A conversation between Dr. Grace Smith and The Canvas
Could you share how you entered into the world of audiology?
My journey started in high school as a flautist. At one of our orchestra rehearsals, an audiology student shared her research on noise induced hearing loss. I was about 16 at the time, and it really piqued my interest. Ultimately I proceeded into college, then graduate school, followed working clinically in a large hospital system for three years as an audiologist. I saw a big range of auditory and vestibular diagnostics, and coordinated the rehabilitation front to fit these newly diagnosed patients. This involved hearing aids, cochlear implants, osseointegrated devices, and different solutions depending on the type of hearing impairment a patient or a candidate was dealing with. Once I got some familiarity, I realized I wanted to support audiologists and clinicians in a more direct role. I made the transition this year to working on the industry side for a manufacturer that produces these solutions to support clinicians, surgeons, candidates — really anyone that is truly involved in a patient's journey to hearing.
When is the earliest hearing loss typically recognized and diagnosed?
In most states, there are mandated requirements for newborns to be screened for hearing loss. There's what we call a 1-3-6 rule: we should screen babies by one month of age, diagnose by three months of age, and if needed, an early intervention plan by six months of age, because as you go longer, that critical window gets smaller for developing language, among many other developments.
Could you elaborate on the varying typologies of hearing aids?
There's a huge portfolio within the world of hearables and hearing aids, with options broadening every year. Regardless of generation, the public's interest in technology has expanded the functionality of hearing aids. A couple of hearing aid style options include: the BTE, behind-the-ear; RIC, or receiver-in–the canal; ITE, in-the-ear; CIC, completely-in-the canal; and IIC, invisible-in-the-canal. The BTE and RIC styles are hearing aids that have an external component sitting behind the ear along with a bit that goes inside the ear canal. The ITE, CIC and IIC styles are custom hearing aid options made from an impression of a patient’s ear. There are a few different manufacturers that offer a hybrid between that may be sitting fully in the ear, but not necessarily custom made to a patient's ear shape. And there are surgical options, such as cochlear implants reserved for more severe cases, and bone conduction implants.
Similar to how there is a 20/20 base standard in vision, is there a numerical base standard in hearing?
Yes, for adults, that base range is from anything below 25 decibels. When testing we're looking at a range from about negative 10 decibels, all the way up to 120 decibels. For children, it's a little bit more stringent, where we're looking at zero to 15 decibels.
Could you speak to the varying battery typologies in hearing aids?
The style of hearing aid you choose really dictates what battery system you're going to interface with. Many of those custom hearing aids will take a disposable or “button” battery. It's a small round zinc-air battery with a sticker; when you take the sticker off, the zinc’s exposure to oxygen activates the battery. The smallest battery is a size 10, then 312, 13, and 675. Many implantables, such as a cochlear implant, a bone anchored hearing aid, or osseointegrated device, most likely will use 13, 675, or even a power 675 battery because they need so much power to operate. The programming of the device also affects the battery life. How much hearing loss is there? And how much power do we need to overcome that? Additionally, a lot of devices are Bluetooth capable, so we need to learn about the patient’s mobile usage and/or music consumption.
When there is no longer a need for hearing aids, is there a program in place that recycles or repurposes the devices?
This depends on the type of hearing aid. Custom hearing aids cannot be repurposed — the device is like a fingerprint for the ear. But a lot of behind-the-ear style hearing aids or receiver-in-the-canal hearing aids can be reused. These days, those often take rechargeable lithium ion batteries or they use disposable batteries. Both can be repurposed. Patients will bring them into clinics to donate, and there are also organizations, like Lions Club*, which will accept donations. People will also give or trade their devices among family members. However, you do have to be careful with donations, because of warranties, ownership, and the ability of a clinician to program that particular device.
What's next for the audiology industry at large?
We're moving to fully implantable devices for patients whose type or degree of hearing loss means that traditional hearing aids are not adequate. A patient’s personal preferences play a role in this decision, along with formal candidacy criteria for device indications. The goal is individualization and simplicity.
Are customizable or bespoke devices accessible for everyone?
It's a good question, because that's really what most decision making comes back to: ”What's it going to cost? How do I get this?” The biggest variable or biggest barrier is insurance coverage, because it's still case by case.
If there is a brand or organization you’d like to collaborate with, who would it be?
I’d have to say a custom hearing protection company like Sensaphonics or Microsonic, to go back to my roots of how I first got into the field of audiology through learning about noise induced hearing loss.