Thank you for tuning in today. Today we are going to talk about incorporating wireless technology into the busy clinic. I am in Miami, and we work in a very busy clinic here. We have 12 audiologists and we are a hospital based system. With that, much of what we do is driven by productivity and revenue, so I definitely have an understanding of what it means to get your patients in and out and to be productive and efficient.
I think sometimes we look at that and say, "How can we add something else to what we are doing with our patients? It seems overwhelming." We will talk bit today about some strategies for an efficient delivery system for wireless technology. First we will just review and introduce wireless technology. We will discuss some of the benefits of the technology, who the candidates are for this technology, as well as a clinically-feasible approach to incorporating it into your practice. Lastly, we will go over some keys to success.
Wireless technology, in general, is rapidly evolving. It is playing an increasing role in the lives of people throughout the world, and most of us rely on wireless applications in one way or the other. When you think about wireless, all it really means is the transmission of a signal from one point to another without a physical, wired connection. What do you think when someone says wireless technology? The average American consumer thinks of things like cell phones, Bluetooth, Internet, global position systems, et cetera. All of these things represent recent advancements that have shaped or changed our society. But when you think about it, the ability to connect without a physical connection is not something new. It dates back as early as radio transmission. That is something that had a global impact of our ability to communicate across long distances. We know that these advancements have had a big impact on society, but why would you want to put that into our practice?
We all share common goals for our patients. At the very basic level we look to increase access to sound, but we also want to improve speech understanding in quiet and in noise. We are looking to provide comfort with listening across multiple listening environments as well as multiple loudness levels. Obviously, we want good overall sound quality. Some of this is achievable with hearing aids alone, but are hearing aids really enough? Many of our patients are unable to reach success with of all these goals using only their hearing aids. We are going to review wireless technology and the potential benefit it may provide to your patients who are challenged with more extensive listening demands.
We know the hearing impaired patient suffers from decreased audibility and decreased clarity. Our goal is to improve speech intelligibility for both quiet and noisy situations as well as provide the patient with improved communication ability. However, this can often be challenged by factors outside of the hearing aids. Speech intelligibility can be impacted by degraded signals due to reverberation or poor room acoustics. A decreased signal to noise ratio (SNR) can make listening more challenging, as can increased distance from the signal. Like the rest of the technological world, hearing aid performance has improved at a rapid rate. However, repeated MarkeTrak data (Kochkin, 2009; 2011; Kochkin, Beck, Christensen, Compton-Conley, Fligor, et al., 2010) continues to demonstrate that we are not seeing a significant increase in market penetration, despite improvements in digital hearing aids. So why would wireless technology be the thing that results in better outcomes?
Wireless technology can bring the signal of interest directly to the ear. It can also overcome significant background noise as well as large distances. Listening in noise is a primary complaint of hearing aid users, and wireless technology may have the ability to significantly improve patient-perceived benefit. We, the clinicians, are the gatekeepers to patient access to this improved technology. We are the ones with the primary responsibility to introduce and make our patients aware of all the capabilities of not only their hearing aids but the associated technology. Wireless technology for the hearing aid user can actually provide us solutions for three of the most commonly reported complaints of hearing-aid users. Again, I want to stress that this is for hearing-aid users, not hearing impaired people.
What are the three most common things our patients who are already using amplification report when they come back and they are still struggling? I would say it is listening in noise, success on the phone, and clarity with watching television. Bringing the signal of interest directly to the ear is not something new. The word wireless has become a buzz word as of late, but historically, hearing-aid users have benefited from things like t coils and FM systems for quite some time. The t coil has been around for more than 50, years but yet it is still not widely accepted. Some of this is because of its subject to interference and buzzing, but much of that has to do with the fact that it requires a magnetic field to be detected from a loop system or telephone. Because it relies on this looped system it is not as readily implemented in public areas such as churches or places of worship, assisted living communities, arenas and theaters. This is being demonstrated more recently in a push called Looping America. Even though it can be easily implemented in the hearing aid it may not be easily used by the hearing aid user.
Another system that has been around for quite some time is the FM system, which requires frequency modulation of electromagnetic signals transmitted to the hearing aid via direct audio input through an attachment or internal component in the hearing aid. One of the benefits is that it does not require the area to be looped; however, FM can be costly. Additionally, adding an extra component to the outside of the hearing aid makes it larger, and management of the entire system can be more complicated. When we are talking about elderly patients, a lot of them are on a fixed income, and cost is an issue. FM systems are also somewhat subject to interference, and streaming the signal can present security and privacy issues for these patients. So if this device has been around for so long, what makes wireless marketable now, and why is this newer technology something we should invest in?
Handheld devices have been trending since the mainstream use of the cell phone. We saw this in the hearing aid market, evidenced by the widespread incorporation of remote controls for operating the hearing aid. Sometimes the remote controls are designed to look like things that are new and trendy like an iPod®. Trending has become a big part of our culture and our society. It has been great for audiology as it has allowed us to provide easy, useable devices for older adults while still projecting an image of being high-tech. They can use it and still feel a part of that young, tech-savvy culture. Essentially, we are in a must-have era. It started with cell phones and quickly moved to handheld organizers. Then we moved to Bluetooth and electronic readers, and many of us are now utilizing tablets. The biggest impact for us as audiologists has been the obsession with ear-level devices. What was once a stigma has now become trendy.
We see this with the devices becoming decorated with crystals and diamonds and graffiti to make them hip and trendy. We see people, worldwide, standing in lines around city blocks for the release of new electronic devices or phones. This is just evidence of how these devices and technology have become part of our must-have culture. There are rapid changes in technology, and with the proliferation of such technology we have now become concerned about which technology is best. If we are going to get something, which one do we get? This trending is driven by ease of use, accessibility and connectivity. We want to know how small it is, if we can access the phone, the Internet, our music and if we can make and change appointments on our schedule. Really, it is all about staying connected. There is a deep need in today's society to be constantly connected. We see this in the Facebook movement and social media. The basis of feeling connected is in communication, so it seems obvious that as healthcare providers whose goal is improving communication that we should be in the forefront of utilizing these advancements. So how are we currently using it?
As mentioned earlier, remote control operation of hearing aids has been in use for a while, as has synchronizing right and left hearing aid communication. What is really becoming trendy, and what we are going to focus on today, is audio signal streaming which is bringing the signal of interest from the TV, phone, or MP3 players, directly to the ear. The reaction is to think that the hearing aids are made with Bluetooth, right? Well, not exactly. Bluetooth can be used to stream the audio signal as well as many other well-known applications, but Bluetooth is a digital FM signal that is currently not being implemented in hearing aids in part to the size and power consumption Bluetooth requires. However, Bluetooth can be used with hearing aids via an adapter that converts the signal so it can be detected by the hearing aids. Essentially what it does is transmit the audio signal to a relay or gateway device which then allows the signal to be detected by the hearing aid. This is what is often referred to as audio streaming.
Audio streaming allows the signal to be streamed directly from the output source to the hearing aids, which ultimately allows for improved SNR in complex listening environments and increased clarity and audibility for more dynamic acoustic signals. In order to accomplish this, most manufacturers are utilizing two solutions: near-field magnetic inductions and radio frequency. This is somewhat beyond the scope of this talk, but I will review it quickly. For an in depth review you can go to the article published by Jen Groth (2011) in The Hearing Review. It details how the systems are different and lists the benefits and limitations of each of them. Essentially, the near field magnetic induction allows a Bluetooth stream from an audio source to a body-worn gateway device. This device can communicate with the hearing instruments via magnetic inductions. This is why many of the systems require a small remote or something to be worn around the neck in order to receive the signal. Radio frequency, on the other hand, relies on an adapter that is connected directly to the sound source that will convert the audio signal so it can be received directly by the hearing aid. It is considered a far-field device because it allows for signals to be transmitted over a larger distance- 25 feet versus 5 feet of the near-field system. It does not require a neckloop or remote, so this may be a good option for those patients who are a bit more concerned about visibility of the device.
Benefits of Wireless Technology
As previously mentioned, wireless technology will bring the signal directly to the ear, allowing for an increased SNR ratio, even over long distances. Wireless technology using Bluetooth now allows for encrypted signals over streaming devices, unlike older devices. The patient can manipulate their personal listening preferences independent of the audio source. For example, if you have a couple at home, the person wearing the streaming system can actually manipulate how loud the TV is without affecting the overall volume and listening experience of the TV for the other person. Additionally, wireless technology does not require direct line of sight. They are more cost effective than older systems. They are easier to use. They are power efficient because we are not relying on Bluetooth alone. Wireless can be incorporated easily into the hearing aid system. Current wireless systems are also not as subject to interference like the earlier t coil and FM systems. Incorporating wireless does not necessarily result in a significant battery drain, either. Although the hearing aids may be working a little harder and you may have to change the batteries a little more often, it certainly is not what we would expect from a true Bluetooth system. Not all systems require devices to be worn around the neck; however, wireless technology does, at this time, require an adapter to connect to the audio source.
We compared the three large companies that currently sell now using wireless systems: Oticon, Phonak, and ReSound. Oticon and Phonak are using near-field magnetic induction with a gateway device for streaming, while ReSound relies on frequency transmission only. Some of the induction systems claim they get more distance with their streaming; however, when you look into it, as long as they are in a nice open environment, most of them can get more than 25 feet up to 80 or 100 feet of transmission, but it is dependent on the environment. All of the systems do have a remote. The near-field magnetic inductions systems can also utilize their gateway as a remote in the radio frequency system. You can adjust your television or phone via the hearing aids or the phone clip on ReSound's system. Oticon and ReSound use a lapel microphone for patients that want to communicate in restaurant environments with their target talker of interest. All of them have some kind of phone transmitter, and all of them require pairing in the software in advance.
One of the nice features about the ReSound system is that you can have two hearing aid wearers using the same unit. So if both listeners at home want to connect to the same TV, they can do that. The other manufacturers require two separate systems. While this is trendy and popular, what is the evidence to indicate I should incorporate this into my practice?
Sergei Kochkin (2010) indicates that more than one million users are not using their hearing aids because of poor performance in noise. At best, directional mics provide 4 to 5 dB SNR improvement (Compton-Conley, Neuman, Killion, & Levitt, 2004). A recent study out of Vanderbilt (Picou & Ricketts, 2010) showed that using the phone with wireless technology demonstrated significant improvement in SNR as well as speech understanding. We know that FMs can improve SNR significantly, yet patients tend not to accept them for a variety of reasons. Wireless technology may resolve many of these roadblocks. In 2006, Kricos suggested that better delivery methods and counseling may improve patient acceptance. If we incorporate this into our fitting practice, we should expect better outcomes with our patients.
Most of us are already incorporating wireless to some degree, whether it is within the hearing aid or the programming. Wireless technology allows for a nice, comfortable fitting with no wires connected to the patient. Real-ear measures can be completed without disconnecting from the software when you need to move the patient, and the instruments can be fine-tuned in real time. Overall, it also allows for faster data transfer for a quicker fitting.
So who are the candidates? According to the recent MarkeTrak data (Kochkin, 2009), the average age of the new user is 69. But as we all know, 69 is the new 39. Many of these people are still in the working force. They are active and tech savvy. Even though there are those in this age range that are retirees, they are often in challenging listening environments. I live in Florida, which is the nationwide capital for retirement. Many of my patients live in typical Florida homes with lots of windows, high ceilings and tile, which keep the home open and airy, but they also create the most reverberant listening environments. Whatever their work or activity status, are these users candidates for advanced technology?
Many of us believe that elderly patients are too challenging for advanced technology, but truly it is not just for the young and tech savvy. Advancements have simplified device management significantly. They can touch it. They can manipulate it very easily- much more easily than they could for direct audio input adapters that had to connect to the back of the hearing aid. Furthermore, these older adults are your "I just want to hear" group. They are less concerned about cosmetics, and wireless technology can provide accessibility to otherwise challenging listening environments.
It can aid those patients with physical limitations. It can enable them to answer the phone or adjust the TV volume without having to ambulate. These are probably the patients you actually want to target, because wireless can simplify their life and keep them connected to the outside world. Communication needs vary by individual and should be assessed during the identification and selection process. When a significant handicap is reported and patient needs cannot be fully addressed by the hearing aids alone, wireless accessories may be the thing that provides added benefit for successful outcomes for your patients.
It is important to consider the wireless accessory, and it should match the needs that are identified during your pre-fit subjective measures. While previous hearing aid users or younger users with active occupational or social needs may seem like obvious candidates, when we are looking at our evidence-based protocols, the optimal candidate is one that is going to demonstrate a SNR loss as well as a significant communication handicap by self-report. When this happens, the concern should be addressed and realistic expectations for hearing aid benefit established. Let the patient know why they are a hearing aid candidate and what things the hearing aid realistically can and cannot do. If they have realistic expectations for the future, then introduce the accessory options are available for them for increased benefit that they can take advantage of at any point down the road. You want them to know there are still options for them to keep them successful.
How do I incorporate this into my clinic?
Establishing a clinically feasible approach is important for ensuring optimal outcomes while maintaining a productive clinic. The Kochkin (2011) data suggests that simple modifications to routine clinical protocols can result in significantly improved patient outcomes. Our clinical protocol should be based in best practices. We want it to be easy. We want it to be effective, but at the same time we want it to be based in evidence. We know that MarkeTrak VIII data (Kochkin, 2009; 2011) showed 76% of patients with above-average success are actually fit within one to two visits. We also know that only one-third of clinics are using verification and validation. I think a lot of us are eliminating our validation measures due to time constraints, but MarkeTrak suggested that using verification and validation measures into the fitting not only improves patient satisfaction but reduces visits by one-half million. That is huge.
For those of you who are feeling overwhelmed or not able to fit it all in, I would suggest that you look at your clinic and do a hearing aid appointment analysis. Look at it what you are doing with your time. Are you focusing on things that may unnecessarily take up time and could be easily replaced by validation verification measures? At the end of the day we have a goal. Our goal is to optimize amplification. Incorporating wireless technology is not a replacement for good fit practices. It should be something that enhances the patient experience, and best success is achieved by using assistive technology with good hearing aid fittings.
The MarkeTrak data demonstrated a strong relationship between best practices and patient benefit. From start to finish you want to follow evidence based practices to ensure that when the time comes to introduce the patient to the wireless accessory options they are already in an optimal fitting. Some widely-accepted key components are comprehensive audiological assessment, which includes speech-in-noise measures, selection of appropriate ear-level devices, and subjective assessment of initial disability and perceived handicap. You are going to use all the subjective data and objective data to establish your realistic expectations and counsel your patient. You also want to make sure you are doing your electroacoustic measures using real ear, then you can fine tune and do post treatment validation. These are commonly accepted and published strategies time and time again.
Applying Wireless in the Clinic
So how do I make it clinically feasible? Well, if an audiogram results in an aidable hearing loss, you should immediately, as part of your comprehensive audiological evaluation, assess speech-in-noise disability. Establishing SNR loss using a test like the QuickSIN (Etymotic, 2001) can be incorporated into your clinic within minutes. Not only does this provide you, as the clinician, with a wealth of knowledge for device selection and establishing realistic expectations, it also tends to foster trust between you and the patient. Patients relate to these tests to the types of environments that they struggle with the most. How many times have you tested a patient with a word list in quiet who says, "I hear fine when I am in quiet. This is not the problem I have." When I perform this test (QuickSIN), most of the time it results in an immediate reaction and emotional response. This establishes trust, and trust empowers you for effective counseling and establishing realistic expectations. Again, this is something you can add right into your audiogram in a matter of minutes and it will provide you with immediate information and valuable insight down the road.
When possible, go ahead and initiate your hearing aid evaluation. Administer your subjective questionnaires. Select your amplification, and then use all of this information to counsel and establish your realistic expectations. If the patient demonstrates a significant SNR loss on your objective measures, then wireless technology should be considered for introduction during counseling. Go ahead and discuss with the patient the added benefit of bringing the signal of interest directly to the ear to overcome the background noise and distance for the signal. Talk about what the hearing aid can do for them, and let them know what is realistic for them in the really challenging environments and what this added technology can provide for them down the road.
I already know what everyone is going to say. "I do not have any time." If there truly is no time, there are some things you can do to make your clinic and your fitting experience a bit more efficient. We already discussed how to reduce the number of visits by using best practices but there are other things you can employ also. I am a huge supporter of technicians or assistants. They can do lots of things for you. They can administer the questionnaires to patients. They can do your electroacoustic checks on your stock or new-order hearing aids in advance. They can enter your audiometric information and set up your fitting. Oftentimes I have my assistant do this while I am counseling so the fitting is ready to go right after I have completed my counseling. They can also review the device use and routine maintenance. You can spend your time doing real-ear measures and fine tuning and counseling and then leave your tech to show them how to change the battery, the dome tip, how to connect and disconnect the device, et cetera, while you move on to your next patient.
If you do not have technicians available to you, you can utilize your front end management to do these tasks. They can administer questionnaires. This is a big one for us. All of my patients get a questionnaire when they walk in the door. By the time they come back for their audiogram, whether they are determined to be an implant candidate or hearing aid candidate, I already have an unbiased report from them about how they feel they are doing with their hearing and communication ability. They can also do things like log in their hearing aids and provide hearing aid packets for dispensing. You can also have quick tip guides in the waiting room or streaming videos of device use in the waiting area and train your front office staff to answer common questions that might arise from these videos.
If you cannot engage a same-day fitting, you absolutely want to make sure that your fitting is prepared in advance. Your time as the professional, as the audiologist, should be spent with the patient focusing on on-ear measurements and fine tuning. You should also be using that time to provide additional counseling regarding patient specific communication means. When it comes to implementing the wireless technology, my belief is the most efficient way to do this is to allow them time to adjust to the new hearing aid technology first. You want to be sure they are in an optimal fitting and that they have a good experience first. Then you can expand and implement the wireless technology at the follow up visit. You do not want to overwhelm them, particularly the older adults. You want to make it simple and introduce it when the time is right.
Is There a Quick Introduction to Wireless Technology?
A great strategy to introducing wireless technology in the office is to have demonstration systems set up for all the different manufacturers. We make sure that everything is charged and ready for demonstration. If you have a patient who is a candidate or interested in wireless technology, have a place where everything is charged and ready to go, with the devices paired in advance. Another great strategy is what we like to call the "1, 2, 3 card" for simple go-to instructions for connecting. A lot of people like to discuss everything with the patient and send them home with a guidebook or instruction manual. I am not a big fan of this. Sometimes our tech-savvy patients are the ones who do not want to be bothered with looking at everything, and older patients need things to be a little less complex and simple for them. Another good tool is to include your web address on this card if they are utilizing telehealth. It could be slipped into their wallet or purse or set next to the phone.
Establishing the initial communication between the audio source, like the phone, and the streamer is the process called pairing. The great thing about pairing is, if you do this in advance, the paired devices will not need to be reset by the patient for each use. This simplifies it for the user and allows them to quickly connect as needed. This can all be easily done by the clinician prior to the appointment. To pair the devices and set up a wireless system in advance, you will need all the pieces required, including the hearing aids, remote, transmitter for the TV and whatever you are utilizing as a transmitter for the phone (Figure 1). It is important to note that these devices have to be paired into the software in advance as well.
Figure 1. Individual components of a traditional wireless system (ReSound) including hearing aids, remote, TV box, and phone clip.
Setting up the TV is pretty simple. You have a wired connection that will connect the wireless transmitter to the TV. It is connected with a red and white cable that are color-coded for convenience. I have to give a caution here, because what we found with the number of wireless demos we are doing is that some patients are coming back and saying they do not have any volume on their TV. What is happening is when you are plugging into the audio-out on these newer TVs, it causes the transmitter to not have any volume or puts the TV itself to mute. Audio-out tends to work fine for the older TVs but the new TVs recognize it as an external audio device like a surround system. In that case, instead of using the audio-out, you need to use the digital audio-out which will convert the signal from digital to analog. In some other cases you may need to use a digital-analog audio converter, but some patients can connect it directly through their TV or cable box at home. If they need to get a converter, you can send them directly to Amazon.com to buy one, or you can buy them in bulk and bundle one into your system cost. They are usually around $25 to $30.
You also need to pair the remote and phone clip to the hearing aids in advance. For the phone clip it is important to remember this is your transmitter from the cell phone to the hearing aid and from you to the other talker. The phone clip needs to be close to the mouth where the microphone can pick up the voice.
There are other simple troubleshooting tips. If you go to use it and there is no sound, first make sure the devices have been paired. The transmitter needs to be paired to the hearing aid as well as to the gateway device. You also need to ensure that the connection has been established. There is a difference between pairing and connecting. Pairing is done in advance by the hearing aid audiologist or technician, and then the user has to connect each time. The connection is usually indicated by some kind of status light either on the TV transmitter, the phone clip or the lapel mic. You also want to ensure that the hearing aids are programmed in the software to detect the wireless technology as well as ensure that the volume is up on the transmitting device or gateway device.
Efficient and Effective Demonstration Strategies
If you have a hesitant patient the best way to show the benefit is by identifying a real-world motivator. A great way to do this is to have a TV set up in your clinic for demonstrating at-home benefit. If you do not have access to a TV another great option is a portable DVD player (Figure 2). These can easily fit into any office or small sound booth at low cost to your clinic. I like to have the TV on when the patient comes in at a low volume and during counseling activate the wireless technology without telling them. It purposefully demonstrates to them how the wireless technology can bring the signal of interest directly to the ear, despite the TV settings.
Figure 2. Example of an in-office TV or portable DVD demonstration setup.
Another great strategy is to engage the significant other. Have the patient set the TV to their comfortable listening level and then have the significant other set the TV to their level and compare the difference. You can have the patient report on their perception of clarity and volume while using their hearing aids when the TV is set for the comfort of the significant other. Leave it set at this level, then go ahead and turn on the connectivity. Typically this creates a great "aha" moment because the sound becomes clear. They both realize they can enjoy TV together without impacting either one's ability to understand what is coming from the television. Another approach is pairing the patient's cell phone in the office and then having the significant other call the patient on their cell phone from another room. This enables both people to experience the benefit of the wireless technology with phone use.
One of the other things we like to do is hide-and-seek. We will put on the lapel mic and walk out of the office down the hall. We talk to the patient and tell them to come out and find us. They will lean out and look down the hall and see we are good 15 to 20 feet away. That usually results in another "aha" moment when they realize they would be able to hear their significant other from another room in the house. You may find other great ways to establish-real world motivators so patients can understand how this can be applicable to their actual life.
Keys to Success
The most proactive thing you can do is to plan ahead and be prepared. Take the time to set up your practice and be patient ready. When possible, employ technicians to pre pair the hearing aids to the TV and other accessories. ReSound's system has the capability for multiple things to be paired to the same device. You can even activate the wireless connectivity before the patient walks back. They will wonder why things sound so great. They are excited already to find out what this new accessory is. Which leads me to my next point: do not overwhelm the patient. There is no reason to inundate them with all this information at the fitting. During your initial counseling, briefly introduce it but not overwhelm them with the details. Let them know you will explore more options if necessity at a follow-up visit. Do not waste your time explaining every feature and option of every manufacturer. You are the professional. You want to use your expertise and consider their needs, lifestyle and hearing loss and give them what you think is best.
Next is follow-up. Outcomes should be assessed using subjective and objective validation measures. Use your aided speech-in-noise testing and post-treatment questionnaires and subjective validation measures. You definitely want to ensure that the patient is successful and optimizing the use of their hearing aids and accessories. Stay connected to your patients. Our goal and responsibility is to monitor success. How do we monitor success without increasing the number of non-revenue-generating visits? I think that the use of telemedicine can do this successfully with little time or cost impact to your clinic. Many patients do not need to drive all the way to your office for a 30-minute appointment. They just need a quick reminder on use or maintenance or how to connect. Remember that time is money for everyone, not just you. Many of these older patients have limited mobility or limited access to driving or getting around, so utilizing things like telehealth can make those older individuals great candidates for wireless technology.
Do you have a Web site? You can easily upload one to two minute videos showing tips for hearing aids and how to connect the TV or remote to the assistive device. Upload your subjective questionnaires and have them e mail or fax back to you. If you have a great IT guy they can even submit them online via the website. If you are utilizing YouTube, manufacturers offer great videos. I know ReSound has awesome one-to-two-minute videos showing how to connect their devices. One of the strategies I use is letting a patient watch the short videos on my tablet or laptop while I am doing my billing and my charting. They may not retain everything in the video but they know it exists, and they can go back to YouTube and look it up if needed.
If you are on an electronic medical record (EMR) system, you can utilize secure questionnaires via e mail health blasts. A lot of these EMR systems allow the patient to log into a private account where they can contact their physician and engage in telehealth and listservs. A few years ago one of our students developed a listserv that we affectionately called QTips (questions and tips). It is a list of tips that goes out quarterly to hearing-impaired individuals, hearing aid users, or implant users. It has been a great source of assistance for keeping our patients using their devices and also engaging significant others.
Conclusion
In summary, newer technology can add ease and simplicity with fitting practices even with older adults. Bringing the signal of interest directly to the ear can benefit all patients who struggle in noise, particularly those who have objective SNR loss. Using an evidence based approach to your validation and fitting can make your practice more efficient. We see this by a reduced number of visits as well as increasing patient satisfaction. Wireless technology should enhance the patient experience. Remember it is not a replacement for good-fit practices. When set up appropriately, wireless technology can be easily incorporated into your hearing aid practice. The use of things like technicians, setting your system up in advance and using your best fitting practices can really make your fitting protocol easily incorporated and efficient without impacting productivity. Reducing the number of unnecessary non-revenue generating visits will also make you much more productive.
It is important to remember that patients of all ages are candidates for wireless technology, and, in fact, the elderly may be the best candidates. These are your patients who may be limited in mobility and having wireless technology may enable them to do things without having to ambulate. They also may be the patients who have limited access to watch television and communicate with their loved ones over the phone. Wireless technology keeps them connected and prevents them from things like social isolation.
Using objective and subjective measures will help you further identify optimal candidates. While the audiogram will help you select hearing aids, speech-in-noise testing will help reveal those optimal candidates who present with an SNR loss. I argue that all patients are going to benefit from wireless technology. Bringing that signal of interest directly to the ear overcomes the distance and helps compensate for reverberation and noise. It also allows our hearing aid users benefit for their three most common complaints which are listening in noise, success on the phone and clarity and audibility with watching the television. Simplifying the process for your patient makes for a very effective delivery system. Furthermore, using resources like technicians and telehealth can make your practice efficient and improve patient outcomes.
Using some of these efficient strategies can reduce the amount of time needed in the clinic and allow more professional time to focus on real-ear measurements and validation measure for your patients. It is feasible to offer wireless technology in a clinic which can provide many patients, particularly those who are older and struggling, the assistance they need in challenging listening environments.
Question & Answer
Are the financial constraints an issue and how do you handle this?
That is kind of a touchy subject. You know, I think that the financial constraints are an issue for everyone. No matter where you go or what you are doing, people are talking about the effects of the economy. I think the people who are committed to getting hearing aids and amplification and are prepared to do what they need to do financially to hear better. For those who have financial constraints, I personally keep them in a mid level or lower-level hearing aid and opt to get them wireless technology instead. I find that they benefit more from the improvement in SNR than they may from advanced signal processing. Again, if you are not using wireless technology I encourage you to investigate it because it is much, much more affordable for patients than the previous FM systems.
If you had to choose, which ReSound Unite accessory would you say is the most popular with patients?
That is a good question. I would definitely say the TV Unite. But ReSound just came out with a lapel mic, the most recent addition to their wireless technology. My hope is that it will get a lot of great application. The Oticon system also uses a lapel mic, and a lot of my patients using that system really like their lapel mic. But even with the Oticon ConnectLine, I would say that the TV is probably the biggest benefit, subjectively.
How is battery life affected when using a wireless system?
I do not find that it makes a huge impact. I think if you talk to other people they might say they see a little more power consumption, but literally when you look at it, it is not that bad. I would say maybe one to two days less. It is definitely not as much such as if we were to incorporate Bluetooth technology. Most of my patients do pretty well with their battery life. It is a little bit less than with the hearing aids but not a huge difference.
References
Compton-Conley, C.L., Neuman, A.C., Killion, M.C., & Levitt, H. (2004). Performance of directional microphones for hearing aids: real-world versus simulation. Journal of the American Academy of Audiology, 15(6), 440-455.
Etymotic Research. (2001). Quick Speech-in-Noise Test. [Audio CD]. Elk Grove Village, IL: Author.
Kochkin, S. (2009). Marke Trak VIII: 25-year trends in the hearing health market. The Hearing Review, 16(11), 12-31.
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