Lippincott Williams & Wilkins
JUNE EPISODES TRANSCRIPT: Main and Aftershow with Dr. JorgensenD' Anne Rudden: "You really don't trust us", says Valery Legasov, a Soviet scientist and the lead character of the HBO's Chernobyl miniseries as he confronts the KGB following the arrest of one of his colleagues.? The head of the KGB replies, "Of course I trust you, but you know the old Russian proverb: Trust, but verify." In Russian, the proverb actually rhymes - daviRyay noh praveRyay.? Thanks to Youtube from a Russian lesson.? It literally means that a responsible person?always verifies everything before committing even if their source is totally trustworthy.? In the world of audiology, “trust but verify” is an oxymoron because we should and can trust the patient to give us information to a certain degree but proper hearing aid fitting should always come with verification.? The old, "How does that sound?" might be a decent starting point.? Trust is about risk-taking and verification is about risk mitigation.? This month's podcast guest is one of our premier authorities on Hearing Aid Verification. Teaching a typically sold-out annual learning lab at AAA fondly title: Trust the Patient, Verify the Hearing Aids.? Dr. Lindsey Jorgensen teaches audiologists to not only learn the ins and outs of proper verification measurements with test box and real-ear measurements but to commit to using these tools in their clinic.? Lindsey Jorgensen completed her Bachelor of Science at the University of Washington and then moved to the University of Pittsburgh where she completed her AuD and her PhD.? She's currently joggling some days more successfully than others raising her two children Gunner and Teagan alongside her husband Kyle while being a professor at the University of South Dakota.? At UST, she teaches, does research, and provides clinical services in the area of hearing aids and hearing assistance technology.? She also holds a clinical position at BA.? She currently sits on the Board of Directors for the American Academy of Audiology, and the Audiology Practice Standard Organizations.? ?Dr. Jorgensen, I was so hoping to have this conversation in person over some kind of delicious New Orleans libation, but that was unfortunately not in the cards for us this year but I really do appreciate that you're taking the time to get together via Zoom call so it can feel a little bit more like we are just hanging out.? Thanks for being here.?02:52?Dr. Jorgensen:? Thank you so much for having me.? I feel like we are all spending a lot of time on Zoom lately, so it's nice to have a relaxed conversation rather than teaching or talking to the patient, so thanks for having me.03:11?D' Anne Rudden:? We are going to jump right in because there is so much that we could talk about, and 15 minutes is just barely going to do you justice.?Tell me a little bit to just get us started on how you got interested in doing verification? And why should audiologists take this seriously??03:33?Dr. Jorgensen:? I grew up in a household where my parents are their backgrounds are also in Special Education, and they both went into the public school administration.? It was all about the data.? Are we sure this trial is meeting appropriate guidelines?? If they are not, what can we do to make sure the child is successful? maybe, we need to change some of the guidelines especially in the areas of special education because standardized testing doesn't always work.? knowing that standardized testing existed; how do we take that information and apply it in my parent's case to children, and in my case, to hearing aid patients. I've always been interested in hearing aids and how a hearing aid works.?I think that Audiology with an exciting mix of technology plus the rehab and the medicine part (I love the technology part), but how do I know that the technology is doing what I wanted it to do?? I can't just say I trusted it that it did exactly what I thought it did, so I needed to verify that, and that's how I got interested in the area of Verification.? Also, with the caveat of Dr. Catherine Palmer was my Ph.D. adviser, so that didn't hurt either, knowing this is one of her passions as well, and I probably took it to the next step as far as why I wanted to do it.??05:08?D' Anne Rudden:? It's good to have good mentors, there's no doubt.??05:10?Dr. Jorgensen: Absolutely.05:12?D' Anne Rudden:? Talk a little bit about the difference between verification and validation because sometimes those words are used interchangeably, and they are very different??05:26?Dr. Jorgensen:? They are definitely different.?Verification in a world of hearing aid, is: Does the device work the way you think that it should or the way you think it supposed to? Verifying the output is the amount of gain you think the hearing aid should be putting out based upon whatever target you are using or whatever prescriptive formula you are using -? that's verification.? Is it doing what I think or do the directional microphones work the way that I think they do?? As a side note, in most patients, you’d want them to hear better on what's in front of them rather than what's behind them.?Those are two little?bitty wires that if the person doing the stuttering accidentally flips those wires then the person's hearing better what's behind them rather than what's in front of them.? Just by verifying that it's functioning the way that we want.? Additionally, verification can go... what's the difference between, for example, an entry-level and a high-end hearing aid? Am I able to verify what the manufacturer is telling me is the difference? Is it worth several thousand dollars that go from entry-level to high end?? Is it worth that for you? Is it worth it for your patients? By the way, a lot of times, I can't verify what they are saying the difference is.? I find it frustrating but that's verification.?Validation is: Does that device work for the patient? Many audiologists in the research suggest somewhere around 60 percent of audiologists skipped over the verification and went directly to the validation. We programmed the hearing aid, and we asked the patients how they hear. Are they happy with the way it sounds?? Is it equal between their ears? Those things are very important and making sure the patient is perceiving it is definitely important.? That's validation, not actually verifying if the hearing is working.??07:39?D' Anne Rudden: Got it.? We were really in unusual times right now.? It's funny because I do feel we met at AAA and have this conversation after I was signed up to take your class.? We probably are talking about some of the same things but with a different lens to it, then we have right now.? Given the fact that we are potentially not seeing people in the clinic as much as or even a month ago.?Talk about how do we make verification measurements work for us in a scenario where we don't have the luxury of having that patient sitting in the chair placing the probe mic down in their ear necessarily but still ensuring that we're providing the highest level of care in this time, and then recognizing it doesn't negate the need to potentially do it down the road.08:43?Dr. Jorgensen: Absolutely.? I would say I do have a few patients out there that I did not verify for some reason.? Those are very few, but we all can't say we are 100 percent.? With that being said, all of my patients before March 4th was verified.?I made sure that the hearing aid was providing an appropriate amount of gain. Your question is what we could do now?? What do I do now? I have in my work several sets of hearing aids for patients that are purchased.? These patients want to buy these hearing aids.? What do I do?? There is a couple of things, the first question is:?Did you run in RECD or Real-ear Coupler Difference? I typically run an RECD on the day that I do the hearing aid fitting.? It is part of our protocol and part of it, I will admit is for the teaching aspect.? A real-ear coupler difference has nothing to do with hearing aids which is one of the reasons I do as part of the audiogram because I am able to talk about that RECD is the accurate conversion of dB HO threshold to dB SPL threshold.? If you think about it, if you put a little insert on your phone in the patient's ear and you are doing an audiogram, you play 60 dB out of the audiometer and a thousand Hz.? How many SPL is hitting their eardrum?? That is going to vary depending upon if they have a big eardrum or ear canal or a little ear canal like a baby? Measuring RS PD gives you some information. The data suggests that if you use age batch norms, you are going to be accurate about 80 percent of the time.? After we've all looked in a bunch of years, we can say this person has a small ear canal or a larger ear canal but how much correction should we put on that?? If you imagine, if I've converted my dB HL threshold to dB SPL threshold, and I just used an average RECD collected by VA a long time ago, so it's an average adult white male.? We are using it, converting accurately, and making sure everything is good by just using this average; we're going to be wrong for some people.?I'll give an example of my husband, my husband is 6 foot 3.? He is about 215 pounds, and he has an ear canal of a 5-year-old.? He has the tiniest ear canal you've ever seen, he doesn't look like he's small, but he definitely has a tiny ear canal.? You can't just look at someone and know but if I were to fit him with the same hearing aid that I fit on someone who has an average ear canal the sound would be much too loud for him. The first thing is; do you have an average... Are you going to use Average? Are you going to use Corrected or are you going to use Measured?? I would hope that at least you would use Corrected, most real-ear verification systems have a drop-down menu where you can use a patient's age or approximate age.? Once an adult hits an adult because they are saying it's the person's probably an adult.? You would be right like I said about 80 percent of the time.? What happens is you can put that hearing aid in the test box and fit your real-ear aided response or your real-ear insertion response to your target, so your target is generated based upon the threshold but the threshold in dB SPL (not dB HL), if that conversion from dB HL? to dB SPL that the RECD is necessary.? You can kind of picture that you are going in the sound to the input of the hearing aid, to the output of the hearing aid, to the ear canal, to the eardrum, and that ear canal is what we are looking for the SPL.? By the way, sometimes I talk to parents as the child gets older, for example, let's say, I first taught a child that was 6 weeks old.? I measured their hearing threshold, and their hearing threshold was 30.? Now, the child grows then comes back when they are 8.? I do another audiogram, and now their threshold is 50.? It's interesting because in many people they would say to the parents, "Your child's hearing threshold is changing", and that's pretty scary especially when you are saying their hearing is getting worse because the parents start thinking that they are going to get even more of that, or is it going to get worse over time? But, if I am able to say their organ of hearing isn't changing, it's just the ear canal got bigger, so I needed more pressure to get the same response.? Sometimes that calms down those patients and those parents.? When you are thinking about this I can actually fit the hearing aid to the target to make sure [inaudible] quality in the test box by making the coupler (where you connect the hearing aid into the test box) makes that test box act as the patient's ear.? There are a few caveats to this and primarily venting.? When I am programming it in the test-box, I'm going to use the same kind of tube whether it's a thin tube or a wreck, or a BPE with a 13 tubing but I'm going to hold all of that sounds into the coupler.? It is much different than an open ear fitting, so we do recognize probably holding in a lot more of those low-frequency sounds then we would in the patient's ear.? ?15:03?D' Anne Rudden:? It is where the marriage of art and science then comes in. The science part is great, and it takes you to a certain way down the road, then you get to utilize the practical art of hearing aid fitting to make educated judgments on how you modify things from there and know that you are going to pull in that validation from the patient and put it all together into a package.? Would you say that's true??15:37?Dr. Jorgensen: Absolutely. You have to know what you are looking at. We are not a cook-book, we are clinicians. Like the guy could have just said, "My job is that technology but there’s also the rehab part of it, talking to the patient?and the validation, and making sure that the patients are happy.? Although I fitted in the test box or to be honest on the patient's ears, and then we needed to get to the patients.? There are several ways that you can do this but I will admit that the other day, we have an entry where a glass door and then an entryway, then another glass door.? I actually had the patient fit on the other side of the glass door. I have 350 hearing aids, I put them on the other side of the glass door with my remote programmer--not a remote programmer there at home but my wireless programmer. I talked to them through the glass door, and I was saying, "How does it sound?" Is that probably the best way to do it, maybe not? But at that point, it was a fantastic hearing aid fitting.? This was a patient who's never worn a hearing aid before, so I didn't feel comfortable sending the hearing aid to them.? Obviously, this is okay with your state's license as far as telepractice is concerned, but one of the things you could do is fit the hearing aid in the test box to make sure that you know how much sound that hearing aid is producing.? Send it to the patient and get on a telesession with them connected to their hearing aid, also making sure those patients are in your state or in a state where you hold the license.? I lived in the corner of a four states complex, we have patients from Iowa, Minnesota, Nebraska, that all come to us.? Making sure that all of your patients are in your states but you could do a telepractice to them and do the validation part of it.? Just at least have that kind of art where you say, "How does it sound, is it too loud?" and then they see adjustments from there.??17:49?D' Anne Rudden:? That's beautiful.? I can not believe that 15 minutes has just flown by.? I have so many questions for you.? Here's what I want to do.? I want to have you come back because we are going to do a little Aftershow, we are going to answer a few more.? I'm going to put you on a spot and make you answer a few more of these technical kinds of things because we all wanted to absorb every bit of knowledge you have for us.? Also, I wanted to get the opportunity for people to get to know you because you are a pretty interesting and amazing woman.? Stay tuned.18:49?ENDAFTESHOW-BONUS INTERVIEW18:53?D' Anne Rudden: We are back on the Hearing Journal Podcast Aftershow with Dr. Lindsey Jorgensen, and we've been talking a lot about verification measurements and the importance of verification measurements, the difference between verification and validation.? One of the things because we ran out of time, it was crazy, so much good information, but Dr. Jorgensen, would you talk a little bit about SII, so when I am running things on my real-ear equipment here, and I am seeing those numbers pop-up.? Tell me, what is it?? When I can tell I have a good SII amount?? How much is enough?? Dive-in, tell us more.19:43?Dr. Jorgensen: That's a fantastic question because when I look at it, it's 60 percent.? Is that good? They went from 20 percent to 60 percent.? Did I do enough? Admitting those targets, but then what targets are you using?? What is your goal? Am I doing enough? There is some good data out of what used to be a University of Western Ontario which is now Western University and Susan Scholey... said, "You can know what is good enough." In so many factors it seems a few black bars that tell you you should be within this range on your verification equipment.? What do those really mean? When you are looking at some older data by Mueller and Killion, say how much audibility do you really need? An adult who is knowledgeable of that language is about 40 percent.? In quiet one-on-one, as long as you can get above 40 percent they can use a lot of brainpower, but they can still-in all that information that they are missing.? It takes a lot of effort and I will say that efforts are one of the buzzwords that we are all talking about.? There's a feature within hearing aid but doesn't show an improvement in intelligibility but it decreases patients' effort.? What are efforts and the mystery-talk right now but it has to do with working memory? Obviously, we want to get higher than that because I don't want them to be using all their brain power just to hear but there is some great data that shows that if you take the patient's pure tone average and you can look on a Y-axis about what area should you be in given that patient's pure tone average.? As their pure-tone average gets worse, obviously, you are not going to get as high of an SII.? That makes sense, you just can't make things audible if the person can not hear itself.? So, that supposed little black bar on many manufacturers of real-ear verification says that you'd probably be fitting within this range if you can get a higher grade? This is probably given the patient an audiogram about what you should be.? What about a kid?? There is some other great data partly by McCreery and Bentler, when the outcomes of children with hearing loss say, "SII is one of the best predictors of how a child is going to do when speech and language development, no doubt." Even a 15-year-old needs a better, more SII than an adult.? I guess it's kind of funny because I am going to say to do the best that you can but do know that there is some data that shows the minimum that you should do.?22:53?D' Anne Rudden:? Thank you.??[Skipped a few minutes of conversation]23:21?D' Anne Rudden: I want to totally switch gears because one of the things that I think about you and your name, and a lot of well-known audiology brethren in the realm of verification.? We see your name on books and on papers, but we have such a small community of people.? I want to know a little bit more about you because I started looking at you, quite frankly.? I'm doing my diligent research on you, low and behold, you have an AuD and a Ph.D. both, so you are a researcher, a professor, and you're a clinician.? I want to hear about that journey.? Were you always like a brainer kid that could not get enough information or wasn't just you love both these things, I love the research, I love the clinic, and I just have to do both???24:27?Dr. Jorgensen: As I said, my parents were teachers, and so part of it is that A is for the only acceptable grade in my house.? Push yourself and always forward.? Always go forward, you can always do better, be better but one of the things my parents always beg me growing up; every night we sit at the dinner table as a family and would say, "What was the best part of your day?? What was the most challenging part of your day?"? they always say, "How did you make a difference?"? I think that was something that really drove me because every day I knew what dinner I would have to come up with something on how I made someone else's life better not how I made my own life better but someone else's life.? Whether it was picking up garbage that was around the garbage can and throwing it in the garbage can because that made the janitor's life easier.? Something I had to do would make someone's life better even if it was just a small way.? It really developed who I am.? I am going to tell you that I have a little brother, he went to West Point and his way of making a difference was making a difference on a much bigger level in Tasty, and then he became an Air-born ranger.? He was about how I can make our world a better place.? I can at least make people hear better.? He and I talk about some of those differences of what he then...he lost his leg and is now a VP of North America for a company that's a part of Pearl & Group.? He does distribution and other sorts of things. We all changed our focuses, but I was at the University of Washington in Seattle, and I thought I wanted to be a Neurosurgeon.? This was in the late 19s or early 2000 when I went to my first neurosurgery, and I was still an undergrad and I thought this was going to be really cool. About halfway through, all the physicians went up to the roof of the hospital, and they started smoking complaining about how they hadn't seen their kids, and they hadn't done this.? I thought this was not what I wanted to do.? I don't want that kind of stress and no connection with their family. I was eighteen or nineteen, or twenty years old, then I decided that I want to do research.? I got involved in Outerstelle?Regeneration Research, working with mice.?27:03?D' Anne Rudden:? It is kind of a hot topic too, though.27:06?Dr. Jorgensen:? A pretty hot topic and it was very interesting but I realized I wanted to work with people, not animals.? I ruled out research completely, and I found Audiology through Outerstelle?Regeneration.? I would say I am one of those unique audiologists that never wanted to be a Speech Pathologist.? I got my degree, I was at the University of Washington and the chair of the department at the time said, "Go somewhere else." Later on, he told me he wanted me to go somewhere else and then come back and do a Ph.D. but he did not tell me that at that time.? I ended up at the University of Pittsburgh and I decided I'm going to get my AuD, I'm going to do practices, that it's going to be great, and I, when I was in the 2nd year of my Aud program and Katherine Palmer, came to me and said, "Have you ever considered a Ph.D.? The questions that you ask are very probing", for example,> Why do we do that???> What's next??> Why haven't we studied this???> Has anybody looked at this??She asked me, and I said, "Absolutely not.? I'm not going to get Ph.D."? I don't want to do research, I don't want to do animal research.? Then, I finished my AuD as part of a Ph.D. while practicing, but then I realized that I don't want to do research full-time either.? I don't want to be just a researcher.? I didn't want to just?be?someone who does research, it's not something I wanted, so that is why I do teach and do research, and a clinic because I really wanted to do all three.? I wanted my patient to drive my questions.28:49?D' Anne Rudden:? In fact, your research is very people-oriented which is interesting, as well.? You found a way to bring all of the things that you are interested in, and your loves, your passions into almost like your own unique lane.? That's a killer, that's amazing.29:12?Dr. Jorgensen:? I thought it was cool but I'm able to do this.? We all do the things that we love, and we all hit the roadblocks, and we all say, "What am I going to do now?"? We are all in a unique situation.? Right now, maybe some of us have a lot more worries,? some of us are going with the flow, I think I had to learn a little bit more on how to go with the flow.? In 2012, I was diagnosed with cancer, which really changed my perspective on the importance of other certain things. Although I'm driven and liked things organized, I had to let some of that go.? I hope that for all of us these kinds of situations we can learn and grow despite being difficult right now.? In the end, I will tell you that cancer for me although incredibly difficult and not something I wished for anybody.? ?I remember saying to my husband that I can't do this anymore when I was going to chemo number six.? He was like, "Yes, you can", and he picked me up and drove me there and I cried the whole way.? I think we learn and grow from a difficult situation... psych.30:37?D' Anne Rudden:? Yes.? We are all in this boat, or maybe not in the same boat.? We are definitely in the same storm.? I have been hearing out in the world and that resonates very much for me.? I may not have been in the boat with you having had cancer, but we're all now in this struggle and how are we going to use that struggle to better ourselves?? Come out on the other side, not just more resilient but actually better than maybe we were 2 months ago.? Part of that, looking at things where there are deficits like verification and taking the time to incorporate those skills that we all know we need.??31:34?Dr. Jorgensen:? We are all taking that time right now.? Developing protocols that we've known we needed for years.? I've known that I've needed a better infection control policy.? I've known I've needed all of these things and that is something that I am working on.? We all are taking this opportunity to hopefully when we open up and start seeing patients full-time, and start bringing everybody back into our clinic, that we will be better.? We can take this time and say, "These are the things I've wanted to do, these are the best things for me and my patients and my practice."??32:12?D' Anne Rudden:? Let's look forward, let's turn the calendar.? I'm going to make you look a little far down the road and give me your best crystal ball of 10 years from now, or 20, or 50 years from now.? What do you see for audiology and what kind of verification tools in your wildest dreams might we have to work with??32:40?Dr. Jorgensen:? I think, that we can incorporate, I think that a couple of manufacturers a few years ago tried to incorporate probe tubes into their hearing aids if I were to guess that there will be some kind of laser or something within the hearing aids that are measuring the ear canal.? We've known how much volume needed to happen or there are ways for us to be able to simulate the actual real-life situations in our clinic.? I think that is the struggle that we all have.? Just because I make someone hear and make someone verify that the sound is audible, that is not real-life.? I think that's been the struggle that a lot of audiologists have had if one of the reasons that maybe they don't do real-ear.? It is not necessarily real-life, it is audibility, and audibility is the only way that we can ensure that people can hear.? That is where it is partly knowing what the hearing is doing in the patient's ear but also we can create these whirls, or we can make it more real-world for the patients.?33:51?D' Anne Rudden:? I love that.? We have just a couple of minutes left in our time together.? I want to say not only thank you but I want to ask you, Dr. Jorgensen, what is one thing we don't know about you? Tell us the little bit of the secret box.? Are you an awesome cook?? Are you a star soccer player?? What do we not learn about you, today??34:27?Dr. Jorgensen:? Okay.? My favorite type of food is Thai food but I can not cook Asian food.? I try but I just can't do it but my favorite singular dish is Cioppino. I make pretty rocking?Cioppino but if anyone has any tips for making good Asian food? I can't get it.? Yes, I've tried turning my walk really high and I did it.?34:57?D' Anne Rudden:? Like, been there, done that, don't tell me the easy stuff.? Give me the real scoop on how to do it.??35:05?Dr. Jorgensen: The real thing, right?? I really just want to know how to make a rag doll, I just can't do it.35:10?D' Anne Rudden: Someday, maybe one day that will happen for you.? I'm going to hope for the best for you.? I want to thank you, again for your time, for your patience, for your expertise, for your willingness, and for your sense of humor to come on and share all this great information and to give us a little more knowledge, to feel more connected to you.? Thank you, you are definitely one of our elite professionals, and I am very happy to have had the opportunity to get to know you better.??35:45?Dr. Jorgensen:? Thank you so much.? I feel glad to know you as a friend, too.??35:49?D' Anne Rudden:? You have a great day.? Thanks so much.35:51?END?? ? ................
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