Humility, Hands, And The Human Ear

What if the biggest upgrade in your fittings isn’t the chip, but the craft? We sit down with industry veteran Ray Woodworth to unpack why the best results happen when technology, anatomy, and hands-on skill align. From the clinic to the factory floor, Ray shares how working alongside engineers reshaped his approach to ear impressions, venting, receivers, and fine tuning—and why humility and patient trust still outplay flashy features.

We take a clear-eyed look at domes versus custom solutions. Domes can be quick and appropriate for mild losses, but they’re often stretched past their limits. Ray explains how custom molds and embedded receivers reduce low-frequency noise bleed, stabilize retention during movement, and unlock better streaming with fuller bass. Vent choice is crucial: the right vent eases occlusion without sacrificing the low-end energy that powers speech and music. Add precise receiver selection, and the same device platform can deliver a whole new acoustic experience.

Verification meets perception in a practical framework you can use tomorrow. Real-ear measurement shows when domes leak lows and where custom coupling wins; patient perception then guides comfort, clarity, and loudness. Think of it like a light dimmer: build toward target so the brain can adapt without fatigue. We also compare ear scanning to silicone impressions. Scanners can shine, but only with expertise; silicone often reveals tactile details—wrinkles, texture, exostoses—that screens smooth over. Technique matters: video otoscopy, block placement, and repetition drive consistent, comfortable fits.

We close with a blueprint for sustainable success: slow down to speed up. Capture impressions even if patients leave with domes first. Educate, listen, and document so you can pivot fast when comfort or streaming falls short. That’s how clinics earn loyalty and ongoing upgrades—by proving that hearing technology is just one third of the process, and the other two thirds are craft and care. If this resonates, follow the show, share it with a colleague, and leave a review to help more listeners find us.

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Chapters

• 0:00 Welcome And Guest Introduction
• 2:40 Ray’s Path From Private Practice To Factory
• 5:40 Humility And Patient-Centered Care
• 9:40 The Human Touch Versus Tech Hype
• 13:30 Custom vs Domes: Fit, Vents, Receivers
• 19:38 The Ear Is The Boss: Craft And Anatomy
• 25:18 Real-Ear Measurement And Perception
• 34:12 Streaming, Bass, And Occlusion Management
• 39:32 Ear Scans vs Silicone Impressions

Transcript

Blaise M. Delfino, M.S. - HIS : 0:06

You're tuned in to the Hearing Matters Podcast, the show that discusses hearing technology, best practices, and a global epidemic. Hearing loss. Before we kick this episode off, a special thank you to our partners. Care Trinity. Here today to help more people here tomorrow. Fader plugs, the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host Blaze Delfino. And as a friendly reminder, this podcast is separate from my work at Starkey. I'm your host, Blaise Delfino, and joining me today is not only a colleague of mine, he's become a friend of mine. It's the one and only Ray Woodworth. Ray, I feel like you don't even need an introduction because everyone in our industry knows you, but they know you because of the impact you've made, the passion that you have for helping patients hear better and live better. And then also the passion you have for sharing your skills and educating hearing care professionals on the importance of a great ear impression. So we're going to take a deep dive today. How are you doing? Good. I'm doing great. Well, thanks for having me, Blaze. I'm excited to be here. Ray, this has kind of been a long time in the making. And first and foremost, I want our listeners to learn a little bit about your history. Okay. Because we see you on LinkedIn, we see you on the CEU webinars, but I want to know who is Ray Woodworth and how did you get introduced to hearing healthcare? Because you've been doing this for uh 25 years.

Ray Woodworth: 1:51

25 years. Yeah, I started in 2000. So in 2000, I worked in Raleigh, North Carolina. I was in a private practice called Capital Hearing. And I was in private practice, dispensing hearing aids. And then Bill invited me up here to the headquarters in 2002, and I've been here ever since. So very interesting to me is working in private practice, I thought I knew a lot about hearing aids and impressions and custom and patient care and so forth. And then when I moved here to the headquarters of Starkey, Bill shined a whole different light on it. He made me humble. Working with him and his team of technicians and engineers gave me a totally different perspective about fittings and how to serve and help patients. So the journey began in 2002 as far as here at the headquarters. And I couldn't ask for a better mentor. Bill has been a mentor of mine for 23 years. Actually, this month would be 23 years here. And we see patients day in, day out. So that's pretty much where I started. I started in a private practice in 2000 in Wally, North Carolina. I give Bill a lot of credit for what I've learned over the years. And hope we get deeper into that.

Blaise M. Delfino, M.S. - HIS : 2:58

Oh, absolutely right. So, what I want to touch on a little bit there before we really deep dive today and talk all things, you know, custom hearing technology, customizing receiver and canal hearing aids. You touched upon a really important word there that I think in our industry, especially, a lot of hearing care professionals encompass. And I hope that this newer generation of hearing care professionals really embrace is humility, being humble. How important is that? Because we're working with a population that presents with an unseen quote disability, end quote, because we don't see hearing loss as a disability, right? But that patient, they're trusting you with their hearing. And as we've said, that's a sacred trust. And when you talk about humility and being humble, how has that helped the patient experience you provide here?

Ray Woodworth: 3:52

Hey, Blaze, that's a great question. You know, we see about 230 a week here at the factory.

Blaise M. Delfino, M.S. - HIS : 3:59

230 patients a week. Wow.

Ray Woodworth: 4:01

So we see people from all over the world that come see Bill and difficult fits and unique cases and you know, you know, treaty collins, you know, atresia, surgical ears. So we've seen we see everything pretty much. And you know, talking about humble, you know, I uh Bill said it best people don't care how much you know until you show how much you care. And that's where it all begins, is about caring. You know, being watching Bill all these years, working with patients with me, he always says that the patient tells the truth. It's the patient that matters most. If you take care of the patient, the rest will come. And so that's always been our motto here is to serve our patients better than anybody else and take good care of them. And so when it comes to, and I'm gonna go into this because this is part of what's important about caring. When you spend time with the patient, explain, you know, you we know that hearing loss affects cognitive. We know that there's things that, you know, your balance fall, you know, overall health. And people want to be healthy, people want to have a good quality of life. And so what I've learned is even just as simple as taking an ear impression, that's why I always take ear impressions, because I feel like it's connecting to the patient. It's giving them a we're giving we're putting a relationship. So it's not just about putting you know, just feeding hearing aids, it's about building relationships. And then when you do that, they trust you with their hearing. And so I've learned that the more you interact with the patient and spend time with them and make it personal, the more you can do for them. And the more they trust you. And when you do that, they'll always be loyal and come see you because you built that relationship. As simple as shooting an ear impression, or cleaning in the air, or just telling about the cognitive decline. You know, all those things that matter to them to make them better for their life and their family and their friends. So people have to understand that if you look at the big picture of in in the hearing industry, it's not just about our skills, it's about how much we care. And if you care, you will get better at your skills. So it's a ripple effect. And so that's why I try to master taking impressions because I want to do what's best for the patient and get the best outcome and make it personal. Because every ear is unique and every ear is different. And so when they see their ear and their ear impression, I'm connecting with them. So it's not just about shooting impressions, it's about connecting and getting to know the patient for who they are. A personal touch with a personal outcome. Yeah.

Blaise M. Delfino, M.S. - HIS : 6:31

I really believe that.

Ray Woodworth: 6:32

Right. We call it the human touch.

Blaise M. Delfino, M.S. - HIS : 6:34

It's absolutely. And living in a day and age that is so technologically driven, which is incredible. I mean, technology has helped so much, not only in medical, but you talk, you know, automotive. It's amazing how far we've come in the advancements just in a short amount of time. But I truly believe, and my personal goal with this episode, not only for our hearing care professionals, but for consumers tuned in, while we live in such a technological world, the hearing aid is one third of the process. That's right. And it's a journey. We believe that hearing technology in the hands of the professional has the best outcomes. And Ray, you and I have talked at nauseum about this specifically, the human touch, the importance of a good ear impression, the importance of educating your patient. And that's where I see five, 10, 15 years from now, this industry growing and us helping even more patients. And that to me is really that North Star. How can we remove the stigma associated with hearing aids and hearing loss and continue to encourage those to wear hearing technology? And while we've been talking about, you know, customization and receiver and canal hearing aids, to your point, there are some patients who need open fittings, right? But but I will say, coming from private practice, the importance of highly considering custom mold attached to a receiver in the canal hearing aid. So we're gonna talk a little bit about that later on in this episode. But before we we go down that avenue, Ray, thank you for sharing your story. I know that it's tough to condense 25 years of hearing healthcare experience into one podcast episode. So we're just hitting these highlights. But talk to me about where this passion for taking A plus impressions started. Like when did this, when did your movement, because I will call it the Ray Woodworth movement, when did that start to just, you know, occur?

Ray Woodworth: 8:52

So that's a that's a really good question, and that's a loaded question. You know how you have an orchestra and everybody's playing their instruments, and everybody has to be aligned to get the best musical. I see the same thing with feeding hearing aids. Everything has to align. We have the technology. But we don't talk about the receivers, we don't talk about the venting, we don't talk about snapping receivers, custom case receivers, CICs, IICs, all these different instruments that we can use to get the best outcome. So I've learned over the years watching Bill and his team of you know, technicians, engineers going into meetings and talking to them. I've learned that, and many people have heard me say this, and I keep saying it because it resonated when Bill told me this. Because Ray remember that he was the boss. And so that that resonated, and that's when I really started realizing that there's more to it than just feeding technology. There's an art, there's a craftsmanship, that that we have to own it because the technology can only do so much. I'll give you an example. I don't know, I think and this is the discussion that is gonna be a whole different discussion, but I think domes are a good thing in the industry. I think it's great that we have them. I think it's very beneficial to some patients, especially for mild to moderate hearing losses. And I see people coming into domes all the time. I I went to the state fair and I see people wearing domes. And it's and again, I think domes are great. However, I think we overutilize those and undermine custom. And the reason why I'm saying that is because I don't know how many times I've seen people wearing domes with moderate to severe hearing loss. And even wearing double domes, when you tailor the ear with the custom, you are doing much greater good with that technology. I'll give you an example. So when you tailor a custom to the ear, it helps block out background noise. And we talk about background noise. And I know that if you tailor a mold to the ear, it blocks some of that background noise out so you can use the technology better. With the dome, all the background goes through the dome, the lower energy frequency. So that's we all know that. But we know that, but the patient doesn't. Yes, yeah. So what happens is if you have people that are wearing domes, and let's say like, man, I'm having a hard time in background noise, I'm just hearing everything. And also when there's streaming, I I hear everything and I can't hear the conversation. If you customize that and tailor it to that ear and get the right sound direction and get the right size event so they won't feel occluded, we know about occlusion, they will stream better and it will sound better and they will hear better in noise because you're trapping the background from going into that ear. So there's a lot of physical benefit to fitting custom versus a dome. So to back to your question. So when it really st what really resonated for me was when when Bill said the hero is the boss. And I and I kind of like, what did you really mean by that? So I started, you know, I lost some sleep at night, you know, trying to figure it out. Like, because he looked me in the right in the eyes and he meant it. And people know, you know, Bill's been fitting here since he was 19. He's 83 now. I mean, he's I believe he's the last person, the last pioneer in the hearing industry. And he's still with us today, and I'm still learning from him. Anyways, when he said that, I said it dawned on me that you can pick any model of hearing aid, CIC, ITC, Full Shell, whatever model you want to select. You can pick any brick you want to use, you know, whatever company you work with, you know, and so forth, but you can't change the ear. The ear is what it is. Now, this is where I've started understanding the art and the craftsmanship. Understanding the ear. What I mean by that is, is this ear good for a dome? Is this ear good for a CIC? Is this ear good for an ITC? Is this ear good for so forth, depending on the hearing loss, the anatomy of the ear, and the patient's needs? Right? So I look at all those things and I try to align it like an orchestra. Align everything right to where it's like, okay, I know what receiver. A lot of people don't know what receiver to use, what vents to use. They know the technology. It's amazing. But the technology is not what makes the power of the hearing aid. It's the receiver, the output, the transducer. So I've learned with Bill that I've learned the output of these receivers, the peak responses of how they perform in an ANSI box. Because you know, working here at the factory, I've learned about, you know, the ANSI box where you see the curve responses on these receivers. So we have different receivers, different sizes, different outputs, and then we have different vent sizes. So working here at the factory gives me a totally different perspective about how we build our products and how do I align it with our technology. So to answer your question, that's when it dawned on me that hey, it's not just about technology, it's about the craftsmanship and the art. And Starkey's known for that. And for me to watch Bill for over two decades, listening to him, I get it now. I understand it.

Blaise M. Delfino, M.S. - HIS : 13:54

I always say transfer of information, process of duplication, and I mean, just talk about servant leadership. Yeah. Mr. Austin absolutely is a servant leader, and he has set the standard for the industry and so many of us.

Ray Woodworth: 14:11

You know, saying that place, I I think Bill, the way he is, like you just said, setting the standard for the industry as far as what he believed as far as humanity, you know, Bill always believed that you always want to make people the best they can be. And by doing that is with helping them with their hearing and overall health. And so when you go that the avenue of what Bill believes, you start wanting to get better. And that's why I really got into ear impression taking, learning about the receivers, the venting, the ear canal, the technology, the features, you know, all those things to align to get the best outcome for the patient.

Blaise M. Delfino, M.S. - HIS : 15:58

Ray, I want to I want to bring up a point here. So you're talking about the difference, you know, between fitting domes on receiver and canal hearing aids and then custom technology. Now, I have a case study. So I work out, I go to the gym. Ray, I know you're into fitness as well. And I'm sure when you're working out, you're listening to music. But I have a case study I want to share with you, and I hope that this sheds light for consumers tuned in and really hearing care professionals. So I have Bluetooth rechargeable earbuds that are just that. They have like little domes on the end, closed domes, they pop right in my ear. No problem. But I experience slit leaks when I'm running or working out, if you know, if I move my jaw, and it's not only uncomfortable, but it's rather annoying. Like it's very annoying when I'm listening to a song, and then the bass just like cuts out because there's a slit leak. And but then I started wearing my sound gear phantoms to the gym, and my right ear canal is very different from my left ear canal. Oh, remember that? Yeah, I have weird canals.

Ray Woodworth: 17:11

So you did.

Blaise M. Delfino, M.S. - HIS : 17:13

Yep. So when I'm wearing my phantoms, Bluetooth, when I'm running, if I move my jaw or like I'm making any funny facial expressions when I'm running or working out, the sound quality is the same. And that to me was this is what Ray is really talking about when it comes to the importance of highly considering customizing receiver and canal hearing aids because today's day and age, now, so we set the stage there and I have normal hearing, I don't present with hearing loss. I do prefer to wear my custom signature series in crowded environments because it just helps me with a better signal-to-noise ratio. Right. If we go to now the dawn of technology and open fittings and, you know, innovation, we're talking a lot about the features of the technology, but we need to really continue to focus on the benefits in the human touch. And that doesn't mean that we're going to slow innovation down. It just means that as humans, hearing is a sense that many of us take for granted and we can't see it. And the human touch, what we're doing right now, AI will never understand.

Ray Woodworth: 18:33

But let me tell you, Blaze, let me tell you the reality, what's going on in the industry. Because I work with audiologists and dispensers across the United States. I always work with them and and we talk about you know about domes and custom case and molds and you know fittings and so forth. When you fit a dome, you can get them in the office, fit them, and walk them out, right? I think what we should do is if you're worried about you're not going to get the best outcome, let them leave with the domes on, but still shooting your impression. Have an impression with you. So if they come back and say, oh, they're uncomfortable or they're not staying in, or I just don't like the way they feel, you have the custom impressions. And it only takes 15 minutes. So I think it's worth shooting the impression, even though it takes time and effort, because at the end of the day, you want to do what's best for the patient. And sometimes you can get better outcome with a custom case, which is an embedded receiver. And some people use snapping receivers, that's another topic. But I think that if you take the time, again, making it personal and you shoot the impression, and people think it's cool to see their ears. I mean, they're like, wow, this is cool, because you know every ear is unique. But I I've gotten to a point where I, when I look at an ear impression, I know if I can get a big vent in there. I know how that should be detailed to make sure it fits right and it's comfortable. And Starkey has always been a custom company. You know, Starkey was founded in 1967, and we've been doing customs since then. So if we don't know customs, we're in trouble. So we know customs. But so I've seen the evolution of custom and where it is, where it was 23 years ago, 25 years, you know, since I've been in the industry to where we are today. And I've seen where the ICs came from, which is Invisible and Canal, and then we we used to call custom case absolute power molds. So I know so I know the history of some of these customs and how it came about and where it is today. So I understand how we build them and how how we put them together, because again, I work here at the factory, so it's giving me a whole different light. But I think the more you understand about custom, I think the more you order them. Because then you understand what you can do for the patient. But at the end of the day, you gotta understand the ear. You gotta understand the ear impression. You know, what's the first bin, what's the second bin, how big is it, how big are the receivers, how big can you make this vent? Because a lot of people say, I'm worried about occlusion. I can tell you right now, we fit a lot of people with mild hearing loss with a custom mold. Because the ear allows it. The ear is the boss. The ear allows a big vent, and I can put the receiver on top to allow that big opening. I have people that wear domes and say, Ray, when I'm streaming, I can barely hear it, you know. And then when you put a custom, like you said about the sound gear, when you customize it, that sound direction goes to the eardrum. It's game changing. Yeah, it's a game changer. So we here at the factory do about 80% custom and 20% domes. So we're the opposite of the industry. And the reason why, because we truly understand customs.

Blaise M. Delfino, M.S. - HIS : 21:22

Well, and and Ray, let's talk about. So there are best practices in the hearing healthcare industry that we talk about, and best practice, the one that's been most talked about within the last, you know, really five to seven years is real ear measurement. But real ear measurement has been around for many years. However, and there's all different statistics on the percentage of hearing care professionals that have a system but actually use it. Yes. But let's just go with 30% of hearing care professionals, that's probably kind, is actually implementing real ear measurement on a daily basis with every single patient. What has your experience been fitting patients with custom technology, not only CICs, IICs, but RIC with custom receivers? When you run real ear measurement, is it just a game changer when you are customizing? Like what do you what do you see?

Ray Woodworth: 22:20

That's a good question, Blaze. You know, if you if you look at you know, like we know, we look at the hearing losses. If you run really with the dome, you'll see that you can't get a lot of lows, especially if the loss is down at 50 or 60 dB in the low frequencies. So when you And what do you have to do then? You gotta customize it. The reason why, so it gives the lows back. It gives you the lows. So and if you don't customize it, you're cranking up those lows and it's gonna sound not good. Yeah, it's not good. Yeah, so my point that's a good point that you brought up. Every ear is unique, so every impression is unique. When you run real ear, every ear is unique because the acoustic response of the ear, the nature of the ear. And when you put a hearing aid air, you know, aided unaided, you can see the response. And when you run, when you fit a dome on an ear that's a moderator, severe loss, and the dome is too small. You're bleeding out all that information they need. So you're not utilizing the technology they can experience. So, so anytime you have a loss that the lows are down, especially at 500 and 750, if it's down at 50, 60, 70 dB, you should make a custom case mode. And I call that best practice. I believe best practice is you make a custom on a loss that needs lows, than doing a double dome or an open dome because you lose the benefit of what they need. So yeah, I think you can see that when you run the response for a dome versus a custom. I mean, I've seen it nine-day difference. Also, when you're streaming, the lows sound, because the lower frequency is what gives you power and volume. Right. The high frequency is what gives you clarity. So if they want to get that bass and that good sound of music, give them the lows by making a custom, especially if the lows are down. Now, like I said earlier, you can fit people with mild hearing losses with a custom if the ear is big enough. And there's some ears, and you you guys know this out in the industry, there's some ears that don't like domes. They're too curved and they're hard to get in, no matter what size dome you use. So we have all different types of domes. But at the end of the day, a dome, uh, an ear is not a commodity. They're uniquely different. And we have to respect that. And I think, and and I told you earlier that, you know, I've shot over a hundred impressions in one day.

Blaise M. Delfino, M.S. - HIS : 24:26

100 impressions in one day.

Ray Woodworth: 24:28

We had a class here, and we're fitting audiologists and the dispensers that have hearing loss. And there was over 50 people that needed hearing help, and we wanted to help them. So we were until two in the morning, just shooting and shooting, shooting. And man, it dawned on me how unique we are in our ears. Not only the anatomy, but the sensitivity. I can go on and on about impressions because that's my specialty. But you can be a great impression-taking person, but every year is different. Some ears are more curved, so it's harder to place the block. Some ears are really straight, you can go right down the ear with it. So when you learn the skill and you master it, you can go up against anything. I'm one of the few, and I'm gonna say, I'm gonna proudly say this: I'm one of the few that enjoy shooting surgical ears. I like surgical ears. I like the challenge. Bring it on. So I see big cavities. I've seen finish-rated ears, I've seen you know, mastoidectomies, I've seen a treasure, I've seen, you know, stenotic ears, I've seen pretty much all of it. And I've learned that it humbles you when you see so many ears and how unique they are. Because you and I talking and you meeting people, you have no idea what their ears look like unless you look in there or shoot an impression. And it just mind-bottles me how different we are from ear to ear. So that's one of the reasons why you hear about real ear, because real ear measures that unique ear. And every ear is unique. I like real ear. Reelio is a great tool to use, and I think it's a great starting point of what the patient's needs are based off their hearing loss. And you know, we use formulas, and every factory has their pyroy formula. We have Estat, and I don't know what phonak and Oticon's pyroy formula is, but so we have all these different formulas, and we run real, and you get to see the response you know, you match target, but there's something to be said about that we don't talk about. And I want to talk about it because it's so important. I've had a hearing loss all my life. I've been wearing hearing since I was eight years old, and I'm I'm 55. I'm f I'll be 55 next month. And I have threshold in my right ear. If you look at my audiogram, I was born with a pretty significant hearing loss. My right ear is down at 90 dB across the board. My left ear is about 40-50 in the lows and 70-80 in the highs. So it's a little precipitous. If you run real ear on my right ear, it's gonna distort and it's so uncomfortable. Even though I have thresholds. The key to fitting successfully is not only real ear, but it's perception. The perception of how we hear is so important. So that's why there's some offices, and I'll be quite honest with you, that don't run real, but they listen to the patient's perception of loudness. You can I've had real run on me many times, I've used it. You can do that's target match and it looks beautiful, but the patient says it's not loud enough. The guy's been wearing hearing aids for 20 years. He's a power junkie, he loves volume. So what do you do? You turn it above target because the patient's telling you it's not loud enough. So you gotta have both. Yes. You gotta have real and you gotta have perception of what the patient's telling you because I see things that I can't explain. You know, sometimes we run really, oh, it's too tiny, it's too sharp. They're hyperacoustic, they're sensitive to high, high frequencies. So you gotta roll it off a little bit. You can't just leave it there and say, oh, get used to that. They're not gonna want to wear it because it's too tanny, it's too much. So I the example that I use is the light dimmer. You know, when you go into a dark room and you turn off the light, or you turn the light off, right? And you sit in a dark room for a couple hours, you turn that light on. It's normal. But to you, it's so bright. Because you gotta remember, an average person waits six to seven years to get hearing help. That's the average. And all of a sudden you turn the hearing aid on and you map it, they're gonna say, whoa, whoa, whoa, whoa, this is a little much. So we use a dimmer. We kind of dim it down, we got compression, we got all these features that we can use to comfort the patient. Compression was made for comfort. That's why we have it. But I think sometimes we put the dim a little too low, sometimes. We put too much compression. And what that does is it doesn't make the sound as bright. So I use an example of a dim with a light. So I tell people, just dim it down a little bit, even though you're not at target. Let them get used to it. And they can always turn it up. So what I'm trying to say is this I've seen real measurements ran where it's too tinny or it's not loud enough, or they don't feel like it's they don't like the way it sounds. And I've seen it where you run it and it's beautiful and they love it and they walk out and they're happy. So I've seen both sides of it, but you gotta understand both. If you understand both, I think you're more successful than just doing real all the time. So there's a lot of subjective, not just objective measurements that we have to talk about. Because we have billions of neurons in our brain that are firing. Do we really understand what they're hearing? The patient tells us. Not the computer or formulas, the patient tells us. So I've learned working here, as many patients I've seen that we have to be humble and listen to the patient, no matter how much we know. Because the patient tells us the truth. I give you an example. If you make a custom mold, and by all means I'm not perfect, believe me, I've made a lot of mistakes in my life. But if I make a perfect mold, but the patient says it's uncomfortable, I'm not gonna tell them go walk out and get used to it. I'm gonna modify it. If a patient's willing real and it said it's not comfortable, I'm not gonna set them to walk out. I'm gonna modify it for their for their perception of what they hear, not what the computer tells me. So I've seen it over and over again that people say real is the best thing, which is it's great, don't get me wrong, but it's not the silver bullet. It's a great tool, and I think it helps a lot of people, and I think we get great responses. I think it's awesome, but you gotta listen to the patient. The patient is just as important as real. And I think that we need to do both and make both as important, not just real ear. So again, Blaze, I the reason why I'm getting so into this is because I've seen it over and over again how patients tell me too tinny, too loud, too soft, too echo, occluded, whatever, all subjective, right? And we do a lot of objective measurements speech and noise, real, you know, all the tests that we do. And I think we don't pay attention to enough to the patient and what they're telling us.

Blaise M. Delfino, M.S. - HIS : 31:50

Ray, I so I love that. So much to impact there. And I will tell you, obviously, we've been connected now for a couple of years and growing up in hearing healthcare, learning about the importance of real-air measurement. And then when I was running the practice in Pennsylvania, real ear measurement was standard. I mean, we ensured that we conducted real ear measurement, but to your point, it was a starting point.

Ray Woodworth: 32:18

Yeah.

Blaise M. Delfino, M.S. - HIS : 32:19

I love the dimmer. The light switch, yeah. I love the light switch analogy because that is so true. And I feel like we are in the greatest industry because we connect people to people through better hearing, and you're reconnecting your patients to their family, to their friends. So we need to listen. We talk about this with Dr. Favrey all the time, listening twice as much as we speak. That's right. So, you know what? You have a busy clinic. If you're showing your patient, oh, I only have a couple minutes for you to no block out. We would block out 90 minutes for new patients. Now, I understand not every clinic can do that, but my suggestion would be consider Saturday hours.

Ray Woodworth: 33:04

But it's funny you say that because when you take your time with these patients, do you know the most successful offices I've seen are people that come back to get newer hearing aids that you've been working with? So those are the offices that are successful. Not the marketing and trying to sell hearing aids. It's about building a relationship and they'll always come back to you for newer technology because they trust you and you built that relationship. But when you, like you just said, you hit it on the head. If you sit there and try to get them out the door, they're gonna feel like, I'm just a number. I don't feel important. Why should I come back here and get newer hearing aids? I can go somewhere else. It's like going to the grocery store. You go get a better service. Your service is huge. Yes. And I think we we miss the boat on that sometimes. So I've seen very successful officers be successful because of the the return of their patients upgrading, getting newer hearing aids. Because they, like you said, they spend time with them and they they feel like they're they're hood and taken care of.

Blaise M. Delfino, M.S. - HIS : 33:54

And Ray, when we talk about the human touch and making the patient feel that when they are in the office, it is all about them. Because we're talking about customization. Customization is very personal. Ray, we talk a lot about emerging technologies. And recently, Brandon Swalic, Dr. Favorie, and myself, we co-wrote an article on audiology online on emerging technologies. And we discussed the Da Vinci surgical system that was introduced in the early 2000s. And surgeons thought, like, this system's gonna completely get rid of our jobs. Well, no, like 20 plus years later, they're still utilizing this technology and it's had great patient outcomes. When we talk about emerging technologies in hearing healthcare, specific to taking impressions, what is your professional opinion as it relates to us continuing to take and shooting ear impressions with silicone versus scanning an ear?

Ray Woodworth: 34:58

That's a very good question. So, you know, being here at the factory, I see what comes in from all over the US as far as older scans versus ear impressions. And one of the things I learned about seeing all these scans that come in from different offices and seeing impressions, and I still see more impressions than I do see older scans. And one of the reasons why I ask people why aren't they using older scans versus ear impressions, one of the things is cost. We all know that it's expensive to buy an older scan. But here's the thing that really caught my attention. The tool is only as good as the person using it. You can have older scans, you can have new impression material, you can have the tools that you use, the shoot impression. I can't tell you how many older scans I've seen come in that are great. You see the second bend, you see the cavities, you see the whole ear canal, you see the concept bow and the helix. And I've seen older scans that are terrible. I've seen the same thing with your impressions. I see really good ear impressions, and I see really terrible impressions. So which one's better? It's the person that's performing. You can have, like I gave you an example. I'd never played a guitar. You're pretty good at playing the guitar, right, Blaze? Yes. If I grabbed your guitar and played it, it would be terrible. Because I don't have the hand eye coordination like you do. If you don't have the eye coordination or hand coordination to how to use an auto scan versus shooting impression with a video autoscope or with an autolite, the outcomes are gonna be different. So I think auto scans is a good thing, but I think it's like I said a few minutes ago, it's only as good as the person that's actually performing it. And same with ear impressions. I've seen, again, really good ear impressions and I've seen really bad ones. So the answer to successful outcomes is repetition. Practice, practice, practice, practice. The more you practice playing your guitar blaze, the better you get. The more you tune in with your fingers and your hands. So I would challenge any older scan with my ear impressions. I do them all the time. And I probably can shoot an impression faster than an older scan because I've been doing it for so many years. So it's not just about the tools, it's about how you use it and how you master it. So if you do an older scan and you're good at it, good for you. I thank you for sending good older scans to the facility. But if you're not good at it, practice, get good at it. Same with your impressions. If you're not good at your impressions, practice. You'll get good at it over time. And believe me, if I when I tell you this, I've made bad ear impressions, many. But I learned from it. You learn from your failures. That's the only way you're gonna get better. So if you're not willing to take the chinas to get better, however you're gonna get how are you gonna get better? So over the years, again, I've seen a lot of things come and go, and there's another thing to be said, and maybe a lot of people don't understand this, but because I a lot of people don't know this, but I detail impressions all the time, and I cut shells for the customs and put the faceplate on, see how it fits, because I have the resources here at the factory. So I've been very hands-on with our hearing aids. And there's a lot to be said about something in your hand. So you know how you go on Amazon and you order something, and then when my wife gets it, she's like, this is nothing like what I saw on the screen. So sometimes what you see on a screen is not the same as what you see in your hand. You in your hand, you see the imperfections of the ear. You see the texture, you see the wrinkles, you see, you think you see things you can't see on the screen. So I've gotten to a point where the little details make a big difference. So the texture, the wrinkles. I can look at an impression and tell you if they're an old person or a young person because of the wrinkles of the impression. An older scan, you can't see that. Smooth, it's that's nice, it looks great. But get that in your hand, you see it, you see a different perspective. Oh, that's impressive, right? So when you start getting deeper into the ear and understanding the ear, you start seeing those subtle things that you can't see unless it's in your hand. So you can go on that screen and do all the dance you want, moving it around, go upside down, and then you can go in and out, zoom in. Wow, it looks really big, zoom out, it looks really small. But in your hand, it's there. There is no zoom in, zoom out, it's there. And so you have a different dimension that you can't see on the screen. So I don't mean to get too much.

Blaise M. Delfino, M.S. - HIS : 39:11

No, in in a world that is so excited about technological advancement. The digital world is different than reality. I believe, to your point, there is beauty in simplicity. Yes. And if it's not broken, don't fix it. Yes.

Ray Woodworth: 39:26

And just remember when you see something on in the digital world, it's not the same you sitting in front of me talking to me. Correct. It's two different things. So I've learned that over the years, looking at your impressions, the imperfection of humanity, who we are as a person. You know, those little subtle things. I see little bumps, I lead little, you know, if they have a what do you call it, exatosis. I see the little ridge. And when you look on the screen, it looks like a void. It looks like an air pocket. Right. But actually, when you look at it in your hand, you can see the little densions of the skin texture. To see that little, it's not a void, it's a growth, it's some sort of growth. But when you see it on the screen, it's like, do we need to fill that in? We don't know if that's a void or not. So you it's important to write that on the forum. So, and again, I'm not trying to get too in-depth in this, but I do know that the more you tune in to a guitar or your instruments that you use, the more you see things a little different. And then you become in tuned, and then you become more a master or an artist of something that's deeper than what you just see.

Blaise M. Delfino, M.S. - HIS : 40:28

You master your craft.

Ray Woodworth: 40:30

Well, I'm still learning because every year is different. I found that, you know, I was training some people about how to use a video autoscope with the with we use what's called JetMed, which is the video scope, and it has an LED light, and it's really bright. We use a big 40, 40, 50-inch screen to to clean ears with a coret and then shoot impressions. A lot of people don't know this, but way before I was using coret to shoot impressions to paste a block, I was cleaning ears. When you clean ears with a coret with a video horoscope, the hand-eye coordination and looking on a flat screen, I thought it was, you know, now it's like it's easy for me. But when I first started, holy come on, I could not look away. And so when I started training and teaching people, I didn't realize that it's it's harder than it looks. And so I've learned to break it down and say, look, hold the camera, just look in the air, just get that depth perception because you're looking at a flat screen and look away from the screen or get familiar with that camera because you can't clean what you can't see. You can't place a block what you can't see. So the video autoscope is very important how you place it in one hand. And some people say, Well, what did you hold it in your left or hold it in your right? Whatever you feel comfortable with. So there's little subtle techniques that we have to learn to master it. So if you talk to certain people that have done really a lot, they know where to go and what to do and get the response they want. Because they've been doing it so much. They place the tube in, you know, they they you know, they set the stage and get everything set up, and they just same with impressing and cleaning ears. People have do it for a long time, they just know where to go, what area to go, but but it's all technique driven. So when I show people how to use the camera, right, to look in the ear, then now they have to use the other hand for something else. And that's where it becomes challenging. So the hand eye coordination and looking on a flat screen, I didn't realize how difficult it could be until you break it down and explain it to them. And then it's like, oh, I got it now. That camera, they don't know where to put that camera. Do they go in, out, do they angle it? So the positioning of that camera and the way you go in with that correct, I'm very repetitious. I do the same thing over and over and over and over until where I feel like I'm very comfortable with it.

Blaise M. Delfino, M.S. - HIS : 42:33

Perfect practice makes perfect.

Ray Woodworth: 42:36

So I think the more you do earlier, the more you do impressions, the more you do counseling, the more you do whatever you're doing, you're gonna find things that get better. And the the repetition, you're gonna say, oh, this works better. I'm gonna do it this way. Or hey, this wasn't good. I'm not gonna do that again. So I think, you know, if you look at Thomas Edison, the light bulb, how many light bulbs did he make until he made the I mean, he made thousands. Thousands. Until he perfected it. You know how many impressions I've shot before I I try to get better? Yeah. And I've failed. I mean, I've done some things that you know I'm not proud of, but but you know, you gotta start somewhere.

Blaise M. Delfino, M.S. - HIS : 43:08

And I love the message that you're leaving to our hearing care professionals, Ray, because we can always get better. And that's what's so exciting about this industry, is we always improve. And when we continue to improve as hearing care professionals, patient outcomes will continue to improve.

Ray Woodworth: 43:25

You know, and Blaise, there's something I want to bring up before we end this, and I think it's something important that I need to bring up. I think, I think the more we understand, like with technology, the more we understand the features and and how it works in the software, you know, and how to adjust and troubleshoot and whatever, the more you learn and understand things, I think the more you're willing to use it. I think the more you understand about impressions and ears, I think you're willing to make more customs. So I think we need to get out of our comfort zone and find things that we want to challenge ourselves to get better. I've got out of my comfort zone many times and and it wasn't fun. But it made me a better fitter. It made me see things a little different. So I think that we need to get out of our comfort zones and not be complacent. We need to, you know, challenge ourselves because we all want to get better, and I think we all can. And I'm still learning today as we speak. I'm always trying to find ways to be better and to help the patients better. I think in our industry, if you think you're the best, then you're not. You still have a lot to learn. And I'm at that place. I still have a lot to learn. But I think we need to challenge ourselves and not be complacent as we do to better serve our patients.

Blaise M. Delfino, M.S. - HIS : 44:40

I always appreciate your conversations. I appreciate you as a mentor, as a friend, and I'm wishing you all the success in the world and looking forward to making an impact together. Thanks so much for tuning in to the Hearing Matters podcast. We had Ray Woodworth join us. And if you have any questions, please send us an email, send us a message, and we'll be sure to answer it on the next episode. Keep hearing and listening well. And until next time, hear life story.