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Re: Inexpensive hearing aids

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.
----- 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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