Interview with John Cariola, Au.D., Director of Product Management, Beltone

Topic: Beltone Reach hearing instruments

Carolyn Smaka: Hello everybody, this is Carolyn Smaka with AudiologyOnline and I'm speaking today with Dr. John Cariola from Beltone. Welcome, John.

John Cariola: Thank you for having me.

Smaka: My pleasure. Before we get into this exciting new product, Reach, can you talk about your background and what you do for Beltone?

Cariola: Sure, I'm an audiologist - I received my Au.D. degree earlier this year. I am the Director of Product Management for Beltone. I've been with the Beltone group for over 15 years. I work closely with the Research & Development group as well as the Marketing group to make sure we are getting the products that the market needs and then once we get that product, how we best present it to the audiologists, dispensers, and the customers out in the market.

Smaka: That sounds like a really exciting position.

Cariola: It's a great job for audiologists because you do get to work with different groups and also keep up to date with what's going on in the field. I highly recommend it to anyone who is interested.

Smaka: Today we're talking about Reach. Can you tell us about the directionality that's featured in these instruments?

Cariola: Sure, with Reach, we have some directionality features that we didn't have in the past and one of them is also an industry first and that is Automatic Smart Beam Steering. Reach has an auto-switching feature so that when the circuitry and the algorithm determine that there is too much noise in the environment as compared to speech, it will switch into the directional mode. With Automatic Steering, after the instrument switches into the directional mode, it automatically adjusts the width of the beam, depending on what's going on with noise to the sides and back of the person wearing the hearing aid. In the past, with our previous circuits, the professional had the choice of how wide to set the beam, i.e. 180°, 120°, or 60°, in each program depending on what the wearer would need. Now, wearers no longer have to switch to a different program to get more focus, it's all happening automatically with Automatic Smart Beam Steering. With Reach, you can have Automatic Smart Beam Steering in one of your programs and you can also have another program that just has fixed directionality with a specific beam width. Patients in our Alpha and Beta trials, and people now wearing Reach in the field, really like Automatic Smart Beam Steering and the fact that it does this automatically. Another advantage of this too is that a lot of people wearing hearing aids with a manual directional don't use the directional mode - so Reach will automatically switch into directional mode and back to omnidirectional as needed. And with that, Automatic Smart Beam Steering provides an even better way to focus and to communicate to someone's who's in front of them.

Smaka: So it sounds like the wearer gets all the different beam widths automatically, depending on what's optimum for the environment.

Cariola: Right. And it's all based on the noise levels to the side and the back of the person wearing the hearing aid. As the noise level goes up, the more it closes into a narrower beam. And for some people, that will be all they need. For others, for a particular situation, you can have a separate program for maybe 60°, the narrowest beam, where they can just leave it there for that environment. Automatic Smart Beam Steering ends up making the instrument more automatic, which is consistent with what we're seeing throughout the industry. Instruments are getting more and more automatic. - whether they're automatically switching to directional mode or automatically turning on the noise reduction or automatically reducing wind noise. Everything's happening automatically so that hopefully instruments become transparent and wearers don't have to make a lot of program choices.

Smaka: In addition to being more automatic, Reach also sounds very flexible for professionals to be able to adapt the instruments for specific patients' needs.

Cariola: Yes. For example, we have three beam settings - 180°, 120° and 60°. 180° is wide, ideal for situations such as a conference table setting where you want to hear everybody around the table. 120° is a narrower beam, and the final setting is a very narrow 60° where you're pretty much concentrating on the one person in front of you. Automatic Smart Beam Steering will automatically adjust the beam to the optimum width for the situation and so far, the word from the field is that it's working really well. But Reach is very flexible in that the professional can also set up specific programs if needed. You might say "Mr. Patient, if you're in your office and you're having a meeting with a group of people, this would probably be the best setting" or, you can just let it happen automatically.

Smaka: Great. Tell us about some of the other automatic features like the learning volume control and Smart Gain.

Cariola: Both of these features are dependent upon our environmental classifier. Reach is able to determine what environment the patient is in and stores that information so you know what your patient's been doing. It classifies the environment into one of seven acoustic environments: quiet, speech, loud speech, speech in noise, speech in noise where the noise is loud, noise only, and then loud noise. So it's monitoring all those environments and you can, with Smart Gain, adjust the gain +/- 4 dB for each of those specific environments independently. We use +/- 4 dB to give you fine tuning ability for each environment without having too much variation from one environment to the next. What's also happening with Reach instruments with volume controls, is that the instruments are monitoring the patient's volume control changes in those seven different environments. Many people today don't have volume controls but if they do, over time, the instrument will learn what the patient has been doing in terms of where they've been setting the volume, and slowly adjust to that setting over time. The end result is hopefully that the patient doesn't have to adjust the volume control anymore, because we've worked out what they like in terms of volume in different environments.

The algorithm's only going to react and start learning when the patient is showing a consistent behavior in a certain environment. Then if there's a change, it only logs it if it's been on for several seconds, so it's not that they just pressed the volume. It measures these behaviors and changes and then conservatively starts to move the volume control closer to what the patient has been shown to use in the past.

Smaka: And it's logging information so that the professional can see exactly what it's doing?

Cariola: Correct. We also have a very good environmental classifier - it's pretty darn accurate. You know, you always have to be careful that you're measuring what you think you're measuring and so far, for the environments that we're classifying, we're doing a very good job of recognizing them correctly. The environments that we're classifying are the most common environments that patients will be in and we've got a very high percentage of being accurate with what environment the patient is actually in.

Smaka: What styles is Reach available in?


Cariola: Reach is available in a completely new line of BTE instruments and also a full custom line. So we have a CIC up to a full ITE shell and also a receiver -in-the-ear product, along with three new BTE styles for mild to moderate, moderate, and then more severe losses. All of the BTEs are new designs. What we've done is make them smaller and also achieve the best kind of power-to-size combination for how much gain and output you can get given the size of the instrument. We accomplished this with the new BTE designs by pulling the programming port and programming components out of the instruments to make them smaller, yet keeping the same size receiver to provide the gain and power. We have a programming adapter that attaches to the instruments much like an audio-input shoe.

We're very pleased with the look, and we've also got some new different colors: soft beige, soft gray and soft stone, which is like a marble color for salt and pepper hair. The new soft colors have a high-tech look and a nice feel to it that helps it stay seated on the ear without rubbing or moving around too much.

As I mentioned, with this product line, you have the gain and output to enable you to fit from mild all the way up to severe losses. They are wide dynamic range compression instruments, so whether you're going to fit that on a very severe loss will be up to the individual;however, we do have the gain and output with Reach to enable you to do it. In addition, all of the new BTE instruments can be fit traditionally with a standard earhook and earmold, or open utilizing an open fitting adaptor and various dome choices.

Smaka: That is a really comprehensive product line. Which models have directional microphones?

Cariola: All the BTE designs including the receiver-in-the-ear have directional microphones.
On the custom side of things, as always, that depends on the size of the ear. Directional microphones are offered on the canal, half shell, low profile ITE and full shell.

Smaka: Great. John, is Reach available now?

Cariola: Yes, at the beginning of July we released the receiver-in-the-ear model and all of the custom models. In another month, we'll be releasing two of the BTEs (the mild to moderate gain, and the moderate gain models), and then later this year we'll release the highest gain BTE of the family. At the same time, we're going to be releasing some models that I haven't mentioned yet. There will be another receiver-in-the-ear model with a VC and a push button that uses a 312 battery. Our current receiver-in-the-ear is a very small instrument, one of the smallest available, and utilizes a 10A battery. For people who want multi memory and a VC, we'll offer this new model with a 312 battery. It will be another brand new design and a very cosmetic instrument to wear, and will also provide a longer battery life.

Smaka: What kind of things are you hearing from people wearing the Reach?

Cariola: One of our professionals has already fit 24 of the receiver-in-the-ear models. This particular professional likes the receiver-in-the-ear model because of the benefits that it provides, and also has seen the advantages of the directionality options that Reach has. We also have one professional who's wearing it herself, and she loves it. She has about a 55 dB flat loss in one ear with some tinnitus. One option that's also available in Reach is a tinnitus masker, which we call the Tinnitus Breaker. It's a noise generator that allows you to present masking. You can also modulate the sound to make it more wave-like. We are developing clinical protocols for this using the Tinnitus Handicap Inventory and some other surveys to determine how severe the tinnitus is in terms of how it's affecting the patient's life. In addition, we have a referral/recommendation protocol as well for when to refer to a physician, neurologist, etc. and for providing patients with information and directing them to certain organizations such as the American Tinnitus Association.

As you know, many patients with mild, high frequency loss will have some tinnitus that's not really bothering them that much and for these people, we find that just wearing a hearing aid helps a lot of the time. For people where tinnitus is starting to bother them, but it's not so severe, we would use our protocol to provide the masker in one program. We'd go through the regular battery of tests of getting the minimum masking level and matching the pitch and loudness as best we can. And then we would work with the patient to get him/her to not pay attention to the tinnitus. This is similar to components of tinnitus retraining therapy. For patients with more significant tinnitus, we're making the appropriate referrals and recommendations as needed.

The one professional I mentioned who has fit herself with Reach, has found the Tinnitus Breaker to be great. She's ecstatic about how it's helping her with her tinnitus. There's some good news out there. We're new to this - having a noise generator within our hearing instruments - so we're on a learning curve with it. We've had many meetings with tinnitus professionals in our industry, and they have provided us their input on how we should use it and how it should be worked. We're happy to have that feature.

Smaka: It sounds like you've built the flexibility around the tinnitus masker just like with the other features - where it can be enabled or disabled by the professional depending on the patient's needs.

Cariola: Yes, exactly. The Tinnitus Breaker will probably not be used with a majority of the patients but its there as a kind of an added benefit if needed. Some patients that were tested liked it and actually used it on its own at certain times, like when they were in a quiet room. They would turn off the hearing aid amplification and just use the masker because they said that and it was very comfortable that way - the masking sound was more pleasing than the tinnitus. You know, again, it depends on the patient. And we offer the flexibility to use the masker as an added benefit to the instrument.

Smaka: Before we wrap up, is there anything else you want to tell us about Reach that I haven't asked you?

Cariola: I think we covered most everything, we're happy that we have this new line, and also about the new designs. You know, cosmetics are still important to our patients out there. They still are concerned about how they look while wearing their hearing aid and these instruments are getting smaller, and getting less noticeable. In some ways I guess, we can also thank all these Bluetooth cell phone users for making our instruments seem even less small in comparison to Bluetooth headsets.

For more information about Reach, people can visit our website at www.beltone.com.

Smaka: More information can also be found at the Beltone web channel at AudiologyOnline.
John, thank you so much for your time today and best of luck with Reach. It was nice speaking with you today.

Cariola: It was great to be here. Thanks for having me on to talk about Reach.



About Beltone Electronics

Founded in 1940, Chicago-based Beltone Electronics is part of the GN Hearing Care Group, utilizing advanced technology to produce hearing instruments sold in the United States, Canada and over 40 countries worldwide. In addition to providing outstanding service and support for its U.S. hearing care network operating in over 1,400 offices in North America, Beltone remains the most trusted brand for quality products and care among its patients and adults aged 50 and older.