SPECIAL EDITION: World Hearing Day 2023 | World Health Organization

The Hearing Healthcare Model: A Team-Based Approach

This year's World Hearing Day theme was "Ear and Hearing Care for All. Let's Make It A Reality." World Hearing Day 2023 highlighted the importance of integrating ear and hearing care within primary care.

Our World Hearing Day Guests:

- Dr. Abram Bailey and Dr. Steve Taddei | HearingTracker
- Dr. Douglas L. Beck Au.D.| Cognivue, Inc.
- Dr. Mark Campbell-Foster | Redux
- Gael Hannan and Shari Eberts | Hear & Beyond
- Dr. Dave Fabry | Starkey Hearing
Dr. Amit Gosalia, AuD, FNAP | AudBoss

In this episode, we discuss:

1. How primary care physicians play an integral role in the hearing healthcare industry.

2. The importance of getting your hearing checked.

3. The comorbidities linked to untreated hearing loss.

4. What companies and providers are doing to create greater access and affordability to hearing healthcare.

With this theme, the communication objectives were to:

• Draw attention of decision makers in governments and civil society groups towards the WHO’s recommendations regarding integration of ear and hearing care into PHC.
• Encourage governments to integrate primary ear and hearing care into training programmes for health care providers at primary level.
• Call attention of primary level health care providers (health workers and physicians) towards the needs of people with hearing loss and ear disease.
• Inform people about the importance of ear and hearing care and encourage them to seek services.

While we know all hearing aids amplify sounds to help you hear them, Starkey Genesis AI uses cutting-edge technology designed to help you understand them, too.

Click here to find a provider near you and test drive Starkey Genesis AI!

Transcript

Blaise Delfino:

You're tuned in to the Hearing Matters Podcast, the show that discusses hearing technology best practices, and a growing national epidemic hearing loss.

Before we kick this episode off, a special thank you to our partners. Starkey. Hear Better, live better. Weave, the all-in-one patient communication and engagement platform. Redux, faster, drier, smarter, verified. Fader Plugs, the world's first custom adjustable mechanical earplug.

Welcome to the celebration of World Hearing Day. I'm your host, Blaise Delfino. And the next hour and 15 minutes, we are going to hear from some of the top thought leaders in the hearing healthcare space. And joining us first is Dr. Steven Taddei and Dr. Abram Bailey from Hearing Tracker. Gentlemen, welcome to the show.

Dr. Steve Taddei:

Hey. Thank you.

Dr. Abram Bailey:

Hi there.

Blaise Delfino:

It is so great to have you both on to celebrate World Hearing Day. And Abram, it's actually Saturday where you're at in good old New Zealand. So for us, Saturday hasn't even happened. So you'll have to let us know what it looks like.

Dr. Abram Bailey:

Welcome to the future guys.

Blaise Delfino:

So Abram, this year's theme for World Hearing Day is Ear and Hearing Care for All. Now, you are the founder of hearingtracker.com, and it is such an excellent resource for not only current hearing aid users, but even potential hearing aid users as well. Share with us what Hearing Tracker is and how does your team create greater accessibility to hearing healthcare?

Dr. Abram Bailey:

Well, first, thank you for having us Blaise. It's an honor to be here with you today to celebrate World Hearing Day. And also, thanks for having us up first.

Blaise Delfino:

Absolutely.

Dr. Abram Bailey:

As you might know, it's coming up to lunch o'clock over here in New Zealand. So yeah, it's hard to imagine because I guess you guys are thinking about dinner right now, probably on your side.

Blaise Delfino:

Sure.

Dr. Abram Bailey:

Yeah. So for those who haven't been part of my journey with this company, I've been doing this for about 10 years. I launched Hearing Tracker at a AAA convention in 2013, and we started the company, I started the company I guess by myself, and it's grown to now quite a number of people who helped me. Steve is kind of the newest member of the team, and he's, I would say our all-star on expert product reviews. So that's something that I'll talk a little bit more about here as I've made a little list of things that I think might be relevant to talk about that Hearing Tracker does.

Blaise Delfino:

Please.

Dr. Abram Bailey:

And your question about accessibility actually kind of stumped me, but I think I've got an answer to that too. So Hearing Tracker started as a product review platform. So when I started it was really, really hard for consumers to, if I would recommend to them in my clinic, "Hey, I recommend a Phonak or an Oticon or Resound." These were products that consumers really hadn't heard about if they were new to hearing aids.

And so when I started the website, I thought, well, this'll be a great way for consumers to go and familiarize themselves with the best products. At the time as well, we had products coming in from, I was actually working in New Zealand back then, so this was before I lived in the States for 10 years. And we had products coming into New Zealand that were not really high quality products coming in from other countries and being sold on the market here. And so there was a lot of confusion in the market. And so I thought, we could start this website, we could help to legitimize the legitimate brands by showcasing them and having consumers review those products.

So that's kind of where it all started. And also, to try to identify even when the big brands occasionally have a bad hearing aid, we would for consumers to know that too. So it kind of started as a consumer review platform, and it's grown to become a lot more than that. So what I have here is that Hearing Tracker is a free hearing aid shopping resource. And right now we've moved from more consumer reviews to expert product reviews. So that is kind of version 2.0 I guess if you want to call it, of what we're doing. And that's where people like Matthew Allsop running our YouTube channel and Steve Taddei who's working in the lab and doing the hands-on part, those two people are pivotal to where we are going with with 2.0.

And we've also started getting into comprehensive service reviews. So looking at some of the networks that are out there. We've done a review of TruHearing, ZipHearing, Yes Hearing, all these different companies that are out there selling product. And also some of the DTC companies like Lively, although that's now Jobber. So we've done some deep dives trying to produce guides that are useful to consumers who are trying to understand the market. And also just more traditional guides, how to find a good audiologist and how to buy hearing aids, things like that.

Then some of the stuff that we do on Hearing Tracker that I would say is fairly unique is we help consumers to understand the prices right across the board from the prescription devices, to the over-the-counter devices. We've got a lot of pricing information available that we come upon by allowing independent practices and others to come onto our platform and put their prices on. So that's something that we help practices advertise their products and services for. And in the process of doing that, we get a lot of pricing information that then we can share on with the consumer. And we've also added audio comparisons, and Steve's going to talk more about that. But that's where we basically allow consumers to compare across the board, OTC or prescription prices and audio quality, listening to samples, all of that. So that's a really unique thing that Hearing Tracker has.

And another unique thing that we have is a product recommendation engine. And that is a really cool thing where people can tell us all about the needs that they have in terms of their listening needs, what their desires are for hearing better, what technology they use, do they use an iPhone or an Android. And we can actually look into our database, which is fairly comprehensive of all the products on the market and say, "Here are the top products that you should consider if you want to meet all of these things, these demands that you've told us, and that would be the most compatible with your existing smartphone technology."

And also, we even factor in accessories. So we look at the entire kind of holistic view of what products should we recommend if we also factor in the accessories that are available for that product. So it's a pretty cool thing if you guys haven't tried that. So that's just one thing. And I'm going to probably have to stop soon Blaise, so we're not going to get to any of these other questions that you had.

Blaise Delfino:

No, I'm loving it.

Dr. Abram Bailey:

We've got a clinic map and services finder, which is really cool. So people can go onto our map. It's got most of the clinics in the US are on there and you can say, "Hey, I want to find somebody that does dizziness and balance, or you cerumen removal. I want to find someone that works with Phonak." So we've got a really cool way to discover products and services that way, locally. We've got communities, so this is obviously a big one for me. There was a forum called the Hearing Aid Forum, which was running for about 10 years before I got involved with the web. And I met the guy who ran it, this guy Osamu, and he's a really nice guy and we sort of had a good relationship. And eventually, he was thinking about letting someone else take it over. So we actually acquired that.

So it's got this immense amount of backlog, like archive conversation going back years and years. And it's still very active to this day where you've got an interesting mix of new users, but also really, really proficient long-term users, sort of techies and that sort of thing. And also a number of providers and industry people who are all sort of mingling in there. And it's really one of the few places you can go if you have a tough question and you can't get help by going to your audiologists. Sometimes people get help on there because there's just such a good mix of people answering tech questions and just also helping people on their way, like if they're just starting.

The other stuff I guess more people are probably familiar with if they follow Hearing Tracker at all is like we, Karl Strom, he runs our news department, so we've got mostly consumer news, but we've also got a little bit of news that comes out. And he also sends a newsletter every morning to, I think it's like 5,100 industry professionals and audiologists and hearing instrument specialists. Every morning he does that.

Blaise Delfino:

It's a big list.

Dr. Abram Bailey:

Yeah. And it's an awesome newsletter. It's one of the newsletters that I open and I get the same thing from everyone that I talk to, even Dr. Cliff and people like that tell me, "Hey, this is the one newsletter I open every day." So it's a super cool way to start your day if you're at all interested in what's going on in the hearing world. And I also put down here, we've got about 1.7 million unique visitors in the last year to the website. And then if you factor in what Matthew's doing in on our YouTube channel, we're probably hitting another million people in a year. So yeah, we're really touching a lot of people with the information and the content that we're putting out there. I don't know if I should go into the part about accessibility. Should I stop? I've got a hard stop now.

Blaise Delfino:

This is the Friday 4:00 PM Mountain Standard Time News. Accessibility, it's such an umbrella term. What Hearing Tracker has done, I give you and your team so much credit because you are sharing trusted news. You are a trusted source when it comes to overall hearing healthcare, hearing technology. And what you're doing is bridging the gap between understanding what hearing technology is and introducing to the patients and potential patients really what it is. And you're able to connect them with trusted professionals in the field that implement best practices and do the whole kit and caboodle when it comes to audiological assessment.

You had mentioned there that an extension of Hearing Tracker. So Steve, Dr. Taddei, we have had so many conversations. He's a fellow audio engineer, he really focuses on sound design. And what better way to implement your passion for audio engineering, but marrying that with hearing technology. And Steve, I'll never forget the conversation we had. You had said, "Blaise, what if there is a way to sort of hear the hearing aids before you purchase them?" And I'm like, "Steve, sick idea. That would be so cool if it happened." Well, guess what? It's happening because you, Abram and Andrew Sabin launched HearAdvisor. So please tell us what is HearAdvisor and why is this such a breakthrough in the hearing healthcare industry?

Dr. Steve Taddei:

Absolutely. And thank you for having me on. This has definitely been kind of a dream project, I think for all three of us. And absolutely, like you just said, it's strange when you think of all the technologies that are available and people really don't have any means to listen to them short of going to a provider and having them programmed for them. And it's just a really clunky system if you want to try and audition several different systems. So what we ultimately did is we sat down and we said, "What is a way that we can provide easily understandable, and unbiased means for people to listen and just evaluate hearing aids?" And one of the main reasons for this is, the catalyst for this, other than it just being really cool to hear hearing technologies of course, is you can go on Amazon and you can find devices that have the same exact advertising language as $8,000 hearing aids that you might purchase from a hearing clinic.

They'll say, "We make speech clear and we help the background noise." And those are pretty much the two big points that are made. And with the technology nowadays, even the cheaper stuff or the less expensive stuff can still stream. So our ultimate goal then is to try and weed through that and provide subjective content for people. And that would be sound samples. So they can sit in the comforts of their home and listen to Apple AirPods Pro and compare that to one of the most, the Cadillac hearing aid from any of the major hearing aid manufacturers. And everything between, it's not just hearing aids. It's OTC devices, it's earbuds. So that's the subjective side of it. And then we also provide objective data. And those kind of give a little bit of a yin and yang. And what I mean by objective data is once we have those recordings, we put them through validated tests from the hearing sciences literature, and those tests emulate the auditory system and the injured auditory system. And they are predictive of outcomes.

And really all that means is it should emulate... The data that we get should coincide with what an individual might experience, who has a similar hearing loss to that as how we've programmed the devices. And really that's what we're doing. I can get into how we're doing that. I don't know how much time you have because it's a long... It's not arduous, but it's a long process. But in a nutshell, the ultimate goal is to provide people a means to actually listen to these devices without having to rely on the marketing information from companies or potentially not to their own fault, but the limited information a hearing care provider might have.

Blaise Delfino:

Steven, I am incredibly excited for what is on the horizon for HearAdvisor. Congrats to you and Abram and the entire team. So we are celebrating World Hearing Day. The theme this year is ear and hearing care for all! Let's make it a reality. With Hearing Tracker's deep passion for introducing and sharing accurate hearing healthcare news. You are doing just that. You're making ear and hearing care for all a reality. Sharing this trusted news. I have to know, Abram, you and your team were at the front lines of all of the O T C hearing aid news the past few years. What were some of the lessons learned and takeaways that you and Steven and the whole team kind of have?

Dr. Abram Bailey:

Yeah, good question. There's been a lot. And admittedly, I haven't read every news article and every paper that's come out. But the big take homes for me, obviously first and foremost is that I think over the counter hearing aids are a good thing. I think there's not really that many people that you'll meet today, audiologists or otherwise, that would argue that OTC hearing aids are a bad thing. I think a lot of us have come around to the idea that there are people who are going to be helped by this, that are going to fit the candidacy criteria well. And there's very little, I think, threat of any kind of harm coming to most of those people. Obviously, these devices aren't for everyone. We all know that. But I think that there's been a lot of clarity coming out, I think, in the media about who the devices are for and who they're not.

One of the things that I actually love about OTC is that it's given an opportunity to a lot of audiologists and people in our industry to get in front of the media and talk about the things that we do as professionals, what our industry does to serve this community. And I think it's helped to differentiate the services. When we're talking about things like best practices or real air measurements, every article that we write, for example, on Hearing Tracker, we're showcasing the opinion of at least one audiologist. And we are always talking about, "Hey, look, these are products that you can get over the counter."

But also remember, these are the things that you'll be missing if you go ahead with that product. And it's not that we're recommending people don't go with an OTC, but we just want them to also learn about the other things that could be part of their care, should they try to go the more comprehensive route. And that might be planting seeds for later too. As that person's going through their OTC experience, they might in the back of their mind, think, "Maybe I could be doing better next time or even this time." So that's one thing.

And the other thing is I think the market is, what I've been hearing is that it's relatively small. I would say that's actually not a good thing. I wish that OTC was having more of an impact. But on the industry side, I guess for audiologists and for the people in the prescription industry, I think it's seen a little bit as a positive that it is opening up a kind of different market where you're talking about younger people who haven't tried hearing aids before. I think a lot of the existing hearing aid users, they have already come to learn the value of the care that they're receiving, the counseling that they've received or the troubleshooting sessions that they've been through. They've already come to realize the value of that.

When you go into our forums and you listen to what people are talking about, whenever we post an article about some OTC hearing aid, most of the people that respond are saying, "That's cool, but I'll stick with my audiologist." I'm not going out there looking for validation of our profession. That's just coming organically, right? So I think it is kind of cool just kind of seeing where it's all going. But I think the other take home too is we don't really know what the future holds. We don't know how good these OTC devices may become. I hope that they become a lot better or how cheap they might become. And I think it is an open question as to will those users who end up having success with these products or future products, will they stick with OTC, or will they eventually migrate over to the medical model as so many people expect?

Blaise Delfino:

Well, being that this year's theme is ear and hearing care for all, especially for the countries that may be underdeveloped and aren't looking for support in those noisy situations, OTC might actually be great for those individuals. Dr. Bailey and Dr. Taddei, I want to thank you both so much for joining us today. Dr. Taddei, if our listeners tuned in, want to learn more about HearAdvisor, how can they do so? Can they go to a website? Kind of share that with our listeners tuned in before we sign off and invite Dr. Doug Beck on the screen?

Dr. Steve Taddei:

Absolutely. You can go to HearAdvisor.com, and you'll learn a lot more about our methods. There's a video on there, there's a white paper as well that goes into the nitty-gritty of our testing. And a lot of the data is now available directly on Hearing Tracker. So you can find any of that information on there. And I would also welcome anyone who has any questions, comments to please email me. And that would just simply be Steve@hearadvisor.com or Steve@hearingtracker.com, and I'll respond to one of them.

Blaise Delfino:

Dr. Taddei, Dr. Bailey, thank you so much for celebrating World Hearing Day with us. Thank you both so much for what you're doing for the hearing healthcare industry. We'll see you soon back on the Hearing Matters Podcast.

Dr. Steve Taddei:

Thank you very much.

Dr. Abram Bailey:

Thank you, Blaise.

Blaise Delfino:

So you heard it from them, Dr. Steven Taddei, Dr. Abram Bailey. Now, again, we are celebrating World Hearing Day. This year's theme is Ear and Hearing Care for All. And now we're going to invite the one, the only, Dr. Doug Beck. Doug, what's going on, my friend?

Dr. Doug Beck:

I just want to compliment you. Very few people have ever worked into an audiology or hearing discussion, the word kit and caboodle. But you did about eight minutes ago.

Blaise Delfino:

We made it happen. Doug, I need to know, what is the connection between cognition, audition, and amplification? Share it with us as we celebrate World Hearing Day.

Dr. Doug Beck:

We got about three hours, right? So here's the thing. In 1949, Dr. Michael Buss was writing for the Journal of Speech, Language, and Hearing Research, which is an ASHA publication. And he said, the thing is, how do you know how much of a hearing or speech and noise or hearing difficulty, how much is from the auditory system versus other parts of the central nervous system? So you have psychology, you have emotion, you have language, you have all these things working together with audition. So to be clear, because it is a celebratory day, hearing is just perceiving or detecting sound. Listening is making sense of sound. And these are very, very different functions. Of course, listening is built on a foundation of hearing. But listening involves memory, it involves executive function, it involves your vocabulary, it involves your brain's ability to assemble these sounds into meaningful units, to derive meaning from what you hear.

So the number one complaint that every audiologist, every hearing [inaudible 00:22:40] deals with every single day is, I can't understand speech and noise. But they don't necessarily complain about hearing because hearing is perceiving or detecting speech, and noise is kind of about making sense of the sound that you perceive.

So what Michael Buss put forward 70 years ago, we now have the ability to say, here's a patient whose primary issue is they can't understand speech and noise. So the question that all of us as doctors, as licensed healthcare professionals, have to ask, "How much of this is their auditory system and how much might be attributed to something else?" Perhaps attention deficit disorder, attention deficit hyperactivity disorder, perhaps dyslexia, perhaps cochlear synaptopathy, perhaps hidden hearing loss, perhaps traumatic brain injury, perhaps mild cognitive impairment, perhaps some sort of neurocognitive disorder. Could be Alzheimer's, could be Parkinson's with dementia, could be frontotemporal, could be a lot of things.

And it turns out the numbers support this. There's about 37 to 38 million people in the USA who have hearing loss on an audiogram. But there's another 26 million who have no hearing loss whatsoever. But they have difficulty understanding speech and noise, and they have difficulty with hearing.

Now, if you go to the brand New American Journal of Audiology, which is an ASHA publication, in March, 2023, they actually talk about this as a functional hearing deficit. And they say, this is a big area that we have-

PART 1 OF 4 ENDS [00:24:04]

Dr. Doug Beck:

[inaudible 00:24:01] hearing deficit. They say this is a big area that we have to investigate and explore because most of the time we talk about hearing, we talk about listening, we talk about speech and noise, what happens is we use hearing as a proxy for the whole system and it's not. It's not. Hearing is just detecting sound and when we measure it on an audiogram there's a lot of problems with that. We're measuring a threshold, we're measuring the least amount of sound that somebody could hear at a particular pitch or frequency. That's cool and that lines up well with otolaryngologic diagnosis. We can look at an audiogram and we can see otosclerosis, we can see noise-induced hearing loss. We can see age-related hearing loss, we can see an assymetry. We can see lots of things but what we can't do is tell how they're getting by in the world unless we do a speech and noise test, that's a functional listening test that kind of replicates the real world.

Now, the question about how does that correlate to cognition? Well, Dave Moore, David Moore wrote an article about seven or eight years ago with a team and he was talking about when your speech and noise score isn't so good that might be a first warning sign of a problem that could occur in mild cognitive impairment or some sort of dementia. Well, that was an interesting observation and I think he was right. But the Biobank Study from the UK came out in 2022 and they said, "When you study 65 and older people and you study them for 10, 12 years, the people who had the worst speech and noise scores had a .61 hazard ratio, 61% hazard ratio for developing dementia and other problems later." That doesn't mean that everybody who does poorly on speech and noise is going to develop dementia, that doesn't mean that at all.

It means there's a correlation though over the years, over the 10 to 12 years that those people who did the worst with speech and noise started to develop more problems with regard to mild cognitive impairment or cognition or related matters, so that's why in audiology I think it's really important to do cognitive screenings. It helps us decide who is a pure audiology patient and who is an audiology patient who might have other issues, in which case all we do is refer. We refer them back to their GP so the GP or their PCP can look at the data and say, "I'm not concerned about this." Or he or she might say, "Okay, I think this is worthy of investigation. You didn't do well on executive function. You didn't do well in memory issues. You didn't do well in spatial temporal so we're going to refer you to a neuropsych or a psychologist or whomever to do a diagnostic test."

Screenings are not diagnostic at all and it's always an issue with screenings because when you think about gastroenterology screenings, when you go and get a lower endoscopy, that's $2,000. That screening is actually kind of diagnostic.

Blaise Delfino:

Right.

Dr. Doug Beck:

People get confused over these terms because you think hearing screening. Well, hearing screenings are not very good. I mean, this is a big, big issue because all it tells you is your detection level. Imagine if we did detection levels in optometry so we look at red, orange, yellow, green, blue, violet, and we say, "How much light does it take for you to detect that?" That wouldn't tell us if anybody's nearsighted or farsighted, that wouldn't tell us what correction, what lenses they need, none of that and it's the same with a pure tone audiogram. It's telling you a very, very little bit of information that's important but nowhere near a complete picture, which is why I always advocate comprehensive audiometric evaluation for adults.

I don't believe in screening for adults. I think there are lots of times when screenings are appropriate, newborn infant hearing screenings mandatory. Probably 99% of all children born in the USA get that right away, and that's incredibly important. Children at school, great, but the thing is, that when you're talking about children in school the bigger issues are things like language, and articulation, and vocabulary, and ADD, and dyslexia, and ADHD, and these sorts of things. If you're just doing pure tones you're going to say, "Oh, the child hears normally," but the bigger issue would be does the child process information normally? So that's the same with adults and that's why I think cognitive screenings are very important.

They allow us to make a decision that this is an audiology patient who we can attend to because we're doctors of audiology, we're licensed hearing instrument specialists, we're otolaryngologists, we can handle the audiology end of it, or there could be something else in your ability to process information that we're not experts in so we're going to refer you for that. But that's a very common thing. When you think about dentists, they'll inspect your mouth for oral cancers. They don't treat that, they refer for that. Think about an optometrist, they check you for glaucoma. They don't treat that, they refer you for that so I think we're in good stead. And ASHA said in 2018, it's part of our respon ... Not our responsibility but our best practice is, is to screen for cognitive disorders because they often overlap with listening disorders.

Blaise Delfino:

Doug, when ...

Dr. Doug Beck:

That was a good answer.

Blaise Delfino:

No, it was ... You must have been doing this for maybe over 20 years to have all of that jargon there. When we talk about cognitive screenings, before we welcome our next guest from backstage, tell us briefly what Cogniview is and how this technology actually helps not only the patient but the hearing healthcare provider as well.

Dr. Doug Beck:

Okay. So Cogniview is the company that I actually work for, and you mentioned it so I feel I should address it. The screener that they make that most audiologists and dispensaries will use is called the Thrive, and the thing that sets it apart ... I mean, there's lots of good screeners, don't get me wrong, it's not like that's the one and only like there's only one hearing. No, there's a million hearing aids and they're all pretty decent. If you buy it from the primary manufacturers, the top five, I can almost assure you you're going to get a very good product. OTC, you might get a good product, I don't know, there's a very good chance. When you talk about cognitive screeners, the thing that's so important for people with hearing and listening disorders is our screener, which is FDA registered, and it went through an FDA analysis and it was approved about four or five years ago.

That screener in particular is very, very good for people with hearing loss and suprathreshold listening disorders because it doesn't have any auditory stimuli. The stimuli that you see is visual and you move like a joystick, it's called a [inaudible 00:30:27] anyway. So you have this little joystick and you have your vision and that's how we determine your executive function, your memory, your visual or spatial and it's different every time you take it because it's driven by adaptive psychophysics. So if you take it really fast you're going to get one answer, take it really slow, take it on a different day it's never the same test twice. I shouldn't say never. The chance of it ever being the same test twice pretty remote because it's always based on the patient's response.

But the beautiful thing here, your hearing loss doesn't get in the way and it prints out a report that you can then send to the physician or the PCP or whomever the patient was referred in by. This becomes very, very important in patient care. As a matter of fact, ASHA, Dr. Arlene Pietranton, was the executive director of ASHA for 17 years. As she was retiring about two years ago I asked her, "What do you think about cognitive screenings by speech language pathologists and audiologists?" And she said this. "That's better patient-centered care and that's more holistic and we've been advocating it for decades." And so, I don't think there's any real question. As a matter of fact, I also am a big fan of AAA and in their new statements coming out they ran by the membership, all of us who are members of AAA got to look at the new best practice statements and they were clear as well that they included cognitive screening in there.

Now, that hasn't been finished or finalized as best I know but it was in there for evaluative purposes and I suspect that they too will get on board and say, "Yes, this is clearly important," because we know that listening, making sense of sound is not just hearing, and this is a big, big issue. The American Journal of Audiology right now, the March 2023 Edition, talks about how important it is to get past the audiogram. You have to do a functional hearing assessment to know what the patient's quality of life, to know what their ability to get by in the real world is. It's not about pure tones. That's why ASHA, AAA, IHS, they all say the same things. If you do your diagnostics, but then you have to do communication and listening assessment, then you have to do speech and noise. These are your best practices so that you're not just looking at somebody's ability to hear beeps at the quietest level possible. It's how are they doing in real world situations.

Blaise Delfino:

Doug, I am super excited for the continued success of Cogniview. As always, my friend, it's always such a pleasure having you on the Hearing Matters Podcast and, from the bottom of my heart, thank you so much for celebrating World's Hearing Day with us.

Dr. Doug Beck:

My pleasure, Blaise, and thank you so much for the kind invitation and I am looking forward to Dr. Fabry, who's one of my dear friends, and I always enjoy what he says so thank you so much for having me.

Blaise Delfino:

Take care, Doug. You heard it from the man himself, Dr. Douglas L. Beck. Now we're going to bring in Dr. Mark Campbell Foster. He is with Redux, and if you wear hearing aids and you ever drop them in the pool or the hot tub or you get caught in a torrential downpour, do not worry because the Redux is here to help. Mark, welcome to the Hearing Matters Podcast.

Dr. Mark Campbell Foster:

Thank you so much for having me, I'm really excited to talk about Redux with you today and help everybody who wears or uses hearing devices hear their best they can with Redux so thank you.

Blaise Delfino:

Mark. This is a huge week for Redux. Your team just launched Redux Light, Redux at Home. Tell us more about these hearing aid dryers, my friend.

Dr. Mark Campbell Foster:

Well perfect. So if you don't know about Redux, Redux has been around for over 10 years. We got our start in Verizon stores. We are in over 3,000 stores right now in Verizon and if you ever have a dead cell phone we actually can bring it back to life over 50% of the time. And when we started having this great success reviving these dead cell phones, the founder of our company, Reuben and Joel Trustee, came out with this concept of let's see if we can apply this to hearing aids. And so, they have this wonderful patented technology that now actually saves dead hearing aids over 50% of the time. We can take weak aids and even good aids, and good aids that sound great will sound better 80% of the time. And the reason is, is that I'm in sunny Aruba right now, it's World Hearing Day, and you can see I'm a little bit dewy. My moisture is coming into my processor.

Well, I wore my Apple watch in the pool, it pulled out 33 microliters, right? We're just getting moisture everywhere. And the thing is, is that just a little bit of moisture really can take away some of your sound because the effects are cumulative, and that's what Redux really went out to [inaudible 00:34:57], is that there really isn't a true dryer on the market that does what we do. And so, some of the things that make us different is that we have humidity sensors that actually literally monitor the moisture in the hearing aid at the time it's in the dryer and we can remove all the moisture until that sensor reads zero humidity. So this was a tool that we had in the clinic but now we have this new patented technology to be at home.

That's really what's exciting is that those that were going to their audiologist, their hearing instrument specialist to get their hearing aids dried can now have access to this dryer at home. I actually don't even like using the word dryer because it's actually an ultra efficient evaporator. In our current model that we have we actually lower the boiling point of water to 99 degrees so if it's safe on the body it's safe in the dryer, and I literally have one right here, I travel with it. So you put it in here and in six to eight minutes all the moisture's gone. And, like I said, if you ever have the stress of, "Oh my gosh, something's going on with my device, it's starting to sound intermittent," a lot of the problems are is that it's moisture. And if we can solve it with a quality dryer, and I'm not knocking the dryers out there, every little bit helps. But our dryer actually has a sensor which is novel, and we actually have a desiccant that rejuvenates itself. And so, that desiccant is constantly pulling the moisture out and it's just a wonderful thing to be able to launch this product this week.

Blaise Delfino:

Mark, being myself a product of the product and a former private practice owner, I cannot tell you how essential ... Well, I can tell you and you'll believe me because you are a product of the product as well.

Dr. Mark Campbell Foster:

Exactly.

Blaise Delfino:

I could not imagine operating a private audiology practice or a hearing healthcare clinic at all without Redux and I truly do mean that because we talk about conducting real ear measurement. So there would be so many times where I would conduct real ear measurement and I would do different case studies and I would share those findings with Dr. Doug Beck and we would nerd out about all these really cool findings. But what I would also do, and what we would do, is before we conduct real air measurement, Mark, on a brand new hearing aid or a hearing aid we just fit, we dry out that hearing aid before we make those adjustments. So we have used Redux for going on four years now. Your team just had this huge, really exciting launch. Tell us a little bit about the difference between the at-home dryers that everyone's sort of seen on Amazon. What's the difference with Redux? You talk like an at-home evaporator. Kind of bring us through the difference there.

Dr. Mark Campbell Foster:

So current dryers right now use a little bit of a low heat and a fan, and what they're taking is they're taking the ambient air in the room. So right now, like I said, I'm in a Aruba on vacation. There's probably 70% humidity in the air right now. And so, if they're taking that humid air and passing it over the hearing aid we're never going to get it any dryer than the ambient air because the dryer actually also has to dry the air around the hearing aid. And thus, you never really get to that total end point, which is where, when we have the humidity sensor to measure it, we can then tell that there is no humidity. But also with the other dryers, they have an open system where they're taking in that ambient air. We actually have a closed system, a chamber that isolates the air within the chamber.

And what we do is that we're taking the environmental air and we dry it to become ultra, ultra thirsty. So that air doesn't exist naturally, it's the driest air. And so, once you put it into the chamber over the hearing aid, it actually acts like a wick. Moisture immediately pulls into that ultra dry air and when it becomes completely saturated we push that air over the sensor to measure how much moisture is there because if there's none we're going to stop. But if it's so full, we pull it over the rejuvenating desiccate, dry that air back to ultra dry, and then we pass that air back over the hearing aid until we get to the endpoint of no moisture. And so, that's the beauty of our device, is that we're truly solving the problem of removing all moisture from the air that we treat the aid with.

And by doing that we can then say, "Oh, we have solved the issue. We've taken all the moisture out, the humidity center said there's no more, you're good to go." And to your point, Blaise, when you did this with the hearing aid before fitting, you are setting it to its baseline of not being affected to moisture. And thus, the aids are then able to be troubleshooted to the best of their ability because you know moisture's not affecting it. And so, that was kind of the other thing is that if you didn't have a quality dryer to remove all the moisture, then you might not have truly resolved the moisture issue to then say, "Oh, what else is going on?" So that's one of the things I'm most excited about is that Redux really does have this awesome patented technology to help truly remove all moisture.

Blaise Delfino:

And Mark, to dovetail off of that, when we talk about this year's theme of ear and hearing care for all let's make it a reality, especially this event right now, we're talking about the team-based approach. When you implement the team-based approach of involving the primary care physicians and individuals on the primary care level, well, the Redux is a system that not only is available at hearing healthcare providers but now patients can have it at home. So when we're talking about access to better hearing, access to dry hearing aids, Redux absolutely solves this problem.

Dr. Mark Campbell Foster:

It does. And I spent 10 years working in the cochlear implant space and I would hear people that would have to drive hours and hours to show up to clinics and sometimes the issue would just simply be moisture, and if they had a quality dryer they could have saved that time, and that's really where I see that. Having hearing loss, these devices are such a lifeline to us and anytime that they start to break down there's such an inherent stress that we all feel and if we all ... Like, I talk about my sister's story. So my sister has MS and she has lesions that around her spine. And sometimes when the lesions get big it can affect her auditory nerve so sometimes she doesn't know if it's her hearing aid or if it's her MS. And so, what she does is she puts it in the Redux and when it comes out ... And I always remember the first time she did it.

She turned to her husband after we were talking and she said, "Mike, I haven't heard you this well in so long." And that's when I got goosebumps because this is my sister who I love dearly and I never want her to be worried about her MS and things like that. And so, just to be able to give this tool to her, I'm getting goosebumps now talking about it because that's really quality of life, right?

Blaise Delfino:

Yes.

Dr. Mark Campbell Foster:

And so, we all deserve that. And so, I'm happy to be here to talk about that because I really thank what you're doing is wonderful work and thank you.

Blaise Delfino:

Oh, Mark, absolutely. Thank you because ... Thank you and your team for providing us hearing healthcare providers with the tools to help our patients because, again, when patients come in for a clean and check appointment, putting their hearing aids in the Redux. Just the other day when James so kindly sent us a new Redux system, I have a relax and Redux on Sundays so I put my Fitbit in there, I put my ear pods in there. We pulled out so much moisture and it is a problem and it always has been a problem for hearing aid users. Mark, before we sign off and bring on our next guest, how much does the Redux help patients who wear custom hearing aids?

Dr. Mark Campbell Foster:

It helps everybody. So if you're wearing custom hearing aids, the ear is like an Amazon rainforest. So as soon as you take a hearing aid that's outside at a lower temperature and you put it into an ear, it's immediately going to get condensation. So anybody that puts anything into the ear is susceptible to moisture, and that's including ear pods, hearing devices, anything, so anybody works. So yes.

Blaise Delfino:

Mark, if our viewers want to learn more about Redux, where can they learn more about Redux and where can they learn more about the Redux Pro Light and the Redux at Home?

Dr. Mark Campbell Foster:

Well, go to redux.com, our website, and if you can't find some of the information there, please email hearing@redux.com. Our website is undergoing a revamp and so more information to come, but anything we can do to help, please feel free to reach out to us directly.

Blaise Delfino:

Mark, I want to thank you so much for celebrating World Hearing Day with us. I'm excited for Redux's continued success, and we'll see you back on the Hearing Matters Podcast in the very near future.

Dr. Mark Campbell Foster:

Awesome, Blaise. Take care and thanks everyone, have a great time.

Blaise Delfino:

Take care, Mark. So that was Dr. Mark Campbell Foster. He is with Redux. They have an incredible hearing aid dryer. Now we are going to welcome Dr. Dave Fabry to the stage. Dave Fabry is the Chief Innovation Officer at Starkey. He's a great friend and he's had quite the busy week so let's bring him back on stage. Hey, Dave.

Dr. Dave Fabry:

Hey, Blaise, how you doing?

Blaise Delfino:

Good to see you, my friend.

Dr. Dave Fabry:

Good to see you too. Really enjoyed the speakers before me. I'm in beautiful Scottsdale, Arizona where we had moisture this week, which was not characteristic to this environment but we ...

Blaise Delfino:

That's why I got my Redux.

Dr. Dave Fabry:

That's why you need redux. So yes.

Blaise Delfino:

Dave, this year's theme, You're in hearing care for all, let's make it a reality, you actually touched upon this this morning with Starkey's live event celebrating World's Hearing Day, and the WHO, World Health Organization, mentions the importance of educating policy makers on hearing healthcare. Why is it so important to educate elected officials?

Dr. Dave Fabry:

Well, I think we touched on this a bit this morning on the broadcast but the issue is, is while creating accessibility and affordability for hearing aids is extremely important, and we applaud the efforts to introduce this new category of over-the-counter hearing aids, but we also want to ensure in that spirit of accessibility and affordability that there is access to professionals. And, in many cases, the elected officials sometimes follow the lead and maybe misinterpret and misunderstand the role of the professional and think that really it's only the technology that's going to solve all of the problems. So one of the things that we saw was, in many cases, a confusion over that over-the-counter versus the prescription category of how the professional fits in and whether or not there should be limit to accessibility of the type of professional who is licensed to provide care.

This, we feel in some cases, in some of the states, it's already cropped up where it was limiting accessibility to certain professionals. And this really penalizes those who live in rural areas especially because, as you know, hearing care professionals are in short supply, there's more demand than there is a supply right now. And so, I think one area where we saw action turn into improved accessibility to professionals was in getting some of the language that existed in state laws when the FDA created this new legislation clarified so that it wasn't having an unintended consequence of limiting access to professionals. And the FDA did follow-up with statements clarifying that that was by no means their intent.

And that would've only happened if the professionals who lived in states contacted their state representatives, and the state is really where a lot of this occurs. This action and activity occurs because every different state has slightly different license laws and we didn't want to see that prevent accessibility to professionals.

Blaise Delfino:

And Dave, this really does spark the challenge that Ohio went through, Matt Starner, a couple of weeks ago. So when you mention living in a rural community, if you will ...

PART 2 OF 4 ENDS [00:48:04]

Blaise Delfino:

... living in a rural community, if you will, and this year, it's all about access to hearing healthcare. It's ironic that if there is a change in a bill that takes out licensure and replaces it with a registration, share that experience with us with Matt Starner in Ohio, what you were able to do with Michael Scholl and what that looked like, but why it was so important to ensure access.

Dr. Dave Fabry:

Well, as you know, Matt reached out to you and me early in the morning on the day when this bill was first proposed that was going to potentially restrict access to professionals, and he was an ambassador for a Listen Carefully program that we happen to have that... It doesn't really benefit Starkey. It looked to really benefit the industry by helping inform people what's going on at the state level. You could find it at listencarefully.org and click on the state where you reside to see what is going on in that state. Matt reached out to us because he had some concerns about the language in Ohio and we were able to quickly canvas with Michael Scholl, who works at Starkey and heads up our government affairs area, and we were able to actually have conversations with Matt. He went and testified and in the matter of just a couple of days, they realized that they were not interpreting the intent of this bill and clarified it and actually were able to exact the change within a week, which is unheard of in politics, right?

Blaise Delfino:

Yeah. It was-

Dr. Dave Fabry:

It was all due to the efforts of the grassroot level at the state to ensure that in providing improved accessibility and affordability, it doesn't limit access to quality technology and quality care.

Blaise Delfino:

Exactly. Dave, it was such a win and you really hit the head of the nail. It was such a win for the hearing healthcare industry in specifically Ohio. This year, ear and hearing care for all, let's make it a reality and we are trying our best to do just that. So Starkey had a very, very busy week. On Tuesday, we had probably the largest product launch in company history. It was incredible. The reason we want to bring this up is because a lot of the benefits of the technology, sharing a lot of those features, not only with caregivers, but also physicians because there's biometrics we're talking about. Tell us more about Genesis AI.

Dr. Dave Fabry:

Sure. I won't go too far into the weeds here. I know it's late in the day and the focus is on access for all, but we were really excited with this product launch, as you said. Genesis AI is our biggest product launch in our history. We had 3000 people participating in the webinar that we put on earlier this week, and we'll have a recording for people who do want to get into more of those details, but one of the big things we've seen is an explosion in the use of AI, artificial intelligence, and even deep neural networks to assist the automation of hearing aid processing with the intent of the person wearing the hearing aids to provide outstanding sound quality and speech intelligibility, both in quiet and in noisy environments. That's always job one, but as you mentioned, the other area that we've seen in explosion in the last few years is with regards to rechargeable hearing aids.

One of our excitements is on the receiver-in-the-canal device that we introduced, which is the most popular style. We delivered a rechargeable battery that can offer up to 51 hours on a single charge. Many people who use electric vehicles, cell phones or hearing aids that are rechargeable have range anxiety. We want to really ensure that all day, every day, both out of the box and years into the future, that no matter how much you're going to stream, whether you're streaming a podcast, whether you're streaming music, that you can confidently listen to those devices all day, and this was really a differentiating feature and part of this launch. We aim to have the longest battery life in every form factor, whether it's custom devices, receiver-in-the-canal devices. We want to give that confidence and peace of mind to hearing aid users for all day benefits in terms of sound quality and speech intelligibility. Durability, you were talking with Redux and moisture, really trying to make these devices as bulletproof as possible to maintain the highest moisture and dust resistance.

We are proud that every form factor we offer is an IP68 rating, which means that you could submerge this in water for 30 minutes and bring it out, dry it off, and still use it. We'd still benefit from being able to dehumidify even more, but that's central to this, and then getting into the health and wellness features, as you say. Since 2018, we've incorporated motion sensors that contract physical activities and Genesis AI, it can actually, I say automagically, determine whether you're walking, running, on a bicycle and control that via the user app we call the My Starkey app and it will keep track of your activity throughout the day. Why is that important? Health and wellness hearing care is healthcare. Many cardiologists will tell you that in an aging individual, the ear is one of the best barometers of cardiovascular health.

We want people to stay active physically but also mentally, and that's the other part that, for years, we've been able to have people track within the app. With My Starkey, we've enabled them to track their social engagement as well because we know you need to wear devices and engage with other people. You can even share a companion app that someone could use and assist you, be a motivator for you to wear your devices more. We say, "Hear better, live better," because we believe it's all commingled. The last area that we're really excited about is we've dramatically improved the range for connectivity with these products so that whether you're connecting to your smartphone, whether you're using one of our accessories like a beamforming microphone that you can use in a classroom or as a TV listening device, that we've improved that range by 40% in some cases. We say all new everything, and if you want more information about that, I'd encourage you to go to starkey.com or contact your representative at Starkey if you're a professional and we can provide you with additional details.

Blaise Delfino:

Dave, really so grateful to have you joining us on the Hearing Matters podcast yet again. I know it's been an incredibly busy week for you. To sign off, in 30 seconds or less, why should our listeners tuned in go get their hearing tested next week?

Dr. Dave Fabry:

Well, I think everyone before me has emphasized this and I'll say again, hear better, live better. The average person waits five to seven years from the time they think they have difficulty until they get hearing aids, and so the issue of... By going to a professional to get the proper assessment, to choose the proper device, people always ask me, what's the best hearing aid? I say the ones that are worn. The professional can not only help do the diagnostic test. I agree with what Doug said on the focus on cognition, also evaluating speech in noise is where people first notice they have difficulty. The evaluation, the selection, and importantly, the follow-up is what delivers the best results. We say our technology in hands of the professional is what delivers the optimal outcomes.

Blaise Delfino:

Absolutely. Dr. Fabry, thank you so much for joining us on the Hearing Matters podcast yet again. Have a wonderful evening, have a safe trip back home, and until next time, hear life story, my friend. It's always a pleasure having you on.

Dr. Dave Fabry:

Thanks so much.

Blaise Delfino:

That was Dave Fabry. He is with Starkey and absolute thought leader and always love when Doug Beck and Dave Fabry are on the same episode because they emphasize that we don't hear with our ears, we hear with our brain and how important that listening and understanding, it's all connected, but it's all very different. I think this is such a great segue. When we talk about not only listening, understanding, and hearing, and when we do hear better, we live better, this is all about communication and who better to talk about communication than Gael Hannan and Shari Eberts. They are the authors of Hear & Beyond: Living Skillfully with Hearing Loss. I have to say this is the book. If you are a current hearing aid user, if you're a future hearing aid user, you need to read this book. We're going to bring them on stage. Gael Hannan and Shari, welcome back to the Hearing Matters podcast.

Gael Hannan:

Great to see you.

Shari Eberts:

Great to be here.

Blaise Delfino:

Oh my gosh, it's been too long. What has it been? Like three weeks since we've all talked to each other? When we talk about communication and you each had a solo episode on the Hearing Matters podcast, and my gosh, we reached so many ears and I'm always so excited about that because of the impact we are making as a community. All of these speakers tonight, it is because of you that we're able to raise awareness of World Hearing Day, of accessibility to overall hearing healthcare. Communication is an exchange of ideas, and in your book Hear & Beyond, you talk about, Gael, communication game changers. Tell us about these game changers. This has to be one of my favorite parts of the book. What are communication game changers?

Gael Hannan:

Communication game changers are the non-technical communication behaviors that we use to communicate. The behaviors that work with technology. It's my favorite part of the book too because I am not technical to say the least. I'm so glad that it was Doug Beck that went through all of that and not me, but communication game changers allow us to handle any listening situation. One of the first and foremost examples of this is self-identifying with hearing loss. This seems to be a real sticking point for so many people with hearing loss, even those who've lived with it for years. If you don't tell someone you have a hearing loss, and when you do that, it's only telling people of a fact.

You let them know and that you cannot converse, you cannot have good communication no matter how good a hearing aid you have unless you self-identify and also self-advocate. It's one thing to go, "I have hearing loss." People go, "Okay." The follow-up is, "and this is what I need for us to communicate well." Self-identification, self-advocacy, speech reading. Speech reading is a skill that can be developed. We all do it naturally to some degree, but learning about speech reading really enhances our ability to communicate. Those are examples of the sorts of non-technical behaviors that work with our technology and with our attitudes. The end. Yes, those are the-

Blaise Delfino:

Shari, if you can dovetail, when Gael mentions these communication game changers and she had mentioned advocating for yourself, if you do present with a hearing loss, and that's so hard to do sometimes. Even as humans, it's like, oh, I really do want to advocate for myself, but why is it so important as a hearing aid user to advocate for yourself?

Shari Eberts:

Yeah. Well, for better or for worse, hearing loss is invisible. Nobody is going to know that you have hearing loss, so you're having trouble hearing them unless you let them know, and so you do have to self-identify. It's one of the most critical skills really in living skillfully with hearing loss and embracing that power to self-identify. We don't care what you call yourself. Person with hearing loss, deaf with a capital D, with a lowercase D, whatever it is. The most important thing, like Gael said, is letting others know that you have trouble hearing them, and then that's only the first step because you need to ask for what you need, whether it's speaking louder, slower, maybe move to another location. The more specific you can be, the better, because hearing loss is just so misunderstood by people. It's very hard to understand it if you haven't experienced it yourself. We are always in that role of identifying and advocating and educating really others about what we need so that we can communicate better, and that's what it's all about.

Blaise Delfino:

You mentioned educating, and Gael, you are a cochlear implant recipient. What was the learning curve like when you entered your new hearing world, when you got your CI? Do you feel as though that the learning curve would have been shortened if Living Skillfully with Hearing Loss was written for you when you were going through that process?

Gael Hannan:

Yeah. That's great. That's three questions in one, all of which I'm delighted to answer.

Blaise Delfino:

I've been known to do that.

Gael Hannan:

I might switch them around a little bit in order of answer. Firstly, I am bimodal. I have a hearing aid on one side and I'm implanted on the other, and I got my implant, and I wore hearing aids for 40 years before that. Got my implant six years ago. It did change my hearing journey, but I didn't feel like I was starting from scratch. It just gave me so much more, and it was just part of my hearing journey, but the book... But the real curve of what... I love you. The real-

Blaise Delfino:

This one.

Gael Hannan:

That book, or a similar book, I could have used it earlier in those 40 years. Growing up, I had to learn on my own, and looking back, I thought basically I was doing fine all those years. I look back and I see how I was struggling. I see how I was ashamed deep down. I felt that I was lesser than. I felt lesser than in retrospect. It explained a lot of my behaviors. If I'd had this book or something similar, I would've felt more comfort sooner. I would've been able to get rid of the stigma sooner. I would've been better at things. Now, I clawed my way through and that's why we wrote the book, but back to the first question, the cochlear implant did change my journey. It enhanced it, but again, being bimodal, it's an interesting process to go through. Who knows? Maybe someday I'll become a bilateral implant, but I don't see that in the future right now, but everything that comes along changes our journey and it's how we adapt to it. It's just been an extremely positive thing.

Blaise Delfino:

Shari and Gael, you are looking at your hearing loss as a hearing gain, and we mentioned that on your solo episodes as well, and it's really amazing what you're doing is educating not only current hearing aid users, but future hearing aid users. Shari, curious to know, do you wish a book like Hear & Beyond was available to you when you were first acclimating to hearing technology?

Shari Eberts:

Yeah, Absolutely. That was really part of the inspiration for the book and the goal of the book is to help people as they're beginning their journey, no matter where they are on that journey. Everyone's going through ups and downs, and this is the book that we really hope is going to shorten that learning curve. I know from talking with Gael, we both struggled unnecessarily with our hearing loss for many years because we had to find this information from all different sources and piece it together on our own, and so what this really is is an operating manual. I don't know if I love that term, because then it sounds like it's dry and boring and it's not because we have all these humor and stories in there, but it's everything that you need to know in one place. All about the mental attitudes, about using technology. We don't go into detail about the technology, but the importance of all different types of technology, and then also those communication game changers that she was talking about.

Blaise Delfino:

Shari-

Gael Hannan:

Shari, tell them about that aha moment that we both came to realize. You know the one.

Shari Eberts:

Well, absolutely. When we finally compared notes and compared our stories, and we realized that we had such different experiences, different onsets, different degrees of hearing loss, but we had both come to this similar set of skills and tools that we use to live well with hearing loss, and when we realized that, we knew we were onto something. We knew that we had this operating manual, this formula that anyone with hearing loss can use to live more skillfully, and so that was very exciting for us, and we couldn't wait to share it with everybody.

Blaise Delfino:

As a hearing healthcare provider, so of course, I've read the book, I've shared it with fellow hearing healthcare providers that have not read the book. I've sent this book to fellow colleagues. You brought up a question here, Shari and Gael. You talk about the mental aspect of being told you have hearing loss. Now, as humans, we hate to feel as though we are at a loss, and whenever we want to try something new or when news is shared with us, we have to have this paradigm shift and this shift in mindset. What was that process like for you when you were acclimating not only to hearing aids, but Gael, a CI? What were some of the strategies you've implemented to ensure that... Really, the question is, did you implement some sort of mindfulness to help you get through and grieve that news?

Gael Hannan:

The aha moment was when I realized, and Shari realized the same as well, was when I shifted my goal from wanting to hear better to wanting to communicate better, that made all the difference, because all of a sudden, you went, "Oh." You go, "All right, because I'll never hear really well, but I can communicate better." Communication is the glue that connects us with other people in the world around us, but the attitude shift was an amazing thing. Just very briefly, I was pregnant. I was worried about causing my child harm, and for the first time I reached out to other people with hearing loss and what a life-changing thing that was. I went into a conference one person and came out another. I realized for the first time, I saw the evidence that it was okay to have hearing loss. It was not shameful to have hearing loss, that I could move forward in a positive way, and I learned to take charge of my own hearing loss journey.

Blaise Delfino:

Shari, I'd love to hear your thoughts too. Feel free to echo Gael. You both wrote the book.

Shari Eberts:

Well, I faced a lot of stigma when I first recognized my hearing loss. I grew up and my father was very stigmatized by his own hearing loss, so I really needed to come out from the closet. I talk about coming out of my hearing loss closet, and it was all about really seeing my children watch me model these negative behaviors, these behaviors where I wouldn't self-identify. I would just isolate myself, and because my hearing loss is genetic, I worried that I was teaching them all the wrong things to do should they develop hearing loss themselves.

That was a major aha moment for me and a shift in my mind where I realized I needed to be a better role model and I wanted the world to be a better place for them, a more accessible place for them. That really inspired me to be an advocate and to not only advocate for myself because when each of us advocate for ourselves, we're actually advocating for everybody else with hearing loss too. It's really been a whole 360, and we talk about that in the book, that importance of having the mind shift where you now feel confident and comfortable in your skin and that you feel like you can advocate for yourself, and that's really step number one in terms of going down that journey.

Blaise Delfino:

Shari, so when I was editing your solo podcast episode, you had said... I edit all the episodes so I get to hear every single episode. Obviously, I'm the host. I get to hear them all before they're released, but my point being is this; you had mentioned on your solo episode, "Every person I talk to that is fit with hearing technology says the same thing. I wish I did it sooner." So Gael and Shari, for listeners tuned in right now, if they are on the fence, and maybe this is the episode that pushes them to get their hearing tested, what's some advice that you would give some of these individuals?

Gael Hannan:

You have nothing to lose. You have nothing to lose. There is a fear, and we all went through that fear. I grew up with hearing loss, so I faced that. I was told I had hearing loss by my parents, so I went through a different process, but with cochlear implants-

PART 3 OF 4 ENDS [01:12:04]

Gael Hannan:

But you have to, with cochlear implants, people say, "Oh, I don't know. I think I do just fine." No, you don't. But we think, people go, "I'm afraid." What are you going to lose? Being checked and [inaudible 01:12:15]. And we know that it's going to perhaps confirm a fear that you have and it's going to buy into the stigma. But take that step, do it. You'd probably be encouraged to do it by your family. Just take that step. You have nothing to lose.

Shari Eberts:

Absolutely. And I would also echo that, also say that you're not alone in this, right? There are so many people who are going through the same struggles of hearing loss. And sometimes with hearing loss, you feel so alone because maybe you don't know anyone else that has this issue and they're not willing to talk about it. But you're not alone. There are lots of us out here to support one another. And so take that first step. You have nothing to lose. You're not alone. And you can live better with your hearing loss. And this is the first step in doing that.

Blaise Delfino:

Shari and Gael, this year's theme is Ear and Hearing Care for All! Let's Make It a Reality. And this week, I can't believe it's this week, it's been crazy busy. We released an episode featuring Andrew Bellavia. And we were talking about raising awareness, of course, of hearing healthcare. Now, how important is the relationship that you as a hearing aid user have with your hearing care provider?

Gael Hannan:

It's crucial. It's crucial to develop it. We talk about this in the book, don't lift the book up again, please, everyone's seen it. It is crucial to develop.

Amit:

There it is, Shari. It wasn't me, Gael.

Gael Hannan:

Oh, both of us, from our own experience, believe strongly in the benefits of a good working relationship with your hearing healthcare provider. It's a two-way street. It's a beneficial, mutually beneficial, but that... When you're with your hearing care provider, you can talk to them in a way you can't talk to your family, but they can help you move to that next step. They can and they should.

We've all had that not so great experience, but most of the time it's good. And it's up to us to come to the table as well. They can help us understand that it's normal what we're going through. And what we like to see both Shari and I, is for that hearing care provider to be practicing client-centered care and to understand and address our needs, not just through a hearing aid, but on our real-life needs and all the other technology. You don't want to be a... Oh, I forget the phrase. But there's so much technology these days that we should use and use it in your office setting as well. So it is very, very important to have a good relationship. If you're not comfortable with your hearing healthcare provider, try elsewhere.

Blaise Delfino:

Yeah, Shari, I'd love to know your thoughts.

Shari Eberts:

Yeah, 100%. I agree with everything Gael said. The other thing I'd add is really that sometimes families are not that supportive and they don't really understand what we're going through. Maybe they think we just need to turn our hearing aids up or we're not trying hard enough to hear. But involving them with our audiologists in an appointment can be really life changing for them, right?

Blaise Delfino:

Yeah.

Shari Eberts:

They're hearing about the hearing loss from an expert and maybe it just has a little bit more weight. Like, "Oh, we've heard about this before," and "Oh, okay, maybe we should take this a little bit more seriously." And sometimes we ask them to speak more slowly or to look at us and they're just sort of tired of hearing us say the same thing over and over. But when a hearing care professional says the same thing, it takes on a little bit more weight. So we can sort of be partners in crime here in terms of working out the skills that we need and then educating the people who are close to us about what they need to do to help us live better too.

Blaise Delfino:

Shari and Gael, I love it. If our listeners tuned in, well, not if. After this episode they're going to want to have a copy of this book, where can they purchase a copy?

Gael Hannan:

As the saying goes, anywhere books are sold. We have a website hearandbeyond.com, and go there and then we'll provide links of where you can get the book. We're also excited to announce that next week, our audiobook is being released. So for some people who don't have time to read a great book, you can listen to it. For five hours, you can listen to us talk about how to live skillfully with hearing loss. So anywhere books are sold. And I just always like to say, get this in, that working with my co-author and partner Shari Ebert has been a joy for the last two years. We just love working together.

Blaise Delfino:

Thank you both so much for the work you're doing. I am truly humbled, grateful, and blessed to be able to learn from you and all the other guests that we've had tonight. So really, our team, we just want to thank you so much for celebrating World Hearing Day with us. Alone, we can't do much, but together we can change the world. So Shari and Gael, thank you so much.

Shari Eberts:

Thank you. Blaise, great to see you. Thank you. Bye.

Blaise Delfino:

See you soon. Happy World Hearing Day.

Shari Eberts:

So that was Gael Hannan and Shari Eberts. Love their book. It's excellent. And for our final guest this evening, celebrating World Hearing Day, is a good friend. He's a mentor of mine. We've known each other for I think going on four years now. And I can't say this enough, I respect so much what he's doing. This is Dr. Amit Gosalia, all the way from California! Welcome, my friend.

Amit:

It's almost midnight here. I mean, you got me really at the tail [inaudible 01:18:33]. Anybody who's still watching is in for a treat. You guys are in for a treat. And by the way, Blaise, I want to compliment you, Autumn, and the Hearing Matters Podcast. I hope you guys recognize the great impact you guys are making.

Blaise Delfino:

Oh, thank you. Like I said, we are grateful because... So Amit, I will never forget this phone call. It was really when the podcast was maybe a year old, you called me and you're like, "Listen, man, keep doing your thing." And obviously there was other mentorship words there, but that really stuck with me because every time you and I talk, it's always about patient-centered care, what is in the best interest of the patient, but how can we continue to band together as hearing care providers and make an impact in the hearing healthcare space. And impact is what you are all about, what we are all about at Hearing Matters Podcast. We're going to dive in. This year's... Got to get my notes here. I didn't remember everyone's question.

Amit:

You wrote questions out. You have notes. I did no prep. So [inaudible 01:19:42].

Blaise Delfino:

You you're going to hear the paper rustling. They're like, what's going on, Blaise?

Amit:

Yeah, on your side. Yeah, absolutely.

Blaise Delfino:

So this year's theme is Ear and Hearing Care for All! Let's Make It a Reality. All right, you are, and this is an understatement, incredibly involved in your community. You're like the mayor of the state of California is, I'll throw that out there, because you're all over the... And you're raising awareness of hearing healthcare. Tell us about how you and your team have and continue to create greater access to hearing healthcare in your community.

Amit:

Okay, yeah, that's a great question. So I think the first thing is when we talk about accessibility, and I was really happy to hear Shari and Gael talk about this. Accessibility is one of those things that we strive to make sure that we're able to provide the best possible patient-centered care possible. Excuse me. So the reality is that every patient that comes in our doors, we want to make sure that we're taking great care of them. So whether it's out in the community, whether it's within our four wall in our offices, I have a resident right now and I'm teaching her how to do the best job she can with our patients, and including with students. So I'm actually going up. We have a national audiology association. It's called the American Academy of Audiology, and it's in Seattle this year. And I'll be speaking to students about private practice.

And one of the things that I'm going to be talking about is not only that we have to be extremely passionate about what we do. We also have to make a great impact on our communities and we have to be able to provide the best patient care to our patients. And the reason I say that is because in our private practice here in Los Angeles, we don't have a hospital or an otolaryngologist or anybody else who can pay our bills. If we don't take care of our patients and follow patient-centered care, we're going to fail. And so it's extremely important. So we've done anywhere from writing... They showed their book. So I'm going to show my book.

Blaise Delfino:

Show it.

Amit:

I have my little... I ran out and grabbed this as soon as I saw they had their book. I created a book. It was just for awareness, right? Just a simple story. We do proclamations to this city's here, city of Los Angeles, Calabasas, all over. And the reason we do that is, hey, you know what? May is Better Hearing Month. We want to make sure that we're promoting that and letting the civic organizations know that, hey, it's okay to have a hearing loss. You just have to make sure you're doing the right things to take care of it and who to see for it. So we strive very hard. And whether it's civic organizations again or philanthropic organizations, we're very involved. My wife and I are very involved in numerous organizations around Los Angeles as we were in our old residence, which was outside of Portland, Oregon, where we were involved in numerous nonprofits. And we just kept spreading the good word of audiology and making sure people understood that, hey, this is something that we can help.

Blaise Delfino:

And spreading the good word of audiology is spreading the good word of patient-centered care. We believe hearing healthcare is best served in the hands of the hearing healthcare professional. A few months ago, the final regulations regarding OTC hearing aids were released. Now, you were very active with state and local elected officials regarding the proposed OTC regulations.

Amit:

Mm-hmm.

Blaise Delfino:

Tell us why it's so important for elected officials to be involved in the hearing healthcare space and why it's so important for us to educate them. And your OTC involvement has just been so exciting because you've testified and you've raised awareness. So why is it so important for us to continue to educate our elected officials?

Amit:

So Blaise, it's a great question and thank you for mentioning this. Just a couple weeks ago, Doug and I were down in Dr. Doug Beck and I were down in Atlanta. And he was giving his talk and he mentioned something that I talk to my patients about all the time. So Blaise, I'm going to ask you, how much does the car cost?

Blaise Delfino:

Average cost is probably what? $50,000 today?

Amit:

Okay. So if I'm in Los Angeles, I live in Brentwood and we're in West LA. There's a lot of Lamborghinis, and Ferraris, and some very high-end cars. Those cars cost anywhere from two to $400,000. So what if I told you that cars cost $200,000? You would probably rage against the automobile industry. And so what's happened, and Dave Fabry will attest this because he has done a great job at Starkey, and Starkey's been great about this, is that some of our legislators thought that hearing aids cost $10,000 each. And that's absolutely wrong. Right? I personally, and I know I'll probably get some heat for this, but I feel that if anybody's spending $10,000 on hearing aids, you're getting ripped off. Hearing aids generally will cost anywhere from a few hundred dollars up to maybe $3,500 or maybe max $4,000 each. Anything above that is just gravy in my opinion.

So I know it's a strong opinion and I don't mean to put your audience off in any way.

Blaise Delfino:

No, not at all.

Amit:

The reality is that spending that kind of money, there are places that sell hearing aids for that amount. And it's absurd in my opinion. So when-

Blaise Delfino:

I agree with you, Dr. Gosalia.

Amit:

Thank you. And when they cherry-pick these numbers and they just choose this big out of proportion number and say, "Hey, hearing aids cost $10,000," which some of them, one of them actually visited Starkey, and they actually were able to educate him on, I can't remember his name, maybe Chuck Grassley, I don't remember who it was, but-

Blaise Delfino:

Chuck Grassley. Yes.

Amit:

And they educated him that, hey, hearing aids don't cost that. So now let's talk about over the counter. Now, back in 2015, when a lot of the conversations were... It actually started even well before. Mead Killion actually wanted to go direct to consumer years ago and went and testified, and he almost got it done. That was a long time ago. I had less gray hair back then, but-

Blaise Delfino:

I had more hair.

Amit:

Yeah. We'll leave... Anyways. So that was the time when we were making some momentum on, hey, how can we make hearing aids more accessible? Well, the problem is that, and you're going to hear this a lot, that better hearing care is not all about the widget. If I can go back to the car example, if somebody gave me a stick shift Ferrari and said, "Here you go." I don't know how to drive a stick shift Ferrari. Right? So if I go and buy over-the-counter device, I don't know if, number one, am I really a candidate for this if I did not go and see a doctor to do a diagnostic evaluation?

And number two is, what if it's earwax, right? At the simplest form of looking at this, what if it's earwax? Well, now you just shoved this over-the-counter device, and you just made that over- the-counter device not work because it just plugged up with earwax. Now, let's go one step further. What if it's the eardrum that's the issue and you're saying, "Well, my ears are plugged. Now I need hearing aids. I'm going to go buy this device." Well, maybe it's the eardrum, and maybe if you had that treated, you wouldn't need hearing aids. What if it's an ear infection, otitis media? What are the bones in our middle ear that are fixated together called otosclerosis, for example? Now let's go even further, which is even a little scarier. What if it's a tumor? Right? What if there's something going on with your nerve? And you went and just bought this device and now, so let's take this to the extreme, and now you let this malignant growth happen and continue going on without even checking it?

And you thought that this little device that you can buy from, I won't name the stores, but you buy it through the store or online, and you thought, "Well, this is going to solve my issue." How do you know you even have a mild to moderate hearing loss without actually testing your hearing? This is something that I know that when you were seeing your patients, Blaise, in your family clinic, you probably had the same issue we have. We have patients who come in saying, "Hey, I've got a hearing loss. I need hearing aids. Can we do a hearing test and then fit me with hearing aids?" And we do the hearing test. We're like, "No, actually, you don't have a hearing loss that requires a hearing aid. You've got whatever it is, or normal hearing." Right? It could be something else going on. They don't need a device.

So that's why it's very important. And back to your question about better hearing care starts here at the provider level. My patients don't do well because of Starkey hearing aids, Oticon hearing aids, et cetera. They do well because that's great technology from those companies, fantastic technology, but anybody can fit those hearing aids. But it's me. And I'm very humble, by the way, I am the best solution for those patients, not the device.

Blaise Delfino:

Yes.

Amit:

I can make almost any device work well for almost any patient because I know what I'm doing and we're following best practices. We're doing follow-up care. Now, the mild to moderate hearing loss, as was mentioned earlier, over the-counter devices are only meant from mild to moderate hearing losses, of course-

Blaise Delfino:

Perceived.

Amit:

Perceived. Have perceived mild to moderate, which I'll tell you, we have patients with severe hearing loss, they think they have normal hearing.

So I don't know what perceived mild hearing loss really means. But when we look at our patients and we're looking at them in a holistic way, just like Shari and Gael, were just talking about, patient-centered care is the best solution. And if somebody is thinking, "Well, I don't want to buy a prescription hearing aid." Well, do the bare minimum. And the bare minimum is get a hearing evaluation. Come see an audiologist, let us check you out. And then some of us actually sell over-the-counter devices in our offices.

Blaise Delfino:

Yeah.

Amit:

Right? So I'm not saying, and I do want to make the other side of the counterpoint here that I'm not against over-the-counter hearing aids. From 2015, all the way up until just a couple of months ago, in fact, I don't know if people know this, but a lot of the over-the-counter devices originally did not have limits put in, meaning you could turn that volume up louder and louder and louder and eventually damage your hearing.

So a group of us actually got involved and really pushed forth, including having a meeting that actually got canceled with the White House, the budget office, and got canceled that morning. But we pushed forth, and luckily, at the 11th hour, they actually put those limits back in because it's all about patient care. I don't want to see a bunch of patients coming in with these devices saying, "Now my hearing is worse."

Blaise Delfino:

Right.

Amit:

So we fought very hard. And most of our national organizations did a very good job of making sure we were proactive on taking care of our patients.

Blaise Delfino:

Dr. Gosalia, we are nearing the end of our World Hearing Day event. Have a couple of minutes left, but I really want you to drive home the point. And what is so exciting about our hearing healthcare industry is AudBoss. Now, this is a group of private practice owners who believe in private practice, who believe in best practices. And every single AudBoss loves what they do. So tell us a little bit more about AudBoss, how this group is revolutionizing the hearing healthcare industry, and what do we have planned for 2023? It's a great sendoff for World Hearing Day.

Amit:

I love this question because I'm so passionate about it. And the reality is that anywhere in medicine that you look, private practice offices, private practice medical clinics are becoming less and less and less. And if I had to choose why I'm going to blame the insurance companies, but that's a different topic, okay? That's on World Insurance Day, we'll talk about that. The reality is that we're seeing less and less private practice medical clinics where arguably you'll find the best care. I talked about it in the very beginning that you know what? If I don't take care of my patients the best I can, they're not going to do well and they're not going to come back. So my business is going to suffer. So my job is to take care of my patients the best I can. So we created this group called AudBoss, and that's not O-D-D.

I know I'm kind of weird, but it's A-U-D. A-U-D Boss, AudBoss. And the reason why we started this was really to incorporate education, motivation, inspiration for private practice owners. Some of these private practice doctors have one location and they have maybe one staff person with them. So they're very small, all the way to one of my close friends has like 26, 27 locations and he's CEO. So we have got this wide range of practitioners, but everyone still deals with some of the same issues. And so what we developed was a place for all of these private practice clinics and owners to get together to kind of share ideas. How can we help some of the smaller clinics? How can we learn from some of the bigger clinics if we wanted to grow? But the fundamental thing is, hey, best practices, overall patient care.

And we started doing a summit every year, including 2020 during the pandemic, which is quite controversial, but it was a great time and nobody got covid. So I'm happy to report that we actually went to Denver and did it in March of, sorry, October of 2020, but this is our fifth year coming up and this year we're doing it in Nashville, Tennessee. We have, our sponsors are actually sold out now, so we have no more sponsor room, which is great. We have about 74 spots left for attendees, which is also great. I just did a video [inaudible 01:32:41]-

Blaise Delfino:

I might be there.

Amit:

You better be there, right? We have a little VIP Phelps chair right in the front for the team Blaise Delfino.

Blaise Delfino:

Thank you, Amit.

Amit:

But you know what? We rented out Luke Bryan's bar on Broadway. And we've got tremendous speakers to talk about, how do we take care of our patients who have tinnitus or ringing in the ears? How do we take care of our dizzy patients? How do we inspire our teams to do better and take care of our patients better? These are all some of the talks. And I don't want to give it away, but I think the last two speakers that were on your podcast here, Shari and Gael, may or may not be there too, just FYI.

Blaise Delfino:

They may or may not. I don't...

Amit:

I'm leaning more towards may. I think they can attest to that if they want. But the idea is that we are going to have some great speakers. We already know, everyone knows that we're going to have a great time because we always have a good time. But I think the bottom line is that we always keep promoting patient care and how can we consistently provide the best care possible for our patients out in private practice.

Blaise Delfino:

Dr. Amit Gosalia, it has been such a pleasure having you on the Hearing Matters Podcast yet again. You are a frequent flyer. Show that book, my friend.

Amit:

Oh, yeah.

Blaise Delfino:

I thought you were grabbing the book.

Amit:

No, I was grabbing my Friday afternoon beverage here.

Blaise Delfino:

No, really. Thank you so much for all of your support. Thank you so much for your mentorship, your friendship. Looking forward to AudBoss this year. Every other year that you have had the conference, it's been my wedding anniversary, but I won't be too far from Nashville, so going to make it happen.

Amit:

Excellent.

Blaise Delfino:

Be there or be square. Dr. Gosalia, if anyone, whether they be a hearing healthcare provider or audiologist, where can they learn more about AudBoss? Obviously, we have the banner on the screen there.

Amit:

Yeah, just right... Hold on, it's coming. It's coming right here. There we go. Yeah, right there. You can actually go to www.audboss.com. We've got a bunch of information there, including the registration site, which is there for our summit.

Blaise Delfino:

Awesome. I look forward to seeing you in person very soon, my friend. Thank you for celebrating World Hearing Day. Alone we can't do much. Together we can change the world. I hope you have a wonderful weekend, my friend.

Amit:

You too. Thank you so much.

Blaise Delfino:

Take care, Amit. Well, ladies and gentlemen, that is it. That concludes the Hearing Matters Podcast, World Hearing Day event, the hearing healthcare model, a team-based approach. Want to thank you for the continued support of Hearing Matters Podcast. And we want to thank every single one of our guests this evening that dedicated their time on a Friday night, some even in New Zealand, a Saturday morning, to raise awareness of the importance of hearing healthcare. I'm Blaise Delfino, host of the Hearing Matters Podcast. And until next time, hear life's story.

PART 4 OF 4 ENDS [01:35:41]