Interview with Mark Flynn Ph.D., Oticon, Denmark

Topic: Smart Hearing Aids & Combining Cochlear Implants and Hearing Aids

Beck: Good Morning Mark. It's nice to be with you.

Flynn: Thanks Doug. Nice to have you in Denmark with us.

Beck: Mark, I hear you are originally from Melbourne, Australia?

Flynn: Yes. I graduated in audiology back in 1994 from the University of Melbourne and then earned my Ph.D. from the
Department of Otolaryngology, also from Melbourne Uni, in 1998.

Beck: What was your dissertation on?

Flynn: It focused on severe and profound hearing loss. It addressed best ways to provide amplification regarding hearing aids and cochlear implants, comparisons between the two, and novel ways of using speech perception tests to improve the ecological validity.

Beck: Very good. How long have you been with Oticon?

Flynn: It's been just over two years now. Prior to that, I was the equivalent of an associate professor at the University of Canterbury in New Zealand, and then I was fortunate enough to be offered the position as Senior Audiologist at Oticon. As such, I get to investigate two primary areas that are fascinating for me. The first is the future development of premium hearing aids, which are those products which may be commercially available some 3 to 4 years down the road. For example, the Syncro was introduced in 2004, but we've been working on it behind the scenes for 2 or 3 years in the lab and with extensive field tests. The other general area involves support of the products once they're in the marketplace as far as initiating or participating in research with private, clinical, academic or research communities. One question we recently addressed was how to assure a good directional response with a large open vent. Another recent question has to do with "bimodal stimulation" combining hearing aids on one ear and a cochlear implant on the other, and that's very exciting too.

Beck: Mark, before we get to combining cochlear implants with hearing aids, let me go back a little please....What separates "premium products" from the general product line?

Flynn: Great question! As you know, the marketplace consistently places better and more sophisticated products into the standard lines all the time! But when I think of "premium" products, it's defined by how the product reacts to the acoustic environment. Premium products detect finer differences in the sound signals to begin with, and offer more selective and efficient processing of the signal for maximal human auditory perception -- and those events happen "in parallel." Further, premium products choose the best possible directionality protocol and deliver the maximum signal-to-noise ratio. So the sound signal and sound quality delivered to the ear is always the best possible solution to any given acoustic environment.

Beck: What can you tell us about the premium products that might be available in 3 to 5 years?

Flynn: Well, that's tough...but I think the premium products in 2007 or 2008 will better respond to the environment and better address the needs and desires of the user. In many ways the processing will be transparent so that it provides the user with exactly the desired sound processing without any artifacts and maximizes the speech understanding in noise. We have already seen this with products now being released which benefit from the outcome of multiple parallel processes occurring in combination. This enables the hearing instrument to compare all the possible processing options and select the processing scheme which presents the best solution.

Beck: I presume you are talking about the Artificial Intelligence in such as exists in Syncro, how do you think that will evolve in the future?


Flynn: As hearing instruments evolve in the future there are two key areas. One is how the instrument itself decides on the optimum processing solution and the second being how the dispenser can continue to successfully match the amplification characteristics to the needs of the client.

We have seen hearing aids move from basic prescriptions to further individualization. This can occur through at least two ways. First, we know a lot more about hearing loss than we ever have and can better match the audiometric characteristics of the person through specific rationale changes for SKI, cookie-bite, and reverse slope for instance. Second, we have also evolved the fitting concept of Identities in Syncro. Whereby we match the listening needs and preferences of the user combined with the auditory ecology in which they live and then prescribe directly from this. This allows us a starting point, from which such concepts of parallel processing and multiple comparisons allow the selection of the best response. A logical progression from here is to combine individualization with increased processing options so that the hearing instrument could learn about the client's typical listening environments as well as to learn to adapt the signal processing and automatic features to match the preferences of the users. Hearing aids in the future could be trained to match the acoustic preferences of the user. In other words, the hearing aid may be enabled to make decisions and choices beyond what it was programmed to do, based on the actions of the client in their everyday listening environments.

Beck: That is amazing. So in some respects you'll start with a basic preferred hearing aid program, and then based on the preferences of the wearer, the hearing aid will make decisions about novel stimuli?

Flynn: Yes, that's the idea. Based on the likes and dislikes of the wearer with known stimuli, the hearing aid will make "intelligent" decisions about new, or novel stimuli.

Beck: Wow. That's very exciting. OK then, what do you think will happen with the combined use of hearing aids and cochlear implants?

Flynn: Well, this is an area very ripe for research and pragmatic application. As you know from your work with cochlear implants, some patients have done really well with an implant on one side, and a hearing aid on the other.

Beck: Sure. We actually had quite a few adults, maybe a dozen or so, which I recall from my years at the House Ear Institute in the mid-1980s. They might have had a severe-to-profound loss on one side, and a totally non-functioning ear on the other side. We placed the cochlear implant on the worse side, and a hearing aid on the better side and some of them did remarkably well. In fact, they usually compared and contrasted the two units which helped us "tweak" the sound processing of the implant to better deliver sound.

Flynn: Exactly...so one application, as you just noted, is "bimodal stimulation" meaning two technologies (acoustic and electric) on two ears, such as the implant on the left and the hearing aid on the right, similar to what you did in the 1980s.... And, there are some groups that now place the implant and the hearing aid on the same side, referred to as "electro-acoustic" stimulation. In these protocols, the implant might be used to process the high frequency sounds while the hearing aid handles the lower tones, and there are a variety of permutations and protocols that can work well using these technologies...but perhaps the largest potential for these combined approaches might be applying them to the SKI hearing loss population...that may be the big win for the combined hearing aid and cochlear implant technologies. The technological advancements in cochlear implants and hearing aids has been breath-taking for the last 5 to ten years or more. Now that implants can efficiently and effectively reach down into the severe hearing loss range, and hearing aids can more effectively reach up to the profound hearing loss range, the possible combinations are greater than ever.

Beck: I agree. Each technology has advantages and disadvantages, but using the two together, in appropriate cases, opens up a vast array of auditory information and opportunity.

Flynn: Sure, we see more of this every day. The other big advantage may be using one technology to help advance the other....for example hearing aid technology, such as FM, directional, noise processing and localization abilities can be very useful for cochlear implants, and vice versa.

Beck: Mark, these really are quite amazing topics. Thanks for sharing your thoughts on these important issues.

Flynn: My pleasure Doug. Thanks for inviting me to participate with www.audiologyonline.com.


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