Sarah Moore

The media, advertisers, politicians, and even some hearing care professionals talk about hearing aids as if they are simply a gadget.  In this fantasy world, you walk into the Verizon Hearing Aid store and pick out your new hearing aids as if you’re picking out your new cell phone.  However, hearing aids ARE NOT simply gadgets.  They are two complex computers that are taking a constant picture of the soundscape in your environment and using what they know about your hearing loss to decide what will help you hear the best during every micro-second of your day.

Let’s imagine for a moment that cell phones worked like hearing aids… you walk into the AT&T store looking for a new cell phone.

The salesperson first has to perform a detailed retinal scan so that you can see your screen properly when you look at it.  Some salespeople will have taken a six-week certificate course to learn how to do this scan, others will have gone to graduate school to learn about the eye, how sight works in the brain, and how to maximize what your retina can see when you are looking at your phone screen. (Pro Tip – this is the difference between Hearing Aid Dispensers and Audiologists!)

You are presented with several different cell phones to choose from that vary in cost.  Some have a screen that only has a few colors and poor resolution, some have more colors and better resolution, and the premium screens have full spectrum color and excellent resolution so that you can watch movies on it and take beautiful photographs.   Which one will work best for you?  It probably depends on what you want to get out of your cell phone and how important those things are to you, and of course your budget.

Let’s say you opt for the premium phone because you’re excited to be able to use FaceTime. You get your new cell phone home and dial.  Hmmmm… it turns out that the screen doesn’t seem to be calibrated quite right for your retina.  The edges of the screen are discolored and fuzzy, and there are a couple of blank spots here and there.  Back to the AT&T store you go.  The technician can’t see your screen the way you do, because she can’t see it through your retina, so she makes a couple of adjustments, and you go home and try it again.  It seems better, but when you go into a low-light situation, you can’t see a thing on the screen at all.  You head back to the AT&T store and they make some more adjustments.  Better, but it’s hard to see the top of the screen… the bottom looks good.  Back to the AT&T store you go.

After several more visits, your phone is working just the way you want it to, but suddenly one day, the screen stops working at all.  Turns out that the screen technology fades over time, so it needs to be cleaned and refreshed every three or four months.  Back to the AT&T store with you for regular maintenance!  In addition to all of this, your retina changes over time, so every year or so, you have to get a new retinal scan and have your screen re-calibrated so that you can continue to get the best quality out of it.

If cell phones actually worked like this, how expensive do you think they’d be?  Cell phone providers would either have to charge you every time you came in to have your cell phone adjusted, or they’d have to make the cell phone a lot more expensive to cover all the time and materials and know-how that would go into keeping it working well for you.  If you have purchased your hearing aids from a clinician who operates on the “gadget” model – chances are you are not getting everything you should out of your devices!  Get thee to a better audiologist!!

Here’s the short answer: the best hearing aid for you is the hearing aid that helps you hear what is important to you at a price point that is affordable to you.  

Here’s the long answer: there are a myriad of options out there, generally falling into three categories. 

1. The “Miracle” Solution! –  These are found in the back of your favorite magazine.  They are not a miracle nor do they provide a solution.  This is 100% a waste of money!

2. OTC hearing aids – These hearing aids can be purchased “over-the-counter”.  Sounds good, but it’s only really workable for a very specific subset of people – those who feel they have only mild to moderate hearing loss, who have the technological know-how to set up their own hearing aids using a cell phone, and have the awareness and patience to manage the settings of those aids in a way that works depending on the listening environment.  These are definitely not “put them in and forget them” hearing aids.

3. Prescription hearing aids – This is what audiologists do, and this is where it gets hard to know.  The vast majority of people with hearing loss can be helped with hearing aids.  But how do you know what is best?  It boils down to your hearing loss, the technology available in the hearing aid, and the affordability.

Every manufacturer has well-researched documentation about why their premium technology is better than everyone else’s premium technology.  Is there one that’s actually better?  No.  They’re just different.  Also, every manufacturer has 4 to 5 different technology levels, ranging from simple to very smart.  The simple aids lack the fancy bells and whistles that make good decisions in hard listening environments.  The smart hearing aids pull out all the stops to help you discern speech in noisy places.

Is it worth the money?  That’s the million dollar question.  Kidding.  That’s the $6,000 question.  The more expensive hearing aids perform better.  That’s just reality.  However, there is more to consider.  How often are you in difficult listening situations?  How much extra help does your brain need to process noisy situations?  Is your hearing so poor that you won’t be able to hear the difference between simple and smart hearing aids?  All of these questions need time and honesty to explore, and if you have a good relationship with your audiologist, he or she should be happy to help you figure it out.

 

The hearing healthcare landscape can feel like a mine field.  The sheer volume of deals!deals!deals! advertising combined with the complexity of technology and the plethora of providers can leave you feeling like it is insurmountable.  Fear not – we’ve got some tips to help you find a provider that will fit your needs.

#1 – Ask people you trust.

Start with your primary care doctor.  Every hearing loss is a medical issue, and your primary care doctor has likely referred hundreds of patients to local providers.  They will know who is reputable in your area, and whose patients are happy.  Don’t forget to ask your friends and family as well.  If they have had a particularly good experience with a local provider, they’ll be happy to share it.  If they aren’t happy, they’ll share that, too!

#2 – Look for an audiologist, not a hearing aid dispenser.

An audiologist is a masters or doctoral level clinician who has had training in diagnostics, hearing aids, balance problems, and tinnitus care.  We receive a well-rounded education in order to be able to diagnose different types of hearing loss, and refer to physicians when necessary.  A hearing aid dispenser is a state-licensed individual who passed a test to be able to dispense hearing aids.  There are dispensers out there who are very good at what they do, but you should always start with an audiologist to have your hearing loss properly diagnosed and make sure there are no medical red flags that warrant further treatment.

#3 – Find someone who follows Best Practices.

Like all medical fields, audiologists should be following “best practices” as set out by our national professional organizations to ensure the best outcomes for our patients.  Unfortunately, not all audiologists will take the time and energy to do so.   Arguably the most important aspect of best practices is Real Ear Measurement.  (See our blog post here).  If your prospective provider does not provide Real Ear Measurement, they are not adhering to best practices, and you’ll have better results with a different provider.

#4 – Ask what hearing aids a provider works with.

There are five big hearing aid manufacturers: Oticon, Phonak, Signia (and Widex), Resound, and Starkey.  Good providers will work with at least two manufacturers.  No one company can satisfy the audiological needs of every single hearing loss.  If a provider wants to be able to offer the best solution to everyone who comes in their door, they will need to work with more than one manufacturer.  Any provider that works with one and only one manufacturer is either owned by that manufacturer or beholden to them in some way.

#5 – Make sure the hearing aids are unlocked.

There are providers out there who “private brand” their hearing aids.  For example, they could be selling Resound hearing aids, but they aren’t called Resound hearing aids, they are labeled something completely different.  Those aids will be locked into that provider, or only providers in that particular network.  Examples of this are MiracleEar, Beltone, and the Costco brand, to name just a few.  You’ll want the freedom to travel or move away, and see another provider for help with your aids if needed, and if they are locked into one provider or network, this is much harder to do.

#6 – Ask how services are provided for the aids.

Traditionally, the services of the provider have been “bundled” in with the cost of the hearing aids.  For how long, and what that includes, is often not clear.  Ask your prospective provider what other costs you can expect to incur over time.  People who have “unbundled” their service from their hearing aid sale are going to sell less expensive hearing aids, but then you have to take into account the maintenance and repair of the aids as they age.

#7- AND MOST IMPORTANT – Find someone you are comfortable with.

Hearing loss is a very personal issue.  Hearing loss profoundly affects how you interact with people.  Not just people on the bus or at the grocery store, but with your loved ones.  It’s hard to talk about the difficulty you have hearing, and you’re going to want to work with someone who you feel comfortable with, someone you can talk to.  Getting hearing aids is not like walking into the cell phone store and picking out a new gadget.  Hearing aids are a journey, and your conductor on that journey should be someone that you trust.  Use your gut.  Don’t be afraid to meet with several providers.  It’s a big decision and you should find someone who helps you feel confident and secure.

© 2020 Brattleboro Hearing Center

The best, most technologically advanced, expensive hearing aid in the world is just a piece of junk if it is not fit well for your hearing loss.  So who decides how to set a hearing aid for you?  Every manufacturer of hearing aids has a formula that they use to decide how much amplification to give at which frequencies.  They will all tell you that they do it the best, and they all have data to prove it.  However, they are basing those numbers of the acoustics of an “average ear canal” which is a 2 ml straight tube.  Picture a thimble with straight sides.  Who has an ear canal that is shaped like a thimble with straight sides?!  That’s correct – no one!

So how do you know if the sound coming out of the hearing aid and into your ear is just right for your ear canal and your hearing loss?  You don’t – unless you measure it!  Believe it or not, it is possible to put a small microphone into the ear canal and listen to your hearing aid.  Not only is it possible, but it is absolutely necessary to achieve a good hearing aid fit.  Studies have shown that hearing aids right out of the box underestimate the amount of amplification necessary to correct a given hearing loss.  Measuring the sound in the canal is the only way to correct this problem.

How Is It Done?

Audiologists use “Real Ear Measurement” systems to accomplish this.  There are several “Real Ear” systems on the market, and they all work in basically the same way.  A small tube is inserted into the ear canal with the hearing aid.  This is a microphone that records the sound coming out of the aid.  The patient sits in front of a speaker that emits sound (usually a sentence about a carrot, of all things!) and the microphone picks up the sound and displays it on a graph for the audiologist to see.  From there, the audiologist can use the hearing aid software to adjust the amplification in the aid until it meets the needs of the patient.

Here’s An Example

This patient is getting new hearing aids.  When we measure her Real Ear response, it doesn’t look great.  We would like the dark green line in the middle of the green band to reach the little green crosses which are “targets” for the patient’s hearing loss.  This patient is not getting enough amplification – her aids are too quiet for her hearing loss and ears.

Let’s Fix It!

So, how do we make it better?  We adjust the amplification in the hearing aids, giving her more volume until we reach those targets.  Here is the final result – much better!  Now her hearing aids will work optimally for her.

 

What Have We Learned?!

This is such an important process to go through, and not all audiologists have the equipment or the training to achieve these results.  If you are looking for an audiologist, please ask whether they perform Real Ear measures.  It’s a great indication of whether or not they will be providing the best service for you and your hearing.

© 2020 Brattleboro Hearing Center

Most hearing loss is not an emergency.   It’s either gradual, happening slowly over years, or it’s temporary, from an ear infection, for example, or from a build-up of wax in the ear.  However, there is one case when hearing loss is a medical emergency:  when it’s sudden.

Sudden hearing loss should always be treated as a medical emergency.  It may not actually BE an emergency.  Maybe it’s a shift of the wax in your ear which now completely blocks off sound.  Maybe it’s a build-up of fluid behind your eardrum because of the sinus infection you’ve been battling.  BUT – maybe it’s your Inner Ear, which will lead to permanent damage of your hearing mechanism.  How can you tell the difference?

You can’t!  But your doctor can.  If you experience a sudden change in hearing, occurring over hours or days, contact your primary care physician right away.  This is especially important if you’ve also noticed a sudden case of ringing in the ears or spinning dizziness (vertigo). If your primary care doctor’s office can’t fit you in, try an Urgent Care center.  The physician’s job in this case is to ascertain what is causing the hearing loss.  If it’s a problem with wax, or with fluid build-up behind the eardrum, or with any of the myriad other things that can change your hearing temporarily, your doctor will treat you.  However, if they discover that your hearing difficulty is a sudden change in hearing in your Inner Ear, you’ll need an urgent referral to an otolaryngologist (that’s an Ear, Nose, and Throat doctor).

So what should your doctor do to determine if your hearing loss is coming from your Inner Ear?  First, they should look in your ear with an otoscope and make sure it’s not plugged up with wax.  If there is no wax impaction, they can indirectly assess your Inner Ear using a quick, simple, painless tool: the tuning fork!  Every doctor should have a tuning fork at the ready for cases just like these.

Tuning fork tests can help tell your doctor where the problem is in the ear system. There are a couple of different tests that are used; sometimes the tuning fork will be placed next to your ear, and sometimes it will be placed on the bone behind your ear, or on top of your head.

So what will happen at the otolaryngologist’s office once you’ve secured your emergency appointment?  First, you’ll see an audiologist who will accurately measure your hearing in both ears and assess what type of hearing loss you have with much more snazzy equipment than a tuning fork!  Then, your otolaryngologist will present you with a treatment plan in the hopes of recovering as much hearing as possible.  The sooner you get started with treatment, the greater your chance of recovering your hearing.  This is why it is so important that you are educated about this issue and can advocate for yourself.  Time is of the essence, and not all physicians out there will treat a sudden hearing loss as the emergency that it is.

Ideally, you’ll be able to begin treatment within just a few days of noticing your sudden hearing loss.  However, we’ve seen many instances of people who noticed a sudden loss months ago, and didn’t pursue medical attention.  Or, they pursued medical attention, but their doctor assumed they had a temporary hearing loss due to an ear infection and treated with several rounds of antibiotics, thus wasting weeks of time before getting the patient the appropriate treatment.

If you notice a sudden change in your hearing,

• Contact your physician immediately and demand an emergency appointment. If they can’t make that happen, go to Urgent Care.
• Ask the doctor to assess whether the hearing loss is in the Inner Ear. If they pull out a tuning fork, breathe a sigh of relief.
• If you are uncomfortable with the diagnosis, or feel you are not being heard, ask for an emergency audiology appointment. An audiologist will take a complaint of sudden hearing loss very seriously.
• Don’t be afraid to advocate for yourself. Remember, the faster a sudden hearing loss is acted upon, the more likely that some or all of the hearing can be recovered!

© 2020 Brattleboro Hearing Center