Interview with Laurel Christensen, PhD - Introducing ReSound Alera

Laurel Christensen, Ph.D.

CAROLYN SMAKA: This is Carolyn Smaka from AudiologyOnline. I'm with Dr. Laurel Christensen who is the Chief Audiology Officer at ReSound and in charge of the company's Global Audiology Group. Laurel, welcome back to AudiologyOnline.

LAUREL CHRISTENSEN: Thanks for having me.

SMAKA: First off, congratulations on your promotion. I think last time that we talked you were Vice President of Research and Development. How are things going in your new role?



CHRISTENSEN: Thing are going great. The new structure for Global Audiology has given the team many more opportunities to impact and grow our business. Having a role in Global Marketing and supporting the subsidiaries world-wide means that we consider the perspective of the Audiology professional in everything we do.

SMAKA: It sounds really exciting! I thought it was so coincidental how your promotion happened just about a month after your last AudiologyOnline interview. I'm wondering if that maybe had something to do with it.

CHRISTENSEN: I'm sure it did.

[Laughter]

SMAKA: Our topic today is Alera™, a new wireless system from ReSound. What makes Alera™ unique?

CHRISTENSEN: Alera™ is really a leap frog in wireless technology in that wireless connectivity to the hearing aid can be achieved without the need for an intermediary device worn around the neck. It's a true wireless system that does not utilize near field induction, like other wireless systems on the market. The radio is in the hearing instrument itself so that you have wireless connectivity directly from the TV or telephone. It also allows wireless fitting though our AirlinkTM. Fitting without cables is something our customers are really excited about.

SMAKA: I think there's still a lot of confusion out there with the buzz word "wireless", specifically when it comes to Bluetooth and hearing instruments. Can you take a step back and explain the difference between near field induction, Bluetooth, and the Alera™ system?

CHRISTENSEN: I'm really glad you asked that because there IS a lot of confusion in the market. Most "wireless" devices rely on a device around the neck to receive the signal from other devices, say the phone or TV. These devices then send this signal inductively to the hearing aids at either 10.6 or 3.84 MHz. The neck-worn device is needed because induction has a limited range (10 to 20 inches).

In contrast, Alera™ uses the 2.4 GHz platform for communication between the hearing aids and the device the patient is connecting to. There is an actual radio in Alera™ and the range for 2.4 GHz is far greater than competitive technology. Our approach means that no intermediary device is needed to receive the signal directly from the TV. Bluetooth wireless also runs at this frequency, but uses more complicated protocols for the wireless communication. This is because Bluetooth is a general technology that is used for communication between all sorts of wireless devices. We are able to use a leaner communication protocol that is more efficient for use in hearing aids.

SMAKA: Thanks for that explanation. What are the advantages of the signal going direct to the hearing instruments?

CHRISTENSEN: Convenience is a huge advantage. Most people do not want to wear something around their necks in order to answer their cell phones or watch TV. These "necklaces" are inconvenient and like it or not they have a stigma attached to them. Even in the age of wearing iPods, people don't want to wear a hearing aid accessory. We surveyed over 200 customers in the U.S., Germany and France about improvements they'd like to see in wireless hearing instruments. The overwhelming number one improvement consumers wanted was to get rid of the neck-worn streamer - that "necklace." An intermediary device is one more piece of equipment to wear or carry, look after, and maintain. For professionals, it means added counseling and it complicates the fitting process. Alera™ is simpler and more convenient for professionals and their patients - no cables and no necklaces and even better, direct connectivity to the television and telephone.

Another significant advantage of using 2.4 GHz is speed. A major problem with the wireless TV streamers on the market today is signal delay. Sometimes patients will experience delay times that are so long that there is a lip sync problem. The delay can also cause echoes as the delayed sound from the streamer and direct sound from the TV combine, resulting in a poor quality signal. With 2.4 GHz, you don't have these problems since there is only an 18 millisecond delay. That means no echo and no lip sync problems. It's a very clear signal from the TV.

SMAKA: So, using the TV or a Bluetooth cell phone with Alera™ seems like it should be pretty simple.

CHRISTENSEN: Yes, it is. Our Unite™ series of wireless accessories gives you strong and clear connections from devices like TVs and mobile phones directly to the hearing aids.

For the phone, we have a phone clip with a microphone, just like your Bluetooth headset has a microphone on it. For TV, you attach the Unite™ TV accessory to the television, and then the signal goes directly to the Alera™ hearing instruments without any intermediary device.

In addition, you can pair up to three Unite™ TVs with one set of hearing aids. So a patient could have a Unite™ TV device in their living room, one in the bedroom and one in the office that's connected to the computer. With other manufacturers, you'd need to constantly be moving one piece of equipment around because their technology only permits one wireless accessory device to be paired to one set of hearing aids at a time. With our system, one Unite™ TV device can be paired to multiple hearing aids. So if you have a husband and wife watching the same TV wearing, Alera™ hearing aids, they will only need to have one Unite™ TV device.

SMAKA: In addition to the phone clip and Unite™ TV, are there other accessories in the Unite™ series?

CHRISTENSEN: Initially, Unite™ accessories also include a remote control for even easier patient use, and AirLink™, the wireless programming device that our professional customers are thrilled about.

We have a roadmap of accessories that we'll be releasing over time. We like to refer to Alera™ as technology that is 'future proof' because there we will introduce new accessories and new options for wireless connections in the future.

Our goal in developing these accessories was to make it easy - easy for patients to use and easier for hearing aid professionals to fit. Our research shows that less than one third of patients who are fit with wireless hearing aids are purchasing wireless accessories that allow them to use the wireless features of their hearing aids. This tells us that current accessories on the market are not living up to expectations - they're not easy or practical. There's a need for connectivity - you get better signal-to-noise ratio when you deliver sound directly to the ear. We know our accessories work, they solve problems for the end-user, they're easy to use and affordable. Our goal with this package is to really bring the benefits of wireless to patients. We'd like to see the majority of Alera™ customers taking home accessories.

SMAKA: Laurel, you mentioned that Alera™ has wireless fitting. Can you explain?

CHRISTENSEN: Yes, this is another significant benefit of Alera™ - they can be programmed wirelessly with no cables and no other device worn by the patient.

SMAKA: No cables?

CHRISTENSEN: No cables whatsoever - no cables to connect, untangle or find. Many of the "wireless fitting systems" on the market today are not really wireless. The patient has to wear a third intermediary device around their neck - the most commonly used being a rather bulky medallion on a large plastic hook - during programming along with another device on some systems.

SMAKA: How is the signal transmitted?



Alera™ features true wireless programming via AirLink™

CHRISTENSEN: The transmitter plugs into the USB port of the computer. It's plug and play. In the Aventa® fitting software, the professional selects AirLink™ and it's ready to program, sending the signal directly to the Alera™ hearing instruments, for true wireless fitting.

Its range is excellent. This means the patient can be fitted in the office, then can walk out of the fitting room into the lobby to try other sound environments. When they return to the fitting room, AirLink™ will automatically detect the instruments, and they can then continue fitting. It's easy to use and it's truly wireless, so it adds convenience and efficiency to the fitting process.

SMAKA: I've had more than one cable die out on me throughout the years. Trying to program binaural hearing aids with one cable is always fun. Not to mention the fun of matching up cables, organizing them and untangling them.

CHRISTENSEN: Yes - for all those reasons professionals have been asking for wireless fitting well before they asked for other wireless functionality in hearing aids.

SMAKA: You also mentioned a remote control?

CHRISTENSEN: Yes, The remote is not a requirement, but is available as an option with some nice benefits. It was developed to make it even easier for patients to use Alera. With the remote control patients can simultaneously change volume or memories in both hearing instruments at the same time, or they can adjust one side only. There's also a simple "streaming" button that enables the wearer to stream other devices like the TV with just the push of a button. The remote will display the memory setting and the device that it's streaming from. We think it will make the system even easier to use by helping patients use easy-to-read visual displays to switch between programs. It's also great for patients with manual dexterity issues.

SMAKA: Let's switch gears for a moment and talk about style. What styles is Alera™ available in?



Alera™ is available in a new receiver-in-the-ear micro BTE design that can fit a wide range of hearing losses.

CHRISTENSEN: Alera™ is in a receiver-in-the-ear micro BTE.
It is a completely new design that can fit a wide range of hearing losses. It can be fit completely open or with micro molds to close the fitting for more power. Later in 2010 and into early 2011, we'll add more form factors to the product line.

SMAKA: I'm assuming with the new wireless features that this is a new chip platform as well?

CHRISTENSEN: Yes, the entire platform is built on a new chip called the ReSound Range™, which is faster than our previous chip;in fact, it has double the processing speed of our Coyote 3 chip, which is what currently runs Live and dot2. Range™ also has four times the memory. Another advantage of the Range™ chip is that it's very quiet- we've significantly decreased the noise floor with an enhanced output stage.

SMAKA: I'm guessing with the features you talked about up to this point that Alera™ is a premium product?

CHRISTENSEN: Alera™ will be available at three different levels: Alera 9, Alera 7 and Alera 5. All three levels have wireless connectivity and have the full package of optional accessories.

SMAKA: In addition to wireless features, what does Alera™ offer?



CHRISTENSEN: I'll start by saying they're all based on the signal processing package that we call "Surround Sound by ReSound." "Surround Sound by ReSound" refers to our entire signal processing including but not limited to our compressor, our digital feedback suppression system, and our noise reduction. We've had very good success with it in our Live product, so we've continued it in Alera™ with some enhancements.

SMAKA: What kinds of enhancements?

CHRISTENSEN: We've added a new digital feedback suppression system called DFS Ultra. DFS Ultra has several benefits. Although it provides more added stable gain than previous generations of our feedback suppression system, probably the biggest improvement for the user is that it does not try to cancel non-feedback sounds so the sound quality is incredible. It also includes the WhistleControl™ system that we have today in Live. WhistleControl™ will control feedback caused by putting something up to the hearing instrument, such as your hand, the telephone, etc. Another benefit to the new system is our calibration - it has built-in intelligence that stops the calibration tone when sufficient data has been collected. Therefore, it's very short and not nearly as loud as in previous products. For most patients, the tone presentation is only about 1 second. It gives us a very accurate picture of the feedback so that the system can cancel it without the artifacts created by many competitive systems.

I would also highlight the Environmental Optimizer II. It allows the dispensing professional to change the volume control settings in up to seven environments. With Alera 9, we've added the ability to change the noise reduction settings in up to seven environments. This gives some control and customization of the automatic steering parameters to the professional. There's nothing worse than a black box hearing aid where you're told, yes, it's automatically steering, but you have no idea exactly what it's doing in various environments.

Say a patient routinely goes into an extremely noisy environment where they don't need to listen to speech;for this situation, the professional can reduce the volume, thereby reducing the loudness of all sounds. On the other hand, if the patient complains that the environment is loud and speech understanding is important, the noise reduction setting can be increased to ease listening effort without affecting the audibility of the speech.

Our research has shown that patients like to turn up volume slightly in quiet environments, but then complain that the hearing aid sounds noisy. The Environmental Optimizer II feature allows an increase in volume for desirable sounds while noise reduction can be set to maintain listening comfort. These are a few of the many reasons to vary noise reduction per environment. And it's something that we'll give the dispenser full control over in the premium product, Alera 9.

SMAKA: What about directionality in Alera™?

CHRISTENSEN: Alera™ has our same proven directional system as in Live called the Surround Sound Processor, which provides an omni-directional response in the lowest frequencies, and directional in the rest of the frequency range. This provides high directivity with a much better sound quality in the directional setting.

Traditional directional settings take out too much of the low frequencies for most listeners. The low frequency roll off is needed to eliminate the microphone noise that's created when you turn on the directional setting. With the Surround Sound Processor, we actually process the lowest frequencies in omni-directional. The signal-to-noise ratio (SNR) benefits are the same but you have much better sound quality with the bass sounds present. The surround sound processor is active in all of our many directional settings.

Alera™ features Natural Directionality II™, where one hearing instrument is in omni-directional and the other is directional. Natural Directionality II™ provides the same SNR improvements as using directional in both instruments, and also provides the added benefit of being aware of your environment and what's behind you. Alera is also available with other directional settings including auto scoping directionality (Alera 9) where the beam width will narrow or widen depending upon the signal level toward the front. Adaptive directionality and fixed directionality are also options. I think we have more directional options than any other company.

SMAKA: What kind of testing has been done with Alera™ and what data do you have?

CHRISTENSEN: We do significant testing on all of our products before we release them. We have clinics in Chicago and in Copenhagen where we see patients and fit them with products before the products are released to the market. Alera™ has been well tested. I think it had four or five pre-alpha tests where we tested different pieces of the system. For example, we had a pre-alpha on the new environmental optimizer, Environmental Optimizer II, where we tested various noise reduction settings. We had many clinical trials where we brought in 30 to 40 patients and tested one or two aspects of the system. And then at the end we finally test the entire system multiple times as well.

We've fit several hundred patients with Alera™ at this point. We've had very, very good feedback. In our clinical trial patients do not get to keep their hearing aids. We've had enormous interest from patients wanting to buy the hearing aids when they come on the market and excellent positive feedback about the accessories. We're excited to be going to the market with a solid product that has a lot of end user benefits.

SMAKA: New software, too, right?

CHRISTENSEN: Yes, Aventa® 3.0. It's a brand new fitting software package that has a lot of usability research behind it. We've worked with dispensing professionals to learn about their workflow and how they use the software during a fitting and validated usability multiple times during development to ensure our understanding of how they work was correct. We've kept all the best parts of Aventa and improved upon them to make a more intuitive, user-friendly software. The development process was so user-centric that we think of this software as designed by the clinicians who will use it.

SMAKA: What kind of training is available for professionals?

CHRISTENSEN: There are a lot of training opportunities for Alera™ going on, both local market seminars and web-based training. We have AudiologyOnline courses on Alera™ that are available for viewing as well as a variety of self-paced online training programs. While we offer extensive training and support, I think that current ReSound customers find moving into Alera™ really quite easy and new customers will find the product and software intuitive and easy to use as well.

SMAKA: Laurel, it's been nice catching up with you and learning about Alera™. Good luck with the product launch.

CHRISTENSEN: Thanks, Carolyn.

For more information about ReSound, visit www.gnresound.com/ or the ReSound web channel on AudiologyOnline.