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What are the costs associated with fitting hearing aids?

The costs associated with a hearing aid fitting include not only the device but also the professional skills and knowledge of your audiologist. The value of an audiologist’s intervention lies in the education and training as a professional with a unique skill set to ensure that your device is fit and adjusted to your specific needs through verification and follow-up.

Audiologists are educated to make specific recommendations regarding hearing aid style and technology based on diagnostic test results and an understanding of your lifestyle and listening needs through a comprehensive discussion with you. A hearing aid solution that works for one person may not work for another. Your audiologist will also consider physical and anatomic factors that can help determine the best hearing aids for you. These factors include dexterity, ear size and shape, wax production, skin conditions and aesthetics.

Your audiologist has considerable clinical training. Audiologists are educated in normal and abnormal auditory anatomy and physiology, and can identify conditions that may require medical treatment. Audiologists are also trained to understand electronics, speech acoustics and how the ear and brain process speech. This background allows your audiologist to select features and programming that will maximize your ability to hear speech and other important sounds in a variety of situations.

To practice audiology in the United States, a license as well as a doctoral degree or master’s degree in audiology is required. Graduate program areas of study include diagnosis and treatment of hearing loss and balance disorders, anatomy and physiology, normal and abnormal communication development, genetics, ethics, physics, pharmacology and more. The audiologist considers all of these in addition to your individual listening needs when assisting you with amplification (hearing aid) selection and fitting.

Using this extensive background of knowledge, an audiologist will verify your hearing aid settings at the fitting appointment. Verification refers to measures made to determine that the hearing aids meet a set of standards which includes volume, output, cosmetic appeal, and physical comfort. Using evidence-based practices, real-ear measurements will be obtained using a small microphone placed in the ear with the hearing aid to ensure that appropriate volume is provided for different signals (such as speech). If earmolds or custom hearing aids are ordered, it is necessary to ensure that their characteristics (type of tubing, venting, style and material) are appropriate for the degree of hearing loss and physical characteristics of the ear.

The cost of a hearing aid also includes the professional time for follow-up visits in addition to the initial fitting and orientation appointment. Adapting to amplification will take time, and follow-up appointments to make adjustments to the device may be necessary as your brain becomes accustomed to hearing new sounds. Everyone has unique tolerances to sound and your audiologist may need to tailor the response of your device based on your comments over an extended period of time as sounds are reintroduced to your ear.

Amplification costs also include the hearing aid technology and the research and development which helped to design the devices. The technology in modern digital hearing aids is sophisticated and consists of microphones, amplifiers, miniature CPU (computer) systems and is designed to enhance the sounds from the environment. All sounds (including speech) are filtered through a series of processors to provide the best signal possible. Additionally, hearing aids can be used effectively with telephones to improve the user’s ability to hear on the phone and the aids can also connect you wirelessly to cell phones and other Bluetooth devices.

In addition to providing customized amplification based on the user’s hearing loss, the device is constantly analyzing the environment and making adjustments based on the type and amount of background noise present in a listener’s environment. Additionally, many of the hearing aids available today have the ability to ‘communicate’ with each other (when worn in pairs) and this can be a great advantage in many listening situations.

In addition to having the capability to make automatic and customized adjustments, the hearing aid must be resilient for daily use. Hearing aids are designed to withstand daily exposure to skin oils, hair spray and other hair products, moisture from the air and, of course, ear wax.

Hearing aid technology is constantly improving in order to maximize enhancement of signals and sounds that reach the ear and keep you connected to your ‘auditory world.’ Audiology researchers and engineers are working to continually improve hearing aid technology.

Finally, it should be recognized that despite wonderful advancements in technology, hearing aids do not restore hearing to normal that is why a comprehensive communications strategy is an essential part of learning to maximize the amplified sound when one has hearing loss.

Obtaining comprehensive hearing care from an audiologist is an investment in your auditory health and results in improved communication, improved speech understanding, and improved quality of life.

What is an audiologist?

An audiologist is a professional who evaluates, diagnoses, treats, and manages hearing loss and balance disorders. The majority of hearing loss cannot be treated with medicines or surgery but can be treated by an audiologist with the use of hearing (re)habilitation (counseling, education, auditory training/exercises), hearing aids and/or assistive listening devices (products to use to enhance television viewing, phone amplifiers, etc.). Audiologists make medical referrals to a physician when appropriate (e.g., ear pain, drainage from the ear, sudden hearing loss, etc.).

Audiologists receive extensive education in hearing and balance disorders. Most audiologists have earned masters and/or doctoral degrees and you may see the initials Au.D., (Doctor of Audiology – clinical degree); Ph.D. (Doctor of Philosophy – research and/or clinical research degree); or Sc.D. (Doctor of science – usually a clinical degree) to designate advanced training.

Audiologists specialize in a multitude of work environments such as members of cochlear implant teams, managing hearing conservation programs, evaluating for and prescribing hearing aids and other hearing assistive devices, and perform hearing-related surgical monitoring. In addition, audiologists also screen the hearing of newborns, teach listening skills and strategies, assess individuals with central auditory processing disorders, and assess and treat individuals who suffer with tinnitus (ear noises). Audiologists work in clinical settings such as a hospital, private practice or other medical facility; many are professors at universities and colleges; there are researchers and some who work within the hearing and balance manufacturing industries.

Why do I need an audiologist for a successful hearing aid fitting?

Hearing aids are medical devices regulated by the Food and Drug Administration (FDA) and must be recommended and prescribed by licensed professionals. This standard is in place to protect the individual with hearing loss as not all individuals are candidates for amplification. Additionally, an improperly fit hearing aid or hearing aid sold online without a face-to-face evaluation with an audiologist can potentially cause various problems. Without a face-to-face evaluation, the consumer will not have an otoscopic evaluation (have the audiologist look into the ear canal) and medical problems such as ear drainage or ear blockages which can cause hearing loss will not be identified. Additionally, hearing aids that are not adjusted to the individual needs of the patient have the potential for increasing the hearing loss if the devices are not set appropriately. Lastly, audiologists can tailor a comprehensive treatment plan for each individual patient so as to ensure maximum performance from any device that may be prescribed.

What is the difference between a hearing aid and a personal sound amplifier?

Hearing aids are designed to compensate for a defined hearing loss. Personal sound amplification products (PSAPs) are designed to assist individuals without hearing loss to magnify environmental sounds.

• U.S. Food & Drug Administration (FDA) definitions stipulate that hearing aids are designed to provide compensation for hearing impairment whereas personal sound amplifiers are for individuals with normal hearing who seek amplification for environmental sounds for recreational purposes.

• Personal sound amplifiers are not regulated by the FDA. Because PSAPs are not intended to diagnose, treat, cure or mitigate disease and do not alter the structure or function of the body, they are not devices as defined in the Food, Drug and Cosmetic Act. As such, there is no regulatory classification, product code, or definition for these products.

• Hearing aids are considered medical devices under the FDA and must comply with labeling requirements; may be purchased by a consumer only with a medical evaluation (or appropriate waiver); and may be subject to premarket review.

• Personal sound amplifiers are not programmed and designed to address specific hearing loss needs and are simply magnifiers of sound, much like a magnifying glass can help a person with normal vision see small print in the newspaper, for example.

• Hearing aids are dispensed by an audiologist who has the ability to personalize and adjust these sophisticated devices for an individual’s hearing loss and hearing needs. Personal sound amplifiers are not adjusted for you specifically and may work only in a few instances by providing simple magnification of sound.

• Consumers should be aware that some advertising and marketing may misrepresent personal sound amplifiers as hearing aids. To report deceptive business practices, you can contact any of the following groups: Federal Trade Commission, Your state Attorney General, Better Business Bureau, Your local consumer protection office.

See the FDA’s Consumer Updates on Personal Amplifiers for more information: http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM187224.pdf

Guidance for Industry and FDA Staff: Regulatory Requirements for Hearing Aid Devices and Personal Sound Amplification Products February 25, 2009

Online hearing tests: How are these used and how effective are they?

While a hearing test completed in the convenience of your own home may be attractive as an alternative to making an appointment to see an audiologist, the tests and equipment currently available has never been approved by the U.S. Food and Drug Administration (the federal agency that is responsible for ensuring medical equipment and devices are approved for their stated usage). The accuracy of online hearing testing for purposes of diagnosing a medical hearing loss is highly suspicious and unlikely to be accurate or reliably identify the extent of your hearing problems.

A face-to-face examination of you and hearing is the best practice and the following sections are components of such an examination:

Medical history and current conditions:
The audiologist will ask you many questions about your current and past medical and physical history, especially as it relates to your hearing abilities. There are many physical conditions that can impact your hearing status or your hearing problems can make other medical conditions worse. Also, there are many medications that can affect your hearing and your audiologist will ask about these as well. Additionally, if you are experiencing ear noise (tinnitus), balance problems such as dizziness or vertigo, are exposed the hazardous loud sounds recreationally or through your work or have any other hearing- and balance-related issues, the audiologist will address these with you in the face-to-face examination. This cannot happen through your computer by an online hearing test that will only focus on a small component of your overall hearing health!

Otoscopic examination:
As part of the overall hearing evaluation, it is mandatory that the audiologist assess your ears (with an otoscope – a lighted, magnifying device) to determine if obstructions like occluding ear wax are present in the ear canal. This important part of the examination is not possible in a self-administered examination in your own home. Further, the audiologist can help to identify other potential medical problems through this external ear examination such as drainage or bleeding in the canal or even identification of abnormal skin rashes or bumps in or around the ear that may require further medical examination.

Equipment used to test hearing:
The American National Standards Institute (ANSI) has published guidelines that specify the acceptable level of ambient (local and ongoing) room noise allowed for an accurate hearing test. It is rarely possible to meet these standards without a uniquely constructed, sound-treated room. It is imperative to control for background noise when evaluating an individual’s hearing thresholds as background noises in your home including roadside traffic, computer monitors and ventilation systems (just to name a few) may produce noise that will artificially elevate (increase) your hearing levels when completing a hearing test online at your computer.

Clearly, having one’s hearing tested in a sound-treated room is not a realistic environment in which to identify the problems a person with hearing loss has in everyday listening situations, but in a sound-treated room, the baseline hearing (or best possible hearing) can be identified. This baseline hearing then helps the audiologist understand the extent of the loss. Just as measuring one’s ‘resting’ pulse or ‘resting’ blood pressure would avoid over-treatment for ‘high blood pressure’, it is important that a baseline of the hearing be measured accurately.

Additionally, there are strict standards for headphone or earphone calibration in the audiologist’s practice that do not exist for home computer systems. Varying test results from the same individual on the same home computer using different kinds of headsets/earphones have been made. So there is simply no way to know the specifications or capabilities of the in-home earphones.

Types of hearing test results:
Hearing tests completed online (using earphones that go into or cover the ear) measure only a single aspect of the hearing system through sound that enters the ear canal (referred to as ‘air conduction’ testing). Air conduction testing evaluates a patient’s hearing sensitivity for different pitches. The results from this type of testing will tell you ‘how much’ hearing loss you have or how normal your hearing is. It cannot determine, in the presence of a hearing loss, ‘where’ along the auditory system the hearing loss exists. That is, there can be a problem in the ear canal or with the ear drum (or the bones attached to the drum) or there can be a problem in the inner ear (the sensory organ for hearing) or there can be a problem with the auditory nerve. Air conduction testing does not determine where the abnormality may occur in the hearing system and therefore is only part of a comprehensive hearing evaluation. However – through online testing, only air conduction results can be obtained. At a minimum, an additional test of hearing sensitivity using ‘bone conduction’ testing is needed to determine ‘where’ the hearing loss is located. Specialized equipment is necessary to evaluate hearing through bone conduction testing (testing completed through the use of a specialized headset that can measure sound that is transmitted through bone!). This equipment is not available for home computer systems. Bone conduction testing is the only way to determine if the individual has a medically treatable hearing loss or one which would benefit from amplification.

Hearing losses that occur when something blocks the ear canal (like wax, for example), or something causes a hole or perforation to occur in the eardrum is referred to as a ‘conductive’ hearing loss. When these kinds of conditions exist, the sound from the outside world is not ‘conducted’ correctly to the inner ear (sense organ for hearing). Some conductive hearing losses can be medically treated and can only be identified through a comprehensive face-to-face examination.

Alternatively, when there is damage to the inner ear – such as damage caused by repeated exposure to loud sounds (noise-induced hearing loss) or damage to the inner ear caused by the natural aging process (called presbycusis), this results in a ‘sensorineural’ hearing loss. These losses are not typically medically treatable and again, this type of loss can only be identified with a comprehensive face-to-face examination. Some people even have a combination of these types of hearing losses (conductive and sensorineural). An online hearing test will not be able to distinguish between these types of losses so it is an imperative that you see an audiologist in order to determine not only how much hearing loss you have but to determine the kind of hearing loss you have.

Same head, two ears, different results:
Some individuals may have a difference in hearing between their ears.When this difference in hearing between the ears is sufficient enough, the better (hearing) ear may actually hear the sound through the earphones used at home rather than the ear that is actually being tested. This is referred to as ‘crossover’ – whereby a sufficiently loud sound will ‘cross-over’ and be heard in the non-tested ear but it will seem like it is being heard in the ear being tested. An audiologist can easily identify this “crossover” phenomenon and can implement testing procedures to ensure that the tested ear responds. Online computer equipment cannot accommodate for these differences in hearing and that will lead to inaccurate results.

A comprehensive diagnostic hearing evaluation completed by an audiologist in a sound-treated environment that meets current testing standards is necessary to ensure hearing test accuracy and to ensure appropriate treatment and management options are provided to you.