Developing a Viable Best Practice Model for Online and OTC Hearing Aid Distribution, Part 2


Ryan Kalef, Canadian Audiologist, Intrepid Reporter, Worthy Competitor
Ryan Kalef, Canadian Audiologist, Intrepid Reporter, Worthy Competitor

Ryan Kalef, Guest Editor, brings back Mr. Ideal for a second week of bliss.  Several weeks ago he introduced us to this gentleman — the perfect Audiology patient and wearer of hearing aids.  

Last time we saw Mr. Ideal, he sailed through the traditional system of assessment and fitting approach, requiring only  3 hours and 5 minutes of professional time spread out over 5-6 weeks to fully assimilate amplification into his lifestyle.  That was Model 1.

Today Mr. Ideal purchases his hearing aids online and tries his luck with Models 2 and 3.


Model 2:  Internet/OTC Hearing Aid Purchase with In-Office Programming


Now that the groundwork for Mr. Ideal has been laid, let’s substitute a mode that would integrate an internet/over-the-counter sale of the hearing aids themselves without precluding best practice.  Readers are referred to the previous post or the footnotes below to review steps that are similar or identical in Models 1,  2 and 3.

  1. Mr. Ideal still requires a Hearing Test identical to that in Step 1.{{1}}[[1]]case/medical history, otoscopy, tympanometry, air conduction, bone conduction, Word Recognition Score, Speech Reception Thresholds, speech assessments, review/affirmation of treatment plan and hearing aid candidacy, confirm amplification recommendation, tube and dome measurements,  color selected.[[1]]  Time length remains 1 hour.
  2. Mr. Ideal purchases the recommended hearing aids from an online or over-the-counter source. It arrives at factory settings, unprogrammed for Mr. Ideal.
  3.  Steps 4 through 6 are repeated in the clinic{{2}}[[2]]Counseled as to expectations and adaptation;  hearing aids programmed to target in the manufacturer’s software; output verified to target using real-ear measures; battery and hearing aid manipulation instruction and practice;  follow-up at 2 weeks and again at one month; COSI completed.[[2]] Time length is 1 hour, 45 minutes.


Model 3:  Internet/OTC Purchase of Programmed Aids


  1. Mr. Ideal still requires a Hearing Test identical to that in step one. Time required is 1 hour.
  2. A real-ear-to-coupler difference (RECD) measurement is taken in clinic so programming can be verified to target in a test box. Time required is 10 minutes.
  3. Mr. Ideal purchases the recommended hearing aids from the online/over-the-counter source while submitting the Hearing Test and RECD.
  4. The online source programs the hearing aids and verifies them to target in a test box using the given RECD and Hearing test. The appropriate length tubing and domes are provided.  The hearing aids are sent to Mr. Ideal.
  5.  Mr. Ideal returns to the clinic to review insertion and removal, battery changing.  Time required is 15 minutes.
  6. Steps 5 and 6 are repeated (2 week and 1 month follow-up).  Time required:  45 minutes.


Professional Time for Each Model


Both Models 2 and 3 appear to be viable ways to incorporate online/over-the-counter dispensing into a best practice model for Mr. Ideal, although there would be some logistical kinks to work out.

Model 2 does not actually alter the traditional clinic process of Model 1, other than to redirect the source of purchase. The time in clinic remains unchanged (minus 20 minutes for administration picked up on the online distributor’s end). And clinicians can and should be remunerated for their professional time spent in the fitting process.

Model #3 removes the programming and REM from the clinician’s hands, although the extra 10-minute test is added for the RECD.  That work is passed to the online dispensary, which must have trained individuals available to perform the programming and verification tasks in the test box.  In Table 1 below, I have assigned 1 hour for work required on the online dispensary’s end. All other time remains the same.

Table 1. Hours Required per Model


Hours in Clinic Hours for Online Dispensary Total  Hours
#1: Clinic Model




#2: Online, unprogrammed




#3: Online, programmed




Model #3 may reduce Mr. Ideal’s costs if the online dispensary can actually provide the hearing aids, programming and verification service at a lower rate than the clinician. And again theoretically the clinician can be remunerated for their time.


So Much for Theory


Model 3 is problematic if I insist on “best practices.”  Online dispensaries may elect to hire and/or train “qualified” personnel to perform programming and verification.  Or they may not.  Without regulation, the best I can expect is “trained” to some internal corporate standard.

Before examining the cases of Mrs. Average and Mr. Difficult in future posts, do any of the current, online dispensaries meet the standards outlined in Models 2 or 3 for Mr. Ideal? I haven’t found a winner yet, based on available online literature, but I’m still looking and I’m sure online sellers are still working out distribution methods to get their products on clients’ ears.

(Editor’s note:  This is Part 18 in the multi-year Hearing Aid Pricing series.  Click here for Part 17). 

Ryan Kalef is a clinical audiologist and clinic manager with Hearing Life Canada.  He holds an Msc in Audiology degree from UBC as well as a Bsc in Integrated Sciences (Physics and Psychology) also from UBC.  He  recently was  the conference co-chair for the 2012 BCASLPA conference in Richmond, BC and is the private practice audiology representative for BCASLPA. Ryan enjoys the active lifestyle Vancouver has to offer including the many scenic hikes, golf courses, and ski hills in the surrounding area. And, oh yes, a healthy interest in economics.  

About Holly Hosford-Dunn

Holly Hosford-Dunn, PhD, graduated with a BA and MA in Communication Disorders from New Mexico State, completed a PhD in Hearing Sciences at Stanford, and did post-docs at Max Planck Institute (Germany) and Eaton-Peabody Auditory Physiology Lab (Boston). Post-education, she directed the Stanford University Audiology Clinic; developed multi-office private practices in Arizona; authored/edited numerous text books, chapters, journals, and articles; and taught Marketing, Practice Management, Hearing Science, Auditory Electrophysiology, and Amplification in a variety of academic settings.