Interview with Dave Fabry, Ph.D., Managing Director of Sales, Starkey Laboratories

Topic: Starkey Update - Spectral iQ, Xino, Patient Engagement Tools

Dave Fabry, Ph.D.

CAROLYN SMAKA: Dave, good to talk with you again. Since you've been on board with Starkey, I know you've had a few different roles. What is your current responsibility?



DAVE FABRY: My title is Managing Director of Sales for Starkey, so it's a bit of a different focus than roles I've held in the past, which have been in areas such as education and training as well as R & D. I'm enjoying it immensely, and I find that my background as an audiologist has been extremely helpful. It's a lot of responsibility, but it's also a lot of fun and I still participate in product management, product development, and marketing. It really allows me to wear many hats, and I have always enjoyed wearing many hats.

SMAKA: Lots going on at Starkey, and my first question is about Spectral iQ, which has just been added to Wi Series. For those who may be unfamiliar, can you give an overview?

FABRY: Sure. We've introduced Spectral iQ both in X Series and in Wi Series, our latest products, in an effort to meet the market demand for patients who have precipitous losses and, presumably, auditory dead regions. We know that there have been other products on the market that have incorporated a frequency lowering strategy, but we wanted to design our systems specifically for dead regions, because our overall philosophy is that every hair cell is sacred. We want to achieve audibility whenever possible. For patients for whom audibility is not possible, such as those with steeply sloping losses, Spectral iQ serves as a tool that intelligently applies frequency lowering only when high frequency energy is present. This is different from the other frequency lowering systems that are always engaged, and in many cases, they've been applied in areas where there is residual hearing. That is inconsistent with our philosophy that audibility should be the first priority, and frequency lowering should be a secondary goal for those patients who can't take advantage of high frequency cues because of their hearing loss.

SMAKA: So Spectral iQ is only engaged when high frequency energy is present in the signal, such as fricative or sibilant consonants, for example?

FABRY: Exactly. This intelligent application of frequency lowering is a whole new approach. What we found in our studies is that in addition to intelligibility, sound quality is better preserved than with other solutions.

SMAKA: How does an audiologist determine who is a candidate for Spectral iQ? Would you have to conduct a TEN test?

FABRY: Another aspect of the intelligent application of Spectral iQ is that it will engage based upon audiometric considerations such as the slope of the audiogram, and the degree of the loss in both the low and high frequency regions. If an audiogram doesn't meet these criteria it would not be activated during the fitting process. Of course, professionals can also engage or disengage it in the software, based upon the results of the TEN test or other clinical decisions. When I was working clinically, if I found a dynamic range at any frequency that was less than 10 dB, then that region was effectively a dead region to me, as it was too narrow a range to effectively provide amplification in most cases. During audiometric testing, I would present a tone at 10 dB above the measured threshold at each frequency, and if that level was uncomfortable for the patient, I would consider it essentially a dead region.

SMAKA: Thanks for that overview. If professionals want more information or to review some of the studies you referred to regarding Spectral iQ, to where should we direct them?

FABRY: Data, white papers and other published research for our technology including Spectral iQ can be found at starkeyevidence.com. Our focus is on providing evidence-based outcomes prior to introducing products rather than having clinicians have their patients serve as guinea pigs after the product is on the market. Unless you're in an official beta test, you're not going to be asked to collect data for us, because we've gathered that data prior to the product launch. This doesn't mean that the evidence-based approach ends at the product launch;in fact, for us it continues throughout the product lifecycle as we look at making continuous improvement to devices out in the field.

SMAKA: I really enjoy the blog on starkeyevidence.com;Jason Galster picks great evidenced-based research that's been published on a variety of topics and provides a nice summary.

FABRY: Yes, I agree, it's a great resource. You can also access it from starkeypro.com.

SMAKA: Tell me about Xino, the new mini Receiver-in-Canal (RIC) from Starkey.



Xino, Starkey's new mini-RIC

FABRY: Xino™ is a continuation of our focus on invisible or nearly invisible cosmetic solutions that provide state-of-the-art signal processing. One of the things that we've seen in the last five years in the U.S. market is the transition from custom devices to BTE or RIC products. As you know, about five years ago 70% of the instruments sold in the U.S. were custom models. Today, the market is about 65 to 70 percent BTE or RIC devices. The interesting thing about this shift is that it hasn't really grown the market. Although MarkeTrak has shown a slight increase in the number of new users, the average age of a hearing aid user has remained steady at about 69 1/2 years of age.
About two-thirds of the devices that are fit in the U.S. market are on existing users rather than capturing new users.

Our invisible-in-the-canal SoundLens™ device was introduced in the past year, and we've found that it is attracting younger individuals. They're more active, they're more likely to be working, and they're more involved socially. In essence, what we're seeing is that SoundLens is attracting the baby boomer market that hadn't been adopting hearing aids. Baby boomers haven't been using hearing aids despite the fact that they're now entering our target age bracket given that roughly 10,000 baby boomers are turning 65 each and every day as of 2011.

Xino was designed to continue the same focus on cosmetics that makes SoundLens so appealing, and offer the advantages of RIC devices and open fit solutions. Xino is the smallest fully featured RIC on the market today. It is a mini RIC utilizing a 10a battery.

SMAKA: What do you mean by 'fully-featured'?

FABRY: By fully-featured, I mean that Xino has all of our X Series leading performance features such as Spectral iQ, Voice iQ, PureWave Feedback Eliminator, and others, as well as features such as a telecoil and the option to change programs or to use a stepped volume control. In other smaller products, we too often find that the telecoil and the user control are sacrificed, but we've been able to retain them in a very cosmetically appealing package with Xino. We think Xino will help grow the market and have an impact with the baby boomer population.

SMAKA: Sorry to keep switching topics but it's not every day I get to sit down with Dave Fabry. What's new with SoundPoint? I got to demo it at AudiologyNOW!

FABRY: SoundPoint has proven to be an important patient engagement tool for that baby boomer patient who wants to be more involved in the fitting experience than his or her predecessor.

At both Mayo Clinic and the University of Miami where I worked clinically, I started to see the impact of the baby boomers who were engaging with hearing aids and who had acquired hearing loss. Philosophically, they're a different breed than their parents were, and even in those "ivory tower" clinical settings I noticed a lack of deferential attitude, i.e. "You're the audiologist, and I'm the patient." Baby boomers come to the appointment armed with reams of data. They want to be involved or engaged in the whole hearing aid process from selection through fitting. To respond to that need, we've developed now ten apps for the iPhone or the iPad that are various kinds of patient engagement tools.

SMAKA: Can you describe a few of those apps?

FABRY: One example is Sound Check, which is a screening tool that is currently our most downloaded app from the iTunes store. We find that in addition to practitioners and audiologists, there are potential patients that are out screening their hearing. Sound Check is not designed to replace a full audiologic evaluation. Rather, it's for when someone suspects they have a hearing loss or is concerned about a family member, and they can quickly run a reasonably consistent screening test. That actually leads to the next app that we developed, the Hearing Loss Simulator. This app has also been used by many clinicians to engage both the patient and the significant other to help them understand what it means to have a hearing loss. They can plot an audiogram in the Hearing Loss Simulator and then play sounds through the speakers or through headphones to give a family member a better appreciation for what it is to have a hearing loss. Another app, Lifestyle Solutions, enables the clinician and the patient to engage in more of a conversation about where they have difficulty hearing and where their expectations are with regards to amplification.

SMAKA: It sounds like these three apps are front-end tools that can help the clinician engage that motivated patient at the beginning of the fitting process.

FABRY: Yes, whereas SoundPoint is an engagement tool for use after the initial fitting.
For example, many patients who are newly fit with amplification aren't used to the way their own voices sound. Most manufacturers' software includes an occlusion management control that provides maybe two to four adjustments to try and address the issue. SoundPoint enables clinicians to use an iPad to change the characteristics of the hearing aid by simply having a patient place a finger on the screen and move it in the subjective space. I think of it like a digital Etch-A-Sketch. The patient listens to a passage and as he moves his finger around the iPad screen, the hearing aid seamlessly moves through different settings. Instead of the clinician making an adjustment and then saying, "How's that sound? Try this, how's that sound?" patients can actively engage and adjust to their own preference. They can save several settings simply by tapping the screen, and then compare between the various settings they've saved. When they arrive at a setting that is satisfactory to them, they can double-tap on it to store it in the hearing instrument.

We find that although we limit the range of possible adjustments that the patient can make with SoundPoint, the very act of involving the patient as an integral part of the initial fitting process lowers return for credit rates, and improves satisfaction and benefit.

SMAKA: I can certainly think of patients I'd seen over the years who would have liked to have a tool like that.

FABRY: Me too. I had the privilege of working for many years with Les Paul as a patient. He was both a great musician and an engineer. Every time I would see him, he would beg me give him the Hi-Pro box and fitting software so that he could adjust his own instruments. After several years of asking, he finally wore me down and I lent him the Hi-Pro, the cables and the software, knowing that he could handle the technology. Two weeks later, when I saw him again, he returned everything to me. As a musician and an engineer, he always thought he could achieve the sound he was looking for if he could program the instruments himself. It wasn't until he could actually drive the system, that he realized that given his damaged auditory system he couldn't achieve the sound he thought he could.

It was those kinds of experiences that convinced me that SoundPoint is a tool that can help other clinicians engage with their patients. It can help them understand the damage to the auditory system that we've always talked about, and that differentiates hearing from vision, and that can prevent us from setting realistic expectations.

SMAKA: Are professionals afraid of giving up a certain level of control?

FABRY: Maybe some are. I do think it's important to emphasize that Starkey does not believe in Internet sales of hearing aids. We believe that the key not only to satisfaction, but to patient delight, is through the application of technology and clinical expertise. SoundPoint is a tool that enables the clinician to use his or her expertise in the initial fitting and programming, and then to have the patient engage in that process in order to move from not only satisfaction, but to delight. As professionals we are absolutely essential to the entire hearing aid fitting, and SoundPoint is a tool that we can use as a small part of the overall process.

SMAKA: If professionals are looking for the Starkey apps on iTunes, we should mention that they should look under Starkey Laboratories. Seems there is an electronic dance band on iTunes named Starkey.

FABRY: Well, I'm not here to endorse the Starkey band, because I have no affiliation with them and I've never actually listened to them, but by all means if electronic dance music is your thing, maybe you'd want to check them out. But if you're looking for our apps, search under Starkey Laboratories.

[laughter]

SMAKA: Excellent. Well, Dave, as much as I'd love to grill you with a million more questions, I'll save them for next time. Thanks for your time today.

FABRY: I appreciate the opportunity, and I always enjoy talking with you.

For more information about Starkey, visit www.Starkey.com or the Starkey web channel on AudiologyOnline.