Interview with David Fabry Ph.D., Past President - American Academy of Audiology, Phonak - Director of Clinical Research
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AO/Beck: Hi Dave, thanks for your time this morning. I want to thank you for your excellent and insightful leadership of the AAA over the past year or so. Additionally, we're honored to spend some time with you to help introduce the community to your new position at Phonak.
Fabry: Thanks Doug, I always enjoy these interviews, and thanks for the invitation.
AO/Beck: Why don't we start with one or two of your reflections on your AAA presidency?
Fabry: Sure, I've got lots of them! I think the events of the last year have really helped us to better define who we are, what we want as professionals, and where we want the Academy to take us through their leadership.
With due respect and thanks to ASHA for having recently removed themselves from the America's Hearing Healthcare Team Initiative (AHHTI), the AHHTI was in fact a great membership drive for the Academy ! Again, I applaud ASHA's decision to withdraw from that particular program.
However, and there's always a however, I do think it's important for audiologists and otolaryngologists to work together -- and now we all have the opportunity to work together on a fair, equitable and appropriate team and I look forward to future discussions on that matter and related issues.
AO/Beck: Very good. During your tenure as president, were there any specific lessons you learned, that you thought really needed to be brought to the membership?
Fabry: Probably one of the most important things I learned from my time on the AAA Board and my time as president was - that in my role as a clinician, a researcher and an educator, I used to think that if I did a good job, good things would happen to me, and to the profession.
The reality I learned, was that I had no idea how important reimbursement and legislative issues were, and they still are. In fact, I will go on record as saying these issues are critically important to the profession and the professionals, as far as achieving our long term goals, such as becoming limited license practitioners, achieving professional autonomy and being able to bill and receive reimbursement under our own professional identity.
AO/Beck: Thanks Dave. I think your record as president of AAA is outstanding and I appreciate all of your many contributions to the profession. Let's talk about your new position. When did you start with Phonak?
Fabry: I started my new position at Phonak USA on April 1, 2002.
AO/Beck: Please tell me, what is your title and what are the job responsibilities?
Fabry: My position is Director of Clinical Research. It's a new position at Phonak USA. Basically my responsibilities include overseeing the clinical trials of new products in the USA, and collaborating with the team in Switzerland on our global products and research. Additionally, I'll have some responsibilities in new technology development, both on the technological side and the service and delivery side.
AO/Beck: I'm really happy to hear you say that! One complaint I've heard time and time again from the professionals in the trenches is that when new products are developed and introduced, there is rarely any clinical data or published research to support the claims of new and improved. Will this be an area you can impact?
Fabry: Yes, that is one area that's very important for us. I want to make sure that we're establishing and fulfilling excellent clinical protocols and as you pointed out, audiologists and other professionals really need outcome data to help support the claims and better determine appropriate candidates for new products. In addition, by developing good products and fitting software that have been empirically determined to provide improved speech intelligibility and sound quality, it should permit a better first fit by clinicians to their patients. My goal is to be involved in the process that helps provide and present these data that helps explain the role of new technologies in hearing healthcare to the professionals, and in a simpler form, to patients and consumers. Ultimately, it is extremely important to the entire industry that we back up claims of new and improved with outcomes data.
AO/Beck: Dave, will the new outcomes-based work happen in a Phonak lab, or will this be done with independent labs, or colleges and universities?
Fabry: As of this time, we're planning to continue to collaborate with universities. We have numerous studies underway in the United States and Canada. In addition, we are beginning several multi-national studies, including one involving a British university and Dr. Catherine Palmer at The University of Pittsburgh. We look to be quite busy, in light of a number of new products, and with the relatively short product life cycle in the hearing aid industry, particularly with the advent of digital circuitry. This is something that I hadn't given much attention in my previous positions, but the reality is that new circuits are often developed in less than a year, and may be obsolete within a year or two of their introduction. Consequently, manufacturers have a lot at stake when they introduce new products, and they need to get it right the first time, every time. Again, outcomes-based research assists with the validation and promotion of the product while the window of opportunity exists.
AO/Beck: What are the products that you'll be involved with...FM, hearing aids, digital, ALDs?
Fabry: Actually, the first product is a really exciting new technology that Phonak and Siemens are collaborating on. The Phonak version is called NemoTech, and that is an acronym for new ear mold technology . In many respects, traditional earmolds are more an art than a science , and the goal is to use digital mechanics to complement the advances that digital acoustics have provided to the hearing aid industry.
We're working on a process that allows us to scan the earmold and work with a three-dimensional digital image to provide a more automated -and accurate—process to be used for electronic impression/shell detailing, after which a three-dimensional copy is made of the finished shell via a process called laser sintering. In fact, Nemotech shells are available now on digital products, and offer the advantage of improved fit, better retention, improved cosmesis, and easy replacement in the event of loss or damage. Ultimately, the process may allow clinicians to scan the ear directly in their office and transmit the impression electronically to the manufacturer, but this is still under development
AO/Beck: Sounds like this technology has really evolved very quickly. I think this is an important and exciting step for the industry, but I think the ultimate application and the big win will be total direct ear scanning. When do you suppose there will be a hand held scanner-probe, that you place in the ear, click, and get a full three dimensional representation, without taking an ear mold at all?
Fabry: Well, 18 to 36 months could be reasonable - but nobody really knows just yet. I do agree though, and I think we're all heading in that direction. The ear impression is one of the next frontiers and we're paying a lot of attention to it now, as are our corporate partners. Some of the complications include the fact that the ear comprises both cartilaginous and osseous materials, and the cartilaginous region, in particular, is compliant, and moves with jaw movement. In other words, even if you had a digital scanning probe tip right now, and even if it could take a full 360 degrees, three dimensional image, the problem is that those dimensions change every time the patient chews or talks. Furthermore, null spots may occur for tortuous ear canals where fiber-optic cameras cannot see . The bottom line is that unless the ultimate process represents an improvement over the current one, it will not lead to better fits or lower remake rates, and digital mechanics will not shift the paradigm from art to science . Despite the challenges, I am optimistic that this change will occur in the future.
AO/Beck: Dave, what is the next step for FM technologies?
Fabry: As you know, Phonak is proud that the MicroLink system has become the standard industry platform for FM amplification in the schools. The next step, however, is to further market FM systems for adults. The benefits of FM, in terms of signal-to-noise ratio, are unequivocal, but the cost-to-benefit , in terms of expense, size, complexity remain a challenge. There are many untapped opportunities and applications for FM systems in most hearing aids, even ITEs, and I think this will happen with continued miniaturization and improved technology.
AO/Beck: Do you think we'll see FM systems commercially available in cochlear implants and middle ear implants in the near future?
Fabry: Yes. I think that is a reasonable and important step in the evolution of these technologies, and I think the benefit to the patients would be phenomenal. I think this is a very exciting opportunity for Phonak and the patients wearing cochlear and middle ear implants.
AO/Beck: Dave, thanks for your time this morning. It's always a pleasure to speak with you and I wish you all the best in your new position.
Fabry: Thank you too Doug. It's always nice to work with you and Audiology Online.
For more information on Phonak click here.
Click here to visit the Phonak website.
Fabry: Thanks Doug, I always enjoy these interviews, and thanks for the invitation.
AO/Beck: Why don't we start with one or two of your reflections on your AAA presidency?
Fabry: Sure, I've got lots of them! I think the events of the last year have really helped us to better define who we are, what we want as professionals, and where we want the Academy to take us through their leadership.
With due respect and thanks to ASHA for having recently removed themselves from the America's Hearing Healthcare Team Initiative (AHHTI), the AHHTI was in fact a great membership drive for the Academy ! Again, I applaud ASHA's decision to withdraw from that particular program.
However, and there's always a however, I do think it's important for audiologists and otolaryngologists to work together -- and now we all have the opportunity to work together on a fair, equitable and appropriate team and I look forward to future discussions on that matter and related issues.
AO/Beck: Very good. During your tenure as president, were there any specific lessons you learned, that you thought really needed to be brought to the membership?
Fabry: Probably one of the most important things I learned from my time on the AAA Board and my time as president was - that in my role as a clinician, a researcher and an educator, I used to think that if I did a good job, good things would happen to me, and to the profession.
The reality I learned, was that I had no idea how important reimbursement and legislative issues were, and they still are. In fact, I will go on record as saying these issues are critically important to the profession and the professionals, as far as achieving our long term goals, such as becoming limited license practitioners, achieving professional autonomy and being able to bill and receive reimbursement under our own professional identity.
AO/Beck: Thanks Dave. I think your record as president of AAA is outstanding and I appreciate all of your many contributions to the profession. Let's talk about your new position. When did you start with Phonak?
Fabry: I started my new position at Phonak USA on April 1, 2002.
AO/Beck: Please tell me, what is your title and what are the job responsibilities?
Fabry: My position is Director of Clinical Research. It's a new position at Phonak USA. Basically my responsibilities include overseeing the clinical trials of new products in the USA, and collaborating with the team in Switzerland on our global products and research. Additionally, I'll have some responsibilities in new technology development, both on the technological side and the service and delivery side.
AO/Beck: I'm really happy to hear you say that! One complaint I've heard time and time again from the professionals in the trenches is that when new products are developed and introduced, there is rarely any clinical data or published research to support the claims of new and improved. Will this be an area you can impact?
Fabry: Yes, that is one area that's very important for us. I want to make sure that we're establishing and fulfilling excellent clinical protocols and as you pointed out, audiologists and other professionals really need outcome data to help support the claims and better determine appropriate candidates for new products. In addition, by developing good products and fitting software that have been empirically determined to provide improved speech intelligibility and sound quality, it should permit a better first fit by clinicians to their patients. My goal is to be involved in the process that helps provide and present these data that helps explain the role of new technologies in hearing healthcare to the professionals, and in a simpler form, to patients and consumers. Ultimately, it is extremely important to the entire industry that we back up claims of new and improved with outcomes data.
AO/Beck: Dave, will the new outcomes-based work happen in a Phonak lab, or will this be done with independent labs, or colleges and universities?
Fabry: As of this time, we're planning to continue to collaborate with universities. We have numerous studies underway in the United States and Canada. In addition, we are beginning several multi-national studies, including one involving a British university and Dr. Catherine Palmer at The University of Pittsburgh. We look to be quite busy, in light of a number of new products, and with the relatively short product life cycle in the hearing aid industry, particularly with the advent of digital circuitry. This is something that I hadn't given much attention in my previous positions, but the reality is that new circuits are often developed in less than a year, and may be obsolete within a year or two of their introduction. Consequently, manufacturers have a lot at stake when they introduce new products, and they need to get it right the first time, every time. Again, outcomes-based research assists with the validation and promotion of the product while the window of opportunity exists.
AO/Beck: What are the products that you'll be involved with...FM, hearing aids, digital, ALDs?
Fabry: Actually, the first product is a really exciting new technology that Phonak and Siemens are collaborating on. The Phonak version is called NemoTech, and that is an acronym for new ear mold technology . In many respects, traditional earmolds are more an art than a science , and the goal is to use digital mechanics to complement the advances that digital acoustics have provided to the hearing aid industry.
We're working on a process that allows us to scan the earmold and work with a three-dimensional digital image to provide a more automated -and accurate—process to be used for electronic impression/shell detailing, after which a three-dimensional copy is made of the finished shell via a process called laser sintering. In fact, Nemotech shells are available now on digital products, and offer the advantage of improved fit, better retention, improved cosmesis, and easy replacement in the event of loss or damage. Ultimately, the process may allow clinicians to scan the ear directly in their office and transmit the impression electronically to the manufacturer, but this is still under development
AO/Beck: Sounds like this technology has really evolved very quickly. I think this is an important and exciting step for the industry, but I think the ultimate application and the big win will be total direct ear scanning. When do you suppose there will be a hand held scanner-probe, that you place in the ear, click, and get a full three dimensional representation, without taking an ear mold at all?
Fabry: Well, 18 to 36 months could be reasonable - but nobody really knows just yet. I do agree though, and I think we're all heading in that direction. The ear impression is one of the next frontiers and we're paying a lot of attention to it now, as are our corporate partners. Some of the complications include the fact that the ear comprises both cartilaginous and osseous materials, and the cartilaginous region, in particular, is compliant, and moves with jaw movement. In other words, even if you had a digital scanning probe tip right now, and even if it could take a full 360 degrees, three dimensional image, the problem is that those dimensions change every time the patient chews or talks. Furthermore, null spots may occur for tortuous ear canals where fiber-optic cameras cannot see . The bottom line is that unless the ultimate process represents an improvement over the current one, it will not lead to better fits or lower remake rates, and digital mechanics will not shift the paradigm from art to science . Despite the challenges, I am optimistic that this change will occur in the future.
AO/Beck: Dave, what is the next step for FM technologies?
Fabry: As you know, Phonak is proud that the MicroLink system has become the standard industry platform for FM amplification in the schools. The next step, however, is to further market FM systems for adults. The benefits of FM, in terms of signal-to-noise ratio, are unequivocal, but the cost-to-benefit , in terms of expense, size, complexity remain a challenge. There are many untapped opportunities and applications for FM systems in most hearing aids, even ITEs, and I think this will happen with continued miniaturization and improved technology.
AO/Beck: Do you think we'll see FM systems commercially available in cochlear implants and middle ear implants in the near future?
Fabry: Yes. I think that is a reasonable and important step in the evolution of these technologies, and I think the benefit to the patients would be phenomenal. I think this is a very exciting opportunity for Phonak and the patients wearing cochlear and middle ear implants.
AO/Beck: Dave, thanks for your time this morning. It's always a pleasure to speak with you and I wish you all the best in your new position.
Fabry: Thank you too Doug. It's always nice to work with you and Audiology Online.
For more information on Phonak click here.
Click here to visit the Phonak website.
