And now let's go ahead and introduce our first speaker, Nashley Brogan, Doctor of Audiology, who will be guiding us through improving outcomes using digital oral rehabilitation. Nashley Brogan is a devoted audiologist with a strong passion for helping individuals with hearing loss. With over 19 years of experience as the sole proprietor of a large audiology practice, which includes both audiologists and hearing instrument specialists, she is dedicated to providing progressive care using the latest tools and advancements in audiology. Nashley's personal experience with progressive hearing loss and her use of cochlear implants has given her a unique insight into the challenges that individuals with hearing loss face and their various treatment options. In addition to her private practice, Nashley is actively involved in advocacy initiatives to increase awareness of the impact of hearing loss on an individual's cognitive and mental health. She participates in discussions on the subject matter and emphasizes the importance of addressing hearing loss beyond just treating the ear. And now let's turn it over to Nashley to begin our first session of the day. Nashley. Thank you. Thank you for having me. I'm really excited to share with everybody here what I've learned about using digital oral rehabilitation tools in my practice. I'd like to thank the International Hearing Society for having me on today. I'm so excited to share this information and I'm hoping that everyone today has something to take home that they can implement in their practice, because that's the whole point for me when I want to talk to people, share the information that I've learned through trial and error is that you can implement some of this with your patients when you go home. Oh. The big thing that happened in the last couple of years, which we've all witnessed, is the virtual shift. And this has transformed, I think, everyone's practices, but it's also allowed tools for us to use in our practices and it's made oral rehabilitation or audiological rehabilitation much more feasible and possible. Because during COVID, so many things with telehealth and virtual care and Zoom became available, but more importantly to me, what happened was that patients got on their cell phones, they joined Facebook groups, they learned how to use iPads. And for many of us here today, we work with the aging population, which is seniors. And now for most of them to have gone to a restaurant in the last three years, they had to use a cell phone with a QR code. They had to use an app probably to access their doctor or go to the hospital, even to show their COVID certificates and vaccine passports. So a lot of our aging population now know how to use digital tools. They're on the internet a lot. 50% of seniors are in Facebook groups and Instagram and they're on social media and they're searching. They definitely know how to use these tools now. So what's made us possible is we have more options to provide care and access to our patients. And for me, the shift was switching from more of a sales model to how can I provide treatment and treatment planning for my patients? And these digital tools make it possible in an easy way. So a little bit about my history. I was diagnosed with a progressive hearing loss when I was 14 years old and basically told that I was going to lose all my hearing over the next 20 years. And I eventually did. I got hearing aids when I was 18 and I had a phenomenal audiologist and she herself with a hearing insurance specialist. So my history has always been with both working as a team and a phenomenal practice in Nova Scotia. And they worked together and then they basically were encouraging me to become an audiologist. And it was through Mark Ross, the father of aural rehabilitation, his articles that they gave me when I was in my undergraduate that made me decide I wanted to become an audiologist. And I just love the psychosocial aspect. I was struggling with anxiety, with hearing loss, losing all my hearing and just getting hearing aids wasn't enough. There were so many more things that happened outside of just having hearing aids, communication struggles, not knowing what to do in noisy environments, starting to suffer from social withdrawal, which I definitely did in my thirties. By the time I had two cochlear implants, I hadn't talked on a telephone in 10 years. And during this time, I was growing my audiology practice. So I opened up Blue Water Hearing in Ontario six months after I graduated. My sister, Michelle, who is a hearing insurance specialist with Grand MacEwan did that program in 2009. And I was their clinical preceptor, helped me grow this practice. Today, we actually have 12 employees at one location. It's very, very busy. I have been a clinical preceptor and mentor three hearing insurance specialists through the last basically 14 years. I've mentored four untrained audiologists and I'm also a clinical preceptor for Western University for audiologists. We have students with us rotating through. So, and I've had a team and I know what it's like to have a very busy dispensing practice. We are a dispensing practice. Our whole focus is the aging population and people with noise induced hearing loss. And that's my passion is people who have acquired hearing loss. How can we treat their hearing loss? And during the last couple of years, I was like, how can I treat them but not just focus on the device? How can I treat them with a better care and model? And some of these tools I'm gonna talk about are what allowed my practice to do it really easily in a very busy practice where we're just seeing patients every 30 minutes to an hour, an hour and a half all day long. So that's the whole point today is I hope some of these tools you can implement because they don't take a lot of time. The other thing with these tools that I'll be talking about is that you can make lists, you make it easy. It's supposed to be easy to implement. So it's not supposed to be complimented and I'm welcoming anybody after the presentation. You can always email me if you want further information or what you can actually do in your practice yourself. Now, I thought because I became an audiologist because of Mark Ross, who's like the father of oral rehabilitation, that I was gonna be like a queen of oral rehab. And then the realities of private practice settled in. And it basically was that back then the oral rehabilitation model was more extinct to me. I don't think many audiologists practice it. It was hard to practice because it took a lot of time. I wasn't an oral rehabilitation audiologist where I had hours and hours to sit down and do group therapy sessions with patients. I was in a very busy practice and my life was lived on the clock where we were just working with patients every day. And every time I even thought I was gonna talk to a patient about their psychosocial or emotional health or communication strategies, they were coming in and the receiver was falling out of their ear or their dome or we had to do another hearing test or I had to remove earwax. So all the things I even planned never happened. So that was the realities of my oral rehabilitation journey and trying to do it through the traditional way was that it didn't happen at all. So today at the end of this presentation, what I'm hoping that you'll get out of it is why use an audiological rehabilitation plan in your practice and how you can identify candidacy, like what people need. Because I think that was the hardest part for us was that we all talk about audiological rehabilitation, but like how do you figure out what your patients need? Can you list the benefits of it? So why do your patients need it? And then just identifying some simple digital tools that you can implement quickly in your practice. First, we're gonna go back just for the history so you understand the digital tools and the model. So the modern definition of audiological rehabilitation happened in 2001, it was a shift. And that was because the World Health Organization became it with a new international classification system. And basically they switched from defining people with disabilities as handicapped to more participation in life activities. So in 2001, when this definition came out, it ruled through all healthcare, not just hearing, in terms of how we looked at people who had disabilities. So we weren't talking about the word handicap, we were talking about their level of participation in society, their wellbeing. And then ASHA picked up on this in 2006 and they basically rewrote it and they redefined audiological rehabilitation to include daily activities, life, wellbeing. Boothroyd in 2007, he has a very popular article that was published and he basically took ASHA's definition and broke it down in different categories and started talking about sensory management and behavioral changes. So he kind of took ASHA's definition and made it into a practice model where we're gonna talk about sensory management, perceptual abilities, patients living communication strategies. But then Montano, which is the one I love the most, in 2014, he came out with the person or family-centered care model. So we basically seen this new modern definition of audiological rehabilitation change from 2001 to current, where it was just changing the definition where we're involving the patient more in the care. So this is the old-fashioned or the old model that I was trained under and it's a technocentric model. And this is a model that I think that most clinicians practice with. I definitely practice with it pretty much for the first 15, 16 years of practice. And the technocentric model is like, you're doing your audiometry, you're fitting them with hearing aids, real ear measure, showing them from right from left. You might do a remote mic or FM system, talking about using their hearing aids at home, maybe pairing with a cell phone app. And that's what we basically called our therapy and counseling. And it's a very technocentric model because the whole model is basically, I'm gonna test them and I'm gonna fit them with the hearing aid and show them how to use a hearing aid. And that's what we think is like rehabilitating the person. And that's more of the older model and that's definitely the model I focused on. I almost left audiology seven years ago because I just felt like this is such a sales model. And it was like, you're chasing how many units you sell or how many people you fit in a month. And it's just so focused on the device, which after so many years just became not as satisfying as what about the patient? And now we have this model, which is the Montana model, which definitely focuses more on counseling. So it's the patient's story. We call it patient-centered care. Some people call it person-centered care or family-centered care. It's whatever you prefer. And our practice is patient-centered care. And that's basically the patient's journey. So it's where is the patient, finding out what the patient needs to using self-assessment questionnaires like the Hearing Handicap Inventory, talking about communication strategies, also their technology, possibly some auditory cognitive training, verifying their hearing aids, but also providing motivation and support. And then we also have over here, like open-ended questionnaires and listening and counseling. So these two diagrams, kind of the new model of patient-centered care. And what I always like thinking about patient-centered care, it's a word thrown around a lot online now. And as clinicians, hearing care professionals, we always say we care. We care about our patients. But just because we care, it doesn't mean that we practice patient-centered care. Patient-centered care means that we're actually taking the time and stopping ourselves in clinic and finding out what the patient needs beyond just our tests that we want to do. So I think I always say to my staff and my team, I said, you know, just because you care doesn't mean you're practicing patient-centered care. Your actions and what you do in clinic dictate whether you're practicing patient-centered care. But I still think it's a balance between making sure you're doing your diagnostics and going with the goals, plus bringing the patient in and meeting them where they are, and not always trying to fix the patient with the hearing aid, because there's definitely other ways to help patients and treat them. So the three pillars of hearing health care when we look at them are we test patients and we treat patients and then rehabilitation. For me, my first, like I said, 15, 16, 17 years was just all testing and treating. It was just doing a basic audiogram, pure tones, beeps, masking, maybe a COSI, and then treating them with hearing aids. And I thought I was doing a great job because I did really our measures. Like, you know, that was the gold standard. There was really little of number three unless we gave them a handout with some communication tips, or they told me that they couldn't hear in a restaurant, so I told them to sit in a booth. But that was my whole, everything that I did in rehab. Now in practice, we're trying to do a lot more, and the digital tools have helped me do the rehabilitation number three a lot more in my practice. But as we get into the digital tools, the first thing I want to point out to everybody is that it's really important that when we look at the different ways we can educate our patients and provide rehabilitation so we're counseling them and we're helping them is that there's different kind of levels. And I mean, most of us probably do good. I'm assuming you all probably do good. We do handouts or we might email. We talk to them what they want. Then there's like a better way to teach them where we can do interactive like apps and interactive computer programs where they're learning, but there is some either like there's learning, it's great at learning or standalone computer programs. And of course the best audiological rehabilitation is always in person or virtual one-on-one. And this can be done on a computer. We're gonna be using some of our digital tools in practice so we are doing it in person too, but usually they're clinician guided. So I just always mentioning that, like even with the digital tools I talk about, of course in person is always the best, but we're trying to, in my practice do, we do some good, we do some better and we're trying to do some best. A lot of the best only used to happen with the patients with severe profound hearing losses where what I want to work on is how do we treat all our patients? So our presbycusis, our 60 year old coming in with a moderate hearing loss or mild to moderate, how do we give them some more of this? Because usually our severe profound patients, yes, they get a lot more of our care because there's a lot more going on with their hearing needs but how do we take our subclinical hearing losses or our mild and our moderate hearing losses and getting a bit more of this? So the components of like to me, the modern audiological rehabilitation, that's a little bit easier to understand the language is I break it down into four pillars. So the four components of audiological rehabilitation that I'm looking at is education. So what can I do to educate them? Can I give them a sense of community because we know social isolation tends to be a big problem with people with hearing loss. It's one of the things we often talk about with like caught in decline is they need to have social engagement. How can I motivate them to keep wearing their devices, to start treatment, to continue treatment and to come back in the future? And the auditory training or cognitive training is how can I stimulate their brain and make improve on their ability to hear and their cognitive function and state? So what we noticed in our practice was that when we started giving our patients some digital tools, we were empowering them. And I think empowering is a big word. Empowering patients to educate themselves is like handing them keys to unlock a world of knowledge, allow them to be active participants in their own journey. So for me, patient-centered care is allowing your patients to be active participants in their own journey. So I'm still guiding them as a clinician. I'm still following a medical model of actually testing and treating, but I'm trying to empower them to learn about their hearing loss and what they need to hear better. So it's kind of combining two approaches. So what we're gonna be talking about is how do you figure out what they need? Because this is something that I don't think that's ever talked about. And we kind of had to figure out in our clinic on our own, is you have your assessment, so the patient comes into your clinic, and then, okay, so you do the assessment, you have to figure out what they need, and then you have all these tools, and you have to treatment plan or figure out what tools they're gonna need. So your assessment basically is you're gonna assess them, and then you can either have a checklist of what tools you have available, and then you decide what ones you're gonna let your patients be exposed to. So in the clinic, how we look at assessments is we look at some subjective measures, which I think is really, really critical. We were not doing this in my practice prior to 2019, is we used to do a COSI, but we switched to using the Hearing Handicap Inventory for adults, and there's also one for the elderly, and there's a screener. So, this is a simple paper-based form that you can get on the internet, and I'll be showing you in a second on the screen, that our patients figure out in the waiting room, fill out in the waiting room, and it allows you to kind of know their psychosocial state. So, you're trying to figure out, do they need a sense of community? Do they need a bit more education? Are they frustrated with their hearing loss? The COSI is a great measure. My always problem with the COSI was that patients don't always know what they need. So, when you use a subjective measure that's been validated, and you're asking them the questions, you might pick up on stuff that they don't even know they have. They might not know they have anxiety unless you ask the questions. They might not know they are socially isolated unless you ask the question. Combining the two measures is fantastic, but we definitely like the Hearing Handicap Inventory, and then there's the Tinnitus Handicap Inventory. The AFAB is much longer. The screening, if you're looking for something quick and you need a screening, measures are great for the use in your waiting rooms, and they're paper-based. So, we have our patients come in, and they're coming in for assessment, and they're going to fill out their HHIA. Then they come in, and we're doing our pure tones and our Bs, but the most important test we do, which I think drives almost all of the audiological rehabilitation, is the speech and noise testing, and Doug Blissback will be talking about that after me, and he does a wonderful job, but speech and noise testing is like the, if you're going to change anything about your practice because you need to figure out how to help your patients more and treat them more, I would add in speech and noise testing. It only takes a few minutes to do in your practice, and it's just loaded with so much information and figuring out what your patient needs that they can't tell you. We also do cognitive screening, computerized, but you can do a questionnaire, a memory questionnaire, which I'll be showing in a screen in a second, and you can also do, there's a computerized and there's paper-based ones. So, just depending on where you are, if you're asking questions about the psychosocial, which is the HHIA in their waiting room, takes a second, it's paper-based, add in the speech and noise, and then do some type of memory assessment. With those three tools, then you kind of know for some rehab what your patient's going to need. What this does when you do this is the patient feels like you're doing so much more for them than just doing pure tones and beeps. Like, when you start doing a little bit more in your assessment, like add on five minutes to that hour assessment, 45 minutes to an hour, your patients would be like, wow, I don't get this anywhere else. You care about me. You're asking questions about anxiety, or you're asking about how I, you're showing me how I hear in background noise. So I'm telling you I can't hear in background noise, and now you're testing how I can't hear in background noise. You're asking about my memory because I am struggling with understanding speech and background noise and remembering things. So it has, it's a fantastic tool. The other thing is for post-fitting, we actually use the HHIA post-fitting again. So we'll fit them with hearing aids, and we'll have them redo that little subjective questionnaire. It takes two seconds, and it's phenomenal because the patients, their scores will get better, and they're like, oh, wow, I'm doing so much better from my hearing treatment. So this is an example of the HHIA, and you'll have this afterwards for the slides. Our patients a lot of times score themselves while they're waiting, so it's really easy. And then you have questions like, does a hearing problem cause you to feel embarrassed when you meet new people? Do you have difficulty understanding your coworkers? Do you feel handicapped by your hearing problem? It just questions that patient's attachment to how they feel psychologically and socially. So it gives you an idea of if they're going to need some more education or support or communication strategies. And then there's a longer version, so the screener was the last one, and this is the longer one. So it's about five questions long, but both are fantastic. It just depends on what you want to add to your practice. So I threw them here on the slides. And then this is just a basic, some questions if you have, if you do do a written case history or you want to ask your patients about memory. Often stumble into things that are near you, have difficulty concentrating, are you paying less attention to your hobbies? So you sometimes have difficulty finding words, misplace things, do you feel fatigued at the end of the day, listening fatigue? So these are questions about memory and their cognitive state. So if you don't want to get into full cognitive screening, you can at least add the paper into your intake and it gives you lots of information to help to figure out how you're going to offer some audiological rehabilitation to the patient. So I'm going back to the four components because I showed this before, but we need to, so you're doing your assessment and from your assessment, so you know, you're looking at, say if a patient has like difficulty in background noise, you're going, okay, what education do they need? Do they need community or peer support? How much motivation do they need? Or do they need some auditory training? So these are my four components of AR and I'm trying to figure out from my assessment that I've just done, which ones do they need, all of these or do they need some of these? Because not everybody needs the same thing. And I also don't believe that you shouldn't just throw spaghetti at the wall and hope it sticks. So the problem with some of the audiological rehabilitation programs I've seen is every single person gets the exact same program and I don't believe that every patient needs the same program. What you want to do is you want to look at your assessment and you want to customize or at least give tools to your patient that they need. They might not need a 12-week or a six-week program. They just might need a peer support or they might need a book to read. So you're trying to figure out what your patients need to help them add some rehabilitation. So this is my toolbox and this is a lot, but this is basically the things I have in my practice that help me in those four categories. So when I'm trying to add some education onto my patients, we can do email automations. That's email them tips and education about hearing loss. We send newsletters home so you can send your patient a newsletter on hearing health, cognitive health, communication strategies. For education, we can send them to Facebook pages, which I list at the end of this because there's lots of Facebook pages for hearing loss now, where there's lots of education about hearing in there. You can also do a program like Five Keys, which is an amazing program. It's an audiological rehabilitation program that is automated emailing in an app that they do for you. And then there's the app called Amplify, a computer-based program that's what we use in my practice, and that program includes all four of these categories, but that basically we set our patients up on Amplify, and then Amplify is just constantly educating them. It sends them emails, and they're receiving everyday updates and education on living with a hearing loss. So that's education. And then that's one thing. So if your patient needs education, there's lots of different digital tools there. If your patient needs community, so if you've noticed during your assessment that your patient is lonely, they're not going to church often, their family is saying that they're starting to feel lonely, they're not going to go out or avoid things. There's different things you can give them. One of them is you can recommend, you can actually do your own Facebook group, which I see more clinics doing. So clinics will have their own private Facebook group for their patients, and that means their own patients within your own practice can communicate with each other. Or you send them to one of the bigger Facebook groups online, which is like Hearing Loss Group of America, Living with a Hearing Loss, there's an emotional hearing loss group. Again, I have them all listed today for you. But those Facebook groups will give the person a sense of community. So they're connecting with other people who have hearing loss to share their journey. And then there's Amplify. Amplify the app, and that program has a community built into it that is controlled by the hearing coaches. It's a fantastic community where people are sharing pictures and talking about their hearing struggles and supporting and basically being each other's cheerleaders so that you don't have to be their cheerleader. The other pillar, motivation, is how do we motivate our patients? Again, we can do automated texts and emails. There's hearing coaches online that we find on Instagram and Facebook that will actually motivate your patients for you. And again, Amplify has it built into its program. And then the last but not least is the auditory cognitive training. So there's different programs that you can get that are digital that you give to your patient that basically works their brain. So it's auditory or cognitive brain training. Amplify, again, has it built into its app. There's LACE, which is a standalone auditory training program. Advanced Phyotics has one. And the APD Institute in Australia is actually getting ready to come out with that. So these are some screenshots of the different ones I have. Five Keys is an app down here, down lower corner. And that shows you plug in, learn more. That is the Aura Rehabilitation Program. The top one I have is the Facebook app. So that shows you Facebook. LACE is a program that is auditory training and communication tips. And then the one over here in the red, which is interactive curriculum, that is Amplify. And Amplify has your hearing coach. It has your community. It has 12 weeks of education. And it has auditory training all built into the app. So that has everything. So these are examples. And I have listed the websites at the end of my presentation today. So you can go check them out if you want to add any of these to your practice. So how do I figure out what patients need? So this is where it all comes together. So a patient comes in to me, a normal patient. And I'm looking like, OK, so do they need any education? Do they need a community? Do they need motivation? Or do they need auditory training? I have a patient come in, a six-year-old. And we do the assessment on them. And their HHIA is OK. But they're not doing as well on speech and noise. And their cognitive screening shows they're having a little bit of problems. So when we fit them, I'm going to recommend all four components. So I want them to have their new hearing aid user. And I want them to learn some education on how to live with the hearing loss. I want to connect them with other people who have hearing loss. I know I'm going to need to motivate them because they're showing some memory issues and problems and difficulties and background noise. They're probably going to struggle with the technology. And I also want to make sure they have some auditory training to make sure, cognitive auditory training, to make sure that I make sure they're empowering them to work with their hearing aids. Because a lot of times when we just fit a patient with hearing aids, we fit them. And then we're done with them. We fit them and we see them for two or three adjustments. When we assign auditory training to our patients, we're actually empowering them. And it's kind of like what I call physiotherapy for the brain. Because I'm saying, I want you to go home and do three or four weeks of exercises on this app or computer. I'm literally giving them a homework assignment. And I'm telling them that wearing hearing aids involves a lot more than just putting them on. And I truly believe that when you get hearing aids, just simply wearing hearing aids is not enough. You have to learn how to listen again. You have to practice listening skills. You have to learn how to use them. But the auditory cognitive training, it actually makes them do it. It's just like physiotherapy. It's prescribing a treatment that they have to do. The cool group that we really noticed a lot of benefit in our practice is these subclinical hearing losses. So these are the people who come in and you don't know what to do with them because they're pretty much normal audiograms. Normal if you're just doing your standard 8,000 hertz. But they can't hear in background noise. And they're upset. And we have them all the time. And we've tested them. And what happens is that if you do speech and noise testing, they'll have poor speech and noise scores. So that's how we pick up in these cases. Normal audiograms, but they do difficulty speech and noise. Often they'll do difficulty though too on their cognitive screening. So what we do with these people is we recommend auditory training and communication strategies. So we're basically saying to them like, I'll recommend Amplify or an auditory training. And they love it because they're coming to you for treatment because they have a problem to be solved. And often when we do our testing and we say, I'm sorry, there's nothing I can do for you. It's horrible because they actually do have damage to their auditory system. It might not be in the ear. But by assigning the auditory training and maybe receiving emails on how to hear in background noise, you're empowering them, educating them that there is actually something wrong because the damage is usually in the auditory system and you're acknowledging that. And then you're giving them something to work with. The other group that we've noticed a huge success with, with giving digital tools to is our experienced users. So we have patients who've been with us for 20 years, the hearing aids on them. And we'll notice say the second, third set, they're still struggling. When we give them some auditory training on their, say they came in and they're upgrading their hearing aids. Well, first of all, it actually gives them much more reason to upgrade. And then we assign that they're like, oh, I didn't do this before. And they're very engaged in doing the new education because they want to hear better. And a lot of times just getting a new hearing aid is not enough. It will not make their hearing, their expectations don't meet reality. By giving them more education and connecting them with the community, it's amazing what that does for them. And then there's your experienced users who are challenging. So we have users who are going through either their cochlear implant patients who are their hearings dropping a lot, and they definitely benefit from auditory training and community and motivation. You have users who are basically having memory issues and they're going to need more communication strategies. So this is just a small example of the different categories. But what it means is that I'm looking at them differently. So my subclinical hearing losses, I might only give them recommend auditory training. And I might have an experienced user and I might be like, okay, this person, I want them to have, you know, four to six weeks on education on cognitive health and brain health because they're not wearing their hearing aids as much as I want. So I'm going to send them an email automation and or give them more handouts to make sure they're basically wearing their devices encouraged and the importance on maintaining their cognitive health. So what we noticed in the clinic with all this that I just said, and I know it's a lot of information, is that how does this become a success? When we first brought Amplify into my practice and we were trying different digital tools, nobody was doing it. And my clinicians, so I have my three HISs and I have two audiologists with two audiology assistants and nobody could get patients to do any of it. And what I decided was, okay, well, when are they discussing it? And they were always waiting till the end of the hearing aid evaluation to bring up any of these programs. They were waiting till the very end to say, hey, by the way, if you want to do this game, brain training game we have, you can do it. Or by the way, would you like this program sent to you and you can work with it at home? And no patients took it up because I think at the end of the hearing aid evaluation, they're exhausted. Usually you've been talking to them for an hour to an hour and a half and they're saturated. So I looked and started having my team, my entire team of bringing the conversation in earlier into the treatment plan. And what we noticed is that it completely transformed our practice. So don't save the best for the last. We talk about our programs right from the beginning. So when they come in and they do their HHIA in their case history and they say they're having difficulty, frustrated with their hearing loss, anxiety, we say, oh, we have a program for that. When we're actually testing them and we do the cognitive screening and they have a poor score, we say, oh, we have a solution for that. When we're doing speech and noise testing that they have poor speech and noise scores, we say we have a program for that and some education that you're going to be working on on top of treatment, treating your hearing loss with hearing aids. And same as our returning patients, when they come back for their adjustments or walk-in checks and they're complaining about their hearing aids or they're complaining about how things aren't working, we bring up these tools. So we just don't, we do it all the time. It's being brought up now all day long and it's really good for your test not treated. So the patients are like, you know, I don't, I'm not ready for hearing aids. Then we'll be like, well, if you're not ready for hearing aids, would you like to do one of our programs online? And a lot of them say yes. And some of them actually come back a month later and decide to start treatment because what they discovered in the digital online program. So when we rethink this, it's basically changing our care model and it's just, it's conversations though. Because what we're doing is we're customizing what we do. We're not just bringing somebody in, testing their hearing, fitting a hearing aid, and then seeing them back in four years after a few adjustments. We're being competitive with OTCs and online hearing aids. These are very cost-effective tools. They're actually super easy once you implement them. Once you actually get the tools in place, it's literally just a conversation. You don't do any, you don't really do anything besides talk to the patient. And they're very, very adaptable to the patient and flexible because you can choose different tools for different patients. So why should you do this for your practice? First, it makes your practice different in your market. A lot of people will not take the time to make a checklist. So we basically just have a list of my practice and we just, if a patient comes in, we check off what they need and then we give it to the front desk and they make sure it happens. And then we follow up with it. It provides best practices that you're actually providing counseling and rehabilitation. It definitely increased treatment acceptance rate. You'll see a lot of patients say yes to treatment because you're not just trying to sell them something. So this is moving away from that sales model to a treatment focused model. And when you're talking about auditory training or education or I need you to have a community of people with hearing loss, the patient just thinks you're providing phenomenal care because you're not talking about a hearing device. It saves a lot of time down the road on routine care because basically they're being educated earlier on or they're just continuously being educated. And it also increases the value to the patient. So this is my citations here. I did put the references at the end. And I put the resources here at the end of anything you would like on the four components, the different auditory training programs. There's different Facebook groups that I listed here living with the hearing loss group, hearing loss and the emotional side, hearing aids and hearing loss. So if you google any of these groups or go into Facebook and you go in the group section and put any of these names in and join some of those Facebook groups to see the types of care they're providing. So that's all I have right now. And I don't know if anyone has any questions. Thank you so much, Ashley. That was a great presentation. Yes, as you said, we'll go ahead and take some questions. As a reminder to our attendees, go ahead and enter your questions into the Q&A box at the bottom of your screen. We'll take as many as we can in the time remaining. So naturally, our first question today is from Katie, who is hoping to hear more specifics from you on what kind of information you provide via that email automation you were discussing for patient education. So what kind of information are you providing? So patient education via email, on email, so we I just pulled a lot off of online. So we have like, I found on different sites. And actually, this is why it's so simple to do is I actually go online, and I'll share from even the different organizations, tips on how to keep your ears clean from the American Academy of Audiology, signs of hearing loss, like so all the organizations have tons of resources on their websites. So I went to the websites, and I emailed that information, my patients. So we just sat down and found a ton of information online, cognitive health, brain health, and then just put it into a folder on our email on our like, desktop. And then we just email that to a patient. So we just like you have a list, and you just check off, I want this patient to receive a tip on cognitive health, and then it gets emailed to them. So it's really simple to do. It takes like two seconds. And I feel like it's much more customized to what the patient needs than just sending everything at them at once. That's great. Thank you so much. The next question is from Sean, in your opinion, which of the four pillars of oral rehabilitation that you discussed, which is the most important for the patient? Oh, you know, that's a hard one. That's, that's a big one. It depends on the person. I, for our practice right now, the auditory training and cognitive training is really changing the patients because I think that we don't do enough after we fit patients with hearing aids. So like we talk to patients a lot, and we give them handouts, but we don't do anything to make them use their brains to hear more. I know if that makes sense, like we're not actively making them that they they have to be listening, they have to be wearing them, they have to be flexing those auditory skills to actually hear. So I feel like the auditory and cognitive training that we have out there, it makes the patient click and realize that and so we've noticed that it's huge because the patients come back and they're like, I just never thought of it this way. But I am a big believer in education, too. So I don't know if it's education. I mean, it's really hard to pick because it depends on what the person needs. Well, and they're so interlocking as well, right? So much overlap. I mean, you can there's so much overlap. And that's why I don't think rehabilitation programs need to be complex. I think it's just saying, okay, this patient struggling in background noise, what do I got to give them on top of a hearing aid? This patient has memory problems? What do I need to give them on top of a hearing aid? This patient's like socially need needs to connect with another person with hearing loss, they just need a Facebook group. Like I try to keep it as simple as possible. And what I call as modern as possible. That's great. Thank you so much. And piggybacking because I heard you mentioned a patient that has trouble with background noise. Our next question is from Martin. And he's asking if you have updated stats on the percent of hearing care providers that are using speech and noise testing, and I would also add, you know, do you have any comments on that? Why should we be doing speech and noise testing? Is it easy to get started with it in our practices? It's very easy. I think I mean, Douglas Beck's gonna be talking about this for the whole hour after me. This is his talk. He's amazing. But I think he always preaches that less than 20% of practices do it. And it's the number one thing I think you can do anything in your practice, it takes a couple of minutes. We do the quicksand, but Doug has his own test to he talks about. And I always said there should be more courses teaching people providers how to do it because it's really easy. And when you do it with the patient, they're going to be shocked, like they're going to be like, because you've now tested them and reconfirm that you're testing their complaint. We'd go one step farther. In my practice, we started a year ago testing speech and noise testing with their hearing aids on. So we'll put them in the sound booth and with a speaker, and we play it again, and to see if their scores change. And all I can say is the patients love it, it creates a different conversation. And that's where I like talking about rehabilitation. To me, rehabilitation is called about conversations, it's having conversations with your patients. So if if you do the proper testing, the conversation comes naturally, and you don't have to think about it. And I think that's why I never did rehabilitation before as I wasn't doing speech and noise testing, or any memory or psychosocial stuff. So I didn't know what conversations to have. So the conversations all happen with the assessment in the beginning. So it's really easy. But yeah, I would definitely and ask, I think I'll leave that question for Doug for the next presentation. And I know he always has a lot of strong opinions about speech and noise testing. I think that's so great. I love that tip, Ashley, about almost using the speech and noise testing as a way of verifying your hearing aid fitting to and really showcasing the benefits of the patient. So thank you for sharing that. And we don't do that. We don't do that enough in practice, by the way, we don't validate the patient's feelings, like so we test and we fit a hearing aid, but we never go back and do stuff that say, you know, that even the subjective measures, that's, they're telling you this, and now you're showing them a number or you're showing them paper. We're supposed to be clinicians, not salespeople. And when we're clinicians in healthcare, so I always say hearing care is healthcare, we should have diagnostics that are healthcare focused in doing these measures, subjective measures, speech and noise, even the cognitive assessments, we move towards being healthcare providers, not salespeople, and we're validating what the patient's experiencing, what they're telling us by a number and subjective measure on paper. And I still think that's really important in healthcare. It's not just all up in our head. We actually have numbers that are driving these decisions. That's great. Thank you. The next question here, Ashley, is from Krista. And this is a great question. She wants to know, how do you delicately address the cognitive questionnaire without scaring the patient? So when we brought, it's interesting. So we do 70, 80 cognitive screenings a month now for the last two years. And when I brought it down with my team, and like I said, I have three hearing nurses specialists, and they were terrified. They thought with the memory questions, patients were going to freak out. What we found was that it's so when someone comes to your office, and you do a hearing test, and you tell them they have a hearing loss, they're never shocked. They're like, yes, I knew I had a hearing loss. And it's the same with the memory questions. They'll mark off yes. And you go, oh, you have a memory problem? They'll go, yes, they're actually actually look at you like you're, you're don't because that's why it's the same as the hearing test. Like they know. So no, we know we've had one person get upset. And the only reason they got upset was because we sent a report to the family doctor because the family doctor requested us to do the test. And the family doctor that was doing further testing because this person actually did have like they had to be referred to a memory clinic for full cognitive assessment. But if you just do the paper questionnaires, and you say to patients, this is part of your hearing health, because hearing health is brain health. And we use our cognitive system. So Doug will be talking about that. So this all ties into what Doug Beck's going to be talking about. Because a lot of our listening skills comes from our brain and our auditory system. And when we ask those memory questions, we're tapping into that. And if you have poor memory, then you're going to have difficulty hearing and background noise. So they're very interlinked. They're not two separate topics. And I think our whole field is we think we hear with our ears, but we're actually processing sound. And how we hear in background noise is in the brain. It's not in the ear. So asking those questions is part of your profession. And what you do. That's great. Thank you so much. It's interesting to hear. And I think maybe a little relieving that a lot of your patients are pretty self aware about their memory or cognitive challenges. We've had one in two years. And they may do they're actually the patients love it. Like they're very happy. And they're like, the number one patients are more worried about taking care of their brain health and their hearing health. So that's that's the flip, like, when you flip that switch and realize more patients are worried about aging and active aging and aging. Well, they they're more likely to say, I'm going to wear my hearing aids, because I want to age well, I want to hear well, when they learn that and the memory questions, again, starts the conversation is when you ask those questions, the conversation rolls with it. And and we never first of all, just to say those, we never tell people, you know, by getting hearing aids, you're going to prevent anything, you can't prevent dementia, but it creates a conversation and encourages them to seek help. Sure. Yeah, great. Thank you. Our next question is from an anonymous attendee who would like to know, do you charge for your AR services nationally? Or is that an added value for your existing chargeable services? So right now, it's it's we so we do two models. So for our subclinical hearing losses, who are basically they come in for the hearing test, and they're not getting hearing aids, basically, they can pay for the program. So we like I said, we do Amplify. So they pay for the Amplify program or any other if they want to do in person sessions, we're getting ready to do other types of digital tools to which they can opt in and pay for, for our treatments right now is it will it is added on to the invoice as like a treatment program. So some patients will decide and we have different ones. So some patients will try decide they can't do a computer based program. So I have like Gail Hannan's living with a hearing loss book. So we'll give them different information. And it's a different price scheme than someone who's going to do the auditory training. I did though included for the first year that we got it going, I was including it in just my my fitting fee. But then we noticed so much value and patients love it so much that now we charge for it. We haven't had any problems. Thank you for sharing that. Um, the next question is about the the apps, how often do this excuse me, this question is from Gerard. How often do clients need assistance to use the apps? And are you training them to how to use the apps at the initial fit and a follow up appointment? What does that look like? So the the apps 10 minutes a day of training for like, for example, for Amplify, they're all different Amplify is 10 minutes a day, and their coach with Amplify, their coach, that's, that's why I like that program is their coach reaches their coach reaches out the hearing coach reaches out to the patients themselves. So with their program, we don't have to do anything. So they're, they're messaging them, they're connecting with them, they actually set them up on the app, they do all that. So we don't have to do any of that, we just got to get them signed up, and then they take care of the rest for us. So that's a huge part of the program. We do have patients who don't do that, and they do other ones. So we have to ask them and even with Amplify, we have to ask them when they come back for their usually we try to get them set up by fitting or adjustment one, and then adjustment two and three, we're asking them. And then now we're actually automating emailing and emailing and calling them to see how they're going. And we're our next level. And that's coming up for us as I just hired an audiology assistant. And for patients who don't want to do it at home, they're going to have the ability to come to the practice and going to Rome, realistically, they could do it with anybody, they can do it at home. So anybody could sit down with them and make sure they know how to use the program. But right now we're we do different things for different patients. Great, thank you so much. The next question here is from Anastasia, who would like to know if you have a cut off on which patients you do or don't do the quicksand. So are you doing quicksand with every patient? Is that determined based on thresholds or other factors? The only patient we would not do I mean, the only patients we wouldn't do quicksand on are ones who can't do it because of obviously they're like their their mental state or ability and their cognitive function. Like if you have patients with like really with dementia, or Alzheimer's who are struggling to test, we would not do it on those patients. And are severe, profound hearing losses. If depending on what their word discrimination score was, it would it depends if they could do it or not. Right. Definitely. Majority almost all of our patients receive quicksand like I don't last time there's only had so few severe, profound hearing loss is pretty much every single person has a quicksand. Thank you. The next question here is from an anonymous attendee who wants to know if you know of any AR resources for French speaking patients? Oh, no, I don't have that answer. I don't have that answer. I could look into it, but they want to reach out I can look I could actually ask I mean, there's people I could ask about that. Okay, great. And so to that anonymous question, asker, excuse me, on the next slide, we'll show Nashley's contact information. So if you want to make sure you jot that down, then maybe you guys could connect following the session today. The next question here, Nashley is from PJ. Are you doing your speech and noise testing through speakers in the booth with headphones or another way? Can you talk about what your setup for that looks like Nashley? Oh, so during so during the hearing test is during the assessments under inserts, obviously, so it's under inserts or headphones, depending on during the actual initial assessment, or if they're being reassessed, or they're coming back for their annuals. For the aided speech and noise testing, we have just two speakers on the side. And then we do it with both hearing aids in with it, because a lot of it's compared, I always say comparing apples to apples or apples to oranges. So like, if a patient is coming back with, we have actually a lot of patients coming back with our four plus, and we'll put them in four or five plus, and they're due for new technology. So we'll put them in them with their old hearing aids, and we'll run it and then we run it again with their new hearing aids, but we just make sure the conditions are identical. Right, so it's apples to apples. And same as like I said, so the initial assessment is inserts or headphones, depending on what your practice uses. And then when aided, we have the two speakers, and we just produce it at the most comfortable listening level. And we run the test, but we just have to always make sure the conditions are the same that we're comparing. That's great. Thank you so much for sharing that. I believe that was our last question. So thank you again so much, Nashley, for your insightful presentation and for answering so many of our attendee questions today. Thank you. Folks, we are going to go ahead and take a break. We will come back for our next session with Dr. Doug Beck, which we've heard a preview of already. We will begin that session at 1130 Eastern Time. So go ahead and take a break and we'll see you back here in a little bit.

Nashley Brogan

Doctor of Audiology

improving outcomes

digital oral rehabilitation

hearing loss

cognitive health

treatment-focused model

digital tools

patient education