All About Innovations In Hearing Aids – Episode 76 – with Dr. Jodi Saski-Miraglia
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As technology moves forward, it continuously helps improve the tools that audiologists use to help their patients. Dr Jodi Sasaki-Miraglia has dedicated her career to focus on the technological side of hearing aids and find ways that technology can shape the future of hearing devices. She is the director of professional education manager at WIDEX USA, and has been working as an audiologist for almost 20 years. In this episode, Dr. Sasaki-Miraglia speaks with host Dr. Lilach Saperstein about the latest innovations in Hearing Aid Technology.
This week on the All About Audiology podcast:
- 3:40 – People with hearing challenges have greatly benefited from online meeting spaces (such as Zoom) and have also benefited from engaging in social media since one can seamlessly engage with others through connecting their hearing devices to such platforms.
- 5:55 – The cost of hearing aids are often inclusive of the care and services of an audiologist or other licensed hearing care professional. They can help guide an individual through the hearing care process since there is not a one-size-fits-all process.
- 11:00 – With the use of artificial intelligence (AI) in hearing devices, such as Widex’s use of My Sound, one can focus on a specific location in which they want to tune into. AI can also allow hearing aids to be adjusted to a specific environment that a hearing aid user finds themselves in.
- 14:30 – Hearing aids will become a part of your body. By the time a user gets up, they should be excited to put their ears on!
- 22:30 – Individuals should not fit their own ears. You want to go to a licensed hearing care professional and make sure that your chosen device is going to fit seamlessly on your ear and that the device will not damage your hearing.
- 25:00 – Many licensed hearing care professionals carry multiple hearing aid brands at their clinic. If you need hearing aid devices, you should try a few on in order to find the right fit. Eventually, the devices may be on your ears every day and you’ll want the most comfortable fit.
For more resources and research visit:
All About Audiology Facebook group
Mentioned in this episode:
Dr. Franklin Lin from John Hopkins
Kids at home: Tips & Fun Games. (for children with hearing aids or cochlear implants)
All About Protecting Our Hearing- episode 23 w/ Cornelius Maxwell
Troubleshooting Hearing Aids & Cochlear Implants – All About YOU! Episode 24
All About YOU! Episode 28 Benefits and Limitations of Hearing Aids + SPEAK UP!
All About Reverse-Slope Hearing Loss- Episode 49 with Natalia Popham
All about YOU: Genetic Hearing Loss Life Experience” – Episode 65 with Olivia Rains
Next time on All About Audiology:
(Intro) Jodi Sasaki-Miraglia:
And the nice thing with our Widex and the data collection that’s anonymous is that real users are providing us with real insights to shape tomorrow’s sound. And the fact that we’ve been doing this now [for] three years and learning from people who really use our devices in these environments allows the technology to really help the person who’s wearing it [And] not from the programming perspective [that is created to pick up on] this is what I think you need to be listening to. It really is honing in on Person-centered care.
Dr. Lilach Saperstein:
Welcome back to the All About Audiology Podcast. I’m your host, Dr. Lilach Saperstein, and this is the show where we talk about audiology and how it affects your life. It’s not just about audiograms and x’s and o’s and hearing aids. It’s about how it affects your life and your relationships and your communication.
So today we’re doing something a little bit different on the podcast, and we’re going to be speaking with Dr. Jodi Sasaki-Miraglia, all about the latest and greatest in hearing aid technology. And this is something that I am very interested in catching up on seeing that I’m out of school for a few years – What’s going on clinically? – And I think that for many of you listening, we always have questions. How do we support the families that we work with or how do we wrap our head around all this new information as parents? So let’s talk about hearing aids. Welcome Jodi to the podcast.
Thank you for inviting me. I’m excited to be here.
What has your journey been as an audiologist and working in different settings and now your industry. So tell us a bit about that.
Hearing loss is near and dear to my heart. My grandparents both had hearing loss. My father has hearing loss and so does my mother. So, I really do believe audiology picked me. No, I didn’t pick audiology, it was sort of in my genes to be in this path. Almost 20 years now into audiology, it’s never gotten old. If anything it’s gotten more exciting and more specifically on the hearing device side of things, I really can see firsthand how technology has really helped my family.
And then more importantly, [for] those tuning in – families, audiologists, other hearing care professionals – how technology has helped us [as audiologists] help more people, not only here in the US but really, I know your podcast reaches far beyond the US. And be able to help so many more people. And hearing devices today is not like what we even thought of five years ago. So, hopefully, if my smile comes through my voice, my hope is that everybody tuning in knows that there’s so much more that technology has to offer and every year that technology continues to move forward outside of the hearing device industry, it helps our industry – [as it] help[s] professionals be able to help more patients. And on the patient end – user end – for them to just have more tools to equalize the playing field so that the hearing doesn’t hold them back anymore. And they can do what they want to do on their own.
So as an audiologist, I’m from Hawaii, originally, so even the word audiologist was not a common thing back in the islands. And when I went to school in Colorado – I was realizing the world was a bigger place, how hearing impacts communication, and not in a good way, unless you go and get treated, [or] get guided by a professional that’s licensed in the state or the country that you’re in. And allowing a professional to help guide you through the journey of hearing care and how much hopefully more impactful it becomes and how much more educated you can become once you are learning what is out there, instead of maybe what you’ve heard through the Internet or what you’ve Googled online, and there’s some really great opportunities there.
[In terms of] What you said about technology moving so quickly and changing all the time. I remember hearing all of our professors saying that, and they were teaching things and saying, even five years ago it was different. Even two years ago it was different. And they were being frustrated because they had to constantly update their course material. [laughs]
To teach the latest stuff. I’m just thinking back [to when] I graduated in 2017, four or five years ago, and this was like the cusp of rechargeable batteries. That was like the latest thing. There was a lot of Bluetooth connectivity, but you always needed an intermediary device, like a stream or something, so that’s where I left off. So where are we now? [laughs]
Where are we now? There is such seamless connectivity now in hearing devices for kids or for adults, [and] the seamlessness and the integration of technology. You know, we all had to learn how to do online learning last year because of COVID-19. We all had to figure out how to engage with our professionals over zoom, or over teams, or other different telehealth avenues. So because there is Bluetooth, because there is integrated 2.4 gigahertz, it allows that level of accessibility to Health care now to really be where it needs to be for the masses if you had some hearing challenges.
And what’s great about zoom and other modes of video is – for people who have hearing challenges is – you can still see the entire face without having the mask over if you have to go in person to do some communication. So at that point, the technology, I believe, has really leveled the playing field to a high minimum level so that either adults, or kids, or other people engaging who have had hearing challenges in the past, the technology in hearing devices today has allowed more people to have more access to technologies that those of us who have good hearing have taken for granted. Now you can do FaceTime through your hearing devices, Google meet, zoom, all that great stuff.
Right, just basically any audio that you listen [to] on anything like Youtube videos, FaceTime audiobooks…
Tiktok [Lilach laughs]. Anything – you name it. You’ve got a pediatric and maybe tween audience, that’s sort of where they live now. They don’t live on Facebook or maybe even Instagram. But maybe even an Instagram story, you want to listen to and you want to engage in. Being able to have that stream live through your hearing devices, and not only that but have it stream beautifully, where you can really engage and not just hear but experience that audio quality has been a huge game changer really, even over the last year, year and a half.
Let alone for the classroom. We didn’t forget about all the educational implications. [Laughs]
For sure, for sure.
Yep, that’s really interesting.
So I have a few questions for you. I think one of the confusing things that people come up against when they learn that they need hearing aids or someone they love needs hearing aids. They want to know why is it so expensive, and why is it not covered by my insurance? And is this a medical thing, is it a cosmetic thing, is it a consumer gadget? [laughs] That was a lot of questions.
Where are we on all of the above? Of course there’s always a price to anything, and within the world of hearing, it is important first and foremost, if you think you have a problem with your hearing, go get it evaluated by a licensed hearing care professional. So here, let’s say in the United States, that is a licensed audiologist or a licensed hearing aid dispenser in your local community – licensed meaning in the US, state by state, – there’s minimum licensure requirements to make sure when you do get that, there is a consistent level of care. Two, if you are a candidate for hearing devices, if you Google the hearing aids or hearing devices, you’ll get millions of hits right within seconds, so there is a lot of things. There is a lot of different price points and the goal from an audiology perspective and why we specialize eight years in anything hearing and ears and balance related, is for us to help guide that person through the hearing care process.
There’s not a one size fits all. It’s not something as easy as vision where you can just try on some glasses and it’s clear all of a sudden. We know that the ear is a very complex thing because you have two ears that connect to your brain, and any device can make you hear, but not every device can help you with the listening task, the active listening, the active engagement. And then, more importantly, communication. As human beings we communicate, and we communicate and we thrive off of that.
So the brain is involved in not only hearing but listening tasks, and now there’s so much more information available. Not only with World Health Organization, [but also] here in the US, and seeing the implications of what even mild hearing loss can do on the brain, [or how even mild hearing loss can cause] reorganizing in a negative way. So gone are the days in audiology where we see or we test somebody’s hearing and if it’s a mild loss, we’ll say, oh, you can come back in a year, we’ll recheck you again.
That sounds like nails on a chalkboard. What? [laughs]
Yeah. So, we now know with a lot of science data coming out of Johns Hopkins with Dr. Frank Lin linking mild hearing loss with your increased risk of cognition, your dementia risk. We’ll look at research coming out of University of Colorado Boulder. Mild hearing loss and the negative brain changes that happen, and how it can be actually reversed with well fitted hearing devices. We now know, even if you think you have a mild hearing loss, get it evaluated, get it checked, just like you and I would get our vision checked or we would get our teeth checked for overall health and wellness.
And then more importantly, I think what we’ve all learned through COVID is isolation as a human being is really tough on us. Hearing devices help fill that gap because many people don’t realize when you don’t hear well, you pull away and you self-isolate. And self-isolation is actually one of the higher risk factors in older adults or adults in general for increased cognitive risk or increased dementia risk. There’s a link there.
We have to think about it as a cycle and a feedback loop, because the harder it is for you to communicate, the less you want to communicate and then the less you communicate, the harder it gets to communicate. Let’s try and break that cycle somewhere.
Yes, there has been some, maybe some negativity or maybe some perception because maybe they’ve tried a hearing device, maybe even two or three years ago and it just wasn’t up to par with what they felt like sound should sound like if they needed to get that part of their body treated and helped – corrected if you will – or help addressed.
And now, today’s technology, obviously I work for Widex and some of the new cool technologies that we’ve come out with – even in the last year – addresses the number one or number two things that are top of mind for most people who have hearing challenges. One, if I’m going to get something and put it on my ear, it has to sound good. It has to sound natural. I’m not going to wear anything that sounds weird and robotic or echoey or tinny or all the things as audiologists we would hear from people in our clinics every day. Two, it needs to work. It needs to be able to modify to what I need. I’m a mother of two, you’re a mother of three. Sometimes we’re moms, sometimes we’re audiologists, sometimes we’re podcasters, sometimes it’s all of the above.
So our listening intent will change depending upon what’s going on. And now segwaying into what hearing devices can do today, the artificial intelligence part of hearing devices have gone leaps and bounds and have really changed the game and how smarter hearing devices have become and how much better learning the hearing device can be.
For instance with Widex, we’ve got a new technology we just released recently called My Sound. You know, if we are at a restaurant and I wasn’t hearing just as right, I could launch the artificial intelligence. It would scan the environment and help me tap into my listening intent in that moment if it was a really noisy restaurant and I wanted to focus more on you. Versus maybe the band playing in the back or maybe there’s a kitchen right next to me.
That automatic change of program where you don’t actually have to click any buttons or play with any apps [where] it just does it on its own by recognizing what environment you’re in. Yeah, it’s like, next level. [laughs].
We already do that as consumers. If you’re shopping on Amazon or you’re shopping on other things, and you go back into the app or you’re ordering, it’ll say “you might like” or ‘we suggest’ or ‘we recommend.’ So, part of artificial intelligence is what we are already using as consumers, day in and day out. And now [applying this] within the Healthcare space, especially hearing,: You and I could have the exact same hearing chart and have very very different listening goals. And part of what we have done at Widex, for a number of years, is looking into that science. Why is it that your listening intent is different than mine, even though we may have the same hearing chart, the same audiogram? And it’s because we’re different. We live different lives. We want to do different things. And at Widex the last thing we’d want somebody to feel is a one size fits all. We want to make sure everything is customized, everything is personalized and once you get well-fitted by a licensed hearing care professional, then if you want to engage in apps or engage in some of the other overrides, then the patient now has the control to do that, all in the palm of their smartphone.
We always used to say that to people. Like, it [the hearing aids] will focus on the person in front of you and they [the users] say ‘no, I want to listen to what’s happening over there.
Exactly. What if you do want to hear kind of farther back or maybe you want to tune into the music for just a little bit more. So all modern hearing devices today that are from the top big five or six in the global marketplace, and Widex is obviously is one of them, is all of our digital chips are trained in some way. For instance with Widex, it’s trained with real life sound samples. The hearing device can recognize: oh, I’m in a car, change to a car-like program. Oh, I’m at home around a small dining room, it’ll change to a small type of listening pod to do that.
And then more importantly once I go out and about, I do want to train my hearing aid to understand what I like and what I need. That is where I’m excited to share with you today, with Widex, the moment technology – and specifically the My Sound technology that’s within that – is the third generation of artificial intelligence that we’ve been working on. Most of the time the automatics of the hearing aid are going to do what you want it to do and it’s hands off. And you go out and about. But like, yesterday, I was at a meeting. Their air conditioning wasn’t working because it was so hot so they had these big fans in the room and we had a meeting for two hours. And the fans were so loud, I had a hard time hearing. If I was wearing a Widex moment hearing aid, I could take out my app, go to the My Sound feature on it, it would launch the AI, scan the environment, and immediately give me two recommendations that I can try. If I told the app, hey I’m trying to concentrate on speech, it would actually hook up to the cloud, download all the potential options I could try and in the moment I could fix the situation right then and there. In the past I’ve had to suffer through the whole two hours, email my audiologist and say, I was at this meeting and I couldn’t hear. Now, as a wearer, you can solve that in seconds, using AI and the technology we’ve built over the last three years, with cloud based computing.
Yeah, very cool. I think one of the problems that people really face when they start wearing hearing aids is that it sounds so different, so unusual, so uncomfortable, and even getting used to the feeling of something in your ear. What do you say about supporting someone through those first couple days or really, first couple of minutes?
It needs to sound natural right from the get go. And part of the technology that is new on the marketplace is how quickly we can deliver that sound from your hearing device to your ear, and up to the brain. And I’m glad you asked, because not all hearing devices are going to sound the same. With the Widex moment technology, we’ve actually been able to speed up the sound to half a millisecond. It’s the fastest hearing device processing now that’s on the market and that has dramatically changed the game and how wearers experience amplified sound. We can finally address the negative comments about ‘oh, it sounds tinny, oh my voice sounds echoey. Oh, it sounds robotic.’
All that – we can actually start to push away, because we can now deliver sound at half a millisecond through our new technology called ZeroDelay, and it’s called PureSound in the patient’s hearing device. So, super cool. Think about it – as an audiologist, you don’t have to, maybe, deal with counseling about that anymore, because we have a revolutionary way to deliver sound much quicker to the ear, up to the brain.
I’m thinking of the experience of sitting in the auditorium of my high school. This just came to me, and I would always sit in the front row because I was goody two shoes. And then you’d have the speaker speaking from the podium and through the microphone. And it would really bother me that there was a delay. I was aware of the microphone delay. So, then I would go to the third row.
I would be right with you in the first three rows.
That’s distracting right? If the timing is off, all of a sudden the sound doesn’t sound as natural anymore. We’ve learned and we focused on Widex to understand the experience of the wearer and also the professional supporting that. The last thing you want to do if you finally got somebody to commit to say ‘yes I want to enter hearing care’ is for that person to say, ‘I don’t like how this sounds’ and then all of a sudden you and I would be counseling over and over and over again. Now with the fact that we’ve helped solve that time delay and almost really have gotten rid of it, it’s the fastest signal delivery [being] half a millisecond. Previously, our hearing devices delivered sound in two and a half milliseconds, and everybody’s thinking, what’s the difference. That’s a big difference! If you ever watched the Olympics and looked at the millisecond difference on a swimming or track meet. Same thing happens in audiology and hearing care and amplification. Or if you’re like me, we have a lot of friends who are sound engineers or musicians; delay is the worst thing right when you’re recording. Or even for podcast. If the delay is on, you get this weird echo or the mouth moves quicker than the audio and the timing just gets wonky, for lack of a better technical term. So we’ve been able to address that, really, really precisely now in a product called Moment because it has two sound engines, so we can kick in that super fast sound engine.
For people who have minimal hearing loss, mild hearing loss especially because that has been a really tough group to fit in the hearing healthcare space.
Unilaterals, correct or anybody who had really good low frequency hearing, and then started dropping off in the high frequencies. You and I would maybe look at that audio and then go ‘oh, they got to hear the difference.’ But now because we’ve been able to close that time gap with our ZeroDelay technology, aka called the PureSound program in our product, professionals can easily add that into your program lineup. Now we are seeing consumers saying ‘wow, I finally want to wear these hearing devices and I want to wear them for as long as you told me I should.’ By the time you get up, you should be excited to put your ears on and get going and just live your life without having the hearing devices hold you back.
I’ve seen what happens with my parents in older technologies, because they’ve been wearing devices for a couple of decades now. They would have to wear them and as soon as they got home, they couldn’t wait to take it out, because it just wasn’t as pleasant, back in the day. Now, I think sometimes the best compliment I hear from patients and wearers who wear Widex, is they’ll say like: ‘I jumped into bed and I still had my ears on.’ Then you know you’ve reached that point where people like the sound. More importantly, they’re able to go out and socially engage, and get out there and finally hang out with you and your kids. Or hang out with friends on a Friday night outdoors or indoors not feeling like you can’t trust your hearing anymore.
I just wanted to mention that something people also can relate to is how zoom picks up, who’s speaking and puts the green box around you and then highlights you if you’re on a phone. And someone sneezes and then though they’re highlighted.
Zoom and other things are using these AI algorithms to assume that’s what you want to hear, and hearing devices are the same way. They’re programmed for some assumptions. But you and I know assumptions are just assumptions which is why we’ve built in that second layer of user override where the wearer can decide: ‘you know what, I want to train my hearing device to be a totally different way.’ And the nice thing with our Widex and the data collection that’s anonymous is that real users are providing us with real insights to shape tomorrow’s sound. And the fact that we’ve been doing this now [for] three years and learning from people who really use our devices in these environments allows the technology to really help the person who’s wearing it [And] not from the programming perspective [that is created to pick up on] this is what I think you need to be listening to. It really is honing in on Person-centered care.
As is always the goal. Yes, we always want that. And that you, whoever is listening, can really also come in there and be like, I am the patient and help me. I am the center! Take that, and don’t just be like ‘I don’t know, what do you think, what do they do.’ Like come in there and say ‘this is what I need. Let’s go, help me.’
I always tell audiologists and Hearing care professionals, or parents, or people looking into Hearing care: ‘this is going to be designed for you. The program, the education, the counseling – is all designed upon where are you today, where do you want to go tomorrow, where do you want to go in two or three years? There are hearing devices to help support those goals, and we’re not naive to think that it’s going to just be a static goal. But we hope that people who have challenges with hearing, or your child has challenges with hearing, that we can now help address that and then more importantly help use that as a stepping stone. [For example:] ‘You want to be an astronaut? Great; oh by the way you just happen to have hearing loss.’ So [the goal of these devices is to ensure that], not having the hearing [will not], hold you back from what you would have access to, if you didn’t have those hearing challenges. And [another goal is] using technology to help people get to that, even playing field. No matter what price point you’re entering into, there is a technology that can fit everybody’s price point that can be a guided experience with a licensed professional.
I do not recommend people kind of fitting their own ears. It’s sort of like trying to take your own mouth impression if you’re trying to make your own retainers for hearing. You want to go to a licensed hearing care professional, making sure that what you are going to be fitted with is not going to damage your hearing. It should fit seamlessly on your ear. The first couple minutes of wearing the hearing device should not be uncomfortable. Because ultimately, if you can hear well and you can communicate, then you’re going to go back out there and be social, and that’s the endgame or end goal for us as audiologists to help people get to that point, and then take off from there.
Yes. Okay, so I have a question for you. A lot of people start with Google, as the thing we do in our world. You Google it, you start to see what are the hearing companies out there and what are the providers around me, and then you start reading reviews, and blogs, and getting all the ads that are being served to you by the AI. And then people many times will come into the audiologist and say ‘I want this particular brand, or I heard of this name, or I want this.’ Then they’ll tell you the exact model. So how can patients, and their families, who are coming in [to seek help] be open to whatever the audiologist is recommending [while also balancing] being a knowledgeable consumer, it’s like a tough thing to balance.
It is a tough thing to balance. First and foremost, it’s in your best interest to obviously go to a licensed hearing care professional, license clinic. Because then you know there’s minimum things in place to be able to make sure that you’re safe, [and that] your best interests are there. And [not only] all of that, but most clinics, hospitals, and private practices carry, typically carry two, three, [or] four primary brands [commonly used with] in the audiology community. And Widex typically is one of them.
And if you saw online, and you looked at the reviews and so on so said ‘try x product,’ then most offices will have demonstrations that you can actually hold in your hand. Obviously from a germ perspective, wipe it down and put it on your ear to feel how it is, because most of the devices on the market today that are dispensed through audiologist and licensed Hearing care professionals are nice and light. All the components of it are medical grade, because here in The US, it’s all through the FDA approval process. And then if you want to hear how it sounds because this is going to be on your ears for 8,10,12,14 hours a day, it needs to feel a part of your body, it needs to be nice and natural. And once it is on your ear, sometimes patients will say ‘oh yeah, now I know why so and so or my neighbor said, oh, it sounded natural. It almost sounded like I wasn’t wearing it.’
And so again, you know obviously back to our shameless plug of Widex is that not all sound is the same. Not all hearing devices sound the same. Not all devices perform the same. And then now that third component of streaming, because most hearing devices connect to smartphones; you know if I’m gonna stream a Disney movie or an Avengers movie, I want to not only watch the movie but hear the audio in its full capacity. And some hearing devices stream better than others in terms of the audio quality. So you can go into many of your audiology and hearing care offices, many of them do have some demonstration sets there during the consultation process if you are a candidate. They can put that on, and you can listen to it and hear the differences. If you’re thinking ‘I really came in and here’s my sheet of what I want to try’ and maybe the hearing care professional goes ‘you know what, I’m glad you said that but what I found successful is option B. Let’s compare A and B, and then let’s move forward with what you believe is going to be right for you and your body and in your Outlook and what you want the hearing system to do for you.’
Great advice! I’m glad that all of our listeners can start knowing a little more about the hearing aid process for yourself and for your loved ones. So Jodi, what would you say as your parting words for any of our listeners, facing this decision.
Go get your hearing checked by a licensed hearing care professional. Because most of us haven’t gotten a hearing screen, quite frankly, since we were a kid. Most of us had to get it done before we entered kindergarten or some type of elementary school. Two is to be an advocate, get educated. When you go to a licensed hearing care professional, your local audiologist, all of us have been trained in knowing multiple brands, [and] keeping up on the technology. And ask questions; be an advocate for your hearing care. And then third would be, if you have goals, if you have specific life goals that you would like to do: Maybe you want to take a cruise every year, maybe you want to take that pottery class, maybe you want to be a podcaster, and you have hearing challenges and you think you can’t do it because of your hearing, With the modern technology today [as well as] guided by the right hearing care professional and the right device that’s made for you and personalized for you, there’s no reason why your hearing has to hold you back or your child’s future goals back.
So know that it’s not the audiologist [that] will tell you what to do, but [it is] in partnership, learning what your specific needs are, knowing that hearing aids don’t sound like hearing aids of yesterday, and that the technology in the hearing devices today have really helped elevate the control that most people wanted in their daily life. So, educate, find your licensed hearing care professional in your local community, ask questions, advocate for your own hearing health, and know that hearing aids don’t have to sound like [old] hearing aids. [But know] that modern devices sound good, sound clean, and there’s great machine learning and AI automation to help you every step of the way.
That’s awesome. Thank you so, so much Dr. Jodi Sasaki-Miraglia for coming on the podcast today. If anybody wants to get in touch with you or find you online, where can they do that?
They can find me on LinkedIn, which is a great place to find me on. If not, for those of the listeners here in The US, we have a local team of professionals of audiologists to help you locally in all the states in The US, and then of course online at Widex.com. You can contact us there and get some more information.
Again, thank you for being a listener of the All About Audiology podcast. A full transcript of today’s conversation is available at https://allaboutaudiology.com. And a special thank you to the patrons of the show. If you’d like to become a patron and get those perks, please visit https://allaboutaudiology.com. I’m Dr. Lilach Saperstein, and this is the All About Audiology Podcast.
Transcribed by https://otter.ai and our team.
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