Why Should You Care About Your Hearing Evaluation?

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We are all familiar with the fact that hearing aids can cost a great deal of money and most of us are aware that Over the Counter (OTC) hearing aids are often quite a bit less expensive.  But there are significant differences between obtaining a hearing aid or assistive listening device from an audiologist and purchasing a hearing aid from an OTC provider.  When faced with needing a hearing assessment and an assistive device such as a hearing aid, the difference between “just getting a hearing aid” and obtaining a device that matches one’s hearing loss and functional needs can be vital.

At the November 14th Chapter meeting of the Madison HLAA Chapter, Veronica Heide, AuD, a private practice audiologist and owner of Audible Difference in Madison, Wi, presented an interesting discussion about Standards of Care that Audiologists are expected to follow.  The standards outline the types of evaluations needed, the protocols for choosing a hearing aid and the verification process.  The verification process involves testing that the type of hearing aid chosen, the programming of the hearing aid,  and the fitting are all appropriate and functioning as expected.  Additionally, the Standards require a review of additional accessories or devices that may be helpful in difficult situations such as noisy rooms or when using the telephone. 

Dr. Heide discussed the Standards for audiologists followed by a lively questioning answer period.  An example of a discussion point was the issue of rechargeable hearing aids and their pros and cons.  The discussion was an excellent illustration of the kind of information that one should expect during an audiological assessment and during the process of selecting a hearing aid.

This article deviates somewhat from Dr. Heide’s presentation in order to bring up some of the differences between audiologists and hearing aid fitters and dispensers, differences that I believe HLAA members should be aware of.  And the reality is that some people will choose to see a hearing aid fitter and dispenser for reasons of cost or, perhaps access.  Whether one chooses to see an audiologist or a hearing aid fitter aid dispenser, it is important to know what to expect.  Both professions have their own published Best Practices Standards to guide their members. But there are important differences.  Audiologists are required to have years of training and an advanced degree.  Hearing aid fitters are required to have a high school diploma and their education may consist of on-the-job training or online education.  Both professions require a state license to practice.  Audiologists are permitted to prescribe; hearing aid fitters are permitted to fit only those with mild to moderate hearing losses and sell over-the-counter (OTC) devices.

The act of hearing is not a simple “you can or you can’t” process.  Some people do, indeed, do well with simple amplification but the reality is that hearing is extraordinarily complicated and a hearing loss often means being able to hear only parts and pieces of the sounds of speech at variable volume levels and in competing noise, forcing the person with a hearing loss to “fill in the blanks” in a variety of ways.  One way we fill in the blanks is by being familiar with the topic or the speaker- largely a case of knowing “what fits” and what does not.  Listening in the presence of a routine is easier than figuring out something new. Visual cues and gestures can be vital.  The more severe the hearing loss, the more the listener needs to actively work to comprehend and make sense of perceived sound.  Trying to hear can, in actuality, be stressful and exhausting.  We are all, for example, well aware of how frustrating it can be to hear others when there is background noise.

A hearing aid that is specifically fitted to an individual’s type and level of loss and accurately transmits the sound as programmed to the listener can make all the difference.  But accomplishing that is a complicated task and requires not only in-depth knowledge of the listener’s needs, but also the time and ability of the provider to perform tests to select and program an appropriate hearing aid and be sure that the hearing aid is performing as desired.

Assessment of hearing loss is not a simple endeavor.  Not only do we want a device that is appropriate and allows us to hear as clearly as possible, we also want to be sure that the cost is justified.  Knowing what the Standards for Audiologists and hearing aid dispensers are can help us  know when we are receiving appropriate assessment, treatment, and follow-up.  Knowing what to expect also enables us to ask appropriate questions and receive appropriate treatment.

Even given the differences in training and experiences, it is also important to know that one of the serious problems facing many audiologists today is pressure from their employers to see a certain number of patients per day and spend a limited amount of time with each patient.  This is a problem that many health professionals are experiencing.  Inevitably this can lead to short-cuts, eliminating procedures which could well help you as a patient to receive the most appropriate hearing device that is programmed to your needs.  And if there are additional assistive devices such as remote microphones or streamers that would be helpful, you should be informed about those as well.  Again – knowing what the Standards are can help you receive the services you need because you know what to expect and ask for.

Several publications of Standards of Care can be found on line.  Three significant Standards are:

Know that obtaining a hearing aid should not be a one-step, one-stop process.   Several appointments may be needed.  Know what the costs, if any, are for the appointments.  Recognize that the cost for an Audiologist may be higher but that cost usually includes several appointments including follow-up. Also know that you should expect thorough explanations and reviews and that you will almost certainly require a trial period

While not a substitute for reading and know the Standard listed above that is most applicable to your situation, the brief summary below of what you as the user of a hearing aid should be aware of is common to all of the Standards.

  1. Know the difference between the skills and knowledge possessed by an Audiologist and those by a hearing aid technician.  One requires years of training and an advanced degree; the other requires a high school diploma plus on the job training or a brief period of training.  Both require a state license to practice.
  2. Take a significant other with you to your first appointment.  You should expect discussions regarding your medical and audiological history, your communication needs, activities you are involved in, and how you interact with others in various settings.
  3. Expect audiological testing in a sound booth to determinate the softest sounds you can hear as well as how well as the level at which you hear speech, recognize words, and hear speech with background noise.  Expect also assessment of your auditory processing skills, lipreading skills, and health status.
  4. A Treatment Plan should be developed and may include medical referral, testing for tinnitus, amplification and technology solutions, and aural rehabilitation.  When indicated, there should be consideration of implants such as BAHA, cochlear implants, and brainstem implants and referral to appropriate sources.  In other words, what is needed, what will fill the need, and what is required to succeed?
  5. When considering hearing aids, the examiner should consider your lifestyle, dexterity, telephone use, compatibility with assistive listening devices and loops, and limitations and costs of replaceable batteries vs. rechargeable batteries.  Other needs that may need to be considered are directional microphone characteristics and control, power requirements (including pro/cons of rechargeable devices), variety of compatible accessories, and whether prescription or over-the-counter hearing aids are most appropriate.  Underlying all these considerations are the perceptions you have of yourself as a hearing impaired person and your motivation, hearing abilities, communication needs, expected treatment goals, and financial resources.  You should also be given clear information about trial periods and for how long and what the potential costs are.
  6. During the actual hearing aid fitting, expect to receive training on how to use and manipulate the hearing aid including controls and linkage to assistive devices direct connection to the telephone and loop systems.  Warranty, repairs, and maintenance and follow-up assessments should be covered. 
  7. Particularly important is the need for real ear measurement to verify that the sound reaching your ears is as expected and programmed for.  Just because there was careful assessment of your hearing loss characteristics and appropriate programming of the hearing device does not mean that the sound that finally reaches your ear is appropriate.  For example, an individual’s ear canal shape can alter the sound from the hearing aid.
  8. Information about enhancing listening and communication skills is also important and includes suggestions on how to minimize background noise, functioning in groups, how to help others communicate clearly with you, and techniques for anticipating and minimizing difficulties with hearing and comprehension.
  9. Ideally your provider should provide information about resources in the community including support groups such as HLAA and information about bluetooth devices and loops in community.

Again, this is only a summation of what one should be aware of when being evaluated for a hearing aid or other assistive device; you are encourage to click on and review one of the Standards listed above.  The more one is aware of what to expect the more likely there will be a complete and beneficial result.  It is important to know what to expect because when expectations are not met, then one can ask questions.

And don’t forget your fellow HLAA members…we are all in this together and we all have experience and knowledge to share.  

Jack Spear

President, HLAA Madison Chapter