Michael Poe, AS

Michael Poe, AS, development team manager at MedRx, Largo, Fla, is a common-sensical sort. So when, in 1993, he came across an article that clearly defined the flaws inherent in the typical method of fitting hearing aids, he knew what his mission was to be. “The reason that this [live speech mapping] works, and the only way you can accurately assess how the hearing aid is processing speech, is to use speech as the stimulus, not some artificially derived noise or signal.”

Poe’s definitive statement was actually a few years in the making, as he, together with his Australian-trained audiologist wife, Gay, proceeded to develop Live Speech Mapping (LSM) until its introduction in 1997.

The aforementioned article by David B. Hawkins and Jodi A. Cook (The Hearing Journal, July 2003) spelled out in detail the relative unreliability of the then-current methods for assessing the electroacoustic characteristics of hearing aids. It pointed to the simulated predictive values based on average and expected performance that are established by the hearing device manufacturer, and the variability, as high as 25 decibels, between predicted gain and actual gain. The article stated that “The clear implication is that if you want to know what the actual hearing aid is doing on the patient who is going to be wearing it, you need to make a validation measurement in situ,” and added, “The use of actual speech signals provides an excellent way to assess the real-ear performance of hearing aids with complex processing.”

Poe’s path to LSM was not always smooth, as he had to meet resistance from a doubting establishment. “The first thing we encountered was people telling us we couldn’t use live speech for testing hearing aids, because speech is not a ‘calibrated stimulus.’ Our comeback was always the same: ‘When most people talk, they’re not calibrated.’ ”

MedRx’s AVANT

The key with LSM, according to Poe, is “that you can see what speech sounds are audible to the hearing impaired and what sounds are inaudible, so that when you begin to fit the hearing aid, you know exactly where you need amplification.”

LSM is a specific aspect of Real Ear Measurements (REM) or Real Ear Aided Response (REAR). It is defined by using live speech as the stimulus and the patient’s own residual auditory area (dynamic range) as the receptor.

“It just makes common sense,” Poe says, “to use real human speech, either the audiologist’s or the patient’s significant other. The solution is to convert the responses into graphics on a screen that make it simple for the lay person to understand their own hearing impairment.”

In particular, Poe stresses, it’s “important to get your ACT together.” The acronym in this case stands for audibility, comfort, and tolerance; audibility of soft (low volume) speech, comfort in hearing normal conversational speech, and tolerance of loud speech and other sounds. It is crucial, Poe asserts, to satisfy all three requirements for a successful fitting.

In 1996, when he was hatching the idea for LSM, Poe approached MedRx president Ron Buck. Up to that point, MedRx’s only product was a video otoscope, which allows the doctor and patient to view the patient’s eardrum and canal on a monitor. “Ron was looking to expand and get into more equipment. I asked him if he’d be interested in developing a new type of REM.”

It took Poe and his wife about a year to develop the protocol. His wife, who worked for National Acoustic Laboratories, “the people writing the prescription rules,” was a great asset with her training in Australia. The product, “Otowizard,” was released by MedRx in 1997, and consisted of an entire audiology suite including audiometry, REM and LSM, and video otoscopy. “It was fairly expensive,” Poe says, “retailing for $21,000, but was successful right away. We sold 250 units in ’97 and by 2001 had sold 1,500.”

Engaging patients in the health process is important to realize, says MedRx’s Michael Poe.

The Otowizard was discontinued in 2001 because “we were looking for a USB interface attribution.” Previously, the computer had been built into the Otowizard, which, of course, contributed to its cost, as well as its weight of 34 pounds. The upgraded, modernized version of MedRx’s LSM technology, called the AVANT REM Speech, weighs a mere 4 ounces, and its companion that handles the other audiometric functions, the AVANT A2D, is identical in weight. Together, the two form a complete audiometric testing and fitting system that is user friendly and requires little space; at a combined cost of $11,450, it is about half the cost of the older Otowizard.

“It’s important to realize,” Poe concludes, “that in today’s society patients want to be engaged in the health process. The doctor is no longer an authority figure whose word is the final say. Patients can research treatments instantly on the Internet. The new Avant REM/LSM technology shows the patient exactly what’s going on with their hearing in a way they can easily understand.”

Although somewhat reluctant to discuss it because of its impending release date, Poe mentioned that his LSM software is going to be incorporated into a new, breakthrough product that will be the first fully automated real-time hearing aid fitting system using Live Speech Mapping. Hearing Products Report was able to speak with Don Campbell, president of Magnatone Hearing Aid Corp, Casselberry, Fla, the developer of the new SpeechPro system. As it turns out, Campbell felt comfortable discussing it since the patent had been applied for in April 2007, and although the product launch is set for this April’s AAA AudiologyNow! convention, the SpeechPro system is already prominently featured on Magnatone’s Web site (www.audiology.com).

The new Avant REM/LSM technology shows the patient exactly what’s going on with their hearing in a way they can easily understand.

Poe approached Magnatone, says Campbell, “because he knew we were straight shooters, a family-run business since 1967, not someone likely to run away with his ideas. We’re not real small, but we’re not bogged down by red tape, either. Plus Michael knew we have some experience with patents. And for us, looking at MedRx, we knew that they’ve been an industry leader in audiometrics, particularly with the Otowizard, video otoscopes, and pocket audiometers. They had done so much for the industry already.”

Poe’s trust in Campbell was well placed. “As soon as I heard his idea,” Campbell says, “it rang true because I know how many calls I get from support staff regarding hearing aid fittings, asking to be walked through the steps, and so on. It occurred to me that the issue of soft speech being audible, medium speech being comfortable, and loud speech tolerable, getting it right in the fittings, is pretty much an industry-wide challenge.”

Campbell stressed that “resistance to learning new software” was one of the problems that Poe knew he needed help to overcome. “It takes time to understand the threshold ratios, compression points, the gain formulas. It’s very challenging to get it done in a rapid period of time.”

Magnatone’s new SpeechPro is the first software that automatically programs to live speech.

Knowing how much gain is achieved in the ear canal during the fitting is crucial. “Every manufacturer has its own auto-fit routine,” Campbell explains, “but they use approximations to achieve target curves, predictive formulas that they believe will suit the ‘average’ person. Our software takes the average person estimate out of the equation and programs to fit the individual every time.”

Speed is also important—SpeechPro programs each ear in a mere 13 seconds—so there is more time for counseling, setting up memories, and dealing with the subjective aspects of the fitting. “We nail the target quickly every time within 3 to 4 dbs. This leaves more time for follow-up with the patient for whatever adjustment may be necessary to be sure they’re satisfied with all aspects of their hearing aid.”

Campbell feels his company has “hit a home run” with SpeechPro. “I tell my employees that we’re ‘Lucky 7,’ just below the top six players in the industry but about to break through.” That would be a big step up for Magnatone, a company with fewer than 100 employees, and Campbell is understandably proud of the achievement.

“We developed this product in 2 years,” he says. “Never, ever, underestimate what a small group of dedicated individuals can achieve.”


Alan Ruskin is staff writer for Hearing Products Report. He can be reached at [email protected]