In a wide-ranging Q&A, Starkey Hearing Research Center Director Brent Edwards takes us for a look at the industry from inside the vaunted facility.

The Starkey Hearing Research Center (SHRC), Berkeley, Calif, a division of Starkey Laboratories, is aptly located a stone’s throw from the University of California, Berkeley, “because innovation is in the air here,” says Brent Edwards, PhD, VP of research for Starkey Laboratories Inc, Eden Prairie, Minn, and director of the SHRC (StarkeyResearch.com). The Center’s interdisciplinary cadre of engineers and scientists investigate auditory perceptual science and signal-processing technology, yielding real-world technologies that help hearing aid wearers.

SHRC routinely taps into the university’s multidiscipline efforts, and while mindful of proprietary discoveries, Edwards champions the merits of collegial sharing. He recruits top researchers worldwide, who learn hearing science, engage in pure research, and collaborate freely in a culture more akin to post-grad academia than the R&D/marketing/sales environments you might find in other hearing instrument manufacturing headquarters. Edwards believes in applying a cognitive science approach to hearing loss, vis-à-vis the cognitive science of music perception, cognitive effects of hearing loss, hearing aids’ impact on cognitive ability, and what signal processing does to speech. He says the hearing industry has not taken a research approach toward software research issues—that the momentum behind new software research exists instead in the academic community.

During my tour of the SHRC, researchers shared a glimpse into some of their pursuits—testing and exploring prototype algorithms, music perception, sound localization, asynchrony detection, developing a new speech corpus, fine-tuning hearing aid processing, and devising user-friendly software features and usability studies. And Professor Ervin Hafter, PhD, director and principal investigator at UC Berkeley’s Auditory Perception Lab, showed how the university’s anechoic chamber is a powerful tool in furthering hearing loss research. SHRC shares a patent application with the Center for New Music and Audio Technology (CNMAT) at the university.

At press time, we were advised that several staff members from the SHRC had been invited to speak at a number of important conferences worldwide: Karrie Recker, AuD, was set to present on three different hearing aid-related topics in February at the VII National Convention of Audiology & EXPO 2010 in Bogota, Colombia. Also in February, Sridhar Kalluri, PhD, was due to present “Binaural function and its benefits for wearers of hearing aids” to the Association of Independent Hearing Healthcare Professionals in Edinburgh, Scotland. In March, Edwards was to present “Binaural psychoacoustic considerations for hearing aid processing” as the opening keynote address for the Swedish Association for Technical Audiology in Stockholm.

In our Q&A, Edwards reflects on cultivating scholars’ expertise, data from the recent MarkeTrak VIII, sluggish progress industry-wide toward evidence-based practice, the future of customized hearing loss solutions, venture capitalists’ approach to hearing aid technology, and more.

Judy O’Rourke  Could you describe the synergy between SHRC and the University of California, Berkeley?

Brent Edwards  We have several projects that we are collaborating on now, and that we have right from the start since we opened the Center 5 years ago. In fact, the reason we put the Center here is specifically to be able to collaborate with some of the greatest researchers in the world at UC Berkeley. We began with a collaboration with the Psychology Department on trying to understand the impact of hearing loss and hearing aids on cognition.

We recently published a paper last year on the results of that project—at least part of that project—demonstrating that hearing aid technology can reduce listening effort when listening to speech in noise. We’re very happy with that, and we’re continuing our collaborations with Professor Erv Hafter, and psychology and cognitive science on that and on other projects. We’re really focused on more higher-level perception—how your brain takes the very complex auditory world around us and focuses your attention, and allows you to understand what you want to listen to. With his large anechoic chamber, one of the most impressive auditory laboratories in the United States, we’re able to work with him in his laboratory and his grad students, on some really interesting, complex problems that I hope will help us understand the impact of hearing loss and hearing aids on the way we function with our auditory system.

We also have another major project with an internationally known music research center here at UC Berkeley to try to understand the impact of hearing loss and hearing aids on music perception, and we’re laying the groundwork in a lot of ways on some fundamental music research that I think will impact not just the hearing aid world, but, generally, the music world as well. Those are two pretty strong initiatives that we’ve had under way for several years. It’s a big university. There are a lot of incredible researchers there, and we will be pursuing other projects, other collaborations with other professors there as well.

I emphasize the collaborative part because we have a great staff of scientists and engineers at our Center and at Starkey, and when we work with people at universities we like to collaborate with them, and we don’t want to just be the big company with the checkbook that comes in and funds someone’s research because we like them or we like their research. We want to work with them, we want to learn from them, and we want them to learn from us. We definitely have done that more than once at UC Berkeley, where we brought people who knew nothing about hearing aids or hearing loss and have really gotten them involved and focused their research in ways that are going to help our industry in the long term.

JO  Could you briefly discuss how Starkey benchmarks its products, and benchmarks against other products in the industry?

BE  We benchmark our products in a couple of ways: there’s engineering benchtop testing, where engineers take our hearing aids or technology, and in the lab can very precisely measure whatever the new technology is doing—whether it’s a new signal-processing algorithm that’s coming out, or, for example, our Sweep technology. We have methods of measuring performance for, basically, all of our technologies. So that’s a very precise, objective way of getting measures on our technology.

But then there’s also the human side of it. We do an enormous amount of testing on how people with hearing loss benefit from the technology that we produce. So, not only during the research phase, when we’re trying to develop the technology and understand how to improve it, but also in the product phase, after we’ve put it all together into a product and we think we’ve got a system for a new product line.

We do extensive alpha and beta testings, which I also consider benchmarking, because it’s gathering of data on performance of technology. But here it’s data obtained from actual, human, real-world use that’s a combination of clinical measures, speech tests, and other measures of auditory function—but then there is also real-world testing, where they take our prototype hearing aids or preliminary versions of our hearing aids out in the real world and wear them, and come back and relay their experience to us.

We use a variety of pretty well-known questionnaires in order to try to understand the benefit that they obtain from it. It’s important to balance that—to not just do the clinical testing, because you can only test so many things. The laboratory is still ultimately somewhat of an artificial environment.

It’s not until technology gets out into the real world that you really understand what’s going on. To the best we can, we try to do the same thing with our competitors’ products, because we want to understand what advances they’re making. We also want to understand how the technology that we’re developing compares to what’s on the market already from our competitors. This helps us understand what we’re doing. Obviously, it helps us explain our technology to practitioners and audiologists as well. We can distill that information down, so that people who wear hearing aids can understand it as well.

We are going to be launching a new, and fairly sophisticated, noise-reduction algorithm that was developed here at the SHRC. I was just reviewing some benchmarking data from our signal-processing team. What we’re doing there is we’re using some fairly advanced auditory models that try to do computer-based quality assessments of sound quality that come out of the telecommunication industry. Nokia and Motorola and others have actual computer programs that can measure the sound coming out of cell phones and give you a prediction of the sound quality of different codecs and different technologies. So we’re applying those also to analyzing the quality from our algorithms—and specifically, we’ve recently been looking at the application of that to noise reduction.

JO  Where do you get ideas for different facets of your products?

BE There’s a great quote that I like from Steve Jobs that, I think it says, “Creativity is just connecting things.” What I like about that is it suggests that innovation and the development of new technology don’t just come out of the air. They don’t just suddenly appear to you in an epiphany. Usually, they come from making connections between two ideas that hadn’t been put together before, or different technologies that hadn’t existed together before. The key is, in part, in developing new ideas looking for opportunities and ideas that exist elsewhere, and perhaps in other industries: the telecommunication industry, the professional audio industry, what Dolby is doing, for example—looking at what they’re doing and making connections between that and the needs of people with hearing loss. Connections between cell phone technology and hearing aid technology, and looking for synergy, looking for ways of transferring the technology.

When we can perceive there will be a benefit to people with hearing loss, we’d be meeting a need. A lot of innovation simply comes from making those connections. To do that you’ve got to get out there and you’ve got to expose yourself to new things. You can’t just stay in your own world of ideas, which is difficult to do because we’re all really comfortable in our own world. You need to take a risk and get out there and find new things. If you look at what we’ve done with Sweep technology, for example, that sort of touch-sensitive technology obviously exists in other technologies before hearing aids. So we didn’t necessarily develop it, but we had the idea of “Boy, there’s a great opportunity for taking this technology and applying it in a hearing aid that is going to be beneficial to people who wear hearing aids.”

I think that’s a perfect example of what Steve Jobs was talking about way back then. I also think that ideas come from human communication and exchange of ideas. In order to facilitate the generation of new ideas, as a research division we need to facilitate interaction and collaboration between people. So when we build a research team, we don’t want to build a team of lone researchers, the sort of iconic researchers who sit by themselves in a basement, working hard on a problem and coming out every year or two to see what’s going on in the world and publishing a paper or two. We want people actually to interact.

What’s important for me is when people of different disciplines interact together, and people with different perspectives have different ideas, and start bouncing ideas against each other and questioning each other—”Why do you do it this way? Here’s something maybe you don’t know about or understand.” And take those different approaches and then create some of those new ideas. As we’ve staffed the Research Center here 5 years ago when we first created the Center, every person that we brought in came from a completely different background: someone from auditory neurophysiology, someone from cochlear implants, someone from audiology, someone from speech. Because we wanted to create that variety of background to create ideas, and I think we’ve done that.

JO  Could you discuss new findings about how the brain performs signal processing?

BE Wow, that’s a really big question. Because I think we’re only just beginning to understand how the brain functions in terms of auditory perception. Maybe not from findings that we at Starkey have found, but from findings that hearing scientists have recently found—we’re really starting to understand how the world gets represented by the cognitive system, and what cues are used by the auditory system in order to create this representation of the world.

Gray skies and the downpour pummeling Berkeley, Calif, during my January visit to the Starkey Hearing Research Center starkly contrasted the bright lights shining within.

Discreetly perched in a fourth-floor, downtown office suite overlooking the city and skirting renowned UC Berkeley, a small, diverse team of elite researchers, led by Brent Edwards, PhD, briefly set aside their work, and one by one offered a peek into their endeavors.

Computers, state-of-the-art laboratories, and a soundbooth comprise their domain. Providing user-friendly nuggets of raw data—bytes of music or words, sounds coming from here or there, words out of synch with the speaker—they briefly cast their visitor as a subject, offering a window into their world.

Edwards led the way across campus, to the remarkable, world-class Auditory Perception Lab, headed by Professor Ervin Hafter, PhD, its director and principal investigator.

In the echo-free anechoic chamber in the basement of Tolman Hall—whose floor resembled a wire-mesh trampoline—Hafter demonstrated the cocktail-party effect, surrounding his visitors with a 48-channel digital surround sound system, which enables the researchers to simulate open-field reverberant environments.

—Judy O’Rourke

From this, [there] really is a jumble of acoustic signals that enters your ear. If you look at the spectrogram in a noisy situation, it’s just a mess. You can’t see anything in there. It’s just power at all frequencies at all times. But our brain is able to take that signal and very elegantly separate it into the fundamental auditory objects and create a world of objects around you that allow you to focus your attention. To listen to individual pieces, or just inform you about the world around you, and let you know someone is approaching you from behind, for example, when you’ve got all of this sound in front of you. We’re just beginning to figure out how the brain does that.

It’s important that we do, because we need to make sure those cues that the brain relies on are conveyed to people with hearing loss. That we don’t, through our algorithms, provide miscues to the brain, so it misinterprets the world. We need to preserve the integrity of the information about the world so the brain can do its thing.

We’ve had some discussion about the way the brain functions with speech in noise, and our research on listening effort, where we’ve shown that noise reduction and directional microphones can reduce the amount of listening effort, could in part be because the algorithms are offloading some of the processing that the brain does itself.

So, allowing the brain to then spend more resources on other actions like storing things in long-term memory, interpreting the sound, or even just daydreaming, or thinking about what you’re going to have for dinner that night. We’re just beginning to understand this complex relationship between hearing and cognitive function, but I think what we’re doing at the Center is we’re making contacts with the right researchers worldwide, in trying to create a big picture and in trying to figure out what it means for hearing aids and what it means for people with hearing loss, which, ultimately, is why we exist.

We’re not here to advance basic auditory science, we’re here to advance the science in a way that benefits people with hearing loss. We are very targeted on taking the knowledge of hearing and engineering science around us, and focusing it as laser-like as we can on providing benefit for people with loss.

JO  Could you discuss developments since the 2007 Clinical Research Summit, and have researchers made progress understanding the discrepancy between hearing aid benefit measured in the clinic versus real-world benefit experienced by hearing aid wearers?

BE That’s a great question because we created the summit in order to try to change things that are happening in our industry. The point of the summit was to identify the most pressing issues facing the hearing aid world, not just the industry, but the audiology field—to try to identify the top issues that need to be resolved. We weren’t trying to come up with answers. We were trying to say, “Look, here are the top issues facing us,” with the hope that people would take that sense of urgency and motivate themselves to answer those questions.

At the end of each paper we had a list of the top questions that needed to be answered. So if we look at, say, the very first paper here, we take a look at the summit recommendations on the disparity between clinical assessment and real-world performance. What we have is our five recommendations:

Find ways to bring real-world conditions into the clinic. That’s exactly what we’re doing and that’s exactly what is starting to happen at a lot of research labs. We’re realizing that our laboratory and the clinic are not representative of the real world. Using speech and speech in noise doesn’t really tell us what’s going on in that complex auditory perception of patients. And we’re starting to develop new technology here at the Starkey Hearing Research Center, but elsewhere that makes things more realistic. Whether it’s audiovisual testing, whether it’s using multitalker testing from different locations, whether it’s having running dialogues instead of just short words or sentences as part of the material, I think those are examples of how we’re actually following that today.

Give greater control of hearing aid fine-tuning to the patient. I think over the past couple of years we have seen research presented from a couple of labs on allowing the hearing aid wearer to do self-adjustments and self-fine-tuning, including some research that we’ve presented here in our labs. Getting the user more in the loop of what their hearing aid does might not only end up with a better fitting, but a more satisfied patient as well. We are moving down the path of giving them better control.

Develop a clear understanding of audiological and nonaudiological factors. There’s still a long way to go there. That’s such a big issue. There are people looking at that. There’s still a lot of research there.

The relationship between signal-to-noise ratio and patient satisfaction, we’ve got, and we have presented on some of the significant research we’ve done over the past 2 years on Acceptable Noise Level (ANL) and understanding the fundamental mechanism behind ANL. Not just measuring acceptable noise levels under different conditions, but understanding the perceptual mechanism that drives ANL thresholds. Why does someone have a high ANL threshold and someone else has a threshold that differs by 20 dB that then drives their acceptance of hearing aids? We’ve really taken that to heart. Those results haven’t been published yet, but I think they’re really exciting.

Explore the use of performance measures that assess cognitive effects, listening effort, in addition to speech intelligibility. We’re definitely doing that. We’ve published on that last year, the results of our collaboration with UC Berkeley—measuring listening effort.

Kathy Pichora-Fuller for a long time has been a proponent of trying to understand the cognitive aspects of people with hearing loss, which requires measuring those abilities so, at the very least, practitioners can better counsel their patients, if not also allow them to understand the deficits they have from their loss and benefits that they’re getting from their hearing aids. So, we’re definitely moving down that road but there’s more work to be done. We have these summaries from, I think, all six of our papers. We seem to be hitting the mark on all of those.

JO  In terms of understanding individual differences in speech understanding ability, have you discovered ways to furnish hearing solutions tailored to an individual’s cochlear damage, psychoacoustic performance, and cognitive function?

BE That’s the pot at the end of the rainbow for us. We’re still chasing that. A lot of people talk about the need to do this. The challenge for us right now is to identify the proper cognitive diagnostics, the proper psychoacoustic diagnostics, to get at the mechanism of hearing loss. Differentiating between inner hair cell versus outer hair cell versus strial damage, so we can provide better technology, better compression fittings.

Diagnostics don’t exist yet. Until we have the diagnostics, we’re not going to then know what to do with that diagnostic data. It’s kind of one step at a time. There are a lot of smart people around the world who are looking at this, including Enrique Lopez-Paveda in Spain, and Ray Meddis in England who are also looking at this. I think some researchers at the NCRAR are also looking at this.

There are a lot of people who are pursuing this, but we’re a long way from really coming up with this comprehensive measure of individual differences. It’s a huge, huge problem. It may not be solved in my lifetime, but it’s important and it’s going to get a lot of research, guaranteed.

JO  Could you briefly discuss advances in wireless technology, and are improvements on the horizon?

BE I’ve talked about the future of hearing aid technology for, I think, 13 years now. In the ’90s, I used to say digital technology is upon us—the next big wave is going to be wireless. I said that so often, without wireless appearing, I started to think that I was looking foolish. But as we all know, wireless technology is here now, and I think there’s a lot of potential for wireless technology.

We’re starting to see some applications—communication with external audio devices like cell phones, TVs, ear-to-ear coordination. I think there are still a lot of challenges. I don’t think there’s a lot of science necessary in getting your hearing aid to communicate with a cell phone, so you can hear your cell phone better, but there are still significant engineering challenges. You still can’t send a signal directly to the hearing aid, right? You still have to wear something around your neck. It’s usability issues like that that I think are still the challenges—engineering and industrial-design challenges—to getting acceptance for the technology and to really make it reap the benefit that I think we’re going to get from wireless technology.

It’s got to be stone-cold simple. It’s got to just work. And if it doesn’t just work, it’s not going to meet the needs of a lot of our hearing aid wearers. Because a lot of our hearing aid wearers are not technologists who like complicated technology. The vast majority of them want simple technology. In fact, they want to put on their hearing aids and they want to forget about them. They don’t want to have to fumble with a lot of things. So, the easier we can make the technology, the more acceptance, the more benefit that it is going to provide.

We’ve still got work to do on that front. There’s a lot of science that can go into the ear-to-ear wireless technology. I’m still not seeing a lot of scientific evidence and a lot of thinking behind the right thing to do with ear-to-ear technology. I think we’re seeing a lot of suggestions on what to do. We’re seeing a lot of attempts being put out there. Maybe they work, maybe they don’t. I don’t see a lot of evidence supporting it. I want to see evidence, because I want it to work. I want wireless binaural technology to improve the lives of people with hearing loss. I’m crossing my fingers. I hope that yes, it will.

We still need to provide that evidence. And the onus is on us, the technology developers, to create that evidence of benefit so that audiologists, practitioners, know the benefit they’re providing to their patients, so they can explain it to them. And so that people who wear hearing aids know they’re getting that benefit.

JO  What challenges does the hearing care delivery model face from changing patient demographics, technological advances, and changing market expectations?

BE This is something that everyone is thinking about right now. I think particularly the patient demographics—everyone’s talking about the Baby Boomers. And the recent MarkeTrak VIII data shows that there’s a huge potential of people with hearing problems who simply aren’t getting hearing aids. I think a lot of them are younger, and I think they have different expectations on what the delivery system’s going to be. I’m not saying they expect to walk in to Best Buy and get hearing aids, but I think they have expectations on maybe “Hey, I buy my iPhone and I can make adjustments with it myself. Why can’t I make adjustments with a hearing aid?” for example. Or “I’m a busy person. I need to be able to do things on my lunch break.”

And I think some of these things are not in harmony with our current approach. I think also on the technology side, expectations about technology performance and functionality are changing with this demographic. People are becoming more tech savvy. As hearing aid manufacturers and as people who distribute hearing aids, we need to appreciate that there are different segments of hearing aid wearers who need different solutions. And the one-hearing- aid-for-all is probably not in our future. Different hearing aids for different people, so that everyone’s got what works best for them, is. It’s a solution that almost every other industry has converged on. We’re going to as well. It’s just a matter of when.

I think the technology developments we see every year now are moving in that direction. All of the new technology we’re getting is launched every year. I think it’s technology that is appealing to this other demographic. You’re always going to have the older population who doesn’t want the high technology and just wants it to work. That’s always going to be there. But we now have this other population and the technology is getting to the point where it’s becoming attractive to them. Historically, it was never sexy. And now it’s sexy. And now it’s something you can take pride in instead of hiding. And when it gets to the point of technology you want to talk to your friends and colleagues about, which I think we’re at—we’re getting to—then it’s a completely different game.

JO  Do you foresee the embrace of hearing aids by the growing number of Baby Boomers?

BE I certainly hope so, and what we’re doing with our new technology. Again, making it more contemporary, putting it in a class with electronics that you see in consumer electronics, where the technology is as sexy and as interesting and has as much of a wow factor as what you see from Sony, and Apple, and Intel, and others. I think it will.

There are still distribution challenges, and there are still some needs of the Boomers that technology has some development necessary to meet. There are still some things technology can do better to meet the unique needs of the Boomers that we haven’t done yet. Which is good for me, as a researcher and technology developer, there are lots of opportunity for us to improve things for the Boomers. But I’m positive, I’m optimistic, that we’re doing the right thing, that we’ll get there.

JO  Being so near the heart of the Silicon Valley, have you found the recession has put a damper on venture capitalists funding new hearing aid technology?

BE I’ll tell you what’s put a damper on the VC funding of hearing aid technology, and that’s the lack of a home-run success over the past decade or so, of hearing-related companies in Silicon Valley. Probably, until recently, the biggest success for investors was the sale of ReSound to Great Nordic, and even that was, I think, disappointing, in terms of the sale value at the time of something like $178 million.

And then there are other companies, Decibel, and then there was a middle ear-implant company, Symphonix, that got a lot of excitement from the venture capitalists. They absorbed a lot of investments from the venture capitalists, and as soon as the product went to market, no one wanted it, which I think was a fundamental flaw with the technology at the time. It seemed to me that it was too expensive and there wasn’t enough benefit for it to do well. And that turned out to be the case.

But venture capitalists look at those failures and they say, “The hearing market is not a good one for us to make money in.” Also it’s a little bit different than other medical devices in terms of the channel, in terms of how we sell, in terms of the fact that there haven’t been a lot of acquisitions of new, small companies like you get in other industries. You might have a Boston Scientific buying six different companies in a quarter as they acquire new technology. We haven’t seen that in our industry.

However, with the success of InSound Medical, and the recent acquisition of InSound Medical by Sonova, I think that’s considered a great success by its investors. There are some prominent venture capitalists in that company—DeNovo was one of the lead investors. That got a lot of attention from the VCs, I can tell you. They like to make money. If they see that hearing aid technology is making people money, they want to be a part of it. And if entrepreneurs see that new hearing aid technology can make money, be successful, they want to be a part of it. I want all hearing aid startups in Silicon Valley to be successful, because I want more people putting their expertise in our industry to help develop new technology and help people with hearing loss. I try to promote that as much as I can. Bring in the best minds and let’s do great things.

JO  In your article “Outsiders Tell Us About the Hearing Industry,” you contrasted the seeming bland perception—”an inertia of reputation”—by outsiders of the hearing industry with the zesty appeal of the iPod and its ever-growing apps. Has the gap narrowed with the advent of sophisticated technologies and marketing strategies?

BE The gap is narrowing. The reputation is still there, but in part, we are getting publicity from the new technology that we’re putting out. Just recently, both Starkey and Sonic Innovations won Innovation Awards at the CES, the Consumer Electronics Show, in Vegas. The more we get that kind of recognition outside of the hearing aid industry, the more that we appear on Dr Oz or on Good Morning America, or in The New York Times in legitimate articles, not advertisements, but articles talking about the great technological advances that we’re making, the more people will forget what hearing aids were like 20, 30 years ago—and that will change.

What I’m finding when I meet with high tech companies from outside of our industry, they’re stunned at what we’re doing. I’ve met with Yahoo, and they couldn’t believe what hearing aid companies were doing with fitting software. They had no idea. I’ve met with some major technology companies looking at novel microelectronics techniques. When we talk to them about the technical requirements that we have, the technology development we’ve done, they’re stunned. Because we’re on an order of magnitude more challenging than anything that they do, in terms of the technology requirements that we have to make hearing aids work in the harsh environment that they do. So, it’s changing. We’re not there yet. But the technology itself will help, but also this public recognition of our advances in mainstream media is going to help even more.

JO  Have there been significant developments industry-wide in evidence-based practice and evidence-based sales?

BE I wish I could say a resounding yes to this. Evidence-based development has always been very important to Starkey, and that’s why the Starkey Hearing Research Center exists. We spend a lot of time creating the evidence through our research behind the technology that we ultimately launch. There’s been a lot of literature, a lot of publication, and discussion of evidence-based practice. I don’t see a lot of evidence that’s being practiced. I’m not as involved on that side to be able to motivate it, or perhaps even understand why it’s not.

I understand there are time challenges and there are also challenges in getting evidence to market fast enough. The technology’s moving so quickly, by the time we can get something through publication, the technology’s moved on, so the evidence is out of date. That’s in part why Starkey’s created Starkeyevidence.com to try to get our own internal evidence out there publicly immediately, without having to go through the journal process. We still publish in journals and peer-review journals, but we recognize that by the time it gets published, it may be behind the times, at least through the peer-review process.

We can get new technology information out there much quicker. But that’s not the whole story in terms of why evidence-based practice isn’t widespread. How many people are using real-ear measurements in their practice? I think there’s a relationship there and I don’t think I’m in a good position to comment why.

JO  Is the hearing aid industry doing enough to promote itself outside the industry?

BE I think we’ve got a lot of good efforts with the HIA [Hearing Industries Association], and I know Sergei Kochkin is really spending a lot of his time trying to promote, even trying to promote some of the cognitive issues I talk about, in the mainstream media—so there’s an awareness that people with hearing loss could also be suffering from psychosocial consequences as well.

Is the hearing aid industry promoting itself to the best that it could be? I think the real question is “What should we be doing?” We’re presenting ourselves at shows like the CES, we’re getting ourselves exposed to mainstream journalists. I think we could do better, but, not being a marketing person, I’m perhaps not quite sure how.

JO  Do you think the recent MarkeTrak VIII data will change the industry’s perception of how many people are realistic candidates for hearing aids?

BE I certainly hope so. I published a paper a couple of years ago on my own perspective on what the realistic number is for people who don’t have hearing aids but need them. The reason I did that is because historically we’ve said 10% of the US population—right now 30 million—needs a hearing aid, and yet we’re only fitting 6 or 7 million. It makes us look terrible. It makes us look like we’re only able to capture one-fourth or one-fifth of the market and we’re just leaving these 24, 23 million people helpless. It’s embarrassing. It makes it look like we’re not doing a very good job.

But the fact is we’re doing a good job because those numbers are inaccurate, and in MarkeTrak VIII Sergei Kochkin is, I think, agreeing with me on this, and it may be for the first time. He may argue it’s not, but I think what he’s saying there is also cutting back quite dramatically on the number of people who need a hearing aid but don’t have them.

I think his latest estimate is at something like 12 or 14 million people, which for me is a big improvement over saying 24 million. I think the number’s probably less than that. It really depends on the level of need, where you do that cutoff. He chose a certain point. If he comes up with that number, that’s fine. But I do think MarkeTrak is helping to downgrade the number. It’s still a huge number, and it’s still a huge problem, and it’s a problem that we are trying to solve. It’s a challenge, but I think it’s readjusting it to be more realistic.

JO  What are some things the hearing industry as a whole is doing right, and where is it veering off track?

BE That’s a challenging question. What are we doing right? Well, I see us on the technology side, I really like the progress that we’re making. Every year we’ve got new technology and it’s focused on patient benefit. We’re broadening our definition of what patient benefit is. It’s not just audibility. It’s also complex auditory perception, it’s functioning in complex environments, it’s how you live your life throughout the whole day and not just speech in noisy situations.

It’s also taking into account usability, so we’re bringing in new fields of thinking into how we’re designing our hearing aids. And design, to make them appealing, to make people interested in them. I think we’re doing a lot of things right.

Where I think we can improve on things is, as an industry, taking a more evidence-based approach. I would like to see all of us introduce technology with claims on feature benefit that are supported by evidence. I still see a lot of that not happening. I see a lot of features with a lot of claims of benefit, for which there is no evidence. We would like it to be true and we want it to be true, but we don’t know if it’s true. That’s disappointing to me, in part, because that’s such a focus for the research that we do. I think those two things probably are the ones that come to mind to me the most.


Judy O’Rourke is Hearing Review Products associate editor. she can be reached at [email protected]