The Ear is the Boss

Every case of hearing loss is unique, and so is every ear. Ray Woodworth understands this so well, he teaches a class called “The Ear is the Boss”. For more than 20 years, Woodworth has worked alongside Starkey founder Bill Austin, mastering the craft of custom hearing aid solutions. In this episode, he explains why understanding the structure of someone’s ear is the key to treating their hearing loss, and why OTC hearing aids aren’t the right fit for everyone. He also shares some tricks of the trade when you’re shooting an ear mold impression and how to help your patients through the process. This episode is packed with news hearing care providers can use. Don’t miss it!  

Link to full transcript

Transcript

SPEAKER_02 0:02

Welcome to Starkey Townbites. I'm Dave Fabri, your host and Starkey's chief innovation officer and an audiologist by training. And uh it gives me great pleasure to introduce my good friend and colleague Ray Woodworth, who's been uh with Starkey for over 20 years. 20 years and in the discipline for over 20 years. And I don't think it's hyperbole to say that you are known as a master of custom hearing aids. And I can tell you that you have many fans who are likely listening to Starkey Soundbites, perhaps for the first time, because of the way that you've helped them achieve the best solutions for their patients by ensuring customized, personalized technology. And that includes not only the programming that goes into compensate for their hearing loss, but importantly, that custom solution that enables the cosmetic benefits, all day comfort, freedom from feedback, uh a nice tight fit in the ear. And there's no one better than I can think to talk about this topic than you, Ray. And I'm really pleased to have you join us today.

SPEAKER_00 1:15

Well, thank you for having me. Um, you know, I I have to give a lot of credit to to Bill Austin. Of course. Yeah. You know, I, you know, I've been with here at the headquarters for over 20 years, and uh and uh you know, but quite honestly, when I first came here, I was I didn't know what I was getting into. Um so you know, working with Bill all these years, I he's he's showing me something a different light. You know, I used to work in a private practice, and when I was in private practice back in 2000, um you know, I was doing custom products at the time. You know, I'd shoot impressions and you know, look at the orders and and make sure I I get the best result for the patients. And that's what we want. We want to make sure our patients are happy and we give them the best results. And quite honestly, I would just shoot the impression, put it in the box, write up the order, and send it out. Yep. I wouldn't pay attention to the little details that I that I've learned through Bill.

SPEAKER_02 2:04

And Bill Bill is fond of saying the ear is the boss. And I know you've taken that mantle too in your day-to-day activities. Why is it that the ear is the boss?

SPEAKER_00 2:15

So that's a very good question. So, you know, in my classes, I always make that phrase, and I got it from Bill.

SPEAKER_02 2:21

Yeah.

SPEAKER_00 2:22

So one time I was uh I was shooting an impression, and uh I take it out and uh I show it to Bill. And Bill looked at me and goes, You remember? I'm not the boss. I love it. I said, Okay. He goes, You're not the boss. He said, He was the boss. Yeah, and I was like, and it didn't really dawn on me until he really said it and he looked at me in the eyes.

SPEAKER_02 2:45

The magnitude of that statement kind of initially it it it totally resonates for anyone that has made custom devices that fitted properly and didn't fit properly.

SPEAKER_00 2:55

So so what we do is we hear a lot of patients tell us what they want, and but we don't hear a lot about what they need. Yeah, and the the ear dictates that. So we want to make sure our patients are happy, we want to give them what they want, but at the end of the day, we can't change the ear for what it is. Nope. The ear is so unique and so different. So Bill always tells you know, tells me, you know, when you work with these patients, you want to do what's best for the patient, but you have to see the ear. The ear tells us a story, right? It tells us what we can and cannot do. And being here at the factory as long as I've been here, I know the parts, the receivers, the vents, the chip, and how with the size of them and how they fit. Yeah. So, you know, I don't know if we're gonna get into discussion about over-the-counters, but but of course, yeah, you know, the ears are not standard.

SPEAKER_02 3:44

Right. Well, people have talked about the uniqueness of the external ear, the ear canal. Yeah. Uh it's it's almost like an earprint as unique as your fingerprint is. Yeah.

SPEAKER_00 3:55

And, you know, if when you when you look at the different styles of hearing aids, you know, with our 2.4 CICs, with our rechargibles, uh the AP molds. Um AP, what's that mean? AP means absolute power.

SPEAKER_02 4:07

Okay. So I would I would beg to differ in series of saying traditionally, historically, AP means absolute power, but I think now all purpose. Yeah. I see more and more customization. Uh when we're talking ear mold impressions and custom products, it's not just an in-the-ear custom product, but also a custom driver, a custom solution that goes in the ear coupled to a RIC, a receiver in the canal device, or even a BTE in the form of an ear mold.

SPEAKER_00 4:35

Yes. So, yes, correct. So, one of the things that people need to understand is, you know, we remember the zone product that we had? It was a Rick with a bud. Yep. And we were trying to reach a certain loss that wasn't a candidate for a bud. They needed more power.

SPEAKER_01 4:48

Yeah.

SPEAKER_00 4:49

So back in 2009, 2010, we got a hollow shell and Bill put a receiver in it.

SPEAKER_01 4:55

Yeah.

SPEAKER_00 4:56

And then we solidified it. We made it hard. And people ask me, why is it a solid shell? So when you talk about absolute power, the receiver vibrates. Yes. And then when you put it in a solid shell, it makes it more stable. Right. And it separates the receiver from the microphone. Correct. So when you do these things, you can drive it harder, give more clarity without feedback. So the A C was born because we wanted to fit losses that needed the power and the clarity. And in 2009, when we started fitting them, like you said, it was they were called absolute power because all we were using was the 70 receiver and a big 60 receiver. Nowadays, we found that some buds don't stay in the ear. Some buds irritate people. So we went into and and then so we went into using APs for all different powers now to allow uh better sitting uh molds in the ear to help it retain. Also, some ears you can get really big vents. And and again, the ears are the boss because some ears you can't get a big vent because the ear doesn't allow it. So when we talk about AP molds, I find that that you can pretty much fit anybody with an AP mold. Yeah. If you if you really look at it. But there's some cases where the ear is too small to where you can't get a too big open vent, they may feel occluded.

SPEAKER_02 6:16

Yeah, it's that trade-off between the power of the receiver and then the consequent size of that receiver and the openness of the vent. And if you want a high-powered receiver with a big vent, which often might only be the case for those steeply sloping losses.

SPEAKER_00 6:30

And you have to be careful with that because if you make the vent too big, you're gonna have feedback issues.

SPEAKER_01 6:34

Exactly.

SPEAKER_00 6:35

But I I've seen that that I've seen people come in with buds and we're not reaching the highs because it's too open. It's not when you make a custom mode, it conceals it better. It just makes it sound better.

SPEAKER_02 6:48

So And you can likely get a more secure and deeper fitting uh in the canal that the receiver can sit deeper in the canal sound direction with better sound direction so that it's not pointing it into a canal wall. It's getting further in the canal wall so that even if you're doing a more open device, there's a smaller residual canal beyond the tip of the receiver than what you likely can get with a dome placement and that more standard location, a little shallower in the canal.

SPEAKER_00 7:17

And also you get less feedback because you got a good seal fit. Right.

SPEAKER_02 7:20

And separating the microphone from the receiver. Yeah.

SPEAKER_00 7:22

So there's a lot of there's a lot of things that were configured for a reason. And and you know, and I think the and and I'll be honest with you, there's people that don't want behind the ear. There's people that want custom, yeah, they don't want something behind their ear. Right. So I've I've seen people come in and they say they want an IIC, which is an invisible internal account. Yeah. And uh and they don't want the the Bluetooth, they don't want to stream, they just want a cosmetic. We're known for cosmetic, we're known to make really small hearing aids. So if the ear dictates says, hey, we can do this, I get excited for the patient. Hey, we can build this for you. You ear tells us we can. So every time I go in when we see patients, nine out of ten times I shoot the ear impression because I can show them and say, look, this is what we have. This is what we have to work with. I can make this what you want, what you told me.

SPEAKER_02 8:13

So Yeah, and and one of the things that I've seen both you and Bill Austin do is really look in the ear with the autoscope and then encourage the patient to talk before you make the impression. Before you ever make the impression, you're looking in the ear because we're not talking about imaging the inside of a coffee cup or a bottle, a stable. That thing is moving. Absolutely. And I've watched both you and Bill look in the ear and really analyze before an impression is ever made or an auto block is even positioned to see what's going on and where that movement, how much movement does it.

SPEAKER_00 8:46

Absolutely. I'm glad you brought that up. So people always ask me, hey, Ray, you know, you know, you know, I work with a lot of our customers over the phone and I troubleshoot a lot, and I work with a lot of difficult cases. And I get people calling me saying, Ray, why is one staying in just fine and the other one is walking out? Yeah. Well, each ear is different. And so I've seen where one ear moves a lot when they chew, and then the other ear doesn't move at all.

SPEAKER_02 9:08

Well, and I'll go a little further with that because I I've done some work in the past in this area, and I think whether or not people realize it, and this is going to drive some people crazy now when they think about this, but we are as humans, we're habitual chewers. And so when you go to chew on a steak or a jawbreaker or anything that is a hard uh resistive object, unconsciously, most people favor one side or the other, uh, whether they have dental work or a cap or a crown or sensitivity, and they're bearing down when they go to chew on something really meaty, uh, they go to the same side all the time. And that is what drives most of the time, people will have a patient who has uh IICs or completely in the canal devices that walk out of both sides. It's usually it walks out of one side, and then when you ask them to start thinking about where are they chewing more aggressively, it's almost always on the same side, and that's going to be the side that walks out more than the other, and you need to take care. Yeah. How do you overcome that then? How do you compensate for that?

SPEAKER_00 10:14

That's a good question. So, you know, when it when it comes to TMJ jaw movements, you know, people think that just because you make it longer, or they think there's certain ways you can do to avoid that area. You have to keep in mind that when you have a profound loss, and let's say you have that jaw movement, you have to make sure you have a good seal. Yes. You can't just start modifying it and trying to take off in that area because feedback will be the result. Yep. And when they chew it, starts feeding back. Yep. But if an ear has good retention, and if it's a mild hearing loss, you can be a little more aggressive. Right. You can start taking off more. So it's not just the ear, but also the hearing loss we have to look at. Correct. So more profound losses, I found that you have to have a good seal fit. And you can take off in certain areas, but don't be too aggressive on that area, especially where the jaw movement is. A lot of people ask me where the jaw movement is typically on the anterior wall before the second bend. Correct. That's where it usually is. It's not on the back wall, it's not on top. It might be, but it's far more common on the anterior wall. Far more common in the uh the the front wall before the second bend. Right. And, you know, you mentioned earlier about why we always look in the ear. Yeah. Another thing we look at is the texture. Yes. The texture of the ear. Yes. I've seen patients where the skin folds. The skin's very loose. Yes. And, you know, we work with a lot of elderly people. Yeah. And when the skin folds and it's very loose, you gotta be careful because you can get what's called prolapsing canal.

SPEAKER_02 11:40

That's where you get sore. And it closes down because that cartilaginous portion is loose and floppy.

SPEAKER_00 11:47

And if you if you if you if you make the hearing a too tight, what happens? The skin goes with it. And then the skin pulls it out again. So you have this motion of why is it walking out? And sometimes because we're not tapering it enough or it's too tight. So when I see an ear uh that has a lot of folds in it, um, I typically try to not make it too tight, especially for some outhering loss.

SPEAKER_01 12:08

Okay.

SPEAKER_00 12:08

I try not to make it too tight and take off on and taper it. So it'll be easier to get in and it won't just push it out. If you have a profound loss and you're worried about it taking off too much, that's where the canal loss come in. Right. That's where you do a half shell. A full shell. We we can do any style. But the question is what's the best style? What's the best solution? So everybody has a solution. But my question is learning from Bill, is it's not the solution. What's the best solution? Right. And the best solution comes down to how much do you understand the ear and understand the product? If you understand dipotic in the ear and hearing loss, you can marry them and interface it better.

SPEAKER_02 12:50

Yeah. So what And so from the professional standpoint, for many of the people listening to this podcast are dispensers, audiologists, the most important thing is garbage in, garbage out. And so they've got to start with a good, deep impression. And I would encourage professionals to make deep impressions on everyone, whether it's a mild gain or a more significant gain, because it helps with how to direct that sound down the ear canal to know and anticipate any turns.

SPEAKER_00 13:20

You know, you I I've seen so many um impressions come in where they're too short.

SPEAKER_02 13:26

Yeah. And I then you're just guessing. We're guessing at the factory level.

SPEAKER_00 13:30

Yeah, and also I I quench because they they call us and why is my hearing walking out? Why is it feeding back? It's because the impression was too short. Yeah. So what happens is you lose the bulbous areas of the ear. One of the things I learned working with Bill all these years is paying attention to the little things. Yeah. The little things can make the biggest impact. So when you shoot an impression, pay attention. You know, people tell me, wait, how do you put it down so far? What, you know, and I'll be quite honest with you, and and there's people that that would admit it, that some people just don't feel comfortable going down to new deal.

SPEAKER_02 14:03

But but part of that is if you get into the habit, if you routinely go instruct the patient what you're gonna be doing, tell them they might feel a little, you know, discomfort as you're placing it, but assuring them that you're not doing any damage, if you get used to doing the same procedures at all of the time on every patient, even knowing that the architecture is different, it's gonna lessen that anxiety. And I think because of those dome tips with the receiver in the canals becoming the most popular style, yeah. Quite frankly, as a discipline, we've gotten out of the habit of making good impressions. You know, Dave. Good first impressions.

SPEAKER_00 14:39

Yeah, you're absolutely right. And you know, I one of the things I bring up in my classes is, you know, when you get the technique and understand how to place the block and so forth, you have to remember if you if you use a big block on a small ear, it's not comfortable. No. And they they react. Sizing it's the size of the block is a huge factor. You know, Bill always tells me to flatten the cotton, flatten the cotton. And I was like, why is he always telling me to flatten the cotton? And it made me realize that when you flatten that cotton, you can you can go down further without putting pressure on the other side. So you prefer cotton over um foam? Absolutely. Me too. I I think you can use foam if it's for the right ear. If you have a surgical ear, absolutely fill up the cavity. Get the cavity filled in. But when it comes to IICs or CICs, something that needs a lot of information about that ear, I would go with cotton because you can flatten it and make it more comfortable. Also, also, it gives us more information. When the block, when the when the block is too big, we lose almost half of the ear canal because you use a foam that was huge. Yeah.

SPEAKER_02 15:48

And people don't realize that as soon as they come to us, the first thing the technician is doing is they take that off, and if it's half filled the canal, there's a lot of guesswork. So that's where I think cotton is customizable. You flatten it, you put it in, and this is ultimately then really the ultimate in blocking, auto-blocking, and tackling the problem unique to the patient.

SPEAKER_00 16:09

And I ask people in the class, why do you guys continue to use foam? And you know what they tell me? What? They're worried about getting a blow by. Okay. So they're Okay, fair enough. Fair enough. You know, that's fair to say. But if you get the right circumference, I I've been shooting one time, Dave, I shot over 100 impressions in one day. Wow. Because we had classes that come in for training. And I had to get, you know, Bill wants those impressions perfect.

SPEAKER_02 16:36

Yeah. 100 perfect impressions in a day is no small feat.

SPEAKER_00 16:39

Yeah, and Bill is a perfectionist. Yeah. And he wants to make sure everything is right where he wants it to make sure to get the best result. So I was I was told three in the morning. You know, you've seen it, but you've seen it. And uh never had a blow by. Yeah.

SPEAKER_02 16:53

Never got it. That's because it becomes ritual when you're doing it over and over, the same process all the time. Yep.

SPEAKER_00 16:59

And I use a videotoscope. Yeah. I don't use a handle.

SPEAKER_02 17:02

Good light is is extremely important. Yeah. What about the, you know, there have been a there's been a time for those of us who've been around a while where people did impressions with a closed jaw and an open jaw using a bite block. What's your position on that? That's a good question.

SPEAKER_00 17:16

I get that question often. Yeah. Um 22 years ago when I started, yeah. I saw a lot of the mouth blocks. And I, you know, back then, uh, one of the reasons why we use mouth blocks is because we wanted to get a nice seal fit. Well, our feedback cancel is phenomenal. Yeah, much so proof. Our tight fits didn't have to be like it used to. Yeah. So people use mouth blocks because they wanted to make sure they get a nice good fit.

SPEAKER_01 17:46

Yeah.

SPEAKER_00 17:46

I mean, tight fit. Well, I'll be quite honest with you, I never use a mouth block. Yeah. I use relaxed jaw.

SPEAKER_02 17:52

I don't and if they have And a stable jaw position, though, is important. Yeah. Not having them talk because the cure rate on these physical impressions, silicone or you know, methyl methyl methyl act like impressions require that you know that cure rate is going to start sealing. And if you're having them talk, you don't control for the for the fit at any position.

SPEAKER_00 18:15

And that's one of the reasons why we look in the air before we shoot it to see what that whether because there's some people that don't have TNJ issues. Right. And there's some that are aggressive. But but um uh yeah, again, I we don't use mouth blocks. I used to, yeah, but not anymore. Okay.

SPEAKER_02 18:28

Um so deep impression, cotton autoblock. Yeah, um, fixed, relaxed jaw position, but a stable jaw position.

SPEAKER_00 18:36

Also, there's another thing that's very important. While you're shooting the impression, keep the tip inside the ear. I think we pull out too soon. Okay.

SPEAKER_02 18:44

So when you to get a solid fill.

SPEAKER_00 18:46

Yeah. So what happens is when you put the block in and you got your material ready, the the the gun, whatever, or the syringe, when you put the tip inside the opening of the aperture, I find that people they they they move it out too quickly and you start getting these voids in their pockets. And layers. Yeah, layers and stuff. And it creates uh it creates uh uh uh voids where we have to fill it in here and start guessing. Yep. And now you have a fit issue. Right. So so I think what you should do is, and I do this all the time, is I stick the chip in and I and I count one thousand, two, one thousand, three, one thousand, I say it in my head. And then when I start seeing the material, I start coming out with it. Okay. And then, and keep in mind, I I've tried to I've tried to perfect it because Bill wants it perfect. Yeah. And I gotta make sure I give it to him perfect. So I've learned to perfect it to where now when I when I pull the tip out, um, I I I let it run out, and then I go up into the helix, right? I come back down, and then I keep it there, and I let the material do its own work. I don't I don't try to do it for it. So what happens is people, when they shoot the impression, when they take it out, they start moving it too much. Yeah. And what happens is you start creating these air pockets in there. So I let the impression do what it's supposed to do.

SPEAKER_02 19:57

Don't be in a hurry.

SPEAKER_00 19:58

Don't be in a hurry. And and when you put it and when you go up and go back down into the bowl, leave it there and let the let the silicone do what it's supposed to do, which is it it was spread out. And it's all you have to do. And then when you take it off, you should have a nice spiral. Yep. And and round flat. Um, yeah, you know, to think about that. You know, when when people talk about, hey, why would why would you shoot a full ear impression or a long impression all the time? Well, you gotta keep in mind that when you scan an ear impression, let's say you decide to change the model. Let's say you decide to add a canal lock or a heeless lock or whatever, we'll have it on file. If you don't fill all that in, you're gonna have to ask for a new impression. So if you give us everything at first, we can always add things to it.

SPEAKER_02 20:45

Do the same process all the time. And don't be in a rush, make it happen. Good lighting, like you said. Yes. And then, you know, and then focus on trying to make it as complete an impression and don't worry about wasting a little bit of material. Yeah, yeah. I mean, it's better to get the same.

SPEAKER_00 21:00

So if they call back and say, hey, can you add a canal? Well, you didn't fill in the ball. Right.

SPEAKER_02 21:04

So I can't. Can't do it in impression. But we need to implement it. It takes time, yeah. Another impression. You know, it's interesting because we live in a TikTok world these days, and I know there have been hundreds of thousands of views of people getting wax removed from their ears. I think you should start a TikTok uh channel on making ear mold impressions. Yeah. Um, because it it is, you know, it's a it putting my nerd hat on, I mean, it is an art and a science to get a quality impression which is absolutely going to deliver that end result, whether it's for an ear mold, a receiver in the canal AP, or whether it's a custom device that fits deeply in the ear. And it all starts with the impression. And if it if you're not beginning from a good analysis, spend a little bit of time with a good light looking in that ear, getting a lay of the land before you ever put the block in, before you ever put any material in the ear, um you're Be so much better off than if you try to rush through it because you're scared.

SPEAKER_00 22:03

Yeah, and you know, quite honestly, Dave, I I think like you said, you you hit it on the head. Slow down. Slow down. Because if you if you take your time and get it right, you you have less returns, you'll have less fit issues, less remakes, if we just get it right on the first.

SPEAKER_02 22:19

So I want to talk about two areas. Um one is uh let's do custom first, and then let's go to I want to get to the issue of um the trade-off between venting and well, let's cover this venting and receiver power. Yeah. Many professionals think worst case scenario, well, what happens if the person's hearing changes? So I'm gonna go with a bigger vent, more, I mean a bigger uh uh receiver, larger power receiver than I need right now, but I want to have a little bit in reserve, but then that means you're having to downsize the vent, particularly on smaller ears. Um, we can make other receivers, other APs. What's your feeling on um an oversizing the power of the receiver and undersizing the vent versus the other way around? Selecting the appropriate power and then going with the biggest venture.

SPEAKER_00 23:11

You know, I you you brought up something that I I I went into a lot as far as um people wanting to overpower over reserve gang. Yeah. Um, like like you mentioned. Yeah. And I'm glad you brought that up because I didn't think about that until you brought it up. I get a lot of calls about, you know, why is the hearing aid bigger? Why is the vent too small? Why, you know, they gave me all these whys. And I found that you have to do the initial fit and make it the most successful fit. Right. You can't think about the reserve because what's gonna happen in the future. Yes. And the reason why is because you want to make sure that patients are happy when you first fit them. Yeah when you start thinking about reserve or the future of well, I need this for later on, you're gonna change that fit. You're gonna make the hearing aid bigger because the receiver sizes are not all the same. No, they're all different. No. So when you ask for more power, you may be asking for a bigger hearing aid. Right. So if cosmetic is more important, I would fit what they need now and make sure they're happy.

SPEAKER_02 24:09

We can remake with a larger receiver, whether it's a customer or an AP.

SPEAKER_00 24:13

But but but they, you know, let's say the hearing changes. Okay, then we get we gotta go back to the drawing board and and make something that suits that change. At that time. At that time. So so I found that people, when they start asking for things that they don't need now, but they may need later on, but they may not. But what happens is you start having occlusion issues. Right. You start having vents being too small because you want a bigger receiver. Right.

SPEAKER_02 24:35

So this is look, I mean, it's really a partnership between us, the manufacturer, and the professional. And the professional knows the patient, they know their business, but we also know that trade-off, because of our experience with millions of ears. No, also the parts, but the parts and how they fit. And so, you know, it and and and I think it's really truly the best results are achieved when there is a meaningful and deep collaboration between the partner, the professional, and the manufacturer, and the trust that it goes along with that. And I know you are really a trusted advisor to a lot of professionals in in the field because they know that you're thinking as they are in the best interest of the patient. And it's not just because we want to sell more products of this size or whatever.

SPEAKER_00 25:21

No, I want to do this basically to the patient like they do. Yeah. You know, we're we're in this to make sure the patients are happy. Right. And uh I I but you know, I'm glad I'm glad you brought that up, Dave, because you know, I truly believe that if you get the initial fit right, you you're gonna have a long-lasting relationship with your patient. Yeah.

SPEAKER_02 25:40

And and and and whether it's custom or whether it's uh AP, I cannot stress the importance, too, of that custom solution to direct the path of the sound down the ear canal so that it's not bouncing and careening down the cartilaginous and bony portion of the canal, but giving as direct a path to the eardrum as possible makes a subtle but important difference on sound quality.

SPEAKER_00 26:02

And you know, when you say that, when it comes to my mind, standard over-the-counter hearing age. Right, right. And think about that. You you you you I've seen people come in with buds and it's hitting right into the wall. Right. And they and they're like, I can't, I can hear you, but it's it doesn't sound clear. It sounds metal.

SPEAKER_02 26:19

You know, and we think about you know, we say, well, oh, the programming is wrong for their hearing loss, but it's the position of that bud. The position of the bud, the way the sound is directed, all of that goes into the sound quality and probably is equally, if not more, important thanks to the thing.

SPEAKER_00 26:32

And sometimes if you have a really big ear and you put a bud in, all the sound bleeds out, and they need more power in the highs, and you can't get it because it's all bleeding out and it starts feeding back, and you run into this situation where they need a custom. So, you know, this over-the-counter, you know, I I tell you, I I see we I see, you know, the the uh commercials and I see uh social media and I see these over-the-counter stuff, and it makes me cringe because I don't know how it may be an important part.

SPEAKER_02 27:00

It is to embrace the new reality and providing accessibility and affordability, however.

SPEAKER_00 27:05

I agree with you. I do agree. However, um uh assessment affordable, I think that's great. But if people have seen as as many years as I've seen, uh our ears are not standard, they're they're uniquely different. And uh I tell you right now, there's gonna be a lot of hearing aids in a drawer. It's gonna increase. And the reason why is because um people don't realize that grey. I feel muffled. Yeah. Um, and and not only because of the sound direction, because the ear is so small and you put a bud in, they feel plugged up, they feel occluded. So nobody's gonna want to walk around feeling plugged up or occluded. Oh, when I take it out, I'm gonna hear better. So there's things that happen with a standard bud, even if you change the tip, some ears just don't work with it. No matter what size tip you use. Yeah, beyond comfort is that sound delivery. Absolutely. You have 90-degree turn, exostoses. You have exatosis, you have mastoid cavities. Yes, and you have conductive components where they need a lot of power. I mean, just there's gonna be people going out there that have, and you know as well as I do, that these are made for mild to moderate hearing losses. There's gonna be people out there that have moderate to severe, they're gonna try it. They're gonna try it.

SPEAKER_02 28:16

Because they think, oh, this is now I can get hearing aids less expensively. You don't have to bother professional.

SPEAKER_00 28:21

Then they don't know the difference of how much better it could be. Yeah. And so, yeah, I I have mixed feelings about it, but I I think you're right. It's more accessible and more affordable. Yeah. But at the end of the day, it's what's best for the patient. Absolutely.

SPEAKER_02 28:34

And you know, so so I I I I mentioned excess doses and mastoid cavities. What's the most difficult type of patient or canal or ears that you've worked with?

SPEAKER_00 28:45

Well, there was a guy that came in uh several years ago. He had treats with Collins and he came up to me and he goes, uh, you know, I I need uh a new hearing aid. He's wearing a hearing aid. He he took off both of his ears and he gave it to me. Yeah, over here.

SPEAKER_02 29:01

First time that, yeah. First time that happens, that'll shock you a little bit. First time, yeah.

SPEAKER_00 29:04

And he used 3M tape.

unknown 29:06

Yeah.

SPEAKER_00 29:06

The tape into his head. Tape them on. Yeah, now they have magnets, they have really sophisticated prosthetic ears. Yeah, the ears that look so real now, sun real. And so the challenge we had was was uh feedback. Yeah. Um because narrow, narrow canal. Yeah, narrow canal, and also when you when you tape an ear to the head, the the the the ear to the head has to be completely sealed. Yeah, it's not sealed, it's not tight. Yeah, and the seal and comes through the side of the ear. And so we uh we told him that he needed more strong, uh stronger tape, more adhesive tape. And when he did that, the feedback went away. But it was a tricky one because you have to shoot the prosthetic ear on the head. You can't shoot the ear and then fit it. I've seen that happen when people send me orders with a pitch of an ear. And I said, Well, you have to have the ear on the head. Right. Because that's where that's how it's gonna fit. Right. And and so that was a tricky one. And I want to I want to bring up something about challenging fits that I ran into. And you know, I've seen uh fittings across all 50 states that come see us, you know, especially the ones where the customer said, Hey, we tried everything and we're not getting any good results. I had a lady that came in and I'll never forget this. And it wasn't a physical fit issue, it was more about word recognition, being able to understand speech. And we we just and the audiologist did a test, and we uh we took the you shot the impressions, and uh and I told the lady, I said, listen, you know, your hearing loss, you know, and she knew she had a bad hearing loss, and and uh and she had zero word recognition. Zero. And uh and she wanted to be able to talk on the phone. And so I was uh concerned because you know, sometimes you have to set expectations, you know, so you have to tell the patient, hey, this is the test, this is the result. And so we um uh we did the test, you know, and again, and and when we fit her, she said she could hear better. You know, hearing wasn't the problem, it was understanding.

SPEAKER_02 31:07

Yes.

SPEAKER_00 31:07

So we we fit her with new hearing aids and we got it up, you know, the way she liked it, you know, verification, aided response. And um She goes, Do you mind if I go to the other room and and talk to you? I said, just let me know you're a great you're a great lip reader. Because I'm I'm a lip reader as well. Because I have a hearing loss too. I said, You're a great lip reader, you you really tune in and you've had a hearing loss for a very long time, and you've you've learned to you know look at people and read lips. And she goes, absolutely. But she goes, Can I try to call you? And I said, Yeah, sure. I'm wondering what she's gonna hear. Yeah, so she goes into another room and closes the door, right? And I told her that we have a glass in our offices, and I told her to turn around not to look at me. Yeah, I pick up the phone and I asked her five simple questions, and she understood now. I wasn't surprised. Sure. I gave the phone to her son. I believe, and you know, we truly don't understand you know, we understand the you and how the you works, but the possession of how we hear, yeah, she's known her son for 25 years. He was 25 at the time. She knew that voice.

SPEAKER_02 32:22

Okay, so her son was talking. It wasn't okay, gotcha. So a familiar talker. The son was with me. Got it. Okay I got the phone and gave it to the son. Gotcha. Okay.

SPEAKER_00 32:30

And I couldn't believe and I couldn't believe it.

SPEAKER_02 32:32

The familiar talker, and she was able to hone hone in on his voice.

SPEAKER_00 32:35

Yes.

SPEAKER_02 32:36

Yeah.

SPEAKER_00 32:36

Oh, I've seen that many times, and it's absolutely in the horror description was zero percent in both views. Yeah, and you know what? She was ecstatic. Yeah, and she said because that's a voice she needs to hear every day. Yeah, so I told people, just because what you see, right, you gotta try it. Right. Because you don't know until you try it. So so she she she she came back to me and she was in tears. She goes, I could hear my son, I can understand him. Right.

SPEAKER_02 32:57

And she looked at it. Which for her is the most important voice in the world. I need to hear you for this example.

SPEAKER_00 33:03

But but it meant so much to her to her son. And and and so I it it made me realize, you know, and Bill, and Bill always tells me this, you know, um you when you when you fit people, and you know, you we know we talk about you know, radio measurements and verifications and hearing and noise tests and all that. I think it's all important. Yeah, very important. But the truth is when the patient actually wears it, yeah, and what they experience personally, because we don't know how the brain's really perceiving it. We know we know how to measure the resonance of the ear canal.

SPEAKER_02 33:36

We know how to matching target, yeah. We're gonna be able to do that. All of that is important. Yeah, an important part of the science. Absolutely. But the art and the emotion of this is like you said, the ear is the boss and the patient is the boss, and the needs of the patient are what are is always uh the only consideration that matters. And that relentless focus is what makes you not only a master ear technician, an ear magician in the sense of understanding the patient's.

SPEAKER_00 34:02

And I've been very fortunate because I've seen it for for many years, and and uh I think that I think the truth is what the patient tells us. If if the you know, I I have people that I could go on and on, Dave. Well, and we're out of time, but I would love to. But but you know, just real quick, you know, I I see people that come in and and you know, like you said, we target the fit and everything looks great. We we do all these measurements, and they're like, Ray, it's not loud enough. I can barely hear you. And everything looks good on the on the on the graphs and the computer, and I keep turning it up. I well, the guy wore analog hair nails for 30 years. Power junkies. He's a power junkie. So, but we don't see it on the audiogram. People listen in different points in different. Those are the best. We fit super thresholds.

SPEAKER_02 34:46

We don't fit thresholds. We do not fit thresholds. We fit super thresholds. Yeah, and people like to listen at various points in that level. That's why comfortable loudness and upper limit of comfortable loudness, I know, factors in a lot to the fittings. And I think it's all part of that personalization, yes, customization, and listening to the patient. And I'm really appreciative of you coming on the nerd out a little bit on the physical factors, the emotional factors, and most importantly the patient components. You had one more story to share, so go for it.

SPEAKER_00 35:18

So um uh I don't know which one you want me to share, but I'll I'll share. So yeah. So I had a um I've seen, you know, seen as many patients I've seen over the years. Um one of the things I we do at here at the headquarters is we we interface the fit before we build the hearing aid. What I mean by that is we actually make the shell and we put it in the patient's ears. And you'd be surprised what you can learn about how how how the shell fits before we actually build the product.

SPEAKER_02 35:56

Right. So this goes back to the earlier part of the discussion where the movement in the ear canal, and before you ever put the components in the product, you're just taking the shell. And this is the benefit of being here at the headquarters. Absolutely. Because because I've watched Bill do this and you do this, where you put it in the ear before the components are there and see how that shell moves. And then it helps you with additional modification before you put the components in. And it's one of the, again, one of the things that makes that truly the Center for Excellence. Yes.

SPEAKER_00 36:26

And the Center for Excellence is a very special place because we have we have the factory behind us and we have Bill Austin.

SPEAKER_02 36:32

I've been really spoiled for the 12 years I've been working here to have them right down the hall. Yeah. You know, I know that the professionals out there in the market don't have that ability to be able to walk down the hall and get the benefit of this. But you as a resource, uh, the Center for Excellence, um, Bill Austin, uh, and that expertise is what I think enables Starkey to continue to have a reputation, the rep, the earned reputation of making the smallest, most uh comfortable, most cosmetically appealing devices, whether they're AP molds, whether they're custom in-the-ear canal devices uh of anyone in the industry, and it that still um the combination of our technology, the role of the professional will deliver optimal results for the patient.

SPEAKER_00 37:18

Can I bring up one more thing? Sure. You know, you mentioned about the professional.

SPEAKER_01 37:24

Yeah.

SPEAKER_00 37:25

You know, when we talk about getting products, you know, over the counter and so forth. Um you know how many people I see that come in that don't know that they're completely plugged with wax um before they get a hearing test. We're gonna have people out there testing themselves. Yeah, they're gonna be completely plugged with wax. I've had people come in with perforated eardrums, um, excessive fluid behind the eardrums, not even aware of it. That that part right there is so vital and so important that that I think the health of the patient I think is the main thing here that we're talking about here, that what's best for the patient. And there was a time where this guy came in and he had a growth and he said, didn't know about it. And we told Bill about it. And he ended up having a tumor. And he went to a doctor, an ENT, and he had to have surgery that day. It was so bad. Um, and and pretty much he told us it saved his life. When I see these things, and it bothers me because I really care about what we do for our patients. When I see that and see what I've seen all these years, and I see these commercials and I see these things on social media, are we truly doing what's best for the patient?

SPEAKER_02 38:45

Yeah, I think you know, and it is part of a longer discussion, but I mean, raising awareness for the importance of hearing, raising awareness for the role of the professional is all a part of this process. And I think, you know, we'll see how this all goes. But I think if more people understand the benefits of amplification and the role of the professional and the importance of technology, the better off we'll all be.

SPEAKER_00 39:08

But don't you think that we should look in the ear before we do anything? Absolutely. Absolutely.

SPEAKER_02 39:11

And do you think that people are gonna get that service and they not you know they have various questions that are gonna be given to them and to sort that out. But uh, you know, I think that issue of OTC is gonna continue to be an evolving one.

SPEAKER_00 39:27

And I think and we just need to see how I I think if if you get an OTC, at least go see a professional. Yeah, and and and let them with you and let them decide what's best. Yeah, because that's what they're there for. Yeah, and I think that's so important, so vital.

SPEAKER_02 39:39

Completely agree. So, okay, we've gone over, but uh lots of great stuff here. Okay, and uh I'll ask one more question. What's your favorite sound? You uh you mentioned you have a hearing loss. What's the one sound that you would really miss if you could no longer hear the way you hear?

SPEAKER_00 39:56

When you said that, that touched my heart. And I'll tell you why. I have a 19-year-old daughter that loves to text just to hear her voice.

SPEAKER_02 40:06

Yeah, yeah. Texting is one thing, but she's a freshman in college.

SPEAKER_00 40:10

Yeah, and she's in a sorry.

SPEAKER_02 40:11

South Carolina.

SPEAKER_00 40:11

Yeah, she's having too much fun, but yeah, she's in a sorority. And I said, honey, don't text me, call me. So if I didn't hear my daughter's voice, that wouldn't bother me a lot. So that's uh that's personal to me.

SPEAKER_02 40:23

We'll end there. So thank you, Ray, for being with us on this issue of sound bites. We talked about a wide array of topics, and uh love to have you back to continue this discussion. Please do. I would love to come back. If you like this uh session, please uh share it with your friends. Uh subscribe to the podcast so you're sure not to miss a single episode. Um, consult with Ray Woodworth, who's in the Center for Excellence, and the rest of the team that we have here. We're we're your partner. We want to help ensure that those fittings deliver optimal results so that your patients are beyond satisfied to delighted. And uh thank you for listening, and we'll look forward to hearing you um the next time.