Can The Web Replace My Audiologist?

Gael Hannan
January 3, 2012

It was a simple email question. What did I think about direct-to-consumer online hearing testing and hearing aid sales?

My fingers hovered over the keyboard to reply, but then I lowered my hands. What did I really think about this?

Not too long ago I would have answered, without hesitation, that a web service could not meet the needs of a person with hearing loss. How could anonymous staff on an arms-length website provide the necessary supports – technical, practical and emotional – that are crucial for successful hearing aid use? Hearing loss has a powerful impact on quality of life, and hearing health care has to go beyond technology to include counselling and other communication strategies.

But what about the person who cannot access those supports, which can carry a hefty price tag, or who has difficulty getting out to the audiologist’s office? It’s estimated that only 20%-25% of people who could benefit from hearing aids actually use them, which means that millions of people with hearing loss  are living without communication supports that could boost their quality of life.

AARP and the American Speech-Language-Hearing Association (ASHA) recently polled Americans, 50 years and older, on their attitudes around hearing loss. Nearly two-thirds of respondents said concerns about cost and lack of health insurance prevented them from pursuing treatment for hearing difficulties. But a similar number said that their hearing loss didn’t require attention, which was ‘easy to hide.’  On the other hand, 70% said they would do something about their hearing loss if they felt it was affecting their relationships.

It’s clear that a great deal of confusion and stigma clings to hearing loss, along with a pervasive reticence to discuss a private issue.

It was only a matter of time before innovators stepped forward with web solutions for the masses. One direct-to-consumer online hearing aid company claims to offer a more convenient, private, and affordable system for people considering hearing aids. The traditional hearing health care world is in an uproar and I’m twisted into an opinion pretzel.

There are benefits and drawbacks to both service options. The need for hearing health services has exploded and service providers, regardless of their delivery model, will succeed only if their goal is a satisfied client who communicates well.

Education and information: If you’re selling hearing aids, give us the back story and the front story. Yes, we need to know the signs of hearing loss, but most people already get that, otherwise they wouldn’t be on the web looking for information.  We need to understand the big picture, including the fundamentals of hearing loss and the scope of assistive technology.

Comprehensive Hearing Testing: My son took the web service’s 5-minute hearing test. It was very basic and didn’t include speech discrimination testing. He was asked how he felt about his hearing and ability to communicate. Can you understand speech in a noisy environment? Not particularly well, but who can? Apparently he has a slight hearing loss and was advised to follow up with a hearing health professional (HHCP).  The kid can hear a pin drop on the other side of the city.

A veteran of the torture chamber (hearing booth), I admit to trying to memorize the hearing test words (Say the word ‘baseball!’, say the word ‘keep!’). Is that any sillier than an incomplete hearing test? With visions of bank-breaking $3000 hearing aids dancing before my eyes, I want a comprehensive test, thank you very much.

Hearing Aid Affordability: Although many professionals and consumer advocates agree that much of today’s technology is overkill – most of us don’t need all the super-aid bells and whistles – a good hearing aid is still the first and most important step in reclaiming good communication.  The new online service offers lower-priced hearing aids and, if their promise holds, who can argue against that?  Hearing aid service providers need to step up and find a way to make hearing aids and other assistive devices  more affordable; otherwise, the 75%-80% of people with hearing loss who are not darkening their doors, will remain un-aided, poorly-aided, or using someone else’s service.

Professional Services: I’m nervous about any service option that bypasses the valuable exchange of information between an HHCP and client. Nearly 75% of the AARP-ASHA poll respondents said that if they were to seek hearing help, it was critically important to them to use a highly trained hearing healthcare provider, but that the internet is a key source of information.

Can we truly choose a hearing aid online in the same way that we buy clothing? Buying a dress doesn’t require counselling or a user manual. I see a cute, affordable dress, and I click in my credit card number and mailing address. If it doesn’t fit, or the color makes me look bad, I return it.  How in blazes is a someone shopping online for their first hearing aid supposed to make an informed decision on which hearing aid model is best, or to effectivly evaluate how well it’s working?

Counselling, Fitting and Follow-up Care: I’ve never read a how-to manual that’s better than a knowledgeable HHCP who not only answers my questions, but anticipates them.  A proper fit and properly-programmed hearing aid takes time, although the process now is a marvel of modern technology. All I really need, though, is an HHCP with patience.

HHCP:   There, it’s in. How does my voice sound to you?

Client:    Do you always breathe so loudly?

HHCP:   Yes I do. But my voice?

Client:    Somewhere between Donald Duck and a vampire.

HHCP:   (adjusting program) Ok how’s that?

Client:    You’re better, but my voice is Niagara Falls.

HHCP:    We’ll adjust the venting…

Client:    How many adjustments before things sound good?

HHCP:    As many as you want, or when your brain gets used to it, whichever comes first.

Client:    Thank you, I love you.

Could I ever love a web-based hearing help program? Maybe, if it gave me good service.   But coming soon, I hope, is a fusion of personal and online hearing health services that will encourage more people to adopt hearing aids for a fully-engaged, communication-rich life.

  1. All too true and thought provoking Gael. I admit to being like you in my first response….but you have addressed some very good points as much as I dont want to admit it. I like the person to person contact. But as you say, not everyone likes it or has access to it. I cringe when I think of people trying to cope with a new aid and the myriad of adjustments they have to make with the digital hearing aids. How ever do they manage before throwing them in the drawer and thinking, “what a bunch of quacks!” Just the other day I had someone saying “help me, I’m so frustrated even with the adjustments!”. Even if they do go to the website to buy aids, can they then go to someone locally or next time they are in the big city for an adjustment and counselling session? Would clinics accept to assist them?
    Times are indeed changing and while we may need to change with them, I wonder if indeed is for the “better”?

  2. Great post Gael!

    On the whole I agree that working with a HHC is preferable to an on-line experience IF the HHC is actually providing all the services defined in Best Practices documents. Sadly, we know this is not the case, at least in the US.

    Many HHCs are not conducting any outcome measures (Real Ear, Questionnaires, etc) and getting information about Hearing Assistive Technology (HAT) is a crap shoot at best. The vast majority say they provide “Counseling” but really provide only how-to device orientation. We won’t even touch Aural Rehabilitation as that is somewhere close to a needle in a haystack except for a very few non-university settings. Thankfully we do have validated options for that online or at-home.

    Of course, there are HHCs that DO provide this, but based on almost 20 years on hearing loss listservs, these folks are the exceptions, not the rules.

    The other real place I see for Internet-based delivery is with the experienced user with a well documented, stable hearing loss. They often do not need all the “bundled” services (which in reality are usually not provided anyway). These folks should, IMO, have the option to get only the parts of the “package” they need, and pocket the savings.

    I believe the “baby boomers” and those just after them will force a change in HHC delivery in the not too distant future.

  3. Hi Gael, I cannot imagine anyone buying hearing aids online, however, we never thought the miracle aid would sell either and people continue to buy into it. Your description of the audi/patient experience was on the nose (or ear).

    The internet is a great place to learn about hearing aids and being a better consumer. However, many consumers do not realize how involved the process of getting the right aid, the right fit, the right audi to do the programming is. The audiologist has become the technologist. If the audiologist does not keep up with the ever changing technology, you can have a consumer/patient who is very unhappy and give up, putting the aids in the drawer. Unfortunately, way too many people give up on the programming too soon, not realizing that it takes several visits to get it to where u need it and where the brain has adjusted.

    One of my biggest concerns is that most audiologists and I say this quite liberally, most audiologists have no clue how to speak to a hearing impaired person. I’ve only had one audiologist in all my years of seeing audiologists, that typed on his computer rather than speak to me, when my hearing aids were off. Even the most experienced audiologist, spoke to me knowing, I have no speech discrimination without the aids on. What does that say for the field?

    Not only do we need consumers educated, we need to educate the audiologist to hearing loss. Put those earplugs in and wear them for several days and try surviving with only a 35-40 db loss and we will see how fast they learn the meaning of having a mild to moderate hearing loss, let alone, a severe loss.

    Thanks for your well written articles, they are always a pleasure to read.

  4. Good thoughts Gael. This is a difficult discussion. Different strokes for different folks. Those of us who are seasoned hearing aid users have different needs than those who are new users. Those with mild hearing loss have different needs than those with severe to profound loss. There are many variables; employment, age, social interests, geographical location, insurance coverage and more. We who have been using hearing instruments for years, trust and respect our HHCPs. I know I do. However, I am concerned about the millions of Americans who cannot or will not find the money needed to appropriately aid their hearing losses. We have been hoping for years for third party payment as a standard, but it hasn’t happened.
    Maybe we should look at this from a dual & different perspective; product vs service. Maybe those need to be sold separately. HHCPs have traditionally bundled the product with the services they provide. Therein lies part of the dilemma. Some customers require very little time with the provider after the fitting, others need much more time. Time is money. Hearing aids are products. Products are sold as part of a business, and so is ‘service’ for those products. A seasoned user will probably use/need much less service time while adjusting to a new hearing aid than a new user will require. Yet, the cost is generally the same to each buyer. Perhaps hearing aid sales could be priced with or without a specific number of ‘service hours’ or orientation classes/appointments.
    Could the solution lie in unbundeling the product and the service? Could a hearing instrument be sold for considerably less if a limited amount of service was included in the price? While I do not know the profit margin on a hearing aid from wholesale to retail, I suspect it’s considerable. If a hearing instrument was purchased via the web at discount, but needed adjustments to assure optimal use, might the HHCP provide services at a higher cost to that person for that aid. In other words one pays for what one uses? I see this being a tremendous advantage for a seasoned hearing instrument user. I believe a new user, in most cases, will require a much stronger service delivery system, and I would encourage anyone in this category to go to a reputable audiologist. I understand this is not a cure-all solution due to the sophistication of today’s digital hearing aids.
    Other products we buy are serviced by those who have the skill and equipment to service them. It would be acceptable for a HHCP to offer service, at a higher cost, to someone who has purchased their hearing aid from a different source, whether it be via the web or from a discount provider. It seems that a satisfied customer, in such a case, might turn to the service provider for future products, so that would be a good business move.
    It appears that the rising cost of hearing instruments has started to drive changes in the product’s service and delivery system. I don’t venture to guess whether this is good or bad. It’s interesting.

  5. How do online hearing support programs resolve ear molds and the fitting thereof?
    I have always felt the hearing (torture) chamber is poorly done. Sometimes I wonder if it’s a “sound” or my tinnitus I’ve just claimed to hear. A little interaction on the part of the tester might help – “Ok let’s try that again” “Can you hear that?” “Ok. We’ll move on”
    It’s an odd situation, but I really need assurance that I did in fact NOT hear that particular frequency.
    As in other areas, audio tech has advanced ahead of the “personal touch” in service.

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