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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.
Concluding Remarks
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.
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