What Happens When An Audiology Startup Tackles COVID-19? AHead Simulations Has The Answer.

New doctors and nurses practice on full-body simulators. Audiologists and COVID testers have no equivalent. AHead Simulations founder Rob Koch is changing that with two perfect patients: CARL and Ned. A Draft Canada original.

August 19, 2020

In the past two years, CARL has been to seven different countries, including Denmark, Australia, Germany, New Zealand and the United States.

He’s participated in scavenger hunts, road trips and the odd hockey game – it turns out, he’s a bit of a St. Louis Blues fan.

He raises eyebrows when he goes through airport security. At the end of a long day, he enjoys a tall, cold happy-hour beer with his team.

Well, sort of.

“CARL stands for Canadian Audiology Simulator for Research and Learning,” explains Rob Koch, founder and president of AHead Simulations. And when he talks about what some audiology students are calling “my new favourite buddy,” he’s referring to a 3D-printed head complete with silicone ears made to realistically mirror its human counterparts.

“CARL is your perfect patient,” he says, built to help teach audiology students how to fit hearing aids. “CARL’s not going to complain. CARL’s not going to scream if you turn the hearing aid too loud. You can experiment with everything you want on CARL. You can even do things improperly on CARL, to see what happens. And it much better prepares people for the risks and the realities of the practice.”

CARL is AHead’s debut product, the older brother (so to speak) of both the child-sized Baby-CARL and NED, or Nasal Swab Educator, released this year to help teach clinicians the proper nasal swab technique used in COVID-19 testing in hopes of reducing the number of false negatives resulting from the procedure.

“I think NED is very, very similar to what we’ve done with CARL, in that we just saw an opportunity where we can help, and where our expertise can help, and where our equipment can help,” says Koch.

Audiology has a hearing problem

“This was the very, very first simulator that we had,” says Koch. He’s sitting at his desk in AHead’s new Cambridge, ON office – the only one of four team members on-site today. In his right hand, he balances a Styrofoam head modelled after Frankenstein’s monster. It’s sliced in half along its profile, with sensors and electronics nestled inside of a carved-out cavity. “As you can see, I made it during Halloween.”

When Koch gave life to CARL’s ancestor – minus all the alchemy and magic of its fictional Doppelganger – he was a master’s student at Western University studying biomedical engineering, and a bit of an audiophile.

“Even during my undergrad, I took a course on biomechanics, and that was really when we learned how the human ear works,” he says. “How we hear sound is literally just waves in the air that vibrate your eardrum, and then your brain and inner ear find a way to decode that and make you understand your environment. I think that’s just the coolest thing ever.”

Through that interest, he made connections at Western’s audiology program. And it turns out, they needed a little help from an engineer.


Despite their education, most audiology graduates leave school with little clinical experience fitting hearing aids, says Koch. Across schools and countries, students are usually limited to practicing on their peers in the classroom. That includes everything from taking molds of a patient’s ear canal to measuring sound in the ear.


There are a few problems with that approach. First, many students don’t have hearing loss, so they can’t properly test the full range of frequency and volume on a hearing aid. There’s no follow-up to see how the fit is working long-term, either.


Then there are the medical emergencies. “If you inject molding material into the ear canal incorrectly, that molding material can actually keep going and burst through the patient’s eardrum,” says Koch. “You would think that it didn’t happen very often, but I’ve heard story after story of when that has happened and a student has had to be rushed to an emergency room for an EMT to help dig out this material from, more or less, the inside of their head.”


“CARL’s not going to complain. CARL’s not going to scream if you turn the hearing aid too loud. You can experiment with everything you want on CARL.” -Rob Koch

In medical schools and nursing programs, students get around these problems by using manikins or simulators that mimic the human body – everything from blood flow to air supply. “It literally simulates the whole internal system for a human.” But in audiology? Nothing.

So when Western’s audiology department wondered if Koch could whip up a custom manikin for its students, Koch said yes… and CARL was born.

Getting the right fit for entrepreneurship


The Franken-head version of CARL soon became a more robust version, this time 3D printed with silicone ears. Everything – from the shape and stretchiness of the ears to the acoustics inside the canal – are as close to human as humanly possible, says Koch.

CARL even became the focus of Koch’s academic research. “The last study that we did during my master’s found that students who used the simulator actually performed better in clinical scenarios than students who did not,” he says. And that gave him an idea. “That was great finding, and that made us think that, if this is useful in London, could this be useful at all the other audiology schools around the world?”

Koch wasn’t totally convinced that he wanted to start a business, though. While the nine-to-five lifestyle never really appealed to him – “I would rather work 60, 70 hours a week on something that I absolutely love doing and I’m excited by than work 30 on something that I just don’t want to be there for” – he wasn’t sure what he was getting himself into.

“Being an engineer, when you look at things like company values and company purpose, it just seems so fluffy … My biggest shock has just been how much that stuff really matters.” -Rob Koch

“I was honestly extremely hesitant at the very beginning,” he says. “I kind of slowly stepped into it. But I think that a lot of what I do and the impact that we want to have, it lent itself very well to the entrepreneur lifestyle.”

Koch quickly became aware of one thing: he had a lot to learn if he was going to take CARL to other schools – and clinics, and research labs – around the world. So he hit the books, attended courses, and even signed up at the Accelerator Centre as part of their AC JumpStart program.

At first, he was happy to get a little extra funding for his new business. But he really saw the value he had tapped into when he sat down for his first meeting with the AC’s mentorship team.


“Being an engineer who starts a business, you vastly underestimate everything in terms of how much time it takes to do something, and how much effort it’s going to take run a sales campaign, or run a marketing campaign, or even put together a website,” he says.


“I would also say, being an engineer, when you look at things like company values and company purpose, it just seems so fluffy,” he adds. “My biggest shock has just been how much that stuff really matters.”


That’s a lesson he learned from the Accelerator Centre. “It really just gave our clinicians more confidence, and it gave me the confidence to be able to keep pushing and keep looking at all these different areas of the business,” he says.


COVID-19: keeping an ear to the ground


There was still one thing Koch and his team were trying to work out: would they be a simulation company that could serve multiple applications across health-care disciplines, or would they laser-focus their efforts on audiology?

COVID-19 answered that question for them.

With demand for COVID-19 testing rising rapidly, more and more front line health-care staff found themselves administering lots of nasopharyngeal swabs – basically, gathering a sample from the place where your nose meets your throat – with little to no training. But if they did the test wrong, the results wouldn’t be accurate. Combined with other factors, like the virus’ incubation period and the window of opportunity for testing, and it all contributes to a false negative rate pegged as high as 20 per cent.

So when one of AHead’s advisors reached out with an idea, Koch was on board. “It literally came from a one-line email that said, ‘Do you think CARL could have a nasal cavity to help simulate nasal swabs?’" he remembers.

Koch went immediately to their otolaryngology partners at London Health Sciences Centre to help figure out if they could build an artificial nasal passage the same way they did the ear canal. At the same time, they solicited feedback to make sure there really was a need.

“Being able to see that, in your every day, you make some part of the world a little bit better… it’s something that just [makes] me extremely happy.” -Rob Koch

Less than three weeks later, Koch and his team had a prototype ready for NED, and less than three months later, they had shipped their newest product out the door.

“We now have six NEDs in frontline testing centres right now, or in long-term care homes,” he says. “86 per cent of swabbers who have used our NED device are more confident on best practices for nasal swabs, now that they have used NED and gone through our training module. So to see that it’s having that much of an impact and people are more confident in swabs after the fact is absolutely fantastic.”


And a growing family – CARL, NED and whatever AHead makes next – is exactly what Koch wants to achieve. “I’m not as ruthless and unforgiving in my pursuit as Steve Jobs’ idea of ‘I want to make a dent in the universe.’ But being able to see that, in your every day, you make some part of the world a little bit better… it’s something that just [makes] me extremely happy and satisfied with what we’re doing. And so to keep doing that, and keep doing that on a larger scale, I think is really the goal and the impact that we want to have.”


There’s just one thing: “Never in my wildest dreams did I imagine in my future office there’d be ears everywhere. But here I am!”


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