The title of this controversial post, originally published 10/18/2011, is more true today than it was 5 years ago, due to rapid technological changes in consumer electronics, wearable health devices, and social policy scrutiny of the FDA-protected hearing aid industry in the US.  Dr Tseng’s post was pioneering in the sense that it revealed entry into relatively unexplored territory in the Internet, including self-tests of hearing, electronic signature to waive medical clearance, and online hearing aid orders.  Though not stated explicitly in the post, it heralded two new paths in hearing healthcare. By creating hi HealthInnovations as a subsidiary, UnitedHealth Group (UNH)  became the first health insurance company to sell hearing aids directly to Medicare enrollees as a membership benefit, also the first to form a contractual sole-source partnership with a hearing aid manufacturing company, IntriCon.

As with most early explorations, neither venture worked out as envisioned.  Within a few years, hi HealthInnovations dropped the at-home test, eventually replacing it with a hearing test kit for PCP offices (which took care of the medical waiver situation in any case).  It expanded eligibility— beyond Medicare enrollees– for direct hearing sales to a larger consumer market. The expansion aimed to grow the market, perhaps in response to sluggish sales reported by Intricon in early 2013.  

Fits and starts notwithstanding, both at-home testing and Internet hearing aid sales are a fact of life in 2017.


By Lisa Tseng

It is a source of frustration for hearing professionals: How to open the door to a new, hearing-enabled life for the millions who could benefit from it but, for a variety of reasons, don’t.

Currently, only 25% of those who can benefit from hearing devices use them, and high cost is a significant contributor to this problem. UnitedHealth Group saw the opportunity to introduce solutions that would address this price barrier that keeps people from fuller lives, especially for the 47 million Americans with Medicare, which does not cover the significant cost of hearing devices.

To explore where we might help bridge this gap, hi HealthInnovations worked with Dianne Van Tasell, PhD, a professor of speech and hearing sciences, and with experienced audio engineers to develop an at-home hearing test. This test is designed to identify people who are good candidates for open-fit hearing aids.

It can also detect types of hearing loss (e.g., asymmetrical hearing loss, loss too severe for open-fit devices, significant low-frequency loss) that would benefit from the services of a physician or hearing health professional. In such cases, it recommends appropriate follow-up.

Lisa Tseng, MD

hi HealthInnovations believes that greater awareness and access to free, at-home testing will enable more people to recognize the signs of hearing loss and benefit from earlier treatment. The more people who access our program, the more we can refer them to physicians and hearing health professionals. Moreover, the individuals that we refer will already be aware that they need specialized treatment from physicians and hearing health professionals. Importantly, these are people who are currently disengaged from the hearing health system.

hi HealthInnovations devices are open-fit, which do not require a custom physical fit. They are custom-programmed to meet an individual’s specific hearing needs, based on the NAL-NL2 gain prescription method. These open-fit hearing devices are made relatively easy for consumers to use via hi HealthInnovations’ how-to videos and user guides. hi HealthInnovations also provides ongoing customer service and support.

Consumers have a growing appetite for more control over their own healthcare. For example, they currently rely on at-home pregnancy tests, blood pressure monitors, glucose monitors, sleep apnea testing, and over-the-counter medications. Self-administered tests do not replace a healthcare professional’s care, but they help consumers manage their health and identify any changes in their health that may need professional attention.

Working together, we have a greater opportunity to engage more consumers in detecting hearing problems early. hi HealthInnovations’ easy-to-use, at-home hearing test is a first step in encouraging millions of consumers to check their hearing more often and seek the treatment they need.

hi HealthInnovations believes that making hearing health more accessible can ultimately improve the lives of millions of Americans–a goal we share with hearing professionals.


Lisa Tseng, MD, is the Chief Executive Officer of hi HealthInnovations, whose mission is to deliver high-quality, yet affordable hearing solutions to the rapidly growing and underserved hearing-impaired population.

feature image from spec savers uk

Robert L. Martin

This post first appeared on HHTM in June 0f 2011.  Before he retired, Dr Martin wrote a monthly column for HHTM.  His down to earth posts about clinical topics continue to attract high readership years after publication.  Here’s one that reflects the way in which times are changing.  Technological help via the Internet for hearing aid wearers is no long an impossibility as it was in 2011 and Dr. Martin’s visionary thinking back then is very much of the moment in 2017. And, when help is needed, it still usually requires hands-on work.  Dr. Martin’s call for standardized procedures is particularly apropos as the FDA considers OTC instruments.

By Robert L. Martin

Today’s hearing aids, like the tiny computers that they are, have enormous potential. But to realize that potential, a lot of things have to be done just right. For example, the software must be installed properly and patients must be knowledgeable and competent enough to operate their hearing instruments successfully.

When things go wrong with your home computer, there are many sources of technical support to turn to. Help is available on the telephone and on the Internet. Very often the owner has a family member or a friend with some computer expertise.

That’s not true with hearing aids. Patients depend on the office where they purchased the hearing aid for all of their support, training, and encouragement. The amount and quality of training provided vary greatly from practice to practice. However, the less-than-stellar rate of consumer satisfaction with hearing aids suggests that more and better training is needed.

  1. In other words, as an industry we need to do a better job. But, how do we do that? That’s not an easy question, and there is no simple answer. However, I have two suggestions that I believe would help: Provide more problem-solving resources on the Internet.
  2. Create a standardized checklist for practitioners to follow when they fit hearing aids on patients.

Hearing aids are unique, and very different from other prosthetics such as eyeglasses. The scope of the services rendered by those who fit and dispense them is also unique. We act as diagnosticians for all levels of hearing function across all generations, from newborns, through pediatrics and adults of working age, to geriatric patients in their final years.

We also recommend and implement every facet of the fitting, as well as teaching our patients and family members how to use the hearing aids optimally and keep them in good working condition. The list of tasks we are expected to perform is long and varied, and includes cleaning ears, selecting gain, counseling patients, and much, much more.

Hearing aids come with another complication that makes fitting them successfully increasingly: the fact that their technology is growing more complex at an ever-increasing rate. Today, manufacturers strive to bring new proprietary software to market several times a year.

Adding to the difficulty for practitioners is the lack of uniformity of the software used by the various manufacturers. Yet another challenge is that the population we serve, primarily geriatric, is becoming older than ever, as average life expectancy increases.




A dozen different things can go wrong with a hearing aid fitting that will make the system unusable. When I discuss this with patients, I like to draw an analogy between hearing aids and a baseball game. In baseball, the batter gets three strikes before he’s out. With hearing aid fittings, patients get only one “strike” before they’re “out.” A single problem, even one that seems minor, can render the system totally non-functioning.

Here are a few of the things that can easily go wrong and make the hearing aids unusable:

  • A bad battery
  • An improperly inserted aid
  • An inappropriate volume setting
  • The wrong program selection
  • Feedback
  • Wax in the sound tube

These are common problems, and every hearing aid office spends a lot of time dealing with them.




To help address the most common problems hearing professionals face, I would like to see the development of a “Seven-Star Checklist” to use in fitting hearing aids. Now, I just made up the “Seven-Star” part. There might be more or fewer items on the list. The number is not important; it’s the concept that matters.

Here’s how it would work. When a practitioner concludes a fitting, he or she consults the checklist, which would be included in the manufacturer’s software. The dispenser goes over the list, item by item, with the patient and, if possible, a family member.

The conversation might go something like this:

“The most common problems people have with hearing aids are well known. We want to make sure you don’t experience them. This checklist is designed to prevent these problems from occurring and to ensure that your hearing aids will continue functioning properly when you take them home. So, let’s go through the list.”

Once all the items have been checked off (insertion and removal of the aid, no feedback, proper volume adjustment, being able to hear and understand a family member at a distance of 10 feet, etc.), the practitioner prints out a document–let’s call it the “Certificate of Initial Quality”–and gives it to the patient.

This certificate, whatever its name, would list several web sites developed by manufacturers to assist patients in using their new hearing aids. One neutral site, perhaps the Better Hearing Institute’s, would act as a clearinghouse for the other web sites.

The specifics of this approach can be determined later. But the key point is this: If, as an industry, we focused on the five or seven or ten basic problems that most often derail hearing aid fittings, we could markedly improve consumer satisfaction and benefit. We would also demonstrate our commitment to providing patients with high-quality care.




Let’s look at how this approach might work for a particular problem. One of the most common reasons that hearing aids malfunction is that they get plugged up with earwax. The average hearing aid office deals with this problem several times a day. The primary clearinghouse for hearing aid assistance would have a dozen links to You Tube or other web sites that had videos showing how to clean out impacted sound tubes.

The accuracy and usefulness of these “How to…” videos would be reviewed by manufacturers and knowledgeable practitioners so that, as with Wikipedia, the content would be constantly updated and improved. The goal would be to provide instructional material that an average consumer or a family member would be able to understand and follow to fix the problem.

The same concept could be applied to procedures such as changing batteries, adjusting the volume control, and using the telephone with a hearing aid.




In his book, Outliers, Malcolm Gladwell discusses quality control and how its absence resulted in abysmal quality in certain fields. He specifically talks about the airline industry, the military, and, anesthesiology.

In all these examples, he says, it took an extensive and coordinated effort to improve quality. That would be true with the hearing industry as well. It’s not enough to just talk about quality. We will all have to start practicing it.

That will require answering tough questions, such as:

  • What organization could take on the role of coordinating this effort? 
  • How many items and which ones should be on the basic checklist?
  • Who would select them?
  • Would manufacturers be open to including a standard industry checklist in their fitting software?
  • And, most importantly, how do we incorporate the patient’s point of view into this push for improved quality?



Robert L. Martin, PhD,  owned and operated a private audiology practice in the San Diego area for more than 30 years. Prior to writing a column at HHTM, he wrote Nuts & Bolts, a monthly column in The Hearing Journal.


feature image courtesy of e gurus