Concerns of a hearing aid buyer
The comment below is from Paul Weston, he originally wrote this as a comment on here but I felt it was worth posting separately as it raises some good points. I don’t necessarily agree with everything he is saying but moving his comment to its own page gives people room for comment.
A quick straw poll of friends shows that of four people that have had hearing aids fitted, four of them are not used. The hearing aid has not been adjusted in a way that gives acceptable sound. 100% dissatisfaction.
I’ve just been fitted with a hearing aid. The specialist said I needed two at $3200 (12 channel) each. I opted for one (6 channel) at $1600. The process has shown severe deficiencies in the ability of the audiologists involved and possibly in the quality of sound from what I consider an expensive aid.
First, the audiologist ignored my specification for a vented tip. When I complained at the first fitting I was told that I wouldn’t get a good result from that type – but that wasn’t mentioned when I ordered the aid. Then a dodgy demo ‘proved’ that a vented tip was prone to feedback – but the closed tip also caused feedback until correctly calibrated.
The adjustment seems very primitive. I would have expected that the aid would be adjusted to match the hearing in my better ear (that has 90% function.) Instead, the aid is reefed up in volume to the max that it will take. I was told I have to ‘maximise’ my hearing. My wishes for a more holistic approach are ignored and the body language of the audiologist is “sit down shut up and accep what WE know is best for you.”
As a result, my ’sound picture’ is distorted. I should perceive a central sound centrally, but with high volume on the right ear, everything is shifted to the right.I’ve been told to return in 3 weeks for fine adjustment. So I have to suffer what I perceive as too high an amplification and not enough compression (sound smoothing) for three weeks? This is the typical approach used to wear down customers – with such protracted visits they eventually give up and throw the unit in a drawer.
The $1600 hearing aid sounds like a $10 novelty amplifier.I have been told that it is normal for it all to sound strange and over amplified. What a lot of horse apples. Has it not occurred to the hearing ‘professionals’ that a hearing aid can be introduced at a lower volume for initial comfort and then slowly, over a week or so, brought up to whatever volume the user finds he or she can adapt to?
In my case, with one ear only amplified, surely the aim would be to match the response of the ‘good’ ear. I’d be happy with 90% in both ears instead of 90% in one and a viciously over amplified 120% in the other.
All this talk of 6 and 12 channels sounds impressive but it’s only a graphic equaliser and it wouldn’t surprise me at all (call me a cynic) to discover that a 6 channel hearing aid is a 12 channel hearing aid with 6 channels disabled. These are digital hearing aids. The frequency response is controlled by software.
Then there’s the matter of price. The street price of these aids varies enormously ($800 to $1200) – which leads me to wonder if they’re made for $100 in a factory in Korea.
I’d also question the mechanism by which a money back guarantee is made. I can return the hearing aid and get an almost complete refund. What happens to that hearing aid? I bet it’s not destroyed and I wasn’t offered a refurbished unit. Is the ‘new’ unit I paid for actually new? The package I was given had been opened and the cord used for the recharger had been undone and re-done.
I pay full price for the hearing aid but am I not given the connectors or the software to access the functionality of the unit because obviously I’m old and stupid and ripe for exploitation?
I think it’s time for a big enquiry into the hearing aid industry. My first impressions are of incompetent service and an over priced product.
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I lived with hearing loss in one ear for over 20 years without purchasing a hearing aid for all of the reasons listed in this post, the biggest ones being the high cost and total lack of control allowed the consumer after the transaction. I am happy to say I finally found a reasonable alternative. In December I purchased a CIC hearing aid from AmericaHears.com. The cost was about $1100 for the hearing aid including the software and connectors to adjust it myself. I have been very happy with the hearing aid and wear it (almost) every day. I have made numerous adjustments myself (4 program memories, 9 channels) and it’s actually kind of fun and interesting to try new settings and learn something along the way. AmericaHears is an online retailer, so you have to obtain your own audiogram and do your own ear mold. If you’re uncomfortable with a little DIY they may not be for you, but their website is very thorough and their audiologists very helpful.
I am a lucky hearing aid wearer. All the customer attitudes spoken about by Peter Weston I have experienced, though.
The reason i am lucky is at the age of 30 I got an in-the-ear (ITE) analogue, programmable hearing aid with a directional microphone – yes, I had all that treatment at first, but now the dispenser is one of the best around – and the minute I walked out of the hospital wearing the aid the new world opening up to me was immediately apparent.
My slurred speech – I used to get excluded from nightclubs when I’d had way less to drink than my friends – has almost totally disappeared. i have been able to re-educate my mind to stop anticipating what people are going to say and actually listen to them.
I have 25 decibel hearing loss, but apparently, sound was duller in the middle frequencies so I found it particularly hard to hear what was being said around or to me. Especially at parties. Now i can probably hear better than everyone else at a party.
That first, instantly life changing hearing aid cost £850.
The point I am making is to convey what is possible from finding the right hearing aid.
Look at the results of hearing aid provision in the UK:
For ten years I haven’t seen much change. Still 8m people who could use hearing aids, 2m who have got hearing aids (not sure what percentage private versus NHS) and 1.4m don’t use them.
Over 5 million people over the age of 60 have hearing loss that could be improved with a hearing aid but the reputation of the industry that provides them is not going to do much to encourage sales.
We regard hearing loss as a disability which attracts all the patronising, pitying disempowerment where potential hearing aid customers are treated like old stupid spongers rather than people able to spend £1,000+ on the right purchase.
Imagine if you went to buy a stereo and were treated like a hard of hearing person: ‘ yes, this is muffled, and is facing the wall and you will have stand on your head to enjoy music but it’s only £3,000.’ If you don’t like it we’ll give you your money back. But pay now if you want to try it.
To give you the biggest advantage before investing in a hearing aid: find a hearing aid wearer who has had a successful fitting and find out what you can expect from the right hearing aid, I’d say.
I totally agree with Peter’s blog. I’ve also been a victim of hearing aid dispensers who think that they know more than the hearing aid wearer.
Recently, I was fitted with bi-lateral aids (digital). After a few visits for adjustment I still have difficulty understanding what someone is saying during conversation. The problem is during the adjustments in the office the instrument sounds good but in your own environment there is alot of feedback and the sound is too loud. My wishes have also been ignored and the treatment extended to me by the professionals is of ‘you’re a pain in the neck’.
On my last visit, the manufacturer was called to advise the audiologist how to reprogram the aids. The first question I was asked was not about my hearing needs but my age. I was then advised that at my age the aid needs to be louder for it to be effective and I should give it a few days. I was also told that all aids have high frequency sounds and feedback is inevitable.
Recently, I went for an appointment and was totally ignored as other patients who arrived after I did were attended to. Verbalizing my feelings in writing did me no good. It’s been over a month since I used this approach and no one has contacted me or responded to my email.
After having paid $3,500 for the aid plus $150 for custom fitted molds. I was expecting better service from my providers. I too feel exploited. I’m currently walking around with aids which do not address my needs and have had to resort to wearing one aid to minimize the high amplified sound.
I’d like to know how to handle this situation?? Are they really caring providers out there somewhere? Or should we keep paying high prices for what just may be refurbished aids?
I think all hearing aid wearers can empathize with you. I believe that I have taken control of my hearing and have, in my mind, found a solution that works best for me. I purchased a set of “Personal Programmable” hearing aids from an internet supplier called HearSource. I wear what is called the “FreeStyle”, which is an open fit type hearing aid. I have a high frequency hearing loss and this type of aid was what everybody seemed to be recommending to me anyway. This company makes a hearing aid system whereby I can do the sound adjustments myself using my own P.C. They provided the software, programmer, cables, etc. They (HearSource) have been quite helpful in assisting me in getting my aids set perfect for me. I paid $1,990 for a set of these hearing aids and again, it came with all the programming stuff included. I really could not be happier. Their website is http://www.HearSourcve.com. Good Luck and god Bless.
I think all hearing aid wearers can empathize with you. I believe that I have taken control of my hearing and have, in my mind, found a solution that works best for me. I purchased a set of “Personal Programmable” hearing aids from an internet supplier called HearSource. I wear what is called the “FreeStyle”, which is an open fit type hearing aid. I have a high frequency hearing loss and this type of aid was what everybody seemed to be recommending to me anyway. This company makes a hearing aid system whereby I can do the sound adjustments myself using my own P.C. They provided the software, programmer, cables, etc. They (HearSource) have been quite helpful in assisting me in getting my aids set perfect for me. I paid $1,990 for a set of these hearing aids and again, it came with all the programming stuff included. I really could not be happier. Their website is http://www.HearSource.com. Good Luck and god Bless.
As an audiologist I have a few observations to Peter’s comments:
I regret that our profession and industry hasn’t displayed behavior and bedside manner that communicate the caring and genuine interest that most audiologists have for their customers/clients/patients.
While some audiologists may “ignore” patient users comments about sound quality, most do not. However, if I followed the comments of most users, particularly those new to amplification, they would have me initially adjust their aids to such a low volume to render them almost useless. This is because what sounds “normal” to user is to have hearing loss; it’s been present for so long that the ears and brain have recalibrated itself to the new “normal” of hearing loss. Anything I do to the sound IS going to be perceived as different, unpleasant, tinny, etc. This is to be expected because of changes that have occured in the brain and ears over time. Many audiologists go to great lengths to explain this physiologic reaction.
You are correct in that there is an adjustment scale whereby we start the volume lower, usually 35-50% softer than ideal gain. Over time we slowly adjust the settings higher until the proper volume is achieved. Any audiologist with experience will do this.
Regarding adjusting one aid to match a more normal ear – this is a challenge. Initially our goal isn’t to ‘match’ the aided ear to the better ear and certainly not to overpower it; often the goal is simply to get the aided ear accustomed to hearing. Then over a period of weeks/months we follow that pattern described above to slowly increase the gain to achieve balance between the ears. Frankly, this balance occurs as much inside your brain as it does through the settings on the hearing aids. Yes, we must have the aids adjusted properly but your brain also needs time to adapt to the new-found sound in that aided ear.
As far as ‘horse apples’ and adjusting to sound – it surprises almost everyone to learn that the brain requires 6 weeks to 8 months in order to fully adapt to new sound. Yes, even the youngest, most well focused, adjusted brain needs 6 weels tp become accustomed to hearing again – even with mild hearing loss.
Consider that most people have had hearing loss for 5-8 years before doing something about it. By that point most people have a 30-50% hearing loss in some frequencies. What do you think has occurred in that 5-8 years? Do you think the ears and brain have laid dormant just waiting for you to flip the switch again? Not hardly. With each passing month there have been miniscule but meaningful losses in neural fine tuning, hair cell clarity, and central processing speed? A study this year showed clearly that untreated hearing loss changes how the brain reacts to sound. Think of the “use it or lose it” idea. Those unused hearing neurons are conscripted for other functions; in this case the hearing neural pathways are taken over by the tactile neurons. So, with all this change going on how long do you think it takes to “undo” these fundamental changes so you can hear more normally again? Most people are ignorant about how the body adapts, adopts, and otherwise changes when things change.
A theme in this thread is “as the user I know more about the sound I’m hearing than the audiologist doing the adjusting”. I agree that you experience the sound firsthand and that the most successful fitting is accomplished when user and audiologist are working and communicating together. This is optimal and what I always aim to achieve. With that in mind I point out that over a 20 year period I have helped over 3000 people move from hearing loss to hearing improvement with hearing aids. If you are dealing with your hearing aids for the first time and you are my 3001 person to help, who do think has some useful insight into the most effective ways to manage it? Your comments are helpful but they are not always accurate when looking at the best long term outcome. Simply because I own a car and hear the grinding doesn’t mean I know more than the mechanic who has fixed hundreds like it before mine.
Related to that is the question of “why cant I have the software and program my own hearing aids”? While saying the words are easy the process is actually much harder than it looks. What do you know about hearing, hearing loss, anatomy of frequency resolution inside the cochlea? What about sound levels, output, gain, MPO, SSPL90? And compression, do you use it or not? If so then how much and at what frequencies and what decibel levels? What about damage to your hearing from overamplification? When you inadvertently make your hearing loss worse who is to blame? Naturally people will blame the manufacturers for making a product potentially harmful to consumers. From a manufacturers stand point it’s a slippery slope. From a users standpoint I think it’s another area where people are unknowing how much knowledge it actually takes to set these devices effectively.
Lastly, what becomes of hearing aids that are returned to the manufacturer? The US Food and Drug Administration requires that those aids be destroyed if they have been used in or on a persons ear outside of the office. We are required to submit documentation stating whether the aid was used for in-office demonstration only or used outside the office. If used outside the office then it must be destroyed. Federal requirement, end of story. There is about a 16% return rate so the manufacturers factor that into the ultimate cost of all hearing aids.
I don’t wish to sound confrontational with my reply and trust the information is received in the helpful, collegial manner that I intend.
Best wishes on your journeys to better hearing!
Scott
Paul,
You are right, exactly right. The audiology industry (and always remember, a for profit industry) is very self serving and usually technologically inept. It’s not the hearing aid or the technology that is lacking. There is really little difference between brands of hearing aids technologically at this point. There are only a couple suppliers of components to ALL hearing aid manufacturers.
What I have found lacking is the audiologists proficiency at properly adjusting the hearing aid themselves. The hearing aid manufacturers have had to dummy down the fitting software and make so much of it automatic and with drop down “fix it for me” menus that almost anybody with about an hour training course could not do it just as well if not better. They use equipment with digital readings to do in-ear sound measurements (real ear), which further isolates them from their patients and automates their delivery of services.
As you can tell, I got totally fed up with my inept audi. (She could not provide me with “quality” sound reproduction, which I felt I deserved) and went against the grain and purchased HearSource hearing aids. I do the adjustments now myself. They have had to help me a couple of times with their “Remote Programming” support service, but other than that I do the fine tuning myself. Believe me, the sound adjustments are soo much more exacting and discreet when you do them for yourself.
I hear very well with a good natural sound “quality”. Anyway, just wanted to let you know, you CAN get of the audiologist merry-go-round and there are other options available.
Hello Dr.Scott,
Your response was very interesting and understandable, I used to pretty much wonder the same (wrong opinion) on Audiologist, I used to think, they knew it all. After your article, it changed my mind on audiologist.
I have been using my hearing aid for about 6 yrs, a week before I switched to 12 channel hearing aid previous one used to be single channel, Does it have lot of difference, if so, in what way?
Thank you,
Archana
Hi,
I am a hearing aid dispenser in Northern California. The issues brought up in this dialog are disturbing and need to be addressed. The first aspect of this is technical. The number of channels that are used to process sound in a hearing aid have very little to do with fine tuning by the dispenser. It is more relevant to the automatic features in the hearing aid. More channels of processing in a device allows noise reduction to be implemented in a narrow bandwidth, leaving adjacent frequencies suitably amplified. This is particularly important for people with high frequency hearing loss. People with normal or near normal thresholds up to 1000hz tend to have better results with 8-16 channel products. This is because processing occurs only in the bands above 1000hz. A 4 or 6 channel device will only have 2-3 bands above 1k and this is not sufficient to handle noise and speech cues effectively. Do not blame the audiologist for following their training. Audiologists are scientists first and counselors second. They believe in the science behind the technology and care greatly for the well being of their patients. The problem lies in the individual providers inability to measure the anecdotal response, or the patients observations, with the clinical verification of the hearing aid fitting. The effective fitting of a hearing aid requires patience on the part of both parties to achieve the desired results. A successful fitting often requires months of counseling and adjustment on the part of both the dispenser and the patient. This does not fit in well with the “fast food” society in which we live. The best that someone with a hearing impairment can hope for is a dispenser/audiologist that is committed to finding the best solution to their problem. This requires trust, financial commitment, and a long term relationship with their provider. Hearing is a complex system comprised of auditory, cognitive, memory, and analytical skills. The hearing aid provides information for the brain to use. If your provider is unwilling to spend time with you, you got ripped off. If they are, and demonstrably care about you and your problems, you got a “good deal”.
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