As of now we’ve got testing instruments and conditions to take into account and REM for fitting that all must be done in office, but I’m wondering if new ways of getting this done might be feasible such that all fitting could be done remotely as an option in the foreseeable future. There also may be business model obstacles or facilitation points and other human factors that would help or hinder a remote practice. But, for those who like to speculate and imagine, what do you think? How might it happen?
For people in small towns and rural areas with only an audiologist or two or who spend the majority of a day driving to and from Costco, the remote model could really help. Also, if you had a good audiologist you were working with you wouldn’t have to give up that relationship if you moved to a different locale (or if the audiologist relocates). It might give us a broader reach too–to find an audiologist that can best help us. There may be other benefits (or downsides) but these are the ones that occur to me.
First of all: I have no idea about the situation in the US. I Imagine a rural area to be way bigger than in Central Europe where I live.
Personally I would prefer the combination of a good first fit that provides a REM and in-situ-audiometry followed by online appointments with an audi. The in person appointment would also be a chance to fit molds and check if the ears are not plugged or have any other condition that would be a contraindication.
Going on a full day trip to see an audi once is perfectly acceptable to me. Doing it several times for services that can be performed online easily is not.
Given that we have a strong social insurance system in Austria I do not think fitting 100% online would be possible as the audi has to prove an improvement when it comes to hearing. One needs calibrated instruments for that which, in my opinion can only be done in Person. Bureaucracy is slow I am in my 30s. I do not expect to whiteness online-only fitting paid by my health insurance.
That is what I hoped would happen with my current aids from Costco. Unfortunately, just after a year, the manufacturer did not release updated firmware to properly work with the newer iPhone version. One of the problems was remote support. I will definitely try to avoid Rexton and sister brands.
As a practitioner who deals with a both new fittings and annual checks, I can tell you only about 20% involve re-programming and if they do, about a fifth of them involve onward clinical referrals.
After initial fitting, most of the ‘work’ we do is based around servicing and cleaning plus changing receivers. Stepping up a prescription would possibly be 10-15%.
I like the concept though, but the practical elements don’t fit that well with our clientele.
@Um_bongo: Stephen, can you give me some insight as to why my practitioner has flatly refused to perform even the most perfunctory adjustments, remotely?
You’ve piqued my curiosity, what with living on a small island yet having at least two audiologists close enough to describe as local. How many households live on your island, and how do you get to and from the mainland (where I assume the audiologists are located)?
With my Philips 9030 remote fittings work fine with Costco. The fitter did mention though that they sometimes have problems with the other brands’ remote software.
Maybe we have manufacturer issues too with the possibility of remote fittings? Surely they could produce adequate technology so if they’re not it must be for some other reason. They do app bells and whistles that clearly based on another thread most of us don’t use (but are trendy in other types of tech).
After trying a few times and hearing they had some issues with my recent model iPhone, I called a different Costco to have them try. As soon as they knew what model phone I had, they refused to try due to their own failure experiences.
I have been limping along with these aids for 3 years since that time.
I think your last statement is the important one @Um_bongo The average hearing aid user today is a person who did not grow up with the internet and is not a “native” user.
Additionally age related diseases like arthrosis make handling and cleaning your aids more difficult.
From an audis POV I think offering both, fitting in person and remote fitting makes sense. The first option for customers who prefer direct communication and need more than just technical service. I am thinking of help with cleaning the aids, teaching how to place the aids behind the ear. Emotional support for people who face some trouble adapting to the new hearing or for old people who are lonely and enjoy a chat.
The second one for a younger generation of hearing aid users who just need a fitting. This way you might keep them as content customers even if they move.
I’m not confident that tele-audiology is quite as ‘nailed-on’ as manufacturers would have you believe. If I make a change to a device that’s very obviously wrong in person, I can physically check the output, assess your response (crows foot reflex), hear the feedback, hear the receiver chatter, assess your speech perception and the distortion of the aid.
Unfortunately none of the manufacturer’s tele-programming offers this. Even the mechanisms that use the in-built mics of the aid become hugely flawed if the mic screens, tubes or filters are obstructed.
So, I prefer to do as much as possible in person and could make the argument that anyone fitting on a ‘fire and forget’ basis is actually short changing you in terms of their duty of care.
Currently if I use a phone clip to my laptop and, after turning it off, try streaming from my iPhone, it usually doesn’t work. It used to work when I bought the aids. I heard Rexton on speakerphone advise to unpair and re-pair as the solution. I discovered I can go deep into the Settings and toggle sound streaming to the aids to fix. Doing that for 3 years has been tiresome.
Does that do anything other than save you a button push or two when you power up the aids? I don’t blame an audiologist for not wanting to take the risk of a remote session for it.