How to Select and Purchase Hearing Aids

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2 How to Select and Purchase Hearing Aids Studies have shown that people are reluctant to get help with their hearing for 4 main reasons: 1. They are unsure they need help 2. They feel uncertain about who to see for help 3. They are confused about exactly what will help 4. They are surprised at the price of hearing care Improving your hearing starts with choosing the right professional to help. At Carolina Hearing Doctors, we have specifically addressed each of these concerns to help you rediscover your hearing. This guide was created to help you understand the factors that go into selecting and purchasing hearing aids. Choosing A Hearing Professional Improving your hearing starts with choosing the right professional to help. With more options available today than ever before, knowing where to turn can be tricky. You should choose your hearing care provider similarly to how you chose your dentist. Most of us see our dentist at least once a year and schedule ongoing visits to make sure our teeth are healthy. You choose your dentist based on his/her experience or reputation usually because others had a good experience with them. We don t entrust our teeth to the direct mail dentist or the cheapest available option. Show the same concern in choosing your hearing care provider because your return to good hearing is largely based on the ability of your provider. Page 2

3 Things to look for when choosing a hearing care specialist: Experience Find a professional with at least 5 years experience. Someone who has been fitting hearing aids for a couple years is not as capable as someone who has been practicing for many years. We have seen this time and again: someone purchased hearing aids from a store on the advice of a provider with limited experience and never felt satisfied with their level of hearing. The person would then come to us, where we could typically solve their problems in just one visit. This is due to having the experience to know what to do and what works. The other provider was trying this and trying that, hoping to stumble on the right solution. That s not something you would want from your dentist, so why would you allow that from your audiologist? Whether it s dentistry or hearing, your satisfaction really depends on the experience of the professional. Ask these questions when choosing a provider: How long have you been a hearing care provider? Where have you worked? How long have you worked for this specific company? Someone who has been fitting hearing aids for a couple of years is not as capable as someone who has been practicing for many years. Knowledge Hearing loss is a complex progression of changes in the ear, brain and neurological system. Your hearing care provider must understand this physiology to give you the right series of steps to solve your specific issue. Page 3

4 I have seen many well-intentioned providers simply fail to produce hearing improvements in patients because they didn t understand the physiology of hearing loss and how to use technology to improve it. Ask your hearing professional these questions: Are you an audiologist or a hearing aid specialist? How long did you go to school for your training? Where did you have that training? If the answer is a series of weekend classes or seminars, then this provider will not have the knowledge they need to solve your problem. If a provider s training only consists of a series of weekend classes or seminars, they will not have the knowledge they need to solve your problem. Good relationship You must get along with your hearing care provider because you will see them many times over the years. Hearing loss is a condition that is ever-changing and will need the attention of a professional every year. Locate a provider who has an excellent bedside-manner, is personable and listens, who works with a welcoming and knowledgeable staff and whose office is pleasant and inviting. A highly skilled professional with a prickly manner will wear you out quickly. A professional working in a busy office with lots of people waiting will often be rushed in every encounter with you. An office in a warehouse store will not have the privacy or intimacy of a regular office. Questions to ask your hearing specialist: How often do I need follow-up? Can I get same-day or next-day assistance for an emergency? When I have an appointment how long can I expect to wait to be seen? Will I see the same provider every time? Page 4

5 Your Personal Hearing Loss What you bring to the situation is perhaps the most important element of successful hearing improvement. Every person brings a unique collection of causes, physiology and reactions to hearing loss. These can include: Your degree of hearing loss Your word understanding ability The length of time you ve had untreated hearing loss Your neurologic system Your ear size Your age Your genetic predisposition for hearing loss Your history of noise exposure Your brain processing abilities The support of your spouse and family Every person brings a unique collection of causes, physiology and reactions to hearing loss. Your lifestyle and situations where you encounter the most problems Examples of Differing Hearing Loss The 78-year old with genetic-related hearing loss will have hearing loss that affects all of the hearing frequencies. There will be some inner ear damage, but also some subtle changes in how the brain processes speech. This person will have more difficulty with fast talkers, foreign accents, and will understand speech best when face-to-face. The 42-year old with hearing decline due to 20 years of direct exposure to industrial noise and power tools will have specific inner ear damage. This person will hear very well in quiet settings and notice their problem primarily in background noise. The family will often be more aware of the hearing problem than the affected person themselves. The 59-year old with hearing loss from ongoing inner ear disease will likely have poorer word understanding ability, even in quiet rooms, and will be more affected by his hearing loss in daily situations. Page 5

6 Even though the people described in all three examples have different causes for their hearing loss, they will all report similar issues: I hear but don t understand Background noise is interfering, and People around me sound like they mumble Despite the similar problems, the ideal solution for each person will be different because of the differences in what caused their hearing loss. Questions to Ask You Provider: Is there anything about my hearing loss that will make hearing aid use difficult? What real improvement can I expect? What are the things that I still will not hear well? Is my hearing loss treatable with medicine or surgery? The Technology Hearing aids are an interesting blend of biomedical, acoustical and consumer electronic technologies. Since they are meant to aid a body function that isn t working properly, a simple out-of-the-box solution won t quite work. Since hearing aids are meant to aid a body function that isn t working properly, a simple out-ofthe-box solution won t quite work. Basic amplifiers have been around for years, but these increase the level of all sounds, much like your TV volume. Impaired hearing needs selective improvement to enhance only the affected frequencies so that what you hear seems natural. Hearing aids do this, processing all sounds at your ear, instantaneously, while also fitting the ear comfortably. It s these complex details that have to be managed for the best hearing outcome. Page 6

7 Factors to Consider: The Provider Even the best technology is limited by a professional who is unable to adapt it for your specific needs. Do not assume that all providers have the same knowledge. The Brand There are 7 major brands of hearing aids: Oticon, Phonak, ReSound, Siemens, Starkey, Unitron and Widex. All of their technology is more similar than different although there are some meaningful variations. Some focus more on small custom devices in the ear while others have more advanced wireless capabilities. Avoid store brands because you will be tied to that specific store forever. Tip: Avoid store brands because you will be tied to that specific office forever. I see people regularly for second opinions only to find that they are using proprietary hearing aids that can only be adjusted by the store where they purchased them. It s akin to purchasing an exotic car that can only be maintained by one specific automotive shop. Even if you lose confidence in their ability you must return to that shop for any followup assistance. A few proprietary store brands are Beltone, Miracle Ear, Avada, Accuquest and NuEar. Big Box stores may also have brands or models that only they can service. You want to purchase open platform brands like the 7 large brands mentioned above. These brands are available at private audiologists (like Carolina Hearing Doctors), medical centers and ear, nose, and throat physician offices. Page 7

8 Bands and Channels These let the hearing professional program your sound in small, incremental frequency slices. When hearing is better in the low frequencies but worse in the higher ones, we can program the specific levels because we split those frequencies into channels. While channels are important, marketers also overemphasize the number of channels making you think that 32 or 48 channels is impressive and necessary to your hearing. The fact is that having 8-10 channels is very helpful, but having 20 or 32 or 48 is not. These high numbers may wow you, but studies have consistently shown that 8 channels is appropriate for practically every type of hearing loss; more than 8 is typically unnecessary. Digital Noise Suppression This helpful circuitry allows the hearing aid to digitally remove a certain level of interfering background sound. This has become a standard feature on most quality hearing aids. Directional Microphones While channels are important, marketers also overemphasize the number of channels, making you think more channels is impressive and necessary to your hearing. There are two microphones inside the hearing aid that allow it to focus on the sounds in front of you more than the sounds behind you. These microphones are most common on behind-the-ear hearing aids and are usually not available on in-the-ear hearing aids. This is the most important technology in controlling the amount of background noise you will hear. Listening Programs Most quality hearing aids will adjust volume and sound settings automatically while others offer user controls to adjust the sound. Individual programs can be adjusted to improve your hearing in specific settings. With the push of a button you can engage the strongest level of noise reduction, improve hearing on the telephone or increase the level of clarity. A program can be created for whatever unique hearing need you may have. Page 8

9 Hearing Aid Size Size matters with hearing aids. Behind-the-ear or on-the-ear hearing aids are the most adaptable and offer the best technology options. They are designed to be more durable and water resistant. For most people, the behind-the-ear instruments are the best option for improved hearing. Questions to ask your Provider: What hearing aids do you think are most appropriate for me? Why? How will these help the specific problems that I have told you about? What other options do you think would help me just as much? The Hearing Aid Fitting Process For most people, behindthe-ear instruments are the best option for improving hearing. Your chosen office should have a well-defined process for fitting your hearing aids. This will ensure that you regain the most hearing and clarity possible. This process should include: 1. Discussing your hearing needs 2. Thoroughly evaluating your ear, hearing, and hearing loss 3. Ruling out medical and treatable conditions that may be causing your hearing loss 4. Discussing hearing aid options for your specific needs 5. Outlining realistic expectations for what recovery is possible with hearing aids. 6. Programming the hearing aids to your specific loss 7. Verification testing to measure the appropriate levels of sound and hearing improvement 8. Teaching the operation standards and care for your hearing aids. 9. Conducting a series of 3-4 follow-up visits to reprogram the sound for the most improvement as your brain and ears adapt to the change. 10. Successfully completing a 6-week trial period with your hearing aids. This ends with a deliberate decision to keep hearing aids and continue using them, or to return them for exchange or refund. Page 9

10 Too often the provider is interested in only doing the fewest services required to get your payment. At Carolina Hearing Doctors, we follow a specific process to ensure that you are using the maximum capability of your remaining hearing. Questions to Ask your Provider: What are the steps you use to fit hearing aids? How will you know if my hearing loss is medically treatable? What improvement can I really expect with my hearing loss? How long is your trial period? Do I lose any money if I return my hearing aids? When do I pay for my hearing aids? Hearing Aid Verification Testing At Carolina Hearing Doctors, we follow a specific process to ensure that you are using the maximum capability of your remaining hearing. Once you have selected hearing aids it s imperative for your provider to measure the level of sound your hearing aids are delivering to you. This is done with tests called Real Ear Measurement or Speech Mapping. These are tests that measure the actual level of sound in each individual ear canal. These verification tests are extremely important because they will indicate if you are receiving the best hearing benefit that hearing aids can offer. Studies reveal that only 27-30% of hearing care providers actually do these important tests. Since every ear canal is shaped differently, every hearing aid creates a different acoustic response in the ear. We don t know what your specific ear response is until we measure it and then make specific adjustments to your hearing aid frequency levels. This is done for new hearing aids as well as for adjustments at the annual hearing checkup. The process is simple: a small tube (microphone) is placed into your ear canal and measurements are taken with hearing aids. Page 10

11 The Audiologist then adjusts and programs your devices based on your hearing test results and ear canal volume. This ensures your hearing aid prescription is customized specifically for you, your ears, and your hearing loss. Fitting hearing aids without Real Ear Measurement is like getting fitted for eyeglasses and forgetting to test your vision for the lenses. Questions to Ask your Provider: Do you do Real Ear or Speech Mapping tests with my hearing aids? (If they say no then go elsewhere; it s that simple.) What are you looking for on Real Ear testing? Do you sometimes change the hearing aids based on the Real Ear? (the answer should be Yes, if hearing aids aren t delivering the right levels of sound then we will find ones that will. ) The Price of Hearing The price of hearing aids is really two costs rolled into one price: 1. The cost of the instrument itself The price of hearing aids include the cost of the instrument itself and the professional services rendered. 2. The professional services Hearing aids are blend of biomedical, acoustical, and consumer electronic technologies. As an FDA class 1 medical device, this technology is expensive to develop and produce for each type of hearing loss. Yet for all their sophistication, they are useless without appropriate fitting and adjustment to ensure that you receive the most benefit from them. Rather than paying for these services at each and every visit, these costs are included in the overall price. Sales offices that advertise dramatically lower prices must achieve these prices by providing less professional service and using older and outdated technology. Page 11

12 Current technology hearing aids will range in price from $1250 to over $2800 per aid. The wide range is related to the level of technology and features. A rule of thumb: more expensive hearing aids will have better technology to reduce interfering background sounds and improve your clarity in every situation. The average cost in America in 2015 is $1750 per ear (this price includes all services). If you have been recommended a hearing aid that exceeds $3,250 per aid, you should seek a second opinion from another Audiologist. Few, if any, hearing aids should exceed $3,250 each. On the other hand, hearing aids costing under $1000 are almost always older, with outdated technology and limited functionality. At Carolina Hearing Doctors we often use mid-range hearing aids. Typically $1750 each, these hearing aids meet the needs of most people with common degree of hearing loss. However, each person is different, so we often select different brands of hearing aids based on those unique needs. Hearing aids costing under $1000 are almost always older, with outdated technology and limited functionality. Questions to Ask your Provider: What services are included in the price? How long is the warranty? What ongoing expenses will I have? What level of hearing aid are you recommending (low, middle, high)? Why are you recommending those? Does my insurance cover any part of the hearing aid fitting process? Page 12

13 Summary All of the steps in this guide formulate a best practices process that is approved by the American Academy of Audiology, the Academy of Doctors of Audiology, and the International Hearing Aid Society. Hopefully you now feel better informed about the necessary steps to improve your hearing. Here s what you really need to know: Your search for information should really focus on the provider and choosing the right Audiologist. If you choose the right provider then all of these other issues will take care of themselves. If you choose the wrong provider you will be making too many decisions that you do not have enough information to make. For instance, when you go to your dentist, do you ask what lab was making your crown, who manufactures the material for your fitting, or what does he/she do to make sure your bridge fits properly? No. You focus on choosing the right dentist and then rely on her/him to make all of those decisions using her/his knowledge and training. Hearing aids and hearing care works in a similar way. We, at Carolina Hearing Doctors, hope that we will be your choice for the best hearing care provider. More information is available at or by contacting us directly using the information below. C. Scott Mills, Au.D. Audiologist DrMills@CarolinaHearingDoctors.com Clemmons 3780-A Clemmons Road Winston-Salem 3742 Vest Mill Road An Audiology Practice Page 13

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