The following post was originally published in April of 2011, soon after HHTM came into existence. Although the regulatory climate has changed a good deal in the last five years, and technology advances have reduced some fitting concerns,  David Kirkwood’s measured and considered thoughts on the subject are well worth repeating and revisiting as social policy and government regulation change how hearing aids are defined, delivered, and priced.  


By David H. Kirkwood

On March 28, 2011, USA Today ran an article that focused welcome attention on the fact that hearing loss has reached epidemic proportions. The story reports that some 36 million Americans have some degree of impairment. What’s more, that number is increasing fast, as every day 10,000 people in this country turn 65. The newspaper adds that only about 20% of people get help for their hearing loss.

Very likely, most of you reading this are already aware of how common hearing loss is and understand that it is seriously undertreated. However, USA Today reaches a very broad audience of about 1.8 million people a day, many of whom know little about the topic. So it’s good for them to be given some basic information.

The story makes some valid points, such as its advice to consumers to have their hearing tested by age 50. It also points out that even today’s “incredibly sophisticated” hearing aid technology is no substitute for a well-functioning natural auditory system. That makes a good case to readers why they should protect their natural hearing and why, if they already need hearing help, they should not expect to regain the hearing they once had.

However, there are a couple of things in the article’s discussion of hearing aids that that I believe are not at all helpful and could be misleading. After noting that the cost of hearing aids is one factor deterring people from wearing them, USA Today states, “Researchers are looking at ways to make…hearing aids easier to get and less expensive.” While that is a worthy goal, the article goes on to suggest an approach that seems to me fundamentally unsound.

Citing Daniel Sklare, PhD, a program director at the National Institute on Deafness and Other Communication Disorders, the article contends, “Generic hearing aids that don’t require fitting by an audiologist could potentially serve 80% to 90% of seniors who have hearing loss.”



It may be true that most hard-of-hearing people could get some benefit from a non-custom device sold off the shelf or by mail order. And if that is all they can or are willing to spend, then they may choose to try such a product. But the suggestion that most patients can address their hearing problems effectively with a one-model-fits-all solution is unfortunate.

For one thing, every patient comes into the clinic with his or her own combination of hearing loss, hearing needs, psychological traits, and physical and mental capabilities. Therefore, what will best serve a particular patient is not just any hearing aid, but one, or more often, two hearing aids that have been expertly selected, fitted, and programmed for that patient by a qualified audiologist or hearing instrument specialist.

Another point that USA Today fails to recognize is the added value a hearing professional brings to the overall treatment process. Appropriately selected and fitted hearing aids are essential to a successful fitting. However, they are not likely to be sufficient.

A successful patient outcome, perhaps especially among the older population most likely to need hearing help, depends upon other factors as well. These include counseling, aural rehabilitation, fine-tuning of the fitting, and other components that can be provided only by a skilled and caring human being.

Bypassing the hearing professional would undoubtedly reduce the cost of hearing aids, but I fear that it would reduce their value even more.






By Richard Reikowski, AuD

Dr. Reikowski was one of HHTM’s earliest supporters — subscribing at the beginning, sending in thoughtful comments in posts that appeared in a variety of sections, even submitting this post back in August of 2011.  The message of the post is at least a relevant today as it was then, reminding audiologists and policy makers that the dimensions of “best practices” go beyond concise and accurate quantification methodology, which are “right” but by themselves are not the thing itself.


Richard Reikowski, AuD

How can we become better? This is a good question to ask ourselves in every phase of our life. Does becoming better involve just us or does it involve other people as well?

In this Hearing View, I am looking at this question in terms of my profession and my relationships with others. As an audiologist, I am focused on the goal of learning what is important to others and what will help each person to acquire a better quality of life. In seeking to achieve this goal, I view myself as a person who assists others in improving their lives.

To do this I ask myself more questions: Can I listen more to learn more? Can I remember what is important to my patients so that I can relate this as important to me as well? Am I willing to make my own concerns secondary to another person’s needs? Am I doing what I am doing for the right reasons?

These questions remind me of something my 6-1/2-year-old son said earlier this year. While planting flowers for Mother’s Day, he had found a frog. He was by himself, but I was close enough to overhear him chattering to the frog. “I better let you go,” he said, then added, “… because it’s the right thing to do.”

This was so powerful to me! He knew that releasing this small frog to our yard would allow this harmless creature to find his home and return to his family. And while my son might have enjoyed keeping the frog to play with, he understood that giving him his freedom was “the right thing to do.”



As audiologists, our daily work requires us to strive to choose “the right thing” for those we serve. I enjoy that striving and being a part of people’s quality-of-life journey. We are called on to make many basic decisions as well as, often, more detailed decisions that affect our patients.

Many years ago, when digital technology was just beginning to be commonly used in hearing aids, I recall a patient asking, “Will digital technology help?” I thought about this and told him, “We see are seeing digital technology improve very regularly. And lab research is finding that it will help in many areas, such as feedback reduction, higher pitch emphasis, and greater control over background noise with directional microphones.”

But what this patient wished to know was, “Will digital technology help me?” I responded that I believed we could expect digital hearing aids to help resolve many of the difficulties he was experiencing with his hearing. I then focused my attention on discussing the quality-of-life effects that were important to him.

When we truly make the decisions that best help our patients to achieve an improved quality of life, then we are searching for success. When we truly listen to our patients and are intent on meeting their needs, they will feel more apt to allow us this incredible opportunity to become a part of their life by helping them.

At our hearing and balance center, we may have a different view from some about the meaning of helping people. When hearing aid patients are experiencing hearing loss, the question we ask is not, “How loud should we set it?” but “Is the patient understanding? Can they comprehend other people when they are in a loud room? Can they hear the spiritual lessons when they attend services in their place of worship? How do they do when they talk on the phone?”

Hearing aids are far more than just devices that make the world louder. What they do goes much deeper because they allow people to truly experience the joys of living that their hearing loss has denied them. Any audiologist can find technology that amplifies the hearing loss. But the job requires much more than that. They need to dig deep to find out what is important to the patient to hear and then design a fitting that provides that.

In our practice, we examine and explore how a hearing impairment is affecting the patient. Is it causing a loss of effectiveness in the workplace? Is it damaging family dynamics? Is the hearing loss accompanied by tinnitus? Is the patient’s balance compromised?

And then we ask ourselves, what is going to make things better? What is the right thing to do?

Richard Reikowski, AuD, is Owner of Family Hearing and Balance Center in Akron, OH, and Cardinal Hearing Centers in Northfield and Parma. Dr. Reikowski follows a holistic, audiological approach in providing comprehensive care in hearing, balance, and tinnitus. Readers are invited to visit his practice’s blog at