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Real Ear Measurement

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

When Is Hearing Loss an Emergency?

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

Hearing Aid Advertising – It’s a Scam

We’ve all seen them.  You can get a FREE HEARING TEST and get the BEST HEARING AIDS on the market that are SO SMALL YOU CAN’T EVEN SEE THEM for the LOW LOW PRICE of $600 as long as you ACT FAST and we’ll also give you FREE BATTERIES FOR A YEAR and we’ll give you a $20 GIFT CARD to Joe’s Pizza Palace to boot!

Here’s the dirty little secret of the hearing aid world: all of these ads are just enticements to get you to visit a hearing aid dealer whose only job is to sell you hearing aids.  I’m about to take a deep dive into these practices so that you can recognize them for what they are, and make a more informed decision about who you’d like to see for your hearing healthcare.  And that’s literally what we as audiologists are supposed to be doing – providing hearing healthcare.  Not all of us are doing a great job, and some of us unfortunately act just like a hearing aid dealer with an advanced degree, but there are providers out there who are looking out for you and your hearing health.

So here we go!

Beware the “free hearing exam”.  A provider offering a free hearing test is often a provider that can’t bill insurance.  It’s also a sign that they are not performing a diagnostic hearing evaluation.  A free hearing test is designed simply to get enough information to be able to fit a hearing aid.  If your hearing test is being billed to your medical insurance, you are having a diagnostic evaluation that should be able to differentiate what type of hearing loss you have, and rule out medical complications that would indicate you need further intervention with a medical doctor.

Every single hearing aid that is advertised is advertised as the best hearing aid ever!  Don’t fall for this marketing scheme.  All hearing aids are not created equal, and there is no one manufacturer of hearing aids that is perfect for all hearing losses and patient lifestyles.  A licensed professional should be helping you discover the hearing aid that will work best FOR YOU – not just for your hearing loss, but your lifestyle, and your bank account, too.  In addition to this, most hearing aid dealers can only work with ONE SINGLE manufacturer, and many of those hearing aids are locked into that particular provider or chain of providers, so that if you’re unhappy with their service you can’t take your hearing aid elsewhere.  Make sure when you are making your decision that the hearing aids you’re considering are not locked to other providers.

You know those teeny tiny hearing aids that disappear inside your ear?  Everyone thinks they want these, but what they don’t realize is that those teeny tiny things can’t fit in everyone’s ear canal, they notoriously need continuing repair, they only fit hearing losses of a mild to moderate level, and in most cases they’ll make your ears feel clogged up.  Advertisers are just dangling this pie in the sky image at you to get you in the door.  It’s a classic “bait and switch” scheme.  Don’t fall for it!

That low, low price is for one hearing aid.  It’s for a hearing aid that only fits a mild hearing loss, and it has no noise management or other bells and whistles to help you hear in difficult listening environments.  If you go into any of the retail chains that advertise this way, they will ALWAYS tell you that your hearing loss is more significant than these aids can handle, and then they’ll show you the $8000 model and tell you that’s what you need.  It’s just a marketing gimmick to get you in their door.

How much are these hearing aids marked up that the provider can afford to trim $2000 of the price and still cover their costs?  We see this all the time – a patient comes in and says, “But they said they’d give me 40% off!” and we ask what the price will be after the discount, and it’s STILL more expensive than what we offer.  Do the math, and make sure you’re really getting a great deal.  40% off sounds like an amazing deal , but it’s 40% off of WHAT EXACTLY?  That’s the real question!

This is the worst.  We don’t know why anyone falls for this.  Do you think for one instant that if this provider got a 34th person interested in trying their hearing aids that they would turn them away and tell them their study is full?  Of course not!  And they’re not running any kind of study – they’re really just trying to give their ad a sense of urgency, so that you call RIGHT AWAY so that you DON’T MISS THE CHANCE TO TRY HEARING AIDS.  HURRY!  IT HAS TO BE RIGHT NOW.   Give me a break.

Free batteries sound like such a great idea.  But here’s the thing: fewer and fewer hearing aids these days need batteries.  Also, if you decide to purchase hearing aids that run on disposable batteries, batteries are CHEAP.  Depending on the battery size, which dictates how long the battery will last, you could spend maybe $85 per year on batteries.  Do you think those providers offering “free batteries” are giving you batteries out of the goodness of their heart?  No – they know “free batteries!” sounds great to the average consumer, and they include the cost of those batteries in the price of their product.  Are those batteries actually free?  No – you’re just paying a premium for these batteries up front!

HAHAHAHAHAHAHA!  This is a great indication that the profit margin on these aids is so high, this provider can afford to throw $15 at anybody who comes in to try hearing aids.  Again, is this a free $15 for you?  No – if you buy these hearing aids, you’re paying for that $15 in the price of the aid, and also the $15 for several other people who came in, tried the aids, and didn’t purchase them.  Come on!

This all seems really shady, right?  That’s because it is.  However, there are providers out there who will listen to your needs, make appropriate recommendations, and not try to trick you into their door using any of these tactics.  These providers rely on referrals from physicians, and word of mouth from their happy, cared-for patients.  Ask your doctor to recommend an audiologist, and talk to trusted friends and family.  Ask them if their provider uses Best Practices (don’t know what this is?  Stay tuned for the next blog post!).  Ask them if their audiologist is transparent about pricing.  Ask them if they feel listened to.  Ask them if they felt pressured into a hearing aid sale.  The answers to these questions should be yes, yes, yes, and NO.  If not, maybe they should be looking for a new provider.

© 2020 Brattleboro Hearing Center