Interview with Thomas Powers Director of Audiology and Strategic Development, Siemens Hearing Instruments, Inc.
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AO/Beck: Hi Tom: It's a pleasure to meet with you again. I know many of the readers are familiar with you from your hundreds of professional presentations and articles in publications, but let's start with a brief thumbnail sketch of your professional education and your positions held.
Powers: Sure Doug. I received my Bachelor's degree at State University of New York at Geneseo, way back in 1971. I spent two years in the public schools doing speech therapy and then went back to Ohio University in Athens, Ohio and earned my masters' degree in 1975. I finished my Ph.D. in 1977 in Audiology and Speech Science. When I finished there, I went into private practice in Huntington, West Virginia and joined Siemens in 1981. I've been with Siemens since that time, except for a short hiatus at Audio Science. I started with Siemens in the position of sales manager for the Northeast and Midwest, which at that time went from Maine to Colorado. I was out visiting customers and selling hearing aids from that time until 1985, when I became the Director of Marketing Back then we were transitioning from primarily a BTE company, to a custom-built manufacturing company, which we started in 1981. We really needed to expand the marketing department and we did. We brought in copywriters and other folks who had marketing expertise. Then in 1986 or 1987, I transitioned into Education and Training and we started the Learning Center Program. We brought people together for education, training and continuing education to push the envelope to where we are today.
AO/Beck: Tom, what percentage of the Siemens hearing aid business is digital?
Powers: I don't know the exact number, but I know more than 85% of our products are digitally programmable or digital. We do have conventional products but those account for a fairly small percentage.
AO/Beck: Do you suspect that in the next year or perhaps two years, you're going to discontinue non-digital products?
Powers: We'll transition to an all digital company over the next year or two, maybe sooner. It depends on our customers' needs. There are two important issues here. The first is that the fastest growing part of the market is digital. Secondly, as odd as this may sound, it's extremely difficult to find analog engineers anymore! The people developing our products tend to be digital and/or software engineering individuals. That's just the way the business is going from a design development and marketplace standpoint.
AO/Beck: What are the features we can expect in entry-level digitals versus the top-shelf lines?
Powers: Within the digital entry-level arena, we have reasonably sophisticated compression systems, for example, wide dynamic range compression systems, which I refer to as get up and go technology. So basically the entry-level systems have gain management and compression. From there it moves into more sophisticated comfort options such as noise reduction and feedback search and destroy programs. Interestingly, probably the most important thing, which is not digitally dependent, are directional microphone options for a variety of users depending on their listening environments and lifestyle.
AO/Beck: What percentage of the instruments sold have directional mics today?
Powers: In the marketplace today it's around 15-20%. I think we're beginning to see a very rapid move into directional microphones and I see it specifically because we see more BTE's being sold than ever. The BTE market is up to about 23% of the total, which is a 4% rise over the last few years.
AO/Beck: I wonder if it's more a back-to-basics movement, or more available real estate in a BTE for circuit options, or is it that obtaining a good directional effect in a CIC is very difficult!
Powers: Good point. It's probably a combination of these issues. We've actually recently started producing canal directionals with our VoiceMic technology, which is a dual, omni-directional microphone system.
AO/Beck: What would the directivity index (DI) be on something like that versus BTE?
Powers: The DIs for a VoiceMic or a two-mic system, whether it's two omni's or this combination omni and directional, or directional plus, tend to be about 3.5 to 4 dB. If we move into the three-mic system, like with Triano, you're talking about a DI of 6 or 7. We've seen a number of them over 7 in the high frequencies, but on average about 6 to 6.5 dB.
AO/Beck: If I recall, the take home point on the directivity index is, for each point that you increase the DI, you add about 15-18% of word recognition.
Powers: Yes, that's right. Most of the time folks are operating somewhere around their 50% criteria, which is why the HINT test has become so popular. But if they're operating in a bad signal-to-noise environment that's causing them to miss about half the words, and then they use directional instruments, for each added dB of DI, they get 10 to 15% more intelligibility. That's been proven time and time again in clinical studies.
AO/Beck: So a change of 3 dB in the DI actually represents a very significant advantage?
Powers: Absolutely.
AO/Beck: What is different about the Tri-Mic, how does it work, and what's its impact as opposed to a two-mic directional system?
Powers: The primary difference in the TriMic is that by adding the third microphone we've taken that system and broken it into two parts. We use a two microphone processing system for processing low frequencies, and we're using the three microphones for processing highs. The reason for that is every time you add a microphone you add noise. We know that when somebody wears this hearing aid in real life, they're probably going to want it vented because of occlusion issues. So the real engineering feat our engineering staff accomplished was using a three mic system for the high frequencies, while using only the two outside mics for the lows. Now we've got the best of both worlds: we drive the DIs in the highs and we drive down the noise component of the low frequencies.
AO/Beck: Well that sounds amazing. I need to really think that through, but I do understand it better now than before! What was the product that was just re-introduced? Was it the Prisma?
Powers: Yes, the PRISMA™ 2. This is a new version of our very successful PRISMA product. We enhanced a proven product and gave it some additional features and benefits. Primarily we've upgraded the directional mic system and the noise reduction system. We've added the beeps, and better programming with more efficient power management so people know when their battery is starting to wind down. Another new feature we've put on a number of our products recently is something we call power-on delay, which is primarily for CIC users or those with dexterity issues when inserting their instrument in their ear, or anyone who just doesn't like to hear feedback. You can engage the power-on delay in the software and it causes about a 7 to 10 second delay between turning on the unit and the unit powering up. So it gives the patient a little extra time to get the hearing aid in their ear without it whistling. And of course, if they are in a meeting and don't want people to know what they are doing, they can get it in the ear before it Powers up, and they're back in business!
AO/Beck: Tom, what are the areas we need to focus on to help assure successful practices and satisfied hearing aid patients?
Powers: I think one of the things that we've been spending a lot of time on recently is post-fitting analysis and follow-up. We're looking at verification and validation aspects of the fitting. In other words, have we accomplished the goal? Have we hit the target? These are very important questions at this time. The more we can prove that we've met and perhaps exceeded expectations through hearing aid amplification, the better it will be for all of us.
AO/Beck: So the final test of a successful fitting really shouldn't be...Did they pass the 30 day trial?
Powers: Correct. I love it when they say, I want to keep this. But as you know Doug, it starts with appropriate pre-selection criteria and two things we focus on in our educational program are the use of the HINT and Quick-Sin to determine what people's ability is to hear in a noisy environment. The nice part about Quick-Sin is that in virtually one minute, you use an assessment tool that gives you a signal-to-ratio (SNR) level and allows you to use that to counsel your patient. If they have a very significant SNR level you'll want to talk about directional microphones, or if it's even worse you might want to discuss FM or other assistive listening devices -- because if you don't, they're probably going to be unhappy! Another quick and very good front-end analysis is the HINT. The HINT is an extremely popular test especially in the clinical research side. When using this test, it's important to tell your patients the nature of the test: they are going to get 50% of the words incorrect. So, don't let them get frustrated by taking the test - it's very challenging.
AO/Beck: Would you say there is any place for the Articulation Index in the pre-fitting assessment?
Powers: Yes. I think it has a place. It's easy to explain. And it can certainly help to explain the unaided hearing and the difference the hearing aids make. The AI is visual. It's easy and patients can understand it. So I think all of these tools are useful, and I think it's important to use at least one of them.
AO/Beck: What about the ECHO?
Powers: The ECHO is the Expected Consequences of Hearing aid Ownership; ECHO is not a lengthy questionnaire. It's about 15-17 questions and it gives you a pretty good idea of their expectations and where they want to go with their amplification.
AO/Beck: Let's talk a little about post-fitting assessment. What do you recommend as efficient and powerful? What impresses the heck out of the patients?
Powers: If you can get them to really understand how well they're doing, that's powerful! Of course, it's difficult to do. I think we need to do more live audio-type demonstrations. We need to let them listen to the hearing aids in environments that are like the real world. In fact, we're about to add a new module to our Connexx software called InterActive Fitting. InterActive Fitting is primarily a post-fitting tool, which is comprised mostly of media files, environmental sounds, and features built-in logic that actually controls our fitting software based on the patient's responses. We can start off with the first fit paradigm and then ask them to judge sound quality.
AO/Beck: Very good. Is the presentation from one or two speakers?
Powers: It can be one speaker but we prefer a two-speaker presentation, especially if you are trying to demonstrate directional microphones. We've just put some information together for our dispensers on how to do this. But the ideal set-up would be to have a speaker in the front where the primary signal is coming from, and preferably two speakers in the back.
AO/Beck: Tom, what else do you perceive as highly valuable for the post-fitting?
Powers: If we would spend as much time counseling as we did playing with software we would see a welcome change in outcomes! We still really need to take the patient through aural rehab programs tailored for their specific situation and needs. I think getting back to counseling and AR basics pays huge benefits. You can certainly give people the most benefit possible when they really understand how it works, and how they work together with that device. That's really key - how the patient and the amplification system work together because sometimes if we're not careful on how we counsel they can certainly work against each other. And that's counterproductive for everybody.
AO/Beck: Thanks Tom. I really enjoyed speaking with you.
Powers: Thank you Doug, it's been my pleasure.
Click here to visit the Siemens Hearing Instruments website.
Powers: Sure Doug. I received my Bachelor's degree at State University of New York at Geneseo, way back in 1971. I spent two years in the public schools doing speech therapy and then went back to Ohio University in Athens, Ohio and earned my masters' degree in 1975. I finished my Ph.D. in 1977 in Audiology and Speech Science. When I finished there, I went into private practice in Huntington, West Virginia and joined Siemens in 1981. I've been with Siemens since that time, except for a short hiatus at Audio Science. I started with Siemens in the position of sales manager for the Northeast and Midwest, which at that time went from Maine to Colorado. I was out visiting customers and selling hearing aids from that time until 1985, when I became the Director of Marketing Back then we were transitioning from primarily a BTE company, to a custom-built manufacturing company, which we started in 1981. We really needed to expand the marketing department and we did. We brought in copywriters and other folks who had marketing expertise. Then in 1986 or 1987, I transitioned into Education and Training and we started the Learning Center Program. We brought people together for education, training and continuing education to push the envelope to where we are today.
AO/Beck: Tom, what percentage of the Siemens hearing aid business is digital?
Powers: I don't know the exact number, but I know more than 85% of our products are digitally programmable or digital. We do have conventional products but those account for a fairly small percentage.
AO/Beck: Do you suspect that in the next year or perhaps two years, you're going to discontinue non-digital products?
Powers: We'll transition to an all digital company over the next year or two, maybe sooner. It depends on our customers' needs. There are two important issues here. The first is that the fastest growing part of the market is digital. Secondly, as odd as this may sound, it's extremely difficult to find analog engineers anymore! The people developing our products tend to be digital and/or software engineering individuals. That's just the way the business is going from a design development and marketplace standpoint.
AO/Beck: What are the features we can expect in entry-level digitals versus the top-shelf lines?
Powers: Within the digital entry-level arena, we have reasonably sophisticated compression systems, for example, wide dynamic range compression systems, which I refer to as get up and go technology. So basically the entry-level systems have gain management and compression. From there it moves into more sophisticated comfort options such as noise reduction and feedback search and destroy programs. Interestingly, probably the most important thing, which is not digitally dependent, are directional microphone options for a variety of users depending on their listening environments and lifestyle.
AO/Beck: What percentage of the instruments sold have directional mics today?
Powers: In the marketplace today it's around 15-20%. I think we're beginning to see a very rapid move into directional microphones and I see it specifically because we see more BTE's being sold than ever. The BTE market is up to about 23% of the total, which is a 4% rise over the last few years.
AO/Beck: I wonder if it's more a back-to-basics movement, or more available real estate in a BTE for circuit options, or is it that obtaining a good directional effect in a CIC is very difficult!
Powers: Good point. It's probably a combination of these issues. We've actually recently started producing canal directionals with our VoiceMic technology, which is a dual, omni-directional microphone system.
AO/Beck: What would the directivity index (DI) be on something like that versus BTE?
Powers: The DIs for a VoiceMic or a two-mic system, whether it's two omni's or this combination omni and directional, or directional plus, tend to be about 3.5 to 4 dB. If we move into the three-mic system, like with Triano, you're talking about a DI of 6 or 7. We've seen a number of them over 7 in the high frequencies, but on average about 6 to 6.5 dB.
AO/Beck: If I recall, the take home point on the directivity index is, for each point that you increase the DI, you add about 15-18% of word recognition.
Powers: Yes, that's right. Most of the time folks are operating somewhere around their 50% criteria, which is why the HINT test has become so popular. But if they're operating in a bad signal-to-noise environment that's causing them to miss about half the words, and then they use directional instruments, for each added dB of DI, they get 10 to 15% more intelligibility. That's been proven time and time again in clinical studies.
AO/Beck: So a change of 3 dB in the DI actually represents a very significant advantage?
Powers: Absolutely.
AO/Beck: What is different about the Tri-Mic, how does it work, and what's its impact as opposed to a two-mic directional system?
Powers: The primary difference in the TriMic is that by adding the third microphone we've taken that system and broken it into two parts. We use a two microphone processing system for processing low frequencies, and we're using the three microphones for processing highs. The reason for that is every time you add a microphone you add noise. We know that when somebody wears this hearing aid in real life, they're probably going to want it vented because of occlusion issues. So the real engineering feat our engineering staff accomplished was using a three mic system for the high frequencies, while using only the two outside mics for the lows. Now we've got the best of both worlds: we drive the DIs in the highs and we drive down the noise component of the low frequencies.
AO/Beck: Well that sounds amazing. I need to really think that through, but I do understand it better now than before! What was the product that was just re-introduced? Was it the Prisma?
Powers: Yes, the PRISMA™ 2. This is a new version of our very successful PRISMA product. We enhanced a proven product and gave it some additional features and benefits. Primarily we've upgraded the directional mic system and the noise reduction system. We've added the beeps, and better programming with more efficient power management so people know when their battery is starting to wind down. Another new feature we've put on a number of our products recently is something we call power-on delay, which is primarily for CIC users or those with dexterity issues when inserting their instrument in their ear, or anyone who just doesn't like to hear feedback. You can engage the power-on delay in the software and it causes about a 7 to 10 second delay between turning on the unit and the unit powering up. So it gives the patient a little extra time to get the hearing aid in their ear without it whistling. And of course, if they are in a meeting and don't want people to know what they are doing, they can get it in the ear before it Powers up, and they're back in business!
AO/Beck: Tom, what are the areas we need to focus on to help assure successful practices and satisfied hearing aid patients?
Powers: I think one of the things that we've been spending a lot of time on recently is post-fitting analysis and follow-up. We're looking at verification and validation aspects of the fitting. In other words, have we accomplished the goal? Have we hit the target? These are very important questions at this time. The more we can prove that we've met and perhaps exceeded expectations through hearing aid amplification, the better it will be for all of us.
AO/Beck: So the final test of a successful fitting really shouldn't be...Did they pass the 30 day trial?
Powers: Correct. I love it when they say, I want to keep this. But as you know Doug, it starts with appropriate pre-selection criteria and two things we focus on in our educational program are the use of the HINT and Quick-Sin to determine what people's ability is to hear in a noisy environment. The nice part about Quick-Sin is that in virtually one minute, you use an assessment tool that gives you a signal-to-ratio (SNR) level and allows you to use that to counsel your patient. If they have a very significant SNR level you'll want to talk about directional microphones, or if it's even worse you might want to discuss FM or other assistive listening devices -- because if you don't, they're probably going to be unhappy! Another quick and very good front-end analysis is the HINT. The HINT is an extremely popular test especially in the clinical research side. When using this test, it's important to tell your patients the nature of the test: they are going to get 50% of the words incorrect. So, don't let them get frustrated by taking the test - it's very challenging.
AO/Beck: Would you say there is any place for the Articulation Index in the pre-fitting assessment?
Powers: Yes. I think it has a place. It's easy to explain. And it can certainly help to explain the unaided hearing and the difference the hearing aids make. The AI is visual. It's easy and patients can understand it. So I think all of these tools are useful, and I think it's important to use at least one of them.
AO/Beck: What about the ECHO?
Powers: The ECHO is the Expected Consequences of Hearing aid Ownership; ECHO is not a lengthy questionnaire. It's about 15-17 questions and it gives you a pretty good idea of their expectations and where they want to go with their amplification.
AO/Beck: Let's talk a little about post-fitting assessment. What do you recommend as efficient and powerful? What impresses the heck out of the patients?
Powers: If you can get them to really understand how well they're doing, that's powerful! Of course, it's difficult to do. I think we need to do more live audio-type demonstrations. We need to let them listen to the hearing aids in environments that are like the real world. In fact, we're about to add a new module to our Connexx software called InterActive Fitting. InterActive Fitting is primarily a post-fitting tool, which is comprised mostly of media files, environmental sounds, and features built-in logic that actually controls our fitting software based on the patient's responses. We can start off with the first fit paradigm and then ask them to judge sound quality.
AO/Beck: Very good. Is the presentation from one or two speakers?
Powers: It can be one speaker but we prefer a two-speaker presentation, especially if you are trying to demonstrate directional microphones. We've just put some information together for our dispensers on how to do this. But the ideal set-up would be to have a speaker in the front where the primary signal is coming from, and preferably two speakers in the back.
AO/Beck: Tom, what else do you perceive as highly valuable for the post-fitting?
Powers: If we would spend as much time counseling as we did playing with software we would see a welcome change in outcomes! We still really need to take the patient through aural rehab programs tailored for their specific situation and needs. I think getting back to counseling and AR basics pays huge benefits. You can certainly give people the most benefit possible when they really understand how it works, and how they work together with that device. That's really key - how the patient and the amplification system work together because sometimes if we're not careful on how we counsel they can certainly work against each other. And that's counterproductive for everybody.
AO/Beck: Thanks Tom. I really enjoyed speaking with you.
Powers: Thank you Doug, it's been my pleasure.
Click here to visit the Siemens Hearing Instruments website.
Thomas A. Powers, PhD
Thomas A. Powers, Ph.D., is the Managing Member of Powers Consulting, providing management consulting to the hearing health industry. Dr. Powers serves an expert audiology consultant for the Hearing Industries Association, and as a Consultant for Sivantos, Inc. Dr. Powers received his B.S. from the State University of New York at Geneseo, and his M.A. and Ph.D. in Audiology and Speech Science from Ohio University. He began his career as a partner in an Audiology private practice and has over 35 years of experience in the hearing health care industry. Prior to his current role, he was Vice-President, Government Services and Professional Relations for Sivantos, Inc.