We are human social beings and at Cubex, our patients are addressed in this manner. Our individualised approach to care makes the most of each patients unique characteristics and personal preferences.
Thinking beyond isolated impairments, we carefully consider the functional and psychosocial state of each individual patient.
Our goal is to ensure that our patients are able to perform all day in difficult communication situations by minimizing the amount of listening effort and energy or “Brain Power” used in order to understand auditory information – also known as cognitive load. In short, we try to make communication easier.
“Objective of hearing care is to reduce cognitive load”
The figure shows how energy for processing sound decreases faster during the day for people with hearing loss.
The reduced energy at the end of the day makes any listening environment troublesome for the hearing impaired. This is where improvements must be made.
We need to help our patients improve their ability to perform all day.
It is important to strike the balance between technology and individual abilities and preferences to help meet the unique needs of each patient. The process of Individualisation entails:
- Understanding individual motivation, needs & willingness to participate in the process
- Complete a battery of diagnostic tests including statistically meaningful functional speech in noise tests
- Ensure a broader assessment of individual characteristics
- Prescribe an optimized individual solution
- Structured follow-up based on the patients real world experiences
Technology for managing hearing loss continues to advance rapidly. However, research has shown that unless the human dynamics associated with hearing loss is addressed, the outcomes are often poor patient acceptance of hearing devices, low levels of patient satisfaction, and general frustration for the patient and clinician.
We recognise the importance of providing care that is truly patient-centred. Hearing loss means different things to different people and the decision to enter a system of care is usually not immediate, for most, it takes several years before this decision is made. Exploring the behaviours and attitudes of each individual towards their hearing and its effect on both themselves and their significant others/communication partners is the first necessary step in creating an individualised counselling strategy/agenda.
Unless an individual is ready and committed to taking the steps to improve their hearing, the benefits of using hearing technology may never be realised by the patient.
Patients are reluctant to address their hearing loss for different reasons. There are various factors that may influence their decision to visit our clinic; pressure from family members, strain on relationships, strain at work, communication breakdowns are more frequent. However, recognising these breakdowns does not necessarily mean that an individual is ready to be introduced to amplification. Patients must acknowledge the impact of the hearing loss and take ownership of the recommended solution. If a patient is not ready to take the next step of care, it is our role is to provide appropriate information and advice to the patient and the family members and assist the patient in getting ready to take the next step which would involve obtaining hearing technology, auditory training and participating on a care plan based on their personal communication goals. The final decision rests with the patient and it is a voluntary choice.
Patient attitudes and behaviours are explored through use of best practice counselling techniques and tools to enhance client satisfaction. These tools shed light on clients’ motivation and how we can facilitate behavioural changes related to their hearing loss. It is used to help our patients move forward on their journey towards better hearing and communication, it allows the patient to consider what hearing loss means to them and what their individual needs are and we in turn get a better understanding of your patients’ motivation and concerns.
Hearing care is not just about making sounds audible, it is about reducing the cognitive load and improving listening. We prefer to view hearing technology as a means of maximizing the Bottom Up Signal so that Top Down functions are easier & more efficient. We want to improve hearing and listening in all of life’s situations, all day and every day.
Treatment technologies used at Cubex are available as Daily Wear, Extended Wear and Implant solutions.
- Daily Wear Solutions
- Ear Hearing Technology
Ear hearing technology is designed to compensate for damage in the ear and focuses primarily on making things audible and improving the speech to noise ratio. Typically, this would entail use of directional microphone systems, noise management systems, frequency lowering and wide dynamic range compression.
Brain Hearing Technology
Every sound has a spatial signature yet hearing loss is commonly addressed on the spectral and amplitude components only. Increasing speech intelligibility depends on so much more. Amplifying sounds while preserving not only the dynamics of the signal but also as many as possible of the fine temporal structures and subtle acoustic cues is essential in our hearing care.
The brain is wired to absorb all of the sensory information around us and to organise it into meaningful percepts. It untangles and separates different sound sources – such as one voice from another; sounds coming from the kitchen versus sounds coming from the TV in the next room; traffic noise versus playground noise, etc. The more accurately and naturally the information can be presented, the easier it becomes for the brain to create order out of the apparent acoustic chaos of a soundscape.
Auditory input is extremely complex: rapidly changing acoustic events can contain everything from intricate timing cues, harmonics and loudness information to a phenomenal amount of information embedded in the frequency spectrum. The purpose of hearing care today is to help the brain restore order to what seems like chaos, using whatever sources of information are available, including: visual cues, situational cues and acoustic information such as spatial cues and speech characteristics.
In the past, research and development of hearing technology focused primarily on making things audible and managing noise. Processing chips in daily wear devices were not fast or efficient enough to restore spatial hearing and replicate the Inter-aural level and time differences of binaural hearing. Today, solutions used in our rehabilitation programmes are designed to support the natural spatial organization process of the cognitive system – organise, select, follow.
Technology isn’t used to indiscriminately ‘raise the volume’, but to sharpen the focus of what our patients hear. So patients are better able to hone in on a conversation in a wall of party noise, and shift attention from one voice to another as they choose.
Issues in Cognition, Audition, and Amplification – Exploring the fascinating links between cognition and hearing healthcare. Moderated by Douglas L. Beck, AuD with,Brent Edwards, PhD; Larry E. Humes, PhD, Ulrike Lemke, PhD; Frank R. Lin, MD, PhD; Thomas Lunner, PhD; and M Kathleen Pichora-Fuller, PhD
- Extended Wear Solutions
Lyric is the world’s first completely invisible hearing aid which can be worn for extended periods of time providing 24/7 replacement of the sense of hearing. It is the result of a unique collaboration between a group of ENT physicians, audiologists, and engineers.
Lyric was launched commercially in January 2007, however, it has been extensively studied in hundreds of clinical research patients since 2001. Audiologists who have completed all training required by Phonak are deemed as Lyric Qualified Professionals. We are one of only three clinics in London who are able to offer the Lyric and currently have 4 trained, competent and experienced Lyric practitioners. Patient motivation is extremely high and we are experiencing great success with Lyric.
Due to the deep placement of the device, Lyric uses the natural properties of the patient’s outer ear to improve localisation making it easy for the patient to make sense of their surrounding and follow conversation. The most significant benefit of the Lyric is the provision of hearing stimulation to the brain 24/7 with natural acoustic cues. It is used successfully by our patients for all daily activities, including showering, exercising and sleeping. No daily insertion or removal, battery changes or maintenance.
Although not initially designed for tinnitus, we have also been able to use Lyric to provide relief from tinnitus during the daytime as well as at night, when tinnitus sufferers need it most for a restful and healthy sleep.
- Implant Solutions
Working with MED-EL, the world’s technology leader in the field of implantable hearing solutions, we are able to advise on the most suitable implant system for a range of hearing losses. For patients meeting the criteria for these innovative solutions we offer comprehensive pre-operative audiological assessments, post-operative audio processor fitting, and ongoing rehabilitation and support.
All implantable solutions supported by us involve a day-surgery procedure performed under general or local anesthesia, at a London-based private hospital. In offering these solutions, Cubex are proud to partner with some of the UK’s most respected and experienced ENT surgeons.
Bonebridge is the world’s first intact skin active bone conduction implant, which uses the natural conductive elements of bone to create the sense of sound. Bonebridge is an award-winning option ideal for customers who need a solution where they can just put it on and go, with no daily maintenance required.
The Bonebridge can be an effective implant solution for individuals aged 5+ with a mild to moderate conductive loss and mixed hearing losses, or single sided deafness.
Bonebridge has only two components: an internal implant and an audio processor (Amadé BB).
Implant and audio processor
The Amadé is worn externally on intact skin, held in place by a lightweight magnet, and can be worn discreetly under the hair. It also sits off the ear so is ideal for customers who wear glasses.
The implant is surgically fixed under the skin during a short, routine surgery. Bonebridge converts sound from the Amadé BB processor into minute mechanical vibrations that are conducted through the skull directly to the inner ear.
This small processor is so lightweight that wearers find it comfortable to wear all day. Combined with the fact that Bonebridge is virtually a no-maintenance option, patients tell us their average time of daily wear is almost double that of other bone conduction devices.
The Vibrant Soundbridge is the world’s most successful middle ear implant system. Most patients describe a very natural hearing experience, being able to join in with conversations in busy restaurants, enjoy their favourite music, and experience sound to the full.
The Vibrant Soundbridge is a ground-breaking alternative to conventional hearing aids, especially for patients who cannot wear them, either due to medical reasons or because the hearing aid does not provide sufficient benefit. The ear canal remains open making it an attractive option for suffers of ear canal inflammation.
This proven intact skin technology provides a hearing solution to customers aged 3+ who have a mild to severe sensorineural hearing loss, or a conductive and mixed hearing loss.
Implant and audio processor
Vibrant Soundbridge has two components: an internal implant called the VORP (Vibrating Ossicular Prosthesis) and an audio processor (Amadé).
The Amadé is worn externally, held in place by a lightweight magnet, and can be worn discreetly under the hair.
During a short, safe surgery, the internal implant is fitted entirely under the skin and connected to a small Floating Mass Transducer (FMT), which is attached to the structure of the middle ear. It is the FMT that converts sound signals from the Amadé audio processor into mechanical energy and vibrates the suitable vibratory structure in the middle ear. This imitates the natural movement of bones in the middle ear, delivering sound waves to the inner ear, and creating sound.
Personalising Hearing Solutions
In addition to objectively verifying hearing instruments, the subjective nature of hearing loss makes personalisation a critical factor in achieving satisfaction.
To achieve even greater satisfaction with hearing aids, Cubex Audiologists address hearing loss according to the individual’s personal preferences. This process enables us to tailor a personalised solution that factors in more of the patients individual listening needs and sound preferences
The goal of the Personalisation Process is to help each patient reach a higher level of overall satisfaction with the hearing device fitting experience. The process focuses on patients playing an active role in determining how their devices sound. The patient’s perceptual experience of sound preference and device performance is central to this process. It also reinforces shared decision-making and goal setting between the Audiologist, patient and their partners.
The Initial Fitting session is an interactive session between the Audiologist and the patient. Setting the devices will be based on the client’s age, audiometric information, objective verification, experience and their personal answers to the preference-related questions.
Active Listening ‘take home’ tasks captures the patient’s own experience with different sound environments in daily life. We provide instructions and reminders to the patient about the types of environment to be assessed. This information is crucial carrying out the personalized performance optimization process.
For experienced hearing instrument users, the listening experience evaluation period lasts about 2 weeks. For those new hearing technology, the evaluation period typically lasts between 2 and 4 weeks.
The Optimisation process forms a cornerstone of the Personalisation Fitting Process. The process consists of two steps: Debrief and Structured Listening.
During the Debrief, information is gathered from clients about their Active Listening. This information can be used to select sound samples in the Structured Listening to make any necessary fine tuning changes.
Structured Listening walks clients through a structured listening task to further match their sound preferences to the device settings to achieve a truly personalised fitting.
Listening is Where Hearing Meets Brain” (Beck & Flexer, 2011)
Improving hearing functionality means we need to think beyond hearing. Brain training is used to improve the patient’s opportunity for Listening Success! The type of training programme used depends largely on the needs and ability of the individual.
Programmes commonly used at Cubex include:
- LACE by Neurotone
- SENTENCE MATRIX
For many, tinnitus is more of an irritant than a problem. However, for some, the brain attends to the tinnitus and recognises it as a threatening event. Negative reactions to tinnitus can cause high levels of anxiety and stress which in turn interferes with sleep, concentration and overall well- being. This often leaves an individual feeling distracted, anxious, restless and even depressed.
We often encounter people with distressing tinnitus who have been told “There is nothing that can be done – you will have to learn to live with it”. Statements like this are not helpful and can leave an individual scared, exasperated, confused or even desperate.
Working together as a multidisciplinary team of Audiology, Psychotherapy, Psychology and integration of Yoga and Pilates, we believe in supporting people with troublesome tinnitus and helping them along a path so that the tinnitus is less intrusive on daily life.
We allow 2 hours for the initial consultation as it is essential to provide the time and space for individuals to express their concerns and for us to understand the impact, level and type of tinnitus and to explore the patient’s motivation, attitude and behaviours.
As tinnitus is generally subjective and cannot be seen, loved ones are encouraged to attend the initial consultation to gain an appreciation for the patient’s situation.
Providing the patient with an understanding of the mechanisms underlying tinnitus, how tinnitus is generated and heard within in the brain and that it is not life threatening is key at this stage.
During the initial consultation, we complete a full diagnostic assessment and measurement of the tinnitus distress. Tests are carried out for both diagnostic and therapeutic purposes.
If the individual is ready and committed to being an active part of their treatment plan, we help the patient implement this into their daily life over a period of time
Depending on the severity, treatment plans can include a combination of the following; counseling, relaxation approaches, exercise, sleep strategies, sound therapy, amplification, Psychology or Psychotherapy.
The Professional Services provided are subject to charges which broadly fall within those recommended by various private health insurers. Most assessment and appointments are usually covered by medical insurance if the patient is referred to us by their GP or ENT.
Working together as a multidisciplinary team of Audiology, Physiotherapy and where necessary Psychology, Psychiatry and integration of Pilates we aim to provide bespoke, individualised treatment plans that are designed to provide greater independence and improve daily activities and quality of life for each patient.
Dizziness and balance disorders are commonly associated with the psychosocial problems and emotional distress. In addition to managing the physical symptoms of the disorder, rehabilitation success depends on the emotional, mental and social health of the patient.
Depending on the severity of distress, emotional and behavioural responses often associated with vestibular disorders warrant the inclusion of Psychology and/or Psychiatry.
In addition, rehabilitation success also depends on the patient’s commitment to follow through with recommended exercises that needs to be completed at home.
Assessing motivation and encouraging patients to take an active role in the treatment plan is essential.
Patient attitudes and behaviours are explored through use of best practice counselling techniques and tools. It is used to explore whether the patient feels they have the necessary resources to follow through with recommended treatment and helps determine how ready the patient is to receive different types of information. This influences how we adjust recommendations and counseling techniques for each patient.
Involvement of loved ones is encouraged. In many instances, the significant other passes through a wide range of feelings and experiences which parallels and intersects with the patient’s own struggle.
Understanding the partners point view of the condition helps us work towards developing common goals and agreeing on the steps towards achieving them. Working toward shared goals enhances the likelihood of success of therapy carryover at home. If counselled appropriately, partners can be an invaluable source of motivation and positive facilitation in the process.
A large part of the initial appointment is devoted to a detailed assessment of the dizziness and balance problems. Following an in-depth discussion and motivational assessment, a series of clinical tests to evaluate balance, vision, and general physical capabilities is performed.
Following the assessment, findings are shared and consolidated with the patient. If the patient is ready to engage in treatment, a bespoke plan with the most appropriate course of treatment is put into action on the day.
Progress is monitored over a period of time and clinical tests repeated to gauge progress.
Careful review and and practise of exercises are carried out over a series of consultations where exercises and treatment may be modified or changed depending on the patients progress.
Pilates provides a long term strategy addressing mood and physical wellness. It involves mental and physical training to develop the deeper central core muscles in the back and abdomen; effective for dealing with muscle imbalances, releasing tight muscles and strengthening weak muscles.
In Association with:
Now available at Cubex: We think beyond isolated impairments and carefully consider the functional and psychosocial state of each individual patient.
The facial rehabilitation team is led by Mr Jeremy Corcoran, Highly Specialist Physiotherapist
Facial therapy specialisation include: Management of synkinesis.