Interview with Kenneth Smith Au.D., Past President Academy of Dispensing Audiologists
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High Technology & Digital Hearing Aids
High Technology & Digital Hearing Aids
AO/Beck: Hi Dr. Smith. Thanks for joining me here today.
Smith: Hi Dr. Beck, always a pleasure to spend time with you.
AO/Beck: Dr. Smith, for the readers who may not be familiar with you, would you please give us a thumbnail sketch review of your professional background?
Smith: Sure. I'm one of those old guys! I graduated from the University of Kansas Medical Center back in 1970 with my doctorate. I stayed there as the Director of Audiology in the University Affiliated Program until 1976, at which time I left the University and went into private practice. As you know, back then, audiologists didn't dispense hearing aids, and in fact we essentially just did diagnostic work and recommended hearing aids. It wasn't until later in that decade (the late 1970s) when audiologists started to dispense hearing aids as a normal part of their clinical work that all of this changed. Anyway, I am still in private practice, and there are four partners in our group, three of us are audiologists and one is a speech-language pathologist. I've been a little bit involved with politics and I was the president of the Academy of Dispensing Audiologists from 1994 to 1996.
AO/Beck: But your practice is essentially just audiology and hearing aids isn't it? Or do you actually offer Speech & Language services too?
Smith: That's a very good question. Actually the partner with a degree in Speech-Language Pathology functions as our operations manager! So no, we don't offer those clinical services.
AO/Beck: Dr. Smith, if I recall from previous discussions, you have a unique practice philosophy, can you please discuss that a little?
Smith: We've always positioned ourselves as a cutting edge practice. We started our practice before audiologists were generally in private practice, and to this day, we are cutting edge, and we really try to be the first to offer new products, technologies and services that really work.
AO/Beck: Dr. Smith, please tell me the name of your practice?
Smith: The name is Hearing Associates Inc. and we're in the Kansas City metro, on both sides of the state line.
AO/Beck: OK then, with that as background, let's redirect the conversation to the issues of high tech hearing systems. I think I'd like to start with your thoughts on the question - Does non-digital technology still have a role in hearing aids?
Smith: I think non-digital has a role, but it will continue to decrease over time. For audiologists and dispensers, the thing to do is base your practice on the patient's needs, not the technology. From the patient's view, they must realize that the future is digital. We're not going back to vinyl records, or 8 track or cassettes! The future is digital, because digital products offer higher quality and many more options and alternatives.
However, everyone doesn't need digital products today - although we are certainly evolving into essentially a digital industry at this time. But again, the patient's needs have to come first. For example, if the patient is a nursing home bound resident, and they truly only go from their room to the cafeteria, and that's about it, spending the money to upgrade that individual to digital technology may not be the right thing to do. However, if we take an active 40 year old patient who is out in the business and social world and interacts with a variety of people, and phones, in many situations all day long - digital is probably the correct answer. So again, what are the patient's needs and expectations? Those are the key questions that determine which technology to recommend.
AO/Beck: Dr. Smith, how can we prioritize the patient's wants and needs?
Smith: There is a paper and pencil tool we like to use in our practice, it's called the COSI (Client Oriented Scale of Improvement) and it allows us to work with the patient to identify their needs, expectations and desires, and it allows us to revisit the same issues later and determine how we've done with respect to accomplishing the pre-identified goals. We use this for most patients and it really does help us focus on their goals - rather than our technologies!
AO/Beck: Very good. What is the process you use to identify which high tech hearing aid to use, after you have identified a candidate? As you know, there are literally dozens of brand names and styles out there, and I'm curious to learn how you pick the right instrument for each patient?
Smith: First, as we mentioned before, I really like to use cutting edge technology, and I like to have lots of bells and whistles! Interestingly, many of the products tend to look alike to patients and perhaps to some professionals, but there are many differences among them. We have preferences based on basics - such as - is it easy for the patient to understand and operate the instrument? As you know, there are many instruments out there that you almost need an engineering degree to program, operate or wear- and that's just too much - even for those of us who embrace technology. The best units will be so well engineered that they are simple to operate for the patient with regards to the operator controls and simple to program for the audiologist. In our practice, we really like dual microphone technology for noise reduction and so often we hear from patients that the dual mics really make a significant difference. We hear that from experienced hearing aid patients all the time, and so if they can tell the difference and they appreciate it - we tend to recommend that almost all of the time. We also like multiple memories, so we can place at least two different listening programs in the instrument. Then again, I think having more than 4 programs starts to get redundant and confusing. Another important thing for us that the hearing aid is built on a platform that is upgradeable...In other words, as the software and technology improves, we like to be able to program the new information and the improvements into the hearing aids that have already been purchased, so we don't face a planned obsolescence situation. Another key issue is the customer service issue. Just like everything else, a great product with poor service soon ceases to be a great product. So we look for an excellent track record on building new orders and perhaps more importantly, on the servicing of the units out in the field, with emphasis on turn around time and accuracy, and of course, how often do the units need to be serviced.
AO/Beck: What about remote controls and volume controls? Are they necessary?
Smith: Well, I personally don't care for either. I think that the digital technology is good enough at this point that hearing instruments should be set to manage the loudness delivered to the ear. After all, the computer in the hearing aid can do a mind-boggling number of calculations per second, which is much faster than anyone can reach up to their ear and adjust it. Less than one-third of the patients, from our practice, that purchased remotes ever used them. Of course, some people just like toys and there are some people who also just like to be in control of the loudness. So, despite the fact that I don't care much for volume controls or remote controls, it goes back to what I said earlier, our goal is to fit the needs and goals of the patients! So we'll probably always need to have volume controls and remote controls available as options for those people who want to have them. But again, with digital technology, I think patients do better without a volume control and I urge them to go that way if I have any input into that part of the decision.
AO/Beck: Some of the new high-tech instruments are simply phenomenal. Can your patients tell the difference?
Smith: Absolutely. The new noise reduction circuits alone are amazing. When you combine those options with directionality via dual mics, it really is a dramatic improvement in noisy situations for the patients. For example, I use a lot of the GN ReSound Canta 7, and those patients are among the most satisfied patients I've ever seen.
One really interesting feature of that instrument is that it essentially tracks the location of the dominant sound source...so it's the next step in directionality. In other words it is not just making the sounds in the front louder, it makes the most prominent sound the loudest, and if the sound source moves, it can actually track it across the room. It is very impressive. Another high tech option that I really like is the feedback cancellation option.
In the early days (a few years ago) feedback cancellation was an option that reduced the overall gain in the high frequencies. That strategy was self-defeating because the reason the audiologist chose that hearing aid was for high frequency emphasis, and then if you had to reduce the high frequency gain because the hearing aid had acoustic feedback - you just couldn't win. It was like a dog chasing it's tail - you can run but you're not gonna get there! The Canta 7 actually uses a digital suppression system that literally eliminates the feedback by determining the small frequency band in which the feedback is happening, and then it uses a reverse phase signal, to effectively cancel out the feedback band, while leaving the rest of the high frequencies intact, so you can get rid of the feedback without sacrificing the high frequencies. These are extremely important features and they make wearing the hearing aids more comfortable and more successful. Importantly, both of these features (that we just discussed) are adaptive, and if the conditions in the ear canal change, the features change and adapt automatically!
I think it's important for the consumers to understand that even the best high tech hearing aids will have a little noise, and there will be an electronic noise that they may hear now and then as the hearing aid detects and solves acoustic problems. That is, the instruments are not perfect, they probably never will be perfect, but they are very, very good, and they get better every year.
AO/Beck: Dr. Smith, thanks for sharing your time and expertise with us today. I really appreciate your thoughts on these topics. Let's do this again in a few months!
Smith: Thanks for the invitation. It was lots of fun for me too and I'll be happy to get together with you again.
FOR MORE INFORMATION of the CANTA 7 by GN ReSOUND, CLICK HERE.
AO/Beck: Hi Dr. Smith. Thanks for joining me here today.
Smith: Hi Dr. Beck, always a pleasure to spend time with you.
AO/Beck: Dr. Smith, for the readers who may not be familiar with you, would you please give us a thumbnail sketch review of your professional background?
Smith: Sure. I'm one of those old guys! I graduated from the University of Kansas Medical Center back in 1970 with my doctorate. I stayed there as the Director of Audiology in the University Affiliated Program until 1976, at which time I left the University and went into private practice. As you know, back then, audiologists didn't dispense hearing aids, and in fact we essentially just did diagnostic work and recommended hearing aids. It wasn't until later in that decade (the late 1970s) when audiologists started to dispense hearing aids as a normal part of their clinical work that all of this changed. Anyway, I am still in private practice, and there are four partners in our group, three of us are audiologists and one is a speech-language pathologist. I've been a little bit involved with politics and I was the president of the Academy of Dispensing Audiologists from 1994 to 1996.
AO/Beck: But your practice is essentially just audiology and hearing aids isn't it? Or do you actually offer Speech & Language services too?
Smith: That's a very good question. Actually the partner with a degree in Speech-Language Pathology functions as our operations manager! So no, we don't offer those clinical services.
AO/Beck: Dr. Smith, if I recall from previous discussions, you have a unique practice philosophy, can you please discuss that a little?
Smith: We've always positioned ourselves as a cutting edge practice. We started our practice before audiologists were generally in private practice, and to this day, we are cutting edge, and we really try to be the first to offer new products, technologies and services that really work.
AO/Beck: Dr. Smith, please tell me the name of your practice?
Smith: The name is Hearing Associates Inc. and we're in the Kansas City metro, on both sides of the state line.
AO/Beck: OK then, with that as background, let's redirect the conversation to the issues of high tech hearing systems. I think I'd like to start with your thoughts on the question - Does non-digital technology still have a role in hearing aids?
Smith: I think non-digital has a role, but it will continue to decrease over time. For audiologists and dispensers, the thing to do is base your practice on the patient's needs, not the technology. From the patient's view, they must realize that the future is digital. We're not going back to vinyl records, or 8 track or cassettes! The future is digital, because digital products offer higher quality and many more options and alternatives.
However, everyone doesn't need digital products today - although we are certainly evolving into essentially a digital industry at this time. But again, the patient's needs have to come first. For example, if the patient is a nursing home bound resident, and they truly only go from their room to the cafeteria, and that's about it, spending the money to upgrade that individual to digital technology may not be the right thing to do. However, if we take an active 40 year old patient who is out in the business and social world and interacts with a variety of people, and phones, in many situations all day long - digital is probably the correct answer. So again, what are the patient's needs and expectations? Those are the key questions that determine which technology to recommend.
AO/Beck: Dr. Smith, how can we prioritize the patient's wants and needs?
Smith: There is a paper and pencil tool we like to use in our practice, it's called the COSI (Client Oriented Scale of Improvement) and it allows us to work with the patient to identify their needs, expectations and desires, and it allows us to revisit the same issues later and determine how we've done with respect to accomplishing the pre-identified goals. We use this for most patients and it really does help us focus on their goals - rather than our technologies!
AO/Beck: Very good. What is the process you use to identify which high tech hearing aid to use, after you have identified a candidate? As you know, there are literally dozens of brand names and styles out there, and I'm curious to learn how you pick the right instrument for each patient?
Smith: First, as we mentioned before, I really like to use cutting edge technology, and I like to have lots of bells and whistles! Interestingly, many of the products tend to look alike to patients and perhaps to some professionals, but there are many differences among them. We have preferences based on basics - such as - is it easy for the patient to understand and operate the instrument? As you know, there are many instruments out there that you almost need an engineering degree to program, operate or wear- and that's just too much - even for those of us who embrace technology. The best units will be so well engineered that they are simple to operate for the patient with regards to the operator controls and simple to program for the audiologist. In our practice, we really like dual microphone technology for noise reduction and so often we hear from patients that the dual mics really make a significant difference. We hear that from experienced hearing aid patients all the time, and so if they can tell the difference and they appreciate it - we tend to recommend that almost all of the time. We also like multiple memories, so we can place at least two different listening programs in the instrument. Then again, I think having more than 4 programs starts to get redundant and confusing. Another important thing for us that the hearing aid is built on a platform that is upgradeable...In other words, as the software and technology improves, we like to be able to program the new information and the improvements into the hearing aids that have already been purchased, so we don't face a planned obsolescence situation. Another key issue is the customer service issue. Just like everything else, a great product with poor service soon ceases to be a great product. So we look for an excellent track record on building new orders and perhaps more importantly, on the servicing of the units out in the field, with emphasis on turn around time and accuracy, and of course, how often do the units need to be serviced.
AO/Beck: What about remote controls and volume controls? Are they necessary?
Smith: Well, I personally don't care for either. I think that the digital technology is good enough at this point that hearing instruments should be set to manage the loudness delivered to the ear. After all, the computer in the hearing aid can do a mind-boggling number of calculations per second, which is much faster than anyone can reach up to their ear and adjust it. Less than one-third of the patients, from our practice, that purchased remotes ever used them. Of course, some people just like toys and there are some people who also just like to be in control of the loudness. So, despite the fact that I don't care much for volume controls or remote controls, it goes back to what I said earlier, our goal is to fit the needs and goals of the patients! So we'll probably always need to have volume controls and remote controls available as options for those people who want to have them. But again, with digital technology, I think patients do better without a volume control and I urge them to go that way if I have any input into that part of the decision.
AO/Beck: Some of the new high-tech instruments are simply phenomenal. Can your patients tell the difference?
Smith: Absolutely. The new noise reduction circuits alone are amazing. When you combine those options with directionality via dual mics, it really is a dramatic improvement in noisy situations for the patients. For example, I use a lot of the GN ReSound Canta 7, and those patients are among the most satisfied patients I've ever seen.
One really interesting feature of that instrument is that it essentially tracks the location of the dominant sound source...so it's the next step in directionality. In other words it is not just making the sounds in the front louder, it makes the most prominent sound the loudest, and if the sound source moves, it can actually track it across the room. It is very impressive. Another high tech option that I really like is the feedback cancellation option.
In the early days (a few years ago) feedback cancellation was an option that reduced the overall gain in the high frequencies. That strategy was self-defeating because the reason the audiologist chose that hearing aid was for high frequency emphasis, and then if you had to reduce the high frequency gain because the hearing aid had acoustic feedback - you just couldn't win. It was like a dog chasing it's tail - you can run but you're not gonna get there! The Canta 7 actually uses a digital suppression system that literally eliminates the feedback by determining the small frequency band in which the feedback is happening, and then it uses a reverse phase signal, to effectively cancel out the feedback band, while leaving the rest of the high frequencies intact, so you can get rid of the feedback without sacrificing the high frequencies. These are extremely important features and they make wearing the hearing aids more comfortable and more successful. Importantly, both of these features (that we just discussed) are adaptive, and if the conditions in the ear canal change, the features change and adapt automatically!
I think it's important for the consumers to understand that even the best high tech hearing aids will have a little noise, and there will be an electronic noise that they may hear now and then as the hearing aid detects and solves acoustic problems. That is, the instruments are not perfect, they probably never will be perfect, but they are very, very good, and they get better every year.
AO/Beck: Dr. Smith, thanks for sharing your time and expertise with us today. I really appreciate your thoughts on these topics. Let's do this again in a few months!
Smith: Thanks for the invitation. It was lots of fun for me too and I'll be happy to get together with you again.
FOR MORE INFORMATION of the CANTA 7 by GN ReSOUND, CLICK HERE.
