Noise in the Quiet

Holly Hosford-Dunn
February 28, 2017

by Harvey Abrams, PhD.

Harvey Abrams PhD

“Peeling the Onion” is a monthly column by Harvey Abrams, PhD.

After the manic flurry of activity during the last quarter of 2016, it seems that we’re in a bit of a lull (in the hearing aid world, at least). As a matter of fact, we haven’t even seen the reintroduction of the Warren-Grassley “Over-the-Counter Hearing Aid Act” in this new Congress .

I’m thinking the good Senators have more important things on their minds these days. I concluded my last post by suggesting that we use this quiet time to consider how we might better communicate the value of our professional services as we prepare for, what appears to be, an inexorable march toward the creation of a new category of hearing aids that can be purchased over-the-counter.


A Call (from K) to Action


As I was preparing this post, this quiet time was interrupted by an email from someone seeking advice about hearing aids. This serendipitous message turned out to represent a perfect crystallization of the current issues (crisis?) facing audiology and an obvious call to action to change our message.

The individual who sent the inquiry (let’s call her “K”) has been fit with “premium-level” hearing aids by an audiologist in her community which she is wearing on a “trial” basis. It turns out that K has suffered from hearing loss for most of her 30+ years but this is her first experience with hearing aids. Given her impressive education and career accomplishments, it’s apparent that her hearing loss, while certainly an obstacle, has not kept her from achieving her objectives. But she now recognizes the additional effort required to perform at her best in her stressful and fast-paced professional world.

After wearing her hearing aids for several weeks, K poses the following questions to me:

  1. “Are there any better hearing aids likely to come out in the next year that would make me regret this?”
  2. “Would Costco or any other place possibly offer a cheaper purchasing price (they’re offering me these for $5k right now though I intend to keep negotiating).”


We’re Baked Into the Hearing Aid, It’s Time to Get Out


If K’s two questions do not scream “COMMODITIZATION” I don’t know what does. K’s work requires her to maintain a high-level of social media, print and broadcast news awareness, so if K–with all of her education, responsibilities, and social/business/political awareness–perceives hearing aids as a commodity, what hope is there that the general public will view our profession any differently?  

But then, we shouldn’t be surprised, should we? After all, even the senior scientific advisors to the President represented hearing aids as a commodity in their report

It’s pretty clear how we got ourselves into this situation but what we need to do now is to figure out how we can move forward (if forward means separating the product from the service and communicating the value of those services). The following list is nothing new but it does bear repeating as these best practices represent a good start at moving us in the right direction:

  • Administer standardized income measures such as COSI, APHAB, and HHIE
  • Test speech recognition in noise
  • Screen for cognitive dysfunction
  • Screen for depression
  • Develop a comprehensive treatment plan to include the goals of treatment based on the expressed needs identified in the income measures
  • Select hearing aid styles and features based on the needs and other examination results – not just on the audiogram
  • Conduct quality control (ANSI S3.22-2014) measures to verify that the electroacoustic performance of the hearing aid is within acceptable tolerances of the manufacturer’s published specifications
  • Conduct probe microphone measures to verify the hearing aid gain and output characteristics, including advanced signal processing features, at the tympanic membrane
  • Employ standardized validation measures to measure the outcomes of treatment
  • Provide post-fitting services such as auditory training and group rehabilitation as appropriate
  • Schedule periodic follow-up visits

The perceived value of these procedures seems to have been lost on the PCAST, the press, and the public (as represented by K). But it’s not going to be enough to simply list the professional services we provide in answer to the question, “why do hearing aids cost so much.”


This Isn’t a Bundling Discussion


The services we provide as part of the hearing rehabilitation process need to be transparent and clearly communicated to each patient at each encounter, preferably through some method of itemization. Note that I purposely avoided the word “bundling” here because bundling is often associated with a false choice – either you charge one fee for everything or you charge a separate fee for everything. There are many ways to separate the product from our services -we are limited only by our imagination.

However, in a recent post to the American Academy of Audiology’s General Audiology Digest, Dr. Roy Sullivan warns us:

Value-added in not an assertion, it is a perception! The “unbundlers” in our field sorely ignore this harsh truth. One cannot justify costs of services detached from cost of product by simply invoking a litany of what you, as dispensing audiologist, promise to provide beyond product. It is the patient’s perception of your intrinsic value-added that drives success or failure of the ensuing clinical encounter and enterprise.

If Dr. Sullivan is correct, and I believe he is, we are faced with a considerable challenge: how to get our patients to perceive what we do as value-added as it is not enough to simply list our services in our marketing material or on an itemized statement. I don’t presume to have an answer to this challenge but I believe we have to begin by changing the language. 

If we don’t want to continue to be seen as hearing aid salespersons or no longer expect patients like K to “negotiate” the cost of the product, we have to ‘pivot’, as Barbara Weinstein suggests, from product to professional service providers. It’s time we start making some noise about that.


This is Part 23 of the Peeling the Onion series.  Click here for Part 1Part 2,  Part 3,  Part 4,Part 5, Part 6, Part 7, Part 8, Part 9Part 10,Part 11,  Part 12, Part 13, Part 14, Part 15, Part 16, Part 17, Part 18, Part 19, Part 20,  Part 21, Part 22.


Harvey Abrams, PhD, is a consulting research audiologist in the hearing aid industry. Dr. Abrams has served in various clinical, research, and administrative capacities in the industry, the Department of Veterans Affairs and the Department of Defense. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice.  Dr. Abrams can be reached at[email protected]


Feature image by Ross Land/Getty

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