Interview with Bill Dickinson, AuD, Vice President of Audiology, Phonak US

Topic: Phonak’s Commitment to Evidence-Based Research

Carolyn Smaka:  Bill, thanks for speaking with me today.  You recently left Vanderbilt to become the Vice President of Audiology at Phonak – how has it been going so far?

Bill Dickinson:  It’s been a great transition.  There is a strong sense of camaraderie here – everyone is on the same team, supporting one another, and trying to produce better outcomes. I am impressed at the depth and breadth of the commitment in bettering the lives of the hearing impaired through technology and innovation. It was immediately apparent to me that Phonak has very high corporate values and employees who live by them daily.   They take it very seriously and it results in a rather amazing company culture.

Carolyn: Tell me about your education and clinical experience before Vanderbilt.

Bill:  I earned my bachelor’s and master's degrees at Michigan State University.  After working for a few years I went back to Central Michigan to finish my AuD.  My first job out of the gate was with the VA system.  I worked with a talented group of audiologists and we ran a great hearing aid program.  From there I went to Henry Ford Hospital in Detroit, which was an excellent learning opportunity for me in terms of expanding clinical knowledge, as well as building valuable management and leadership skills.  There I worked for Dr. Gary Jacobson for 10 years, until I later joined him in 2004 at Vanderbilt, where I directed the hearing technologies program, as well as served as a faculty member teaching AuD courses, directing student Capstone projects, and contributing to many professional committees.

I've been incredibly blessed to be a part of great audiology programs with highly respected colleagues.  Working and learning in such professional environments has allowed me to move into new challenges and stimulating opportunities throughout my career. 

Carolyn:  What excites you about your role at Phonak?

Bill: I’m very excited to be with Phonak because of their commitment to using evidence-based science to benefit patients.  It is true testimony to the goal of “innovation with purpose.” Whether creating policy or technology, end user benefit and making meaningful differences in people’s lives is at the forefront of all business decisions.  On a more global picture, with Sonova’s acquisition of other industry leading companies such as Lyric and Advanced Bionics, we can deliver the very best technology in the full spectrum of hearing solutions, from daily-wear or extended-wear hearing aids to cochlear implants.  Phonak technology supports innovative features available throughout the entire range of products - from premium products through essential-level products.  These are truly life-changing features like DuoPhone or Binaural VoiceStream Technology™, for example which are not just reserved for premium level technologies. To me that approach is what has always defined Phonak – taking the relevant science and applying evidence-based applications to produce very patient-centric technologies.

A perfect example is the plethora of data we have in the profession regarding the function and importance of binaural hearing and binaural processing.  There are decades of research on the subject.  A great case in point of how clinicians have incorporated such research into their clinical decision making is evidenced by the fact that most of the market growth we’ve seen in our industry over the past 20 years is largely due to the fact that we’re now fitting two ears rather than one!  Well, Phonak took what is known from the binaural hearing science and incorporated such scientific research into a dedicated signal processing platform that has become the current Binaural Voice Stream Technology™.

This technology is industry leading because Binaural VoiceStream Technology™ does not just send command data from ear to ear.  Binaural VoiceStream Technology™ uses all four independent microphones of a binaural fitting to monitor the listening environment, specifically looking at the levels and location of both speech and noise.

As listeners, our ability to hear in noise is due to a component of binaural processing that in a large part is a monaural ear effect.  Part of the reason why I can do well in noisy situations is because one ear is often receiving a better speech signal differently than the opposite side.  This may be best explained by the classic tilting your head toward the speaker – specifically the better hearing ear when hearing loss is present - when listening in high amounts of noise.   Research has established that the monaural signal from the good side allows the whole system to work efficiently when noise is at one ear and speech is predominately at the other.  This process is what Phonak has modeled with Binaural VoiceStream Technology™.  Once we isolate a better speech signal on one side, it is possible to stream that over to the other side so that the identical audio input is heard from instruments.  And that's a true industry first.

Personally, I’m most interested in measuring the impact this technology can have in real world listening environments. My team will be focusing more on the efficacy of the technology rather than the effectiveness of the hearing technology. From extensive validation testing, we know the technology works.  We know exactly what it does and there have been numerous great patient outcome stories.  My area of research is going to look at the benefit with patients, with the goal of detailing the efficacy of such technology and quantifying the patient benefits.

Carolyn:  What are you most looking forward to in your new position? 

Bill: Phonak technology has been providing wearers the best products possible to hear better in more situations. In the new VP of Audiology position, I am interested in exploring how these innovative technologies can be coupled with processes that provide an unequivocal better experience for the end user.  For example, we all agree that the purchasing of new amplification is much more of a process than an event. To that end, technology alone cannot drive the end user outcomes, but rather the entire fitting process in which we implement such technologies. I firmly believe, from 21 years of providing patient care, that better outcomes can be experienced simply by empowering the patient or elevating their knowledge on what to expect with obtaining new amplification. The patients we serve deserve to know what good hearing care should look like, feel like and certainly sound like!  This enables patients to be better advocates for themselves throughout the process.

Of particular interest, I will be looking at how can we better motivate patients so that they move from, "I know I have hearing loss or I think  I'm having trouble here” to finally succeeding with amplification.   There is no question this can be accomplished through many different channels. In my opinion, two components are mandatory before we can improve current market conditions.  First, the customer deserves well defined realistic expectations throughout the entire process and second, the end result needs to be delivering products and care that create outrageously positive customer satisfaction.  Every stakeholder wins if we can accomplish these two goals.  I believe there is significant opportunity for the hearing aid industry to partner with those providing the direct clinical care to improve the overall process and customer experience. Maybe that means working with physicians to move patients forward with more evidence of positive realistic expectations.  Or, it may not be the physician to do this; it really might be the nurse.  Maybe one path to patient empowerment and ensuring a successful amplification experience begins with an innovative self-screening app.  Maybe it means a new approach to trial devices.  We all recognize there are a lot of opportunities in this area to demystify the overall process.

Carolyn:  To switch gears here, I see Phonak has recently launched a Tinnitus Balance Portfolio.  Is tinnitus an area of interest for you?

Bill:  Most definitely.  I think tinnitus is one of the biggest examples of clinical audiology where the more we learn, the more we realize how much we didn’t know.  The current models of tinnitus are now telling us that the problem is not specifically localized within the cochlea, but also involves areas further up the auditory system, often involving the limbic system and more central pathway structures. So, while tinnitus starts with a neurophysiological stimulus or trigger, there is also an emotional response and negative association to that stimulus.  The result can be metabolic changes and/or chemical releases in the body that cause anxiety, stress, depression, etc.  Such systemic involvement often becomes very cyclical in nature, exacerbating the initial onset.  

Our Tinnitus Balance Portfolio takes a multi-tiered approach.  We know most patients with tinnitus also experience hearing loss.  Hearing loss results in decreased neural activity to higher auditory centers.   Improving audibility in the cochlea often helps, but that doesn't mean tinnitus is a cochlear issue, as that improved audibility is also beneficial further up in the system.  Providing audition and sound therapy are part of all existing tinnitus treatment approaches, along with counseling.  The Tinnitus Balance Portfolio enables clinicians to now use a Phonak solution in tandem with whatever tinnitus treatment approach they currently use in their clinics.  Whether professionals are working with Tinnitus Retraining Therapy, Progressive Tinnitus Management, or other masking approaches they now have an innovative Phonak platform to help manage patients with tinnitus.  With sophisticated programming capabilities in the Target fitting software, clinicians can implement the flexible noise generator found in the new Phonak Audéo Q,  along with a new smartphone app to give them even more sound therapy options for their  tinnitus patients.

It’s very exciting technology, but at the same time, we are not just taking a shotgun approach to the launch of the Tinnitus Balance Portfolio.  We know that for tinnitus treatment to be successful it needs to be part of an evidenced-based program.  We are therefore targeting this portfolio to those professionals who are already using one of the well-defined tinnitus management  programs.  The onus is on us at Phonak to tell the appropriate clinical story, i.e., who are candidates?  What practices does it work for?  What's the patient's relevant story?   When does it work, and when does it not work?  As an audiologist, I think this is a very responsible, cautious approach and one that speaks to Phonak’s commitment to the evidence by wanting both professionals and patients to succeed with this new technology.

Carolyn:  Bill, what’s your philosophy on discussing negative research findings?  So, if a study doesn’t turn out as expected or reflects negative on the technology – should it be published?

Bill:  Yes, absolutely.  Part of the freedom I’ve been given at Phonak is to speak to the research findings that we didn’t necessarily expect or that may not always be positive for our devices.  Historically, that dialogue has been missing in the audiology community and really speaks to my heart as a clinician.  As an industry, we need to be willing to talk openly about our research findings, even if such results do not yield a strong marketing message for our products. More importantly, we have to allow those with whom we partner for research, like university colleagues, to have the liberty to report all findings that have a relevant or worthy learning opportunity for providers.  There is a lot of clinical value and a great learning opportunities when the research outcomes don’t turn out as intended. Without question, such situations happen regularly in the clinic – and if we cannot get good outcomes in a controlled research study, it will likely become even more of a challenge in a busy clinical environment! We owe it to the very people we are here to serve, clinical providers and the end users of our products, to speak openly about our research findings.  

I realize that I've been given an enormous opportunity and responsibility here at Phonak. I am truly impressed with Phonak’s commitment to supporting evidence-based technology development and innovation with a purpose. With my years of clinical experience, I find the patient-centric approach to improving the overall quality of both the products and the process of care delivery to be honorable and refreshing.   At the end of the day, from the product designers to those who manage the daily care, we're all looking out for what's best for the patient. I’m very excited to work with Phonak in this new capacity to achieve this worthy goal.  

Carolyn:  Thanks Bill, it’s been great speaking with you.

For more information, please visit https://www.phonakpro.com/ and https://www.phonak.com/ or the Phonak Expo Page on AudiologyOnline.