New Research from BHINew Research from BHI(Methods of Promoting Your Practice) (Methods of Promoting Your Practice)

Sergei Kochkin, PhD.Sergei Kochkin, PhD.

AgendaAgenda• Update of Best Practices – impact of hearing aids on Update of Best Practices – impact of hearing aids on

quality of lifequality of life• Impact of hearing aids on income and employmentImpact of hearing aids on income and employment• Economics of verification and validation on private Economics of verification and validation on private

practicespractices• Positive impact of mini-BTEs on the marketPositive impact of mini-BTEs on the market• Prevalence of tinnitus and treatment efficacyPrevalence of tinnitus and treatment efficacy• If time:If time:

– Validation of the BHI Quick Hearing Check Validation of the BHI Quick Hearing Check – Impact of direct mail and PSAP on private practicesImpact of direct mail and PSAP on private practices

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PromotionPromotion• Goal to leverage positive research findings from Goal to leverage positive research findings from

non-profit BHI to promote your practice.non-profit BHI to promote your practice.

• Redesign of HHP section on BHI website to make Redesign of HHP section on BHI website to make resources more accessibleresources more accessible

• Our general design for campaignsOur general design for campaigns– National press releaseNational press release– Customizable press release for audiologistsCustomizable press release for audiologists– Media handout or backgrounderMedia handout or backgrounder

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New HHP Resource SectionNew HHP Resource Sectionwww.betterhearing.org/professionals

Benefit & Quality of Life Changes Benefit & Quality of Life Changes Associated with Hearing Aid UsageAssociated with Hearing Aid Usage

June 2011 June 2011

Hearing JournalHearing Journal

MethodMethod• Consumers rated on 0-100% scale hearing Consumers rated on 0-100% scale hearing

handicap improvement in 10 acoustic handicap improvement in 10 acoustic environments due to their hearing aids.environments due to their hearing aids.

• Consumers rated 14 QOL changes in their Consumers rated 14 QOL changes in their life due to hearing aids life due to hearing aids

• N=1,900 for hearing aids <= 4 yrs of ageN=1,900 for hearing aids <= 4 yrs of age

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Hearing handicap improvement (%) Hearing handicap improvement (%)

Mean = 55%

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Hearing handicap improvement (%) for the Hearing handicap improvement (%) for the U.S. population in 10 listening situations U.S. population in 10 listening situations

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Quality of life changes attributed to hearing Quality of life changes attributed to hearing aid usage by hearing aid ownersaid usage by hearing aid owners

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Quality of life changes attributed to hearing aid usage Quality of life changes attributed to hearing aid usage 75% of hearing aid owners experience improvement in 75% of hearing aid owners experience improvement in

at least 1 of 14 QOL issues.at least 1 of 14 QOL issues.

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Consumer satisfaction with QOL changes attributed to Consumer satisfaction with QOL changes attributed to hearing aid usagehearing aid usage

8 of 10 people are satisfied with QOL changes in their life due 8 of 10 people are satisfied with QOL changes in their life due to hearing aids.to hearing aids.

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Hearing handicap improvement (%) segmented by Hearing handicap improvement (%) segmented by composite best practices ranking scored in percentiles composite best practices ranking scored in percentiles

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QOL changes attributed to hearing aids by hearing aid QOL changes attributed to hearing aids by hearing aid owners segmented by composite best practices owners segmented by composite best practices

ranking scored in percentilesranking scored in percentiles

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Overall consumer success (mean=5, std=2) by level of Overall consumer success (mean=5, std=2) by level of composite best practices ranking scored in percentiles composite best practices ranking scored in percentiles

Highly vulnerable to disruptive technologies: over-the-counter, direct-mail and personal sound amplifierProducts (PSAP)

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SummarySummary• The average benefit The average benefit (hearing handicap improvement)(hearing handicap improvement) achieved achieved

by patients with recent hearing aid technology is 55%.by patients with recent hearing aid technology is 55%.• The upper bounds of hearing handicap improvement may be in The upper bounds of hearing handicap improvement may be in

the 65-70% range.the 65-70% range.• Wireless revolution and inductive looping should improve this Wireless revolution and inductive looping should improve this

figure.figure.• 75% patients report at least one area of their life was improved 75% patients report at least one area of their life was improved

through wearing hearing aids.through wearing hearing aids.• 8 out of 10 hearing aid users are satisfied with the changes that 8 out of 10 hearing aid users are satisfied with the changes that

have occurred in their lives due to hearing aidshave occurred in their lives due to hearing aids• 9 out of 10 patients are projected to experience significant 9 out of 10 patients are projected to experience significant

improvements in their QOL once they experience a 70% improvements in their QOL once they experience a 70% reduction in their hearing handicap.reduction in their hearing handicap.

• Strong relationship between quality hearing healthcare, benefit Strong relationship between quality hearing healthcare, benefit and quality of life improvementsand quality of life improvements

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PromotionPromotion

• Use the positive findings of Use the positive findings of hearing aids and quality of life in hearing aids and quality of life in your press releases to promote your press releases to promote your practice.your practice.

• http://www.betterhearing.org/professionals/public_relations_campaigns.cfm– Under 2011 customer satisfaction Under 2011 customer satisfaction

campaigncampaign– Local press releaseLocal press release– Backgrounder for mediaBackgrounder for media

• See how other audiologists are See how other audiologists are using our material – sample media using our material – sample media clippings.clippings. 16

Efficacy of Hearing Aids in Achieving Efficacy of Hearing Aids in Achieving Compensation Equity in the Compensation Equity in the

WorkplaceWorkplace

The Hearing JournalThe Hearing Journal

October 2010October 2010

Update of 2005 studyUpdate of 2005 study• What is the mitigating impact of hearing aids on What is the mitigating impact of hearing aids on

income for income for hearing aid users hearing aid users compared to non-users compared to non-users controlling for demography and hearing loss?controlling for demography and hearing loss?

• Are people with hearing loss more likely to be Are people with hearing loss more likely to be unemployed?unemployed?

• Do people with hearing loss believe their Do people with hearing loss believe their compensation is equitable compared to their peers compensation is equitable compared to their peers with equal skills, experience, and education?with equal skills, experience, and education?

• Do people with hearing loss believe they have been Do people with hearing loss believe they have been passed over for promotions?passed over for promotions?

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MethodMethod• MarkeTrak VIII databaseMarkeTrak VIII database

– Aided:Aided: 1818 households in which the head of 1818 households in which the head of household or spouse indicated that one or more household or spouse indicated that one or more or them had a hearing loss and that one or both or them had a hearing loss and that one or both wore wore a hearing aid. a hearing aid.

– UnaidedUnaided: 3232 households where neither the : 3232 households where neither the head of household nor spouse wore a hearing head of household nor spouse wore a hearing aid, but where one or both reported having a aid, but where one or both reported having a hearing loss. hearing loss.

– Normal hearingNormal hearing: 34,351 households in which : 34,351 households in which neither the head of household nor spouse neither the head of household nor spouse reported having a hearing loss.reported having a hearing loss. 19

MethodMethod• People with hearing loss segmented into ten People with hearing loss segmented into ten

hearing loss groups (deciles) based on subjective hearing loss groups (deciles) based on subjective information (via factor analysis):information (via factor analysis):– Ears impairedEars impaired– Gallaudet scaleGallaudet scale– Subjective evaluation of lossSubjective evaluation of loss– BHI Quick Hearing Check (15 items)BHI Quick Hearing Check (15 items)– Plomp difficulty of hearing in noise scalePlomp difficulty of hearing in noise scale

• Controlled for demography (household Controlled for demography (household composition, age, geography and degree of composition, age, geography and degree of hearing loss) in calculating income per household.hearing loss) in calculating income per household.

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Income declines as a function of hearing lossIncome declines as a function of hearing loss

Mild Moderate Severe

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Significant divergence in income profiles for aided Significant divergence in income profiles for aided and unaided householdsand unaided households

Mild Moderate Severe

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Estimated Income loss ($000) compared to normal hearing Estimated Income loss ($000) compared to normal hearing households (n=34,351) by severity of hearing loss for aided households (n=34,351) by severity of hearing loss for aided

(n=1,818) and unaided (n=3,232) households(n=1,818) and unaided (n=3,232) households

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Salary differential ($000) between aided and unaided Salary differential ($000) between aided and unaided subjects by severity of hearing loss in decilessubjects by severity of hearing loss in deciles

• Mitigating impact of Mitigating impact of hearing aids for mild HL = hearing aids for mild HL = 90-100%90-100%

• Mitigating impact hearing Mitigating impact hearing aids for moderate to aids for moderate to severe HL = 77% - 65%severe HL = 77% - 65%

• The estimated cost in lost The estimated cost in lost earnings due to untreated earnings due to untreated hearing loss is $176 hearing loss is $176 billionbillion

• cost to society in terms of cost to society in terms of unrealized federal taxes is unrealized federal taxes is $26 billion. $26 billion.

$$ (000)

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Unaided individuals have significantly higher unemployment ratesUnaided individuals have significantly higher unemployment ratesSegmentation in hearing loss quintiles Segmentation in hearing loss quintiles

Considering only individuals still in the workforceConsidering only individuals still in the workforce

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Key findingsKey findings• No evidence that people with hearing lossNo evidence that people with hearing loss

– feel passed over for promotion more than normal feel passed over for promotion more than normal hearing subjects.hearing subjects.

– feel discriminated against in the workplace with feel discriminated against in the workplace with exception of older people with hearing loss.exception of older people with hearing loss.

• Hearing aid efficacyHearing aid efficacy– Use of hearing aids have significant impact on Use of hearing aids have significant impact on

achieving compensation equity for people with HL in achieving compensation equity for people with HL in the workplace.the workplace.

– Unaided subjects more than twice as likely to be Unaided subjects more than twice as likely to be unemployed.unemployed.

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Leveraging these findingsLeveraging these findings

• Cost to individual and society is very large and Cost to individual and society is very large and needs to be leveraged:needs to be leveraged:

• Convince people with HL to seek early Convince people with HL to seek early solution to their hearing loss.solution to their hearing loss.

• Convince HR executives that aided Convince HR executives that aided individuals are good for their corporations.individuals are good for their corporations.

• Convince politicians that tax credits will Convince politicians that tax credits will help people with hearing loss become more help people with hearing loss become more productive citizensproductive citizens

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Leveraging income study in mediaLeveraging income study in media

Tools on BHI websiteTools on BHI website• 1 page media or patient 1 page media or patient

handouthandout• Detailed fact sheet on income Detailed fact sheet on income

study for media and patientstudy for media and patient• OpEd pieces which may be OpEd pieces which may be

modified to promote audiology modified to promote audiology practicepractice

• Handout to Human Resource Handout to Human Resource executivesexecutives

• Sample media clips from Sample media clips from colleaguescolleagues

• Customizable press releaseCustomizable press release• The original publicationThe original publication

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Examples of leveraging income study in mediaExamples of leveraging income study in media

Current OpEd PieceCurrent OpEd Piece Sample Private Practice AdSample Private Practice Ad

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Example : Leveraging income study in Example : Leveraging income study in mediamedia

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Mini-BTEs attract new market, users more Mini-BTEs attract new market, users more satisfiedsatisfied

Hearing JournalHearing Journal

March 2011March 2011

IntroductionIntroduction

• BTE hearing aids represented less than 20% of BTE hearing aids represented less than 20% of hearing aid sales prior to 2000.hearing aid sales prior to 2000.

• With introduction of open-fit hearing aids and With introduction of open-fit hearing aids and receiver-in-the-canal hearing aids (RIC), BTEs now receiver-in-the-canal hearing aids (RIC), BTEs now represent 63% of all hearing aid sales. represent 63% of all hearing aid sales.

• In looking at the resurgence of BTE hearing aids, In looking at the resurgence of BTE hearing aids, we wanted to answer two key questions:we wanted to answer two key questions:– Did mini-BTE hearing aids result in market expansion?Did mini-BTE hearing aids result in market expansion?– Do mini-BTEs improve the consumer's experience with Do mini-BTEs improve the consumer's experience with

hearing aids?hearing aids?

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Hearing aid style mix (%) CY 2005-2008Hearing aid style mix (%) CY 2005-2008Source = MarkeTrak VIII DatabaseSource = MarkeTrak VIII Database

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MethodMethod

• Simple comparisonSimple comparison– Mini-BTE usersMini-BTE users– Traditional style usersTraditional style users

• First look at demographyFirst look at demography

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DemographyDemographyMini-BTE versus traditional style HAMini-BTE versus traditional style HA

• No age differences between the two samplesNo age differences between the two samples

• Mini-BTE usersMini-BTE users– more likely to appeal to males 64% versus 58%more likely to appeal to males 64% versus 58%– on average earn $15,000 more per year on average earn $15,000 more per year – more likely to be married (72% versus 61%)more likely to be married (72% versus 61%)– more likely to be in the work force (38% versus 26%)more likely to be in the work force (38% versus 26%)– have a less severe hearing loss and less difficulty have a less severe hearing loss and less difficulty

hearing in noisehearing in noise– more likely to purchase binaural hearing aids and more likely to purchase binaural hearing aids and

more likely to have a bilateral lossmore likely to have a bilateral loss– more likely to be a new users (59% versus 41%)more likely to be a new users (59% versus 41%)

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Customer satisfactionCustomer satisfactionMini-BTE compared to traditional styleMini-BTE compared to traditional style

Controlling for degree of hearing loss (ANCOVA)Controlling for degree of hearing loss (ANCOVA)

• Overall satisfaction ratings are significantly higher Overall satisfaction ratings are significantly higher for mini-BTE hearing aids (85% versus 76%)for mini-BTE hearing aids (85% versus 76%)

• No significant differences in:No significant differences in:– perceptions of benefit or value (despite higher $perceptions of benefit or value (despite higher $

$),$),– hearing aids in the drawerhearing aids in the drawer– brand loyaltybrand loyalty

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Customer satisfactionCustomer satisfactionMini-BTE compared to traditional styleMini-BTE compared to traditional style

Controlling for degree of hearing lossControlling for degree of hearing loss• Significant differences with corresponding practical Significant differences with corresponding practical

significance (10% or more):significance (10% or more):– Product variables: visibility, warranty Product variables: visibility, warranty

– Sound quality variables: all 13 variables Sound quality variables: all 13 variables measuredmeasured

– 4/19 listening situations: performance on cell 4/19 listening situations: performance on cell phones, telephones, in large group situations and phones, telephones, in large group situations and in the schoolroom/classroomin the schoolroom/classroom

– lower on ability to control volumelower on ability to control volume37

Key findingsKey findings• Did not tap into younger segments of people with hearing Did not tap into younger segments of people with hearing

loss.loss.• But is expansionary influencing HA purchases by:But is expansionary influencing HA purchases by:

• more affluentmore affluent• more active and elderly consumer segments more active and elderly consumer segments • with milder hearing losseswith milder hearing losses

• Controlling for degree of hearing loss mini-BTE hearing aids Controlling for degree of hearing loss mini-BTE hearing aids would appear to offer significant improvements in:would appear to offer significant improvements in:• overall satisfactionoverall satisfaction• cosmeticscosmetics• sound qualitysound quality• multiple environmental listening utility (MELU)multiple environmental listening utility (MELU)

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PromotionPromotion

• Promote the positive Promote the positive benefits of mini-BTE benefits of mini-BTE based on BHI on based on BHI on consumer feedback:consumer feedback:

• overall satisfactionoverall satisfaction

• cosmeticscosmetics

• sound qualitysound quality

• multiple environmental multiple environmental listening utility (MELU)listening utility (MELU)

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Economics of Verification and Economics of Verification and Validation on Private PracticesValidation on Private Practices

Hearing ReviewHearing Review

June 2011June 2011

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Introduction – Time is Money!Introduction – Time is Money!• In Best Practice publication it was determined In Best Practice publication it was determined

that the number of patient visits to adjust the that the number of patient visits to adjust the hearing aid were highly correlated with real-hearing aid were highly correlated with real-world success.world success.

• Comparing patients who experienced above Comparing patients who experienced above or below average success with their hearing or below average success with their hearing aids the following was discovered:aids the following was discovered:– 76% of above average patients were fit in 1-2 76% of above average patients were fit in 1-2

visits compared to 40% of below average patientsvisits compared to 40% of below average patients– 47% of below average patients required 4-6 visits 47% of below average patients required 4-6 visits

to fit their hearing aids compared to 7% of above to fit their hearing aids compared to 7% of above average patients.average patients.

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Introduction – Time is Money!Introduction – Time is Money!• Highly successful patients required fewer visits to the clinic. Highly successful patients required fewer visits to the clinic. • What could explain this difference in number of visits? What could explain this difference in number of visits?

• Hypothesis = lack of verification Hypothesis = lack of verification (real-ear measurement)(real-ear measurement) and and validation validation (confirmation of a patient’s performance with their hearing (confirmation of a patient’s performance with their hearing aids)aids) during the hearing aid fitting increased the number of patient during the hearing aid fitting increased the number of patient visits. For some patients the result was:visits. For some patients the result was:– Less than optimum fit, Less than optimum fit, – reduced hearing aid utility, reduced hearing aid utility, – mediocre benefit each of mediocre benefit each of – End result = rejection and return of the hearing aids for credit. End result = rejection and return of the hearing aids for credit.

• In this study we will explore the relationship between verification, In this study we will explore the relationship between verification, validation and patient visits. validation and patient visits.

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Percent of patients reporting that verification and/or Percent of patients reporting that verification and/or validation was used during the hearing aid fitting validation was used during the hearing aid fitting

process (New hearing aids, n=787)process (New hearing aids, n=787)

Average patient visits to fit hearing aids based on use of Average patient visits to fit hearing aids based on use of verification (REM) & validation procedures (objective or verification (REM) & validation procedures (objective or

subjective).subjective).

Patient visits=3.57 – REM*.75 – validate*1.02 + V+V*.6

Simulating Impact of V + VSimulating Impact of V + V• In 2010, nearly 2.7 million hearing aids were fit in the In 2010, nearly 2.7 million hearing aids were fit in the

U.S. hearing aid market representing over 1.5 million U.S. hearing aid market representing over 1.5 million patients patients (binaural rate=74.3% in 2008)(binaural rate=74.3% in 2008). .

• Assuming the same distribution of best practices as Assuming the same distribution of best practices as noted by patients and the estimate of reduced patient noted by patients and the estimate of reduced patient visits.visits.

• The systematic utilization of both verification and The systematic utilization of both verification and validation procedures while fitting hearing aids will validation procedures while fitting hearing aids will reduce patient visits by a total of 521,779 visits. reduce patient visits by a total of 521,779 visits.

• This is an opportunity available for every one of the This is an opportunity available for every one of the 64% of U.S. practices not utilizing64% of U.S. practices not utilizing both both verification verification and validation. and validation. 45

Simulating Impact of V + VSimulating Impact of V + V• Assuming 45 minutes a visit:Assuming 45 minutes a visit:

– inclusion of these best practices could reduce the time inclusion of these best practices could reduce the time spent with patients in fitting hearing aids by 391,334 spent with patients in fitting hearing aids by 391,334 hours in a single.hours in a single.

– Manpower cost @$144 per hour = $56.3 millionManpower cost @$144 per hour = $56.3 million– Much higher cost when you consider lost revenue due Much higher cost when you consider lost revenue due

to hearing aid returns (18.6% national average)to hearing aid returns (18.6% national average)

• This additional time frees the hearing healthcare This additional time frees the hearing healthcare

professional for additional counseling, marketing, professional for additional counseling, marketing, community outreach or in fitting new patients with hearing community outreach or in fitting new patients with hearing aids.aids.

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Prevalence of Tinnitus and Prevalence of Tinnitus and Efficacy of TreatmentsEfficacy of Treatments

Co-authorsCo-authors

Richard Tyler – U of IowaRichard Tyler – U of Iowa

Jennifer Born - ATAJennifer Born - ATA

Hearing ReviewHearing Review

November 2011November 2011

47

IntroductionIntroduction

• 40% of non-adopters do not see 40% of non-adopters do not see audiologists for their hearing loss because audiologists for their hearing loss because they have tinnitus and believe nothing can they have tinnitus and believe nothing can be done. (MarkeTrak VII).be done. (MarkeTrak VII).

• Thus they suffer from both untreated Thus they suffer from both untreated hearing loss and tinnitus.hearing loss and tinnitus.

• Need to convince people with tinnitus that Need to convince people with tinnitus that by visiting an audiologist you can help them by visiting an audiologist you can help them manage their tinnitus.manage their tinnitus.

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MethodMethod

• 80,000 household MarkeTrak survey where we 80,000 household MarkeTrak survey where we added to our normal screening survey added to our normal screening survey “Does “Does anyone in your household have tinnitus (ringing in anyone in your household have tinnitus (ringing in their ears)”. – captured up to 5 family members.their ears)”. – captured up to 5 family members.

• Scales: time of day experienced, loudness, Scales: time of day experienced, loudness, annoyanceannoyance

• Impact on lifeImpact on life• Efficacy: nine treatment methodsEfficacy: nine treatment methods• Hearing aids: Direct probeHearing aids: Direct probe

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Tinnitus population (millions, 2008)Tinnitus population (millions, 2008)

Population CommentaryPopulation Commentary

• Approximately 30 million experience Approximately 30 million experience persistent tinnitus (10% population)persistent tinnitus (10% population)

• Around half of hearing aid owners and Around half of hearing aid owners and non-adopters report tinnitusnon-adopters report tinnitus

• Another 13 million people are aware of Another 13 million people are aware of their tinnitus but not hearing losstheir tinnitus but not hearing loss

• The market for hearing healthcare much The market for hearing healthcare much larger than thoughtlarger than thought

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Incidence of tinnitus by age group. Incidence derived Incidence of tinnitus by age group. Incidence derived by comparing age population from NFO panel with by comparing age population from NFO panel with

U.S. Bureau of Census population in 2008.U.S. Bureau of Census population in 2008.

Tinnitus Demography CommentaryTinnitus Demography Commentary

• Peaks at ages 65-84; 85+ drop due to:Peaks at ages 65-84; 85+ drop due to:– Lack of family member awarenessLack of family member awareness– Non-survey of nursing homesNon-survey of nursing homes

• Tends to affect:Tends to affect:– Lower educatedLower educated– Smaller rural communitiesSmaller rural communities– Retirees and those on medical disabilityRetirees and those on medical disability– Single peopleSingle people– Lower incomeLower income

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Severity of TinnitusSeverity of Tinnitus(Means on 0-100% scale; n=3,187)(Means on 0-100% scale; n=3,187)

• % time of day: % time of day: 49%49%• Loudness: Loudness: 41%41%• Annoyance: Annoyance: 39%39%• Disabling estimate (70-100%) – 22%Disabling estimate (70-100%) – 22%• Key QOL impact:Key QOL impact:

– Ability to hearAbility to hear– Ability to concentrateAbility to concentrate– Ability to sleepAbility to sleep

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Impact of tinnitus on quality of life (n=3,431)Impact of tinnitus on quality of life (n=3,431)

Efficacy of treatments Efficacy of treatments (n=3,473 on 0-100% scale)(n=3,473 on 0-100% scale)

• Aided awareness on 9 treatmentsAided awareness on 9 treatments– Hearing aids; music; medication; relaxation; Hearing aids; music; medication; relaxation;

HHP counseling; Non-wearable sound HHP counseling; Non-wearable sound generator; herbs/dietary supplements; generator; herbs/dietary supplements; wearable sound generator; psychological wearable sound generator; psychological counselingcounseling

• Consumer asked:Consumer asked:– If they tried treatment for their tinnitusIf they tried treatment for their tinnitus– 0-100% scale on efficacy or tinnitus mitigation.0-100% scale on efficacy or tinnitus mitigation.

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Efficacy of TreatmentsEfficacy of Treatments

• No method tried by more than 7% of No method tried by more than 7% of people.people.

• Hearing aids were not viewed as a Hearing aids were not viewed as a treatment.treatment.

• Highest rated (median mitigation):Highest rated (median mitigation):– Hearing aids (34%)Hearing aids (34%)– Music (30%)Music (30%)– Relaxation techniques (10%)Relaxation techniques (10%)

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Direct Query on Hearing Aids.Direct Query on Hearing Aids.Effectiveness in mitigating effects of tinnitus (n=1,314)Effectiveness in mitigating effects of tinnitus (n=1,314)

Direct QueryDirect QueryHow often hearing aids are effective in How often hearing aids are effective in mitigating effects of tinnitus (n=553)mitigating effects of tinnitus (n=553)

Greater chance of tinnitus mitigation with hearing aids Greater chance of tinnitus mitigation with hearing aids when best practices used in hearing aid fitting (n=732)when best practices used in hearing aid fitting (n=732)

OpportunityOpportunity

• People may not visit you for their hearing People may not visit you for their hearing loss but they may if you hold the promise loss but they may if you hold the promise of relief for their tinnitus.of relief for their tinnitus.

• The market for hearing healthcare is The market for hearing healthcare is dramatically expanded when you consider:dramatically expanded when you consider:– 40% of non-adopters with hearing loss not visiting 40% of non-adopters with hearing loss not visiting

audiologists because they have tinnitusaudiologists because they have tinnitus– 13 million additional with tinnitus reporting they do not 13 million additional with tinnitus reporting they do not

have hearing losshave hearing loss

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PromotionPromotion• Move toward ADA sponsored Move toward ADA sponsored

Tinnitus Management Tinnitus Management Certification Program Certification Program if you do if you do not have the credentials now not have the credentials now for tinnitus management.for tinnitus management.

• Review Review BHI material on setting on setting up a tinnitus clinic.up a tinnitus clinic.

• Distribute BHI Guide to Distribute BHI Guide to TinnitusTinnitus

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PromotionPromotion

• Take a course in Cognitive Take a course in Cognitive Behavioral Therapy.Behavioral Therapy.

• Learn about tinnitus Learn about tinnitus management resources management resources and outcome measures.and outcome measures.

• Read and distribute a good Read and distribute a good consumer handbook consumer handbook on on tinnitus to your patients tinnitus to your patients with tinnitus.with tinnitus.

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PromotionPromotion• Learn from your peers on how to Learn from your peers on how to

promote tinnitus in your practice.promote tinnitus in your practice.• Look for updated Look for updated Opinion Editorials

from BHI in the future.from BHI in the future.• Set correct expectations on tinnitus Set correct expectations on tinnitus

mitigation with HA:mitigation with HA:– 30% moderate – substantial relief30% moderate – substantial relief– Could be 50%-60% with best Could be 50%-60% with best

practices.practices.

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The Validity and Reliability of the The Validity and Reliability of the BHI Quick Hearing CheckBHI Quick Hearing Check

Kochkin, S. and Bentler, R. Kochkin, S. and Bentler, R. The Hearing ReviewThe Hearing Review

November 2010November 2010

IntroductionIntroduction• Key obstacle to hearing aid adoption is Key obstacle to hearing aid adoption is

awareness of degree of hearing lossawareness of degree of hearing loss– 50% of people admitting hearing loss have 50% of people admitting hearing loss have

never had their hearing tested never had their hearing tested professionallyprofessionally

– Have insufficient information to seek a Have insufficient information to seek a hearing solution and to visit an audiologisthearing solution and to visit an audiologist

– Problem recognition is a precursor to Problem recognition is a precursor to problem resolutionproblem resolution

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IntroductionIntroduction• Wide-scale availability of simple self-Wide-scale availability of simple self-

measures of hearing loss may influence measures of hearing loss may influence increased throughput into audiologist increased throughput into audiologist officesoffices

• BHI adopts the American Cancer Society BHI adopts the American Cancer Society and American Diabetes Association models and American Diabetes Association models with online testing: “Are you at risk”…if so with online testing: “Are you at risk”…if so visit an audiologistvisit an audiologist

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BHI Quick Hearing CheckBHI Quick Hearing Check

• 15 items – standard “signs of hearing loss”. 15 items – standard “signs of hearing loss”. Sample items:Sample items:– I have a problem over the telephoneI have a problem over the telephone– I have trouble understanding things on TVI have trouble understanding things on TV– I have to strain to understand conversationsI have to strain to understand conversations– Many people I talk to seem to mumbleMany people I talk to seem to mumble

• Based on AAO-HNS 5 minute testBased on AAO-HNS 5 minute test

• Revised by Koike and validated on small Revised by Koike and validated on small sample (n=74) but not in use todaysample (n=74) but not in use today

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BHI Quick Hearing CheckBHI Quick Hearing Check

• BHI adopted the testBHI adopted the test

• Changed to 5 point Likert scale Changed to 5 point Likert scale (Strongly agree – (Strongly agree – Strongly disagree)Strongly disagree)

• Validated on 11,000 subjects using 4 databases:Validated on 11,000 subjects using 4 databases:• NCOA database – self perceptionsNCOA database – self perceptions• NCOA database – spouse perceptionsNCOA database – spouse perceptions• MarkeTrak VIII database – self perceptionsMarkeTrak VIII database – self perceptions• Objective HL information from 64 clinics on 987 Objective HL information from 64 clinics on 987

patientspatients– Audiogram (5 frequencies)Audiogram (5 frequencies)– Speech discrimination scoresSpeech discrimination scores

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BHI Quick Hearing Check reliabilityBHI Quick Hearing Check reliability

• Separate factor analysis of NCOA and Separate factor analysis of NCOA and MarkeTrak database items demonstrate MarkeTrak database items demonstrate one dimension:one dimension:– Unidimensionality means we can add Unidimensionality means we can add

the items togetherthe items together

• Reliability Reliability (internal consistent – (internal consistent – Cronbach’s alpha) Cronbach’s alpha) very high where a very high where a score of 100% is perfection:score of 100% is perfection:– NCOA database = 95%NCOA database = 95%– MarkeTrak = 94%MarkeTrak = 94%

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Objective ValidityObjective Validity

Correlation between audiogram Correlation between audiogram information and BHI Quick information and BHI Quick

Hearing CheckHearing Check

Relationship between the BHI Quick Hearing Check and Relationship between the BHI Quick Hearing Check and average speech threshold scoresaverage speech threshold scores

Model = better earModel = better ear

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Relationship between the BHI Quick Hearing Check and Relationship between the BHI Quick Hearing Check and

average threshold scoresaverage threshold scoresModel = 5PTA both earsModel = 5PTA both ears

y = 25.38 +.6787xR2 = .84

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Probability of hearing loss of 40 dB (both ear average) Probability of hearing loss of 40 dB (both ear average) or higher based on BHI Quick Hearing Check scoresor higher based on BHI Quick Hearing Check scores

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Subjective ValiditySubjective Validity

Correlations between Correlations between subjective measures of hearing subjective measures of hearing loss and the BHI Quick Hearing loss and the BHI Quick Hearing

CheckCheck

Average BHI Quick Hearing Check Score by level of Average BHI Quick Hearing Check Score by level of performance on the Gallaudet Scaleperformance on the Gallaudet Scale

Self-ratings MarkeTrak VIIIN=7,201, r=.49

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Average BHI Quick Hearing Check Score by level of Average BHI Quick Hearing Check Score by level of self and family member perception of hearing lossself and family member perception of hearing loss

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Average BHI Quick Hearing Check score by level Average BHI Quick Hearing Check score by level of Plomp’s difficulty of hearing in noise scale of Plomp’s difficulty of hearing in noise scale

Self ratings – MarkeTrak VIIIN=7,201, r=.64

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Concurrent ValidityConcurrent Validity

BHI Quick Hearing Check BHI Quick Hearing Check correlations with issues correlations with issues

tangentially related to hearing tangentially related to hearing lossloss

Scores on the BHI Quick Hearing Scores on the BHI Quick Hearing Check correlated with QOL issuesCheck correlated with QOL issues

• According to spouses of people According to spouses of people with HL:with HL:– Concerns about safety Concerns about safety – Family accommodation Family accommodation – Rejected by others Rejected by others – Withdrawal Withdrawal – Difficulty in communication Difficulty in communication – Independence of person Independence of person – Effect of hearing loss on family Effect of hearing loss on family – Compensatory behavior Compensatory behavior – Cognitive functioning Cognitive functioning – Self confidence Self confidence – Discrimination against individual Discrimination against individual – Anger & frustration Anger & frustration – Emotional stability Emotional stability – Introversion Introversion

• According to individual According to individual with HL:with HL:– Anger & frustration Anger & frustration – WithdrawalWithdrawal– Impact of hearing on health Impact of hearing on health – Phobia symptoms Phobia symptoms – Paranoia Paranoia – Overall health and pain Overall health and pain

assessmentassessment– Anxiety symptoms Anxiety symptoms – Activity on phone with social Activity on phone with social

network network – Depression symptoms Depression symptoms – Problems with friends Problems with friends – Problems with all relationships Problems with all relationships

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Promotion using the new BHI Promotion using the new BHI online hearing testonline hearing test

• Complete redesign of BHI Complete redesign of BHI online hearing testonline hearing test

• URL createdURL created– www.hearingcheck.org

• Items presented one at a Items presented one at a time with background time with background photophoto

• Internet banner ads now Internet banner ads now directing traffic to the test directing traffic to the test as well as Google adsas well as Google ads

• BHSM initiative similar to BHSM initiative similar to American Diabetes and American Diabetes and Cancer risk test Cancer risk test campaigns.campaigns.

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BHI Online Hearing TestBHI Online Hearing Test• Comprehensive report:Comprehensive report:

– BHI Quick Hearing Check BHI Quick Hearing Check scorescore

– Norm compared to U.S. Norm compared to U.S. population with HLpopulation with HL

– Estimated dB loss better Estimated dB loss better ear – speech rangeear – speech range

– Estimated dB loss 5 tone – Estimated dB loss 5 tone – PTA both earsPTA both ears

– Probability HL > 40 dB in Probability HL > 40 dB in both earsboth ears

– Subjective classification of Subjective classification of HL based on consumer HL based on consumer perceptions perceptions (standard (standard audiological classification audiological classification judged too conservative judged too conservative based on consumer based on consumer perceptions)perceptions)

– RecommendationRecommendation82

Using the new Using the new online hearing test at BHIonline hearing test at BHI

• Encouraging hearing Encouraging hearing health industry to link to health industry to link to this online hearing test at this online hearing test at www.hearingcheck.org

• Developed Developed logos for hyperlinking. Placement hyperlinking. Placement on your websiteon your website

• Also available in paper-Also available in paper-and-pencil formand-pencil form– Drug storeDrug store– AdsAds– Chiropractor officesChiropractor offices– Health fair handoutHealth fair handout

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Impact of Direct Mail and Low Impact of Direct Mail and Low Cost Listening Devices on Hearing Cost Listening Devices on Hearing

Aid SalesAid Sales

Hearing ReviewHearing Review

June 2010June 2010

IntroductionIntroduction

• Low cost listening devices (PSAPs) and direct mail Low cost listening devices (PSAPs) and direct mail hearing aids have been available for at least 25 years.hearing aids have been available for at least 25 years.

• PSAPSPSAPS• Price range $20-$50 Price range $20-$50 • Some infomercials 2 for $19.95Some infomercials 2 for $19.95• Most notable historically Whisper 2000Most notable historically Whisper 2000• Legal as long as they don’t target people with Legal as long as they don’t target people with

hearing loss.hearing loss.

• Direct mailDirect mail– Products such as Crystal Ear usually sells in the $300 Products such as Crystal Ear usually sells in the $300

rangerange– Some DM firms even allow consumer to take their own Some DM firms even allow consumer to take their own

ear impressionsear impressions– Legal in many states with medical waiverLegal in many states with medical waiver 85

IntroductionIntroduction

• Recent proliferation of devices with extensive Recent proliferation of devices with extensive television ads.television ads.– Lee Major’s Bionic EarLee Major’s Bionic Ear– Silver Sonic XLSilver Sonic XL– Loud N’clearLoud N’clear– + dozen others+ dozen others

• Apparently tend to be introduced close to recessionsApparently tend to be introduced close to recessions

• How many people with hearing loss are using them?How many people with hearing loss are using them?

• Do these devices cannibalize legitimate hearing aids Do these devices cannibalize legitimate hearing aids sales?sales?

• How do people with hearing loss rate these products?How do people with hearing loss rate these products?86

Sample productsSample products

87

Resurgence of Internet, DM and Resurgence of Internet, DM and over-the-counter sold hearing aidsover-the-counter sold hearing aids

88

Direct mail firms selling pre-programmed Direct mail firms selling pre-programmed digital open fit hearing aids ($400-$895) digital open fit hearing aids ($400-$895)

89

Increased trend in non-owner Increased trend in non-owner purchase of listening devicespurchase of listening devices

• Use less expensive device in place of hearing Use less expensive device in place of hearing aidsaids

• MarkeTrak III (1993)MarkeTrak III (1993)– 2.6% “somewhat a reason”2.6% “somewhat a reason”– 1.1% “definitely a reason”1.1% “definitely a reason”– 3.7% Total3.7% Total

• MarkeTrak VII (2004)MarkeTrak VII (2004)– 5% “somewhat a reason”5% “somewhat a reason”– 3% “definitely a reason”3% “definitely a reason”– 8% Total8% Total

• MarkeTrak VIII (2008) – analysis to followMarkeTrak VIII (2008) – analysis to follow90

Relative internet ranking (000)Relative internet ranking (000)Internet ALDs versus HIA membersInternet ALDs versus HIA members

576462

427397

385356

334271

178156

11874

6762

0 100 200 300 400 500 600 700

HIA1

HIA2

HIA3

HIA4

HIA5

HIA6

Ampli-ear

HIA7

HIA8

HIA9

HIA10

Loud n Clear

Songbird

Silver Sonic

Rank (000)Note: Lower ranks denote higher traffic 91

Estimated web visitors per monthEstimated web visitors per monthALDs versus HIA membersALDs versus HIA members

ALD= Songbird, Sonic XL, Loud n Clear, Ampli-earALD= Songbird, Sonic XL, Loud n Clear, Ampli-ear

0 100000 200000 300000 400000 500000 600000

Jan

Dec

Nov

Oct

Sep

Aug

Jul

Jun

May

Apr

Mar

Feb

Jan

HIA

ALD2008

2009

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Summary demographySummary demographyCustom vs DM vs PSAPCustom vs DM vs PSAP

Demography Custom Direct Mail

PSAP

Male % 59 71 53

Age (mean) 71 71 66

Income (Median) 41k 31k 31k

Income (Mode) 112k 21k 24k

Employed (%) 29 28 35

Marital Status (%) 62 52 57

Binaural HA (%) 76 41 n/a

Yrs aware of HL -Mean

7 8 1593

TargetingTargeting• Direct mail hearing aids are marketed to compensate Direct mail hearing aids are marketed to compensate

for hearing loss where legalfor hearing loss where legal– Some calling them PSAPsSome calling them PSAPs– Due to legitimization of them by FDADue to legitimization of them by FDA

• PSAPs not sold to compensate for hearing lossPSAPs not sold to compensate for hearing loss

• But here are some of the PSAP ad messages:But here are some of the PSAP ad messages:– Never miss another word at lectures, movies, Never miss another word at lectures, movies,

shows, or even churchshows, or even church– Turn up the volume on what people around you are sayingTurn up the volume on what people around you are saying– Listen at the level you want without disturbing othersListen at the level you want without disturbing others– Hear a pin drop from across the roomHear a pin drop from across the room– Turns ordinary hearing into extraordinary hearing Turns ordinary hearing into extraordinary hearing

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Hearing loss distributionHearing loss distribution

• What is the hearing loss profile of DM What is the hearing loss profile of DM and PSAP customers:and PSAP customers:– People with admitted hearing lossPeople with admitted hearing loss– Compared to your typical patientCompared to your typical patient

• And what is the likelihood PSAPs took And what is the likelihood PSAPs took business away from you?business away from you?

95

Hearing loss decile distribution of owners of custom Hearing loss decile distribution of owners of custom hearing aids, direct mail hearing aids and hearing aids, direct mail hearing aids and

personal sound amplifying products (PSAP)personal sound amplifying products (PSAP)

Decile 50% or higher

83%

79%

72%

96

Likelihood of purchasing custom hearing aids in Likelihood of purchasing custom hearing aids in absence of PSAP as reported by non-owner populationabsence of PSAP as reported by non-owner population

Overall likelihood = 17.8%

97

The numbers please!The numbers please!

• 3.28% (280,000 people) of hearing aid 3.28% (280,000 people) of hearing aid owners indicated they received their owners indicated they received their hearing aids by direct mail (2008)hearing aids by direct mail (2008)– 3.68% (270,000) were direct mail hearing aid 3.68% (270,000) were direct mail hearing aid

owners in 2004owners in 2004

• 4.79% of the non-adopter population uses 4.79% of the non-adopter population uses PSAPs representing 1,237,700 peoplePSAPs representing 1,237,700 people

• Total market = 1.5 million people with Total market = 1.5 million people with hearing loss.hearing loss.

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CannibalizationCannibalization

• Probable cannibalization of custom hearing aid Probable cannibalization of custom hearing aid market by PSAP owners approximately 17.8% market by PSAP owners approximately 17.8%

• Translating into 220,310 PSAPs probably Translating into 220,310 PSAPs probably siphoned off from the custom hearing aid siphoned off from the custom hearing aid marketmarket

• Considering a four year purchase cycle the Considering a four year purchase cycle the hearing aid industry is probably losing about hearing aid industry is probably losing about 55,000 patients a year55,000 patients a year

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ConclusionsConclusions

• Approximately 1.5 million people with hearing impairments Approximately 1.5 million people with hearing impairments use either direct mail or personal sound amplification to use either direct mail or personal sound amplification to compensate for their hearing loss.compensate for their hearing loss.– Number much higher if you consider over-the-counter pre-Number much higher if you consider over-the-counter pre-

programmed hearing aids at Walmart, Drugstores, Sam’s Club, programmed hearing aids at Walmart, Drugstores, Sam’s Club, etc.etc.

  • Users of these devises on average have incomes $10,000 Users of these devises on average have incomes $10,000

less than custom hearing aid users.less than custom hearing aid users.  • 3 out of 4 PSAP or direct mail hearing aid users have hearing 3 out of 4 PSAP or direct mail hearing aid users have hearing

loss profiles equivalent to the custom hearing aid userloss profiles equivalent to the custom hearing aid user  • The PSAP user has been aware of their hearing loss on The PSAP user has been aware of their hearing loss on

average for 10 years compared to 3 years for the typical average for 10 years compared to 3 years for the typical hearing aid user (median). hearing aid user (median).

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ConclusionsConclusions

• Little doubt that PSAPs are used to compensate Little doubt that PSAPs are used to compensate for hearing lossfor hearing loss

• Estimate that less than 18% of PSAP users Estimate that less than 18% of PSAP users substituted personal sound amplification substituted personal sound amplification products for custom hearing aids products for custom hearing aids

• In the absence of PSAPs in the market place in In the absence of PSAPs in the market place in all likelihood the majority would have lived with all likelihood the majority would have lived with their hearing losstheir hearing loss

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PromotionPromotion

• Markets are perfect! Products Markets are perfect! Products and services will be developed and services will be developed and introduced to meet unmet and introduced to meet unmet consumer needs.consumer needs.

• The best strategy is to practice The best strategy is to practice BEST PRACTICESBEST PRACTICES

• Share our eGuide and Share our eGuide and press on on How to Buy Hearing aidsHow to Buy Hearing aids and let and let the public know this is the ONLY the public know this is the ONLY hearing solution.hearing solution.

• Share our Share our press release: BHI : BHI Warns on Do-it-Yourself Hearing Warns on Do-it-Yourself Hearing Care.Care.

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AcknowledgementAcknowledgement

• All MarkeTrak research All MarkeTrak research is made possible by a is made possible by a special grant from special grant from Knowles Electronics.Knowles Electronics.

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