In this episode Blaise Delfino talks with Dr. Dave Fabry, Chief Innovation Officer at Starkey.
His Journey to Audiology
Dr. Fabry planned to be a veterinarian, however, he found his fellow students in the pre-vet curriculum to be extremely competitive. He learned of a discipline known as experimental psychology while doing the job of a chinchilla tester in college. The anatomy of the chinchilla’s ears is very similar to that of human ears. While he was a master’s student at Mayo Clinic, he worked with patients who had hearing and balance disorders. That’s when he decided to go into audiology. He wanted to help patients. He went on to get a PhD and became a researcher.
Patient Driven Focus
Dr. Fabry says inventions only become innovations when they make an impact on the market. The features most people want from hearing aids is audibility for speech and sound quality, in quiet and listening environments; reduction in background noise, using noise suppression and directional microphones; and spatial awareness. Clinicians can test patients’ spatial awareness by having the patient close his/her eyes and move around quietly and ask the patient “Where am I?” For patients with low visibility, the inability to locate sound can be life threatening.
Helping the World
Dr. Fabry is licensed in Minnesota, Florida and Rwanda. He has traveled to Rwanda to help people there by providing hearing instruments. Many people there get malaria and are treated with quinine. Quinine is ototoxic, so even many children have significant hearing loss. In addition to providing hearing aids, Starkey goes into countries and develops a community of support. Wearers have a place to go to learn how to change batteries and care for their aids. Nevertheless, in most countries, even if people have a hearing insurance benefit, only 50 percent of them wear hearing aids. There is still a stigma surrounding hearing loss.
Speech in Noise
Patients usually first notice they’re having a hearing problem when they are in noisy environments. Dr. Fabry says he advises all clinicians to do speech in noise testing. Many say they don’t have time; however, it is imperative to a proper fitting to do speech in noise testing, along with quiet testing.
Automatic classification of noise by the hearing aids is only 80 percent effective. By giving the patient the ability to choose which sounds he wants to hear via an app, it closes the gap of the remaining 20 percent. The hearing instruments scan the environment for speech and noise at the rate of 55 adjustments every hour. During the pandemic, Starkey hearing instruments helped patients hear someone who was wearing a mask.
Telehealth is Born
In the early ‘90s Mayo Clinic in Minnesota set up a secure teleconferencing system that allowed clinicians to speak to colleagues at their institutions in Florida and Arizona. During the pandemic, when audiologists were considered non-essential and were shuttered, many used telehealth to help their patients. Minor adjustments to hearing aids make up a third of patients in audiology practices. Telehealth appointments can take care of these. Patients on vacations or patients who don’t go out in bad weather can always use telehealth. Famil
In this episode Blaise Delfino talks with Dr. Dave Fabry, Chief Innovation Officer at Starkey.
His Journey to Audiology
Dr. Fabry planned to be a veterinarian, however, he found his fellow students in the pre-vet curriculum to be extremely competitive. He learned of a discipline known as experimental psychology while doing the job of a chinchilla tester in college. The anatomy of the chinchilla’s ears is very similar to that of human ears. While he was a master’s student at Mayo Clinic, he worked with patients who had hearing and balance disorders. That’s when he decided to go into audiology. He wanted to help patients. He went on to get a PhD and became a researcher.
Patient Driven Focus
Dr. Fabry says inventions only become innovations when they make an impact on the market. The features most people want from hearing aids is audibility for speech and sound quality, in quiet and listening environments; reduction in background noise, using noise suppression and directional microphones; and spatial awareness. Clinicians can test patients’ spatial awareness by having the patient close his/her eyes and move around quietly and ask the patient “Where am I?” For patients with low visibility, the inability to locate sound can be life threatening.
Helping the World
Dr. Fabry is licensed in Minnesota, Florida and Rwanda. He has traveled to Rwanda to help people there by providing hearing instruments. Many people there get malaria and are treated with quinine. Quinine is ototoxic, so even many children have significant hearing loss. In addition to providing hearing aids, Starkey goes into countries and develops a community of support. Wearers have a place to go to learn how to change batteries and care for their aids. Nevertheless, in most countries, even if people have a hearing insurance benefit, only 50 percent of them wear hearing aids. There is still a stigma surrounding hearing loss.
Speech in Noise
Patients usually first notice they’re having a hearing problem when they are in noisy environments. Dr. Fabry says he advises all clinicians to do speech in noise testing. Many say they don’t have time; however, it is imperative to a proper fitting to do speech in noise testing, along with quiet testing.
Automatic classification of noise by the hearing aids is only 80 percent effective. By giving the patient the ability to choose which sounds he wants to hear via an app, it closes the gap of the remaining 20 percent. The hearing instruments scan the environment for speech and noise at the rate of 55 adjustments every hour. During the pandemic, Starkey hearing instruments helped patients hear someone who was wearing a mask.
Telehealth is Born
In the early ‘90s Mayo Clinic in Minnesota set up a secure teleconferencing system that allowed clinicians to speak to colleagues at their institutions in Florida and Arizona. During the pandemic, when audiologists were considered non-essential and were shuttered, many used telehealth to help their patients. Minor adjustments to hearing aids make up a third of patients in audiology practices. Telehealth appointments can take care of these. Patients on vacations or patients who don’t go out in bad weather can always use telehealth. Famil
You're tuned into the Hearing Matters Podcast with Dr. Gregory Delfino and Blaise Delfino of Audiology Services and Fader Plugs the show that discusses hearing technology, best practices and a growing national epidemic, hearing loss. On this episode, we have the Chief Innovation Officer at Starkey, Dave Fabry. Dr. Fabry, welcome to the Hearing Matters Podcast.
Dr. Dave Fabry:
Thank you very much place. It's a pleasure to be here with you today.
Blaise Delfino:
The pleasure is all ours, truly. Dr. Fabry, I have been following your journey. Well, I'm only 30 years young now, so I have known, I have known about you and your work for quite some time truly because I grew up in hearing healthcare. And as an entrepreneur and fellow innovator, I admire so much of what you've done and what you've accomplished and the fact that you are just here at this interview. We're so grateful, Dave, you are currently the Chief Innovation Officer at Starkey. However your career is quite expansive. Can you briefly share with us your journey in hearing healthcare?
Dr. Dave Fabry:
Sure. My journey in healthcare actually in hearing healthcare in particular, begins with a chinchilla. I actually grew up I was first in my family to go to college, and I grew up wanting to be a veterinarian. Ever since I was a little boy, I began showing our Pomeranian dog and grew her to be an AKC champion obedience dog. And then that translated into a job working for a veterinarian through junior high in high school. And Dr. Williamhorn was my first real glimpse at what a profession could look like. And so I aspired at that tender age to be a veterinarian and actually came to the University of Minnesota in 1977. There's no such thing as pre vet. So I became an AG major. And what I quickly discovered was I didn't like the competitive educational environment that was in place for pre vet or AG at the time, because literally at the time, it was roughly a 3.9 grade point average to get into vet school. Well, a B destroyed you. And so the students were such gunners that they wouldn't even ask questions of the professors. They would rush the professor after class to ask the question so that only they would be the beneficiary of the answer. And I'm much more of a collaborative person, right. So I discovered experimental psychology because of a job that I got when I was a sophomore in college working as a chinchilla tester for W. Dickson Ward and David Nelson. DIX Ward was instrumental in damage risk criteria. I figured that might be a name when recognized. Yeah, work with fader plugs, did a lot of the work and I worked as a behavioral tester for chinchillas who have an auditory system very similar to the human anatomy, most of what we know about human anatomy and physiology of the ear is through the guinea pig, or through the chinchilla. A lot of North American research is on chinchillas a lot of the Asian work is done on guinea pigs in Australia where a lot of the pioneers work out. And so I worked as a Guinea tester and happily discovered the discipline of audiology through hearing science in my background with mentors like Dix Ward, Dave Nelson, Neil V. Meister, Mario Ruggero, real pioneers in anatomy, physiology psychophysics of the ear was my entry point. And it was a dying Van Tassel who took me on as a mentee, and I received my master's degree I like to say I've three degrees below zero all from the University of Minnesota. Undergrad in Psych masters at the time was the first professional degree for Audiology, and then PhD in hearing science. The interesting thing along the way, and really is part of my journey is that I've always been interested in the corner cases, the extremes even though I had amazing mentors along the way, and straight academic chops in terms of anatomy and physiology, psychophysics speech perception, I was always interested in patient care. And while I was a master student, I had the opportunity to do an internship at the world famous Mayo Clinic in the sunny southeastern tropical portion of the state of Minnesota. And it changed my life because I got to see and understand the needs of patients with hearing and balance disorders. And it really changed my focus where I thought I was going to be more of a straight academic professional. And I did after I received my PhD work briefly as a full time researcher, but I needed to that poll to the clinic and to the patient has been one that has been a balance my whole life. I love the technology. I love my job now, because no day is a typical day, I can't really look at my calendar and anticipate what direction it's going to take and including this podcast. But I'm grounded. I'm centered by fitting technology or working to assess and the mystery, if you will, of working with patients and figuring out what I can do to help them whether it's through technology, whether it's through counseling, whether it's through care, it's all a big mystery to me, and it's fueled me for now nearly 40 years.
Blaise Delfino:
Dave, this is getting me really hyped up because being a younger clinician in the field, and I have the opportunity to learn from professionals a lot like yourself, and what you are speaking is so much truth because we had dinner last night. And you said, Yeah, I had two hearing aid fittings today. And I'm like, that is awesome because you're not a technician, you are helping individuals on their journey to better hearing healthcare and you are staying sharp with that patient interface. And thank you for what you are doing for the industry. Of course, you are one of the brightest minds in hearing healthcare
Dr. Dave Fabry:
You have got to hang out with better friends.
Blaise Delfino:
Dave, what is so interesting about your position as Chief Innovation Officer is that while the human ear has essentially remained the same, anatomically speaking for 1000s of years, we as an industry have continued to innovate and release hearing technology to you know, reconnect patients to their friends, family and community. And of course, Starkey proves to be at the forefront of innovation, how to Starkey's latest innovation continue to raise the standard in hearing healthcare.
Dr. Dave Fabry:
Great question, my title, which, you know, Chief Innovation Officer, I think a lot of people just think I sit and look out the window and think deep thoughts. And there's my next question component to that. But the issue is people use invention and innovation synonymously, I'm pretty clear on saying that many inventions have died a lonely death, because they didn't serve a market or patient or end user need. And so really, inventions only become innovations when they make an impact in the market. So you're right in saying my role is to really ensure that when Starkey's developing these technologies that they have a patient focus, even patient driven technology, and that we continue to introduce technologies that are similar to what our founder Bill Austin did when he founded the company back in 1967. By zigging when other people were zagging. The history of this company is really built on innovation and on Yes, patient focused innovation, whether it was custom devices, when Mr. Austin really purchased the initial company for ear molds, because he saw a technology that the gentleman that he bought the company from, was using and some of the technicians were using for making ear mold impressions. And that evolved into custom devices. And we had many innovations in terms of custom technology, and many inventions and innovations. And I would say a real milestone was in the early 80s When President Reagan was fitted with custom devices when 80% of the products sold were BT ease. The other thing that Mr. Dawson did that I think often goes by the wayside is at that time in the early 80s, approximately 80% of hearing aids fitted in the US were monaural in one year. And instead President Reagan was fit with custom devices in both ears, and he wore them it's a big deal. And to this day, if you look at the market Trek 10 survey data, they talk about the top drivers of what people want and expect out of hearing aids. And of course, they want audibility for speech and sound quality and quiet and noisy listening environments. They want reduction of background noise using noise suppression, directional microphones, they want to ensure that loud sounds are not uncomfortable so that they can wear them in environments. But then the last one, they want to preserve spatial awareness. They want to preserve localization. Yes. And that's taken for granted. A lot of times I'd say that even now, to the clinicians listening, when we're fitting to hearing aids, what are you really doing to ensure that you're preserving spatial awareness, most of us then the most sophisticated test that most of us do is say OK, to the patient, close your eyes. And then we move around silently, like a ninja, where am I talking point and ensure that they're not pointing in the opposite direction, but we need to be more serious about ensuring that when we're fitting devices, particularly because the majority of devices today, we've swung back and forth between that early 80s, when we increased custom devices so that by the early 90s, nearly 80% of products were custom with a more natural mic location, particularly for those small devices that we innovated with, to over the ear products today that comprise 80% plus of the market, when you go over the ear with microphones, patients make a lot of front to back errors for those of us with good vision. That's a nuisance, you know, front to back error. But if I see you and I hear you, I know you're in front of me if I hear you but I don't see you you're in back of me, for a person with low vision or no vision. And increasingly, we're focused on comorbidity between hearing loss and other health conditions. For someone with low vision, that inability to locate sound can be life threatening. Absolutely. So we want to always be focused on that patient need and I think the resurgence in interest in custom devices and small custom devices that today connect directly with smartphones is a large part of what I'm interested in because I don't think that patients ever stopped being interested in custom devices never. I think it was really us the professionals we got out of the habit of making your mold impressions. Don't get me wrong. I love Rick and Beatty he receiver in the canal and behind the ear devices but custom devices provide a more natural microphone location. Admittedly one of the other benefits of receiver in the canal devices for people with mild moderate losses, they don't include the ear as much. But by the time you have about 30 decibels of hearing loss in the low frequencies, the occlusion for your own voice isn't a big deal. And a custom form factor with a microphone that's deep in the ear provides the opportunity to provide some spatial awareness better than over the ear microphone location. So that's one area that I think has been a consistent thread throughout Starkey's history in terms of the innovations that Bill Austin started. And we continue today with CIC devices that connect seamlessly to Android and iPhones, and also have a more natural microphone location at the entrance to the canal, preserving those Pinna and even contra resonances to provide patients with those four drivers of what they want and expect out of hearing aid performance for that better hearing experience.
Blaise Delfino:
And of course, Dave, the goal of a hearing aid is not to make everything louder. It is to make speech clearer, to reduce listening effort and increase speech understanding and intelligibility. That is the goal of a hearing instrument. I want to back up just a little bit because I believe it was 1967 , that Bill Austin purchased an earmold lab. And I am rereading Michael Hyatts vision driven leader. I believe we spoke about this last night, being CIO at Starkey and working with your incredible team. What is so amazing is pulling up to the campus today. And you see the center for excellence and the Starkey campus vision as an entrepreneur vision as a company vision as a team member here is so important and how Bill Austin has been able to explicitly share his vision in a manner that is really simple to understand, I believe is one of the reasons why Starkey has been around for over 50 years introducing technology for the better and overall health of your patients
Dr. Dave Fabry:
Completely agree. Simon Sinek refers to it as know your why. And Bill Austin knew his why well before Simon Sinek ever uttered those words. And you will see it when you speak about what we're focused on and hearing is our concern has been one of the mantras from the start with the company and also so the world may hear I've had the privilege of volunteering and traveling around the world
Blaise Delfino:
Share with us because you are licensed in Rwanda?
Dr. Dave Fabry:
Minnesota and Florida and Rwanda. And I mentioned when we had dinner last evening that because of the genocide that unfortunately, Rwanda went through, they really want to ensure that people coming in are qualified to assist them lift their people up, whether it's for better hearing, you know, obviously, the concerns in many emerging African nations are different than the presbycusis that we face as the primary concern in the aging population here in Rwanda. Not that long ago, the life expectancy of a male there was around 40 years of age, so they didn't live long enough to get presbycusis. But malaria, because of the high fever that accompanies malaria, and the fact in my opinion, now I can get on a soapbox. Quinine is still used worldwide as the medication of treatment because it's so inexpensive and effective. But unfortunately, quinine is ototoxic. And there are alternative drugs like art as soon as that can be used to treat malaria, lb it at a slightly higher cost $1 A patient more, but it's not ototoxic. And I think it's raising awareness for the importance of hearing so that we don't see some of these kids that have a moderate degree of hearing loss, that are in a school for the deaf when it's really a school for the hard of hearing, and they're using sign language. And they've been deprived during critical life periods so that they effectively with a moderate degree of hearing loss and no amplification, and no speech and language training of Deaf speech. So I think Mr. Austin and his wife Tanny, have had the vision so the world may hear to raise awareness for the importance of hearing to develop a community model of care where in addition to going in and providing the initial hearing aids, it is developing and building a community of support that can assist with the care and feeding of those devices, ensuring they have batteries, ensuring they know how to take care of the hearing aids long term. And that's really been part of this simple phrase. So the world may hear. I've been with Mr. Ross, and when he hopped off of a bus to just see someone struggling with hearing on the road. And next thing we knew we were working on getting amplification for them and giving them the opportunity to hear has been his life's mission today. And that bleeds through the entire company from the start. And so again, it resumes and so clearly with my personal vision of really wanting to help people live better through enabling them to communicate better and we provide the products and the professional provides the expertise and the care to deliver those outstanding results. All of the commoditization and all of the threats we see and disruptions we see from both ends on the healthcare side. And from the consumer electronics side you Can't commoditize caring, you cannot commoditize the role of a professional who sits across from a patient and listens really listens to the concerns that they have in the fears that they have regarding what's going to happen if they admit they have hearing loss and wear hearing aids. Unfortunately, we still are in a position where there's stigma associated with hearing aids hearing loss and use of hearing aids beyond the cost and the accessibility and affordability will be addressed by the over the counter category that has been created. But we still have no matter where you are in the world as a hearing care professional, less than half the people even in countries where they have a social benefit that includes hearing aids at no additional cost less than half the people use hearing aids. So accessibility, affordability major concern, OTC will help. But you can't commoditize the role of caring and raising awareness for why it's so important. Absolutely. People hear better and live better when they acknowledge that they have a hearing loss, get a hearing test and do something about it.
Blaise Delfino:
Dave, so many incredible talk points there. And again, when you talk about innovation, you are not only innovating and creating new products, but you are innovating the patient experience as we go year after year after year, we have products to support the hearing loss but what you're telling me is especially your work with the foundation is that first and foremost, you're giving back and it is in giving that we receive I know Bill Austen is a huge Albert Schweitzer fan, and that Albert Schweitzer sort of inspired him to start his journey in health care, Dave, I am so curious to know, because what does a mastermind at Starkey look like? And how does your team farm innovation?
Dr. Dave Fabry:
It's a great question. Well, first of all, I think mastermind is a term that puzzles me in the sense that I think if you ever begin to think that you really are a mastermind, then you're focused on the wrong thing. Because it's interesting. You know, I think the moment that you feel you're a mastermind, and you have all the answers is the moment that you better be concerned because I learned something every day and I learned it from patients. I learned it from colleagues, I learned it from clinicians. And if you ever think you have all of the answers in our a mastermind like some cartoon character, then maybe it's time to think about how your view on the outside world is I have a colleague and he's become a good friend Mike Maddock, who says, You can't read the label when you're inside the jar
Blaise Delfino:
Or you can't see the picture when you're in the frame.
Dr. Dave Fabry:
Same difference, as I love that my job is to always stay outside the jar outside the frame. I tried to stay fresh every day, my mental calisthenics, I get up every morning, and I try to look and see what important events took place in history. Because every day something cool
Blaise Delfino:
EFAB word of the day, ladies and gentlemen, this is so true. I see on Facebook almost every day, I love it. Sorry for interrupting
Dr. Dave Fabry:
Oh, no, no. And so you know, every day, every day of the year, something important happened. And then I look for inventions in history. I focus on historical events where inventions that became innovations occurred and also those that failed, because why it is that they fail is equally important to trying to think about other solutions. And so that's where I say mastermind is the term that perplexes me because no one really is a mastermind. The people that think they know all the answers really are probably those that have the biggest blind spots. The way that I tried to minimize those blind spots and mitigate them is by remaining connected with clinicians, with patients. And to ask the dumb questions of all my brilliant colleagues and I met a strange point in my career. 62 This year, I have no shame in admitting young Dave. Yeah, come on. It's all a frame of mind in his mind over matter if you don't mind. It doesn't matter what age you are. But the issue is, is for the first time in my career, I've managed teams up to 200 people. I don't manage directly people right now I'm really more leadership by example, I roll up my sleeves, I walk around, I engage with my colleagues in r&d, where I reside, and I work very closely with our CTO in Beaumont comm. I think you're also speaking to during your visit here, yes. But then I also am intimately involved on the customer facing side of things in terms of classes that we do around the world, because you know, the other thing is, is hearing and hearing treatment is different. In different countries around the world, there are still countries where monaural hearing aid fittings are the norm rather than binaural. Same technology. So interesting, people are still using one ear for a variety of reasons, lack of understanding of the benefits of two hearing aids. And so we have to look at that global framework. And the only way to do that is to not think of us as a US only company that happens to make hearing aids for the world. But we really want to be embedded in thinking about what are the unique concerns around the world, as they're faced in those countries where presbycusis is a dream to have their population live to be 70 years of age to think about binaural fitting to think about raising awareness for the importance of hearing and overall health and well being. And so even though I'm an audiologist for 40 years, I want to stay outside the jar by constantly reinventing my Self to ensure that I'm remaining as fresh and patient focused as possible.
Blaise Delfino:
I would say that you have you're curious on, Dr.Fabry and just from having the opportunity to hear you speak at different conferences, your applied knowledge is one of the reasons why so many patients have the ability to hear life's story. That's what we always say at Audiology Services is hearing life story. And being a thought leader in this industry, you encompass empathy. And this is something that I'm really am learning from you, you are able to look through the eyes of the patient, look through the eyes of your fellow colleagues, and maybe see a void that needs to be filled. That's sort of what I'm getting here from your leadership style. And my gosh, this is just incredible. I thank you on behalf of every single hearing healthcare provider, thank you for what you continue to do for the industry because as a team, you and Starkey and the entire Starkey family, you continue to implement best practices, which again yields highest patient outcomes. So important, so essential. Dr. Fabry, much of what you do does include problem solving. So what is the problem we're trying to solve? One of the biggest challenges that our patients face is understanding speech in noise. Now, audiologists and hearing healthcare professionals should be conducting speech and noise testing throughout the comprehensive evaluation. Because how do we know how a patient performs in a noisy situation? They could have 100% word discrimination, but they just scored 20% speech and noise or they have a severe speech and noise score after conducting the quick SIN which understanding speech and noise assists the clinician and making the best recommendation when it comes to technology. Someone has a severe score or recommending evolve ai 2400s Because that will provide you with the most support in that complex listening situation. How to Starkey's hearing instruments assist patients in these complex listening situations like restaurants, meetings and lectures and things of that nature
Dr. Dave Fabry:
Now so much to unpack there. So first off, kudos. I've been a big fan of speech and noise testing since the 90s. SIG soli when he was then at house hero Institute, along with Michael Nielsen had developed the hearing noise test the hint test and then Mead Killian later the sin speech and noise test and then the quick sin as an expedited measure. And we were involved while I was at Mayo and some of the data collection leading up to the development of the quicks in from the original sin Original Sin. I guess that's true. And you know, one of my issues, as I've talked to clinician over the years is that the time spent on speech recognition in quiet testing, they said, Well, I don't have time to do speech and noise testing. from a patient perspective, they say, okay, where I'm first noticing I'm having difficulty is in a noisy listening environment, I go into see the professional, they locked me in a quiet room and bombard me with beeps, and then send words at me in quiet, none of that has any face validity to me. So the very first time in the 90s, when I started using speech and noise tests, they said, This is the first time anyone has tested me in the environment, where I have difficulty and it was an insight for me to really see that when clinician said, Well, I don't have time to do speech and voices, I asked them what they're doing with the results of the speech and quiet testing, because in the 80s, we used it to look at the channel capacity. So we'd say, Okay, we're going to decide which ear to fit. Now, as long as every patient has measurable hearing in both ears, we're beginning the exercise with fitting every patient in the US with two hearing aids. So the speech and quiet testing only tells us channel capacity, but you're going to begin with likely trying to hearing aids on every patient. So forget about that speech and noise really gets at the issue of where it is and how much difficulty the patient has in real world types of environments that can be tested in the clinic. So if people say I don't have time for both, I say, Forget about the speech and quiet test unless your state license requires you to do that speech and quiet testing. And there are few that do speech and noise testing far more valuable, efficient, and face valid to what the real world types of situations are that patients have. And then to get to the technology. I think we've seen dramatic improvements. I mean, I was practicing when directional microphones really enjoyed a resurgence. They were originally developed back in the 70s. They weren't very good. But then in the 90s. Again, we saw the modern implementation of directional microphones on custom and behind the era of RIC receiver in the canal devices. The issues and challenges is is that if we wanted to build hearing aids that had that capability, the patient had to switch manual programs. They had to have dedicated programs that they had to remember to switch when they went from a quiet to a noisy environment. Now, the understanding and the expectation with every Starkey Hearing Aid and the other manufacturers as well as we're directing towards an automatic hearing aid that the patient doesn't have to intervene with. The challenge with that is as you mentioned going from quiet to noise due to musical environments and riding a bike so that you have wind noise, we have different features to apply only in the situations that are appropriate. So we don't want to turn on wind cancellation. When you're listening to music. We don't want to turn on directional microphones necessarily when it's quiet, and you want to be spatially aware of those sounds. So the important thing is with artificial intelligence and machine learning, we're able to classify the types of environments that patients encounter on a day to day basis. But the most sophisticated automatic environmental classification systems only are accurate about 85% of the time. Why is that? And that's not a rhetorical question why Starkey's automatic acoustic environmental classification systems are among the most if not the most sophisticated on the market, but they're still only accurate about 85% of the time. And that is because speech can serve as both a stimulus of interest and noise. If we're out at the restaurant last night, out there
Blaise Delfino:
Started to sweat there a little bit Dave, I'm like, man.
Dr. Dave Fabry:
You put me on the spot. So, you know, so the loud voice at the table behind me may or may not be the voice that I'm interested in. Like, remember having a conversation last night, music might be something I'm interested in. But it could also be a noise if it's a speaker piped in overhead while we're engrossed in conversation. So what we did when we developed Edge mode back at the beginning of 2020, yes, was to use that very sophisticated acoustic environmental classification system to automatically adapt from quiet to noisy to musical environments. But then we put the individual in control, we say, we put the power of artificial intelligence at the patient's fingertips to tap on the device or press a button in the app to do an acoustic scan, in that setup, where they were with the person or whatever it is that they want to hear in front of them, and provide offsets to enhance audibility in that specific, challenging listening environment. So that regardless of whether it's music of interest, or a voice, I know when I double tap, or when I engage in the classification system, by putting that power in my hands to say right now is where I want to hear better and right, the person in front of me is what I want to hear and optimize for that environment. It closes the gap for that remaining 20% of times that automatic classification doesn't work. It's really the combination of the machine and human intervention that delivers results that technology alone cannot do well
Blaise Delfino:
And again, Dr. Fabry, correct me if I'm wrong, digital noise reduction, essentially, we have this term called amplitude modulation noise is this steady state like a fan. But speech could be up in frequency, it could be down in frequency, it could be high in pitch. And so the microphones first and foremost, and the instruments are scanning the environment. They're collecting all this information. They're processing this information. They're having to know what the difference between speech and noise is. So how fast are these devices actually working?
Dr. Dave Fabry:
Oh, we're operating on the millisecond level. In terms of in the samplings on this latest product evolve AI 55 million adjustments automatically are made every hour underneath the hood, without intervention on the part of the patient 55 million adjustments, the combination of compression that is that amplitude modulation on noise management on binaural, and monaural, noise reduction, all of them are operating on the level that are making 55 automatic adjustments per hour. But still those situations occur where speech is a signal or a noise. Music is a signal or a noise or some other intervention like what we've seen during the pandemic, a patient a hearing aid user encounters someone else wearing a facemask. And what we found this happened again, because of my focus on working with patients in April of 2020, my patients after we had launched edge AI and Edge mode in January of 2020. We talked about and I used an example from the stage at our big product launch of where I was at the Green Bay Packers in a playoff game The weekend before and Edge mode. I wore the devices I used Edge mode and it helped improve my ability to understand the person standing next to me that I wanted to hear during the game when we were winning. And we talked about the benefit of edge mode primarily being in noisy environments. Yes, in April, when the full brunt of the pandemic started to hit us in mask modes, mask mandates started to become in different states standard performance standard operating procedure. Sure. My patients came back and said, you know, you told me to use them in noise. But when I'm wearing my face mask and when I'm encountering someone else wearing a mask, when I use edge more, I'm hearing better. So I went into the lab and we started looking at the impact of face masks of social distancing with noise obscuring the loss of audibility and the loss of lip reading. And we further optimized Edge mode to really be agnostic to social distancing the type of facemask that's used, because all masks are not the same. And that was the big learning lesson. Even some of these ones that have clear plastic panels, they do funny resonances that are unanticipated. And so we looked at that we used Edge mode. We did like some of the other companies used a mask mode, a manual program, but the issue is is that then you have to decide are directional mics going to always be on? It's like those old days where you had a manual program, you had to decide what parameters you want to do include Edge mode optimizes to whether there's noise present, whether the mask is born, the type of the mask, the social distancing, that use, and that's all seamless. Once they engage the listener intent in combination with those 55 million adjustments made every hour helped provide audibility, that is personalized and customized by the patient to double tap or button press to enhance that automatic classification to their specific concern right at that moment. We're pretty proud of that because it is really focused on quiet and noisy listening environments to personalize and optimize audibility. For each individual hearing aid user.
Blaise Delfino:
Dr. Fabry, technology aside, the COVID 19 pandemic has definitely forced those of us in hearing healthcare to pivot and think critically, what non hearing aid innovations have you seen in the hearing healthcare industry that have proven you know, to positively impact our industry, but most importantly, our patients?
Dr. Dave Fabry:
Great question. And the one that immediately comes to mind is I would argue that 2020 leading into 2021 has definitely been the year or years of telehealth. I was in a special circumstance when I had the privilege of being at Mayo Clinic in the early 90s until 2002. And one of my mentors there Dr. Darrell Rose had the foresight to begin using the mayo video conference system that they had developed before anyone was thinking of telehealth because mayo in the late 80s. In addition to Rochester, Minnesota, they developed facilities in Jacksonville, Florida and Scottsdale, Arizona, but the integrated plan for health care that they really grew and built their reputation on allowed physicians and health care workers in Jacksonville in Scottsdale, to preserve that integrated model with their colleagues in the other two institutions by simply going into a telehealth room and securely pre HIPAA, ensuring that they had a secure way for patients and providers to confer confidently and confidentially and Darryl had the insight to start doing video conferencing. And in the early 90s, when we had digitally programmable hearing aids and then later digital hearing aids I did reprogramming via telehealth in around 1993. And I demonstrated it live on the video conferences I like to only have kiddingly say telehealth for hearing aids hid in plain sight for almost 25 years until the pandemic occurred. It's a sensitive subject when we were told we weren't essential. And we had to limit care. We still had patients who needed to hear and so telehealth suddenly our telehealth system was used four times as much as it had been previously. Isn't that incredible? My concern, however, is now that hopefully the peak of the pandemic and the waves are diminishing. We're going back to business as usual and not really thinking about the ways that we can innovate to bring in telehealth into the standard practice of care for facilities because it's not always about us. I think one of the reasons again is the resistance has been from the in the mind of the professional that I can't engage with the patient in the same way if I'm virtual. We know from surveys from large clinics that up to a third of every clinic in terms of their clinical appointments. The third of those appointments are for minor fine tuning adjustments that could easily be handled remotely. That's not to say that we want to see in any way that face to face care diminish, right? If I as a patient know that I can get you and I need you for important face to face type care. But also know that if I need a minor fine tuning adjustment and the professionals should be engaged in this because otherwise we're leaving it to OTC if absolutely you can use your expertise and be more efficient for the patient and create clinical efficiencies as well. Then we need to think about telehealth for more than pandemics absolutely biggest concern.
Blaise Delfino:
Dave, absolutely, of course we at Audiology Services we implement telehealth and for every new patient that we fit with technology. Alright, we're going to download the app, you need to create an account. This is why we need to implement telehealth. Of course, it's not for first fittings by any means with our counseling program after we've conducted real ear measurement, we've gotten them set up with their technology. Their final follow up could be telehealth. Yeah, and then they know and they are confident if they're ever on vacation, and they need to touch base because something just sounds weird for lack of a better term with my hearing aids, I can check in with Dr. Fabry, I can check in with Blaise and there is absolutely that sense of comfort, when it comes to telehealth. We've had this vision of having our own telehealth room, where it's a computer dedicated to telehealth that we know is of course secure. But that's all it's used for is telehealth because Dr. Fabry, I could go on for another hour here. If a patient has difficulty in their own environment, let's just say, you know, my cabinets making this weird noise, or I don't like the way that my hearing aids are set in the higher frequencies when I'm home, it just sounds a little different. We are making those adjustments for them in their environment.
Dr. Dave Fabry:
The patient has this established trust with you. And they know that you know their concerns. And in the early 2000s It was popular to try to simulate real world environments with surround sound systems in clinics. But as somebody that was working every day in those days in clinics, patients would say Well, yeah, that's a restaurant but it's not my restaurant. And yes, even if you have male and female and child voices, they say yeah, that's a young woman's voice, but it's not my granddaughter's voice. Now, you think about telehealth, it can involve the actual loved ones in a telehealth session and adjustments and when they're there. Think about when we talk about first time consultations with new hearing aid users. Many clinics sort of mandate that family members come along to that initial visit. We know close rates are higher satisfaction and benefit is higher when you engage the family member. Telehealth actually enables the family member to be engaged on an ongoing basis in their hearing journey. And then as well allows adjustments without everyone having to make a special trip into See you in ways it creates efficiencies. It builds trust builds that engagement not only with the patient, but the family member if they all get to be involved in this process. And then another unexpected benefit and I don't mean to say that COVID has any silver lining at all. But one other issue that we learned from some of the studies that have been published during the pandemic is that those individuals with severe to profound hearing loss actually prefer telehealth synchronous telehealth real time telehealth to the situation where they had to mask up, because when they're in their own environment, as long as they're in a secure and safe environment and the professional is as well, where they had a telehealth room, they could be unmasked. And those individuals who really rely on lip reading, if they're in a clinical setting, they'd have to remain masked. When they're in a telehealth setting. They're unmasked. Yeah, and they could communicate better. So there were all sorts of unexpected benefits. Again, if you just stay aware, stay awake, keep asking questions, as my dad would say, use two ears and one mouth in direct proportion so that you're not talking all the time, but you're listening and observing to what the patient is saying. And telehealth is one of those ones where it hid in plain sight for an awfully long time. It served a critical need during the pandemic. But now we need to figure out ways and get beyond our own concerns and barriers, to build it into Best Practice moving forward for those patients who can handle it. Now, I've worked with telehealth with patients 90 years of age. And telehealth takes on a whole variety of different roles. I mean, it can be counseling, it can be fine tuned fitting, we now on our latest application of telehealth our version of telehealth, we can do an insight to audiogram I encourage clinicians to use that feature. So that now if the patient says I'm not hearing as well out of my right ear, you can do that inside to audiogram and determine whether there's been a change. I think we're the only company in the industry still that has a self check diagnostic tool, which is phenomenal. You know, the patient can run that every day if they want if they're not hearing well. Getting in the routine habit of running that self check feature can help them determine as my hearing changed. Is my hearing aid in need of repair or do I simply need to change a wax guard? Yes, and it saves them visits by enabling them telehealth takes on all kinds of forms. Clinician assistant, patient driven can be YouTube videos, it can be podcast instruction that you have been instrumental in driving those for patients to use and better understand their technology or technology they're interested in so telehealth isn't just for fine tuning of hearing aids. It's for a whole host of things.
Blaise Delfino:
You're tuned in to the Hearing Matters Podcast with Dr. Gregory Delfino, and Blaise Delfino of Audiology Services and Fader Plugs. Today we had Dr. Dave Fabry Chief Innovation Officer at Starkey. Until next time, hear life's story.