HEARING AIDS: THE PROCESS
Modern hearing instrument technology and digital signal processing circuitry provide opportunities to improve the lives of many hearing impaired individuals not previously amenable to successful instrument fitting and rehabilitation. These advances demand extensive training in critical hearing assessment techniques as well as a firm understanding of the effects and specific application of scientifically sophisticated circuitry. It is our philosophy that the key element in the fitting and managing advanced hearing technology is not the instrument or circuit but the Audiologist managing the process of hearing rehabilitation. From the clinical assessment of your hearing loss to the follow-up care provided after your hearing instrument fitting, you will be seen by professional Audiologists with advanced training and doctoral degrees.
Audiologists are the hearing care professionals uniquely educated and qualified to provide the best diagnostic hearing assessment and hearing instrument fitting and follow-up care services for your specific hearing needs. The critical elements in the process of hearing instrument fitting and follow-up care follows:
HEARING AID EVALUATION:
FIRST TIME WEARER
The first step in the process of improving your hearing is deeply rooted in the hearing examination. The history and Hearing Handicap Inventory provides the beginnings of the framework your care. They guide the Audiologist in his/her assessment strategy as well as in rehabilitation planning. Following the hearing examination, the Audiologist will develop options for your consideration in both circuitry and available styles of instruments. The style of the instrument is critical to the overall success of your fitting. Styles include hearing instruments that are completely in the ear canals, extend from the canals and those worn behind the ears. The most appropriate style for your needs will be discussed. Every effort will be made to satisfy your wishes, however, certain styles may be removed from the list of options due to size, power limitations, or other important criteria.
Once the style and circuitry are agreed upon, earmold impressions will be taken from each ear. The earmolds are sent to the manufacturer with our specifications and the hearing instrument is custom built in the style selected. The manufacturer delivers the hearing instruments to our offices—usually within 10 to 12 days of the earmold impression. We will contact you to set up an appointment for your hearing instrument fitting once the instruments are received and evaluated in our office.
HEARING AID EVALUATION:
CURRENT USERS
For those patients with hearing instruments in use, we provide an evaluation protocol to determine if their instruments are providing adequate support for their particular hearing needs. Following a comprehensive audiologic evaluation the instruments undergo electroacoustic evaluation (done to determine how much and what type of amplification is being provided) as well as a probe microphone assessment of the instruments capabilities while the patient is wearing the instruments. The findings are presented and the instruments are adjusted (if they are programmable or otherwise able to be modified) or alternative plans are developed.
HEARING AID FITTING
When you come in for your hearing aid fitting, it is best to bring along your spouse or another family member or friend. They are helpful as a familiar voice and can help retain information discussed during your fitting. The fitting process includes four steps:
The first is assessment of the physical fit of the instruments. Careful inspection of the canal and the fit of the instruments might result in adjustments to the shell of the instrument done at the time of the fitting.
The second involves programming the instrument relative to your specific hearing needs.
The third part includes hearing instrument assessment with the instruments in your ears. A small microphone tube is placed in your ear canal along with the hearing instrument and a readout is obtained on the performance of your instruments. Adjustments will be made in the hearing instrument program as needed. Assessment will be completed under specific acoustic situations to determine the adequacy of fitting in a calibrated sound field. These results will be compared to the electroacoustic data and adjustments will be made accordingly.
The fourth step in the process includes instruction on insertion and removal of the instruments, cleaning and battery insertion and removal. Once these skills are established, another visit is scheduled for follow-up care.
HEARING AID FOLLOW-UP CARE
The first follow-up visit after your fitting is the most important visit in the process of improving your hearing status. We will look at the situations in which you thrive and in those where you might need some improvement. Adjustments will be made to the instruments based on your observations. Keep in mind that most hearing instruments fitted today are modifiable and can be adjusted readily to suit most patients needs. Limitations posed by either the instruments or your hearing loss will be discussed and an assessment of the realistic goals previously established will be completed during the follow-up visits.
Items that will be addressed in the follow-up visits will include reviews of care and cleaning of the instruments, protective maintenance, troubleshooting minor problems, when to call for assistance, annual check ups following the post-fitting care period, extended warranty availability and the need to wear your hearing instruments consistently, every day.
HEARING AID PRICING AND WARRANTIES
Hearing instrument prices range dramatically. Instrument style and circuitry are two key factors that influence the price of hearing instruments. Generally, the smaller the instrument, the higher the cost, although that generalization is changing as more manufacturers are considering instrument costs while disregarding size. Advanced circuit research and development adds to the cost of hearing instruments. Manufacturers of hearing aids set pricing structures relative to their costs to develop advanced circuitry. With the development of various levels of digital signal processing circuits, advanced technology is now available within reasonable price ranges. Solutions to your hearing difficulties should not be tied to your budget-we will find the right solution for you within your price range.
Hearing instruments come with at least one year, unlimited warranty. Depending on the manufacturer, loss is covered within the first year. Additional warranty time can be purchased from the manufacturer. We offer after-warranty instrument care and maintenance plans that cover repairs into the 5th year of operation. Since most hearing instruments are built to last 5 to 7 years with good care, extended repair plans should be considered.
AUDIOLOGISTS VS. HEARING AID DEALERS
We are frequently asked by patients in our office, "What’s the difference between an audiologist and a hearing aid dealer?" It is not uncommon to have patients scheduled for second opinions about their hearing instrument fitting or who are dissatisfied with the fitting and follow up care provided by a hearing aid dealer. There are two common findings in these cases: The first centers on the instrument-inappropriate selection of the style of the hearing aid (e.g., fitting a small, canal style instrument in an ear with severe-to-profound loss) or inappropriate programming of the hearing aid such that it fails to meet the patient’s needs. The second centers on the limited training of the dispenser whose primary focus is selling hearing aids.
In order to fairly and appropriately answer the question about the difference between audiologists and hearing aid dealers, we need to examine those sections of state law that defines the scope of practice and the minimum academic training required for each provider group. Audiologists are defined in Chapter 4753 of the Ohio Revised Code (ORC). Hearing aid dealers in Chapter 4747, ORC.
State laws are enacted by the legislature to provide consumer protection.
Boards composed of members including licensed practitioners, a member representing the public and an ex officio representative of the Attorney General’s office, issue licenses. Each practitioner licensed by the board must operate within the standards of care and conduct established in the law (scope of practice). Failure to practice within the law can result in fines and/or revocation of their license to practice within their profession
Definition of Practice (as written in the Ohio Revised Code)
Hearing Aid Dealers
4747.01(B)
"Practice of dealing in" or "fitting of" hearing aids means the sale of a hearing aid, and the measurement and testing of human hearing by means of an audiometer or by any other means for the purpose of selecting, adapting and selling a hearing aid to any person, and includes the making of impressions for earmolds.
Audiologists
4753.01 (G)
"Practice of audiology" means the planning, directing, supervising, and conducting of habilitative or rehabilitative counseling programs for individuals or groups of individuals who have (been diagnosed) or are suspected of having disorders of hearing; any service in audiology, including prevention, identification, evaluation, consultation, habilitation or rehabilitation, instruction, and research; participating in hearing conservation, hearing aid and assistive listening device, evaluation, selection, preparation, dispensing, and orientation; fabricating ear molds; providing auditory training and speech reading; and administering tests of vestibular function and tests for tinnitus in accordance with section 4753.14 of the Revised Code.
Comments
Defining the practice of a health care profession limits areas in which the licensee may practice. For example, Hearing Aid Dealers are limited to testing hearing solely for the purposes of fitting hearing aids. Unlike Audiologists, they may not engage in, nor are they trained to complete diagnostic hearing or balance examinations nor participate in the assessment of patients with tinnitus. Audiologists are uniquely qualified and trained to identify a wide variety of pathology and underlying medical conditions of the hearing and balance systems and to refer these cases for appropriate medical or surgical treatment.
Requirements for License (as written in the Ohio Revised Code)
Hearing Aid Dealers
4747.05. (1-4) & 4747.10 (B)
-18 yrs old
-good moral character
-free of contagious or infectious disease
-High School diploma or equivalent education (GED)
-pass qualifying examination specified and administered by board which "shall be a thorough testing of knowledge required for the proper selecting, fitting and sale of hearing aids, but shall not be such that a medical or surgical education is required for successful completion. It shall consist of written and practical portions which shall include, but not be limited to, the following areas: Basic physics of sound, anatomy and physiology of the human ear, the function and purpose of hearing aids, pure tone audiometry, speech reception threshold testing and speech discrimination testing, masking techniques, recording and evaluation of audiograms and speech audiometry to determine proper selection and adaptation of hearing aids, earmold impression techniques."
Audiologists
4753.06 (B-E)
-Master’s or Doctoral degree in Audiology
-Minimum of 350 hours of patient care hours obtained in an accredited college or university, in a cooperating program of an accredited college or university, or in another program approved by the board.
-He/she submits to the board evidence that he has passed the examination for licensure to practice
Comments
A High School diploma or GED coupled with a correspondence course in hearing aids offered by the International Hearing Society is the basis of academic training for the majority of hearing aid dealers across the country. The academic and clinical preparation of audiologists differs dramatically. By January 1, 2006 all new graduates applying for a license to practice audiology in Ohio must have an AuD or other equivalent doctoral degree. For 40 years the primary clinical degree in audiology was a Master’s degree; a one or two-year
course of academic and clinical study following the bachelor’s degree.
Over 15 years ago, the leaders and educators in the profession of audiology realized that one or two years was not enough time to cover the expanding body of scientific, engineering, diagnostic and treatment methods needed to meet the needs of the patients being served. The American Academy of Audiology and other related professional organizations developed a four-year, post-bachelors curriculum for the professional doctorate in audiology-the Doctor of Audiology or AuD degree. Since that time over 1500 have graduated with over 3000 projected for 2006. Master’s training programs have either closed or upgraded their academic and clinical offerings to train AuD audiologists.
The result has been an improved profession with well-educated, capable practitioners prepared to handle any hearing or balance problem that comes to their clinics and offices. With extensive training in counseling and rehabilitation, audiologists extend hearing rehabilitation beyond just fitting a hearing aid. They approach their patients with both clinical and technical skills necessary to optimize success with today’s advanced and highly sophisticated hearing instruments. By their knowledge, extensive training and professional integrity, audiologists are best qualified to provide comprehensive solutions to patients in need of hearing rehabilitation.