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Hearing Aids and Consumers: A Brief Tutorial

There are an estimated 27.2 million Americans with hearing loss. However, only about 20% of them own hearing aids (Kochkin, 1999). More, importantly, of that 20 percent, we cannot say they all USE the hearing aids they own! What is it that makes the idea of hearing aids so daunting? Why do so many people with hearing loss choose not to use hearing aids? Are psychosocial issues so over-bearing that they overpower a persons desire to communicate with greater ease?

It is no big secret that psychosocial issues do play a major role in a persons decision not to purchase hearing aids. Audiologists hear all too often "only old people wear hearing aids" or "my hearing is not bad enough to warrant hearing aids." However, these excuses may not be the only obstacle that audiologists and hearing-impaired individuals have to overcome.

Some audiologists refer to the people in their office as "patients," others use the term "clients." However, when the time comes to invest in hearing aids, the patient takes on an additional role, that of a "consumer." As consumers, people look to audiologists and other hearing healthcare professionals to provide them with a service and a product that will best fit their needs, while giving them the biggest bang for their buck. Consumers need to feel both comfortable and confident in their decisions to pursue and choose appropriate amplification. For many people, hearing aids appear very foreign and far too complicated.

By simply knowing what to expect through appropriate education and counseling, the consumer can gain confidence, and enjoy the experiences involved, rather than feeling anxious or unnecessarily frustrated. Patients should be aware that obtaining hearing aids involves a significant time investment, and that it is a multi-step process.

First and foremost, a comprehensive audiometric evaluation should be performed by a hearing healthcare professional. Audiologists are licensed specialists with a masters degree or a doctorate in audiology or hearing sciences, and they are the professionals who typically perform these comprehensive evaluations. An audiologist will also interpret the results, diagnose the type and degree of hearing loss (ASHA, 1996) counsel their patients, and refer appropriate patients to MDs for medical treatment. Most audiologists also fit, dispense and sell hearing aids. Hearing instrument dispensers are licensed to test hearing for the purposes of fitting hearing instruments. Although they do not have the same educational training as audiologists, they also fit, dispense, and sell hearing aids.

Initially, the hearing healthcare professional will take a case history and obtain an initial hearing evaluation. Each patient is unique. Many audiologists use a rehabilitative model of service, rather than a medical model (Erdman et al., 1994). This simply means that audiologists are concerned with treating the "patient" (addressing the needs of the individual by developing a rapport and involving them as a mutual participant), rather than the "disease" (hearing loss). Patients should feel free to explain their individual difficulties during the initial session. Once the hearing evaluation is completed, the test results are reviewed with the patient. Although we do our best to explain things, patients should feel free to ask for clarification if there is something they do not understand, or something that needs additional explanation or clarification.

Just as each person is unique, so is each hearing loss. Although two people may have identical hearing loss (in terms of how loud sounds have to be to hear them) they may possess very different degrees of difficulty in understanding speech! The way in which hearing loss affects speech understanding is often a good indicator of how well (or how poorly) the patient may do with hearing aids. These differences lead to different levels of benefit from hearing aids. Some people will likely experience improved sound awareness, but will still have much difficulty in understanding speech. Others are likely to see significant gains in speech understanding. Regardless, it is certainly reasonable to expect significantly improved benefits, as a whole, from todays hearing aids, as compared to those worn by prior generations.

To some extent, buying hearing aids is a lot like car shopping. In other ways, the comparison leaves much to be desired! Just as all cars get you from point A to point B, all hearing aids work in the same capacity they amplify sound. The decision between different technologies is analogous to choosing between different cars, such as Ford versus BMW. Some people think they do not know enough about cars to make an educated decision, and the same is true with hearing aids. When automotive terms and "buzzwords" are not understood, some consumers find it embarrassing to ask questions. The same is true of hearing aids. There are many terms, such as directional microphones, compression, suppression, digital circuits, and multiple channels, which can overwhelm people. For this reason, I find it VERY useful to bring a spouse or a loved one along, to the hearing aid evaluation. Having an extra set of ears is very helpful when trying to gather information and digest it all.

Additionally, cars are quite expensive. Increased technology has caused the price of hearing aids to rise as well, and amplification can often put a bigger dent in a persons pocket than expected. People may go shopping for a car wanting something sleek and sporty, but needing something larger and more reliable. A family of five will not fit well into a sports car - a mini-van would be a more appropriate choice. The same analogy can be made of hearing aids. A person with a profound hearing loss will not receive sufficient power from a completely in the canal (CIC) hearing aid, a larger style would be more appropriate. Typically, the larger the hearing aid, the less expensive it is. If one is determined to have a successful experience with hearing aids, better communication may come with a higher price tag.

Although all hearing aids DO function in the same capacity, not all hearing aids are created equal. Revisiting the original car analogy, sometimes just "getting from point A to point B" is not enough. Julie Purdy (2001) best stated this idea when she wrote, "I cannot win the Daytona 500 in a Yugo."

One final car analogy..Many people buying a new automobile are interested in a test drive. The good news about hearing aids, is that most professionals offer the ability to test drive new hearing aids. These "trial periods" are not mandated nation-wide, and different rules may apply in different states. It should also be noted, the trial period does not constitute the time period in which a person fully adjusts to new hearing aids. Trial periods usually last about a month, which is significantly longer than a test drive!

The consumer should understand that often included in the hearing aid price tag is the in-the-office service program, and the time of the professional, across the lifetime of the hearing aid (usually about five years). Of course, this too varies, and the consumer needs to ask the professional which services are included and which are not. The relationship to the professional and their office does not stop when you acquire your hearing aids. There are follow-up visits and future servicing that will be necessary. All of these factors need to be assessed when looking at costs versus benefits. It has already been said that the high price tag placed on some higher end hearing aids often offers a very important benefit, specifically more time spent with the audiologist (Ross and Beck, 2001).

It is important for the consumer to know that hearing aids DO NOT restore normal hearing, and things will not suddenly be crystal clear. Better hearing takes time. Both adjusting
the hearing aids, and adjusting to the hearing aids takes time.

CONCLUSION:

The take home message is the more educated the consumer, the greater the likelihood of a successful hearing aid experience. Allowing people to feel more comfortable, by teaching them what to expect, is essential in todays high tech world. Professionals and consumers each must work together to establish reasonable expectations to achieve the common goal of enhanced communication.

REFERENCES

ASHA - American Speech-Language-Hearing Association, Scope of Practice Statement. 1996

Erdman, S.A., Wark, D.J., & Montano, J.J. (1994). Implications of service delivery models in audiology. JARA, 27, 45-60.

Kochkin, S. (1999). MarkeTrakV: "Baby boomers" spur growth in potential market, but penetration rate declines. The Hearing Journal, 52(1), 33-48.

Purdy, J.K. (2001). Roles in successful hearing aid fitting: consumers, audiologists, and manufacturers. Audiology Online, April, 2001.

Ross, M., & Beck, D.L. (2001). Expensive hearing aids: investing in technology and the audiologists time. Audiology Online, March 2001.

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