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How Clinical Research Validates Hearing Aid Tech Before Launch · Starkey Sound Bites: Hearing Aids, Tinnitus, and Hearing Healthcare

• 0:05
  Dr. Dave Fabry: Welcome to Starkey Soundbites.
• 0:07
  Dr. Dave Fabry: I'm your host, Dave Fabry, Starkey's Chief Hearing Health Officer.
• 0:11
  Dr. Dave Fabry: Now, in addition to making amazing technology, clinical product verification and validation are really essential.
• 0:18
  Dr. Dave Fabry: We the best products, if they don't last in the field or perform in the patient's ears, really aren't uh anything at all.
• 0:26
  Dr. Dave Fabry: And uh so it it gives me great pleasure that we have Dr.
• 0:30
  Dr. Dave Fabry: Maddie Olson with us today, who is our manager of clinical research at Starkey.
• 0:35
  Dr. Dave Fabry: And Maddie, it's a pleasure to work with you on a day-to-day basis for nearly the last five years and uh and to have you on the podcast for the first time.
• 0:43
  Dr. Maddie Olson: Yeah, thank you for having me.
• 0:44
  Dr. Maddie Olson: It's so fun to get to see you every day and talk to you every day.
• 0:47
  Dr. Maddie Olson: And now we get to do it on a live platform.
• 0:49
  Dr. Maddie Olson: How fun is that?
• 0:50
  Dr. Maddie Olson: I know it.
• 0:50
  Dr. Dave Fabry: And so uh, you know, let's just see where this takes us.
• 0:53
  Dr. Dave Fabry: So uh I want to start a little bit about you.
• 0:56
  Dr. Dave Fabry: So I know you were born in St.
• 0:58
  Dr. Dave Fabry: Paul, but then you chose to go to God's country and uh the University of Wisconsin uh for school.
• 1:03
  Dr. Dave Fabry: But talk a little bit about your journey uh through audiology, what brought you here?
• 1:09
  Dr. Dave Fabry: What was the catalyst for uh your interest in audiology?
• 1:13
  Dr. Maddie Olson: Yeah, I think like a lot of us, the journey was not straight and narrow.
• 1:17
  Dr. Maddie Olson: It it went on a pretty winding path.
• 1:20
  Dr. Maddie Olson: I knew in high school at least that I wanted to do something that was working directly with people and I wanted to help people in any way I could kind of think of.
• 1:28
  Dr. Maddie Olson: So at first I was thinking, should I be a lawyer?
• 1:31
  Dr. Maddie Olson: I love justice.
• 1:32
  Dr. Maddie Olson: I love doing what's what's right, and I'm kind of obsessed with that.
• 1:36
  Dr. Maddie Olson: And then I thought about dentistry because I thought my personality would be kind of well suited to making people calm in kind of a situation where they're not very excited to come see me.
• 1:47
  Dr. Maddie Olson: So I could kind of put them at ease and make them feel comfortable while doing a great service for their teeth.
• 1:51
  Dr. Maddie Olson: So that brought me to Marquette University.
• 1:54
  Dr. Maddie Olson: They have a great dental school.
• 1:55
  Dr. Maddie Olson: And it wasn't until probably my first semester that I was like, I don't think I can be working on teeth all day, every day.
• 2:02
  Dr. Maddie Olson: It's it's not my passion.
• 2:03
  Dr. Maddie Olson: So then I started thinking more about how else could I help people?
• 2:08
  Dr. Maddie Olson: And my dad's a teacher.
• 2:09
  Dr. Maddie Olson: So I thought, well, what if I was a teacher?
• 2:11
  Dr. Maddie Olson: I mean, that has a big impact.
• 2:12
  Dr. Maddie Olson: So then I thought about teaching.
• 2:14
  Dr. Maddie Olson: So yeah, very, very windy path we took here.
• 2:17
  Dr. Dave Fabry: Okay, but it but there's a there's a thread.
• 2:19
  Dr. Dave Fabry: There is a thread helping people.
• 2:21
  Dr. Maddie Olson: Yep, exactly.
• 2:22
  Dr. Maddie Olson: And kind of helping people in a one-on-one scenario was what I was getting more and more drawn to versus like a big classroom.
• 2:30
  Dr. Maddie Olson: Um, so then that brought me to speech pathology.
• 2:32
  Dr. Maddie Olson: And I did see a speech pathologist as a child, so I had fond memories of that and thought, what if I could do that for for children or adults across the lifespan?
• 2:41
  Dr. Maddie Olson: And in that path, then I met Dr.
• 2:43
  Dr. Maddie Olson: Patterson at Marquette, and she's a wonderful audiologist, and she really sparked my passion for audiology once we started getting into that course material.
• 2:52
  Dr. Maddie Olson: I was hooked.
• 2:53
  Dr. Maddie Olson: I thought it was just a perfect fit of a lot of you know heart science, but also the art of working with people, getting to know people, getting to know what makes them tick, and being a part of their hearing journey along the way.
• 3:08
  Dr. Maddie Olson: So definitely windy path, but I think where I landed is the perfect spot for me.
• 3:13
  Dr. Dave Fabry: Oh, thank you for sharing that.
• 3:14
  Dr. Dave Fabry: I actually didn't know all of that backstory.
• 3:17
  Dr. Dave Fabry: And so it's a perfect role for you now.
• 3:20
  Dr. Dave Fabry: Um, you've been with Starkey just under five years, correct?
• 3:22
  Dr. Dave Fabry: Yep.
• 3:23
  Dr. Dave Fabry: And then talk about your recent promotion.
• 3:26
  Dr. Maddie Olson: Yeah, yeah.
• 3:27
  Dr. Maddie Olson: So I was recently promoted to manager of clinical product research.
• 3:31
  Dr. Maddie Olson: Um, when I started with Starkey, I was a research audiologist and was doing that for the past four years.
• 3:37
  Dr. Maddie Olson: And I really, really enjoyed that.
• 3:39
  Dr. Maddie Olson: And I think what I enjoyed most was having new team members come on and getting to kind of show them the way.
• 3:46
  Dr. Maddie Olson: It is very much a journey that isn't comfortable for audiologists.
• 3:52
  Dr. Maddie Olson: We're trained in very much a clinical fashion.
• 3:55
  Dr. Maddie Olson: So then to take that leap into research and take that kind of bold leap, I guess, into research and learning in a very different way and working with our patients in a different way takes a lot of mentorship and guidance.
• 4:06
  Dr. Maddie Olson: And I think what I found as we had new team members was that I really liked serving that role and liked, you know, making few people feel comfortable in taking those big steps and helping bolster their confidence along the way.
• 4:20
  Dr. Maddie Olson: So then I had kind of been working with my manager at the time to express my interest in that and my passion for it.
• 4:27
  Dr. Maddie Olson: And the role worked itself out, where now I do get to manage a team of six audiologists.
• 4:32
  Dr. Maddie Olson: So that's been really wonderful.
• 4:34
  Dr. Maddie Olson: Um, most of the team does work on validation.
• 4:37
  Dr. Maddie Olson: I do have some that work specifically and exclusively on post-market work.
• 4:42
  Dr. Maddie Olson: So that's a little different too, and we can get into the nuances of that.
• 4:45
  Dr. Maddie Olson: But all I think are a wonderful team.
• 4:48
  Dr. Maddie Olson: They collaborate together so well.
• 4:50
  Dr. Maddie Olson: We have um PhDs on the team that don't report to me, but we are still one team and we collaborate together so effectively that I sometimes even joke that coming into this role is kind of like a PhD light for audiologists because they do still get to have that mentorship from PhDs on the staff and continue to learn and grow about research throughout their journey at Starkey.
• 5:12
  Dr. Dave Fabry: Yeah, I have to say, just in the relatively short time that you've been in the role, you've made a significant impact in terms of the way you know, and it's interesting, your background then with your um drive for justice, uh, it serves nicely for that verification and validation role of ensuring that once we develop this technology, and it's very easy to become intoxicated by AI and machine learning and DNN now in hearing aids with all of the features and what that brings.
• 5:41
  Dr. Dave Fabry: But we have to constantly remember and remind ourselves it's it's the participants as you refer to them, or patients, as our many of our listeners are working with patients or customers, but but uh participants that um you know talk a little bit about this wealth of um uh resource that we have of people that live in and around the Twin Cities who want to participate in research studies and also have a hearing loss.
• 6:09
  Dr. Maddie Olson: Yeah.
• 6:09
  Dr. Maddie Olson: Yeah, I think that is a huge plus of being in our role, is our participant database.
• 6:15
  Dr. Maddie Olson: We have, I think we're almost up to our 5,000th participant, which is huge.
• 6:20
  Dr. Maddie Olson: And then we have in that database a lot of notes on all of our participants too.
• 6:25
  Dr. Maddie Olson: So if we're looking for someone who's gonna be a tough critic with a new accessory, we can look for that within our database and invite those individuals to come in to put our newest accessory to the test, or people who really love telecoils.
• 6:38
  Dr. Maddie Olson: I mean, those are not, you know, the easiest to find sometimes.
• 6:40
  Dr. Maddie Olson: So having a database where you can look to people who are already familiar with telecoils and loops and want to test them is a huge benefit and really allows us to put our products through a very thorough test with the right participants.
• 6:54
  Dr. Maddie Olson: I think the other thing that's really nice about working with participants too is that you get to choose who you work with too.
• 7:00
  Dr. Maddie Olson: So if you know that someone is going to be just very candid and honest and you are looking for that feedback in an early development process of is this viable, you can seek those individuals out and then build that relationship with them so that they're comfortable telling you what's working, what could be better.
• 7:18
  Dr. Maddie Olson: Um, it's close, but if we made these tweaks, I'd be happier.
• 7:22
  Dr. Maddie Olson: And that doesn't just happen on your first meeting with a patient, as you know.
• 7:27
  Dr. Maddie Olson: You have to really work to get to know that patient, to be open and candid and honest with each other so that they feel comfortable to share what's not working.
• 7:38
  Dr. Maddie Olson: Because of course, they don't want to offend us either if it isn't working well, but that's our job to make sure that it's thoroughly vetted and serving our patients' needs.
• 7:47
  Dr. Dave Fabry: Yeah, we really need clinical research to be the source of truth that sort of ensures that what we think the technology is going to do actually performs that way in the patients here.
• 7:57
  Dr. Dave Fabry: So let's go through a little bit of the, you know, uh definition of the role of clinical research and product validation.
• 8:06
  Dr. Dave Fabry: And uh what does that mean?
• 8:07
  Dr. Dave Fabry: You know, a lot of people may kind of understand it at the top level, but talk a little bit about what it is that your team is responsible for.
• 8:16
  Dr. Maddie Olson: Yeah, so product validation is really the culmination of all of the product development work coming together and serving as like the final product before we launch that product.
• 8:27
  Dr. Maddie Olson: So it should be really everything in its final form before we send it out to our patients and providers.
• 8:35
  Dr. Maddie Olson: And in the process of validating that product, we're looking at user requirements.
• 8:40
  Dr. Maddie Olson: So there's requirements that we have to meet in order to feel good about the product, have confidence in the product, and also from a regulatory standpoint, be able to sell that product with their blessing, of course, and within the regulations.
• 8:55
  Dr. Maddie Olson: So there's lots and lots of user requirements, and they can span from things like sound quality of streaming to how accurately can we match to target, which is a huge thing for audiologist.
• 9:07
  Dr. Maddie Olson: I wouldn't be satisfied if I couldn't match to target effectively.
• 9:11
  Dr. Maddie Olson: Um, so there's lots of things that are very much driven by our provider's needs and our patients' needs.
• 9:17
  Dr. Maddie Olson: And my team focuses a lot more on the patient's needs, but we do think a little bit about the provider's needs too.
• 9:24
  Dr. Maddie Olson: We just can't be the sole deciders on the provider's needs since we are so enmeshed in the development process that we're we're a bit biased.
• 9:34
  Dr. Maddie Olson: So we do also invite external providers, clinicians, audiologists to participate in usability studies and do market research with our product development team and product management team.
• 9:47
  Dr. Maddie Olson: So we do focus a bit on providers, but our main focus is really on the patients, the end users of our product.
• 9:54
  Dr. Maddie Olson: So there's lots of user requirements where I started.
• 9:57
  Dr. Maddie Olson: There's also some very specific things we have to measure from a regulatory standpoint.
• 10:02
  Dr. Maddie Olson: We have to make sure our products are safe.
• 10:05
  Dr. Maddie Olson: We have to make sure they're effective.
• 10:07
  Dr. Maddie Olson: We have to make sure that the benefit that they provide our patients is meaningful and is um equivalent to what's on the market.
• 10:15
  Dr. Maddie Olson: So it can't just be, you know, it can't be worse than what's on the market, of course.
• 10:21
  Dr. Maddie Olson: And of course, we wouldn't want it to be either.
• 10:23
  Dr. Maddie Olson: But from a regulatory standpoint and from our own interest, we would never launch something that was worse than our predecessor or from what's on the market.
• 10:29
  Dr. Maddie Olson: But that is interesting, that is part of the regulations as well.
• 10:32
  Dr. Maddie Olson: And then there's a lot of other things too that go into validation that aren't necessarily needed for validation, but validation would be not as robust without it.
• 10:42
  Dr. Maddie Olson: Right.
• 10:43
  Dr. Maddie Olson: So we also are looking at new features.
• 10:45
  Dr. Maddie Olson: When there's a new feature, that's where we get to have a lot of fun with developing that test protocol and then putting that feature through its paces.
• 10:53
  Dr. Maddie Olson: And when we're developing those protocols, we try to strike a pretty good balance of things that we can do with our fancy setup and with our industry know-how to really put that feature through its paces.
• 11:05
  Dr. Maddie Olson: But we also try to come up with ideas that you can do in your clinic to replicate what we've found in clinical research.
• 11:13
  Dr. Maddie Olson: So that would involve things like trying to use just one speaker from time to time for, you know, co-located quickson testing.
• 11:20
  Dr. Maddie Olson: Or maybe we'd use two speakers.
• 11:22
  Dr. Maddie Olson: If your sound booth has two, you could replicate that as well to look at the the Qixen with noise behind you at 180 degrees.
• 11:30
  Dr. Dave Fabry: Sure.
• 11:30
  Dr. Maddie Olson: So it is a delicate balance of wanting to do really rigorous research protocols as well as things that you can replicate in your own clinic.
• 11:38
  Dr. Dave Fabry: So there's a lot there.
• 11:39
  Dr. Dave Fabry: Yeah.
• 11:41
  Dr. Maddie Olson: I'm rambling.
• 11:41
  Dr. Maddie Olson: No, no, no, not at all.
• 11:43
  Dr. Dave Fabry: Between the regulations and then just ensuring that the devices do what we think they do.
• 11:47
  Dr. Dave Fabry: Um, you know, I think a couple things.
• 11:50
  Dr. Dave Fabry: Um, in the last decade, um uh CR has changed in the sense that many practitioners feel the same burden with Bluetooth connectivity and smartphone connectivity to hearing aids.
• 12:01
  Dr. Dave Fabry: Many feel like they have to be a Geek Squad member or Apple Genius and our CR team, thinking about even before it comes out to market, you know, in many cases, as you said, it's the final firmware ready to go, but but you also are specifically looking for any sorts of things that aren't ready to go.
• 12:18
  Dr. Dave Fabry: And and and the team has really critical, a critical role in uncovering those things.
• 12:23
  Dr. Dave Fabry: But but the connectivity issue has uh to the app has been a big deal.
• 12:27
  Dr. Dave Fabry: And then Starkey really, since um the time that you've been here, we've had a a significant focus, probably a unique focus in our space on the health and wellness features.
• 12:37
  Dr. Dave Fabry: Things like balance, which I only half kiddingly say many audiologists forget that hearing and balance are part of their the top of their scope of practice when they leave school, but they end up focusing almost exclusively on hearing, whether it's pediatric or adult or geriatric populations.
• 12:53
  Dr. Dave Fabry: That balance component has really been central to a lot of the work that there's been a really nice thread from all the way from fall detection to balance risk assessment to uh balanced training exercises.
• 13:05
  Dr. Dave Fabry: But how do you evolve your team to consider the scope of practice, not only for the audiologists that we're having on your team, but then reflecting how the market's going to adapt to that?
• 13:19
  Dr. Maddie Olson: We do find ourselves specializing a little bit too.
• 13:22
  Dr. Maddie Olson: So on our team, we have a couple individuals that do really kind of specialize in falls and balance, Justin Burwinkle, who's been on the show before.
• 13:30
  Dr. Maddie Olson: Um, so having individuals that can be both kind of well-rounded but jump into that specialty when needed has been really critical to our team's success.
• 13:40
  Dr. Maddie Olson: We need a well-rounded team, but also a team that can kind of explore their passions too, because we know that when you're able to kind of do those passion projects, you're just happier overall, too.
• 13:50
  Dr. Maddie Olson: Um, so I think having a really well-rounded team with specialties kind of woven in as well has been really integral to the success of our team.
• 14:00
  Dr. Maddie Olson: Um, and I think we've done quite a bit of work too, as you know, a clinical research team, but as Starkey as a whole, too, to really be thinking more about the whole health initiative and trying to dive into the research a bit more about how falls might impact hearing loss or how they're they're related.
• 14:20
  Dr. Maddie Olson: Um, and looking at um things like loneliness or social isolation, um, depression.
• 14:28
  Dr. Maddie Olson: And we've been incorporating more and more whole health initiative questionnaires into our surveys too, and our validations or other studies, so that we can really learn a little bit more about our participants and build up kind of a wealth of information where we can start to look at correlations and dive into how some of these things might be related.
• 14:49
  Dr. Maddie Olson: So eventually we can use that information to better help our patients too.
• 14:53
  Dr. Dave Fabry: For sure.
• 14:54
  Dr. Maddie Olson: So I think, yeah, we really do try to not just be so narrow-minded in the hearing initiative, but thinking about balance and thinking about psychosocial outcomes too, and how that really is meaningful for our patients and our providers.
• 15:07
  Dr. Dave Fabry: Yeah, let's let's talk even just from a higher level, like for Omega AI, for example.
• 15:12
  Dr. Dave Fabry: Give us an example of um how many uh participants uh were in the studies that came out, you know, that we conducted internally before we launched the product.
• 15:24
  Dr. Dave Fabry: Uh you mentioned, you know, we do laboratory testing, we do in the field and questionnaires.
• 15:28
  Dr. Dave Fabry: Um, how did you go about designing the study?
• 15:32
  Dr. Dave Fabry: Which groups within the organization do you work with to design the studies that we're going to do for purposes of verification and validation?
• 15:40
  Dr. Maddie Olson: Yeah, that's a great question.
• 15:41
  Dr. Maddie Olson: Off the top of my head, I don't know how many were in the Omega AI studies.
• 15:45
  Dr. Maddie Olson: I know in the validations we had at least 50, but I know there were tons that led up to feature development studies before we even got to the validation.
• 15:55
  Dr. Maddie Olson: Um, I wish I knew that number off the top of my head.
• 15:58
  Dr. Maddie Olson: That's okay.
• 15:58
  Dr. Maddie Olson: It's a big one, I bet.
• 15:59
  Dr. Maddie Olson: Um, so that that's one piece of it is just determining how many participants we need.
• 16:04
  Dr. Maddie Olson: And we do that with power analyses, of course, to make sure that we're sufficiently powered with the outcome measures we've chosen.
• 16:10
  Dr. Maddie Olson: And then when we're designing the study, it is very much a cross-functional effort.
• 16:16
  Dr. Maddie Olson: So we work very closely with audio systems, with software, firmware I work closer with than I ever thought I would as an audiologist.
• 16:25
  Dr. Maddie Olson: And they're a great resource for us.
• 16:28
  Dr. Maddie Olson: Um, we'll also work with the advanced development team who kind of helps develop the features.
• 16:33
  Dr. Maddie Olson: They've been very critical in engineering the feature before it gets into our hands.
• 16:37
  Dr. Maddie Olson: So they have a lot of information to share with us that's useful in either developing the test or just knowing what to kind of look out for from the field when they do come back with feedback.
• 16:50
  Dr. Maddie Olson: Um, so that's a huge piece of who's involved in the development.
• 16:54
  Dr. Maddie Olson: And then from there, we kind of look at the the scope of the project to determine how many sessions we might need.
• 17:01
  Dr. Maddie Olson: And in general, for validation, we have at least four, and each of them is two hours.
• 17:07
  Dr. Dave Fabry: So it's it's a lot of time that's and these participants do this for maybe a little bit of gas money, but that's that's pretty much it.
• 17:15
  Dr. Dave Fabry: They're doing it because they want to give back the you know, they also, I think there's a persona of people that really want to know what's coming out, what's the future.
• 17:24
  Dr. Dave Fabry: And of course, I love working with patients like that, where they're strongly motivated.
• 17:28
  Dr. Dave Fabry: They say, I don't care about the stigma associated with hearing is, I want what, where's the leading edge going and and that volunteer spirit, if you will, where they're willing to spend those kind of hours participating on this, knowing full well that you know, these are products under development and they're IRB approved and all of this.
• 17:48
  Dr. Dave Fabry: Yeah.
• 17:49
  Dr. Dave Fabry: But but first and foremost, do no harm is is serves the same for you as it does for other healthcare professionals.
• 17:54
  Dr. Maddie Olson: Yeah, absolutely.
• 17:55
  Dr. Maddie Olson: So we do have to ensure that our products are safe and effective, even in those early development stages.
• 18:02
  Dr. Maddie Olson: And that's all reflected in our submission to the Institutional Review Board.
• 18:06
  Dr. Maddie Olson: Um, and we talk about that with our patients too when we go through the consent form.
• 18:10
  Dr. Maddie Olson: We make sure that they know that these products are unreleased and there may be risks that we don't know about.
• 18:16
  Dr. Maddie Olson: We don't encounter risks that we don't know about, but we have to inform them that, you know, this is not a fully vetted released product yet.
• 18:24
  Dr. Maddie Olson: And they then have to put our their trust in us to know that it's it's safe and um they're willing to try it, even though it is not a fully formed product yet sometimes.
• 18:35
  Dr. Dave Fabry: Yeah, let's let's go a little deeper into sort of some of the the test measures.
• 18:39
  Dr. Dave Fabry: Like you said, there's a lot of the the the idea of best practice is something relevant to clinical audiologists out there, thinking about what measures are the the most uh useful for determining if a patient is receiving benefit?
• 18:54
  Dr. Dave Fabry: Are they are they getting accessories if they need them?
• 18:57
  Dr. Dave Fabry: Um, you know, and and you're in the catbird seat of really being able to see what new measures are out there that are provide are exciting to you for even the transition from your role into clinical audiology.
• 19:10
  Dr. Dave Fabry: So, right now, what would be one clinical measure uh or that you're using in the verification validation studies that you would say, boy, clinical audiologists should consider something like this?
• 19:22
  Dr. Maddie Olson: So the the AFAB, the abbreviated profile of hearing aid benefit, that is a questionnaire that we use almost every validation.
• 19:29
  Dr. Maddie Olson: And Cox.
• 19:30
  Dr. Maddie Olson: Yeah, it's a great survey.
• 19:33
  Dr. Maddie Olson: Um you do have to be careful sometimes that they understand the directions and make sure that they're filling it out correctly.
• 19:39
  Dr. Maddie Olson: But once you've got that sorted, it is an excellent tool for measuring aided benefit.
• 19:44
  Dr. Maddie Olson: And we use it to compare to normative data as well.
• 19:47
  Dr. Maddie Olson: So if you're curious, either the benefit score or the aided performance, how does that match up against normative data?
• 19:54
  Dr. Maddie Olson: You can look that up on the Harl website and see how that compares to normative data.
• 20:01
  Dr. Maddie Olson: So that's been a huge tool for us and one that is clinically available.
• 20:04
  Dr. Maddie Olson: I know when I was in clinic, I would use it, not super routinely, um, but one that we use all the time and really do enjoy.
• 20:12
  Dr. Maddie Olson: In another survey out of that same lab, um, the doso, I had never used in clinic, but I do feel like it's an excellent survey for just looking at hearing aid benefit.
• 20:22
  Dr. Maddie Olson: So that's the device-oriented subjective outcome or doso.
• 20:26
  Dr. Maddie Olson: And that kind of breaks down benefit into different categories.
• 20:30
  Dr. Maddie Olson: So you have like listening effort, speecues, convenience, and just looking through how they're performing.
• 20:37
  Dr. Maddie Olson: You do see pretty immediately some trends on the form depending on the individual and what they're struggling with.
• 20:44
  Dr. Maddie Olson: And that's really helpful.
• 20:45
  Dr. Maddie Olson: And we often do administer that with their own hearing aids and the test hearing aids to see how we compare to what they're currently using.
• 20:53
  Dr. Maddie Olson: So that's been another really helpful tool.
• 20:55
  Dr. Maddie Olson: So for questionnaires, those are two that we really enjoy using.
• 20:59
  Dr. Maddie Olson: The hearing handicap inventory too is a classic that we we use pretty routinely too.
• 21:05
  Dr. Maddie Olson: And then for some outcome measures, we use things like the Quixen, which is very nice because many clinicians have access to that in their audiometers.
• 21:14
  Dr. Maddie Olson: And that provides just a very quick measure of their S and R loss or how they're performing in noise, what their detriment is in noise.
• 21:22
  Dr. Dave Fabry: You know, Mead Killian developed that and he died last year and was a good friend.
• 21:27
  Dr. Dave Fabry: But uh when I was still at Mail Clinic uh in the 90s, we participated in the team that helped establish the initial the the original sin, I guess you could call it.
• 21:37
  Dr. Dave Fabry: Mead always had a great sense of humor about things like that.
• 21:39
  Dr. Dave Fabry: Yeah, the quick sin.
• 21:40
  Dr. Dave Fabry: But uh and then Robin improved it with the R sin even further.
• 21:44
  Dr. Dave Fabry: But um, you know, it's something that is clinically efficacious.
• 21:48
  Dr. Dave Fabry: Uh I think everyone knows that speech and noise is a useful advance from what they do, but it seems like still many people are still doing that speech in quiet measurement.
• 21:59
  Dr. Dave Fabry: What you're saying is that it's useful for uh accessories, I think I heard you say earlier, and then even also just to look at how difficult, how compromised is a person in a noisy environment, and then of course, does the technology assist?
• 22:13
  Dr. Maddie Olson: Exactly.
• 22:14
  Dr. Maddie Olson: So looking at that aided benefit too is very, very helpful.
• 22:17
  Dr. Dave Fabry: One one kernel to sort of get people to start recognizing and act on it.
• 22:21
  Dr. Dave Fabry: Matt Fitzgerald shares this passion too.
• 22:23
  Dr. Dave Fabry: He's picked up the charge, I think, with data.
• 22:25
  Dr. Dave Fabry: And I think that's what you can come with too.
• 22:27
  Dr. Dave Fabry: Yeah, exactly.
• 22:28
  Dr. Dave Fabry: That's from the the benefit of evidence basis.
• 22:30
  Dr. Dave Fabry: One of the areas that I'm kind of intrigued by because your team has been working with ecological momentary assessment measures over the last few years.
• 22:38
  Dr. Dave Fabry: And I think it's a really nice way to augment what you do in laboratory testing.
• 22:43
  Dr. Dave Fabry: And the clinical parallel to this is many times working with patients, you know, they come back and maybe they come back by themselves or with a family member, and you say, How are you doing?
• 22:52
  Dr. Dave Fabry: Where are situations where you still need to do better?
• 22:54
  Dr. Dave Fabry: Where are you doing well?
• 22:55
  Dr. Dave Fabry: And you're really taxing their memory.
• 22:57
  Dr. Dave Fabry: And many times if patients are alone, they can't remember.
• 23:01
  Dr. Dave Fabry: Family member may be a little helpful.
• 23:04
  Dr. Dave Fabry: But talk about what is ecological momentary assessment?
• 23:07
  Dr. Dave Fabry: How are you using it?
• 23:09
  Dr. Dave Fabry: And do you think that it has uh relevance to not only the work you're doing, but also clinical world?
• 23:15
  Dr. Maddie Olson: Yeah, I think right now the benefit is primarily in the research world, but I think it could have some implications for how we work in clinic too.
• 23:24
  Dr. Maddie Olson: Um, so ecological momentary assessment is generally an app-based measurement where if you're in a certain environment and it's using the hearing aid data log to look at the environment and the classification of that environment, if it detects that it's noisy and it's you're hoping to learn more about a noisy environment, which we often are, that's an environment that our patients, you know, will always kind of still struggle in.
• 23:47
  Dr. Maddie Olson: It's a difficult environment even with normal hearing.
• 23:49
  Dr. Maddie Olson: So if that's the environment you're targeting, the EMA app can notify the patient, hey, you're in this noisy environment, let's go through a survey together.
• 23:58
  Dr. Maddie Olson: And we try to keep it so that it's not so burdensome that they're getting notified 15 times a day.
• 24:04
  Dr. Maddie Olson: Um, but we also try to keep it so that the survey is brief enough that if it were 15 times a day, maybe they'd still go through the measurement together.
• 24:12
  Dr. Maddie Olson: And that really gives us an indication of that environment and in the moment, what that patient is feeling in that environment, which then really removes that recall bias, like you were talking about.
• 24:25
  Dr. Maddie Olson: Um, it also really gives us a way to know how often are people in those noisy environments.
• 24:30
  Dr. Maddie Olson: If they're not often getting surveys because they're not in environments that are that noisy, then that's an important indication too of just the daily environments that your patient finds themselves in.
• 24:41
  Dr. Maddie Olson: And I think the one thing that we could probably leverage for this to be more meaningful for clinicians is really just a more robust data log in the hearing aids.
• 24:53
  Dr. Maddie Olson: Like if we do have a better understanding of when an environment is noisy and what that patient is doing to interact with their hearing aids in that environment, I think that would be really helpful.
• 25:05
  Dr. Maddie Olson: Because we know too, a lot of the time when patients need adjustments, they don't need adjustments for every single environment.
• 25:13
  Dr. Maddie Olson: They generally come back with a complaint of this specific restaurant or this one Starbucks I go to.
• 25:20
  Dr. Maddie Olson: So if we could also get some better detail of what they're doing and when they're doing it, it allows us to better fine-tune the hearing aids too.
• 25:30
  Dr. Maddie Olson: So if I'm accidentally, because they haven't told me all the details, increasing gain across the board, but they only need it situationally, then I'm not best serving that patient.
• 25:40
  Dr. Maddie Olson: So using something more like an advanced data logger, I think, is probably a future direction.
• 25:45
  Dr. Dave Fabry: I just it kills me that um, you know, I think a lot of clinicians don't really take advantage of what the manufacturers.
• 25:52
  Dr. Dave Fabry: I'll speak from Starkey's perspective, what we're reporting in the data logging.
• 25:56
  Dr. Dave Fabry: Right.
• 25:56
  Dr. Dave Fabry: Even ProFit, whenever you're fitting a patient with ProFit and they come back after the initial fitting, data log, the data log screen is what populates first when you read in the data.
• 26:06
  Dr. Dave Fabry: And uh obviously people are looking to see hours of daily use.
• 26:10
  Dr. Dave Fabry: And I will tell you, as somebody who was practicing in the ple previous millennium, you know, we often inferred that if someone was using their hearing aids 10 hours a day, that was pretty good.
• 26:19
  Dr. Dave Fabry: They were likely satisfied.
• 26:21
  Dr. Dave Fabry: But I can tell you the people that I'm working with now increasing their 15, 16 hours a day, which is amazing.
• 26:27
  Dr. Dave Fabry: But there's so much more in data logging that people are just, you know, not paying attention to.
• 26:33
  Dr. Dave Fabry: One recent change that came about with Omega AI is now we uh in addition to looking at volume control adjustments, program adjustments, I've been somebody that's champion championing uh the use of the personal program plus edge mode, but we haven't been able to see in data log how many times are people activating edge mode.
• 26:53
  Dr. Dave Fabry: That was again just requiring the bias from how many times a person could remember that they did it.
• 26:59
  Dr. Dave Fabry: But now we can see in data logging um how many times are they activating edge mode.
• 27:05
  Dr. Dave Fabry: And then if you scroll down to the what I said, the second page of Google on the bottom of data log, uh many people never go down there, but you see, according to the different acoustic classes where they're finding themselves on a daily basis, right?
• 27:17
  Dr. Dave Fabry: There's a there's a wealth of information there.
• 27:19
  Dr. Dave Fabry: So one thing's on the burden on us to produce more useful data that clinicians could use, that you could use in your research team.
• 27:29
  Dr. Dave Fabry: But I I think in many cases, your team is a great crucible for the clinical environment.
• 27:35
  Dr. Dave Fabry: But we have to get the message out there that there's a wealth of information in data logging.
• 27:39
  Dr. Maddie Olson: Yeah.
• 27:40
  Dr. Dave Fabry: And but people have to use it, otherwise, we're not gonna work on it.
• 27:43
  Dr. Maddie Olson: Right, right.
• 27:43
  Dr. Maddie Olson: And you it has to be used in conjunction with your patients' reports, too.
• 27:47
  Dr. Maddie Olson: But I think that's where maybe a more advanced data logger could really help with that too.
• 27:53
  Dr. Maddie Olson: Like we had a poster at the American Auditory Society last year.
• 27:56
  Dr. Dave Fabry: Just going there.
• 27:57
  Dr. Maddie Olson: Yeah, where we were looking at um two different groups of patients within a validation.
• 28:01
  Dr. Maddie Olson: One who had some volume-related complaints and often they were situational, like maybe too soft when I'm talking to my granddaughter or too loud at this one restaurant I go to.
• 28:11
  Dr. Maddie Olson: And then another group that didn't really request any fine-tuning adjustments.
• 28:15
  Dr. Maddie Olson: And then we looked through to see how often each group was making volume-related adjustments, and they both were almost equally, which was kind of interesting too.
• 28:24
  Dr. Maddie Olson: So then it kind of makes you wonder: are there some that would rather not tinker?
• 28:29
  Dr. Maddie Olson: So they're reaching out to you because they need some assistance so that they don't have to tinker anymore.
• 28:34
  Dr. Maddie Olson: And then that other group that wasn't really complaining but was still tinkering, did they enjoy that or was it more of a personality thing?
• 28:40
  Dr. Maddie Olson: Like, did they not feel comfortable raising that to their audiologist?
• 28:44
  Dr. Maddie Olson: So that was a really interesting finding for us.
• 28:46
  Dr. Maddie Olson: And I think there were, you know, lots of future directions that we could go with that data.
• 28:50
  Dr. Maddie Olson: But just the first inkling was I think there's there's more to this.
• 28:54
  Dr. Dave Fabry: Absolutely.
• 28:55
  Dr. Dave Fabry: And I can tell you as somebody, you know that I still see patients uh post-market, post uh launch.
• 29:01
  Dr. Dave Fabry: Um, and and I would say the I would say the majority of patients want to set it and forget it.
• 29:07
  Dr. Dave Fabry: The way you put your glasses on in the morning, yeah.
• 29:09
  Dr. Dave Fabry: Maybe you put sunglasses on when you go outside, maybe not.
• 29:12
  Dr. Dave Fabry: But um, I've got many patients who don't want to tinker with the volume control, just want to put it in in their ears and go, I can talk to them till I'm blue in the face about edge mode and what it can do to optimize in noise or uh quiet or challenging environments.
• 29:25
  Dr. Dave Fabry: And um, and they'll say, No, I I'm comfortable, I just put them in, I wear them 16 hours a day, I don't tinker with them and and I'm happy.
• 29:32
  Dr. Dave Fabry: And then others who just have an inherent personality train to want to fiddle with them a little bit, and that that'd be more mean.
• 29:38
  Dr. Dave Fabry: Yeah, me too.
• 29:39
  Dr. Dave Fabry: And but but that's again part of this issue with the participants that you're selecting.
• 29:45
  Dr. Dave Fabry: You need to get a broad uh uh response, a broad inclusion.
• 29:49
  Dr. Dave Fabry: And do you take that into consideration when you're when you're developing studies?
• 29:53
  Dr. Dave Fabry: We do.
• 29:54
  Dr. Maddie Olson: We do.
• 29:54
  Dr. Maddie Olson: We look for a broad age range, especially if the study is pretty large, then we're able to do that more effectively.
• 30:00
  Dr. Maddie Olson: And we also look at a variety of hearing loss severities too.
• 30:04
  Dr. Maddie Olson: So we try to make sure that we're testing the L receiver up through the UP receiver to make sure we've got good representation there and good representation of the different severities of losses, because we don't always see the same benefit across the variety of losses.
• 30:19
  Dr. Dave Fabry: People don't realize there's what looks very smooth on the surface, there's a lot of paddling that's going on underneath the water.
• 30:26
  Dr. Dave Fabry: Yeah.
• 30:26
  Dr. Dave Fabry: With trying to consider all degrees of hearing loss and the hardware changes and firmware changes that come with that, um, the personality types.
• 30:34
  Dr. Dave Fabry: Yeah, all of that needs to come into consideration.
• 30:37
  Dr. Dave Fabry: And like I said, I am really impressed by the team that you've assembled with their skill sets.
• 30:45
  Dr. Dave Fabry: Uh, you have a group of specialty generalists, some team members like Justin that are working and passionate about vestibular Jingjing, has been particularly interested in EMA for a long time and on and on.
• 30:58
  Dr. Dave Fabry: But your entire team, I could go through and just look, they they all can do it, you know, they have some area that that they're really passionate about.
• 31:07
  Dr. Dave Fabry: And I agree with you as somebody that's managed teams before, that if you can put someone and channel them into something they're good at, that they love to do, that makes an impact on your team, uh, and that we need, um, it's always best for everybody.
• 31:20
  Dr. Dave Fabry: Yeah.
• 31:20
  Dr. Dave Fabry: But then sometimes we all have to do things that we that aren't our passion, but but help ensure that we're moving the ball forward.
• 31:28
  Dr. Dave Fabry: And so that's the hard part of management.
• 31:30
  Dr. Dave Fabry: And I think you're doing it greatly.
• 31:31
  Dr. Dave Fabry: Well, thank you.
• 31:32
  Dr. Maddie Olson: Thank you.
• 31:33
  Dr. Maddie Olson: We just had an interview too, and it was so interesting to hear from that interviewee or interviewer, interviewee.
• 31:40
  Dr. Maddie Olson: Interviewee, yeah, yeah.
• 31:41
  Dr. Maddie Olson: Um, that he was saying, I feel like I have an interest in talking to each person on your team about something very specific to them.
• 31:50
  Dr. Maddie Olson: Like everyone has kind of their own thing that they're interested in and they're passionate about.
• 31:54
  Dr. Maddie Olson: And that was really reaffirming to hear that back.
• 31:56
  Dr. Maddie Olson: So I was like, you know what, I totally agree.
• 31:58
  Dr. Maddie Olson: There's people that I go to on the team for things that are related to EMA, or maybe like a sound-related complaint.
• 32:05
  Dr. Maddie Olson: There's some people on the team that are just really, really good at parsing that apart.
• 32:10
  Dr. Maddie Olson: And I'll even call them into my appointments sometimes to be like, I don't think I'm understanding this musician's complaint correctly.
• 32:16
  Dr. Maddie Olson: Like, what are you thinking?
• 32:17
  Dr. Maddie Olson: And I think that's really the beauty of our team is just how um we have kind of different specialties, but we also collaborate together so effectively.
• 32:26
  Dr. Maddie Olson: And we're never really afraid to say, you know, I'm actually not sure.
• 32:30
  Dr. Maddie Olson: Let me go get someone that is.
• 32:32
  Dr. Maddie Olson: So I feel like that's really the the beauty of the team is just how effectively we collaborate.
• 32:37
  Dr. Dave Fabry: And you guys are really uh just a silent force that is essential to ensuring that when we develop this technology, that it it continues working out in the field.
• 32:45
  Dr. Dave Fabry: Yeah.
• 32:46
  Dr. Dave Fabry: I also really I was I'm glad you brought up the Auditory Society poster sessions.
• 32:50
  Dr. Dave Fabry: You know, sometimes we're not going to publish material where there's uh IP involved, where we don't want to kind of tip our hand before it's too early before we're ready to come to market.
• 33:02
  Dr. Dave Fabry: But your team has also been very active in terms of publishing when we can, that is a benefit to clinical audiology, to other research, and elevating the field and scope of practice.
• 33:12
  Dr. Dave Fabry: So grateful for that too.
• 33:14
  Dr. Dave Fabry: So in closing, because we're out of time as usual, but so you talked a little bit about your circuitous pathway to audiology.
• 33:23
  Dr. Dave Fabry: Um, would you do it again?
• 33:25
  Dr. Maddie Olson: I would.
• 33:25
  Dr. Maddie Olson: I would.
• 33:26
  Dr. Maddie Olson: I think there's more possibilities for audiologists than we think.
• 33:31
  Dr. Maddie Olson: Like when I was in school, I had no idea I could be doing this today.
• 33:35
  Dr. Maddie Olson: And like, how cool is this job?
• 33:37
  Dr. Maddie Olson: I mean, I'm obviously biased because I do it and love it, but I I think there's more possibility than I even imagined, and I'm forever grateful for that.
• 33:46
  Dr. Maddie Olson: And I do try to go back to my alma mater now and explain what I'm doing and get some interest there too.
• 33:51
  Dr. Maddie Olson: Because I do think that there's a little bit of a lack of representation of this role that audiologists can serve in industry and elsewhere too, but especially in industry.
• 34:01
  Dr. Maddie Olson: So yeah, I'm very passionate about that.
• 34:03
  Dr. Dave Fabry: So, what bit of advice now that you're a few years out of school, not not nearly as many as many, but uh what advice would you give for young professionals who are currently in their program or just new graduates that that you, from the benefit of a number of years of experience now, could um could provide to them?
• 34:23
  Dr. Maddie Olson: Yeah, that's a really good question.
• 34:24
  Dr. Maddie Olson: I think one bit of advice would be to really not sell yourself short.
• 34:30
  Dr. Maddie Olson: When I was initially applying to this role, I kind of felt like, well, what could they want with an audiologist?
• 34:35
  Dr. Maddie Olson: You know, like I I'm not a PhD.
• 34:37
  Dr. Maddie Olson: How would I do this kind of work?
• 34:39
  Dr. Maddie Olson: And then as I got to know the team in the interview process, it was like, oh, no, of course they need audiologists.
• 34:44
  Dr. Maddie Olson: We are the customers of Starkey, but we're the first customers now before it gets to our customers.
• 34:51
  Dr. Maddie Olson: So having really a keen clinical eye in clinical research, it's a lot of clinicals, is really um important.
• 35:00
  Dr. Maddie Olson: We couldn't really launch products without people like my team.
• 35:05
  Dr. Maddie Olson: So I think in a in a nutshell, the advice would really just be be brave, try things that seem a little bit scary because you'll be shocked how much you can learn and just shocked how well you can exceed when you're stretching yourself a little bit.
• 35:19
  Dr. Dave Fabry: Great advice, Matty.
• 35:20
  Dr. Dave Fabry: Thank you very much for joining us today on the podcast.
• 35:22
  Dr. Dave Fabry: And uh for our listeners, um, if you like this, uh subscribe, share with any friends that you think this might be of value to.
• 35:31
  Dr. Dave Fabry: Um, and um, you know, we look forward to seeing and hearing you again very soon.
• 35:36
  Dr. Dave Fabry: And uh, we want to continue to provide content that help you and your patients hear better and live better.
• 35:42
  Dr. Dave Fabry: See you next time.