Hearing Health and Technology -- Workshop, Project No. P171200
I would like to share the factors that contribute to a successful hearing aid fitting. I have worked to build up a small but busy clinic offering diagnostic hearing tests as well as hearing aid services: fitting, verification, validation, counseling, aural rehab, repairs, etc.I feel that consumers are faced with an onslaught of information and misinformation when they pursue treatment for hearing loss. There are several avenues that consumers have to choose from today: order a PSAP online, go to a big box store, visit a private hearing clinic or otolaryngology clinic, and by using VA services. I can speak to treating hearing loss in a private audiology clinic. A great deal of time is spent with each patient to ensure the best outcome possible. First, a comprehensive hearing test and detailed hearing and balance health history are conducted. If any red flags are raised (unusual symptoms, asymmetric hearing loss, signs of infection, etc.), the patient will receive care from a primary care physician and possibly be referred on to otolaryngology. This is a regular occurrence. A hearing test or an unusual symptom mentioned in our initial visit can be the first sign of a serious condition, such as an acoustic neuroma or a cholesteatoma. Next, various options for hearing aids are discussed. Brands, style, features, price, size of battery, possible accessories, lifestyle considerations, previous experiences, degree and type of hearing loss, degree of hyperacusis, recruitment, changes in cognition, ability to adapt to change, number of years with untreated hearing loss, concurrent health concerns, stress levels, specific anatomical features, type and amount of earwax typically in the ear, and dexterity are all variables that must be considered. These factors guide our efforts in selecting and recommending a particular hearing aid. Next, when fitting a hearing aid, real ear testing (in which a small microphone is placed in the ear) allows us to evaluate how the acoustics of the user's ear canal affects the output of the hearing aid and helps confirm appropriate and safe levels of amplification. This is a crucial step. Significant variations in level across the frequency range are possible and this can mean overamplifying or underamplifying at specific frequencies if we do not have access to the information provided by these measurements. It is emphasized to the patient that hearing aids are more similar to acclimatizing to prosthetics than they are to eyeglasses: the brain must learn to use these new signals. This is not an instantaneous process. Properly done, the trial period offers 4-5 chances over 4-8 weeks for patients to return to the clinic for further analysis, discussions of challenges, as well as to increase the output of the aid until we are nearing the user's target level. By the end of the trial period, by using these methods, we can ensure that we are offering maximum benefit to that user. Hearing aids can be very expensive, and it is our duty as audiologists and hearing instrument specialists to ensure that this investment has value. There are many pitfalls for an OTC hearing aid: these devices are not set to the specific acoustics of the patient's ear canal. There are few options for coupling the device to the ear. This can cause discomfort, poor retention, poor acoustic quality, and feedback. If a problem occurs while using a PSAP (wax occlusion, discomfort, lack of perceived benefit, occlusion effect, feedback, inability to use on the phone or in challenging listening conditions), then the device will often end up in a drawer. This is a wasted opportunity; the individual recognized a problem with communication and spent money on a solution, and it failed. The problem continued, and often hearing aids are generalized as unhelpful. Individuals with hearing loss would be best served with better insurance coverage for audiology services and equal cost for aids for large and small clinics.