Over the years I’ve had the pleasure of working with many patients with a common set of complaints. Let me set the scene for you. It’s a morning or an afternoon on a day that ends with ‘y’, and your new patient explains that they have noticed that they’re having increasing difficulty understanding in situations such as restaurants and meetings, when trying to understand a lecture, or that they’re engaged in a nightly battle with a loved one for the TV remote control. ‘Hmm, I think I may have heard that one before,’ you think to yourself and start the case history and diagnostics. Your test results are unremarkable, with a little bit of a high frequency shift, but no red flags or glaring loss of hearing sensitivity. After explaining the test results to the patient, you’re faced with a bit of a dilemma. The subjective impact of these situational listening difficulties often outstrips the objective severity of the hearing profile of the individual.
So, it’s decision time. Do you explain that many people experience these challenges, but that because there isn’t really a significant change in hearing sensitivity as of yet that hearing aids are not an ideal solution at this time, and suggest some listening strategies? Or, do you by default bring up the idea of amplification and assistive technologies like an FM setup?
Day in and day out, I found this to be a frustrating decision to make. We know that the right technology can help these patients and have a substantial positive effect on their overall quality of life, but hard won experience has shown us time and time again that it is a truly rare patient who is able to justify and afford thousands of dollars of technology to address difficulties that arise in only a few situations each day. The solution that has been needed is one that gives patients a speech intelligibility enhancement, maybe a little gain in the right frequency range, an improvement in signal to noise ratio that’s comparable to an FM, and a way to package it all so that the cost to the patient is easy to justify for those few hours a day where the technology is needed. Because it’s likely to be a low cost solution, it shouldn’t take up too much of the clinician’s time, so it should be easy to set up, adjust and use. Oh, and ideally, we don’t want the device to be visually confused with a hearing aid, because the devices have very different purposes. Until recently, there simply hasn’t been a solution that would fulfill these needs, so we were forced to suggest that the patient come back in a year or so for retest, and, well, how often does that really happen?
One of the worst things that can happen here for the patient (and the clinician) is to establish the idea that technology isn’t going to help, because once this idea is established, it’s very difficult to alter. It may also explain why many of the patients never return to our practices. Instead, if we can establish and demonstrate that technology can be helpful, we create a therapeutic relationship with the patient that will bring them back to the clinic if and when their difficulty worsens. What a great opportunity for patient and provider alike, especially when we consider that it typically takes years for people to seek assistance and adopt traditional technology after recognizing the existence of a significant problem.
Here’s where PSAPs come into the picture, and equally importantly, into the economics of the dispensing practice. Marketing wisdom suggests that it costs between 5 and 25 times more to capture a new customer than it does to retain an existing one.[1] Further, hearing industry data suggests that once a patient has purchased a solution from a hearing healthcare professional, that there is a 95% probability that they will purchase their next device from that same practice. Third, once technology is adopted, the average product lifecycle is less than five years.[2] Contrast this with the average time to adoption of hearing aids after identification of hearing impairment, at greater than 9 years. From a purely financial perspective, it makes sense to the professional to offer PSAP solutions, as this provides an opportunity to build a relationship with a patient, makes the patient more likely to return to the practice, and opens the door for earlier adoption of hearing aids when audiometrically appropriate. Of course, there’s an extensive set of much more important reasons to offer these technologies to patients who are not yet ideal hearing aid candidates, that fit under the umbrella of improving quality of life.
Evidence suggests that individuals with untreated even mild hearing impairments experience an increased incidence and severity of depression relative to normal hearing 
peers AND those who make use of hearing technologies.[3] They are also more likely to experience fatigue, irritability, anxiety and social isolation.[4] Most recently, researchers have identified a link between untreated hearing impairments and cognitive decline. [5]These problems help to create a compelling argument in favor of adopting assistive listening technologies sooner, rather than later.
PSAP products can provide a ‘gateway’ solution for individuals who are not yet ideal hearing aid candidates. Some products are designed to emphasize signal to noise ratio enhancement, providing many of the features found in high end hearing aid devices in addition to wireless remote microphone technology. Most are intended for situational use only, instead of all day wear. A new generation of these devices has introduced designs that don’t look like hearing aids from the 1970s, and simultaneously provide additional connectivity and great flexibility for the user. Most importantly, they are not visually confused with hearing aids, making it easier for the professional to make the differences in intended use between PSAPs and hearing aids clear to the patient.
We are now experiencing the first significant step forward in hearing technology since the introduction of digital signal processing. The confluence of mobile computing power, increased connectivity and enhanced communication is combining with commercially available audio processing solutions and hearing science to create a new marketplace, rather than cannibalizing from existing sales. Hearing healthcare professionals now have the opportunity to establish the appropriate time and place for PSAP technology in the hearing journey of the patient. Incorporating these products into your practice helps to maintain the professional’s position of authority relative to hearing healthcare, and furthers the aim of every professional, namely to provide the best solution for the patient and to become a partner in hearing health, for life.
The long and short of it is that PSAPs are not a threat to Audiology, or a hearing aid alternative, but rather, they are simply another tool in the box of options, an opportunity to build relationships with new clients, a chance to consider more than a ‘hearing aid or nothing’ and maintain credibility with the patient by providing more than a single approach to dealing with listening difficulties. Most importantly, considering PSAP products for the right patients is another way to serve the highly varied needs of our rapidly expanding patient base. The next time you encounter a patient who isn’t yet a great candidate for full-time amplification but who still reports a lifestyle impact due to situational listening difficulties, why not consider a PSAP product? You just might be surprised.
Drew Dundas, PhD, FAAA, CCC-A is President and Chief Technology officer at Soundhawk Corporation in Menlo Par California. Clinically trained as an audiologist at the Cleveland Clinic Foundation, Dr. Dundas entered the world of hearing research at Vanderbilt University, culminating in a PhD in Audiology and Biomedical Engineering. Dr. Dundas conducted development research into fitting algorithms, compressor design and advanced signal processing while a research audiologist at Starkey Hearing Technologies in Eden Prairie, MN. Prior to joining Soundhawk, he served as director of Audiology and Professor of Otolaryngology in the School of Medicine at the University of California, San Francisco where he oversaw clinical operations, resident education, research and made time to work closely with patients of all ages. He has been an invited speaker at State, National and International hearing and balance meetings, published numerous peer-reviewed articles, and co-authored chapters on balance function assessment. He holds multiple US and European patents relating to hearing devices and the personalization of sound.
References
[1] Gallo, A. (2014). The Value of Keeping the Right Customers. Harvard Business Review. Retrieved from https://hbr.org/2014/10/the-value-of-keeping-the-right-customers/
[2] Allen, R.L. (2002). Hearing Aids: Reasonable Expectations for the Consumer. AudiologyOnline. Retrieved from http://www.audiologyonline.com/articles/hearing-aids-reasonable-expectations-for-1176
[3] Amieva, H., Ouvrard C., Giolioli, C., Meillon, C., Rullier, L., Dartigues, J.F. (2015). Self-Reported Hearing Loss, Hearing Aids, and Cognitive Decline in Elderly Adults: A 25-Year Study. J Am Geriatr Soc, 63(10):2099-104.
[4] Ciorba, A., Bainchini, C., Pelucchi, S., Pastore, A. (2012). The Impact of Hearing Loss on the Quality of Life of Elderly Adults. Clin interv Aging, 7:159-163.
[5] Lin, F.R., Metter, E.J., O’Brien, R.J., Resnick, S.M., Zonderman, A.B., Ferucci, L. (2011). Hearing Loss and Incident Dementia. Arch Neurol, 68(2):214-220.
