By Steven J. Cuddy, M.S., CCC-A Certified Audiologist Copyright 2010, all rights reserved.

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1 The insider s guide to hearing loss and digital hearing aids By Steven J. Cuddy, M.S., CCC-A Certified Audiologist Copyright 2010, all rights reserved.

2 Five keys to successfully improving your hearing The insider s guide to hearing loss and digital hearing aids Hearing loss is prevalent in the United States with over 28 million Americans of all ages affected. 30% of individuals over age 65 having some degree of hearing loss. Since it is so common, why do a fair number of people feel awkward talking about it? Adults do not generally try to ignore or cover-up a vision problem. They usually get tested and find a solution, which helps them to see more clearly. With hearing loss, people may deny any difficulty and in the process, delay getting tested and finding a solution which will help them to hear more clearly. Because of this, they will continue to miss conversational details and have less enjoyment when they spend time with their friends and family. Since many people have questions about hearing-related issues, this guide will give you some clear information and help you to start making informed decisions about your hearing health or the hearing health of a loved one. By the time you have finished reading this guide, you will be better equipped to pursue appropriate hearing testing and care. If there is a loss, you will be better informed on how to obtain the best digital hearing technology for your individual needs and situation. If you would like to be seen at our clinic in Fort Mill, SC, please call us at (803) You are also welcome to me with any questions or comments: Sincerely, Steven J. Cuddy, M.S., CCC-A Certified and Licensed Audiologist Healthy Hearing for Life 2

3 Five Keys to Successfully Improving your Hearing pg 4 Choosing the right hearing professional This decision can be the most important. pg 11 Getting a proper diagnosis of your hearing Not getting this right can cost you time, money, and endanger your health. pg 12 Choosing the best technology for your lifestyle and hearing challenges A poor decision here could lead to frustration, over-spending, and less than optimal results. pg 17 Getting the best fit with your technology Like a modern computer, today s digital technology must be set and fine-tuned to perform well for you, otherwise you will be paying for performance that you are not getting the benefit of. pg 18 What is your job Believe it or not, you play a big part in your success with digital hearing technology. 3

4 How to Choose the Right Hearing Professional. First things first When you have concerns about your hearing, the first step is to see your primary health provider. This is especially true if the hearing loss came on suddenly or if it is only in one ear. Typically a primary care doctor will refer you to an ENT (ear, nose, and throat) physician. The ENT can determine if your hearing loss is part of a medical condition and also if it can be treated by medicine or surgery. An example of this may be a child who has some hearing loss due to chronic middle ear infections. The doctor may use medicines, pressure equalization tubes, or a combination approach to attempt to resolve this type of hearing loss. ENT physicians are well-trained to diagnose and treat medical conditions of the ear, including ear infections, ruptured eardrums, Meniere s Disease and other issues. At the ENT office, the audiologist will typically test your hearing on the same day that you see the doctor. The ENT relies on the testing and treatment performed by the audiologist, to manage many of the patients with hearing loss. For a mature adult who has a hearing loss in both ears, which has progressed slowly over time, the diagnosis is often Presbycusis. Presbycusis just means age-related hearing loss. Presbycusis tends to occur as the delicate hair cells in the inner-ear start to lose function. This type of loss, which is due to dysfunction in the inner-ear, is a Sensorineural Hearing Loss. This can be caused by a number of factors but most commonly it is due to noise exposure and the aging process. This is the most common type of hearing loss in adults. It is not generally treatable by prescription medications or surgery. The best treatment option is digital hearing technology. 4

5 After you are medically cleared The doctor will give you medical clearance to obtain a hearing aid. As an adult, you also have the right to waive a doctor s exam by signing a waiver stating that this is your wish. At this point, you may be fit with hearing aids by a licensed audiologist or a licensed hearing aid dispenser. Audiologists Audiologists are not medical doctors, but they are highly-trained healthcare professionals, who are responsible for diagnostic hearing testing. Some also perform balance testing (vestibular testing). Many will also to fit patients with digital hearing aids when needed. Audiologists have all attended a university and obtained a Master s Degree or greater. Their studies include anatomy and physiology, pathology, speech, hearing, hearing aids, aural-rehabilitation and psychoacoustics. Some even purse further doctoral-level (Ph.D/ Au.D) education. They must go through supervised internships, working with patients in various clinical environments, before they are granted their degrees. Many audiologists also pursue a Certification of Clinical Competency (CCC-A), from the American Speech and Hearing Association, which has its own requirements for additional supervised clinical experience beyond their university training. To maintain this certification, audiologists must continue to attend approved continuing education classes each year, in topics related to the practice of Audiology. Audiologists must obtain a state license to practice and some states will also require a separate license to dispense hearing aids. Most audiologists will generally test patient s hearing and many dispense hearing aids as needed. Some have other specializations such as working with balance issues or auditory processing disorders. 5

6 ENT/audiology office vs. independent audiology office An Audiologist can work in a doctor s office or independently and will refer a patient to an ENT physician if the patient seems to require evaluation for a medical condition. Audiologist at ENT office You will generally find a high level of medical training and experience when using the services of an audiologist who is at the ENT physician s office. In this setting, the audiologist has usually worked with a variety of patients with different type of hearing loss and medical conditions. This can be an asset if you have a medical condition. The ENT is also nearby and may be consulted with if needed. This setting also has its own limitations. Often if the doctor needs to get a hearing test for a patient they will be worked in. This means they are tested without a previous appointment with the audiologist. The result is that people with appointments may have to wait longer to be seen. The audiologist may also be restricted on the amount of time they can spend with their hearing aid patients, based on what type of scheduling the practice manager has setup. So you could feel a bit rushed during some of your visits. The prices of hearing aids at these offices is generally on the higher end, though often less pricey than some of the national hearing aid chains. Pricing of hearing aids at the ENT physician s office is affected by overhead and what the practice manager determines as the appropriate profit level from hearing aids fittings. Often audiologists do not have the final say on the pricing of hearing aids here. 6

7 Audiologist in private practice Many audiologists decide to open their own practices which are separate from physicians. Many have gained valuable experience working alongside physicians and due to a desire to have more control over how they can serve their patients, open their own practices. This type of practice has great potential to deliver high quality service, insuring each patient receive adequate time with the audiologist, and perhaps even keep pricing a bit lower than the physician s office. The independent audiologist has a high motivation to keep his patients hearing well since the success of his practice depends greatly on it. One caution would be to avoid a practice which has been recently started by an audiologist, who has just graduated. It is better if the audiologist has had 2-3 years of clinical experience working among other professionals, in order to better serve his or her patients. Hearing Instrument Dispenser/ Hearing Instrument Specialist Hearing instruments specialists do not generally have any university education. Requirements to become a Hearing Instrument dispenser vary from state to state but generally there is a required period of time where the candidate must work supervised, under a licensed hearing instrument dispenser. This is often one-year. At the end of this period, the apprentice will usually take an exam to become a licensed hearing instrument dispenser. After becoming licensed, they are able to legally dispense hearing aids. Hearing instrument specialists are allowed to do limited hearing testing for the purposes of fitting hearing aids. They are not allowed to do the type of diagnostic testing that audiologists are able to perform. They will also sometimes test without a soundbooth. Hearing instrument specialists tend to work in hearing aid stores or at their own locations. 7

8 National Hearing Aid Stores vs Independent Offices National Hearing Aid Stores You will generally find large nation hearing aid chains staffed with Hearing instrument specialists as opposed to Audiologists. There are exceptions but that is the general rule. These stores generally sell only their own brand of products. Although the products can be good, there are several potential disadvantages to you as a consumer. Limited selection. As a consumer, you can only choose from the aids they are selling right now. If they have a good product for your needs with good quality at a reasonable price, all is well. However, if that company is having some problem with the performance or reliability of the current product line, the hearing instrument specialist has no alternative but to fit you with the product and hope for the best. They don t have an alternative brand to choose from. Pricing. The national hearing chains sell hearing aids which have been labeled with their own company name. As a consumer, you have no way to know if their pricing is reasonable because you cannot directly compare pricing on their products. This can create an artificially inflated price since they don t have any outside competition to bring their prices down. As an audiologist, I have spoken to several patients who were quoted $8000- $10,000 for a pair of hearing aids at a national hearing aid chain. To give you perspective, even for the best technology and service package available from our clinic today, you would not pay more than $7000. And this is for some of the best digital technology available. As a patient, you need to ask yourself if it makes sense to pay $1000-$3000 more for technology which is at best just equal. The knowledge and skills of the person who will be testing your hearing. There are some highly competent people who are hearing instrument specialists. Some have worked in this field for decades. You may sometimes even find some of these people working in one of the national hearing chain stores. Ideally, people would be hired based on the best qualifications to serve their potential clients. 8

9 Unfortunately, you don t really know who you will be sitting across from when you go to one of these stores. The quality and caliber of hearing instrument specialists can vary greatly. Although this is generally true in most professions, it is even more dramatic in the hearing aid industry. In many states, if a person is a high school graduate, they can become an apprentice to a dispenser and work under them until they take the licensing exam. This means that they are supposed be working with patients with supervision. It is up to each office to maintain the quality of its supervision. It is crucial that the person who will be testing your hearing and advising you about the various aids, programming and fitting the aids, and taking care of any follow-up adjustments, cleanings, or repairs is competent. Independent Hearing Instrument Dispenser office Hearing instrument specialists can also have their own offices, once they are licensed. If a dispenser has been practicing for several years and seems to be successful, it is likely that they are serving their customers well. A hearing instrument specialist with their own practice, has the advantage of being able to chose from a number of high-quality hearing devices, from any of the top manufacturers. If one company has a device with problems, she can decide to skip that model and fit her client with a more reliable product from a different manufacturer. Note on audiologist as compared with dispenser fittings It should be noted that when you are fit by an audiologist you are working with a more highly-trained professional, yet the costs are similar to working with a dispenser. 9

10 Choosing Wisely It is important to check around before choosing an office. Ask friends, family, co-workers, and fellow church members if they have found someone in your area who served their hearing healthcare needs well. This can be a great starting point. The Better Business Bureau can also be a resource for checking out a local provider. Just be sure to read the outcomes of disputes. It is important to know what the company did to resolve the issue. It is extremely important to find someone you can communicate with who has your best interests at heart. Please call a couple of offices and ask a couple of general questions regarding the experience and training of the professional there. The answers are important, but how you are treated on the phone is equally important. If your hearing prevents you from using the phone easily, ask someone who you trust to call and give you their impressions. Is the staff member friendly and patient? Do the answers seem sincere? Remember that if you are fit by this practice, you are likely to be counting on these folks to keep everything working smoothly, for years to come. Each state has a licensing board for audiologists. There will also be a board which licenses hearing aid dispensers. You can find them through an internet search for your state. The board will be able to tell you if a given provider is licensed and in good standing. The American Speech and Hearing Association (ASHA), is the national body which certifies Audiologists. They have a website, if you would like to find local audiologists who are certified by them. The American Academy of Audiology (AAA), is another organization for audiologists which maintains a website, A professional organization for hearing instrument specialists is the International Hearing Society and its website is 10

11 The Importance of an Accurate Hearing Diagnosis Although the vast majority of hearing loss in adults is not due to a medically treatable condition, it is important to be sure, before a person is fitted with a hearing aid. In fact, the Food and Drug Administration strongly suggests a physician s exam before getting a hearing aid. Adults can skip the doctor s visit by signing a waiver when they are fitted with the hearing aid. If a patient presents with any of the following, they definitely need to get seen by a physician and preferably an ENT physician before they are fit: Sudden hearing loss, one-sided loss, fever, redness, balance problems, discharge from the ear, and swelling in the ear. If none of these red-flags are present, a full hearing test should be performed, preferably in a sound-booth. Tones will be presented to ear each. Words will also be read to determine how well you are discriminating speech sounds. Additional tests with speech-in-noise may also be given. Lastly, a special bone-vibrator will be placed behind your ear and more tones will be presented. The bone-testing helps the hearing professional to rule out any middle-ear problems which might be causing hearing loss. This type of hearing loss is also known as a conductive loss. Some types of conductive loss can be often be treated by drugs or surgical procedures. You should be referred to an ENT physician if your test shows a conductive loss which has not been previously diagnosed. Good testing is essential to choose appropriate digital hearing technology and getting it programmed properly to maximize your hearing ability. IF THIS TESTING IS IMPROPERLY DONE OR INCOMPLETE, IT WILL BE EXTREMELY DIFFICULT TO GET GOOD RESULTS WITH THE FITTING. 11

12 Three steps to pick the right hearing technology Discussing your hearing test results The first step is the review of the results of your hearing evaluation. If there is a hearing loss, it will be classified mild-moderate-severe or profound. You will also be told if there are differences in how you are hearing in the right vs. left ear. The professional will also discuss which particular frequencies or pitches of sound are affected. Your overall speech discrimination score will also be discussed, as this will give some indication of how successful you can expect to be with hearing technology. While there are many choices of styles today, certain losses are better suited to in-ear devices, while others are easier to fit with a Behindthe-Ear device that has a small piece in-the-ear. It is important to understand that two people who are the same age, can have very different hearing losses, which may require different technology to be successfully fit. Although there are a few people with hearing losses who won t receive much benefit from hearing aids, the vast majority will be able to receive benefit from appropriate hearing technology. This is why you need to work with a professional who is competent and who you feel you can trust. Most hearing devices are now micro-technology based. Each device incorporates a computer-chip which performs hundreds of calculations and adjustments automatically! Many old issues such as whistling and excessive loudness have been greatly reduced or eliminated. 12

13 Discuss your hearing challenges-honestly The second step is to honestly discuss your lifestyle and share with the professional those situations where you tend to miss parts of the conversation or become frustrated. For example, a person who likes to eat out at busy restaurants will generally need the performance of a higher level of technology than someone who just needs things to be louder when their family members come to visit them at their home. The devices must increase the loudness of the speech, while at the same time, not over-amplifying all the other noises in the restaurant. This is one of the most challenging listening situations that you will encounter. For folks who use cell-phones and other Bluetooth compatible devices, many of the manufacturers now have wireless connection with these devices for better quality sound and convenience. There are even wireless devices which will send the sound from the television directly to you, for the clearest possible sound. Small remote controls are also available for those who would like to fine-tune volume and other settings. This can be helpful for those with less flexibility or sensitivity in their fingers. It may be difficult for these folks to use the small controls that are typically put on hearing devices. Again, every person has different needs and it is important to work with someone who will find the best technology for your needs. The good news is that although no technology can give you back your childhood hearing, you really can improve how well you understand those around you and get back to enjoying conversations a lot more. 13

14 Deciding what you really need and what you can afford. Hearing aids sell for $599 each to up to $8000-$10,000 a pair. About 95% of the aids fit in the United States today are digital hearing aids. Digital hearing aids convert the sounds they receive into to computer language and then automatically adjust that sound based on the patient s needs. The better technology will also adjust by responding to the sounds in wearer s environment. Digital technology has allowed for much less noise from the aid and also better ability to adjust for the patient s individual hearing and the sounds they encounter. The best part of digital hearing devices is that most of these adjustments are automatic. Gone are the days when a person would need to constantly be turning their volume up and down, trying to keep it at a comfortable level. Today the aids do the work for you. There are about six major hearing aid manufacturers and probably the same number of minor companies who are making digital hearing devices today. Some of the major brands are Oticon, Starkey, GN Resound, Phonak, Widex, and Siemens. Although many of these companies are based in Europe, they all have fully-staffed divisions in the United States as well. I recommend that you purchase from a well-established manufacturer. Although some smaller hearing aid companies have produced interesting products, many have tended to get bought out or go out of business in a few years. This can make it difficult for you to obtain parts and service when you need them. It is essential to have a local hearing professional to work with for initial set-up, adjustments, and any cleaning or repairs which are needed while you own your devices. 14

15 Believe it or not, there are companies on the internet who will program a set of aids and send them out to you, hoping for the best. If you don t like the sound, you need to pack the aids up, send them back to the company, and wait for them to reprogram and send them back. If you still don t like the way they are set, you will need to do it all over again. Your chances are getting a really good fit this way are really low. Consider that your local provider may let you try a few different settings IN ONE SESSION. It is important to check back after using your devices outside the office. This allows for fine-tuning of the sound, based on your unique needs. Visits with your local provider do much to insure your success with hearing technology. What determines the price? First you should understand that the hearing technology purchase includes service. Initial programming and fitting, adjustments, cleanings, and in-office repairs are generally included for a period of 1-5 years or more. Also the manufacturer will include a warranty and usually a loss and damage protection for anywhere from 1-3 years. Remember that once you start using your technology and are hearing better, you don t want to be slowed down if there is an issue with your devices. Like your automobile, you want to be able to count on them everyday. If something goes wrong, you want it taken care of quickly. Aside from service, the leading companies spend millions of dollars on researching hearing and electronic micro-technology to continue to improve performance. The costs of this research is reflected in the pricing as well. 15

16 The most advanced features are seen in the top models first and then may trickle down to the other models in over the next few years. Not everyone needs top level technology. In fact, many people are able to save money by finding mid-level solutions, which work well for them. Sometimes, spending more for the top models is justified. An example of this is a person with limited word discrimination scores or other specialized needs. During your evaluation appointment, you will be discussing appropriate technology, including the best choices for your needs. Better models use automated technology which will electronically aim the microphones to focus on the speech you want to hear, but avoid a lot of the noise you wish to avoid. This is called adaptive directionality. The latest breakthrough technology is the use of special algorithms to electronically capture all sounds in the room and filter out the noise, leaving the speech to be heard more clearly. When this technology is combined with adaptive directionality, people who struggle to understand speech in background noise, tend to notice remarkable improvement. An example of one of today s advanced micro-technology devices. 16

17 Your trial period It is important to remember that you should always be given a full 30 days to try out any technology. In fact, in most states this is the law. If you decide that you don t like the devices, you are allowed to change them or receive a refund. The dispenser is allowed to keep a portion of the amount you paid, to cover the time of fitting and follow-up visits during your trial period. However, they are required to tell you about any fees up front, when you are first fit. The fees vary but generally are no more than $250 per aid or $500/ pair. Some clinics charge no fitting fee and all should be able to tell you about their fees when you book your appointment. Hopefully you have chosen a professional you feel is competent and trustworthy and who is motivated to help you and stick with you even if you need extra time and attention. Getting the best fit with your technology Generally once you have decided upon hearing technology it will be ordered and shipped to the clinic within 7-14 days. Custom-molded in the ear type aids tend to take longer than ready to wear type devices. On the day of your fitting, your devices will be programmed with special software from the hearing device company to give the correct sound balance for your hearing. This is based on your hearing test results and previous experience wearing hearing devices. With the devices connected to the computer, they will be placed in your ears. Generally some adjustments will be made to the overall volume at this time. The professional may then do a probe mic measurement now or on a future visit. This involves putting a tiny flexible tube into your ear canal with the hearing device and playing speech sounds and/or tones and measuring the actual sound pressure level in your ear canal. This information can be used to fine-tune the sound as needed. 17

18 Further samples of actual speech can be played for you, to see how well you are hearing and whether the volume settings are appropriate. The audiologist may at this point also explain how to change the batteries, how to clean the devices, and how to use any buttons or remote controls. Generally, your first follow-up appointment will be booked for about a week out, depending on what seems appropriate. What else do I need to do? In our clinic, we have seen that patients who are motivated and committed to better hearing, generally experience the best results. Remember this is a new experience and your attitude toward it can increase your success level. For the first couple weeks after you start wearing your new technology, you should expect to hear lots of strange sounds. These aren t really strange sounds, but sounds which you have not heard clearly in a long time due to hearing loss. As long as no sound hurts your ears, just go with it. You may find for example, that your refrigerator makes certain sounds that you can now hear. You may also hear your own feet as you walk. Of course, it will also be easier to hear pleasant sounds such as birds chirping and children talking. You are rediscovering the sounds of your world! Your brain is actually waking up to sounds both in the environment and in the speech of those around you. This includes the speech sounds which you have not been hearing clearly. Scientists now know that the brain changes based on what information we give it to work with. The more consistently you give your brain good input, the sooner it will be at working at maximum effectiveness. 18

19 If you want to insure your success, follow these important guidelines: 1. During your 30 day trial, wear your devices at least 6 days a week, for at least 6-8 hours per day. Any patient who is unwilling to make this commitment greatly reduces their chances for full benefit from the technology they have purchased. Your brain absolutely needs this consistent input to adapt and attain maximum proficiency in speech understanding. 2. Communicate with your hearing professional whenever you have a question or something seems to change. Often a short phone conversation can get things back on track or bring improvement. 3. Consider the LACE program. This is a computer-based program, which trains your brain to hear better in difficult situations, such as in background noise. It has been proven to increase overall hearing success and satisfaction with hearing technology. The LACE program is designed to be used with your hearing devices and is done at home using your own computer or DVD player. You can visit their website to learn more I wish you the best of luck on your journey to clearer hearing. 19

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