Interview with Robert Baker MS, CCC-A, MBA, Audiologist & Marketing Manager, Symphonix Devices, Inc.

Middle Ear Implants - Patient Issues
AO/Beck: Hi Robert, thanks for your time today.

Baker: Hi Doug. Thanks for the opportunity.

AO/Beck: Robert, before we get to patient issues, I wonder if we can start by talking a little about your professional audiology background and then maybe you can tell me a little about obtaining your MBA too?

Baker: Sure. I got my audiology master's in Baltimore at Towson University some 21 years ago. After that, I worked for the department of Health and Mental Hygiene for the state of Maryland and then I went into industrial audiology in the shipyard division of the Tenneco Corporation. After that, I started to work with hearing aid manufacturing companies. I worked for Bernafon in the mid-1980s and I was one of the reps that helped introduce the first programmable hearing aid that was commercially available. It was an exciting time and we were all learning a lot about audiology, computers, marketing, sales, and that got me interested in obtaining an MBA, which I pursued through Johns Hopkins University.

AO/Beck: So it was really the introduction of new products that got you thinking about the business aspects of the profession?

Baker: Yes, it was really a combination of things. I wanted to understand and help create new ways of applying business philosophies to the professional arena, and I wanted to be involved in the introduction and creation of new solutions to problems we dealt with daily as clinicians. The MBA program seemed to offer me a way to formalize and organize my business knowledge, while providing more professional opportunity.

AO/Beck: Would you say that the MBA has impacted your clinical practice?

Baker: Absolutely. The MBA not only enhances your day-to-day business experiences and practices, but it gives you an exposure to finance, marketing, taxes, personnel and business management.

AO/Beck: I know there are many MBA programs out there, from residential on-site to distance education, much like the options available for audiologists regarding Au.D. programs. Was yours an on-site program?

Baker: Yes, mine was a complete on-site MBA package. It was about 60 credit hours.

AO/Beck: OK, so after you completed the MBA, you moved west?

Baker: Yes, at that point I decided to move to California and I joined ReSound Corporation as their product manager. I was with ReSound for about three years and then about a year ago, I joined Symphonix as the marketing manager.

AO/Beck: Thanks Robert. I think it's useful for the readers to know a little bit about you so they can better understand the knowledge base from which you speak while addressing issues related to middle ear implants. So moving to that issue - It seems to me that because middle ear implants were only recently approved by the FDA, that few audiologists and otologists really know much about them. So let's start with a few clinical issues. For instance, who is the ideal middle ear implant patient?

Baker: The ideal patient for middle ear implants varies. Regarding type and degree of hearing loss, patients must have a moderate to severe sensorineural hearing loss. The patients must be adults and they certainly should try conventional amplification before deciding on a middle ear implant. One thing that might trigger the thought that this person is a candidate for a middle ear implant is if the patient doesn't like the sound of their own voice with amplification. Of course that's a somewhat common first response to traditional amplification, but if their own voice quality cannot be made satisfactory through traditional amplification, he or she may be a good candidate for a middle ear implant. Another category of patients who might consider middle ear implants are those who require so much high frequency gain that they either have acoustic feedback or simply not enough gain - those people might also consider middle ear implants. Lastly, another group of candidates might be patients with external auditory canal issues; contact dermatitis, tiny ear canals, exostosis and other physical issues.

AO/Beck: What are the benefits patients might realize with a middle ear implant, that they may not achieve with traditional amplification?

Baker: The first thing I tell patients is that there is a large difference in comfort between the two. Traditional hearing aids tend to plug up ear canals. Most people can and do get used to having their ears plugged-up, but some folks simply cannot tolerate the occlusion issues. Another big difference is the sound quality. Of course sound quality is subjective and very hard to quantify. Nonetheless, when you speak to patients who have middle ear implants, one of the impressive things you hear over and over is that the quality of the sound is much better than they experienced previously with their traditional hearing aids.

AO/Beck: What do you tell the patient about the surgical procedure?

Baker: I essentially tell them as little as possible about the surgery, and I always refer those questions to the surgeon. However, I do tell the patient that in general, the middle ear implant surgery typically takes 1 to 2 hours of surgery, and that it is an outpatient procedure, so they usually go home a few hours after surgery. Again, I think it's very important to tell the candidates to address surgical issues to the otologist. The procedure used to implant the Vibrant^® Soundbridge^™ is a basic otologic protocol done daily and the physicians love to speak about those issues.

AO/Beck: What do you tell the patients regarding cost and insurance coverage?

Baker: Those are big issues! I tell candidates the average cost for everything, including surgery, anesthesia, the device and audiology pre and post-op care is about 15 to 16 thousand dollars. Of course there are places that charge more, and some that charge less, but that's a pretty good average national number to use. Currently, the Vibrant Soundbridge has received pre-authorization by private insurance companies, and we expect more of them to start pre-approving the procedure and the device as we move forward. So basically, I encourage all patients to work with their physicians' office to try to pre-approve the expenses, and that's the best way to go.

AO/Beck: What do you tell patients who say they are considering obtaining a middle ear implant because they have difficulty in noise, or difficulty in the cocktail party situation?

Baker: That's one of the situations that comes up a lot. Many of our patients come to us because they have had a difficult time in noise with traditional amplification. We know through our clinical research that patients fit with the Vibrant Soundbridge report they do well in noise, and in multiple listening situations, such as television, movie theaters, telephones and various other background noises. So, based on our research, I feel comfortable saying that they can expect to do reasonably well in noisy situations, but noisy backgrounds are a problem for all amplification systems, and probably always will present a challenging situation.

AO/Beck: Robert, what percentage of patients fit with the Vibrant Soundbridge are happy with the device and are using it?

Baker: About 97 percent of the implanted patients are pleased with the device and are using it daily. Another important statistic from our research is that 94 percent of the implanted patients report the quality of sound is better than they recall with their traditional hearing instruments.

AO/Beck: That is impressive. Robert, what about patients or audiologists who would like to speak with others who have gone through the procedure? Do you have people available who can speak about their own first hand experience?

Baker: Yes, we certainly do. We're happy to promote and encourage the exchange of information among patients and I am happy to facilitate that. We have a list of people who have the Vibrant Soundbridge implant, and they are always happy to speak with, or email the candidates and professionals who are interested in these topics.

AO/Beck: Thanks Robert, as always, it's a pleasure to speak with you. I appreciate your time, knowledge and insight.

Baker: Thank you too, Doug. It's been a lot of fun.

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