Hearing Aids often out of reach


#1

Nothing new to us, but at least it’s becoming more widely recognized.
https://www.medpagetoday.com/surgery/otolaryngology/77300?xid=nl_mpt_DHE_2019-01-10&eun=g348227d0r&pos=111111&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-01-10&utm_term=NL_Daily_DHE_Active


#2

Costco realized that years ago.

The audiology profession is pricing themselves out of the market with high prices and “optimistic” marketing claims.


#3

My understanding is that even in places where hearing aids are freely provided by the government or heavily subsidized, uptake isn’t much higher than in the US. People focus on pricing, but I wonder whether more empahsis should be placed on the difficulty people of lower SES have navigating the medical system. I think the article mentioned that the dual eligibility people where more than twice as likely to access services if they had someone helping them.


#4

I think more focus should be placed on the performance of the aids to reduce the patient’s issues and the skill ( & sometimes lack thereof) of the hearing professionals.


#5

I agree. I think this is a huge issue. Many people just give up.


#6

Either give up or suffer with bad corrected hearing & all the other life consequences.


#7

It’s not just hearing issues. Many people I know have a medical issue that they’ve seen the doctor for but the condition persists, but they don’t followup. Doctors don’t know if a problem got better unless people let them know. Hi copays certainly gets in the way of this, but it’s more than that.


#8

Yup. Or they don’t have a permanent family doctor so they just go to different walk-in clinics over and over with no continuation of care, so the next doctor doesn’t realize that the thing that looks like athlete’s foot has been seen by 5 other doctors and never resolved. And they don’t know how to bully the doctor into sending them to a dermatologist. So the doctor looks and says “Oh, that’s just athlete’s foot” and the patient, who never experiences improvement, develops a sense of learned helplessness–that nothing can be done for them.

The other big PR problem for hearing aids, too, is that when they are annoying people are vocal and when they are working well they are invisible and people are quite. A happy hearing aid user doesn’t walk around telling everyone, but an unhappy user complains and so do all the people around them. So there is HUGE perception that hearing aids are just generally awful, so why bother even looking into getting one if all you’ve ever heard is that they are no good?


#9

I don’t think there’s usually a need to “bully” a doctor into a referral. If a patient could concisely communicate that they’d seen doctors five times before and what the treatment was, I think most would be happy to refer. Ideally this would be in the medical record, but we don’t live in an ideal world and doctors are under tremendous time pressure.


#10

CI know our health systems are very different. But some Dr’s are just way too conservative, and refuse to do further investigations/referrals. They think that they know best! I asked for an X-ray request, got told it’s not necessary, you have arthritis in the spine. Being a nurse I didn’t accept that and saw a different GP a week later in the same clinic. He sent me for an X-ray, 2 discs had disintegrated, my spine was unstable. I now have an implemtataion in my spine. So you might have to go to a different Dr to get a referral, go by your gut instinct…


#11

Yeah, bully was maybe too strong a word, but probably one of the side effects of having universal heathcare is that doctors might be a bit more gate-keeper-y about referring you on to specialists. I would imagine that in America they don’t care who you want to see because you are paying for it yourself anyway? Up here, doctors can be a bit more sensitive about wasting time and tax money for unnecessary testing. I think that’s understandable, but you do need to be able to advocate for yourself if you are in a situation where you feel something else if going on beyond the doctor’s first instinct.


#12

We have a variety of plans here (US), ranging from being able to self refer to any specialist one wants (expensive and not very efficient) to needing a referral from a primary physician. Yes, they’re “gatekeepers,” but if they can “punt” to somebody else, it can save them work, so there are multiple incentives. In the HMO I’m familiar with, Kaiser, they place a big emphasis on patient satisfaction so it doesn’t tend to be hard to get a referral. They’re more careful with imaging however and don’t do MRIs and CAT scans without a good reason. I think I read in the US there are 250 CAT scan procedures per 1000 persons, so being stingy with imaging may be a good idea.


#13

@Neville: If you haven’t already decided against it for whatever reason, it might be useful to add the little flag to your profile to indicate where you’re from. Regulars will know but noob drive-bys won’t.


#14

Sad but true! My mom has known scores of seniors in that very position. They were fit with aids at 80 or older, HATED them, can not articulate what their hearing preferences are, some even with senior dementia and have lost the aids (or the dog ate them, or they were resting on a pile of newspapers the spouse recycled, or, or, or! a million other scenarios).

Folks are generally WAY too passive when it comes to being fit with aids. They spend $6K (give or take!) and then just take what they get. Part of that is due to their own angry denial of having to get the aids in the first place. It’s as if they want them to fail so family & friends will be empathetic and say, “Yeah, you’re right. These hearing aids are no more than plastic ear plugs.”

I have advocated on my mother-in-law’s behalf as much as I can (being a 4-hr drive from her), but now she is 93 and simply lacks the dexterity to press the button and change programs, much less use any kind of streaming with her iPhone. It’s sad, but if folks would get fit with aids at an age where they need them, they may be young enough to adapt and embrace them!


#15

Part of the problem with doctors here is that (apart from the general underfunding of the NHS delivery) they get approximately half a day’s explanation of hearing aids within seven years of training. Looking at the average career of forty years, that involves recalling something you looked at which had no appeal to a 20-year old for a couple of hours 20 years ago.

To double down on this the technology they perceive (or looked at, at the time) is probably on average over 5 years old (in the NHS) - put all this together with all of the negative stereotypes and stigma involving hearing aids and your average GP is thinking of technology and outcome efficacy from a generation (25 years) back. Couple this to technology product cycles - which don’t really exist in the pathology side of medicine, but do for treatment, so soak up the training time and budget and you’ve got the perfect mix of ignorance and intransigence.

Now that’s not all Doctors, but as the gatekeepers to the service here, it doesn’t get people who need intervention off on a very good footing.


#16

I think there is a similar issue here with the degreed Audiologists. They spend time on the mechanics & biology of hearing and not much time on the skills needed to test & fir for hearing aids.

The certified Hearing Instrument Specialists concentrate more time on testing & fitting of aids. Unfortunately, the Audiologists are paid more and, many times, manage the HIS.


#17

I think that’s probably true–I think the time spend on hearing aid fitting at my school was a bit weak. Though, given the differences in time spent studying overall (4 years for an american audiologist versus I’m not sure what for an american HIS–anywhere from 6 weeks to 2 years?) maybe it would come out the same.

In constrast, however, unless an HIS is coming to the program with related background, there is no training on evidence-based practice at that level, which means if they are doing REM I don’t know that they have a strong understanding of why they are, and they don’t really have much reason not to take all manufacturer’s claims at face value, or any reason not to sell some random supplement as tinnitus treatment or suggest that tinnitus patients quit coffee because they saw it somewhere on the internet.

But to be fair, a strong understanding of evidence-based practice seems difficult even for a lot of audiologists. The top students coming out of a science undergraduate program generally only have rough skills when it comes to reading and critically assessing research papers. Professional graduate school builds on this but again if a student isn’t motivated they can probably slide by. I probably value it more than necessary.


#18

I think a lot depends on the individual. Given somebody bright, curious, some humility and with some experience I think one could get good results regardless of background. Given somebody lazy and greedy, no amount of education is going to get good results.


#19

Some specialists allow direct contact for new patients but most require a referral from your primary. ENT is one specialty where it seems more normal for the patient to make the initial contact without a referral.


#20

Not getting involved in most of this discussion but this article has made the rounds (first posting best I can tell and repost by co-author):


Most insurance in the US will not pay one penny towards the cost of hearing aids or best I can tell implants.

Please keep in mind that many, if not most hearing aid “professionals” are hearing aid dispensers NOT audiologists (perhaps similar to what Neville refers to as a HIS?). No degree required to be a dispenser but many US states require a certification of some sort (no classes required in California). Having had exposure to the music industry prior to my hearing loss and having a number of professional musicians as friends I am of the belief that audiologists and hearing aid fitters should have some courses and experience in audio engineering.

The manufactures have paid attention to the markups and now many of them are moving into the retail supply side. Audiologists and hearing aid dispensers are currently subsidizing their own demise in a way.

Will hearing aids soon be a thing of the past for all but cochlear implants? Modern phones have more processing power and there are earbuds available with less THD and what should be better acoustical responses (haven’t verified yet) than current hearing aid receivers. High priced examples include UEs products but cheaper versions of same exist.

While technology developed in 2001 baed on Ormia ochracea, a cricket parasite, may finally make it to hearing aids in the next couple years there’s no reason it can’t be used with a phone or tablet.

https://asknature.org/strategy/eardrums-provide-directional-hearing/

I couldn’t find the fabrication information right away but the second link has some info. Cheaper to make and way better than using the time difference between two microphones to locate targets (time domain). FFTs (frequency domain) are coming to hearing aids but that’s trivial for phones (Apple even has a native FFT function built in to iOS).