Sergei Kochkin, Ph.D. – Better Hearing Institute, Washington, DC
These consumer guidelines are intended to guide you through the entire hearing aid journey as you take your first steps in the purchase of appropriate amplification. It represents the most current thinking in the hearing health industry concerning how you should be treated by hearing care professionals and their staff. No matter the educational background or experience of the hearing healthcare professional (HHP) you choose to see, you should expect to be treated with dignity and respect as the HHP focuses on your individual requests and needs.
There are five distinct phases of the customer experience as it relates to acquiring hearing aids. For each of the five phases, there is a detailed, step-by-step breakdown of what every customer should expect when they visit a hearing care professional.
Phase 1: Gathering Information and Scheduling the First Appointment
The initial step is related to receiving information about hearing loss, treatment options, and scheduling an appointment with a HHP. You can find hearing healthcare professionals in the yellow pages or internet by searching “audiology”, “hearing aid dispensers”, “hearing aids”, or physicians specializing in Otolaryngology i.e. Ear Nose and Throat Specialist (ENT) or Otologist. See our definitions of the three main HHPs on the Better Hearing Institute (BHI) website. Prior to visiting any HHP it is best to:
- Consult your family members or friends with hearing loss to determine if they know of a HHP who delivered superior customer service. Make sure they are satisfied with their hearing aids as well as the service. If your friend does not wear their hearing aids ask them why?
- Consult your family doctor for a referral to a HHP the doctor trusts. Usually a referral will be based on someone the doctor has a professional relationship with in that the doctor has sufficient evidence from his or her patient base that the patient is satisfied with the hearing healthcare received. Check with the better business bureau to determine if the HHP has any complaints filed against them.
- In most cases, the first contact you will make with a HHP office or clinic will be over the phone. For this reason, you should expect to have a polite and professional experience over the phone.
- When you place a call to the office of a HHP, the person who answers the phone should offer clear and precise answers to your questions. Because hearing loss varies significantly between individuals, you can expect that some of your questions may not be answered by the receptionist or office assistant. In those cases, you should request to speak to the HHP for a more exact answer. The HHP should be available to take your call upon request, or return your call within a reasonable period of time.
- Given the variability in hearing loss and technology options, questions about prices and models of hearing aids are extremely difficult to answer in a thorough manner over the phone. In most cases, HHPs are only able to give you precise answers to technology and price questions after a personal consultation.
- There may be a fee for a consultation. Be sure to ask if there is a fee for an initial consultation or hearing test before you schedule the appointment.
- If you decide to make an appointment with an HHP, you should not have to wait more than 2 weeks to be seen in their office for a consultation. Be sure, moreover, to ask for driving directions, if you do not know how to get to the office. Office hours should be flexible and meet your needs.
- If you decide that you simply want information, and do not wish to schedule an appointment, the office should be willing to mail you information on hearing loss and treatment options. If they don’t have information they can mail you, ask them about some useful educational websites such as the Better Hearing Institute.
Phase 2: Arriving for Your First Appointment
Exceptional hearing care professionals pride themselves on meticulous attention to detail and taking the time to know you as a person. Before you actually get a hearing test, there are a few steps you will need to go through with the HHP. These steps are necessary as they help the HHP get to know your unique needs and medical history.
- You should expect a warm and friendly greeting by the office staff. Even though you may feel anxious about your appointment, the office should make you feel welcome.
- Educational material (brochures, etc.) about hearing loss and treatment options should be readily available in the reception area or upon request. The information should be current. The reception area should be clean, organized and inviting. There should be comfortable chairs. It must be handicap accessible.
- You should not have to wait more than 15 minutes to see the HHP, unless you have been advised otherwise.
- You likely will have to complete some forms asking for your name and signature. These forms are required by some government and third party insurance companies. The forms are designed to protect your privacy and inform you of your rights as a patient.
Phase 3a: What to Expect During Your First Appointment – Preliminary Interviews
The HHP professional needs to invest a significant amount of time getting to know not only you personally, but also classifying the type and degree of hearing loss you have. Your first visit should be a combination of in-depth conversation with the HHP about your communication needs, along with some objective medical-type tests that identify the extent of a possible hearing loss.
Companion. A significant other or a companion should accompany you to the first appointment. The first appointment will be very educational because you will discuss many aspects of hearing loss and treatment options. Having another person you trust accompany you can ease anxiety and make it a more comfortable experience for you. In many offices, the familiar voice of the companion will be used for hearing aid demonstration purposes.
Medical History. The HHP should complete a detailed medical case history with you personally in a private examination room. More than likely, the HHP will ask you questions about your ears, hearing ability and current communication situation.
Communication Assessment. An individualized and detailed assessment of your current communication ability should be conducted by the HHP as it relates to your individual lifestyle and hearing needs.
Counseling. The HHP may provide comprehensive counseling that focuses on the underlying emotions of adult hearing loss. The HHP should allow you to express your feelings about your hearing loss and communication without pressure or presumption. At times, the HHP may refer you to a psychologist, especially where unresolved feelings of shame, guilt, and anger could interfere with your treatment.
Phase 3b: What to Expect During Your First Appointment – Assessment Phase
You should expect to receive a thorough and detailed auditory assessment (hearing test). There is often a charge for this assessment. It is sometimes covered by insurance. Be sure to ask before the test begins, if you are not sure.
The actual hearing test takes about 20 minutes. The primary goal of the initial hearing test is to rule out a medical condition involving your ears, and to assess your candidacy for amplification.
Ear Inspection.Prior to an auditory assessment the HHP should thoroughly inspect your ears to make sure you do not have a medical condition or wax buildup in your ears.
Testing. As part of a clinical protocol, the HHP should conduct the following tests or procedures in a sound booth/sound proof room. Without testing in a sound treated area, you cannot be assured of receiving an accurate or valid auditory assessment. An exception is if you are confined to a nursing home or are not ambulatory and are home bound. In these instances testing should be done at your place of residence in the quietest area of your home. Below are the basic make-up of tests that allow the HHP to evaluate your hearing abilities:
- Pure tone audiometry measuring your hearing sensitivity in each ear.
- Loudness discomfort level testing utilizing tones to assess your tolerance of loud sounds.
- Speech in noise testing, measuring your ability to understand speech in noisy listening situations.
- Annoyance of noise testing that measures your annoyance to noise.
- May include some “automatic” tests assessing the mechanics of the middle and inner ear.
Immediately following the hearing test the HHP should do the following:
Review Tests. Review the results of the comprehensive battery of tests you just completed in language that you understand. The explanation should include type and degree of hearing loss, and a summary of possible treatment options based on these results. Feel free to ask questions at any time. The results of these tests may indicate that you need to see a physician specializing in diseases of the ear (ENT doctor).
Education. Information on the consequences of untreated hearing loss and your current treatment options. The HHP should be able to share specific research findings as they relate to untreated hearing loss and treatment options (hearing aids, etc.) in clear language. This education could be in the form of a book or brochure, published article, fact sheet, or educational video.
Demonstration. A live demonstration of modern digital hearing aids may be offered to you. The demonstration should be conducted with noise in the background, so you can experience how hearing aids perform in realistic situations. Some HHPs are able to simulate how you hear with and without the hearing aids in what’s called a simulated sound field. By all means, ask for this simulation for it is truly enlightening to your significant other to understand how you hear the world. It also gives you a decent demonstration of what to expect from the hearing aids. With modern computers most HHPs should be able to simulate how you will hear with hearing aids in many listening situations such as in a place of worship, noisy restaurant, at a cocktail party or in a car.
No Pressure Situation. You should never feel pressured to buy or make an immediate decision. Be sure to freely ask any questions that will help you make an informed decision. If you decide not to pursue amplification at the end of the first appointment, the HHP will give you additional educational material and a precise price quote upon request. You should receive a copy of your test if you wish to show to your doctor or for your records.
Hearing Aid Styles. The HHP should review in considerable detail the styles and features of modern hearing aids and how they will potentially benefit you in everyday listening situations that are important to you. A description of hearing aid technology and styles is available on the BHI website. Part of this presentation should include the advantages and disadvantages of each style and feature options in relation to your communication needs, lifestyle, etc.
Clinical Evidence. During the explanation of technology options, the HHP should be able to review clinical evidence supporting their claims and recommendations. If you wish, ask for clinical evidence supporting their recommendations.
One or Two. Part of the discussion you will have with the HHP revolves around using one or two hearing aids. Generally speaking, if you have a hearing loss in both ears, research indicates that two hearing aids work better than only one. When you are fitted with two instruments it is called a binaural fitting. Your HHP should be able to review with you the advantages of a binaural fitting compared to a monaural (one ear only) fitting. In most instances, two ears are better than one and there is a significant amount of literature to substantiate that claim. See the binaural advantage on the BHI website for more information.
Recommendations. The HHP should provide you with clear and concise treatment recommendations, allowing you to make an informed decision. The HHP will provide at no cost a professionally written assessment for your family doctor detailing your hearing loss and their recommendations.
Financial Issues. The HHP should present to you clear and easily understood pricing options as well as financing options. Pricing varies due to style and technology and can range anywhere from approximately $700 to $3000 per hearing aid. The price differences should be explained to you thoroughly. If you purchase hearing aids, the HHP or office assistant should check to see if you have insurance benefits that partially cover part of the expense. Be sure to ask if hearing aids are a covered medical benefit before agreeing to purchase them. You may find that you can get financial assistance for your hearing aids. See the BHI’s Your Guide to Financial Assistance for possible sources of financial assistance.
Ear Molds. If you decide to pursue hearing aids, the HHP will take a mold or cast of your ear. The mold allows the hearing aid manufacturer to customize the hearing aid or ear mold to your ears. This procedure will take 5 to 10 minutes and in few cases, may cause minimal discomfort. If you are purchasing a mini-behind-the-ear device with a thin tube this step will not be necessary. An ear mold will be required if you purchase completely-in-the canal (CIC), in-the-ear (ITE), in-the-canal (ITC), or larger behind-the-ear models.
Medical Waiver. The HHP will ask you to sign a medical waiver or to see a physician for medical clearance before fitting you with hearing aids. While seeing your physician to get authorization before using hearing aids is never a bad idea, it is not always necessary. Rely on the expert advice of the HHP, if you feel comfortable with him or her.
Purchase Agreement. Before leaving the first appointment you should have a signed copy of a purchase agreement or contract that outlines what you are buying (model and make of hearing aids), price, trial period, any non-refundable fees as well as warranty on the hearing aids.
When you leave the first appointment you should feel comfortable with the HHP and the entire office experience. The first appointment may take an hour or more, so you should never feel rushed or hurried. Don’t be afraid to ask questions – even after you get home from the appointment.
Phase 4: What to Expect During The Hearing Aid Fitting
If you decide to pursue hearing aids requiring ear molds, you can expect to return to the HHP for an appointment in 2 to 3 weeks. Hearing aids are customized instruments so it takes some time to have them made and shipped to the HHP’s office. Before you are fitted with the hearing aids, the HHP should carefully check them to ensure they are working properly. With digital mini-BTEs with thin tubes or receivers in the ear the HHP should be able to fit you with these devices after the hearing assessment phase. Here are some issues, processes and expectations that should occur in this phase:
- Fitting Time Frame. You can expect the initial hearing aid fitting to last between 60 and 90 minutes.
- Orientation. A thorough orientation to the care, use, maintenance and expectations regarding initial hearing aid use. This orientation should take at least 45 minutes, possibly longer. Be sure to feel comfortable getting the hearing aids in and out of your ears.
- Wearing Schedule. If you are a new hearing aid wearer, you should be given a detailed wearing schedule that outlines approximately how long and where you should wear your hearing aids the first week or two. It takes your brain a little time to get rewired with hearing aids, especially if you have had a hearing loss for several years. Experienced wearers may not need an adjustment period unless the technology is radically different from what they had in the past.
- Hearing Aids are Fit Prescriptively. This means that the loudness and other characteristics of the hearing aid is determined by a thoroughly researched formula incorporating your individual test results and entered into a computer. This prescriptive formula has been shown to be a reasonable starting point for the vast majority of hearing aid users. Don’t be surprised if that initial starting point sounds a little loud or abrasive. Remember you are hearing a lot of sounds you could not hear for many years. It is advisable to follow the recommendations of the HHP when dealing with initial discomfort and annoyance associated with early use of new hearing aids. Be patient. However, never accept hearing aids which are uncomfortably loud. If they are uncomfortable, communicate this to the HHP who has the ability to turn down the gain.
- Verification. Your HHP should verify the quality of the fit by conducting an automated test called a real ear or probe microphone measure. This measure may use actual speech or a calibrated tone. This measure will ensure the hearing aid has been customized to your hearing loss and ears. Additionally, this measure can be used by the HHP to demonstrate to you how certain advanced features, like directional microphones, digital noise reduction, and automatic feedback reduction work. Since these advanced features contribute to the cost of the instruments, don’t be afraid to ask the HHP to demonstrate how these features work in your hearing aids. They can be demonstrated rather easily with probe microphone measures during the initial fitting.
- Batteries. You should be given an ample supply of batteries and instructed on how they are to be changed and discarded. Some HHP bundle the cost of life-time batteries in their purchase price.
- Care and Maintenance. You should be given an instruction booklet, cleaning tool, and something to store the hearing aids when not in use.
- Satisfaction Guaranteed. The HHP should be able to answer your questions, offer reassurance and guidance during all aspects of this appointment. If during the appointment your hearing aids do not fit well or sound wrong tell the HHP so that adjustments can be made prior to the start of your 30 day trial date.
- Timely Follow-up. Because getting used to hearing aids can be demanding (there is a lot to learn), the HHP should give you a phone call 1 to 2 days after the fitting to see how you are doing. Don’t be afraid to make a personal visit to the HHP right away if you need immediate help or further instruction. You will find that the vast majority of HHPs are willing to see you right away for a check-up appointment, if you are struggling or feel frustrated.
Phase 5: What to Expect During Post-Fitting Follow-Up and After Care
Buying hearing aids from the HHP is the first step in a successful hearing improvement journey. The service you receive after the initial purchase is extremely important. You will need to make sure that you get the most out of your investment of new hearing aids, by getting them serviced when needed. Part of the service provided should include periodic hearing tests, hearing aid cleanings and fine tuning adjustments of the instruments. In some cases there may be a charge for these important professional services. As usual, it is important to ask the HHP about out-of-pocket expenses you may incur throughout the life of the hearing aids before purchasing the hearing aids; it is best to get these post-purchase services in writing prior to purchase.
Here are some issues that should be covered or considered during this phase:
- Acclimatization. Years of clinical research suggest that it takes the typical user of hearing aids about 30 days to get adjusted to amplified sound and to realize maximum benefit. Of course, individual results will vary, so it is up to you to communicate your progress to the HHP and provide a detailed report of your initial experience with amplification.
- Outcome Measures. In order to demonstrate to you that the hearing aids are actually benefiting you in the places you need them, the HHP should systematically measure your progress. These are commonly called outcome measures. Outcome measures should occur 14 to 45 days following the initial hearing aid fitting. These measures will tell you how much benefit you are receiving. Generally, there are two ways the HHP can assess your outcome or progress. Both types of outcome measures should be employed by the HHP to ensure you are getting the most out of your investment. Ask for objective evidence of the utility from your hearing aid which has been programmed to your unique hearing loss. This means you should receive test results of how you hear with and without the hearing aids preferably in quiet and noise. These results should be shared with your family physician.
- Objective Assessment. The first type of outcome measure is called a laboratory assessment. This is generally a procedure in which the HHP compares your ability to hear with hearing aids to the unaided condition (without hearing aids). This will demonstrate to you in a sort of “snapshot” manner how much the hearing aids are benefiting you. Either tones or speech in noise can be used as laboratory measures of your progress with hearing aids.
- Subjective Assessment. The second way that the HHP may assess your progress with hearing aids is through the use of questionnaires. Theses are questions that the HHP should ask you about how the hearing aids are impacting your overall quality of life after you have begun wearing aids. This assessment can be in writing, by computer or through an interview.
- Customer Satisfaction Survey. A third way of measuring your progress is a straight-forward customer satisfaction survey. These surveys normally cover your attitudes about the hearing aid including its features and your perceptions of the ability of the hearing aid to meet your needs in various listening situations.
- Customer Service Survey. The HHP should also ask you to complete a questionnaire that addresses the quality of the service you received from the office. The vast majority of HHPs want to improve their service any way they can, and your responses on the questionnaire are valuable. If they do not assess customer service please tell them how to improve their service.
- Aural Rehabilitation. It’s important to remember that hearing aids don’t make you a more effective listener. In some cases, you will be offered hearing and communication exercises, commonly called auditory training or aural rehabilitation as well as communication strategies for optimizing use of your hearing aids. Today, some auditory training can be done at home with a personal computer. Research has shown these auditory training exercises to be extremely beneficial at getting the most out of your hearing aids. Be sure to ask your HHP what auditory training exercises are right for you.
- Group Counseling and Education. Many HHP combine all aspects of hearing aid counseling, aural rehabilitation, communication strategies, effective listening, assistive listening devices, care and maintenance, etc into multiple group sessions where the spouse or significant other is invited. Some of these group sessions can take 3 or more hours over the first few months of the hearing aid fitting. If these are offered attend the sessions. If you are unable to attend a particular session inquire about make-up sessions.
- Patience and Persistence. It may take more than a few visits to the HHP to get your hearing aids fine tuned. If that happens to you, be patient and work with your HHP to “get it right.” Be aware that changing hearing aids, while possible, doesn’t always translate into instant success. Many hearing aid users expect satisfactory results to occur in a short period of time. This can be achieved by patients who make an effort and follow the HHP’s prescribed treatment plan and advice.
- Ear Wax Management. After you have given your ears and brain a few weeks to get acclimated to new hearing aids, they should be worn every day for several hours each day. Because they are worn in a very humid ear canal that often contains large amounts of cerumen (ear wax) hearing aids must be cleaned every day. This is very important. Your HHP should not only show you how to clean your devices, he or she should review some sundry products that will prolong the life of your hearing aids.
- Life of Hearing Aids. Today’s hearing aids should last about 3-5 years before needing to be replaced, possibly longer if you are meticulous about taking care for them.
- Warranties. New hearing aids have between a 1 and 3 year limited warranty. You may wish to purchase a longer warranty. The decision to purchase an extended warranty should be discussed with your HHP.
- Hearing Aid Insurance. Hearing aid warranties may not cover lost hearing aids or damage to the hearing aids not due to the manufacturer. Because of their size, hearing aids are easy to lose. Discuss with your HHP how you can insure your hearing aids against loss and damage. Typically new hearing aids are insured by the manufacturer even against loss for the first year. Be sure to find out the details of your policy from the HHP.
- Periodic Check-ups. Because your hearing can change and problems to the instrumentation can occur without you knowing it, you should schedule periodic check-ups with your HHP. These check-ups should occur 2 to 4 times per year, and usually include cleaning and fine-tuning the devices. Ask your HHP if there is a charge for these periodic check-up appointments. Most HHP bundle the first year or two of follow-up visits into the cost of the hearing aid.
It is very important that the consumer of hearing aids become an active participant in the success of the hearing aid fitting process. In partnering with the HHP this means:
- You have to aggressively communicate on an ongoing basis with the HHP regarding needs, wants, desires, expectations and disappointments. Some people give up without really trying and place their hearing aids in the drawer. Give your hearing aids a chance and work with your HHP to assure that you have derived maximum benefit given your degree of hearing loss. If you are unable to articulate your needs and desires by all means bring an advocate who can articulate your needs such as a spouse, adult child, or friend. See Getting The Most out of Your Hearing aids on the BHI website.
- You should read all material given to you by the HHP and become familiar with the technology. If the HHP recommends auditory training, counseling, psychotherapy, wearing schedules, or group educational sessions then the consumer must actively participate. Passive participation is the road to failure.
- The HHP may recommend additional assistive listening devices to supplement your hearing aids and it is within the consumer’s budget, by all means purchase and use this technology. See our write-up on assistive listening devices on the BHI website.
- It is vital that consumers have realistic expectations of the benefit expected from their hearing aids to avoid disappointment. One should not form expectations of the ability to hear based on the experience of a friend. Remember, no two hearing losses are the same. See Realistic Expectations on the BHI website for more information.
Today, people with a hearing handicap choose digital hearing aids as their treatment of choice. They are programmed to precisely optimize your residual hearing. In the hands of a skilled HHP this is the very best possible hearing solution. Coupled with assistive listening devices where necessary and aural rehabilitation whether through exercises, supplemental reading material, or group
participation we are confident that you can be a successful hearing aid user. But remember in Discovering a World of Better Hearing it takes an active partnership between you, your family members and the HHP to assure hearing technology is best optimized for your unique hearing loss.