Interview with Geoff Ball Founder of Symphonix and Wearer of Two Middle Ear Implants

AO/Beck: Hi Geoff, it is a pleasure to spend some time with you.

Ball: Hi Doug, thanks for contacting me. I've heard a lot about Audiology Online and I'm happy to spend some time with you too.

AO/Beck: Geoff, before we get into your experience as a person wearing two middle ear implants, please tell me a little about your education?

Ball: Sure, I have a master's degree in systems management from the University of Southern California and I've worked as a biomedical engineer for many years. In particular, I worked with Dr. Richard Goode at Stanford University from 1986 to 1994 directing the biomedical lab there.

AO/Beck: Wasn't that lab the one that created the 'Innovaid' in the early or mid 1980s?

Ball: Yes it was. The Innovaid was an interesting product. I did a little work on that. It was originally designed for third world countries to help people with hearing loss. Basically it was a resonating chamber, custom fit, which made the world a little louder. It was creative and innovative and essentially a passive hearing aid.

AO/Beck: Of course the other thing I recall from that lab was their work related to ReSound and their products. Didn't ReSound get their start in those labs?

Ball: Yes, they did in some respects. Of course they had input from many sources, but Dr. Goode was one of their early advocates and they did quite a bit of their early work in that lab.

AO/Beck: Geoff, please tell me about your hearing loss and your interest in middle ear implants?

Ball: I've pretty much had hearing loss my whole life. As a child, I was a pretty sick kid. I was diagnosed with severe hearing impairment following an ototoxic reaction to medicine. In fact, I've worn hearing aids for some 30 years now and I've benefited greatly from audiologists and hearing aids. I have a 'cookie bite' audiogram, about a 75 dB loss in both ears. I believe I know what hearing aids can do, but I wanted something else. I didn't want to wear hearing aids for the rest of my life. You know, a lot of the work on middle ear implants (MEI) was done in the 1930s, and the progress was very slow, mostly due to power needs of the electronic systems. Anyway, the one thing that was common across all of the research studies for many decades was that the patients reported the sound of the various MEIs was very clear and it was a much more natural sound than the hearing aids they were compared to. So, after reading and studying the literature, and after considering all of my own personal amplification options, I decided I wanted to do everything I could to help make these products available. Better sound and non-occluded ears were the attributes I was looking for.

AO/Beck: After wearing hearing aids for many decades, what was your first thought when your Symphonix Soundbridge was finally turned on?

Ball: The first thing I thought was...'There are a lot of TV cameras here!' But the second thing was -- Yes, the sound was better, the sound was clearer , and the sound was more realistic. These were not astonishing findings to me, because I tried the implant years earlier in the lab in the experimental stage by placing the unit on my eardrum in the lab with Dr. Goode, and the sound was great. I got my first Symphonix Soundbridge in 1996 at the House Ear Institute and the second unit was implanted in 2000.

AO/Beck: Very good. Let me switch gears a bit. Please tell me about your position with Symphonix?

Ball: Sure, I am the founder, the Vice-President and the Chief Technology Officer of Symphonix, and as you know, I wear two Symphonix SoundBridge units.

AO/Beck: What was it that convinced you to have a second MEI?

Ball: Well, after only having the first implant for a few days, I thought the sound was so great, that I wanted more of it. In retrospect, adding the second unit was not at all a 'one plus one equals two' sort of experience. It was more like 'one plus one equals four.' As good as the first one was, adding the second unit was infinitely better.

AO/Beck: Can you tell me the most significant differences for you personally, regarding hearing aids versus MEIs?

Ball: Yes. The differences are enormous. First of all, I have to say that newer, digital hearing aids are fantastic. The technology and the results are very good. Nonetheless, getting an even better sound, and getting the darn thing out of my ear canal was an enormous relief. Occlusion was a big issue for me, and I love hearing without my ears being plugged up! For those of us with significant hearing loss, the occlusion issue is bigger than you can imagine. I have to tell you that it took about a month for me to get used to having my ear canals open - while hearing people speaking - it was amazing!

AO/Beck: Tell me about wearing the Symphonix SoundBridge hardware?

Ball: The audio processor (AP) is about the size of three quarters stacked up and it's held it place by a magnet. All of the guts of the signal processor and the battery are in the audio processor. There are no restrictions on showering or swimming because the unit is held in place by magnets across the skin, so there are no wires or electronics that pierce the skin.

AO/Beck: What about the technology of the AP?

Ball: The new APs are 100 percent digital, powered by a SIEMENS system, which is essentially the system used in their SIGNIA technology. This is an important point because the electronics are highly reliable and accurate and they are flexible. Again, the technology is very impressive. It's important to realize that even my early implant is now operating on a digital system, because we've upgraded the external AP. So in essence, my old implant and my new implant are both using digital systems.

AO/Beck: Can you tell me about the magnetic contact point? Are you able to let hair grow across the magnet site? I can recall a few of my previous cochlear implant patients and for some of them, they had to keep the hair between the magnets shaved or the magnet wouldn't have enough strength to hold on.

Ball: Yes, a lot of people ask about that. I let my hair grow over the contact point and it has been no problem at all. I don't know for sure but I cannot recall anyone with the Symphonix Soundbridge who has had to keep the contact point shaved.

AO/Beck: How many people are wearing the Symphonix unit at this time?

Ball: Across the world, I think there are about 500 as of April, 2001

AO/Beck: Geoff, as we're conversing here, you are using a telephone. How are you doing that? What is the connection between the MEI and the telephone?

Ball: Great question. One of my pet peeves on this planet is that T-Coils stink. I have tried many Tcoils, and some are better than others, but they all stink. So what I do, is I use a speaker phone with my MEIs sometimes, and other times, like right now, I hold the phone up to the AP (audio processor) and I do pretty well.

AO/Beck: Yes, you're doing great. You've obviously been hearing my questions and responding appropriately. So you're using the microphone of the AP placed against the telephone's speaker?

Ball: Yes, that's exactly what I'm doing at the moment. Again, phones in general are crummy with hearing aids, and I do much better on the phone with the Symphonix Soundbridge.

AO/Beck: Who do you think are the ideal candidates for the device?

Ball: I think the primary candidates may be the baby-boomers with moderate-to-severe hearing loss, who have tried and failed with traditional hearing aids. In other words, I think it's really important for the candidates to try regular hearing aids and give that the best effort they can. Then, if they don't do well with those, they really ought to try the Soundbridge. I think it's important for them to work with traditional units first because that helps clarify their motivation and their knowledge of what amplification can do for them, and what the issues are before seeking a middle ear implant. Another reason to try traditional hearing aids first is to weed out the people who are basically miserable and they aren't going to be happy with anything! We want candidates who are seeking better hearing and who are motivated to try new and exciting technology, and we want them to know what they are doing before they agree to a middle ear implant!

AO/Beck: What's the new upcoming technology going to be like?

Ball: The new stuff is even more amazing and very exciting. Of course it's in the development stage right now and I cannot say anything with certainty. Nonetheless, I think the next big step will be the totally implantable hearing aids and looking into my crystal ball, I think that could be ready to in the next few years. Of course clinical trials, FDA approval and technological advances can all add to or change the timeline.

AO/Beck: Geoff, who pays for the Symphonix Soundbridge implant at this time?

Ball: In Europe there is some limited coverage for the Soundbridge through insurance companies. In the USA there is no coverage at this time. I think that'll change quickly as more and more patients benefit from it and request coverage.

AO/Beck: Geoff, how many candidates do you think there are for this technology in the USA?

Ball: Of course no one really knows, but I would guess there are easily a million candidates for this technology in the USA.

AO/Beck: Geoff, how do the audiologists learn more about the topic?

Ball: They can send me email directly, or they can visit the website. The website address is symphonix.com, and my email address is geoffb@symphonix.com

AO/Beck: Geoff, it's been a pleasure speaking with you. Thanks for your time today.

Ball: Thank you Doug. Let's do this again and I'll keep you updated.