Interview with Mike Hall Audiologist, SeboTek Consultant
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Topic: SeboTek Hearing Aids; Options and Alternatives
AO/BECK: Hi Mike. Thanks for meeting with me today. Before we get to the topic at hand, would you please tell me where you went to school, and perhaps a little about your practice?
HALL: I did my undergraduate work at the University of Oklahoma and my graduate work in audiology at the University of Tulsa. Since 1970 I've been practicing audiology. I was the director of The Tulsa Speech and Hearing Association and I worked for Easter Seals Society of Oklahoma as their Speech and Hearing Director for a year and a half. After that I was at the House Ear Clinic and eventually I went into the Army as an audiologist. In the late 1970s, I came up to Walnut Creek, California and set up a private practice. I did clinical audiology and a lot of hearing aid dispensing too through the year 2000. It was a great experience for me. I retired from active practice in 2000 and have been watching the industry from the "sidelines" so to speak since that time.
AO/BECK: Mike, what was it that motivated you to return to hearing healthcare, and by returning, what is it that you hope to accomplish?
HALL: I've always enjoyed audiology, it's been good to me. When I saw the SeboTek PAC, I thought -- if it did what it advertised, it was what I had always looked for as a clinician. The cosmetics of a CIC, a modular design, a deep canal fitting. Well, I had a colleague order a pair for me and the rest is history. My goal is to tell the professionals and the patients that we have new choices and opportunities available to us, and some of them are quite good!
AO/BECK: Mike, I read in your bio that you dispensed over 8,000 advanced technology instruments. That's quite a lot of hearing aids! Would you please tell me your thoughts on SeboTek instruments, based on your 8000 hearing aids and 30 year history in the profession?
HALL: I think many of us "in the trenches" have a lot of experience, and mine are not unique. Those of us that dispense hearing aids see the complications with certain devices every day - especially CIC's. I love to wear and to fit CICs but they need lots of follow-up. Many people have difficult or prohibitive anatomy, moisture and wax issues, and of course -- feedback and occlusion related problems. I was intrigued when I saw the SeboTek Post-Auricular Canal (PAC) because it has the cosmetic appeal of a CIC, with the advantages typically associated with BTE's and it has none of the traditional CIC drawbacks.
AO/BECK: Please elaborate on that for me?
HALL: Sure. For example, the PAC has the removable receiver, which was designed so it's almost impossible for earwax to damage the receiver. This is possible because there is ¼ inch or more between the receiver and the end of the silicon ear tip. I've been wearing the PAC myself and I've experimented with it in many situations -- it really is different. Maybe the way to look at it is that the PAC was designed to solve the problems all of us deal with daily. It's a different and effective approach regarding how to build and fit hearing aid.
AO/BECK: Very good. I know you've had a specific interest in fitting hearing aids for patients with TMJ (temperomandibular joint) syndrome and also patients with significant occlusion problems. Can you please tell me about that?
HALL: Sure. I started reviewing articles in various journals from the past ten years, looking for articles related to deep canal fittings for occlusion issues and for patients with TMJ issues. I read about deep canal fittings over and over again, but the common theme was these fittings failed to minimize occlusion and failed to effectively help TMJ patients. As I read those articles, I noticed the recommended solutions go all over the place and they conflict with each other. In other words, one author says shorten the canal, another says make it longer. Some say to increase the diameter, others say decrease the diameter. In the final analysis, there really are no universally successful solutions. So when you have a TMJ patient and that patient has occlusion, the possible solutions are vast and varied, and you have to hope that you solve the problem before the patient runs out of patience!
AO/BECK: I have not seen many TMJ patients with occlusion as their chief complaint, but I think the solutions do vary tremendously, and what works with one patient may not work with the next. What is it about the PAC that better addresses these issues?
HALL: I think the design of the ear tip is the key. The design is unique and offers many advantages. We all know that if you go deeper in the canal, you hit the bony portion of the canal and if you're deep enough, you are supposed to theoretically avoid the occlusion effect. Sometimes that works! Well, the receiver, which we call the "speaker" on the PAC, is placed very deep in the ear canal. Some people have said that using the soft tip is the key, but a study several years ago looked into that idea and determined that hard material was just as effective as soft material. So it seems the key is to effectively seal the ear, and doing that in the bony portion of the canal works well to reduce or eliminate the occlusion effect. With the TMJ patients in particular, I think the seal is important. And for TMJ patients, the soft tipped receiver keeps the PAC comfortably located deep in the canal. It doesn't increase their TMJ discomfort and they can wear it all day. I don't have a giant study of TMJ patients with occlusion that were fit with soft versus hard tipped deep canal fittings, but it does make intuitive sense, and it seems to be working!
AO/BECK: How does the SeboTek fitting software differ from other software?
HALL: Most of the software parameters found in the SeboTek system can be found in other software packages. To the best of my knowledge, however, none of the other manufacturers have incorporated all of the features in one software package, as SeboTek has done. Some of the SeboTek programmable features include; compression thresholds, attack and release times across four memories and four bands/channels, various maximum power outputs, auto select of compression thresholds, telephone response curves, crossover frequency options for each band/channel, copy control from one memory to another and memory to memory, compression ratio options, an autofit feature and adjustable directionality characteristics. So I guess in summary, the "menu" options are enormous, simple and practical.
AO/BECK: Are there contraindications, advantages, or disadvantages to using the PAC for pediatric fittings?
HALL: The majority of the SeboTek fittings have been on adults. We are seeing reports of PAC use with children. However, there have been no clinical studies to date focused on children. The advantages of children wearing the PAC is that it provides them with a small hearing device on which repairs, and even the occasional re-sizing of the seal to keep them properly fit during those dramatic growth years, can be carried out in the office. This is especially important for active kids, and those who tend to require multiple repairs!
AO/BECK: Regarding directional microphone systems, how is the SeboTek PAC different from other directional mic systems?
HALL: In selecting the microphone system for the PAC, SeboTek identified several key features they wanted to offer. They elected to use multi-microphones having very tight tolerances with no more than 1dB difference between the microphones. The microphones have a calibration mode that monitors the microphones and maintains their tight tolerances, allowing optimal directional performance. Also, the noise floor of the directional microphone used in the PAC is reportedly lower than that of other microphones. Digital technology allows directional microphones to be designed as either adaptive or non-adaptive. In an adaptive system the directional characteristics of the microphone become "more active" as the background noise increases. In a non-adaptive (or selectable) system the directional microphone is turned on or off by the patient touching a switch on the hearing device or remote control. There are advantages and disadvantages to both systems. With adaptive systems, some patients object to the directional mode becoming active when they don't want it. The leading objection against the non-adaptive directional microphone systems are that the patient has to make the desired changes manually. In the SeboTek PAC, the ability to change the directional characteristics is within the software. Using the software the clinician can adjust the system from an omnidirectional, caridiod, to a hypercardioid pattern.
AO/BECK: Does SeboTek use a standard receiver on its PAC device?
HALL: The receiver SeboTek uses a receiver that is available to most manufacturers. The receiver, along with the processor and microphone, has a frequency range which provides higher frequency amplification than is found in most manufacturers' devices. It has been modified according to SeboTek's criteria for developing a high frequency amplification system.. The receiver has a custom housing and it is attached to the "speaker link." The receiver and speaker link are attached very tightly so they can be inserted and removed from the ear without breakage or failure. The housing for the receiver is designed to accommodate the silicone ear tips. The combination of the receiver housing and the ear tips provides a natural "horn effect" which provides even more emphasis for high frequencies. The placement of the ear tip on the receiver provides a means to minimize wax and/or debris damage to the receiver. So the whole design from soup to nuts is new, interesting, and effective.
AO/BECK: Mike, welcome back to the industry. And thanks for your time and thoughts on the SeboTek PAC.
HALL: Thank you. It's been my pleasure, Doug.
HALL: I did my undergraduate work at the University of Oklahoma and my graduate work in audiology at the University of Tulsa. Since 1970 I've been practicing audiology. I was the director of The Tulsa Speech and Hearing Association and I worked for Easter Seals Society of Oklahoma as their Speech and Hearing Director for a year and a half. After that I was at the House Ear Clinic and eventually I went into the Army as an audiologist. In the late 1970s, I came up to Walnut Creek, California and set up a private practice. I did clinical audiology and a lot of hearing aid dispensing too through the year 2000. It was a great experience for me. I retired from active practice in 2000 and have been watching the industry from the "sidelines" so to speak since that time.
AO/BECK: Mike, what was it that motivated you to return to hearing healthcare, and by returning, what is it that you hope to accomplish?
HALL: I've always enjoyed audiology, it's been good to me. When I saw the SeboTek PAC, I thought -- if it did what it advertised, it was what I had always looked for as a clinician. The cosmetics of a CIC, a modular design, a deep canal fitting. Well, I had a colleague order a pair for me and the rest is history. My goal is to tell the professionals and the patients that we have new choices and opportunities available to us, and some of them are quite good!
AO/BECK: Mike, I read in your bio that you dispensed over 8,000 advanced technology instruments. That's quite a lot of hearing aids! Would you please tell me your thoughts on SeboTek instruments, based on your 8000 hearing aids and 30 year history in the profession?
HALL: I think many of us "in the trenches" have a lot of experience, and mine are not unique. Those of us that dispense hearing aids see the complications with certain devices every day - especially CIC's. I love to wear and to fit CICs but they need lots of follow-up. Many people have difficult or prohibitive anatomy, moisture and wax issues, and of course -- feedback and occlusion related problems. I was intrigued when I saw the SeboTek Post-Auricular Canal (PAC) because it has the cosmetic appeal of a CIC, with the advantages typically associated with BTE's and it has none of the traditional CIC drawbacks.
AO/BECK: Please elaborate on that for me?
HALL: Sure. For example, the PAC has the removable receiver, which was designed so it's almost impossible for earwax to damage the receiver. This is possible because there is ¼ inch or more between the receiver and the end of the silicon ear tip. I've been wearing the PAC myself and I've experimented with it in many situations -- it really is different. Maybe the way to look at it is that the PAC was designed to solve the problems all of us deal with daily. It's a different and effective approach regarding how to build and fit hearing aid.
AO/BECK: Very good. I know you've had a specific interest in fitting hearing aids for patients with TMJ (temperomandibular joint) syndrome and also patients with significant occlusion problems. Can you please tell me about that?
HALL: Sure. I started reviewing articles in various journals from the past ten years, looking for articles related to deep canal fittings for occlusion issues and for patients with TMJ issues. I read about deep canal fittings over and over again, but the common theme was these fittings failed to minimize occlusion and failed to effectively help TMJ patients. As I read those articles, I noticed the recommended solutions go all over the place and they conflict with each other. In other words, one author says shorten the canal, another says make it longer. Some say to increase the diameter, others say decrease the diameter. In the final analysis, there really are no universally successful solutions. So when you have a TMJ patient and that patient has occlusion, the possible solutions are vast and varied, and you have to hope that you solve the problem before the patient runs out of patience!
AO/BECK: I have not seen many TMJ patients with occlusion as their chief complaint, but I think the solutions do vary tremendously, and what works with one patient may not work with the next. What is it about the PAC that better addresses these issues?
HALL: I think the design of the ear tip is the key. The design is unique and offers many advantages. We all know that if you go deeper in the canal, you hit the bony portion of the canal and if you're deep enough, you are supposed to theoretically avoid the occlusion effect. Sometimes that works! Well, the receiver, which we call the "speaker" on the PAC, is placed very deep in the ear canal. Some people have said that using the soft tip is the key, but a study several years ago looked into that idea and determined that hard material was just as effective as soft material. So it seems the key is to effectively seal the ear, and doing that in the bony portion of the canal works well to reduce or eliminate the occlusion effect. With the TMJ patients in particular, I think the seal is important. And for TMJ patients, the soft tipped receiver keeps the PAC comfortably located deep in the canal. It doesn't increase their TMJ discomfort and they can wear it all day. I don't have a giant study of TMJ patients with occlusion that were fit with soft versus hard tipped deep canal fittings, but it does make intuitive sense, and it seems to be working!
AO/BECK: How does the SeboTek fitting software differ from other software?
HALL: Most of the software parameters found in the SeboTek system can be found in other software packages. To the best of my knowledge, however, none of the other manufacturers have incorporated all of the features in one software package, as SeboTek has done. Some of the SeboTek programmable features include; compression thresholds, attack and release times across four memories and four bands/channels, various maximum power outputs, auto select of compression thresholds, telephone response curves, crossover frequency options for each band/channel, copy control from one memory to another and memory to memory, compression ratio options, an autofit feature and adjustable directionality characteristics. So I guess in summary, the "menu" options are enormous, simple and practical.
AO/BECK: Are there contraindications, advantages, or disadvantages to using the PAC for pediatric fittings?
HALL: The majority of the SeboTek fittings have been on adults. We are seeing reports of PAC use with children. However, there have been no clinical studies to date focused on children. The advantages of children wearing the PAC is that it provides them with a small hearing device on which repairs, and even the occasional re-sizing of the seal to keep them properly fit during those dramatic growth years, can be carried out in the office. This is especially important for active kids, and those who tend to require multiple repairs!
AO/BECK: Regarding directional microphone systems, how is the SeboTek PAC different from other directional mic systems?
HALL: In selecting the microphone system for the PAC, SeboTek identified several key features they wanted to offer. They elected to use multi-microphones having very tight tolerances with no more than 1dB difference between the microphones. The microphones have a calibration mode that monitors the microphones and maintains their tight tolerances, allowing optimal directional performance. Also, the noise floor of the directional microphone used in the PAC is reportedly lower than that of other microphones. Digital technology allows directional microphones to be designed as either adaptive or non-adaptive. In an adaptive system the directional characteristics of the microphone become "more active" as the background noise increases. In a non-adaptive (or selectable) system the directional microphone is turned on or off by the patient touching a switch on the hearing device or remote control. There are advantages and disadvantages to both systems. With adaptive systems, some patients object to the directional mode becoming active when they don't want it. The leading objection against the non-adaptive directional microphone systems are that the patient has to make the desired changes manually. In the SeboTek PAC, the ability to change the directional characteristics is within the software. Using the software the clinician can adjust the system from an omnidirectional, caridiod, to a hypercardioid pattern.
AO/BECK: Does SeboTek use a standard receiver on its PAC device?
HALL: The receiver SeboTek uses a receiver that is available to most manufacturers. The receiver, along with the processor and microphone, has a frequency range which provides higher frequency amplification than is found in most manufacturers' devices. It has been modified according to SeboTek's criteria for developing a high frequency amplification system.. The receiver has a custom housing and it is attached to the "speaker link." The receiver and speaker link are attached very tightly so they can be inserted and removed from the ear without breakage or failure. The housing for the receiver is designed to accommodate the silicone ear tips. The combination of the receiver housing and the ear tips provides a natural "horn effect" which provides even more emphasis for high frequencies. The placement of the ear tip on the receiver provides a means to minimize wax and/or debris damage to the receiver. So the whole design from soup to nuts is new, interesting, and effective.
AO/BECK: Mike, welcome back to the industry. And thanks for your time and thoughts on the SeboTek PAC.
HALL: Thank you. It's been my pleasure, Doug.
