Abstract
This study analyzes the customer experience with Symphonia, a software designed to create soundscapes to help patients with hearing aids understand the benefits of using them and compare different models directly in the clinic. The survey, conducted in Northern Italy, involved 28 patients from three hearing aid shops. The results indicate that Symphonia is highly effective in enhancing patient satisfaction, involvement, and expectations regarding hearing aid performance in the real world, with strong endorsements from both patients and audiologists.
Introduction to Symphonia
Symphonia, developed by Inventis, stands as a cutting-edge counseling tool for Hearing Care Professionals. Designed to simulate realistic sound environments, Symphonia employs advanced auditory algorithms such as Ambisonic and Vector-Based Amplitude Panning (VBAP) to create immersive audio experiences. This innovative software allows patients to experience the benefits of hearing aids before purchase, through lifelike simulations of everyday noise scenarios and directional sound sources.
System Configuration
Symphonia's system setup is both versatile and user-friendly, designed to seamlessly integrate into professional environments. The configuration includes a computer with the Symphonia software, a multi-channel sound card such as the ESI Gigaport, and a variable array of three to eight speakers, depending on the room's size and acoustics. This system can be quickly configured using a wizard interface, guiding users through steps to place speakers in optimal positions around the patient, ensuring an accurate and effective auditory experience.
Calibration is a very important aspect. With Symphonia, it is possible to adjust the levels in dB SPL, both for the sources and the background sound field. The reference level is 65 dB SPL at 1 meter from the patient, approximately corresponding to the level of normal speech at that distance. The extremes are 51 dB SPL at 5 meters and 85 dB SPL at 10 cm, similar to speech of the same intensity at those distances. The measurement of distances can be displayed in both meters and feet. See Figure 1 for an illustration of the set up.
Figure 1. Symphonia calibration.
Symphonia Main View: Signal Commands and Controls for Customizable Soundfields
Different soundfields such as a coffee shop, restaurant, street, car, and ocean waves can be selected. The user has the capability to choose the signal for reproduction and its corresponding level. Up to three directional sound sources can be added to emit simultaneously, each with distinct angles and intensities. Examples include a male voice, a female voice, or a violin performance. Additionally, users can import custom sound files in .wav or .mp3 formats to further tailor the auditory experience for a patient.
Upon adding a source, the polar graph in the main interface will display the new source and its position. The source position can be easily adjusted by dragging the source circle on the graph with the mouse. There is a direct relationship between distance and level for the sources; thus, altering one of these properties will automatically adjust the other. Figure 2 shows the main view of the Symphonia software.
Figure 2. Symphonia software - main view.
Advanced Sound Algorithms: Ambisonic and VBAP
At the heart of Symphonia’s sound simulation capabilities lie two sophisticated algorithms: Ambisonic and Vector-Based Amplitude Panning (VBAP). Ambisonic, developed at Oxford University in the 1970s, provides a rich, multidimensional sound environment by manipulating a sound field with spherical harmonics. This technique has been revitalized with virtual reality advancements, allowing for precise sound localization and a natural listening experience. Symphonia adopts a unique approach by integrating Ambisonic for creating broad soundscapes from real recordings, which is essential for simulating environments like busy streets or tranquil ocean waves. VBAP further enhances this by enabling sharp, directional audio cues, essential for simulating realistic auditory spaces.
Developed in collaboration with Prof. Lorenzo Picinali from Imperial College London, Symphonia utilizes a hybrid solution that combines Ambisonic and VBAP. This collaboration has led to the adoption of VBAP for its superior spatial resolution, allowing pinpoint accuracy in the placement of point sound sources, such as individual voices or musical instruments, within the simulated environment. Together, these algorithms allow Symphonia to create highly accurate audio environments that can be customized for each patient’s needs, providing a comprehensive tool for auditory professionals.
Survey Execution and Findings with Symphonia
Hearing aid adoption and satisfaction are crucial factors in improving the quality of life for individuals with hearing loss. Despite advancements in hearing aid technology, the adoption rate remains relatively low, with many individuals not utilizing these devices due to various barriers, including motivation and perceived need.
Symphonia, a software developed to simulate real-world sound environments, aims to enhance the decision-making process for patients in clinical settings by providing a realistic demonstration of hearing aid benefits. This study explores the efficacy of Symphonia in improving patient experiences and overall satisfaction with hearing aids.
Methodology
Participants
The survey involved 28 patients from three hearing aid centers in Northern Italy.
Participating Hearing Aid Centers
- Pontoni Udito & Tecnologia
- Centro per l’Udito Dottori Comini
- Centro Audiologico AUDIRE
Additionally, the audiologist who treated each patient was interviewed to provide their perspectives on Symphonia's efficacy.
Survey Design
The survey was divided into two sections:
- Patient Section: Included 7 mandatory questions (Q1 to Q7) to capture patients' experiences and feedback.
- Audiologist Section: Included identifying information and questions (Q8 to Q10) to understand audiologists' perspectives on Symphonia's efficacy.
The survey was administered through Google Forms.
Results - Patient Section
Question 1: Experience Level with Hearing Aids
The results for question 1, experience level with hearing aids, are shown in Figure 3.
Figure 3. Survey results for Question 1: Experience level with hearing aids. Experienced users = 53.6%; Novice users = 46.4%.
Given that the majority of patients were experienced hearing aid users, it is likely that they provided valuable insights based on their familiarity with various hearing aid technologies. This distribution suggests that experienced users might have been able to offer more detailed feedback on the efficacy of Symphonia compared to novice users.
Question 2: Previous Experience with Similar Systems
The results for question 2, previous experience with similar systems, are shown in Figure 4.
Figure 4. Survey results for Question 2: Previous experience with previous systems. Tried similar systems = 10.7%; No previous experience = 50%; Novice users = 39.3%.
Half of the patients had no prior experience with similar systems, suggesting that Symphonia offers a unique approach that may be new to many users.
Question 3: Symphonia's Role in Building Trust
The results for question 3, Symphonia's role in building trust, are shown in Figure 5.
Figure 5. Survey results for Question 3: Symphonia's role in building trust. Highly determinant = 35.7%; Sufficiently determinant = 53.6%; Not determinant = 10.7%.
A significant proportion of patients found Symphonia to be a crucial factor in building trust with their audiologists. This indicates that Symphonia likely played an important role in enhancing the patient-audiologist relationship, which could be crucial for effective treatment.
Question 4: Improvement in Overall Experience
The results for question 4, improvement in overall experience, are shown in Figure 6.
Figure 6. Survey results for Question 4: improvement in overall experience. Greatly improved = 28.6%; Somehow improved = 64.3%; No effect = 7.1%.
The majority of patients reported an improvement in their overall experience, which underscores the positive impact of Symphonia. This suggests that Symphonia likely contributed to enhancing patient satisfaction during their visits.
Question 5: Increase in Patient Involvement
The results for question 5, increase in patient involvement, are shown in Figure 7.
Figure 7. Survey results for Question 5: increase in patient involvement. Fully involved = 60.7%; Somewhat involved = 39.3%; No effect = 0%.
Most patients felt involved in the customization process of their hearing aids, which is crucial for ensuring that the devices meet their individual needs and preferences. The fact that no patients reported "no effect" suggests that Symphonia was universally perceived as enhancing patient involvement to some extent, which could likely enhance patient satisfaction and adherence to using their hearing aids.
Question 6: Importance of Simulation Before Purchase
The results for question 6, importance of simulation before purchase, are shown in Figure 8.
Figure 8. Survey results for Question 6: Importance of simulation before purchase. Very important = 25%; Quite important = 53.6%; Slightly important = 17.9%; Not important = 3.5%.
A significant majority of patients deemed the simulation of external environments important, highlighting the value of Symphonia in the pre-purchase decision-making process. This suggests that such simulations are likely critical in helping patients make informed choices about their hearing aids.
Q7: Improvement in Real-World Sound Understanding
The results for question 7, improvement in real-world sound understanding, are shown in Figure 9.
Figure 9. Survey results for Question 7: Improvement in real-world sound understanding. Slight improvements = 57.1%; Significant improvements = 35.8%; No improvements = 7.1%.
Almost all patients experienced improvements in understanding real-world sounds, indicating that Symphonia effectively prepares patients for real-world listening situations. This likely demonstrates Symphonia's efficacy in enhancing auditory experiences outside the clinical setting.
Results - Audiologist Section
Question 8: Help in Adaptation to Real-World Environments
The results for question 8, help in adaptation to real-world environments, are shown in Figure 10.
Figure 10. Survey results for Question 8: Help in adaptation to real-world environments. Significantly helped: 57.1 %; Somewhat helped: 39.3 %; Not helped: 3.6 %.
Almost all audiologists observed that Symphonia significantly or somewhat helped patients adapt to real-world environments, validating the tool's practical benefits.
Question 9: Strengths of Symphonia
Each audiologist provided unique feedback on the strengths, with highlights such as:
- The realistic recreation of environments (a common strength noted).
- The ease of use, allowing for effective demonstrations in clinical settings.
Question 10: Suggestions for Improvement
Suggestions varied, with ideas such as:
- Adding a timer to monitor patients' response times to different acoustic stimuli.
- Providing a printed summary for patients.
- Enhancing the variety of simulated environments.
- Improving technical support and training materials.
Discussion
The survey results indicate that Symphonia significantly boosts patient involvement and satisfaction by providing realistic sound simulations. Both patients and audiologists reported positive experiences, with notable improvements in understanding real-world sounds and trust-building with audiologists. The high percentages of ease of use and overall satisfaction suggest that Symphonia has strong potential for enriching the hearing aid experience.
Audiologists highlighted the realistic recreation of environments and ease of use in clinical settings as significant strengths of Symphonia. These strengths suggest that Symphonia is an effective tool for demonstrating the benefits of hearing aids in a realistic and user-friendly manner. By providing realistic soundscapes, Symphonia helps patients better understand the benefits of different hearing aids, thereby aiding in the decision-making process and increasing overall satisfaction.
Audiologists also provided several suggestions for improvement. These suggestions offer valuable insights into potential enhancements for Symphonia, which could further improve its effectiveness and user satisfaction. Implementing these improvements could lead to even higher levels of patient involvement and satisfaction, making Symphonia an even more valuable tool in clinical settings.
The positive feedback from both patients and audiologists underscores Symphonia's potential for success in improving the hearing aid experience. By addressing the suggested improvements, Symphonia could further solidify its position as an essential tool for audiologists and patients alike.
Conclusion
Symphonia has demonstrated its effectiveness in improving the hearing aid experience for patients, regardless of their level of experience with hearing aids. Given the positive reception and the valuable feedback from both experienced and novice users, as well as audiologists, Symphonia could significantly advance the adoption and satisfaction of advanced hearing aids.
Key Features
- Realistic Sound Simulation: Whether it’s the hustle of a busy street, the chatter in a coffee shop, or the serene waves at the sea, Symphonia replicates these environments to demonstrate the effectiveness of hearing aids in various settings.
- Professional Enhancement: By enabling detailed sound adjustments and simulating real-world acoustics, Symphonia not only boosts the confidence of patients in their hearing aids but also elevates the professionalism and service quality of auditory clinics.
Transforming Daily Practice
Symphonia is not just about hearing aid trials; it can be an essential part of daily practice for audiologists. It supports detailed consultations, helping professionals assess and adjust the gains of hearing aids, and ensures that patients receive the most effective auditory solutions tailored to their environments.
For Patients and Professionals
Symphonia's real-world simulations allow patients to understand and prepare for the challenges they might face in noisy environments, ensuring a smooth transition to using hearing aids in their daily lives. For professionals, the system’s simplicity and the detailed feedback it provides on hearing aid settings make it an indispensable tool in offering superior care.
Inventis is proud to offer Symphonia, a system that stands out for its technical sophistication and ease of use as well as its ability to make a real difference in the lives of those with hearing impairments. Experience the future of auditory care with Symphonia, where sound meets innovation to enhance hearing like never before.
Additional Expert Perspective: Chiara Comini, AuD
Chiara Comini, AuD, has shared her opinion on the use of Symphonia, highlighting its practical benefits and potential impact on patient outcomes. Her insight provides valuable context and underscores the broader applicability and effectiveness of Symphonia.
Chiara is a hearing care professional at Centro per l’udito Dottori Comini in Italy. She received her doctor of Audiology from Siena University (Tuscany). She has over 10 years of experience working with consulting, selection of hearing products and acoustic re-education. In addition to adult patients, she follows pediatric patients by working in a team with different pediatric hospitals. She has presented at various workshops and meetings nationally and internationally. She is also engaged in performing assistance and evaluation of the functionality of cochlear implants.
Dr. Comini utilizes Symphonia extensively in her daily practice, serving both as a counseling tool and for fine-tuning the gain settings of hearing aids. Symphonia proves particularly advantageous in helping patients grasp the necessity of hearing aids, especially those with milder hearing loss. By generating a background noise that simulates a realistic sound environment, Symphonia effectively highlights the improvement in speech comprehension afforded by hearing aids.
For patients with unilateral hearing loss, where one ear maintains normal hearing and the other suffers from moderate-to-profound hearing loss, Symphonia's directional test is invaluable. In such cases, amplifying the impaired ear can adversely impact speech understanding and localization, as well as cause general acoustic discomfort. Relying solely on the manufacturer's software target without further testing poses the risk of a negative patient experience.
Symphonia allows for objective verification of localization. Patients with unilateral loss typically perceive all sound sources as originating from the normal hearing side. After a period of auditory training with a hearing aid, localization can be reassessed using Symphonia. Sounds are presented through various speakers, and the patient indicates the direction of each sound. Improved balance in sound identification from both sides suggests enhanced localization. Conversely, if sounds are predominantly lateralized to the impaired ear, it may indicate excessive amplification, detracting from the natural function of the healthy ear. Without Symphonia, recognizing and verifying such benefits would be challenging, if not impossible. This capability is also crucial for CROS fittings and for optimizing levels in patients with asymmetric hearing loss, where different degrees of hearing loss in each ear necessitate a balanced fitting.
In adjusting hearing aid gain, Dr. Comini employs Symphonia to deliver sound through its speakers while conversing with the patient to assess auditory clarity. She adjusts the gain accordingly using the manufacturer's fitting software, and also checks the hearing aid's maximum output parameters, compression, microphone settings, and any adaptive features.
A notable case involved a 26-year-old patient with unilateral hearing loss who began using a hearing aid on the impaired ear ten years post-diagnosis. Initially, the patient struggled with sound directionality, particularly from the impaired ear. After a month of using the hearing aid, the patient demonstrated perfect sound direction recognition during a Symphonia test, responding confidently to sounds from both the right and left sides. This improvement highlighted the successful fitting and significant benefit provided by the hearing aid.
Dr. Comini emphasizes the intuitive and user-friendly nature of Symphonia, which immerses patients in a simulated yet realistic soundscape. The natural sound sources used in Symphonia mirror those encountered in daily life, helping to anticipate and mitigate the annoyance of noises that patients might have grown unaccustomed to. This proactive approach ensures a positive outcome with hearing aids.
By predicting and addressing potential obstacles, Symphonia allows for precise counseling and hearing aid adjustments, ensuring successful amplification. Patients can immediately experience advanced hearing aid features such as noise reduction and directionality in the office, fostering confidence in the fitting from the start.
Utilizing Symphonia differentiates a practice in terms of service and professionalism. While a dedicated space is not essential, having a room specifically for simulating acoustic environments, conducting sound directionality studies, and providing consultations creates a positive impression on patients and demonstrates a commitment to their auditory success.
