Interview with Rebecca A. Younk, Au.D., Product Training & Education Program Manager
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Topic: Current trends in hearing aid fittings
Paul Dybala: Hello everybody, Paul Dybala with Audiology Online, and today I'm talking with Dr. Rebecca Younk who is the Product Training and Education Program Manager for Amplifon. Rebecca, welcome and thanks, and if you would, tell us a little bit about yourself and Amplifon.
Younk: Sure, and thank you, Paul. I've been an audiologist for almost 9 years and my whole career has been focused on the hearing aid dispensing side of the profession. I have not only dispensed hearing instruments I have also worked on the manufacturer side of the business too.
At Amplifon we have a professional development department that is charged with the mission of training everybody who fits hearing aids for us. Amplifon USA is a part of Amplifon International, who is a distributor of hearing aids. Our world headquarters is in Milan, Italy, and the US headquarters is in Plymouth, Minnesota. In the US, Amplifon oversees three separate divisions: There's Miracle Ear, which everybody is familiar with, and is more of a retail hearing aid outlet; Amplifon Hearing Aid Centers, which are also more retail-based; and the Sonus clinics, which are more along the audiology/medical model, where there is an emphasis on diagnostics as well as dispensing and rehabilitation.
Dybala: Very good. I wanted to ask you about a few trends that you have seen in the area of hearing aids, but I think it may be helpful to give everyone a further perspective about what you do as part of your day-to-day with Amplifon.
Younk: Sure. One of the things that we do, by virtue of being in Amplifon's Professional Development Department, is travel around the country and put on training seminars for offices in all our different divisions. It's actually a good source of information for us because we talk to audiologists and hearing instrument specialists who are everywhere in the country. We have well over 1,500 offices. We don't hit each one of those offices, but we put on regional seminars where people come in and they attend training sessions.
We learn as much as we teach because the people who are out in the field using the products are the ones who are sitting in the classes. We ask them what they're interested in, what they're fitting, and what their patients and customers are coming in and asking for.
Dybala: Thanks for that. Based on seeing all of these professionals, what are the big trends that you are seeing today?
Younk: There are several, including open-fit hearing aids, direct marketing to consumer by the hearing aid manufacturers, use of first-fit algorithms, the convergence of hearing aids with other electronic consumer devices and the changing needs of the baby-boomer generation.
Dybala: Sounds interesting. Tell us about what you are seeing in the area of open-fit devices.
Younk: Because a lot of new products being introduced are the slim tube, open-canal or receiver-in-the-canal fittings, at Amplifon, we've designed a few classes and some training experiences for the people in the field on these topics.
In the process of doing that we are asking people, "How many of these are you fitting?" Some people are only fitting up to 10% of their patients with open products, and they are just a little bit resistant to new technology and are waiting until the products prove their worth, if you will. You know, let other people experiment with them, and when we know they're good, then we'll start fitting them, that kind of thing. Then we have other people who are at the complete other end of the extreme, and they're fitting over 75% of their patients with open canal or receiver-in-the-canal fittings.
So, there doesn't seem to be too much rhyme or reason with this. Some people just like new products and they're fitting them because they're new products. Some people are afraid of new products and are holding off a little bit until they see how this develops.
What concerns me about this is that we, as dispensing professionals, are probably pushing the fitting range a little bit. When you are looking at offices that are fitting 75% or more of their patients with open fit products, I have to suspect that some people are fitting them on inappropriate candidates
Dybala: I would agree. That seems high to me.
Younk: The Hearing Review also published the results of a survey that supports that there are some dispensers fitting 75% to 100% of open canal products. That's just way too many.
Dybala: What's the key to fitting these devices properly? Do you feel that more specific training is needed in the area of open-fit hearing aids?
Younk: Well, it's not so much training as it is bringing them back to the basics. It's really reminding them of all the things that make for good dispensing practices in the first place. For example, doing something like the COSI and determining the needs and expectations of the patient, then looking at the audiogram and trying to determine an appropriate instrument that would provide enough gain and advanced features that the patient desires is really what we should be focusing on when considering amplification for patients.
Dybala: You also mentioned direct-to-consumer marketing with hearing aids from the manufacturers. Can you talk more about that?
Younk: This is similar to what we saw a few years ago in the medical industry when the pharmaceutical companies started putting commercials on TV for specific medications so that patients would walk in to their doctor's office and say, "Here are my symptoms, and I saw a commercial for this particular medication, and I want it."
Now, certainly, it hasn't reached that proportion in the hearing world and it may not ever. But people are doing their homework and research before they go out to buy hearing aids. They're going to the Internet and coming into the office with features in mind that specific companies advertised. Keep in mind that most of these people with hearing loss wait until they really feel the pain of having a hearing loss before they make the decision to pursue the aids in the first place. So, they're probably a little bit more apprehensive and suspicious about the whole process because of the stigma and all the negative things they've heard about hearing aids to begin with. So when they come in and they say "Well, I read an ad or I saw something on the Internet about this particular product and how it works so well because the speaker is down inside my ear and it has a remote control and it has all of these fancy features and comes in all these neat colors. This is the one I want," we know they are likely a dedicated consumer.
It really puts us between a rock and hard place as audiologists, because we are still responsible for recommending the best aid, regardless of manufacturer, that will be appropriate for the patient's loss and lifestyle. We have to make a choice at that point. We can either give people what they want or we can tell them, "This is really not the best thing for you."
Dybala: Right. And as you probably know, the word "doctor" comes from the word "to teach." I always felt if I was not educating my patients or trying to educate my patients about these things that I wasn't doing my job completely. As audiologists, we should be keeping up and staying educated. So that when we do have those "pre-determined" patients coming in, we can say, "Okay, I think it's a very good hearing aid, but let's talk about why it might or might not work for you and what your other options are."
Younk: You're absolutely right, and that's certainly the best way to approach it. And I have found, similar to what you're talking about, is when you explain things to a patient that way, it's hard for somebody who's reasonable to be unreasonable.
Dybala: You also mentioned the use of first-fit software when programming hearing aids. Why is this important to pay attention to when considering open-fit devices?
Younk: Well, first-fitting results on the software for the most part are just an approximation of what the hearing aid is actually doing inside the ear, and there have been several studies published that will support that. It's just not a good way to fit hearing aids. We know without any doubt that what we see on the computer screen for the manufacturer's software varies dramatically from what we measure inside the ear canal. There's really no good way to know what a hearing aid's doing inside the ear other than by measuring it with a probe microphone.
A lot of people are under the misconception that you can't measure open canal fittings with probe microphones because the sound leaks out around the tip, but you absolutely can! I think that not only is it as important as a more traditional or more conventional instrument, it's probably even more important because we have to look at how much benefit we're providing with our hearing aids.
If we're fitting people with open-canal fittings, these people don't have as severe hearing losses to begin with. So if somebody has a less-severe hearing loss and we provide amplification, there's not as much room for benefit. If we're not guaranteeing that every dB of benefit that we can provide is being reached by verifying the fit, then we're doing a gross injustice to the people. We're selling hearing aids that may not provide as much benefit as the cost would warrant. In my opinion it really has to be verified with a probe microphone fitting.
Dybala: I agree completely. I wonder why people thought that you could not perform real-ear on open fit devices. We measure REURs all day long and with that measurement, the canal is completely open!
Younk: Right!
Dybala: Rebecca, you mentioned that we're becoming more of an audio- and ear-level-based world. Talk about what you are seeing.
Younk: Sure. A couple of the big manufacturers already have some products out there that make hearing aids compatible with Bluetooth devices so that, for example, when your phone rings, all you have to do is push a button on a remote control, or some intermediary device, and then you can just talk and your hearing aid is linked to the phone automatically.
We've just started to tap into that at Amplifon, and I think that's going to be the next generation of products that we all have to learn about, figure out how we're going to sell to people, and fit well. If you just look at people sitting in restaurants and in the airport and everywhere you go they've all got Bluetooth devices for their telephones.
So somehow we have to be able to make hearing aids compatible and competitive in that way as well. We're going to see a whole explosion of products, and it's starting now. Like I said, there are a handful of manufacturers who already have devices available, but once one introduces it then the next one comes along and figures out how to improve on it, and they just keep getting better and better and more and more sophisticated. Yeah, we're going to see a lot of them. There's going to be a flood.
Dybala: Let's wrap up this interview talking about the baby boomers. When people talk about the boomers, they usually focus on the large number of them. You would say we have to think beyond just the sheer number of boomers, correct?
Younk: Absolutely. I definitely have some insight on that. We're real big on customer satisfaction here at Amplifon, and we do customer satisfaction surveys on large numbers of people, so we collect a lot of data. We've identified three groups that are less satisfied than the average and, unfortunately, one of those groups is the under 65 demographic. So these people, by and large, tend to be less satisfied with the services we provide.
Now, if you look at any of the customer satisfaction surveys or some of the MarkeTrak data, as a whole our consumers love us. People may not rate their hearing aid real highly, but they'll rate the professional who fit them top shelf. The baby boomers are not quite as generous and or forgiving, and they're a lot more demanding, so we need to be prepared for that.
They're younger people, they're more technologically sophisticated, so they have better information when they come in. They have greater expectations. They have less time. They want things to be done quickly, they don't want to wait for their appointments, and they want to be able to get in quickly and they want to be seen on time when they show up. They want the experience to be positive. They don't want to sit in a waiting room. They want nice surroundings and efficiency. I think probably more than anything, they need to perceive value in what they're getting. So whatever we do for them has to be quick, easy, and valuable.
Dybala: That's great, Rebecca. If anybody reading this needs more information, I would encourage you to visit the Amplifon USA website, at amplifonusa.com. We've also got information here on Audiology Online through their web channel at audiologyonline.com/channels/amplifon.asp
Rebecca, thank you so much for your insights today and for spending time with us.
Younk: Thank you, Paul.
About Amplifon:
For more than 50 years, Amplifon Hearing Aid Centers have helped improve the way people of all ages and walks of life hear the world around them. We're committed to hiring the most qualified professionals and bringing you the latest technology at the most competitive prices. You can choose from a full range of up-to-date styles, some barely visible to the eye, including revolutionary new "open fit" models.
Younk: Sure, and thank you, Paul. I've been an audiologist for almost 9 years and my whole career has been focused on the hearing aid dispensing side of the profession. I have not only dispensed hearing instruments I have also worked on the manufacturer side of the business too.
At Amplifon we have a professional development department that is charged with the mission of training everybody who fits hearing aids for us. Amplifon USA is a part of Amplifon International, who is a distributor of hearing aids. Our world headquarters is in Milan, Italy, and the US headquarters is in Plymouth, Minnesota. In the US, Amplifon oversees three separate divisions: There's Miracle Ear, which everybody is familiar with, and is more of a retail hearing aid outlet; Amplifon Hearing Aid Centers, which are also more retail-based; and the Sonus clinics, which are more along the audiology/medical model, where there is an emphasis on diagnostics as well as dispensing and rehabilitation.
Dybala: Very good. I wanted to ask you about a few trends that you have seen in the area of hearing aids, but I think it may be helpful to give everyone a further perspective about what you do as part of your day-to-day with Amplifon.
Younk: Sure. One of the things that we do, by virtue of being in Amplifon's Professional Development Department, is travel around the country and put on training seminars for offices in all our different divisions. It's actually a good source of information for us because we talk to audiologists and hearing instrument specialists who are everywhere in the country. We have well over 1,500 offices. We don't hit each one of those offices, but we put on regional seminars where people come in and they attend training sessions.
We learn as much as we teach because the people who are out in the field using the products are the ones who are sitting in the classes. We ask them what they're interested in, what they're fitting, and what their patients and customers are coming in and asking for.
Dybala: Thanks for that. Based on seeing all of these professionals, what are the big trends that you are seeing today?
Younk: There are several, including open-fit hearing aids, direct marketing to consumer by the hearing aid manufacturers, use of first-fit algorithms, the convergence of hearing aids with other electronic consumer devices and the changing needs of the baby-boomer generation.
Dybala: Sounds interesting. Tell us about what you are seeing in the area of open-fit devices.
Younk: Because a lot of new products being introduced are the slim tube, open-canal or receiver-in-the-canal fittings, at Amplifon, we've designed a few classes and some training experiences for the people in the field on these topics.
In the process of doing that we are asking people, "How many of these are you fitting?" Some people are only fitting up to 10% of their patients with open products, and they are just a little bit resistant to new technology and are waiting until the products prove their worth, if you will. You know, let other people experiment with them, and when we know they're good, then we'll start fitting them, that kind of thing. Then we have other people who are at the complete other end of the extreme, and they're fitting over 75% of their patients with open canal or receiver-in-the-canal fittings.
So, there doesn't seem to be too much rhyme or reason with this. Some people just like new products and they're fitting them because they're new products. Some people are afraid of new products and are holding off a little bit until they see how this develops.
What concerns me about this is that we, as dispensing professionals, are probably pushing the fitting range a little bit. When you are looking at offices that are fitting 75% or more of their patients with open fit products, I have to suspect that some people are fitting them on inappropriate candidates
Dybala: I would agree. That seems high to me.
Younk: The Hearing Review also published the results of a survey that supports that there are some dispensers fitting 75% to 100% of open canal products. That's just way too many.
Dybala: What's the key to fitting these devices properly? Do you feel that more specific training is needed in the area of open-fit hearing aids?
Younk: Well, it's not so much training as it is bringing them back to the basics. It's really reminding them of all the things that make for good dispensing practices in the first place. For example, doing something like the COSI and determining the needs and expectations of the patient, then looking at the audiogram and trying to determine an appropriate instrument that would provide enough gain and advanced features that the patient desires is really what we should be focusing on when considering amplification for patients.
Dybala: You also mentioned direct-to-consumer marketing with hearing aids from the manufacturers. Can you talk more about that?
Younk: This is similar to what we saw a few years ago in the medical industry when the pharmaceutical companies started putting commercials on TV for specific medications so that patients would walk in to their doctor's office and say, "Here are my symptoms, and I saw a commercial for this particular medication, and I want it."
Now, certainly, it hasn't reached that proportion in the hearing world and it may not ever. But people are doing their homework and research before they go out to buy hearing aids. They're going to the Internet and coming into the office with features in mind that specific companies advertised. Keep in mind that most of these people with hearing loss wait until they really feel the pain of having a hearing loss before they make the decision to pursue the aids in the first place. So, they're probably a little bit more apprehensive and suspicious about the whole process because of the stigma and all the negative things they've heard about hearing aids to begin with. So when they come in and they say "Well, I read an ad or I saw something on the Internet about this particular product and how it works so well because the speaker is down inside my ear and it has a remote control and it has all of these fancy features and comes in all these neat colors. This is the one I want," we know they are likely a dedicated consumer.
It really puts us between a rock and hard place as audiologists, because we are still responsible for recommending the best aid, regardless of manufacturer, that will be appropriate for the patient's loss and lifestyle. We have to make a choice at that point. We can either give people what they want or we can tell them, "This is really not the best thing for you."
Dybala: Right. And as you probably know, the word "doctor" comes from the word "to teach." I always felt if I was not educating my patients or trying to educate my patients about these things that I wasn't doing my job completely. As audiologists, we should be keeping up and staying educated. So that when we do have those "pre-determined" patients coming in, we can say, "Okay, I think it's a very good hearing aid, but let's talk about why it might or might not work for you and what your other options are."
Younk: You're absolutely right, and that's certainly the best way to approach it. And I have found, similar to what you're talking about, is when you explain things to a patient that way, it's hard for somebody who's reasonable to be unreasonable.
Dybala: You also mentioned the use of first-fit software when programming hearing aids. Why is this important to pay attention to when considering open-fit devices?
Younk: Well, first-fitting results on the software for the most part are just an approximation of what the hearing aid is actually doing inside the ear, and there have been several studies published that will support that. It's just not a good way to fit hearing aids. We know without any doubt that what we see on the computer screen for the manufacturer's software varies dramatically from what we measure inside the ear canal. There's really no good way to know what a hearing aid's doing inside the ear other than by measuring it with a probe microphone.
A lot of people are under the misconception that you can't measure open canal fittings with probe microphones because the sound leaks out around the tip, but you absolutely can! I think that not only is it as important as a more traditional or more conventional instrument, it's probably even more important because we have to look at how much benefit we're providing with our hearing aids.
If we're fitting people with open-canal fittings, these people don't have as severe hearing losses to begin with. So if somebody has a less-severe hearing loss and we provide amplification, there's not as much room for benefit. If we're not guaranteeing that every dB of benefit that we can provide is being reached by verifying the fit, then we're doing a gross injustice to the people. We're selling hearing aids that may not provide as much benefit as the cost would warrant. In my opinion it really has to be verified with a probe microphone fitting.
Dybala: I agree completely. I wonder why people thought that you could not perform real-ear on open fit devices. We measure REURs all day long and with that measurement, the canal is completely open!
Younk: Right!
Dybala: Rebecca, you mentioned that we're becoming more of an audio- and ear-level-based world. Talk about what you are seeing.
Younk: Sure. A couple of the big manufacturers already have some products out there that make hearing aids compatible with Bluetooth devices so that, for example, when your phone rings, all you have to do is push a button on a remote control, or some intermediary device, and then you can just talk and your hearing aid is linked to the phone automatically.
We've just started to tap into that at Amplifon, and I think that's going to be the next generation of products that we all have to learn about, figure out how we're going to sell to people, and fit well. If you just look at people sitting in restaurants and in the airport and everywhere you go they've all got Bluetooth devices for their telephones.
So somehow we have to be able to make hearing aids compatible and competitive in that way as well. We're going to see a whole explosion of products, and it's starting now. Like I said, there are a handful of manufacturers who already have devices available, but once one introduces it then the next one comes along and figures out how to improve on it, and they just keep getting better and better and more and more sophisticated. Yeah, we're going to see a lot of them. There's going to be a flood.
Dybala: Let's wrap up this interview talking about the baby boomers. When people talk about the boomers, they usually focus on the large number of them. You would say we have to think beyond just the sheer number of boomers, correct?
Younk: Absolutely. I definitely have some insight on that. We're real big on customer satisfaction here at Amplifon, and we do customer satisfaction surveys on large numbers of people, so we collect a lot of data. We've identified three groups that are less satisfied than the average and, unfortunately, one of those groups is the under 65 demographic. So these people, by and large, tend to be less satisfied with the services we provide.
Now, if you look at any of the customer satisfaction surveys or some of the MarkeTrak data, as a whole our consumers love us. People may not rate their hearing aid real highly, but they'll rate the professional who fit them top shelf. The baby boomers are not quite as generous and or forgiving, and they're a lot more demanding, so we need to be prepared for that.
They're younger people, they're more technologically sophisticated, so they have better information when they come in. They have greater expectations. They have less time. They want things to be done quickly, they don't want to wait for their appointments, and they want to be able to get in quickly and they want to be seen on time when they show up. They want the experience to be positive. They don't want to sit in a waiting room. They want nice surroundings and efficiency. I think probably more than anything, they need to perceive value in what they're getting. So whatever we do for them has to be quick, easy, and valuable.
Dybala: That's great, Rebecca. If anybody reading this needs more information, I would encourage you to visit the Amplifon USA website, at amplifonusa.com. We've also got information here on Audiology Online through their web channel at audiologyonline.com/channels/amplifon.asp
Rebecca, thank you so much for your insights today and for spending time with us.
Younk: Thank you, Paul.
About Amplifon:
For more than 50 years, Amplifon Hearing Aid Centers have helped improve the way people of all ages and walks of life hear the world around them. We're committed to hiring the most qualified professionals and bringing you the latest technology at the most competitive prices. You can choose from a full range of up-to-date styles, some barely visible to the eye, including revolutionary new "open fit" models.
