Posted by Dr. Alejandra Ullauri:
As an Audiologist, I take great pride in what I do to help people hear better, which in reality, means live better. However, I am also sad and frustrated when I encounter individuals and families that have given up on hearing aids. They tell me:
“We tried hearing aids and they don’t work”.
I take this statement very seriously, and try to find out the full story.
I’d like to share the story of a young professional I’ll call Peter. His hearing loss almost led him to give up on his professional dreams because he thought hearing aids didn’t work.
The first time I met Peter, I realized the complexity of his hearing loss, the lack of appropriate amplification he received from his current hearing aid, and the lack of information he had about his hearing loss. He came to pick up a hearing aid he had left for repair, and I was the only one in the clinic. When I looked at his records and saw his older audiogram, his lack of follow-up testing, and his current hearing aid, I became concerned. He hadn’t been tested recently, as he thought his older model hearing aid worked fine. I asked if he heard well, and he answered: “not really, but this aid is what I have and I’m glad it’s repaired, although it doesn’t sound as good as before.” I suggested we review his current fitting, as I thought things could be improved, and he replied, “I have tried it all, and I can tell you they don’t work. All I want is to get this aid fixed so I can hear enough to go on with my job.” Seeing he had demanding professional duties, I became more concerned about his current hearing situation.
Peter’s problems went beyond the fact that his hearing aids did not work that well. I can identify 3 main issues that every hard-of-hearing patient should keep in mind:
Adult patients, with no cognitive difficulties, are the sole decision makers on their treatment options, type of care, and hearing professionals they choose. As professionals, our duty is to provide you with evidence based information so you can make choices based on scientific facts. We also recommend a course of action based on test results, and treatment options available for specific cases. However, you must decide what to do with the information. The patient is responsible and should be empowered to make informed decisions about his/her hearing health.
Peter was overwhelmed with professional demands so he put his hearing as the last priority. However, his hearing loss was the cause of many of his professional frustrations and difficulties. His visits to his Audiologist were mainly for hearing aid repairs, not for proper testing and follow-up. He stopped pursuing ways to improve his hearing, was unaware of advances in technology, and unwilling to become an informed patient. He lived unhappily with the minimal relief he received from his dated hearing aid.
Take Home message: Take charge! If you are experiencing major hearing difficulties, make an appointment for a proper consultation: a comprehensive assessment. Allow your Audiologist to provide the best care by making the proper appointment. A comprehensive assessment cannot be performed in a 15-minute hearing aid repair appointment, and if you are constantly experiencing problems, it is very unlikely that they are ONLY due to hearing aid technical problems. Pursue improvement and make informed choices.
An audiologist has a deep knowledge and understanding of the disorders he/she diagnoses and treats, as well as the most current diagnosis approaches and treatment options.
They will conduct a full assessment and make recommendations based on those current results. A thorough assessment includes a test battery that evaluates different parts of your auditory system, as well as your functional hearing (what you do with what you hear). Hearing loss requires accurate and thorough testing to diagnose and treat. Because diagnostic and treatment protocols change and improve, hearing assessments need to be current.
In Peter’s case, his follow up care was compromised by his lack of interest and current clinical test results. He had no records in the past 2 years of any speech perception testing or a comprehensive assessment. Peter had a moderate hearing loss in one ear and a non-hearing ear on the other side. His hearing loss started as a bilateral, moderate loss, but in the last 10 years the deterioration of hearing in one ear was total. Due to these changes in his hearing, Peter had become a candidate for other forms of treatment, but without current testing results this could not be acknowledged or recommended.
Take home message: If you have a hearing loss and struggle despite having hearing aids, make an appointment for a FULL assessment with your Audiologist. Follow up care is as important as the initial diagnosis. Proper follow up will provide you and your Audiologist with an objective way to monitor your progress as well as to identify any issues. You should find out if your hearing is any worse, if your device is functioning properly for your current loss, your functional hearing scores, if there are new developments with technology, and if there are any other forms of treatment available. Discuss how to improve your current communication situation. There may be other alternatives available.
Treating hearing loss appropriately relies on accurate diagnostic results, and most important of all, CURRENT results. Professional knowledge of current treatment options and changes in patient selection criteria is also very important. Choosing Audiologists that practice on-going education is crucial as they will have the latest knowledge of the most recent treatment options and protocols. Hearing Sciences are advancing at an incredible speed as more technology is developed and as we discover more about how our ears and auditory pathways work. For example, cochlear implant criteria are continuously changing as technology, design and protocols improve. More patients with significant hearing losses who struggle with hearing aids and were not previously cochlear implant candidates could be great candidates today.
Peter was told years before that he was not a cochlear implant candidate and believed that this was still true. He was not using a hearing aid in his non-hearing ear. He was unaware of bimodal amplification, which is a cochlear implant in one ear and a hearing aid in the other. He didn’t know his current speech discrimination test scores. In short, he didn’t know what he didn’t know.
Once he had a full hearing assessment, and a new hearing aid properly fitted for his moderate hearing loss in one ear, his speech understanding scores improved dramatically. He realized how much he was missing, and was happy to learn there were more options for him. He was now a cochlear implant candidate in his non-hearing ear.
Take Home Message: Changes in technology, treatment options and candidate selection criteria are in constant flux. Follow up with your Audiologist. Even if you are an experienced hearing aid user, you still need an annual visit. Changes in hearing happen slowly, making it hard to notice them. Your hearing might be changing, your current device might need adjustments or changes, you may benefit from other forms of treatment, or technology that will make your communication struggles improve. Choose a professional who believes, invests and practices continuing education.
Peter’s story has a happy ending. Once he acquired a better understanding of his current hearing needs, his life changed dramatically. Four months after receiving his new hearing aid, Peter received a cochlear implant in his non-hearing ear. By 6 months’ post-implantation, wearing bimodal amplification (a cochlear implant in one side and a hearing aid in the other side), he scored over 90% in speech in noise tests. That is a remarkable improvement and he is extremely pleased with his new hearing life!
Hearing technology works and gives patients, the power to define their life experience. Patients have the power to keep their hearing at the best level possible by being informed and active partners in their hearing health. As an Audiologist, I find joy in helping patients achieve their best hearing. I know that hearing technology works. I also know that it does not work by itself. Hearing disorders must be accurately diagnosed, and devices must be appropriately selected, and fitted. Follow-up care and aural rehabilitation must be included for best results. Most important of all, patients need to take charge of their conditions, become active stakeholders, seek more information and make informed decisions. We can work together to make sure that hearing is easier in all of life’s situations – keeping people active and living life in full.