Dr. Erin Wright - What's New in Hearing Aid Technology for 2018

My name is Dr. Erin Wright.  I'm an audiologist and I was just doing the math; I've been an audiologist for 22 years.

FROM THE AUDIENCE:  Wow!

DR. ERIN WRIGHT:  Wow, that makes me feel old!  I'm a native of Carman, Manitoba, and got my undergraduate degree in University of North Dakota, then I went to Portland State University in Oregon and health sciences to get my doctorate in audiology.

So I started out my profession working with kids at the Clark County School District in Las Vegas Nevada, where I was an audiologist there for seven years, and then I moved to Victoria with my husband with the dream of opening our own clinic, our own private practice.  So we opened up Broadmead Hearing Clinic July 4th, 2006, and then we opened up our Oak Bay clinic in February of 2011. 

So I'm very proud to be able to put on this seminar to the people in our community.  I'm proud to be an independent hearing clinic and to be able to have the support of all of the manufacturers to come to this event to provide information to everybody and give everybody a chance to really get an unbiased piece of information and, you know, do a little bit of your own research about hearing‑aids.  So thank you very much for coming. 

I just wanted to go through the manufacturers ‑‑ the big six manufacturers.  The percentages that I have on this screen just talks ‑‑ oh, I'm sorry, I forgot to thank the captioner.  I wanted to thank the captioner and I also wanted to thank Oticon for sponsoring the captioner today.  She's doing an amazing job.  She's going to have hand cramps by the end of the day, but she is giving us the transcripts, which we are going to be putting on our website after we get them.  So about a week or two from now, after we get the transcripts, we'll have them on the website, so if you forget anything, you know, you can refer back to the transcripts on the website.  So thank you. 

Okay.  So these are the big six manufacturers, so the industry ‑‑ all of these manufacturers outside of Starkey are Europe‑based companies, most of them in Germany or Switzerland or Denmark.  The little percentage again is the market share that each of these manufacturers hold worldwide.

So Phonak is one of the major manufacturers.  They're based in Switzerland, their parent company is called Sonova.  They also own Unitron Hearing and Connect Hearing, so Connect Hearing being a clinic that provides hearing‑aids like our own hearing clinic, Broadmead Hearing Clinic.

Oticon is right up there with Phonak.  Their parent company is called William Demant.  They own Bernafon, a little lesser known.  As well they have ownership stake in companies like NextGen and they completely hundred per cent own Hearing Life Canada, and on the east coast it's called Listen Up Canada.

Widex is Denmark, from Denmark.  They have a side business off their parent company called Helix and Helix owns certain hearing‑aid clinics as well, and in our community the clinic they own is McNeil Audiology.  McNeil Audiology was an independent clinic for years and years until Brent retired and then they sold to Widex. 

GN ReSound is another manufacturer from Denmark.  They own Beltone hearing centres, so Beltone hearing centres, if you got a hearing‑aid from their clinic, it would be labelled Beltone, but it's identical technology to the ReSound technology.  So ReSound supplies hearing‑aids to clinics like mine, but if you're a Beltone clinic, you're using Beltone hearing‑aids entirely.

Then Siemens, which is a German company.  Siemens actually sold to a private equity group about three years ago called Sivantos, so they're in the process of changing that brand from Siemens to Sivantos.  They own a company in town called Miracle Ear. 

And Starkey, which is an American ‑‑ the only American‑based company.  They don't have any particular clinic ownership; they're not in that business.

Okay.  So in Victoria, there are 22 locations where you can buy hearing‑aids.  Four of those locations are independently owned or have no manufacturer stake and our clinics, Oak Bay and Broadmead, are two of those four clinics.

So one of the things ‑‑ and a couple of questions that I've been asked today, really good questions, is, "Where do I start?  Like I'm here, I'm talking to these companies.  I don't know.  I don't know what I need.  I don't know if I need this one or that one.  I don't even know what's going on."  And it's a very difficult industry to really do your research in, because it's hard to know what it is that you need unless you have a little bit of background about what these hearing‑aid manufacturers do and why one is better than another. 

And so one of the things that I'm very proud of, and somebody, just before I walked in ‑‑ I don't know if you're in this room, but you said, "Thank you for staying independent."  And it's because it's important to me, you know, and it's important to me that we provide that service to the community without any bias at all. 

So what factors you need:  So one of the things when you're looking for hearing‑aids is to find an audiologist that you trust so that they can take a look at the ‑‑ your particular needs, and some of the things that we consider are things like dexterity.  There's niche products out there that suit different people when they have different challenges. 

So for example, dexterity is a challenge.  I have a couple of people who have really severe tremors and have difficulty with inserting their hearing‑aids.  So there's a niche product by Phonak called the Lyric which can be inserted into the ear and stay in there for six weeks to three months and that person doesn't have to then deal with their hearing‑aids on a regular basis.  So we would take a look at, you know, what's happening in terms of dexterity. 

Slope and degree of hearing loss are huge factors.  A lot of people who have noise‑induced hearing loss have really good hearing in the low frequencies and then it drops off the charts to the high frequencies and that's a very difficult hearing loss to try to fit.  Some of the manufacturers I'll talk about, some of the features coming up, have little features and products that can help with those type of challenging hearing losses. 

Cosmetics:  There are some super tiny hearing‑aids out there right now; Starkey in particular makes the smallest hearing‑aid.  They have an excellent shell lab and they're able to fit all of their little circuits and components into a tiny shell that can fit right down into the ear canal where most people wouldn't notice that you're wearing one.

Ease of use:  Some people want to just put it in and let it work.  Other people want to control it and change the programmes and play with it and have it work with their iPhone. 

Tinnitus is a huge one.  If somebody's suffering from tinnitus, we need a product that's going to have a feature to manage that particular issue.

The size and the shape of the ear:  I've had two people in the last month who've had the complete top of their ear surgically removed because of skin cancer and now what are we going to do?  We don't have anything to hang the hearing‑aid on.  So we have to figure out what is happening with your ear and what's going to fit on that challenging ear. 

And also the need or the desire to have your hearing‑aid connect.  So connectivity is an exciting new development with a lot of these manufacturers that help with really anything that you're listening to.  So if there's anything out there that you listen to on a regular basis, we can get it connected to your hearing‑aids.  So I'm thinking of somebody who I know who listens to CBC radio and we have a little microphone plugged into a radio and the radio's in her kitchen.  It's just a little basic kitchen radio, but she plugs this little thing into the kitchen radio and it streams the CBC radio right into our hearing‑aids so she can go off to the bathroom, she can go to the garden, she can do all these things and still be catching that radio signal.

So it's good to think about, "What do I need?  What do I listen to?  What is my life like?"  And all of those things kind of come together to ‑‑ to become really important little bits of information to communicate with your audiologist so the audiologist can make the right recommendation from all of these hearing‑aid manufacturers. 

The wonderful thing about these hearing‑aid manufacturers is all of them provide us with a three‑month trial period.  So they give you three months to make sure that the product is the right product and if it's not, if it's not working for this and that, we can move on and each new product comes with a new three‑month trial.  So the end result being that in the end, the person has something that they're wearing 12 hours a day and they love it.  So that's the ultimate goal. 

So not all of these hearing‑aids are the same.  Somebody asked me today, "Is this the same hearing‑aid kind of repackaged in different brands?"  No.  They have proprietary fitting formulas, they have different ways of doing things, a different little niche product, and so they're not all created equal. 

So the first part of my talk ‑‑ was anybody here last year?  To this talk?  So in the last year, last year and the year before that, I broke this talk down into talking specifically about features, what features are available in hearing‑aids and what they do.  This year I'm going to do it a little bit differently.  I'm going to talk about the new product launches.  So I'm going to break down each manufacturer and talk about the product that they have just released, their latest product on their portfolio, and we'll talk a little bit about some of the pros and cons of each of those things and then if ‑‑ you know, and for you guys, if it sort of resonates with you, you can think, "Oh, yeah, I like the idea that that one connects to an android phone because that's what I have and that's what I want." 

So this year, instead of breaking it feature to feature, I'm going to talk about each manufacturer and what they've just launched and after that we are going to talk about what is to come, you know, in the next year or two. 

So I'm going to start with Phonak.  In August of 2017, Phonak launched a new platform that they call Belong.  It's called Belong because it's their first iteration of a rechargeable product, so like "be" "long".  So Phonak is using a lithium ion product to ‑‑ they say this battery's going to last about three years, which is great because they have a three‑year warranty, so we can get it replaced at the end of the three‑year warranty and hopefully have it done in the warranty period and then you get another three years out of that battery.  So it's wonderful, these lithium‑ion batteries.  Kind of takes a lot of issues away around batteries.

So they have ‑‑ they were the first company to introduce connectivity to an android phone.  So since 2012, we've had hearing‑aids connect to iPhones, but the new Phonak Belong product is the first android‑capable hearing‑aid that came out in August '17.

One of the features that I really like about this Phonak product is their second ‑‑ their 2.0 version of something called frequency transposition, or frequency shifting.  So Phonak is the only company right now to be on their second iteration of this and they're doing it better than the other manufacturers. 

What this means is for people who have hearing loss in the high frequencies ‑‑ so high‑frequency sounds are going to be "s", "f", "th", "sh", "p", "k", those sounds that don't have a lot of voice behind them, they're just sort of air flow.  If the person's hearing loss is quite severe in those regions, they don't have a lot left in their ear to hear.  So a hearing‑aid is going to make it louder, but when that part of the ear is so damaged, it doesn't really respond very well; even if it's louder, it doesn't really matter, it's not clear.

What this frequency shifting is is it takes those high frequencies and shifts them to a lower frequency region of the ear, so some of the bass tones.  It takes those treble sounds, moves them to the bass area of the cochlea, where the hearing is generally better, so the better part of the cochlea that's more preserved can take advantage of those cues and be able to then distinguish between the "s" and the "sh" sound.  So that's a hard thing to do when you have severe high‑frequency hearing loss and this new 2.0 version of Phonak's frequency shifting is doing the best job that we've seen so far in this.

It reminds me of a little story.  The first time this came out was when I was a school district audiologist and I was dealing with this girl that was 12 and she had really deaf speech because she was born with that type of a hearing loss where she could hear all the vowels really well, but had no hearing in the high frequencies, and I fit her with the first version of this frequency transposition and within six weeks, she became so clear in her speech, you could hear these sounds coming through her speech again, and that was in, I would say, like 2000, so this is now 18 years later and they've done a good job at sort of keeping on tweaking that particular feature. 

The other great thing about the new Phonak Belong is their product that they call Naida.  Naida is their power hearing‑aid; comes in three different versions.  Phonak has long been the go‑to company for people who have severe to profound hearing losses.  The way that that hearing‑aid can represent that sound, it's the best power product so far and this new one just was released on March 26th and the new one has a new proprietary fitting formula, which is why it took longer.  So they originally released the whole product line, the family, in August of 2017, but it took them until March of this year to release the power version of the Belong ‑‑ of this Belong product.

So they have a proprietary fitting formula called adaptive Phonak digital contrast, which is really good if your hearing loss is severe, because it helps to distinguish ‑‑ or discriminate between the vowels and the consonants.  It's also a rechargeable version of a power product, which has been something we've been waiting for.  So Phonak does a great job with this particular area of need. 

Unitron has come out with a new hearing‑aid as well just this past February, February 2018, that is called the Moxi All.  So if you can remember, Phonak and Unitron are both owned by the same parent company, Sonova Corporation, and they often share technologies.  So Unitron also has an android‑connected phone (sic).  So now if you have an android phone, you can connect it using a phone app or a Unitron hearing‑aid, and the way it works is it's actually a true hands‑free option, which is different from the iPhone hearing‑aids.  So the iPhone hearing‑aids, you still need the iPhone to talk into it so the other person can hear you.  With the Unitron Moxi All and the Phonak hearing‑aid, it's called the direct hearing‑aid, when you get a call, you don't have to be near your phone.  You push a button on your hearing‑aid to answer the call and the microphone on that hearing‑aid picks up your voice for the caller on the other end. 

So the call is coming into one ear, but you don't have to hold your phone at all.  Your phone can be, you know, 30 feet from you, and it's the hearing‑aid microphone that is picking up your voice through their call and streaming their call into your hearing‑aid.  So it's really cool to be able to answer and hang up like that.  Unitron has a little bit of an edge over the Phonak product in that their android‑connected product is also rechargeable and Phonak's is not.  So if you want rechargeability and android connectivity, this is a great option.

Starkey is another manufacturer.  They're an American company and Starkey, as I had mentioned earlier, in my opinion does the best job at the smallest hearing‑aid.  So the little one inside, this is called completely in the canal, and the other one is called invisible in the canal, so we can make a deeper ear impression and get that hearing‑aid to sink right down the ear canal and, you know, they ‑‑ I've seen some of the hearing‑aids that they come back with the impressions I send, they come back and I'm like, "Wow, that is a small hearing‑aid."  I'm impressed all the time with the size we can get those hearing‑aids.

Starkey also has a new product family that they just recently launched in the last two months called their Muse iQ, and it's ‑‑ you know, remembering all these names are kind of difficult; imagine how it is for us.  But the Muse iQ, what I really like about the Muse iQ is a couple of things:  They have the most beautiful chargeable.  The charger is that black case, there.  I mean it might seem like no big deal, but it's really well designed and it has a dehumidifier in there and it lasts for three days and it's easy to open, it's easy to put in.  So they've really done a great job at designing that charger.  That is lithium‑ion battery.

And what's niche and unique about this Starkey product is that it's the first and only hearing‑aid that is rechargeable that can also function as a CROS hearing‑aid.  I know somebody in here with a CROS.  A CROS hearing‑aid is when you have one ear that has no hearing at all and one ear that has hearing loss, and what we do is we can't really aid an ear that is completely gone, so we put a microphone on one ear and the sound coming into that side of the head is routed wirelessly to a hearing‑aid on the other ear so that when somebody is sitting on that side, the person can still hear them without turning their whole body and ‑‑ you know, turning their better ear towards that person.

So the CROS‑style of technology has been available for a long time, but the battery drain on it is horrific.  Three days, two days sometimes, because it's constantly streaming audio to another hearing‑aid.  So the ‑‑ you know, having a rechargeable CROS hearing‑aid is really great for people who are changing batteries every two days. 

ReSound is another manufacturer.  ReSound is the hearing‑aid company that was the first company to launch their ‑‑ the iPhone product and they were sort of alone in the market in 2012 for almost a year.  So, you know, they have some really interesting sort of forward thinking about their company.  They often ‑‑ they often come out with things first. 

They have a different new product called the Linx 3D, so that's their third version of the Linx.  The first version of the Linx was the one to connect to the iPhone and now they're on the third version of the Linx, the Linx 3D.

So ReSound has a different philosophy of processing the signal when the environment is noisy.  So what they believed their philosophy ‑‑ what they call it is binaural directionality.  What they've shown in studies is people hear better when the microphones on the hearing‑aid are picking up sound from all directions, when they get that full soundscape, so ReSound is trying to keep the hearing‑aid ‑‑ is trying to keep it in an ‑‑ to preserve the sound cues and keep the listen.

Their binaural directionality is a little bit different because they have a true dual core processing system where both hearing‑aids are working together as a system.  So now you have four microphones, two on each hearing‑aid, that are sending information continually back and forth to figure out what is the best directional set‑up for this person in any given environment.

So there's four options:  You can have both hearing‑aids in an omnidirectional position, both of them in a directional or forward‑focused position, or you can have one be omni, one be directional, depending on where the primary speech signal is coming from. 

For example people in noisy restaurants:  For a lot of years, hearing‑aids have had adaptive directional microphones; that means when the noise gets loud enough, the hearing‑aid microphones start to do that.  Even with Phonak, it's a super tight zoom with Phonak.  So the microphone directionality is going to be dependent on the environment around you.  So when you're in a restaurant and your microphones are in a really tight directional zoom and a waiter comes up behind you and says, "Do you want another drink," you're going to miss that.  You're only going to know that because your partner is going to look up over your shoulder and then you're going to go, "What are you looking at?"  Then you'll get that cue.  ReSound, in their binaural feature, would keep that one ear in an omnidirectional position so you can continue to hear what's going on in that direction as well.  So they are using the 2.4 gig ... platform to do that.  That's the name of the wireless technology that works ear to ear. 

The other thing they're working on, and they're on their second version of it and I talked little bit about this last year, was cloud‑based adjustments. 

So ReSound has its own cloud that apparently is in Ireland (laughter), and what this means is that if you have a ReSound hearing‑aid and you have it connected to your iPhone, you will have an app on your iPhone that you download and it's the ReSound app and that ‑‑ all these manufacturers have apps for their hearing‑aids, but with the ReSound app, you can use the app like you would to make volume adjustments or change your programme or even change your microphone directionality.  If you don't like what it's doing, automatically you can decide, "I want it to be in the forward directional position," or, "I have kids in the back of the car, I want it to be reverse directional."   That kind of thing is consistent among all the apps, you can play around with all the settings if you want to.

What's a little bit new with ReSound is this cloud‑based technology.  So if you are at home or you're at a restaurant and you think, "I don't really like how it sounds here," you can open up the app and sort of answer a few questions that they've designed on the app and you can even type in some words saying, "Hi, Erin, I'm just at Pagliacci's and it's horrible here and what I'm noticing is that the dishes and the knives and forks are really, really tinny when I'm in this high‑noise environment," and then you can send that message and when I get to my computer, I open up my computer and I get an e‑mail saying, "Julia's just sent you an e‑mail."  Then I will open up that e‑mail and it has a link and I click on the link and it goes right to your particular software page.  And anybody who's had hearing‑aids remembers you go in to the audiologist's office and you can see her working on the computer and making little adjustments.  Well, that's called your profile, your NOA profile, so the e‑mail sends a link right to your profile and then I can make some adjustments based on that e‑mail you just sent me.  I can say, "Okay, Julia's having a hard time with these knives and forks, so she must be in the restaurant programme," so I'm going to go into the profile, make an adjustment through the programme and send it through this cloud back to her iPhone and then she'll get a message, a notification on her phone saying, "Erin just responded to your message.  Do you want to accept these changes?"  And then she'll say yes and the changes load into the hearing‑aids, and then she might say, "Oh, God, this is horrible!  What was she thinking?"  And then you can reject it:  "I don't like those, I'm rejecting it, I'm going back to the way it was." 

So it's ‑‑ you know, it's obviously great for people who go to Palm Springs after they get their hearing‑aids for six months and then they don't have any way to get them adjusted.  It's great for people who have difficulty getting into the clinic and they can kind of do these things remotely.  It's great for the audiologists because we can help people more instantaneously than having to wait a week or two to come in and get an appointment.

So there are some real advantages to this type of technology and I can only assume all of these manufacturers are going to follow suit, where you're going to have more ability to have the hearing‑aids adjusted sort of, you know, within a shorter timeframe. 

So Siemens:  Siemens isn't here today, if you noticed.  They ‑‑ the rep from Siemens, she couldn't make it today, she had a different thing going on, so for the first time, they're not here, but they do have a new product that's excellent.  It was released in October of 2017 and what they're really focusing on with Siemens is people's own voice.  So their product is called the Nx and their main feature is called own‑voice technology.

So if anybody ever has had the experience of putting hearing‑aids in for the first time and saying, "Oh, my voice sounds different.  It sounds louder or echoey or it feels like I'm in a tunnel, I'm just not used to the way my own voice sounds."  I mean everybody has that feeling.  When people come and say to me, I say, "A hundred per cent feel how you're feeling right now.  We'll just gradually make the sound louder, you'll adjust to it."  Some people don't, some people have a hard time adjusting to the way their own voice sounds.

Siemens is trying to tackle this problem using a different processor to amplify the person's own voice as compared to speech around them.  So it's got sort of learning in that it's going to learn that person's own voice and apply different levels of volume or amplification or not amplify the person's own voice, like it would if there was a voice next to them. 

So they've patented this technology, it's working really well.  Again, like anything, there's niche areas for this and for some people ‑‑ some people have hearing loss that's in the low frequencies and their hearing gets better in the high frequencies, and those people have a harder time with their own voice because we need to give a lot of volume in the low frequencies and it's a harder adjustment for sure.  So this is a really good product for that type of a hearing loss. 

What they're also doing is they have a hearing‑aid that connects to your iPhone, but they're using the iPhone a little bit differently than any other manufacturers because they have these motion sensors that they are picking up from the iPhone.  So if you have your phone with you and your phone is connected to your hearing‑aids and you're in the car, your phone knows that you are travelling at a certain miles per hour, so it's going to make the assumption that you're in a car and it's going to send that information to your hearing‑aid to affect the settings, the programme, so you can hear speech in a car better. 

So it's using the information from the gyroscope ‑‑ the accelerometer, sorry, of the phone to figure out are you sitting still, are you walking, are you in a car?  Are you jogging?  What is going on in your environment?  It's just another little piece of data that the hearing‑aid can use to better adjust for the automatics in all of these hearing‑aids. 

When I said the data, it made me think of something I didn't tell you about the ReSound hearing‑aid.  One of the things they're doing with that cloud‑based adjustment is they're going to be able to use the data of people sending in these adjustments.  So if everybody's saying the same thing, "These hearing‑aids are too tinny," it's going to give them information on a large scale of, you know, what are people having problems with and then they are going to use that data to better design the next iteration of hearing‑aids.  So it's ‑‑ it also adds that particular component to it. 

Siemens ‑‑ this little box, here, is a T.V. streamer, so every hearing‑aid, now, has a box about that size that plugs directly into your television and can wirelessly send that audio to your hearing‑aids, so you don't have to wear a thing around your neck called a streamer, like we've had to have people do for years.  That sound can go right from A to B, it doesn't have to go through a middleman.  So those T.V. streamers are pretty consistent among the manufacturers.  Most of them have a version of it where you can press the button on your hearing‑aid or your remote control to directly feed that audio into your ears, which is really great if you have somebody else in the room who doesn't want to watch that show.  You can mute the television and be the only one to hear it.  So if your partner is asleep, you know, you can turn the volume right off, or if you have, you know, two people living in the same house and one of them wants to watch CNN all day and the other one doesn't, you don't have to both do the same thing.  One person can watch T.V. all day long and have it streaming right into their ears.  It's really ‑‑ it's almost a really nice thing for the partner of the person with hearing loss.

It's also fantastic with those British shows!  Those accents are crazy!  So many people have a hard time hearing those British accents.  It really helps with that.  And again that's not just Siemens; all manufacturers have that same kind of T.V. adapter.

So Widex is another manufacturer.  Their new platform of hearing‑aids is called Beyond.  So what I really like about that Beyond hearing‑aid is how it's processing music.  So Beyond Widex, for a few iterations of their hearing‑aid now, has been a choice product for musicians because of their microphones.  They have a different microphone set‑up in there and so the microphones aren't confusing music with noise and trying to compress it.  So it really does a nice job at processing and amplifying music. 

And, you know, if you were hear for Lia's talk, she talked a lot about their new zen therapy.  It's not necessarily new.  We've had that zen option in the last couple of versions of their hearing‑aid, but Widex has gone above and beyond with doing research about how to help audiologists properly programme these programmes for people who suffer from tinnitus and help people to manage their tinnitus using different counselling strategies, different sound therapy in their ears.  So Widex has really put a lot of effort into helping audiologists help people manage tinnitus. 

So I personally have had a lot of really great success with people who have been told by countless doctors and other people, "There's nothing you can do about it," and that's just totally not true.  There's absolutely something you can do about it.  I'd say in my practice, 85 per cent of people with tinnitus, we can help manage that using this type of a product, here.  By manage, I don't mean go away completely and have absolute silence, I mean manage it to the point where you don't notice it, it's not as front and centre.  It's called habituation.  It's like this projector is making a fan noise, but I don't hear it unless I draw my attention to it. 

It's okay, I'm going to take questions at the end, if that's okay.  Okay.

So Widex is also releasing a new product in ‑‑ April 21st.  So April 19th to the 21st in Nashville, Tennessee is our American Academy of Audiology conference and Widex is releasing a new product at that conference, which they're kind of keeping their lips sealed about right now, but from my understanding about it, it's going to involve a little bit more machine learning.  Machine learning meaning that if you're inputting information into your phone with the ones that are connected to the iPhone, it's going to learn your preferences and, you know, be able to monitor your environments just that much more accurately.  But I don't have a lot of information about that product.  We'll know more after the launch in April.

What they have told me is that in the fall of this year, they are planning to release the first fuel cell hearing‑aid.  So I talked about this a little bit last year about what's coming up in 2018.  So I'm going to talk a little bit about rechargeable batteries, but Widex is hoping to launch a fuel cell, meaning that it takes three seconds to charge your hearing‑aid and it's going to last for three days, and it's battery free is what a fuel cell is. 

So we'll see.  I mean it's new technology, it hasn't ‑‑ you know, they're trying to take that technology from the automotive industry and put it into some hearing‑aids, so we'll see what kind of problems come up with that and how it actually works, but it's an exciting advancement, though.

The Oticon Opn hearing‑aid.  It's not a new release this year, it's been out for a little while, but they have released a few new software updates to this hearing‑aid.  So the software updates are available to you if you have an Opn hearing‑aid.  You have to come into the clinic to see the audiologist, we plug your hearing‑aid into the computer and just load the new updates into the hearing‑aid.  So the updates are helping the hearing‑aid connect to new devices.  There's a little microphone they've come up with, it can stabilize some of the connection to the iPhone.  So it's always good to have the new update in this hearing‑aid.  If you have it, you want to make sure you have the newest update.

The Opn hearing‑aid has a different way of processing sound and so it ‑‑ it's really doing a great job of managing noisy environments, and this is probably the biggest problem that most people have is hearing in noise.  So when they rereleased this technology, they really emphasized they were doing noise management differently than the other manufacturers, and they really are.  It's a different theory, a different philosophy around processing noise and it's moving away from that directional microphone strategy. 

So I talked about the directional microphones a little bit, with adapting when the environment gets noisy and how the manufacturers are doing that different.  The Oticon Opn product is not even using directionality at all, so they're using, you know, different cycles in that processing.  So the hearing‑aid picks up the sound and the hearing‑aid analyzes it and then it balances it and then it cleans it from noise, and so it kind of goes through ‑‑ like I imagine it kind of goes through like a car wash cycle until the ‑‑ until the sound is spit out the end, all the while trying to clean up that signal to help that signal be a little bit more speech and a little bit less noise.

And it's even doing that in between syllables of a word.  So it's processing things quite quickly.  It has, you know, 64 frequency bands in it and it is doing a better job in noise than I've seen historically for a while.  So for people who have difficulty with that environment, this is a good product.

So I just want to touch a little bit about batteries.  I kind of talked about the changing landscape of hearing‑aid batteries a wee bit.  Things are really changing in the last year.  We've always had disposable batteries.  So with batteries, we've always been using these sync air disposable batteries that last 25 days depending on the size of your hearing‑aid.  That's because the hearing‑aid industry and battery industry hasn't been able to find a battery that has enough power to power the hearing‑aid all day long or be small enough to fit into a hearing‑aid.

So the rechargeable options currently are the initial nickel metal hydrate which was released by Siemens a long time ago.  It was the first version of a rechargeable battery; good if we really needed to use it, but it was only lasting like ten hours in the day.  People would have low battery beeps towards the end of the day, so it wasn't really a good solution.  It wasn't really getting people through the whole day.  So the other manufacturers went on board with that nickel hydrate battery. 

So then a company came out called Z Power ‑‑ or Zee (phon.), it's an American company ‑‑ and Z Power is using a different battery called a silver zinc battery, and a silver zinc battery is apparently a spin‑off technology from NASA.  These four manufacturers, Unitron, Oticon, Widex and ReSound, had all contracted with Z Power to have Z Power make new battery doors for their hearing‑aids and chargers so we can retrofit those hearing‑aids and make them into a rechargeable product.  So it's kind of, you know, two different companies coming together to try to provide a rechargeable solution. 

So these rechargeable batteries are lasting about six to eight months.  We're sometimes seeing battery failure; I would say about 20 per cent of the time people come back before six months and say, "My battery's dead," so there is some times where we see that the battery isn't fully lasting the amount of time that they say it's going to last. 

The great thing about these, though, is that you can replace it with a disposable battery if you want.  So if you're going away on holiday and you don't want to take your charger or you're worried about the power source, you don't have to take the charger, you can take a package of regular, disposable batteries and take the chargeable battery out and put a regular battery in that's going to last a week like normal regular batteries do.  So you have the flexibility of going back and forth and if your battery dies before you're expecting it to, you're not without your hearing‑aids until you can get another rechargeable battery.  You can just put another battery in until you get around to go to the clinic to get another battery.

And then there's the philosophy of the lithium‑ion batteries.  So Siemens, Starkey and Phonak have all decided to choose to use the rechargeable lithium‑ion batteries and ReSound is saying their product in the fall is going to have a lithium‑ion battery as well. 

The lithium‑ion battery is integrated into the hearing‑aid, so you can't get at it.  You have to send it back to that manufacturer to have it changed, so if there's a problem, you have to get a loaner hearing‑aid from the clinic until we can get that battery changed, although I haven't seen a problem with those batteries since they've been released.  I haven't seen the hearing‑aid since September of 2016, that lithium‑ion battery, I haven't seen one that's had to go back so far, so it's a good sign. 

But when the battery dies, it's going to be an expensive thing to repair, you know?  Probably a couple of hundred dollars, like $300, to get a new battery in there.  But like I said earlier, we can hopefully sneak it in under the warranty and get a new battery before the warranty expires.  So if you have a lithium‑ion battery, keep your warranty date in mind so you can bring it back to us so we can get a new battery in there.  We're finding they're just a little bit more stable.  If you forget to charge it, you can't use it.  So that's kind of a down side there.  You have to wait for, I think, a three‑hour charging cycle in order to use it.  So you have to be pretty diligent about recharging it every night.

And then finally I'd just like to take a little quick peek into what's coming up in the next couple of years in terms of hearing‑aid iterations and what these manufacturers are working on currently.

Artificial intelligence is kind of what they're working on right now and artificial intelligence, you know, there's ‑‑ the world is a little bit on fire with applications for artificial intelligence and I read an article that said hearing‑aids are now where cell phones were 25 years ago.  So they're just starting to start to use some of this information and data and they're be able to miniaturize it to get it into a hearing‑aid, so it can use a little bit more advanced technology to help people to hear a bit better.

The first sensors are going to be called inertial sensors.  They're going to put sensors into your hearing‑aids.  These inertial sensors will allow the person to control it by tapping it.  So Starkey says they're currently working on this right now for a product to be released later this year.  So these sensors will include an accelerometer and a gyroscope so it knows where you are ‑‑ how fast you're moving and where you're facing.

So we can use these inertial sensors to complement the body's vestibular system.  With an inertial sensor in a hearing‑aid, you can do physical activity tracking, so it can be your new Fitbit, and you can programme things into it, like, "I want to do 10,000 steps in a day," and your hearing‑aid might say, "You've only done 8,000 steps.  Do you want to do another 2,000?"  You can send that information, if you want it.  (Laughter) So you can do these kind of things, you know, coming up in your hearing‑aid, obviously if you want it.

Fall detection is another one.  The first version of these inertial sensors are going to help to be able to indicate a fall.  So falls are happening quite often and with this artificial intelligence, what they're going to be able to do is alert somebody if somebody else has had a fall.  But hopefully in the future, they're going to be able to use these sensors to actually predict falls.  So the inertial senators in the hearing‑aid will be able to quantify gait changes and, you know, predict someone's propensity to fall and then hopefully give an alert to that prior to the actual fall. 

And then imagine language translation.  You know, that would be amazing and something that they're working on where you can have realtime language translation.  You can go to Japan and, you know, have that being fed.  Obviously, probably, with the help of your phone, but having those kinds of technologies marrying with the hearing‑aid technology just makes them more usable.  Like phones used to be just phones, and now they're everything.  You know, they're your entertainment device and texting and communication and videos and photos and it's camera.

So where hearing‑aids are now, they're just hearing‑aids, but where they're going to be is they're going to have those multipurpose devices in addition to these faster processors, which are going to help people to hear better in noise as well as provide other sort of added things. 

So I know that there's a ton of options out there and it's kind of dizzying to know what's appropriate for you, and one of the things that we sort of pride ourselves on with our education and our clinic, we only hire audiologists and we all keep up‑to‑date on all of this technology so you don't have to.  So you can come and say, "This what I'm looking for, this is what my life is like," and then we can help you.

I mean it's a lot easier when you're owned by one hearing‑aid company to keep track of one type of hearing‑aid.  That's easy.  It's easy for me, but it's not about me, it's about you and what you need and so we are dedicated to keeping up with all of this technology and making sure that, you know, we are able to use it for people who want ‑‑ who want this type of technology. 

So thank you guys for coming and listening.  I know that's a lot of stuff to hear.  I'm just going to sneak out that door on the side, so if you have any questions, we can ‑‑ oh, we can do questions.  Let's do a couple questions right now.  Julie, did you have a question? 

FROM THE AUDIENCE:  I did.  I can't remember if I remember it now, though (laughter).  If you have really high tinnitus and you get fight‑or‑flight thing from it ‑‑ oh, is that the question I wanted to ask? 

DR. ERIN WRIGHT:  I won't put you on the spot.  I'll just take a couple of questions and if anybody wants to leave, go ahead and then I'll just sneak out the door and we can do more of a one‑on‑one question, if you are ‑‑

FROM THE AUDIENCE:  Can you comment just a little bit on which of the hearing‑aid providers have outlets in different parts of Canada and the U.S.?  Like clinics in different parts of Canada?  I know Connect Hearing does.

DR. ERIN WRIGHT:  Right ‑‑

FROM THE AUDIENCE:  When you're in Canada, you can find Connect Hearing. 

DR. ERIN WRIGHT:  If you're going to go to, like, a big chain store, it would be like any other chain.  Like if you're going to go to ‑‑ you know, there's a ton of examples like that, right?  So you can go to different clinics, but all of these companies provide hearing‑aids all over the world, so if you didn't get your hearing‑aids from a company ‑‑ from a chain company, you can still get them dealt with if you went to Europe or Palm Springs or wherever, because there's only six companies, you know, and clinics all over the world have access to the software and the ability to adjust them for you.  Yeah. 

FROM THE AUDIENCE:  So the warranties ‑‑

FROM THE AUDIENCE:  I'm not hearing the question.

DR. ERIN WRIGHT:  Yeah.  Right.  And in fact I've seen quite a few people in the last year who've come up from Seattle because the hearing‑aids are ‑‑ you know, our premium technology's around 5,000 and they're 8,000 in the U.S., so people come over to see me to get the hearing‑aids, have the initial adjustment and then they're paying for service down there, but the cost of the hearing‑aid is far less here.  It's 8,000 American compared to 5,000 Canadian.  Yeah. 

FROM THE AUDIENCE:  What causes the mumbled nature of your hearing when you're starting to have hearing loss, where you can't hear the words succinctly?

DR. ERIN WRIGHT:  That comes from high‑frequency hearing loss.  So why does it sound mumbly?  It's because you're not catching "s", "f", "th".  So it sounds like people are talking with a sock in their mouth because those sounds are very quiet.  Like an "f", there's nothing to it, it's just air flow.  So when you're only hearing the vowel, you're missing the consonants, you're missing a lot of the clarity, so it is a result of high‑frequency hearing loss.

FROM THE AUDIENCE:  Apparently most of us are not hearing the questions.

DR. ERIN WRIGHT:  I'm sorry, Hal, I'll repeat the questions.  Thanks.

FROM THE AUDIENCE:  Can you comment on which companies are going to support android devices again?  You said there's only one right now.

DR. ERIN WRIGHT:  There's two, Phonak and Unitron are working with that android platform, but my understanding is there's so many different types of platforms, it's difficult, so they're finding it difficult, but I think eventually they'll all break into that market.  But if you're looking for that right away, it would be Phonak or Unitron.  Yeah.  Yeah, Julia.

FROM THE AUDIENCE:  When you have those little tiny in‑the‑canal hearing‑aids, the invisible in‑the‑canal, keeping something like in there that long, does ‑‑ like I don't have wax in my ears, as you know, so I don't have to worry about that, but does it still block humidity or mould grow?

DR. ERIN WRIGHT:  She's wondering if you have those little ones all the time, is it going to be a problem with the health of your ear canal, is it going to get mouldy, and no is the answer, because what they do is they put these little vents, so there's a hole that runs right through the hearing‑aid that allows for normal air in and out and sort of ventilates the ear in that way.

FROM THE AUDIENCE:  But wax? 

DR. ERIN WRIGHT:  It's not bad for wax, because it pushes up against the sebaceous glands of your ear canal and it almost prevents the ear canal from secreting wax, because it's pushing up against those glands.

Thank you guys for coming.  Again I appreciate your attendance, if you have any questions.  (Applause)