Severe to Profound Hearing Loss from the other side of the Otoscope
An Interview with Peter Stelmacovich of Phonak Canada
I recently had the opportunity to ask Peter to share some of his experiences as a consumer and an Audiologist regarding living with a severe to profound hearing loss. I was interested in how he uses some of Phonak’s latest product offerings to overcome the barriers his sensory loss imposes.
I started by asking Peter how his hearing loss and hearing technology journey started.
Peter: I was born with normal hearing, but experienced a series of ear infections. My first-grade teacher detected my hearing loss. She was the one who expressed concern to my parents which is not unusual given that my hearing loss started as mild. I then began to use a hearing aid in grade one. But only one.
Jan: Did you also have an FM system at the time?
Peter: No, I didn’t. They were not available yet.
Jan: Wasn’t it a struggle to hear your teachers?
Peter: Absolutely. I was in an open-concept classroom meaning that at the time, schools were being built without any walls between classrooms. It was a strange time in education. So with only one hearing aid and no FM system, I struggled immensely.
Jan: Did you eventually get two hearing aids?
Peter: Yes, I did. Fitting philosophies had changed and my hearing loss kept progressing. So by high school I had two hearing aids, but still no FM.
Jan: How did you cope?
Peter: For some odd reason, I have always been a pretty good advocate for myself especially when it comes to my hearing needs. So I always sat near the front, and did routinely ask for clarification. But school was different back then. The teacher really was the main speaker and I relied heavily on any notes written on the blackboard. I did have some classes that resembled today’s more highly interactive teaching styles and I did not do well in these classes at all since I could not hear at least 75% of what was being said! It was awful.
Jan. When did you finally get an FM?
Peter: It wasn’t until my 3rd year of university. This was also unfortunate because there were commercially available FMs for several years by then. I just wasn’t told about them by my Audiologist. Remember, too, information was not as readily available as the internet was not around then. This is one of the main reasons I went into Audiology and why I work for Phonak. No other hearing aid company has the complete portfolio of hearing equipment that a person with a hearing loss needs like Phonak.
Jan: Would you mind telling me what equipment you currently use?
Peter: Currently I use a Naida P-UP in my non-implanted ear with RogerDirect, a cochlear implant and of course the Roger On microphone.
Jan: Walk us through a day in your life. How does your day start?
Peter: My hearing dog Emma hears the alarm in the morning and jumps up on the bed to wake me up. I mention this because this is also an area that Audiologists should ensure they discuss with patients who need a Naida. Alarm clocks and smoke detectors will not be audible to someone with this degree of hearing loss and poses a significant safety risk.
Jan: What’s next?
Peter: Usually I start with virtual meetings like we all do nowadays. I use the Roger On connected to the computer's headphone jack to stream the audio to my hearing devices. This enables me to participate in team discussions with a mic to pick up my voice fully.
Jan: How is the sound quality?
Peter: It is excellent for the most part. If someone is difficult to understand, it is because they are not using a head-worn microphone at their end. That’s not Roger’s fault!
Jan: Agreed! I know that in this pandemic, social interactions have been severely curtailed. But where else do you use your Roger On?
Peter: I have it connected to my television which results in everything being much clearer. I am still practicing my bass guitar and using the Roger On connected to the headphone jack of the bass amp so I do not disturb the other household members. I have also taken up piano again, and my digital piano has a headphone jack I can plug my Roger On into. And this is where the Naida P-UP shines. Sound quality and music are massively enhanced compared to just using a CI alone. And with RogerDirect, there is no need for an external receiver. This has been such an improvement.
Jan: How have you dealt with the mask issue? Have you found that challenging?
Peter: Absolutely! Extremely challenging. The combination of the mask, the plexiglass barriers and the surrounding noise makes it very hard to communicate these days. But what I do here is I use my Roger On mic again. For example, if I was ordering take-away, I place the Roger On on the counter near the small opening where they slide the payment terminal device. This dramatically improves audibility of the high-frequency consonants and reduces the background noise. Roger is the best solution to overcome the detrimental auditory effects of these safety measures.
Jan: Do you have another example in which Roger really helped you?
Peter: Yes, when I attended University of Toronto to complete my Master’s degree in health administration. There I used 2 Touchscreen mics for the two professors we had for each course. And in addition, I used 12 Pass-around microphones, one for each of the 12 tables of 4 students. And of course a Multimedia Hub. Finally, we added a Digimaster speaker so that the entire class could benefit from Roger. It was an incredible experience to be able to hear everyone clearly for this first time at university. I was finally on a level playing field with my peers and was able to be fully engaged. And I should also mention how less fatigued I am at the end of the day when I use Roger. Struggling to understand is very exhausting and Roger addresses that too.
Jan: This sounds as if for the first time in a formal educational setting you had accessibility. However, people reading this may wonder about the cost of all this equipment, as their clients do not work for Phonak as you do. Do you care to comment on this?
Peter: With pleasure. There is a Federal Grant called the Canada Study Grant for students with permanent disabilities, and any student with hearing loss would qualify for that as long as they also qualify for at least $1 of a student loan. Now, I did not qualify for the Canada Study Grant, however, I used the concept of Duty to Accommodate. The University of Toronto paid for my equipment through the Duty to Accommodate as they had accepted me into the program. If I could share two takeaways from this it would be to always ask about funding and start the process when you are accepted into the program, not the first day of class.
Jan: This pandemic will end, and hopefully soon we will resume some of the activities we did before. Do you have other examples where you use your Roger equipment?
Peter: Certainly. In the past I used mainly the Roger Select and occasionally the Roger Pen for pointing mode. Roger On really combines the best of both of these into one product. While I loved the Select, I did miss having pointing mode. With the Roger On I can have someone wear it, I can point it, and I can place it on the table for groups. It really does everything. So, other places I am looking forward to using Roger On include the car, lectures, restaurants, small in-person meetings, parties, and conferences.
Jan: We know that the uptake of Roger in the adult market could be better. Who do you think is a candidate for Roger On?
Peter: I believe that Audiologists need to take a holistic look at the patient and not just see a pair of ears that need hearing aids. Certainly 100% of all Naida users should be using Roger. So it is imperative to counsel the patient that Roger On is a critical communication device early in the patient journey. And not just Naida. Roger is compatible with virtually all hearing aids and implants. So anyone with a significant hearing loss needs Roger if they want to function well in today’s world.
Jan: So are you saying the Roger On is just for patients with severe hearing losses?
Peter: No, not at all. We have data showing that the largest group of Roger users have a moderate degree of hearing loss. So I would say that Roger is needed for anyone who attends frequent meetings at work or volunteering, anyone who reports continuing challenges hearing speech in noise or over distance. It’s really the combination of the hearing loss and the patient’s lifestyle, not audiogram alone. We need to move away from a medical model to a wellness model of considering everything a person needs within their lifestyle to succeed.
Jan: What are some of the objections you have heard about using Roger?
Peter: In the past we talked about the three C’s: Cost, Cosmetics, and Complexity. With Roger Direct, the cosmetic concerns are gone as you do not need to wear the external receiver, you just install it into the Marvel or Paradise hearing aid. Then with the simple press of the connect button on the Roger On, you are set up. It’s that simple. Finally, we have made Roger more affordable through our Roger Certified Partner program which HCP’s can discuss with their Regional Territory Manager. There has never been a better time to fit Roger!
Jan: We have talked a lot about Roger On, but would you share some comments on your experience with the Naida P-UP?
Peter: Happy to. However I must remind you that as I am bimodally fitted I do not experience some of the true binaural effects of some of the Naida P features such as Digital Noise Cancellation or Speech in Loud Noise for example. I have noticed an appreciable improvement in the sound quality of music, having the direct connectivity of the Paradise product with iOS and Android devices and, of course, Roger Direct with no external Roger receiver. The Naida P is now smaller and lighter than its predecessor, making the long hours of use more comfortable, which is important to me.
Jan: Peter, thank you so much for being willing to share your experiences with your Phonak technology over the years. Any last words of advice?
Peter: Yes, for more information on working with those who have significant hearing loss, Phonak sponsored a working group who have released an Open Access Guideline for Best Practice in the Management of Adults with Severe to Profound Hearing Loss (https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0040-1714744.pdf)