 1 | 2012
• They will be looking online. Make sure that you have a presence online and that it sends a message that emphasizes what you do differently than others in your market or what you can do that direct-to-consumer online sales cannot.
2. The professionalism, office space, staff and experience are important.
• Be prepared to answer questions from an informed consumer. “Informed” may not necessarily be well informed. Some impressions gleaned from online materials may be misguided or just plain wrong. Be ready with evidence-based facts that will redirect the patients’ knowledge in an appropriate direction.
3. Cosmetics are important. Figure 3 gives an overview of traditional versus invisible hearing aid users. Note that the two groups are fundamentally different on every characteristic illustrated. Patients looking for invisible products are not just choosing a style because it appeals to them – they tend to be younger, active, working, fashion conscious, have more income and embrace technology.
• What are your first impressions to patients? First impressions are a factor for all patients,
Traditional vs. Invisible Hearing Aid Consumer Profiles TECHNOLOGY
Intimidated
FASHION
Conscious
LIFESTYLE
Sedentary
Active
EMPLOYMENT
Retired
Working
INCOME
Lower
Higher
AGE
65+ -100
Interested
-80
-60
-40
-20
0
41-64 20
40
60
80
100
Percentage (%)
moving to outside servers and storage
Figure 2: A decade of improved connectivity for boomers (Rainie, 2010).
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Take the time to build your own roadmap for the patient experience as they enter your world.
1. More people are motivated by their significant others or have recognized the need for hearing aids.
Not Concerned
2000
Meeting Their Needs and Expectations
ear canal. Boomers want to be delighted with your services and products, not just satisfied. The difference between a satisfied and delighted hearing aid user is threefold.
Figure 3: Data compiled from AlphaWise, Morgan Stanley Research (2011). Percentages indicate the percentage of audiologists stating that the typical customer was displaying these respective characteristics.
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Boomers are similar to other adults in their online search behavior 90% 80% 70% 60% 50% 40%
Boomers
30%
Gen Y
20%
Gen X
10%
es Ho bb i
s ln es
th /W el
al
Tr av el
He
ng Sh op pi
on s c;
M ap s/ di re
En te rta i
nm
en t
0%
Type of information searched for online
The Internet is the most widely used resource for health information: 59 percent of adults use online resources to obtain health and wellness information, versus 55 percent who go to their doctors and 29 percent who talk to relatives, friends or co-workers. Specifically, boomers use Internet resources and their physicians as their primary sources for health and wellness related information (Elkin, 2008). Additionally, 83 percent of consumers who are online report using websites to get the health and wellness information they need.
Source: Google/Nielsen Boomer Survey, 2010
but especially so for the boomers. Emotionbased first impressions are very persistent with boomers, especially those impressions that conflict with an idealized image of self, vitality, and personal validity (Coming of Age Incorporated, 2011). • T he first phone call is key. It needs to reflect on your practice well and provide information to motivate the caller to make an appointment for a consultation. • T he appearance of the office needs to be congruent with how they view themselves. Your office should be accessible for everyone, but it should appear appropriate for the patient who sees him- or herself as a young, active and vital person. • Send them away with the information they will need to take the next step. They won’t remember a portion of what you tell them or may misunderstand some information. Reinforce your recommendations with simple, concise materials that they can refer to later. They should be confident that your
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INNOVATIONS | Volume 2 | Issue 1 | 2012
recommendations are unique to them and appropriate for their individual needs. • Contact them the next day and reinforce your connection. Call them with a question or comment, offer additional information or refer them to a specific piece of collateral information you sent home with them.
traditional advertising approaches. If television is a key tool in your marketplace, then determine how your practice can become part of a campaign or featured on a local news channel. When a 65-year-old boomer looks in the mirror, an image of someone 15 years younger may be perceived. Your marketing message should promote a slightly younger, active lifestyle. Boomers will likely walk into your office with more information than previous generations of hearing aid candidates had access to. Be prepared to address their questions about over-the-counter products and direct-to-consumer Internet sales. Build value for the individualized services and products that you offer so that they can appreciate the advantages of working with you. To succeed in providing baby boomers with the best possible experience, put them first. Make your patients the center of every interaction. Make your patients and their significant others part of your care team and give them some responsibility for the outcome of their own care. With your guidance, as they take part in the ownership of their own care, your practice becomes an integral part of their long-term care.
About the Author: Susan Good, Au.D., joined Starkey Group in August 2003 and works as an expert in business development for retail, audiology and physician-based dispensing programs. She has extensive clinical, teaching and practice management experience. Prior to her current position, she spent 10 years in clinical practice. Good received her Au.D. from the University of Florida and her master’s from Pennsylvania State University.
Succeeding with Baby Boomers General descriptions about population groups give us just that, a general sense of what they may be like. The baby boom generation was influenced in large part by the teachings of pediatrician Benjamin Spock, whose influential book Baby and Child Care was published in 1946. Spock advocated treating children as unique individuals. If we are to take home a general sense of the boomers, it should include the concept that they were raised as unique individuals and expect to be regarded as such. Appeal to them in your marketing with methods that they will be receptive to. If you do not have an online presence, you are limiting your outreach. Money spent developing an online point of entry to your practice is well spent and will back up more
References Chadwick Martin Bailey. (2011). A Consumer Perspective on Health and Wellness. Downloaded from http://blog.cmbinfo.com/downloads/ Coming of Age Incorporated (2011). Retrieved from http://www.comingofage. com/baby-boomer-marketing/ Retrieved from CMB Consumer Pulse (2011). A consumer perspective on health and wellness (blog.cmbinfo.com/downloads/) Elkin, N. (2008). How America Searches-Health and Wellness. iCrossing. Jungling, M.K., Bradshaw, K., Olanow, A., & Rinecker, V. (2011). Hearing Aid Update, The Invisible: Yet to Be Seen. Morgan Stanley Alphawise. The Nielsen Company. (2010). Boomers Spend Money, Use Tech. The Nielsen Company. Retrieved from http://www.marketingcharts.com/television/boomersspend-money-use-tech-13570/ Rainie, L. (2010). Baby Boomers in the Digital Age. Pew Internet & American Life Project. What’s Next in Your Life? (2011). What’sNextInYourLife.com. Retrieved from http:// www.whatsnextinyourlife.com/_pdf/WhatsNextInYourLife_BoomerFastFacts.pdf
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Sound Check:
Goal #1: Easy-to-Perform Self-Screening
Connecting with Your Patients in the
Digital Age Mark Mercury & Justyn Pisa, Au.D.
We live in an era of enhanced connectivity through handheld electronics and social media. As
Tools & Resources
patients adopt these new technologies, hearing
42
care professionals may find that they need to reach out to patients via unconventional methods. Taking advantage of the era of digital connectivity and addressing the growing need to increase awareness of hearing loss, Starkey released Sound Check, a hearing loss screening tool designed to educate the general public about hearing loss and to connect them with hearing professionals in their areas. Sound Check is a mobile application (app) for the iPhone®, iPod® Touch, or iPad® and can be downloaded for free by hearing care professionals or the general public.*can be downloaded for free by hearing care pnals
INNOVATIONS | Volume 2 | Issue 1 | 2012
One method hearing care professionals have used to educate patients is hearing screenings, often performed at community events (O’Day, 2003). Providing easy and educational methods of prescreening for individuals who may have hearing loss is critical to creating awareness that can ultimately lead to increased adoption of hearing instruments (Kochkin, 2009). Research suggests that six of ten new hearing aid users purchased their very first hearing aid because they began to realize that their hearing loss was progressing (Kessels, 2003).
Developing Sound Check Sound Check was designed with three main goals in mind: 1. Provide a method for self-screening that is quick and relatively easy 2. Present results that are meaningful to the average user 3. Provide an efficient means for individuals
To ensure that Sound Check would be simple and straightforward, the design focused on including clear instructions, large diagrams and touch navigation. Each of the screens, from the setup interface to the results screen, provides users with a clearly defined task. The high-resolution iPod Touch, iPhone and iPad screens support rich and engaging graphics that draw users into the app (shown in Figure 1). The result of this is an enhanced user experience for what could otherwise be deemed a mundane task. Our development of Sound Check involved comparisons of several different models of over-the-counter earphones from a variety of manufacturers including Apple®, Sony ®, Philips®, Corby and Sennheiser ®.* The calibration process involved comparisons of audiometric thresholds obtained via Sound Check versus those obtained under ER-3A insert earphones in a sound booth. This verification step ensured Sound Check would produce reliable results regardless of the model, make or price of the listening devices. Users are instructed to tap the large button in the center of the screen as soon as they hear a tone (Figure 2). Instructional text remains visible throughout the screening process while colorful progress bars provide the user with a sense of how long the screening will take. Balancing accuracy with efficiency, Sound Check evaluates hearing thresholds at four frequencies (500 Hz, 1,000 Hz, 2,000 Hz and 4,000 Hz) using a standard ascending/descending method. In total, a screening session takes less than five minutes to complete.
Figure 1: Setup screens for the Sound Check hearing application. Clear instructions and diagrams ensure setup is completed successfully.
Figure 2: Instruction and testing screens for Sound Check application. Users are instructed to tap the large button in the center of the screen whenever they hear a tone, while colorful progress bars indicate status.
with hearing loss to seek professional help
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Goal #2: Easy-to-Understand Results Hearing professionals are often required to convey technical, physiologic and psychoacoustic information in order to educate patients about the effects of hearing loss on everyday life. That counseling session occurs even before the hearing professional discusses hearing instrument technology with the patient. Given the amount of highly technical information that must be shared, it is no wonder that up to 80 percent of the information communicated by a professional during an office visit is immediately forgotten by patients (Kessels, 2003). Sound Check was developed to convey information in a simple manner to facilitate patient understanding.
Figure 3: Basic Results
Figure 4: Intermediate Results
Figure 5: Advanced Results
The results are plotted on the shaded gauge at the bottom of the screen, which makes it easier to compare the overall performance of each ear at a glance. The pure-tone average (PTA) of all test frequencies is used in determining the position of the marker on the gauge. If a potential hearing loss is detected, users are notified and encouraged to seek additional information and evaluation from a hearing care professional through the built-in locator feature.
This screen separates individual ear data into three separate frequency regions to compare the performance of both ears at low, mid and high pitches. As in the basic results screen, the intermediate results screen draws a line separating normal hearing from potential hearing loss. Red shading is in the hearing loss range and green shading is in the normal hearing range.
The graphs that are displayed on this screen resemble an audiogram, providing more detailed information than the Basic and Intermediate screens. Hearing professionals may compare these graphs to a diagnostic audiogram when explaining results to a patient.
A complete and accurate hearing evaluation should only be performed by a licensed hearing professional. Sound Check was not designed as a replacement for diagnostic tests administered by hearing professionals; instead, Sound Check simply offers brief recommendations rather than making detailed clinical conclusions. The results of the screening are separated into three user-friendly screens: Basic (Figure 3), Intermediate (Figure 4) and Advanced (Figure 5). Results are automatically stored to allow for tracking hearing performance over time. A â&#x20AC;&#x153;Detailsâ&#x20AC;? button on each of the screens provides users with additional information regarding interpretation of the results.
Goal #3: Simple Office Locator The built-in locator feature is an intuitive way to find a hearing professional for those who are interested in receiving a complete hearing evaluation. Sound Check uses the capabilities of the iPhone, iPod Touch or iPad to search for
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There’s Even
MORE
About the Authors:
to our wireless
Mark Mercury is a Software Product Manager focusing on the design and development of mobile applications for Starkey. Prior to his role with mobile applications, Mercury was heavily involved in the design of the company’s current
Figure 6: The “Find a Professional” feature in Sound Check allows users to locate hearing health care providers in their immediate area.
wireless fitting platform. Before joining Starkey in 2007, he spent seven years working for both small and large web-based software companies. He holds joint degrees in psychology and marketing.
and list hearing professionals nearest to the user (Figure 6). Manual searches can also be performed for hearing professionals located outside a users’ general area by entering a zip code in the search field. Search results are displayed in a list format and users can tap on any of the records in the list to view contact information, see the office location on a map and receive directions to that location.
Discussion
Justyn Pisa, Au.D, is a Senior Software Product Manager at Starkey. Before joining Starkey in 2005, he was a clinical audiologist for a private medical practice with patients of all ages. During his time with the company, he has helped develop several products including Live Real Ear Measurement, Voice iQ and SoundPoint. Pisa earned his master’s degree from Minot State University and his doctorate from PCO School of Audiology.
Wi Series delivers true wireless connectivity, including the first set-and-forget media streaming solution, and the ultimate speed and flexibility in direct-to-hearing aid wireless programming — all without any body-worn relay devices.
The Sound Check hearing screening app is one of many free applications available from Starkey that bring the hearing aid patient and hearing care professional closer together. With more than 10,000 downloads in just a few weeks, Sound Check is on the way to achieving this goal. We are excited to evaluate how Sound Check is being used by the public, whether it is for informal hearing screenings, as an educational tool used in a professional’s waiting room, or simply as an app shared between a savvy grandchild and grandparent. Starkey’s goal is to craft applications that ensure benefit for both professionals and patients alike.
Now, we’ve updated and integrated new features and styles to enhance product performance, the patient experience, and your practice even more. • Voice iQ2 improves our already leading noise reduction and speech preservation system • New Spectral iQ dynamically enhances audibility by intelligently identifying high-frequency speech cues and replicating them in lower frequencies
References: O’Day, J. (2003). The importance of hearing screening. Journal of the American Academy of Audiology, 15(3), 45.
• Wi Series is the world’s only hearing aid that delivers the benefits of Binaural Spatial Mapping • Plus, you get our leading performance features like PureWave Feedback Eliminator, ® Live Real Ear Measurement, HydraShield 2, a new sound architecture, and more
We’ve also added a full lineup of fully-featured wireless custom products to Wi Series.
Kessels, R.P.C. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96, 219–222.
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*All trademarks or trade names are properties of their respective owners.
05591-11 11/11
Kochkin, S. (2009). MarkeTrak VIII: 25-year trends in the hearing health market. Hearing Review, 16(10), 12–31.
Contact a Starkey Representative at 800.328.8602 for more information.
Kirsty Gerlach Shares Her Perspective on the
Importance
of the
Clinic Environment
Kirsty Gerlach was raised in New Zealand and received her training as an audiologist in the U.S. at California State University, Long Beach. She has experience working as an audiologist in a wide variety of settings in the U.S. and New Zealand. She currently owns and directs Kirsty Gerlach Hearing in Rotorua, New Zealand. Beyond her extensive experience as an audiologist, the story behind her philosophy and approach to people with hearing loss is a personal one. Gerlach’s husband suffered a sudden hearing loss in 2001 as a result of Meniere’s disease, ultimately leading to cochlear implant surgery. Viewing the process not as a clinician but as a significant other gave her a unique perspective on how she feels a clinic should look and feel. The profound negative effect that the hearing loss and the associated diagnosis had on her husband gave her the resolve to create a different approach in her own clinic. Innovations interviewed Gerlach to get a better sense of her approach and how it has impacted her clientele.
Expert Q&A
IN (Innovations): Kirsty, I know that your experience
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INNOVATIONS | Volume 2 | Issue 1 | 2012
is broad enough that you didn’t develop a patient care philosophy based only on the experience that your husband had with the diagnosis and treatment of his hearing loss. What feedback have you received from patients that helped shape your approach?
KG (Kirsty Gerlach): I hear far too often that
patients are having negative experiences within a clinic setting. They don’t feel cared about, and they don’t feel understood. I’ve always felt very compassionate about this disability and now, having lived through it with my husband and seeing the
Kirsty Gerlach’s office
negative vibes he gets from people even when I’m standing right beside him, I realize that we are key in the lives of these patients to make things better. If someone comes to me and says, “No one has ever explained that to me before?” or asks, “Why has no one ever told me this before?” or “How come you seem to care more than others I have seen?” that upsets me. We should all be treating them with a great deal of understanding and compassion, giving them information freely, and making them feel entirely comfortable. We should be making them know that when they come in to our office, we are there to advocate for them, and we will go the extra mile to maximize the benefits they can get from our services. This approach is really close to my heart.
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Every single interaction with the patient can reinforce the message that we understand, and we care; or it can negate that message. About the Author: Kirsty Gerlach, M.A., was raised in New Zealand and completed her master’s degree in audiology in California. She worked for many years with deaf children in Los Angeles school programs as well as in private audiology clinics. She returned to New Zealand in 1988, creating Bay Audiology and acting as primary audiologist and director, before another eightyear stint in the U.S. She returned permanently to New Zealand in 2002 with her U.S.-born husband and four children to build her premium business, Kirsty Gerlach Hearing.
IN: Do you feel that the impression these patients
get goes beyond the “shoot the messenger” reaction that is sometimes present or the inevitable forgetfulness that we encounter even when we have actually done a very thorough evaluation in the past?
KG: Yes, I do believe it goes beyond that. I
feel that from the front door to the back workroom, each and every one of us should be tuned in to the needs of our patients. If they feel rushed, hassled or misunderstood anywhere in the process of the visit, we haven’t done a good job. So it’s not just the initial breaking of the news, it’s the drop-in repair visits, the phone calls. Every single interaction with the patient can reinforce the message that we understand, and we care; or it can negate that message.
IN: Clearly, every employee in your clinic who talks
to or faces patients needs to be on board with this philosophy. How do you manage your staff to ensure that level of excellence?
KG: To begin with, I’m very careful with whom
I employ. I work alongside people very closely, and I feel my example trickles down when they are facing a patient alone. I remember one of my first employees was an audiologist trained in the Philippine Islands, where she had worked for several years. She spent a few weeks at my shoulder. At one point she said to me, “Gosh, Kirsty, these people really love you!” The comment was surprising to me but underscores the fact that my heart projects not only to the patients but to the people around me. I try to spend a lot
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INNOVATIONS | Volume 2 | Issue 1 | 2012
of time instilling my philosophy in everyone in the office, whether they are working the front desk or as another clinician. We have regular meetings and discuss cases in an open manner so we are all on the same page with our approach to patient care.
Many of them are elderly and somewhat isolated, and even further isolated by their hearing loss. They get a sense of belonging and being cared for that would be missing if we didn’t reach out to them.
I take care to make sure that all of my employees hear about any positive feedback that we receive about the office. Last night, my father told me about talking with another fellow on the golf course who spoke so positively about a single interaction that he had with our office. He had come in from another office to see us for a tubing change. He was so struck by the caring, kindness and attention that he received that he felt compelled to tell my father about it. That positive feedback goes straight back to the front desk employees responsible for his care, reinforcing their actions. It is especially rewarding because they are getting praise not only from patients, but, also recognition from their boss.
things that you felt most important to do in setting up your office to eliminate some of the negative experiences your husband encountered?
IN: What efforts seem to work for you to keep connected with your patients?
KG: We do a lot of phone calling just to
ask how people are doing. Those calls, along with birthday cards, give people an ongoing connection that reinforces the fact that we have a genuine concern and interest in them. This contact has a huge impact on our patients.
IN: From your unique perspective, what were the
KG: One factor is that in the U.S. the clinical
settings are prefabricated sound treated booths, which tend to be very sterile. Environments and protocols tend to be rigid and standardized. In New Zealand, we have more freedom to modify our approach to better meet the needs of each patient. When I was able to come back to New Zealand and set up our clinic, I had the ability to not only meet sound environment standards, but to choose wall coverings and furnishings within the room that would soften the feel of the setting. Coming from the concrete jungle of Los Angeles, I can really appreciate the natural beauty of my home in the central north island of New Zealand full of rivers, waterfalls, forests and native bush. It is an absolutely beautiful, beautiful environment. We really wanted to bring some of that feel into our clinic. We didn’t want people to feel that they were walking into a medical clinical
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in everyone in the office, whether they are working the front desk or as another clinician..
setting that smells of disinfectant. We wanted them to sense that they were in an inviting, welcoming and beautiful place. Our clinic has a waterfall, carvings, ferns and photography to evoke a calmness that will help put them at ease. Another aspect is that our native people — the Maori — can be very suspicious of medical treatment other than that from their own culture. They resist coming into traditional clinical settings. They do not feel that they belong in a place that doesn’t practice their medicine. I wanted them to feel that when they came into my clinic, this was their place as well. We have beautiful prints of ferns and a Maori translation of a familiar hymn displayed on the wall — all to give a sense that this is not just a place for Western medicine. My husband lost the hearing in his only hearing ear overnight. He was literally in a state of terror. Sitting in a metal booth with his back to the clinician and hearing nothing only reinforced that terror. We do not want that. What we want is for people to be in a friendly place, especially if we have to give them some bad news about their hearing. Even in the sound room, we have decorative corner pieces and plants to make the environment beautiful and friendly.
IN: Did you do some research on colors or other
Spectral
factors that make the environment friendly?
KG: I can’t take the credit for the actual
design. My husband is the creative genius behind the design and used his personal perspective to put it together.
IN: How have your patients reacted to your design
and clinical approach? As we discussed earlier, all of us hear from time to time questions that suggest that a patient forgot what happened at a previous appointment. Does your approach make the experience somehow more memorable?
Spectral iQ raises the bar on frequency lowering technologies.
KG: I don’t think our clinical work and the
Still fitting patients with other frequency lowering technologies? Then you haven’t tried Starkey’s Spectral iQ. Starkey’s newest innovation, Spectral iQ, is the industry’s smartest way to restore audibility for patients with steeply sloping, high-frequency hearing loss.
passing of information and counseling is much different from many other places. What we do get constantly, probably on a daily basis is, “Wow, this is so beautiful! This is such a nice place to come. Why didn’t I know that you were here?” That is probably what sets us apart, rather than the strict clinical work, and makes us memorable in a very nice way. We also are sensitive to any extra needs that patients may have, including offering home visits and frequent follow-ups. We try to assess each patient and go the extra mile if that is what he or she needs. Although we have to make our business viable through the sale of hearing aids, our primary goal is that our patients get an improved quality of life, and they’ll only get that if the technology is working for them. It is in everyone’s best interest that the hearing aids are in good order, managed properly and that the patient continues to do well.
iQ
frequency lowering technology
Spectral iQ Off
Spectral iQ:
Spectral iQ Max Setting
Intelligently identifies high-frequency speech cues, then replicates them in lower frequencies
100 90 80 70
Percentage
I try to spend a lot of time instilling my philosophy
Introducing
Is designed to introduce less distortion than other approaches due to preservation of spectral cues and harmonic relationships
60 50 40 30 20 10 0 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Number of people
S-test results after Spectral iQ frequency lowering technology is turned on.*
Features the broadest active bandwidth of any manufacturer Is available on all Wi Series™ and X Series™ hearing aids
Enhance speech audibility the smart way Hear for yourself
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To experience Spectral iQ, contact your Starkey Representative at 800.328.8602.
how Spectral iQ outperforms the competition at www.SpectraliQ.com or by scanning the QR code.
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06046-11 11/11
Today, Starkey has17 different groups that make up the product development team.
Kendra Klemme, MBC, & Keith Guggenberger
Excerpted from an interview with Keith Guggenberger, Senior Vice President of Operations at Starkey Laboratories, Inc.
Quality has been a hot topic in the manufacturing sector for more than 20 years, and Starkey’s operations have been keeping pace the entire time. While quality is still defined by the technicians that build the devices and measured by the success of each individual hearing aid, there is much more to quality now than 20 years ago. Seventy-five people at Starkey have the word “quality” in their titles, meaning the rigor around Starkey’s specific
QUALITY
brand of quality has grown exponentially.
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INNOVATIONS | Volume 2 | Issue 1 | 2012
Starkey Quality Today Today, Starkey has 17 different groups that make up the product development team. Those 17 groups work collaboratively to bring products to market. And, those products are not brought to market until they are ready – ensuring they are more consistent and successful. Predictability is an important element of quality. Within the processes of creating hearing aids, Starkey technicians and engineers simulate conditions, happenings or effects using computers, simulation models and functional testing. This happens at a small feature, component and assembly level to ensure that products work well as a system. For example, an engineer can add the material properties of a plastic, the form factor or geometry of the component, and the loads that a particular component will see in the field into a computer simulator. The engineer can simulate the stress and strain on a battery door as well as the components around it, creating a map to show where breakage may happen if opened too far. These models help identify potential issues of strength, but they can also simulate what happens
with conditions of heat, all before a hearing aid is ever made. In Starkey’s leading-edge Quality and Reliability Lab, repetition testing is done to simulate component wear and tear. These include open and close, click on and off, and exposure in environmental chambers that simulate how components will react to swings in temperature, humidity and other environmental conditions. There are 40 different functional tests used to assess components on a variety of important characteristics. In addition, verification, validation, mechanical and clinical testing takes place on every product.
The photos represent Starkey’s quality testing methods. From top to bottom: Mechanical Touch Point Analysis, Component Qualification and Design Verification Testing.
This process of predicting and testing a device helps identify what might potentially fail, and helps Starkey’s designers and engineers create products that last longer and perform better. Being a U.S.-based, privately held company has its advantages. Starkey is nimble enough to create new designs or processes very quickly when necessary. For example, the need for a deep insertion hearing aid came to the attention of Starkey’s leadership, who immediately began
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By the Numbers
75: The number of people at Starkey with “quality” in their titles.
17: The number of different groups that make up the product development group and help bring products to market.
40: The number of different functional tests performed on hearing aid components to assess a variety of important characteristics.
working on a solution. The subsequent design, testing, validation and production of the invisiblein-the-canal (IIC) product was completed in the matter of a few months.
clinicians support their patients’ hearing journeys. While speed is paramount, the company doesn’t always respond to statistics — it responds to the underlying issues.
Patient Satisfaction
The Future of Starkey Quality
Starkey is more attuned to the needs of patients today because quality is built into user system requirements to ensure the best possible performance. For example, testing is done to study the force with which battery doors open, the usability of controls for patients of different ages, the robustness of devices coming on and off the ear, and many more.
The future of quality at Starkey looks clinician and patient centric. It requires the company to look beyond its own walls and continue to engage with clinicians to:
Quality is also built into Starkey’s overall service model. Quality engineers spend time solving problems with clinicians about specific patients and details; customer service is instrumental in gathering information from clinicians and summarizing those calls for the engineers and technicians working on products, who can then engage more quickly. These engagements and the vast number of others that happen throughout the company give Starkey the best opportunity to help
• Continue to evolve how measurement is conducted. • Reduce return rates from patients. • Increase successful fittings. • Understand how refinements that are needed should be made. • Improve the number of patient revisits. • Increase successful patient word of mouth by having the best possible products. • Provide the tools and products that free up clinicians to see more new patients.
Additional testing method: the top and middle photos show Component Qualification, the bottom shows a clinical evaluation.
• Starkey becomes strong in manufacturing and learns how to build key strengths in technicians. • The company creates tools to help manage suppliers and hold them accountable for component success.
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• Late 80s: Starkey begins qualifying components through certifying suppliers. Quality Engineers begin to visit potential suppliers around the world in person to see how the components are actually made and qualified. • Quality is professed everywhere — for example, Ford’s Quality is Job #1. Awards for quality performance, such as the Malcolm Baldridge Award and the Minnesota Quality Award, begin cropping up. Starkey is presented the top Gold quality level in the Minnesota Quality Awards. The International Organization for Standardization (ISO) also begins around this time.
• With ISO and other quality programs taking hold, Starkey establishes new frameworks and programs for the company that help bring quality to the forefront throughout all departments, including customer service, design, development and human resources, with the goal of continuous improvement.
1990s
1980s
• Many programs begin at the technician level, holding technicians accountable for the success of the products shipped to customers every day. For example, technicians are measured on return rate, rework, successful hearing aids and other metrics, many of which are still in place today.
• Mid 90s: Quality means extending beyond how Starkey delivers hearing aids to how products are designed. To that end, the company begins building a research and development group focused on bringing more successful products to market.
• Early 00s: The product development group has resources with feet in both the creative and executional camps, so some technologies are released to market without the same scrutiny that is now employed. • 2004: The decision is made to divide research and technical development from product development. This allows the research group to create new innovations, which can then be moved to product development for product integration.
2000s
A timeline of Starkey’s quality development:
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40 different functional tests used There are
to assess components.
Kendra Klemme, MBC, is the Communications Manager for Starkey. She is responsible for public relations and social media, along with other internal and external communication activities. Klemme has more than 12 years of experience in public relations including communication strategy and execution, both in corporate and agency settings. She holds a bachelor’s degree from the University of South Dakota and a Master of Business Communication from the University of St. Thomas.
Keith Guggenberger is Senior Vice President of Operations at Starkey. He has held both technical and management positions during his career at Starkey. Guggenberger leveraged his business and quality background into information technology and held the position of Vice President of Information Technology for three years before expanding to lead Operations. Today, he helps guide Starkey’s Manufacturing, Materials, Quality and Process initiatives. Guggenberger has a Bachelor of Science Degree from the University of Wisconsin-Stout in Industrial Technology.
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INNOVATIONS | Volume 2 | Issue 1 | 2012
As the baby boomer generation ages, the expectations for hearing aids and hearing aid providers will change. The baby boomers have a vast amount of experience with consumer electronics that are easy to use and robust. They will expect the same level of performance from their hearing aids. Starkey will be challenged to provide the right mix of usability and robustness in ever-more-functional, smaller and complex devices. In addition, quality and components are global. Starkey has built an enterprise that works at a global level — from suppliers and distributors to manufacturing. The systems, processes and rigor serve a global marketplace. This means communication with all facilities around the world has to take place on a daily basis. As shown here, quality is built into every process and department at Starkey. It is successful when every person in every department works toward the same collective vision of producing quality products every day.
&
NEWS VIEWS
Starkey Awards Au.D. Scholarships
Starkey awarded the William F. Austin and Outstanding Student Clinician scholarships for 2011. The scholarships are part of Starkey’s educational outreach program that offers hearing care professionals and audiology students unique learning opportunities that focus on a variety of relevant, hands-on curricula. Five $10,000 William F. Austin scholarships were awarded to outstanding audiology graduate students pursuing clinical, teaching and research careers in audiology. This year’s scholarship recipients were Jennifer Fowler, University of Iowa; Brittany Hensley, University of Florida-College of Public Health and Health Professions; Andy Lau, Salus University George S. Osborne College of Audiology; Imola Major, San Diego State University and University of California-San Diego; and Alexandra Parbery-Clark, Northwestern University. Starkey also awarded 10 Outstanding Student Clinician scholarships to students pursuing careers in clinical audiology and private practice. This year’s recipients were Kristin Baldwin, Long Island Au.D. Consortium; Mary Catherine Denman, University of Pittsburgh; Deyanira Gonzalez, Lamar University; Jacqueline Hackbarth, University of Iowa; Dyanna Hamstra, Purdue University; Courtney Luffler, Northeast Ohio Au.D. Consortium/University of Akron; Dana Matthyssen,
Missouri State University; Kari Morgenstein, University of Florida; Viral Tejani, University of Maryland; and Julie Wheeler, University of Oklahoma Health Science Center. To learn more about Starkey’s Au.D. scholarship programs and practice opportunities, visit StarkeyPro.com.
Starkey’s AMP Wins Consumer Electronics Show Innovations 2012 Award Starkey was named an International CES Innovations 2012 Design and Engineering Awards Honoree for its AMP™ hearing aid. This is the fourth consecutive year Starkey has been an Honoree — having won for SoundLens™, S Series™ with Sweep™ Technology and ZonTM previously. The CES is the preeminent trade association promoting growth in the consumer technology industry. The International CES, which is sponsored, produced and managed by the Consumer Electronics Association, is the world’s largest consumer electronics tradeshow.
starkey news
About the Authors:
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2011 Starkey Research Summit Takes Place in Sonoma Starkey hosted the 2011 Starkey Research Summit in Sonoma, Calif., in September 2011. Comprised of 15 world-class researchers and key Starkey representatives, the Summit was a follow-up to the successful Starkey Research Summit that was held in Napa, Calif., in 2007. The Summit covered four major themes: Effects
William F. Austin Celebrated for 50 Years of Purpose
of aging on auditory processing and cognition;
For the past 50 years, William F. Austin has changed the world â&#x20AC;&#x201D; transforming his dream into a global enterprise, and giving the gift of hearing to millions. On December 10, a surprise party was held for him in Minneapolis to celebrate 50 Years of Purpose. The black tie event was attended by friends, family, employees and customers.
of training on auditory processing and cognition
effects of hearing technology on auditory processing and cognition in the elderly; effects in the elderly; and effects of aging on hearing help-seeking behavior. The participants plan to produce a number of research papers surrounding the Research Summit topics in the coming months.
Starkey Hearing Foundation Gives Thousands the Gift of Hearing The Starkey Hearing Foundation gave thousands of people the gift of hearing last fall during missions in countries including Haiti, Honduras, Madagascar and India. Miley Cyrus made the return trip to Haiti in October, where she joined Haitian President Michel Martelly to help children and adults in Port au Prince and the surrounding areas.
Visit StarkeyHearingFoundation.org for information about missions and other Foundation programs.
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