What a great question! I’ll focus on two:
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Price! I’m peppered with emails from <hear.com> that tell me they’ll provide me a 45 day trial of “the best hearing aids on the planet, because they’re DUAL PROCESSOR!” Turns out they’ll charge me a refundable $3,000, $5,000, or $7,000 for Rexton HAs after they send me a kit containing a tablet pre-loaded with their software and some padded headphones, which which I’d do a virtual “hearing test” with them online. Apparently, similar HAs are available from Costco for < $2,000, with a 6 MONTH return window, so I declined the “offer.”
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Concern about whether the HAs provided really match my needs. I need to tell a (long) story to explain this.
I spent my professional career as a busy nephrologist. Two of my patients were a nice woman and her 20-something yo son. They both carried the X-linked gene for Alport Syndrome (which for the non-geneticist readers here causes deafness and kidney failure). Women, with two X chromosomes, are typically dramatically less affected by this disorder than are their male children (each of whom has a 50% likelihood of “receiving” the X chromosome carrying the variant gene from their mom). Of course, if a woman is unlucky enough to have received TWO copies of the Alport gene, one from her mom and one from her father, it’s likely the mom would never have had children, because the disorder would have been apparent so soon in life that she’d be infertile because of her kidney failure.
In any event, in the family under discussion, the son needed to start dialysis in his early 20s. His mom developed kidney failure and impaired hearing only much later in life.
When the son began dialysis, typically I would see him while “making rounds” in the dialysis center where he received treatments on the standard 3 times per week schedule. He was an EXCELLENT lip reader, and when I’d see him I’d stand in front of him while he was sitting or reclining in his dialysis chair, and we’d have a pleasant conversation.
Being young and otherwise healthy, he was an excellent candidate for a kidney transplant, but of course his mom could not be a donor, nor could any female 1st degree relatives (an issue likely to be resolved by whole genome DNA analysis if that’s not already the case—I’m old and well into retirement, so don’t know the state of research on that particular).
He received his transplant in the midst of the real estate boondoggle “great recession.” One of the few “good” things to come from that era was the replacement of illegible written physicians’ progress notes by the “EHR” (electronic health record), thanks to President Obama’s promotion of that technology by getting congress to budget more than $20 Billion to its development and adoption. However, the earliest iterations of that technology were far from perfect, and it was only because the enabling legislation was not just dollars in medical care providers’ pockets for purchasing the technology, but REQUIREMENTS that it be purchased in order to continue functioning as a Medicare approved provider that ensured its evolution into truly useful technology (the curious are invited to read UCSF Department of Medicine chair Bob Wachter’s book The Digital Doctor.
My 20-something patient was a techie who worked for the most prominent pacemaker manufacturer in the world.
In any event, his transplant came relatively soon AFTER my practice purchased an early iteration of the 900 pound gorilla of the EHR, “Epic.” The first time I saw him in my office following surgery, it was an “epic” disaster. I sat, struggling with the software, behind two giant flatscreen monitors; neither of us could see the other, and he couldn’t understand ANYTHING I’d say. Of course we realized what the problem was, but the solution wasn’t immediately apparent, beyond my emerging from behind my workstation to ask my questions, scribbling notes in an office that was supposed to have graduated from “paper,” then making my next patient wait while I entered my scribbled notes into the EHR.
At least a PART of this dilemma stemmed from the fact that I ALSO had some early hearing loss. I’d never seen an ENT nor an audiologist for this problem, partly because my prior experience with HAs had been with my father-in-law, whose devices screeched at others in the same room, inaudibly to him but distressing everyone who COULD hear!
Then, one day my patient came in for a routine follow-up appointment. More accustomed than ever by that time to crouching behind my monitors to conduct my interview, it took me a few minutes to realize that when I asked questions, HE ANSWERED THEM, even though he couldn’t see me. In fact, we both realized it pretty much at the same time and lept towards each other, me to find out what had happened, and he to show me his new tech (BT-enabled ReSOUND HAs, through which he could not only receive speech he could understand, but also through which he could sample his phone playlist, make phone calls with the phone in his pocket, and watch TV at home without bothering his hearing family members!
By that time my partners were tiring of my so-frequently uttered “could you say that again, please” that I made an appointment with an audiologist, who told me she was quite certain she could help me. I was probably TOO emphatic that I needed those miraculous little devices from ReSOUND, so she ordered a pair for me, albeit a bit reluctantly. I found their software problematic (at least for me) and the fidelity of their sound amplification distressingly “off” (far too “metallic.”).
At my first followup visit, she substituted the Phonak devices she’d planned for me to trial, and I’m now on my third generation of devices from their manufacturer, Sonova. However, Costco and Sonova have divorced, so no KS-10 replacements on the horizon for me. That leaves the question, “just what IS the best way for the hearing-impaired to find the best help?” Is it the case, for example, that a particularly skilled audiologist can infer from testing just WHICH manufacturer’s product, and which model, and which program settings are best for an individual patient, or does that come only from listening to one’s spouse’s oft repeated complaint “you know, you REALLY need new hearing aids.”
