Phonak Audiology Blog Winter Read_FIN
As 2018 draws to a close, we invite you to cozy up at home and enjoy a collection of Winter Reads - some of our favorite blog posts that you may have missed!
As 2018 draws to a close, we invite you to cozy up at home and enjoy a collection of Winter Reads - some of our favorite blog posts that you may have missed!
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Phonak Audiology Blog
Winter Reads Collection
“The journey of a thousand miles
begins with one step.”
Phonak Audiology Blog - Winter Reads Collection 2
Table of contents
“Please, tell me more…”
Looking to differentiate yourself from your competitors while also providing
the best clinical care? This tip is simple and it doesn’t cost a dime.
Building brain architecture one conversation at a time
Conversational turn-taking is important for building strong neural connections and pathways.
By encouraging these serve-and-return interactions, we are promoting language development
and healthy brains.
Why implementing Family-Fentered Care
is like making home-made pasta
You can do a good job practicing Family-Centered Care (FCC) without any special tools, but
with the right tools, you can do it much better!
Helping every client feel connected requires
a broad product portfolio
Before choosing a hearing solution, HCPs must first understand what is most important for
their client to feel connected.
Digital transformation in audiology
Comparable industries have shown us that if you’re open-minded and agile, digital
transformation offers a big opportunity.
Phonak Audiology Blog - Winter Reads Collection 3
“Please, tell me more…”
By Paul Kreimer
Looking to differentiate yourself from your competitors while also providing the best clinical care?
This tip is simple and it doesn’t cost a dime.
I’ve been an audiologist for 20 years and have worked for Phonak as a clinical trainer for 9 of those years. I am always
looking for ways of self-improvement for myself and also to find new ideas to share with others. One of my favorite tips
is especially topical given the current evolution of
Practices and clinicians are always looking for ways
to differentiate themselves from their competitors
while also looking for ways to provide the best
clinical care. They want patients to easily
“The tip is merely to ask more
questions. It seems so simplistic,
but it is incredibly effective.”
understand why they should stay with them for hearing healthcare. My tip is so simple and it doesn’t cost a dime. It
actually is an investment that saves money in the end. The tip is merely to ask more questions. It seems so simplistic, but
it is incredibly effective.
Deeper questions, deeper bond
Whether you are a new clinician, or one who has been practicing for many years, the idea of asking your patient more
questions can yield significant returns. For example, I have seen countless clinicians ask about a person’s lifestyle in an
attempt to make a solid hearing aid recommendation. They ask where the patient doesn’t hear well and where they want
to hear better. For the majority of my experiences, this makes up the bulk of the conversation.
By asking deeper questions, a clinician can learn more about the challenges the patient is facing. It also effectively
allows the patient to see that the clinician cares because they are really getting to know the root of the problem. Asking
how about how a person feels by not hearing well in that situation shows true empathy to the challenges faced by the
patient. This creates a deeper bond that will win you a patient for life.
Phonak Audiology Blog - Winter Reads Collection 4
Helping your patients and your bottom line
The idea of asking more questions extends well beyond the hearing aid evaluation, it also helps during the hearing aid
follow up appointments. Many times, a patient may say that they don’t hear well in a noisy situation. Being natural
problem solvers, clinicians frequently will then begin to make adjustments to the hearing aid without digging a little
deeper. “Tell me about the person or thing you were trying to hear?”… “Does this happen all of the time?”… “How often
are you in this situation?”… “How badly does this bother you?”… “Does it affect others?”… “How important is it for you to
hear in that situation?”… “Would you like me to make an adjustment to attempt to minimize this problem?” This will not
only lead to better hearing outcomes, it will help your bottom line by reducing hearing aid returns and repeat follow-up
So in closing, I challenge each and everyone one of you to ask at least one question more. Dig a little deeper. Get to
really know your patient. In the end, you’ll be happy that you did.
If you’d like to learn more about the art of asking questions, check out this article from Harvard Business Review.
Paul Kreimer, Clinical Training Manager at Phonak US
Paul received his degree in audiology in 1998 and
joined the Phonak team in 2009 as a clinical field
trainer. He currently serves as a training manager over
a team of 6 clinical field trainers covering the central
portion of the United States. His duties include
supporting the professional growth and development
of his staff along with creating and editing educational
content and occasionally performing national and
regional main stage educational presentations to
practicing professionals and university students.
+ Read more about the author, Paul Kreimer and or other audiologists who work at Phonak by checking out our
Faces of Audiology campaign.
Phonak Audiology Blog - Winter Reads Collection 5
Building brain architecture
one conversation at a time
By Lindsay Zombek
Conversational turn-taking is important for building strong neural connections and pathways. By encouraging
these serve and return interactions, we are promoting language development and healthy brains.
There has been a debate about what influences who we are since at least 1869 when Francis Galton coined the term
“nature versus nurture”. Are our genes fixed at birth (nature) or does the environment in which we grow up (nurture)
determine our outcomes?
A new challenge for professionals
Research is showing that it is a combination of the two. Furthermore, there is now the study of epigenetics – how our
behaviors and experiences can actually change how our genes express themselves. Epigenetics provides professionals
working with children with hearing loss with a new challenge: how do we interact with a child with hearing loss to help
develop their brains and influence whether genes are turned on or off to promote best outcomes? The short answer: we
build the brain.
How to become a brain architect
Professionals who work with children with hearing loss are brain architects (a term used by the Center on the Developing
Child at Harvard) tasked with helping build the brain of the child. Many professionals at this point know the words of
Carol Flexor, “it’s all about the brain”, and the concept that the ears bring sounds to our brains but the brain is what
truly hears and listens. We can acknowledge that we are brain architects, but what part of the brain are we building? The
language cortex in the temporal lobe? …The auditory system in the temporal lobe?…Executive function in the frontal
cortex? What about emotional regulation and resilience in the limbic system?
Even if we know what areas of the brain we are building, how do you build the brain and provide the correct supports for
appropriate brain architecture? As professionals working with children with hearing loss, we have many tools to give
children: appropriate amplification, strategies for language development, techniques for speech articulation
development, methods for enhancing social skills, and myriad other areas.
Responsive parenting changes the brain’s response
How do we build the brain and how do we make this easy for families with children with hearing loss? Are hearing aids
and appropriate amplification enough?
A growing bed of research is finding that the most effective way to build strong neural connections and pathways is
turn-taking conversation between a child and another person. MIT’s McGovern Institute for Brain Research investigator
Rachel Romeo used functional magnetic resonance imaging (fMRI) to demonstrate that the brain region responsible for
Phonak Audiology Blog - Winter Reads Collection 6
production of language, Broca’s area, responds more in children who have had more conversational turn-taking with an
adult. By having conversation with turns, the brain’s response was actually changed. Even when researchers looked at
socioeconomic levels, IQ, and other factors, conversational turn-taking emerged as the most important factor.
Furthermore, studies have shown that children in responsive parenting relationships have higher social competence,
better cognitive skills, have better work skills in school, more self-confidence, and better language development (National
Scientific Council on the Developing Child, 2004).
Serve and returns optimize neural development
Our “hammer and nails” when we are building brains is the serve and return between a child and their parent. While we
do need children to have appropriate amplification to have listening access to the oral part of these conversations, we
need serve and return between the child and the parent for optimal brain development. For serve and return, the parent
or caregiver needs to look for communication efforts from the child and provide an appropriate response back. If the
parent tickles the baby and the baby wiggles, the parent then recognizes that the wiggle is a communication attempt for
“more.” The parent can respond with, “You want more tickles? More tickles!” and repeat the desired action. This does not
seem hard because it is natural and involves very intrinsic interactions with the child.
Parents can impact outcomes
Teaching parents about the significance of natural interactions through serve and return and to encourage these
interactions is so important for brain architecture. Serve and return builds language centers in the brain and resilience,
and changes the child’s gene expression to promote better outcomes. Using serve and return helps parents and
professionals to become brain architects and impact outcomes.Serve and return is natural to do and research keeps
proving that it may be the most important tool in our arsenal when promoting language development and healthy brains.
If you would like to learn how Roger technology increases a young child’s access to words and conversations, we invite
you to read a previous blog post, Millions of words to build a child’s growing brain.
Lindsay Zombek, Speech-Language Pathologist,
University Hospitals Cleveland Medical Center
Lindsay is Team Lead for Speech Language Pathology
and a Listening and Spoken Language Auditory Verbal
Therapist in Rehabilitation Services at University
Hospitals Cleveland Medical Center in Cleveland, OH.
She provides evaluation and therapy services for
children and adults with hearing loss and presents
nationally on topics related to aural rehabilitation.
1. National Scientific Council on the developing Child (2004). Young Children Develop in an Environment of
Relationships: Working Paper No. 1. Retrieved from www.developingchild.harvard.edu.
2. Romeo, R et al. (2018). Beyond the 30-Million Word Gap: Children’s Conversational Exposure is Associated
with Language-Related Brain Function. Psychological Science, 29(5): 700-710.
Phonak Audiology Blog - Winter Reads Collection 7
Why implementing Family-
Centered Care is like
making home-made pasta
By Bettina Turnbull
Just like a great home-made pasta is a fantastic way to get the family together for dinner, how can we get the
family to come together during audiology visits?
“Making pasta?”, I hear you ask. Well, yes, it may seem a bit of a stretch, but last night as I was kneading my pasta
dough and thinking about what I would write in this blog, it came to me that in order to make really good pasta, you
need the right tools. You can make pasta without any tools or use a rolling pin, and it will be okay pasta, but if you have
one of those windy pasta rollers that get it really thin, and cuts it really evenly for you, it’s sooo much better. It’s the
same with FCC – you need the right tools to do a really good job.
Old tools don’t meet clinician needs
According to a survey my colleague David Crowhen and I conducted, the Client Oriented Scale of Improvement (COSI) is
the most used communication assessment tool amongst HCPs. It’s not surprising, it’s simple to use and allows us to
measure outcomes. But, while it is client oriented, it isn’t designed for teasing out family input.
According to our survey, current commonly used scales do not meet all the needs of the clinician (and therefore the
family). Our survey indicated that clinicians want more from their tools. They want a way to include the family, a way to
better integrate conversations about technology and finally, they want it available in languages other than English.
FOCAS looks beyond hearing aids
That’s why the Family Oriented Communication Assessment and Solutions (FOCAS) tool was developed. FOCAS addresses
the needs of families by providing a clear structure to involve them and it looks beyond hearing aids alone to meet those
needs. It is based on the work of great minds –
Harvey Dillon (COSI), and Jill Preminger &
Christopher Lind from the Goal Sharing for Partners
“FOCAS addresses the needs of
families by providing a clear
structure to involve them...”
The FOCAS uses the basic principles of the COSI and
the GPS to better involve the family by encouraging
the inclusion of both individual and shared goals to assess outcomes. In addition, clinicians are encouraged to focus on
the emotional impact and quality of life issues that hearing loss may be causing in the family.
Phonak Audiology Blog - Winter Reads Collection 8
A noise versus distance graph allows the clinician to plot the family’s identified needs to facilitate these discussions. To
overcome the language barrier causing some clinicians to use no tool at all, the FOCAS has been translated into 22
languages, making it a truly universal tool. So wherever your clinic may be – there is a FOCAS for you.
The FOCAS also offers the clinician a platform to discuss possible technology options in a simple, yet effective way. A
small pilot study with 6 clinicians using the FOCAS over the course of 2 months indicated that the ‘technology talk’ was
judged to be much easier and swifter, and uptake of recommendations was higher than those of a matched control
Truly a FCC tool
Clinicians also reported that where they had thought they had been including the family previously, the FOCAS made it
much easier to really explore the family’s point of view and actively involve them in the audiologic process.
Just like the proverbial pasta (or noodle dish) that brings families together weekly in just about every country, having the
right tools – like FOCAS – at hand is paramount for bringing families together in your clinic.
Bettina Turnbull, Director of Audiology and Education
for Sonova Asia Pacific
Bettina has extensive experience in wholesale and
retail markets, as well as a strong interest in finding
new opportunities to bridge the research-practice gap.
She is a member of the Phonak Expert Circle on Family-
Centered Care, contributing to tools and evidencebased
recommendations so clinicians can integrate the
latest research into their own clinical practices.
+ Please keep an eye out for a related article in an upcoming Hearing Review publication and visit our Family-
Centered Care pages on Phonakpro.com.
Phonak Audiology Blog - Winter Reads Collection 9
Helping every client feel
connected requires a
broad product portfolio
By David Crowhen
Before choosing a hearing solution, HCPs must first understand what is most important for their client to feel
I (as you do) recently typed the word ‘connection’ into my computer’s thesaurus. Amongst the alternatives it returned
were: joining, linking, fitting together, piecing together, association, relationship, context, and union. It struck methat
these are some of the fundamental benefits of good hearing. Different people of course have different priorities on the
way they make the connections that are important to them.
Every client is unique
Audiologically, this is where the hearing needs assessment fits. This fundamental step helps identify what’s important for
each unique client. For some, the most important way to connect may be hearing well in noisy bars and restaurants, for
others it may be hearing grandchildren at family gatherings, and for others it may be the ability to communicate easily
on the phone (I’m picturing Grant, the real estate agent who helped us sell our last house – he was constantly on his
mobile phone!). Cosmetics may also be important. A broad portfolio of solutions is needed to help meet these diverse
At recent events with hearing care professionals (HCPs) we asked them (n=69) what was generally most important for
their clients to connect with the hearing world and people around them.
What HCPs told us
Results are shown in Figure 1 and, consistent with the
diverse needs of those with hearing loss, indicate a range of
responses. Of the 4 responses available, perhaps
unsurprisingly, the vast majority of HCPs reported that the
most important way their clients want to connect with
others is by hearing speech better in noisy situations.
Features such as StereoZoom 1, 2 that filter out more
background noise are optimal to meet these needs, and only
made possible by wireless transmission like Phonak’s
Binaural VoiceStream Technology (BVST). And for signals
originating farther afield, the benefits of Roger 3 are
Figure 1. HCP responses to Q1: What is generally the most important
for your clients?
The HCPs rated ‘ease of use’ as the next most important quality their clients are looking for. Phonak’s broadest
rechargeable hearing aid portfolio that delivers 24 hours of hearing from a quick 3 hour charge 4 is optimal for this, and
contain BVST, so help address these two top needs. Interestingly, no HCPs in our cohort selected ‘direct connectivity to
mobile phone’ as the MOST important need for their clients (Figure 1). That’s not to say it isn’t a need, and when we
asked the HCPs what is important for clients who do have direct connectivity as a higher priority – ‘hands free phone
calls’ was the most important, followed by ‘app-based remote control’, followed by a ‘convenient audio solution for TV’
Phonak Audiology Blog - Winter Reads Collection 10
App-based remote control earns top spot
‘Streaming music on the go’ was reported as being less important for the majority of their clients. These reports are
similar to the findings of an online survey conducted by Phonak in 2017 5 asking nearly 1000 people (all 40+ years of age
with hearing loss) what would be important for them in terms
of direct connectivity. Survey results showed ‘direct phone
connectivity’ was most important, and ‘direct with hands-free’
was found to be a key driver. Also, ‘streaming music on the
go’ was found not to be a key need within this group. While
our HCPs reported an ‘app-based remote control’ as the next
most important functionality their clients are looking for (Fig
2), the Phonak survey showed ‘TV/stereo streaming’ filling that
Figure 2. HCP responses to Q12: What is generally the most important for
your clients with direct connectivity as a high priority ?
Audéo B-Direct was specifically designed to meet all of these
priority direct connectivity needs: Not only direct phone
connectivity – but direct connectivity to any mobile phone 6 ,
true hands-free calls via the ‘Own Voice Pick Up’ feature,
connectivity to the TV connector for direct TV/stereo experience and the remote app for client control.
And for those where cosmetics are high on the priority hit parade, Phonak Lyric – the only extended wear solution – is
optimal. Or for those where a discreet customised solution is required, the Virto B-Titanium fits the bill. With such a
broad portfolio of hearing solutions, there truly is a Phonak solution to ensure every client feels connected!
David Crowhen, Audiology and Brand Manager, Phonak New Zealand
David is the Audiology and Brand Manager at Phonak NZ, where he has
worked for 9 years. An interest in music and helping people made Audiology
a natural career choice. He graduated from the Master of Audiology course at
University of Auckland, NZ in 1999 and worked clinically for 10 years, in both
public and private settings in NZ and the UK.
1. Stuermann, B. (2011) StereoZoom – Improved speech understanding even with open fittings. Phonak Field Study
2. Picou, E. M., Aspell., E. & Ricketts, T. A. (2014). Potential benefits and limitations of three types of directional
processing in hearing aids. Ear and Hearing, Vol. 35(3): pp 339-352.
3. Thibodeau, L. (2014). Comparison of Speech Recognition with Adaptive Digital and FM Wireless Technology by
Listeners who use Hearing Aids. American Journal of Audiology, 23, 201-210.
4. Expected results when fully charged, and up to 80 minutes wireless streaming time. Please refer to
5. Source: no. 669 Sonova B2C Segmentation 2017.
6. with Bluetooth® 4.2 wireless technology and most older Bluetooth® phones
Phonak Audiology Blog - Winter Reads Collection 11
By François Julita
Comparable industries have shown us — if you’re open-minded and agile, digital transformation offers
a big opportunity.
“Will I still have a job? What about data privacy? When will OTC (over-the-counter) come?”
I have been touring the world for the last 4 years and telling the story about digital transformation in audiology. These
are the usual questions I am asked by audiologists. It is a global phenomenon in audiology, no matter if you are a
German, French, British, Brazilian, US, Canadian or any other regionally certified audiologist.
I do not have the ability to foresee the future but we can reflect and compare to other industries and try to understand
the reasons for the change in general. We can also look at our own industry and adjacent ones. And lastly, we can look at
new entrants, market players entering our industry from a different category such as consumer electronics.
Mega trend and drivers
The universal truth is that digital transformation is a mega trend and here to stay. What is digital transformation? It’s
more than an app, it’s also not a website. It is the transformational power of new technologies, which are changing
whole value chains, business processes, products and services. Digital transformation is for example AirBnB disrupting
hotel businesses, Uber disrupting taxi businesses, Amazon disrupting book (in the beginning) and by now all retail
business. How is this possible?
Let’s take the well documented AirBnB case. AirBnB offers a (web) platform connecting providers of rooms, apartments
and houses with consumers and thus they created a completely new model serving the same need as hotels: a room to
stay while traveling. A new business model enabled by new technologies (web/apps), driven by cost pressure (hotel prices,
real-estate crises in 2008) and new empowered consumers, looking for more value for money and convenience.
The bad guys?
“Why do they do that? Why are these bad guys out there?”. It’s not about bad or good. If there is an unmet need there is
a market. The supplier who can address the unmet need will eventually create a new market and be the leader. If there is
no market, no buyer – there won’t be any vendors – at least not in sustainable way. Hence, we need to ask differently.
What are the unmet needs of our consumers, people with hearing impairment? Could it be that we have users out there
who do not wear hearing aids because current products and services do not meet their expectations? I think yes.
Actually, I think there are many of them. I think we as an industry have failed to increase market penetration of hearing
aids over last decades – and price is not the main reason as we know from research.
Who are they? It is not only age related. We can call them baby boomers, but not only since younger generations are
getting involved too. The hypothetical consumer – let’s call him Alex – is of the generation of emancipated, empowered
senior adults or elderly, often still working, with smartphones and connected, like most of us are. The user who is looking
Phonak Audiology Blog - Winter Reads Collection 12
for convenience. Foremost the user who does not like the current service model, does not like to be called “patient” or to
be treated like a sick person. Such users gravitate towards alternative form factors but foremost alternative service
models. They gravitate towards new types of offerings similar to lifestyle products such as glasses or headphones and not
medical devices for chronic diseases. Honestly, I
am 50 and I have a 65dBHL at 8kHz already – I
feel exactly like Alex.
Hearables, PSAPs, Apps and OTC
Where there is an unmet need, there will be a
market or supplier. Alex is the reason we are
having the discussion in the first place. We as an
“…the user who doesn’t like the
current service model, doesn’t like
to be called ‘patient’…”
industry fear the disruption. We are afraid of all the articles in magazines about new tech gadgets potentially disrupting
our industry – just like hotels feared AirBnB and taxis feared Uber. Again – why is there a market? Digital transformation
in audiology could, and in my opinion will be, the potential answer and huge opportunity to serve Alex’s unmet needs
and potentially increase adoption in hearing devices by overcoming the famous, paralyzing stigma in *hearing aids* – yes,
words again, who wants to wear an “aid”. What if Hearables and hybrid solutions like Apps with a device or new service
models like OTC could open up and grow the market for younger users and they would, over time, switch to a hearing
Digital transformation offers a big opportunity for open-minded hearing care professionals who are not afraid to explore
new products and business processes to serve the needs of the younger segment of users with unmet needs. There is no
silver bullet. No one way to do it. There is the opportunity for the ones willing to try, willing to fail and learn and
ultimately succeed. That is another phenomenon of digital transformation called agility.
Change is unavoidable
Digital transformation will also impact our industry, the question is only when and how. I propose we all try hard to
address Alex’s unmet needs and create new roles, service models and products which address his expectations and ideally
increase overall penetration of hearing devices and reduce stigma. Personally I think that there will be huge gains in
provided value for hearing impaired people in solutions and services through digital transformation – isn’t that the
reason why we all became hearing care professionals and hearing device manufacturers in the first place?
François Julita, Former Director Digital Experience,
In his role, François was responsible for driving new
concepts and developing new types of digital solutions,
meeting fundamental needs of consumers and
professionals alike. He has extensive experience in
Digital Strategy, eHealth, Software Development and
mobile Solutions and was responsible for many Digital
Projects for Fortune500 companies over the past 15
years. He received his Master in Science at Zurich
University of Technology (ETH) and holds a
postgraduate degree in Master of Business
+ Francois Julita’s recorded webinar on this same topic is available on Phonak Learning (accessible in participating
countries). Please visit learning.phonakpro.com.
Phonak Audiology Blog - Winter Reads Collection 13
A Sonova brand
© 2018 Sonova AG