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Hi,
A little story ...
About a year ago I planned to make my fortune by
starting a part-time business selling OTC hearing aids.
I contacted zillions of manufacturers and bought
MANY aids for evaluation.
However just ONE manufacturer wrote me a letter
explaining the errors of my ways. My wife & I discussed this and realised he
was right.
I then gave up my very well paid senior role at a
mobile comms company and am now training as a dispensing
audiologist.
Having worked with patients for some weeks I can
now confirm that you simply should NOT sell aids OTC without a medical
evaluation and proper fitting. The health & social issues are simply too
complex. You don't take say 2 hours total for testing and fitting for no
reason.
Sure, you can question the pricing of the product
& service ... but the technology and method of delivery is the right one for
most people.
Don't forget that the average client is aged 74
.... with possible cognitive issues, possible dexterity issues, possible unusual
ear canal shape due to age/surgery etc.
Perhaps WE here can buy an OTC unit, twiddle with
its controls and stuff it in our ears with success - but these elderly and
sometimes very hard or hearing people simply couldn't do that.
If I were to revisit the "instant millionaire"
path, I would aim for a slick, high speed, low cost, discounted service ... but
it would still be based on the current traditional practice
structure.
regards,
Richard
----- Original Message -----
Sent: Thursday, March 25, 2004 6:48
PM
Subject: Inexpensive hearing aids
I just read the piece on Mead Killion's idea of inexpensive
hearing aids. Hearing aids are not just something to slap in your ears
and off you go. There are a myriad of considerations to take into
account when not only choosing the setting during the first fitting, but the
follow up care. This is largely due to the plasticity of the auditory
system and the absolute need for the Audiology, Dispensing, Manufacturing and
other related medical fields to go beyond hearing aids as a simple
correction.
Auditory neuroscience has been my specialty for the last 6 1/2
years. It's taken me a long time to amass the amount of journal articles
(3400) among multidisciplinary fields of medical science to be able to fit
successfully those patients that range from mild to severe hearing
losses. Considerations such as their current and past medical or
developmental history is of utmost importance if I am to be successful at
fitting the hearing aids during the first 6 months that match the initial
auditory system capability and to keep pace with the neurophysiological
changes that occur through stimulation and rehabilitation
For example, if I have a patient with panic and anxiety
disorders and a patient who is a professional musician, even though they may
have the exact same audiogram, their settings on the hearing aids will be
completely different including the type of hearing aid. The P and A will
be drastically below the expected settings and the PM will be above.
This is due to their specific neurophsyiology makeup that give
substantial control over his system in the musician and the lack of control in
the P&A. The neuroanatomical differences in musicians vs.
non-musicians have been established numerous times. With a
25% greater response to piano harmonics than pure tones, I need to try to
match the hearing aids to musical harmonics instead of the pure tones
we use during testing. Additionally, the counselling that would go
into encouraging and maintaining use of the hearing aid is also going to
markedly different.
An Alzheimer's patient and a Parkinson's patient's
rehabilitation time is going to be significantly longer than a normal healthy
control due to the depletion of Acetylcholine through the degenerative process
of AD and the anticholinergic medication of the PD patient.
Acetylcholine is largely responsible for auditory system plasticity during
rehabilitation. A decreased availability will extend the rehabilitation
time and potentially reduce the final recovery of function.
I could go on and on about the different parameters that make
hearing aid fittings difficult for so called "easy" mild hearing losses.
But I won't. Suffice it to say, if more University programs would
concentrate on the neuroscience end of central auditory processing and the
degenerative processes as a result of a hearing loss (which can begin at
20dBHL with the loss of GABA receptors creating more spontaneous activity,
less temporal resolution, less frequency resolution, less spatial acoustics,
etc.) Mr. Killion, with all due respect to his position in Audiology would not
be so quick to relegate hearing aids to the "over the counter reading glasses"
genre.
Barbara Reynolds, M.S.
Clinical Audiologist
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