Starkey Livio AI With Integrated Sensors and Artificial Intelligence Creates New Tier in Healthables

AudiologyOnline (AO):  Tell us about the new Starkey Livio launch.

Dave Fabry, PhD: Starkey is the first hearing aid manufacturer to directly embed sensors and use machine learning and Artificial Intelligence (AI) in a hearing device to track physical activity and track hearing aid use.  In doing so, we're motivating individuals to wear their hearing aids more from the context of hearing better and living better. We know physical activity is related to a lot of cardiovascular disease issues that have strong comorbidity with hearing loss.

The acoustic activity that they’re experiencing on a day-to-day basis will think of the ears as sensors sending the input to the brain in the same way as your eyes, your ears, your touch do.  They can track that in the Thrive Hearing App, which gives them a body and brain score. It re-calibrates every day and then they can track their history.

Brandon Sawalich: With Livio AI, we’re creating a new tier within healthable tech, and we’re forging a new path.

AO: It seems like this is a lifestyle product as well, not just a hearing aid?

Dave: First and foremost, we have to rely on our 50-plus years of experience in the hearing aid industry because we can’t have a foundation that is a sub-par hearing aid. We’re making the best-sounding, best-performing hearing aid we’ve ever made and adding additional functionality. We’re on the cusp of moving hearing aids from single-purpose devices that amplify gain as a function of frequency to multifunction, multipurpose devices. I have normal hearing. I’ve been wearing these for four months. I get all my notifications for texts. I use it for navigation. Although I’m a traditional male and never ask for directions, I can log into Google Maps and have the instructions delivered to me verbally so I don’t have to look at a watch or at my phone. It makes me a better driver and I look like I know where I’m going.  I can take binaural phone calls with them and listen to information delivered by Siri. Every app that has an audio component is translated directly and discretely to the ear, so it becomes a fully integrated communication device.

Brandon:  We’re making hearing aids cool, which addresses the stigma factor that is usually the biggest objection to getting people to wear hearing aids.

Dave:  We still think this is a good-looking hearing aid. I think this is a better-looking hearing aid and more discrete than an Apple AirPod. We want to continue to focus on providing good cosmetic solutions, but as a baby boomer I am less stigmatized by hearing loss and hearing aids than my mother was, but I have higher expectations for what hearing aids should do for me

AO:  Does this technology get ahead of some of the target market from a demographic standpoint?

Dave:  Six months ago I might have said yes, but my team is responsible for alpha studies for validation and verification. We had participants who were 85 years old in the study who were motivated and gamified to improve their score every day. With Livio AI, the person can track are they getting better on their physical score, on their body score as well as their brain score and they can follow that. An 83-year-old study participant said, “You know, every day I get up and I want to see what I did yesterday and I want to do better today.”

In addition certainly the baby boomers and even the traditionalist generation is more engaged today. We’re all tracking sleep and steps and everything else and we want to integrate that for hearing aid users.

AO: I would assume this is a great counseling tool for audiologists.

Dave: Absolutely. In going from a single-purpose device to a multipurpose one you can be more proactive with people. You can review the physical activity, why it is that they’re not wearing their hearing aids, and directly identify small problems. If someone’s not using the hearing aid, if they’re not talking to other people, if they’re not getting out into social situations, that becomes a counseling tool. It enhances the provider-patient relationship.

AO: Can you explain the tracking features in more detail?

Dave: We’re tracking the body. Every day the wearer can get a score between 0 and 100 on the physical side, which comprises steps. We set an initial target of 10,000 steps a day, 30 minutes of exercise (a brisk walk or better) and whether they get up and move around for a minute or two every hour. It’s good for musculoskeletal health. It’s good for obesity and cardiovascular disease, which have comorbidity with hearing loss. On the brain side, we’re looking at 12 hours of use or more per day.  The engagement piece gets into machine learning and AI. The classifier right now is monitoring to see if speech is present, if speech in noise is present, if the wearer is streaming a phone call, etc.  All of that will contribute to the score for social engagement. And, it only utilizes features that are appropriate to the environment to optimize the experience for the individual.  

In terms of AI, we’re scratching the surface right now.  It will get much more sophisticated in the next generation.

AO: How would you define AI and machine learning to patients who have no idea of what those are?

Dave: AI mimics human intelligence - it is able to sense and act. It is able to actually then learn. AI is then able to learn and improve based on the individual.

AO: How does Livio AI fit into a market that may be changing with more and more OTC devices?

Brandon:  From our standpoint, we’re raising the bar. Today, people are talking about the unknown with over-the-counter devices, and many are afraid the industry will change.  However, for those of us who have been in the industry for decades, we’ve seen this before.  In the past it was catalog sales, or other off the shelf products, causing alarm.

To me, over-the-counter is a different type of channel. At the end of the day, the patient is going to choose what they want for better hearing, and we will continue to raise the bar; these hearing aids are truly healthable devices. 

Dave: It’s important to differentiate what we’re doing from what the Consumer Technologies Association is doing; we’re not just developing cool features because they’re cool.

The thing that we see from studies, is that the aging population wants access to the latest technology, but they don’t necessarily want to do it themselves. While technology is important the impact to the end-user depends on the professional who’s working with them. The professional is identifying their unique needs, concerns, and auditory ecology and bringing it into the clinical environment. Professionals often hear patients say, “You were the only one who solved my issues.” Many patients will still want and need that engagement, even if they are early adopters of technology.

When you have a mild hearing loss you’re at three times the risk of a fall versus someone with normal hearing; every 10 dB loss above that increases the falls risk by 1.5 times. We have a motion sensor into the device’s architecture. We’ve designed it so that you can identify up to three people to receive a text alert if the wearer has fallen.  We think that provides peace of mind not only for the hearing aid user who wants to remain independent, but for the family.

In addition to these sensors, as well as a Bluetooth connection, Livio AI also has a telecoil in it, which can be used with loop systems.  And it’s simple to use.  With only a tap, you can start and stop the streaming.  We know wearers may have neuropathy, arthritis, or other manual dexterity issues.  So we’re taking this sophisticated technology and applying it to real-world problems that real hearing aid users need, to make sure that it’s patient focused.

Brandon: With Livio AI, we like to say that we’re making the ear the new wrist. There’s not a better place than the ear for step counting and the other features we offer today and those that we’re working on.

Dave: Using the iPhone to track steps will under count steps by about 20-25% because you don’t always have your phone on your body. With Livio AI, every step counts and is recorded. The body-brain score encourages people to wear their hearing aids more.

Another great feature we haven’t even mentioned yet is real-time translation.

AO: Tell us more about the real-time translation feature.

Dave:  Livio AI provides real-time translation to and from 27 different languages. The difference from other apps or other applications is that Livio AI will amplify appropriate for the wearer’s loss and will discretely put the audio of the translation into the ear directly so no one else can hear it.  It’s not just delivering it out of the phone. That’s the difference.

AO: Telehealth is becoming commonplace today, with remote applications in all aspects of healthcare.  Can you describe Hearing Care Anywhere?

Brandon: Hearing Care Anywhere is a remote fine-tuning telehealth program. If a patient comes in and says, “Well, I hear fine every time I’m in your office, but where I really have trouble is ...” You know that in-office simulation only goes so far. Now, when the patient is in their natural environment, they can initiate a request using asynchronous telehealth.

For example, say the patient goes to a favorite restaurant and they notice that female voices are not loud enough in both ears and it’s mildly annoying. They can write a note that goes to the secure cloud, and then the clinician gets a notification when he or she is back in the office.  It’s not dependent on real-time synchronous care. That’s very important.

AO: Sure, because if the provider is unavailable then they’re not going to see it. This way it’s stored and they can get access between appointments.

Dave: The problem with a synchronous connection is that it sets up the expectation that you will drop everything in order to address the issue, which is just not practical. Being asynchronous makes it convenient for the patient to indicate when and where they’re having trouble. The clinician can apply the settings with full control over the software as if the patient were there and send it back up to the cloud. The patient gets the notification. The patient can apply the setting when they’re back in that environment. They can save it, wait until they go back to the restaurant, apply it and either reject it or keep it. We think that goes a long way towards more engagement between the end-user and the fitter.  I’ve seen many times where patients will say, “I don’t want to take time off of work,” or “I don’t want to arrange to have my son come and pick me up and drive me there so I’ll just live with it.” We think this can contribute to more optimization and personalization.

Brandon: Some people might think, aren’t hearing aids already pretty good now? We would argue that although satisfaction with hearing aids is up to 82% in the US, the reality of the situation is we’re only reaching 30% of the market. We want to continue to ensure that those people who are already wearing hearing aids move from single-purpose to multifunction, as well as tap into that 70% of people who are not using hearing aids but could benefit. We want to shorten that delay of five to seven years from the first time a person thinks or is told that they have a hearing loss to when they act on that.

Dave: We think that the work by Frank Lin and others on the correlation between untreated hearing loss and dementia and cognitive decline is perhaps a reminder that although hearing is taken for granted, it is critical to healthy aging.  If hearing aids can help improve social isolation to depression, which are factors that contribute to cognitive decline, and help people to truly hear better and live better, that’s a win.

For more information, please visit Starkeypro or the Starkey Partner Page on AudiologyOnline.