Tech Topic: Extended Wear Hearing Aids | March 2014 Hearing Review
By Mark J. Sanford, MS, Tamara Anderson, and Christine Sanford
The InSound Medical Lyric hearing device (now owned by Sonova and sold under the Phonak brand since January 2010) was developed over the past 12 years in Newark, Calif, and was offered commercially for the first time in January 2007.
Lyric is the first hearing device that can be worn continuously in the ear canal 24 hours a day for up to 4 months. This extended wear device was developed on several key concepts:
- Sound quality improves with proximity to the tympanic membrane;
- Some people with hearing impairment resist wearing hearing aids due to stigma associated with hearing loss; and
- People want an invisible and hassle-free solution to their hearing loss.1
- There are many benefits to having a device deep in the ear canal, including2,3:
- An overall increase in gain and output, especially in the high frequencies;
- Reduction in the occlusion effect;
- Ability to use the telephone and other ear level listening devices (headphones, stethoscopes) without feedback;
- Security of fit and retention;
- Reduction of wind noise; and
- Improved localization.
Sergei Kochkin has documented through his MarkeTrak studies that the market penetration of hearing aids is approximately 25%. Therefore, even with all the improvements in technology during the past decade—directional microphones, Bluetooth compatibility, multiple programs, etc—the percentage of hearing-impaired people using hearing aids has not changed or, more importantly, increased. The Lyric device has the benefit of being a device placed deeply in the ear canal and eliminates the stigma of wearing a hearing device due to its invisibility and convenience.
The Lyric device received approval by the FDA to be placed by an ear nose throat (ENT) physician in 2002. In May 2008, InSound Medical received approval by the FDA that audiologists and hearing aid dispensers also could size and place the Lyric device with proper training. It also received clearance from the FDA to be worn for up to 120 days continuously by a patient.
Integrating Lyric into a Practice
The Lyric device is very different compared to fitting a traditional hearing aid. The equipment, the evaluation of the ear canal, and skills of the clinician are critical to being successful with the Lyric. In addition, the medical issues that should be considered make the learning curve substantial.
Fitting the Lyric Device
Candidacy. There are three steps to evaluating a patient for the Lyric hearing device. First, the ear canal is evaluated otoscopically to determine if a patient’s ear is an appropriate candidate for the device. Second, an audiogram is performed to determine if the patient’s hearing loss is in the fitting range. Third, the ear canal is then sized by the Lyric fitting procedure, ideally under a high-magnification microscope, to determine if the patient’s ears can accommodate the Lyric device. There are some medical conditions that are contraindications for some patients: transplant recipients, uncontrolled diabetes, radiation to head and neck, and autoimmune compromised patients.
The otoscopic examination is the foundation for placement and successful fitting of Lyric. The bony portion of the ear canal is very sensitive, and visualizing where the medial seal should/will sit in this part of the ear canal is extremely important. Discomfort is the number-one reason patients do not keep the Lyric, and 95% of pain complaints come from this area when fitting Lyric. The discomfort or pain is almost always on the floor of the ear canal or on the lower sides of the canal wall. In some cases, the top of the ear canal by the tympanic membrane can be sore.
The customary hearing aid evaluation for Lyric takes 45-60 minutes if you decide to test, size, fit, and counsel all at the same appointment. Approximately 5-20% of patients who are sized will need to return for fitting 5-10 days later due to sensitive skin that may appear slightly bruised during cerumen removal and/or during the sizing procedure. As a practitioner gains experience and knowledge, the number of patients who need to return for an initial fitting after bruising from initial sizing will decrease to less than 5%.
The Lyric device is sold on a subscription basis, so patients will want to be “re-fit” as soon as possible after the device ceases to function.. A re-fit generally takes only 5-10 minutes, depending on if it is a unilateral or bilateral change. When a pattern of device longevity develops for a patient, they may decide to come in at regular intervals before a device becomes weak and runs out of power.
Subscription model. Lyric is sold on a subscription model, meaning the cost the patient pays covers all services for a year. The subscription is usually for 1 year, and patients can buy extended years, especially if they have an insurance benefit that covers more than the cost of 1 year. There are a few patients whose devices last 120 days, but this cannot be determined in the beginning for a patient trying the Lyric. The patient’s ear adapts to Lyric over time and a fairly consistent interval of service life develops. Most patients will come in at regular time intervals to have their Lyric(s) changed for a new device(s).
There is an interesting irony with patients who wear the Lyric: they have an invisible device, but they tell everyone about it. They say to their friends to look in their ears that they have this great new device. The hearing aid industry has been trying to be cosmetically oriented for years to reduce the stigma of wearing an aid, and now there is a device that is basically so invisible that our patients want everyone to know they are wearing a device.
Additional benefits. The Lyric differentiates our clinic from local and even national competitors. In many ways, the Lyric sells itself and should be introduced to all patients, especially those who will not use a traditional device. The patients who do wear Lyric provide incredible word of mouth about the device, creating a higher referral rate for the practice.
Lyric changes the clinic’s perception of hearing as patients are extremely satisfied, happy, and want to wear a hearing device. This is compared to many traditional device users who tend to have more negative feelings toward their devices.
We believe the relationship between the patient and practitioner also changes. The practitioner is much more involved with the patient when sizing and fitting the Lyric compared to a traditional device. This intimacy makes the patient more loyal and “tied” to the office than with a traditional hearing device that the patient can think they can get from any dispensing office.
The Lyric hearing device is a great option for hearing-impaired patients, and we believe that it is tapping into people with hearing loss who normally would not wear a traditional device. It has been fit on thousands of patients successfully who have the appropriate anatomy and hearing loss for the Lyric, and the latest version of the device has proven to fit a high percentage of ears.