Some blanket statements:
Nobody ever obtained hearing aids because of the hearing test.
The most important component of the hearing aid evaluation is the needs assessment.
Absolutes can be tricky. There is always an exception to an absolute. (There’s another absolute right there.) Hyperbole!! “A rhetorical formulation of exaggerated statements or claims not meant to be taken literally.” But these statements I literally mean to be taken literally. Even if they are not absolutely true, they should be treated as if they are.
The hearing test, virtually unchanged in decades, is the centerpiece of any hearing aid evaluation. I am not talking here about the diagnostic hearing test, a horse of a different color – literally! (You’ve never seen a hearing test in the form of a pink horse?). But for the hearing aid evaluation (HAE), the focus must be on the needs assessment.
I do not advocate the elimination of the hearing test from the HAE. It is critical in identifying an aidable hearing loss or a condition of the ear that requires attention from an MD. It is certainly critical to the fitting of hearing instruments.
But the hearing evaluation does not address the reason your patient is there to see you or what they require from you.
Addressing the Problem
The reason your patient came to see you is to solve the problems they are having with their hearing, not with their ears. If they have a condition which can be addressed by a physician, that referral is not only appropriate, but ethically required. But most of the time the hearing evaluation will identify a hearing loss for which there is no medical or surgical treatment.
While we cannot treat conditions of the ear, we are exquisitely trained and equipped to treat hearing problems. And these are what the needs assessment is designed to uncover. The ENT down the street knows more about the ear than most hearing professionals, but when it comes to hearing, their expertise is limited to non-existent. In terms of life and death and health they have bigger fish to fry.
I have never known a physician who knows as much about hearing as any hearing professional I have ever met. (Hyperbole again, but I mean it.)
Which brings us back to the importance of the needs assessment. It is in the needs assessment that we identify the very specific hearing problems our patients are experiencing. In identifying those problems we are able to identify hearing aids with the technology that will address those problems. A physician, with all the technology in the world cannot recover normal hearing for any patient they see with sensory hearing loss. Their mighty medical tools are powerless against that particular foe. But we have the tools to appreciably improve that same patients’ life by offering them the gift of re-connection.
Our tools are sadly not perfect. We are dealing with diseased ears, after all. Perhaps someday physicians will be able to “cure” sensory hearing loss. I pray for that day, while knowing it is far off.
Our tools fall short of perfection, but they do offer great hope. I tell my patients, “I believe that I am doing my job if I can make 80% of the situations where you have been encountering difficulty better. I can’t fix everything, and I can’t make everything perfect, but would you agree with me that 80% better would be a good thing?” My patients invariably agree. With the amazing tools at my disposal today, I can do that standing on my head.
We should be spending as much time on the needs assessment as we do performing the hearing test. Ask those probing open-ended questions. Allow your patients to tell you their story. Engage the primary communication partner. Facilitate a conversation between your patient and their communication partner that is more positive than those they have been having at home. Tailor your recommendation to the specific needs of your patient – and show them how the hearing aids you recommend will do what you claim.
Hearing care is a Great Profession because we change people’s lives; not just the lives of our patients themselves, but the lives of everyone with whom they come in contact.
The following quote I have shared before, but it is on my wall and I read it every day. It is the final sentence of a brilliant article about the effect of hearing aids on quality of life and cognitive function. The emphasis is mine.
Unbeknownst to us, as long as people in our profession have been fitting hearing aids, we have benefited all of mankind by positively affecting the quality of life and cognitive function of millions of people.*
*Julia Sarant, David Harris, Peter Busby, Paul Maruff, Adrian Schembri, Ulrike Lemke, Stefan Launer. The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function? Journal of Clinical Medicine, 2020; 9 (1): 254 DOI: 10.3390/jcm9010254
