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Interview with Dr. John Nelson, Vice President of Audiology and Professional Services, ReSound

John Nelson

April 21, 2008

Topic: dot by ReSound
Dr. Paul Dybala: Hello, everyone. This is Dr. Paul Dybala with AudiologyOnline. Today, I have the pleasure of speaking with Dr. John Nelson who is calling in from Copenhagen, Denmark. John, thanks for taking time to speak with me today. I appreciate it.

Dr. John Nelson: Thank you, Paul. It is my pleasure.

John Nelson, Ph.D., Vice President of Audiology and Professional Services, ReSound.

Dybala: John, if you could, give us a little background of what you've done as far as working in research, working in audiology, working in the hearing aid industry and finally your role with ReSound.

Nelson: Sure, Paul. Actually, my interest in the hearing aid industry started when I was working on my Ph.D. at Iowa with Ruth Bentler. This is when I stepped over into the engineering world. I took some digital signal processing coursework with the thought that someday I might actually work for a manufacturer. Who knew? I actually ended up doing that!

About three years ago, I made a big move from Chicago to Copenhagen and directed the Research Audiology Team in Research & Development at ReSound's corporate headquarters.

ReSound's Research & Development is global. We have offices in the United States, the Netherlands, China, as well as in Denmark. I worked closely with the different research groups. I also traveled to many countries to educate on ReSound hearing technology and improving the lives of individuals with hearing losses. The delivery model for hearing healthcare is quite different across the world.

One individual who I worked closely with was Bjorn Christ. During my years in Copenhagen, he was running the ReSound Japan subsidiary. In 2007, Bjorn was promoted to the President of ReSound USA. He proceeded to make some big changes.

Dybala: Yes, Bjorn was nice enough to sit down and talk with me and we published that interview in December of 2007. He spoke mainly about what some of his objectives were as the new President of ReSound US. (Click to view interview)

Nelson: Yes, and one of those objectives was to have a focus on audiology and the future of audiology. I was recruited by him for the new position, Vice President of Audiology and Professional Services. My team consists of the regional audiologists, trainers, and audiology technical support.

Some my focus areas are product training, education, and student outreach. Our plan with student outreach is to educate the Au.D. students on the hearing aid industry and also offer product education. It's a great opportunity that I didn't see coming; it's a great transition from my role in Copenhagen.

Dybala: Absolutely. You've got to understand some of the research on how the hearing aids work if you want to effectively fit them, but you also have to have a sense of what works in the industry, too. Sounds like great role!

What's your short-term plan at this point? Can people expect to see you doing things at the Bloomington headquarters, or are you going to be out and about doing regional seminars?

Nelson: Well, there are a lot of initiatives that I want to take on, and it's going to have to be rolled out with realistic resource expectations. Since I started the position I have been quite involved in the release of dot by ReSound specifically, empowering audiologists on the technology and signal processing in dot to increase end-user benefits.

Part of my job will also be working with ReSound headquarters on future products. With my background working in various countries, research and development experience, and now with direct audiology and end-user feedback, I can provide specific information back to the product management and development teams. It is exciting to be part of that process.

In fact, that is why I am in Copenhagen this week. I had a discussion this morning about the algorithms that should be in the products launching in 2009 and 2010. We started discussing end-user benefits and it turned into available MIPS and bits. I feel fortunate to be able to follow those conversations and understand different levels of limitations.

Dybala: I imagine there's a bit of translation to get used to with all of that, correct?

Nelson: Exactly. It's one thing to talk marketing terms; it's another thing to be able to talk algorithm coding. I do not profess to be an expert, but at least I can talk the language to some degree on both sides.

Dybala: What else do you think you'll be focusing on?

Nelson: Well, ReSound is reaching out to future audiologists in the doctoral programs. We have invited AuD students from across the US to attend educational programs at ReSound US headquarters in Bloomington. These are part of our ReSound University events. Audiology students are the future of this profession and we'd like to give them the opportunity to learn as much as they can before they start practicing.

Dybala: Well, that's tremendous. Since you are doing a lot of work with the dot by ReSound, we'll go ahead and segue into that. If you could, give us kind of a high-level overview about what dot is and what the main features are. it is

dot by Resound

Nelson: When we launched dot by ReSound, we wanted to ensure the product would fix some of the problems people have with receiver-in-the-ear products. We focused on what products were on the market, what worked well and what did not work so well.

Dybala: What were some examples of the things audiologists and dispensers were looking for?

Nelson: First off, we found that size was a concern. We know for cosmetics, size is often seen as the most important factor. As far as BTEs go, there is not a product smaller than the dot: smallest in terms of thickness as well as height. It also has an ergonomic design allowing it to sit nicely behind the pinna.

Another thing is begin able to fit more hearing losses. While a device might have enough power for more sever hearing losses, it must also have effective feedback cancellation. So, ReSound's sixth-generation digital feedback cancellation was optimized for this device to provide more real ear gain: not just what you see simulated on the screen, but actual usable gain and providing more audibility.

Dybala: What are some of the other physical features, as well as technical features for dot that make it stand out?

Nelson: Well, we looked at what some of the headaches are that people have had with the behind-the-ear receivers and in-the-ear devices. For example, one headache is receiver resistance to wax, debris and moisture. ReSound engineers developed a double wax protection system, which is comprised of a filter on the dome and a wax guard on the receiver. I like to use the analogy of a colander that's going to filter out the first level of debris followed by the HF3 filter, which is the most powerful filter in the industry to protect from wax. We've gone so far as to say that the receiver does not need to be replaced on a regular basis and have included it in the warranty. The receiver has always been part of the hearing instrument so, why shouldn't we include that in the warranty?

Other things we've worked on include making sure the receiver has a double-locking mechanism - it should not come off during use or during programming. Battery life is maximized; colors are interchangeable in the office; and a tubing re-bending kit when a unique bending is needed - those types of things.

In terms of the technology, we provide the high-quality sound that ReSound is known for: wide dynamic range compression, feedback cancellation, as well as directional choices, including natural directionality. We provide options to allow the audiologist to make the appropriate decisions for their patients.

Dybala: I was reading in the literature about the environmental optimizer. Could you talk about that and explain that a little bit?

Nelson: Sure. The idea for the Environmental Optimizer began as some small side discussions when I was working in Research & Development in Copenhagen. Our ReSound Metrix has data logging that was to classify the listening environment into one of seven categories: quiet, soft speech, loud speech, soft speech-in-noise, loud speech-in-noise, moderate noise, and loud noise. By using this Environmental Classification, discussions with the end-user on directional microphones, noise reduction, or fine tuning could be based on end-user comments and also actual acoustic data obtained during use.

A University in Antwerp, Belgium did a research project on our Environmental Classifier. They found that our classifier was accurate 98% of the time when compared to the test subject's classification to the same sound files.

Dybala: That's pretty good.

Nelson: Yes. The system works really well, not only for input intensity but also type of input (speech, speech-in-noise, or noise). We started thinking about how to use this great feature and take it to the next level.

If we go back a bit in history, ReSound introduced the first wide dynamic range compression (WDRC) years ago. This concept was also referred to as automatic volume control (AVC). Then began the great debate often lead by Ruth Bentler or Dave Fabry about if a volume control is needed and what lifestyle type would need one. Looking back, I think it is more that end-users want to adjust the volume based on the input level and the type of listening environment.

The Environmental FineTuner (available in dot by ReSound and Azure) allows the overall hearing instrument volume to be automatically adjusted based on which of the seven environments the end-user is listening. These are adjusted in the Aventa fitting software and the gain is automatically in day-to-day use.

So, if the end-user does not like noisy environments, the hearing instrument can be programmed to automatically turn down gain in noisy situations without affecting the gain in speech or speech-in-noise situations.

Dybala: Now, once you do some data logging on these devices and get feedback from patients, if there are other situations where the aid might not be adjusting quite perfectly, the audiologist can go back in and adjust the aid for those issues as well, correct?

Nelson: Absolutely. We did another research study at the University of Oldenburg (Germany) to investigate individual user preferences to volumes in different environments. There was a statistical trend that individuals preferred more gain for speech and less gain for noise. These results are implemented into the initial fitting. The audiologist can go in and adjust these settings based on the end-user's preferences.

So I would suggest combining the data-logging information, patient input, and specific questions to ensure the correct adjustment is obtained. Combining the information can increase fine-tuning accuracy. For example, consider end-user that complains of loud noise and the data-logging reports use in moderate noise but not loud noise. I would expect that the subjective rating of loud actually corresponds to moderate and loud noises.

Dybala: Absolutely. One example of that, I guess, for that could be a new user who just needs to take some time to adjust to use of a hearing aid, correct?

Nelson: Yes. And that brings up another feature available in the dot and the Azure. The Acceptance Manager allows the hearing instrument to be programmed at a comfortable starting point and gradually transition the patient to an ideal end-target over a specified period of time. The hearing aid automatically changes the gain and compression over a period of time.

dot by Resound

Dybala: What's the average amount of time that most people need for that adjustment? Is it around one month, or does it vary?

Nelson: I would say an adaption period of 2-4 weeks is adequate for most. Quite a bit of flexibility is available in the Aventa fitting software. The hearing aid settings can be set uniquely for the needs of the end-user. That's one thing I like about the ReSound products: choice and flexibility for the clinician to make those decisions based on the individual end-user's needs.

Dybala: I can see this working for new users. But is this something that could work for experienced users as well? Because we all know that we have some patients who are used to a particular sound or frequency response. Is it set up to change, or "morph?" Have you had any instances where you've used it for that reason?

Nelson: It's absolutely available for all individuals, experienced and inexperienced. I never thought about it as morphing, but in some ways, it is that.

Let's say you have an individual who is under-fit with amplification, and you want to increase their amplification. You could utilize the Acceptance Manager there if they're not ready to accept the new gain settings.

Or you might have somebody who's going from linear amplification into wide dynamic range compression. You could have it start linear and slowly adapt to WDRC, so the person learns that they don't need to as many volume control adjustments.

dot by Resound

Dybala: Fabulous. Well, John, we're actually just about out of time, but I do want to say thank you for talking with me today. I want to instruct any of our readers to visit the ReSound Web site at, in addition to a special Web site for dot,

You can also visit the ReSound Web Channel on Audiology Online at, where we post everything we have from ReSound into one place.

Also, be sure to be looking for John and his work. I'm sure he will be coming to a location near you, or maybe you'll see him in Bloomington. With that, I'm going to close up the interview. Again, John, thank you so much for your time and sharing all of your expertise.

Nelson: Thank you, Paul. I look forward to seeing you soon.

About ReSound

ReSound develops technology and solutions to improve quality of life for hearing impaired throughout the world. Founded in 1999 through a merger of GN Danavox and ReSound Corporation combining 90 years of hearing instrument development, ReSound today upholds its illustrious history as a leading manufacturer of cutting-edge hearing instruments in major global markets. ReSound North America is headquartered in Bloomington, Minnesota.
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John Nelson

Vice President of Audiology and Professional Services, ReSound