MilesRick Miles, PhD, president and CEO of Micromedical Technologies, Chatham, Ill, recently spoke with the Hearing Review about vestibular technology, the growth of the audiometric industry, and other topics.

Q. Please tell us about Micromedical, and what the company specializes in?
: I founded Micromedical in 1986 to design and manufacture computerized ENG systems. That was about the time the first PCs were being sold, so it gave us a chance to capitalize on new technology to replace strip chart ENG systems. We continue today to specialize in vestibular and balance instrumentation.

Q. What is the biggest challenge facing the industry today?
Usually the challenge is Medicare reimbursement for ENG diagnostic tests. However, since the beginning of this year, reimbursement has increased and is now very attractive. The biggest challenge is the acceptance of the insurance industry for new diagnostic tests. This hampers innovation because reimbursement drives clinical purchases.

Q. Why is the acceptance for new diagnostic tests not happening?
There are several steps for getting new medical equipment approved for payment. First is the FDA review process and scientific publications showing the test’s efficacy. Next, a CPT code must be created for the test, and, finally, reimbursement agreements from Medicare, HMO, and other insurance companies must be signed. This all takes time. But even if CPT codes are assigned, any negative reports from the medical experts hired by insurance companies or independent scientists can be used by insurance companies as a reason for denying payment on a CPT code. Thus, it is more prudent for manufacturers of medical instruments to design only products where reimbursement has a proven track record. That reduces innovation.

Q. What sorts of changes would you like to see in the industry? In other words, how do you think it could be improved?
I would like to see standardization of ENG test protocols and competency requirements for examiners performing ENG tests. This includes more emphasis on vestibular testing in audiology programs.

Q. Do you have any ideas on how standardization of ENG testing could happen?
Physical therapists who perform vestibular rehabilitation have access to competency training and testing courses several times a year. The courses are taught by members of the Neurology Special Interest Group (SIG) of the American Physical Therapy Association. I believe that our AAA should form a vestibular testing SIG for their members and perform competency training and certification. Another group, the American Neurotology Society (ANS), has attempted to offer ENG technician training courses over the past several years with physician instructors. There is a self-graded quiz at the end of the one-day course, but no competency certificate.

Q. How is technology changing the industry, specifically with regard to vestibular products?
Video technology has dramatically altered how eye movements are recorded. For the past 50 years, skin electrodes recorded eye movements. In the past 5 years, Micromedical and other manufacturers have designed video nystagmography (VNG) that produces “clean” waveforms without frequent calibration, drift, or noise. Thus, video eye tracking is not only a time saver for the examiner, but it also produces an easier method to interpret waveform and digital video for the test interpreter. Now, a majority of our customer’s investments are in VNG with digital video capture.

Q. How is vestibular research changing what you do? More specifically, have there been any technological breakthroughs that have led to new products for your company?
Most vestibular research that has interested Micromedical has dealt with balance assessment and vestibular rehabilitation. Previously, patients with vestibular problems were tested, diagnosed, and offered surgery or medication as treatments. Now, audiologists and physicians are frequently including vestibular rehabilitation as a treatment option for many patients. For example, John Epley popularized a canalith repositioning maneuver to treat BPPV, a common disorder, and physical therapists have demonstrated remarkable success in treating balance disorders. This has led Micromedical to develop a “comprehensive balance center” product line for testing and treating these patients. Comprehensive meaning that it includes ENG/VNG, rotational vestibular chair, computerized dynamic posturography, video goggles, and the software that makes it all work together.

Q. What do you see for the future, both for the industry in general and for the vestibular segment?
As a measure of the growth of the audiometric industry, one just has to look at the size and number of commercial booths at the annual AAA meeting. You can see that over the past dozen years, audiology attendance and thus the investments of exhibitors have grown dramatically. This bodes well for all of us in the field because it indicates a very healthy industry. Also, with Medicare’s recent improvements in reimbursement for vestibular diagnostics and rehabilitation, the vestibular segment is projected to continue its steady growth. New technologies and successful treatments for vestibular disorders energize not only the clinicians ,but also the instrument developers.