Interview with Michael Glasscock, III M.D., Otologist, Neurotologist, Co-Founder of TYMPANY
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AO/Beck: Good Morning Dr. Glasscock. Thanks for meeting with me today. It really is an honor to share the morning with you.
Glasscock: Hi Dr. Beck. It's nice to catch up with you too. Audiology Online has really been an important venue for all of us, and I'm happy to work with you.
AO/Beck: Let's start with a little information about your personal background, if you don't mind. Where did you grow up?
Glasscock: I was born in, Longview, Texas, and raised on a ranch close to Utopia, Texas, until age eight. I attended a Catholic grade school in Alamo Heights in San Antonio until the beginning of World War II when I went to live with my grandmother in Carthage, Tennessee. My grade school and high school years were spent traveling between Tennessee and Texas. I attended a small college 30 miles from Carthage, called Tennessee Tech University. Then I went to UT Medical School in Memphis, graduated from there in '58 and went to the Navy for a couple of years. I spent a year in the Antarctic on something called Operation Deep Freeze.
AO/Beck: What did you do in Operation Deep Freeze?
Glasscock: I was on a very small ship called a destroyer escort. They normally don't have a doctor on those, but we were a radar and a rescue ship. We were stationed between Christ Church, New Zealand, to McMurdo Sound. The planes flying between these two points used us to navigate. There were 150 very healthy young sailors on the ship, so most of the time, I read. I spent some time in Dunedin, New Zealand, which I enjoyed. I did my otolaryngology training at the University of Tennessee in Memphis, and then I did a fellowship with the House Group in Los Angeles.
AO/Beck: What year was your fellowship?
Glasscock: I started in 1965 and finished in 1966.
AO/Beck: Was your fellowship under Howard House or Bill House?
Glasscock: I spent about ten months of my time with Bill and two weeks with all the other doctors After my fellowship, I went back to Memphis, and practiced with John Shea for about seven or eight months. Bill offered me a job back at the House Group so I went to Los Angeles and stayed there until August 1969 when I moved to Nashville. I joined the Vanderbilt faculty and planned to stay there a year or two. As it turned out, I didn't fit well in the academic arena.
So after a few months I started my own practice in Nashville. I stayed there for 27 years and worked as hard as I could.
AO/Beck: What year did you establish your practice?
Glasscock: I started my practice in 1970 and I left it in August, 1997. Dr. Jackson still runs the clinic, it's called The Otology Group. I left Nashville in 1997 and bought a ranch outside of Utopia, about a mile or two from the ranch I was raised on. A beautiful place, but it was a 100 mile round trip to the grocery store, As you can imagine, my wife rebelled. We decided to move to Austin.
AO/Beck: Since you've been in Austin, one of the projects you've been involved with is the formation of a new company?
Glasscock: Yes. In the later part of 2000 I met Chris Wasden and Chris is now the CEO of Tympany. We started the process of creating Tympany in January 2001, then actually started the company in July 2001 and had our working prototype in clinical trials at Eastern Virginia Medical School a year later. We raised a little money as we went along, and now we're trying to raise more. We introduced the Otogram at the 2002 AAO-HNS annual convention in San Diego.
AO/Beck: Tell me please....What is an Otogram and what is Tympany?
Glasscock: Tympany is the company that designs, develops, markets and sells the first ever automated diagnostic hearing testing device, called the Otogram. We founded Tympany to address the needs of the 22 million people in the US, and the countless millions in other countries, that suffer from hearing loss but have never been diagnosed or treated. Presently, only about 6 million of the 28 million Americans that suffer from hearing loss get diagnosed or treated.
When we founded the company, we realized that there were four reasons why these patients were not diagnosed and treated. It had to do with what we call the four C s - cost, convenience, confidence and compensation. Manual testing is very expensive and consequently can't be done in a primary care setting -- only in an audiologist or ENT practice. Patients often find it inconvenient to be referred to a specialist for a hearing evaluation. Attempts to get testing techs or nurses to provide comprehensive, diagnostic hearing evaluations in primary care offices have often compromised the quality of the test results. And today, the high cost of testing provides little economic incentive to a primary care physician to conduct hearing testing.
Tympany's founders believed that by combining automation, artificial intelligence and miniaturization, we could conquer the four C s and create a product that would revolutionize the hearing health field by engaging primary care physicians in hearing health and expanding the ability to identify and treat millions of patients.
The Otogram is the product we invented and is based upon nine patents that have been filed. It is the first true automated diagnostic hearing testing device. It addresses the four C s in the following way. It eliminates 75% of the costs of manual testing by enabling the patient to self-administer the test in any quiet examination room and allows the hearing professional to spend more time treating patients and dispensing hearing aids. It increases convenience by allowing testing on demand. Any healthcare professional can be trained to enable a patient to self-administer the diagnostic test. The reliability of the test results allows hearing health professionals to have confidence in diagnosis and treatment. And by eliminating 75% of the costs, and increasing the testing throughput, the Otogram provides the lowest cost method for getting these test results. The Otogram increases the compensation for those that have traditionally done these tests and provides a new revenue stream to primary care physicians that have never done these test in the past.
The team that worked to create the Otogram includes several innovative scientists and audiologists like Jon Birck, from Virtual, Jeff Harrison, from AlgoTek (Natus), Dr. Barry Strasnick and John Jacobson PhD, from Eastern Virginia Medical School, and of course, Aaron Thornton, PhD.
AO/Beck: Aaron Thornton from Mass Eye and Ear?
Glasscock: Yes, he retired from Mass Eye and Ear in September 2001 and joined us the next month. He's been fascinated with the idea of automating the routine parts of audiometry and he did some of that ground breaking work at Mass Eye and Ear over nearly two decades. Aaron wanted to take the technology much further than Mass Eye and Ear wanted to go. So after he retired we enabled Aaron to continue the development of his ideas to create a revolutionary new product. So basically, all the audiometry and masking programs in the Otogram are from Aaron Thornton, while all the audiometric equipment was developed by Jon Birck.
AO/Beck: Very good. OK, can you please describe the Otogram for me?
Glasscock: Sure. The Otogram consists of a touchscreen computer, the Otogram Audiometer, cart, printer, Otovest and Otobow. The Otovest rests on the patient's shoulders and holds two ambient noise microphones, two earphone transducers and the cables for the Otobow. The Otobow is a patent pending headband that holds the bone oscillator on the patients forehead for bone conduction testing.
The Otogram completely automates the Comprehensive Audiogram (pure-tone air and bone conduction with masking, speech discrimination (or word recognition) and speech reception threshold, both with masking. For customers that also want tympanometry, we can sell the Otogram with another manufacturer's tympanometer integrated into the Otogram
Testing starts by having the patient wear the Otovest, which sets on the patient's shoulders and holds the two ambient noise microphones, two transducers with ear inserts and a bone oscillator. The inserts have to be placed far down into the ear canal to eliminate the occlusion effect. Some customers place the Otogram in a sound booth because that is already their dedicated hearing testing space. The Otogram can be used in a quiet exam room because every couple of milliseconds we measure the ambient noise in the room across all the octave bands. We get about 30 or 40 decibels of attenuation depending on the frequency, just from the inserts. If the ambient noise floor rises because, for example, somebody suddenly slammed the door, a fire engine drives buy, or a baby screams, the microphones would pick up the noise, wait and re-present the stimulus. Most doctor's offices are quiet, so you get very accurate test results in the same amount of time it takes an audiologist to complete a comprehensive audiogram in a sound proof room. We get within 10 dB of manual test results, which published research indicates is the same test-re-test variability that audiologists get when doing manual testing. Once you hook the patient up, you leave the room and the patient sits by themselves to complete the test. The Otogram will then complete pure tone, air and bone with masking, SRT with masking, and speech discrimination with masking, and it prints out the results automatically at the end of the test.
AO/Beck: And I think I read that there is a paging system too. What does that do?
Glasscock: Right. There's a patent-pending paging system built into the Otogram. Since the patient is taking the test in an examination room all by themselves, we feel that it is important that the test administrator be connected to the patient in case they have a problem or need help. The administrator carries a small pager and after the tympanogram is done, the individual can leave the room. If the patient becomes confused or needs to go to the bathroom, they touch the help button on the screen and test administrator is paged and comes back to address whatever the patient needs. At the end of the test, it automatically pages the administrator or audiologist. The pager will also go off if the patient has fallen asleep, the bone vibrator falls off, the patient is a malingerer, or the patient is trying to achieve better thresholds than they actually posses. Bone conduction tests are handled using an oscillator on the forehead, and masking for bone is automatically applied, so the bone conduction tests are very accurate too.
AO/Beck: What about testing older patients or children?
Glasscock: We have tested many patients in their 90s, some with dementia, as well as children as young as six years old. All have been able to do the test successfully and frequently tell us how they prefer it to manual testing. Although the Otogram uses a computer, it is so simple that you don't have to know anything about computers to use it, which enables older patients to take the test without any computer anxiety.
AO/Beck: What about malingerers?
Glasscock: We have developed algorithms that can detect aberrant testing behavior including malingerers. Some of our customers compare their manual results with the Otogram's results to confirm a malingerer because they feel it is very difficult for a patient to trick both the audiologist and the Otogram the same way twice.
AO/Beck: How are the speech reception and word recognition tests administered?
Glasscock: These tests are done using technology developed by Richard Wilson of the VA and June McCullough at San Jose State University - it is called Picture Identification Tasks (PIT) technology. For the SRT test, the patient is provided 9 choices and for the discrimination testing they select from a set of four choices. Research indicates that if the presentation level for the discrimination test is appropriate (based upon the use of the Articulation Index) both our closed set and the more traditional open set NU6 and W22 will yield similar results. In addition, we have developed the technology to do speech testing, and indeed the entire Otogram test, in five languages (Russian, Spanish, Mandarin, Vietnamese and of course English) with more languages planned by the end of the year.
AO/Beck: Do you sell the product through distributors, or is it sold directly from your company?
Glasscock: At this point we're selling it direct. We have several sales people across the country and also market the product at medical conferences.
AO/Beck: Have the Otogram results been validated?
Glasscock: Yes they have. We did a number of side-by-side tests with John Jacobson PhD in Norfolk, Virginia and we had other validation sites too. One of those was with K.J. Lee, the past-president of the American Academy of Otolaryngology. Dr. Lee is going to present a paper at the Eastern Section of the Triological Society meeting in Boston next January on his testing results based on about 120 patients, tested side-by-side by audiologists in a soundproof booth, versus the same patient with Otogram in a quiet examination room. The final analysis demonstrated very similar and accurate results. John Dickens is an otologist in Little Rock, Arkansas, and his office did a series of about 50 patients, and all were within 5 or 10 dB. So yes, there have been a number of validation studies.
As I mentioned before, our side-by-side test results indicate that we have the same test-re-test variability as found in published studies on manual testing variance, which is that 95% of the pure-tone air results will be within 10dB of manual results.
AO/Beck: From your perspective as an otologist, what are the advantages of the Otogram?
Glasscock: One advantage to the Otogram is that it's available in different languages. As I mentioned above, we already have English, Spanish, Vietnamese, Mandarin, and Russian. By September, 2003, I believe we'll have Korean as well. It's all in the software, so if you want Spanish you just push Espanol and it automatically switches everything. All the instructions, all the discrim, everything automatically switches. I should mention that we are developing what we call our 3-in-1 Otogram that will provide further automation and simplification to testing by adding tympanometry and OAE to the standard Otogram. The intent is that you would put the inserts in one time, walk away with the pager, and the patient will automatically get all the pre-selected tests such as an OAE, a tympanogram, acoustic reflex, and all of the other audiometric tests.
AO/Beck: How long does it take for a typical patient to complete the Otogram?
Glasscock: A normal person is going to take between 15 and 20 minutes. Importantly, that's not the audiologist's or otologist's time, that's the patient's time. So while that Otogram is administering the test, the audiologist and the physician can be doing something else.
AO/Beck: It sounds like the Otogram is primarily designed for the otolaryngologist's office?
Glasscock: Not really. Our business model was actually set up for primary care physicians, and that's still the largest market for us. We went to otolaryngologists and audiologists first, because they understand hearing loss. There are a lot of otolaryngologists who have an audiologist in their office once or twice a week and they can't get tests done on the off-days, so they're happy because they can keep their office flow going when the audiologist is not there, This frees the audiologist to spend more time on interpreting test results, treating hearing loss, and dispensing hearing aids. Think of it like an EKG machine, the genius is not in doing the test, the machine does that, the genius is in interpreting the results. As you and as you might guess, we've sold the product mostly to otolaryngologists at this point. The other reason we didn't go directly to primary care, was that when we talked to a few primary care doctors they said, What do the otolaryngologists think? So we felt we had to have a large number of otolaryngologists who use this in their practice every day before we went further. At the end of the day, however, Tympany developed the Otogram to address that group of patients in the 22 million people suffering from hearing loss that never make it into the hearing health system. Rather than wait for them to try and get found by the current system, Tympany created the Otogram to take the technology to these hearing loss sufferers. All these 22 million patients currently go to their primary care physician, so Tympany figured that rather than bring Mohammed to the mountain we would bring the mountain to Mohammed. So by placing the Otogram in primary care physician offices, we believe that we will be able to get more patients diagnosed and treated for hearing loss.
AO/Beck: Dr. Glasscock, can you please give us the website address and the toll free number for people interested in learning more about Tympany and the Otogram?
Glasscock: Sure Doug. The toll free number is 866-316-3606, and the website address is www.tympany.net.
AO/Beck: What do you say to audiologists that might feel threatened by this technology?
Glasscock: We get two responses from audiologists. One response is, I've sat and pushed buttons for 20 years and I'm tired of doing that. I'd much rather counsel patients, do an ABR, do a vestibular test, program cochlear implants or hearing aids, sell hearing aids, etc. In other words, some say I'd much prefer to use my time doing higher value added activities and things I'm more interested in, rather than routine tests over and over again. I've heard that from some audiologists, especially with regard to once a year follow-up patients and retesting after surgery. Those audiologists love the technology. They see it as a way to free-up time during their day.
The other response from audiologists is The box can't do everything audiologists can do! And of course, they're right. In fact, we say the Otogram can at best test 90% of your patients. Some patients will have to be tested, at least partially, by manual testing. In addition, physicians rely heavily upon audiologists to interpret the test results, which the Otogram doesn't do. So, it's really not going to replace the audiologist! Audiologists will continue to test difficult cases, interpret test results, counsel patients, treat hearing loss and dispense hearing aids. But for an otolaryngologist who has a part-time audiologist and can't get a test done when it's needed, this is a major way to help his/her practice. We're not trying to cause problems for audiologists or put them out of business but we are trying to provide tools that will make professionals more productive and efficient and allow them to spend more time in treatment activities, which is where we think the whole AuD program is trying to push audiologists. In fact, when we've spoken with leaders in AAA, they find the Otogram is a necessary technology if audiologists are to achieve all that they hope to achieve by becoming doctors. And again, importantly, I think there are many applications for this technology outside of audiology and ENT circles, across the world. In fact, as the Otogram's acceptance increases, audiologists and ENT physicians should see their patient rolls increase as primary care physicians refer more and more hearing loss patients to them after identification by the Otogram in primary care settings.
AO/Beck: Thanks Dr. Glasscock. I am very appreciative of your time, and I thank you for sharing your thoughts about the Otogram with us.
Glasscock: Thank you too Dr. Beck. I appreciate your time and the opportunity to discuss Tympany and the Otogram with you.
Glasscock: Hi Dr. Beck. It's nice to catch up with you too. Audiology Online has really been an important venue for all of us, and I'm happy to work with you.
AO/Beck: Let's start with a little information about your personal background, if you don't mind. Where did you grow up?
Glasscock: I was born in, Longview, Texas, and raised on a ranch close to Utopia, Texas, until age eight. I attended a Catholic grade school in Alamo Heights in San Antonio until the beginning of World War II when I went to live with my grandmother in Carthage, Tennessee. My grade school and high school years were spent traveling between Tennessee and Texas. I attended a small college 30 miles from Carthage, called Tennessee Tech University. Then I went to UT Medical School in Memphis, graduated from there in '58 and went to the Navy for a couple of years. I spent a year in the Antarctic on something called Operation Deep Freeze.
AO/Beck: What did you do in Operation Deep Freeze?
Glasscock: I was on a very small ship called a destroyer escort. They normally don't have a doctor on those, but we were a radar and a rescue ship. We were stationed between Christ Church, New Zealand, to McMurdo Sound. The planes flying between these two points used us to navigate. There were 150 very healthy young sailors on the ship, so most of the time, I read. I spent some time in Dunedin, New Zealand, which I enjoyed. I did my otolaryngology training at the University of Tennessee in Memphis, and then I did a fellowship with the House Group in Los Angeles.
AO/Beck: What year was your fellowship?
Glasscock: I started in 1965 and finished in 1966.
AO/Beck: Was your fellowship under Howard House or Bill House?
Glasscock: I spent about ten months of my time with Bill and two weeks with all the other doctors After my fellowship, I went back to Memphis, and practiced with John Shea for about seven or eight months. Bill offered me a job back at the House Group so I went to Los Angeles and stayed there until August 1969 when I moved to Nashville. I joined the Vanderbilt faculty and planned to stay there a year or two. As it turned out, I didn't fit well in the academic arena.
So after a few months I started my own practice in Nashville. I stayed there for 27 years and worked as hard as I could.
AO/Beck: What year did you establish your practice?
Glasscock: I started my practice in 1970 and I left it in August, 1997. Dr. Jackson still runs the clinic, it's called The Otology Group. I left Nashville in 1997 and bought a ranch outside of Utopia, about a mile or two from the ranch I was raised on. A beautiful place, but it was a 100 mile round trip to the grocery store, As you can imagine, my wife rebelled. We decided to move to Austin.
AO/Beck: Since you've been in Austin, one of the projects you've been involved with is the formation of a new company?
Glasscock: Yes. In the later part of 2000 I met Chris Wasden and Chris is now the CEO of Tympany. We started the process of creating Tympany in January 2001, then actually started the company in July 2001 and had our working prototype in clinical trials at Eastern Virginia Medical School a year later. We raised a little money as we went along, and now we're trying to raise more. We introduced the Otogram at the 2002 AAO-HNS annual convention in San Diego.
AO/Beck: Tell me please....What is an Otogram and what is Tympany?
Glasscock: Tympany is the company that designs, develops, markets and sells the first ever automated diagnostic hearing testing device, called the Otogram. We founded Tympany to address the needs of the 22 million people in the US, and the countless millions in other countries, that suffer from hearing loss but have never been diagnosed or treated. Presently, only about 6 million of the 28 million Americans that suffer from hearing loss get diagnosed or treated.
When we founded the company, we realized that there were four reasons why these patients were not diagnosed and treated. It had to do with what we call the four C s - cost, convenience, confidence and compensation. Manual testing is very expensive and consequently can't be done in a primary care setting -- only in an audiologist or ENT practice. Patients often find it inconvenient to be referred to a specialist for a hearing evaluation. Attempts to get testing techs or nurses to provide comprehensive, diagnostic hearing evaluations in primary care offices have often compromised the quality of the test results. And today, the high cost of testing provides little economic incentive to a primary care physician to conduct hearing testing.
Tympany's founders believed that by combining automation, artificial intelligence and miniaturization, we could conquer the four C s and create a product that would revolutionize the hearing health field by engaging primary care physicians in hearing health and expanding the ability to identify and treat millions of patients.
The Otogram is the product we invented and is based upon nine patents that have been filed. It is the first true automated diagnostic hearing testing device. It addresses the four C s in the following way. It eliminates 75% of the costs of manual testing by enabling the patient to self-administer the test in any quiet examination room and allows the hearing professional to spend more time treating patients and dispensing hearing aids. It increases convenience by allowing testing on demand. Any healthcare professional can be trained to enable a patient to self-administer the diagnostic test. The reliability of the test results allows hearing health professionals to have confidence in diagnosis and treatment. And by eliminating 75% of the costs, and increasing the testing throughput, the Otogram provides the lowest cost method for getting these test results. The Otogram increases the compensation for those that have traditionally done these tests and provides a new revenue stream to primary care physicians that have never done these test in the past.
The team that worked to create the Otogram includes several innovative scientists and audiologists like Jon Birck, from Virtual, Jeff Harrison, from AlgoTek (Natus), Dr. Barry Strasnick and John Jacobson PhD, from Eastern Virginia Medical School, and of course, Aaron Thornton, PhD.
AO/Beck: Aaron Thornton from Mass Eye and Ear?
Glasscock: Yes, he retired from Mass Eye and Ear in September 2001 and joined us the next month. He's been fascinated with the idea of automating the routine parts of audiometry and he did some of that ground breaking work at Mass Eye and Ear over nearly two decades. Aaron wanted to take the technology much further than Mass Eye and Ear wanted to go. So after he retired we enabled Aaron to continue the development of his ideas to create a revolutionary new product. So basically, all the audiometry and masking programs in the Otogram are from Aaron Thornton, while all the audiometric equipment was developed by Jon Birck.
AO/Beck: Very good. OK, can you please describe the Otogram for me?
Glasscock: Sure. The Otogram consists of a touchscreen computer, the Otogram Audiometer, cart, printer, Otovest and Otobow. The Otovest rests on the patient's shoulders and holds two ambient noise microphones, two earphone transducers and the cables for the Otobow. The Otobow is a patent pending headband that holds the bone oscillator on the patients forehead for bone conduction testing.
The Otogram completely automates the Comprehensive Audiogram (pure-tone air and bone conduction with masking, speech discrimination (or word recognition) and speech reception threshold, both with masking. For customers that also want tympanometry, we can sell the Otogram with another manufacturer's tympanometer integrated into the Otogram
Testing starts by having the patient wear the Otovest, which sets on the patient's shoulders and holds the two ambient noise microphones, two transducers with ear inserts and a bone oscillator. The inserts have to be placed far down into the ear canal to eliminate the occlusion effect. Some customers place the Otogram in a sound booth because that is already their dedicated hearing testing space. The Otogram can be used in a quiet exam room because every couple of milliseconds we measure the ambient noise in the room across all the octave bands. We get about 30 or 40 decibels of attenuation depending on the frequency, just from the inserts. If the ambient noise floor rises because, for example, somebody suddenly slammed the door, a fire engine drives buy, or a baby screams, the microphones would pick up the noise, wait and re-present the stimulus. Most doctor's offices are quiet, so you get very accurate test results in the same amount of time it takes an audiologist to complete a comprehensive audiogram in a sound proof room. We get within 10 dB of manual test results, which published research indicates is the same test-re-test variability that audiologists get when doing manual testing. Once you hook the patient up, you leave the room and the patient sits by themselves to complete the test. The Otogram will then complete pure tone, air and bone with masking, SRT with masking, and speech discrimination with masking, and it prints out the results automatically at the end of the test.
AO/Beck: And I think I read that there is a paging system too. What does that do?
Glasscock: Right. There's a patent-pending paging system built into the Otogram. Since the patient is taking the test in an examination room all by themselves, we feel that it is important that the test administrator be connected to the patient in case they have a problem or need help. The administrator carries a small pager and after the tympanogram is done, the individual can leave the room. If the patient becomes confused or needs to go to the bathroom, they touch the help button on the screen and test administrator is paged and comes back to address whatever the patient needs. At the end of the test, it automatically pages the administrator or audiologist. The pager will also go off if the patient has fallen asleep, the bone vibrator falls off, the patient is a malingerer, or the patient is trying to achieve better thresholds than they actually posses. Bone conduction tests are handled using an oscillator on the forehead, and masking for bone is automatically applied, so the bone conduction tests are very accurate too.
AO/Beck: What about testing older patients or children?
Glasscock: We have tested many patients in their 90s, some with dementia, as well as children as young as six years old. All have been able to do the test successfully and frequently tell us how they prefer it to manual testing. Although the Otogram uses a computer, it is so simple that you don't have to know anything about computers to use it, which enables older patients to take the test without any computer anxiety.
AO/Beck: What about malingerers?
Glasscock: We have developed algorithms that can detect aberrant testing behavior including malingerers. Some of our customers compare their manual results with the Otogram's results to confirm a malingerer because they feel it is very difficult for a patient to trick both the audiologist and the Otogram the same way twice.
AO/Beck: How are the speech reception and word recognition tests administered?
Glasscock: These tests are done using technology developed by Richard Wilson of the VA and June McCullough at San Jose State University - it is called Picture Identification Tasks (PIT) technology. For the SRT test, the patient is provided 9 choices and for the discrimination testing they select from a set of four choices. Research indicates that if the presentation level for the discrimination test is appropriate (based upon the use of the Articulation Index) both our closed set and the more traditional open set NU6 and W22 will yield similar results. In addition, we have developed the technology to do speech testing, and indeed the entire Otogram test, in five languages (Russian, Spanish, Mandarin, Vietnamese and of course English) with more languages planned by the end of the year.
AO/Beck: Do you sell the product through distributors, or is it sold directly from your company?
Glasscock: At this point we're selling it direct. We have several sales people across the country and also market the product at medical conferences.
AO/Beck: Have the Otogram results been validated?
Glasscock: Yes they have. We did a number of side-by-side tests with John Jacobson PhD in Norfolk, Virginia and we had other validation sites too. One of those was with K.J. Lee, the past-president of the American Academy of Otolaryngology. Dr. Lee is going to present a paper at the Eastern Section of the Triological Society meeting in Boston next January on his testing results based on about 120 patients, tested side-by-side by audiologists in a soundproof booth, versus the same patient with Otogram in a quiet examination room. The final analysis demonstrated very similar and accurate results. John Dickens is an otologist in Little Rock, Arkansas, and his office did a series of about 50 patients, and all were within 5 or 10 dB. So yes, there have been a number of validation studies.
As I mentioned before, our side-by-side test results indicate that we have the same test-re-test variability as found in published studies on manual testing variance, which is that 95% of the pure-tone air results will be within 10dB of manual results.
AO/Beck: From your perspective as an otologist, what are the advantages of the Otogram?
Glasscock: One advantage to the Otogram is that it's available in different languages. As I mentioned above, we already have English, Spanish, Vietnamese, Mandarin, and Russian. By September, 2003, I believe we'll have Korean as well. It's all in the software, so if you want Spanish you just push Espanol and it automatically switches everything. All the instructions, all the discrim, everything automatically switches. I should mention that we are developing what we call our 3-in-1 Otogram that will provide further automation and simplification to testing by adding tympanometry and OAE to the standard Otogram. The intent is that you would put the inserts in one time, walk away with the pager, and the patient will automatically get all the pre-selected tests such as an OAE, a tympanogram, acoustic reflex, and all of the other audiometric tests.
AO/Beck: How long does it take for a typical patient to complete the Otogram?
Glasscock: A normal person is going to take between 15 and 20 minutes. Importantly, that's not the audiologist's or otologist's time, that's the patient's time. So while that Otogram is administering the test, the audiologist and the physician can be doing something else.
AO/Beck: It sounds like the Otogram is primarily designed for the otolaryngologist's office?
Glasscock: Not really. Our business model was actually set up for primary care physicians, and that's still the largest market for us. We went to otolaryngologists and audiologists first, because they understand hearing loss. There are a lot of otolaryngologists who have an audiologist in their office once or twice a week and they can't get tests done on the off-days, so they're happy because they can keep their office flow going when the audiologist is not there, This frees the audiologist to spend more time on interpreting test results, treating hearing loss, and dispensing hearing aids. Think of it like an EKG machine, the genius is not in doing the test, the machine does that, the genius is in interpreting the results. As you and as you might guess, we've sold the product mostly to otolaryngologists at this point. The other reason we didn't go directly to primary care, was that when we talked to a few primary care doctors they said, What do the otolaryngologists think? So we felt we had to have a large number of otolaryngologists who use this in their practice every day before we went further. At the end of the day, however, Tympany developed the Otogram to address that group of patients in the 22 million people suffering from hearing loss that never make it into the hearing health system. Rather than wait for them to try and get found by the current system, Tympany created the Otogram to take the technology to these hearing loss sufferers. All these 22 million patients currently go to their primary care physician, so Tympany figured that rather than bring Mohammed to the mountain we would bring the mountain to Mohammed. So by placing the Otogram in primary care physician offices, we believe that we will be able to get more patients diagnosed and treated for hearing loss.
AO/Beck: Dr. Glasscock, can you please give us the website address and the toll free number for people interested in learning more about Tympany and the Otogram?
Glasscock: Sure Doug. The toll free number is 866-316-3606, and the website address is www.tympany.net.
AO/Beck: What do you say to audiologists that might feel threatened by this technology?
Glasscock: We get two responses from audiologists. One response is, I've sat and pushed buttons for 20 years and I'm tired of doing that. I'd much rather counsel patients, do an ABR, do a vestibular test, program cochlear implants or hearing aids, sell hearing aids, etc. In other words, some say I'd much prefer to use my time doing higher value added activities and things I'm more interested in, rather than routine tests over and over again. I've heard that from some audiologists, especially with regard to once a year follow-up patients and retesting after surgery. Those audiologists love the technology. They see it as a way to free-up time during their day.
The other response from audiologists is The box can't do everything audiologists can do! And of course, they're right. In fact, we say the Otogram can at best test 90% of your patients. Some patients will have to be tested, at least partially, by manual testing. In addition, physicians rely heavily upon audiologists to interpret the test results, which the Otogram doesn't do. So, it's really not going to replace the audiologist! Audiologists will continue to test difficult cases, interpret test results, counsel patients, treat hearing loss and dispense hearing aids. But for an otolaryngologist who has a part-time audiologist and can't get a test done when it's needed, this is a major way to help his/her practice. We're not trying to cause problems for audiologists or put them out of business but we are trying to provide tools that will make professionals more productive and efficient and allow them to spend more time in treatment activities, which is where we think the whole AuD program is trying to push audiologists. In fact, when we've spoken with leaders in AAA, they find the Otogram is a necessary technology if audiologists are to achieve all that they hope to achieve by becoming doctors. And again, importantly, I think there are many applications for this technology outside of audiology and ENT circles, across the world. In fact, as the Otogram's acceptance increases, audiologists and ENT physicians should see their patient rolls increase as primary care physicians refer more and more hearing loss patients to them after identification by the Otogram in primary care settings.
AO/Beck: Thanks Dr. Glasscock. I am very appreciative of your time, and I thank you for sharing your thoughts about the Otogram with us.
Glasscock: Thank you too Dr. Beck. I appreciate your time and the opportunity to discuss Tympany and the Otogram with you.
