Make “Look, listen, evaluate, and solve” your standard operating procedure

Most patients have some problem or a concern about their hearing aids when they return to our office for a follow-up visit. Sometimes, we can quickly remediate their problem by unplugging a sound tube or changing a battery. Other times there is something in the fitting that needs adjusting or we can help the patient hear better by adjusting the technical aspects of the hearing aid.

Today I want to describe a basic protocol that I follow every time I see a returning patient. This protocol is: Look at everything carefully, listen to the aid, and make sure that the amplification is set at the proper level. Then, having evaluated the patient’s ear, hearing aid, and hearing, study and solve the patient’s problem. In simple language, these four steps are: look, listen, evaluate, and solve.

Now, suppose for a moment that you do not follow these four steps. You may be the kind of person who goes directly to the problem and attempts to “fix it.” Or maybe you have a very social personality that places the importance of interpersonal relationships above professional issues. In either of these cases, you might tend to interact with patients without first looking in their ears and listening to their hearing aids.

In my opinion, this is a serious mistake. In the hearing aid business, we constantly see patients whose ear canals are impacted with debris and we find many hearing aids that are functioning poorly. Only a careful, systematic, comprehensive inspection of a patient’s ears and hearing aids will ensure that we get to the root of the patient’s problem.



The first step in this protocol is to look in the ear with a fiber-optic otoscope. I also use the scope to look into the sound opening of the hearing aid and the opening to the microphone. Debris in these openings degrades the amplified sound.



Step two is to use a listening scope and listen to the hearing aid. I then place the hearing aid in the test box and run a frequency response curve. By going through this sequence (listening to the hearing aid, evaluating it on a test box…) you train your ears. With practice, your own ears become your most valuable professional tool. I can quickly determine how properly or poorly a hearing aid is working by listening to it.



The next item in this protocol is to evaluate the clarity and volume of the hearing aid’s performance. This is part of the preceding step, only now you need to check what you find against the patient’s audiogram. You also need to interact with the patient to make sure he or she is getting adequate amplification.

To evaluate the fitting you answer questions like these: Is the amplification adequate? Is the spectral balance correct, i.e. is there adequate gain in the lower frequencies as well as in the higher frequencies? Is the amplified sound distorted? Will the output regulators (output and automatic gain control settings) hold the amplification below the patient’s “uncomfortable level”?



Once you have gathered all this information, you are in a position to solve the patient’s current problem. What’s more, you have also gained a better understanding of this patient’s long-term amplification needs, which helps you ensure that he or she will be a successful hearing aid wearer.


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