Phonak Audiology Blog Winter Read_FIN

Phonak Audiology Blog

Winter Reads Collection

Quote

“The journey of a thousand miles

begins with one step.”

Lao Tzu

Phonak Audiology Blog - Winter Reads Collection 2

Table of contents

O1

“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.

02

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.

03

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!

04

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.

05

Digital transformation in audiology

Comparable industries have shown us that if you’re open-minded and agile, digital

transformation offers a big opportunity.


01

“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

hearing healthcare.

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.


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

visits.

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.

Author

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.


02

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


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.

Author

Lindsay Zombek, Speech-Language Pathologist,

University Hospitals Cleveland Medical Center

Cleveland, OH

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.

+ References:

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.


03

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

Strategy (GPS).

“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.


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

group.

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.

Author

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.


04

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

connected.

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

needs.

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

undisputed.

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’

(Figure 2).


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

spot.

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!

Author

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.

+ References:

1. Stuermann, B. (2011) StereoZoom – Improved speech understanding even with open fittings. Phonak Field Study

News.

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

www.phonakpro.com/evidence.

5. Source: no. 669 Sonova B2C Segmentation 2017.

6. with Bluetooth® 4.2 wireless technology and most older Bluetooth® phones


05

Digital transformation

in audiology

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.

New consumers

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


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

devices.

The opportunity

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?

Author

François Julita, Former Director Digital Experience,

Phonak

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

Engineering.

+ Francois Julita’s recorded webinar on this same topic is available on Phonak Learning (accessible in participating

countries). Please visit learning.phonakpro.com.


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